ALT to qHBsAg ratio predicts long-term HBsAg seroclearance after entecavir cessation in Chinese patients with chronic hepatitis B

BACKGROUND

Factors predicting HBsAg seroclearance after treatment cessation, irrespective of nucleos(t)ide analogue (NA) resumption, have important clinical implications. We evaluated predictors of long-term HBsAg seroclearance after entecavir cessation.

METHODS

This study followed up Chinese chronic hepatitis B patients from two previous studies of entecavir cessation. All patients were non-cirrhotic, HBeAg-negative, with undetectable HBV DNA (<20 IU/ml) at end-of-treatment (EOT). They had close monitoring for 48 weeks with regular HBV DNA, qHBsAg and ALT measurements. Entecavir was resumed at HBV DNA >2000 IU/ml, irrespective of ALT levels. After the initial 48 weeks, patients were assessed every six months, regardless of entecavir resumption, to monitor for HBsAg seroclearance.

RESULTS

194 patients (63.4% male, mean age 49.9 years, on entecavir for a median of 47.2 months) were recruited. 94 (48.5%) and 158 (81.4%) patients had EOT qHBsAg <100 IU/ml and <1000 IU/ml respectively. 151 (77.8%) patients were eventually resumed on entecavir. After follow-up for a median of 70.7 (51.0-118.2) months, 28 (14.4%) patients had HBsAg seroclearance. qHBsAg levels at weeks 36 and 48 after EOT independently predicted HBsAg seroclearance (both p<0.01), whereas qHBsAg from EOT to week 24 only trended towards statistical significance. The ratio of ALT/qHBsAg at all time points from EOT to week 48 independently predicted HBsAg seroclearance (HR ranging from 1.003-1.028, all p<0.01) with excellent diagnostic performance (Area-under-receiver-operating-characteristics 0.799-0.933, negative-predictive-value >90% at different time points), regardless of whether entecavir was resumed.

CONCLUSIONS

The ALT/qHBsAg ratio after entecavir cessation predicts HBsAg seroclearance, even in patients who were resumed on treatment. Its use may mitigate the risk of severe hepatitis flares in patients managed by observation without treatment resumption.

A novel method for the natural frequency estimation of the jet engine turbine blades based on its dimensions

This study provides a novel methodology for the natural frequency estimation of the jet engine turbine blade by using the dimension check. This paper presents a summarization of the ongoing research devoted to the method for the turbine blade natural frequency estimation. The main target of the research presented in the paper is to develop a novel method that can calculate the natural frequency of a particular turbine blade by using the dimensions of investigated turbine blade from a dimension check. This goal is achieved by the combination and interaction of several methods as for instance computed aided design (CAD) finite element modelling (FEM), artificial neural network (ANN) and others. As it is mentioned in the following chapters of the article a unique novel method is developed that can predict natural frequency according to the dimensions. The results confirmed the correctness of the new methodology, which can predict natural frequency by the dimensions of a turbine blade immediately with a relatively high level of accuracy (maximal errors are under 1.5%). Every jet engine manufacturer (GE aviation, Rolls Royce, Prat and Whitney, etc.) has to test jet engine parts for the natural frequencies in order to avoid the resonance at early stage of the manufacturing process in order to mount the blades into the engine. The experimental tests of every single turbine blade are time-consuming, a novel method can predict natural frequency according to the dimensions by using data from dimension check in 0.0051 s. The presented method is under patent pending.

Chronic hepatitis B - A scoping review on the guidelines for stopping nucleos(t)ide analogue therapy

INTRODUCTION

Nucleos(t)ide analogues (NAs) are effective in suppressing the replication of the hepatitis B virus. However, NAs cannot effectively induce hepatitis B surface antigen (HBsAg) seroclearance, which represents the optimal treatment endpoint in chronic hepatitis B (CHB). Hence, most CHB patients are advised for indefinite NA therapy, but recent data has supported the concept of finite NA therapy before HBsAg seroclearance.

AREAS COVERED

This article covered the latest evidence on stopping NAs in CHB, with focused analysis on international guidelines. Articles were retrieved by a literature search on PubMed with the keywords "chronic hepatitis B", "antiviral therapy", "nucleos(t)ide analogue", "cessation", "stopping" and "finite". Studies up till 1 December 2022 were included.

EXPERT OPINION

Finite NA therapy in CHB has potential in enhancing HBsAg seroclearance, however it also carries rare but potentially severe risks. NA cessation before HBsAg seroclearance is only suitable for a highly-selected group of patients, whereas the majority of CHB patients should be treated indefinitely or until HBsAg seroclearance. Current guidelines have provided recommendations on stopping NAs, but further research is required to optimize the monitoring and retreatment protocol after stopping NAs.

Application of the lambda plate on condylar fractures: Finite element evaluation of the fixation rigidity for different fracture patterns and plate placements

PURPOSE

The treatment challenges of condylar fractures necessitated the production of several plate designs. Among the relatively new plate designs is the lambda plate, for which biomechanical and clinical data are lacking. The purpose of this study is to examine the rigidity of fixation achieved when the lambda plate is applied to different fractures of the condylar neck and base.

METHODS

Five fractures of the condylar area were designed on a virtual model of a healthy mandible obtained from a CT scan. The fractures were reduced using the lambda plate. For the same fractures, alternative placements of the plate were simulated. The generated models were analysed using the finite element analysis for a 500 N bite load. The displacement of the two condylar fragments along the fracture line was calculated as an indicator of the rigidity of the fixation.

RESULTS

The displacement along the fracture was less than 0.144 mm for the neck fractures and greater than 0.165 mm for the fractures of the condylar base. A more cranial placement of the plate for the neck fractures further reduced the displacement, while a more anterior placement of the plate for the base fractures resulted in displacements greater than 0.330 mm.

CONCLUSION

According to our study, the lambda plate offers better rigidity when applied as cranially as possible for condylar neck fractures. The lambda plate did not provide adequate fixation for base fractures. A second plate at the sigmoid notch should be considered to achieve better stabilization along the fracture if the lambda plate is eventually used.

Finite element analysis of different titanium miniplates: Evaluation of three-dimensional designs applied on condylar neck fractures

INTRODUCTION

The fixation of condylar neck fractures is raising difficulties and for this reason, many plate designs have been developed. The current study compares the performance of four miniplates used in the condylar neck.

MATERIAL AND METHODS

A virtual condylar neck fracture in a mandible obtained from a CT scan was fixed with four miniplates (two straight miniplates, lambda, strut, and trapezoidal). Using finite element analysis, we examined the fragments' displacements and stress distribution in the titanium material and bone. The models were analyzed under two loading conditions: a reduced bite force of 135 N and a force of 500 N.

RESULTS

No risk of material failure was observed. For a load of 135 N, all four plates offer an adequate fixation. For 500 N of applied loading, the lambda and strut plates showed the best rigidity and lowest bone strains. The two parallel plates showed the lowest rigidity and the trapezoidal plate the highest bone strains around all screws.

DISCUSSION

These findings imply that three-dimensional miniplates (lambda, strut) perform better when higher loads are applied. On the other hand, the trapezoidal plate has an increased risk of screw loosening and the two straight plates higher mobility of the fragments.

Verb production tasks in the measurement of communicative abilities in aphasia

BACKGROUND

The neurofunctional correlates of verbs and nouns have been the focus of many theoretically oriented studies. In clinical practice, however, more attention is typically paid to nouns, and the relative usefulness of tasks probing nouns and verbs is unclear. The routine administration of tasks that use verbs could be a relevant addition to current batteries. Evaluating performance on both noun and verb tasks may provide a more reliable account of everyday language abilities than an evaluation restricted to nouns.

AIMS

To assess the benefits of administering verb tasks in addition to noun tasks, and their relation to three functional measures of language.

METHOD AND PROCEDURE

Twenty-one subjects with poststroke language disorders completed four picture-naming tasks and a role-playing test (Communicative Abilities in Daily Living, Second Edition, CADL-2), commonly used as measure of everyday language abilities. Two questionnaires (Communicative Effectiveness Index, CETI, and Communicative Activity Log, CAL) were completed by caregivers. Picture-naming tasks were matched for psycholinguistic variables to avoid lexicosemantic and morphosyntactic confounds.

RESULTS

No significant differences emerged across picture-naming tasks. Scores on the role-playing test and the two questionnaires differed; scores between the two questionnaires did not. The four naming tasks correlated significantly with CADL-2, CETI, and CAL. The strength of the correlation with CADL-2 was significantly greater for Naming Finite Verbs than for Object Naming. Thirteen participants showed no differences in performance between tasks, 6 fared significantly worse on verb tasks than on Object Naming, 1 fared better at Naming Finite Verbs though his performance was poor overall, and 1 was significantly more impaired on verbs.

CONCLUSIONS

Performance on tasks that use verbs, and especially Naming Finite Verbs, may provide a more accurate estimate of language abilities in daily living than Object Naming alone. Administering both verb and noun tasks may be recommended in clinical practice.