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Wei-Che Lin,Wen-Chieh Chen,Pei-Wen Wang,Yi-Chia Chan,Yen-Hsiang Chang,Harn-Shen Chen,Szu-Tah Chen,Wei-Chih Chen,Kai-Lun Cheng,Shun-Yu Chi,Pi-Ling Chiang,Chen-Kai Chou,Feng-Fu Chou,Shun-Chen Huang,Feng 대한초음파의학회 2023 ULTRASONOGRAPHY Vol.42 No.3
Radiofrequency ablation (RFA) is a minimally invasive management strategy that has been widely applied for benign and recurrent malignant thyroid lesions as an alternative to surgery in Taiwan. Members of academic societies for specialists in interventional radiology, endocrinology, and endocrine surgery collaborated to develop the first consensus regarding thyroid RFA in Taiwan. The modified Delphi method was used to reach a consensus. Based on a comprehensive review of recent and valuable literature and expert opinions, the recommendations included indications, pre-procedural evaluations, procedural techniques, post-procedural monitoring, efficacy, and safety, providing a comprehensive review of the application of RFA. The consensus effectively consolidates advice regarding thyroid RFA in clinical practice for local experts.
Lin Meng-Ying,Wu Cheng-Lin,Su Yung-Yeh,Huang Chien-Jui,Chang Wei-Lun,Sheu Bor-Shyang 거트앤리버 소화기연관학회협의회 2023 Gut and Liver Vol.17 No.2
Background/Aims: A high-quality sample allows for next-generation sequencing and the administration of more tailored precision medicine treatments. We aimed to evaluate whether heparinized wet suction can obtain higher quality samples than the standard dry-suction method during endoscopic ultrasound (EUS)-guided biopsy of pancreatic masses. Methods: A prospective randomized crossover study was conducted. Patients with a solid pancreatic mass were randomly allocated to receive either heparinized wet suction first or dry suction first. For each method, two needle passes were made, followed by a switch to the other method for a total of four needle punctures. The primary outcome was the aggregated white tissue length. Histological blood contamination, diagnostic performance and adverse events were analyzed as secondary outcomes. In addition, the correlation between white tissue length and the extracted DNA amount was analyzed. Results: A total of 50 patients were enrolled, and 200 specimens were acquired (100 with heparinized wet suction and 100 with dry suction), with one minor bleeding event. The heparinized wet suction approach yielded specimens with longer aggregated white tissue length (11.07 mm vs 7.96 mm, p=0.001) and less blood contamination (p=0.008). A trend towards decreasing tissue quality was observed for the 2nd pass of the dry-suction method, leading to decreased diagnostic sensitivity and accuracy, although the accumulated diagnostic performance was comparable between the two suction methods. The amount of extracted DNA correlated positively to the white tissue length (p=0.001, Spearman̕s ρ=0.568). Conclusions: Heparinized wet suction for EUS tissue acquisition of solid pancreatic masses can yield longer, bloodless, DNA-rich tissue without increasing the incidence of adverse events (ClinicalTrials.gov. identifier NCT04707560).
( Lai Wei ),( Qing Xie ),( Jin Lin Hou ),( Hong Tang ),( Qin Ning ),( Jun Cheng ),( Yuemin Nan ),( Lunli Zhang ),( Jun Li ),( Jianning Jiang ),( Megan Kim ),( Brian Mcnabb ),( Fangqiu Zhang ),( Gregor 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Aims: Chronic hepatitis C virus (HCV) infection remains a major health threat in China, affecting at least 10 million people, with approximately 58% having genotype (GT) 1 infection. There is a critical need for simple, all oral, direct-acting antiviral regimens to treat GT1 HCV in this region. Treatment with ledipasvir (LDV)/sofosbuvir (SOF) results in high sustained virologic response rates 12 weeks after therapy (SVR12) in GT1 HCV infected patients in clinical trials and real-world settings. This study evaluated the efficacy and safety of LDV/SOF for 12 weeks in Chinese patients with chronic GT1 HCV infection. Methods: Treatment experienced and treatment naïve patients with chronic GT1 HCV infection with no cirrhosis or with compensated cirrhosis were eligible to enroll in a single-arm, openlabel trial to receive a fixed dosed combination of LDV/SOF 90/400 mg daily for 12 weeks. The primary efficacy endpoint was SVR12 using the CAP/CTM HCV 2.0 assay (LLOQ =15 IU/mL) and the primary safety endpoint was adverse events (AEs) leading to LDV/SOF discontinuation. Results: A total of 206 Chinese patients were enrolled and treated. Of these, 50% were male, 16% had compensated cirrhosis, 49% were treatment-experienced, 76% had IL28B CC genotype, and 100% had GT1b HCV infection. The mean (range) age and body mass index of enrolled subjects were 47 (21-72) years and 23 (14-34) kg/m2, respectively. The overall SVR12 rate is 100% (206/206). All 32 patients with cirrhosis (15 of whom were treatment-experienced), achieved SVR12. There were no discontinuations due to AEs. No serious or severe AEs were assessed by the investigator as related to study drug and there were no deaths. Conclusions: Treatment with the single tablet regimen of LDV/SOF for 12 weeks resulted in 100% SVR12 and was well tolerated in treatment experienced and treatment naïve GT1 HCVinfected Chinese patients with and without cirrhosis.
Meng-Ying Lin,Cheng-Lin Wu,Mitsuhiro Kida,Wei-Lun Chang,Bor-Shyang Sheu 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.3
Background/Aims: Endoscopic ultrasonography (EUS)-guided tissue acquisition requires a long learning curve. We aimed tocompare the skill maturation curves between fine needle aspiration (FNA) and biopsy (FNB) for tissue acquisition. Methods: The initial 60 procedures performed by the trainee endosonographer (30 FNA vs. 30 FNB) were consecutively enrolled. The difference in procedure performance was compared between the two groups. Learning curves were assessed. Twenty additionalcases were subsequently enrolled to assess the consistency of performance in the FNB group. Results: The FNB group acquired larger tissue samples (2.35 vs. 0.70 mm2; p<0.001) with lower blood content (p=0.001) and highertissue quality (p=0.017) compared with the FNA group. In addition, the FNB group required less needle pass to establish a diagnosis(2.43 vs. 2.97; p=0.006). A threshold diagnostic sensitivity of ≥80% was achieved after performing 10 FNB procedures. The numberof needle passes significantly decreased after conducting 20 FNB procedures (1.80 vs. 2.70; p=0.041). The diagnostic sensitivity andnumber of needle passes remained the same in the subsequent FNB procedures. By contrast, this skill maturation phenomenon wasnot observed after performing 30 FNA procedures. Conclusions: In EUS-guided tissue acquisition, the FNB needle was more efficient and thus shortened the learning curve of EUSguidedtissue acquisition in trainee endosonographers.
Review : Surveillance for Hepatocellular Carcinoma
( Kung Hung Lin ),( Wei Lun Tsai ) 대한간암학회 2013 대한간암학회지 Vol.13 No.2
Hepatocellular carcinoma (HCC) is the fifth most common cancer and the third leading cause of cancer death worldwide. HCC is a suitable disease for surveillance programs because it is relatively common in patients with chronic liver disease, and has very good prognosis if diagnosed at an early stage. When HCC presents with clinical symptoms, the tumor is typically very far advanced and the patient has few therapeutic options. Individuals with chronic viral hepatitis and other forms of liver disease are at risk for developing HCC. Thus, screening and surveillance for HCC would appear to be very appropriate. However, there is no definitive evidence that surveillance improves patient outcomes and the current surveillance tests have less than optimal sensitivity, specificity and accuracy. Nonetheless, measurement of alpha-fetoprotein levels in serum and ultrasound of the liver have become routine practice in many countries, despite a lack of evidence of their overall benefit. Clearly, better methods are needed for early diagnosis of HCC. This review outlines the target population at risk for HCC and diagnostic techniques for screening and surveillance.
( Ching-chih Lin ),( Ta-wei Liu ),( Ming-lun Yeh ),( Yi-shan Tsai ),( Pei-chien Tsai ),( Chung-feng Huang ),( Jee-fu Huang ),( Wan-long Chuang ),( Chia-yen Dai ),( Ming-lung Yu ) 대한간학회 2021 Clinical and Molecular Hepatology(대한간학회지) Vol.27 No.2
Background/Aims: Growth hormone (GH) is the main regulator of somatic growth, metabolism, and gender dimorphism in the liver. GH receptor (GHR) signaling in cancer is derived from a large body of evidence, although the GHR signaling pathway involved in the prognosis of hepatocellular carcinoma (HCC) in patients with hepatitis C virus (HCV)-related HCC, remains unclear. We aimed to explore the expression of GHR and analyze its association with clinicopathologic features and prognosis of patients with chronic hepatitis C and HCC. Methods: The expression of GHR mRNA was investigated by quantitative real-time polymerase chain reaction in paired tumors and adjacent non-tumorous (ANT) liver tissues of 200 patients with chronic hepatitis C and HCC. Western blotting and immunofluorescence assays using the HCV-infected Huh7.5.1 cell model was performed. Results: GHR mRNA was significantly lower in HCV-HCC tissues than in corresponding ANT liver tissues. GHR mRNA and protein levels also decreased in the HCV-infected Huh7.5.1 cell model. Notably, lower GHR expression was associated with age of >60 years (P=0.0111) and worse clinicopathologic characteristics, including alpha-fetoprotein >100 ng/mL (P=0.0403), cirrhosis (P=0.0075), vascular invasion (P=0.0052), pathological stage II-IV (P=0.0002), and albumin ≤4.0 g/dL (P=0.0055), which were linked with poor prognosis of HCC. Most importantly, the high incidence of recurrence and poor survival rates in patients with a low ratio of tumor/ANT GHR (≤0.1) were observed, indicating that low expression levels of GHR had great risk for development of HCC in patients with chronic hepatitis C. Conclusions: Our study demonstrates a significant down-regulation of GHR expression as a new unfavorable independent prognostic factor in patients with chronic hepatitis C and HCC. (Clin Mol Hepatol 2021;27:313-328)