Summary
Background
Clearance of hepatitis B surface antigen (HBsAg) indicates clinical control of hepatitis B virus (HBV) infection. However, little is known about the impact of viral genomic ...variations on HBsAg loss.
Methods
We explored the association between viral genomic factors and HBsAg loss in 2121HBeAg‐negative patients. HBV pre‐core stop codon (1896) and basal core promoter (BCP) (1762/1764) sequences were determined in patients with HBV DNA ≥200 IU/mL (N = 1693). The effect of HBV genotype on HBsAg loss was further validated in the whole cohort of 3445 HBsAg carriers.
Results
The cumulative lifetime (age 28–75 years) incidence of HBsAg loss was 50.4% in 2121 HBeAg‐negative patients. We found that genotype C, but not pre‐core stop codon or BCP mutants, was associated with HBsAg loss. Compared to genotype B patients, genotype C patients had higher lifetime chance of HBsAg loss, with hazard ratio of 1.8 (95% confidence interval: 1.4–2.4). Multivariable analysis showed that male sex, elevated ALT levels, lower serum HBV DNA and HBsAg levels, and genotype C infection were associated with higher chance of HBsAg loss independently. We then performed sensitivity analysis, which re‐included HBeAg‐positive, cirrhotic and treatment‐experienced patients, and confirmed the robustness of our results in 3445 HBsAg carriers.
Conclusion
Genotype C infection, compared to genotype B, is associated with a higher lifetime chance of HBsAg loss in Asian HBV carriers.
Summary Objectives To investigate the association of ultrasound (US) features with pain and the functional scores in patients with equal radiographic grades of osteoarthritis (OA) in both knees. ...Methods Fifty-six consecutive patients with knee OA: 85 symptomatic knees (81 knees with medial pain) and 27 asymptomatic knees, and 10 healthy patients without knee OA as a control were enrolled. US was done by two ultrasonographers blinded to patient diagnoses. US features were semiquantitatively scored (0–3) when appropriate. Results In the OA group, common US findings were marginal osteophyte, suprapatellar synovitis, suprapatellar effusion (SPE), medial meniscus protrusion, medial compartment synovitis (MCS), lateral compartment synovitis, and Baker's cyst. Only SPE and MCS were significantly associated with knee pain. Visual analog pain scale (VAS) scores on motion were positively linearly associated with SPE and MCS ( P < 0.01). Only MCS was degree-dependently associated with VAS scores at rest, the Western Ontario and McMaster Universities pain subscale, and the presence of medial knee pain ( P < 0.01) after adjustments for age, gender, body mass index (BMI), radiographic grade, and other US features. In the control group, no US features were associated with knee pain. Conclusions US inflammation features, including SPE and MCS, were positively linearly associated with knee pain in motion. MCS was also degree-dependently associated with pain at rest and the presence of medial knee pain. These findings show that synovitis was one important predictive factor of pain. Further studies to confirm the association of US features and pain are warranted.
Abstract Background The necessity of routine sub-nipple biopsy was uncertain, and the role of preoperative magnetic resonance imaging (MRI) in detecting nipple invasion in patients who have been ...selected for nipple-sparing mastectomy (NSM) has not been adequately evaluated. Methods We retrospectively collected and analyzed the medical and surgical records of 434 patients with primary operable breast cancer who met the criteria for NSM and underwent breast surgery during the period January 2011 to December 2015. Patients were stratified into three risk groups (low, intermediate, and high) according to tumor size and tumor-to-nipple distance. Results Among the 434 patients in this study, 29 (6.7%) had occult invasion of the nipple-areola complex (NAC). Sub-nipple biopsy had a sensitivity of 84.6%, a specificity of 100%, a false negative rate of 1.2%, a false positive rate of 0%, and an overall accuracy rate of 98.8% in confirming NAC invasion. The NAC invasion rate was 0% in the low-risk group, 5.1% in the intermediate-risk group, and 19.7% in the high-risk group (P<0.01). The overall NPV of preoperative MRI for predicting NAC invasion was 94.8%. Cost analysis revealed that the cost of NSM with sub-nipple biopsy was significantly higher than that of NSM alone, with a mean difference in cost of USD 238.5 (P<0.01). Conclusion The high negative predictive value of MRI for NAC invasion is useful for selection of patients receiving NSM. Sub-nipple biopsy is a reliable procedure to detect occult NAC invasion, however, routine use is not cost-effect for low risk patients.
Two approaches for integrating encryption with multimedia compression systems are studied in this research, i.e., selective encryption and modified entropy coders with multiple statistical models. ...First, we examine the limitations of selective encryption using cryptanalysis, and provide examples that use selective encryption successfully. Two rules to determine whether selective encryption is suitable for a compression system are concluded. Next, we propose another approach that turns entropy coders into encryption ciphers using multiple statistical models. Two specific encryption schemes are obtained by applying this approach to the Huffman coder and the QM coder. It is shown that security is achieved without sacrificing the compression performance and the computational speed. This modified entropy coding methodology can be applied to most modern compressed audio/video such as MPEG audio, MPEG video, and JPEG/JPEG2000 images.
Here, we present a sample-variance-limited measurement of the temperature power spectrum (TT) of the cosmic microwave background using observations of a ~1500 deg2 field made by the SPT-3G in 2018. ...We report multifrequency power spectrum measurements at 95, 150, and 220 GHz covering the angular multipole range 750 ≤ ℓ < 3000. We combine this TT measurement with the published polarization power spectrum measurements from the 2018 observing season and update their associated covariance matrix to complete the SPT-3G 2018 TT/TE/EE dataset. This is the first analysis to present cosmological constraints from SPT TT, TE, and EE power spectrum measurements jointly. We blind the cosmological results and subject the dataset to a series of consistency tests at the power spectrum and parameter level. We find excellent agreement between frequencies and spectrum types and our results are robust to the modeling of astrophysical foregrounds. We report results for Λ CDM and a series of extensions, drawing on the following parameters: the amplitude of the gravitational lensing effect on primary power spectra AL, the effective number of neutrino species Neff, the primordial helium abundance YP, and the baryon clumping factor due to primordial magnetic fields b. We find that the SPT-3G 2018 TT/TE/EE data are well fit by Λ CDM with a probability to exceed of 15%. For Λ CDM, we constrain the expansion rate today to H0 = 68.3 ± 1.5 km s–1 Mpc–1 and the combined structure growth parameter to S8 = 0.797 ± 0.042. The SPT-based results are effectively independent of Planck, and the cosmological parameter constraints from either dataset are within <1σ of each other. The addition of temperature data to the SPT-3G TE/EE power spectra improves constraints by 8–27% for each of the Λ CDM cosmological parameters. When additionally fitting AL, Neff, or Neff + YP, the posteriors of these parameters tighten by 5–24%. In the case of primordial magnetic fields, complete TT/TE/EE power spectrum measurements are necessary to break the degeneracy between b and ns, the spectral index of primordial density perturbations. We report a 95% confidence upper limit from SPT-3G data of b<1.0. The cosmological constraints in this work are the tightest from SPT primary power spectrum measurements to date and the analysis forms a new framework for future SPT analyses.
Ultralight axionlike particles (ALPs) are compelling dark matter candidates because of their potential to resolve small-scale discrepancies between Λ CDM predictions and cosmological observations. ...Axion-photon coupling induces a polarization rotation in linearly polarized photons traveling through an ALP field; thus, as the local ALP dark matter field oscillates in time, distant static polarized sources will appear to oscillate with a frequency proportional to the ALP mass. We use observations of the cosmic microwave background from SPT-3G, the current receiver on the South Pole Telescope, to set upper limits on the value of the axion-photon coupling constant gφγ over the approximate mass range 10-22–10-19 eV , corresponding to oscillation periods from 12 hours to 100 days. For periods between 1 and 100 days ( 4.7×10-22 eV≤mφ≤4.7×10-20 eV ), where the limit is approximately constant, we set a median 95% C.L. upper limit on the amplitude of on-sky polarization rotation of 0.071 deg. Assuming that dark matter comprises a single ALP species with a local dark matter density of 0.3 GeV/cm3 , this corresponds to gφγ<1.18×10-12 GeV-1× ( mφ1.0 × 10 - 21 eV ) . These new limits represent an improvement over the previous strongest limits set using the same effect by a factor of ~3.8 .
Summary
Background Hand‐foot skin reaction is a distinctive cutaneous side‐effect of antineoplastic kinase inhibitor‐targeted therapy. Severe hand‐foot skin reaction requires postponement of ...treatment or dose reduction. Histopathological studies of skin toxicity associated with kinase inhibitors are currently unavailable.
Objectives To report the clinical and histopathological findings of hand‐foot skin reaction produced by the multikinase inhibitor sorafenib.
Methods Nine patients with metastatic carcinoma—seven with renal cell carcinoma (RCC), one with melanoma and one with hepatocellular carcinoma (HCC)—received continuous, oral sorafenib 400 mg twice daily. Hand‐foot skin reaction was defined and graded according to National Cancer Institute Common Toxicity Criteria 3.0. Biopsies from lesions of erythematous scaly or blistering skin were obtained from five cases (four RCC and one HCC).
Results Seven of the nine (78%) patients developed hand‐foot skin reaction characterized by well‐demarcated, tender, erythematous papules and plaques with greyish blisters or hyperkeratotic, callus‐like formations on palmoplantar surfaces and distal phalanges. Skin biopsy of hand‐foot skin reaction lesions revealed epidermal acanthosis, papillomatosis, parakeratosis, dispersed dyskeratotic cells and keratinocyte vacuolar degeneration. Other skin toxicities included angular cheilitis, seborrhoeic dermatitis and perianal dermatitis.
Conclusions The clinical manifestations and histopathological features of sorafenib‐induced skin reactions are unique. The most relevant histopathological findings of hand‐foot skin reaction include keratinocyte vacuolar degeneration, the presence of intracytoplasmic eosinophilic bodies, and intraepidermal blisters in the stratum malpighii. Further studies are warranted to elucidate the mechanisms of this novel multitargeted kinase inhibitor‐associated skin reaction.
Snow in the environment acts as a host to rich chemistry and provides a matrix for physical exchange of contaminants within the ecosystem. The goal of this review is to summarise the current state of ...knowledge of physical processes and chemical reactivity in surface snow with relevance to polar regions. It focuses on a description of impurities in distinct compartments present in surface snow, such as snow crystals, grain boundaries, crystal surfaces, and liquid parts. It emphasises the microscopic description of the ice surface and its link with the environment. Distinct differences between the disordered air-ice interface, often termed quasi-liquid layer, and a liquid phase are highlighted. The reactivity in these different compartments of surface snow is discussed using many experimental studies, simulations, and selected snow models from the molecular to the macro-scale. Although new experimental techniques have extended our knowledge of the surface properties of ice and their impact on some single reactions and processes, others occurring on, at or within snow grains remain unquantified. The presence of liquid or liquid-like compartments either due to the formation of brine or disorder at surfaces of snow crystals below the freezing point may strongly modify reaction rates. Therefore, future experiments should include a detailed characterisation of the surface properties of the ice matrices. A further point that remains largely unresolved is the distribution of impurities between the different domains of the condensed phase inside the snowpack, i.e. in the bulk solid, in liquid at the surface or trapped in confined pockets within or between grains, or at the surface. While surface-sensitive laboratory techniques may in the future help to resolve this point for equilibrium conditions, additional uncertainty for the environmental snowpack may be caused by the highly dynamic nature of the snowpack due to the fast metamorphism occurring under certain environmental conditions. Due to these gaps in knowledge the first snow chemistry models have attempted to reproduce certain processes like the long-term incorporation of volatile compounds in snow and firn or the release of reactive species from the snowpack. Although so far none of the models offers a coupled approach of physical and chemical processes or a detailed representation of the different compartments, they have successfully been used to reproduce some field experiments. A fully coupled snow chemistry and physics model remains to be developed.
SUMMARY
Foreign bodies should not be allowed to remain in the esophagus beyond 24 hours after presentation. However, some patients with esophageal foreign body ingestion do not come to the hospital ...immediately and may delay medical intervention from the time of ingestion. The aim of this study was to investigate the outcomes of adults with suspected esophageal foreign body ingestion according to the time of ingestion and types of foreign bodies. A total of 326 adult patients (151 men and 175 women) were analyzed, and divided into two groups according to the time period: within or beyond 24 hours from ingestion to endoscopic intervention. A total of 172 patients (52.7%) were found to have ingested foreign bodies; 73.5% were removed smoothly, 10.3% were treated by push technique and 16.0% with failed retrieval received alternative treatments. A higher proportion of patients in the beyond‐24 hours group suffered from odynophagia (25.9 vs. 12.9%, P < 0.05). Negative identification of esophageal foreign bodies was more frequent in the beyond‐24 hours group (67 vs. 40.2%, P < 0.05), but these patients showed higher proportions of esophageal ulcers (21.1 vs. 7.2%, P < 0.05). The beyond‐24 hours group also showed a significantly higher rate of foreign bodies in the lower esophagus (40.0 vs. 15.3%, P < 0.05). Patients with esophageal food bolus impaction had significant delayed endoscopic intervention, longer therapeutic endoscopic time, higher proportions of esophageal cancer, stricture and fewer complications. Endoscopic intervention within 24 hours from the time of ingestion should be considered early in adults, because delaying intervention may produce more symptomatic esophageal ulcerations with odynophagia.
Mutations in the enzyme superoxide dismutase 1 (SOD1) initiate a progressive motoneurone degeneration in amyotrophic lateral
sclerosis (ALS). Transgenic mice overexpressing this mutation develop a ...similar progressive motoneurone degeneration. In spinal
motoneurones cultured from presymptomatic mice expressing the glycine to alanine mutation at base pair 93 (G93A) SOD1 mutation,
a marked increase in the persistent component of the Na + current was observed, without changes in passive properties. This increase only enhanced neuronal excitability in high input
conductance cells, as low input conductance cells exhibited a compensatory outward shift in the current remaining after Na + blockade. High input conductance motoneurones tend to be large, so these results may explain the tendency of large motoneurones
to degenerate first in ALS. Riluzole, at the therapeutic concentration used to treat ALS, decreased neuronal excitability
and persistent Na + current in G93A motoneurones to levels observed in the control motoneurones. Aberrations in the intrinsic electrical properties
may be among the first symptoms to emerge in SOD1-linked ALS.
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