Should transanal total mesorectal excision be implemented in medium-sized colorectal unit? technical and oncological outcome

Man-fung Ho,Dennis Chung-Kei Ng,Janet Fung-yee Lee,Simon Siu-man Ng 대한대장항문학회 2022 Annals of Coloproctolgy Vol.38 No.3

Purpose: This study was performed to evaluate the outcome of implementation of transanal total mesorectal excision (TaTME) for low rectal cancer in a regional hospital and in comparison to laparoscopic (Lap) TME. Methods: Consecutive patients with low rectal cancer of which the lowest border of the tumour was located beween 1 and 5 cm from the puborectalis who underwent TME at North District Hospital between January 2013 and December 2019 were included. Clinical, operative, and pathologic outcomes were compared between Lap TME and TaTME. The primary end point was complication profile. Results: Thirty-five patients underwent Lap TME and 45 patients underwent TaTME for low rectal cancer. The conversion rate of the TaTME group was significantly lower than that of the Lap TME group (4.4% vs. 20%, P=0.029), but the operating time was longer (259 minutes vs. 219 minutes, P=0.009). The tumour location was significantly lower in the TaTME group, but the distal resection margins were adequate and not different between both groups. The TaTME group had higher incidence rates of prolonged ileus and urinary tract infection, but the other complications were similar between the two groups. The resection margin positivity rates of the TaTME and Lap TME groups were 2.2% and 5.7%, respectively (P=0.670). At a median follow up of 39 months, no abnormal early recurrence was detected. Conclusion: It is technically feasible and oncologically safe to perform TaTME in a medium-volume colorectal unit. Patients with difficult pelvic anatomy can benefit by reducing the risk of conversion and margin positivity rate.

New Drugs; Pharmacological Advantage and Clinical Impact : A Phase I/IIa, Double-blind, Randomized, Placebo-controlled Trial of a Novel Antiviral Agent, LB80380 in Patients with Chronic Hepatitis B Infection

( Man Fung Yuen ),( John Kim ),( Danny Ka Ho Wang ),( Vincent Wing Shun Ngai ),( John Chi Hang Yuen ),( Ching Lung Lai ) 대한간학회 2004 Clinical and Molecular Hepatology(대한간학회지) Vol.10 No.1(S)

Acute effect of dynamic stretching and retained cupping on hamstring flexibility and contractile properties and sprinting performance

( Kwo Fung Calvin Lam ),( Indy Man Kit Ho ),( Jim Tse Chung Luk ) 대한운동사협회 2017 대한운동사협회 운동사대회자료집 Vol.2017 No.-

Antiviral activity and safety of LB80380 in hepatitis B e antigen–positive chronic hepatitis B patients with lamivudine-resistant disease

Yuen, Man-Fung,Han, Kwang-Hyub,Um, Soon-Ho,Yoon, Seung Kew,Kim, Hye-Ryon,Kim, John,Kim, Chung Ryeol,Lai, Ching-Lung Wiley Subscription Services, Inc., A Wiley Company 2010 Hepatology Vol.51 No.3

<P>We aimed to determine the antiviral activity and safety of a new nucleotide analogue, LB80380, in chronic hepatitis B (CHB) patients with lamivudine-resistant virus. Sixty-five patients with lamivudine-resistant virus were randomized to receive five ascending daily doses (30, 60, 90, 150, 240 mg) of LB80380. LB80380 was given together with lamivudine for the first 4 weeks, followed by 8 weeks of LB80380 monotherapy. This was then followed by 24 weeks of adefovir. Hepatitis B virus (HBV) DNA levels, serology, liver biochemistry, and safety were monitored. The extent of the HBV DNA reduction at week 12 was dose-dependent. The mean reduction from baseline was 2.81, 3.21, 3.92, 4.16, and 4.00 log<SUB>10</SUB> copies/mL for the five ascending dose groups. The dose-proportionate effect was statistically significant (P < 0.001) with a decrease of HBV DNA levels by an average of 1.54 log<SUB>10</SUB> copies/mL for every 1-unit increase in log<SUB>10</SUB> dose of LB80380. In 93.4% of patients, HBV DNA decreased by >2 log<SUB>10</SUB> copies/mL, and 11.5% of patients had undetectable HBV DNA levels (<300 copies/mL) by week 12. HBV DNA suppression was maintained during the 24 weeks of adefovir treatment. Hepatitis B e antigen seroconversion and normalization of alanine aminotransferase were seen in 14.6% and 24.6% of patients, respectively, at week 12; 44.6% of patients experienced mild and self-limiting adverse events, none of which were attributed to the study drug. Conclusion: LB80380 at doses of up to 240 mg is safe, well tolerated, and effective at reducing viral load in CHB patients with lamivudine-resistant virus for a period of 12 weeks. (HEPATOLOGY 2010.)</P>

Development of a Non-Invasive Liver Fibrosis Score Based on Transient Elastography for Risk Stratification in Patients with Type 2 Diabetes

Chi-Ho Lee,Wai-Kay Seto,Kelly Ieong,David T.W. Lui,Carol H.Y. Fong,Helen Y. Wan,Wing-Sun Chow,Yu-Cho Woo,Man-Fung Yuen,Karen SL Lam 대한내분비학회 2021 Endocrinology and metabolism Vol.36 No.1

Background: In non-alcoholic fatty liver disease (NAFLD), transient elastography (TE) is an accurate non-invasive method to identify patients at risk of advanced fibrosis (AF). We developed a diabetes-specific, non-invasive liver fibrosis score based on TE to facilitate AF risk stratification, especially for use in diabetes clinics where TE is not readily available. Methods: Seven hundred sixty-six adults with type 2 diabetes and NAFLD were recruited and randomly divided into a training set (n=534) for the development of diabetes fibrosis score (DFS), and a testing set (n=232) for internal validation. DFS identified patients with AF on TE, defined as liver stiffness (LS) ≥9.6 kPa, based on a clinical model comprising significant determinants of LS with the lowest Akaike information criteria. The performance of DFS was compared with conventional liver fibrosis scores (NFS, FIB-4, and APRI), using area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, positive and negative predictive values (NPV). Results: DFS comprised body mass index, platelet, aspartate aminotransferase, high-density lipoprotein cholesterol, and albuminuria, five routine measurements in standard diabetes care. Derived low and high DFS cut-offs were 0.1 and 0.3, with 90% sensitivity and 90% specificity, respectively. Both cut-offs provided better NPVs of >90% than conventional fibrosis scores. The AUROC of DFS for AF on TE was also higher (P<0.01) than the conventional fibrosis scores, being 0.85 and 0.81 in the training and testing sets, respectively. Conclusion: Compared to conventional fibrosis scores, DFS, with a high NPV, more accurately identified diabetes patients at-risk of AF, who need further evaluation by hepatologists.

Phase IIb multicentred randomised trial of besifovir (LB80380) versus entecavir in Asian patients with chronic hepatitis B

Lai, Ching-Lung,Ahn, Sang Hoon,Lee, Kwan Sik,Um, Soon Ho,Cho, Mong,Yoon, Seung Kew,Lee, Jin-Woo,Park, Neung Hwa,Kweon, Young-Oh,Sohn, Joo Hyun,Lee, Jiyoon,Kim, Jeong-Ae,Han, Kwang-Hyub,Yuen, Man-Fung BMJ Publishing Group Ltd 2014 Gut Vol.63 No.6

<P><B>Background</B></P><P>Besifovir (LB80380) is an acyclic nucleotide phosphonate effective in hepatitis B virus (HBV) DNA suppression for both treatment-naive and lamivudine-resistant chronic hepatitis B (CHB) patients in preliminary studies.</P><P><B>Design</B></P><P>We aimed to compare the safety and antiviral activity of two doses of besifovir (90 mg and 150 mg daily) with entecavir 0.5 mg daily in CHB patients. 114 patients were randomised to receive besifovir 90 mg daily (n=36), besifovir 150 mg daily (n=39) or entecavir 0.5 mg daily (n=39). HBV DNA and liver biochemistry, including serum L-carnitine levels, were monitored.</P><P><B>Results</B></P><P>At week 48, in the intention-to-treat population, the proportion of patients achieving undetectable HBV DNA (<20 IU/mL) were 63.6%, 62.9% and 58.3%, respectively (p>0.05). The serum mean log<SUB>10</SUB> HBV DNA changes from baseline for the HBeAg-positive patients were −5.84, −5.91 and −6.18, respectively; and for the HBeAg-negative patients were −4.65, −4.55 and −4.67, respectively (p>0.05). There were no differences in the proportions of patients achieving normalisation of alanine aminotransferase (91.7%, 76.9%, 89.7%, respectively) and HBeAg seroconversion (11.11%, 15%, 9.52%, respectively) among all three groups. None of the patients had resistant mutations or increase in serum creatinine of >0.5 mg/dL from baseline. 64 (94.1%) patients on besifovir had lowering of serum L-carnitine (not tested in entecavir patients). L-carnitine levels returned to normal with carnitine supplement.</P><P><B>Conclusions</B></P><P>At 48 weeks, 90 mg and 150 mg daily of besifovir were non-inferior to entecavir 0.5 mg daily in treatment-naive CHB patients. The only significant side effect of besifovir was L-carnitine depletion, requiring carnitine supplementation.</P>

Entecavir Reduced Serum Hepatitis B Core-Related Antigen in Chronic Hepatitis B Patients with Hepatocellular Carcinoma

Lung-Yi Mak,Kwan-Lung Ko,Wai-Pan To,Danny Ka-Ho Wong,Wai-Kay Seto,James Fung,Man-Fung Yuen 거트앤리버 소화기연관학회협의회 2020 Gut and Liver Vol.14 No.5

Serum hepatitis B core-related antigen (HBcrAg) was shown to predict the risk of hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients undergoing treatment. We investigated the longitudinal profile of HBcrAg in entecavir (ETV)-treated CHB patients with subsequent HCC development. We identified HCC cases diagnosed at ≥1 year after ETV initiation. CHB patients without HCC (matched for age, sex, cirrhosis status, baseline hepatitis B virus [HBV] DNA level, and ETV treatment duration) were identified as controls at an HCC:non-HCC ratio of 1:2. Serum samples were retrieved at baseline (ETV initiation) and at 3 and 5 years of ETV therapy for HBcrAg measurement (log IU/mL). In total, 180 patients (60 HCC patients matched with 120 CHB patients without HCC; median age, 56.5 years; 80.6% male; baseline HBV DNA, 5.9 log IU/mL; median follow-up, 6.8 years) were recruited. The median time from ETV initiation to HCC development was 3.2 years. HBcrAg levels were higher in HCC cases than in controls at all three time points: 5.69 log IU/ mL versus 5.02 log IU/mL (p=0.025), 4.23 log IU/mL versus 3.36 log IU/mL (p=0.007), and 3.86 log IU/mL versus 3.36 log IU/mL (p=0.009), respectively. ETV led to similar rates of decline in HBcrAg from baseline to 3 years in both groups (0.34 log IU/mL/year vs 0.39 log IU/mL/year, p=0.774), although the decline from 3 to 5 years was slower in the non- HCC group (0.05 log IU/mL/year) than in the HCC group (0.09 log IU/mL/year, p=0.055). ETV time-dependently reduced HBcrAg in HCC and non-HCC patients. HBcrAg interpretation should consider the antiviral treatment duration.

Clinical practice guidelines and real-life practice in hepatocellular carcinoma: A Hong Kong perspective

Rex Wan-Hin Hui,Lung-Yi Mak,Tan-To Cheung,Victor Ho-Fun Lee,Wai-Kay Seto,Man-Fung Yuen 대한간학회 2023 Clinical and Molecular Hepatology(대한간학회지) Vol.29 No.2

Hepatocellular carcinoma (HCC) is a major public health burden in Hong Kong, and chronic hepatitis B is the most common HCC etiology in our region. With the high case load, extensive local expertise on HCC has been accumulated. This article summarized local guidelines and real-life practice on HCC management in Hong Kong. For HCC surveillance, liver ultrasound and serum alpha-fetoprotein for periodic screening is recommended in viral hepatitis or cirrhotic patients, and this is adhered to in clinical practice. HCC diagnosis is not covered in local guidelines, yet our practice is in-line with regional guidelines, where diagnosis is usually achieved by cross-sectional imaging and without the need for histology. Our guidelines recommend using the Hong Kong Liver Cancer Staging for pre-treatment staging, yet we routinely use other widely-adopted systems such as the Barcelona Clinic Liver Cancer Staging and the Tumor-Node-Metastasis Staging as well. Our local guidelines have provided clear treatment algorithms for the whole range of HCC therapies, including resection, ablation, transplant, transarterial chemoembolization, transarterial radioembolization, stereotactic body radiation therapy, targeted therapy, and immunotherapy. Real-life treatment choices are largely in line with the guidelines, although treatment protocols are individualized, and availability of specific therapies can vary between centers. Overall, HCC guidelines in Hong Kong are tailored based on local expertise and our unique patient population. The guidelines are up-to-date and provide practical pathways to assist our routine practice. Regular updates of local guidelines are warranted to account for the rapidly evolving paradigm of HCC management.

Prevalence and Risk Factors of Undernutrition among Older Adults Living in Nonsubsidized Residential Care Homes: A Cross-sectional Descriptive Study

Daphne Sze Ki Cheung,Shanshan Wang,Franco Tsz Fung Cheung,Ken Hok Man Ho,Justina Yat Wa Liu,Hui lin Cheng,Simon Ching Lam 한국성인간호학회 2023 성인간호학회지 Vol.35 No.3

Purpose: This study investigated the prevalence and risk factors of undernutrition among older adults living in nonsubsidized Residential Care Homes (RCHs). Methods: Face-to-face interviews and assessments were conducted in a convenience sample of 298 older adults (aged 65 years or older) residing in nonsubsidized RCHs in Hong Kong in January 2015. Subjects who ate by mouth (with or without assistance) and who had no communication barriers were included. We employed a descriptive cross-sectional study design according to the STROBE reporting guidelines. Data were collected on participants' demographics, history of chronic illness, physical function (assessed by the 10-item Simplified Barthel Index with the self-care ability and mobility subscales), cognitive function (assessed by the 10-item Abbreviated Mental Test), and nutritional status (assessed by the 18-item Mini Nutritional Assessment). After identifying the variables associated with undernutrition, hierarchical multivariate logistic regression was used to identify salient predictors. Results: In total, 40.9% of participants had undernutrition, which was associated with a longer length of stay in RCHs and poorer physical and cognitive functions compared to adequate nutrition or being at risk of undernutrition. Hierarchical multivariate logistic regression showed that residents with better cognitive function (adjusted Odds Ratio [OR]=0.88) and self-care ability (adjusted OR=0.75) were at a lower risk of undernutrition. Conclusion: Undernutrition is prevalent among residents in RCHs in Hong Kong and poses a significant risk of cognitive impairment and poor self-care skills. To lessen the likelihood and the consequences of undernutrition, RCHs must give special consideration to residents with these risk factors.