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Barcelona Clinic Liver Cancer outperforms Hong Kong Liver Cancer staging of hepatocellular carcinoma in multiethnic Asians: Real-world perspective

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World Journal of Gastroenterology 2017年第22期23卷 4054-4063页

作者： James Weiquan Li boon-Bee George Goh Pik-eu Chang Chee-Kiat Tan Department of Gastroenterology and Hepatology Duke-NUS Medical School

To compare the Barcelona Clinic Liver Cancer (BCLC) and Hong Kong Liver Cancer (HKLC) classification systems when applied to HCC patients from the largest tertiary-level centre in *** thousand two hundred and seventy hepatocellular carcinoma (HCC) patients prospectively enrolled in a tertiary-level centre registry in Singapore since 1988 were studied. Patients were grouped into their respective BCLC and HKLC stages. Data such as demography, aetiology of HCC and type of treatment were collected. Survival data was based on census with the National Registry of Births and Deaths on 31st October 2015. Statistical analyses were done using SPSS version 21 (Chicago, IL, United States). Survival analyses were done by the Kaplan-Meier method. Differences in survival rates were compared using the log-rank *** median age at presentation was 63 years (range 13-94); male 82.4%; Chinese 89.4%, Malay 7.1%, Indian, 2.8%. Hepatitis B was the predominant aetiology (75.0%; Hepatitis C 7.2%, Hepatitis B and C co-infection 3.8%, non-viral 14.0%). Both BCLC and HKLC staging systems showed good separation with overall log rank test confirming significant survival differences between stages in our cohort (P < 0.001). 206 out of the 240 patients (85.8%) assigned for curative treatment by the BCLC treatment algorithm received curative therapy for HCC [Stage 0 93.2% (68/73); Stage A 82.6% (138/167)]. In contrast, only 341/558 (61.1%) patients received curative treatment despite being assigned for curative treatment by the HKLC treatment algorithm [Stage I 72.7% (264/363); Stage II 40.2% (66/164); Stage Va 35.5% (11/31)]. Patients who were assigned to curative treatment by HKLC but did not receive curative treatment had significantly poorer ECOG (P < 0.001), higher Child-Pugh status (P < 0.001) and were older (median age 66 vs 61, P < 0.001) than those who received curative therapy. Median overall survival in patients assigned to curative treatment groups

关键词： Hepatocellular carcinoma Barcelona Clinic Liver Cancer Hong Kong Liver Cancer Staging systems Prognosis Survival

Low serum albumin predicts early mortality in patients with severe hypoxic hepatitis

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World Journal of Hepatology 2017年第22期9卷 959-966页

作者： Pik-eu Chang boon-Bee George Goh Victoria Ekstrom Ming-Liang Ong Chee-Kiat Tan Department of Gastro enterology and Hepatology Singapore General Hospital Duke-NUS Medical School

To evaluate the incidence, etiology, and predictors of mortality of severe hypoxic hepatitis. METHODSWe used computerized patient records to identify consecutive cases of severe hypoxic hepatitis admitted to a tertiary hospital in Singapore over a one-year period. We defined severe hypoxic hepatitis as elevation of serum transaminases more than 100 times upper limit of normal in the clinical setting of cardiac, circulatory or respiratory failure after exclusion of other causes of hepatitis. We used multivariable regression analysis to determine predictors for mortality. RESULTSWe identified 75 cases of severe hypoxic hepatitis out of 71380 hospital admissions over one year, providing an incidence of 1.05 cases per 1000 admissions. Median age was 65 years (range 19-88); 57.3% males. The most common etiologies of severe hypoxic hepatitis were acute myocardial infarction and sepsis. Fifty-three patients (71%) died during the hospitalization. The sole independent predictive factor for mortality was serum albumin measured at the onset of severe hypoxic hepatitis. Patients with low serum albumin of less than 28 g/L have more than five-fold increase risk of death (OR = 5.39, 95%CI: 1.85-15.71). CONCLUSIONSevere hypoxic hepatitis is uncommon but has a high mortality rate. Patients with low serum albumin are at highest risk of death.

关键词： Severe Mortality Albumin Incidence Hypoxic hepatitis Predictors Etiology Prognosis

Clinical applications, limitations and future role of transient elastography in the management of liver disease

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2016年第1期7卷 91-106页

作者： Pik eu Chang George boon-Bee Goh Jing Hieng Ngu Hiang Keat Tan Chee Kiat Tan Department of Gastroen- terology and Hepatology Singapore General Hospital George boon-Bee Goh Duke- NUS Graduate Medical School

Transient elastography(TE) is a reliable tool for the non-invasive assessment of liver fibrosis in routine clinical practice. TE is currently approved for use in europe, Asia and the United States. The widespread adoption of this technology is certain to increase the use of TE worldwide. Although TE has been well validated in chronic viral hepatitis, its clinical role in other liver diseases remains less clear. The advent of new treatment for chronic hepatitis C and emerging prevalence of non-alcoholic steatohepatitis raises new questions on the role of TE in current clinical practice. This review aims to examine the clinical applications, limitations and future role of TE in current clinical practice in light of the changing epidemiology of liver diseases and new clinical management paradigms. In current clinical practice, TE is the most accurate noninvasive method for diagnosis of liver cirrhosis. TE is useful to rule out fibrosis and cirrhosis but does not have sufficient accuracy to discern between various stages of fibrosis. The clinical role of TE has evolved from cross-sectional point-in-time assessment of fibrosis and cirrhosis to the more relevant role of prediction of vital clinical end-points. This provides clinicians with the ability to modify treatment strategies based on the information provided by TE. TE has evolved over the past decade to become an essential tool to assist the clinician in the management of chronic liver disease.

关键词： Liver stiffness Transient elastography Non-invasive Fibrosis Chronic

Cashless payment and economic growth

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Financial Innovation 2016年第1期2卷 49-57页

作者： Hock-Han Tee Hway-boon Ong Economics Unit Faculty of ManagementMultimedia UniversityPersiaran Multimedia63100 CyberjayaMalaysia

Background:This study examines the effect of adopting cashless payment in five european Union(eu)countries,namely,Austria,Belgium,France,Germany,and Portugal,for the period of ***:The within and between effect of adopting cheque payment,telegraphic transfer,card payment and electronic money on these eu’s economy are examined by applying the Pedroni residual cointergration and Panel Vector Error Correction Model(VECM).Results:There is short run causality running from cheque payment to telegraphic transfer and card payment,as well as causality running telegraphic transfer to card *** the long run,there is significant effect of adopting cashless payment on the economy of the five eu ***:The adoption of one type of cashless payment will affect another type of cashless payment in the short *** impact of adopting cashless payment on economic growth can only be significantly observed in the long ***,any policy that promotes cashless payment will not affect the economy immediately.

关键词： VECM payment money