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Veterans health administration hepatitis B testing and treatment with anti-CD20 antibody administration

World Journal of Gastroenterology 2016年第19期22卷 4732-4740页

作者： Christine M Hunt Lauren A Beste Elliott Lowy Ayako Suzuki Cynthia A Moylan Hans L Tillmann George N Ioannou joseph k lim Michael J kelley Dawn Provenzale Department of Medicine Duke University School of Medicine Durham NC 27710 United States Department of Medicine Durham VA Medical Center Durham NC 27705 United States Department of Medicine Veterans Affairs Puget Sound Health Care System Seattle WA 98108 United States Health Services Research and Development Veterans Affairs Puget Sound Health Care System Seattle WA 98108 United States Department of Medicine University of Washington Seattle WA 98195 United States University of Washington School of Public Health Seattle WA 98195 United States Department of Medicine University of Arkansas for Medical Sciences Little Rock AR 72205 United States Division of Hepatology Central Arkansas Veterans Heathcare System Little Rock AR 72205 United States Department of Medicine Eastern Carolina University Greenville NC 27858 United States Yale Liver Center Section of Digestive Diseases Yale University School of Medicine New Haven CT 06520 United States Office of Patient Care Services Department of Veterans Affairs Washington DC 20420 United States Hematology-Oncology Service Durham Veterans Affairs Medical Center Durham NC 27705 United States Cooperative Studies Program Epidemiology Center-Durham Durham Veterans Affairs Medical Center Durham NC 27705 United States Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center Durham NC 27710 United States

AIM: To evaluate pretreatment hepatitis B virus (HBV) testing, vaccination, and antiviral treatment rates in Veterans Affairs patients receiving anti-CD20 Ab for quality ***: We performed a retrospective cohort study using a national repository of Veterans Health Administration (VHA) electronic health record data. We identified all patients receiving anti-CD20 Ab treatment (2002-2014). We ascertained patient demographics, laboratory results, HBV vaccination status (from vaccination records), pharmacy data, and vital status. The high risk period for HBV reactivation is during anti-CD20 Ab treatment and 12 mo follow up. Therefore, we analyzed those who were followed to death or for at least 12 mo after completing anti-CD20 Ab. Pretreatment serologic tests were used to categorize chronic HBV (hepatitis B surface antigen positive or HBsAg+), past HBV (HBsAg-, hepatitis B core antibody positive or HBcAb+), resolved HBV (HBsAg-, HBcAb+, hepatitis B surface antibody positive or HBsAb+), likely prior vaccination (isolated HBsAb+), HBV negative (HBsAg-, HBcAb-), or unknown. Acute hepatitis B was defined by the appearance of HBsAg+ in the high risk period in patients who were pretreatment HBV negative. We assessed HBV antiviral treatment and the incidence of hepatitis, liver failure, and death during the high risk period. Cumulative hepatitis, liver failure, and death after anti-CD20 Ab initiation were compared by HBV disease categories and differences compared using the χ2 test. Mean time to hepatitis peak alanine aminotransferase, liver failure, and death relative to anti-CD20 Ab administration and follow-up were also compared by HBV disease ***: Among 19304 VHA patients who received anti-CD20 Ab, 10224 (53%) had pretreatment HBsAg testing during the study period, with 49% and 43% tested for HBsAg and HBcAb, respectively within 6 mo pretreatment in 2014. Of those tested, 2% (167/10224) had chronic HBV, 4% (326/7903) past HBV, 5%

关键词： Hepatitis B Hepatitis B reactivation Anti-CD20 antibody Rituximab Lymphoma Chemotherapy Hepatitis B antivirals Vaccination Veteran

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Clinical Outcome Event Adjudication in a 10-Year Prospective Study of Nucleos(t)ide Analogue Therapy for Chronic Hepatitis B

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Journal of Clinical and Translational Hepatology 2020年第4期8卷 377-384页

作者： joseph k lim Alex Y Chang Atif Zaman Paul Martin Conrado M Fernandez-Rodriguez Mete korkmaz Simona Rossi James M Ford Tamara Noonan Elizabeth Cooney Victor Navarro Luis Colombato Yale University School of Medicine New HavenCTUSA Johns Hopkins School of Medicine BaltimoreMDUSA and Johns Hopkins SingaporeSingapore Oregon Health&Science University PortlandORUSA University of Miami Miller School of Medicine MiamiFLUSA Hospital Universitario Fundación Alcorcón MadridSpain OSF Saint Anthony Center for Cancer Care RockfordILUSA Einstein Healthcare Network PhiladelphiaPAUSA Stanford University School of Medicine StanfordCAUSA Bristol-Myers Squibb WallingfordCTUSA Hospital Británico UCA School of MedicineBuenos AiresArgentina

Background and Aims:In the REALM (Randomized, Obser-vational Study of Entecavir to Assess Long-Term Outcomes Associated with Nucleoside/Nucleotide Monotherapy for Pa-tients with Chronic HBV Infection) study, 12,378 patients with chronic hepatitis B virus (HBV) infection received up to 10 years of randomized therapy with entecavir or another HBV nucleos(t)ide analogue. Monitored clinical outcome events (COEs) included malignant neoplasms, HBV disease progres-sion events, and deaths. An external event adjudication com-mittee (EAC) was convened to provide real-time review of reported COEs to optimize data quality, and minimize poten-tial adverse effects of the large cohort, interdisciplinary out-come assessments, geographic scope, and long duration. Methods:The EAC comprised an international group of hep-atologists and oncologists with expertise in diagnosis of tar-geted COEs. The EAC reviewed and adjudicated COEs according to prospectively defined diagnostic criteria cap-tured in the EAC charter. Operational processes, including da-ta collection and query procedures, were implemented to optimize efficiency of data recovery to maximize capture of adjudicated COEs, the primary study outcome measure. Results: A total of 1724 COEs were reported and 1465 of these events were adjudicated by the EAC as reported by the investigators (85.0% overall concordance). Concordance by COE type varied: deaths, 99.6%;hepatocellular carcino-ma (HCC), 83.3%;non-HCC malignancies, 88.0%;non-HCC HBV disease progression, 68.2%. Reasons for lack of con-cordance were most commonly lack of adequate supporting data to support an adjudicated diagnosis or evidence that the event pre-dated the study. Conclusions: The REALM EAC performed a critical role in ensuring data quality and consis-tency;EAC performance was facilitated by well-defined diag-nostic criteria, effective data capture, and efficient operational processes. Trial registration: *** NCT00388674.

关键词： Hepatitis B Antiviral therapy Clinical outcomes Event adjudication Liver cirrhosis

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Hydroxycut hepatotoxicity:A case series and review of liver toxicity from herbal weight loss supplements

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World Journal of Gastroenterology 2008年第45期14卷 6999-7004页

作者： Lily Dara Jennifer Hewett joseph kartaik lim Department of Medicine Griffin Hospital Section of Digestive Diseases Yale University School of Medicine

Dietary supplements represent an increasingly common source of drug-induced liver injury. Hydroxycut is a popular weight loss supplement which has previously been linked to hepatotoxicity, although the individual chemical components underlying liver injury remain poorly understood. We report two cases of acute hepatitis in the setting of Hydroxycut exposure and describe possible mechanisms of liver injury. We also comprehensively review and summarize the existing literature on commonly used weight loss supplements, and their individual components which have demon-strated potential for liver toxicity. An increased effort to screen for and educate patients and physicians about supplement-associated hepatotoxicity is warranted.

关键词： Hydroxycut Dietary supplements Liver Liver failure Toxicity Weight loss Medicine Hepatitis

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Enhanced apoptosis in post-liver transplant hepatitis C:Effects of virus and immunosuppressants

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World Journal of Gastroenterology 2012年第18期18卷 2172-2179页

作者： Eu Jin lim Ruth Chin Peter W Angus joseph Torresi Liver Transplant Unit Austin HospitalHeidelbergVictoria 3084Australia Department of Medicine University of MelbourneAustin HealthHeidelbergVictoria 3084Australia Department of Infectious Diseases Austin HospitalHeidelbergVictoria 3084Australia

Hepatitis C(HCV)-infected patients have a poorer survival post-liver transplantation compared to patients transplanted for other indications,since HCV recurrence post-transplant is universal and commonly follows an aggressive *** is increasing evidence that in the non-transplant setting,induction of hepatocyte apoptosis is one of the main mechanisms by which HCV drives liver inflammation and fibrosis,and that HCV proteins directly promote *** studies have shown that post-liver transplant,there is a link between high levels of HCV replication,enhanced hepatocyte apoptosis and the subsequent development of rapidly progressive liver *** the responsible mechanisms remain unclear,it is likely that immunosuppressive drugs play an important *** is well known that immunosuppressants impair immune control of HCV,thereby allowing increased viral *** there is also evidence that immunosuppressants may directly induce apoptosis and this may be facilitated by the presence of high levels of HCV *** HCV and immunosuppressants may synergistically interact to further enhance apoptosis and drive more rapid *** findings suggest that modulation of apoptosis within the liver either by changing immunosuppressive therapy or the use of apoptosis inhibitors may help prevent fibrosis progression in patients with post-transplant HCV disease.

关键词： Hepatitis C Liver transplantation Apoptosis Immunosuppressive agents transforming growth factor-β

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Unintended targeting of Dmp1-Cre reveals a critical role for Bmpr1a signaling in the gastrointestinal mesenchyme of adult mice

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Bone Research 2017年第1期5卷 41-48页

作者： Joohyun lim joseph Burclaff Guangxu He Jason C Mills Fanxin Long Department of Orthopaedic Surgery Washington University School of MedicineSt.LouisMOUSA Division of Gastroenterology Departments of Medicine and Pathology and ImmunologyWashington University School of MedicineSt.LouisMOUSA Department of Orthopedics The Second Xiangya HospitalCentral South UniversityHunan 410011China Department of Developmental Biology Washington University School of MedicineSt.LouisMOUSA

Cre/loxP technology has been widely used to study cell type-specific functions of genes. Proper interpretation of such data critically depends on a clear understanding of the tissue specificity of Cre expression. The Dmpl- Cre mouse, expressing Cre from a 14-kb DNA fragment of the mouse Dmpl gene, has become a common tool for studying gene function in osteocytes, but the presumed cell specificity is yet to be fully established. By using the Ai9 reporter line that expresses a red fluorescent protein upon Cre recombination, we find that in 2-month-old mice, Dmpl-Cre targets not only osteocytes within the bone matrix but also osteoblasts on the bone surface and preosteoblasts at the metaphyseal chondro-osseous junction. In the bone marrow, Cre activity is evident in certain stromal cells adjacent to the blood vessels, but not in adipocytes. Outside the skeleton, Dmpl-Cre marks not only the skeletal muscle fibers, certain cells in the cerebellum and the hindbrain but also gastric and intestinal mesenchymal cells that express Pdgfra. Confirming the utility of Dmpl-Cre in the gastrointestinal mesenchyme, deletion of Bmprla with Dmpl-Cre causes numerous large polyps along the gastrointestinal tract, consistent with prior work involving inhibition of BMP signaling. Thus, caution needs to be exercised when using Dmpl-Cre because it targets not only the osteoblast lineage at an earlier stage than previously appreciated, but also a number of non-skeletal cell types.

关键词： gene cell bone Unintended targeting of Dmp1-Cre reveals a critical role for Bmpr1a signaling in the gastrointestinal mesenchyme of adult mice Figure

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Philippine retinoblastoma initiative multi-eye center study 2010-2020

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International Journal of Ophthalmology(English edition) 2024年第1期17卷 144-156页

作者： Roland joseph D.Tan Gary John V.Mercado Patricia E.Cabrera Paulita Pamela P.Astudillo Rolando Enrique D.Domingo Josept Mari S.Poblete Charmaine Grace M.Cabebe Adriel Vincent R.Te Melissa Anne S.Gonzales Jocelyn G.Sy Beltran Alexis A.Aclan Jayson T.So Fatima G.Regala kimberley Amanda k.Comia Josemaria M.Castro Mara Augustine S.Galang Aldous Dominic C.Cabanlas Benedicto Juan E.Aguilar Gabrielle S.Evangelista Jo Michael Maniwan Andrei P.Martin Calvin Y.Martinez John Alfred H.lim Rena Ivy Bascuna Rachel M.Ng kevin B.Agsaoay kris Zanna A.Acluba-Arao Ellaine Rose V.Apostol Beatriz M.Prieto Department of Ophthalmology and Visual Sciences Philippine General HospitalManila 1000Philippines Department of Ophthalmology Baguio General Hospital and Medical CenterBaguio City 2600Philippines Department of Ophthalmology Manila Doctors HospitalManila 1000Philippines Department of Ophthalmology Rizal Medical CenterPasig City 1600Philippines Department of Ophthalmology Jose B.Lingad Memorial Regional HospitalPampanga 2000Philippines Department of Ophthalmology Southern Philippines Medical CenterDavao City 8000Philippines Department of Ophthalmology East Avenue Medical CenterQuezon City 1100Philippines Department of Ophthalmology Northern Mindanao Medical CenterCagayan de Oro City 9000Philippines Department of Ophthalmology Cebu Velez General HospitalCebu City 6000Philippines Legazpi Eye Center Legazpi City 4500Philippines Department of Ophthalmology Cagayan Valley Medical CenterTuguegarao City 3500Philippines

AIM:To provide a comprehensive and more representative national data on the disease,especially on treatment options and outcomes,and to determine access of retinoblastoma patients from Luzon,Visayas and Mindanao to eye care,and determine if access is associated with delay in consultation,staging and ***:Cohort study of retinoblastoma patients seen in eleven institutions located in the three major areas of the Philippines namely Luzon,Vizayas and Mindanao from ***:Totally 636 patients,involving 821 eyes,were ***(57%)were from Luzon and were seen in institutions in Luzon(72%).Annually,58±10 new cases were seen with 71%having unilateral *** delay of consultation remained long at 9(3,17)mo,longest in patients with unilateral disease(P<0.02)and those from the Visayas(P<0.003).Based on the International Retinoblastoma Staging System,only 35%of patients had Stage 1 while 47%already had extraocular *** was the most common treatment received by 484 patients while intravenous chemotherapy was received by *** were 250(39%)patients alive,195(31%)dead,85(13%)abandoned,17(3%)refused and 89(14%)with no ***:This study presents the largest cohort of retinoblastoma patients in the Philippines in terms of patients’and participating institutions’number and geographical location and type of institution(private and public).It also presents more comprehensive data on the treatments used and outcomes(survival,globe salvage,and vision retention rates).Delay in consultation was still long among patients leading to advanced disease stage and lower survival *** increasing capacity to diagnose and manage retinoblastoma in the country,the delay of consultation remains long primarily due to accessibility issues to eye care institutions especially in the Visayas and financial *** delay was still significant that overall survival rate remain low.

关键词： retinoblastoma Philippines clinical profile

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Retreatment in locally recurrent nasopharyngeal carcinoma:Current status and perspectives

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Cancer Communications 2021年第5期41卷 361-370页

作者： Sharon Shuxian Poh Yoke lim Soong kiattisa Sommat Chwee Ming lim kam Weng Fong Terence Wk Tan Melvin Lk Chua Fu Qiang Wang Jing Hu joseph TS Wee Division of Radiation Oncology National Cancer Centre SingaporeSingapore 169610 Oncology Academic Clinical Programme Duke-NUS Graduate Medical SchoolSingapore 169857 Department of Otorhinolaryngology-Head and Neck Surgery Singapore General HospitalSingapore 169608 Surgery Academic Clinical Programme Duke-NUS Graduate Medical SchoolSingapore 169857

1 Background Nasopharyngeal carcinoma(NPC)arises from the epithelial cells that cover and line the *** it is considered a rare cancer globally,it is commonly observed in South China and a few other ethnically distinct racial *** to its propensity to spread early through the submucosal tissue and the highly infiltrative nature of this disease,NPC spreads easily through areas of lesser resistance within the pharyngobasilar fascia with a tendency for neural infiltration[1-3].

关键词： Nasopharyngeal Carcinoma Radiation Oncology Head and Neck Tumor

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Laparoscopic resection of gastrointestinal stromal tumors:Does laparoscopic surgery provide an adequate oncologic resection?

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World Journal of Gastrointestinal Endoscopy 2017年第9期9卷 448-455页

作者： joseph J kim James Y lim Scott Q Nguyen Department of Surgery Icahn School of Medicine at Mount SinaiNew YorkNY 10029United States

Gastrointestinal stromal tumors (GISTs) are rare tumors of the GI *** resection remains the mainstay of non-metastatic ***,the ability to provide an adequate oncologic resection using laparoscopic surgery is still an area of *** is a thorough review of the current literature,looking particularly at the use of laparoscopic surgery for larger GISTs and the long-term oncologic outcomes compared to the results of open *** resections provide an adequate oncologic result for GISTs of all sizes,including those greater than 5 cm in size.

关键词： Gastrointestinal stromal tumors Oncologic Laparoscopy Surgery

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Complication rates in emergent endoscopy for foreign bodies under different sedation modalities:A large single-center retrospective review

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World Journal of Gastrointestinal Endoscopy 2021年第2期13卷 45-55页

作者： Ming-Han Cha Rashi Sandooja Saher khalid Nicole Lao joseph lim Roshan Razik Department of Internal Medicine Cleveland Clinic Akron GeneralAkronOH 44307United States Department of Gastroenterology Cleveland Clinic Akron GeneralAkronOH 44307United States

BACkGROUND Foreign object ingestion(FOI)and food bolus impaction(FBI)are common causes of emergent endoscopic *** choice of sedation used is often dictated by physician *** endoscopists frequently prefer to use monitored anesthesia care(MAC)and general anesthesia(GA)as opposed to conscious sedation(CS)due to the concern for inadequate airway ***,there is insufficient data examining the safety of different sedation modalities in emergent endoscopic management of FOI and *** To investigate the complication rates of emergent endoscopic extraction performed under different sedation *** We conducted a retrospective chart review of patients presenting with acute FBI and FOI between 2010 and 2018 in two hospitals.A standardized questionnaire was utilized to collect data on demographics,endoscopic details,sedation practices,hospital stay and adverse *** recognized during and within 24 h of the procedure were considered early,whereas patients presenting with a procedure-related adverse event within two weeks of the index event were considered delayed *** rates of patients who underwent emergent endoscopic retrieval were compared based on sedation types,namely CS,MAC and ***-square analysis and multiple logistic regression were used to compare complication rate based on sedation *** Among the 929 procedures analyzed,353 procedures(38.0%)were performed under CS,278 procedures(29.9%)under MAC and the rest(32.1%)under *** median age of the subjects was 52 years old,with 57.4%being *** majority of the procedures(64.3%)were FBI with the rest being FOI(35.7%).A total of 132 subjects(14.2%)had chronic comorbidities while 29.0%had psychiatric *** most commonly observed early complications were mucosal laceration(3.8%)and bleeding(2.6%).The most common delayed complication was aspiration pneumonia(1.8%).A total of 20 patients(5.6%)could not adequately be sed

关键词： Foreign body Food bolus impaction Endoscopy Sedation Anesthesia Complications

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Phenothiazine vs 5HT3 Antagonist Prophylactic Regimens to Prevent Post‐Anesthesia Care Unit Rescue Antiemetic: An Observational Study

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Open Journal of Anesthesiology 2015年第2期5卷 27-32页

作者： joseph R. Ruiz Joe E. Ensor Jeffrey W. lim Antoinette Van Meter Thomas F. Rahlfs Department of Anesthesiology and Perioperative Medicine The University of Texas MD Anderson Cancer Center Houston USA Department of Biostatistics The University of Texas MD Anderson Cancer Center Houston USA

Purpose: Our practitioners are asked to consider a patient’s postoperative nausea and vomiting (PONV) risk profile when developing their prophylactic antiemetic strategy. There is wide variation in employed strategies, and we have yet to determine the most effective PONV prophylactic regimen. The objective of this study is to compare prophylactic antiemetic regimens containing: phenothiazines to 5HT3 antagonists for effectiveness at reducing the incidence of Post‐Anesthesia Care Unit (PACU) rescue antiemetic administration. Methods: This is an observational study of 4392 nonsmoking, women who underwent general anesthesia for breast surgery from 1/1/2009 through 6/30/2012. Previous history of PONV or motion sickness (HxPONV/MS) and the use of PACU opioids were recorded. Prophylactic antiemetic therapy was left to the discretion of the anesthesia care team. We compared phenothiazines and 5HT3 antagonists alone and with a glucocorticoid to determine the most effective treatment regimen in our practice for the prevention of the administration of PACU rescue antiemetics. Results: Patients who received a phenothiazine regimen compared to a 5HT3 antagonist regimen were less likely to have an antiemetic administered in the PACU (p = 0.0100) and this significant difference in rates holds in a logistic regression model adjusted for HxPONV/MS and PACU Opioid use (p = 0.0103). Conclusions: Based on our findings our clinicians are encouraged to administer a combination of a phenothiazine and a glucocorticoid in female, nonsmoking surgical breast patients for the prevention of PACU rescue antiemetic administration.

关键词： Phenothiazines 5HT3 Antagonists Prophylactic Antiemetics PACU Antiemetic Administration

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