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Elevated red cell distribution width is associated with advanced fibrosis in NAFLD.

Hwa Mok KIM ; Bum Soo KIM ; Yong Kyun CHO ; Byung Ik KIM ; Chong Il SOHN ; Woo Kyu JEON ; Hong Joo KIM ; Dong Il PARK ; Jung Ho PARK ; Kwan Joong JOO ; Chang Joon KIM ; Yong Sung KIM ; Woon Je HEO ; Won Seok CHOI

Clinical and Molecular Hepatology.2013;19(3):258-265. doi:10.3350/cmh.2013.19.3.258

BACKGROUND/AIMS: The red-blood-cell distribution width (RDW) is a newly recognized risk marker in patients with cardiovascular disease, but its role in nonalcoholic fatty liver disease (NAFLD) has not been well defined. The aim of the present study was to determine the association between RDW values and the level of fibrosis in NAFLD according to BARD and FIB-4 scores. METHODS: This study included 24,547 subjects who had been diagnosed with NAFLD based on abdominal ultrasonography and questionnaires about alcohol consumption. The degree of liver fibrosis was determined according to BARD and FIB-4 scores. The association between RDW values and the degree of fibrosis in NAFLD was analyzed retrospectively. RESULTS: After adjusting for age, hemoglobin level, mean corpuscular volume, history of hypertension, history of diabetes, and high-sensitivity C-reactive protein, the RDW values were 12.61+/-0.41% (mean+/-SD), 12.70+/-0.70%, 12.77+/-0.62%, 12.87+/-0.82%, and 13.25+/-0.90% for those with BARD scores of 0, 1, 2, 3, and 4, respectively, and 12.71+/-0.72%, 12.79+/-0.66%, and 13.23+/-1.52% for those with FIB-4 scores of <1.30, 1.31-2.66, and > or =2.67, respectively (P<0.05). The prevalence of advanced fibrosis (BARD score of 24 and FIB-4 score of > or =1.3) increased with the RDW [BARD score: 51.1% in quartile 1 (Q1) vs. 63.6% in Q4; FIB-4 score: 6.9% in Q1 vs. 10.5% in Q4; P<0.001]. After adjustments, the odds ratio of having advanced fibrosis for those in Q4 compared to Q1 were 1.76 (95%CI=1.55-2.00, P<0.001) relative to BARD score and 1.69 (95%CI=1.52-1.98, P<0.001) relative to FIB-4 score. CONCLUSIONS: Elevated RDW is independently associated with advanced fibrosis in NAFLD.
Adult ; Alcohol Drinking ; C-Reactive Protein/analysis ; Diabetes Mellitus/pathology ; Erythrocyte Indices ; Fatty Liver/complications/*diagnosis/ultrasonography ; Female ; Humans ; Hypertension/pathology ; Liver Cirrhosis/*diagnosis/epidemiology/etiology ; Male ; Middle Aged ; Odds Ratio ; Prevalence ; Questionnaires ; Severity of Illness Index

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Chasing after novel non-invasive markers to identify advanced fibrosis in NAFLD.

Wonseok KANG ; Seung Up KIM

Clinical and Molecular Hepatology.2013;19(3):255-257. doi:10.3350/cmh.2013.19.3.255

No abstract available.
Fatty Liver/*diagnosis ; Female ; Humans ; Liver Cirrhosis/*diagnosis ; Male

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Nonalcoholic fatty liver disease: molecular mechanisms for the hepatic steatosis.

Seung Hoi KOO

Clinical and Molecular Hepatology.2013;19(3):210-215. doi:10.3350/cmh.2013.19.3.210

Liver plays a central role in the biogenesis of major metabolites including glucose, fatty acids, and cholesterol. Increased incidence of obesity in the modern society promotes insulin resistance in the peripheral tissues in humans, and could cause severe metabolic disorders by inducing accumulation of lipid in the liver, resulting in the progression of non-alcoholic fatty liver disease (NAFLD). NAFLD, which is characterized by increased fat depots in the liver, could precede more severe diseases such as non-alcoholic steatohepatitis (NASH), cirrhosis, and in some cases hepatocellular carcinoma. Accumulation of lipid in the liver can be traced by increased uptake of free fatty acids into the liver, impaired fatty acid beta oxidation, or the increased incidence of de novo lipogenesis. In this review, I would like to focus on the roles of individual pathways that contribute to the hepatic steatosis as a precursor for the NAFLD.
Acetyl Coenzyme A/metabolism ; Fatty Acids/metabolism ; Fatty Liver/*metabolism/pathology ; Humans ; Lipogenesis ; Mitochondria/metabolism ; Triglycerides/metabolism

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Options for the management of antiviral resistance during hepatitis B therapy: reflections on battles over a decade.

Hyung Joon YIM ; Seong Gyu HWANG

Clinical and Molecular Hepatology.2013;19(3):195-209. doi:10.3350/cmh.2013.19.3.195

Although much advancement has been achieved in the treatment of chronic hepatitis B, antiviral resistance is still a challenging issue. Previous generation antiviral agents have already developed resistance in a number of patients, and it is still being used especially in resource limited countries. Once antiviral resistance occurs, it predisposes to subsequent resistance, resulting in multidrug resistance. Therefore, prevention of initial antiviral resistance is the most important strategy, and appropriate choice and modification of therapy would be the cornerstone in avoiding treatment failures. Until now, management of antiviral resistance has been evolving from sequential therapy to combination therapy. In the era of tenofovir, the paradigm shifts again, and we have to decide when to switch and when to combine on the basis of newly emerging clinical data. We expect future eradication of chronic hepatitis B virus infection by proper prevention and optimal management of antiviral resistance.
Adenine/analogs & derivatives/pharmacology/therapeutic use ; Antiviral Agents/pharmacology/*therapeutic use ; Drug Resistance, Viral/drug effects ; Drug Therapy, Combination ; Hepatitis B virus/genetics ; Hepatitis B, Chronic/*drug therapy/prevention & control ; Humans ; Mutation ; Nucleosides/*chemistry/pharmacology/therapeutic use ; Organophosphonates/pharmacology/therapeutic use ; Virus Replication/drug effects

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Antitoxin treatment for liver abscess caused by Clostridium perfringens.

Toru HIFUMI ; Yuichi KOIDO ; Motohide TAKAHASHI ; Akihiko YAMAMOTO

Clinical and Molecular Hepatology.2013;19(1):97-98. doi:10.3350/cmh.2013.19.1.97

No abstract available.
Antitoxins/*therapeutic use ; Clostridium perfringens/*pathogenicity ; Hemolysis ; Humans ; Immunologic Factors/*therapeutic use ; Liver Abscess/*drug therapy/microbiology

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Hepatocellular carcinoma composed of two different histologic types: imaging features on gadoxetic acid-enhanced liver MRI.

Seung Hyun KIM ; Woo Kyoung JEONG ; Yongsoo KIM ; Min Yeong KIM ; Jinoo KIM ; Ju Yeon PYO ; Young Ha OH

Clinical and Molecular Hepatology.2013;19(1):92-96. doi:10.3350/cmh.2013.19.1.92

No abstract available.
Antigens, CD34/metabolism ; Carcinoma, Hepatocellular/pathology/*radiography ; Contrast Media/chemistry/diagnostic use ; Gadolinium DTPA/chemistry/*diagnostic use ; Humans ; Immunohistochemistry ; Liver Neoplasms/pathology/*radiography ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Tomography, X-Ray Computed

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Reactive lymphoid hyperplasia of the liver.

Woo Sung MOON ; Keum Ha CHOI

Clinical and Molecular Hepatology.2013;19(1):87-91. doi:10.3350/cmh.2013.19.1.87

No abstract available.
Aged ; Antigens, CD20/metabolism ; Antigens, CD3/metabolism ; Bile Duct Neoplasms/ultrasonography ; Female ; Humans ; Immunohistochemistry ; Liver Diseases/*pathology/radiography ; Pseudolymphoma/*pathology/radiography ; Tomography, X-Ray Computed

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Two cases of telbivudine-induced myopathy in siblings with chronic hepatitis B.

Eun Hye KIM ; Hana PARK ; Kun Ho LEE ; Sang Hoon AHN ; Seung Min KIM ; Kwang Hyub HAN

Clinical and Molecular Hepatology.2013;19(1):82-86. doi:10.3350/cmh.2013.19.1.82

Telbivudine is an L-nucleoside analogue with potent antiviral activity against hepatitis B virus (HBV). Clinical trials have shown that telbivudine has a more potent and sustained antiviral activity with a lower frequency of viral resistance than lamivudine. Although there are several reports concerning the safety profile of telbivudine, most adverse events are described as mild and transient in nature. Here we report two cases of telbivudine-induced myopathy in patients with chronic hepatitis B who were siblings.
Adult ; Antiviral Agents/adverse effects/*therapeutic use ; Creatine Kinase/blood ; Electromyography ; Hepatitis B, Chronic/*drug therapy/metabolism/pathology ; Humans ; Male ; Muscle, Skeletal/pathology ; Muscular Diseases/etiology ; Siblings ; Thymidine/adverse effects/*analogs & derivatives/therapeutic use

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A case of variceal bleeding from the jejunum in liver cirrhosis.

Chan Woong PARK ; Sae Hee KIM ; Hyeon Woong YANG ; Yun Jung LEE ; Sung Hee JUNG ; Ho Sup SONG ; Sang Ok LEE ; Anna KIM ; Sang Woo CHA

Clinical and Molecular Hepatology.2013;19(1):78-81. doi:10.3350/cmh.2013.19.1.78

While esophagogastric varices are common manifestations of portal hypertension, variceal bleeding from the jejunum is a rare complication of liver cirrhosis. In addition, ectopic variceal bleeding occurs in the duodenum and at sites of previous bowel surgery in most cases, including of stomas. We report a case of obscure overt gastrointestinal bleeding from jejunal varices in a 55-year-old woman who had not previously undergone abdominal surgery, who had liver cirrhosis induced by the hepatitis C virus. Emergency endoscopy revealed the presence of esophageal varices without stigmata of recent bleeding, and no bleeding focus was found at colonoscopy. She continued to produce recurrent melena with hematochezia and received up to 21 units of packed red blood cells. CT angiography revealed the presence of jejunal varices, but no active bleeding was found. Capsule endoscopy revealed fresh blood in the jejunum. The patient submitted to embolization of the jejunal varices via the portal vein, after which she had a stable hemoglobin level and no recurrence of the melena. This is a case of variceal bleeding from the jejunum in a liver cirrhosis patient without a prior history of abdominal surgery.
Angiography ; Capsule Endoscopy ; Embolization, Therapeutic ; Esophageal and Gastric Varices/complications/diagnosis ; Female ; *Gastrointestinal Hemorrhage ; Humans ; Hypertension, Portal ; Jejunal Diseases/*diagnosis/therapy ; Liver Cirrhosis/*diagnosis ; Melena/complications ; Middle Aged ; Tomography, X-Ray Computed

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Impact of serum C-reactive protein level on the prognosis of patients with hepatocellular carcinoma undergoing TACE.

Chung Hwan JUN ; Ho Seok KI ; Ki Hoon LEE ; Kang Jin PARK ; Seon Young PARK ; Sung Bum CHO ; Chang Hwan PARK ; Young Eun JOO ; Hyun Soo KIM ; Sung Kyu CHOI ; Jong Sun REW

Clinical and Molecular Hepatology.2013;19(1):70-77. doi:10.3350/cmh.2013.19.1.70

BACKGROUND/AIMS: The aim of this study was to determine the relationship between serum CRP levels and the prognosis of hepatocellular carcinoma (HCC) patients. METHODS: HCC patients who underwent the first session of transcatheter arterial chemoembolization (TACE) between January 2005 and December 2009 (n=211) were analyzed retrospectively. The patients were divided into two groups: high C-reactive protein (CRP; > or =1 mg/dL, n=51) and low CRP (<1 mg/dL, n=160). They were followed for a mean of 22.44 months and their clinicoradiological variables and overall survival were compared. RESULTS: There were significant differences between the two groups in regard to tumor type, tumor-progression-free survival, 10-month mortality, white blood cell (WBC) count, tumor size, and TNM stage. Multivariate analysis revealed that a high serum CRP level was independently associated with tumor size and tumor type. Subgroup analysis of CRP groups according to tumor size demonstrated that a high serum level of CRP was significantly associated with poorly defined (diffuse) tumor type in the tumor size <5 cm group [hazard ratio (HR)=4.81, P=0.018]. A Lipiodol dose exceeding 7 mL (HR=5.55, P=0.046) and the 10-month mortality (HR=7.693, P=0.004) were significantly associated with high serum CRP level in the group of patients with a tumor size of > or =5 cm. In addition, subgroup analysis of matched CRP according to TNM stage revealed that elevated serum CRP was independently associated with tumor type, WBC count, and tumorprogression-free survival. CONCLUSIONS: A high serum CRP level is associated with large tumors and a poorly defined tumor type, and is significantly associated with 10-month mortality in patients with large HCC (size > or =5 cm) who undergo TACE.
Adult ; Aged ; Aged, 80 and over ; C-Reactive Protein/*analysis ; Carcinoma, Hepatocellular/metabolism/mortality/*therapy ; Chemoembolization, Therapeutic ; Disease-Free Survival ; Female ; Humans ; Leukocyte Count ; Liver Neoplasms/metabolism/mortality/*therapy ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Staging ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Severity of Illness Index

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