Frequency and clinical outcomes of flares related to nucleos(t)ide analogue therapy in patients with chronic hepatitis B.

Flares in chronic hepatitis B are often detrimental but sometimes lead to sustained immune control and disease remission. The aim of this study was to estimate the frequency of hepatitis flares which occur during and/or after cessation of nucleos(t)ide analogue (NA) therapy, and to assess their outcomes. In a single centre cohort study we investigated 227 patients who received a total of 351 NA treatment courses. NA therapy was discontinued after 149 treatment courses. In total, 27 flares were observed during 9779 on-treatment patient-months. The frequency was estimated as 3.2 per 100 person-years (95% CI 2.2-4.7). Lamivudine (LAM)-treated patients demonstrated the highest frequency (4.9/100 person-years, 95% CI 3.2-7.4). Twenty (74%) of 27 on-therapy flares were associated with development of genotypic resistance, which all occurred during LAM therapy. NA withdrawal flares occurred after a median post-treatment follow-up of 3.5 months in 17 (11%) of 149 treatment discontinuations. No flares were observed in patients who switched to another antiviral agent (n = 51). None of the on-therapy and withdrawal flares related to NA therapy were associated with sustained disease remission, and seven flares resulted in decompensated liver disease. In this study, flares related to NA therapy never led to immune control and sustained disease remission, and sometimes resulted in decompensated liver disease.

Digital replantation in children: a long-term follow-up study.

Twenty-six children aged from 14 months to 12 years had a total of 44 amputated digits replanted in our hospital between May 1979 and May 1985. The length of follow-up was from 9 to 15 years (average, 11 years). Among the 43 surviving digits, the mean total active motion of the thumb and fingers was 130 degrees and 151 degrees, respectively. Sensibility recovery was excellent, with normal 2-point discrimination in 88%. A mean of 19 of 20 preselected activities of daily living could be accomplished. Relative grip strength was 79% that of the normal side and the relative pinch strength was 88%. Cold intolerance was slight or moderate in 40% of patients, and slight atrophy was present in 12 digits. Angulatory deformity or malalignment were remodeled. The circulatory status of the replanted fingers was excellent in 88% of digits and good in 12%. Bone growth had a mean relative length of 93% of normal in digits without joint involvement and 88% in those with joint involvement. Assessed with Nakamura Tamai criteria, the results were excellent in 25 cases (96%) and good in 1. All patients and their parents were satisfied with the results of the digital replantation.

Reliability and validity of the Chinese versions of the Scales for Assessment of Positive and Negative Symptoms.

This 4-center study assesses the reliability and validity of the Chinese versions of the Scale for Assessment of Positive Symptoms and the Scale for Assessment of Negative Symptoms. Interrater reliability, short-term test-retest reliability, and internal consistency were excellent; intraclass correlation coefficients and Cronbach alphas for the overall scores were all over 0.8. The strong correlation of the scales with an independently assessed parallel measure (the Chinese version of the Brief Psychiatric Rating Scale) and the separate positive and negative factors found with principal components analysis confirm the construct validity of the instruments. These findings demonstrate the importance of culturally sensitive revision and rigorous psychometric evaluation of Western instruments prior to their use in non-Western cultures.