Efficacy and Safety of Glecaprevir/Pibrentasvir in Combination Therapy in Chronic Hemodialysis Patients with Genotype 2 Hepatitis C Virus Infection

Background: Glecaprevir (nonstructural protein 3/4A protease inhibitor) and Pibrentasvir (nonstructural protein 5A inhibitor) (G/P), a coformulated once-daily, all oral, ribavirin (RBV)-free, direct-antiviral regimen, was evaluated for safety and efficacy in chronic hemodialysis patients with genotype 2 hepatitis C virus infection. Methods: In this prospective, observational, single-center study at Masuko Memorial Hospital, between November 2017 and December 2018, a total of 8 HD patients with an HCV infection genotype 2 received G/P combination therapy. Age was an average of 67.1 (61 - 75) years and there were four men and two women. It was FIB4 INDX an average of 2.67 (1.5 - 3.34) before the start of therapy. It was quantity of HCV RNA an average of 4.43 (2.1 - 6.5). HCV RNA levels were measured by real-time RCR-based method (COBAS AmpiPrep/COBAS TaqMan HCV Test. 4 cases 12 weeks were 2 cases eight weeks for dosing period. Patients were excluded if they had evidence of hepatocellular carcinoma. This study was approved by the ethics committee of our hospital, while we obtained written consent from the participants after providing a thorough explanation of the contents and methods of this study. Results: 6 patients were available for total dose internal use. As for the HCV RNA of the fourth week, (100%) HCV RNA became negative after administration start of therapy. Rapid virologic response (RVR) achieved all cases. 5 patients achieved 12-week sustained virologic response (SVR12) and were following up the 1 patient. The itching appeared in two cases (33%), but there was symptom improvement in nalfurafine hydrochloride use treatment, and treatment continuation was possible. Conclusion: It is thought that G/P can be given to the HD patients’ safety, but we will accumulate a case in future, and it is thought to be necessary to examine utility and safety.

Noninvasive Assessment of Liver Disease—Measurement of Hepatic Fibrosis Using Shear Wave Elastography (SWE)

The evaluation of liver fibrosis is said to be one of the factors of the liver cancer development. The noninvasive testing is considered for abdominal echography, MRI, a blood marker in various ways. We announce the evaluation as an article by liver fibrosis using the probe for the heart before, too. This time is shear wave elastography using the echo probe for the abdomen (SWE). We used and examined it in normal, chronic hepatitis patients with cirrhosis. We tried it, but, in the patients with cirrhosis, there was no examination in the change in a value after ascites time and ascitic drainage. The future examination thinks about a comparison with the liver biopsy, the comparison with the liver fibrosis marker. Also, we think that a malignancy and the benign differentiation should be possible for a liver tumor.

The Use of Castor Oil for Bowel Preparation for Colon Capsule Endoscopy

Colon capsule endoscopy was approved for reimbursement under the national health insurance system of Japan in 2014. At our hospital, specialized mainly in renal, hepatic, and diabetic diseases, we have been performing colon capsule endoscopy since December 2014. Dialysis patients are potentially susceptible to bleeding because of the fragile intestine, impaired platelet function, or oral administration of nonsteroidalanti inflammatory drugs (NSAIDs) or anticoagulants. For this reason, detailed examination by capsule endoscopy appears to be useful. However, the capsule excretion rate after recommended bowel preparation reportedly ranges from 70% to 90%, and administration of boosters is also necessary. For dialysis patients, liquid loading is a problem. In this study, we evaluated the efficacy of bowel preparation with castor oil for improving the capsule excretion rate. In all 20 patients (including four dialysis patients), both capsule transit time and duration of capsule endoscopy were shortened. The results are presented and briefly discussed in this report.

Non-invasive assessment of hepatic fibrosis by tissue strain imaging in chronic hepatitis C patients

The development of fibrosis in hepatitis C patients is associated with increased rates of liver cancer. Assessing hepatic fibrosis during interferon treatment for chronic hepatitis C is thus an important factor in treatment planning. Complications such as bleeding may occur in association with liver biopsy and there are also some reports of sampling error [1,2]. In recent years, however, a number of studies looking at noninvasive means of assessing hepatic fibrosis have appeared in the literature [3-5]. The present study was conducted to determine whether it would be possible to apply an easily performed technique of myocardial examination to hepatic fibrosis. We have already documented our findings for strain rate imaging used to differentiate the normal condition, chronic hepatitis and cirrhosis of the liver identified by diagnostic imaging and haematology data [6]. In this study, patients identified by liver biopsy were investigated, and a comparative investigation with several fibrosis markers was carried out.

Carnitine Deficiency and Improvement of Muscle Cramp by Administration of Carnitine in Patients with Liver Cirrhosis

Aim: We measured carnitine levels in patients with carnitine including dialysis patients, and examined whether administration of L-carnitine improved muscle symptoms. Methods: We measured carnitine levels in 27 patients with liver cirrhosis who were receiving treatment in our hospital, and administered L-carnitine (600 mg - 1800 mg) to patients having muscle cramps for approximately one month and examined the presence/absence of the symptom. We measured carnitine concentration before and after dialysis, before dialysis after the administration to eight dialysis patients, before and after the administration to 19 nondialytic patients. Results: The total carnitine levels before the dialysis of dialysis patients were an average of 42.2 μmol/L and fell to 17.7 μmol/L after more dialysis, but it was increased to 155 μmol/L after the administration of L-carnitine. In the nondialytic patients, the total carnitine levels were significantly increased from 71.7 μmol/L to 101.7 μmol/L after the administration of L-carnitine (P = 0.038). For symptomatic patients, significant improvement of muscle clamps was observed in the L-carnitine administrated group when compared with the non-administrated group (P = 0.0002). Conclusions: Total carnitine levels were low even before dialysis in the dialysis patients with liver cirrhosis in particular and they further decreased after the dialysis. Administration of L-carnitine increased the total carnitine levels and improved the symptom. Based on these results, we conclude that L-carnitine is useful for carnitine deficiency in patients with liver cirrhosis.

Usefulness of new live 3D ultrasound probe during radiofrequency ablation in a case of hepatocellular carcinoma

We report a case of hepatocellular carcinoma (HCC) with chronic hepatitis C virus (HCV) infection, suc-cessfully treated with percutaneous radiofrequency ablation (RFA) under new Live trhree-dimensional (3D) echo guidance for hearts probe before [1], but ,at the time, perform RFA with a new Live3D probe de- veloped flants. A 61 year-old Japanese man had a 3.5 cm in diameter HCC nodule in the liver S3 region. We applied the Live 3D ultrasonography during RFA therapy with a cool-tip needle electrode. The echo guidance facilitated an accurate approach for the needle puncture. The guidance was also useful for confirming, whether an adequate safety marging for the nodule had been obtained. Thus new Live 3D ul-trasonography echo technique appears to provide safe guidance of RFA needles via accurate targeting of HCC nodules, thereby allowing real-time visualize- tion when combined with echo contrast.

Usefulness of Castor Oil for Bowel Preparation for Colon Capsule Endoscopy in the Patients on Dialysis

Since Colon capsule endoscopy (CCE) was approved for reimbursement under the national health insurance system of Japan in January 2014. Dialysis patients are potentially susceptible to bleeding because of the fragile intestine, impaired platelet function, or oral administration of nonsteroidal antiinflammatory drugs (NSAIDs) or anticoagulants. Increasing experience with CCE different bowel preparation regimens have been used with variable results. The patient on dialysis has moisture restrictions. We experienced the case of the half a dose of the previous protocol by a method using the castor oil. In this study, we evaluated the efficacy of bowel preparation with castor oil for improving the capsule excretion rate. In 23 of 24 (95.8%) patients capsule transit time and duration of capsule endoscopy were shortened. The results are presented and briefly discussed in this report.

The Use of Elobixibat and Lactulose for Bowel Preparation for Colon Capsule Endoscopy

Colon capsule endoscopy was approved for reimbursement under the national health insurance system of Japan in 2014. We decreased quantity of the castor oil and examined an intestinal irrigation degree using Elobixibat and lactulose that could maintain a discharge rate at 100% at a discharge rate and discharge time.

Usefulness of Radiofrequency Ablation with the PVT-350BTP Probe for the treatment of Hepatocellular Carcinoma

Radiofrequency ablation (RFA) has been clinically employed in Japan, and its usefulness in the treatment of hepatocellular carcinoma (HCC) has been reported by many researchers. In the present study, the convex puncture probe PVT-350BTP, rather than a conventional convex probe, was used for RFA for the treatment of HCC and its usefulness was assessed. At the same time, evaluation of the therapeutic effect using ultrasound contrast agent was investigated. The subjects were 20 patients (16 men and 4 women) with 20 HCC nodules as confirmed by contrast CT or abdominal angiography. No nodules were ≤1.0 cm in diameter, 12 were 1.1 cm - 2.0 cm, and 8 were 2.1 cm - 3.0 cm. An Aplio diagnostic ultrasound system (Toshiba Medical Systems, Tokyo, Japan) and the PVT-350BTP probe (Toshiba) were employed for RFA. The PVT-350BTP supports puncture angles of 55, 70, 85, and 100 degrees. By mounting various types of puncture adapters on the probe, 13 G to 22 G puncture needles can be used. The needle can easily be attached and detached by operating a lever. Contrast echo studies with Levovist were performed before and after RFA, and the results were evaluated using the Advanced Dynamic Flow (ADF) imaging technique. Puncture was performed successfully using this probe for 20 cases with 20 nodules. It was confirmed that RFA with the PVT-350BTP permits percutaneous treatment to be performed more reliably than with a conventional probe.