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Leung N.,Alice Ho Miu Ling Nethersole Hospital | Leung N.,Chinese University of Hong Kong
Liver International | Year: 2011

HBeAg seropositivity is a marker for active viral replication. In the natural history of chronic hepatitis B infection, HBeAg marks the first two of the four phases, namely the immune tolerant phase and the immune clearance phase, and is associated with highly replicative activity of the hepatitis B virus (HBV). Most HBV consensus reports and guidelines recommend antiviral therapy if the immune clearance phase is prolonged and if there is evidence of significant necroinflammation and fibrosis. Two main types of antiviral agents have been approved for treating patients in the immune clearance phase: interferon and nucleos(t)ide analogues (NUCs). The endpoints of therapy are viral suppression with HBeAg seroconversion, undetectable serum HBV DNA, normalization of serum alanine transaminase and improvement in the histological necroinflammatory and fibrosis scores. The ultimate goal of therapy is to obtain clinical benefit for the patient by reducing complications including hepatocellular carcinoma (HCC). The choice between interferon-based immune modulators or NUCs that target the HBV DNA polymerase must be carefully weighed on an individual basis. Therapy with NUCs is often preferred by doctors and patients because it is easy to administer, with predictable efficacy and minimal side-effects. In specific patient subgroups such as those with decompensated disease, poor predictors of response or lack of response to interferon-based therapy and/or significant comorbidities that cannot tolerate interferon-induced side effects, NUCs therapy is the obvious choice. Entecavir and tenofovir are the treatments of choice because their efficacy and safety profile are better than lamivudine, adefovir and telbivudine. More importantly, there is a minimal risk of drug resistance during long-term therapy with these agents. © 2011 John Wiley & Sons A/S. Source

Seto W.-K.,University of Hong Kong | Hui A.J.,Alice Ho Miu Ling Nethersole Hospital | Wong V.W.-S.,Chinese University of Hong Kong | Wong G.L.-H.,Chinese University of Hong Kong | And 4 more authors.
Gut | Year: 2014

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 11 000 (range 2115 to >1.98×108) 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. © 2014 BMJ Publishing Group Ltd & British Society of Gastroenterology. Source

Szeto G.P.Y.,Hong Kong Polytechnic University | Wong K.T.,Hong Kong Polytechnic University | Law K.Y.,Alice Ho Miu Ling Nethersole Hospital | Lee E.W.C.,Prince of Wales Hospital
International Journal of Industrial Ergonomics | Year: 2013

Nurses are known to be a group at high risk of developing work-related musculoskeletal disorders due to the heavy physical demands of their work. Community nurses are a special group within the profession whose work is different from that carried out in hospital settings. In Hong Kong, community nursing teams are responsible for visiting elderly patients in their homes or in residential institutions where the nursing care provided is inadequate. One of the tasks they commonly perform on such patients is wound care. The present study aimed to examine community nurses' movements and postures when performing wound-dressing tasks in nursing homes. Nineteen female community nurses (age range = 26-50) agreed to participate. Motion sensors were attached to their back at the thoracic and lumbar spine regions to capture the three-dimensional motion when they performed wound-dressing tasks at the patients' bedsides. The low, median, and peak joint angles in the thoracic region (torso segment) and the lumbar region (pelvic segment) during these tasks were recorded. The results showed that the mean extent of movement was 27.64° (±7.36°) with 28.49° (±10.64°) of flexion at the torso and pelvic segments. This amounts to nearly 60° of flexion in the spine, in addition to about 20° of side flexion and 42° of rotation from side to side. The movement data measured when dressing the wounds of real patients were very similar to those recorded in a further, simulated task involving moving cotton-wool balls from a high to a low surface. Another such simulation was performed using a high benchtop only, and this showed markedly reduced movement ranges. The results illustrate the potential risks to community nurses of performing such frequent and large-amplitude trunk movements, which may contribute towards the development of low back disorders. Such biomechanical data can provide objective evidence for the introduction of ergonomic interventions for community nurses. Relevance to industry: This study examined the physical movements involved in a frequently performed task of wound dressing by community nurses, and illustrated the use of biomechanical measurement devices in a field setting to estimate the nurses' physical workloads. © 2013 Elsevier B.V. Source

Lam M.-H.,Chinese University of Hong Kong | Fong D.T.-P.,Chinese University of Hong Kong | Yung P.S.-H.,Chinese University of Hong Kong | Ho E.P.-Y.,Chinese University of Hong Kong | And 2 more authors.
American Journal of Sports Medicine | Year: 2011

Background: The restoration of knee rotational stability after anatomic double-bundle anterior cruciate ligament (ACL) reconstruction has been demonstrated in the cadaveric model and with passive stress tests on humans but not yet with dynamic functional biomechanical tests performed by human participants. Purpose: To prospectively investigate the range of tibial rotation of ACL-deficient and ACL-reconstructed knees during a pivoting task. The authors hypothesized that there would be a significant increase in tibial internal rotation in the ACL-deficient knee compared with the contralateral knee and that the increased rotation would return to normal after anatomic double-bundle ACL reconstruction. Study Design: Case series; Level of evidence, 4. Methods: Ten men with unilateral ACL injury performed a high-demand jump-landing and pivoting task before and after ACL reconstruction with mean follow-up of 11 months. The range of tibial rotation of the injured, reconstructed, and intact knees during the pivoting movement was measured by an optical motion analysis system. Paired t tests were performed to investigate any significant difference between the 2 limbs preoperatively and postoperatively and within the injured limb before and after the surgical treatment. Statistical significance was set at P <.05. Results: The range of tibial rotation was higher in the ACL-deficient knee (12.6° ± 4.5°) than in the intact knee (7.9° ± 3.1°) preoperatively (P <.05). The increased rotation was reduced in the reconstructed knee (8.9° ± 3.0°) after ACL reconstruction versus the intact knee postoperatively (8.2° ± 2.6°) (P <.05). There was no significant difference in the tibial rotation between the intact knee and the reconstructed knee postoperatively (P >.05). Conclusion: As assessed with a dynamic functional pivoting movement, the anatomic double-bundle ACL reconstruction successfully restores knee rotational stability from an impaired level. © 2011 The Author(s). Source

Chan J.Y.-S.,Chinese University of Hong Kong | Fang F.,Chinese University of Hong Kong | Zhang Q.,Chinese University of Hong Kong | Zhang Q.,University of Sichuan | And 6 more authors.
European Heart Journal | Year: 2011

Aims: The Pacing to Avoid Cardiac Enlargement (PACE) trial is a prospective, double-blinded, randomized, multicentre study that reported the superiority of biventricular (BiV) pacing to right ventricular apical (RVA) pacing in the prevention of left ventricular (LV) adverse remodelling and deterioration of systolic function at 1 year. In the current analysis, we report the results at extended 2-year follow-up for changes in LV function and remodelling. Methods and results: Patients (n=177) with bradycardia and preserved LV ejection fraction (EF <45) were randomized to receive RVA or BiV pacing. The co-primary endpoints were LVEF and LV end-systolic volume (LVESV).Eighty-one (92) of 88 in the RVA pacing group and 82 (92) of 89 patients in the BiV pacing group completed 2-year follow-up with a valid echocardiography. In the RVA pacing group, LVEF further decreased from the first to the second year, but it remained unchanged in the BiV pacing group, leading to a significant difference of 9.9 percentage points between groups at 2-year follow-up (P < 0.001). Similarly, LVESV continues to enlarge from the first to the second year in the RVA pacing group, leading to a difference of 13.0 mL (P < 0.001) between groups. Predefined subgroup analysis showed consistent results with the whole study population for both co-primary endpoints, which included patients with pre-existing LV diastolic dysfunction. Eighteen patients in the BiV pacing group (20.2) and 55 in the RVA pacing group (62.5) had a significant reduction of LVEF (of <5, P < 0.001). Conclusion: Left ventricular adverse remodelling and deterioration of systolic function continues at the second year after RVA pacing. This deterioration is prevented by BiV pacing. © 2011 The Author. Source

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