Bacteremia (Sepsis), Hepatorenal Syndrome, and Serum Creatinine Levels Rather than Types or Microbial Patterns Predicted the Short-Term Survival of Cirrhotic Patients Complicated with Spontaneous Bacterial Peritonitis.

(1) Background: Spontaneous bacterial peritonitis (SBP) is a major and severe complication in cirrhosis patients with ascites. Over the years, advance in antibiotic treatment has led to changes in microbial patterns in some regions, including the emergence of extended-spectrum beta-lactamases resistant (ESBL)-producing bacteria and an increase in Gram-positive bacteria (GPC). In addition, three SBP types (classic SBP, culture-negative neutrophilic ascites (CNNA), and monomicrobial non-neutrocytic bacterascites (MNB)), may also have different prognoses.

Comparing CLIF-C ACLF, CLIF-C ACLF, and CLIF-C ACLF-D Prognostic Scores in Acute-on-Chronic Liver Failure Patients by a Single-Center ICU Experience.

Patients with liver cirrhosis have a higher risk of developing acute-on-chronic liver failure (ACLF). Poor prognosis with a high rate of short-term mortality leads to limited opportunities for further liver transplantation. Thus, precise prognostic evaluation of patients with ACLF is necessary before transplant surgery.

Comparing Eight Prognostic Scores in Predicting Mortality of Patients with Acute-On-Chronic Liver Failure Who Were Admitted to an ICU: A Single-Center Experience.

Limited data is available on long-term outcome predictions for patients with acute-on-chronic liver failure (ACLF) in an intensive care unit (ICU) setting. Assessing the reliability and accuracy of several mortality prediction models for these patients is helpful. Two hundred forty-nine consecutive patients with ACLF and admittance to the liver ICU in a single center in northern Taiwan between December 2012 and March 2015 were enrolled in the study and were tracked until February 2017.

Integrated model for end-stage liver disease maybe superior to some other model for end-stage liver disease-based systems in addition to Child-Turcotte-Pugh and albumin-bilirubin scores in patients with hepatitis B virus-related liver cirrhosis and spontaneous bacterial peritonitis.

Objectives: For mortality prediction of spontaneous bacterial peritonitis (SBP) in patients with cirrhosis, no direct comparisons have been made among the eight models, Child-Turcotte-Pugh (CTP) score, model for end-stage liver disease (MELD), MELD-Na, integrated MELD (iMELD) score, MELD to sodium (MESO) index, modification of the MELD scoring system (Refit MELD), Refit MELD-Na and Albumin-Bilirubin (ALBI) score.

Materials And Methods: Between January 2005 and July 2017, 314 patients who met the criteria for liver cirrhosis with the first episode of SBP were enrolled in this retrospective study. Clinical and laboratory data were obtained at diagnosis.

Increased EMR2 expression on neutrophils correlates with disease severity and predicts overall mortality in cirrhotic patients.

Patients with liver cirrhosis are susceptible to infections with high short-term mortalities. One CD97-related EGF-TM7 molecule, EMR2 (EGF-like molecule containing mucin-like hormone receptor 2), had been shown to regulate human neutrophil function, potentiate systemic inflammation. Nevertheless, EMR2 could also suppress neutrophil survival.

Clinical Characteristics and Manifestation of Herpes Esophagitis: One Single-center Experience in Taiwan.

We aimed to investigate the clinical characteristics of patients with herpes esophagitis (HE) based on endoscopic typing.Herpes simplex virus infection in the gastrointestinal tract primarily affects the esophagus. However, little is known about the presentation, endoscopic findings, and outcomes of HE.

Predictors of mortality within 6 weeks after treatment of gastric variceal bleeding in cirrhotic patients.

Acute gastric variceal bleeding (GVB) is a catastrophic problem and accounts for one of the major causes of death in cirrhotic patients. Although, N-butyl cyanoacrylate (NBC) has been shown to control bleeding effectively, it still carries up high mortality rate. This study aimed to find the predictors of mortality within 6 weeks after emergent endoscopic treatment with NBC injection.

Increased regulatory T cells in patients with liver cirrhosis correlated with hyperbilirubinemia and predict bacterial complications.

Background And Aim: Patients with liver cirrhosis (LC) were regarded as immunocompromised status with high incidence of bacterial infection. Regulatory T cell (Treg cell) is known as an immune suppressor and also plays an important role in patients with sepsis. This paper aims to study the role of Treg cells in patients with liver cirrhosis and their correlations to bacterial complications.

HCV core-induced nonobese hepatic steatosis is associated with hypoadiponectinemia and is ameliorated by adiponectin administration.

Obesity-related hepatic steatosis is commonly associated with central fat accumulation and alterations in adipocytokine secretion; however, the connection between nonobese hepatic steatosis and adipocytokines remains unclear. We aim to investigate this connection using an animal model of conditional hepatitis C virus (HCV) core-transgenic mice. Double transgenic mice (DTM) with doxycycline (dox)-regulated hepatic overexpression of the HCV core protein were fed standard rodent chow ad libitum following 1 month of a dox-rich diet.

Factors that influence cecal intubation rate during colonoscopy in deeply sedated patients.

Background And Aim: The technical performance of colonoscopy performed in deeply sedated patients differs from that performed without sedation or under minimal to moderate sedation. The aim of this study is to evaluate the factors affecting cecal intubation during colonoscopy performed under deep sedation.

Methods: A total of 5352 consecutive subjects who underwent a screening colonoscopy as part of a health check-up between January 2008 and December 2008 at an academic hospital were reviewed.

MELD score can predict early mortality in patients with rebleeding after band ligation for variceal bleeding.

Aim: To investigate the outcomes, as well as risk factors for 6-wk mortality, in patients with early rebleeding after endoscopic variceal band ligation (EVL) for esophageal variceal hemorrhage (EVH).

Methods: Among 817 EVL procedures performed for EVH between January 2007 and December 2008, 128 patients with early rebleeding, defined as rebleeding within 6 wk after EVL, were enrolled for analysis.

Result: The rate of early rebleeding after EVL for acute EVH was 15.

Recurrence of spontaneous bacterial peritonitis in cirrhotic patients non-prophylactically treated with norfloxacin: serum albumin as an easy but reliable predictive factor.

Background: Several large studies revealed that selective intestinal decontamination (SID) prevented recurrence of spontaneous bacterial peritonitis (SBP) in cirrhotic patients. Nonetheless, there are no definitive patient selection parameters identifying who would benefit from SID.

Aims: To investigate long-term outcomes in cirrhosis patients with recurrence of SBP and to identify predictive factors for SBP recurrence.

Tumor necrosis factor-α and interleukin-10 contribute to immunoparalysis in patients with acute pancreatitis.

Immunoparalysis, defined as downregulation of human leukocyte antigen-DR (HLA-DR) expression on monocytes, is strongly associated with septic complications of acute pancreatitis. However, the possible causes of this immunoparalysis have been largely unknown. A prospective case control study was performed in 54 patients with acute pancreatitis and 24 normal volunteers.

The application of miniprobe ultrasonography in the diagnosis of colorectal subepithelial lesions.

Background: Difficulty with the proximal lesion approach and durability of endoscopic ultrasonography (EUS) instruments usually limits its application for lower gaotrointestina (GI) lesions to locoregional staging of rectal cancer. This study investigated the value of colonoscopic miniprobe ultrasonography for differential diagnosis and treatment strategy in patients with colorectal subepithelial lesions (SEL).

Methods: Miniprobe ultrasonography was Performed in 40 consecutive patients with suspected colorectal SEL or residual lesions after endoscopic resection at one medical center by the same endoscopist (C-J Lin).

Hepatic inflammation mediated by hepatitis C virus core protein is ameliorated by blocking complement activation.

Background: The pathogenesis of inflammation and fibrosis in chronic hepatitis C virus (HCV) infection remains unclear. Transgenic mice with constitutive HCV core over-expression display steatosis only. While the reasons for this are unclear, it may be important that core protein production in these models begins during gestation, in contrast to human hepatitis C virus infection, which occurs post-natally and typically in adults.

Hydrodynamics-based transfection of pancreatic duodenal homeobox 1 DNA improves hyperglycemia and is associated with limited complications in diabetic mice.

The biohazards caused by the viral delivery of pancreatic duodenal homeobox gene 1 (Pdx1) to the murine liver limits its application. We aimed to evaluate the feasibility of hydrodynamics-based transfection (HBT) with Pdx1 in improving hyperglycemia. Murine hepatocellular carcinoma (Hepa1-6) cells were transfected with the Pdx1-expressing plasmid, pcDNA3.

Endoscopic treatment of colorectal neoplasms: a simple and safe procedure to lower the incidence of colorectal cancers.

Aim: For many physicians who ordinarily treat patients with colonic diseases, colonoscopy is considered a prime study interest. Developments in colonoscopic equipment and methods have led to larger numbers of endoscopic diagnoses and treatments for colorectal neoplasms. The purpose of this investigation is to evaluate the efficacy and outcomes of endoscopic treatment for colorectal neoplastic lesions and the development of colorectal cancers after colonoscopic therapy.

Efficacy of color sonography and harmonic scalpel in laparoscopic management of multiple/lobulated liver cysts and abscesses.

Background/aims: Major concerns of multiple/lobulated liver cysts and abscesses managed by laparoscopic approach are inadequate deroofing/ drainage and hemorrhage. The aim of this study was to test the efficacy of color sonography and ultrasonically activated scalpel employed in this field.

Methodology: Ten patients with multiple/lobulated liver cysts and eight patients with lobulated pyogenic liver abscesses were managed laparoscopically with the aid of laparoscopic color sonography and harmonic scalpel.

Endotoxemia contributes to the immune paralysis in patients with cirrhosis.

Background/aims: Immune paralysis, defined as decreased HLA-DR expression on monocytes and indicated immune dysfunctions, was found in sepsis, severe acute pancreatitis and acute liver failure. However, the relationship between HLA-DR expression and cirrhosis is unclear.

Methods: We enrolled 64 patients with liver cirrhosis and 23 healthy volunteers.

A useful model to audit liver resolution from cirrhosis in rats using functional proteomics.

Background: We conducted a rat cirrhosis and recovery model, on the basis of which proteomics was used to audit liver resolution from cirrhosis.

Materials And Methods: Micronodular cirrhosis was established using Sprague-Dawley rats fed thioacetamide, and spontaneous recovery from cirrhosis was acquired after thioacetamide withdrawal.

Results: Over the course of a 2-, 3-, and 6-week recovery, macronodular cirrhosis, uneven liver surface, and nearly normal liver surface were acquired, respectively.

Comparative study of conventional colonoscopy, chromoendoscopy, and narrow-band imaging systems in differential diagnosis of neoplastic and nonneoplastic colonic polyps.

Aim: To identify the feasibility of the narrow-band imaging (NBI) method compared with that of conventional colonoscopy and chromoendoscopy for distinguishing neoplastic and nonneoplastic colonic polyps.

Method: This study enrolled consecutive patients who underwent colonoscopy using a conventional colonoscope between January and February 2006 at Chang-Gung Memorial Hospital, Linkou Medical Center, Taiwan. These 78 patients had 110 colorectal polyps.

A strong association between down-regulation of HLA-DR expression and the late mortality in patients with severe acute pancreatitis.

Objectives: There is no reliable parameter to predict the late mortality of patients with severe acute pancreatitis though it is an important issue. Recently a proposed parameter for "immunoparalysis," a down-regulation of Human Leukocytes Antigens-DR (HLA-DR) expression on monocytes, had been detected in patients with severe but not mild acute pancreatitis. However, the relationship between this parameter and late mortality of acute pancreatitis is still unclear.

Adrenal insufficiency in patients with cirrhosis, severe sepsis and septic shock.

Patients with cirrhosis are susceptible to bacterial infection, which can result in circulatory dysfunction, renal failure, hepatic encephalopathy, and a decreased survival rate. Severe sepsis is frequently associated with adrenal insufficiency, which may lead to hemodynamic instability and a poor prognosis. We evaluated adrenal function using short corticotropin stimulation test (SST) in 101 critically ill patients with cirrhosis and severe sepsis.

Treating colorectal polypoid neoplasms during a colonoscopy.

Background: To evaluate the efficacy and outcomes of endoscopic treatment for colorectal polypoid neoplastic lesions.

Methods: From September 1999 to May 2003, 11,447 consecutive colonoscopic examinations were performed in 9864 patients, totaling 5355 endoscopic polypectomies for colorectal polypoid neoplasms. According to the macroscopic characteristics, the neoplasms were classified into protruded (n = 3953) and sessile (n = 1402) ones.

Clinical and endoscopic features for alimentary tract cytomegalovirus disease: report of 20 cases with gastrointestinal cytomegalovirus disease.

Background: The clinical presentations and endoscopic features of cytomegalovirus (CMV) infection in the gastrointestinal (GI) tract are diverse, and can mimic other inflammatory gastrointestinal diseases.

Methods: From 1987 to 2003 at Chang-Gung Medical Center, 20 patients with CMV infections of the GI tract who were assessed using endoscopic examinations and diagnosed via pathologic studies were retrospectively reviewed.

Results: Most of the patients were adults with immunocompromised conditions (10/20).