Prevention of hepatitis B reactivation in patients requiring chemotherapy and immunosuppressive therapy

Hepatitis B virus(HBV)reactivation can lead to severe acute hepatic failure and death in patients with HBV infection.HBV reactivation(HBVr)most commonly develops in patients undergoing cancer chemotherapy,especially B cell-depleting agent therapy such as rituximab and ofatumumab for hematological or solid organ malignancies and that receiving hematopoietic stem cell transplantation without antiviral prophylaxis.In addition,the potential consequences of HBVr is particularly a concern when patients are exposed to either immunosuppressive or biologic therapies for the management of rheumatologic diseases,inammatory bowel disease and dermatologic diseases.Thus,screening with HBV serological markers and prophylactic or pre-emptive antiviral treatment with nucleos(t)ide analogues should be considered in these patients to diminish the risk of HBVr.This review discusses the clinical manifestation,prognosis and management of HBVr,risk stratifications of cancer chemotherapy and immunosuppressive therapy and international guideline recommendations for the prevention of HBVr in patients with HBV infection and resolved hepatitis B.

Composition of common bile duct stones in Chinese patients during and after endoscopic sphincterotomy

AIM： Endoscopic sphincterotomy （ES） is a well-established therapeutic modality for the removal of common bile duct （CBD） stones. Alter ES there are still around 10% of patients that experience recurrent CBD stones. The aim of this study is to investigate the composition of CBD stones before and alter ES and its clinical significance in Chinese patients.METHODS： From January 1996 to December 2003, 735 patients with CBD stones received ES at Kaohsiung Veterans General Hospital and stone specimens from 266 patients were sent for analysis. Seventy-five patients had recurrent CBD stones and stone specimens from 44 patients were sent for analysis. The composition of the stones was analyzed by infrared （IR） spectrometry and they were classified as cholesterol or bilirubinate stones according to the predominant composition. Clinical data were analyzed.RESULTS： In the initial 266 stone samples, 217 （82%） were bilirubinate stones, 42 （16%） were cholesterol stones,3 were calcium carbonate stones, 4 were mixed cholesterol and bilirubinate stones. Patients with bilirubinate stones were significantly older than patients with cholesterol stones （66＋13 years vs 56＋17 years, P = 0.001）. In the 44 recurrent stone samples, 38 （86%） were bilirubinate stones, 3 （7%） were cholesterol stones, and 3 were mixed cholesterol and bilirubinate stones. In 27 patients, both initial and recurrent stone specimens can be obtained,23 patients had bilirubinate stones initially and 2 became cholesterol stones in the recurrent attack. In the four patients with initial cholesterol stones, three patients had bilirubinate stones and one patient had a cholesterol stone in the recurrent attack.CONCLUSION： Bilirubinate stone is the predominant composition of initial or recurrent CBD stone in Chinese patients, The composition of CBD stones may be different from initial stones afl：er ES,

Implications of anti-parietal cell antibodies and anti-Helicobacter pylori antibodies in histological gastritis and patient outcome

AIM： To develop a serum or histological marker for early discovery of gastric atrophy or intestinal metaplasia. METHODS： This study enrolled 44 patients with gastric adenocarcinoma, 52 patients with duodenal ulcer, 14 patients with gastric ulcer and 42 consecutive healthy adults as controls. Each patient received an endoscopy and five biopsy samples were obtained. The degrees of histological parameters of gastritis were categorized following the Updated Sydney System. Anti-parietal cell antibodies （APCA） and anti- Helicobacter pylori （ H pylori） antibodies （AHPA） were analyzed by immunoassays. Hpyloriinfection was diagnosed by rapid unease test and histological examination. RESULTS： Patients with gastric cancer and gastric ulcer are significantly older than healthy subjects, while also displaying higher frequency of APCA than healthy controls. Patients with positive APCA showed higher scores in gastric atrophy and intestinal metaplasia of corpus than patients with negative APCA. Patients with positive AHPA had higher scores in gastric atrophy, intestinal metaplasia, and gastric inflammation of antrum than those patients with negative AHPA. Elderly patients had greater prevalence rates of APCA. Following multivariant logistic regression analysis, the only significant risk factor for antral atrophy is positive AHPA, while that for corpus atrophy is positive APCA. CONCLUSION： The existence of positive APCA correlates with glandular atrophy in corpus and the presence of positive AHPA correlates with glandular atrophy in antrum. The existence of serum APCA and AHPA betokens glandular atrophy and requires further examination for gastric cancer.

Screening and prevention of hepatitis C virus reactivation during chemotherapy

Hepatitis C virus(HCV)reactivation occurs in 23%of HCV-infected cancer patients receiving chemotherapy.Forty-three percent of the patients with reactivation of HCV during chemotherapy develop a hepatitis flare.Most of the cancer patients with HCV reactivation have an unremarkable clinical course following an HCV-related hepatitis flare during chemotherapy.However,26%–57%of the cancer patients developing an acute flare of chronic hepatitis C during chemotherapy require unanticipated discontinuation or dose reduction of chemotherapy,which results in deleterious changes in the cancer treatment plan.Although an optimal strategy for HCV screening in cancer patients receiving chemotherapy has not been established,universal pre-chemotherapy HCV testing for patients with hematological malignancies is recommended by current guidelines.All the currently approved direct-acting antivirals(DAAs)can be used in cancer patients,but the use of DAAs during chemotherapy should avoid drug–drug interactions between chemotherapy and antiviral agents.If there are no contraindications or anticipated drug–drug interactions,DAAs treatment can be administered before,during,or after chemotherapy.In conclusion,HCV reactivation occurs in approximately one-fourth of HCV-infected cancer patients receiving chemotherapy.An HCV-related hepatitis flare during chemotherapy may lead to the discontinuation of potentially life-saving chemotherapy.Currently,universal HCV screening is recommended in hematological malignancy patients before chemotherapy,but there is no evidence-based guideline for other cancer patients.DAAs treatment can cure HCV infection and prevent HCV reactivation during chemotherapy.

Clinical application of dip-assisted endoscopic method for nasoenteric feeding in patients with gastroparesis and gastroesophageal wounds

AIM: To report the clinical experiences in the application of clip-assisted endoscopic method for nasoenteric feeding in patients with gastroparesis and patients with gastroesophageal wounds, and to compare the efficacy of nasoenteric feeding in these two indications. METHODS: From April 2002 to January 2004,21 consecutive patients with gastroparesis or gastroesophageal wounds were enrolled and received nasoenteric feeding for nutritional support. A clip-assisted method was used to place the nasoenteric tubes. Outcomes in the two groups were compared with respect to the successful rate of enteral feeding, percentage of recommended energy intake (REI), and complication rates. RESULTS: The gastroparesis group included 13 patients with major burns (n = 7), trauma (n = 2), congestive heart failure (n = 2) and post-surgery gastric stasis syndrome (n = 2). The esophageogastric wound group included eight patients with tracheoesophageal fistula (n = 2) and wound leakage following gastric surgery (n = 6). Two study groups were similar in feeding successful rates (84.6% vs 75.0%). There were also no differences in the percentage of REI between groups (79.4% vs 78.6%). Additionally, no complications occurred in any of the study groups. CONCLUSION: Nasoenteric feeding is a useful method to provide nutritional support to most of the patients with gastroparesis who cannot tolerate nasogastric tube feeding and to the cases who need bypass feeding for esophageogastric wounds.

Effect of Pre-Ageing on the Precipitation Behaviors and Mechanical Properties of Al-7Si-Mg Alloys

For alloys that are quenched to 25℃ room temperature, there are Mg-Mg, Si-Si and Mg-Si clusters shown by exothermic peaks in a A357 alloy. However, there are no clear Mg-Mg, Si-Si and Mg-Si cluster exothermic peaks in a A356 alloy. Hence, the low Mg content in a A356 alloy has less impact with natural ageing. The natural ageing impact on the mechanical properties of a A357 alloy is higher than a A356 alloy due to the precipitation of Mg-Si clusters for which the nucleation size does not reach the critical size. The 90℃ pre-ageing process could promote Mg-Si clusters to a critical size to become the nucleation site for of β''. This then increases the artificial ageing strength and mitigates the impact of natural ageing.

Efficacy of Frankincense and Myrrha in Treatment of Acute Interstitial Cystitis/Painful Bladder Syndrome

Objective:To investigate the efficacy of frankincense and myrrha in the treatment of acute interstitial cystitis/painful bladder syndrome(IC/PBS).Methods:The effects of frankincense and myrrha on the proliferation and migration of primary human urothelial cells(HUCs)were assessed in vitro.In the animal study,48 virgin female rats were randomized into 4 groups(12 in each group):(1)control group(saline-injected control);(2)cyclophosphamide(CYP)group(intraperitoneal injected 150 mg/kg CYP);(3)CYP+pentosan polysulfate sodium group(orally received 50 mg/kg pentosan polysulfate sodium);and(4)CYP+frankincense and myrrha group[orally received frankincense(200 mg/kg)and myrrha(200 mg/kg)].Rats orally received pentosan polysulfate sodium or frankincense and myrrha on day 1,2,and 3.The experiments were performed on day 4.Pain and cystometry assessment behavior test were performed.Voiding interval values were assessed in rats under anesthesia.Finally,immunohistochemistry and Western blot were used to confirm the location and level,respectively,of cell junction-associated protein zonula occludens-2(ZO-2)expression.Results:Low dose frankincense and myrrha increased cell proliferation and migration in HUCs compared with control(P<0.05).Rats with acute IC/PBS rats exhibited lower voiding interval values,pain tolerance,and ZO-2 expression(P<0.05).Voiding interval values and pain tolerance were higher in the frankincense and myrrha group than CYP group(P<0.05).ZO-2 expression in the bladder was increased in the CYP+pentosan polysulfate and frankincense+myrrha groups compared with the CYP-induced acute IC/PBS group(P<0.05).Conclusion:frankincense and myrrha modulate urothelial wound healing,which ameliorates typical features of acute IC/PBS in rats.

Gas Kinetic Scheme for Anisotropic Savage-Hutter Model

The gas-kinetic scheme is applied to a depth-integrated continuum model for avalanche flows,namely the Savage-Hutter model.In this method,the continuum fluxes are calculated based on the pseudo particle motions which are relaxed from nonequilibrium to equilibrium states.The processes are described by the Bhatnagar-GrossKrook(BGK)equation.The benefit of this scheme is its capability to resolve shock discontinuities sharply and to handle the vacuum state without special treatments.Because the Savage-Hutter equation bears an anisotropic stress on the tangential space of the topography,the equilibrium distribution function of the microscopic particles are shown to be bi-Maxwellian.These anisotropic stresses are the key to preserve the coordinate objectivity in the Savage-Hutter model.The effect of the anisotropic stress is illustrated by two examples:an axisymmetric dam break and a finite mass sliding on an inclined plane chute.It is found that the propagation of the flow fronts significantly depends on the orientation of the principal axes of the tangential stresses.