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Importance of adequate immunosuppressive therapy for the recovery of patients with "life-threatening" severe exacerbation of chronic hepatitis B

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World Journal of Gastroenterology 2005年第8期11卷 1109-1114页

作者： Keiichi Fujiwara Osamu Yokosuka Hiroshige Kojima tatsuo kanda Hiromitsu Saisho Hiroyuki Hirasawa Hiroshi Suzuki Department of Medicine and Clinical Oncology Department of Emergency and Critical Care Medicine Department of Surgery

AIM: Hepatitis B virus (HBV) re-activation often occurs spontaneously or after withdrawal of immunosuppressive therapy in patients with chronic hepatitis B. Severe exacerbation, sometimes developing into fulminant hepatic failure, is at high risk of mortality. The efficacy of corticosteroid therapy in 'clinically severe' exacerbation of chronic hepatitis B has not been well demonstrated. In this study we evaluated the efficacy of early introduction of high-dose corticosteroid therapy in patients with life-threatening severe exacerbation of chronic hepatitis B. METHODS: Twenty-two patients, 14 men and 8 women, were defined as 'severe' exacerbation of chronic hepatitis B using uniform criteria and enrolled in this study. Eleven patients were treated with corticosteroids at 60 mg or more daily with or without anti-viral drugs within 10 d after the diagnosis of severe disease ('early high-dose' group) and 11 patients were either treated more than 10 d or untreated with corticosteroids ('non-early high-dose' group). RESULTS: Mean age, male-to-female ratio, mean prothrombin time (FT) activity, alanine transaminase (ALT) level, total bilirubin level, positivity of HBeAg, mean IgM-HBc titer, and mean HBV DNA polymerase activity did not differ between the two groups. Ten of 11 patients of the 'early high-dose' group survived, while only 2 of 11 patients of the 'non-early high-dose' group survived (P<0.001). During the first 2 wk after the introduction of corticosteroids, improvements in PT activities and total bilirubin levels were observed in the 'early high-dose' group. Both ALT levels and HBV DNA polymerase levels fell in both groups. CONCLUSION: The introduction of high-dose corticosteroid can reverse deterioration in patients with 'clinically life-threatening' severe exacerbation of chronic hepatitis B , when used in the early stage of illness.

关键词： Chronic hepatitis B Severe exacerbation Immunosuppressive therapy

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Hepatitis C virus genotypes in Myanmar

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World Journal of Gastroenterology 2016年第27期22卷 6095-6099页

作者： Nan Nwe Win tatsuo kanda Shingo Nakamoto Osamu Yokosuka Hiroshi Shirasawa Department of Molecular Virology Chiba University Chuo-ku Chiba 260-8670 Japan Department of Gastroenterology and Nephrology Chiba University Chuo-ku Chiba 260-8670 Japan

Myanmar is adjacent to India, Bangladesh, Thailand, Laos and China. In Myanmar, the prevalence of hepatitis C virus(HCV) infection is 2%, and HCV infection accounts for 25% of hepatocellular carcinoma. In this study, we reviewed the prevalence of HCV genotypes in Myanmar. HCV genotypes 1, 3 and 6 were observed in volunteer blood donors in and around the Myanmar city of Yangon. Although there are several reports of HCV genotype 6 and its variants in Myanmar, the distribution of the HCV genotypes has not been well documented in areas other than Yangon. Previous studies showed that treatment with peginterferon and a weight-based dose of ribavirin for 24 or 48 wk could lead to an 80%-100% sustained virological response(SVR) rates in Myanmar. Current interferon-free treatments could lead to higher SVR rates(90%-95%) in patients infected with almost all HCV genotypes other than HCV genotype 3. In an era of heavy reliance on direct-acting antivirals against HCV, there is an increasing need to measure HCV genotypes, and this need will also increase specifically in Myanmar. Current available information of HCV genotypes were mostly from Yangon and other countries than Myanmar. The prevalence of HCV genotypes in Myanmar should be determined.

关键词： Direct-acting antivirals Genotypes Hepatitis C virus Interferon-free Myanmar

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Nonalcoholic fatty liver disease and hepatic cirrhosis: comparison with viral hepatitis-associated steatosis

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World Journal of Gastroenterology 2015年第46期21卷 12989-12995页

作者： Yuki Haga tatsuo kanda Reina Sasaki Masato Nakamura Shingo Nakamoto Osamu Yokosuka Department of Gastroenterology and Nephrology Chiba UniversityGraduate School of Medicine Department of Molecular Virology Chiba UniversityGraduate School of Medicine

Nonalcoholic fatty liver disease(NAFLD) including nonalcoholic steatohepatitis(NASH) is globally increasing and has become a world-wide health problem. Chronic infection with hepatitis B virus or hepatitis C virus(HCV) is associated with hepatic steatosis. Viral hepatitis-associated hepatic steatosis is often caused by metabolic syndrome including obesity,type 2 diabetes mellitus and/or dyslipidemia. It has been reported that HCV genotype 3 exerts direct metabolic effects that lead to hepatic steatosis. In this review,the differences between NAFLD/NASH and viral hepatitis-associated steatosis are discussed.

关键词： Hepatocellular carcinoma Hepatitis B virus Hepatit

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Effect of lamivudinein in BeAg-positive chronic hepatitis B: Discordant effect on HBeAg and HBV DNA according to pretreatment ALT level

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World Journal of Gastroenterology 2005年第22期11卷 3346-3350页

作者： Tomoko Kurihara Fumio Imazeki Osamu Yokosuka Kenichi Fukai tatsuo kanda Shigenobu Kawai Hiromitsu Saisho Department of Medicine and Clinical Oncology Graduate School of Medicine Chiba University 1-8-1 Inohana Chuou Ward Chiba 260-8670Japan

AM: To clarify differences in antiviral effect of the drug in patients with different ALT levels, we examined the changes in HBV markers in patients with high or low ALT levels with or without lamivudine treatment. METHODS: Thirty-seven HBeAg-positive patients were studied. Ten patients with ALT levels higher than 200 IU/L (group 1) and 8 patients with ALT below 200 IU/L (group 2) were treated orally with 100 mg/d of lamivudine. As untreated control, 9 patients with ALT above 200 IU/L (group 3) and 10 patients with ALT below 200 IU/L (group 4) were examined. ALT level, HBeAg/HBeAb status, and HBV DNA level were examined monthly for 11.9±0.4 mo. RESULTS: The ALT level normalized in all 10 patients of group 1, 7/8 of group 2, 4/9 of group 3, and 1/10 of group 4 within 6 mo (groups 1 vs2, P= NS; groups 1 vs 3, P= 0.002; groups 1 vs4, P<0.0001). HBV DNA fell below the detection limit in all 10 patients of group 1, 7/8 of group 2, 0/9 of group 3, and 0/10 of group 4 within 6 mo (groups 1 vs 2, P - NS). HBeAg became seronegative in 7/10 patients of group 1, 1/8 of group 2, 3/9 of group 3, and 0/10 of group 4 within 12 mo (groups 1 vs2, P= 0.02; groups 1 vs 3, P= NS). CONCLUSION: Our data suggest that HBeAg-positive patients with higher ALT levels can be considered good candidates for lamivudine therapy, probably because lamivudine accelerates the natural seroconversion of HBeAg, accompanied by HBV DNA loss, in these patients.

关键词： Lamivudine Chronic hepatitis B HBeAg HBV DNA ALT

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Successful treatment for esophageal carcinoma with lung metastasis by induction chemotherapy followed by salvage esophagectomy: Report of a case

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World Journal of Gastroenterology 2006年第25期12卷 4101-4103页

作者： Shin Ichi Kosugi tatsuo kanda Tadashi Nishimaki Satoru Nakagawa Kazuhito Yajima Manabu Ohashi Katsuyoshi Hatakeyama Division of Digestive and General Surgery Niigata University Graduate School of Medical and Dental Sciences Niigata CityJapan First department of Surgery Faculty of Medicine University of the RyukyusOkinawaJapan

We here report a case of a 51-year-old man with lung metastasis from esophageal carcinoma that was initially treated by combination chemotherapy consisting of fluorouracil and nedaplatin. Because metastatic disease disappeared, salvage esophagectomy was performed. Although chest wall recurrence developed at the thoracotomy wound, prolonged survival of 48 months was achieved by local tumor resection and additional chemotherapy. This combination chemotherapy is regarded as a promising and considerable treatment for metastatic esophageal carcinoma.

关键词： Esophageal carcinoma Lung metastasis Induction chemotherapy Fluorouracil Nedaplatin Salvage esophagectomy

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Direct-acting Antiviral Agents for the Treatment of Chronic Hepatitis C Virus Infection

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Journal of Clinical and Translational Hepatology 2014年第1期2卷 1-6页

作者： tatsuo kanda Shingo Nakamoto Masato Nakamura Xia Jiang tatsuo Miyamura Shuang wu Osamu Yokosuka Department of Gastroenterology and Nephrology Chiba University Graduate School of Medicine Inohana Chuo-ku Chiba Japan

Hepatitis C virus (HCV) is a leading cause of cirrhosis and hepatocellular carcinoma (HCC) in the US and ***,eradication of HCV may reduce the occurrence of HCC in HCV-infected *** 2011,the use of firstgeneration HCV NS3/4A protease inhibitors such as telaprevir and boceprevir was initiated for clinical treatment of *** of telaprevir and boceprevir plus peginterferon and ribavirin increased rates of sustained virological response (SVR) in HCV genotype 1-infected ***,this treatment regimen also led to severe adverse ***-generation direct-acting antiviral agents (DAAs) for HCV,such as simeprevir plus peg-interferon and ribavirin also resulted in higher SVR rates,with similar adverse events to other peg-interferon and ribavirin *** SVR rates in HCV genotype 1-and 2-infected patients were achieved with 12-16 weeks of sofosbuvir plus other class DAAs with/without ribavirin and 12 weeks of sofosbuvir plus ribavirin,respectively,For "difficult-to-treat"HCV-infected patients,more therapeutic options are *** studies examining the efficacy and adverse effects of such therapies will be required for the development of additional treatments.

关键词： Daclatasvir Interferon-free Protease inhibitors Simeprevir Sofosbuvir

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Severe hypercholesterolemia associated with primary biliary cirrhosis in a 44-year-old Japanese woman

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World Journal of Gastroenterology 2004年第17期10卷 2607-2608页

作者： tatsuo kanda Osamu Yokosuka Hiroshige Kojima Fumio Imazeki Keiich Nagao Ichiro Tatsuno Yasushi Saito Hiromitsu Saisho First Department of Medicine Chiba University School of MedicineChiba 260-8670Japan Health Sciences CenterChiba UniversityChiba 260-8670Japan Health Sciences Center Chiba UniversityChiba 260-8670Japan Second Department of Medicine Chiba University School of MedicineChiba 260-8670Japan

A 44-year-old woman developed jaundice and was diagnosed as stage Ⅱ of primary biliary cirrhosis(PBC).She showed a severely high total cholesterol *** article focuses on atypical presentations of PBC and the need to ... 详细信息

关键词： Adult Cholesterol Female Humans Hypercholesterolemia Japan Liver Cirrhosis, Biliary Severity of Illness Index

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Antiviral therapy for ＂difficult-to-treat＂ hepatitis C virus-infected patients

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Chinese Medical Journal 2013年第23期126卷 4568-4574页

作者： tatsuo kanda Osamu Yokosuka Masao Omata Department of Gastroenterology and Nephrology Chiba UniversityGraduate School of Medicine 1-8-1 Inohana Chuo-ku Chiba Japan Yamanashi Hospitals(Central and Kita)Organization 1-1-1 FujimiKofu-shi Yamanashi Japan University of Tokyo 7-3-1 Hongo Bunkyo-ku Tokyo Japan

Objective To review the updated research on direct antiviral agents （DAAs）-including regimens for hepatitis C virus （HCV）,and focus on ＂difficult-to-treat＂ HCV-infected *** sources The literature concerning DAAs and hepatitis C cited in this review was collected from PubMed and Google Scholar databases published in English up to July *** selection Data from published articles regarding HCV and DAAs in clinical trials and in clinical use were identified and *** It was recognized that some ＂difficult-to-treat＂ patients would still exist,even though stronger treatments using such as DAAs,including telaprevir and boceprevir,which lead to higher sustained virological response rates,are *** patients include those with advanced fibrosis/cirrhosis,elderly persons,children,HCV-human immunodeficiency virus co-infected patients,HCV-infected recipients,and so *** Certain ＂difficult-to-treat＂ patients would still exist,even though stronger treatment is *** evidence from clinical trials is still lacking,interferon-sparing regimens could have stronger effects for eradicating HCV in such cases.

关键词： advanced cirrhosis direct antiviral agents elderly hepatocellular carcinoma hepatitis C virus interferon-free treatment liver transplant

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Multiple carcinoids in the duodenum, pancreas and stomach accompanied with type A gastritis: A case report

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World Journal of Gastroenterology 2007年第15期13卷 2247-2249页

作者： Takeo Bamba Shin-ichi Kosugi tatsuo kanda Toshihiro Tsubono Yasuo Sakai Nobuyuki Musha Noriko Ishihara Katsuyoshi Hatakeyama Division of Digestive and General Surgery Niigata University Graduate School of Medical and Dental Sciences Japan Division of Surgery Saiseikai Niigata Daini Hospital Japan Division of Pathology Saiseikai Niigata Daini Hospital Japan

We report a case of multiple duodenal, pancreatic, and gastric carcinoids. A 67-year old woman was admitted to our hospital for treatment of a duodenal carcinoid. Laboratory tests revealed that the patient was associated with macrocytic anemia and hypergastrinemia, and type A gastritis was shown by gastrofiberscopy. During surgery, another tumor was incidentally found in the head of the pancreas. The tumors in the duodenum and pancreas were completely excised by pancreatoduodenectomy and immunohistologically diagnosed as gastrin-and serotonin-producing carcinoids, respectively. Pathological examination revealed that in addition to the grossly found carcinoids, there were subclinical carcinoids, one of which was an endocrine cell micronest, located in the stomach and duodenum. The tumors in the duodenum, pancreas, and stomach showed different characteristics from one another morphologically and immunochemically. Although no definitive evidence has been obtained, some sort of genetic anomaly may have been involved in this case, and hypergastrinemia due to duodenal gastrinoma may induce multiple gastric carcinoids.

关键词： Carcinoid Stomach Duodenum Pancreas Type A gastritis

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Retreatment of patients with treatment failure of directacting antivirals: Focus on hepatitis C virus genotype 1b

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World Journal of Gastroenterology 2017年第46期23卷 8120-8127页

作者： tatsuo kanda Kazushige Nirei Naoki Matsumoto Teruhisa Higuchi Hitomi Nakamura Hiroaki Yamagami Shunichi Matsuoka Mitsuhiko Moriyama Division of Gastroenterology and Hepatology Department of Internal MedicineNihon University School of Medicine

The recent development of direct-acting antiviral agents(DAAs) against hepatitis C virus(HCV) infection could lead to higher sustained virological response(SVR) rates, with shorter treatment durations and fewer adverse events compared with regimens that include interferon. However, a relatively small proportion of patients cannot achieve SVR in the first treatment, including DAAs with or without peginterferon and/or ribavirin. Although retreatment with a combination of DAAs should be conducted for these patients, it is more difficult to achieve SVR when retreating these patients because of resistance-associated substitutions(RASs) or treatment-emergent substitutions. In Japan, HCV genotype 1 b(GT1 b) is founded in 70% of HCVinfected individuals. In this minireview, we summarize the retreatment regimens and their SVR rates for HCV GT1 b. It is important to avoid drugs that target the regions targeted by initial drugs, but next-generation combinations of DAAs, such as sofosbuvir/velpatasvir/voxilaprevir for 12 wk or glecaprevir/pibrentasvir for 12 wk, are proposed to be potential solution for the HCV GT1 b-infected patients with treatment failure, mainly on a basis of targeting distinctive regions. Clinicians should follow the new information and resources for DAAs and select the proper combination of DAAs for the retreatment of HCV GT1 b-infected patients with treatment failure.

关键词： Direct-acting antiviral agent Genotype 1b Hepatitis C virus Resistance-associated substitutions

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