Racial and ethnic disparities in untreated patients with hepatitis C virus-related hepatocellular carcinoma but not in those with sustained virologic response

BACKGROUND

Racial and ethnic disparities exist for hepatitis C virus (HCV) treatment and hepatocellular carcinoma (HCC) survival.

AIM

To evaluate the impact of HCV treatment on such disparities.

METHODS

In a retrospective cohort study, we analysed 6069 patients with HCV-related HCC (54.2% Asian, 30.1% White, 8.5% Black, and 7.3% Hispanic) from centres in the United States and Asia.

RESULTS

The mean age was 61, 60, 59 and 68, respectively, for White, Black, Hispanic and Asian patients. Black patients were most likely to have Barcelona Clinic Liver Cancer stage D, vascular invasion and distant metastasis (23% vs. 5%-15%, 20% vs. 10%-17% and 10% vs. 5%-7%, respectively; all p < 0.0001). Treatment rate with direct-acting antiviral agents (DAA) was 35.9% for Asian, 34.9% for White, 30.3% for Hispanic (30.3%), and 18.7% for Black patients (p < 0.0001). Among those untreated or without sustained virologic response (SVR), 10-year survival rates were 35.4, 27.5, 19.3 and 14.0, respectively, for Asian, Hispanic, White and Black patients (p < 0.0001). There were no statistically significant differences among those with SVR (p = 0.44). On multivariable analysis adjusted for relevant confounders, there was no statistically significant association between survival and being Hispanic (aHR: 0.68, p = 0.26) or Black (aHR: 1.18, p = 0.60) versus White. There was a significant association between being Asian American and survival (aHR: 0.24, p = 0.001; non-U.S. Asian: aHR: 0.66, p = 0.05), and for SVR (aHR: 0.30, p < 0.0001).

CONCLUSION

DAA treatment rates were suboptimal. Racial and ethnic disparities resolved with HCV cure. Early diagnosis and improved access to HCV treatment is needed for all patients with HCV infection.

Adversarial Attacks on Medical Image Classification

Due to the growing number of medical images being produced by diverse radiological imaging techniques, radiography examinations with computer-aided diagnoses could greatly assist clinical applications. However, an imaging facility with just a one-pixel inaccuracy will lead to the inaccurate prediction of medical images. Misclassification may lead to the wrong clinical decision. This scenario is similar to the adversarial attacks on deep learning models. Therefore, one-pixel and multi-pixel level attacks on a Deep Neural Network (DNN) model trained on various medical image datasets are investigated in this study. Common multiclass and multi-label datasets are examined for one-pixel type attacks. Moreover, different experiments are conducted in order to determine how changing the number of pixels in the image may affect the classification performance and robustness of diverse DNN models. The experimental results show that it was difficult for the medical images to survive the pixel attacks, raising the issue of the accuracy of medical image classification and the importance of the model's ability to resist these attacks for a computer-aided diagnosis.

Real-world effectiveness of national pit and fissure sealants program in Taiwan

OBJECTIVES

This study investigated the effectiveness of a national population-based pit and fissure sealants (PFS) program in Taiwan.

METHODS

Part 1 (effectiveness of national PFS program) involved children who had participated in the PFS program from 2015 to 2019. After propensity score matching, 670,840 children were selected for analysis until the end of 2019. During follow-up, the permanent first molars of the participants were assessed for caries-related treatments by employing multilevel Cox proportional hazards models. In Part 2 (effectiveness of retained sealants), which involved 1,561 children, sealant retention was evaluated 3 years after placement. A structured questionnaire was employed to collect information on family and individual factors. The endpoints were the same as in Part 1.

RESULTS

In Part 1, the adjusted hazard ratios (HRs) for caries-related treatments among participants in the PFS program were 0.90 (95% confidence interval [CI] = 0.89, 0.91) for dental restoration, 0.42 (95% CI = 0.38, 0.46) for initiation of endodontic treatment, 0.46 (95% CI = 0.41, 0.52) for completion of endodontic treatment, and 0.25 (95% CI = 0.18, 0.34, all Ps < 0.0001) for extraction. In Part 2, the adjusted HR for dental restoration of teeth with retained sealants was 0.70 (95% CI = 0.58, 0.85), significantly lower than that for teeth without retained sealants (P = 0.0002).

CONCLUSIONS

Participation in the national PFS program was associated with a significant reduction of at least 10% in the risk of caries-related treatments, and an additional 30% risk reduction may have been attributed to sealant retention.

CLINICAL SIGNIFICANCE

In a real-world setting, schoolchildren in the national PFS program were associated with a significant reduction of at least 10% in the likelihood of caries-related treatments. The program provided moderate protection against caries for the study population and could be improved by increasing the sealant retention rate.

Effort-reward imbalance and job strain index associated with health-related quality of life for civil servants in a national survey: the mediation effect of job support and over-commitment

OBJECTIVES

Work-related stress (WRS) is significantly associated with health-related quality of life (HRQoL), but the amounts of evidence on differences of effort-reward imbalance (ERI) and job strain index (JSI) remain sparse and have limited generalizability. Therefore, we aimed to assess the association between ERI and JSI with HRQoL and assess the mediation effect of social support (JS) and over-commitment (OC) on this association in Taiwan's civil servants.

MATERIAL AND METHODS

A cross-sectional national survey was given to registered civil servants in Taiwan - 20 046 civil servants from 647 institutions were enrolled using multistage stratified random cluster sampling. A web-questionnaire collected demographic information, job characteristics, and different indexes of ERI and job-control-demand-support (JCDS) models. Structural equation model (SEM) was used to examine the association between ERI and JSI with HRQoL, and the mediation effect of JS and OC on the associations.

RESULTS

In the ERI model, ERI and OC were consistently negatively associated with the mental component score (MCS) (r = -0.46 and r = -0.37) and physical component score (PCS) (r = -0.45 and r = -0.34), which were higher than job demand (r = -0.28 and r = -0.22) and JSI (r = -0.38 and r = -0.29). Using hierarchical multiple regression analyses, ERI was significantly correlated with MCS and PCS, which was consistently higher than JSI. The ERI and JSI were significantly correlated with MCS (β = -0.170 and β = -0.140) and PCS (β = -0.150 and β = -0.082) using SEM analysis, whereas ERI was considerably higher than in JSI. In addition, OC and JS mediated the association between The ERI and JSI with HRQoL.

CONCLUSIONS

We found the ERI index is significantly correlated with HRQoL superior to JSI, in particular among Taiwan civil servants. Further longitudinal studies are needed to determine the causality and spatiotemporal relation of these differences. Int J Occup Med Environ Health. 2022;35(4):425-36.

Risk of CVD Following Radiotherapy for Head and Neck Cancer: An Updated Systematic Review and Meta-Analysis

Background

The relative risk for cerebrovascular disease (CVD) is increased in patients with head and neck cancer (HNC) treated with radiotherapy (RT). However, the current relative risk for CVD following RT has not been well clarified. The purpose of this study was to analyze the effect of RT and update the risk of CVD following RT in HNC patients through a systematic review and meta-analysis.

Material and Methods

We conducted an online database search and systematic review of observational studies that reported on CVD and extracranial carotid stenosis in patients with HNC who had undergone RT. Articles published in Medline and PubMed from 1980 to 2021 were identified and collected.

Results

Of the forty-seven articles identified from PubMed and forty-four articles identified from 3 systematic reviews, twenty-two studies were included. We found that neck RT was a significant risk factor for CVD (HR 3.97, 95% CI: 2.89-5.45). Patients with HNC treated by RT had an increased OR (7.36, 95% CI: 4.13-13.11) for CVD, and approximately 26% (95% CI: 22%-31%) of HNC patients treated with RT were at risk for CVD with more than 50% reduction in carotid diameter.

Conclusion

The risk of CVD is increased in patients with HNC treated by RT, and recent improvements in RT techniques may have contributed to the decreased risk of CVD. These results suggest that regular follow-up and appropriate screening for CVD should be required for patients with HNC.

Effects of oral exercise on tongue pressure in Taiwanese older adults in community day care centers

Background/purpose

Oral exercise is a training method for swallowing dysfunction in older adults. The study investigated the effect of oral exercise on tongue pressure in older adults in Taiwanese community day care centers over a 3-month period.

Materials and methods

Participants over age 50 who were able to communicate and participating for the duration of the 12-week period were recruited from five community day care centers. A 15-min weekly group oral exercise activity was conducted. The tongue pressures were measured and multivariable linear regression models were used to assess the effect of oral exercise intervention on the participants’ tongue pressures.

Results

A total of 66 older adult participants, among whom the mean age was 78.06 ± 10.74 years. Tongue pressure continued improving during the intervention period, and the mean tongue pressure at the end of the study was 20.63 ± 10.45 kPa, which was significantly higher than the baseline measurement (16.92 ± 10.62 kPa, p < 0.001). Participants exhibited significant improvement in tongue pressure regardless of their age groups. Moreover, participants with one to seven pairs of functional tooth units (FTUs) exhibited significantly more improvement in tongue pressure (16.00 kPa, 95% CI = 2.58–29.43) than those without FTUs (p = 0.021).

Conclusion

Oral exercise over a 3-month period significantly improved tongue pressure among the study participants regardless of their gender or age group. Oral exercise should be integrated into comprehensive health promotion programs to assist in the improvement and maintenance of oral function among older adults.

Modification Effect of Job Demand and Contingent Work Schedule on Overweight and Obesity Among Civil Servants in Taiwan

OBJECTIVE

Evidence indicated that shift work is a contributing factor to risk of obesity and leads to cardiovascular diseases (CVDs), but few researches have examined the moderating effects of job demand and contingent work schedule on overweight and obesity. Thus, we assessed the modification effect of contingent work schedules and job demand on overweight and obesity among Taiwan's civil servants.

METHODS

Multistage stratified random cluster sampling was used based on a proportional probabilistic sampling (PPS) in a national survey for civil servants. A total of 20,046 participants from 647 registered governmental institutions were enrolled and anonymously and voluntarily filled out web-based questionnaires.

RESULTS

Compared to fixed work schedule, odd ratios (ORs) of obesity and overweight were 1.63 and 1.78 times in contingent work schedule, respectively. In addition, the modification effects of contingent work schedule and high job demand on overweight and obesity with Rothman's synergy index were 2.43 and 2.56, respectively. Using a hierarchical regression model adjusted for covariates, both high job demand and contingent work schedule were interactively associated with overweight and obesity compared to low job demand and fixed work schedule.

CONCLUSION

Since precarious schedules affect employee's obesity through work-related stress and unhealthy behaviors, further research is needed to determine whether interventions aimed at modification of work schedule may be useful in combating obesity.

Additive Interaction of Work-Related Stress and Sleep Duration on Arthritis Among Middle-Aged Civil Servants

Aim

Occupational strain is recognized as a risk for arthritis, yet little is known about how psychological stress affects arthritis moderated by sleep duration. The objective of this study is to assess work-related stress using the effort-reward imbalance (ERI) model and the job-demand-support (JDS) model on arthritis moderated by sleep duration.

Methods

A nationwide cross-sectional study randomly collected a total of 11,875 middle-aged, employed civil servants from 647 registered governmental institutions. Each participant anonymously and voluntarily filled out a web-based questionnaire and informed consent at the time of the study. Psychosocial work stress was assessed by ERI and JDS measured by a Chinese version of the job content questionnaire.

Results

There were significant odds ratios (ORs) of arthritis positively associated with high ERI (OR = 1.58), high overcommitment (OC) (OR = 1.57), and job demand (OR = 1.31) and negatively associated with job support (OR = 0.69) using multivariate analysis after being adjusted for covariates. For the short sleep duration group, there was an interaction effect of both high ERI and OC on arthritis, with a synergy index of 18.91 and 1.52, respectively. Similarly, there are high ORs of arthritis in both the high job demand and low job support groups.

Conclusion

Work-related stress related to arthritis moderated by sleep duration for civil servants. Civil servants with high job demand and low job support should use caution to reduce the risk of arthritis.

Higher serum homocysteine level and frequency of hyperhomocysteinemia in carcinoembryonic antigen-positive or squamous cell carcinoma-antigen-positive oral leukoplakia patients

BACKGROUND/PURPOSE

Our previous study found significantly lower serum hematinic levels and higher serum homocysteine level as well as higher frequencies of serum hematinic deficiencies and hyperhomocysteinemia in oral leukoplakia (OL) patients than in healthy control subjects. This study evaluated whether carcinoembryonic antigen (CEA)-positive or squamous cell carcinoma-antigen (SCC-Ag)-positive OL patients had significantly lower serum hematinic levels and higher serum homocysteine level as well as significantly higher frequencies of hematinic deficiencies and hyperhomocysteinemia than CEA-negative or SCC-Ag-negative OL patients or healthy control subjects.

METHODS

The complete blood count, serum iron, vitamin B12, folic acid, and homocysteine levels in 184 OL patients including 85 CEA-positive, 99 CEA-negative, 25 SCC-Ag-positive, and 159 SCC-Ag-negative OL patients and in 184 age- and sex-matched healthy control subjects were measured and compared.

RESULTS

We found that the 85 CEA-positive or 25 SCC-Ag-positive OL patients had a significantly lower mean serum folic acid level and a significantly higher mean serum homocysteine level as well as significantly higher frequencies of serum folic acid deficiency and hyperhomocysteinemia than 184 healthy control subjects. Moreover, the 25 SCC-Ag-positive OL patients had a significantly higher mean serum homocysteine level than the 159 SCC-Ag-negative OL patients. The 85 CEA-positive OL patients had a higher mean serum homocysteine level and a higher frequency of hyperhomocysteinemia than 99 CEA-negative OL patients (marginally significant, P = 0.060).

CONCLUSION

CEA-positive or SCC-Ag-positive OL patients tend to have a higher mean serum homocysteine level and a higher frequency of hyperhomocysteinemia than CEA-negative or SCC-Ag-negative OL patients, respectively.

Postoperative incision scars and cosmetic satisfaction of living liver donors

Cosmetic appearance is a major concern for living donors. However, little is known about the impact of a surgical scar on body image changes in living liver donors. The aim of this study was to identify potential factors that cause displeasing upper midline incision scar, and to evaluate the overall satisfaction regarding body image and scarring after living donor hepatectomy.Donors who underwent right lobe hepatectomy were recruited. Exclusion criteria included reoperation, refusal to participate, and lost follow-up. All donors were invited to complete the Vancouver Scar Scale (VSS) and the body image questionnaire. According to the VSS results of upper midline incision scar, donors were divided into 2 groups: good scarring group (VSS ≤4) and bad scarring group (VSS >4). we compared the clinical outcomes, including the demographics, preoperation, intraoperation, and postoperation variables. The study also analyzed the results of the body image questionnaire.The proportion of male donors was 48.9%. The bad scarring group consisted of 63% of the donors. On multivariate analysis, being a male donor was found to be an independent predictor of a cosmetically displeasing upper midline incision scar with statistical significance. The results of body image questionnaires, there were significant differences in cosmetic score and confidence score among the 2 groups.The upper midline incision and male donors have higher rates of scarring in comparison with the transverse incision and female donors. Donors who reported having a higher satisfaction with their scar appearance usually had more self-confidence. However, the body image won't be affected. Medical staff should encourage donors to take active participation in wound care and continuously observe the impact of surgical scars on psychological changes in living liver donors.

Evaluation of Clinical Neuropathy After Living Donor Liver Transplant

OBJECTIVES

Neurologic complications are more common in liver transplants than in other solid-organ transplants. One such neurologic complication, peripheral neuropathy, may cause functional limitations for recipients and have a negative effect on posttransplant quality of life. We aimed to examine the risk factors associated with the occurrence of clinical neuropathy after liver transplant and to investigate the frequency of sensory deficits.

MATERIALS AND METHODS

In this case-control study, we analyzed factors from medical records of 63 recipients who underwent living donor liver transplant during the period from January 2010 to December 2016. A neuropathy symptom score was assigned to identify the patients who had clinical neuropathy (case group) and the patients without clinical neuropathy (control group). Quantitative sensory testing was performed to measure the warm and cold detection thresholds, and the difference between the 2 groups was examined.

RESULTS

Compared with controls, patients with clinical neuropathy were older (61.0 vs 55.4 years; P = .028), had higher rates of diabetes (46.2% vs 16.0%; P = .03), and were taking antiviral agents against hepatitis B (100% vs 62%; P = .006). Patients with neuropathic symptoms had significantly increased frequencies of impairment of warm and cold detection thresholds. In addition, the greater severity of symptoms showed higher detection thresholds of warm (control, 40.7℃; mild-to-moderate, 43.8 ℃; severe, 46.0 ℃; P = .007) and cold (control, 28.8℃ ; mild-to-moderate, 27.0 ℃; severe, 21.8 ℃ ; P = .008).

CONCLUSIONS

Our findings show that older age, diabetes, and treatment with oral antiviral agents against hepatitis B virus were more likely to be associated with the occurrence of clinical neuropathy after liver transplant. Early awareness and careful monitoring are warranted.

Association between surgical volumes and hospital mortality in patients: a living donor liver transplantation single center experience

Background

Many factors cause hospital mortality (HM) after liver transplantation (LT).

Methods

We performed a retrospective research in a single center from October 2005 to June 2019. The study included 463 living donor LT patients. They were divided into a no-HM group (n = 433, 93.52%) and an HM group (n = 30, 6.48%). We used logistic regression analysis to determine how clinical features and surgical volume affected HM. We regrouped patients based on periods of surgical volume and analyzed the clinical features.

Results

Multivariate analysis revealed that donor age (OR = 1.050, 95% CI 1.011–1.091, p = 0.012), blood loss (OR = 1.000, 95% CI 1.000–1.000, p = 0.004), and annual surgical volumes being < 30 LTs (OR = 2.540, 95% CI 1.011–6.381, p = 0.047) were significant risk factors. A comparison of years based on surgical volume found that when the annual surgical volumes were at least 30 the recipient age (p = 0.023), donor age (p = 0.026), and ABO-incompatible operations (p < 0.001) were significantly higher and blood loss (p < 0.001), operative time (p < 0.001), intensive care unit days (p < 0.001), length of stay (p = 0.011), rate of re-operation (p < 0.001), and HM (p = 0.030) were significantly lower compared to when the annual surgical volumes were less than 30.

Conclusions

Donor age, blood loss and an annual surgical volume < 30 LTs were significant pre- and peri-operative risk factors. Hospital mortality and annual surgical volume were associated with statistically significant differences; surgical volume may impact quality of care and transplant outcomes.

Significantly higher serum tumor marker levels in patients with oral submucous fibrosis

Background/purpose

Our previous study showed that carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC-Ag), and ferritin are significantly higher in patients with oral potentially malignant disorders (OPMDs including oral leukoplakia, oral erythroleukoplakia, and oral verrucous hyperplasia) than in healthy controls (HCs). Oral submucous fibrosis (OSF) is also recognized as an OPMD. This study evaluated whether these three serum tumor marker levels were also significantly higher in OSF patients than in HCs.

Materials and methods

The serum CEA, SCC-Ag, and ferritin levels in 41 OSF patients and 164 HCs were measured and compared. Patients with serum CEA level ≥3 ng/mL, SCC-Ag level ≥2 ng/mL, and ferritin level ≥250 ng/mL were scored as serum positive for CEA, SCC-Ag, and ferritin, respectively.

Results

We found significantly higher mean serum CEA, SCC-Ag, and ferritin levels in 41 OSF patients than in 164 HCs (all P-values < 0.05). Moreover, 41 OSF patients had significantly higher serum positive rates of CEA (39.0%), SCC-Ag (19.5%), and ferritin (53.7%) than 164 HCs (all P-values < 0.05). Of the 41 OSF patients, 26 (63.4%), 7 (17.1%), and 2 (4.9%) had serum positivities of one, two, or three tumor markers including CEA, SCC-Ag, and ferritin, respectively.

Conclusion

There are significantly higher mean serum CEA, SCC-Ag, and ferritin levels and significantly higher serum positive rates of CEA, SCC-Ag, and ferritin in OSF patients than in HCs. The serum CEA, SCC-Ag, and ferritin levels may be served as tumor markers for evaluation of malignant potential of OSF lesions.

Using Glissonian sheath as an alternative way to prevent biliary stricture in living-donor liver transplantation

BACKGROUND

/Objective: The aim of this study was to report a single-institution experience involving a Glissonian sheath-to-duct method for biliary reconstruction in living donor liver transplantation, focusing on the association between surgical techniques and biliary stricture rates.

METHODS

Three hundred and twenty adult right lobar living donor liver transplantation procedures were analyzed through a comparison of 200 Glissonian sheath-to-duct (GD) reconstructions and 120 duct-to-duct (DD) reconstructions in biliary anastomosis.

RESULTS

At a mean follow-up period of 60.8 months, the GD group had a significantly lower biliary stricture rate (13.5%, 27/200) than the DD group (26.7%, 32/120) (p = 0.003). In biliary anastomosis with single duct anastomosis, the incidence of biliary stricture was significantly greater for the DD group (17/79, 21.5%) than for the GD group (14/141, 9.9%) (p = 0.018).

CONCLUSION

This study has shown that GD anastomosis of the bile duct produced outstanding results with respect to the reduction of biliary stricture. The GD technique can therefore be suggested as an alternative method for biliary reconstruction in LDLT.

Adjunctive local treatments for patients with residual pockets during supportive periodontal care: A systematic review and network meta-analysis

AIM

This systematic review and network meta-analysis aimed to evaluate the efficacy of adjunctive locally delivered antimicrobials, compared to subgingival instrumentation alone or plus a placebo, on changes in probing pocket depth (PPD) and clinical attachment level (CAL), in patients with residual pockets during supportive periodontal care.

MATERIALS AND METHODS

Literature search was performed with electronic databases and by hand until 31 May 2020. Primary outcome was the changes in PPD. The treatment effects between groups were estimated with weighted mean differences (WMD) with 95% confidence intervals (CI) and prediction intervals (PI) by using random-effects network meta-analysis.

RESULTS

Twenty-two studies were included. Significantly greater PPD reduction was achieved in chlorhexidine chip group (WMD: 0.65 mm, 95% CI: 0.21-1.10) and tetracycline fibre group (WMD: 0.64 mm, 95% CI: 0.20-1.08) over 6-month follow-up. Other adjunctive antimicrobial agents achieved non-significant improvements compared to scaling and root planing alone. All differences between adjunctive therapies were statistically non-significant. Similar findings were observed for CAL gain.

CONCLUSION

Adjunctive local antimicrobial agents achieved small additional PPD reduction and CAL gain in residual pockets for a follow-up of up to 6 months. Tetracycline fibre and chlorhexidine chip achieved better results than other antimicrobials.

Comparison of the diagnostic performance of magnetic resonance elastography and agglutinin-positive Mac-2-binding protein in the determination of advanced liver fibrosis stages in patients with chronic liver disease

The present study aimed to compare the accuracy of Wisteria floribunda agglutinin-positive Mac-2-binding protein (WFA⁺-M2BP) and magnetic resonance elastography (MRE) in determining the liver fibrosis stage in patients with chronic liver disease. A retrospective review of a prospectively maintained database was performed. The eligible patients had hepatic tumors and chronic liver disease, including hepatitis B (HBV) and HCV. All patients underwent blood sampling, MRE and hepatectomy at Changhua Christian Hospital (Changhua, Taiwan). Surgical specimens were used to determine definitive histopathological diagnoses and liver fibrosis stages. Measurement of liver stiffness was performed via MRI. The value of WFA⁺-M2BP in each patient was also assessed. The area under the receiver operating characteristic (ROC) curve (AUC) was measured to compare the diagnostic accuracy of the two examinations. The results indicated that the serum WFA⁺-M2BP levels were able to detect severe liver fibrosis (≥F3) in patients with chronic liver disease and performed as well as MRE in patients with HCV. Of the 238 patients enrolled in the present study, 135 had chronic HBV 75 had chronic HCV, 92 had early liver fibrosis (F1-F2) and 139 patients had advanced liver fibrosis (F3-F4). In predicting fibrosis stages ≥F3, MRE had an AUC of 0.89 with a cutoff value of 3.76 and serum WFA⁺-M2BP had an AUC of 0.65 with a cutoff value of 1.32. MRE had higher AUCs than serum WFA⁺-M2BP for predicting the severity based on the fibrosis stage in the total cohort and the HBV subgroup. In patients with HCV, no significant differences in diagnostic performance were identified between MRE and serum WFA⁺-M2BP. In conclusion, determination of WFA⁺-M2BP as a biomarker for predicting severe liver fibrosis (≥F3) is a reliable and non-invasive method and performs as well as MRE in patients with chronic liver disease, particularly those with HCV.

Prognostic Role of Serum Wisteria Floribunda Agglutinin-Positive Mac-2 Binding Protein Level in Early Stage Hepatocellular Carcinoma

The purpose of this study is to evaluate the prognostic value of preoperative Wisteria floribunda agglutinin-positive Mac-2 binding protein (WFA+-M2BP) in predicting overall survival for patients with hepatitis B- and hepatitis C-related early-stage hepatocellular carcinoma (ESHCC) after liver resection. Post-operative survival rates were compared according to WFA+-M2BP level and tumor stage. Six hundred and ten patients were identified and 198 were removed after application of the exclusion criteria; the median follow-up time was 4.33 years, and cancer-related death occurred in 117 (28.4%) patients. Age (p = 0.03), fibrosis grade (p = 0.042), cancer stage (p = 0.01), and WFA+-M2BP level (p = 0.001) were identified as independent risk factors for poor overall survival. The overall survival rates at 3 and 5 years for patients with WFA+-M2BP ≤ 1.12 were 0.92 and 0.90, respectively, and 0.76 and 0.61 for patients with WFA+-M2BP > 1.12 (p < 0.001). During the analysis of survival prediction, serum WFA+-M2BP level exhibited a higher log-likelihood and a lower AIC value compared to TNM stage (log likelihood: -638; AIC: 1279). Pre-operative serum WFA+-M2BP level provided important prognostic information after curative hepatic resection in our study.

Clinical Outcome of Residual Liver Volume and Hepatic Steatosis After Right-Lobe Living-Donor Hepatectomy

Background

We examine how residual liver volume (RLV) and hepatic steatosis (HS) of living liver donors affect the regeneration process and clinical outcomes.

Material/Methods

We longitudinally studied 58 donors who underwent right-lobe hepatectomy during the period February 2014 to February 2015 at a single medical institution. The patients were classified based on RLV (30–35%, 35–40%, 40–50%) subgroups and HS (<10%, 10–30%, 30–50%) subgroups. Clinical parameters such as clinical outcome, liver volumetric recovery (LVR,%) rate and remnant left-liver (RLL,%) growth rate were collected for analysis.

Results

The clinical features of postoperative peak total bilirubin (p=.024) were significant in the 3 RLV subgroups. Body mass index (p=.017), preoperative alanine transaminase (p<.001), and pleural effusion (p=.038) were significant in the 3 HS subgroups. The LVR rate and RLL growth rate equations showed significant variation in regeneration among the 3 RLV subgroups. The LVR rate and RLL growth rate equations did not show significant variation in regeneration among the 3 HS subgroups.

Conclusions

Hyperbilirubinemia was a risk factor in the small-RLV group, and a large amount of pleural effusion was a risk factor in the steatosis 30–50% group. Hepatic steatosis subgroups did not show significantly different degrees of regeneration. The safety of living donors was a major concern while we compiled the extended living-donor criteria presented in this paper.

Efficacy of a Latex Agglutination Test for Rapid Identification of Staphylococcus aureus: Collaborative Study

Fifteen laboratories completed a collaborative study comparing the efficacy of a latex agglutination kit (Aureus Test) with that of AOAC Official Method 987.09 (coagulase test for identification of Staphylococcus aureus). Each laboratory analyzed 240 strains of bacteria, including 160 isolates of S. aureus and 80 isolates of other bacteria. Upon receipt of cultures, collaborators subcultured each isolate on both tryptic soy agar (TSA) and Baird-Parker agar medium (BPA) to determine whether the growth medium has any effect on either method. For cultures grown on TSA, the latex test had sensitivity and specificity rates of 99.2 and 97.1 %, respectively, whereas the coagulase test had respective rates of 98.4 and 92.5%. For cultures able to grow on BPA, the latex test had sensitivity and specificity rates of 99.2 and 96.6%, respectively, while the coagulase test had respective rates of 98.3 and 91.3%. By using the McNemar pairwise comparison test of the 2 methods, the falsepositive and false-negative rates of the latex test were significantly lower (p &lt; 0.01) than those of the coagulase test for strains grown either on TSA or BPA. The latex agglutination test for identification of S. aureus isolated from foods has been adopted by AOAC INTERNATIONAL.

Prevention of Postdental Procedure Bacteremia: A Network Meta-analysis

Postdental procedure bacteremia is common and troublesome. The comparative efficacy of multiple prophylactic interventions is unclear. We compared the efficacy of interventions for the prevention of postdental procedure bacteremia. We conducted a review of ClinicalKey, Cochrane CENTRAL, Embase, ProQuest, PubMed, ScienceDirect, Web of Science, and ClinicalTrials.gov from inception to December 4, 2018. Randomized controlled trials that evaluated prophylactic interventions for the prevention of postdental procedure bacteremia were eligible. The primary outcome was the incidence of postdental procedure bacteremia. A total of 24 trials were included with 2,147 participants. Our network meta-analysis demonstrated that intravenous administration of 1,000/200 mg of amoxicillin/clavulanate provided the least incidence of postdental procedure bacteremia among all the prophylactic interventions (odds ratio = 0.03, 95% CI = 0.00 to 0.63) as compared with the placebo/controls. Oral 3 g of amoxicillin had the least incidence of postdental procedure bacteremia among all oral or topical forms of prophylactic interventions (odds ratio = 0.10, 95% CI = 0.02 to 0.44) as compared with the placebo/controls. No serious adverse events, such as anaphylactic shock, mortality, and the development of antibiotic-resistant bacteria, were reported. None of the included subjects were of high risk of infectious endocarditis. Our network meta-analysis demonstrates that intravenous amoxicillin/clavulanate and oral amoxicillin might be the best prophylactic interventions in preventing postdental procedure bacteremia among all the oral/topical forms of interventions for the overall populations.

Blockade of STAT3 Signaling Contributes to Anticancer Effect of 5-Acetyloxy-6,7,8,4'-Tetra-Methoxyflavone, a Tangeretin Derivative, on Human Glioblastoma Multiforme Cells

Glioblastoma multiforme (GBM) is the most aggressive primary brain tumor with poor prognosis, largely due to resistance to current radiotherapy and Temozolomide chemotherapy. The constitutive activation of Signal Transducer and Activator of Transcription 3 (STAT3) is evidenced as a pivotal driver of GBM pathogenesis and therapy resistance, and hence, is a promising GBM drug target. 5-acetyloxy-6,7,8,4'-tetramethoxyflavone (5-AcTMF) is an acetylated derivative of Tangeretin which is known to exert anticancer effects on breast, colon, lung, and multiple myeloma; however, its effect on GBM remains elusive. Herein, we reported that 5-AcTMF suppressed the viability and clonogenicity along with inducing apoptosis in multiple human GBM cell lines. Mechanistic analyses further revealed that 5-AcTMF lowered the levels of Tyrosine 705-phosphorylated STAT3 (p-STAT3), a canonical marker of STAT3 activation, but also dampened p-STAT3 upregulation elicited by Interleukin-6. Notably, ectopic expression of dominant-active STAT3 impeded 5-AcTMF-induced suppression of viability and clonogenicity plus apoptosis induction in GBM cells, confirming the prerequisite of STAT3 blockage for the inhibitory action of 5-AcTMF on GBM cell survival and growth. Additionally, 5-AcTMF impaired the activation of STAT3 upstream kinase JAK2 but also downregulated antiapoptotic BCL-2 and BCL-xL in a STAT3-dependent manner. Moreover, the overexpression of either BCL-2 or BCL-xL abrogated 5-AcTMF-mediated viability reduction and apoptosis induction in GBM cells. Collectively, we, for the first time, revealed the anticancer effect of 5-AcTMF on GBM cells, which was executed via thwarting the JAK2-STAT3-BCL-2/BCL-xL signaling axis. Our findings further implicate the therapeutic potential of 5-AcTMF for GBM treatment.

The Interaction Effects of Burnout and Job Support on Peptic Ulcer Disease (PUD) among Firefighters and Policemen

Policemen and firefighters encounter numerous emergency events that frequently lead to high burnout and low job support, resulting in adverse health effects. A number of studies reported the correlation between job characteristics and the risk of peptic ulcer diseases (PUD) across various industries. However, there is very little research on evaluating the interaction effects of burnout and job support on the prevalence of PUD among firefighters and policemen. The objective of this study was to assess the interactional effects between burnout and job support on the prevalence of PUD among firefighters and policemen. This was a cross-sectional quantitative study. Registered, full-time police officers and firefighters in Taiwan were anonymously interviewed by a mail-delivered questionnaire. All female workers were excluded due to different job characteristics and a limited sample size. A total of 9328 firefighters and 42,798 policemen completed the questionnaire, with a response rate of 78.7%. Overall, prevalence rates of self-reported and self-reports of physician-diagnosed PUD were 8.3% and 6.5% for policemen and 7.1% and 5.5% for firefighters, respectively. There was a 22% reduced odds ratio of PUD as diagnosed by physicians for the group with low burnout and high job support, but an increased odds ratio of 53% for the group with high burnout and low job support, after adjusting for lifestyle and demographic variables. There must be an increase of job support and reduction of burnout through the modification of work structure and setting up of counseling services to reduce workplace stress and the prevalence of PUD among policemen and firefighters.

Dual Infection with Hepatitis B Virus and Hepatitis C Virus Correlated with Type 2 Diabetes Mellitus

BACKGROUND

Conflicting data exist regarding the relationship between dual infection of hepatitis B virus (HBV) and hepatitis C virus (HCV) with type 2 diabetes mellitus (T2DM). We assessed dual infection of HBV and HCV with the levels of blood glucose and development of DM.

METHODS

A total of 9621 participants in a community-based study were enrolled from 18 towns in Maoli county of Taiwan. Blood samples were collected and tested for hepatitis B surface antigen (HBsAg) and antibodies (HBsAb), antibodies against hepatitis C virus (anti-HCV) and fasting plasma glucose. DM was defined as fasting plasma glucose≥126 mg per 100 ml.

RESULTS

Only 0.7% of total participants had HBV/HCV coinfection. The prevalence of HBV and HCV monoinfection were 9.9  and 5.7%, respectively. Adjusted blood glucose levels and development risk of T2DM (odds ratio [OR], 2.55; p<0.001) were significantly high among HBV/HCV coinfection group using multivariate linear regression adjusted for age, gender, education, race and BMI. Furthermore, using multivariate logistic regression models adjusted for covariates, HCV mono-and HBV/ HCV coinfection significantly increased on blood glucose levels.

CONCLUSIONS

Our study shows HBV/HCV coinfection was significantly correlated with blood glucose levels. A significant proportion (28%) of participants with HBV/HCV coinfection developed T2DM. Although the precise mechanisms of dual positive infection of HBV and HCV are unclear, there is increasing evidence that dual infection of HCV and HBV is strongly associated with the development of T2DM.

Detection of a novel HLA-A*11 variant, A*11:292, in a Taiwanese individual

One nucleotide substitution at residue 860 of HLA-A*11:01:01:01 results in a novel allele, HLA-A*11:292.

Detection of an HLA-C*03 variant, HLA-C*03:258, in a Taiwanese individual

One nucleotide substitution at residue 506 of HLA-C*03:02:01 results in a novel allele, HLA-C*03:258.

HLA-B*40:400, a novel HLA-B*40 variant, identified in a Taiwanese individual

One nucleotide substitution at residue 314 of HLA-B*40:01:01 results in a novel allele, HLA-B*40:400.

HLA-A*26:160, a novel variant of HLA-A*26, discovered in a Taiwanese individual

One nucleotide replacement at residue 755 of HLA-A*26:01:01:01 results in a novel allele, HLA-A*26:160.

A possible association of HLA-C*07:18:01:01 and HLA-B*58:01

HLA-C*07:18:01:01 is possibly in association on the same haplotype as HLA-B*58:01.

Assessing men with erectile dysfunction before and after living donor liver transplantation in real-world practice: Integrating laboratories into clinical settings

Objective

To evaluate the predictive role of the Model for End-Stage Liver Disease (MELD) score concerning changes in testosterone levels following living donor liver transplantation (LDLT) and the effects of LDLT on total testosterone and sex hormone-binding globulin (SHBG) levels, the free androgen index (FAI) and erectile function in LDLT recipients.

Participants

41 adult male recipients of LDLT were evaluated before transplantation and six months after LDLT.

Main outcome measures

We evaluated the effects of LDLT on total testosterone and SHBG levels, the FAI and erectile function in LDLT recipients. In this prospective study, MELD score, serum total testosterone, SHBG levels and FAI were measured in the morning of the operation day and 1 month, 3 months and 6 months after LDLT. The 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire was administered before LDLT and six months after LDLT to evaluate erectile function.

Results

The main outcome measure was dynamic parameter changes of total testosterone, SHBG, FAI and erectile dysfunction. The mean FAI value before LDLT was 16.75±10.10. The mean FAI was significantly higher 1 month (32.75±15.56; p < 0.01), 3 months (25.23±10.26; p < 0.01) and 6 months (29.16±11.05; p < 0.01) after LDLT. Mean IIEF-5 scores significantly increased after LDLT (from 11.7±7.7 before LDLT to 14.7±7.5, p< 0.01).

Conclusions

MELD score correlates with severity of hypogonadism in men with end-stage liver disease. LDLT results in a reduction in serum levels of SHBG, an increase in FAI and improvement in erectile function.

Portal venous velocity affects liver regeneration after right lobe living donor hepatectomy

OBJECTIVES

We investigated whether chronological changes in portal flow and clinical factors play a role in the liver regeneration (LR) process after right donor-hepatectomy.

MATERIALS AND METHODS

Participants in this prospective study comprised 58 donors who underwent right donor-hepatectomy during the period February 2014 to February 2015 at a single medical institution. LR was estimated using two equations: remnant left liver (RLL) growth (%) and liver volumetric recovery (LVR) (%). Donors were classified into an excellent regeneration (ER) group or a moderate regeneration (MR) group based on how their LR on postoperative day 7 compared to the median value.

RESULTS

Multivariate analysis revealed that low residual liver volume (OR = .569, 95% CI: .367- .882) and high portal venous velocity in the immediate postoperative period (OR = 1.220, 95% CI: 1.001-1.488) were significant predictors of LR using the RLL growth equation; high portal venous velocity in the immediate postoperative period (OR = 1.325, 95% CI: 1.081-1.622) was a significant predictor of LR using the LVR equation. Based on the two equations, long-term LR was significantly greater in the ER group than in the MR group (p < .001).

CONCLUSION

Portal venous velocity in the immediate postoperative period was an important factor in LR. The critical time for short-term LR is postoperative day 7; it is associated with long-term LR in donor-hepatectomy.

Ursolic Acid-Induced Apoptosis via Regulation of the PI3K/Akt and MAPK Signaling Pathways in Huh-7 Cells

Ursolic acid (UA), is a kind of triterpene acid that exhibits wide biological properties. In this article, the effects of UA on apoptosis and the proliferation of human hepatoma Huh-7 cells were reported. The MTT results showed that cell viability of Huh-7 was reduced in a concentration and time-dependent effect. In addition, DAPI staining was used to detected condensation of chromatin in nucleus. Apoptotic cell population was examined using Annexin V/PI staining. The results showed that exposure to UA affected extrinsic and intrinsic pathways through, reduced expression of Bcl-2, Mcl-1, and TCTP; increased levels of the apoptotic proteins TNF-α, Fas, FADD, and Bax; and activation of cleaved caspase-3 and PARP. UA also inhibited the p-Akt and p38 MAPK signaling transduction pathways, and increased activity in the p-ERK signaling pathway. Taken together, UA inhibited the cell growth of Huh-7 cells and affected apoptosis, via regulated cellular signaling transduction.

The novel HLA-DRB1*15:158 allele discovered in a Taiwanese individual

Three nucleotide substitutions in HLA-DRB1*15:01:01:01 result in a new allele, HLA-DRB1*15:158.

HLA-A*24:386, a novel variant of HLA-A*24, discovered in a Taiwanese blood donor

One nucleotide replacement at residue 181 of HLA-A*24:02:01:01 results in a novel allele, HLA-A*24:386.

Detection of an HLA-C*03 variant, HLA-C*03:187, in a Taiwanese individual

One nucleotide substitution at residue 527 of HLA-C*03:03:01:01 results in a novel allele, HLA-C*03:187.

Identification of an HLA-B*27 variant, B*27:120, by sequence-based typing in a Taiwanese bone marrow stem cell donor

One nucleotide substitution at residue 577 of HLA-B*27:04:01 results in a novel allele, HLA-B*27:120.

HLA-B*15:436, a novel variant of HLA-B*15, discovered in a Taiwanese individual

Nucleotide substitutions in codons 43 and 45 of HLA-B*15:18:01:01 result in a new allele, HLA-B*15:436.

HLA-DQB1*03:01:40, an HLA-DQB1*03:01 variant, identified in a Taiwanese individual

One nucleotide substitution at codon 106 of HLA-DQB1*03:01:01:01 results in a new allele, HLA-DQB1*03:01:40.

HLA-C*15:29, an HLA-C*15 variant, identified in a Taiwanese individual

One nucleotide substitution at codon 116 of HLA-C*15:02:01:01 results in a new allele, HLA-C*15:29.

HLA-B*40:55, an HLA-B*40 variant, identified in Taiwanese individuals

One nucleotide substitution at codon 248 of HLA-B*40:01:01 results in a new allele, HLA-B*40:55.

Environmental health risks perception, attitude, and avoidance behaviour toward municipal solid waste incinerator

This study aims to assess the relationship between risk perception, attitude, and avoidance among residents toward an urban incinerator in Taichung, Taiwan. A cross-sectional study was conducted and three schools were enrolled. The case group was composed of 514 residents who live near an incinerator. The control group was composed of 264 people nearly the same age and who have lived in that area basically the same period of time. All participants were interviewed using a structured questionnaire. Results of this study showed that there was no significant difference between the exposure group and the control group in risk perception and attitude regarding the incinerator. However, the exposure group showed a significantly higher desire to move within one year or move sometime in the future than the control group. Therefore, these people should encourage the Environmental Protection Administration (EPA) to do everything it can to make sure that the incinerator operates safely.

Detection of an HLA-B*15 variant, HLA-B*15:192, in a Taiwanese individual

One nucleotide replacement at codon 145 of HLA-B*15:01:01:01 results in a new allele, HLA-B*15:192.

Impact of tumor size on the prognosis of hepatocellular carcinoma in patients who underwent liver resection

BACKGROUND

Health burdens of hepatocellular carcinoma (HCC) are emerging quickly in the world, including in Taiwan. Surgical resection has been recognized as the first-line treatment for early tumors. This study aimed to investigate the prognostic risk factors for mortality and recurrence rate in Taiwan, which has a high prevalence of chronic viral hepatitis.

METHODS

A total of 397 HCC patients receiving tumor resection were consecutively examined in central Taiwan from 2008 to 2014. A hospital-based patient cohort was designed to collect serological markers to further assess liver function. We modified the Kaplan-Meier method according to the competing death risks for comparing recurrence and used multivariate Cox proportional hazard regression to adjust for significant risk factors.

RESULTS

In addition to advanced fibrosis, tumor size ≥5 cm was significantly associated with higher mortality within the 5-year period when compared with <5 cm (43.3% vs. 13.2%, p < 0.0001). Patients with tumor size ≥5 cm also easily progressed to early recurrence within two years when accounting for death as a competing risk (20.1% vs. 10.1%, p = 0.01). Higher AFP levels played a major role in further predicting higher mortality in those patients. We determined that there were a 4.5-fold and 2.2-fold higher mortalities in patients with size ≥5 cm/AFP ≥20 ng/mL and with size ≥5 cm/AFP< 20 ng/mL, respectively, when compared to patients with small tumors.

CONCLUSION

Tumor size ≥5 cm might be a good predicting factor for death and early recurrence when considering death as a competing risk.

Rapidly increasing liver progenitor cell numbers in human regenerating liver after portal vein ligation and liver partition

BACKGROUND

Liver regeneration is dependent on the proliferation of hepatocytes. Hepatic progenitor cells are intra-hepatic precursor cells capable of differentiating into hepatocytes or biliary cells. Although liver progenitor cell proliferation during the regenerative process has been observed in animal models of severe liver injury, it has never been observed in vivo in humans because it is unethical to take multiple biopsy specimens for the purpose of studying the proliferation of liver progenitor cells and the roles they play in liver regeneration. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a staged procedure for inducing remnant liver hypertrophy so that major hepatectomy can be performed safely. This staged procedure allows for liver biopsy specimens to be taken before and after the liver begins to regenerate.

CASE PRESENTATION

The liver progenitor cell proliferation is observed in a patient undergoing ALPPS for a metastatic hepatic tumour. Liver biopsy is acquired before and after ALPPS for the calculation of average number of liver progenitor cell under high magnification examination by stain of immunomarkers. This is the first in vivo evidence of growing liver progenitor cells demonstrated in a regenerating human liver.

Prospective Comparison of the Diagnostic Performance of Magnetic Resonance Elastography with Acoustic Radiation Force Impulse Elastography for Pre-operative Staging of Hepatic Fibrosis in Patients with Hepatocellular Carcinoma

The purpose of this study was to compare the diagnostic accuracy of magnetic resonance (MR) elastography with that of acoustic radiation force impulse (ARFI) elastography for pre-operative staging of hepatic fibrosis in patients with hepatocellular carcinoma. We prospectively enrolled 77 patients who were scheduled to undergo hepatectomy for hepatocellular carcinoma. Pre-operative MRE and ARFI elastography examinations were performed on the same day, and liver stiffness/velocity values were determined. Fibrosis stage and necro-inflammatory activity of resected specimens were determined histopathologically using the METAVIR scoring system. Correlations between MRE and ARFI elastography findings and histologic findings were determined by receiver operating characteristic (ROC) analysis. Correlation of MRE was excellent and correlation of ARFI elastography was good with fibrosis stage. MRE had better diagnostic performance than ARFI elastography in estimating substantial fibrosis (F2), severe fibrosis (F3) and cirrhosis (F4). The optimal cutoff value and the area under the ROC curve (AUROC) were determined using ROC curve analysis. The highest Youden index was used as a criterion for selecting the optimal cutoff value. ROC analysis revealed that MRE discriminated advanced stages of fibrosis (F ≥ 2) well in patients with hepatocellular carcinoma at a cutoff value of 3.0 kPa with an AUROC value of 0.93, and ARFI elastography did so at a cutoff value of 1.77 m/s with an AUROC value of 0.81 for predicting advanced stages of fibrosis (F ≥ 2). In conclusion, MRE is a more accurate imaging modality than ARFI elastography in estimating advanced stages of fibrosis and cirrhosis.

Detection of a novel HLA-DRB1*12 variant, HLA-DRB1*12:68, in a Taiwanese individual

One nucleotide substitution at residue 628 of HLA-DRB1*12:01:01:01 results in a novel allele, HLA-DRB1*12:68.

Central Pontine Myelinolysis After Living-Donor Liver Transplant: A Report of 2 Cases

Here, we present 2 patients who developed central pontine myelinolysis after living-donor liver transplant. Both patients had abnormal sodium level before living-donor liver transplant. Patient 1 presented with severe hyponatremia on admission. After administration of 3% saline, her sodium level during the first 24 hours was kept at 100 mEq/L and then increased to 116 mEq/L during the next 24 hours. The level increased 5.8 mEq/L during the 4- to 5-hour transplant procedure. Patient 2 was admitted to the hospital with an unprovoked seizure. The serum sodium concentration was 111 mEq/L, which was treated with 3% saline infusion. Serum sodium concentration escalated to 118 mEq/L over an 8-hour period. Intraoperatively, both patients received large amounts of replacement fluids (0.9% normal saline and albumin), blood transfusion, and sodium bicarbonate during the anhepatic phase, all of which carry high sodium load. Variations in sodium levels changed rapidly in patient 1 during transplant surgery. After they underwent liver transplant, patient 1 had clear mental status and patient 2 demonstrated worsened mental status. On approximately day 14 and day 4 after liver transplant, magnetic resonance imaging showed diffuse abnormalities of the pons, resulting in diagnosis of central pontine myelinolysis. Although both patients survived, 1 remains in a vegetative state and the other continues to present with mild balance and swallowing abnormalities. To reduce the chance of inadvertent overcorrection in patients with hyponatremia, it is therefore important that sodium concentrations should be monitored frequently and fluids and electrolytes titrated carefully.