Lacerated Liver Graft in an Open Abdomen Setting: A Case Report.

Posted by on 10 Apr 2019 | Tagged as: Hepatitis B Alternative Medicine

Related Articles Lacerated Liver Graft in an Open Abdomen Setting: A Case Report. Exp Clin Transplant. 2018 12;16(6):765-768 Authors: Junrungsee S, Ongprasert K, Ko-Iam W, Lapisatepun W, Jirapongcharoenlap T, Boonsri S, Lorsomradee S, Chotirosniramit A, Sandhu T Abstract Donor scarcity is a primary problem in the development of a transplant program. The imbalance between an extremely increasing demand and the number of organs in the supply has led to an extended criteria donor approach. The successful use of donors with infectious diseases and septic shock has been reported. However, organs from deceased donors with traumatic abdominal injury and open abdomen are usually discarded due to risks of severe infections. Thus far, only 1 such case, in which a liver graft from an open abdomen was used successfully, has been reported. Herein, we report of a case of liver transplant using a traumatized liver allograft procured from a deceased donor with an open abdomen. The donor was a 16-year-old patient who had blunt abdominal trauma and severe head injury from a car accident, resulting in emergency laparotomy with suturing of the lacerated wound at the liver and abdominal packing. The donor was subsequently pronounced brain dead, and the family consented to organ donation. A multiorgan procurement was performed, and the liver was transplanted to 52-year-old patient who had multiple hepatocellular carcinomas. The postoperative course was without any infection or rejection. In conclusion, the use of donor livers with preexisting trauma in open abdomen settings can be used as alternative to expand the organ donor pool. PMID: 27211988 [PubMed – indexed for MEDLINE]

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Lacerated Liver Graft in an Open Abdomen Setting: A Case Report.

Prevalence and predictors of complementary and alternative medicine modalities in patients with chronic hepatitis B.

Posted by on 27 Mar 2019 | Tagged as: Hepatitis B Alternative Medicine

Related Articles Prevalence and predictors of complementary and alternative medicine modalities in patients with chronic hepatitis B. Liver Int. 2019 Mar 25;: Authors: Liem KS, Yim C, Ying TD, Zanjir W, Fung S, Wong DK, Shah H, Feld JJ, Hansen BE, Janssen HLA Abstract BACKGROUND & AIMS: The use of complementary and alternative medicine (CAM) in patients with chronic hepatitis B (CHB) can interact with antiviral treatment or influence health-seeking behavior. We aimed to study the use of individual CAM modalities in CHB and explore determinants of use, particularly migration-related, socio-economic and clinical factors. METHODS: A total of 436 CHB outpatients who attended the Toronto Centre for Liver Disease in 2015-2016 were included in this cross-sectional study. Using the comprehensive I-CAM questionnaire and health records, data were collected on socio-demographic and clinical variables and on usage of 16 CAM modalities in the last year. RESULTS: Sixty percent of patients were male, 74% were Asian and 46% were using antiviral treatment. Three-hundred nine (71%) patients used CAM. Vitamin/mineral preparations (45% of patients) were most commonly used. Overall CAM use and the specific use of potentially injurious CAM, such as green tea extract (9.2%) and St. John’s wort (0.2%), were not associated with liver disease severity. Female sex, family history of CHB, lower serum HBV DNA, and higher socio-economic status were independently associated with bio-holistic CAM use, the clinically most-relevant CAM group (p<0.05); ethnicity, antiviral therapy use and liver disease severity were not. CONCLUSIONS: CAM use among CHB patients was extensive, especially use of vitamin and mineral preparations, but without direct influence on liver disease severity. Bio-holistic CAM use appeared to be associated with socio-economic status rather than with ethnicity or liver disease severity. Despite the rare use of hepatotoxins, physicians should actively inquire about it. This article is protected by copyright. All rights reserved. PMID: 30912219 [PubMed – as supplied by publisher]

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Prevalence and predictors of complementary and alternative medicine modalities in patients with chronic hepatitis B.

Serum hepatocyte apoptosis biomarker predicts the presence of significant histological lesion in chronic hepatitis B virus infection.

Posted by on 21 Mar 2019 | Tagged as: Hepatitis B Alternative Medicine

Related Articles Serum hepatocyte apoptosis biomarker predicts the presence of significant histological lesion in chronic hepatitis B virus infection. Dig Liver Dis. 2016 Dec;48(12):1463-1470 Authors: Cao ZJ, Li J, Wang Y, Bao R, Liu YH, Xiang XG, Lin LY, Ye FX, Lu J, Xie Q, Bao SS, Wang H Abstract BACKGROUND: Hepatocyte death, either apoptosis or necrosis, is closely associated with hepatic inflammation and fibrosis. AIMS: To investigate the potential values of hepatocytes death biomarker, M30 (apoptosis) and M65 (total death) in predicting histological lesions in chronic hepatitis B virus (HBV) infection. METHODS: Total 201 treatment-naïve patients were prospectively recruited. Liver biopsies were performed prior to antiviral treatments for treatments starting evaluation. Sera were collected on the day of liver biopsy for biomarker measurements. Sera from 200 age-matched healthy volunteers served as healthy controls (HCs). RESULTS: Significant histological lesions (SHL, i.e. significant inflammation and/or significant fibrosis) were confirmed in 150 (74.63%) patients. There were significantly higher serum M30 and M65 in patients with SHL than those without SHL (p<0.001) or than HCs (p<0.001). Serum M30, but not M65, independently predicted SHL [odds ratio:3.4 (95% CI, 1.8-6.2) per increase of 50U/L, p<0.001] after adjusting other potential confounding factors. A novel model based on M30 provided good diagnostic performance in predicting SHL [AUC, 0.87 (0.81-0.92)]. Cut-off value of >0 to confirm or ≤-0.5 to exclude SHL has ∼12% misclassification rate. CONCLUSION: Hepatocyte apoptosis biomarker, M30 is a promising non-invasive alternative to liver biopsy in chronic HBV infection upon treatment evaluation. PMID: 27575659 [PubMed – indexed for MEDLINE]

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Serum hepatocyte apoptosis biomarker predicts the presence of significant histological lesion in chronic hepatitis B virus infection.

Hepatitis C core antigen highly correlated to HCV RNA.

Posted by on 19 Mar 2019 | Tagged as: Hepatitis B Alternative Medicine

Related Articles Hepatitis C core antigen highly correlated to HCV RNA. Kaohsiung J Med Sci. 2018 Dec;34(12):684-688 Authors: Chang C, Hung CH, Wang JH, Lu SN Abstract Hepatitis C virus core antigen (HCV-Ag) immunoassay has been proposed as a more cost and time efficient one-step alternative to the current two-step screening and diagnostic process. This study investigates the correlation between the HCV-Ag immunoassay and the current gold standard of Hepatitis C Virus (HCV) ribonucleic acid (RNA) molecular assay. Stored sera of 221 consecutive treatment-naive patients tested anti-HCV positive were selected to undergo both HCV-Ag immunoassay and HCV RNA molecular assay. Active infection status and HCV genotype were determined using both assays, and correlation was calculated using a logarithmic scale. Among 221 anti-HCV-positive sera, 197 were positive for both HCV Ag (≥3 fmol/L) and HCV RNA (>15 IU/mL), 22 were negative for both tests, while 2 were positive to HCV RNA only. The sensitivity and specificity for HCV Ag in predicting HCV RNA were 99% and 100%, respectively. Out of 199 patients (90%) tested positive for HCV viremia, 107 (56%) were of genotype 1, 77 (38.7%) of genotype 2 and 15 of other genotypes. Analysis of 221 anti-HCV-positive patient sera found a strong positive correlation between HCV RNA and HCV-Ag (r = 0.960, p < 0.001). Genotype 1 (log [HCV RNA] = 0.988 x log [HCV-Ag] + 2.768), with correlation coefficient 0.945, exhibited a stronger correlation than genotype 2 (log [HCV RNA] = 0.859 x log [HCV-Ag] + 2.859; r = 0.862). Given the strong positive correlation between HCV-Ag immunoassay and HCV RNA molecular assay in genotyping affected individuals, we propose that HCV-Ag immunoassay is a more cost and time efficient alternative to the current two-step diagnostic process. PMID: 30527202 [PubMed – indexed for MEDLINE]

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Hepatitis C core antigen highly correlated to HCV RNA.

Yinchenhao decoction for chronic hepatitis B: Protocol for a systematic review and meta-analysis.

Posted by on 07 Mar 2019 | Tagged as: Hepatitis B Alternative Medicine

Related Articles Yinchenhao decoction for chronic hepatitis B: Protocol for a systematic review and meta-analysis. Medicine (Baltimore). 2019 Feb;98(8):e14648 Authors: Xu L, Xie T, Shen T, Jian S Abstract BACKGROUND: Chronic hepatitis B (CHB) is a very critical threat to public health worldwide, and is the primary cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma (HCC). Yinchenhao decoction (YCHD) is a classic prescription of traditional Chinese medicine for the treatment of jaundice. Despite the satisfactory clinical efficacy of YCHD in the treatment of CHB, the safety of YCHD is still uncertain. Therefore, we will provide a systematic review of YCHD in CHB treatments. METHODS: The purpose of this review is to retrieve relevant literature on YCHD therapy for CHB in the electrical databases, including 4 Chinese databases (e.g., Wanfang database, Chinese National Knowledge Infrastructure (CNKI), Chinese Biomedical database (CBM), Chinese Science and Technology Periodical database (VIP)) and 3 English databases (e.g., PubMed, Cochrane Library, and EMBASE). The literatures involved are from the establishment of the databases to January 2019. The primary outcomes are HBV-DNA, HBeAg, and ALT. We will calculate the data synthesis for meta-analysis using RevMan V.5.3 software if the results are suitable. RESULTS: This study will offer a high-quality composite of existing evidence for YCHD in CHB treatment according to HBV-DNA quantitative detection, HBeAg qualitative detection, ALT levels, TCM syndrome evaluation criteria, status changes in quality of life assessment participants, and adverse events. CONCLUSION: This systematic review will provide evidence to assess the clinical efficacy of YCHD in the treatment of patients with CHB. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019119720. PMID: 30813205 [PubMed – indexed for MEDLINE]

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Yinchenhao decoction for chronic hepatitis B: Protocol for a systematic review and meta-analysis.

Characterization of Hepatocellular Carcinoma Patients with FGF19 Amplification Assessed by Fluorescence in situ Hybridization: A Large Cohort Study.

Posted by on 01 Mar 2019 | Tagged as: Hepatitis B Alternative Medicine

Related Articles Characterization of Hepatocellular Carcinoma Patients with FGF19 Amplification Assessed by Fluorescence in situ Hybridization: A Large Cohort Study. Liver Cancer. 2019 Feb;8(1):12-23 Authors: Kang HJ, Haq F, Sung CO, Choi J, Hong SM, Eo SH, Jeong HJ, Shin J, Shim JH, Lee HC, An J, Kim MJ, Kim KP, Ahn SM, Yu E Abstract Background: FGF19 amplification is a relatively novel type of genetic aberration that has been proposed to be a driver of hepatocarcinogenesis. Selective inhibitors of FGFR4, a receptor of FGF19, have been developed as targeted therapies for hepatocellular carcinoma (HCC). Despite the role of FGF19 in mediating HCC progression, the clinicopathological characterization of patients exhibiting FGF19 amplification remains unclear. Immunohistochemical staining is the simplest and most widely used method of identifying aberrations in the FGF19 gene, although its specificity is very low. Methods: This study investigated the prognostic significance of FGF19 amplification in a large cohort of 989 HCC patients using fluorescence in situ hybridization (FISH), which has a high degree of specificity. In addition, FISH data from formalin-fixed, paraffin-embedded sections were compared with copy number variation (CNV) data obtained from fresh frozen sections to validate the use of FISH as a diagnostic tool. Results: FGF19 amplifications were detected by FISH in 51 (5.15%) of the 989 patients, and were independently associated with poor survival and a higher risk of tumor recurrence, as well as with poor prognostic factors such as a high α-fetoprotein level, hepatitis B or C virus infection, a large tumor size, microvascular invasion, and necrosis. In addition, FGF19 amplification was associated with TP53 mutation, and was mutually exclusive with CTNNB1 mutation. The results of the FISH and CNV analyses exhibited a significant concordance rate of 96% (κ = 0.618, p < 0.001). Conclusions: These data indicate that FGF19 amplification represents a unique molecular subtype associated with poor prognostic characteristics, which supports the hypothesis that the FGF19-FGFR4 signaling pathway plays an important role in hepatocarcinogenesis. We have also demonstrated that FISH is a viable alternative to CNV analysis, offering a number of advantages in the clinical setting. PMID: 30815392 [PubMed]

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Characterization of Hepatocellular Carcinoma Patients with FGF19 Amplification Assessed by Fluorescence in situ Hybridization: A Large Cohort Study.

Cell Type Diversity in Hepatitis B Virus RNA Splicing and Its Regulation.

Posted by on 26 Feb 2019 | Tagged as: Hepatitis B Alternative Medicine

Related Articles Cell Type Diversity in Hepatitis B Virus RNA Splicing and Its Regulation. Front Microbiol. 2019;10:207 Authors: Ito N, Nakashima K, Sun S, Ito M, Suzuki T Abstract Although RNA splicing of hepatitis B virus (HBV) is a commonly observed in livers of hepatitis B patients as well as in the cultured cells replicating the viral genome, its biological significance in the HBV life cycle and the detailed regulatory mechanisms are still largely unclear. In this study, we found cell-type dependency of HBV splicing of the 3.5 kb pregenomic RNA, which is efficiently spliced in human hepatoma cells but not in cells derived from human hepatic stellate, mouse hepatoma and human non-hepatic cells. It may be likely that RNA splicing is one of the determinants of host range restriction of HBV. Given the finding indicating the difference in cell-type dependency of the splicing efficiency between HBV and simian virus 40, we carried out intron-swapping experiments. The results suggest the presence of putative exonic splicing enhancer that possibly works in the cell-type dependent fashion. Together with further mutational analyses, a novel 50-nt intronic splicing silencer, whose secondary structure is well conserved among the HBV strains, was identified. It appears that this intronic silencer functions effectively independent of cell backgrounds. PMID: 30800119 [PubMed]

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Cell Type Diversity in Hepatitis B Virus RNA Splicing and Its Regulation.

Second-line Treatments of Advanced Hepatocellular Carcinoma: Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

Posted by on 24 Dec 2018 | Tagged as: Hepatitis B Alternative Medicine

Related Articles Second-line Treatments of Advanced Hepatocellular Carcinoma: Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. J Clin Gastroenterol. 2018 Dec 19;: Authors: Bakouny Z, Assi T, El Rassy E, Nasr F Abstract BACKGROUND: Advanced hepatocellular carcinoma (HCC) constitutes the second leading cause of cancer-related deaths. First-line therapy is either sorafenib or lenvatinib. Several treatment options have been recently added to the second-line treatment of advanced HCC. The aim of this network meta-analysis of randomized controlled trials was to compare the second-line treatments of advanced HCC. METHODS: Network meta-analyses were computed for overall survival (OS), progression-free survival, rates of grade 3 to 5 adverse events, and for treatment discontinuation due to adverse events. OS was considered to be the primary outcome of this study, and everolimus was chosen to be the common comparator for efficacy analyses and placebo for safety analyses. Subgroup analyses were computed for OS in patients with hepatitis B, patients with hepatitis C, Asian patients, patients with macrovascular invasion, and patients with extrahepatic metastases. RESULTS: Thirteen randomized controlled trials including 5076 patients and evaluating 11 agents were found to be eligible. Regorafenib [hazard ratio (HR)=0.60, 95% confidence interval (CI)=0.44-0.81] and cabozantinib (HR=0.72, 95% CI=0.55-0.95) were found to significantly prolong OS compared with everolimus. The effect of regorafenib on OS tended to be conserved across patient subgroups. Regorafenib was also found to significantly prolong progression-free survival (HR=0.46, 95% CI=0.35-0.62) and significantly increase the rates of grade 3 to 5 adverse events (odds ratios=3.18, 95% CI=2.22-4.54) and treatment discontinuation due to adverse events (odds ratios=2.67, 95% CI=1.21-5.87). CONCLUSIONS: This network meta-analysis concludes that, based on current evidence, regorafenib could be the agent of choice in the second-line treatment of HCC, with cabozantinib as a possible alternative for sorafenib-intolerant patients. PMID: 30575632 [PubMed – as supplied by publisher]

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Second-line Treatments of Advanced Hepatocellular Carcinoma: Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

The Role of Hepatitis B Surface Antigen in Nucleos(t)ide Analogues Cessation among Asian Chronic Hepatitis B Patients: A Systematic Review.

Posted by on 19 Dec 2018 | Tagged as: Hepatitis B Alternative Medicine

The Role of Hepatitis B Surface Antigen in Nucleos(t)ide Analogues Cessation among Asian Chronic Hepatitis B Patients: A Systematic Review. Hepatology. 2018 Dec 18;: Authors: Liu J, Li T, Zhang L, Xu A Abstract In actual clinical practice, infinite nucleos(t)ide analogues (NAs) treatment for chronic hepatitis B virus (HBV) infection is unrealistic. The most commonly used endpoint is suppression of HBV DNA to undetectable levels with normalization of alanine aminotransferase (ALT). However, this criterion for cessation of treatment is associated with various incidences of virological and clinical relapse. Recent studies suggest that decreasing hepatitis B surface antigen (HBsAg) level at the end of treatment (EOT) to an appropriate cutoff value appears to be a practicable and attainable cessation criterion. We performed a systematic review to explore the optimal cutoff value of HBsAg at EOT for the cessation of NAs treatment. Eleven studies with 1716 patients were included in this review. When the HBsAg levels at EOT were < 100 IU/mL and > 100 IU/mL, the respective off-therapy virological relapse rates were 9.1 (range) and 31.4 (range) at ≥ 12 months off-therapy regardless of HBeAg status, the respective off-therapy clinical relapse rates were 15.4 (range) and 48.1 (range) at ≥ 12 months off-therapy regardless of HBeAg status, and the respective off-therapy HBsAg loss rates were 21.1 (range) and 3.3 (range) for HBeAg-negative patients at ≥ 39 months off-therapy. Conclusion: Cessation of long-term NAs therapy prior to HBsAg seroclearance in patients with chronic hepatitis B is a feasible alternative to indefinite treatment. A HBsAg level < 100 IU/mL at EOT seems to be a useful marker for deciding when to discontinue NAs therapy. However, regular monitoring is required after the cessation of NAs treatment, and long-term outcomes must be further evaluated. This article is protected by copyright. All rights reserved. PMID: 30561829 [PubMed – as supplied by publisher]

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The Role of Hepatitis B Surface Antigen in Nucleos(t)ide Analogues Cessation among Asian Chronic Hepatitis B Patients: A Systematic Review.

Emergence of oncogenic-enhancing hepatitis B virus X gene mutants in patients receiving suboptimal entecavir treatment.

Posted by on 16 Dec 2018 | Tagged as: Hepatitis B Alternative Medicine

Emergence of oncogenic-enhancing hepatitis B virus X gene mutants in patients receiving suboptimal entecavir treatment. Hepatology. 2018 Dec 15;: Authors: Lin CL, Chu YD, Yeh CT Abstract Entecavir is a widely used nucleoside analogue for antiviral therapy against chronic hepatitis B virus (HBV) infection. Despite its remarkable efficacy in suppressing HBV replication, a substantial proportion of cirrhotic patients still developed hepatocellular carcinoma (HCC) after entecavir treatment (1). Presumably, it is largely attributed to the existing precancerous hepatocytes, which sturdily progresses into cancer despite effective viral suppression. HBV X (HBx) protein is a well-known oncogenic protein. Here, we explored an alternative possibility that oncogenic-enhancing mutations developed in HBx in HCC patients having received entecavir treatment. This article is protected by copyright. All rights reserved. PMID: 30552766 [PubMed – as supplied by publisher]

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Emergence of oncogenic-enhancing hepatitis B virus X gene mutants in patients receiving suboptimal entecavir treatment.

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