Wonseok Kang

Liver stiffness measurement in combination with noninvasive markers for the improved diagnosis of B-viral liver cirrhosis.

Goal To investigate the performance of liver stiffness measurement (LSM) in combination with available noninvasive markers in hepatitis B virus-related chronic liver disease. Background Few noninvasive methods are available for predicting liver cirrhosis in chronic hepatitis B (CHB). Study Between January 2006 and June 2007, we studied 130 consecutive treatment-naive CHB patients who underwent liver biopsy (LB) and LSM. The aspartate to alanine aminotransferase ratio, age-platelet index (API), aspartate aminotransferase to platelet ratio index (APRI), LSM, and their combinations were compared with liver histology. Results The API, APRI, and LSM, but not the aspartate to alanine aminotransferase ratio, correlated significantly with liver cirrhosis (all P<0.001). The diagnostic accuracy of LSM and API exceed that of the other diagnostic methods for predicting liver cirrhosis (area under the receiver operating characteristic curve=0.840 and 0.818). When LSM was combined with API and APRI, the diagnostic accuracy was improved markedly (area under the receiver operating characteristic curve =0.871, and 0.846). When both LSM and API results were in agreement, LB confirmed them in 89.1% (41/46) of cases for liver cirrhosis. LB could have been avoided in 41 (31.5%) of the 130 patients who were examined for the potential diagnosis of liver cirrhosis. Conclusions The combination of LSM and API can avoid unnecessary invasive LB procedures in CHB patients.

Clinical outcomes and predictors for relapse after cessation of oral antiviral treatment in chronic hepatitis B patients

BackgroundLittle is known about stopping rules of nucelos(t)ide analog (NA) treatment for chronic hepatitis B (CHB).MethodsA total of 113 consecutive patients with CHB (45 HBeAg-positive and 68 HBeAg-negative CHB patients), who met the cessation criteria of NA treatment as per the Asian-Pacific Association for the Study of the Liver (APASL) guideline, were enrolled in this prospective cohort study. The primary endpoint was to evaluate virological relapse (VR) rate within 1xa0year, which was defined as reappearance of hepatitis B virus (HBV)–DNAxa0>xa02000xa0IU/mL after cessation of NA treatment. In this cohort, entecavir was used in 81 (71.7xa0%) and lamivudine in 32 (28.3xa0%) patients.ResultsWithin 1xa0year after NA treatment, VR occurred in 26 (57.8xa0%) HBeAg-positive patients and in 37 (54.4xa0%) HBeAg-negative patients. In univariate and subsequent multivariate analysis, agexa0>xa040xa0years [odds ratio (OR) 10.959; 95xa0% confidence interval (CI) 2.211–54.320; Pxa0=xa00.003) and a pre-treatment HBV DNA level >2000,000xa0IU/mL (OR 9.285; 95xa0% CI 1.545–55.795; Pxa0=xa00.036) were identified as independent risk factors for VR in HBeAg-positive patients, and agexa0>xa040xa0years (OR 6.690; 95xa0% CI 1.314–34.057; Pxa0=xa00.022) and an end-of-treatment HBcrAg level >3.7xa0logxa0IU/mL (OR 3.751; 95xa0% CI 1.187–11.856; Pxa0=xa00.024) were identified in HBeAg-negative patients. During follow up, neither hepatic decompensation nor hepatocellular carcinoma (HCC) occurred, and HBV DNA suppression was achieved in all patients who received antiviral re-treatment.ConclusionOur data suggested that the APASL stopping rule could be applied if a candidate was properly selected using individual risk factors. However, regular monitoring should be performed after cessation of NA treatment and long-term outcomes need to be evaluated further.

Low‐level viremia and the increased risk of hepatocellular carcinoma in patients receiving entecavir treatment

The long‐term clinical impact of low‐level viremia (LLV; <2,000 IU/mL) is not well understood. As a result, it is unclear whether the development of LLV during entecavir monotherapy requires a change in therapy. A retrospective cohort of 875 treatment‐naive chronic hepatitis B virus (HBV) monoinfected patients (mean age 47.7 years, male = 564 [65.5%], cirrhosis = 443 [50.6%]) who received entecavir monotherapy were analyzed for the development of hepatocellular carcinoma (HCC). The HCC risk was compared between patients who maintained virological response (MVR), defined by persistently undetectable HBV DNA (<12 IU/mL), and patients who experienced LLV, defined by either persistent or intermittent episodes of <2,000 IU/mL detectable HBV DNA. During a median 4.5 years of follow‐up (range 1.0‐8.7 years), HCC was diagnosed in 85 patients (9.7%). HCC developed more frequently in patients who experienced LLV than MVR (14.3% versus 7.5% at 5 years, P = 0.015). The hazard ratio comparing those with LLV to MVR was 1.98 (95% confidence interval = 1.28‐3.06, P = 0.002, adjusted for age, sex, hepatitis B e antigen, baseline HBV DNA levels, and cirrhosis). Among patients with cirrhosis, those with LLV exhibited a significantly higher HCC risk than those with MVR (HCC incidence rate at 5 years 23.4% versus 10.3%, adjusted hazard ratio = 2.20, 95% confidence interval 1.34‐3.60; P = 0.002). However, for patients without cirrhosis, there was no significant difference in the HCC risk between LLV and MVR. Conclusion: LLV observed during entecavir monotherapy was associated with a higher risk of HCC, especially for those with cirrhosis, indicating that LLV during potent antiviral therapy is consequential. (Hepatology 2017;66:335–343).

Prognostic value of the combined use of transient elastography and fibrotest in patients with chronic hepatitis B

Liver stiffness (LS) measurement using transient elastography and the FibroTest (FT) are alternatives to liver biopsy (LB) in assessing liver fibrosis. We investigated the prognostic role of the combined use of LS and FT in predicting liver‐related events (LREs) in patients with chronic hepatitis B (CHB).

Fabrication of superconducting MgB2 thin films on textured Cu(100) tape by hybrid physical-chemical vapor deposition

We report on the fabrication of superconducting MgB2 thin films on textured Cu(100) tape under low pressure and temperature by using a hybrid physical–chemical vapor deposition (HPCVD) technique to explore the possible broad range of deposition. Thermodynamic calculations for the Mg–B system have been carried out and the pressure–temperature phase diagram was obtained. Our results demonstrate that the deposition of superconducting MgB2 films is possible beyond the theoretically calculated growth window, where the sublimation of Mg is taking place. The structural and microstructural investigations reveal that MgB2 films are c-axis-oriented normal to the substrate. The highest Jc of ~1.34 × 105xa0Axa0cm−2 at 5xa0K under 3xa0T is obtained for the film grown at 460u2009°C. The critical current density (Jc) and flux pinning force density (Fp) of MgB2 films are enhanced with decreasing growth temperature. This could be attributed to the high density of grain boundaries which may act as effective flux pinning centers. These findings suggest an alternative route to fabricate MgB2 tapes at low temperature for large scale applications.

Red cell volume distribution width-to-platelet ratio in assessment of liver fibrosis in patients with chronic hepatitis B.

Precise assessment of liver fibrosis is necessary in patients with chronic liver disease. We investigated the performance of red cell volume distribution width‐to‐platelet ratio for the assessment of liver fibrosis in patients with chronic hepatitis B.

Thickness dependence of critical current density in GdBa2Cu3O7−δ thin films with BaSnO3 addition

We investigated influence of 4u2009wt. % BaSnO3 (BSO) addition on the thickness dependence of critical current density (Jc) of GdBa2Cu3O7−δ (GdBCO) thin films deposited by using the pulsed laser deposition technique. The results show that Jc measured at 77u2009K of the GdBCO films is significantly enhanced by the addition of BSO. Thickness dependence of self-field Jc in the BSO doped GdBCO films is reduced in comparison with that of pure GdBCO films. Improved field performance of Jc is also observed for the BSO-doped GdBCO films up to thickness of 1.5u2009μm. The enhancements are attributed to the growth of artificial pinning centers in the form of BSO nano precipitates confirmed by the cross-sectional transmission electron microscopy images.

Observation of strong intrinsic pinning in MgB2 films

By using three types of MgB2 superconductors, such as c-axis-oriented single-crystal films, c-axis-oriented columnar-structure films and films without c-axis orientation perpendicular to the substrate surface, we have investigated the intrinsic pinning effect in MgB2 superconductors. The strong field performance of Jc was observed by turning the orientation of grains from the c axis to the a axis. No c-axis-oriented MgB2 films showed a noticeable increase of Jc at high fields compared with c-axis-oriented films, whether they had columnar structures or not. Our results clearly show that MgB2 has strong intrinsic pinning caused by the large anisotropy of the superconducting energy gap in the boron layers like high-Tc cuprate superconductors with a layered structure.

Nonspecific interstitial pneumonitis after bortezomib and thalidomide treatment in a multiple myeloma patient.

Bortezomib, an inhibitor of 26S proteosome, is recently approved treatment option for multiple myeloma. Thalidomide, a drug with immunomodulating and antiangiogenic effects, has also shown promise as an effective treatment in multiple myeloma. Pulmonary complications are believed to be rare, especially interstitial lung disease. Here, we describe a patient with dyspnea and diffuse pulmonary infiltrates while receiving bortezomib and thalidomide in combination with dexamethasone for treatment-naïve multiple myeloma. Bronchoalveolar lavage demonstrated a significant decrease in the ratio of CD4 : CD8 T lymphocytes (CD4/8 ratio, 0.54). Extensive workup for other causes, including infections, was negative. A lung biopsy under video-assisted thorascopic surgery revealed a diagnosis of nonspecific interstitial pneumonitis. The symptoms and imaging study findings improved after initiating steroid treatment. Physicians should be aware of this potential complication in patients receiving the novel molecular-targeted antineoplastic agents, bortezomib and thalidomide, who present with dyspnea and new pulmonary infiltrates and fail to improve despite treatment with broad-spectrum antibiotics.

Reducing thickness dependence of critical current density in GdBa2Cu3O7-δ thin films by addition of nanostructured defects

The effect of incorporating nanostructured defects in a form of BaSnO3 (BSO) nanorods on the thickness dependence of critical current density (Jc) in GdBa2Cu3O7-x (GdBCO) thin films was investigated. Pure and 2u2009wt. % BSO-doped GdBCO films were fabricated by the pulsed laser deposition with the thicknesses t of both films increasing from 0.2u2009μm to 1.5u2009μm. The magnetization data measured at 77u2009K with the field being applied parallel to the c-axis of the films showed two important improvements. First, the Jcs of the GdBCO film were significantly enhanced with the BSO addition. Second, the BSO-doped GdBCO films exhibited less formation of a-axis grains on the film surface than the pure GdBCO films. As a result, a reduced thickness dependence of Jc was obtained for the BSO-doped GdBCO films. The two improvements may be explained by assuming that the growth of BSO nanostructured defects observed in the cross-sectional transmission electron microscopy functioned as effective artificial pinning centers.