Risk of hepatocellular carcinoma in chronic hepatitis B: Assessment and modification with current antiviral therapy

SummaryIn the treatment of chronic hepatitis B (CHB), the ultimate goal is preventing hepatitis B virus (HBV)-associated liver disease, including hepatocellular carcinoma (HCC). Recently published studies show that in CHB patients treated with the currently recommended first-line nucleos(t)ide analogs (NAs) entecavir or tenofovir, annual HCC incidences range from 0.01% to 1.4% in non-cirrhotic patients, and from 0.9% to 5.4% in those with cirrhosis. In Asian studies including matched untreated controls, current NA therapy consistently resulted in a significantly lower HCC incidence in patients with cirrhosis, amounting to an overall HCC risk reduction of ∼30%; in non-cirrhotic patients, HCC risk reduction was overall ∼80%, but this was only observed in some studies. For patients of Caucasian origin, no appropriate comparative studies are available to date to evaluate the impact of NA treatment on HCC. Achievement of a virologic response under current NA therapy was associated with a lower HCC risk in Asian, but not Caucasian studies. Studies comparing entecavir or tenofovir with older NAs generally found no difference in HCC risk reduction between agents, except for one study which used no rescue therapy in patients developing lamivudine resistance. Overall, these data indicate that with the current, potent NAs, HCC risk can be reduced but not eliminated, probably due to risk factors that are not amenable to change by antiviral therapy, or events that may have taken place before treatment initiation. Validated pre- and on-therapy HCC risk calculators that inform the best practice for HCC surveillance and facilitate patient counseling would be of great practical value

Finite element analysis of cracking and delamination of concrete beam due to steel corrosion

This paper presents the analytical results to investigate cracking and delamination of concrete beam due to steel corrosion. A series of concrete beams were idealised as two dimensional models via their cross section and analysed using the finite element software – LUSAS. The corrosion of steel bars was simulated using a radial expansion. The FE results show that cracking of beam section due to steel corrosion can be clarified into four types, i.e., Internal Cracking, Internal Penetration, External Cracking (HS) and External Cracking (VB). The amount of corrosion in term of radial expansion required to causes Internal Cracking, Internal Penetration, External Cracking (HS) and External Cracking (VB) varies almost linearly with bar diameter d, bar clear distance s and concrete cover c, respectively. If the ratio s/c was less than the critical value of about 2.2, the delamination of concrete cover could occur before the cracks can be visualised on the concrete surface, which does concern engineers

Quasi-Normal Modes of Schwarzschild Anti-De Sitter Black Holes: Electromagnetic and Gravitational Perturbations

We study the quasi-normal modes (QNM) of electromagnetic and gravitational perturbations of a Schwarzschild black hole in an asymptotically Anti-de Sitter (AdS) spacetime. Some of the electromagnetic modes do not oscillate, they only decay, since they have pure imaginary frequencies. The gravitational modes show peculiar features: the odd and even gravitational perturbations no longer have the same characteristic quasinormal frequencies. There is a special mode for odd perturbations whose behavior differs completely from the usual one in scalar and electromagnetic perturbation in an AdS spacetime, but has a similar behavior to the Schwarzschild black hole in an asymptotically flat spacetime: the imaginary part of the frequency goes as 1/r+, where r+ is the horizon radius. We also investigate the small black hole limit showing that the imaginary part of the frequency goes as r+^2. These results are important to the AdS/CFT conjecture since according to it the QNMs describe the approach to equilibrium in the conformal field theory.Comment: 2 figure

The Sachs-Wolfe Effect: Gauge Independence and a General Expression

In this paper we address two points concerning the Sachs-Wolfe effect: (i) the gauge independence of the observable temperature anisotropy, and (ii) a gauge-invariant expression of the effect considering the most general situation of hydrodynamic perturbations. The first result follows because the gauge transformation of the temperature fluctuation at the observation event only contributes to the isotropic temperature change which, in practice, is absorbed into the definition of the background temperature. Thus, we proceed without fixing the gauge condition, and express the Sachs-Wolfe effect using the gauge-invariant variables.Comment: 5 pages, closer to published versio

Hepatitis B surface antigen quantification: Why and how to use it in 2011 – A core group report

Quantitative HBsAg had been suggested to be helpful in management of HBV, but assays were cumbersome. The recent availability of commercial quantitative assays has restarted the interest in quantitative serum hepatitis B surface antigen (HBsAg) as a biomarker for prognosis and treatment response in chronic hepatitis B. HBsAg level reflects the transcriptional activity of cccDNA rather than the absolute amount of cccDNA copies. Serum HBsAg level tends to be higher in hepatitis B e antigen (HBeAg)-positive than HBeAg-negative patients. Among patients with a low HBV DNA (<2000IU/ml), HBsAg <1000IU/ml in genotype D HBV infection and HBsAg <100IU/ml in genotype B/C HBV infection is associated with inactive carrier state in HBeAg-negative patients. The HBsAg reduction by nucleos(t)ide analogues (NA) is not as pronounced as by interferon treatment. On peginterferon treatment, sustained responders tend to show greater HBsAg decline than the non-responders. The optimal on-treatment HBsAg cutoff to predict response needs further evaluation in HBeAg-positive patients, but an absence of HBsAg decline together with a <2 log reduction in HBV DNA at week 12 can serve as stopping rule in HBeAg-negative patients with genotype D HBV infection. A rapid serum HBsAg decline during NA therapy may identify patients who will clear HBsAg in the long-term. There are early reports among Asian patients that an HBsAg level of <100IU/ml might predict lower risk of relapse after stopping NA treatment. In clinical practice, serum HBsAg level should be used together with, but not as a substitute for, HBV DNA

The Effect of Recycled High-Density Polyethylene (HDPE) as an Additional Binder in Porous Asphalt Pavement

Porous asphalt has excellent permeability and larger air voids. Due to the low stability strength of asphalt binder with aggregates, Malaysia uses porous asphalt roads for lightweight vehicle road transportation. Numerous studies indicate utilizing Recycled High-Density Polyethylene in porous asphalt road surface. As a result, it was utilised as an additional binder material to enhance the asphalt binder. The main purpose of this study is to investigate the stability of modified porous asphalt samples and evaluate the optimum percentage of HDPE plastic waste from 3%, 6% and 9%. The aggregates, asphalt properties, Marshall Parameters and waster absorption test are in comply with JKR Standard and PWD 2008. At 3% of plastic addition has improved the stability of porous asphalt specimens. Adding plastic waste as a binder helps strengthen asphalt binding