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Simple hepatic cysts are common benign liver lesions that usually have no malignant capability. They are generally asymptomatic and are often found incidentally by abdominal imaging procedures. Treatment becomes necessary, however, when huge hepatic cysts cause symptoms and develop complications, such as hemorrhage, adjacent organ damage, and infection. Several therapeutic options have been performed for symptomatic and huge cysts, including the aspiration of cystic fluid, infusion of various sclerosing agents, and surgical intervention. The optimal management of huge hepatic cysts is controversial and each option has its complications and limitations. This paper reports a case of a 66-year-old woman diagnosed with a simple hepatic cyst 2 years earlier, who was referred to hospital due to abdominal pain. The diagnosis was a huge hepatic cyst with symptoms by abdominal imaging studies. During the follow-up period, the huge cysts resolved spontaneously without treatment.

Background Contrast-enhanced ultrasound is highly accurate in depicting the vascularity of liver nodules. The aim of this study was to evaluate the usefulness of contrast-enhanced ultrasound for the differentiation of hepatocellular carcinomas from dysplastic nodules in cirrhotic patients with small liver nodules showing atypical or not coincidental typical vascular pattern on two dynamic imaging techniques (computed tomography and magnetic resonance imaging). Methods A total of 46 patients with cirrhosis and a liver nodule smaller than 3 cm showing an atypical or non-coincident typical vascular pattern on two dynamic imaging techniques, who underwent liver contrast-enhanced ultrasound and ultrasound-guided liver biopsy, were retrospectively reviewed. Contrast-enhanced ultrasound findings were compared with histopathological and clinical data, and with the two dynamic imaging findings. Results Significantly different contrast-enhanced ultrasound enhancement patterns were observed among dysplastic nodules, Edmondson grade I and grade II–III hepatocellular carcinomas. Ten out of 11 (90.9%) non-hypervascular hepatocellular carcinomas on two dynamic imaging techniques showed a hypervascular pattern on contrast-enhanced ultrasound, and these made it possible to distinguish hepatocellular carcinomas from dysplastic nodules. Conclusion Contrast-enhanced ultrasound is useful for the differentiation of hepatocellular carcinomas from dysplastic nodules in cirrhotic patients with small liver nodules.

Recently, the structured data format in RDF/OWL has played an increasingly vital role in the semantic web. We converted pediatric and oncologic nuclear medicine imaging reports in free text into RDF/OWL format and evaluated the usefulness of nuclear medicine imaging reports in RDF/OWL by comparing SPARQL query results with the manually retrieved results by physicians from the reports in free text. SPARQL query showed 95% recall for simple queries and 91% recall for dedicated queries. In total, SPARQL query retrieved 93% (51 lesions of 55) recall and 100% precision for 20 clinical query items. All query results missed by SPARQL query were of some inference. Nuclear medicine imaging reports in the format of RDF/OWL were very useful for retrieving simple and dedicated query results using SPARQL query. Further study using more number of cases and knowledge for inference is warranted.

Background/AimsLiver stiffness (LS) as assessed by transient elastography (TE) can change longitudinally in patients with chronic hepatitis B (CHB). The aim of this study was to identify the factors that improve LS.MethodsBetween April 2007 and December 2012, 151 patients with CHB who underwent two TE procedures with an interval of about 2 years were enrolled. Ninety-six of the 151 patients were treated with nucleos(t)ide analogues [the antiviral therapy (+) group], while the remaining 55 patients were not [the antiviral therapy (-) group]. The two groups of patients were stratified according to whether they exhibited an improvement or a deterioration in LS during the study period (defined as an LS change of ≤0 or >0 kPa, respectively, over a 1-year period), and their data were compared.ResultsNo differences were observed between the antiviral therapy (+) and (-) groups with respect to either their clinical characteristics or their initial LS. The observed LS improvement was significantly greater in the antiviral therapy (+) group than in the antiviral therapy (-) group (-3.0 vs. 0.98 kPa, P=0.011). In the antiviral therapy (+) group, the initial LS was higher in the LS improvement group (n=63) than in the LS deterioration group (n=33; 7.9 vs. 4.8 kPa, P

We preprocessed and pickled Deodeok with Doenjang to improve its preservability and to distribute it widely, and we stored Deodeok for 3 weeks at 7°C and measured its quality. The sample pre-treated with 20% of dextrin retained its early texture better than the samples pre-treated with other methods after 3 weeks of storage (p

BACKGROUND/AIMS B-mode ultrasound (US) has difficulty targeting small hepatocellular carcinomas (HCCs) with poor conspicuity during radiofrequency ablation (RFA). Contrast-enhanced ultrasound (CEUS) can improve visualization of small or inconspicuous HCCs. This study was conducted to evaluate the effectiveness of CEUS-guided RFA electrode insertion during the arterial phase in inconspicuous HCCs. MATERIALS AND METHODS Ninety-three treatment-naive HCCs from 80 patients treated with RFA from August 2012 to December 2014 were retrospectively reviewed. Seventy-five HCCs from 65 patients underwent B-mode US-guided RFA, and 15 HCCs from 14 patients that were inconspicuous on B-mode US underwent CEUS-guided RFA during the arterial phase after injection of sulfur hexafluoride microbubbles (SonoVue®). Technical success was assessed by contrast-enhanced computed tomography within 1 week and 3 months after the procedure. RESULTS The mean size of HCCs treated with CEUS-guided RFA was smaller than that of HCCs treated with B-mode US-guided RFA (1.17±0.36 vs. 1.63±0.55 cm, p=0.003). Technical success rates of CEUS-guided RFA within 1 week and 3 months were 100% (15/15) and 93.3% (14/15), respectively. Technical success rates of B-mode US-guided RFA were 97.3% (73/75) and 94.5% (69/73), respectively. CONCLUSION CEUS-guided RFA is highly efficacious for ablation of very small and inconspicuous HCCs.

Preoperative localization is essential for minimally invasive colorectal surgery. However, conventional endoscopic tattooing agents such as India ink have safety issues. The availability of new endoscopic markers such as non-India-ink-based agent is limited. We assessed the efficacy and safety of preoperative endoscopic tattooing using autologous blood in colorectal surgery. From February 2016, all patients who required localization of a target lesion before colorectal surgery underwent endoscopic tattooing using autologous blood, and the outcomes were collected prospectively. As a comparison, we retrospectively reviewed the medical records of a further 51 consecutive patients who underwent endoscopic tattooing using India ink before February 2016. A total of 102 patients who underwent endoscopic tattooing using either India ink or autologous blood were included in this study. The primary outcomes were the visibility of the tattooing in the peritoneal cavity and related adverse events. Endoscopic tattoos produced using India ink were visible in 49 (96.1%) patients, and tattoos created using autologous blood were visible in 47 (92.2%) patients. In the autologous blood group, the tattoo could not be identified in four patients due to excessive peritoneal fat, bleeding tendency, congenital anomaly, and suboptimal tattooing. Seven (13.7%) patients in the India ink group and three (5.9%) patients in the autologous blood group experienced endoscopic tattooing-related adverse events. Autologous blood is a feasible and safe tattooing agent for preoperative endoscopic localization of colorectal lesions within maximal interval of 5 days.

Recently, it has been suggested that peritumoral decreased uptake area (PDUA) in the hepatobiliary phase (HBP) of gadoxetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) was associated with vascular invasion in hepatocellular carcinoma (HCC). We aimed to investigate correlations between microvascular invasion and PDUA, and elucidate the predictability of PDUA for tumor recurrence after resection. We retrospectively analyzed clinicopathological and radiological data from 126 consecutive patients with single HCC ≤5 cm without macrovascular invasion who underwent preoperative Gd-EOB-DTPA-enhanced MRI and surgical resection. The presence of a faint and hypointense area around the tumor in the HBP was defined as PDUA. Among 126 patients with HCCs, microvascular invasion was observed in 29 (23.0%) patients and PDUA was observed in 15 (11.9%) patients. PDUA [odds ratio (OR) 20.06, confidence interval (CI) 4.74–84.96, P

The objective of this study was to investigate the antioxidant activities and anthocyanin profiles in the anthocyanin rich fraction (ARFAM) of Aronia melanocarpa, which are considered functional substances and are available as food coloring agents in Korea. Anthocyanins were identified by reversed-phase C18 column chromatography and HPLC-DAD-ESI/MS analysis. The antioxidative activity of the acidic ethanol extract (AME) and the anthocyanin-rich fraction (ARFAM) was determined by scavenging of the diphenylpicrylhydrazyl (DPPH) radical, the hydroxy radical, and the superoxide anion in addition to reducing power using a commercial antioxidant as a reference.

There is increasing interest in freshly cut products, that is, foods produced without washing and cutting. In this study, the quality of freshly cut sliced Deodeok was compared with that of what based on its washing methods. In bubble washing, the Deodeok rises to the water surface apace and is broken into centimeter sizes. Microbubble washing calls for the production of a great number of 0.1 mm-sized bubbles in anions-bearing water and their passing through a trumpet-shaped hole at a high pressure. To compare the product deterioration rates of the specimens, they were stored at 10°C for 10 days. In the specimens washed with the control method and with hand washing, the deterioration rate was 80%; and in the specimens washed with bubble and microbubble washing, 20~30%. The L-value (an index of browning) was higher in the bubble and microbubble washing than in the control and the hand washing, which implies that browning was minimized during the storage. As for the viable cell and coliform group counts that were measured during the storage, the specimens washed with the control method showed the highest values. In contrast, the specimens washed with microbubble washing showed the lowest values. In the sensory test, the specimens washed with microbubble were highest in storage preference. In conclusion, the Deodeok that was stored after it was washed with microbubble washing was found to have had the best quality.

Anti-tumor necrosis factor (TNF)-α therapy is being increasingly used to treat several rheumatic diseases and inflammatory bowel diseases. However, treatment with anti-TNF-α therapy of patients with a concurrent hepatitis B virus (HBV) or hepatitis C virus (HCV) infection can promote viral reactivation and potentially fatal liver failure. The medical records of 176 patients who had been treated with an anti-TNF-α therapy at single center from January 2010 to December 2012 were retrospectively analyzed. Of the 176 patients, the hepatitis B surface antigen (HBsAg) status of 114 (64.8%) were tested at the baseline. Five (4.4%) of them were HBsAgpositive, and 109 (95.6%) were negative. Only 10 of the HBsAg-negative patients (9.2%) were checked for hepatitis B core antigen. Ninety-one patients were checked for anti-HCV, and two (2.2%) were positive. After their anti-TNF-α therapy, HBV reactivation was confirmed in two patients. The reactivation of HBV after the anti-TNF-α therapy was observed in the HBsAg-positive patients.

Genetic variations in interleukin 28B (IL28B) have been strongly associated with a sustained virological response (SVR) in European and African-American patients. Genetic variation of IL28B was investigated in healthy controls and chronic hepatitis C (CHC) patients, and the treatment response in the CHC patients was analyzed according to IL28B polymorphism in the Korean population.IL28B polymorphisms (rs12979860 and rs8099917) were studied in 200 healthy controls and in 167 CHC patients who were treated with peginterferon-α and ribavirin.The prevalence of rs12979860 in healthy controls is as follows: the CC-genotype was 88.5%, the CT-genotype was 11.5%, and the TT-genotype was not found. The prevalence of rs8099917 in healthy controls is as follows: the TT-genotype was 89.5%, the TG-genotype was 10.5%, and the GG-genotype was not found. The CC-genotype of rs12979860 and the TT-genotype of rs8099917 were found to be closely related (linkage disequilibrium; D'=1.0, χ =0.9082). In 106 CHC patients treated with peginterferon and ribavirin, the SVR was 67.2% (n=58) for 1b, 91.6% (n=47) for 2a. In hepatitis C virus (HCV) genotype 1b with respect to rs12979860, the SVR in CC-genotype was 72.9% and that in CT-genotype was 40.0%. On investigating predictive factors for SVR, pretreatment low-HCV RNA levels, HCV genotype non-1, early virological response, and also the IL28B CC-genotype for rs12979860 were good indicators of an SVR.In Korea, genetic variation of IL28B is different from that in western countries in view of high prevalence of rs12979860 CC-genotype. It seems likely that a high SVR in Korean patients with genotype 1 CHC patients is due to the genetic polymorphism in IL28B.

The effects of the initial storage temperature and the PA film packaging on the extension of the shelf-life and the improvement of the postharvest storage quality of muskmelons were studied during their storage. Their storage quality was tested as follows: PA-film-wrapped muskmelons, stored at or for 30 days after their harvest, were kept at for 27 days (total: 57 days). On the fifth day of storage at (35th day overall), the weight loss reached 6.4% in the 7-control. However, the 2-PA showed the smallest loss of 2.2%. The soluble solids content and the acidity that were measured before the storage were and 0.26% in all the groups. After 27 days of storage at (on the 57th day overall), the values were highest in the 2-PA group with and 0.15%, respectively. Microorganisms were not detected at first; but on the fifth day of storage at (35th day overall), their values were 3.87 and 2.68 log CFU/g in the seven-control and the 2-PA, respectively. In other words, the 2-PA was found to be more effective in inhibiting microbial proliferation. In relation to sensory properties such as appearance, flavor, sweetness and chewiness, the 2-PA was superior to the other groups and was found to be most effective in improving the storability of muskmelons. In conclusion, it was found that low-temperature injury and fast storage quality deterioration did not occur in film-wrapped muskmelons that were stored at for 30 days after they were harvested.

In this study, the changes that occurred in the quality of minimally processed sliced Deodeok (Codonopsis lanceolata) in relation to the packing method during storage at were investigated. The storage tests were conducted for seven days using PE sealing, but PP sealing and vacuum packaging preserved the Deodeok for 14 days. On the seventh day, the vinyl-packaged Deodeok showed a remarkable fall in quality with 4.5 °Brix, but the PP-sealed and vacuum-packaged Deodeok showed slight falls with 6.4 and , respectively. The PE- and PP-sealed Deodeok did not show significant differences in texture and moisture content for two days, and the moisture content was highest in the vacuum-packaged Deodeok during storage. In relation to the total viable cell and the coliform count, the vacuum-packaged Deodeok showed the lowest rate of increment during storage, followed by the others. Thus, the bubble-washed and vacuum-packaged minimally processed sliced Deodeok was found to have the best quality.

Background/Aims Matrix metalloproteinases (MMP)-2 and -9 can degrade essential components of vascular integrity. The aim of this study was to investigate the association between those MMPs and variceal bleeding (VB). Methods Fifteen controls, 12 patients with acute ulcer bleeding (UB) group, 37 patients with varix (V group), and 35 patients with acute VB group were enrolled. Serum was obtained to measure MMP-2 and -9 activity by zymogram protease assays. Results The activity levels of these compounds were compared with the controls' median value. The median MMP-9 activity was 1.0 in controls, 1.05 in the UB group, 0.43 in the V group, and 0.96 in the VB group. The level of MMP-9 activity was higher in the VB group than in the V group (p

The chemical components of four muskmelons (Thankyou, Beauty, Picnic, and Symphony), according to the cultivars, were investigated during storage at for 28 days. After the storage period, the Picnic cultivar indicated a weight decrease of up to 4.70% whereas the Symphony cultivar showed the best weight maintenance during storage (1.02%). The Thankyou and Symphony cultivars had higher sugar content and acidity levels than the Beauty and Picnic cultivars during storage. While the Symphony and Beauty cultivars showed high hardness at the start of their storage, their hardness decreased much during storage while the Thankyou and Picnic cultivars showed little change in hardness during storage. Further, the Thankyou cultivar not only maintained its unique muskmelon yellow color but also showed lower microorganism growth than the other cultivars. The stem water loss seen in this cultivar, however, tends to be the first thing seen by the consumers and may thus determine its merchantable quality. In addition, as the Thankyou cultivar showed the least quality change during storage, it will be useful for the development of a technology for minimizing the moisture content of a muskmelon's stem.

Changes in the flavor of muskmelons stored at different temperatures were examined to judge aroma patterns during storage. A mass-spectrometry based electric nose was used to distinguish the subtle differences in the muskmelon's volatile compounds. The data were used for a discriminant function analysis (DFA), and then the partial least square algorithm was used for a quantitative analysis. Volatile components in the muskmelons increased with storage, and the first discriminant function score (DF1: r 2 =99.88%, F=3072.5) moved from a positive position to a negative position as the storage period increased. The proper point of maturity was anticipated as the 28 th day at 0 o C, 21 st day at 4 and 7 o C, and 14 th day at 10 o C. Also, using the DF1 score we could predict the general tendency (vitamin C, stem moisture, acidity) of the muskmelons. The electronic nose revealed that the major volatile compounds that changed during storage of the melons were ethyl ethyl acetate, butyl acetate, nonanol, dodecanoic acid, hexadecanoic acid and tricosane. The amount of volatile compounds detected increased during storage.

Contrast-enhanced ultrasound (CEUS) is highly accurate in depicting the vascularity of liver nodules. The aim of this study was to verify the characteristics of CEUS in distinguishing small (≤3 cm) hepatocellular carcinoma (HCC) from intrahepatic cholangiocarcinoma (ICC). A total of 65 patients with a liver nodule (HCC, n = 58; ICC, n = 7) smaller than 3 cm who underwent liver CEUS and pathologic confirmation were retrospectively reviewed. CEUS findings were compared with histopathologic and clinical data. Arterial-phase hyperenhancement and portal-delayed-phase wash-out on CEUS were observed in 77.6% (45/58) of HCCs and 85.7% (6/7) of ICCs. Time of arterial-phase hyperenhancement (11 seconds [6–20] vs 16 seconds [14–19], P = .008), time of portal-delayed-phase wash-out (65 seconds (15–260) vs 35 secconds (27–54), P = .002), and time interval between arterial-phase hyperenhancement and portal-delayed-phase wash-out (50 seconds [5–249] vs 19 seconds [13–35], P

A primary benign schwannoma of the liver is extremely rare. Only 30 cases have been reported in the medical literature worldwide, and only one case has been reported in Korea previously. A 56-year-old man was admitted to Gil Medical Center with incidental findings of a hepatic mass by abdominal computed tomography. The computed tomography and magnetic resonance image revealed a 3×2 cm-sized solid mass in the left lobe of the liver. Histological examination confirmed the diagnosis of a benign schwannoma, proven by positive immunoreaction with the neurogenic marker S-100 protein and a negative response to CD34, CD117, and smooth muscle actin. We report a primary benign schwannoma of the liver and review the literature.

It is well known that [(18)F]FDG PET has a low sensitivity in the detection of hepatocellular carcinoma (HCC). We prospectively compared [(11)C]acetate PET/CT results with those of [(18)F]FDG PET/CT in patients with HCCs. Thirteen patients (M:F=11:2, mean age of 51+/-12) with suspicious or confirmed HCCs underwent [(11)C]acetate PET/CT with or without [(18)F]FDG PET/CT (both [(11)C]acetate and [(18)F]FDG PET/CT were performed in 10 patients). HCC was confirmed by histopathology or clinical criteria in 12 patients and one benign liver lesion. Both PET/CT images were interpreted by two experienced nuclear physicians, supported by standardized uptake value (SUV). A total of 12 patients were confirmed to have initial or recurrent HCCs. [(18)F]FDG PET/CT showed markedly increased uptake in only two patients, moderately increased uptake in another two and negative in six. [(11)C]acetate PET/CT demonstrated markedly increased uptake in seven patients, moderately increased uptake in three and negative in only two. One HCC metastatic lesion was detected only by [(11)C]acetate PET/CT. For detection of HCC, [(11)C]acetate PET/CT showed a high sensitivity of 83%, whereas [(18)F]FDG PET/CT only of 40%. The study results demonstrated that [(18)F]FDG PET/CT has a limitation in detection of HCC and [(11)C]acetate PET/CT has a complementary role to [(18)F]FDG PET/CT. When primary HCC showed low [(18)F]FDG uptake, it was [(11)C]acetate-avid, and vice versa. It may be useful to combine both [(18)F]FDG and [(11)C]acetate PET/CT for detection of HCCs.

Garlics were aged at 60, 70, 80, and for 1, 3 and 6 days. Samples were analyzed for physico-chemical components and antioxidant activities, such as DPPH scavenging activity and reducing power of hot water and ethanol extracts. The Hunter L, a and b values were significantly lower in sample aged at higher temperature and for longer time. In initiation of aging, the share force was the lowest in sample aged at and it increased for 6 days to in aging. The pH of garlic was acidified at increasing aged temperature and periods. In sample aged for 6 days at and , pH was 6.12 and 3.90, respectively. Contents of total phenolics and flavonoids also increased in sample aged at higher temperature and for longer time. Their contents increased about 3.5 and 9.1 times higher in sample aged for 6 days at than sample aged for 6 days at , respectively. Total pyruvate contents were fluctuated by aging temperature and periods. DPPH scavenging activity was increased in sample aged at higher temperature and longer time. The highest activity of DPPH scavenging showed in sample aged for 6 days at . Similar results were observed in reducing power activity. It was estimated that such increases in anti-oxidant activities in aged garlics may come from actions of phenolics, flavonoids and browning compounds in them.

The antioxidant activities of hot water and ethanol extracts from fresh, steamed and black garlic were compared. The levels of phenolic compounds of extracts from fresh, steamed and black garlic were /100 g and their contents were not significantly different. The contents of flavonoids in ethanol extracts, /100 g, was higher than hot water extracts. DPPH radical scavenging activity was higher in ethanol extract. Although the highest level was in concentration of 10 mg/mL from black garlic ethanol extract, ethanol extracts showed in concentration of 15 mg/mL. Reducing power was significantly higher in black garlic extract and higher in the order of black garlic> fresh garlic> steamed garlic in ethanol extract. Hydroxyl radical scavenging activity was higher in ethanol extract, showing over 60% in concentration of 5 mg/mL. In oil emulsion, TBA value was significantly lower in hot water extracts from black garlic, however ethanol extracts were not significantly different. TBA value of ethanol extract were and from steamed and black garlic, respectively. Antioxidant activity to the linoleic acid was in 1-day storage, but its level was increased at 4-day storage to .

Prohibitin, a tumor suppresser protein, plays an important role in the transcriptional regulation of various genes involved in cell-cycle control and proliferation. Recent studies have reported that the growth-suppressive property of the prohibitin protein is exhibited in its physical interaction with E2F family proteins and its subsequent repression of their transcriptional activity. Herein, we report that prohibitin interacts with RING finger protein 2 (RNF2), a member of the PcG (polycomb-group) family of proteins, and that the two proteins regulate the activity of E2F1 via dual pathways: the direct, prohibitin-mediated pathway and the indirect, p16-mediated pathway of E2F1 transcriptional regulation. Co-immunoprecipitation experiments showed that endogenous prohibitin interacts with endogenous RNF2. Interestingly, the expressed amounts of RNF2 and prohibitin were interdependently affected at the post-translational level. Furthermore, the depletion of either endogenous RNF2 or prohibitin using the RNA interference technique increased the level of p16 protein expression, resulting in a decrease in the transcriptional activity of E2F1 via the p16-CDK4-Rb pathway. In addition, chromatin immunoprecipitation assays showed that RNF2 was recruited to E2F1-response promoters along with prohibitin to inhibit the transcriptional activity of E2F1. Cell proliferation was also regulated by the prohibitin-RNF2 interaction. These results suggest that the RNF2-prohibitin complex regulates the activity of E2F1 via dual pathways.

The quality characteristics of cookies, prepared with the freeze dried fresh garlic (FGP) and steamed (, 20 min) garlic (SGP) powders, were investigated. The cookie samples in the present study were made by adding the garlic powders at different levels (0, 0.5, 1, 2, 4, and 6%). The highest spread ratio, and , were obtained by mixing 6% FGP and 0.5% SGP with the cookies. Among the surface color of the cookies, the L-value decreased with increasing garlic powder contents compared to that of the control group, but the difference in the surface color among the kinds of garlic powders was insignificant. Although increases in the garlic powder content resulted in no noticeable difference among the a-value of the test group, the b-value was decreased significantly, particularly with increasing SGP contents. Hardness was also increased along with the garlic powder contents and was highest at its 2% content. When viewed from the sensor properties, the measured color tended to become brown at the garlic powder contents greater than 2%. The surface crack of the cookies also increased as the SGP content increased. Its garlic taste and flavor were slightly low at SGP added with 6% garlic powder content than FGP. The overall acceptability was higher in added test samples than those in control group sample; it was highest for 1%, 2% and 0.5%, in decreasing order. In the sensor evaluation, the overall acceptability of the cookies was considerably different in the comparison of FGP added cookies with SGP added ones. Therefore, the optimal ratio investigated for making the garlic added cookies was shown to be 1 %, and its acceptability was relatively high for SGP added cookies.

Infection with the Gram-negative pathogen Helicobacter pylori (H. pylori) has been associated with gastro-duodenal disease and the importance of H. pylori eradication is underscored by its designation as a group I carcinogen. The standard triple therapy consists of a proton pump inhibitor, amoxicillin and clarithromycin, although many other regimens are used, including quadruple, sequential and concomitant therapy regimens supplemented with metronidazole, clarithromycin and levofloxacin. Despite these efforts, current therapeutic regimens lack efficacy in eradication due to antibiotic resistance, drug compliance and antibiotic degradation by the acidic stomach environment. Antibiotic resistance to clarithromycin and metronidazole is particularly problematic and several approaches have been proposed to overcome this issue, such as complementary probiotic therapy with Lactobacillus. Other studies have identified novel molecules with an anti-H. pylori effect, as well as tailored therapy and nanotechnology as viable alternative eradication strategies. This review discusses current antibiotic therapy for H. pylori infections, limitations of this type of therapy and predicts the availability of newly developed therapies for H. pylori eradication.

Background: Experience with endoscopic transmural drainage of pancreatic pseudocysts prompted the use of a similar technique for the primary treatment of pancreatic abscess. The aim of this study was to assess the feasibility, safety, and effectiveness of endoscopic transmural drainage for the treatment of pancreatic abscesses compressing the gut lumen. Methods: In 9 patients, a total of 11 pancreatic abscesses compressing the stomach, duodenum, or both organs were drained endoscopically by means of endoscopic fistulization followed by saline solution irrigation and subsequent stent(s) placement. Complete resolution of the pancreatic abscess was defined as the absence of symptoms and no residual collection on follow-up CT. Observations: Endoscopic transmural drainage was technically successful in all cases. Ten abscess cavities (91%) resolved completely after stent placement for a mean duration of 32 days. In 2 patients, insertion of a nasopancreatic catheter was required to irrigate thick pus or necrotic debris. Bleeding occurred in 1 case (11%) but there was no mortality. The relapse rate was 13% over a mean follow-up of 18 months. Conclusion: Endoscopic transmural drainage is an effective therapy with minimal morbidity for pancreatic abscess compressing the gut lumen and is a valuable alternative to surgical drainage.

It is difficult to characterize the nodular lesions in cirrhotic liver if typical enhancement pattern is not present on dynamic contrast-enhanced imagings. Although the signal intensity of the hepatobiliary phase in gadoxetic acid-enhanced magnetic resonance imaging (MRI) is helpful for characterization of the lesions, some dysplastic nodules may also exhibit low signal intensity in the hepatobiliary phase. We aimed to assess the usefulness of gadoxetic acid (Gd-EOB-DTPA)-enhanced MRI including diffusion-weighted imaging (DWI) for differentiation between atypical small hepatocellular carcinomas (HCCs) and dysplastic nodules showing low signal intensity (SI) in the hepatobiliary phase, and to evaluate the MRI findings in determining the histological grade of atypical HCCs in patients with cirrhosis. A total of 43 cirrhotic patients with a small (≤3 cm) liver nodule (n = 25, HCC; n = 18, dysplastic nodule) who underwent Gd-EOB-DTPA-enhanced MRI and pathologic confirmation were retrospectively reviewed. Atypical HCC was defined as not showing arterial hyperenhancement and delayed washout on dynamic MRI. High SI on both T2WI and DWI (sensitivity 80.0%, specificity 100%, positive predictive value 100%, negative predictive value 78.3%) was the most specific feature to differentiate atypical HCCs from dysplastic nodules. High SI on both T2WI and DWI (100% vs 61.5%, P = .039) or low SI on pre-enhanced T1WI (83.3% vs 30.8%, P = .021) was more frequent observed in Edmonson grade II–III HCCs compared with those in grade I HCCs. The combination of DWI and T2WI is most useful for the differentiation of atypical small HCCs from dysplastic nodules showing low SI in the hepatobiliary phase. Combination of DWI and T2WI or pre-enhanced T1WI seems to be useful for predicting the histological grade of atypical HCCs.

AIM: To evaluate the diagnostic yield and safety of a modified technique for the histological diagnosis of subepithelial tumors (SETs). METHODS: A retrospective review of patients who underwent a modified technique for the histological diagnosis of gastric SETs, consisting of a mucosal incision with a fixed flexible snare (MIF) and deep-tissue biopsy under conventional endoscopic view, from January 2012 to January 2013 was performed. Eleven patients with gastric SETs 10-30 mm in diameter and originating from the third or fourth layer on endoscopic ultrasonography were included. RESULTS: The mean age was 59.8 (range, 45-76) years, and 5 patients were male. The mean size of the SETs was 21.8 (range, 11-30) mm. The number of biopsy specimens was 6.3 (range 5-8). The mean procedure time was 9.0 min (range, 4-17 min). The diagnostic yield of MIF biopsies was 90.9% (10/11). The histological diagnoses were leiomyoma (4/11, 36.4%), aberrant pancreas (3/11, 27.3%), gastrointestinal stromal tumors (2/11, 18.2%), an inflammatory fibrinoid tumor (1/11, 9.1%); one result was non-diagnostic (1/11, 9.1%). There were six mesenchymal tumors; the specimens obtained in each case were sufficient for an immunohistochemical diagnosis. There was no major bleeding, but one perforation occurred that was successfully controlled by endoscopic clipping. CONCLUSION: The MIF biopsy was simple to perform, safe, and required a shorter procedure time, with a high diagnostic yield for small SETs.

Sequential antiviral therapy for chronic hepatitis B may lead to the selection of multidrug-resistant mutation. This study was carried out to assess the efficacy of entecavir in patients that have experienced adefovir monotherapy failure after the development of lamivudine resistance.Fifty-three patients with confirmed genotypic lamivudine-resistant chronic hepatitis B were treated with entecavir. Thirty patients were switched to entecavir directly (LAM-ETV group), whereas the remaining 23 were adefovir-refractory patients who were switched to entecavir (LAM-ADV-ETV group). These 23 patients included 9 patients with inadequate response (ADV-I subgroup) and 14 that exhibited adefovir resistance (ADV-R subgroup).Significantly greater reductions in HBV DNA levels were observed after 24, 48 and 72 weeks of entecavir therapy in the LAM-ETV group than in the LAM-ADV-ETV group, respectively. However, between these two groups at 48 and 72 weeks, no significant differences were observed in cumulative proportions of virological response or breakthrough, respectively. Furthermore, efficacy of entecavir was not significantly different in the ADV-I and ADV-R subgroups. Four patients in the LAM-ETV group and six patients in the LAM-ADV-ETV group developed genotypic resistance to entecavir.Entecavir therapy is less effective in adefovir-refractory patients with prior lamivudine resistance than in lamivudine-resistant patients.

BACKGROUND/AIMS A combination of peginterferon and ribavirin is the standard therapy for chronic hepatitis C (CHC). However, the respective study has not been carried out in a large scale in Korea. The purpose of this study was to collect the studies that have been reported in Korea in order to analyze the therapeutic effect of combination therapy and compare to find racial difference. METHODS Twenty-eight papers related to the therapeutic effect of combination therapy in CHC patients were analyzed based on pooled analysis. RESULTS Based on the analysis for genotype 1 in Korea, early virologic response (EVR), end of treatment response (ETR), and sustained virologic response (SVR) were 79.6% (125/157), 80.1% (166/207), and 62.7% (341/543). The EVR, ETR, and SVR for genotype 2 and 3 were 89.4% (119/133), 92.2% (203/220), and 84.1% (434/516). Data from other Asians showed that EVR and SVR for genotype 1 were 88.9% (290/326) and 64.4% (491/762) respectively and 88.8% (135/152), and 79.4% (151/190) for genotype 2 and 3 respectively. In Western, EVR and SVR for genotype 1 were 51.3% (1,981/3,860) and 42.4% (1,798/4,231) respectively, and for genotype 2 and 3 were 87.7% (350/399) and 77.8% (533/685) respectively. Based on the comparative analysis, no statistical difference in SVR between Koreans and other Asians (p=0.955) was observed; However, the SVR of Koreans was higher with significance than that of Westerns (p

Reactive oxygen species (ROS) attack guanine bases in DNA easily and form 8-hydroxydeoxyguanosine (8-OHdG), which can bind to thymidine rather than cytosine, based on which, the level of 8-OHdG is generally regarded as a biomarker of mutagenesis consequent to oxidative stress. For example, higher levels of 8-OHdG are noted in Helicobacter pylori-associated chronic atrophic gastritis as well as gastric cancer. However, we have found that exogenous 8-OHdG can paradoxically reduce ROS production, attenuate the nuclear factor-κB signaling pathway, and ameliorate the expression of proinflammatory mediators such as interleukin (IL)-1, IL-6, cyclo-oxygenase-2, and inducible nitric oxide synthase in addition to expression of nicotinamide adenine dinucleotide phosphate oxidase (NOX)-1, NOX organizer-1 and NOX activator-1 in various conditions of inflammation-based gastrointestinal (GI) diseases including gastritis, inflammatory bowel disease, pancreatitis, and even colitis-associated carcinogenesis. Our recent finding that exogenous 8-OHdG was very effective in either inflammation-based or oxidative-stress-associated diseases of stress-related mucosal damage has inspired the hope that synthetic 8-OHdG can be a potential candidate for the treatment of inflammation-based GI diseases, as well as the prevention of inflammation-associated GI cancer. In this editorial review, the novel fact that exogenous 8-OHdG can be a functional molecule regulating oxidative-stress-induced gastritis through either antagonizing Rac-guanosine triphosphate binding or blocking the signals responsible for gastric inflammatory cascade is introduced.

Background/Aims: Transforming growth factor beta1 (TGF-β1) is a key cytokine in the production of extracellular matrix. A genetic polymorphism at codon 10 of the TGF-β1 gene is associated with liver fibrosis. We investigated the effect of genetic polymorphisms at codon 10 on the development of alcoholic liver cirrhosis (ALC). Methods: In total, 119 controls and 182 patients with ALC, were enrolled in the study. Clinical and laboratory data including total lifetime alcohol intake were collected at enrollment. The genotype at codon 10 was determined for each patient by single-strand conformation polymorphism. Results: There were three types of genetic polymorphism at codon 10: homozygous proline (P/P), heterozygous proline/leucine (P/L), and homozygous leucine (L/L). Among the controls, the proportions of P/P, P/L, and L/L were 26.1%, 44.5%, and 29.4%, respectively in the ALC group, these proportions were 23.1%, 43.4%, and 33.5%, respectively. The genotype distribution did not differ between the controls and the ALC group. In the ALC group, age, total lifetime alcohol intake, and distribution of Child-Pugh class did not differ with the genotype. Of the male patients with ALC (n=164), the proportions of P/P, P/L, and L/L were 20.1%, 44.5%, and 35.4%, respectively the genotype distribution did not differ between the male controls and the male ALC patients. Conclusions: The genotype at codon 10 in TGF-β1 does not appear to influence the development of ALC. Further study is needed to investigate other genetic factors that influence the development of ALC in patients with chronic alcohol intake. (Korean J Hepatol 2011;17:37-43)

Primary hepatic epithelioid hemangioendothelioma is a rare neoplasm of endothelial origin. The clinical manifestations are nonspecific, ranging from complete absence of symptoms to hepatic failure and death. Spontaneous rupture of a hepatic epithelioid hemangioendothelioma is an extremely rare presentation. We present a case of primary hepatic epithelioid hemangioendothelioma in a 65-year-old male patient with alcoholic liver cirrhosis. He was hospitalized due to epigastric pain and multiple liver masses on abdominal ultrasound. Dynamic liver CT imaging revealed multiple peripheral nodular enhanced mass lesions with delayed centripetal enhancement, and the adjacent collection of high-attenuation fluid along the liver capsule. Abdominal tapping revealed blood in the peritoneal cavity. Primary hepatic epithelioid hemangioendothelioma with spontaneous rupture was finally diagnosed based on a histopathologic examination revealing positive immunohistochemical staining for CD34. (Korean J Hepatol 2009;15:510-516)

Background/Aims: Bleeding from esophageal varices (EV) is a major cause of death in patients with liver cirrhosis. Endoscopic screening is recommended for diagnosing EV, but various noninvasive parameters can also be used to predict EV. The liver stiffness measurement (LSM), a noninvasive technique for estimating liver fibrosis, was recently reported to be strongly correlated with the hepatic venous pressure gradient. This study evaluated the usefulness of LSM for predicting the presence and size of EV in patients with cirrhosis. Methods: The relationships of LSM with the presence and size of EV were analyzed in 112 patients with liver cirrhosis. Liver cirrhosis was diagnosed histologically or clinically. The presence and size of EV were assessed by endoscopy, and LSM was determined by the Fibroscan Ⓡ technique. Results: LSM was strongly correlated with the presence of EV (P