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Tips for Responding to Reviewer Comments
( Grace Lai-hung Wong ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Writing research papers is an indispensable part of the academic life of a researcher. All peer-reviewed journals send out the papers to several, typically 2 to 6, reviewers for their critical comments. The editors will then make a decision of accepting it, rejecting it, and most often allowing revision (minor or major) based on the reviewers’ comments. Getting a chance to revise a research paper is wonderful, just that there is often not guarantee that the journal must accept the paper after revision. Again, this final decision depends heavily on whether the reviewers are satisfied by the authors’ responses to their comments. In this talk some practical tips about the review process, how to digest the reviews, revise the paper and finally communicate the revisions to the reviewers and editors will be discussed.
Unmet Needs in Chronic Hepatitis B Management
( Grace Lai-hung Wong ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Unmet needed in chronic hepatitis B (CHB) management are present in various aspects related to education, vaccination and prevention, diagnosis and treatment. Screening and diagnosis of CHB, appropriate evaluation of patients with CHB, initiation of antiviral therapy, and retention of patients on treatment, all which need to be addressed at the levels of healthcare systems. Oral nucleos(t)ide analogues (NAs) have revolutionalised the chronic hepatitis B treatment by good on-treatment viral suppression, a daily oral dosing, few side effects and improved patient outcome.1,2 Long-term, if not life-long, NA treatment is still a necessity. Furthermore, functional cure as evidenced by hepatitis B surface antigen (HBsAg) seroclearance is uncommon in NA-treated patients, especially in Asian patients who acquire HBV infection through perinatal transmission.3 New treatment of finite duration and high rate of HBsAg seroclearance is very much wanted and currently under clinical evaluation at different phases of clinical trials.4 Biomarkers to predict treatment responses and clinical outcomes are also needed. Apart from the conventional serum HBV DNA and HBsAg levels, serum HBV RNA, HB core-related antigen (HBcrAg) have evolving roles in these aspects.
Review : Prediction of fibrosis progression in chronic viral hepatitis
( Grace Lai Hung Wong ) 대한간학회 2014 Clinical and Molecular Hepatology(대한간학회지) Vol.20 No.3
Prediction of liver fibrosis progression has a key role in the management of chronic viral hepatitis, as it will be translated into the future risk of cirrhosis and its various complications including hepatocellular carcinoma. Both hepatitis B and C viruses mainly lead to fibrogenesis induced by chronic inflammation and a continuous wound healing response. At the same time direct and indirect profibrogenic responses are also elicited by the viral infection. There are a handful of well-established risk factors for fibrosis progression including older age, male gender, alcohol use, high viral load and co-infection with other viruses. Metabolic syndrome is an evolving risk factor of fibrosis progression. The new notion of regression of advanced fibrosis or even cirrhosis is now strongly supported various clinical studies. Even liver biopsy retains its important role in the assessment of fibrosis progression, various non-invasive assessments have been adopted widely because of their non-invasiveness, which facilitates serial applications in large cohorts of subjects. Transient elastography is one of the most validated tools which has both diagnostic and prognostic role. As there is no single perfect test for liver fibrosis assessment, algorithms combining themost validated noninvasive methods should be considered as initial screening tools. (Clin Mol Hepatol 2014;20:228-236)
Review : Personalized management of cirrhosis by non-invasive tests of liver fibrosis
( Grace Lai-hung Wong ),( Wendell Zaragoza Espinosa ),( Vincent Wai-sun Wong ) 대한간학회 2015 Clinical and Molecular Hepatology(대한간학회지) Vol.21 No.3
Owing to the high prevalence of various chronic liver diseases, cirrhosis is one of the leading causes of morbidity and mortality worldwide. In recent years, the development of non-invasive tests of fibrosis allows accurate diagnosis of cirrhosis and reduces the need for liver biopsy. In this review, we discuss the application of these non-invasive tests beyond the diagnosis of cirrhosis. In particular, their role in the selection of patients for hepatocellular carcinoma surveillance and varices screening is highlighted. (Clin Mol Hepatol 2015;21:200-211)
Management of chronic hepatitis B patients in immunetolerant phase: what latest guidelines recommend
Grace Lai-Hung Wong 대한간학회 2018 Clinical and Molecular Hepatology(대한간학회지) Vol.24 No.2
The natural history of chronic hepatitis B (CHB) is complex and may run through different immune phases that may overlap. In particulars, the immune-tolerant phase is the most interesting and not as well understood as we thought. The concept of true immune tolerance have been under challenged from immunology points of view. The major international guidelines have not yet reached a consensus on the definition of the immune-tolerant phase. While positive hepatitis B e antigen (HBeAg), high serum hepatitis B virus (HBV) DNA and normal serum alanine aminotransferase (ALT) levels are the three key features of this phase, some guidelines also put age into consideration. A new nomenclature, Phase 1 or HBeAg-positive chronic HBV infection, is given by the latest European Association for the Study of the Liver (EASL) published in April 2017. While current guidelines advise against starting antiviral treatment for immune-tolerant CHB patients, some new data suggest treating such patients may reduce the risk of liver fibrosis progression and hepatocellular carcinoma.
Huapeng Lin,Grace Lai-Hung Wong,Xinrong Zhang,Terry Cheuk-Fung Yip,Ken Liu,Yee Kit Tse,Vicki Wing-Ki Hui,Jimmy Che-To Lai,Henry Lik-Yuen Chan,Vincent Wai-Sun Wong 대한간학회 2022 Clinical and Molecular Hepatology(대한간학회지) Vol.28 No.1
Background/Aims: We aimed to determine the association between blood urea level and incident cirrhosis, hepatic decompensation, and hepatocellular carcinoma in chronic liver disease (CLD) patients. Methods: The association between blood urea level and liver fibrosis/liver-related events were evaluated on continuous scale with restricted cubic spline curves based on generalized additive model or Cox proportional hazards models. Then, the above associations were evaluated by urea level within intervals. Results: Among 4,282 patients who had undergone liver stiffness measurement (LSM) by transient elastography, baseline urea level had a U-shaped association with LSM and hepatic decompensation development after a median follow-up of 5.5 years. Compared to patients with urea of 3.6–9.9 mmol/L, those with urea ≤3.5 mmol/L (adjusted hazard ratio [aHR], 4.15; 95% confidence interval [CI], 1.68–10.24) and ≥10 mmol/L (aHR, 5.22; 95% CI, 1.86–14.67) had higher risk of hepatic decompensation. Patients with urea ≤3.5 mmol/L also had higher risk of incident cirrhosis (aHR, 3.24; 95% CI, 1.50–6.98). The association between low urea level and incident cirrhosis and hepatic decompensation was consistently observed in subgroups by age, gender, albumin level, and comorbidities. The U-shaped relationship between urea level and LSM was validated in another population screening study (n=917). Likewise, urea ≤3.5 mmol/L was associated with a higher risk of incident cirrhosis in a territory-wide cohort of 12,476 patients with nonalcoholic fatty liver disease at a median follow-up of 9.9 years (aHR, 1.27; 95% CI, 1.03–1.57). Conclusions: We identified a U-shaped relationship between the urea level and liver fibrosis/incident cirrhosis/hepatic decompensation in patients with CLD.