Biomedical subjects

Naoky Tsai

Publications and source records attributed to Naoky Tsai.

7 recordsLinked to original sources

PubMed2006

Chronic hepatitis B: a critical appraisal of current approaches to therapy.

BACKGROUND & AIMS: Treatment of chronic hepatitis B (CHB) involves a number of complex and controversial issues. Expert opinions may differ from those of practicing hepatologists and gastroenterologists. We aimed to explore this issue further after a critical review of the literature. METHODS: A panel of 14 international experts graded the strength of evidence for 16 statements addressing 3 content areas: patient selection, therapeutic end points, and treatment options. Available data relating to the statements were reviewed critically in 3 small work groups. After discussion of each statement with the entire panel, the experts voted anonymously to accept or reject statements based on the strength of evidence and their experience. A total of 241 members of the American Association for the Study of Liver Diseases (AASLD) responded to the same statements and their responses were compared with those of the experts. A discordant response was defined as a difference of more than 20% in any of the 5 graded levels of response (accept or reject) between the 2 groups. RESULTS: With the exception of 2 statements, the experts' responses were relatively uniform. However, the responses of the AASLD members were discordant from the experts in 12 statements, spanning all 3 content areas. CONCLUSIONS: Several areas of disagreement on the management of CHB exist between experts and AASLD members. Our results indicate a potential knowledge gap among practicing hepatologists. Better educational efforts are needed to meet the challenge of managing this complex disorder in which even expert opinion occasionally may disagree.

Adenine↗

PubMed2006

Liver transplant in Hawai'i: over a hundred cases.

One hundred and two liver transplants have been performed since the program's inception in Hawai'i in 1993. Viral hepatitis continues to be the primary indication for liver transplant, though hepatocellular cancer is involved in 23.5% of cases. One, 3 and 5-year patient survival rates have been 88%, 79%, and 74% respectively which is comparable to mainland centers and national data.

Adult↗

PubMed2005

Hepatitis B and alcohol affect survival of hepatocellular carcinoma patients.

AIM: In the USA, Hawaii has the highest incidence of hepatocellular carcinoma (HCC) and a diverse population. It is an ideal place to characterize HCC in the context of ethnicity/risk factors. METHODS: A total of 262 cases of HCC (1992-2003) were retrospectively reviewed for demographics, ethnicity, birthplace, viral hepatitis, alcohol use, diabetes, smoking and risk factors for viral hepatitis such as intravenous drug abuse (IVDA), transfusions, tattoos and vertical transmission. Tumor stage, Child's class, Cancer of the Liver Italian Program (CLIP) score, alpha-fetoprotein level, treatment and survival were recorded. RESULTS: Gender, age, viral hepatitis, alcohol, IVDA, and diabetes differed significantly in Asians, non-Asians and Pacific Islanders. There were also specific differences within Asian subgroups. Alpha-fetoprotein, smoking, transfusions, stage and resectability did not differ between groups. Asians were more likely to have hepatitis B, while non-Asians were more likely to have hepatitis C. Factors that decreased survival included hepatitis B, alcohol, elevated alpha-fetoprotein, CLIP>2 and increased Child's class. When Asians were combined with Pacific Islanders, median survival (1.52 years vs 3.54 years), 1- and 3-year survival was significantly worse than those for non-Asians. After Cox regression analysis for hepatitis B and alcohol, there was no difference in survival by ethnicity. CONCLUSION: Various ethnicities have different risk factors for HCC. Hepatitis B, alcohol, and alpha-fetoprotein are more important factors for survival than ethnicity.

Alcohol Drinking↗

PubMed2004

Genotype and phylogenetic characterization of hepatitis B virus among multi-ethnic cohort in Hawaii.

AIM: Hepatitis B virus (HBV) genomes in carriers from Hawaii have not been evaluated previously. The aim of the present study was to evaluate the distribution of HBV genotypes and their clinical relevance in Hawaii. METHODS: Genotyping of HBV among 61 multi-ethnic carriers in Hawaii was performed by genetic methods. Three complete genomes and 61 core promoter/precore regions of HBV were sequenced directly. RESULTS: HBV genotype distribution among the 61 carriers was 23.0% for genotype A, 14.7% for genotype B and 62.3% for genotype C. Genotypes A, B and C were obtained from the carriers whose ethnicities were Filipino and Caucasian, Southeast Asian, and various Asian and Micronesian, respectively. All cases of genotype B were composed of recombinant strains with genotype C in the precore plus core region named genotype Ba. HBeAg was detected more frequently in genotype C than in genotype B (68.4% vs 33.3%, P<0.05) and basal core promoter (BCP) mutation (T1762/A1764) was more frequently found in genotype C than in genotype B. Twelve of the 38 genotype C strains possessed C at nucleotide (nt) position 1858 (C-1858). However there was no significant difference in clinical characteristics between C-1858 and T-1858 variants. Based on complete genome sequences, phylogenetic analysis revealed one patient of Micronesian ethnicity as having C-1858 clustered with two isolates from Polynesia with T-1858. In addition, two strains from Asian ethnicities were clustered with known isolates in carriers from Southeast Asia. CONCLUSION: Genotypes A, B and C are predominant types among multi-ethnic HBV carriers in Hawaii, and distribution of HBV genotypes is dependent on the ethnic background of the carriers in Hawaii.

Adult↗

PubMed2004

Differences in hepatitis C virus core protein processing among genotypes 1 and 2.

Two forms of hepatitis C virus (HCV) core protein, p23 and p21, are produced from a precursor polyprotein. Production of p21 by cleavage at the c-terminus of p23 is considered essential for viral assembly and replication. In the present experiment, an in vitro translation and transcription assays were used to examine cleavage of p21 from p23 among 19 clones isolated from patients with chronic hepatitis, including 10 infected with genotype 1, and nine infected with genotype 2. Significantly greater p21 to p23 ratios were observed among genotype 1 clones, compared to genotype 2 clones. A comparison of the amino acid sequences of these clones revealed greater production of p21 core protein among clones which contained alanine, rather than valine, at amino acid residue 189. An exploration of Hepatitis Virus Database revealed that efficient p21 production related alanine at amino acid position 189 was observed in most clones of genotype 1 and in rare clones of genotype 2. These data suggest that the efficiency of core protein production differs among genotypes depending on differences in the c-terminus amino acid sequences of their core region. This may explain differences in some of the clinical characteristics of various genotypes or clones.

Journal Article↗

PubMed2004

Liver transplant for hepatocellular cancer: a treatment for the select few.

Hepatocellular cancer (HCC) is increasing in incidence and liver transplant (LT) is likely the best treatment for long-term survival and decreased recurrence in those with localized disease. Optimal treatment for HCC is limited by advanced stage at presentation and available donors. We retrospectively reviewed 232 cases of HCC from 1993 to 2002 referred to our medical center, which also has the only transplant program in the state. Demographic data, risk factors, stage, previous treatment, candidacy for LT, and outcome were noted. Stage distribution was as follows: stage I - nine patients, II - 115 patients, III - 31 patients, and IV - 76 patients. Mean age was 61.1 yr and 62 patients were over the age of 70 yr. Thirty-five patients (15.1%) were offered LT evaluation. Nineteen patients (8.2%) eventually underwent LT, five are currently on a transplant waiting list, three were on a list but removed due to death or progression of disease, six were evaluated but not listed, and two refused evaluation. Five patients were transplanted because implementation of the Model of End-stage Liver Disease (MELD) system for organ allocation. Of 19 patients who underwent LT, 14 are still alive 3-52 months post-transplant, three developed recurrent HCC, and two died of lung cancer. Although LT may be the best treatment for HCC, a relatively small number of patients (15%) will qualify for this therapy. About half of those who qualify will actually undergo LT. This further emphasizes the need for other strategies such as vaccination, chemoprevention, and early detection to improve survival from HCC.

Adult↗

PubMedDate not supplied

Diagnosis and management of chronic hepatitis B in the primary care setting.

Chronic hepatitis B is a complex disease for which there are an increasing number of approved treatment options. Clinicians who strive to keep up to date on the diagnosis and treatment of hepatitis B will be in the best position to meet the challenge of managing patients with this serious infection.

Hepatitis B, Chronic↗