早期肺康复联合ESCAPE集束化护理对ICU有创机械通气患者呼吸机相关膈肌功能障碍的影响

目的:探讨早期肺康复联合ESCAPE集束化护理对ICU有创机械通气患者呼吸机相关膈肌功能障碍(VIDD)的影响。方法:将2023年2月1日~12月31日综合ICU收治的41例成人有创机械通气患者随机分为实验组20例和对照组21例,其中实验组3例、对照组4例因转出ICU而脱落,最终纳入实验组和对照组各17例。实验组给予早期肺康复训练联合ESCAPE集束化护理,对照组给予ESCAPE集束化护理。比较两组膈肌移动度及增厚率、临床肺部感染评分(CPIS)、急性生理学与慢性健康状况评分(APACHEⅡ)。结果:实验组治疗后膈肌移动度高于治疗前(P<0.05),膈肌增厚率比较差异无统计学意义(P>0.05);实验组治疗后CPIS、APACHEⅡ评分均低于治疗前(P<0.05)。结论:早期肺康复联合ESCAPE集束化护理可改善ICU有创机械通气患者的膈肌移动度,降低肺部感染发生风险、改善健康状况,减轻膈肌萎缩,控制ICU呼吸机相关性肺炎。

Escape room游戏宣教对阴道分娩初产妇分娩恐惧及产程进展的影响

目的探究Escape room游戏宣教对阴道分娩初产妇分娩恐惧及产程进展的影响。方法采用便利抽样法,选取本院2021年1月—2022年6月收治的140例阴道分娩初产妇为研究对象,按随机数字表法将其分为对照组和观察组,每组各70例。对照组采取常规教育模式,观察组在常规护理基础上应用Escape room游戏宣教,比较两组初产妇分娩恐惧水平、产程进展。结果观察组分娩恐惧中高水平初产妇占比为57.14%小于对照组的80.00%,差异有统计学意义(P<0.05);观察组初产妇第一产程时间、第二产程时间均短于对照组,差异有统计学意义(P<0.05),两组第三产程时间比较差异无统计学意义(P>0.05)。结论Escape room游戏宣教在阴道分娩初产妇中的应用,能缓解产妇分娩恐惧情绪,可一定程度上加快产程进展。

优化ESCAPE集束化策略对ICU亚临床谵妄患者的效果评价

目的 分析优化ESCAPE集束化策略对ICU亚临床谵妄患者的效果。方法 选取本院入住ICU超过24h的亚临床谵妄患者,对照组予常规护理,观察组在常规护理上给优化ESCAPE集束化策略。比较2组睡眠质量、认知水平、谵妄发生率及48h内亚临床谵妄持续时间。结果 观察组睡眠质量、认知水平、谵妄发生率、亚临床谵妄持续时间低于对照组,差异有统计学意义(P<0.05)。结论 优化ESCAPE集束化策略可提高患者睡眠质量,改善亚临床谵妄患者认知水平,缩短亚临床谵妄持续时间,降低谵妄发生率。

When Fleeing Matters:Differences in Escape Behaviours of Three Northeast Asian Anurans

Prey species may have their own optimal escape strategy to balance predation risks and the energetic cost of fleeing.Some species have an advantage when maintaining a short fleeing distance,while others may favour an earlier escape based on microhabitat,size,or body condition.Here,we examined the escape behaviour of the three syntopic Northeast Asian anuran species:Mongolian toads(Strauchbufo raddei),Amur brown frogs(Rana amurensis),and Japanese treefrogs(Dryophytes japonicus)in Mongolia,Russia,China and DPR Korea.We examined flight initiation distance(FID;the distance from a potential predator to the point when the individual starts to flee)and distance fled(DF;distance between flight initiation and flight termination points)of each species and the effects of microhabitat,sex,and body size.Strauchbufo raddei and R.amurensis had a longer FID than D.japonicus,and S.raddei also had a longer DF than D.japonicus.These trends remained similar when dividing FID and DF by a size proxy(snout-vent length)for all individuals.This suggests that the treefrog D.japonicus used a strategy to stay immobile even when they were detected,and the toad S.raddei reacted quicker and more sensitively to predators despite the presence of toxin.Female S.raddei had a significantly longer FID than males suggesting that females are more sensitive to predation risk in this species,but body size was not significant for any of the three species.Our results indicate that the three sympatric species have different escaping strategies,likely related to differences in physiology and crypticity.

Correction:The escape mechanisms of the proto-atmosphere on terrestrial planets:“boil-off”escape,hydrodynamic escape and impact erosion

In the original publication of the article,the affiliation“College of Earth and Planetary Sciences,University of Chinese Academy of Sciences,Beijing,People’s Republic of China”for author Ziqi Wang was missing and included in this correction article.

改良ESCAPE集束化策略在急性呼吸衰竭有创机械通气脱机患者中的应用价值

目的:探讨改良ESCAPE集束化策略在急性呼吸衰竭有创机械通气脱机患者中的应用价值。方法:接受有创机械通气治疗的急性呼吸衰竭患者116例,随机分为观察组60例和对照组56例。对照组由主管医师制定整体治疗方案,采用常规治疗护理。观察组在常规治疗护理基础上,实施改良ESCAPE集束化策略。结果:观察组脱机后1 h、12 h、24 h时SaO_(2)分别为(96.7±3.7)%、(97.3±3.8)%和(97.4±3.3)%,高于对照组的(92.1±4.3)%、(92.5±2.1)%和(93.3±3.9)%,观察组脱机后1 h、12 h、24 h时PaO_(2)/FiO_(2)分别为255.5±33.5 mmHg、257.5±28.7 mmHg和271.3±32.6 mmHg,高于对照组的213.4±30.7 mmHg、218.1±30.4 mmHg和225.5±30.3 mmHg,差异均有统计学意义(P<0.05);观察组患者脱机后1 h RR 20.5±3.7次/min,低于对照组的25.6±4.1次/min,差异有统计学意义(P<0.05)。观察组机械通时间5.9±2.7 d,短于对照组的8.6±3.1 d,差异有统计学意义(P<0.05);观察组48 h内再插管5例(8.3%),对照组48 h内再插管6例(10.7%),两组再插管率的差异无统计学意义(P>0.05)。观察组谵妄发生率18.3%,低于对照组的35.7%,观察组ICU-AW发生率16.7%,低于对照组的25.0%,差异均有统计学意义(P<0.05);观察组ICU住院时间8.3±3.7 d,短于对照组的11.2±4.1 d,差异有统计学意义(P<0.05)。结论:改良ESCAPE策略可改善急性呼吸衰竭患者呼吸机撤机后的氧合指标,降低谵妄及ICU获得性衰弱的发生率,缩短机械通气时间和ICU住院时间。

Possible mechanisms associated with immune escape and apoptosis on anti-hepatocellular carcinoma effect of Mu Ji Fang granules

BACKGROUND Hepatocellular carcinoma(HCC)is one of the most common digestive system cancers with high mortality rates worldwide.The main ingredients in Mu Ji Fang Granules(MJF)are alkaloids,flavonoids,and polysaccharides.MJF has been used in the clinical treatment of hepatitis,cirrhosis and HCC for more than 30 years.Few previous studies have focused on the mechanism of MJF on tumor immunology in the treatment of HCC.AIM To explore the mechanism of action of MJF on tumor immunology in the treatment of HCC.METHODS The absorbable ingredients of MJF were identified using Molecule Network related to High Performance Liquid Chromatography-Electron Spray Ionization-Time of Flight-Mass Spectrometry,and hub potential anti-HCC targets were screened using network pharmacology and pathway enrichment analysis.Forty male mice were randomly divided into the Blank,Model,and MJF groups(1.8,5.4,and 10.8 g/kg/d)following 7 d of oral administration.Average body weight gain,spleen and thymus indices were calculated,tumor tissues were stained with hematoxylin and eosin,and Interferon gamma(IFN-γ),Tumor necrosis factorα(TNF-α),Interleukin-2,aspartate aminotransferase,alanine aminotransferase,alpha-fetoprotein(AFP),Fas,and FasL were measured by Enzyme-linked Immunosorbent Assay.Relevant mRNA expression of Bax and Bcl2 was evaluated by Real Time Quantitative PCR(RTqPCR)and protein expression of Transforming growth factorβ1(TGF-β1)and Mothers against decapentaplegic homolog(SMAD)4 was assessed by Western blotting.The HepG2 cell line was treated with 10 mg/mL,20 mg/mL,30 mg/mL,40 mg/mL of MJF,and another 3 groups were treated with TGF-β1 inhibitor(LY364947)and different doses of MJF.Relevant mRNA expression of TNF-α,IFN-γ,Bax and Bcl2 was evaluated by RT-qPCR and protein expression of TGF-β1,SMAD2,p-SMAD2,SMAD4,and SMAD7 was assessed by Western blotting.RESULTS It was shown that MJF improved body weight gain and tumor inhibition rate in H22 tumorbearing mice,protected immune organs and liver function,reduced the HCC indicator AFP,affected immunity and apoptosis,and up-regulated the TGF-β1/SMAD signaling pathway,by increasing the relative expression of TGF-β1,SMAD2,p-SMAD2 and SMAD4 and decreasing SMAD7,reducing immune factors TNF-αand IFN-γ,decreasing apoptosis cytokines Fas,FasL and Bcl2/Bax,and inhibiting the effect of LY364947 in HepG2 cells.CONCLUSION MJF inhibits HCC by activating the TGF-β1/SMAD signaling pathway,and affecting immune and apoptotic cytokines,which may be due to MJF adjusting immune escape and apoptosis.

Secondary electron emission and photoemission from a negative electron affinity semiconductor with large mean escape depth of excited electrons

The formulae for parameters of a negative electron affinity semiconductor(NEAS)with large mean escape depth of secondary electrons A(NEASLD)are deduced.The methods for obtaining parameters such asλ,B,E_(pom)and the maximumδandδat 100.0 keV≥E_(po)≥1.0 keV of a NEASLD with the deduced formulae are presented(B is the probability that an internal secondary electron escapes into the vacuum upon reaching the emission surface of the emitter,δis the secondary electron yield,E_(po)is the incident energy of primary electrons and E_(pom)is the E_(po)corresponding to the maximumδ).The parameters obtained here are analyzed,and it can be concluded that several parameters of NEASLDs obtained by the methods presented here agree with those obtained by other authors.The relation between the secondary electron emission and photoemission from a NEAS with large mean escape depth of excited electrons is investigated,and it is concluded that the presented method of obtaining A is more accurate than that of obtaining the corresponding parameter for a NEAS with largeλ_(ph)(λ_(ph)being the mean escape depth of photoelectrons),and that the presented method of calculating B at E_(po)>10.0 keV is more widely applicable for obtaining the corresponding parameters for a NEAS with largeλ_(ph).

Noise color influence on escape times in nonlinear oscillators-experimental and numerical results

The interplay between noise and nonlinearites can lead to escape dynamics.Associated nonlinear phe-nomena have been observed in various applications ranging from climatology to biology and engineering.For reasons of computational ease,in most studies,Gaussian white noise is used.However,this noise model is not physical due to the associated infinite energy content.Here,the authors present extensive experimental investigations and numerical simulations conducted to examine the impact of noise color on escape times in nonlinear oscillators.With a careful parameterization of the numerical simulations,the authors are able to make quantitative comparisons with experimental results.Through the experi-ments and simulations,it is illustrated that the noise color can drastically influence escape times and escape probability.

Meta-Analysis of the Effect of the Escape Room Teaching Method on Nursing Education

Objectives:A meta-analysis was conducted to systematically evaluate the effect of the escape room teaching method on nursing education.Methods:We searched PubMed,Medline,Web of Science,CNKI,VIP,and Wanfang databases,with a search time frame from the first day of database establishment to October 2022.Two researchers evaluated the quality of the obtained literature and extracted the data.The RevMan5.4 software was used for meta-analysis.Results:A total of 7 studies involving 1487 nursing students were included.Compared with the control group,the escape room teaching method improved the professional performance of nursing students[standardized mean difference(SMD)=0.98,95%confidence interval(CI;0.38,1.59),P<0.0001].The critical thinking ability of nursing students was enhanced[mean difference(MD)=12.64,95%CI(7.91,17.37),P<0.0001],and the investment level of nursing students in learning was improved[MD=4.18,95%CI(1.74,6.62),P<0.0001].Conclusion:The escape room teaching method can improve nursing students’professional performance,critical thinking ability,and learning engagement level.There is no significant difference in the impact of nursing teaching satisfaction,and there is still a lack of data support.This paper is limited by the quality and quantity of included literature,and more high-quality studies are still needed to further demonstrate the above conclusions.

ESCAPE策略在机械通气患者谵妄管理的应用

目的评价ESCAPE策略用于机械通气患者谵妄管理的效果。方法将165例机械通气患者采用随机数字软件分为干预组(n=86)、对照组(n=79)。对照组采用ICU常规护理,包括观察患者生命体征、呼吸机及循环监测、常规镇痛镇静护理、药物不良反应及脏器功能监测。干预组采用ICU常规护理的同时应用ESCAPE策略,包括早期活动、睡眠管理、每日唤醒及自主呼吸试验、精神状态评估、情感支持、镇痛镇静管理。比较两组患者谵妄发生率、谵妄持续时间、镇痛镇静药物使用量、机械通气时间、ICU住院时间。结果干预组患者谵妄发生率、谵妄持续时间、镇痛镇静药物使用量、机械通气时间、ICU住院时间显著低于/短于对照组(P<0.05,P<0.01)。结论实施ESCAPE策略可有效降低ICU机械通气患者谵妄发生率,缩短谵妄持续时间,提高临床护理质量。

Escape from the Besieged Fortress——An Analysis of Alice Munro's "Runaway"

Alice Munro is one of the famous Canadian writers and is renowned above all for the astonishing subtlety of her short stories.Her theme has often been the dilemmas of the female coming to terms with family, friends in a small town. This paper attempts to make a brief introduction about the stories of Alice Munro's Runaway and explores the protagonist's choices in the dilemma situation, and then exposes the cruelty of reality is that they cannot get rid of the ineluctable reality of life. Escape is only a temporary action which cannot save them from endless triviality of life. What they should do is not to escape from life, but to adapt to the reality of life.

Single-cell RNA-seq reveals the immune escape and drug resistance mechanisms of mantle cell lymphoma

Objective:Mantle cell lymphoma(MCL)is a rare subtype of non-Hodgkin lymphoma(NHL)with high heterogeneity and a high recurrence rate.How heterogenous cell populations contribute to relapse remains to be elucidated.Methods:We performed single cell RNA sequencing(scRNA-seq)on approximately 4,000 bone marrow cells sampled from one patient with multidrug resistant MCL.We identified 10 subpopulations comprising 4 malignant B cell subtypes,3 T cell subtypes,2 dendritic cell subtypes and 1 natural killer(NK)cell subtype.Subsequently,we identified cell markers,including a series of genes associated with immune escape and drug resistance.In addition,we explored the roles of these genes in the mechanism of immune escape and drug resistance,and we verified the expression imbalance and clinical prognostic potential by using GEO datasets including 211 MCL samples.Results:The major immune escape mechanisms of MCL included anti-perforin activity,decreased immunogenicity and direct inhibition of apoptosis and cell killing,as mediated by type I and II B cells.The drug resistance mechanisms of different cell clusters included drug metabolism,DNA damage repair,apoptosis and survival promotion.Type III B cells closely communicate with other cells.The key genes involved in the resistance mechanisms showed dysregulated expression and may have significant clinical prognostic value.Conclusion:This study investigated potential immune escape and drug resistance mechanisms in MCL.The results may guide individualized treatment and promote the development of therapeutic drugs.

Costimulatory Molecule B7-H1 on the Immune Escape of Bladder Cancer and Its Clinical Significance

B7-H1, a recently described member of the B7 family of costimulatory molecules, is thought to be involved in tumor immune escape by inducing T-cell apoptosis. In order to investigate the relationship between B7-H1 and immune escape of bladder cancer, B7-H1 expression in 50 cases of bladder cancer was detected by using immunohistochemical method. Survival curves were con- structed using the Kaplan-Meier method and independent prognostic factors were evaluated using the Cox regression model. Our results showed that the positive rate of B7-H1 immunostaining in normal bladder tissue and bladder cancer was 0 and 72% respectively. The expression of B7-H1 was strongly associated with the pathological grade, clinical stage and recurrence （P〈0.05）. The survival rate was significantly lower in patients with B7-H1 positive group than in those with B7-H1 negative group and multi-variable analysis revealed that B7-H1 could be regarded as an independent factor in evaluating the prognosis of bladder cancer. It is concluded that the expression of B7-H1 is strongly associated with neoplastic progression and prognosis of bladder cancer. The manipulation of B7-H1 may become a beneficial target for immunotherapy in human bladder cancer.

Overwhelming low ammonia escape and low temperature denitration efficiency via MnOx-decorated two-dimensional MgAl layered double oxides

Low temperature catalysts are attracting increasing attention in the selective catalytic reduction(SCR)of NO with NH3.Mn Ox-decorated Mg Al layered double oxide(Mn/Mg Al-LDO)was synthesized via a facile fast pour assisted co-precipitation(FP-CP)process.Compared to the Mn/Mg Al-LDO obtained via slow drop assisted coprecipitation(SD-CP)method,the Mn/Mg Al-LDO(FP-CP)has excellent activity.The Mn/Mg Al-LDO(FP-CP)catalyst was shown to possess a high NO conversion rate of 76%-100%from 25 to 150℃,which is much better than the control Mn/Mg Al-LDO(SD-CP)(29.4%-75.8%).In addition,the Mn/Mg Al-LDO(FP-CP)offered an enhanced NO conversion rate of 97%and a N2selectivity of 97.3%at 100℃;the NO conversion rate was 100%and the N2selectivity was 90%at 150℃with a GHSV of 60,000 h^-1.The Mn/Mg Al-LDO(FP-CP)catalyst exhibited a smaller fragment nano-sheet structure(sheet thickness of 7.23 nm).An apparent lattice disorder was observed in the HRTEM image confirming the presence of many defects.The H2-TPR curves show that the Mn/Mg Al-LDO(FP-CP)catalyst has abundant reducing substances.Furthermore,the enhanced surface acidity makes the NH3concentration of the Mn/Mg Al-LDO(FP-CP)catalyst lower than 100 ml·m^-3after the reaction from 25 to 400℃.This can effectively reduce the ammonia escape rate in the SCR reaction.Thus,the Mn/Mg Al-LDO(FP-CP)catalyst has potential applications in stationary industrial installations for environmentally friendly ultra-low temperature SCR.

Shuyu pills inhibit immune escape and enhance chemosensitization in hepatocellular carcinoma

BACKGROUND Hepatocellular carcinoma(HCC)is characterized by dysregulation of the immune microenvironment and the development of chemoresistance.Specifically,expression of the programmed cell death protein 1(PD-1)/programmed cell death 1 ligand 1(PD-L1)axis,an immune checkpoint,may lead to tumour immune escape,resulting in disease progression.The latest research shows that tumour immune escape may be caused by the upregulation of PD-L1 mediated by hypoxia-inducible factor-1 alpha(HIF-1α),and simultaneous inhibition of HIF-1αand PD-L1 has the potential to enhance the host’s antitumour immunity.Moreover,inhibition of the PD-1/PD-L1 axis may mitigate tumour chemoresistance.Shuyu pills(SYPs)contain immunity-enhancing and antitumour components,making them a potential HCC treatment.AIM To investigate the efficacy of SYPs for HCC treatment via simultaneous HIF-1α and PD-L1 inhibition and the mechanism involved.METHODS A subcutaneous xenograft tumour model was first established in BALB/c nude mice by the subcutaneous injection of 1×107 SMMC-7721 cells.Male mice(male,5 weeks old;n=24)were then randomly divided into the following four groups(n=6):Control(0.9%normal saline),SYP(200 mg/kg),SYP+cisplatin(DDP)(200 mg/kg+5 mg/kg DDP weekly via intraperitoneal injection),and DDP(5 mg/kg cisplatin weekly via intraperitoneal injection).The dose of saline or SYPs for the indicated mouse groups was 0.2 mL/d via intragastric administration.The tumour volumes and body weights of the mice were measured every 2 d.The mice were euthanized by cervical dislocation after 14 d of continuous treatment,and the xenograft tissues were excised and weighed.Western blot assays were used to measure the protein expression of HIF-1α,PD1,PD-L1,CD4+T cells,and CD8+T cells in HCC tumours from mice.Quantitative reverse transcription polymerase chain reaction was used for real-time quantitative detection of PD-1,PD-L1,and HIF-1α mRNA expression.An immunofluorescence assay was conducted to examine the expression of CD4+T cells and CD8+T cells.RESULTS Compared to mice in the control group,those in the SYP and SYP+DDP groups exhibited reduced tumour volumes and tumour weights.Moreover,the protein and mRNA expression levels of the oncogene HIF1α and that of the negative immunomodulatory factors PD-1 and PD-L1 were decreased in both the SYP and SYP+DDP groups,with the decrease effects being more prominent in the SYP+DDP group than in the SYP group(HIF-1α protein:Control vs SYP,P=0.0129;control vs SYP+DDP,P=0.0004;control vs DDP,P=0.0152,SYP+DDP vs DDP,P=0.0448;HIF-1αmRNA:control vs SYP,P=0.0009;control vs SYP+DDP,P<0.0001;control vs DDP,P=0.0003,SYP vs SYP+DDP,P=0.0192.PD-1 protein:Control vs SYP,P=0.0099;control vs SYP+DDP,P<0.0001,SPY vs SYP+DDP,P=0.0009;SYP+DDP vs DDP,P<0.0001;PD-1 mRNA:control vs SYP,P=0.0002;control vs SYP+DDP,P<0.0001;control vs DDP,P=0.0003,SPY vs SYP+DDP,P=0.0003;SYP+DDP vs DDP,P=0.0002.PD-L1 protein:control vs SYP,P<0.0001;control vs SYP+DDP,P<0.0001;control vs DDP,P<0.0001,SPY vs SYP+DDP,P=0.0040;SYP+DDP vs DDP,P=0.0010;PD-L1 mRNA:Control vs SYP,P<0.0001;control vs SYP+DDP,P<0.0001;control vs DDP,P<0.0001,SPY vs SYP+DDP,P<0.0001;SYP+DDP vs DDP,P=0.0014).Additionally,the quantitative and protein expression levels of CD4+T cells and CD8+T cells were simultaneously upregulated in the SYP+DDP group,whereas only the expression of CD4+T cells was upregulated in the SYP group.(CD4+T cell quantitative:Control vs SYP+DDP,P<0.0001,SYP vs SYP+DDP,P=0.0005;SYP+DDP vs DDP,P=0.0002.CD4+T cell protein:Control vs SYP,P=0.0033;Control vs SYP+DDP,P<0.0001;Control vs DDP,P=0.0021,SYP vs SYP+DDP,P=0.0004;SYP+DDP vs DDP,P=0.0006.Quantitative CD8+T cells:Control vs SYP+DDP,P=0.0013;SYP vs SYP+DDP,P=0.0347;SYP+DDP vs DDP,P=0.0043.CD8+T cell protein:Control vs SYP+DDP,P<0.0001;SYP vs SYP+DDP,P<0.0001;SYP+DDP vs DDP,P<0.0001).Finally,expression of HIF-1αwas positively correlated with that of PD-1/PD-L1 and negatively correlated with the expression of CD4+T cells and CD8+T cells.CONCLUSION SYPs inhibit immune escape and enhance chemosensitization in HCC via simultaneous inhibition of HIF-1α and PD-L1,thus inhibiting the growth of subcutaneous xenograft HCC tumours.

New high-resolution 2D seismic imaging of fluid escape structures in the Makran subduction zone,Arabian Sea

Seabed fluid escape is active in the Makran subduction zone,Arabian Sea.Based on the new highresolution 2D seismic data,acoustic blanking zones and seafloor mounds are identified.Acoustic blanking zones include three kinds of geometries:Bell-shaped,vertically columnar and tilted zones.The bellshaped blanking zone is characterized by weak and discontinuous reflections in the interior and upbending reflections on the top,interpreted as gas chimneys.Vertically columnar blanking zone is interpreted as side-imaged gas chimneys associated with focused fluid flow and topped by a seafloor anomaly expressed as a localized reflection discontinuity,which may together serve as a vent structure.Tilted acoustic blanking zone could be induced by accretionary thrust activity and rapid sedimentation surrounding slope.Seafloor mounds occur at the sites of bell-shaped acoustic blanking zone and may be associated with the material intrusion.Bottom simulating refectors(BSRs)are widely distributed and exhibit a series of characteristics including diminished amplitude,low continuity as well as local shoaling overlapping with these acoustic blanking zones.The large amount of gases dissociated from the gas hydrates migrated upwards and then arrived at the near-seafloor sediments,followed by the formation of the gas hydrates and hence the seafloor mound.

Characteristics of escape mutations from occult hepatitis B virus infected patients with hematological malignancies in South Egypt

AIM To investigate the prevalence and virological characteristics of occult hepatitis B virus(HBV) infections in patients with hematological malignancies in South Egypt.METHODS Serum samples were collected from 165 patients with hematological malignancies to monitor titers of HBV DNA, hepatitis B surface antigen(HBs Ag), and antibodies to HBV core(anti-HBc) and surface antigens. Serum samples negative for HBs Ag and positive for anti-HBc were subjected to nucleic acid extraction and HBV DNA detection by real-time polymerase chain reaction. DNA sequences spanning the S region were analyzed in cases with occult HBV infection. In vitro comparative study of constructed 1.24-fold wild type and S protein mutant HBV genotype D clones was further performed. RESULTS HBV DNA was detected in 23(42.6%) of 54 patients with hematological malignancies who were HBsA g negative, but anti-HBc positive, suggesting the presence of occult HBV infection. The complete HBV genome was retrieved from 6 occult HBV patients, and P120 T and S143 L were detected in 3 and 2 cases, respectively. Site directed mutagenesis was done to produce 1.24-fold genotype D clones with amino acid mutations T120 and L143. The in vitro analyses revealed that a lower level of extracellular HBsA g was detected by chemiluminescence enzyme immunoassay(CLEIA) with the clone containing T120 mutation, compared with the wild type or the clone with S143 L mutation despite the similar levels of extracellular and intracellular HBs Ag detected by Western blot. Southern blot experiments showed that the levels of intracellular HBV DNA were not different between these clones. CONCLUSION Occult HBV infection is common in patients with hematological malignancies and associated with P120 T and S143 L mutations. 120 T mutation impairs the detection of HBsA g by CLEIA.

Hepatitis B surface antigen escape mutations: Indications for initiation of antiviral therapy revisited

Approximately 240 million people are chronically infected with hepatitis B. The implementation of rigorous vaccination programs has led to an overall decrease in the prevalence of this disease worldwide but this may also have led to emergence of viral mutations that can escape the protection of hepatitis B surface antibody. As this phenomenon is increasingly recognized, concern for transmission to vaccinated individuals has also been raised. Herein, we describe two cases where the suspected presence of a hepatitis B surface antigen escape mutation impacted the decision to initiate early antiviral therapy, as well as provide a brief review of these mutations. Our findings described here suggest that a lower threshold for initiating therapy in these individuals should be considered in order to reduce the risk of transmission, as vaccination does not provide protection.

Hepatitis B virus subgenotype F3 reactivation with vaccine escape mutations:A case report and review of the literature

Hepatitis B represents a global health threat because its chronic course and sequelae contribute to a high morbidity and mortality. Hepatitis B virus(HBV) infection can be controlled by vaccines, antiviral treatment, and by interrupting transmission. Rare vaccine escape mutants are serious because they eliminate vaccine protection. Here, we present a 74-year-old vaccinated patient with HBV reactivation 11 years after kidney transplantation. The patient was HBV-positive but HBs Ag-negative prior to vaccination 6 years before transplantation. The reactivated virus was HBV genotype F3 with vaccine escape mutations G145 R, P120 Q, and Q129 P. The patient was successfully treated with entecavir. The epidemiological reasons for this subgenotype, which is extremely rare in Western Europe, were unclear. This case illustrates that second-generation vaccines are not always effective in a specific group of patients.