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Piratvisuth T.,Prince of Songkla University | Marcellin P.,University Paris - Sud | Popescu M.,Hoffmann-La Roche | Kapprell H.-P.,Abbott Laboratories | And 2 more authors.
Hepatology International | Year: 2013

Purpose: Patients with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B, who achieve HBeAg seroconversion 6 months after completing 48 weeks of peginterferon alfa-2a therapy, have an increased chance of clearing hepatitis B surface antigen (HBsAg) during long-term treatment-free follow-up. This analysis aimed to determine whether HBsAg quantification during treatment could be used to identify posttreatment response. Methods: Patients (n = 399) treated with peginterferon alfa-2a (180 μg/week) alone or in combination with lamivudine (100 mg/day) for 48 weeks during a large, randomized study were included in this retrospective analysis. Receiver-operating characteristic analyses were used to identify baseline and on-treatment HBsAg levels associated with response (HBeAg seroconversion 6 months posttreatment). Results: Baseline HBsAg levels were lower in patients achieving posttreatment response than in nonresponders (3.97 and 4.21 IU/mL, respectively, p = 0.039). Two baseline HBsAg cutoff levels (5,000 and 50,000 IU/mL) provided a positive predictive value of 42% and a negative predictive value of 77%. HBsAg decline was significantly greater during and posttreatment in responders than in nonresponders (p < 0.0001). HBeAg seroconversion rates 6 months posttreatment were significantly higher in patients with HBsAg < 1,500 IU/mL at weeks 12 and 24 (56.7 and 54.4%, respectively) versus patients with HBsAg 1,500-20,000 IU/mL (32.3 and 26.1%, respectively) or HBsAg < 20,000 IU/mL (16.3 and 15.4%, respectively) (all p < 0.0001 and <0.0001). Conclusions: HBsAg levels at baseline strongly associated with posttreatment response were not identified. Low HBsAg levels during peginterferon alfa-2a therapy were associated with high rates of posttreatment response. On-treatment HBsAg quantification may, therefore, help guide patient management in the future. © 2011 Asian Pacific Association for the Study of the Liver.

Mao G.H.,Nanchang University | Wang Q.H.,Ruijin Hospital
British Journal of Neurosurgery | Year: 2013

We described the first case of transvenous embolization with Onyx for a cerebral arteriovenous fistula (CAVF) originating from the distal lenticulostriate artery (LSA). A 16-year-old patient presented with right intraventricular hemorrhage. Angiography demonstrated that CAVF originating from the right distal LSA directly connected to the contralateral basal vein of Rosenthal. We treated the fistula with Onyx through transvenous approach by the balloon-Assisted method. CAVF was completely obliterated and remained closed as ascertained by follow-up angiograms. © 2013 The Neurosurgical Foundation.

Luo Z.,Shanghai JiaoTong University | Cai J.,Ruijin Hospital | Gu L.,Shanghai JiaoTong University
International Journal of Computer Assisted Radiology and Surgery | Year: 2013

Purpose In this paper, we propose a pilot study for transcatheter aortic valve implantation guided by an augmented magnetic tracking system (MTS) with a dynamic aortic model and intra-operative ultrasound (US) images. Methods The dynamic 3D aortic model is constructed from the preoperative 4D computed tomography, which is animated according to the real-time electrocardiograph (ECG) input of patient. Before the procedure, the US probe calibration is performed to map the US image coordinate to the tracked device coordinate. A temporal alignment is performed to synchronize the ECG signals, the intra-operative US image and the tracking information. Thereafter, with the assistance of synchronized ECG signals, the spatial registration is performed by using a feature-based registration. Then the augmented MTS guides the surgeon to confidently position and deploy the transcatheter aortic valve prosthesis to the target. Results The approach was validated by US probe calibration evaluation and animal study. The US calibration accuracy achieved 1.37±0.43mm, whereas in the animal study on three porcine subjects, fiducial, target, deployment distance and tilting errors reached 3.16±0.55mm, 3.80±1.83, 3.13±1.12mm and 5.87±2.35°, respectively. Conclusion Our pilot study has revealed that the proposed approach is feasible and accurate for delivery and deployment of transcatheter aortic valve prosthesis. © 2013 CARS.

Zhu Y.,Shanghai JiaoTong University | Xu X.-Y.,Ruijin Hospital
Foot and Ankle Specialist | Year: 2015

The role of arthroereises in the treatment of adult acquired flatfoot deformity (AAFD) has been controversial. This study aims to evaluate the outcome of subtalar arthroereisis in treating stage II AAFD. A total of 24 feet with stage II AAFD were treated surgically between 2009 and 2011 using subtalar arthroereisis. The average follow-up was 29.7 months (range = 24 to 35 months). The average postoperative AOFAS (American Orthopaedic Foot and Ankle Society) Ankle-Hindfoot Scale score was 85.6 (compared with 51.7 preoperatively). Average preoperative talar-first metatarsal angle and talonavicular coverage angle were −13.9° and 38.3°, respectively. The average postoperative angles were 1.6° and 11.2°, respectively (P <.01). No deformity recurrences were found at the time of last follow-up, with the exception of 1 case. Subtalar arthroereisis appears to be a reasonable treatment option for stage IIA and IIC AAFD. It can be used alone to correct mild hindfoot valgus, and it can also be performed with a calcaneal osteotomy to gain more correction in severe stage II AAFD. Levels of Evidence: Therapeutic, Level IV: Retrospective Case Series © 2014 The Author(s).

Sonneveld M.J.,Erasmus Medical Center | Hansen B.E.,Erasmus Medical Center | Piratvisuth T.,Prince of Songkla University | Jia J.-D.,Capital Medical University | And 8 more authors.
Hepatology | Year: 2013

On-treatment levels of hepatitis B surface antigen (HBsAg) may predict response to peginterferon (PEG-IFN) therapy in chronic hepatitis B (CHB), but previously proposed prediction rules have shown limited external validity. We analyzed 803 HBeAg-positive patients treated with PEG-IFN in three global studies with available HBsAg measurements. A stopping-rule based on absence of a decline from baseline was compared to a prediction-rule that uses HBsAg levels of <1,500 IU/mL and >20,000 IU/mL to identify patients with high and low probabilities of response. Patients with an HBsAg level <1,500 IU/mL at week 12 achieved response (HBeAg loss with HBV DNA <2,000 IU/mL at 6 months posttreatment) in 45%. At week 12, patients without a decline in HBsAg achieved a response in 14%, compared to only 6% of patients with HBsAg >20,000 IU/mL, but performance varied across HBV genotype. In patients treated with PEG-IFN monotherapy (n=465), response rates were low in patients with genotypes A or D if there was no decline of HBsAg by week 12 (negative predictive value [NPV]: 97%-100%), and in patients with genotypes B or C if HBsAg at week 12 was >20,000 IU/mL (NPV: 92%-98%). At week 24, nearly all patients with HBsAg >20,000 IU/mL failed to achieve a response, irrespective of HBV genotype (NPV for response and HBsAg loss 99% and 100%). Conclusion: HBsAg is a strong predictor of response to PEG-IFN in HBeAg-positive CHB. HBV genotype-specific stopping-rules may be considered at week 12, but treatment discontinuation is indicated in all patients with HBsAg >20,000 IU/mL at week 24, irrespective of HBV genotype. © 2013 by the American Association for the Study of Liver Diseases.

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