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Carvedilol Versus Other Nonselective Beta Blockers for Variceal Bleeding Prophylaxis and Death: A Network Meta-analysis

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Journal of Clinical and Translational Hepatology 2023年第5期11卷 1143-1149页

作者： ka-shing cheung Chiu-Hang Mok Lok-ka Lam Xian-Hua Mao Lung-Yi Mak Wai-kay Seto Man-Fung Yuen Department of Medicine School of Clinical MedicineThe University of Hong KongQueen Mary HospitalHong KongChina Department of Medicine The University of Hong Kong-Shenzhen HospitalShenzhenGuangdongChina School of Clinical Medicine The University of Hong KongHong KongChina State Key Laboratory of Liver Research The University of Hong KongHong KongChina

Background and Aims:We aimed to perform a network meta-analysis(NWM)to examine comparative effectiveness of non-selective beta blockers(NSBBs)on prophylaxis of gastroesophageal variceal bleeding(GVB)and mortality ***:MEDLINE(OVID)and EMBASE databases were searched for eligible randomized clinical trials(RCTs)from inception to July 3,*** of interest included primary/secondary prophylaxis of GVB,failure to achieve hepatic venous pressure gradient(HVPG)decremental response,liver-related and all-cause mortality.A Bayesian NWM was performed to derive relative risk(RR)with 95%credible intervals(CrIs).The ranking probability of each NSBB was assessed by surface under cumulative ranking curve(SUCRA).Results:Thirty-three RCTs including 3,188 cirrhosis patients with gastroesophageal varices were *** with placebo,nadolol ranked first for reducing variceal bleeding[RR:0.25,(95%CrI:0.11–0.51);SUCRA:0.898],followed by carvedilol[RR:0.33,(95%CrI:0.11–0.88);SUCRA:0.692]and propranolol[RR:0.52,(95%CrI:0.37–0.75);SUCRA:0.405].Carvedilol was more effective than propranolol in achieving HVPG decremental response[RR:0.43,(95%CrI:0.26–0.69)].Carvedilol ranked first for reducing all-cause mortality[RR:0.32,(95%CrI:0.17–0.57);SUCRA:0.963],followed by nadolol[RR:0.48,(95%CI:0.29–0.77);SUCRA:0.688],and propranolol[RR:0.77,(95%CI:0.58–1.02);SUCRA:0.337].Similar findings were observed for liver-related *** ranked the *** RR of adverse events was 4.38,(95%CrI:0.33–161.4);SUCRA:0.530,followed by propranolol[RR:7.54,(95%CrI:1.90–47.89);SUCRA:0.360],and nadolol[RR:18.24,(95%CrI:91.51–390.90);SUCRA:0.158].Conclusions:Carvedilol is the preferred NSBB with better survival benefit and lower occurrence of adverse events among patients with gastroesophageal varices.

关键词： NSBB Carvedilol Nadolol Propranolol Varices Cirrhosis CPSH

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Gastrointestinal bleeding in patients on novel oral anticoagulants:Risk,prevention and management

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World Journal of Gastroenterology 2017年第11期23卷 1954-1963页

作者： ka-shing cheung Wai K Leung Department of Medicine The University of Hong KongQueen Mary HospitalHong KongChina

Novel oral anticoagulants(NOACs), which include direct thrombin inhibitor(dabigatran) and direct factor Xa inhibitors(rivaroxaban, apixaban and edoxaban), are gaining popularity in the prevention of embolic stroke in non-valvular atrial fibrillation as well as in the prevention and treatment of venous thromboembolism. However, similar to traditional anticoagulants, NOACs have the side effects of bleeding, including gastrointestinal bleeding(GIB). Results from both randomized clinical trials and observations studies suggest that high-dose dabigatran(150 mg b.i.d), rivaroxaban and high-dose edoxaban(60 mg daily) are associated with a higher risk of GIB compared with warfarin. Other risk factors of NOAC-related GIB include concomitant use of ulcerogenic agents, older age, renal impairment, Helicobacter pylori infection and a past history of GIB. Prevention of NOAC-related GIB includes proper patient selection, using a lower dose of certain NOACs and in patients with renal impairment, correction of modifiable risk factors, and prescription of gastroprotective agents. Overt GIB can be managed by withholding NOACs followed by delayed endoscopic treatment. In severe bleeding, additional measures include administration of activated charcoal, use of specific reversal agents such as idarucizumab for dabigatran and andexanent alfa for factor Xa inhibitors, and urgent endoscopic management.

关键词： Warfarin Endoscopy Apixaban Edoxaban Gastrointestinal bleeding Dabigatran Rivaroxaban Novel anticoagulants

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Risk of gastric cancer development after eradication of Helicobacter pylori

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World Journal of Gastrointestinal Oncology 2018年第5期10卷 115-123页

作者： ka-shing cheung Wai K Leung Department of Medicine The University of Hong Kong Queen Mary Hospital

Helicobacter pylori(H. pylori) infection is the most important risk factor for gastric cancer(gc) development through the correa's gastric carcinogenesis cascade. However, H. pylori eradication alone does not eliminate gc, as pre-neoplastic lesions(atrophic gastritis, intestinal metaplasia and dysplasia) may have already developed in some patients. It is therefore necessary to identify patients at high-risk for gastric cancer after H. pylori eradication to streamline the management plan. If the patients have not undergone endoscopy with histologic assessment, the identification of certain clinical risk factors and non-invasive testing(serum pepsinogen) can predict the risk of atrophic gastritis. For those with suspected atrophic gastritis, further risk stratification by endoscopy with histologic assessment according to validated histologic staging systems would be advisable. Patients with higher stages may require long-term endoscopic surveillance. Apart from secondary prevention to reduce deaths by diagnosing gc at an early stage, identifying medications that could potentially modify the gc risk would be desirable. The potential roles of a number of medications have been suggested by various studies, including proton pump inhibitors(PPIs), aspirin, statins and metformin. However, there are currently no randomized clinical trials to address the impact of these medications on gc risk after H. pylori eradication. In addition, most of these studies failed to adjust for the effect of concurrent medications on gc risk. Recently, large population-based retrospective cohort studies have shown that PPIs were associated with an increased gc risk after H. pylori eradication, while aspirin was associated with a lower risk. The roles of other agents in reducing gc risk after H. pylori eradication remain to be determined.

关键词： Gastric adenocarcinoma Stomach cancer Helicobacter pylori Chemoprevention Intestinal metaplasia

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Application of Big Data analysis in gastrointestinal research

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World Journal of Gastroenterology 2019年第24期25卷 2990-3008页

作者： ka-shing cheung Wai K Leung Wai-kay Seto Department of Medicine The University of Hong KongQueen Mary HospitalHong KongChina Department of Medicine The University of Hong Kong- Shenzhen HospitalShenzhen 518053Guangdong ProvinceChina

Big Data,which are characterized by certain unique traits like volume,velocity and value,have revolutionized the research of multiple fields including *** Data in health care are defined as large datasets that are collected routinely or automatically,and stored *** the rapidly expanding volume of health data collection,it is envisioned that the Big Data approach can improve not only individual health,but also the performance of health care *** application of Big Data analysis in the field of gastroenterology and hepatology research has also opened new research *** it retains most of the advantages and avoids some of the disadvantages of traditional observational studies(case-control and prospective cohort studies),it allows for phenomapping of disease heterogeneity,enhancement of drug safety,as well as development of precision medicine,prediction models and personalized *** randomized controlled trials,it reflects the real-world situation and studies patients who are often under-represented in randomized controlled ***,residual and/or unmeasured confounding remains a major concern,which requires meticulous study design and various statistical adjustment *** potential drawbacks include data validity,missing data,incomplete data capture due to the unavailability of diagnosis codes for certain clinical situations,and individual *** continuous technological advances,some of the current limitations with Big Data may be further *** review will illustrate the use of Big Data research on gastrointestinal and liver diseases using recently published examples.

关键词： Healthcare dataset Epidemiology Gastric cancer Inflammatory bowel disease Colorectal cancer Hepatocellular carcinoma Gastrointestinal bleeding

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Molecular Evidence for the Hybrid Origin of Bauhinia blakeana(Caesalpinioideae)

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Journal of Integrative Plant Biology 2008年第1期50卷 111-118页

作者： Chun Yin Mak ka shing cheung Pui Ying Yip Hoi Shan Kwan Department of Biology The Chinese University of Hong KongShatinHong KongChina

Bauhinia blakeana Dunn is the Hong Kong Special Administrative Region emblem and a popular horticultural species in many Asian countries. It was first described as a new species from Hong Kong almost a century ago. This plant is sterile and has long been considered a hybrid, possibly from two related species, B. purpurea and B. variegata. However, not much evidence based on molecular methods was available to support this hypothesis. In this study, sequences of internal transcribed spacer I （ITS1）, rbcL and atpB-rbcL intergenic spacer for five Bauhinia species and two varieties of one of the species were determined and compared. There were two types of ITS1 sequences in B. blakeana, one indistinguishable from that of B. purpurea and the other one identical to that of B. variegata. This confirmed that B. blakeana was a hybrid of these two species. Chloroplast atpB-rbcL intergenic spacer sequence of B. blakeana was identical to that of B. purpurea, indicating that B. purpurea was the female parent. The hybridization event seemed to occur only recently and was a rare incident. Its occurrence was likely facilitated by interspecific pollen competition. It appeared that human efforts played a crucial role in the preservation and ubiquity of B. blakeana.

关键词： atpB-rbcL intergenic spacer Bauhinia internal transcribed spacer 1 interspecific hybrid interspecific pollen competition.

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Housing price dispersion in the presale market

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Economic and Political Studies 2020年第1期8卷 65-81页

作者： Siu Kei Wong ka shing cheung Department of Real Estate and Construction University of Hong Kongthe Hong Kong SARChina The Ronald Coase Centre for Property Rights Research University of Hong Kongthe Hong Kong SARChina Department of Property The University of Auckland Business SchoolAucklandNew Zealand

Sale before completion(***)is a common practice that real estate developers use to sell residential *** presale buyers are unable to inspect uncompleted units,developers may take advantage of asymmetric information and release information about quality to the market *** search theory also suggests that incomplete pricing information,especially for new products,will induce a less competitive market that is characterised by dispersed presale *** price dispersion be reduced if developers were required to provide more quality and pricing information?In this study,we argue that this is not necessarily the *** conduct a natural experiment using a new information disclosure ordinance governing first-hand residential sales in the Hong Kong SAR,*** find that the ordinance reduced the price dispersion of presale units with asymmetric information about property quality,but increased their price dispersion when limited pricing information(*** trading volume)was available in the *** a critical test,we further show that the ordinance increased price dispersion even more after the units were *** suggests that the ordinance has indeed made presale pricing more difficult because developers are no longer allowed to use different strategies to test market demand.

关键词： Price dispersion presale housing market pricing information quality information natural experiment

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Prediction of hepatocellular carcinoma development by aminotransferase to platelet ratio index in primary biliary cholangitis

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World Journal of Gastroenterology 2017年第44期23卷 7863-7874页

作者： ka-shing cheung Wai-kay Seto James Fung Lung-Yi Mak Ching-Lung Lai Man-Fung Yuen Department of Medicine The University of Hong Kong Queen Mary Hospital State Key Laboratory for Liver Research The University of Hong Kong

AIM To investigate the usefulness of aspartate aminotransferase to platelet ratio index(APRI) in predicting hepatocellular carcinoma(HCC) risk in primary biliary cholangitis(PBC).METHODS We identified PBC patients between 2000 and 2015 by searching the electronic medical database of a tertiary center. The hazard ratio(HR) of HCC with different risk factors was determined by Cox proportional hazards model. RESULTS One hundred and forty-four PBC patients were recru-ited. Patients were diagnosed at a median age of 57.8 years [interquartile range(IQR): 48.7-71.5 years), and 41(28.5%) patients had cirrhosis at baseline. The median follow-up duration was 6.9 years(range: 1.0-26.3 years). Twelve patients developed HCC, with an incidence rate of 10.6 cases per 1000 patient-years. The overall 5-, 10-and 15-year cumulative incidences of HCC were 2.3% 95%CI: 0%-4.8%), 8.4%(95%CI: 1.8%-14.5%) and 21.6%(6.8%-34.1%), respectively. Older age(HR = 1.07), cirrhosis(HR = 4.38) and APRI at 1 year after treatment(APRI-r1) > 0.54(HR = 3.94) were independent factors for HCC development. APRI-r1, when combined with treatment response, further stratified HCC risk(log rank P < 0.05). The area under receiver operating curve of APRI-r1 in predicting HCC was 0.77(95%CI: 0.64-0.88).CONCLUSION APRI-r1 can be used to predict the development of HCC in PBC patients. Combination of APRI-r1 with treatment response can further stratify the HCC risk.

关键词： Aspartate aminotransferase 血小板比率索引 Hepatocellular 癌主要胆汁的胆管炎 Ursodeoxycholic 酸肝硬化

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Epidemiology and natural history of Wilson's disease in the Chinese: A territory-based study in Hong Kong between 2000 and 2016

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World Journal of Gastroenterology 2017年第43期23卷 7716-7726页

作者： ka-shing cheung Wai-kay Seto James Fung Lung-Yi Mak Ching-Lung Lai Man-Fung Yuen Department of Medicine The University of Hong KongQueen Mary Hospital State Key Laboratory for Liver Research The University of Hong Kong

AIM To investigate the epidemiology and natural history of Wilson's disease in the *** Data were retrieved via electronic search of hospital medical registry of the Hong Kong Hospital Authority,which covers all the public healthcare services. We identified cases of Wilson's disease between 2000 and 2016 by the International Classification of Diseases(ICD)-9 code. We analyzed the incidence rate,prevalence and adverse outcomes of Wilson's *** We identified 211 patients(male cases 104; female cases 107; median age 27.2 years,IQR: 17.1-38.6 years; duration of follow-up 8.0 years,IQR: 5.0-14.0 years). The average annual incidence rate was 1.44 per million person-years while the prevalence was 17.93 per million. Between 2000 and 2016,there was a decrease in the annual incidence rate from 1.65 to 1.23 per million person-years(P = 0.010),whereas there was an increase in the annual prevalence from 7.80 to 25.20 per million(P < 0.001). Among the 176 cases with hepatic involvement,38(21.6%) had cirrhosis,three(1.7%) developed hepatocellular carcinoma,24(13.6%) underwent liver transplantations,and 26(14.8%) died. Seven patients had concomitant chronic viral hepatitis B or C. The 5-year and 10-years rates of overall survival were 92.6% and 89.5%,and for transplant-free survival rates 91.8% and 87.4%,respectively. Cirrhosis and possibly chronic viral hepatitis were associated with poorer overall survival. CONCLUSION There was a significant increase in the prevalence of Wilson's disease in Hong Kong. The prognosis was favorable except for those with cirrhosis or concomitant viral hepatitis.

关键词： Hepaticolenticular 退化肝硬化 Hepatocellular 癌移植

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Indications of pro-inflammatory cytokines in laparoscopic and open liver resection for early-stage hepatocellular carcinoma

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Hepatobiliary & Pancreatic Diseases International 2024年第3期23卷 257-264页

作者： Kevin Tak-Pan Ng Li Pang Jia-Qi Wang Wong Hoi She Simon Hing-Yin Tsang Chung Mau Lo Kwan Man Tan To cheung Department of Surgery HKU-SZH&School of Clinical MedicineLi Ka Shing Faculty of MedicineThe University of Hong KongHong KongChina State Key Laboratory of Liver Research The University of Hong KongHong KongChina

Background:Our clinical practice of laparoscopic liver resection(LLR)had achieved better short-term and long-term benefits for patients with hepatocellular carcinoma(HCC)over open liver resection(OLR),but the underlying mechanisms are not *** study was to find out whether systemic inflammation plays an important ***:A total of 103 patients with early-stage HCC under liver resection were enrolled(LLR group,n=53;OLR group,n=50).The expression of 9 inflammatory cytokines in patients at preoperation,postoperative day 1(POD1)and POD7 was quantified by Luminex Multiplex *** relationships of the cytokines and the postoperative outcomes were compared between LLR and ***:Seven of the circulating cytokines were found to be significantly upregulated on POD1 after LLR or OLR compared to their preoperative *** to OLR,the POD1 levels of granulocytemacrophage colony-stimulating factor(GM-CSF),interleukin-6(IL-6),IL-8,and monocyte chemoattractant protein-1(MCP-1)in the LLR group were significantly *** POD1 levels of these cytokines were significantly correlated with longer operative time and higher volume of blood loss during *** levels of these cytokines were positively associated with postoperative liver injury,and the length of hospital ***,a high level of IL-6 at POD1 was a risk factor for HCC recurrence and poor disease-free survival after liver ***:Significantly lower level of GM-CSF,IL-6,IL-8,and MCP-1 after liver resection represented a milder systemic inflammation which might be an important mechanism to offer better short-term and long-term outcomes in LLR over OLR.

关键词： Laparoscopic liver resection Open liver resection Hepatocellular carcinoma Postoperative cytokines Inflammatory responses

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Exacerbated VEGF up-regulation accompanies diabetes-aggravated hemorrhage in mice after experimental cerebral ischemia and delayed reperfusion

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Neural Regeneration Research 2022年第7期17卷 1566-1575页

作者： Angela ka Wai Lai Tsz Chung Ng Victor ka Lok Hung ka cheung Tam Chi Wai cheung Sookja Kim Chung Amy Cheuk Yin Lo Department of Ophthalmology Li Ka Shing Faculty of MedicineThe University of Hong KongHong Kong Special Administration RegionChina Department of Anesthesiology Laboratory and Clinical Research Institute for PainThe University of Hong KongHong Kong Special Administration RegionChina Macao University of Science and Technology TaipaMacao Special Administration RegionChinaSchool of Biomedical SciencesThe State Key Laboratory of Pharmaceutical BiotechnologyThe University of Hong KongHong Kong Special Administration RegionChina

Reperfusion therapy is the preferred treatment for ischemic stroke,but is hindered by its short treatment window,especially in patients with diabetes whose reperfusion after prolonged ischemia is often accompanied by exacerbated *** mechanisms underlying exacerbated hemorrhage are not fully *** study aimed to identify this mechanism by inducing prolonged 2-hour transient intraluminal middle cerebral artery occlusion in diabetic Ins2Akita/+mice to mimic patients with diabetes undergoing delayed mechanical *** results showed that at as early as 2 hours after reperfusion,Ins2Akita/+mice exhibited rapid development of neurological deficits,increased infarct and hemorrhagic transformation,together with exacerbated down-regulation of tight-junction protein ZO-1 and upregulation of blood-brain barrier-disrupting matrix metallopeptidase 2 and matrix metallopeptidase 9 when compared with normoglycemic Ins2+/+*** indicated that diabetes led to the rapid compromise of vessel integrity immediately after reperfusion,and consequently earlier death and further aggravation of hemorrhagic transformation 22 hours after *** observation was associated with earlier and stronger up-regulation of pro-angiogenic vascular endothelial growth factor(VEGF)and its downstream phospho-Erk1/2 at 2 hours after reperfusion,which was suggestive of premature angiogenesis induced by early VEGF up-regulation,resulting in rapid vessel disintegration in diabetic *** reticulum stress-related pro-apoptotic C/EBP homologous protein was overexpressed in challenged Ins2Akita/+mice,which suggests that the exacerbated VEGF up-regulation may be caused by overwhelming endoplasmic reticulum stress under diabetic *** conclusion,the results mimicked complications in patients with diabetes undergoing delayed mechanical thrombectomy,and diabetes-induced accelerated VEGF up-regulation is likely to underlie exacerbated hemorrhagic transformat

关键词： blood-brain barrier brain injury diabetes mellitus hemorrhagic transformation infarct ischemia/reperfusion injury middle cerebral artery occlusion mouse model stroke vascular endothelial growth factor

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