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Efficacy and safety of dual therapy with daclatasvir and asunaprevir in elderly patients

World Journal of Hepatology 2017年第11期9卷 544-550页

作者： Kazuo Tarao Katsuaki Tanaka Akito Nozaki Akira Sato Toshiya Ishii Hirokazu Komatsu Takaaki Ikeda Tatsuji Komatsu Shozo Matsushima Kenji Oshige Tarao’s Gastroenterological Clinic Gastroenterological Center Medical Center Yokohama City University Division of Gastroenterology Department of Internal Medicine St. Marianna University Yokohama City Seibu Hospital Department of Gastroenterology Yokohama Municipal Citizen’s Hospital Department of Gastroenterology Yokosuka General Hospital Uwamachi Department of Clinical Research National Hospital Organization Yokohama Medical Center Yokohama National University Center for Health Service Sciences

AIM To survey the efficacy and safety of dual therapy with daclatasvir and asunaprevir in the elderly hepatitis C virus(HCV) patients multicentricity.METHODS Interferon-ineligible/intolerant patients and non-responders to previous pegylated-interferon/ribavirin therapy with chronic HCV genotype 1b infection were enrolled. Child B, C cirrhotic patients were excluded.Patients received oral direct acting antiviral treatment consisting of 60 mg daclatasvir once daily plus 200 mg asunaprevir twice daily for 24 wk. We divided the patients into two groups of 56 elderly patients(≥ 75 years-old) and 141 non-elderly patients(< 75 years old) and compared the efficacy and safety. RESULTS Ninety-one point one percent of elderly patients and 90.1% of non-elderly patients achieved sustained virological response at 24 wk(SVR24). In the former, 1.8% experienced viral breakthrough, as compared with 3.5% in the latter(not significant). Adverse events occurred in 55.4% of the former and 56.0% of the latter. In the former, 7 cases(12.5%) were discontinued due to adverse events, and in the latter 9 cases were discontinued(6.4%, not significant). CONCLUSION Dual therapy with daclatasvir and asunaprevir achieved the same high rates of SVR24 in HCV elderly patients without more adverse events than in the non-elderly patients.

关键词： Asunaprevir 长期的肝炎 Daclatasvir 双口头的治疗老病人丙肝病毒感染丙肝病毒肝肝硬化

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Seroprevalence of hepatitis B surface antigen in pregnant women attending antenatal clinic in Honiara Solomon Islands,2015

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World Journal of Hepatology 2016年第34期8卷 1521-1528页

作者： Aneley Getahun Margaret Baekalia Nixon Panda Alice Lee Elliot Puiahi Sabiha Khan Donald Tahani Doris Manongi Department of Public Health and Primary Care College of Medicine Nursing and Health SciencesFiji National University Department of Health and Social Affairs Yap State Hospital School of Nursing and Allied Health Sciences Solomon Islands National University Concord Repatriation General Hospital University of Sydney National Referral Hospital

AIM To determine the seroprevalence of hepatitis B surface antigen(HBsAg) among pregnant women attending antenatal clinic in Honiara, Solomon Islands. METHODS This descriptive cross-sectional study was carried out in seven area health centers in Honiara. From March to June 2015, identification of eligible pregnant women in each site was conducted using systematic random sampling technique. A total of 243 pregnant women who gave written informed consent were enrolled. Standardized tool was used to record demographics, obstetric history and serology results. HBsAg and hepatitis B e antigen(HBeAg) were tested using point-of-care rapid diagnostic test. All HBsAg positive samples were verified using enzyme-linked immunosorbent assay. RESULTS The mean age of participants was 26 ± 6 years. The overall hepatitis HBsAg prevalence was 13.8% with higher rate(22%) reported in women between 30-34 years of age. Majority of HBsAg positive participants were Melanesians(29 out for 33). None of the pregnant women in the 15-19 years and ≥ 40 years tested positive for HBsAg. There was no statistically significant difference in HBsAg prevalence by age, ethnicity, education and residential location. The overall HBeAg seroprevalence was 36.7%. Women between 20-24 years of age had the highest rate of 54.5%. Low level of knowledge about hepatitis B vaccination was reputed. Overall, 54.6% of participants were not aware of their hepatitis B vaccination status and only 65.2% of mothers reported their child had been vaccinated. CONCLUSION Hepatitis B is a disease of public health importance in Solomon Islands and emphasize the need for integrated preventative interventions for its control.

关键词：肝炎 B 长期的肝炎肝炎 B 表面抗原肝炎 B e 抗原 Seroprevalence 怀孕女人所罗门群岛

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Anemia and iron deficiency in gastrointestinal and liver conditions

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World Journal of Gastroenterology 2016年第35期22卷 7908-7925页

作者： Jürgen Stein Susan Connor Garth Virgin David Eng Hui Ong Lisandro Pereyra Interdisciplinary Crohn Colitis Centre Rhein-Main Frankfurt am Main Department of Gastroenterology and Clinical Nutrition DGD Clinics Sachsenhausen Frankfurt am Main60594 Frankfurt Germany Department of Gastroenterology and Hepatology Liverpool Hospital South Western Clinical School University of New South Wales Vifor Pharma Flughofstrasse 61 CH-8152 Zurich Switzerland Division of Gastroenterology and Hepatology University Medicine Cluster National University Hospital Servicio de Gastroenterología y Endoscopia Hospital Alemán

Iron deficiency anemia(IDA) is associated with a number of pathological gastrointestinal conditions other than inflammatory bowel disease, and also with liver disorders. Different factors such as chronic bleeding, malabsorption and inflammation may contribute to IDA. Although patients with symptoms of anemia are frequently referred to gastroenterologists, the approach to diagnosis and selection of treatment as well as follow-up measures is not standardized and suboptimal. Iron deficiency, even without anemia, can substantially impact physical and cognitive function and reduce quality of life. Therefore, regular iron status assessment and awareness of the clinical consequences of impaired iron status are critical. While the range of options for treatment of IDA is increasing due to the availability of effective and well-tolerated parenteral iron preparations, a comprehensive overview of IDA and its therapy in patients with gastrointestinal conditions is currently lacking. Furthermore, definitions and assessment of iron status lack harmonization and there is a paucity of expert guidelines on this topic. This review summarizes current thinking concerning IDA as a common co-morbidity in specific gastrointestinal and liver disorders, and thus encourages a more unified treatment approach to anemia and iron deficiency, while offering gastroenterologists guidance on treatment options for IDA in everyday clinical practice.

关键词：熨缺乏贫血症胃肠的流血 Nonsteroidal 反煽动性的药胃炎感染 Bariatric 外科腹的疾病胃肠的瘤长期的肝炎非酒精的脂肪肝疾病

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Different pre-S deletion patterns and their association with hepatitis B virus genotypes

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World Journal of Gastroenterology 2016年第35期22卷 8041-8049页

作者： Bing-Fang Chen School of Medicine Fu Jen Catholic University New Taipei City 24205 Taiwan

AIM To investigate the associations of different types of pre-S deletions with hepatitis B virus(HBV) genotypes.METHODS The sequences of the pre-S region, basal core promoter(BCP) mutation, and precore(PC) mutation were examined through direct DNA sequencing or clonal analysis and sequencing in 273 HBV carriers, namely 55 asymptomatic carriers, 55 carriers with chronic hepatitis(CH), 55 with liver cirrhosis(LC), 53 with liver cirrhotic hepatocellular carcinoma(LC-HCC), and 55 with noncirrhotic HCC. A total of 126 HBV carriers(46.2%) harbored pre-S deletions. The DNA sequences of pre-S deletion mutants from 43 age-matched genotype B(HBV/B)-infected carriers and 43 agematched genotype C(HBV/C)-infected carriers were further examined, aligned, and compared.RESULTS No significant difference was observed in the mean age distribution(P = 0.464), male sex(P = 0.805), viral load(P = 0.635), or BCP mutation(P = 0.117) between the HBV/B and HBV/C groups. However, the rate of PC mutation was significantly higher in the HBV/B-infected carriers than in the HBV/C-infected carriers(P = 0.003). Both genotypes exhibited a high rate of deletion in the C-terminal half of the pre-S1 region and N-terminus of the pre-S2 region(86.0% and 79.1% in the HBV/B group; 69.8% and 72.1% in the HBV/C group, respectively). Epitope mapping showed that deletion in several epitope sites was frequent i n both genotypes, particularly p S1-BT and p S2-B2. Conversely, the rate of p S2-B1 deletion was significantly higher in the HBV/B group(72.1% vs 37.2%, P = 0.002), and the rate of pS 2-T deletion was significantly higher in the HBV/C group(48.8% vs 25.6%, P = 0.044). Functional mapping showed that the rate of deletion in three functional sites(the nucleocapsid binding site, start codon of M, and site for viral secretion) located in the N-terminus of the pre-S2 region was significantly higher in the HBV/B group(P < 0.05). One type of N-terminus pre-S1 deletion mutant with deletion of the start codon of the L protein was frequently observed in the HBV/

关键词：肝炎 B 病毒 Pre-S 删除长期的肝炎 Hepatocellular 癌遗传型肝肝硬化

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