Risk factors for de novo hepatitis B during solid cancer treatment

BACKGROUND Reactivation of hepatitis B virus(HBV)during anticancer treatment is a critical issue.When treating patients with solid tumors,it is unclear whether specific cancer types or treatments affect HBV reactivation in hepatitis B surface antigen(HBsAg)-negative and hepatitis B core antibody(HBcAb)-positive patients,socalled de novo hepatitis B patients.The risk of de novo hepatitis B may vary based on different background factors.AIM To determine the frequency and risk factors for de novo hepatitis B during solid tumor treatment.METHODS This retrospective cohort study comprised 1040 patients without HBsAgs and with HBcAbs and/or hepatitis B surface antibodies(HBsAbs).The patients were treated for solid cancer from 2008 to 2018 at the National Kyushu Cancer Center and underwent HBV DNA measurements.Patient characteristics and disease and treatment information were investigated.HBV DNA measurements were performed using TaqMan polymerase chain reaction(PCR).To identify the risk factors associated with HBV DNA expression,the age,sex,original disease,pathology,treatment method,presence or absence of hepatitis C virus(HCV),and HBsAb and/or HBcAb titers of all subjects were investigated.In patients with HBV DNA,the time of appearance,presence of HBsAgs and HBsAbs at the time of appearance,and course of the subsequent fluctuations in virus levels were also investigated.RESULTS Among the 1040 patients,938 were HBcAb positive,and 102 were HBcAb negative and HBsAb positive.HBV DNA expression was observed before the onset of treatment in nine patients(0.9%)and after treatment in 35 patients(3.7%),all of whom were HBcAb positive.The HBV reactivation group showed significantly higher median HBcAb values[9.00(8.12-9.89)vs 7.22(7.02-7.43),P=0.0001]and significantly lower HBsAb values(14 vs 46,P=0.0342)than the group without reactivation.Notably,the reactivated group showed a significantly higher proportion of cancers in organs related to digestion and absorption(79.0%vs 58.7%,P=0.0051).A high HBcAb titer and cancers in organs involved in digestion and absorption were identified as independent factors for HBV reactivation(multivariate analysis,P=0.0002 and P=0.0095).The group without HBsAbs tended to have a shorter time to reactivation(day 43 vs day 193),and the frequency of reactivation within 6 mo was significantly higher in this group(P=0.0459)than in the other group.CONCLUSION A high HBcAb titer and cancers in organs involved in digestion and absorption are independent factors that contribute to HBV reactivation during solid tumor treatment.

The Effect of Active Knee Extension in Sitting on Lumbopelvic Curvature in Individuals with Clinically Tight Hamstring Muscles: A Cross-Sectional Reliability Study

Relative flexibility between the hamstring and lumbar extensor muscles, which can be evaluated using lumbopelvic curvature during active knee extension in sitting, can sometimes be assessed in physical therapy. However, reliability for its quantitative measure has not been established yet and its establishment was the aim of the current study. Twenty-seven individuals with clinically tight hamstring muscles were recruited. On two separate sessions, the lumbopelvic curvature was evaluated in sitting when the right knee was moved from 90&deg flexion to 10&deg flexion on 15 occasions using a flexible ruler by two examiners on Day 1 and one on Day 2. Lines drawn tangential to the lumbopelvic curvature were traced at T12 and S2 vertebral levels and the angle between the two vertical lines was calculated. Using Day 1 data, the minimum number of repetitions and inter-examiner reliability were assessed. Inter-session reliability was also examined. As a result, there was no statistical difference (P?> 0.05) in the mean absolute difference between the mean value of N-1 and N repetitions (6 ≤ N ≤ 15) in the lumbopelvic curvature angle, indicating that five was considered the minimum number of repetitions. Intraclass correlation coefficient (ICC)(1, 5)?for the inter-session reliability and ICC(2, 5)?for the inter-examiner reliability was 0.97 and 0.93, respectively, indicating excellent reliability. The measure for the lumbopelvic curvature during active knee extension in sitting, which was established in the current study, will be a foundation for further research regarding the relative flexibility of the lumbar and adjunct regions.