Durability of Sustained Virologic Response and Improvement of Fibrosis Markers after Daclatasvir and Asunaprevir Treatment in Genotype 1b Hepatitis C Virus-Infected Patients: a Real Life and Multicenter Study

BACKGROUND: The long-term data with direct acting antiviral agents were rare. This study investigated the durability of a sustained virologic response (SVR) and the improvement of fibrosis after daclatasvir and asunaprevir (DCV/ASV) treatment in genotype 1b (GT1b) hepatitis C virus (HCV)-infected patients. METHODS: A total of 288 HCV GT1b patients without baseline non-structural 5A (NS5A) resistance-associated substitution (RAS) treated with DCV/ASV were enrolled. Virologic response was measured at 12 weeks and 1 year after treatment completion. In cirrhotic patients, liver function, aspartate transaminase to platelet ratio index (APRI), FIB-4 index, fibrosis index (FI), and liver stiffness measurement (LSM) at baseline and 1 year after treatment completion were evaluated. RESULTS: SVR12 was obtained in 278 patients (96.5%). Six patients who checked NS5A RAS after treatment failure were RAS positive. Only one patient showed no durability of SVR. In cirrhotic patients who achieved SVR12 (n = 59), the changes of albumin (3.8 [2.2–4.7] to 4.3 [2.4–4.9] g/dL; P < 0.001), platelet count (99 [40–329] to 118 [40–399] × 103/mm3; P < 0.001), APRI (1.8 [0.1–14.8] to 0.6 [0.1–4.8]; P < 0.001), FIB-4 index (5.45 [0.6–32.8] to 3.3 [0.4–12.2]; P < 0.001), FI (5.5 [0.6–32.8] to 3.3 [0.4–12.2]; P < 0.001), and LSM (17.2 [5.3–48.0] to 11.2 [3.7–28.1] kPa; P = 0.001) between baseline and 1 year after treatment completion were observed. CONCLUSION: DCV/ASV treatment for HCV GT1b infected patients without RAS achieved high SVR rates and showed durable SVR. Cirrhotic patients who achieved SVR12 showed the improvement of liver function and fibrosis markers.

A Case of Endovascular Treatment of Severe Graft Limb Kinking after Endovascular Abdominal Aortic Aneurysm Repair

Endovascular aneurysm repair (EVAR) has been recommended as an alternative to open aneurysm repair. The risk of severe perioperative complications is lower than that in open surgical repair; however, late complications are more likely. After EVAR, regular yearly surveillance by duplex ultrasonography or computed tomography is recommended. We report the case of a 67-year-old man with a severely kinked left iliac branch of the stent graft 10 years after EVAR. He had not undergone regular follow-up during the last 4 years. We realigned the endograft kink by percutaneous transluminal angioplasty.

Changes in the Outcomes of Very Low Birth Weight Infants in Busan Area

PURPOSE: To evaluate mortality and morbidity of very low birth weight infants(VLBW infants) born in the Busan area from 1996 to 2005. METHODS: A total of eight neonatal intensive care units (4 university hospitals and 4 general hospitals) in Busan participated in this study. A total of 1,414 VLBW infants were divided into three groups: period I, 1996 to 2000; period II, 1999 to 2002; period III, 2003 to 2005, based on date of birth. We performed a retrospective review of medical records of VLBWinfants and compared the survival rate, morbidity and mortality over the three periods. RESULT: The number of VLBW infants admitted to 8 NICUs in 1996-2005 was a total of 1,414 (1.3% incidence, mean gestational age 29.1+/-2.7 wk, mean birth weight 1158+/-235 g), including 361 (24.7%) extremely low birth weight infants (ELVW infants) who were less than 1,000 g at birth weight. Overall survival rate of VLBW infants was 66.1%. The survival rate of VLBW infants increased significantly over the three periods (period I:57.6%, period II:67.8%, period III:75.7%, P<0.01). Overall survival rate of ELBW infants was 33.8%, and increased from 26.4% in period I to 44.2% in period III (P<0.01). The incidence of respiratory distress syndrome was 45.1%; patent ductus arteriosus, 16.4%; bronchopulmonary dysplasia, 13.1%; blood culture positive sepsis, 12.7%; necrotizing enterocolitis, 6.6%; severe intracranial hemorrhage, 6.5%; and severe retinopathy of prematurity, 5.9%. The main causes of death were respiratory distress syndrome and sepsis. CONCLUSION: Overall survival rate of very low birth weight infant in Busan area during the last 10 years was 66.1%, and increased significantly over the three periods.