Ming-Tzung Lin

Comparison of renal safety and efficacy of telbivudine, entecavir and tenofovir treatment in chronic hepatitis B patients: real world experience

This study aims to assess the nephrotoxicity and efficacy of tenofovir disoproxil fumarate (tenofovir), telbivudine and entecavir. A retrospective study of 587 patients with chronic hepatitis B treated with tenofovir (n = 170), telbivudine (n = 184) and entecavir (n = 233) for at least 1 year. Renal function and efficacy were assessed. The estimated glomerular filtration rate (eGFR) decreased significantly in the tenofovir group after a mean of 17 months treatment (from 92.2 to 85.6 mL/min/1.73 m(2), p < 0.001), but increased in the telbivudine group after a mean of 32 months of treatment (from 86.1 to 95 mL/min/1.73 m(2), p < 0.001). There was no significant change in eGFR in the entecavir group after a mean of 44 months. By multivariate analysis, pre-existing renal insufficiency (p = 0.003), tenofovir (p = 0.007) and diuretic treatment (p = 0.001) were independent predictors for renal function deterioration. Cumulative virological breakthrough was 0% in tenofovir after 2 years, 3.4% in entecavir after 7 years and 22.9% in telbivudine after 5 years. Liver cirrhosis (p = 0.008) and virological breakthrough (p = 0.040) were independently associated with increased risk of hepatocellular carcinoma development. Tenofovir may lead to deterioration in renal function as assessed by serial eGFR measurements. Although telbivudine appeared to be associated with an improvement in eGFR, it was associated with high rates of virological breakthrough, which was an independent risk factor for HCC development. With low rates of virological breakthrough and preservation of renal function, entecavir could be the best choice among these three agents.

Surveillance cultures of samples obtained from biopsy channels and automated endoscope reprocessors after high-level disinfection of gastrointestinal endoscopes

BackgroundThe instrument channels of gastrointestinal (GI) endoscopes may be heavily contaminated with bacteria even after high-level disinfection (HLD). The British Society of Gastroenterology guidelines emphasize the benefits of manually brushing endoscope channels and using automated endoscope reprocessors (AERs) for disinfecting endoscopes. In this study, we aimed to assess the effectiveness of decontamination using reprocessors after HLD by comparing the cultured samples obtained from biopsy channels (BCs) of GI endoscopes and the internal surfaces of AERs.MethodsWe conducted a 5-year prospective study. Every month random consecutive sampling was carried out after a complete reprocessing cycle; 420 rinse and swabs samples were collected from BCs and internal surface of AERs, respectively. Of the 420 rinse samples collected from the BC of the GI endoscopes, 300 were obtained from the BCs of gastroscopes and 120 from BCs of colonoscopes. Samples were collected by flushing the BCs with sterile distilled water, and swabbing the residual water from the AERs after reprocessing. These samples were cultured to detect the presence of aerobic and anaerobic bacteria and mycobacteria.ResultsThe number of culture-positive samples obtained from BCs (13.6%, 57/420) was significantly higher than that obtained from AERs (1.7%, 7/420). In addition, the number of culture-positive samples obtained from the BCs of gastroscopes (10.7%, 32/300) and colonoscopes (20.8%, 25/120) were significantly higher than that obtained from AER reprocess to gastroscopes (2.0%, 6/300) and AER reprocess to colonoscopes (0.8%, 1/120).ConclusionsCulturing rinse samples obtained from BCs provides a better indication of the effectiveness of the decontamination of GI endoscopes after HLD than culturing the swab samples obtained from the inner surfaces of AERs as the swab samples only indicate whether the AERs are free from microbial contamination or not.

Comparing the efficacy and clinical outcome of telbivudine and entecavir naïve patients with hepatitis B virus-related compensated cirrhosis.

There is limited data on the efficacy and outcome of telbivudine (LdT) therapy in patients with chronic hepatitis B and compensated cirrhosis. We evaluated LdT as first‐line therapy in these patients and compared with those treated with entecavir (ETV).

Diagnostic sensitivity of hepatocellular carcinoma imaging and its application to non-cirrhotic patients.

Background and Aims:u2002 The American Association for the Study of Liver Disease issued guidelines that proposed that hepatocellular carcinoma (HCC) can be diagnosed if a mass is larger than 2u2003cm in a cirrhotic liver and shows typical features of HCC at triphasic liver computed tomography (CT) or dynamic magnetic resonance imaging (MRI). In non‐cirrhotic livers, the criteria were not applicable. The aim of the present study was to retrospectively analyze the sensitivity of imaging by samples of definite HCC postoperatively and test their application to diagnose HCC in non‐cirrhotic livers.

Surveillance culture monitoring of double‐balloon enteroscopy reprocessing with high‐level disinfection

Eur J Clin Invest 2012; 42 (4): 427–431

A novel experience of antiviral therapy for chronic hepatitis B in renal transplant recipients.

BACKGROUNDnEntecavir (ETV) is a potent inhibitor of viral replication in chronic hepatitis B. There is no published data concerning ETV therapy in nucleoside analogue (NUC)-naive hepatitis B surface antigen (HBsAg)-positive renal transplant recipients (RTRs).nnnMETHODSnWe prospectively treated 27 HBsAg-positive RTRs with ETV since 2007. Serial HBV DNA was assessed at baseline and weeks 12, 24, 52 and 104 after treatment. A cohort of 19 patients who received 2-year lamivudine (3TC) therapy during 2004-2007 was used as a historical control.nnnRESULTSnOf the 27 RTRs, 18 (67%) were NUC-naive patients and 9 (33%) were 3TC-experienced without YMDD mutations. HBV DNA levels became undetectable in 70%, 74%, 96% and 100% of patients after 12, 24, 52 and 104 weeks, respectively, of ETV treatment without viral resistance. There was no change of glomerular filtration rate, and no lactic acidosis or myopathy during treatment. By comparison with the 19 3TC-treated patients, ETV-treated RTRs presented higher rates of undetectable HBV DNA than 3TC-treated RTRs (32%, 37%, 63% and 63% at 12, 24, 52 and 104 weeks; P<0.005). In an analysis excluding 9 patients from the ETV group who were also 3TC-experienced, the remaining 18 ETV-naive RTRs exhibited a better virological response at 52 and 104 weeks than 19 3TC-treated RTRs (P<0.05). Even in the 9 patients who overlapped in two cohorts, ETV exhibited a more rapid virological response than 3TC did, especially at 12 and 24 weeks (P=0.009).nnnCONCLUSIONSnETV is effective in treating chronic hepatitis B in RTRs. ETV is safe with regards to renal graft function, lactic acidosis, myopathy and virological resistance.

Swab culture monitoring of automated endoscope reprocessors after high-level disinfection

AIMnTo conduct a bacterial culture study for monitoring decontamination of automated endoscope reprocessors (AERs) after high-level disinfection (HLD).nnnMETHODSnFrom February 2006 to January 2011, authors conducted randomized consecutive sampling each month for 7 AERs. Authors collected a total of 420 swab cultures, including 300 cultures from 5 gastroscope AERs, and 120 cultures from 2 colonoscope AERs. Swab cultures were obtained from the residual water from the AERs after a full reprocessing cycle. Samples were cultured to test for aerobic bacteria, anaerobic bacteria, and mycobacterium tuberculosis.nnnRESULTSnThe positive culture rate of the AERs was 2.0% (6/300) for gastroscope AERs and 0.8% (1/120) for colonoscope AERs. All the positive cultures, including 6 from gastroscope and 1 from colonoscope AERs, showed monofloral colonization. Of the gastroscope AER samples, 50% (3/6) were colonized by aerobic bacterial and 50% (3/6) by fungal contaminations.nnnCONCLUSIONnA full reprocessing cycle of an AER with HLD is adequate for disinfection of the machine. Swab culture is a useful method for monitoring AER decontamination after each reprocessing cycle. Fungal contamination of AERs after reprocessing should also be kept in mind.

Mantle Cell Lymphoma with Diffuse Gastrointestinal Tract Involvement: A Case Report

Gastrointestinal tract mantle cell lymphoma accounts for only approximately 1% to 2% of non-Hodgkin lymphomas. Multiple lymphomatous polyposis is an uncommon disease entity that is regarded as the intestinal form of mantle cell lymphoma. We present here a case of mantle cell lymphoma with peculiar endoscopic presentations in the stomach and colon in a 70 year-old woman. She suffered from abdominal pain, progressive abdominal fullness, and body weight loss of 11 kilograms within 6 months. Big polypoid masses with ulcerations were found at the fundus and high body of the stomach by endoscopy and at the cecal area by colonoscopy. Biopsies from both sites confirmed the diagnosis of mantle cell lymphoma. Computer tomography of the abdomen revealed diffuse wall thickening involving the gastric fundus, high body, antrum, duodenum and proximal ascending colon with extensive mesentery lymph node enlargement. She received one cycle of cyclophosphamide, vincristine and prednisone (COP) followed by seven cycles of rituximab plus cyclophosphamide and prednisone, which resulted in significant tumor regression and prompt symptomatic palliation.

648 VALIDATION OF 2010 AASLD GUIDELINE IN THE DIAGNOSIS OF HEPATOCELLULAR CARCINOMA FOR NON-CIRRHOTIC LIVER

in staining patterns is seen in 5% of cases. One case has features of both I-HCA and b-HCA and also contains a focus of hepatocellular carcinoma. A subset of H-HCA also shows immunoreactivity for SAA and CRP. Interestingly, 20% of H-HCA does not show the typically described steatosis. We have examined 61 resected HCA at our institution in the US, confirming the practical use of IHC in the accurate classification of HCA. The important recognition of b-HCA for patient management is also reemphasized.

717 THE EXPRESSION AND PROGNOSTIC ROLE OF CHIBBY GENE IN HUMAN HEPATOPCELLULAR CARCINOMA

716 PROGNOSTIC GENE-EXPRESSION SIGNATURE FOR HEPATITIS C-RELATED EARLY-STAGE LIVER CIRRHOSIS Y. Hoshida, A. Villanueva, A. Sangiovanni, M. Sole, C. Hur, K.L. Andersson, R.T. Chung, J. Gould, K. Kojima, S. Gupta, B. Taylor, A. Crenshaw, S. Gabriel, B. Minguez, M. Iavarone, S.L. Friedman, M. Colombo, J.M. Llovet, T. Golub. Broad Institute of Harvard and MIT, Dana-Farber Cancer Institute, Boston, MA, USA; Laboratori de Reserca Translacional d’Oncoloǵia Hepatica, IDIBAPS, Ciberehd, Hospital Clinic, Barcelona, Spain; Division of Gastroenterology, Fondazione Ca Granda IRCCS Ospedale Maggiore Policlinico, Universita degli Studi di Milano, Milan, Italy; Dept. of Pathology, Hospital Cĺinic, Barcelona, Spain; Massachusetts General Hospital-Harvard Medical School, Boston, MA, USA; Liver Unit, Department of Medicine, Hospital Universitari Vall d’Hebron, Barcelona, Spain; Department of Liver Diseases, Mount Sinai School of Medicine, New York, NY, USA E-mail: hoshida@broadinstitute.org