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Tomoyuki Takashima,
Hirayuki Enomoto,
Toshiaki Ninomiya,
Soo Ryang Kim,
Hiroaki Okushin,
Masahiko Sugano,
Susumu Imoto,
Yoshihiko Yano,
Teruji Ooka,
Yasushi Seo, [......],
Hisato Jomura,
Soji Shimomura,
Michiko Shindo,
Hideji Nakamura, Nobuhiro Aizawa,
Yoshinori Iwata,
Masaki Saito,
Hiroyasu Imanishi,
Hiroko Iijma,
Shuhei Nishiguchi
[show abstract]
[hide abstract]
ABSTRACT: AIM: The recommended treatment for chronic hepatitis C is a combination of pegylated interferon (PegIFN) plus ribavirin (RBV). However, the sustained virological response (SVR) rate of PegIFN-RBV therapy was approximately 50% in patients with genotype 1b and a high viral load. Thus, we compared the efficiencies and side effects of PegIFN-RBV and self-injected low-dose natural (n) IFNα in patients with HCV. METHODS: A prospective, multicenter, open-label study was conducted in 12 Japanese institutions. A total of 129 patients with chronic hepatitis C and no detectable HCV after 24-72 weeks of PegIFN-RBV treatment were assigned to the control (N = 82) or treated (N = 47) group. Treated patients received 3 million units of nIFNα 2-3 times/week over 96 weeks. The groups were compared regarding treatment efficiency, side effects, and quality of life. RESULTS: Significant treatment success regarding virus negativation rates was found, with 89% and 73% for the treated and control groups, respectively (p = 0.039). In contrast, there was no difference in relapse rate between the groups 24 weeks after the 96-week nIFNα treatment (p = 0.349). However, when early viral responders and late viral responders (LVR) were separated, LVR patients responded significantly to the treatment with 90% sustained virologic response, compared to 53% for the control group (p = 0.044). The side effects and therapeutic issues of nIFNα were less than that of PegIFN-RBV treatment. CONCLUSIONS: Self-injected nIFNα has larger benefits than prolonged PegIFN-RBV for chronic hepatitis C patients with high viral loads of genotype 1b who fail to achieve early viral response during initial combination treatment.
Hepatology Research 05/2013; · 2.20 Impact Factor
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Yoshinori Iwata,
Hirayuki Enomoto,
Yoshiyuki Sakai, Nobuhiro Aizawa,
Hironori Tanaka,
Naoto Ikeda,
Tomoyuki Takashima,
Akio Ishii,
Kunihiro Hasegawa,
Yukihisa Yuri,
Kazunari Iwata,
Masaki Saito,
Hiroyasu Imanishi,
Hiroko Iijima,
Shuhei Nishiguchi
[show abstract]
[hide abstract]
ABSTRACT: Background/Aims: The development of esophageal varices depends on the progression of liver fibrosis. However, it has not yet been sufficiently clarified whether biomarkers of liver fibrosis can be used to predict the incidence of varices in cirrhotic patients with a well-maintained liver function (Child-Pugh class A). Methodology: Three established markers of liver fibrosis, including AST-to-ALT ratios (AAR), FIB-4 and AST-to-platelet ratio indices (APRI), were analyzed in HCV-positive cirrhotic patients with Child-Pugh class A status, and the relationships between these markers and the risk of variceal bleeding were investigated. Results: The values of AAR and FIB-4 in the patients with varices with a high risk of hemorrhage were significantly higher than those in the patients without high-risk varices, whereas the value of APRI was not found to be related to the risk of variceal bleeding. Of all the parameters examined, the values of AAR were the most significantly different between the two (with or without high-risk varices) groups. In addition, the values of AAR increased in line with variceal severity. Conclusions: The value of AAR is related to the severity and risk of variceal bleeding in patients with HCV-related compensated cirrhosis.
Hepato-gastroenterology 09/2012; 60(121). · 0.66 Impact Factor
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Yoshiyuki Sakai,
Hirayuki Enomoto, Nobuhiro Aizawa,
Yoshinori Iwata,
Hironori Tanaka,
Naoto Ikeda,
Tomoyuki Takashima,
Ryo Takata,
Takashi Iwai,
Kazunari Iwata,
Masaki Saito,
Hiroyasu Imanishi,
Hiroko Iijima,
Hideji Nakamura,
Shuhei Nishiguchi
[show abstract]
[hide abstract]
ABSTRACT: Background/Aims: Variceal hemorrhaging due to portal hypertension is a severe complication of liver cirrhosis. Although several biomarkers have been reported as predictors of the presence of varices, it is still difficult to assess the risk of variceal bleeding without esophagogastroduodenoscopy (EGD). The ratio of glycated albumin (GA) to glycated hemoglobin (HbA1c) was reported to increase with the progression of liver fibrosis. The aim of the study was to investigate whether the GA/HbA1c ratio is related to the severity and bleeding-risk of the varices. Methodology: We measured the GA/HbA1c ratio of HCV-related cirrhotic patients with Child-Pugh class A status and analyzed its relationship with the presence and bleeding risk of varices. Results: The GA/HbA1c ratio was higher in the patients who had the varices with a high risk of hemorrhage than in the patients with a low risk of bleeding. In addition, the GA/HbA1c ratio was higher in patients with varices than that in patients without varices. Furthermore, the GA/HbA1c ratio was the most significantly different parameter of all the factors examined, including the platelet count, prothrombin activity and albumin level. Conclusions: The GA/HbA1c ratio is increased in patients with varices and with the bleeding risk of the varices.
Hepato-gastroenterology 03/2012; 59(119). · 0.66 Impact Factor
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Nobuhiro Aizawa,
Hirayuki Enomoto,
Hiroyasu Imanishi,
Masaki Saito,
Yoshinori Iwata,
Hironori Tanaka,
Naoto Ikeda,
Yoshiyuki Sakai,
Tomoyuki Takashima,
Takashi Iwai,
Ei-Ichiro Moriwaki,
Soji Shimomura,
Hiroko Iijima,
Hideji Nakamura,
Shuhei Nishiguchi
[show abstract]
[hide abstract]
ABSTRACT: To analyze the relationship between the glycated albumin (GA) to glycated hemoglobin (HbA1c) ratio and the histological grading of liver fibrosis.
The study retrospectively included consecutive hepatitis C virus positive chronic liver disease patients (n = 142) who had undergone percutaneous liver biopsy between January 2008 and March 2010 at our institution. The ratios of GA/HbA1c were calculated in all patients to investigate the relationship with the degree of the liver fibrosis. The values of the aspartate aminotransferase-to-platelet ratio index (APRI), an excellent marker for the evaluation of liver fibrosis, were also calculated. In addition, we combined the ratio of GA/HbA1c and the APRI in order to improve our ability to detect the presence of significant liver fibrosis.
Sixty-one (43%) patients had either no fibrosis or minimal fibrosis (METAVIR score: F0-F1), while 25 (17%) had intermediate fibrosis (F2). Fifty-six (39%) patients had severe fibrosis (F3-F4) and 27 of them had cirrhosis (F4). The mean values of the GA/HbA1c increased with the progression of the fibrosis (F0-1: 2.83 ± 0.24, F2: 2.85 ± 0.24, F3: 2.92 ± 0.35, F4: 3.14 ± 0.54). There was a significant difference between the F0-F1 vs F4, F2 vs F4, and F3 vs F4 groups (P < 0.01, P < 0.01, P < 0.01 and P < 0.05, respectively). The GA/HbA1c ratio was significantly higher in the patients with cirrhosis (F4) than in those without cirrhosis (F0-F3) (3.14 ± 0.54 vs 2.85 ± 0.28, P < 0.0001). The GA/HbA1c ratio was also significantly higher in the patients with severe fibrosis (F3-F4) than in those without severe liver fibrosis (F0-F2) (3.03 ± 0.41 vs 2.84 ± 0.24, P < 0.001). Furthermore, the GA/HbA1c ratio was also significantly higher in the patients with significant fibrosis (F2-F4) than in those without significant liver fibrosis (F0-F1) (2.98 ± 0.41 vs 2.83 ± 0.24, P < 0.001). The diagnostic performance of the increased GA/HbA1c ratio (> 3.0) was as follows: its sensitivity and specificity for the detection of liver cirrhosis (F4) were 59.3% and 70.4%, respectively and its sensitivity and specificity for the detection of severe liver fibrosis (F3-F4) were 50.0% and 74.4%, respectively. With regard to the detection of significant fibrosis (F2-F4), its sensitivity was 44.4% and its specificity was 77.0%. Although even the excellent marker APRI shows low sensitivity (25.9%) for distinguishing patients with or without significant fibrosis, the combination of the APRI and GA/HbA1c ratio increased the sensitivity up to 42.0%, with only a modest decrease in the specificity (from 90.2% to 83.6%).
The GA/HbA1c ratio increased in line with the histological severity of liver fibrosis, thus suggesting that this ratio is useful as a supportive index of liver fibrosis.
World journal of hepatology. 01/2012; 4(1):11-7.
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Hironori Tanaka,
Hiroko Iijima,
Kazuhiro Nouso,
Noriaki Aoki,
Takashi Iwai,
Tomoyuki Takashima,
Yoshiyuki Sakai, Nobuhiro Aizawa,
Kazunari Iwata,
Naoto Ikeda,
Yoshinori Iwata,
Hirayuki Enomoto,
Masaki Saito,
Hiroyasu Imanishi,
Shuhei Nishiguchi
[show abstract]
[hide abstract]
ABSTRACT: Aim: Sonazoid is a new contrast agent for ultrasonography (US). Contrast-enhanced ultrasonography (CEUS) using Sonazoid enables Kupffer imaging, which improves the sensitivity of hepatocellular carcinoma (HCC) detection. However, there are no studies on the cost-effectiveness of HCC surveillance using Sonazoid. Methods: We constructed a Markov model simulating the natural history of HCV-related liver cirrhosis (LC) patients, and compared three strategies (no surveillance, US surveillance and CEUS surveillance). The transition probability and cost data were obtained from published data. The simulation and analysis were performed using TreeAge pro 2009 software. Results: When compared to the no surveillance group, the US and CEUS surveillance groups increased the life expectancy by 1.67 and 1.99 quality-adjusted life-years (QALY), respectively, and the incremental cost effectiveness ratio (ICER) were 17 296 $US/QALY and 18 384 $US/QALY, respectively. These results were both less than the commonly-accepted threshold of $US 50 000/QALY. Even if the CEUS surveillance group was compared with the US surveillance group, the ICER was $US 24 250 and thus cost-effective. Sensitivity analysis showed that the annual incidence of HCC and CEUS sensitivity were two critical parameters. However, when the annual incidence of HCC is more than 2% and/or the CEUS sensitivity is more than 80%, the ICER was also cost-effective. Conclusions: Contrast-enhanced ultrasonography surveillance for HCC is a cost-effective strategy for LC patients and gains their longest additional life years, with similar degree of ICER in the US surveillance group. CEUS surveillance using Sonazoid is expected to be used not only in Japan, but also world-wide.
Hepatology Research 01/2012; 42(4):376-84. · 2.20 Impact Factor
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Hirayuki Enomoto,
Shin-ichi Inoue,
Akio Matsuhisa, Nobuhiro Aizawa,
Hiroyasu Imanishi,
Masaki Saito,
Yoshinori Iwata,
Hironori Tanaka,
Naoto Ikeda,
Yoshiyuki Sakai,
Tomoyuki Takashima,
Soji Shimomura,
Hiroko Iijima,
Hideji Nakamura,
Shuhei Nishiguchi
[show abstract]
[hide abstract]
ABSTRACT: Despite the importance of identifying the causative pathogen(s), ascitic fluid cultures are occasionally negative in patients with spontaneous bacterial peritonitis (SBP). A novel strategy using the in situ hybridization (ISH) method was introduced to detect the bacterial genomic DNA phagocytized in the blood of patients with sepsis. In the present study, we developed a new ISH probe to detect global bacterial DNA (named as GB probe) and evaluated its utility for detecting the phagocytized bacterial DNA in SBP ascites.
Hybridization of bacterial DNA with the GB probe was examined by dot-blot and ISH tests. In addition, the utility of the ISH method to detect the bacterial DNA in the leukocytes of SBP ascites was evaluated.
The GB probe hybridized with the genomic DNA of all 59 bacterial strains tested (59 species of 36 genus). Eleven of 51 patients with ascites (out of total 542 cirrhotic inpatients) were categorized as SBP. The ISH tests showed positive results in 10 of 11 SBP cases. However, the ISH tests all showed negative results in the 40 non-SBP ascitic samples. Therefore, the ISH tests yielded highly sensitive and specific results for detecting the phagocytized bacterial DNA in the leukocytes of SBP ascites. Moreover, all of the ISH test results were obtained within only one day.
Our newly established ISH method was found to provide both a rapid and sensitive detection of bacterial DNA in SBP ascites, thus suggesting its utility for providing early and direct evidence of bacterial infection in SBP ascites.
Journal of Hepatology 08/2011; 56(1):85-94. · 9.26 Impact Factor
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Nippon rinsho. Japanese journal of clinical medicine 05/2011; 69 Suppl 4:201-5.
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Hirayuki Enomoto,
Akio Ishii,
Hiroyasu Imanishi,
Masaki Saito,
Hironori Tanaka,
Yoshinori Iwata,
Yoshiyuki Sakai,
Takashi Iwai,
Kazunori Yoh,
Tomoyuki Takashima,
Shohei Yoshikawa, Nobuhiro Aizawa,
Teruhisa Yamamoto,
Naoto Ikeda,
Soji Shimomura,
Hiroko Iijima,
Seiichi Hirota,
Shuhei Nishiguchi
[show abstract]
[hide abstract]
ABSTRACT: We report a case of hepatocellular carcinoma (HCC) in association with autoimmune hepatitis (AIH). In May 2003, a 66- year-old man was admitted to our hospital because of acute liver dysfunction. He was diagnosed with AIH, and his liver function was normalized by oral administration of the corticosteroid. In July 2007, when he was admitted for the treatment of bacterial pneumonia, two liver tumors (S4: ø4 cm and S2: ø1 cm) were revealed by abdominal CT scan, and the serum level of AFP was high. According to the findings of imaging diagnosis and laboratory data, the patient was diagnosed as having HCC. Since the standard invasive therapies of HCC were not accepted by the patient and his family, he was treated by oral administration of UFT-E (tegafur/uracil: 200 mg/day). Three months after the initiation of administration, CT scan showed a remarkable reduction of the tumors, and his serum AFP level was decreased to the normal range. This case shows that HCC develops in an AIH patient even if liver function is maintained in the normal range. It also suggests the clinical usefulness of UFT-E in the management of HCC given the difficulty of treatment by the standard therapies.
Gan to kagaku ryoho. Cancer & chemotherapy 05/2010; 37(5):919-22.
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Soji Shimomura,
Naoto Ikeda,
Masaki Saito,
Akio Ishii,
Tomoyuki Takashima,
Yoshiyuki Sakai,
Shohei Yoshikawa, Nobuhiro Aizawa,
Hironori Tanaka,
Yoshinori Iwata,
Hirayuki Enomoto,
Hiroyasu Imanishi,
Teruhisa Yamamoto,
Hisato Jomura,
Hideji Nakamura,
Hiroko Iijima,
Shuhei Nishiguchi
[show abstract]
[hide abstract]
ABSTRACT: This study investigates the usefulness of long-term interferon (IFN) therapy following radiofrequency ablation (RFA) for HCV-associated hepatocellular carcinoma (HCC).
This is a retrospective observational study. Patients underwent pegylated IFN-α/ribavirin combination therapy for 48 weeks and then were maintained on IFN-α administration on average for 68 weeks (mean total duration 116 weeks). Patients who underwent IFN monotherapy were maintained on IFN administration on average for 78 weeks.
There were biases in the background factors between the IFN and non-IFN groups. Therefore, a covariate adjustment was performed using the propensity score. An analysis of 20-matched patients from each group showed the 5-year cumulative survival rate was higher in the IFN group than in the non-IFN group (100 and 76%, respectively), and the 3-year cumulative recurrence rate was significantly lower in the IFN group than in the non-IFN group (38.0 and 64.2%, respectively). In 14 patients (i.e., IFN responders), the serum alanine aminotransferase (ALT) level remained normalized at 30 IU/mL or lower, regardless of disappearance of serum HCV RNA. In these patients, the cumulative recurrence rate was low, the hazard ratio was 0.158 (95% confidence interval = 0.045-0.561, P = 0.004), and the serum albumin level was retained.
These results show the importance of maintaining the liver function and suggest that long-term IFN administration after RFA inhibits recurrence and contributes to an improved outcome in patients (in particular, IFN responders) who initially develop HCC.
Hepatology International 01/2010; 5(1):559-66. · 2.64 Impact Factor
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Naozumi Higaki,
Itsuro Soma,
Nobuyasu Hayashi,
Katsutoshi Nakano,
Masakazu Murakami,
Hirohito Hayashida,
Kazuomi Kan,
Takao Ichihara, Nobuhiro Aizawa,
Noriyuki Saito,
Takashi Niju,
Toshiyuki Ikeda,
Masato Sakon
[show abstract]
[hide abstract]
ABSTRACT: We report a case in which advanced lung cancer with mediastinal lymph node metastasis and recurrence of brain metastasis was completely responsive to combination chemotherapy and gamma knife radiosurgery. The patient was a 61-year-old woman, who suffered from advanced lung cancer (SCC) with bilateral mediastinal lymph node metastasis and contralateral lung nodule. She was treated with CBDCA combined with PTX. Bilateral lung nodules were surgically resected. Seven months after resection, solitary brain metastasis appeared, and gamma knife radiosurgery was performed. Histological efficacy of both primary lung tumor (SCC) and metastatic brain tumor was evaluated as Ef 3 (pCR). She has had no recurrence for 3 years after radiosurgery.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2009; 36(12):2111-3.
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Arerugī = [Allergy] 08/2003; 52(7):586-90.
