- 1 Younger age and female sex predict a better therapeutic response in HBeAg-positivechronic hepatitis B patients to entecavir therapy
The rates of serum alanine aminotransferase (ALT) normalization at treatment Year
1 and Year 2 were 86% and 88%, respectively. The cumulative rate of HBeAg loss at treatment
Year 1 and Year 2 were 17% and 33.3%, respectively. The rates of undetectable levels of serum
hepatitis B virus (HBV) deoxyribonucleic acid (DNA) at treatment Year 1 and Year 2 were 64%
and 80.8%, respectively. In univariate analysis, HBeAg loss at 2 years was associated with a
young age (35 years; p Z 0.007) and a high baseline ALT level (p < 0.001). Multivariate analysis
after adjusting for age, sex, and ALT level [>5 times the upper limit of normal (ULN)]
showed that a young age (odds ratio, 2.66; 95% confidence interval, 1.2e5.92) and male sex
(odds ratio, 0.36; 95% confidence interval, 0.16e0.83) were independent factors associated
with HBeAg loss at 2 years of therapy.
Conclusion: Two-year entecavir therapy has good biochemical and virologic responses; however,
the rate of HBeAg loss is modest in HBeAg-positive CHB patients. A young age (i.e., 35
years) and female sex were also associated with a better serologic response.
Copyright ª 2014, The Gastroenterological Society of Taiwan and The Digestive Endoscopy Society
of Taiwan. Published by Elsevier Taiwan LLC.
- 2 Toward personalized therapy of chronic hepatitis B
During the natural history of chronic hepatitis B virus (HBV)
infection, the loss of serum hepatitis B e antigen (HBeAg)
and the development of anti-HBe antibodies (HBeAg seroconversion)
make a transition from the immune-clearance
phase of disease to the inactive carrier state. Clinical
studies on the natural history involving patients with
HBeAg-positive chronic hepatitis B (CHB) have demonstrated
that HBeAg seroconversion confers improved outcomes,
including a sustained reduction in HBV DNA levels, a
regression of fibrosis, a lower risk for cirrhosis and hepatocellular
carcinoma and a higher incidence of
complication-free survival [1e3]. Hsu et al reported on the
natural course of chronic HBV infection after spontaneous
HBeAg seroconversion in 283 patients [2]; the estimated
annual incidence of cirrhosis and hepatocellular carcinoma
development was 0.9% and 0.2%, respectively, during a
mean follow-up of 8.6 years. Another study involving patients
with perinatally acquired chronic HBV infection has
shown that spontaneous HBeAg seroconversion occurring at
age 15e35 years is associated with a low rate of progression
to cirrhosis, whereas delayed seroconversion (after age 40
years ) confers a poorer prognosis [4]. Thus, the younger
the age at which HBeAg seroconversion occurs, the better
the outcome.
- 3 Clinical and endoscopic features of gastric pyogenic granuloma
Pyogenic granuloma (PG) is a polypoid form of capillary hemangioma.
This study aimed to analyze the clinical and endoscopic features of gastric PG.
Methods: We retrospectively reviewed nine patients with gastric PGs who were evaluated by
esophagogastroduodenoscopy and diagnosed by pathological study at the Chang Gung Medical
Center (Taoyuan, Taiwan) between 2000 and 2009. Demographic data, clinical presentations,
endoscopic findings, treatment, and outcome were collected and analyzed.
Results: The median age of the study patients was 62 years (range, 40e73 years) with a female
preponderance. The most common symptom at presentation was overt gastrointestinal
bleeding, followed by anemia and epigastralgia. Two patients were asymptomatic at diagnosis.
The most common underlying diseases were liver cirrhosis [5 (56%) patients] and hypertension
[5 (56%) patients]. Five (56%) cases of gastric PGs originated at the site of prior ulcer lesions.
Most gastric PGs were solitary [7 (78%) patients] and located in the antrum [8 (89%) patients].
The gastric PGs typically appeared morphologically as smooth protruding hyperemic lesions
with adherent white or yellow deposits. One patient received an endoscopic mucosal resection
with complete excision of the lesion. Another patient received surgical intervention. Four
gastric PG lesions were stationary or regressed with conservative management.
Conclusion: Overt gastrointestinal bleeding was the most common clinical presentation in patients
with gastric PG. Gastric ulcers were the most common precursors of PG with the antrum
being the most frequent site involved. Gastric PGs were characteristically protruding hyperemic
lesions with adherent exudates.
- 4 Risk factors for 1-year mortality in patients with intermediate-stage hepatocellular carcinoma treated solely with transcatheter arterial chemoembolization
Transcatheter arterial chemoembolization (TACE) is a main
therapy for patients with intermediate-stage hepatocellular carcinoma (HCC). The purpose
of our study was to determine the risk factors for 1-year mortality in patients treated solely
with TACE.
Methods: A total of 123 patients with intermediate-stage HCC treated solely with TACE were
recruited from Ren-ai Branch, Taipei City hospital during the period from January 1998 to June
2013. Baseline characteristics and factors associated with 1-year mortality were analyzed.
Results: There were 94 men (76.4%) and 29 women (23.6%) among 123 newly diagnosed
intermediate-stage HCC patients treated solely with TACE. The mean age was 63 11 years
(range, 31e92 years). The 1e5-year overall cumulative survival rates were 65.9%, 46%,
33.2%, 22%, and 18.4% [median: 23 months, 95% confidence interval (CI): 16.4e29.6 months],
respectively. Of these, 42 (34.1%) and 81 (65.9%) patients had survival time shorter (Group 1)
and longer (Group 2) than 1 year, respectively. There were no significant differences in sex,
age, hepatitis B virus/hepatitis C virus positive rate and tumor number between Group 1
and Group 2 patients.
- 5 Pseudomelanosis duodeni in a female adult with chronic renal failure
Pseudomelanosis duodeni is a rare endoscopic finding that manifests as dark
speckled spots in the duodenum. It is considered a benign condition and is associated with
certain diseases and the use of certain medications. This study reports a case of a 74-yearold
woman, with end-stage renal disease under maintenance hemodialysis, hypertension under
regular medical control, iron deficiency anemia under oral iron supplement, and progressive
anemia with suspicious occult gastrointestinal bleeding. Upper gastrointestinal endoscopy revealed
multiple tiny brownish-black pigmentation throughout the proximal second portion of
the duodenum. The histopathological examination showed pigment-laden macrophages with
positive iron stain and negative melanin stain in the lamina propria of the mucosal villi.
Copyright ª 2014, The Gastroenterological Society of Taiwan and The Digestive Endoscopy Society
of Taiwan. Published by Elsevier Taiwan LLC.
- 6 Stromal tumor presents as a large extragastrointestinal mass in the abdominal cavity
Gastrointestinal stromal tumors are nonepithelial neoplasms of the gastrointestinal
tract and have been increasingly recognized in recent years. In contrast, stromal tumor
outside the gastrointestinal tract is not frequently found. Here, we present a 57-year-old male
patient who had abdominal fullness for several months. It was caused by a 23-cm heterogeneous
tumor mass that was successfully removed from the left upper abdominal cavity. The
tumor adhered tightly to adjacent organs but postoperative histopathological analysis revealed
no direct connection to the stomach, liver, pancreas, spleen, or kidneys. Immunohistochemical
examination of the tumor revealed proliferative spindle-shaped cells stained positive for
CD117 and CD34 and negative for smooth muscle actin and S-100. The patient received regular
follow up. A suspected recurrent liver metastatic lesion was noted 2 years later and radiofrequency
ablation of the liver tumor was performed followed by oral imatinib treatment. No tumor
recurrence was detected at 3 years after radiofrequency ablation. This case reminds us
that extragastrointestinal stromal tumors should be considered in the differential diagnosis
when a large heterogeneous mass is present in the abdominal cavity. The characteristics of extragastrointestinal
stromal tumor are described and the literature is reviewed in this report.
Copyright ª 2014, The Gastroenterological Society of Taiwan and The Digestive Endoscopy Society
of Taiwan. Published by Elsevier Taiwan LLC.
- 7 A tubular polyp in the cecum during colonoscopic examination
A 48-year-old woman came to our hospital for a health
examination. She had no known medical conditions, but
underwent cesarean section due to malpresentation about
20 years ago. Physical and laboratory findings were unremarkable.
Colonoscopy disclosed a 0.5 cm 5 cm tubular
lesion within the cecum (Fig. 1).
- 8 How to publish a scientific manuscript in a high-impact journal
Scientific publishing is an essential aspect of medical progress. New advances in
human knowledge are communicated to the outside world through publications. It is essential
that this knowledge is accurate, valid, reproducible, and clinically useful. Many aspiring clinicians
and scientists dream of publishing their work in high-impact journals. For these dreams to
become reality, it is essential to follow the basic principles of scientific research and publishing.
In this paper, I outline my own personal view on how to publish your paper in such highimpact
journals. I discuss the strategy for high-impact research, the logistics of manuscript
submission, the likely outcomes, and the reasons for failure or success. I provide an insider’s
view of what editors look for in a successful manuscript and I offer advice on how to achieve
this success.
- 9 Advances in Digestive Medicine
The consistently high quality of papers that are published in Advances in Digestive Medicine (AIDM) can only be maintained with the cooperation and dedication of a number of expert referees. The Editors would like to thank all those who donated the hours necessary to review, evaluate and comment on manuscripts; their conscientious efforts have enabled the Journal to maintain its tradition of excellence. We are grateful to the following reviewers for their contributions in 2014.
