Reduced risk of relapse after long-term nucleos(t)ide analogue consolidation therapy for chronic hepatitis B.

BACKGROUND: Before stopping nucleos(t)ide analogue (NA) treatment in chronic hepatitis B (CHB), 6-12 months of consolidation therapy is recommended. AIM: To investigate the effect of consolidation therapy on off-treatment outcomes in CHB patients. METHODS: We included 94 patients who stopped NA after at least 1 year of therapy. Patients could be HBeAg-positive or HBeAg-negative at start-of-treatment, but were HBeAg-negative and had undetectable HBV DNA at time of discontinuation. Consolidation therapy was defined as treatment after the first undetectable HBV DNA (and HBeAg loss for HBeAg-positive patients) until NA cessation. RESULTS: At 3 years, 74% of the start-of-treatment HBeAg-positive and 75% of the start-of-treatment HBeAg-negative patients developed HBV DNA >2000 IU/mL at a single time point, whereas a persistent virological relapse (≥2 tests of HBV DNA >2000 IU/mL 6 months apart within 1 year) developed in 49% of the start-of-treatment HBeAg-positive and 53% of the start-of-treatment HBeAg-negative patients. For both HBeAg-positive and HBeAg-negative patients, consolidation therapy of ≥3 years was associated with lower persistent virological relapse rates compared to <1 year (1-year relapse rate: 25% vs. 54%; P = 0.063 and 24% vs. 57%; P = 0.036, respectively). At 3 years, 9% of the HBeAg-positive and 14% of the HBeAg-negative patients became HBsAg-negative. Prolonged consolidation therapy increased the likelihood of HBsAg loss. Two cirrhotic patients developed hepatic decompensation but both recovered. CONCLUSIONS: After nucleos(t)ide analogue discontinuation, relapse was common in patients with chronic hepatitis B. Prolongation of consolidation therapy beyond 3 years decreased the risk of persistent virological relapse and increased the likelihood of HBsAg loss.

Loss of intrahepatic HBsAg expression predicts sustained response to peginterferon and is reflected by pronounced serum HBsAg decline.

There is a lack of knowledge regarding the effect of peginterferon (PEG-IFN) on the expression of intrahepatic hepatitis B core and surface antigen (HBcAg and HBsAg) in chronic hepatitis B (CHB) and its relation with response to therapy. Fifty-two HBeAg-positive and 67 HBeAg-negative CHB patients with paired liver biopsies taken at baseline and after 1 year of PEG-IFN therapy were studied. After PEG-IFN therapy, HBeAg-negative patients showed a significant reduction in both intrahepatic HBcAg (P = 0.04) and HBsAg expression (P < 0.001). In contrast, a reduction in intrahepatic HBcAg expression was not observed in HBeAg-positive patients, while a trend in reduction of intrahepatic HBsAg staining was found (P = 0.09). Post-treatment, 7 (13%) HBeAg-positive and 9 (14%) HBeAg-negative patients had no expression of intrahepatic HBsAg. Patients without any intrahepatic HBsAg expression post-treatment were more likely to achieve a combined response (HBeAg loss with hepatitis B virus (HBV) DNA <2000 IU/mL for HBeAg -positive and HBV DNA <2000 IU/mL and normal alanine aminotransferase for HBeAg-negative CHB): 71% vs 5% for HBeAg-positive (P < 0.001) and 60% vs 16% for HBeAg-negative patients (P = 0.004), respectively. Moreover, a more profound decline of serum HBsAg was observed in patients with absence of intrahepatic HBsAg staining (3.1 vs 0.4 log IU/mL, P < 0.001 and 1.7 vs 0.4 log IU/mL, P = 0.005 for HBeAg-positive and HBeAg-negative CHB, respectively). In conclusion, PEG-IFN reduces expression of intrahepatic HBsAg. Loss of HBsAg as assessed by immunohistochemistry from the liver predicts a sustained response and is reflected in a pronounced serum HBsAg decline.

Radiation protection for the sentinel node procedure in breast cancer.

AIMS: The purpose of our study was to determine the radiation dose for those who are involved in the sentinel node procedure in breast cancer patients and testing of a theoretical model. METHODS: We studied 12 consecutive breast cancer patients undergoing breast surgery, and a sentinel node dissection including an axillary lymph node dissection (ALND). We performed measurements on the surgeon, the assistant, the theatre nurse, the pathologist and his assistant. RESULTS: The measurements on the theatre nurse and both pathologist as his assistant are beneath the detection limit of 10 micro Sv. The highest measured doses are the hands of the surgeon and his assistant (17-61 micro Sv), however the dose limits for hands are higher than for other parts of the body. Taking the dose limits into account the abdominal wall of the surgeon relatively receives the highest dose, with an average of 8.2 micro Sv per procedure. CONCLUSION: Radiation dose levels are less than the established dose limits for (nonexposed) workers if the number of procedures is restricted to about 100/person/year.

[Autochthonous babesiosis in dogs in the Netherlands?]. / Autochtone babesiose bij de hond in Nederland?

For the first time cases of babesiosis have been diagnosed in dogs that had not been abroad. Three cases were seen in the province of Gelderland (Bennekom, Elspeet), two in North-Holland (Koog aan de Zaan). A female Dermacentor reticulatus tick, the main vector of the disease in Europe, was found on one of the dogs at Koog; previously specimens of this tick species had only occasionally been seen on dogs returning from abroad. Serological evidence was obtained that in at least four of the cases European Babesia canis, transmitted by Dermacentor ticks, was involved.

DDAVP-induced changes of factor VIII-related activities and bleeding time in patients with von Willebrand's syndrome.

5 patients suffering from von Willebrand's syndrome were treated with DDAVP administered intravenously or intransally. The concentration of F. VIII-related activities (F. VIII:C, F. VIII R:AG, F. VIII R:WF), as well as the mobility of F. VIII R:AG in crossed immunoelectrophoresis and the alterations of bleeding time were continuously monitored. DDAVP induced both quantitative and qualitative changes of F. VIII-related properties. The bledding time was markedly reduced for some hours. The therapy was well tolerated and should be submitted to further clinical trials as a possible way to avoid the disadvantages connected with the transfusion of blood components.