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ANDREW Orr is a man who knows about luck. As a teenager he started taking heroin, swapping needles a regular part of his dependency, but unlike some of his friends he was lucky enough not to overdose.
His luck held when he managed to kick the habit, thanks to a methadone programme which helped him put his life together.
But the luckiest moment of his life came five years ago when a "brain fog", as he describes it, forced him to hospital. A blood test soon proved what he had suspected might be the problem - hepatitis C. The lucky part is that if he'd left it much longer, he would now be dead.
"They told me that if I'd left it another year before getting a blood test and the diagnosis then my liver would have been too bad and the treatment wouldn't have worked," he says.
"I'd have been unlikely to get a transplant as the problem was self-inflicted and there would have been many more deserving cases on the waiting list before me. In fact, they said that I would have been dead within five years."
Andrew, a foreman joiner from Bo'ness, speaks matter-of-factly about such a shocking moment, but he knows how fortunate he has been.
"I contracted the hepatitis C virus from swapping needles when I was taking heroin," he says. "I think when you've done drugs you're always wondering if it will catch up with you at some point, and it did.
"I was running a building site and I'd noticed that my concentration was going, my stamina had gone and I just felt really run down all the time. I knew there was something wrong.
"I thought it might be something like hepatitis but I kept putting off going to see the doctor about it. But one day it was so bad I just went straight to the hospital and they did a blood test and told me it was hep C. Even though I'd been expecting something it was still a real blow to hear it."
He adds: "The main problem is that there can be no symptoms. Some people can turn yellow and have real physical signs. For me it was a lack of concentration, like having a brain fog.
"My memory was going and I wasn't doing the simplest of things right anymore... Continue reading...
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How do genes contribute to treatment outcomes in both hepatitis B and hepatitis C infections?
Seminars in Liver Disease, July 2011
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The ECHO program showed that primary care clinicians can successfully treat underserved hepatitis C patients using video teleconferencing.
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Predictors of relapse in chronic Hep B after discontinuation of anti-viral therapy
The latest issue of the Alimentary Pharmacology & Therapeutics identifies predictors of relapse in chronic hepatitis B after discontinuation of anti-viral therapy.
Optimal duration of anti-viral therapy in chronic hepatitis B virus infection remains unclear.
Dr Liang and colleagues from China investigated factors that could predict relapse after stopping anti-viral agents.
Chronic hepatitis B patients who were treated with anti-viral agents and have stopped the treatment were recruited.
Anti-viral agents were stopped according to the recommendations of the Asian Pacific Association for the Study of the Liver.
1-year probability of virological relapse was 42% in hepatitis B e antigen-positive patients
Alimentary Pharmacology & Therapeutics
Virological relapse was defined as an increase in serum hepatitis B virus DNA to more than 1000 copies/mL after discontinuation of treatment.
The research team found that 84 patients were eligible for this study.
The team noted that 37 patients developed virological relapse at 4 months after discontinuation of therapy.
The research team found that 1-year cumulative probability of virological relapse was 42% and 47% in hepatitis B e antigen-positive, and hepatitis B e antigen-negative patients, respectively.
On multivariate analysis by Cox proportional hazard model, pre-existing lamivudine resistance, delayed suppression of hepatitis B virus DNA to undetectable level during anti-viral therapy and to a higher hepatitis B surface antigen level at the end of treatment were associated with virological relapse.
The researchers found that 80% of lamivudine resistant patients developed virological relapse.
Among the 11 treatment naïve patients who had hepatitis B surface antigen 2 log IU/mL or less at the end of treatment, and 1 had virological relapse.
Dr Liang's team concluded, "Treatment cessation among lamivudine resistant patients is associated with high risk of virological relapse."
"Serum hepatitis B surface antigen level at the end of treatment and rate of hepatitis B virus DNA suppression can provide supplementary information to guide the timing of stopping anti-viral
Malia Ruiz waiting on call from Riley
Updated: Thursday, 07 Jul 2011, 7:03 PM EDT
Published : Thursday, 07 Jul 2011, 5:49 PM EDT
Published : Thursday, 07 Jul 2011, 5:49 PM EDT
LAFAYETTE, INDIANA (WLFI) - At eight years old she's already endured open heart surgery, 13 balloon angioplasties, and multiple fractures in her bones. She has broken her leg 25 times.
Malia Ruiz suffers from Allagile Syndrome, a genetic disease that affects her heart and liver. She and her family are waiting by the phone for a call from Riley Children's Hospital. Malia is at the top of the list for the next available liver.
Malia, though eight, is the size of a three-year-old. At 32 pounds, she hasn't grown physically in three years. She has a feeding tube in her stomach. Each morning Malia takes at least 15 medicines for the pain and problems caused by her disease."I don't think she's gone a day in her life without pain," said Jan Early, Malia's grandmother.
"We've got a long road ahead but it's going to be for the best," said Ryan Hall, Malia's mother.
Malia's mom and grandmother said the child's condition is rare and that most children stabilize by Malia's age. Malia, however, has gotten worse and is now waiting on the call from Riley to have a liver transplant.
"Hopefully fewer meds, the jaundice, the itching, which the itching is one of the worst problems. Some people just have transplants just because of the itching," said Hall.
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With Allagile Syndrome, bile builds up in the liver and causes scarring that prevents the liver from working properly to eliminate waste from the bloodstream. It causes jaundice, terrible itching and brittle bones.
Hall said any little knock could break Malia's bones.
"They are basically like an 80-year-old woman's bones, so it's just... She tripped over a blanket, last time, just a month ago, and broke it," said Hall.
Malia's left leg is broken, but doctors won't fix it until after her liver transplant. Then, Ruiz will be in a half body cast.
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"She says she's ready for her new body she wants her leg fixed as soon as possible and they said it could be as soon as two weeks after transplant to fix the leg," said Hall.
Malia enjoys cartoons, playing on her iPad and swimming during the summer with her two-year-old sister. Although Malia can eat anything she wants, her body doesn't process food not taken through her feeding tube. Still, cheese pizza and slushies top the 8-year-old's list..
There will be a benefit dart tournament to help offset some of the costs for the family. It will be held Saturday, July 30 at the Moose Lodge at 3601 Union Street in Lafayette. Sign up begins at 1:30 p.m. Play starts at 3:00 p.m. There is a $10.00 entry fee, 50/50 Raffle tickets and food.
A fund has also been set up at Lafayette Bank and Trust called Mulligans for Malia.
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By Ming Yeung (HK Edition)
The University of Hong Kong (HKU) has identified tumor-producing cells capable of maintaining resistance to chemotherapy and resulting in recurrences of liver cancer.
Liver cancer is the third most deadly form of cancer in Hong Kong.
More than 1,700 new cases of liver cancer are reported each year.
The leading cause is hepatitis B virus. About 10 percent of the city's population are hepatitis B virus carriers transmitted mainly through maternity.
At present, removal of tumors and liver transplants are the mainstays of treatment. Advanced patients are able to undergo conventional chemotherapy and local ablative therapies.
Results from chemotherapy and ablative therapy are considered unsatisfactory. In both there are high rates of recurrence and mortality. No more than 25 percent of liver cancer patients are able to receive first line treatment because in the majority of cases, there is late diagnosis of liver cancer.
Compounding the problem is a limited supply of liver grafts, explained professor Irene Ng from the Department of Pathology at HKU's Faculty of Medicine.
"The main hurdles in treating liver cancer are a high chance of tumor recurrence even after surgical resection and that the tumor is resistant to chemotherapeutic drugs," Ng said.
When cancer recurs, it often does so in a treatment-resistant form or it is widely spread. For many patients, relapse presages failure of all treatment.
"Therefore, understanding the mechanism of tumor recurrence and chemoresistance will help improve treatment results," Ng said.
According to a study led by Professor Ng, liver cancer patients whose cancer stem cells had high expression of a protein known as CD24+ had a significantly high risk of tumor recurrence and metastasis through activation of another protein labelled as STAT3.
"The CD24+ is like a button, when the button is turned on, it will trigger a lot of activation within the cell and one of the main targets is STAT3," Ng explained.
Research Assistant Professor Terence Lee said that liver cancer patients whose tumor have high CD24+ expression had three times higher risk of tumor relapse in the first year after surgery when compared to those with low CD24+ expression.
Patients having low expression of CD24+ lived seven times longer (42 months) than their high expression counterparts (6.6 months), Lee added.
However, the new targeted drugs, which would not be marketable for 10 years at the earliest, may help patients prolong life and reduce unwanted side-effects even though they cannot be used to cure the disease completely.
The HKU is conducting a further study to evaluate therapeutic efficacy of STAT3 inhibitors in the suppression of liver cancer relapse and its combined effect with traditional chemotherapy.
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The University of Hong Kong (HKU) has identified tumor-producing cells capable of maintaining resistance to chemotherapy and resulting in recurrences of liver cancer.
Liver cancer is the third most deadly form of cancer in Hong Kong.
More than 1,700 new cases of liver cancer are reported each year.
The leading cause is hepatitis B virus. About 10 percent of the city's population are hepatitis B virus carriers transmitted mainly through maternity.
At present, removal of tumors and liver transplants are the mainstays of treatment. Advanced patients are able to undergo conventional chemotherapy and local ablative therapies.
Results from chemotherapy and ablative therapy are considered unsatisfactory. In both there are high rates of recurrence and mortality. No more than 25 percent of liver cancer patients are able to receive first line treatment because in the majority of cases, there is late diagnosis of liver cancer.
Compounding the problem is a limited supply of liver grafts, explained professor Irene Ng from the Department of Pathology at HKU's Faculty of Medicine.
"The main hurdles in treating liver cancer are a high chance of tumor recurrence even after surgical resection and that the tumor is resistant to chemotherapeutic drugs," Ng said.
When cancer recurs, it often does so in a treatment-resistant form or it is widely spread. For many patients, relapse presages failure of all treatment.
"Therefore, understanding the mechanism of tumor recurrence and chemoresistance will help improve treatment results," Ng said.
According to a study led by Professor Ng, liver cancer patients whose cancer stem cells had high expression of a protein known as CD24+ had a significantly high risk of tumor recurrence and metastasis through activation of another protein labelled as STAT3.
"The CD24+ is like a button, when the button is turned on, it will trigger a lot of activation within the cell and one of the main targets is STAT3," Ng explained.
Research Assistant Professor Terence Lee said that liver cancer patients whose tumor have high CD24+ expression had three times higher risk of tumor relapse in the first year after surgery when compared to those with low CD24+ expression.
Patients having low expression of CD24+ lived seven times longer (42 months) than their high expression counterparts (6.6 months), Lee added.
However, the new targeted drugs, which would not be marketable for 10 years at the earliest, may help patients prolong life and reduce unwanted side-effects even though they cannot be used to cure the disease completely.
The HKU is conducting a further study to evaluate therapeutic efficacy of STAT3 inhibitors in the suppression of liver cancer relapse and its combined effect with traditional chemotherapy.
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TRIALS of an Australian treatment to help prolong the lives of people with liver cancer are about to be expanded around the world.
Patients with bowel cancer that has spread to the liver are being sought in Australia, the US and Europe to take part in the study.
Earlier results of the selective internal radiation therapy in Europe show the treatment helped prolong the lives of patients with inoperable primary liver cancer by up to two years.
Oncologist at the Royal Melbourne Hospital and Ludwig Institute for Cancer Research, Assoc Prof Peter Gibbs, said the new trials would involve 450 patients, including 150 Australians, with bowel and liver cancer.
Its main aim was to test how effective the treatment was in people who were also having chemotherapy.
"Most of the time they have multiple spots and can't have liver surgery so they maybe only survive two years.
"We are hopeful that some patients will be cured that would not otherwise be cured.
"But also other patients have an extra six to 12 months of survival."
The trial is expected to be completed by mid 2012 with results published a year later.
They follow the publication of a retrospective analysis of 325 patients with inoperable primary liver cancer treated with the radioactive therapy in Europe.
The study, published in the Hepatology journal on Thursday, was the largest of its kind so far and revealed the therapy was safe and effective.
More than half the group had advanced liver cancer and managed to survive an extra 10 months after having one injection of the radioactive therapy.
Twenty-seven per cent had intermediate stage cancer and survived an extra 17 months.
The remainder, who had milder forms of the disease, added an extra two years to their lives
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Organ donation: an essential guide
National Transplant Week, which runs until 10 July, is a good time to sign up to the Organ Donor Register. Find out all you need to know about organ donation in our guide
More than 7,500 people are waiting for an organ to save their lives, and three people die every day while they wait. NHS Blood and Transplant is calling on people to reduce waiting times for a transplant by signing up to the NHS Organ Donor Register. One donor can save up to nine lives and many more can be saved through tissue donation.
What is the NHS Organ Donor Register?
It is a confidential, computerised database that holds the details of more than 18 million people who have decided that they want to donate organs after their death. The register is used to help establish whether a person wanted to donate and, if so, what they wanted to donate.
Who can donate an organ?
Any person of any age, race or gender can donate an organ. Having a medical condition does not necessarily prevent a person from becoming an organ or tissue donor. The decision about whether some or all organs or tissue are suitable for transplant is made by a healthcare professional, taking into account your medical history. There are only two conditions where organ donation is ruled out completely. A person cannot become an organ or tissue donor if they have been diagnosed with HIV or if they have, or are suspected of having, vCJD.
Which organs can be transplanted?
Kidneys, heart, liver, lungs, pancreas and the small intestine can all be transplanted. Techniques are improving all the time and it may soon be possible to transplant other parts of the body.
Can you donate an organ while you are still alive?
Yes, in some cases. The shortage of organs has led to an increasing number of organ donations by living people. The most common organ donated by a living person is a kidney, as a healthy person can lead a completely normal life with only one functioning kidney. Part of a liver can be transplanted and it may also be possible to donate a segment of a lung and, in a very small number of cases, part of the small bowel. Living donors are often a close relative of the recipient but may on occasion be a partner or close friend. Donors may also offer to give a kidney to someone who is on the waiting list for a transplant but whom they have never met (non-directed altruistic donation).
What is tissue donation?
Tissue donation is the gift of tissue such as corneas, skin, bone, tendons, cartilage and heart valves. Most people can donate tissue. Unlike organs, it may be possible to donate tissue up to 48 hours after a person has died.
Why are even more donors needed?
Over 7,500 people are currently waiting for an organ. Every year 1,000 people die while waiting for an organ transplant and many others die before they even get on to the transplant waiting list. The gap between the number of organs donated and the number of people waiting for a transplant is increasing. Only a small number of people die in circumstances where they are able to donate their organs. Because organs have to be transplanted very soon after someone has died they can only be donated by someone who has died in hospital. Usually organs come from people who are certified dead while on a ventilator in a hospital intensive care unit, generally as a result of a brain haemorrhage, a major accident such as a car crash, or a stroke.
Do I need to discuss my wishes with my close family and friends?
Yes, they need to know what you would like to happen after your death so they can confirm your wishes to NHS staff. If you register your wishes without telling the people closest to you, it may come as a surprise at a time when they are trying to deal with their loss.
Do I need to write about my organ donation wishes in my will?
No. By the time your will is read it will be far too late for you to become a donor. This is why it is so important to let your family and friends know now that you have joined the register.
Can I be sure doctors will try to save me if I am registered as a potential organ donor?
Yes. Health professionals have a duty of care to try and save life first. If, despite their efforts, the patient dies, organ and tissue donation can then be considered and a completely different team of donation and transplant specialists would be called in.
Will my details be given to any other organisations?
No. The information you provided is only used by NHSBT to register your wishes on the NHS Organ Donor Register and by healthcare professionals in the event of your death.
Can I change my mind?
Yes. You can ring 0300 123 23 23 or visit organdonation.nhs.uk and fill in the form asking for your name to be removed. Also, it's important to let your family know.
How do I sign up?
Signing up to the NHS Organ Donor Register is quick and simple. You can join by visiting organdonation.nhs.uk, calling 0300 123 23 23, or texting SAVE to 84118.
Got a question about organ donation that hasn't been answered here? Visit the FAQs section at organdonation.nhs.uk or email enquiries@nhsbt.nhs.uk
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