Incidence of Primary Liver Cancer in Subjects with Chronic Hepatitis B in Korean National Liver Cancer Screening Program

BACKGROUND/AIMS: To optimize efficacy of National Liver Cancer Screening Program (NLCSP) for subjects with chronic hepatitis B (CHB), it is needed to know the incidence of liver cancer and its predisposing factors in the program. METHODS: From January 2010 to December 2014, all the hepatitis B surface antigen (HBsAg) positive participants who received at least two or more abdominal ultrasonography under NLCSP were retrospectively enrolled in a single tertiary hospital. Annual incidence of primary liver cancer was calculated and related clinical factors were investigated. RESULTS: During 5 years, 541 subjects were enrolled. Mean age was 53 years old and 292 subjects (54%) were receiving antiviral agents. Liver cirrhosis (LC) was diagnosed in 212 (39.2%). Mean follow-up time was 2.36 years and 15 hepatocellular carcinoma and 1 intrahepatic cholangiocarcinoma were diagnosed. Annual incidence of primary liver cancer was 9.8 per 1,000 patient year. Cumulative incidence at 1, 3, and 5 year was 0.6%, 2.6%, and 6.4%, respectively. In multivariate analyses, LC (hazard ratio [HR] 8.74, 95% confidence interval [CI] 1.97–38.71, P=0.024), age (HR 1.08, 95% CI 1.01–1.15, P=0.024) were significantly associated with cancer development. CONCLUSIONS: Despite of high rate of oral antiviral therapy, incidence of primary liver cancer is not low in CHB patients in Korea. Old age and presence of LC are independently associated with higher risk of cancer development during surveillance. This study could be used as baseline data for quality control of NLCSP.

Hypocomplementemic Urticarial Vasculitis Syndrome with Membranous Nephropathy: Case Report

Urticarial vasculitis is a rare disorder that principally manifests with recurrent urticarial, sometimes hemorrhagic, skin lesions and/or angioedema. Its clinical presentation is not always limited to cutaneous lesions and it can potentially affect other organs, such as the joints, lungs, kidneys, and eyes. Systemic involvement can either be present at the onset of disease or develop over time. In cases with systemic manifestations, urticarial vasculitis is more likely to be associated with a low complement level. We present the case of a teenage boy with hypocomplementemic urticarial vasculitis syndrome (HUVS) that occurred shortly following swine-origin influenza A virus infection in 2009. Afterwards, HUVS was systemically complicated with myositis and membranous nephropathy that developed several months and about 2 years after its onset, respectively. A combination of glucocorticoid and immunosuppressive agents has been used to effectively control disease activity.

The Assessment of Chronic Low Back Pain by Surface Electromyography

OBJECTIVE: We studied the clinical utility of surface electromyography (SEMG) for the assessment of chronic low back pain (CLBP). METHOD: We compared electrical activity from electrodes placed on the 16 lumbar paraspinal areas between 25 CLBP patients and 25 control subjects in static neutral standing posture and dynamic flexion-reextension state. The CLBP patients and the control subjects were matched for age, gender, and body mass index (BMI) to adjust for any confounding effects. We analyzed amplitudes and areas of electrical activity on lumbar paraspinal muscles in neutral standing posture and dynamic flexion-reextension state. RESULTS: In the static neutral posture, there are increased amplitudes of electrical activity in CLBP compared with controls (p<0.01). In the dynamic flexion-reextension state, area ratio of electrical acitivity during the extension state to electrical acitivity during flexion state are significantly decreased in CLBP compared with controls (p<0.01). The presence of lumbar radiculopathy or the severity of LBP is not well correlated with the electrical acitivity on SEMG. The sensitivity and the specificity of SEMG are 72% and 80% respectively. CONCLUSION: These results indicate that SEMG is a useful method for the assessment of CLBP.