Hepatitis B surface antigen reduction by switching from long-term nucleoside/nucleotide analogue administration to pegylated interferon.

Hepatitis B surface antigen (HBsAg) reduction during nucleoside/nucleotide analogue (NA) therapy is slow and an alternative strategy for patients receiving ongoing NA to facilitate HBsAg reduction is required. We investigated whether switching to pegylated interferon (PEG-IFN) after long-term NA administration enhances HBsAg reduction. Forty-nine patients who switched from long-term NA to 48 weeks of PEG-IFN alfa-2a were studied. The mean duration of previous NA was 48 months (sequential group). A total of 147 patients who continued NA and matched for baseline characteristics were analysed for comparison (NA continuation group). The treatment response was defined as HBsAg reduction ≥1.0 logIU/mL at the end of PEG-IFN. HBsAg reduction at week 48 was 0.81±1.1 logIU/mL in the sequential group, which was significantly higher than that in the NA continuation group (0.11±0.3 logIU/mL, P < .001). The treatment response was achieved in 29% and 2% of the sequential group and NA continuation group (P < .001), and the odds ratio of sequential therapy for the treatment response was 19 compared with the NA continuation (P < .001). In patients tested positive for hepatitis B e antigen (HBeAg), HBeAg seroconversion was higher in the sequential group (44% vs 8%, P < .001). In HBeAg-negative patients, only patients in the sequential group achieved HBsAg loss. No patient needed to resume NA administration because of HBV DNA increase accompanied by alanine aminotransferase flares. In summary, sequential therapy with PEG-IFN after long-term NA enhances the reduction of HBsAg and may represent a treatment option to promote HBsAg loss.

Pharmacokinetics and enhanced PKR response in patients with chronic hepatitis C treated with pegylated interferon alpha-2b and ribavirin.

This study investigated the molecular and pharmacokinetic mechanisms of the enhanced antiviral efficacy associated with pegylated interferon (PEG-IFN) alpha-2b and ribavirin. The study involved comparing the expression of serial double-stranded RNA-activated protein kinase (PKR) before and during treatment in 26 PEG-IFN alpha-2b and 26 conventional IFN alpha-2b recipients matched for age, body weight and dose of ribavirin. The pharmacokinetics of PEG-IFN alpha-2b and ribavirin was analysed in 15 of the 26 PEG-IFN recipients. There was a rapid increase in PKR expression in both treatment groups, although expression from day 2 onwards was maintained at a significantly higher level in the PEG-IFN recipients (P < 0.05). C(max) of PEG-IFN occurred 12-48 h after the initial administration, with t(1/2) and C(min) being 49 h and 190 pg/mL, respectively. In contrast to ribavirin, accumulation of PEG-IFN was minimal. There was no association between serum PEG-IFN and ribavirin levels and virological response. Although baseline expression of PKR before treatment was marginally higher in nonresponders (NRs), from day 2 onwards, sequential PKR expression in response to PEG-IFN was higher in sustained viral responders compared with the NRs (P < 0.05). Significant correlations were found between kinetics of PKR expression and viral decline rates in each phase of hepatitis C virus dynamics (first phase, r = 0.67, P = 0.0006; second phase, r = 0.67, P = 0.001). In conclusion, improvement in pharmacokinetics following pegylation led to higher intracellular PKR expression, which was associated with enhanced virological efficacy of PEG-IFN-based combination therapy. The concentrations of both ribavirin and PEG-IFN alpha-2b were not associated with viral response and PKR expression.

[Evaluation of masticatory efficiency and the analysis of occlusal pattern factors using computer image processing method].

The purpose of this study was to evaluate the newly developed computer-assisted image processing method. We applied this method for the evaluation of masticatory efficiency and the analysis of occlusal pattern factors: the number and the size of occlusal contact areas, the number of and the size of the projected facets. We compared this new method with our conventional one which is the simplified particle counting method using a sieve and measuring the occlusal pattern factors with a planimeter. The results were as follows: 1. It is possible to count the number of particles within an optional range of size with the new method. 2. The new method may be used with minimum error for the measurement of occlusal pattern factors. We believe that this newly developed computer-assisted image processing method can be put to practical use for clinical evaluation of masticatory efficiency and analysis of occlusal pattern factors.

[Survey on oral and maxillofacial injuries in contact sports and diffusion of mouthguards].

Recent reports have shown an increase of oral and maxillofacial injuries caused by sports activities. In European and American countries, mouthguards are the popular measure against these injuries. The purpose of this study was to survey the rate of incidence of oral and maxillofacial injuries caused by contact sports, the diffusion and the evaluation of mouthguards and the interest in mouthguards in Japan. Questionnaires were sent to 244 Rugby football teams in Aichi prefecture and 27 American football teams in the Tokai area. We received replies from 153 Rugby football teams and 17 American football teams, and the results were as follows: 1) The rate of incidence of oral and maxillofacial injuries was 239 players out of 4721 players, which means 5.1% in Rugby football and 22 players out of 428 players, which means 5.1% in American football. 2) The diffusion of mouthguards was 20 out of 153 teams in Rugby football and 16 out of 17 teams in American football. And most of them are using commercially available mouthguards. 3) Almost all teams were not satisfied with their mouthguards and complained of speaking difficulties, discomfort and easy dislocation. 4) Almost all teams desire the improvement of mouthguards. 5) Teams with no experience of mouthguards were very much interested in the use of mouthguards but they do not have enough information about mouthguards. 6) We have to enlighten players and their instructors about mouthguards and diffuse the use of mouthguards more positively to contact sports players.