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  • 1
    Online Resource
    Online Resource
    Long-Term follow-up of Lamivudine Treatment in Patients with Severe Acute Exacerbation of Hepatitis B e Antigen (HBeAg)-Positive Chronic Hepatitis B
    SAGE Publications ; 2008
    In:  Antiviral Therapy Vol. 13, No. 4 ( 2008-05), p. 571-579
    Details
    In: Antiviral Therapy, SAGE Publications, Vol. 13, No. 4 ( 2008-05), p. 571-579
    Abstract: The long-term efficacy of lamivudine treatment for patients suffering from severe acute exacerbation of hepatitis B e antigen (HBeAg)-positive chronic hepatitis B is unknown. Methods Consecutive patients with severe acute exacerbation of HBeAg-positive chronic hepatitis B were prospectively recruited from 1999 to 2004 and treated with lamivudine. All patients had alanine amino-transferase (ALT) and serum bilirubin levels 10x and 3x above the upper limit of normal, respectively. HBeAg-positive patients without severe acute exacerbation served as controls. Results Forty-five patients with severe acute exacerbation and 31 controls were treated with lamivudine for a median of 2.8 (range 1.0–7.1) years and 3.8 (range 3.5–8.4) years, respectively. Compared with controls, patients with severe acute exacerbation had higher HBeAg seroconversion rates (78% versus 52%; P=0.02) and lower risk of virological breakthrough. However, 33% of patients with severe acute exacerbation still developed lamivudine resistance and virological breakthrough by year 5. HBV DNA levels at week 4 and prolonged baseline prothrombin time were independent factors associated with virological breakthrough. All patients with week 4 HBV DNA 〈 3 log 10 copies/ml had maintained virological response. Among 15 patients who stopped lamivudine after sustained HBeAg seroconversion for ≥6 months, 11 (73%) had virological relapse at a median of 1.4 (0.2-3.9) years. ALT increased beyond 10x the upper limit of normal in six (38%) patients who stopped lamivudine and two (7%) patients on maintained lamivudine treatment ( P=0.02). Conclusion Among patients with severe acute exacerbation of HBeAg-positive chronic hepatitis B treated with lamivudine, virological breakthrough and post-treatment relapse are common despite a high rate of HBeAg seroconversion. Severe hepatitis flare is also common particularly among patients developing virological relapse after discontinuation of lamivudine.
    Type of Medium: Online Resource
    ISSN: 1359-6535 , 2040-2058
    URL: Article
    DOI: 10.1177/135965350801300407
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2008
    detail.hit.zdb_id: 2118396-X
    SSG: 15,3
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  • 2
    Online Resource
    Online Resource
    On-Treatment Monitoring of Liver Fibrosis with Transient Elastography in Chronic Hepatitis B Patients
    SAGE Publications ; 2011
    In:  Antiviral Therapy Vol. 16, No. 2 ( 2011-02), p. 165-172
    Details
    In: Antiviral Therapy, SAGE Publications, Vol. 16, No. 2 ( 2011-02), p. 165-172
    Abstract: The performance of liver stiffness measurement (LSM) to monitor the changes in the severity of liver fibrosis in chronic hepatitis B (CHB) patients on antiviral treatment is uncertain. Methods We prospectively studied CHB patients undergoing paired liver biopsy and transient elastography before and at week 48 of antiviral treatment. Based on our previously reported LSM algorithm, advanced liver fibrosis (F3–4) could be excluded or confirmed at 〉 90% confidence. Results A total of 71 CHB patients were studied. The median alanine aminotransferase (ALT) level decreased from 99I U/l to 33I U/l, and the median LSM decreased from 8.8 kPa to 6.6 kPa, respectively, from baseline to week 48. Overall, 17 and 11 patients had regression and progression of histological fibrosis, respectively. Areas under the receiver operating characteristics curves of the LSM algorithm at baseline and week 48 for advanced fibrosis were 0.80 (95% confidence interval [CI] 0.69– 0.90) and 0.78 (95% CI 0.64–0.92), respectively. The sensitivity of LSM algorithm to exclude advanced fibrosis was 100% at baseline and 75% at week 48. The specif-city of the LSM algorithm to diagnose advanced fibrosis was 84% at baseline and 91% at week 48. Overall, 11/28 (39%) patients with LSM that decreased by 〉 30%, 28/41 (68%) of patients with LSM that changed within 30% and 1/2 (50%) patients with LSM that increased by 〉 30% had decreased, unchanged and increased histological fibrosis stages, respectively. Conclusions LSM could predict advanced fibrosis during antiviral therapy according to the ALT-based algorithm. Decrease in absolute LSM value, which could be related to ALT normalization, was unreliable to indicate regression of liver fibrosis.
    Type of Medium: Online Resource
    ISSN: 1359-6535 , 2040-2058
    URL: Article
    DOI: 10.3851/IMP1726
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2011
    detail.hit.zdb_id: 2118396-X
    SSG: 15,3
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  • 3
    Online Resource
    Online Resource
    Veno-arterial extracorporeal membrane oxygenation with concomitant Impella versus concomitant intra-aortic-balloon-pump for cardiogenic shock
    SAGE Publications ; 2023
    In:  Perfusion Vol. 38, No. 1 ( 2023-01), p. 51-57
    Details
    In: Perfusion, SAGE Publications, Vol. 38, No. 1 ( 2023-01), p. 51-57
    Abstract: The intra-aortic balloon pump (IABP) and Impella are left ventricular unloading devices with peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) in place and later serve as bridging therapy when VA-ECMO is terminated. We aimed to determine the potential differences in clinical outcomes and rate of complications between the two combinations of mechanical circulatory support. Methods: This was a retrospective, single institutional cohort study conducted in the intensive care unit (ICU) of Queen Elizabeth Hospital, Hong Kong. Inclusion criteria included all patients aged ⩾18 years, who had VA-ECMO support, and who had left ventricular unloading by either IABP or Impella between January 1, 2018 and October 31, 2020. Patients 〈 18 years old, with central VA-ECMO, who did not require left ventricular unloading, or who underwent surgical venting procedures were excluded. The primary outcome was ECMO duration. Secondary outcomes included length of stay (LOS) in the ICU, hospital LOS, mortality, and complication rate. Results: Fifty-two patients with ECMO + IABP and 14 patients with ECMO + Impella were recruited. No statistically significant difference was observed in terms of ECMO duration (2.5 vs 4.6 days, p = 0.147), ICU LOS (7.7 vs 10.8 days, p = 0.367), and hospital LOS (14.8 vs 16.5 days, p = 0.556) between the two groups. No statistically significant difference was observed in the ECMO, ICU, and hospital mortalities between the two groups. Specific complications related to the ECMO and Impella combination were also noted. Conclusions: Impella was not shown to offer a statistically significant clinical benefit compared with IABP in conjunction with ECMO. Clinicians should be aware of the specific complications of using Impella.
    Type of Medium: Online Resource
    ISSN: 0267-6591 , 1477-111X
    URL: Article
    DOI: 10.1177/02676591211033947
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2029611-3
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