Journal of clinical oncology : official journal of the American Society of Clinical Oncology, Jan 2, 2018
Purpose Selective internal radiation therapy or radioembolization (RE) shows efficacy in unresect... more Purpose Selective internal radiation therapy or radioembolization (RE) shows efficacy in unresectable hepatocellular carcinoma (HCC) limited to the liver. This study compared the safety and efficacy of RE and sorafenib in patients with locally advanced HCC. Patients and Methods SIRveNIB (selective internal radiation therapy v sorafenib), an open-label, investigator-initiated, phase III trial, compared yttrium-90 (Y) resin microspheres RE with sorafenib 800 mg/d in patients with locally advanced HCC in a two-tailed study designed for superiority/detriment. Patients were randomly assigned 1:1 and stratified by center and presence of portal vein thrombosis. Primary end point was overall survival (OS). Efficacy analyses were performed in the intention-to-treat population and safety analyses in the treated population. Results A total of 360 patients were randomly assigned (RE, 182; sorafenib, 178) from 11 countries in the Asia-Pacific region. In the RE and sorafenib groups, 28.6% and 9.0...
To determine the prevalence of hepatitis B surface antigen (HBsAg) seropositivity among adult Fil... more To determine the prevalence of hepatitis B surface antigen (HBsAg) seropositivity among adult Filipinos. Testing for HBsAg was performed on serum samples from persons aged ≥ 20 years old who participated in the National Nutrition and Health Survey (NNHeS) conducted in 2003. Information on age, sex, marital status, educational attainment, employment status, and income were collected. For this study, marital status was classified as never married or otherwise (i.e., married, divorced, separated, widowed); educational attainment was classified as high school graduate or below or at least some tertiary education; and employment status was classified as currently employed or currently unemployed. Annual income was divided into 4 quartiles in Philippine pesos (PhP): Q1, ≤ PhP 53064; Q2, PhP 53065-92192; Q3, PhP 92193-173387; and Q4, ≥ PhP 173388. Prevalence estimates were weighted so that they represented the general population. Social and demographic factors were correlated with HBsAg se...
Non-alcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease. Most patien... more Non-alcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease. Most patients with cryptogenic cirrhosis are considered to have had "burned out NAFLD." Although the recurrence and progression of NAFLD after liver transplantation (LT) have been shown previously, the incidence of de novo NAFLD after LT has not been extensively reported. In this issue of the American Journal of Gastroenterology, Dumortier et al. report the incidence of de novo post-LT NAFLD. Although most of the risk factors for post-LT NAFLD are similar to those for primary NAFLD, hepatic steatosis in the donor livers and a pre-transplant diagnosis of alcoholic liver disease remain independent risk factors. Although there are some limitations, this study provides the largest cohort of patients for whom post-LT NAFLD is reported.
Severe recurrent cholestatic hepatitis C after liver transplantation has a poor prognosis and no ... more Severe recurrent cholestatic hepatitis C after liver transplantation has a poor prognosis and no standard therapy is currently available. Four cases of severe recurrent cholestatic hepatitis C treated with a combination of interferon alpha 2b and ribavirin are described. All four patients were transplanted for hepatitis C-related cirrhosis. The mean age at transplantation was 45 years (range 41-51 years). Three of the patients were male and one was female. All four patients had hepatitis C virus viremia before and after liver transplantation. At 2 to 23 months after liver transplantation, all four patients developed jaundice, cholestatic elevation of liver enzymes, and histopathology consistent with severe recurrent cholestatic hepatitis C. Combination of interferon and ribavirin was given with prompt virological suppression. Despite this rapid viral suppression, all four patients developed progressive graft failure with three deaths.
Introduction: In our local setting, medical management of hepatic encephalopathy predominates due... more Introduction: In our local setting, medical management of hepatic encephalopathy predominates due to various medical or social problems e.g. low economic profile, comorbidities associated with advancing age, etc. In view of the widespread importance of zinc and its role in the pathophysiologic mechanism of hepatic encephalopathy, this study aims to investigate the effect of oral zinc supplementation in improving the course of hepatic encephalopathy in chronic liver disease. Methods: All published randomized controlled trials regarding the use of zinc in hepatic encephalopathy were included in this study. Participants were adult patients (>18 y/o) identified with hepatic encephalopathy from chronic liver disease. Primary outcome was an improvement of mental status and secondary outcome was an increase in blood urea nitrogen and/or a decrease in serum ammonia levels. A systematic search of local and international electronic databases was done: (PubMed (January 1950-June 2012), Coch...
Background: Use of DA and FL for anemia and neutropenia of combination therapy for CHC may improv... more Background: Use of DA and FL for anemia and neutropenia of combination therapy for CHC may improve patients’ quality of life (HRQL) and adherence. Methods: Open label study of CHC patients treated with Pegylated Interferon α-2b (1.5 mcg/kg/wk) and Ribavirin (800-1400 mg/d). Patients who developed severe anemia [hemoglobin (Hgb) ≤ 10.5 g/dL] received DA [3 mcg/kg once every-two-wks] titrated to Hgb of 12 g/dL. Patients with significant neutropenia [absolute neutrophil count (ANC) ≤ 0.75 x109/L] received FL, dose titrated from 150 mcg SQ once a week to 300 mcg SQ thrice weekly, to keep ANC ≥ 0.75 X 109/L and < 10 x109/L. Clinical and HRQL data [Short-Form 36 (SF-36) and Chronic Liver Disease Questionnaire (CLDQ)] were assessed. Results: 60 patients were enrolled [Age 47.6± 8.9; 60% male; 60% Caucasians; 100% treatment-naïve, 55% HCV Genotype 1; HCV RNA 3.68 ± 5.54 million IU/ml, Hgb 14.7± 1.3 g/dL; ANC 3.77± 1.59 x 109/L]. By treatment week 12, 61.7% of patients experienced mild (H...
Case: A 33 year-old female with UC presented with severe abdominal pain, bloating, bloody diarrhe... more Case: A 33 year-old female with UC presented with severe abdominal pain, bloating, bloody diarrhea, and abnormal liver enzymes. A CT scan of the abdomen showed hepatomegaly, ascites, small bowel edema, and thrombosis of the hepatic, portal, superior mesenteric, ...
Accumulating evidence supports an association between nonalcoholic fatty liver disease (NAFLD) an... more Accumulating evidence supports an association between nonalcoholic fatty liver disease (NAFLD) and metabolic syndrome, diabetes, and obesity. The epidemiology, pathogenesis, and approach to treatment of NAFLD follow the same trends as these other metabolic disorders, and insulin resistance is the key event linking NAFLD to these diseases. The impairment in fat and glucose metabolism that ensues once insulin resistance occurs leads to similar biochemical and clinical abnormalities in patients with NAFLD. Many recent studies investigating the cellular and genetic basis of these diseases have led to a better understanding of their pathogenesis and insight into treatment and management. The most effective treatment thus far is weight loss and the use of insulin-modulating pharmacologic agents. A few additional treatment strategies include the use of lipid-lowering, antioxidants or cytoprotective agents, but there is no single therapeutic approach that is effective for managing NAFLD. Fu...
Nonalcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease in the United... more Nonalcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease in the United States. It describes several clinicopathologic entities from simple hepatic steatosis to nonalcoholic steatohepatitis, cirrhosis, and hepatocellular carcinoma. This article describes the epidemiology, clinical features, natural history, and pathogenesis of NAFLD.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, Jan 2, 2018
Purpose Selective internal radiation therapy or radioembolization (RE) shows efficacy in unresect... more Purpose Selective internal radiation therapy or radioembolization (RE) shows efficacy in unresectable hepatocellular carcinoma (HCC) limited to the liver. This study compared the safety and efficacy of RE and sorafenib in patients with locally advanced HCC. Patients and Methods SIRveNIB (selective internal radiation therapy v sorafenib), an open-label, investigator-initiated, phase III trial, compared yttrium-90 (Y) resin microspheres RE with sorafenib 800 mg/d in patients with locally advanced HCC in a two-tailed study designed for superiority/detriment. Patients were randomly assigned 1:1 and stratified by center and presence of portal vein thrombosis. Primary end point was overall survival (OS). Efficacy analyses were performed in the intention-to-treat population and safety analyses in the treated population. Results A total of 360 patients were randomly assigned (RE, 182; sorafenib, 178) from 11 countries in the Asia-Pacific region. In the RE and sorafenib groups, 28.6% and 9.0...
To determine the prevalence of hepatitis B surface antigen (HBsAg) seropositivity among adult Fil... more To determine the prevalence of hepatitis B surface antigen (HBsAg) seropositivity among adult Filipinos. Testing for HBsAg was performed on serum samples from persons aged ≥ 20 years old who participated in the National Nutrition and Health Survey (NNHeS) conducted in 2003. Information on age, sex, marital status, educational attainment, employment status, and income were collected. For this study, marital status was classified as never married or otherwise (i.e., married, divorced, separated, widowed); educational attainment was classified as high school graduate or below or at least some tertiary education; and employment status was classified as currently employed or currently unemployed. Annual income was divided into 4 quartiles in Philippine pesos (PhP): Q1, ≤ PhP 53064; Q2, PhP 53065-92192; Q3, PhP 92193-173387; and Q4, ≥ PhP 173388. Prevalence estimates were weighted so that they represented the general population. Social and demographic factors were correlated with HBsAg se...
Non-alcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease. Most patien... more Non-alcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease. Most patients with cryptogenic cirrhosis are considered to have had &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;burned out NAFLD.&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; Although the recurrence and progression of NAFLD after liver transplantation (LT) have been shown previously, the incidence of de novo NAFLD after LT has not been extensively reported. In this issue of the American Journal of Gastroenterology, Dumortier et al. report the incidence of de novo post-LT NAFLD. Although most of the risk factors for post-LT NAFLD are similar to those for primary NAFLD, hepatic steatosis in the donor livers and a pre-transplant diagnosis of alcoholic liver disease remain independent risk factors. Although there are some limitations, this study provides the largest cohort of patients for whom post-LT NAFLD is reported.
Severe recurrent cholestatic hepatitis C after liver transplantation has a poor prognosis and no ... more Severe recurrent cholestatic hepatitis C after liver transplantation has a poor prognosis and no standard therapy is currently available. Four cases of severe recurrent cholestatic hepatitis C treated with a combination of interferon alpha 2b and ribavirin are described. All four patients were transplanted for hepatitis C-related cirrhosis. The mean age at transplantation was 45 years (range 41-51 years). Three of the patients were male and one was female. All four patients had hepatitis C virus viremia before and after liver transplantation. At 2 to 23 months after liver transplantation, all four patients developed jaundice, cholestatic elevation of liver enzymes, and histopathology consistent with severe recurrent cholestatic hepatitis C. Combination of interferon and ribavirin was given with prompt virological suppression. Despite this rapid viral suppression, all four patients developed progressive graft failure with three deaths.
Introduction: In our local setting, medical management of hepatic encephalopathy predominates due... more Introduction: In our local setting, medical management of hepatic encephalopathy predominates due to various medical or social problems e.g. low economic profile, comorbidities associated with advancing age, etc. In view of the widespread importance of zinc and its role in the pathophysiologic mechanism of hepatic encephalopathy, this study aims to investigate the effect of oral zinc supplementation in improving the course of hepatic encephalopathy in chronic liver disease. Methods: All published randomized controlled trials regarding the use of zinc in hepatic encephalopathy were included in this study. Participants were adult patients (>18 y/o) identified with hepatic encephalopathy from chronic liver disease. Primary outcome was an improvement of mental status and secondary outcome was an increase in blood urea nitrogen and/or a decrease in serum ammonia levels. A systematic search of local and international electronic databases was done: (PubMed (January 1950-June 2012), Coch...
Background: Use of DA and FL for anemia and neutropenia of combination therapy for CHC may improv... more Background: Use of DA and FL for anemia and neutropenia of combination therapy for CHC may improve patients’ quality of life (HRQL) and adherence. Methods: Open label study of CHC patients treated with Pegylated Interferon α-2b (1.5 mcg/kg/wk) and Ribavirin (800-1400 mg/d). Patients who developed severe anemia [hemoglobin (Hgb) ≤ 10.5 g/dL] received DA [3 mcg/kg once every-two-wks] titrated to Hgb of 12 g/dL. Patients with significant neutropenia [absolute neutrophil count (ANC) ≤ 0.75 x109/L] received FL, dose titrated from 150 mcg SQ once a week to 300 mcg SQ thrice weekly, to keep ANC ≥ 0.75 X 109/L and < 10 x109/L. Clinical and HRQL data [Short-Form 36 (SF-36) and Chronic Liver Disease Questionnaire (CLDQ)] were assessed. Results: 60 patients were enrolled [Age 47.6± 8.9; 60% male; 60% Caucasians; 100% treatment-naïve, 55% HCV Genotype 1; HCV RNA 3.68 ± 5.54 million IU/ml, Hgb 14.7± 1.3 g/dL; ANC 3.77± 1.59 x 109/L]. By treatment week 12, 61.7% of patients experienced mild (H...
Case: A 33 year-old female with UC presented with severe abdominal pain, bloating, bloody diarrhe... more Case: A 33 year-old female with UC presented with severe abdominal pain, bloating, bloody diarrhea, and abnormal liver enzymes. A CT scan of the abdomen showed hepatomegaly, ascites, small bowel edema, and thrombosis of the hepatic, portal, superior mesenteric, ...
Accumulating evidence supports an association between nonalcoholic fatty liver disease (NAFLD) an... more Accumulating evidence supports an association between nonalcoholic fatty liver disease (NAFLD) and metabolic syndrome, diabetes, and obesity. The epidemiology, pathogenesis, and approach to treatment of NAFLD follow the same trends as these other metabolic disorders, and insulin resistance is the key event linking NAFLD to these diseases. The impairment in fat and glucose metabolism that ensues once insulin resistance occurs leads to similar biochemical and clinical abnormalities in patients with NAFLD. Many recent studies investigating the cellular and genetic basis of these diseases have led to a better understanding of their pathogenesis and insight into treatment and management. The most effective treatment thus far is weight loss and the use of insulin-modulating pharmacologic agents. A few additional treatment strategies include the use of lipid-lowering, antioxidants or cytoprotective agents, but there is no single therapeutic approach that is effective for managing NAFLD. Fu...
Nonalcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease in the United... more Nonalcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease in the United States. It describes several clinicopathologic entities from simple hepatic steatosis to nonalcoholic steatohepatitis, cirrhosis, and hepatocellular carcinoma. This article describes the epidemiology, clinical features, natural history, and pathogenesis of NAFLD.
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Papers by Janus Ong‡