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Search Results: 1 - 10 of 9126 matches for " Kwok-Hung Lai "
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Factors linked to severe thrombocytopenia during antiviral therapy in patients with chronic hepatitis c and pretreatment low platelet counts
Kung-Hung Lin, Ping-I Hsu, Hsien-Chung Yu, Chun-Ku Lin, Wei-Lun Tsai, Wen-Chi Chen, Hoi-Hung Chan, Kwok-Hung Lai
BMC Gastroenterology , 2012, DOI: 10.1186/1471-230x-12-7
Abstract: Medical records were reviewed for 125 patients with CHC treated with antiviral therapy according to the standard of care, with regular follow-up examinations. Early platelet decline was defined as platelet decrease during the first 2 weeks of therapy.Severe thrombocytopenia developed in 12.8% of patients with baseline thrombocytopenia, and predicted a higher therapeutic dropout rate. Multivariate analysis revealed baseline platelet count < 100,000/μL and rapid early platelet decline (> 30% decline in the first 2 weeks) were significantly associated with severe thrombocytopenia (P < 0.001 and 0.003, odds ratios, 179.22 and 45.74, respectively). In these patients, baseline PLT ≥ 100,000/μL and lack of rapid early platelet decline predicted absence of severe thrombocytopenia (negative predictive values were 95.1% and 96.6%, respectively). In contrast, baseline platelet count < 100,000/μL combined with rapid early platelet decline predicted severe thrombocytopenia (positive predictive value was 100%).For patients with CHC on antiviral therapy, baseline platelet counts < 100,000/μL and rapid early platelet decline can identify patients at high risk of developing on-treatment severe thrombocytopenia.Patients with chronic hepatitis C (CHC) treated with antiviral therapy consisting of pegylated interferon-α (peg-IFN-α) and ribavirin experience a response superior to that of therapies used in the past. This combination is the current standard of care [1]; however, side effects, especially hematologic abnormalities, may decrease both therapeutic adherence and the therapeutic success rate. Thrombocytopenia is one of the potential hematologic abnormalities associated with peg-IFN-α-based therapy [2-4].One recent study reported that development of a platelet count < 50,000/μL was independently associated with bleeding during antiviral therapy [5]. In clinical practice, there is no approved therapy for reversing the decline in platelet count, even though some anti-thrombocytopeni
The Frequencies of Gastroesophageal and Extragastroesophageal Symptoms in Patients with Mild Erosive Esophagitis, Severe Erosive Esophagitis, and Barrett’s Esophagus in Taiwan
Sung-Shuo Kao,Wen-Chih Chen,Ping-I Hsu,Seng-Kee Chuah,Ching-Liang Lu,Kwok-Hung Lai,Feng-Woei Tsai,Chun-Chao Chang,Wei-Chen Tai
Gastroenterology Research and Practice , 2013, DOI: 10.1155/2013/480325
Abstract: Background. Gastroesophageal reflux disease (GERD) may present with gastroesophageal and extraesophageal symptoms. Currently, the frequencies of gastroesophageal and extragastroesophageal symptoms in Asian patients with different categories of GERD remain unclear. Aim. To investigate the frequencies of gastroesophageal and extragastroesophageal symptoms in patients with mild erosive esophagitis, severe erosive esophagitis, and Barrett’s esophagus of GERD. Methods. The symptoms of symptomatic subjects with (1) Los Angeles grade A/B erosive esophagitis, (2) Los Angeles grade C/D erosive esophagitis, and (3) Barrett’s esophagus proven by endoscopy were prospectively assessed by a standard questionnaire for gastroesophageal and extragastroesophageal symptoms. The frequencies of the symptoms were compared by Chi-square test. Result. Six hundred and twenty-five patients (LA grade A/B: 534 patients; LA grade C/D: 37 patients; Barrett’s esophagus: 54 patients) were assessed for gastroesophageal and extragastroesophageal symptoms. Patients with Los Angeles grade A/B erosive esophagitis had higher frequencies of symptoms including epigastric pain, epigastric fullness, dysphagia, and throat cleaning than patients with Los Angeles grade C/D erosive esophagitis. Patients with Los Angeles grade A/B erosive esophagitis also had higher frequencies of symptoms including acid regurgitation, epigastric acidity, regurgitation of food, nausea, vomiting, epigastric fullness, dysphagia, foreign body sensation of throat, throat cleaning, and cough than patients with Barrett’s esophagus. Conclusion. The frequencies of some esophageal and extraesophageal symptoms in patients with Los Angeles grade A/B erosive esophagitis were higher than those in patients with Los Angeles grade C/D erosive esophagitis and Barrett’s esophagus. The causes of different symptom profiles in different categories of GERD patients merit further investigations. 1. Introduction The Montreal Definition and Classification of Gastroesophageal Reflux Disease defines GERD as a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications [1]. Gastroesophageal reflux occurs when there is a transient decrease in tension in the lower esophageal sphincter, allowing gastric contents to leak into the esophagus [2]. In most people with GERD, gastric juice reflux causes heartburn, as a painful or burning sensation in the esophagus, but regurgitation of digestive juices is also common [3]. Other than two classic reflux symptoms above, dysphagia is reported by more than
7-Day Nonbismuth-Containing Concomitant Therapy Achieves a High Eradication Rate for Helicobacter pylori in Taiwan
Sung-Shuo Kao,Wen-Chi Chen,Ping-I Hsu,Kwok-Hung Lai,Hsien-Chung Yu,Hui-Hwa Cheng,Nan-Jing Peng,Chiun-Ku Lin,Hoi-Hung Chan,Wei-Lun Tsai,Huay-Min Wang,Tzung-Jiun Tsai,Kung-Hung Lin,Feng-Woei Tsay
Gastroenterology Research and Practice , 2012, DOI: 10.1155/2012/463985
Abstract: Background. Ten-day concomitant therapy achieves a high eradication rate in Taiwan. Whether shortening the duration of concomitant therapy can still keep a high eradication rate remains unclear. Aim. To assess the eradication rate of 7-day pantoprazole-containing concomitant therapy in Taiwan and to investigate factors influencing the eradication outcome. Methods. From March 2008 to March 2012, 319 H. pylori-infected patients receiving a 7-day pantoprazole-containing concomitant regimen (pantoprazole 40?mg, amoxicillin 1?g, clarithromycin 500?mg, and metronidazole 500?mg twice daily for 7 days) were included. Patients were asked to return at the second week to assess drug compliance and adverse effects. Repeated endoscopy or urea breath test was performed at 8 weeks after the end of eradication therapy. Results. The eradication rates according to intention-to-treat and per-protocol analyses were 93.7% (299/319) and 96.4% (297/308), respectively. Adverse events occurred in 13.2% (42/319) of the patients. The compliance rate was 98.4% (314/319). Multivariate analysis disclosed that poor compliance was the only independent factor influencing the efficacy of anti-H. pylori therapy with an odds ratio of 0.073 (95% confidence interval, 0.011–0.483). Conclusion. 7-day concomitant therapy achieved a very high eradication rate for H. pylori infection in Taiwan. Drug compliance was the only clinical factor influencing treatment efficacy. 1. Introduction Helicobacter pylori (H. pylori) infection is a global human pathogen and plays a cardinal role in the development of peptic ulcer disease, gastric adenocarcinoma, and mucosa-associated tissue lymphoma [1]. The Maastricht III Consensus Report has recommended that proton-pump-inhibitor- (PPI-) clarithromycin-amoxicillin or metronidazole treatment for 7 to14 days is the first choice treatment for H. pylori infection [2]. Initial data suggested that high eradication rates could be achieved [3, 4]. However, this gold standard has recently become declining in cure rates to unacceptable levels ( ), largely as a result of emerging resistance of the organism to clarithromycin [5–9]. In some European countries, the success rates were astonishingly low with values 25~60% [7, 10, 11]. The cure rates for first-line 7-day triple therapy in southern Taiwan declined from 84% to 80% in recent 5 years [4, 12]. Therefore, searching for more effective first-line therapies is urgently required [4, 13]. One recent therapeutic innovation is 10-day sequential regimen with a 5-day dual therapy (a PPI plus amoxicillin), followed by a 5-day
Hepatic Arterial Infusion Chemotherapy for Patients with Huge Unresectable Hepatocellular Carcinoma
Wei-Lun Tsai, Kwok-Hung Lai, Huei-Lung Liang, Ping-I Hsu, Hoi-Hung Chan, Wen-Chi Chen, Hsien-Chung Yu, Feng-Woei Tsay, Huay-Min Wang, Hung-Chih Tsai, Jin-Shiung Cheng
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0092784
Abstract: Background and Aim The optimal treatment for huge unresectable hepatocellular carcinoma (HCC) remains controversial. The outcome of transcatheter arterial chemoembolization (TACE) for patients huge unresectable HCC is generally poor and the survival benefit of TACE in these patients is unclear. The aim of the study is to compare the effect of hepatic arterial infusion chemotherapy (HAIC) versus symptomatic treatment in patients with huge unresectable HCC. Methods Since 2000 to 2005, patients with huge (size >8cm) unresectable HCC were enrolled. Fifty-eight patients received HAIC and 44 patients received symptomatic treatment. In the HAIC group, each patient received 2.4+1.4 (range: 1–6) courses of HAIC. Baseline characteristics and survival were compared between the HAIC and symptomatic treatment groups. Results The HAIC group and the symptomatic treatment group were similar in baseline characteristics and tumor stages. The overall survival rates at one and two years were 29% and 14% in the HAIC group and 7% and 5% in the symptomatic treatment group, respectively. The patients in the HAIC group had significantly better overall survival than the symptomatic treatment group (P<0.001). Multivariate analysis revealed that HAIC was the significant factor associated with the overall survival (relative risk: 0.321, 95% confidence interval: 0.200–0.515, P<0.001). None of the patients died due to immediate complications of HAIC. Conclusions HAIC is a safe procedure and provides better survival than symptomatic treatment in patients with huge unresectable HCC.
Endoscopic papillary large balloon dilation alone without sphincterotomy for the treatment of large common bile duct stones
Hoi-Hung Chan, Kwok-Hung Lai, Chiun-Ku Lin, Wei-Lun Tsai, E-Ming Wang, Ping-I Hsu, Wen-Chi Chen, Hsien-Chung Yu, Huay-Min Wang, Feng-Woei Tsay, Cheng-chung Tsai, I-Shu Chen, Yu-chia Chen, Huei-Lung Liang, Huay-Ben Pan
BMC Gastroenterology , 2011, DOI: 10.1186/1471-230x-11-69
Abstract: We retrospectively evaluated the safety and efficacy of using large balloon dilation alone without the use of sphincterotomy for the treatment of large common bile duct stones in Kaohsiung Veterans General Hospital. Success rate of stone clearance, procedure-related adverse events and incidents, frequency of mechanical lithotripsy use, and recurrent stones were recorded.A total of 247 patients were reviewed in the current study. The mean age of the patients was 71.2 years. Most of them had comorbidities. Mean stone size was 16.4 mm. Among the patients, 132 (53.4%) had an intact gallbladder and 121 (49%) had a juxtapapillary diverticulum. The mean size of dilating balloon used was 13.2 mm. The mean duration of the dilating procedure was 4.7 min. There were 39 (15.8%) patients required the help of mechanical lithotripsy while retrieving the stones. The final success rate of complete retrieval of stones was 92.7%. The rate of pancreatic duct enhancement was 26.7% (66/247). There were 3 (1.2%) adverse events and 6 (2.4%) intra-procedure bleeding incidents. All patients recovered completely after conservative and endoscopic treatment respectively, and no procedure-related mortality was noted. 172 patients had a follow-up duration of more than 6 months and among these, 25 patients had recurrent common bile duct stones. It was significantly correlated to the common bile duct size (p = 0.036)Endoscopic papillary large balloon dilation alone is simple, safe, and effective in dealing with large common bile duct stones in relatively aged and debilitated patients.Endoscopic sphincterotomy (EST) is effective in the treatment of common bile duct stones (CBDS), with complete stone removal in 85%-90% of patients[1-3]. However, EST is technically demanding and the likelihood of complications is closely related to the skill and training of the endoscopist[4].Endoscopic papillary balloon dilation (EPBD), which is easy to perform using the wire-guided method, has become an alternative
Rapid induction of orthotopic hepatocellular carcinoma in immune-competent rats by non-invasive ultrasound-guided cells implantation
Hoi-Hung Chan, Tian-Huei Chu, Hsin-Fan Chien, Cheuk-Kwan Sun, E-Ming Wang, Huay-Ben Pan, Hsiao-Mei Kuo, Tsung-Hui Hu, Kwok-Hung Lai, Jiin-Tsuey Cheng, Ming-Hong Tai
BMC Gastroenterology , 2010, DOI: 10.1186/1471-230x-10-83
Abstract: Rat Novikoff hepatoma cells were injected percutaneously into the liver lobes of Sprague-Dawley rats under the guidance of high resolution ultrasound. The implantation rate and the correlation between dissected and ultrasound-measured tumor sizes were evaluated. A similar induction procedure was performed by means of laparotomy in a different group of rats. Pairs of tumor measurement were compared by ultrasound and computerized tomography scan. Rats with a successful establishment of the tumor were divided into the treatment (7-day low-dose epirubicin) group and the control group. The tumor sizes were non-invasively monitored by the same ultrasound machine. Blood and tumor tissues from tumor-bearing rats were examined by biochemical and histological analysis respectively.Ultrasound-guided implantation of Novikoff hepatoma cells led to the formation of orthotopic hepatocellular carcinoma in 60.4% (55/91) of the Sprague-Dawley rats. Moreover, tumor sizes measured by ultrasound significantly correlated with those measured by calipers after sacrificing the animals (P < 0.00001). The rate of tumor induction by ultrasound-guided implantation was comparable to that of laparotomy (55/91, 60.4% vs. 39/52, 75%) and no significant difference in sizes of tumor was noted between the two groups. There was a significant correlation in tumor size measurement by ultrasound and computerized tomography scan. In tumor-bearing rats, short-term and low-dose epirubicin chemotherapy caused a significant reduction in tumor growth, and was found to be associated with enhanced apoptosis and attenuated proliferation as well as a decrease in the microvessel density in tumors.Ultrasound-guided implantation of Novikoff hepatoma cells is an effective means of establishing orthotopic hepatocellular carcinoma in Sprague-Dawley rats. Short-term and low-dose epirubicin chemotherapy had perturbed tumor progression by inducing apoptosis and neovascularization blockade.Hepatocellular carcinoma (HCC) is t
A Novel Compact Dual-Frequency Coupled-Line Transformer with Simple Analytical Design Equations for Frequency-Dependent Complex Load Impedance
Yongle Wu;Weinong Sun;Sai-Wing (Peter) Leung;Yinliang Diao;Kwok-Hung Chan
PIER , 2013, DOI: 10.2528/PIER12101906
Abstract: In order to perfectly match arbitrary frequency-dependent complex load impedances at two uncorrelated frequencies, a novel coupled-line impedance transformer without transmission-line stubs is proposed in this paper. This transformer mainly features small size, wide bandwidth, simple analytical design method, and easy planar implementation. The transformer simply consists of a coupled-line section and an additional transmission-line section. Due to the usage of a coupled-line section, the theoretical synthesis of the proposed transformer becomes very simple when compared with previous transformers and the total size of the planar circuit without deterioration of operating bandwidth becomes small. Furthermore, several numerical examples are presented to demonstrate the flexible dual-frequency matching performance. Finally, the profile of matching frequency-dependent complex load impedance at two arbitrary frequencies has been examined by simulation and measurement of two microstrip generalized T-junction power dividers. Good agreement between the calculated results and measured ones justifies this proposed transformer and the design theory.
Age- Matched Comparison of Children Hospitalized for 2009 Pandemic H1N1 Influenza with Those Hospitalized for Seasonal H1N1 and H3N2
Susan S. Chiu, Kwok-Hung Chan, Wilfred H. S. Wong, Eunice L. Y. Chan, J. S. M. Peiris
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0021837
Abstract: Background A wide spectrum of clinical manifestation ranging from deaths to a mild course of disease has been reported in children infected with the 2009 pandemic H1N1 (pH1N1) influenza. Methodology/Major Findings We conducted an age-matched control study comparing children hospitalized for pH1N1 with historic controls infected with seasonal H1N1 and H3N2 influenza to correct for the effect of age on disease susceptibility and clinical manifestations. We also compared children with pH1N1 to children concurrently admitted for seasonal influenza during the pandemic period to adjust for differences in health-seeking behavior during the pandemic or other potential bias associated with historic controls. There was no death or intensive care admission. Children with pH1N1 were more likely to have at least one risk condition for influenza, an underlying chronic pulmonary condition, more likely to have asthma exacerbation and to be treated with oseltamivir. There was no difference in other aspects of the clinical course or outcome. Conclusion Disease manifestation of children hospitalized for pH1N1 infection was mild in our patient population.
Clinical and Virological Factors Associated with Viremia in Pandemic Influenza A/H1N1/2009 Virus Infection
Herman Tse,Kelvin K. W. To,Xi Wen,Honglin Chen,Kwok-Hung Chan,Hoi-Wah Tsoi,Iris W. S. Li,Kwok-Yung Yuen
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0022534
Abstract: Positive detection of viral RNA in blood and other non-respiratory specimens occurs in severe human influenza A/H5N1 viral infection but is not known to occur commonly in seasonal human influenza infection. Recently, viral RNA was detected in the blood of patients suffering from severe pandemic influenza A/H1N1/2009 viral infection, although the significance of viremia had not been previously studied. Our study aims to explore the clinical and virological factors associated with pandemic influenza A/H1N1/2009 viremia and to determine its clinical significance.
Model Selection in Time Series Studies of Influenza-Associated Mortality
Xi-Ling Wang, Lin Yang, King-Pan Chan, Susan S. Chiu, Kwok-Hung Chan, J. S. Malik Peiris, Chit-Ming Wong
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0039423
Abstract: Background Poisson regression modeling has been widely used to estimate influenza-associated disease burden, as it has the advantage of adjusting for multiple seasonal confounders. However, few studies have discussed how to judge the adequacy of confounding adjustment. This study aims to compare the performance of commonly adopted model selection criteria in terms of providing a reliable and valid estimate for the health impact of influenza. Methods We assessed four model selection criteria: quasi Akaike information criterion (QAIC), quasi Bayesian information criterion (QBIC), partial autocorrelation functions of residuals (PACF), and generalized cross-validation (GCV), by separately applying them to select the Poisson model best fitted to the mortality datasets that were simulated under the different assumptions of seasonal confounding. The performance of these criteria was evaluated by the bias and root-mean-square error (RMSE) of estimates from the pre-determined coefficients of influenza proxy variable. These four criteria were subsequently applied to an empirical hospitalization dataset to confirm the findings of simulation study. Results GCV consistently provided smaller biases and RMSEs for the influenza coefficient estimates than QAIC, QBIC and PACF, under the different simulation scenarios. Sensitivity analysis of different pre-determined influenza coefficients, study periods and lag weeks showed that GCV consistently outperformed the other criteria. Similar results were found in applying these selection criteria to estimate influenza-associated hospitalization. Conclusions GCV criterion is recommended for selection of Poisson models to estimate influenza-associated mortality and morbidity burden with proper adjustment for confounding. These findings shall help standardize the Poisson modeling approach for influenza disease burden studies.
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