Entecavir is a potent antiviral agent with high genetic barrier to resistance, hence it is currently recommended as first-line antiviral therapy for chronic hepatitis B (CHB). The aim of this study was to investigate the efficacy of entecavir on clinical outcomes and deaths. It was a retrospective-prospective cohort study based on two cohorts of patients. The entecavir cohort included consecutive CHB patients who had received entecavir 0.5 mg/day for at least 12 months. The historical control cohort included untreated patients recruited since 1997 who underwent routine clinical care. The primary outcome was the 5-year cumulative probability of hepatic events, defined as any cirrhotic complications, hepatocellular carcinoma (HCC), and/or liver-related mortality. A total of 1,446 entecavir-treated patients (72% men; age, 51 6 12 years; follow-up, 36 6 13 months) and 424 treatment-naïve patients (65% men; age, 41 6 13 years; follow-up, 114 6 31 months) were studied. Overall, there was no difference in hepatic events between the entecavir and control cohorts. Among patients with liver cirrhosis (482 entecavir-treated, 69 treatment-naïve), entecavir-treated patients had reduced risks of all clinical outcomes when compared with treatment-naïve patients with cirrhosis after adjusted for model for end-stage liver disease score: hepatic events (hazard ratio [HR], 0.51; 95% confidence interval [CI], 0.34-0.78; P 5 0.002), HCC (HR, 0.55; 95% CI, 0.31-0.99; P 5 0.049), liver-related mortality (HR, 0.26; 95% CI, 0.13-0.55; P < 0.001), and all-cause mortality (HR, 0.34; 95% CI, 0.18-0.62; P < 0.001). Entecavir-treated patients with cirrhosis who failed to achieve undetectable hepatitis B virus DNA (105/482 [22%]) had comparable risk of hepatic events as the untreated patients. Conclusion: Entecavir therapy reduces the risks of hepatic events, HCC, liver-related and all-cause mortality of CHB patients with liver cirrhosis in 5 years, particularly among those who had maintained viral suppression. (HEPATOLOGY 2013;58:1537-1547 C hronic hepatitis B (CHB) is the leading cause of liver cirrhosis and hepatic events, including various cirrhotic complications and hepatocellular carcinoma (HCC) in Asia. 1 A high level of hepatitis B virus (HBV) DNA has been consistently shown to be an independent risk factor for the development of cirrhosis and HCC. 2,3 Antiviral therapy is effective in suppressing HBV DNA and reducing the risk of hepatic events and HCC. 4,5 Lamivudine, the first generation oral nucleoside analogue was shown to reduce the incidence of hepatic events in patients with advanced fibrosis or compensated cirrhosis by 50%. 6 However, the clinical benefit may be negated by lamivudine resistance and virologic relapse after cessation of treatment. 6,7 Therefore, lamivudine is no longer the firstline antiviral therapy for CHB. Instead, nucleos(t)ide analogues with high genetic barrier to resistancenamely, entecavir and tenofovir disoproxil fumarateare recommended by international guidelines. [8][9][10] Entecavir is a more potent ...

No abstract

No abstract

Aim The aim of the present study was to compare the safety and early postoperative outcomes of bipolar transurethral enucleation and resection of the prostate (TUERP) and transurethral resection of the prostate (TURP) in patients with prostates larger than 80 g. Patients and Methods Between January 2014 and December 2016, 41 and 61 patients had bipolar TUERP and bipolar TURP performed at our unit for the treatment of prostates larger than 80 g. All patients were evaluated preoperatively by digital rectal examination, transrectal ultrasonography and laboratory studies, including measurement of haemoglobin and prostate‐specific antigen levels. Patients were reassessed postoperatively at 3 months. Results The preoperative parameters between bipolar TUERP and TURP were comparable. Bipolar TUERP is more efficient in tissue removal, with more tissue retrieved per minute of theatre time (0.73 g/min vs 0.64 g/min, P = 0.022). The hospitalization time between the groups was comparable. Bipolar TUERP achieved a lower serum prostate‐specific antigen level (1 ng/mL vs 1.8 ng/mL, P < 0.001), lower transrectal ultrasonography volume (18.3 cm3 vs 23.8 cm3, P < 0.001) and higher peak flow rate (23.1 mL/s vs 16.9 mL/s, P = 0.026) compared with bipolar TURP at 3 months postoperatively. Postoperative complications due to urinary tract infection were more common in the bipolar TURP group, while the readmission rate due to transient haematuria was higher among bipolar TUERP patients. The transfusion rate was low in both groups, and postoperative urethral stricture was uncommon. Conclusions Bipolar TUERP is a safe technique for the surgical treatment of large prostates. More complete removal of adenoma can be achieved without an increase in theatre time. Bipolar TUERP results in better early postoperative functional outcomes in terms of higher peak flow rate compared with bipolar TURP. The complication rate is not increased with bipolar TUERP.

No abstract