133 results on '"Jeffers LJ"'
Search Results
2. Quantitative Detection of Hepatitis C Virus RNA in Patients Undergoing Hemodialysis
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G. Perez, H. O'sullivan, S. Larue, Mary Hill, B. Leclercq, M. De Medina, Jeffers Lj, X. Li, Eugene R. Schiff, K. R. Reddy, J. P. Pennell, and Tally Parker
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biology ,business.industry ,medicine.medical_treatment ,Hepatitis C virus ,Biomedical Engineering ,Biophysics ,virus diseases ,Bioengineering ,General Medicine ,biology.organism_classification ,medicine.disease_cause ,Virology ,Virus ,Biomaterials ,Reverse transcription polymerase chain reaction ,Flaviviridae ,medicine ,BDNA test ,biology.protein ,Hemodialysis ,Antibody ,business ,Dialysis - Abstract
The purpose of the current study was to detect quantitatively hepatitis C virus (HCV)-RNA among patients undergoing maintenance hemodialysis. Study subjects were 88 patients on hemodialysis at the Miami Veterans Administration Medical Center and the REN Dialysis Unit at the University of Miami School of Medicine. There were 66 men and 22 women, mean age 52 years (range, 22-87 years), and mean duration of dialysis was 2.8 years (range 0.2-12.5 years). Seventy-three percent had a history of blood transfusion. Anti-HCV was determined by enzyme linked immunosorbent assay (ELISA), confirmed by four antigen strip immunoblot assay (RIBA 2.0 SIA). HCV-RNA was quantitated directly in human sera using a branched DNA (bDNA) signal amplification assay. Twenty-seven of 88 (31%) patient samples were found to be anti-HCV reactive by ELISA. Twenty-two of 27 were confirmed reactive, 2 were indeterminate, and 3 were nonreactive by RIBA HCV. Eighteen of 22 (82%) reactive by RIBA 2.0 HVC were found to have detectable (> 3.5 X 10(5) Eq/ml) HCV-RNA levels (mean [&/- SD], 43.3 +/- 35.4 X 10(5) Eq/ml; range 4.9-123.3). No additional cases were identified with reverse transcription polymerase chain reaction (RT-PCR) using 5' untranslated region "nested" primers. HCV-RNA was not detected in four RIBA HCV 2.0 reactive, the two intermediate, or the 64 patient samples nonreactive for anti-HCV. The two epitopes most commonly associated with HCV-RNA were c22-3 and c33c. Sixteen of 18 (89%) patients with detectable levels of HCV-RNA had normal alanine aminotransferase (ALT). Three patients with the highest levels of HCV-RNA were infected with the human immunodeficiency virus. The authors conclude that HCV-RNA by bDNA assay is a sensitive, specific, and simple test that can be used in association with antibody assays and a PCR-based assay to study the prevalence and management of HCV infection in the dialysis setting.
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- 1997
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3. Antiviral efficacy of entecavir in nucleos(t)ide-naïve patients of Black/African descent with chronic hepatitis B
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C. J. Van Rensburg, Jeffers Lj, C. Llamoso, W. Hu, Stephen Schmidt, A. Banks, M. Schechter, and R. Parana
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Adult ,Male ,medicine.medical_specialty ,Hepatitis B virus ,Guanine ,Black african ,Microbial Sensitivity Tests ,Gastroenterology ,Antiviral Agents ,Therapy naive ,Hepatitis B, Chronic ,Chronic hepatitis ,Virology ,Internal medicine ,medicine ,Clinical endpoint ,Humans ,Hepatitis B e Antigens ,African american ,Hepatology ,business.industry ,Entecavir ,Viral Load ,Surgery ,Black or African American ,Safety profile ,Infectious Diseases ,Treatment Outcome ,HBeAg ,DNA, Viral ,Female ,business ,medicine.drug - Abstract
This single-arm, open-label, descriptive study assessed the efficacy and safety of entecavir (ETV) in nucleos(t)ide-naïve Black/African American patients with chronic hepatitis B (CHB), a patient population underrepresented in ETV registration trials. Forty patients with HBeAg(+) or HBeAg(-) compensated CHB of self-described Black/African American race received ETV 0.5 mg daily for 52 weeks; 37 patients completed 52 weeks of treatment. At Week 48, 29/40 (72.5%, noncompleter = failure) patients achieved the primary endpoint of HBV DNA50 IU/mL. Rates for HBeAg loss (11/22; 50%) and HBeAg seroconversion (9/22; 41%) were high, possibly due to the high HBV genotype A prevalence (70%). No patient experienced virological breakthrough. Samples for resistance testing were available in 6/8 patients with HBV DNA50 IU/mL at Week 48 or last on-treatment visit. No ETV resistance was detected. The safety profile of ETV was consistent with that observed in ETV registration trials. This study shows that in Black/African American patients with CHB, ETV was well tolerated and demonstrated comparable antiviral efficacy to that observed in White and Asian patients in ETV Phase III studies.
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- 2013
4. Detection of hepatitis C virus RNA in hemodialysis patients
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Marcelo Silva, M. De Medina, G. Perez, K. R. Reddy, Eugene R. Schiff, Anne L. McNamara, Margarita Pérez Jiménez, Carmen J. Ortiz-Interian, Mary C. Kuhns, and Jeffers Lj
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Adult ,Male ,Hepatitis B virus ,Hepatitis B virus DNA polymerase ,medicine.medical_treatment ,Hepatitis C virus ,Molecular Sequence Data ,Hepacivirus ,medicine.disease_cause ,Hepatitis B virus PRE beta ,Renal Dialysis ,medicine ,Humans ,Hepatitis Antibodies ,Aged ,DNA Primers ,NS3 ,Base Sequence ,biology ,business.industry ,virus diseases ,General Medicine ,Hepatitis C ,Hepatitis C Antibodies ,Middle Aged ,medicine.disease ,Virology ,digestive system diseases ,Nephrology ,biology.protein ,RNA, Viral ,Female ,Hemodialysis ,Antibody ,business - Abstract
The clinical significance of the high prevalence of antibodies to hepatitis C virus (HCV) in dialysis patients remains undefined. In order to assess the relationship between seropositivity and potential infectivity, 63 patients undergoing maintenance hemodialysis were evaluated between April and May 1990. The mean duration of maintenance hemodialysis was 45 mo (range, 13 to 144). Eighty-two percent (52 of 63) had received blood transfusions, and 16% (10 of 63) had a history of iv drug abuse. Serum samples were analyzed by HCV-cDNA polymerase chain reaction; antibodies to HCV structural (core) and nonstructural regions NS3 and NS4 were determined by enzyme immunoassay. Specimens repeatedly reactive for anti-HCV and HCV-RNA-positive samples were tested by HCV MATRIX dot immunoblot assay and HBV-DNA PCR. Twenty-five percent (16 of 63) were anti-HCV-positive. Of the 16 anti-HCV-positive patients, HCV-RNA was detected in 5 (31%) with the NS3 primers and in 12 (75%) with 5'-noncoding primers. Among the anti-HCV-negative patients, HCV-RNA was detected in 2 (4.3%) of 47 patients. Eleven of the 18 patients with HCV infection (anti-HCV and/or HCV-RNA-positive) had evidence of additional present or past viral infections (human immunodeficiency virus and/or hepatitis B virus). In summary, HCV-RNA is present in at least 75% of anti-HCV-positive patients, suggesting that they may be infectious. The detection of HCV-RNA in anti-HCV-negative patients may indicate early or chronic HCV infection not detected by current antibody assays or the inability of these patients to mount or sustain a significant antibody response.
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- 1994
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5. Prevalence of hepatitis C and G virus infection in chronic hemodialysis patients
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M. Ashby, Mary Hill, M. De Medina, K. R. Reddy, Eugene R. Schiff, V Schluter, Jeffers Lj, Guido O. Perez, J. P. Pennell, G Hess, and B. Leclerq
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Hepatitis ,education.field_of_study ,biology ,business.industry ,Hepatitis C virus ,Population ,virus diseases ,RNA virus ,Hepatitis C ,medicine.disease ,biology.organism_classification ,medicine.disease_cause ,Virology ,digestive system diseases ,Virus ,Flaviviridae ,Nephrology ,Immunology ,medicine ,education ,NS5A ,business - Abstract
An RNA virus designated hepatitis G virus (HGV) has been recently identified in patients with acute and chronic liver disease. HGV is transfusion transmissible, it has global distribution, and it is present in the volunteer blood donor population in the United States. One hundred sixty patients undergoing maintenance hemodialysis at the University of Miami-affiliated unit were evaluated. There were 99 men and 61 women ranging in age from 22 to 80 years. Sixty percent had a history of blood transfusion, 6% had a history of drug abuse, and 9% were infected with the human immunodeficiency virus. HGV-RNA was detected by reverse-transcriptase polymerase chain reaction with amplification of two independent regions (5'-nontranslated region and NS5a coding region). Detection of digoxigenin-labeled amplification products with specific capture probes to the coding and noncoding regions was performed with the Enzymun-test DNA on an ES-300 Immunoassay System (Boehringer-Mannheim, Mannheim, Germany). Hepatitis C antibodies were measured with anti-hepatitis C virus enzyme-linked immunosorbent third-generation assays and hepatitis C virus RNA by reverse-transcriptase polymerase chain reaction. There were 32 (20%) patients with detectable HGV RNA with both primer pairs. Because of possible mutations, the HGV virus may be detectable only with one primer pair. We considered the latter as indeterminate: 12 had detectable levels to the NS5a region only, seven to the 5'-nontranslated region, and six had borderline results. Detectable and indeterminate samples were confirmed by repeat measurements in a new blood sample. Seven of 24 (29%) patients with detectable hepatitis C virus RNA had coexisting HGV with one or both HGV primer pairs (four with both and three with one). Five patients were hepatitis B surface antigen positive and HGV negative. We conclude that HGV infection is prevalent in our dialysis patients. The clinical significance of HGV infection remains to be established.
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- 1998
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6. Recombinant leukocyte interferon, doxorubicin, and 5FUDR in patients with hepatocellular carcinoma-A phase II trial
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Eugene R. Schiff, Christopher B. O'Brien, Bach Ardalan, Niramol Savaraj, Lynn G. Feun, Angela Marini, Jeffers Lj, Miguel J. Rodriguez, and Enrique Molina
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Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,medicine.medical_treatment ,Alpha interferon ,Gastroenterology ,Drug Administration Schedule ,Interferon ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Leukocytes ,Humans ,Doxorubicin ,Treatment Failure ,Infusions, Intravenous ,Interferon alfa ,Aged ,Chemotherapy ,business.industry ,Liver Neoplasms ,General Medicine ,Middle Aged ,medicine.disease ,Recombinant Proteins ,Oncology ,Hepatocellular carcinoma ,Toxicity ,Cancer research ,Chills ,Female ,Interferons ,medicine.symptom ,business ,Floxuridine ,medicine.drug - Abstract
To study the combination of 5FUDR, recombinant leukocyte interferon (IFN), and doxorubicin in patients with unresectable hepatocellular carcinoma. IFN was administered at a dose of 6 miu/m2 subcutaneously followed in 2 h by doxorubicin 20 mg/m2 intravenously. After doxorubicin, 5FUDR was given as a 24-h infusion at a starting dose of 80 mg/kg. The dose of IFN was escalated to three times a week if tolerated. Both doxorubicin and 5FUDR were administered once weekly. There were 30 patients entered into the study. Among the 30 patients, there were two partial responses (7%) and one patient had stable disease. Toxicity was generally tolerable with fever, and chills, fatigue, and myelosuppression as the most common side effects. This chemotherapy combination was generally well tolerated, but has limited activity in unresectable, advanced hepatocellular carcinoma.
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- 2002
7. 1360 PEGYLATED INTERFERON-LAMBDA (PEGIFN-λ) SHOWS SUPERIOR VIRAL RESPONSE WITH IMPROVED SAFETY AND TOLERABILITY VERSUS PEGIFNα-2A IN HCV PATIENTS (Gl/2/3/4): EMERGE PHASE IIB THROUGH WEEK 12
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Ricard Solà, S.C. Gordon, S. Zeuzem, Mitchell L. Shiffman, Terry Box, M.S. Sulkowski, Lawrence Serfaty, Ira M. Jacobson, J.C. Lopez-Talavera, Vinod K. Rustgi, Andrew J. Muir, Michael Charlton, Douglas T. Dieterich, Norman Gitlin, Samuel S. Lee, E. Ramos, Jeffers Lj, John M. Vierling, J. Lester, Andrzej Gładysz, Stefan Lueth, M. Diago, Paul J. Pockros, Susan Greenbloom, R. Esteban Mur, Jacob George, A. Horga, Maribel Rodriguez-Torres, Hugo E. Vargas, Boris Yoffe, Robert Flisiak, T. Gray, J. Hillson, L. Ishak, Reem Ghalib, Dong Xu, Barbara A. Leggett, G.T. Everson, Michael B. Fallon, Bruce R. Bacon, Tarek Hassanein, E.J. Lawitz, David R. Nelson, Sanjeev Arora, Kris V. Kowdley, Morris Sherman, D. Fontana, and Peter Ferenci
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medicine.medical_specialty ,Hepatology ,Nucleoside analogue ,business.industry ,Ribavirin ,virus diseases ,Nucleoside inhibitor ,Interim analysis ,Virology ,Gastroenterology ,chemistry.chemical_compound ,Regimen ,Tolerability ,chemistry ,Pegylated interferon ,Internal medicine ,Medicine ,business ,Mericitabine ,medicine.drug - Abstract
1359 FIRST SVR DATA WITH THE NUCLEOSIDE ANALOGUE POLYMERASE INHIBITOR MERICITABINE (RG7128) COMBINED WITH PEGINTERFERON/RIBAVIRIN IN TREATMENT-NAIVE HCV G1/4 PATIENTS: INTERIM ANALYSIS FROM THE JUMP-C TRIAL P. Pockros, D. Jensen, N. Tsai, R.M. Taylor, A. Ramji, C. Cooper, R. Dickson, A. Tice, S. Stancic, D. Ipe, J.A. Thommes, J.M. Vierling. Scripps Clinic Research Center, La Jolla, CA, Center for Liver Diseases, University of Chicago Hospitals, Chicago, IL, Hawaii Medical Center, Honolulu, HI, The University of Kansas Hospital Medical Center, Kansas City, KS, USA; Division of Gastroenterology, University of British Columbia, Vancouver, BC, The Ottawa Hospital, Ottowa, ON, Canada; Dartmouth-Hitchcock Medical Center, Lebanon, NH, Infections Limited Hawaii, Honolulu, HI, Roche, Nutley, NJ, Genentech, South San Francisco, CA, Baylor College of Medicine, Houston, TX, USA E-mail: pockros.paul@scrippshealth.org Introduction: Mericitabine (RG7128, MCB) is a potent, selective nucleoside inhibitor of the HCV NS5B RNA-dependent RNA polymerase with activity across all HCV genotypes. MCB has demonstrated a high barrier to resistance without treatmentemergent resistance observed to date. Methods: JUMP-C is an ongoing randomised, double-blind, placebocontrolled phase 2b study in treatment naive patients infected with HCV G1/4. The trial objective was to compare a response guided therapy regimen of MCB plus peginterferon alfa-2a/ribavirin (P/R) with P/R alone. Patients randomised to arm A achieving an extended RVR (eRVR; HCVRNA
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- 2011
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8. Detection of anti-hepatitis C virus antibodies in patients undergoing dialysis by utilizing a hepatitis C virus 3.0 assay: correlation with hepatitis C virus RNA
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K. R. Reddy, H.O. Sullivan, M. De Medina, Eugene R. Schiff, Guido O. Perez, J.R Pennell, B. Leclerq, Mary Hill, and Jeffers Lj
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Adult ,Male ,Hepacivirus ,Hepatitis C virus ,Viremia ,medicine.disease_cause ,Polymerase Chain Reaction ,Virus ,Pathology and Forensic Medicine ,Immunoenzyme Techniques ,Flaviviridae ,mental disorders ,Medicine ,Humans ,Aged ,medicine.diagnostic_test ,biology ,business.industry ,virus diseases ,General Medicine ,Hepatitis C Antibodies ,Middle Aged ,biology.organism_classification ,medicine.disease ,Virology ,Real-time polymerase chain reaction ,Immunoassay ,Immunology ,RNA, Viral ,Female ,Viral disease ,business - Abstract
Hepatitis C virus (HCV) infection is endemic in long-term dialysis units. We assessed the performance of a recently developed HCV 3.0 assay for the detection of HCV antibodies in patients undergoing dialysis. The study evaluated 128 patients undergoing long-term maintenance hemodialysis. Anti-HCV was detected by 2.0 and 3.0 enzyme immunoassay (EIA). Results were confirmed with recombinant immunoblot assays (RIBA 2.0 and RIBA 3.0). HCV RNA was detected by using reverse transcriptase-polymerase chain reaction (RT-PCR). Thirty-two patients (25%) were HCV EIA 2.0 positive. Of these, 1 was RIBA 2.0 negative (PCR positive), 3 were indeterminate (3 PCR positive), and 28 were positive (23 PCR positive). Thirty-five (27%) were HCV EIA 3.0 positive. One was RIBA 3.0 negative (PCR positive), 1 was indeterminate (c33c, PCR positive), and 33 were positive (27 PCR positive) by RIBA 3.0. Thus only 1 PCR-positive patient was negative with RIBA 2.0 and 3.0 assays. Two of the 3 RIBA 2.0 indeterminate samples were positive with RIBA 3.0. One remained indeterminate but was HCV RNA positive. In summary, HCV 3.0 EIA detected 4 additional viremic patients but was positive in 6 PCR-negative subjects. A high correlation of the presence of antibody to c33c with HCV RNA (28 of 34, 82%) was found, and it was found in all anti-HCV positive samples and in 1 indeterminate sample. We conclude that the HCV EIA 3.0 test with the supplemental confirmatory RIBA 3.0 test may improve the sensitivity for the detection of anti-HCV. Nevertheless, in potentially immunocompromised patients undergoing dialysis, PCR continues to be the only reliable test for detecting viremia.
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- 1998
9. Recombinant factor VIIa corrects prothrombin time in cirrhotic patients: a preliminary study
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U Hedner, RM Bech, Eugene R. Schiff, Jeffers Lj, D. E. Bernstein, S Glazer, K. R. Reddy, E Erhardtsen, and P Squiban
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Adult ,Liver Cirrhosis ,Male ,medicine.medical_specialty ,Cirrhosis ,Factor VIIa ,Gastroenterology ,Fibrin Fibrinogen Degradation Products ,chemistry.chemical_compound ,Internal medicine ,Coagulopathy ,Medicine ,Humans ,Adverse effect ,Fibrinopeptide A ,Prothrombin time ,Disseminated intravascular coagulation ,Hepatology ,biology ,medicine.diagnostic_test ,Factor VII ,Dose-Response Relationship, Drug ,business.industry ,Middle Aged ,medicine.disease ,Recombinant Proteins ,Surgery ,chemistry ,Recombinant factor VIIa ,biology.protein ,Prothrombin Time ,Female ,Partial Thromboplastin Time ,business ,Intramuscular injection - Abstract
BACKGROUND & AIMS: Cirrhotic patients with a prolonged prothrombin time (PT) are known to have low levels of factor VII. Because the current modalities to correct this problem are not ideal, recombinant factor VIIa (rFVIIa) may be useful in correcting the prolonged PT observed in the coagulopathy of cirrhosis. The aim of this study was to evaluate the effectiveness of rFVIIa in nonbleeding volunteer patients with the coagulopathy of cirrhosis. METHODS: A preliminary, single-center, dose- escalation trial was performed. Cirrhotic patients with a PT of > 2 seconds above the upper limit of the reference value received an intramuscular injection of vitamin K. Ten patients whose PT did not correct to within 2 seconds above the control of the upper limit of the reference value were given three successive dosages of rFVIIa (5, 20, and 80 micrograms/kg) during a 3-week period. RESULTS: The mean PT transiently corrected to normal in all three dosage groups. No adverse effects were noted. There was no evidence of the induction of disseminated intravascular coagulation. CONCLUSIONS: This preliminary trial shows rFVIIa to be effective in transiently reversing the prolonged PT in a select group of nonbleeding cirrhotic patients. These preliminary observations support conducting a large-scale efficacy trial. (Gastroenterology 1997 Dec;113(6):1930-7)
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- 1997
10. Hepatitis C virus RNA quantification in right and left lobes of the liver in patients with chronic hepatitis C
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Jeffers Lj, Eugene R. Schiff, Peter J. Dailey, Mark L. Collins, Victor Idrovo, E. Coelho-little, L. Alvarez, Mickey S. Urdea, David Bernstein, and Maria Bartholomew
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Adult ,Male ,Hepatitis B virus DNA polymerase ,viruses ,Hepacivirus ,Biopsy ,Polymerase Chain Reaction ,Severity of Illness Index ,Liver disease ,Virology ,medicine ,BDNA test ,Humans ,Aged ,Hepatitis ,Hepatology ,medicine.diagnostic_test ,biology ,business.industry ,Nucleic Acid Hybridization ,Hepatitis C ,Middle Aged ,Viral Load ,medicine.disease ,biology.organism_classification ,Infectious Diseases ,Liver ,Liver biopsy ,RNA, Viral ,Female ,business ,Viral load - Abstract
Quantification of hepatitis C virus RNA in liver tissue is likely to be useful in the study of the natural history, pathogenesis, progression and treatment of hepatitis C virus-associated liver disease. Quantitative measurements of hepatitis C virus RNA in liver biopsy samples using the branched DNA (bDNA) signal amplification assay were carried out. The aims of this study were threefold: first, to assess the level of hepatitis C virus RNA in biopsy samples from the right and left lobes of the liver; second, to evaluate the correlation between hepatitis C virus RNA levels in serum and liver; and third, to investigate the relationship between serum and liver hepatitis C virus RNA levels and the severity of hepatic histology in non-cirrhotic patients with chronic hepatitis C. There was a strong correlation (r = 0.92, P < 0.01) between hepatitis C virus RNA levels in the right and left lobes of the liver as well as a strong correlation between hepatitis C virus RNA levels in liver and serum (r = 0.82, P < 0.01). However, there was no significant correlation between the severity of hepatic histology and levels of hepatitis C virus RNA in serum and liver among patients with chronic active hepatitis classified according to Knodell's hepatic activity index (KI). Our results indicate that hepatitis C virus RNA quantification from a single liver biopsy is representative of both lobes in patients with chronic hepatitis, and suggest that serum hepatitis C virus RNA levels are a meaningful reflection of hepatitis C virus RNA levels in the liver.
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- 1996
11. Hepatitis C virus in alcoholic patients with and without clinically apparent liver disease
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Eugene R. Schiff, K. R. Reddy, J. J. Goodman, D. E. Bernstein, M. De Medina, Mary Hill, Jeffers Lj, M. E. Coelho‐Little, S. La Rue, and X. Li
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Adult ,Male ,medicine.medical_specialty ,Alcoholic liver disease ,Hepatitis C virus ,Medicine (miscellaneous) ,Viremia ,Enzyme-Linked Immunosorbent Assay ,Hepacivirus ,Toxicology ,medicine.disease_cause ,Gastroenterology ,Polymerase Chain Reaction ,Virus ,Liver disease ,Flaviviridae ,Internal medicine ,Epidemiology ,medicine ,Humans ,Liver Diseases, Alcoholic ,biology ,business.industry ,virus diseases ,Hepatitis C Antibodies ,Middle Aged ,medicine.disease ,biology.organism_classification ,Hepatitis C ,digestive system diseases ,Psychiatry and Mental health ,Alcoholism ,Immunology ,biology.protein ,Antibody ,business - Abstract
A high prevalence of antibodies to the hepatitis C virus (anti-HCV) has been demonstrated among patients with alcoholic liver disease, whereas the prevalence of HCV viremia in these patients remains uncertain. The aims of this study were to determine the prevalence of anti-HCV in alcoholic patients both with and without clinically apparent liver disease and to determine the presence of HCV RNA in those patients who tested positive for anti-HCV by RIBA II (Chiron Corporation, Emeryville, CA). One hundred male patients consecutively admitted to an alcoholic rehabilitation program were included. Group 1 was comprised of 40 patients with clinically apparent liver disease. Group 2 was comprised of 60 patients without clinically apparent liver disease. Anti-HCV was performed by a second-generation ELISA assay and confirmed by RIBA II. HCV RNA was performed by Quantiplex assay (Chiron Corporation) and a nested reverse transcriptase-polymerase chain reaction. No significant differences were found between the two groups with regards to age, quantity and duration of alcohol intake, or accepted risk factors for HCV. The overall prevalence of anti-HCV in our patients was 23%, with 43% of these in group 1 and 10% in group 2. HCV RNA tested positive in 94% of the anti-HCV-positive patients in group 1 and in 67% of the anti-HCV-positive patients in group 2. These data suggest that HCV infection is an important cofactor in the pathogenesis of liver disease among alcoholic patients.
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- 1995
12. Identification of hepatitis C virus by immunoelectron microscopy
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X. Li, B. Moore, Eugene R. Schiff, K. R. Reddy, L. Shao, M. De Medina, Jeffers Lj, and J. Scheffel
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medicine.drug_class ,viruses ,Hepatitis C virus ,Immunoelectron microscopy ,Hepacivirus ,Biology ,Monoclonal antibody ,medicine.disease_cause ,Virus ,Inclusion Bodies, Viral ,Mice ,Virology ,medicine ,Centrifugation, Density Gradient ,Animals ,Humans ,Microscopy, Immunoelectron ,Hepatitis ,Hepatology ,Antibodies, Monoclonal ,Immunogold labelling ,Hepatitis C ,medicine.disease ,Molecular biology ,Infectious Diseases ,Blood ,Liver ,Transmission electron microscopy ,Hepatitis C Antigens - Abstract
Summary. Sequencing of the hepatitis C virus (HCV) has provided a better understanding of the natural history, immunology, and epidemiology of this virus. However, the morphology of HCV has not been definitively characterized. In this study, through a sequence of concentration processes, virus-like particles were isolated from human serum and liver tissue, visualized by transmission electron microscopy and identified as hepatitis C virion by immunoelectron microscopy. Spherical flavi-like virus particles, approximately 70 nm in diameter, were observed in the fraction with 1.04–1.12 g ml-1 sucrose density and bound to immunogold particles with monoclonal antibodies (mAb) against hepatitis C. The nucleocapsid of the particles, which were 50 nm in diameter, appeared to be icosahedral in structure and surrounded by an envelope covered with surface projections. A ‘tadpole’ form of particles was also observed. The findings indicate that the low buoyant density in sucrose and the morphological features of the hepatitis C virion are consistent with the characteristics of flaviviruses and pestiviruses.
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- 1995
13. Autoantibodies in sclerosing cholangitis against a shared peptide in biliary and colon epithelium
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Linda Squillante, Rajender Reddy, Eugene R. Schiff, Jeffers Lj, Aditya Mandal, Arunansu Dasgupta, Kiron M. Das, and Shakir A. Hyder
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Adult ,Male ,medicine.medical_specialty ,Pathology ,endocrine system diseases ,Colon ,Biliary Tract Diseases ,Cholangitis, Sclerosing ,Enzyme-Linked Immunosorbent Assay ,digestive system ,Gastroenterology ,Immunoglobulin G ,Epithelium ,Primary sclerosing cholangitis ,Immunoenzyme Techniques ,Epitopes ,Primary biliary cirrhosis ,Internal medicine ,medicine ,Humans ,Aged ,Autoantibodies ,Sclerosis ,Hepatology ,biology ,business.industry ,Bile duct ,Tissue Extracts ,Gallbladder ,digestive, oral, and skin physiology ,Autoantibody ,Antibodies, Monoclonal ,Middle Aged ,medicine.disease ,digestive system diseases ,medicine.anatomical_structure ,Blood ,Biliary tract ,biology.protein ,Female ,Bile Ducts ,Antibody ,business ,Peptides - Abstract
Background/Aims: A strong association exists between ulcerative colitis and primary sclerosing cholangitis (PSC). Previously, the presence of a unique epitope shared by colon and biliary epithelial cells was shown by using the novel monoclonal antibody (MAb) 7E12H12 developed against a colonic epithelial protein. In the present study, the presence of circulating autoantibody in PSC against this peptide was examined. Methods: Sera from 16 patients with PSC, 13 with primary biliary cirrhosis, 6 with secondary biliary stricture, and 6 with chronic liver diseases and 10 normal subjects were used. An inhibition immunoperoxidase assay using the 7E12H12 MAb was developed against sections of bile duct and gallbladder. Sera were also examined in an enzyme-linked immunosorbent assay (ELISA) against the gallbladder extract enriched in 7E12H12-reactive protein. Results: About two thirds of the sera from patients with PSC blocked the binding of 7E12H12 MAb on the bile duct and gallbladder, whereas non-PSC sera did not. In the ELISA, 93% of PSC sera had circulating immunoglobulin G antibodies against the enriched gallbladder extract. The reactivity of sera from the PSC group was significantly (P Conclusions: Sera from patients with PSC contains autoantibodies against a cross-reactive peptide shared by colon and biliary epithelial cells.
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- 1994
14. Hepatitis C in liver transplantation: preliminary study of prognostic factors
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Jeffers Lj, Rajender Reddy, J. Smith, Joshua Miller, Sharon Babischkin, M. Markow, Carmen Gomez, Violet Esquenazi, S. Larue, Manuel Carreno, Mustafa Allouch, Eugene R. Schiff, Jose Nery, Deborah Weppler, H. Gharagozloo, Robert Cirocco, J. Casella, Keith Zucker, G. Bourke, Talley Parker, Werviston De Faria, and Mary Hill
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Serotype ,Adult ,Male ,medicine.medical_specialty ,Time Factors ,Adolescent ,medicine.medical_treatment ,Black People ,Viremia ,Human leukocyte antigen ,Hepacivirus ,Liver transplantation ,Chronic liver disease ,Gastroenterology ,White People ,Hospitals, University ,Risk Factors ,Internal medicine ,medicine ,Humans ,Risk factor ,Child ,Survival rate ,Aged ,Retrospective Studies ,Transplantation ,business.industry ,Histocompatibility Testing ,Alanine Transaminase ,Hepatitis C ,gamma-Glutamyltransferase ,Middle Aged ,medicine.disease ,Prognosis ,Liver Transplantation ,Immunology ,Florida ,Female ,business ,Follow-Up Studies - Abstract
At the University of Miami liver transplantation for chronic liver disease in HCV-positive patients has shown good results, with a 92% patients survival rate (follow up 8 to 57 months, median 21). None the less, we found that a large number of patients are expected to develop serious histological graft damage and may need retransplantation, which may place a further strain on the already scarce donor resources. We have conducted a preliminary investigation on the importance of parameters which may correlate with the prognosis of HCV grafts. We found no impact of HLA match or typing. An interesting hypothesis, which deserves further investigation, is that some HCV strains could be more virulent than others and play a role as an independent risk factor. We have identified six strains among our patients and the BK serotype shows a trend to be associated with a worse outcome. We have found that patients developing and maintaining higher liver enzyme levels (ALT and GGT) after transplant and those with higher levels of viremia may be at risk to develop serious damage to their grafts.
- Published
- 1994
15. Indeterminate hepatitis C
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Eugene R. Schiff, K. R. Reddy, X. Li, Talley Parker, M. De Medina, and Jeffers Lj
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business.industry ,Immunoblotting ,General Medicine ,Hepatitis C ,Hepacivirus ,medicine.disease ,Virology ,Polymerase Chain Reaction ,Text mining ,medicine ,Humans ,RNA, Viral ,Indeterminate ,business - Published
- 1993
16. The use of recombinant factor VIIA (rFVIIA) in laparoscopic liver biopsy (LB): A pilot trial
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David E. Bernstein, E Erhardsten, Eugene R. Schiff, K. R. Reddy, W Acebo, RM Bech, and Jeffers Lj
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medicine.medical_specialty ,Hepatology ,biology ,business.industry ,Recombinant factor VIIa ,Pilot trial ,Gastroenterology ,biology.protein ,Medicine ,Laparoscopic liver biopsy ,business ,Surgery - Published
- 1998
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17. Correlation between CT and laparoscopy findings in patients with hepatocellular carcinoma
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P. Mendez, Enrique Molina, K. R. Reddy, Jeffers Lj, Salvatore Badalamenti, and Eugene R. Schiff
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medicine.medical_specialty ,Hepatology ,medicine.diagnostic_test ,business.industry ,Hepatocellular carcinoma ,General surgery ,Gastroenterology ,medicine ,In patient ,Radiology ,medicine.disease ,business ,Laparoscopy - Published
- 1998
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18. Pegylated (40 KDA) interferon alfa-2a (PEGASYS®) in new combination therapies: a report of a randomized, multicenter efficacy and safety study
- Author
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Norman Gitlin, V.R. Rustgi, David E. Bernstein, D. Simon, Stephen C. Pappas, Jeffers Lj, A. M. Di Bisceglie, and J. Campagna
- Subjects
Oncology ,medicine.medical_specialty ,Hepatology ,business.industry ,Internal medicine ,Interferon alfa-2a ,Medicine ,business - Published
- 2001
- Full Text
- View/download PDF
19. Fulminant hepatitis A: Coincidence or a new trend?
- Author
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Kapur, A, primary, Molina, EG, additional, Rodriguez, MJ, additional, Reddy, KR, additional, Jeffers, LJ, additional, Weppler, D, additional, Tzakis, AG, additional, and Schiff, ER, additional
- Published
- 1998
- Full Text
- View/download PDF
20. The use of recombinant factor VIIA (rFVIIA) in laparoscopic liver biopsy (LB): A pilot trial
- Author
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Jeffers, LJ, primary, Bernstein, DE, additional, Erhardsten, E, additional, Acebo, W, additional, Reddy, KR, additional, Bech, RM, additional, and Schiff, ER, additional
- Published
- 1998
- Full Text
- View/download PDF
21. Prevalence of hepatitis C and G virus infection in chronic hemodialysis patients
- Author
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de Medina, M, primary, Ashby, M, additional, Schluter, V, additional, Hill, M, additional, Leclerq, B, additional, Pennell, JP, additional, Jeffers, LJ, additional, Reddy, KR, additional, Schiff, ER, additional, Hess, G, additional, and Perez, GO, additional
- Published
- 1998
- Full Text
- View/download PDF
22. Diagnostic laparoscopy: a 5-year experience in a hepatology training program
- Author
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Vargas, C, primary, Jeffers, LJ, additional, Bernstein, D, additional, Reddy, KR, additional, Munnangi, S, additional, Behar, S, additional, Scott, C, additional, Parker, T, additional, and Schiff, ER, additional
- Published
- 1995
- Full Text
- View/download PDF
23. Fulminant hepatitis A: Coincidence or a new trend?
- Author
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Deborah Weppler, A. Kapur, Eugene R. Schiff, Enrique Molina, Jeffers Lj, K. R. Reddy, Andreas G. Tzakis, and Miguel J. Rodriguez
- Subjects
medicine.medical_specialty ,Hepatology ,business.industry ,Internal medicine ,Gastroenterology ,medicine ,Fulminant hepatitis ,business ,Coincidence - Published
- 1998
- Full Text
- View/download PDF
24. Hypertriglyceridemia: An explanation of persistant ALT elevation despite favorable virologic response to interferon/ribavirin treatment of chronic hepatitis C
- Author
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R. Khan, W. Jafri, Eugene R. Schiff, Salvatore Badalamenti, David I. Bernstein, and Jeffers Lj
- Subjects
medicine.medical_specialty ,Randomization ,Hepatology ,business.industry ,Ribavirin ,Hypertriglyceridemia ,Gastroenterology ,virus diseases ,Alpha interferon ,Hepatitis C ,medicine.disease ,Virology ,digestive system diseases ,Persistence (computer science) ,chemistry.chemical_compound ,chemistry ,Chronic hepatitis ,Interferon ,Internal medicine ,medicine ,business ,medicine.drug - Abstract
Background and Aim: Hepatitis C continues to be a major cause for chronic hepatitis. Presently, alpha interferons are available to treat it with limited success. Interferon/Ribavirin treatment has been shown to be efficacious in sustaining virological, biochemical, and histological remission. In some cases, there have been a discordance between virologic and biochemical responses, e.g. persistence of ALT elevation despite undetectable HCV-RNA. The aim of this study is to determine if hypertriglyceridemia or other factors explain the discordance between ALT and HCV-RNA responses. Patient and Methods: 37 patients who were part of an Interferon/Ribavirin protocol for non-responders and relapsers were evaluated. Ages ranged from 32 to 53 years (mean age 44 years); there were 23 males and 14 females. All patients were treated with alpha interferon, 5 million units t.i.w, and Ribavirin 600 -1000 mg/day based on randomization. HCV-RNA, ALT and AST were evaluated at baseline and at 12 weeks. Results: 27/37 patients had >50% reduction in HCV-RNA with normalization of ALT (Group 1). 10/37 patient had >50% reduction in HCV-RNA, but had ~ersistent elevation of ALT (Group 2).
- Published
- 1998
- Full Text
- View/download PDF
25. The use of 2 mm laparoscope to evaluate bleeding at the trocar site during diagnostic laparoscopy
- Author
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Salvatore Badalamenti, Eugene R. Schiff, Jeffers Lj, K.R. Reddy, P. Mendez, and Enrique Molina
- Subjects
medicine.medical_specialty ,Hepatology ,business.industry ,Medicine ,Diagnostic laparoscopy ,business ,Trocar site ,Surgery - Published
- 1998
- Full Text
- View/download PDF
26. Ascites predicts the presence of high grade varices by screening gastroscopy
- Author
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J Lavergne, AK Nader, Enrique Molina, K. R. Reddy, Jeffers Lj, Roberto León, and Eugene R. Schiff
- Subjects
medicine.medical_specialty ,business.industry ,Internal medicine ,Ascites ,Gastroenterology ,Medicine ,Radiology, Nuclear Medicine and imaging ,medicine.symptom ,business ,Varices - Published
- 1997
- Full Text
- View/download PDF
27. Laparoscopic and histological findings in patients with chronic hepatitis C virus infection correlation with platelet count
- Author
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F Civantos, K. R. Reddy, J Lavergne, AK Nader, David Bernstein, A Fazel, A Watane, Eugene R. Schiff, Jeffers Lj, C Milikowsky, Enrique Molina, and Roberto León
- Subjects
Pathology ,medicine.medical_specialty ,Chronic hepatitis ,business.industry ,Gastroenterology ,Medicine ,Radiology, Nuclear Medicine and imaging ,In patient ,Platelet ,business ,Virus - Published
- 1997
- Full Text
- View/download PDF
28. A pilot study using 2 mm minilaparoscope for the evaluation of liver diseases
- Author
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Enrique J. Martinez, Roberto León, Enrique Molina, Jeffers Lj, P. Rassam, Eugene R. Schiff, J Lavergne, AK Nader, and K. R. Reddy
- Subjects
medicine.medical_specialty ,business.industry ,Internal medicine ,Gastroenterology ,medicine ,Radiology, Nuclear Medicine and imaging ,business - Published
- 1997
- Full Text
- View/download PDF
29. Procollagen-III Peptide and Chronic Viral C Hepatitis
- Author
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M. De Medina, E Coelho-Little, Carlos Eduardo Orihuela Vargas, M Hills, Tally Parker, F Civantos, Eugene R. Schiff, Hugo Cheinquer, S. Larue, Jeffers Lj, L Alvarez, K. Rajender Reddy, and Xingjia Li
- Subjects
Hepatitis ,Hepatology ,business.industry ,Hepatitis B virus DNA polymerase ,Gastroenterology ,Medicine ,business ,medicine.disease ,Virology ,Procollagen iii peptide - Published
- 1995
- Full Text
- View/download PDF
30. Changes in HCV anti-core and anti-E2 antibody levels relative to response to interferon treatment
- Author
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M. Bartholomew, M de Medina, B Burres, K. R. Reddy, Eugene R. Schiff, David I. Bernstein, Mary C. Kuhns, R Johnson, Anne L. McNamara, Vinod K. Rustgi, H. O'sullivan, and Jeffers Lj
- Subjects
Core (anatomy) ,Hepatology ,Interferon ,business.industry ,medicine ,Antibody level ,business ,Virology ,medicine.drug - Published
- 1995
- Full Text
- View/download PDF
31. Hepatitis G virus infection in patients with acute and chronic liver disease of unknown etiology
- Author
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M de Medina, A Yun, K. R. Reddy, E Coelho-Little, Eugene R. Schiff, Jeffers Lj, M Piatak, Jungsuh P. Kim, JD Lifson, and David E. Bernstein
- Subjects
medicine.medical_specialty ,Hepatology ,business.industry ,Internal medicine ,medicine ,Etiology ,In patient ,Chronic liver disease ,medicine.disease ,business ,Gastroenterology ,Virus ,Hepatitis G - Published
- 1995
- Full Text
- View/download PDF
32. E1 antibody level monitoring predicts long term response of hepatitis C virus(HCV) infection in patients treated with interferon (IFN)
- Author
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S. Jonnalagadda, B Price, David E. Bernstein, G Maertens, K. R. Reddy, A Ducatteeuw, AT Banks, L Wolfe, Jeffers Lj, S Lombardi, Eugene R. Schiff, and M. DeMedina
- Subjects
Long term response ,Hepatology ,Interferon ,business.industry ,Hepatitis C virus ,medicine ,Antibody level ,In patient ,medicine.disease_cause ,business ,Virology ,medicine.drug - Published
- 1995
- Full Text
- View/download PDF
33. Confocal laser scanning microscopy (CLSM) observation of cultured human hepatocytes infected with HCV in vitro
- Author
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E.A. Roberts, David E. Bernstein, M. de Medine, Eugene R. Schiff, Jeffers Lj, X. Li, and K. R. Reddy
- Subjects
Hepatology ,Chemistry ,Gastroenterology ,Confocal laser scanning microscopy ,Biophysics ,In vitro - Published
- 1995
- Full Text
- View/download PDF
34. The role of diagnostic laparoscopy in the diagnosis of cirrhosis
- Author
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T. Cornell, S. Munnangi, T. Banks, J. Poniachik, David E. Bernstein, Eugene R. Schiff, K. R. Reddy, M. Bartholomew, Jeffers Lj, and S. Jonnalagadda
- Subjects
medicine.medical_specialty ,Cirrhosis ,business.industry ,General surgery ,Gastroenterology ,Medicine ,Radiology, Nuclear Medicine and imaging ,Diagnostic laparoscopy ,business ,medicine.disease - Published
- 1995
- Full Text
- View/download PDF
35. Resection of metachronous hepatocellular carcinomas
- Author
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Jeffers Lj, Schiff Er, Robert Zeppa, K. R. Reddy, and S.C. Gordon
- Subjects
Adult ,Reoperation ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,business.industry ,Liver Neoplasms ,General Medicine ,Partial hepatectomy ,medicine.disease ,Resection ,Hepatic neoplasm ,Hepatocellular carcinoma ,Rare case ,Medicine ,Hepatectomy ,Humans ,Female ,Radiology ,alpha-Fetoproteins ,Neoplasm Recurrence, Local ,business - Abstract
We have described the rare case of a woman with no recognized predisposing factors for hepatocellular carcinoma in whom a second hepatic neoplasm was successfully resected nine years after a presumed "curative" partial hepatectomy. The importance of long-term measurements of available tumor markers as well as aggressive surgical management is emphasized.
- Published
- 1986
36. 'Love Boat' Hepatitis
- Author
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Schiff Er, S.C. Gordon, Jeffers Lj, and K. R. Reddy
- Subjects
Hepatitis ,medicine.medical_specialty ,Sexual behavior ,business.industry ,Family medicine ,medicine ,General Medicine ,Hepatitis B ,medicine.disease ,business - Published
- 1985
- Full Text
- View/download PDF
37. E1 antibody level monitoring predicts long term response of hepatitis C virus(HCV) infection in patients treated with interferon (IFN)
- Author
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Jeffers, LJ, Banks, AT, Jonnalagadda, S, Maertens, G, Reddy, KR, Bernstein, DE, Ducatteeuw, A, Wolfe, L, Lombardi, S, Price, B, deMedina, M, and Schiff, ER
- Published
- 1995
- Full Text
- View/download PDF
38. Hepatitis G virus infection in patients with acute and chronic liver disease of unknown etiology
- Author
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Jeffers, LJ, Piatak, M, Bernstein, DE, Reddy, KR, Lifson, JD, Yun, A, Coelho-Little, E, de Medina, M, Kim, JP, and Schiff, ER
- Published
- 1995
- Full Text
- View/download PDF
39. Changes in HCV anti-core and anti-E2 antibody levels relative to response to interferon treatment
- Author
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Kuhns, MC, Bartholomew, M, Rustgi, V, Reddy, KR, Jeffers, LJ, de Medina, M, McNamara, A, Burres, B, Johnson, R, Bernstein, D, O'Sullivan, H, and Schiff, ER
- Published
- 1995
- Full Text
- View/download PDF
40. Sofosbuvir and Simeprevir Combination Therapy for HCV Genotype 1 Infection: Results of a Single-Center VA Experience.
- Author
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Sclair SN, Hernandez MD, Vance E, Gilinski D, Youtseff H, Toro M, Antoine M, Jeffers LJ, and Peyton A
- Abstract
Treatment of chronic hepatitis C virus (HCV) infection remains a priority in the veterans affairs (VA) health care system nationwide, as there is a high burden of liver disease due to HCV infection among US veterans. The combination of sofosbuvir and simeprevir was the first all-oral antiviral regimen used in clinical practice to treat veterans with HCV infection. In this study, we report a single-center experience showing both the feasibility and effectiveness of this all-oral combination to treat HCV genotype 1 infection. One hundred patients with HCV genotype 1 infection were treated between December 2013 and June 2014. Eighty-six patients were treated with sofosbuvir and simeprevir, with or without ribavirin, for 12 weeks; 12 patients were treated with sofosbuvir, pegylated interferon, and ribavirin for 12 weeks; and 2 patients were treated with sofosbuvir and ribavirin for 24 weeks. Overall, treatment was well tolerated and feasible, with compliance rates over 95% in patients treated with all-oral therapy. The sustained virologic response (SVR) rate for sofosbuvir and simeprevir (88.4%) was superior to the rate for sofosbuvir, pegylated interferon, and ribavirin (50.0%). Subgroup analysis showed diminished SVR rates in cirrhotic patients vs noncirrhotic patients. There were no significant differences in SVR when comparing treatment with or without ribavirin or among genotype subtypes. In conclusion, this study demonstrated excellent completion rates for all-oral treatment of veterans with chronic HCV infection. Additionally, treatment was highly effective, nearing a 90% cure rate. Thus, we recommend that the VA health care system continue to incorporate new HCV medications into its formulary so as to expand HCV treatment for US veterans.
- Published
- 2016
41. Safety and efficacy of ledipasvir-sofosbuvir in black patients with hepatitis C virus infection: A retrospective analysis of phase 3 data.
- Author
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Wilder JM, Jeffers LJ, Ravendhran N, Shiffman ML, Poulos J, Sulkowski MS, Gitlin N, Workowski K, Zhu Y, Yang JC, Pang PS, McHutchison JG, Muir AJ, Howell C, Kowdley K, Afdhal N, and Reddy KR
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Antiviral Agents adverse effects, Benzimidazoles adverse effects, Female, Fluorenes adverse effects, Humans, Male, Middle Aged, Retrospective Studies, Sofosbuvir, Treatment Outcome, Uridine Monophosphate adverse effects, Uridine Monophosphate therapeutic use, Young Adult, Black or African American, Antiviral Agents therapeutic use, Benzimidazoles therapeutic use, Fluorenes therapeutic use, Hepatitis C, Chronic drug therapy, Uridine Monophosphate analogs & derivatives
- Abstract
Unlabelled: Black patients chronically infected with genotype 1 hepatitis C virus (HCV) have historically had lower rates of response to interferon-based treatment than patients of other races. In the phase 3 ION program, the single-tablet regimen of the NS5A inhibitor ledipasvir and NS5B nucleotide polymerase inhibitor sofosbuvir was shown to be safe and highly effective in the general population. The aim of this study was to evaluate the safety and efficacy of ledipasvir/sofosbuvir in black patients using data from the three open-label ION clinical trials, which evaluated the safety and efficacy of 8, 12, and 24 weeks of ledipasvir/sofosbuvir with or without ribavirin for the treatment of treatment-naïve and treatment-experienced patients with genotype 1 HCV, including those with compensated cirrhosis. The primary endpoint was sustained virologic response at 12 weeks after the end of therapy (SVR12). For our analysis, rates of SVR12, treatment-emergent adverse events, and graded laboratory abnormalities were analyzed in black versus non-black patients. Of the 1949 patients evaluated, 308 (16%) were black. On average, black patients were older, had higher body mass index, were more likely to be IL28B non-CC, and had a lower serum alanine aminotransferase at baseline than non-black patients. Overall, 95% of black and 97% of non-black patients achieved SVR12. The rate of relapse was 3% in black patients as compared with 2% in non-black patients. The most common adverse events included fatigue, headache, nausea, and insomnia. The majority of adverse events occurred more frequently in the ribavirin-containing arms of the studies. No differences were observed in overall safety by race., Conclusion: A once-daily dosage of ledipasvir/sofosbuvir was similarly effective in black and non-black patients with genotype 1 HCV infection. The addition of ribavirin did not appear to increase SVR12 but was associated with higher rates of adverse events., (© 2015 The Authors. HEPATOLOGY published by Wiley Periodicals, Inc., on behalf of the American Association for the Study of Liver Diseases.)
- Published
- 2016
- Full Text
- View/download PDF
42. The effect of donor race on the survival of Black Americans undergoing liver transplantation for chronic hepatitis C: is racial mismatch a predictor of graft survival?
- Author
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Hernandez MD and Jeffers LJ
- Subjects
- Hepatitis C, Chronic mortality, Humans, Liver Transplantation adverse effects, Liver Transplantation mortality, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Black or African American, Graft Survival, Health Status Disparities, Hepatitis C, Chronic ethnology, Hepatitis C, Chronic surgery, Liver Transplantation ethnology, Tissue Donors, White People
- Published
- 2009
- Full Text
- View/download PDF
43. Peginterferon alfa-2a and ribavirin in Latino and non-Latino whites with hepatitis C.
- Author
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Rodriguez-Torres M, Jeffers LJ, Sheikh MY, Rossaro L, Ankoma-Sey V, Hamzeh FM, and Martin P
- Subjects
- Adult, Alanine Transaminase blood, Antiviral Agents adverse effects, Drug Therapy, Combination, Female, Genotype, Hepacivirus genetics, Hepatitis C, Chronic drug therapy, Hepatitis C, Chronic virology, Humans, Interferon alpha-2, Interferon-alpha adverse effects, Liver pathology, Logistic Models, Male, Middle Aged, Polyethylene Glycols adverse effects, Prospective Studies, Recombinant Proteins, Recurrence, Ribavirin adverse effects, Viral Load, White People, Young Adult, Antiviral Agents therapeutic use, Hepatitis C, Chronic ethnology, Hispanic or Latino, Interferon-alpha therapeutic use, Polyethylene Glycols therapeutic use, Ribavirin therapeutic use
- Abstract
Background: Race has been shown to be a factor in the response to therapy for hepatitis C virus (HCV) infection, and limited data suggest that ethnic group may be as well; however, Latinos and other ethnic subpopulations have been underrepresented in clinical trials. We evaluated the effect of Latino ethnic background on the response to treatment with peginterferon alfa-2a and ribavirin in patients infected with HCV genotype 1 who had not been treated previously., Methods: In a multicenter, open-label, nonrandomized, prospective study, 269 Latino and 300 non-Latino whites with HCV infection received peginterferon alfa-2a, at a dose of 180 microg per week, and ribavirin, at a dose of 1000 or 1200 mg per day, for 48 weeks, and were followed through 72 weeks. The primary end point was a sustained virologic response. We enrolled Latinos whose parents and grandparents spoke Spanish as their primary language; nonwhite Latinos were excluded., Results: Baseline characteristics were similar in the Latino and non-Latino groups, although higher proportions of Latino patients were 40 years of age or younger, had a body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) of more than 27 or more than 30, and had cirrhosis. The rate of sustained virologic response was higher among non-Latino whites than among Latinos (49% vs. 34%, P<0.001). The absence of HCV RNA in serum was more frequent in non-Latino whites at week 4 (P=0.045) and throughout the treatment period (P<0.001 for all other comparisons). Latino or non-Latino background was an independent predictor of the rate of sustained virologic response in an analysis adjusted for baseline differences in BMI, cirrhosis, and other characteristics. Adherence to treatment did not differ significantly between the two groups. The numbers of patients with adverse events and dose modifications were similar in the two groups, but fewer Latino patients discontinued therapy because of adverse events., Conclusions: Treatment with peginterferon alfa-2a and ribavirin for 48 weeks resulted in rates of sustained virologic response among patients infected with HCV genotype 1 that were lower among Latino whites than among non-Latino whites. Strategies to improve the sustained virologic response in Latinos are needed. (ClinicalTrials.gov number, NCT00107653.), (2009 Massachusetts Medical Society)
- Published
- 2009
- Full Text
- View/download PDF
44. Correlation of Laparoscopic Liver Biopsy to Elasticity Measurements (FibroScan) in Patients With Chronic Liver Disease.
- Author
-
Nudo CG, Jeffers LJ, Bejarano PA, Servin-Abad LA, Leibovici Z, De Medina M, and Schiff ER
- Abstract
Background: Elastography is a noninvasive method to assess liver fibrosis by measuring liver stiffness. Studies have compared elas-tography to percutaneous biopsy. Laparoscopic biopsy is associated with decreased sampling error compared to percutaneous biopsy, as laparoscopic biopsies are obtained from both liver lobes and gross nodu-larity can be visualized., Methods: Patients undergoing laparoscopic liver biopsy were enrolled. Gross liver appearance was assessed, and biopsy specimens were blindly evaluated by a pathologist. Elastography (FibroScan) was used to measure liver stiffness., Results: 101 patients were examined. Fibrosis was related to elasticity (Spearman correlation r=0.63; P<.0001). Elasticity was strongly associated with advanced stages of fibrosis (stages 3 and 4; Spearman correlation r(2)=0.44; P<.001). Significant fibrosis was associated with an irregular liver surface, nodularity, and thickened edge (multiple regression r(2)=0.41; P<.001). Increased elasticity was associated with a fatty-appearing liver, irregular surface, firmness, and nodularity (multiple regression r(2)=0.46; P<.001). Receiver operating characteristic curve for elasticity for identifying patients with a liver fibrosis stage of at least 3 or of 4 had an area under the curve (AUC) of 0.85 or 0.86, respectively. AUC was 0.857 when gross nodularity was used as the gold standard for cirrhosis and 0.875 when nodularity/histology were used. Elasticity of at least 7 kPa, at least 9.5 kPa, and at least 11.8 kPa had the highest accuracy for identifying patients with a fibrosis stage of at least 2, at least 3, and 4, respectively. In hepatitis C patients, AUC was 0.921, 0.882, and 0.925 when histology, gross nodularity, and nodularity/histology, respectively, were used as the gold standard for cirrhosis., Conclusion: FibroScan could be useful for detecting advanced stages of fibrosis when validated against laparoscopic liver biopsy.
- Published
- 2008
45. Distinct BRCT domains in Mcph1/Brit1 mediate ionizing radiation-induced focus formation and centrosomal localization.
- Author
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Jeffers LJ, Coull BJ, Stack SJ, and Morrison CG
- Subjects
- Amino Acid Sequence, Animals, Avian Proteins genetics, BRCA1 Protein genetics, Cell Cycle Proteins, Cell Line, Chickens, Cytoskeletal Proteins, Molecular Sequence Data, Nerve Tissue Proteins genetics, Peptide Fragments genetics, Protein Structure, Tertiary genetics, Avian Proteins physiology, B-Lymphocytes metabolism, B-Lymphocytes radiation effects, BRCA1 Protein physiology, Centrosome metabolism, Nerve Tissue Proteins physiology, Peptide Fragments physiology
- Abstract
Microcephalin (MCPH1/BRIT1) forms ionizing radiation-induced nuclear foci (IRIF) and is required for DNA damage-responsive S and G(2)-M-phase checkpoints. MCPH1 contains three BRCT domains. Here we report the cloning of chicken Mcph1 (cMcph1) and functional analysis of its individual BRCT domains. Full-length cMcph1 localized to centrosomes throughout the cell cycle and formed IRIF that colocalized with gamma-H2AX. The tandem C-terminal BRCT2 and BRCT3 domains of cMcph1 were necessary for IRIF formation, while the N-terminal BRCT1 was required for centrosomal localization in irradiated cells. Centrosomal targeting of cMcph1 was independent of ATM, Brca1 or Chk1. cMcph1 formed IRIF in ATM- and Brca1-deficient cells, but not in H2AX-deficient cells. Inability to form cMcph1 IRIF impaired the cellular response to DNA damage. These results suggest that the role of microcephalin in the vertebrate DNA damage response is controlled by interaction of the C-terminal BRCT domains with gamma-H2AX.
- Published
- 2008
- Full Text
- View/download PDF
46. Prospective Evaluation of FIBROSpect II for Fibrosis Detection in Hepatitis C and B Patients Undergoing Laparoscopic Biopsy.
- Author
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Jeffers LJ, Cortes RA, Bejarano PA, Oh E, Regev A, Smith KM, De Medina M, Smith-Riggs M, Colon M, Hettinger K, Jara S, Mendez TP, and Schiff ER
- Abstract
Serum markers of liver fibrosis are difficult to validate, due to the sampling error and observer variability associated with percutaneous liver biopsies. Laparoscopic biopsy decreases sampling error and increases the reliability of histopathologic assessment. We prospectively evaluated the FIBROSpect(SM) II serum marker test for viral liver fibrosis against laparoscopic biopsies by studying 145 patients with chronic hepatitis B or C who underwent laparoscopy in a tertiary care setting. Serum samples obtained at biopsy were tested with FIBROSpect II to assess the degree of fibrosis. Multiple biopsies were obtained from each patient and scored blindly using the Batts-Ludwig system. An average biopsy stage was calculated and the performance of the test panel assessed. FIBROSpect II was able to rule in significant fibrosis (stages 2-4), with a likelihood ratio of 2.6. It correctly indicated absence of disease in 74% of stages 0-1 patients and correctly predicted significant disease in 67% of stages 2-4 patients. Test correlation was highest with Batts-Ludwig stages 3 (77%) and 4 (96%) and lowest with stage 2 (43%). Multiple biopsies from 52% of patients differed by at least 1 stage. In 13 patients (9%), cirrhosis was detected by laparoscopy but not histologically; in 4 (3%), a stage of 4 was obtained, but cirrhosis was not evident by laparoscopy. FIBROSpect II provided valuable additional information for assessing fibrosis. The discordance in fibrosis stage seen in multiple biopsies from the same patient underscores the need to consider all available information when assessing fibrosis. This study confirms and extends results of previous studies evaluating FIBROSpect II using percutaneous liver biopsy.
- Published
- 2007
47. Treating hepatitis C in African Americans.
- Author
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Jeffers LJ
- Subjects
- Antiviral Agents therapeutic use, Hepatitis C, Chronic diagnosis, Hepatitis C, Chronic therapy, Humans, Liver Transplantation, Black or African American, Hepatitis C, Chronic ethnology
- Abstract
Background: The epidemiology, natural history and response to therapy of chronic hepatitis C differs significantly between African Americans and other ethnic populations. The reasons for these differences are not entirely clear but include mode of transmission, viral kinetics, immune responsiveness, and demographics., Objective: Review of the peer-reviewed literature and expert opinion from 1990 to 2005 regarding features of hepatitis C virus (HCV) infection in African Americans, differences in presentation and response to therapy, and treatment recommendations., Results: The epidemiology of HCV infection in African Americans appears to be predominantly associated with socio-economic status and high-risk behaviors. However, disease course, response to treatment, and virologic outcome may be a function of race. African Americans may clear HCV less efficiently than other ethnic groups, although impaired immune responsivity may also lead to decreased necro-inflammatory activity and progression to cirrhosis. Therapy-naive African Americans have lower sustained virologic response rates to this treatment than other populations., Conclusions: Strategies to improve outcomes in African Americans include higher doses of current medications, medications with fewer adverse events, and new experimental molecular therapies.
- Published
- 2007
- Full Text
- View/download PDF
48. Imatinib mesylate (gleevec) hepatotoxicity.
- Author
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Mindikoglu AL, Regev A, Bejarano PA, Martinez EJ, Jeffers LJ, and Schiff ER
- Subjects
- Aged, Alanine Transaminase blood, Alkaline Phosphatase blood, Aspartate Aminotransferases blood, Benzamides, Bilirubin blood, Blood Cell Count, Erythrocyte Indices, Humans, Imatinib Mesylate, Leukemia, Myelogenous, Chronic, BCR-ABL Positive drug therapy, Liver Failure blood, Liver Failure pathology, Male, Necrosis, Prothrombin Time, Time Factors, Antineoplastic Agents adverse effects, Liver Failure chemically induced, Piperazines adverse effects, Protein Kinase Inhibitors adverse effects, Pyrimidines adverse effects
- Published
- 2007
- Full Text
- View/download PDF
49. Modeling hepatic fibrosis in African American and Caucasian American patients with chronic hepatitis C virus infection.
- Author
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Fontana RJ, Kleiner DE, Bilonick R, Terrault N, Afdhal N, Belle SH, Jeffers LJ, Ramcharran D, Ghany MG, and Hoofnagle JH
- Subjects
- Analysis of Variance, Area Under Curve, Biopsy, Hepatitis C, Chronic complications, Hepatitis C, Chronic virology, Humans, Liver Cirrhosis etiology, Multivariate Analysis, RNA analysis, ROC Curve, Reproducibility of Results, Severity of Illness Index, Black or African American, Hepacivirus genetics, Hepatitis C, Chronic ethnology, Liver Cirrhosis ethnology, Logistic Models, White People
- Abstract
Assessment of histological stage is an integral part of disease management in patients infected with the hepatitis C virus (HCV). The aim of this study was to develop a model incorporating objective clinical and laboratory parameters to estimate the probability of severe fibrosis (i.e., Ishak fibrosis > or = 3) in previously untreated African American (AA) and Caucasian American (CA) patients with HCV genotype 1. The Ishak fibrosis scores of 205 CA and 194 AA patients enrolled in the Viral Resistance to Antiviral Therapy of Chronic Hepatitis C study (Virahep-C) were modeled using simple and multiple logistic regression. The model was then validated in an independent cohort of 461 previously untreated patients with HCV. The distribution of fibrosis scores was similar in the AA and CA patients as was the proportion of patients with severe fibrosis (35% vs. 39%, P = .47). After accounting for the number of portal areas in the biopsy, patient age, serum aspartate aminotransferase, alkaline phosphatase, and platelet count were independently associated with severe fibrosis in the overall cohort, and the relationship with fibrosis was similar in both the AA and CA subgroups. The area under the receiver operating characteristic curve (AUROC) of the Virahep-C model (0.837) was significantly better than in other published models (P = .0003). The AUROC of the Virahep-C model was 0.851 in the validation population. In conclusion, a model consisting of widely available clinical and laboratory features predicted severe hepatic fibrosis equally well in AA and CA patients with HCV genotype 1 and was superior to other published models. The excellent performance of the Virahep-C model in an external validation cohort suggests the findings are replicable and potentially generalizable.
- Published
- 2006
- Full Text
- View/download PDF
50. Peginterferon and ribavirin treatment in African American and Caucasian American patients with hepatitis C genotype 1.
- Author
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Conjeevaram HS, Fried MW, Jeffers LJ, Terrault NA, Wiley-Lucas TE, Afdhal N, Brown RS, Belle SH, Hoofnagle JH, Kleiner DE, and Howell CD
- Subjects
- Adolescent, Adult, Aged, Drug Carriers, Drug Therapy, Combination, Female, Follow-Up Studies, Genotype, Hepatitis C ethnology, Hepatitis C virology, Humans, Interferon alpha-2, Male, Middle Aged, RNA, Viral genetics, Recombinant Proteins, Retrospective Studies, Treatment Outcome, United States epidemiology, Black or African American, Antiviral Agents therapeutic use, Hepacivirus genetics, Hepatitis C drug therapy, Interferon-alpha therapeutic use, Polyethylene Glycols therapeutic use, Ribavirin therapeutic use, White People
- Abstract
Background & Aims: Compared with Caucasian Americans (CA), African Americans (AA) with chronic hepatitis C are less likely to respond to interferon-based antiviral therapy., Methods: In a multicenter treatment trial, 196 AA and 205 CA treatment-naive patients with hepatitis C virus (HCV) genotype 1 infection were treated with peginterferon alfa-2a (180 microg/wk) and ribavirin (1000-1200 mg/day) for up to 48 weeks. The primary end point was sustained virologic response (SVR)., Results: Baseline features were similar among AA and CA, including HCV-RNA levels and histologic severity, but AA had higher body weights, a higher prevalence of diabetes and hypertension, and lower alanine transaminase levels (P < .001 for all). The SVR rate was 28% in AA and 52% in CA (P < .0001). Racial differences in viral responses were evident as early as treatment week 4. Breakthrough viremia was more frequent among AA than CA (13% vs 6%, P = .05); relapse rates were comparable (32% vs 25%, P = .30). Proportions of patients with serious adverse events and dose modifications and discontinuations were similar among AA and CA. In multiple regression analyses, CA had a higher SVR rate than AA (relative risk, 1.96; 95% confidence interval, 1.48-2.60; P < .0001). Other factors independently associated with higher SVR included female sex, lower baseline HCV-RNA level, less hepatic fibrosis, and more peginterferon taken., Conclusions: AA with chronic hepatitis C genotype 1 have lower rates of virologic response to peginterferon and ribavirin than CA. These differences are not explained by disease characteristics, baseline viral levels, or amount of medication taken.
- Published
- 2006
- Full Text
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