46 results on '"Grace Lai-Hung Wong"'
Search Results
2. Dipeptidyl peptidase-4 inhibitors are associated with improved survival of patients with diabetes mellitus and hepatocellular carcinoma receiving immunotherapy: Letter to the editor on 'Statin and aspirin for chemoprevention of hepatocellular carcinoma: Time to use or wait further?'
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Dorothy Cheuk-Yan Yiu, Huapeng Lin, Vincent Wai-Sun Wong, Grace Lai-Hung Wong, Ken Liu, and Terry Cheuk-Fung Yip
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dpp4i ,liver cancer ,mortality ,systemic therapy ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Published
- 2024
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3. P-11 REAL-WORLD DATA WITH PANGENOTYPIC DIRECT-ACTING ANTIVIRALS IN LATINAMERICA: PRELIMINARY RESULTS OF THE SVR10K STUDY
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Mario Alvares da Silva, Fatima Higuera de la Tijera, Miguel Castruita Garcia, Oscar Beltran Galvis, Ming Lung Yu, Soo Aleman, Grace Lai-Hung Wong, Javier Garcia Samaniego, Joaquin Cabezas Gonzalez, Marta Casado Martin, Mohamed Alzaabi, Aastha Chandak, Marta Martinez, Artak Khachatryan, Linda Chen, Candido Hernandez Lopez, and Yu Jun Wong
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Specialties of internal medicine ,RC581-951 - Abstract
Conflict of interest: Yes, Gilead-sponsored research Introduction and Objectives: A previous real-world data (RWD) analysis demonstrated high effectiveness of sofosbuvir/velpatasvir (SOF/VEL) without ribavirin in > 6,000 HCV patients from 12 clinical cohorts across Australia, Canada, Europe & USA. Expand this research initiative with the ongoing SVR10K study, to include even more patients from additional geographical areas, which will allow to show SOF/VEL effectiveness across multiple diverse populations, including Latin-American (LATAM) region. Patients / Materials and Methods: This RWD analysis includes patients ≥ 18 years treated with SOF/VEL without RBV for 12 weeks, as decided by the treating HCP, from 13 sites across Brazil, Colombia, Hong Kong, Mexico, Singapore, Sweden, Spain, Taiwan, and the United Arab Emirates. Age, sex, treatment experienced (TE), cirrhosis stage (no decompensated included), genotype, coinfections, time to treatment initiation (TTI) from HCV diagnosis, and SVR were analyzed for LATAM region. Results and Discussion: Overall, 7,027 patients have been included up to now, 13% (n=890) of them from four sites in the LATAM region (Table). There, median age was 54.5 [IQR 43.2-63.5], where males 51%, and age > 50 years in 62%. Genotype 3 was present in 14%, cirrhotic (CC) 34%, TE 8%, while HIV, HBV and HDV coinfection was reported in 7.2%, 0.3%, and 0.0%, respectively. The TTI was available in 94%, with 28% having ≤30 days (In Brazil 57%). In terms of effectiveness, SVR was achieved in 99.6% of the treated population (n=788); being 98.2% in GT3 patients (n=112), 99.6% in CC patients (n=279), and 97.4% in GT3 CC patients (n=38). Conclusions: Results on treatment effectiveness in LATAM region did not differ from RWD studies of patients in the North-Western countries, reinforcing that HCV treatment guidelines are globally applicable, and supporting the efficacy of panfibrotic, pangenotypic, and pangeographic DAA therapy. Although with positive signs, there is still a significant room for improvement in the time to treatment initiation in the LATAM region.
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- 2024
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4. Hepatocellular carcinoma surveillance after HBsAg seroclearance
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Jimmy Che-To Lai, Vicki Wing-Ki Hui, Grace Lai-Hung Wong, Vincent Wai-Sun Wong, and Terry Cheuk-Fung Yip
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cirrhosis ,hbsag seroclearance ,liver cancer ,surveillance ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Hepatitis B surface antigen (HBsAg) seroclearance is considered the functional cure and the optimal treatment endpoint for chronic hepatitis B (CHB). Patients with CHB who cleared HBsAg generally have a favorable clinical course with minimal risk of developing hepatocellular carcinoma (HCC) or cirrhotic complications. Nevertheless, a minority of patients still develop HCC despite HBsAg seroclearance. While patients with liver cirrhosis are still recommended for HCC surveillance, whether other non-cirrhotic patients who achieved HBsAg seroclearance should remain on HCC surveillance remains unclear. This review provides an overview of the incidence of HBsAg seroclearance, the factors associated with the occurrence of HBsAg seroclearance, the durability of HBsAg seroclearance, the risk of developing HCC after HBsAg seroclearance, the risk factors associated with HCC development after HBsAg seroclearance, the role of HCC risk scores, and the implications on HCC surveillance. Existing HCC risk scores have a reasonably good performance in patients after HBsAg seroclearance. In the era of artificial intelligence, future HCC risk prediction models based on artificial intelligence and longitudinal clinical data may further improve the prediction accuracy to establish a foundation of a risk score-based HCC surveillance strategy. As different novel hepatitis B virus (HBV) antiviral agents aiming at HBsAg seroclearance are under active development, new knowledge is anticipated on the natural history and HCC risk prediction of patients treated with new HBV drugs.
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- 2024
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5. Alcohol-associated hepatitis trends before and following the onset of the COVID-19 pandemic across two distinct cohorts in the United States and Hong Kong
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Zeyuan Yang, Vicki Wing-Ki Hui, Terry Cheuk-Fung Yip, Mandy Sze-Man Lai, Jimmy Che-To Lai, Vincent Wai-Sun Wong, Ramsey Cheung, Grace Lai-Hung Wong, and Robert J. Wong
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Alcoholic hepatitis ,Alcohol-associated liver disease ,Alcohol use disorder ,Veterans ,Global burden ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background & Aims: Alcohol-associated liver disease (ALD) burden has been rising globally, fueled by increases in high-risk alcohol use following the coronavirus disease 2019 (COVID-19) pandemic. We evaluated trends in annual incidence of alcohol-associated hepatitis (AH) before and following the onset of the COVID-19 pandemic across two geographically distinct populations in the USA and Hong Kong. Methods: Using US national Veterans Affairs (VA) data and Hong Kong territory-wide data, trends in annual incidence of AH were evaluated from 2000 to 2023. AH was identified using a combination of International Classification of Diseases (ICD)-9/10 diagnostic codes, laboratory data, and available alcohol use data. Results: Among the VA data, annual incidence of AH rose steadily from 39.4 to 53.7 per 100,000 persons (2010–2020), then declined to 36.2 per 100,000 persons in 2023. Annual AH incidence was substantially lower in Hong Kong, but demonstrated similar trends, peaking at 0.28 per 100,000 persons during the first year of the pandemic. Among both cohorts, incidence of AH was significantly higher in men vs. women, but particularly for the VA cohort, the increase in AH incidence was more rapid in women. Among both cohorts, the highest incidence of AH in 2023 was among the 40–49-year age group (VA: 72.7 per 100,000 persons; Hong Kong: 1.89 per 100,000 persons). Conclusions: We provide a comprehensive analysis of epidemiological trends in AH incidence across two distinct populations, highlighting the need for continued awareness of targeted interventions to curb unhealthy alcohol use and its complications. Impact and implications:: Alcohol-associated hepatitis (AH) is a severe complication of high-risk alcohol use associated with significant morbidity and mortality. Increasing alcohol use fueled by the COVID-19 pandemic has led to parallel increases in alcohol-related comorbidities. The current study provides a comprehensive analysis of trends in the incidence of AH across two distinct world regions before and following the onset of the COVID-19 pandemic. Better identification of epidemiological trends in AH incidence as well as highlighting populations most affected can help target public health resources and health system interventions to address the dangers of high-risk alcohol use more effectively.
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- 2025
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6. Hepatocyte apoptosis fragment product cytokeratin-18 M30 level and non-alcoholic steatohepatitis risk diagnosis: an international registry study
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Huai Zhang, Rafael S. Rios, Jerome Boursier, Rodolphe Anty, Wah-Kheong Chan, Jacob George, Yusuf Yilmaz, Vincent Wai-Sun Wong, Jiangao Fan, Jean-François Dufour, George Papatheodoridis, Li Chen, Jörn M. Schattenberg, Junping Shi, Liang Xu, Grace Lai-Hung Wong, Naomi F. Lange, Margarita Papatheodoridi, Yuqiang Mi, Yujie Zhou, Christopher D. Byrne, Giovanni Targher, Gong Feng, Minghua Zheng, and Yuanyuan Ji
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Medicine - Abstract
Abstract. Background:. Liver biopsy for the diagnosis of non-alcoholic steatohepatitis (NASH) is limited by its inherent invasiveness and possible sampling errors. Some studies have shown that cytokeratin-18 (CK-18) concentrations may be useful in diagnosing NASH, but results across studies have been inconsistent. We aimed to identify the utility of CK-18 M30 concentrations as an alternative to liver biopsy for non-invasive identification of NASH. Methods:. Individual data were collected from 14 registry centers on patients with biopsy-proven non-alcoholic fatty liver disease (NAFLD), and in all patients, circulating CK-18 M30 levels were measured. Individuals with a NAFLD activity score (NAS) ≥5 with a score of ≥1 for each of steatosis, ballooning, and lobular inflammation were diagnosed as having definite NASH; individuals with a NAS ≤2 and no fibrosis were diagnosed as having non-alcoholic fatty liver (NAFL). Results:. A total of 2571 participants were screened, and 1008 (153 with NAFL and 855 with NASH) were finally enrolled. Median CK-18 M30 levels were higher in patients with NASH than in those with NAFL (mean difference 177 U/L; standardized mean difference [SMD]: 0.87 [0.69–1.04]). There was an interaction between CK-18 M30 levels and serum alanine aminotransferase, body mass index (BMI), and hypertension (P
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- 2023
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7. Moving toward hepatitis B virus functional cure - the impact of on-treatment kinetics of serum viral markers
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Lilian Yan Liang, Vincent Wai-Sun Wong, Grace Lai-Hung Wong, and Terry Cheuk-Fung Yip
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hepatitis b virus ,hepatitis b ,antiviral agents ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Published
- 2023
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8. Baveno VII criteria for recompensation predict transplant-free survival in patients with hepatitis B-related decompensated cirrhosis
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Vicki Wing-Ki Hui, Grace Lai-Hung Wong, Vincent Wai-Sun Wong, Henry Lik-Yuen Chan, Jimmy Che-To Lai, Yee-Kit Tse, Mandy Sze-Man Lai, Tsz-Fai Yam, Dongrong Li, XiaoDan Fan, and Terry Cheuk-Fung Yip
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Liver stiffness measurement ,Platelet count ,Transient elastography ,Variceal bleeding ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background & Aims: The latest Baveno VII consensus has provided guidance for identifying patients who have truly recompensated from those with hepatic decompensation. This study aimed to evaluate patients’ transplant-free survival in three different stages of cirrhosis. Methods: All patients with chronic HBV infection and liver cirrhosis treated with oral nucleos(t)ide analogues from March 2006 to December 2022 were identified from a territory-wide database in Hong Kong. Patients with follow-up duration of
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- 2023
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9. Halfway through HBV elimination – are we not waiting?
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Grace Lai-Hung Wong, Janus P. Ong, Apichat Kaewdech, and Tung-Hung Su
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Infectious and parasitic diseases ,RC109-216 - Published
- 2023
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10. Non-invasive tests of non-alcoholic fatty liver disease
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Guanlin Li, Xinrong Zhang, Huapeng Lin, Lilian Yan Liang, Grace Lai-Hung Wong, Vincent Wai-Sun Wong, and Yuanyuan Ji
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Medicine - Abstract
Abstract. For the detection of steatosis, quantitative ultrasound imaging techniques have achieved great progress in past years. Magnetic resonance imaging proton density fat fraction is currently the most accurate test to detect hepatic steatosis. Some blood biomarkers correlate with non-alcoholic steatohepatitis, but the accuracy is modest. Regarding liver fibrosis, liver stiffness measurement by transient elastography (TE) has high accuracy and is widely used across the world. Magnetic resonance elastography is marginally better than TE but is limited by its cost and availability. Several blood biomarkers of fibrosis have been used in clinical trials and hold promise for selecting patients for treatment and monitoring treatment response. This article reviews new developments in the non-invasive assessment of non-alcoholic fatty liver disease (NAFLD). Accumulating evidence suggests that various non-invasive tests can be used to diagnose NAFLD, assess its severity, and predict the prognosis. Further studies are needed to determine the role of the tests as monitoring tools. We cannot overemphasize the importance of context in selecting appropriate tests.
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- 2022
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11. U-shaped relationship between urea level and hepatic decompensation in chronic liver diseases
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Huapeng Lin, Grace Lai-Hung Wong, Xinrong Zhang, Terry Cheuk-Fung Yip, Ken Liu, Yee Kit Tse, Vicki Wing-Ki Hui, Jimmy Che-To Lai, Henry Lik-Yuen Chan, and Vincent Wai-Sun Wong
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urea ,liver cirrhosis ,fibrosis ,non-alcoholic fatty liver disease ,hepatitis b ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background/Aims We aimed to determine the association between blood urea level and incident cirrhosis, hepatic decompensation, and hepatocellular carcinoma in chronic liver disease (CLD) patients. Methods The association between blood urea level and liver fibrosis/liver-related events were evaluated on continuous scale with restricted cubic spline curves based on generalized additive model or Cox proportional hazards models. Then, the above associations were evaluated by urea level within intervals. Results Among 4,282 patients who had undergone liver stiffness measurement (LSM) by transient elastography, baseline urea level had a U-shaped association with LSM and hepatic decompensation development after a median follow-up of 5.5 years. Compared to patients with urea of 3.6–9.9 mmol/L, those with urea ≤3.5 mmol/L (adjusted hazard ratio [aHR], 4.15; 95% confidence interval [CI], 1.68–10.24) and ≥10 mmol/L (aHR, 5.22; 95% CI, 1.86–14.67) had higher risk of hepatic decompensation. Patients with urea ≤3.5 mmol/L also had higher risk of incident cirrhosis (aHR, 3.24; 95% CI, 1.50–6.98). The association between low urea level and incident cirrhosis and hepatic decompensation was consistently observed in subgroups by age, gender, albumin level, and comorbidities. The U-shaped relationship between urea level and LSM was validated in another population screening study (n=917). Likewise, urea ≤3.5 mmol/L was associated with a higher risk of incident cirrhosis in a territory-wide cohort of 12,476 patients with nonalcoholic fatty liver disease at a median follow-up of 9.9 years (aHR, 1.27; 95% CI, 1.03–1.57). Conclusions We identified a U-shaped relationship between the urea level and liver fibrosis/incident cirrhosis/hepatic decompensation in patients with CLD.
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- 2022
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12. Epidemiology, Symptomatology, and Risk Factors for Long COVID Symptoms: Population-Based, Multicenter Study
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Martin Chi-Sang Wong, Junjie Huang, Yuet-Yan Wong, Grace Lai-Hung Wong, Terry Cheuk-Fung Yip, Rachel Ngan-Yin Chan, Steven Wai-Ho Chau, Siew-Chien Ng, Yun-Kwok Wing, and Francis Ka-Leung Chan
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Public aspects of medicine ,RA1-1270 - Abstract
BackgroundLong COVID induces a substantial global burden of disease. The pathogenesis, complications, and epidemiological and clinical characteristics of patients with COVID-19 in the acute phase have been evaluated, while few studies have characterized the epidemiology, symptomatology, and risk factors of long COVID symptoms. Its characteristics among patients with COVID-19 in the general population remain unaddressed. ObjectiveWe examined the prevalence of long COVID symptoms, its symptom patterns, and its risk factors in 4 major Chinese cities in order to fill the knowledge gap. MethodsWe performed a population-based, multicenter survey using a representative sampling strategy via the Qualtrics platform in Beijing, Shanghai, Guangzhou, and Hong Kong in June 2022. We included 2712 community-dwelling patients with COVID-19 and measured the prevalence of long COVID symptoms defined by the World Health Organization (WHO), and their risk factors. The primary outcomes were the symptoms of long COVID, with various levels of impact. A descriptive analysis of the prevalence and distribution of long COVID symptoms according to disease severity was conducted. A sensitivity analysis of increasing the number of long COVID symptoms was also conducted. Univariate and multivariate regression analyses were performed to examine the risk factors of severe long COVID symptoms, including age, gender, marital status, current occupation, educational level, living status, smoking habits, monthly household income, self-perceived health status, the presence of chronic diseases, the use of chronic medication, COVID-19 vaccination status, and the severity of COVID-19. ResultsThe response rate was 63.6% (n=2712). The prevalence of long COVID, moderate or severe long COVID, and severe long COVID was 90.4% (n=2452), 62.4% (n=1692), and 31.0% (n=841), respectively. Fatigue (n=914, 33.7%), cough (n=865, 31.9%), sore throat (n=841, 31.0%), difficulty in concentrating (n=828, 30.5%), feeling of anxiety (n=817, 30.2%), myalgia (n=811, 29.9%), and arthralgia (n=811, 29.9%) were the most common severe long COVID symptoms. From multivariate regression analysis, female gender (adjusted odds ratio [aOR]=1.49, 95% CI 1.13-1.95); engagement in transportation, logistics, or the discipline workforce (aOR=2.52, 95% CI 1.58-4.03); living with domestic workers (aOR=2.37, 95% CI 1.39-4.03); smoking (aOR=1.55, 95% CI 1.17-2.05); poor or very poor self-perceived health status (aOR=15.4, 95% CI 7.88-30.00); ≥3 chronic diseases (aOR=2.71, 95% CI 1.54-4.79); chronic medication use (aOR=4.38, 95% CI 1.66-11.53); and critical severity of COVID-19 (aOR=1.52, 95% CI 1.07-2.15) were associated with severe long COVID. Prior vaccination with ≥2 doses of COVID-19 vaccines was a protective factor (aOR=0.35-0.22, 95% CI 0.08-0.90). ConclusionsWe examined the prevalence of long COVID symptoms in 4 Chinese cities according to the severity of COVID-19. We also evaluated the pattern of long COVID symptoms and their risk factors. These findings may inform early identification of patients with COVID-19 at risk of long COVID and planning of rehabilitative services.
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- 2023
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13. The truth of the matter: will immune-tolerant chronic hepatitis B patients benefit from antiviral treatment?
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Wen-Juei Jeng and Grace Lai-Hung Wong
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Published
- 2023
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14. Non-invasive biomarkers for liver inflammation in non-alcoholic fatty liver disease: present and future
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Terry Cheuk-Fung Yip, Fei Lyu, Huapeng Lin, Guanlin Li, Pong-Chi Yuen, Vincent Wai-Sun Wong, and Grace Lai-Hung Wong
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cytokeratin-18 ,deep learning ,fatty liver ,liver cancer ,machine learning ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Inflammation is the key driver of liver fibrosis progression in non-alcoholic fatty liver disease (NAFLD). Unfortunately, it is often challenging to assess inflammation in NAFLD due to its dynamic nature and poor correlation with liver biochemical markers. Liver histology keeps its role as the standard tool, yet it is well-known for substantial sampling, intraobserver, and interobserver variability. Serum proinflammatory cytokines and apoptotic markers, namely cytokeratin-18, are well-studied with reasonable accuracy, whereas serum metabolomics and lipidomics have been adopted in some commercially available diagnostic models. Ultrasound and computed tomography imaging techniques are attractive due to their wide availability; yet their accuracies may not be comparable with magnetic resonance imaging-based tools. Machine learning and deep learning models, be they supervised or unsupervised learning, are promising tools to identify various subtypes of NAFLD, including those with dominating liver inflammation, contributing to sustainable care pathways for NAFLD.
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- 2023
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15. Serum fibrosis index-based risk score predicts hepatocellular carcinoma in untreated patients with chronic hepatitis B
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Lilian Yan Liang, Hye Won Lee, Vincent Wai-Sun Wong, Terry Cheuk-Fung Yip, Yee-Kit Tse, Vicki Wing-Ki Hui, Grace Chung-Yan Lui, Henry Lik-Yuen Chan, and Grace Lai-Hung Wong
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hepatitis b, chronic ,carcinoma, hepatocellular ,fibrosis ,surveillance ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background/Aims Serum fibrosis scores comprised of common laboratory tests have high utility to assess severity of liver fibrosis. We aimed to derive and validate a hepatocellular carcinoma (HCC) risk score based on serum fibrosis scores to predict HCC in treatment-naïve chronic hepatitis B (CHB) patients. Methods Fifteen thousand one hundred eighty-seven treatment-naïve adult CHB patients were identified to form the training cohort in this retrospective study. Individual fibrosis score was included to construct a new HCC prediction score. The score was externally validated in an independent treatment-naïve Korean CHB cohort. Results 180/15,187 patients (1.2%) in training cohort and 47/4,286 patients (1.1%) in validation cohort developed HCC during a mean follow-up of 52 and 50 months, respectively. The newly developed HCC risk score, Liang score, is composed of gender, age, hepatitis B virus DNA, fibrosis-4 (FIB-4) index, and ranges from 0 to 22. Area under the time-dependent receiver operating characteristic curve of Liang score was 0.79 (95% confidence interval, 0.70–0.89). A cutoff value of nine provided an extremely high negative predictive value of 99.9% and high sensitivity of 90.0% at 5 years in the validation cohort. Patients with Liang score ≤9 had HCC incidence
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- 2021
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16. Colonoscopy and Risk of Colorectal Cancer in Patients With Nonalcoholic Fatty Liver Disease: A Retrospective Territory‐Wide Cohort Study
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Xinrong Zhang, Vincent Wai‐Sun Wong, Terry Cheuk‐Fung Yip, Yee‐Kit Tse, Lilian Yan Liang, Vicki Wing‐Ki Hui, Guan‐Lin Li, Henry Lik‐Yuen Chan, and Grace Lai‐Hung Wong
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
The benefit of colonoscopy and/or polypectomy for colorectal cancer (CRC) prevention in patients with nonalcoholic fatty liver disease (NAFLD) remains unclear. We aimed to estimate the incidence rate of CRC in patients with NAFLD who had and had not undergone colonoscopy. We conducted a retrospective territory‐wide cohort study for patients aged over 40 years with NAFLD identified with the International Classification of Diseases, Ninth Revision, Clinical Modification codes between January 1, 2000, and December 31, 2014. Patients were followed until CRC diagnosis, death, or December 31, 2017. We estimated CRC incidence and standardized incidence ratio (SIR) using the general population of Hong Kong as reference. We included 8,351 patients with NAFLD in the final analysis (median age, 56.2 years; interquartile ratio [IQR], 49.2‐65.3 years; 45.4% male; median follow‐up, 7.4 years; IQR, 5.4‐9.6 years). Compared with the general population, patients with NAFLD who had not undergone colonoscopy had a higher incidence of CRC (SIR, 2.20; 95% confidence interval [CI], 1.64‐2.88; P 2.67) had a significantly higher risk of CRC after adjusting for demographic and metabolic factors. Conclusion: Patients with NAFLD who had undergone colonoscopy had a lower incidence of CRC than the general population, especially among those aged ≥50 years or with DM. A high FIB‐4 index was associated with a higher risk of CRC.
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- 2021
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17. Negligible risk of hepatocellular carcinoma in chronic hepatitis B patients in immune-tolerant phase: Myth or fact
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Terry Cheuk-Fung Yip, Grace Lai-Hung Wong, and Vincent Wai-Sun Wong
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hepatitis b ,immune tolerance ,fibrosis-4 index ,liver fibrosis ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Published
- 2021
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18. Alanine Aminotransferase Level: The Road to Normal in 2021
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Terry Cheuk‐Fung Yip, Vincent Wai‐Sun Wong, and Grace Lai‐Hung Wong
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Published
- 2021
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19. A prospective 5-year study on the use of transient elastography to monitor the improvement of non-alcoholic fatty liver disease following bariatric surgery
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Shirley Yuk-Wah Liu, Vincent Wai-Sun Wong, Simon Kin-Hung Wong, Grace Lai-Hung Wong, Carol Man-sze Lai, Candice Chuen-Hing Lam, Sally She-Ting Shu, Henry Lik-Yuen Chan, and Enders Kwok-Wai Ng
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Medicine ,Science - Abstract
Abstract Liver stiffness measurement (LSM) by transient elastography (TE) is a non-invasive assessment for diagnosing and staging liver fibrosis in non-alcoholic fatty liver disease (NAFLD). Evidence on its role as a longitudinal monitoring tool is lacking. This study aims to evaluate the role of TE in monitoring NAFLD improvement following bariatric surgery. This study prospectively recruited 101 morbidly obese patients undergoing laparoscopic bariatric surgery for intraoperative liver biopsy. Thirty-seven patients of the cohort received perioperative TE. Postoperative anthropometric, biochemical and LSM data were collected annually for 5 years. In 101 patients receiving liver biopsy (mean age 40.0 ± 10.3 years, mean body-mass-index (BMI) 40.0 ± 5.7 kg/m2), NASH and liver fibrosis were diagnosed in 42 (41.6%) and 48 (47.5%) patients respectively. There were 29 (28.7%) stage 1, 11 (10.9%) stage 2, 7 (6.9%) stage 3, and 1 (1.0%) stage 4 fibrosis. In 37 patients receiving TE (mean age 38.9 ± 10.8 years, mean BMI 41.1 ± 5.6 kg/m2), the percentages of total weight loss were 21.1 ± 7.6% at 1 year, 19.7 ± 8.3% at 3 years, and 17.1 ± 7.0% at 5 years after surgery. The mean LSM reduced significantly from 9.8 ± 4.6 kPa at baseline to 6.9 ± 3.4 kPa at 1 year, 7.3 ± 3.0 kPa at 3 years, and 6.8 ± 2.6 kPa at 5 years (P = 0.002). Using pre-defined LSM cut-offs, the rates of significant fibrosis, advanced fibrosis and cirrhosis being ruled out at 5 years improved from baseline values of 43.7 to 87.5% (P
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- 2021
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20. Pattern and impact of hepatic adverse events encountered during immune checkpoint inhibitors – A territory‐wide cohort study
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Stephen Lam Chan, Terry Cheuk‐Fung Yip, Vincent Wai‐Sun Wong, Yee‐Kit Tse, Becky Wing‐Yan Yuen, Hester Wing‐Sum Luk, Rashid Nok‐Shun Lui, Henry Lik‐Yuen Chan, Tony Shu‐Kam Mok, and Grace Lai‐Hung Wong
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hepatic adverse events ,immunotherapy ,liver cancer ,programmed cell death‐1 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background Immune checkpoint inhibitors (ICIs) are increasingly used in the treatment of cancers. We aimed to evaluate the incidence and prognostic impact of hepatic adverse events (AEs) in a territory‐wide cohort of patients who received ICIs. Methods Patients were identified from a territory‐wide database who received ICIs in 2014‐2018. Hepatic AEs were defined as any elevation of liver biochemistries including serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), or total bilirubin levels. Hepatic AEs were graded according to Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Results Total of 1480 patients were identified (mean age 60 years, male 65.5%) and the commonest malignancies being lung cancer (39.6%), liver cancer (16.5%), and gastrointestinal cancer (10.0%). Grade 1‐2 and grade 3‐4 hepatic AEs occurred in 41.3% and 14.9% of patients during ICI treatment, respectively. Patients with liver cancer had the highest rate of hepatic AEs (grade 1‐2:54.1%; grade 3‐4:32.8%). Among 711 patients with hepatic AEs, 383 (53.9%) had raised ALT/AST only, and 328 (46.1%) had concomitant raised ALT/AST and bilirubin levels. In the whole cohort, median overall survival of patients without any hepatic AEs, grade 1‐2 and grade 3‐4 hepatic AEs during ICI treatment was 9.0 months, 7.2 months, and 3.3 months (P
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- 2020
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21. Application of transient elastography in nonalcoholic fatty liver disease
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Xinrong Zhang, Grace Lai-Hung Wong, and Vincent Wai-Sun Wong
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liver cirrhosis ,fatty liver ,metabolic syndrome ,obesity ,diagnostic imaging ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Nonalcoholic fatty liver disease (NAFLD) is currently the most common chronic liver disease worldwide. Although it has become one of the leading causes of cirrhosis and hepatocellular carcinoma in the Western world, the proportion of NAFLD patients developing these complications is rather small. Therefore, current guidelines recommend non-invasive tests for the initial assessment of NAFLD. Among the available non-invasive tests, transient elastography by FibroScan® (Echosens, Paris, France) is commonly used by hepatologists in Europe and Asia, and the machine has been introduced to the United States in 2013 with rapid adoption. Transient elastography measures liver stiffness and the controlled attenuation parameter simultaneously and can serve as a one-stop examination for both liver steatosis and fibrosis. Liver stiffness measurement also correlates with clinical outcomes and can be used to select patients for varices screening. Although obesity is a common reason for measurement failures, the development of the XL probe allows successful measurements in the majority of obese patients. This article reviews the performance and limitations of transient elastography in NAFLD and highlights its clinical applications. We also discuss the reliability criteria for transient elastography examination and factors associated with false-positive liver stiffness measurements.
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- 2020
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22. High incidence of hepatocellular carcinoma and cirrhotic complications in patients with psychiatric illness: a territory-wide cohort study
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Terry Cheuk-Fung Yip, Grace Lai-Hung Wong, Yee-Kit Tse, Becky Wing-Yan Yuen, Hester Wing-Sum Luk, Marco Ho-Bun Lam, Michael Kin-Kong Li, Ching Kong Loo, Owen Tak-Yin Tsang, Steven Woon-Choy Tsang, Henry Lik-Yuen Chan, Yun-Kwok Wing, and Vincent Wai-Sun Wong
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Liver fibrosis ,Liver neoplasms ,Liver failure ,Mortality ,Mental disorders ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Abstract Background Because of high-risk behaviours, sedentary lifestyle and side effects of medications, psychiatric patients are at risk of viral hepatitis, alcohol-related liver disease and non-alcoholic fatty liver disease. We aimed to study the incidence of hepatocellular carcinoma (HCC) and cirrhotic complications in psychiatric patients. Methods We identified consecutive adult patients in all public hospitals and clinics in Hong Kong with psychiatric diagnoses between year 2003 and 2007 using the Clinical Data Analysis and Reporting System, which represents in-patient and out-patient data of approximately 80% of the 7.4-million local population. The patients were followed for liver-related events (HCC and cirrhotic complications) and deaths until December 2017. Age- and sex-standardized incidence ratio (SIR) of HCC in psychiatric patients to the general population was estimated by Poisson model. Results We included 105,763 psychiatric patients without prior liver-related events in the final analysis. During a median (interquartile range) follow-up of 12.4 (11.0–13.7) years, 1461 (1.4%) patients developed liver-related events; 472 (0.4%) patients developed HCC. Compared with the general population, psychiatric patients had increased incidence of HCC (SIR 1.42, 95% confidence interval [CI] 1.28–1.57, P
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- 2020
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23. Novel machine learning models outperform risk scores in predicting hepatocellular carcinoma in patients with chronic viral hepatitis
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Grace Lai-Hung Wong, Vicki Wing-Ki Hui, Qingxiong Tan, Jingwen Xu, Hye Won Lee, Terry Cheuk-Fung Yip, Baoyao Yang, Yee-Kit Tse, Chong Yin, Fei Lyu, Jimmy Che-To Lai, Grace Chung-Yan Lui, Henry Lik-Yuen Chan, Pong-Chi Yuen, and Vincent Wai-Sun Wong
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Antiviral treatment ,Cirrhosis ,Liver cancer ,Mortality ,World Health Organization ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background & Aims: Accurate hepatocellular carcinoma (HCC) risk prediction facilitates appropriate surveillance strategy and reduces cancer mortality. We aimed to derive and validate novel machine learning models to predict HCC in a territory-wide cohort of patients with chronic viral hepatitis (CVH) using data from the Hospital Authority Data Collaboration Lab (HADCL). Methods: This was a territory-wide, retrospective, observational, cohort study of patients with CVH in Hong Kong in 2000–2018 identified from HADCL based on viral markers, diagnosis codes, and antiviral treatment for chronic hepatitis B and/or C. The cohort was randomly split into training and validation cohorts in a 7:3 ratio. Five popular machine learning methods, namely, logistic regression, ridge regression, AdaBoost, decision tree, and random forest, were performed and compared to find the best prediction model. Results: A total of 124,006 patients with CVH with complete data were included to build the models. In the training cohort (n = 86,804; 6,821 HCC), ridge regression (area under the receiver operating characteristic curve [AUROC] 0.842), decision tree (0.952), and random forest (0.992) performed the best. In the validation cohort (n = 37,202; 2,875 HCC), ridge regression (AUROC 0.844) and random forest (0.837) maintained their accuracy, which was significantly higher than those of HCC risk scores: CU-HCC (0.672), GAG-HCC (0.745), REACH-B (0.671), PAGE-B (0.748), and REAL-B (0.712) scores. The low cut-off (0.07) of HCC ridge score (HCC-RS) achieved 90.0% sensitivity and 98.6% negative predictive value (NPV) in the validation cohort. The high cut-off (0.15) of HCC-RS achieved high specificity (90.0%) and NPV (95.6%); 31.1% of patients remained indeterminate. Conclusions: HCC-RS from the ridge regression machine learning model accurately predicted HCC in patients with CVH. These machine learning models may be developed as built-in functional keys or calculators in electronic health systems to reduce cancer mortality. Lay summary: Novel machine learning models generated accurate risk scores for hepatocellular carcinoma (HCC) in patients with chronic viral hepatitis. HCC ridge score was consistently more accurate than existing HCC risk scores. These models may be incorporated into electronic medical health systems to develop appropriate cancer surveillance strategies and reduce cancer death.
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- 2022
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24. Glucose-lowering drugs and outcome from COVID-19 among patients with type 2 diabetes mellitus: a population-wide analysis in Hong Kong
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Vincent Wai-Sun Wong, Grace Lai-Hung Wong, Terry C F Yip, Ronald Ching Wan Ma, Andrea On Yan Luk, Xinge Zhang, and Alice Pik Shan Kong
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Medicine - Abstract
Objectives To investigate the association between baseline use of glucose-lowering drugs and serious clinical outcome among patients with type 2 diabetes.Design Territory-wide retrospective cohort of confirmed cases of COVID-19 between January 2020 and February 2021.Setting All public health facilities in Hong Kong.Participants 1220 patients with diabetes who were admitted for confirmed COVID-19.Primary and secondary outcome measures Composite clinical endpoint of intensive care unit admission, requirement of invasive mechanical ventilation and/or in-hospital death.Results In this cohort (median age 65.3 years, 54.3% men), 737 (60.4%) patients were treated with metformin, 385 (31.6%) with sulphonylureas, 199 (16.3%) with dipeptidyl peptidase-4 (DPP-4) inhibitors and 273 (22.4%) with insulin prior to admission. In multivariate Cox regression, use of metformin and DPP-4 inhibitors was associated with reduced incidence of the composite endpoint relative to non-use, with respective HRs of 0.51 (95% CI 0.34 to 0.77, p=0.001) and 0.46 (95% CI 0.29 to 0.71, p
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- 2021
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25. Association of metformin use on metabolic acidosis in diabetic patients with chronic hepatitis B‐related cirrhosis and renal impairment
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Terry Cheuk‐Fung Yip, Raymond Ngai Chiu Chan, Vincent Wai‐Sun Wong, Yee‐Kit Tse, Lilian Yan Liang, Vicki Wing‐Ki Hui, Xinrong Zhang, Guan‐Lin Li, Henry Lik‐Yuen Chan, and Grace Lai‐Hung Wong
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Child‐Pugh score ,chronic kidney diseases ,hepatic complications ,metabolic acidosis ,metformin ,Medicine - Abstract
Abstract Background and Aims Metformin is an oral anti‐hyperglycemic recommended by the American Diabetes Association (ADA) as a preferred initial pharmacologic agent for type 2 diabetes. Metabolic acidosis is a rare yet severe side effect of it. We examined the association of metformin use and dosage on the risk of metabolic acidosis in diabetic patients with different degrees of chronic hepatitis B (CHB)‐related cirrhosis and chronic kidney disease (CKD). Methods Metabolic acidosis was defined by blood pH ≤7.35, together with lactate >5 mmol/L or arterial bicarbonate ≤18 mmol/L or venous bicarbonate ≤21 mmol/L, and/or diagnosis codes. Child‐Pugh class and CKD stage were included in the model as time‐dependent covariates. Age, gender, comorbidities, and use of relevant medications were adjusted as covariates. Maximum daily dose of metformin was classified into ≤1000 mg and >1000 mg. Results We identified 4431 diabetic patients with CHB‐related cirrhosis between 2000 and 2017 from a territory‐wide database in Hong Kong. The risk of metabolic acidosis increased with Child‐Pugh class B and C cirrhosis regardless of CKD stage (adjusted subdistribution hazard ratio [aSHR] ranged from 3.50 to 86.16). Metformin use was associated with a higher risk in patients with Child‐Pugh class B or C cirrhosis and stage 3A CKD or above (aSHR ranged from 1.55 to 2.46). In stage 4/5 CKD, a daily dose of metformin ≤1000 mg was still associated with a higher risk of metabolic acidosis regardless of the severity of cirrhosis (aSHR ranged from 2.45 to 3.92). Conclusion In conclusion, patients with Child‐Pugh class B cirrhosis or above were at a higher risk of metabolic acidosis. Metformin further increased the risk in patients with Child‐Pugh class B cirrhosis or above and stage 3A CKD or above. Dose adjustment in stage 4/5 CKD did not reduce the risk of metabolic acidosis.
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- 2021
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26. Unmet need in chronic hepatitis B management
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Lilian Yan Liang and Grace Lai-Hung Wong
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Hepatitis B ,Cirrhosis ,Hepatocellular carcinoma ,Mortality ,Tenofovir alafenamide ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Despite all these exciting developments, there remain some unmet needs in the management for patients with chronic hepatitis B (CHB). As majority of CHB patients are going to use oral nucleos(t)ide analogues (NAs) for decades, Safety profile of NAs is of no doubt an important issue. The newest nucleotide analogue tenofovir alafenamide is potent in terms of viral suppression, together with favourable renal and bone safety profile. Biochemical response as reflected by alanine aminotransferase (ALT) normalization is recently found to be prognostically important. Patients who achieved ALT normalization have reduced the risk of hepatic events by 49%. Functional cure as reflected by hepatitis B surface antigen seroclearance not only implies patients may stop NA treatment, it also confers to a reduced risk of hepatocellular carcinoma and other hepatic events. Hence functional cure should be the ultimate treatment goal in CHB patients. Preemptive antiviral treatment may reduce mother-to-child transmission of hepatitis B virus, especially if birth dose of vaccination cannot be given in the first two hours after delivery. Lastly, despite the currently first-line NAs have high-genetic barrier to drug resistance mutations, there are still are many patients who were previously treated with low barrier of resistance including lamivudine, telbivudine or adefovir dipivoxil which could lead to antiviral resistance and affecting the choice of NAs.
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- 2019
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27. Tips for Responding to Reviewers’ Comments?from an Editor’s or Reviewer’s Points of View
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Grace Lai-Hung Wong
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Published
- 2019
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28. Increasing antiviral treatment uptake improves survival in patients with HBV-related HCC
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Vicki Wing-Ki Hui, Stephen Lam Chan, Vincent Wai-Sun Wong, Lilian Yan Liang, Terry Cheuk-Fung Yip, Jimmy Che-To Lai, Becky Wing-Yan Yuen, Hester Wing-Sum Luk, Yee-Kit Tse, Hye-Won Lee, Henry Lik-Yuen Chan, and Grace Lai-Hung Wong
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Entecavir ,Hazard ratio ,Lamivudine ,Local ablative therapy ,Propensity scores ,Surgical resection ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background & Aims: Antiviral treatment is known to improve survival in patients with chronic hepatitis B (CHB)-related hepatocellular carcinoma (HCC). Yet, the treatment uptake in CHB patients remains low. We aimed to report the secular trend in antiviral treatment uptake from 2007–2017, and to compare the effect of different nucleos(t)ide analogue (NA) initiation times (before vs. after HCC diagnosis) on survival. Methods: A 3-month landmark analysis was used to compare overall survival in patients not receiving NA treatment (i.e. no NA), patients receiving NAs after their first HCC treatment (i.e. post-HCC NA), and patients receiving NAs ≤3 months before their first HCC treatment (i.e. pre-HCC NA). A propensity score-weighted Cox proportional hazards model was used to balance clinical characteristics between the 3 groups and to estimate hazard ratios (HRs). Results: The uptake of antiviral treatment in HCC patients increased from 47.3% in 2007 to 98.3% in 2017. The pre-HCC NA group contributed mostly to the uptake rate, which increased from 72.7% to 96.0% in the past decade. In addition, 3,843 CHB patients (407 no NA; 2,932 pre-HCC NA; 504 post-HCC NA) with HCC, receiving at least 1 type of HCC treatment, were included in the analysis. Lack of NA treatment at the time of HCC diagnosis increased the risk of death (weighted HR 3.05; 95% CI 2.70–3.44; p
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- 2020
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29. Management of chronic hepatitis B patients in immunetolerant phase: what latest guidelines recommend
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Grace Lai-Hung Wong
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Chronic hepatitis B ,Hepatocellular carcinoma ,Immune tolerance ,Liver fibrosis ,Positive HBeAg ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
The natural history of chronic hepatitis B (CHB) is complex and may run through different immune phases that may overlap. In particulars, the immune-tolerant phase is the most interesting and not as well understood as we thought. The concept of true immune tolerance have been under challenged from immunology points of view. The major international guidelines have not yet reached a consensus on the definition of the immune-tolerant phase. While positive hepatitis B e antigen (HBeAg), high serum hepatitis B virus (HBV) DNA and normal serum alanine aminotransferase (ALT) levels are the three key features of this phase, some guidelines also put age into consideration. A new nomenclature, Phase 1 or HBeAg-positive chronic HBV infection, is given by the latest European Association for the Study of the Liver (EASL) published in April 2017. While current guidelines advise against starting antiviral treatment for immune-tolerant CHB patients, some new data suggest treating such patients may reduce the risk of liver fibrosis progression and hepatocellular carcinoma.
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- 2018
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30. Drug-drug interactions with direct-acting antivirals — less is more
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Grace Lai-Hung Wong
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hepatitis c ,antiviral agents ,drug-related side effects and adverse reactions ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Published
- 2021
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31. Treatments of Hepatocellular Carcinoma Patients with Hepatitis B Virus Infection: Treat HBV-related HCC
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Charing Ching-Ning Chong and Grace Lai-Hung Wong
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hepatitis B ,HBV DNA ,hepatocellular carcinoma ,cirrhosis ,lamivudine ,entecavir ,tenofovir ,interferon ,sorafenib ,sirolimus ,Medicine (General) ,R5-920 - Abstract
There have been major advances recently on the therapeutic approaches of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). Surgical treatments are the key curative treatments of HCC, whereas local ablative treatments may also achieve clinical remission in selected cases. Trans-arterial locoregional therapies are regarded as palliative but still lead to improved survival. There have been major breakthroughs in the systemic therapies for HCC. The first marketed targeted therapy, sorafenib, was shown to improve survival in patients with advanced HCC. Studies on other targeted therapies also showed promising results. Suppressing HBV with effective antiviral treatment would also benefit HCC patients by reducing recurrence and improving liver function.
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- 2016
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32. Personalized management of cirrhosis by non-invasive tests of liver fibrosis
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Grace Lai-Hung Wong, Wendell Zaragoza Espinosa, and Vicnent Wai-Sun Wong
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Transient elastography ,FibroScan ,FibroTest ,Hepatocellular carcinoma ,Varices ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Owing to the high prevalence of various chronic liver diseases, cirrhosis is one of the leading causes of morbidity and mortality worldwide. In recent years, the development of non-invasive tests of fibrosis allows accurate diagnosis of cirrhosis and reduces the need for liver biopsy. In this review, we discuss the application of these non-invasive tests beyond the diagnosis of cirrhosis. In particular, their role in the selection of patients for hepatocellular carcinoma surveillance and varices screening is highlighted.
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- 2015
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33. Prediction of fibrosis progression in chronic viral hepatitis
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Grace Lai-Hung Wong
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Cirrhosis ,Death ,Fibroscan ,Hepatic events ,Hepatocellular carcinoma ,Liver stiffness measurement ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Prediction of liver fibrosis progression has a key role in the management of chronic viral hepatitis, as it will be translated into the future risk of cirrhosis and its various complications including hepatocellular carcinoma. Both hepatitis B and C viruses mainly lead to fibrogenesis induced by chronic inflammation and a continuous wound healing response. At the same time direct and indirect profibrogenic responses are also elicited by the viral infection. There are a handful of well-established risk factors for fibrosis progression including older age, male gender, alcohol use, high viral load and co-infection with other viruses. Metabolic syndrome is an evolving risk factor of fibrosis progression. The new notion of regression of advanced fibrosis or even cirrhosis is now strongly supported various clinical studies. Even liver biopsy retains its important role in the assessment of fibrosis progression, various non-invasive assessments have been adopted widely because of their non-invasiveness, which facilitates serial applications in large cohorts of subjects. Transient elastography is one of the most validated tools which has both diagnostic and prognostic role. As there is no single perfect test for liver fibrosis assessment, algorithms combining the most validated noninvasive methods should be considered as initial screening tools.
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- 2014
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34. Non-invasive assessment of liver fibrosis with transient elastography (FibroScan®): applying the cut-offs of M probe to XL probe
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Grace Lai-Hung Wong, Julien Vergniol, Peter Lo, Vincent Wai-Sun Wong, Juliette Foucher, Brigitte Le Bail, Paul Cheung-Lung Choi, Faiza Chermak, Kwong-Sak Leung, Wassil Merrouche, Henry Lik-Yuen Chan, M.D., and Victor de Lédinghen
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Liver fibrosis ,Cirrhosis ,Biopsy ,Hepatitis B ,Hepatitis C ,Nonalcoholic fatty liver disease ,Specialties of internal medicine ,RC581-951 - Abstract
Background and rationale for the study. Limited studies have aimed to define the cut-offs of XL probe (XL cut-offs) for different stages of liver fibrosis, whereas those of M probe (M cut-offs) may not be applicable to XL probe. We aimed to derive appropriate XL cut-offs in overweight patients. Patients with liver stiffness measurement (LSM) by both probes were recruited. XL cut-offs probe for corresponding M cut-offs were derived from an exploratory cohort, and subsequently validated in a subgroup patients also underwent liver biopsy. The diagnostic accuracy of XL cut-offs to diagnose advanced fibrosis was evaluated.Results. Total 517 patients (63% male, mean age 58) who had reliable LSM by both probes were included in the exploratory cohort. There was a strong correlation between the LSM by M probe (LSM-M) and LSM by XL probe (LSM-XL) (r2 = 0.89, p < 0.001). A decision tree using LSM-XL was learnt to predict the 3 categories of LSM-M (< 6.0kPa, 6.0–11.9kPa and ≥ 12.0kPa), and XL cut-offs at 4.8kPa and 10.7kPa were identified. These cut-offs were subsequently validated in a cohort of 147 patients who underwent liver biopsy. The overall accuracy was 89% among 62 patients whose LSM-XL < 4.8kPa or ≥ 10.7kPa. These cut-offs would have avoided under-staging of fibrosis among patients with body mass index (BMI) > 25–30 kg/m2 but not > 30 kg/m2.Conclusions. XL cut-offs at 4.8kPa and 10.7kPa were the best estimates of 6.0kPa and 12.0kPa of M probe for patients with BMI > 25–30 kg/m2. Patients with BMI > 30 kg/m2 might use M probe cut-offs for XL probe.
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- 2013
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35. Treatment of nonalcoholic steatohepatitis with probiotics. A proof-of-concept study
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Vincent Wai-Sun Wong, Grace Lai-Hung Wong, Angel Mei-Ling Chim, Winnie Chiu-Wing Chu, David Ka-Wai Yeung, Kevin Chi-To Li, and Henry Lik-Yuen Chan
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Fatty liver ,Obesity ,Randomized controlled trial ,Prebiotics ,Specialties of internal medicine ,RC581-951 - Abstract
Background. Probiotics have profound effect on nonalcoholic steatohepatitis (NASH) in animal models. We aimed to test the hypothesis that probiotics treatment was superior to usual care in reducing liver fat in NASH patients.Material and methods. Patients with histology-proven NASH were randomized to receive probiotics (n = 10) or usual care (n = 10) for 6 months. The Lepicol probiotic formula contained Lactobacillus plantarum, Lactobacillus deslbrueckii, Lactobacillus acidophilus, Lactobacillus rhamnosus and Bifidobacterium bifidum. The primary endpoint was change in intrahepatic triglyceride content (IHTG), as measured by proton-magnetic resonance spectroscopy, from baseline to month 6. Secondary endpoints included changes in liver biochemistry and metabolic profile.Results. IHTG decreased from 22.6 ± 8.2% to 14.9 ± 7.0% in the probiotic group (P = 0.034) but remained static in the usual care group (16.9 ± 6.1% to 16.0 ± 6.6%; P = 0.55). Six subjects in the probiotic group had IHTG reduced by more than 30% from baseline, compared to 2 subjects in the usual care group (p = 0.17). The probiotic group also had greater reduction in serum aspartate aminotransferase level (P = 0.008). On the other hand, the use of probiotics was not associated with changes in body mass index, waist circumference, glucose and lipid levels.Conclusions. Probiotics treatment may reduce liver fat and AST level in NASH patients. The therapeutic potential of probiotics in NASH should be tested in larger studies.
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- 2013
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36. Diet-Quality Scores and Prevalence of Nonalcoholic Fatty Liver Disease: A Population Study Using Proton-Magnetic Resonance Spectroscopy.
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Ruth Chan, Vincent Wai-Sun Wong, Winnie Chiu-Wing Chu, Grace Lai-Hung Wong, Liz Sin Li, Jason Leung, Angel Mei-Ling Chim, David Ka-Wai Yeung, Mandy Man-Mei Sea, Jean Woo, Francis Ka-Leung Chan, and Henry Lik-Yuen Chan
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Medicine ,Science - Abstract
Dietary pattern analysis is an alternative approach to examine the association between diet and nonalcoholic fatty liver disease (NAFLD). This study examined the association of two diet-quality scores, namely Diet Quality Index-International (DQI-I) and Mediterranean Diet Score (MDS) with NAFLD prevalence. Apparently healthy Chinese adults (332 male, 465 female) aged 18 years or above were recruited through a population screening between 2008 and 2010 in a cross-sectional population-based study in Hong Kong. DQI-I and MDS, as well as major food group and nutrient intakes were calculated based on dietary data from a food frequency questionnaire. NAFLD was defined as intrahepatic triglyceride content at ≥5% by proton-magnetic resonance spectroscopy. Multivariate logistic regression models were used to examine the association between each diet-quality score or dietary component and prevalent NAFLD with adjustment for potential lifestyle, metabolic and genetic factors. A total of 220 subjects (27.6%) were diagnosed with NAFLD. DQI-I but not MDS was associated with the prevalence of NAFLD. A 10-unit decrease in DQI-I was associated with 24% increase in the likelihood of having NAFLD in the age and sex adjusted model (95% CI: 1.06-1.45, p = 0.009), and the association remained significant when the model was further adjusted for other lifestyle factors, metabolic and genetic factors [OR: 1.26 (95% CI: 1.03-1.54), p = 0.027]. Multivariate regression analyses showed an inverse association of the intake of vegetables and legumes, fruits and dried fruits, as well as vitamin C with the NAFLD prevalence (p
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- 2015
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37. Higher estimated net endogenous Acid production may be associated with increased prevalence of nonalcoholic Fatty liver disease in chinese adults in Hong Kong.
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Ruth Chan, Vincent Wai-Sun Wong, Winnie Chiu-Wing Chu, Grace Lai-Hung Wong, Liz Sin Li, Jason Leung, Angel Mei-Ling Chim, David Ka-Wai Yeung, Mandy Man-Mei Sea, Jean Woo, Francis Ka-Leung Chan, and Henry Lik-Yuen Chan
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Medicine ,Science - Abstract
Nonalcoholic fatty liver disease (NAFLD) has been associated with reduced growth hormone levels and signaling. Such hormonal changes also occur in metabolic acidosis. Since mild metabolic acidosis can be diet induced, diet-induced acid load may constitute a nutritional factor with possible influence on NAFLD development. This study explored whether a higher diet-induced acid load is associated with an increased likelihood of NAFLD. Apparently healthy Chinese adults (330 male, 463 female) aged 19-72 years were recruited through population screening between 2008 and 2010 in a cross-sectional population-based study in Hong Kong. Estimated net endogenous acid production (NEAP) was calculated using Frassetto's method and potential renal acid load (PRAL) was calculated using Remer's method based on dietary data from a food frequency questionnaire. NAFLD was defined as intrahepatic triglyceride content at >5% by proton-magnetic resonance spectroscopy. Possible advanced fibrosis was defined as liver stiffness at >7.9 kPa by transient elastography. Multivariate logistic regression models were used to examine the association between each measure of dietary acid load and prevalent NAFLD or possible advanced fibrosis with adjustment for potential anthropometric and lifestyle factors. 220 subjects (27.7%) were diagnosed with NAFLD. Estimated NEAP was positively associated with the likelihood of having NAFLD after adjustment for age, sex, body mass index, current drinker status and the presence of metabolic syndrome [OR (95% CI) = 1.25 (1.02-1.52), p = 0.022]. The association was slightly attenuated but remained significant when the model was further adjusted for other dietary variables. No association between PRAL and NAFLD prevalence was observed. Both estimated NEAP and PRAL were not associated with the presence of possible advance fibrosis. Our findings suggest that there may be a modest association between diet-induced acid load and NAFLD. More studies are needed to ascertain the link between diet-induced acid load and NAFLD and to investigate the underlying mechanisms.
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- 2015
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38. Molecular characterization of the fecal microbiota in patients with nonalcoholic steatohepatitis--a longitudinal study.
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Vincent Wai-Sun Wong, Chi-Hang Tse, Tommy Tsan-Yuk Lam, Grace Lai-Hung Wong, Angel Mei-Ling Chim, Winnie Chiu-Wing Chu, David Ka-Wai Yeung, Patrick Tik-Wan Law, Hoi-Shan Kwan, Jun Yu, Joseph Jao-Yiu Sung, and Henry Lik-Yuen Chan
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Medicine ,Science - Abstract
The human gut microbiota has profound influence on host metabolism and immunity. This study characterized the fecal microbiota in patients with nonalcoholic steatohepatitis (NASH). The relationship between microbiota changes and changes in hepatic steatosis was also studied.Fecal microbiota of histology-proven NASH patients and healthy controls was analyzed by 16S ribosomal RNA pyrosequencing. NASH patients were from a previously reported randomized trial on probiotic treatment. Proton-magnetic resonance spectroscopy was performed to monitor changes in intrahepatic triglyceride content (IHTG).A total of 420,344 16S sequences with acceptable quality were obtained from 16 NASH patients and 22 controls. NASH patients had lower fecal abundance of Faecalibacterium and Anaerosporobacter but higher abundance of Parabacteroides and Allisonella. Partial least-square discriminant analysis yielded a model of 10 genera that discriminated NASH patients from controls. At month 6, 6 of 7 patients in the probiotic group and 4 of 9 patients in the usual care group had improvement in IHTG (P=0.15). Improvement in IHTG was associated with a reduction in the abundance of Firmicutes (R(2)=0.4820, P=0.0028) and increase in Bacteroidetes (R(2)=0.4366, P=0.0053). This was accompanied by corresponding changes at the class, order and genus levels. In contrast, bacterial biodiversity did not differ between NASH patients and controls, and did not change with probiotic treatment.NASH patients have fecal dysbiosis, and changes in microbiota correlate with improvement in hepatic steatosis. Further studies are required to investigate the mechanism underlying the interaction between gut microbes and the liver.
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- 2013
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39. Bacterial microbiota profiling in gastritis without Helicobacter pylori infection or non-steroidal anti-inflammatory drug use.
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Xiao-Xing Li, Grace Lai-Hung Wong, Ka-Fai To, Vincent Wai-Sun Wong, Larry Hin Lai, Dorothy Kai-Lai Chow, James Yun-Wong Lau, Joseph Jao-Yiu Sung, and Chunming Ding
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Medicine ,Science - Abstract
Recent 16S ribosomal RNA gene (rRNA) molecular profiling of the stomach mucosa revealed a surprising complexity of microbiota. Helicobacter pylori infection and non-steroidal anti-inflammatory drug (NSAID) use are two main contributors to gastritis and peptic ulcer. However, little is known about the association between other members of the stomach microbiota and gastric diseases. In this study, cloning and sequencing of the 16S rRNA was used to profile the stomach microbiota from normal and gastritis patients. One hundred and thirty three phylotypes from eight bacterial phyla were identified. The stomach microbiota was found to be closely adhered to the mucosa. Eleven Streptococcus phylotypes were successfully cultivated from the biopsies. One to two genera represented a majority of clones within any of the identified phyla. We further developed two real-time quantitative PCR assays to quantify the relative abundance of the Firmicutes phylum and the Streptococcus genus. Significantly higher abundance of the Firmicutes phylum and the Streptococcus genus within the Firmicutes phylum was observed in patients with antral gastritis, compared with normal controls. This study suggests that the genus taxon level can largely represent much higher taxa such as the phylum. The clinical relevance and the mechanism underlying the altered microbiota composition in gastritis require further functional studies.
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- 2009
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40. Hepatitis Flare During Immunotherapy in Patients With Current or Past Hepatitis B Virus Infection.
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Grace Lai-Hung Wong, Wai-Sun Wong, Vincent, Wing-Ki Hui, Vicki, Cheuk-Fung Yip, Terry, Yee-Kit Tse, Lilian Yan Liang, Nok-Shun Lui, Rashid, Shu-Kam Mok, Tony, Lik-Yuen Chan, Henry, and Lam Chan, Stephen
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IMMUNOTHERAPY , *ANTIGENS , *HEPATITIS B treatment , *HEPATITIS treatment , *HEPATITIS associated antigen - Abstract
INTRODUCTION: Immunotherapy has dramatically improved the survival of patients with advanced or metastatic malignancies. Recent studies suggest thatimmunotherapy may increase the risk of hepatitis, whereas it may also induce functional cure of chronic hepatitis B virus (HBV) infection. We evaluated the incidence of hepatitis flare, HBV reactivation, hepatitis B surface antigen (HBsAg) seroclearance or seroreversion in patients with current or past HBV infection who had received immunotherapy. METHODS: This was a territory-wide observational cohort study in Hong Kong. We identified patients through electronic medical records based on the prescriptions of immune checkpoint inhibitors from July 1, 2014, to December 31, 2019. Patients who were HBsAg positive or HBsAg negative with results for antibody to hepatitis B surface or core antigen (anti-HBs or anti-HBc) were included. RESULTS: A total of 990 patients (397 HBsAg-positive, 593 HBsAg-negative with 482 anti-HBc and/or anti-HBs positive, and 111 both anti-HBc and anti-HBs negative) were identified. All of HBsAg-positive and 15.9% HBsAg-negative patients were put on oral antiviral treatment. Hepatitis flare (alanine aminotransferase >2 times of the upper limit of normal) occurred in 39.3%HBsAg-positive and 30.4% HBsAg-negative patients. High baseline alanine aminotransferase and combination of immunotherapy increased the risk of hepatitis. HBV reactivation (≥2 log increase in HBVDNA from baseline) occurred in 2 HBsAg-positive patients; HBsAg seroclearance and seroreversion was observed in 1 HBsAg-positive and 1 HBsAg-negative patient, respectively (<1%). DISCUSSION: Hepatitis flare occurs in approximately 40% of HBsAg-positive patients and 30% of HBsAg-negative patients during immunotherapy. HBV reactivation, HBsAg seroclearance, and HBsAg seroreversion are rare. Current or past HBV infection has no impact on the emergence of hepatic flare associated with immunotherapy. [ABSTRACT FROM AUTHOR]
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- 2021
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41. improvement of cardiovascular risk factor control in patients with type 2 diabetes and nonalcoholic fatty liver disease--time for action! Authors' reply.
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Xinrong Zhang, Grace Lai-Hung Wong, Vincent Wai-Sun Wong, and Terry Cheuk-Fung Yip
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NON-alcoholic fatty liver disease , *CARDIOVASCULAR diseases risk factors , *DISEASE risk factors , *TYPE 2 diabetes - Published
- 2023
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42. Four-year Outcomes After Cessation of Tenofovir in Immune-tolerant Chronic Hepatitis B Patients.
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Vincent Wai-Sun Wong, Hui, Aric J., Grace Lai-Hung Wong, Rosita Suk-Yi Chan, Angel Mei-Ling Chim, Angeline Oi-Shan Lo, Henry Lik-Yuen Chan, Wong, Vincent Wai-Sun, Wong, Grace Lai-Hung, Chan, Rosita Suk-Yi, Chim, Angel Mei-Ling, Lo, Angeline Oi-Shan, and Chan, Henry Lik-Yuen
- Published
- 2018
- Full Text
- View/download PDF
43. Screening diabetic patients for non-alcoholic fatty liver disease with controlled attenuation parameter and liver stiffness measurements: a prospective cohort study.
- Author
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Kwok, Raymond, Kai Chow Choi, Grace Lai-Hung Wong, Yuying Zhang, Chan, Henry Lik-Yuen, Luk, Andrea On-Yan, Shu, Sally She-Ting, Chan, Anthony Wing-Hung, Ming-Wai Yeung, Chan, Juliana Chung-Ngor, Kong, Alice Pik-Shan, and Wong, Vincent Wai-Sun
- Subjects
PEOPLE with diabetes ,COHORT analysis ,TYPE 2 diabetes ,FATTY liver ,CHRONIC diseases ,FIBROSIS ,EPIDEMIOLOGY ,ULTRASONIC imaging ,DISEASE risk factors - Published
- 2016
- Full Text
- View/download PDF
44. Treatment cessation of entecavir in Asian patients with hepatitis B e antigen negative chronic hepatitis B: a multicentre prospective study.
- Author
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Wai-Kay Seto, Aric Josun Hui, Vincent Wai-Sun Wong, Grace Lai-Hung Wong, Kevin Sze-Hang Liu, Ching-Lung Lai, Man-Fung Yuen, and Henry Lik-Yuen Chan
- Subjects
CHRONIC hepatitis B ,DISEASE relapse ,VIRUS reactivation ,MEDICAL protocols ,MEDICAL statistics ,THERAPEUTICS - Abstract
Background and objective The off-treatment durability of nucleos(t)ide analogue therapy in Asian hepatitis B e antigen (HBeAg) negative chronic hepatitis B (CHB) and the role of hepatitis B surface antigen (HBsAg) levels in predicting off-treatment durability has not been well investigated. Methods Following Asia-Pacific Association for the Study of the Liver guidelines, entecavir was stopped in Asian HBeAg negative patients treated for ≤ 2 years with undetectable HBV DNA levels on ≤3 separate occasions 6 months apart before treatment cessation. HBsAg and HBV DNA levels were prospectively monitored every 6-12 weeks for 48 weeks. Entecavir was restarted if there was virologic relapse (defined as HBV DNA >2000 IU/mL). Result 184 patients (mean age 53.9 years, 67.9% male) were recruited. The cumulative rate of virologic relapse at 24 and 48 weeks was 74.2% and 91.4%, respectively. The median HBV DNA level at virologic relapse was 11000 (range 2115 to >1.98x10
8 ) IU/mL. 42 (25.8%) patients had elevated alanine aminotransferase (median level 97 U/L, range 37-1058 U/L) during virologic relapse. Mean rate of off-treatment HBsAg decline was 0.018 (±0.456) log IU/mL/year. No patients cleared HBsAg. There was no correlation between off-treatment serial HBsAg and HBV DNA levels (r=-0.026, p=0.541). HBsAg levels at the time of entecavir commencement, entecavir cessation and the subsequent rate of HBsAg reduction were not associated with virologic relapse (all p>0.05). Conclusions Entecavir cessation in Asian HBeAg negative CHB resulted in high rates of virologic relapse, suggesting nucleos(t)ide analogue therapy should be continued indefinitely until the recognised treatment endpoint of HBsAg seroclearance. [ABSTRACT FROM AUTHOR]- Published
- 2015
- Full Text
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45. The effect of caffeine and alcohol consumption on liver fibrosis - a study of 1045 Asian hepatitis B patients using transient elastography.
- Author
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Arlinking Ong, Vincent Wai-Sun Wong, Grace Lai-Hung Wong, and Henry Lik-Yuen Chan
- Subjects
HEPATITIS B virus ,PHYSIOLOGICAL effects of caffeine ,ALCOHOL drinking ,ALANINE aminotransferase ,CYSTIC fibrosis ,PATIENTS ,DISEASE risk factors - Abstract
Background: Role of caffeine consumption in chronic hepatitis B virus (HBV)-infected patients and the interaction with alcohol consumption is unclear. Aim: This study aimed to investigate the relationship between caffeine and alcohol consumption and liver stiffness in chronic HBV-infected patients. Methods: Chronic HBV-infected patients who underwent transient elastography examination in 2006–2008 were studied. Advanced fibrosis was defined as liver stiffness 49 kPa for patients with normal alanine aminotransferase (ALT) or 412 kPa for those with elevated ALT according to previous validation study. Caffeine and alcohol consumption was recorded using a standardized questionnaire. Excessive alcohol intake was defined as 30 g/day in men and 20 g/day in women. Results: The liver stiffness of 1045 patients who completed the questionnaire was 8.3 ± 6.2 kPa. Two hundred and sixteen (20.7%) patients had advanced fibrosis. Ninety-five (19.0%) patients who drank Z1 cup of coffee had advanced fibrosis, compared with 121 (22.2%) patients who drank o1 cup (P = 0.21). The amount of caffeine intake had positive correlation with the amount of alcohol intake (rs = 0.167, Po0.001). Although 231 (22.1%) patients reported alcohol consumption, only 11 (1%) had excessive alcohol intake. The prevalence of advanced fibrosis among patients with mild to moderate alcohol intake (26, 18.8%) was comparable to that among non-drinkers (190, 21.0%) (P = 0.57). Conclusion: Caffeine intake does not affect liver stiffness in chronic HBV-infected patients. Patients who drink coffee regularly tend to drink alcohol. Most chronic HBV-infected patients do not have excessive alcohol consumption. The prevalence of advanced fibrosis among mild tomoderate alcohol drinkers was low in this population. [ABSTRACT FROM AUTHOR]
- Published
- 2011
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46. Molecular virology in chronic hepatitis B: genotypes.
- Author
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Grace Lai-Hung Wong and Henry Lik-Yuen Chan
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- 2005
- Full Text
- View/download PDF
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