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Mitrani R, Kohut T, Panganiban J, Carr RM. Transition of Care Model for Pediatric Patients With Nonalcoholic Fatty Liver Disease. Clin Liver Dis (Hoboken) 2021; 18:30-36. [PMID: 34484702 PMCID: PMC8405046 DOI: 10.1002/cld.1093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/18/2020] [Accepted: 01/03/2021] [Indexed: 02/06/2023] Open
Affiliation(s)
- Robert Mitrani
- Division of Gastroenterology and HepatologyUniversity of PennsylvaniaPhiladelphiaPA
| | - Taisa Kohut
- Division of Gastroenterology, Hepatology and NutritionChildren’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Jennifer Panganiban
- Division of Gastroenterology, Hepatology and NutritionChildren’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Rotonya M. Carr
- Division of Gastroenterology and HepatologyUniversity of PennsylvaniaPhiladelphiaPA
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Sharma MR, Mitrani R, Werth VP. Effect of TNFα blockade on UVB-induced inflammatory cell migration and collagen loss in mice. J Photochem Photobiol B 2020; 213:112072. [PMID: 33181431 DOI: 10.1016/j.jphotobiol.2020.112072] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/25/2020] [Accepted: 10/26/2020] [Indexed: 11/27/2022]
Abstract
UVB irradiation induces pro-inflammatory cytokines including interleukin-1 (IL-1) and tumor necrosis factor-α (TNFα) in the skin. TNFα stimulates the chemotaxis of inflammatory cells to the skin. These cells secrete metalloproteinases (MMPs) and other enzymes that damage the cutaneous matrix. Therefore, blocking TNFα activity could be effective in preventing the influx of inflammatory cells and subsequent collagen degradation in the skin. In addition, TNFα downregulates procollagen mRNA, and thus blockade may be beneficial to production of type I collagen. Female C57BL/6 J mice were treated with etanercept (TNFα blocker, 4 mg/kg/day) for 4 days 1 h prior to UVB irradiation (100 mJ/cm2/day for 5 days). On the 5th day mice were sacrificed 3 h after UVB exposure. Blocking TNFα significantly inhibited UVB-induced recruitment of macrophages, mast cells, and neutrophils. UVB-irradiated mice skin contained more mature collagen compared to etanercept and UVB + etanercept-treated mice. Skin from UVB + etanercept-treated mice had more collagen fragments relative to UVB-irradiated mice. Procollagen protein was lower in UVB-irradiated and UVB + etanercept-treated mice. TNFα blockade decreased decorin and TGF-β1 in UVB-irradiated mice compared to UVB alone. MMP13 was inhibited by etanercept in UVB-irradiated mice (p < 0.01). In conclusion, blockade of TNFα significantly decreased mature collagen in UVB-irradiated mice, while increasing collagen fragmentation and decreasing procollagen.
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Affiliation(s)
- Meena R Sharma
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States of America; Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States of America
| | - Robert Mitrani
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States of America; Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States of America
| | - Victoria P Werth
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States of America; Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States of America.
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Singal AG, Rich NE, Mehta N, Branch A, Pillai A, Hoteit M, Volk M, Odewole M, Scaglione S, Guy J, Said A, Feld JJ, John BV, Frenette C, Mantry P, Rangnekar AS, Oloruntoba O, Leise M, Jou JH, Bhamidimarri KR, Kulik L, Tran T, Samant H, Dhanasekaran R, Duarte-Rojo A, Salgia R, Eswaran S, Jalal P, Flores A, Satapathy SK, Wong R, Huang A, Misra S, Schwartz M, Mitrani R, Nakka S, Noureddine W, Ho C, Konjeti VR, Dao A, Nelson K, Delarosa K, Rahim U, Mavuram M, Xie JJ, Murphy CC, Parikh ND. Direct-Acting Antiviral Therapy Not Associated With Recurrence of Hepatocellular Carcinoma in a Multicenter North American Cohort Study. Gastroenterology 2019; 156:1683-1692.e1. [PMID: 30660729 PMCID: PMC6598433 DOI: 10.1053/j.gastro.2019.01.027] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/15/2018] [Accepted: 01/09/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND & AIMS There is controversy over the effects of direct-acting antiviral (DAA) therapies for hepatitis C virus (HCV) infection on hepatocellular carcinoma (HCC) recurrence and tumor aggressiveness. We compared HCC recurrence patterns between DAA-treated and untreated HCV-infected patients who had achieved a complete response to HCC treatment in a North American cohort. METHODS We conducted a retrospective cohort study of patients with HCV-related HCC with a complete response to resection, local ablation, transarterial chemo- or radioembolization, or radiation therapy from January 2013 through December 2017 at 31 health systems throughout the United States and Canada. Cox regression was used to examine the association between DAA therapy and time to recurrence after a complete response, with DAA therapy analyzed as a time-varying exposure. We also estimated the association between DAA therapy and risk of early HCC recurrence (defined as 365 days after complete response). RESULTS Of 793 patients with HCV-associated HCC, 304 (38.3%) received DAA therapy and 489 (61.7%) were untreated. HCC recurred in 128 DAA-treated patients (42.1%; early recurrence in 52 patients) and 288 untreated patients (58.9%; early recurrence in 227 patients). DAA therapy was not associated with HCC recurrence (hazard ratio 0.90, 95% confidence interval 0.70-1.16) or early HCC recurrence (hazard ratio 0.96, 95% confidence interval 0.70-1.34) after we adjusted for study site, age, sex, Child-Pugh score, α-fetoprotein level, tumor burden, and HCC treatment modality. In DAA-treated and untreated patients, most recurrences were within the Milan criteria (74.2% vs 78.8%; P = .23). A larger proportion of DAA-treated than untreated patients received potentially curative HCC therapy for recurrent HCC (32.0% vs 24.6%) and achieved a complete or partial response (45.3% vs 41.0%) but this did not achieve statistical significance. CONCLUSION In a large cohort of North American patients with complete response to HCC treatment, DAA therapy was not associated with increased overall or early HCC recurrence. HCC recurrence patterns, including treatment response, were similar in DAA-treated and untreated patients.
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Affiliation(s)
- Amit G. Singal
- Division of Digestive and Liver Disease, UT Southwestern Medical Center Dallas, Texas
| | - Nicole E. Rich
- Division of Digestive and Liver Disease, UT Southwestern Medical Center Dallas, Texas
| | - Neil Mehta
- Division of Gastroenterology, University of California San Francisco, San Francisco, California
| | - Andrea Branch
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anjana Pillai
- Division of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, Illinois
| | - Maarouf Hoteit
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael Volk
- Transplantation Institute and Division of Gastroenterology, Loma Linda University Health, Loma Linda, California
| | - Mobolaji Odewole
- Division of Digestive and Liver Disease, UT Southwestern Medical Center Dallas, Texas
| | - Steven Scaglione
- Division of Hepatology, Loyola University Medical Center, Chicago, Illinois,Edward Hines Veterans Affairs, Chicago, Illinois
| | - Jennifer Guy
- Department of Transplantation, California Pacific Medical Center, San Francisco, California
| | - Adnan Said
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine, Madison, Wisconsin
| | - Jordan J. Feld
- Toronto Center for Liver Disease, Toronto General Hospital, Toronto, Ontario, Canada
| | - Binu V. John
- Division of Gastroenterology and Hepatology, McGuire VA Medical Center, Richmond, Virginia
| | - Catherine Frenette
- Division of Organ Transplantation, Scripps Green Hospital, San Diego, California
| | | | - Amol S. Rangnekar
- Division of Gastroenterology, Georgetown University Hospital, Washington, DC
| | - Omobonike Oloruntoba
- Division of Gastroenterology and Hepatology, Duke University Health Center, Durham, North Carolina
| | - Michael Leise
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Janice H. Jou
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon
| | | | - Laura Kulik
- Division of Hepatology, Northwestern University, Chicago, Illinois
| | - Tram Tran
- Liver Disease and Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Hrishikesh Samant
- Division of Gastroenterology and Hepatology, Louisiana State University Health Sciences Center, Baton Rouge, Louisiana
| | | | - Andres Duarte-Rojo
- Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Reena Salgia
- Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan
| | - Sheila Eswaran
- Division of Gastroenterology, Rush Medical College, Chicago, Illinois
| | - Prasun Jalal
- Division of Abdominal Transplantation, Baylor College of Medicine, Dallas, Texas
| | - Avegail Flores
- Division of Gastroenterology, Washington University School of Medicine, Louis, Missouri
| | - Sanjaya K. Satapathy
- Division of Transplant Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Robert Wong
- Division of Gastroenterology and Hepatology, Alameda Health System, Oakland, California
| | - Annsa Huang
- Division of Gastroenterology, University of California San Francisco, San Francisco, California
| | - Suresh Misra
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Myron Schwartz
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert Mitrani
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sasank Nakka
- Transplantation Institute and Division of Gastroenterology, Loma Linda University Health, Loma Linda, California
| | - Wassim Noureddine
- Transplantation Institute and Division of Gastroenterology, Loma Linda University Health, Loma Linda, California
| | - Chanda Ho
- Department of Transplantation, California Pacific Medical Center, San Francisco, California
| | - Venkata R. Konjeti
- Division of Gastroenterology and Hepatology, McGuire VA Medical Center, Richmond, Virginia
| | - Alexander Dao
- Division of Gastroenterology, Georgetown University Hospital, Washington, DC
| | - Kevin Nelson
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Kelly Delarosa
- Liver Disease and Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Usman Rahim
- Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California
| | - Meher Mavuram
- Division of Gastroenterology and Hepatology, Louisiana State University Health Sciences Center, Baton Rouge, Louisiana
| | - Jesse J. Xie
- Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Caitlin C. Murphy
- Division of Digestive and Liver Disease, UT Southwestern Medical Center Dallas, Texas
| | - Neehar D. Parikh
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan
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Roccaro GA, Mitrani R, Hwang WT, Forde KA, Reddy KR. Sustained Virological Response Is Associated with a Decreased Risk of Posttransplant Diabetes Mellitus in Liver Transplant Recipients with Hepatitis C-Related Liver Disease. Liver Transpl 2018; 24:1665-1672. [PMID: 30291672 PMCID: PMC6279473 DOI: 10.1002/lt.25351] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/28/2018] [Indexed: 01/13/2023]
Abstract
Posttransplant diabetes mellitus (PTDM), an increasingly recognized complication of solid organ transplantation, is associated with increased morbidity and mortality following liver transplantation (LT). Hepatitis C virus (HCV) infection is a consistent and modifiable risk factor for PTDM. Prior studies have demonstrated improvement in glucose metabolism following sustained virological response (SVR). However, the effect of SVR on the incidence of PTDM has not been previously investigated in a large cohort of LT recipients. We performed a single-center retrospective cohort study of LT recipients with HCV from January 1, 2010 to June 30, 2015 to compare the risk of sustained posttransplant diabetes mellitus (s-PTDM) prior to and following SVR. SVR was treated as a discrete time varying exposure. The s-PTDM was defined as de novo diabetes mellitus following LT of a >6-month duration. Univariate and multivariate Cox proportional hazards models were used to compare crude and adjusted time to s-PTDM prior to and following SVR. There were 256 eligible LT recipients analyzed. Median follow-up was 41.2 months. Overall, 31 (12.1%) and 178 (69.5%) patients achieved SVR prior to LT and following LT, respectively. During follow-up, 71 (27.7%) patients developed s-PTDM. The incidence of s-PTDM was greatest in the first year after LT. After adjustment for potential confounders, SVR was associated with a significantly reduced risk of s-PTDM (HR, 0.40; P = 0.048). In conclusion, eradication of HCV is independently associated with a reduced incidence of s-PTDM. This benefit appears to be most influenced by pre-LT SVR and persists throughout the post-LT period. Given the association between PTDM and posttransplant morbidity and mortality, these data provide another motivator for pre-LT or early post-LT treatment of HCV.
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Affiliation(s)
- Giorgio A. Roccaro
- Division of Gastroenterology, Emory University Medical Center, Atlanta, GA
| | - Robert Mitrani
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA
| | - Wei-Ting Hwang
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kimberly A. Forde
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - K. Rajender Reddy
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA
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Rice J, Dodge JL, Bambha KM, Bajaj JS, Reddy KR, Gralla J, Ganapathy D, Mitrani R, Reuter B, Palecki J, Acharya C, Shaw J, Burton JR, Biggins SW. Neutrophil-to-Lymphocyte Ratio Associates Independently With Mortality in Hospitalized Patients With Cirrhosis. Clin Gastroenterol Hepatol 2018; 16:1786-1791.e1. [PMID: 29705264 DOI: 10.1016/j.cgh.2018.04.045] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 04/15/2018] [Accepted: 04/17/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The neutrophil to lymphocyte ratio (NLR) is a biomarker of immune dysregulation in patients with cirrhosis and is inexpensive to measure. We investigated the association between NLR and mortality in hospitalized patients with cirrhosis at 4 liver transplant centers, controlling for severity of acute-on-chronic liver failure (ACLF). METHODS We performed a retrospective study using data from the North American Consortium for the Study of End-stage Liver Disease on patients with index hospitalizations for cirrhosis from December 2011 through December 2016. We collected data on patient demographics, NLR, model for end-stage liver disease (MELD) scores, serum levels of Na, cirrhosis stages, infections, hepatocellular carcinomas, and ACLF severity (based on number of organ failures). Competing risk regression analysis evaluated mortality within 1 year after hospital discharge, accounting for competing events (liver transplant). RESULTS At admission, the patients' mean age was 57 years, mean MELD score was 21, and mean serum level of Na was 134 mmol/L. Sixty-eight patients had no organ failure, 21 patients had 1 organ failures, 7 patients had 2 organ failures, 4 patients had 3 organ failures, and 1 patient had 4 organ failures; 36% of the patients had confirmed or suspected infections. In univariate models, risk of death associated with increasing NLR, up to a value of 8 (hazard ratio [HR]= 1.14; 95% CI, 1.07-1.20; P < .001), and NLR quartile (for NLR range of 3-5, HR = 2.17; for NLR range of >5-9, HR=2.46; for NLR quartile >9, HR=2.84 vs the lowest quartile [NLR<3]) (P ≤ .001). The NLR remained statistically significant in multivariable models, adjusting for age, MELD score, hepatocellular carcinoma, and ACLF severity. Additionally, NLR was a statistically significant independent predictor of length of index hospital stay and mortality within 90 days after discharge. CONCLUSION In a retrospective analysis of patients with cirrhosis, we found NLR to associate with death within 1 year after non-elective hospitalization. In these patients, the risk of death associated with acute immune dysregulation persists long after their initial hospitalization.
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Affiliation(s)
- Jonathan Rice
- Division of Gastroenterology, University of Colorado, Aurora, Colorado
| | - Jennifer L Dodge
- Center for Liver Investigation Fostering Discovery (C-LIFE), University of Washington, Seattle, Washington; Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Kiran M Bambha
- Center for Liver Investigation Fostering Discovery (C-LIFE), University of Washington, Seattle, Washington; Division of Gastroenterology, University of Washington, Seattle, Washington
| | - Jasmohan S Bajaj
- Division of Gastroenterology, Virginia Commonwealth University, Richmond, Virginia; Division of Gastroenterology, McGuire VA Medical Center, Richmond, Virginia
| | - K Rajender Reddy
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jane Gralla
- Division of Gastroenterology, University of Colorado, Aurora, Colorado
| | - Dinesh Ganapathy
- Division of Gastroenterology, Virginia Commonwealth University, Richmond, Virginia; Division of Gastroenterology, McGuire VA Medical Center, Richmond, Virginia
| | - Robert Mitrani
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bradley Reuter
- Division of Gastroenterology, Virginia Commonwealth University, Richmond, Virginia; Division of Gastroenterology, McGuire VA Medical Center, Richmond, Virginia
| | - Julia Palecki
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chathur Acharya
- Division of Gastroenterology, Virginia Commonwealth University, Richmond, Virginia; Division of Gastroenterology, McGuire VA Medical Center, Richmond, Virginia
| | - Jawaid Shaw
- Division of Gastroenterology, Virginia Commonwealth University, Richmond, Virginia; Division of Gastroenterology, McGuire VA Medical Center, Richmond, Virginia
| | - James R Burton
- Division of Gastroenterology, University of Colorado, Aurora, Colorado
| | - Scott W Biggins
- Center for Liver Investigation Fostering Discovery (C-LIFE), University of Washington, Seattle, Washington; Division of Gastroenterology, University of Washington, Seattle, Washington.
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Bunchorntavakul C, Mitrani R, Reddy KR. Advances in HCV and Cryoglobulinemic Vasculitis in the Era of DAAs: Are We at the End of the Road? J Clin Exp Hepatol 2018; 8:81-94. [PMID: 29743799 PMCID: PMC5938331 DOI: 10.1016/j.jceh.2017.11.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 11/30/2017] [Indexed: 12/12/2022] Open
Abstract
Hepatitis C Virus (HCV)-related Mixed Cryoglobulinemia (MC) is a unique condition with complex pathogenesis that involves HCV antigen-driven B-lymphocyte clonal proliferation and mutagenesis. Clinical spectrum of MC ranges from asymptomatic state to clinically-apparent vasculitis involving multiple organs. In the era of Direct-Acting Antiviral (DAA) therapy, patients with HCV-related MC achieve high rates of viral clearance that is commonly accompanied by an improvement in clinical symptoms as well as immunological profiles. Rituximab, either alone or in combination with DAA, has also been shown to be effective. Nevertheless, there have been limited and somewhat conflicting data, particularly over the long-term, regarding the rate and degree of clinical response of MC following DAA therapy. It appears that we have come quite a long way in the last decade with this condition. As with non-MC related HCV, undoubtedly long term outcome data will be forthcoming over the next few years. As we move forward successful therapy of HCV is not likely to be a challenge in contrast to access to therapy.
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Affiliation(s)
- Chalermrat Bunchorntavakul
- Division of Gastroenterology and Hepatology, Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Rajavithi Road, Ratchathewi, Bangkok 10400, Thailand
| | - Robert Mitrani
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania, 2 Dulles, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - K. Rajender Reddy
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania, 2 Dulles, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Hlaing NKT, Banerjee D, Mitrani R, Arker SH, Win KS, Tun NL, Thant Z, Win KM, Reddy KR. Hepatitis C virus therapy with peg-interferon and ribavirin in Myanmar: A resource-constrained country. World J Gastroenterol 2016; 22:9613-9622. [PMID: 27920482 PMCID: PMC5116605 DOI: 10.3748/wjg.v22.i43.9613] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 09/13/2016] [Accepted: 09/28/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate peg-interferon (peg-IFN) and ribavirin (RBV) therapy in Myanmar and to predict sustained virologic response (SVR). METHODS This single-center, open-label, study was conducted in Myanmar between 2009 and 2014. A total of 288 patients infected with HCV genotypes 1, 2, 3 and 6 were treated with peg-IFN alpha-2a (180 μg/wk) or alpha-2b (50 to 100 μg as a weight-based dose) and RBV as a weight-based dose (15 mg/kg/d). Treatment duration was 48 wk for genotypes 1 and 6, 24 wk for genotype 2, and 24 or 48 wk for genotype 3 based on rapid virologic response (RVR). Those co-infected with hepatitis B received 48 wk of therapy. RESULTS Overall, SVR was achieved for 82% of patients and the therapy was well tolerated. All patients achieved SVR at equivalent rates regardless of HCV genotype (P = 0.314). Low fibrosis scores (P < 0.001), high baseline albumin levels (P = 0.028) and low baseline viral loads (P = 0.029) all independently predicted SVR. On the other hand, IL-28B TT and CC genotypes were not found to significantly predict SVR (P = 0.634; P = 0.618). Among those who completed treatment, the occurrence of RVR showed a > 96% positive predictive value for achieving SVR. Treatment duration did not significantly impact the likelihood of achieving SVR for patients infected with genotype 3 HCV (P = 0.371). The most common adverse events were fatigue (71%) and poor appetite (60%). Among patients with genotype 3 HCV, more patients in the 48-wk treatment group required erythropoietin than in the 24-wk treatment group (61.1% vs 49.2%). CONCLUSION SVR rates were high with peg-IFN and RBV therapy in Myanmar. Fibrosis scores, baseline albumin, HCV RNA levels and RVR independently predicted SVR.
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Sharma M, Mitrani R, Werth V. 584 Role of UVB-induced, IL-1 in dermal collagen alteration in murine skin. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.02.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mitrani R, Rubenstein JE, Kois JC, Phillips KM. Alternative uses of a visible light-polymerized material. J Prosthet Dent 2001; 86:107-10. [PMID: 11491073 DOI: 10.1067/mpr.2001.115505a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Three different procedures that involve the use of Triad gel are described. This light-polymerized resin material is versatile and easy to use in the dental clinic and laboratory. The procedures described include the transfer of ridge topography for ovate pontic sites, implant lab analog fixation, and solid/soft tissue cast fabrication.
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Affiliation(s)
- R Mitrani
- School of Dentistry, University of Washington, Seattle 98195, USA.
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Mitrani R, Rubenstein JE, Kois JC, Phillips KM. Alternative uses of a visible light-polymerized material. J Prosthet Dent 2001; 85:501-3. [PMID: 11357078 DOI: 10.1067/mpr.2001.115505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Three different procedures that involve the use of Triad gel are described. This light-polymerized resin material is versatile and easy to use in the dental clinic and laboratory. The procedures described include the transfer of ridge topography for ovate pontic sites, implant lab analog fixation, and solid/soft tissue cast fabrication.
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Affiliation(s)
- R Mitrani
- School of Dentistry, University of Washington, Seattle, Washington 98195, USA.
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Mitrani R, Nicholls JI, Phillips KM, Ma T. Accuracy of electronic implant torque controllers following time in clinical service. Int J Oral Maxillofac Implants 2001; 16:394-9. [PMID: 11432659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
Tightening of the screws in implant-supported restorations has been reported to be problematic, in that if the applied torque is too low, screw loosening occurs. If the torque is too high, then screw fracture can take place. Thus, accuracy of the torque driver is of the utmost importance. This study evaluated 4 new electronic torque drivers (controls) and 10 test electronic torque drivers, which had been in clinical service for a minimum of 5 years. Torque values of the test drivers were measured and were compared with the control values using a 1-way analysis of variance. Torque delivery accuracy was measured using a technique that simulated the clinical situation. In vivo, the torque driver turns the screw until the selected tightening torque is reached. In this laboratory experiment, an implant, along with an attached abutment and abutment gold screw, was held firmly in a Tohnichi torque gauge. Calibration accuracy for the Tohnichi is +/- 3% of the scale value. During torque measurement, the gold screw turned a minimum of 180 degrees before contact was made between the screw and abutment. Three torque values (10, 20, and 32 N-cm) were evaluated, at both high- and low-speed settings. The recorded torque measurements indicated that the 10 test electronic torque drivers maintained a torque delivery accuracy equivalent to the 4 new (unused) units. Judging from the torque output values obtained from the 10 test units, the clinical use of the electronic torque driver suggests that accuracy did not change significantly over the 5-year period of clinical service.
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Affiliation(s)
- R Mitrani
- University of Washington, Seattle 98195, USA
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Phillips K, Mitrani R. Implant management for comprehensive occlusal reconstruction. Compend Contin Educ Dent 2001; 22:235-8, 240, 242-6; quiz 248. [PMID: 11913260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Implant prosthodontics is a predictable treatment modality for patients who require occlusal reconstruction. Specific indications include lack of distal abutment, long span segment, compromised natural abutments, and occlusal dysfunction. With proper treatment planning and an understanding of the occlusion and biomechanics of implant prosthodontics, the restorative team can predictably fabricate a functional, esthetic, and comfortable prosthesis.
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Affiliation(s)
- K Phillips
- Department of Restorative Dentistry, University of Washington School of Dentistry, Seattle, Washington, USA
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Mitrani R, Kois JC. Restorative dentistry using a multidisciplinary approach. Compend Contin Educ Dent 2000; 21:316-8, 320, 322-3. [PMID: 11199683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Multidisciplinary treatment was essential for this patient to optimally manage the occlusion and missing teeth. When the space distribution was completed, ridge management procedures for pontic site development were accomplished. The final restorative treatment required was actually minimized to a 7-unit fixed partial denture. It was apparent the multidisciplinary treatment was essential to predictably manage this patient by decreasing risk and ensuring a long-term strategy for enhanced patient satisfaction.
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Myerburg RJ, Mitrani R, Interian A, Simmons J, Kloosterman M, Castellanos A. The interpretation and clinical application of data from trials on sudden cardiac death. J Interv Card Electrophysiol 2000; 4 Suppl 1:95-102. [PMID: 10590495 DOI: 10.1023/a:1009886700374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- R J Myerburg
- Department of Medicine, Division of Cardiology, University of Miami School of Medicine, Miami, Florida 33101, USA.
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Abstract
The objectives of this review are to discuss the diversity of mechanisms that may explain the association between heart rate (HR) variability and mortality, to appraise the clinical applicability of traditional and new measures of HR variability and to propose future directions in this field of research. There is a large body of data demonstrating that abnormal HR variability measured over a 24-h period provides information on the risk of subsequent death in subjects with and without structural heart disease. However, the mechanisms responsible for this association are not completely established. Therefore, no specific therapy is currently available to improve the prognosis for patients with abnormal HR variability. Reduced HR variability has been most commonly associated with a risk of arrhythmic death, but recent data suggest that abnormal variability also predicts vascular causes of death, progression of coronary atherosclerosis and death due to heart failure. A consensus is also lacking on the best HR variability measure for clinical purposes. Time and frequency domain measures of HR variability have been most commonly used, but recent studies show that new analysis methods based on nonlinear dynamics may be more powerful in terms of risk stratification. Before the measurement of HR variability can be applied to clinical practice and used to direct therapy, more precise insight into the pathophysiological link between HR variability and mortality are needed. Further studies should also address the issue of which of the HR variability indexes, including the new nonlinear measures, is best for clinical purposes in various patient populations.
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Affiliation(s)
- H V Huikuri
- Department of Medicine, University of Oulu, Finland.
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Myerburg RJ, Cox MM, Interian A, Mitrani R, Girgis I, Dylewski J, Castellanos A. Cycling of inducibility of paroxysmal supraventricular tachycardia in women and its implications for timing of electrophysiologic procedures. Am J Cardiol 1999; 83:1049-54. [PMID: 10190518 DOI: 10.1016/s0002-9149(99)00013-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Arrhythmias in women may be affected by phases of the menstrual cycle. This study was designed to determine the prevalence of perimenstrual clustering of spontaneous episodes of paroxysmal supraventricular tachycardia (SVT) in women. It also tested the hypothesis that women with this temporal pattern of events have an altered probability of induction of paroxysmal SVT during electrophysiologic testing at higher estrogen states (midcycle or with estrogen replacement therapy) than at low estrogen states (perimenstrual or without estrogen replacement). A structured history of the relation of spontaneous paroxysmal SVTs to phases of the menstrual cycle was obtained prospectively among 42 women referred during a 3-year period. Patients with cyclical patterns of spontaneous tachycardias, who had had negative electrophysiologic studies at midcycle or while receiving estrogen replacement therapy, had repeat procedures (1) when premenstrual or at the onset of menses, or (2) after stopping estrogen replacement therapy. Seventeen of 42 consecutive female patients (40%) had histories of perimenstrual clustering of arrhythmias. Six women (4 with normal menstrual cycles, 2 on estrogen replacement therapy), who qualified for paired electrophysiologic studies because of a negative initial electrophysiologic study that included provocation with isoproterenol, had inducibility into SVTs during the second study. All 6 had dual atrioventricular (AV) nodal pathway physiology, 4 had AV nodal reentrant tachycardia (AVNRT) induced, 1 had both AVNRT and reciprocating AV tachycardias, and 1 had nonsustained AVNRT and an atrial tachycardia induced. Successful ablation procedures were performed in 5 of the 6 patients. Thus, among women with a history of perimenstrual clustering of paroxysmal SVT and among those receiving estrogen replacement therapy, scheduling of elective electrophysiologic procedures at times of low estrogen levels (premenstrual or off estrogen replacement therapy) may facilitate the probability of a successful procedure.
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Affiliation(s)
- R J Myerburg
- Department of Medicine, University of Miami School of Medicine, Florida 33136, USA
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Affiliation(s)
- R J Myerburg
- Department of Medicine, University of Miami School of Medicine, Florida 33101, USA.
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Affiliation(s)
- R J Myerburg
- Department of Medicine, University of Miami School of Medicine, Fla 33101, USA.
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Mitrani R. Edrophonium Hydrochloride Does Not Elevate Ventricular Fibrillation Thresholds in Humans. J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(97)84099-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
The influence of an X-ray dose of 10 Gy (1000 rads) on mitosis in the rat conjunctival epithelium was assessed. A mitotic inhibition began 1 hour postirradiation and continued for 4 days. The mitotic index was depressed to 10% of control values. After 5 days postirradiation, the mitotic index surpassed the control values peaking at 7 days postirradiation. The spindle axes of cells in telophase of the perilimbal rat conjunctival epithelium assume a characteristic, three dimensional orientation relative to the limbus. Ionizing radiation did not disrupt this organization at any time postirradiation. In fact, the frequency of mitotic figures preferentially aligned in irradiated tissue was enhanced during the mitotic rebound.
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