Significant Association of HLA-DQ5 with Autoimmune Hepatitis in Taiwan

Genetic predisposition is known to be an important etiopathogenic factor of autoimmune hepatitis (AIH). HLA antigens associated with AIH have been well studied in Western countries and Japan, but there is no HLA typing data of AIH patients in Taiwan. We therefore investigated HLA phenotypes and their association with AIH patients and compared the results with those of normal subjects and patients with chronic liver disease. Group 1 consisted of 22 AIH patients. All were born in Taiwan with no history of blood transfusion. Group 2 consisted of 19 chronic liver disease patients. Group 3 consisted of 81 unrelated healthy subjects who were normal blood donors. All three groups were tested for HLA phenotypes (HLAA, B, C, DR, DQ) using the polymerase chain reaction—sequence specific probe method. The statistical method used was Fisher's exact test. We found that HLA-DQ5 was significantly more frequent in the AIH group compared to the control group (RR, 2.03; p = 0.034). Low frequency of A1 (n = 2/22), B8 (n = 1/22) and DR3 (n = 0/22) were noted compared to results from the West; only HLA-DR4 showed a higher rate in our AIH patients (n = 8/22). This is a preliminary report of our study of HLA antigens in AIH patients. Further investigation to characterize AIH patients into HLA allelic subgroups is being done

Randomized Trial of Low-pressure Carbon Dioxide-elicited Pneumoperitoneum Versus Abdominal Wall Lifting for Laparoscopic Cholecystectomy

Two alternative surgical techniques for elective laparoscopic cholecystectomy (LC), low-pressure insufflation of the peritoneal cavity and abdominal wall lifting (AWL), have been developed over time to minimize the disadvantages associated with CO2-elicited pneumoperitoneum. To the best of our knowledge, the 2 methods have seldom been compared as regards their relative advantages and disadvantages. Methods: Eighty patients scheduled for elective LC were randomized into either a low-pressure (8 mmHg) CO2 insufflation method (LPLC) group, or a gasless technique using a subcutaneous abdominal wall lifting device (GLC group). The duration of the surgical procedure, the surgical results including level of postoperative pain, and perioperative cardiopulmonary function changes experienced by the members of both groups were compared. Results: Laparoscopic surgery was completed for all but 1 patient from each group due to an inadequate surgical-site exposure. There was no mortality for study participants, and no major complications were noted for members of either group. The LPLC group evidenced a shorter surgical duration as compared to the GLC group (77 ± 28 minutes vs. 98 ± 27 minutes, respectively; p < 0.01) and a lower incidence of postoperative shoulder pain (2/38 vs. 8/39, respectively; p < 0.05), although significant differences in intraoperative pulmonary function were noted (an increased PaCO2, PetCO2 and peak-airway pressure and decreased arterial blood pH; p < 0.01) for the LPLC group compared to the GLC group. Conclusion: Both alternative methods for this type of surgery appeared feasible and safe for LC. Low-pressure CO2 pneumoperitoneum had a shorter surgical duration and less postoperative shoulder pain compared to the GLC technique, but did not feature any other advantage over the AWL technique with regard to impact on cardiopulmonary function

Nonresponse to 18-month Lamivudine Monotherapy in Chronic Hepatitis B Patients with Dual Genotype B and C Infection and Acute Exacerbation

Molecular epidemiologic studies have indicated the possible existence of mixed infection of different hepatitis B virus (HBV) genotypes in chronic hepatitis B (CH-B) carriers, but the effect of dual HBV genotype B and C infection on the efficacy of lamivudine therapy remains unclear. We report four CH-B patients with dual HBV genotype B and C infection and acute exacerbation who received lamivudine monotherapy for about 18 months. None of them had achieved a sustained response at the end of the 18-month trial of treatment

Manifestations of perihepatic lymph nodes in acute flare of chronic hepatitis B: association with HBeAg status and with HBeAg seroconversion.

UNLABELLED:It has been observed that enlargement of perihepatic lymph nodes may be seen in patients with chronic hepatitis B, particularly during acute flares of CHB. We hypothesized that there may be a correlation between the nodal change patterns in CHB patients with acute flare and HBeAg status. Perihepatic lymph node sizes of 87 patients with acute flares of CHB were documented, with a median follow up of 43 months. Patients were separated into 3 groups, HBeAg-positive with HBe seroconversion (group 1), HBeAg-positive without HBe seroconversion (group 2), and HBeAg-negative (group 3). Group 1 has the highest incidence of enlarged lymph nodes (92.3%) compared with group 2 (75.8%) and group 3 (46.8%) (p = 0.003). And if nodal width at acute flare was > 8mm and interval change of nodal width was >3mm, the incidence of HBeAg seroconversion will be 75% (p<0.001). CONCLUSION:Larger perihepatic lymph nodes are seen in CHB acute flare patients with positive HBeAg and the magnitude of nodal width change may predict HBeAg seroconversion at recovery

Distribution for CHB w AE eAg+ vs. CHB w AE eAg- including the results of nodal widths.

<p>Group 1 and 2: HBeAg-positive and group 3: HBeAg-negative.</p><p>*p-value is from Wilcoxon rank sum test for continuous variables and Pearson’s chi-square test for categorical variables.</p><p>Abbreviations: WBC = white blood cell count, ALT = alanine aminotransferase, AFP = alpha-fetoprotein, BilT = total bilirubin level, VL = viral load, CLD = chronic liver parenchymal disease, LC = liver cirrhosis both diagnosed as ultrasonographic criteria, NUC = nucleos(t)ide analogue, PEG = pegylated interferon, both current standard antiviral therapies for chronic B hepatitis, WT = nodal width.</p><p>Distribution for CHB w AE eAg+ vs. CHB w AE eAg- including the results of nodal widths.</p

The multiple logistic regression analysis for variables between HBeAg-positive and HBeAg-negative.

<p>Abbreviations: VL = viral load, WT = nodal width, CLD = chronic liver parenchymal disease, LC = liver cirrhosis.</p><p>The multiple logistic regression analysis for variables between HBeAg-positive and HBeAg-negative.</p

The ROC curve of nodal width for predicting HBeAg seroconversion in chronic B hepatitis with acute flare.

<p>The area under curve is 0.8052.</p

Validation for nodal length values measured by ultrasound (LT-US) with computed tomography (LT-CT).

<p>Validation for nodal width values measured by ultrasound (WT-US) with computed tomography (WT-CT).</p