Background:Despite the global prevalence of SARS-CoV-2 reinfection, relatively little is known regarding its association with osteoporosis in older adults. This study investigated the potential impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on bone health or osteoporosis risk in adults aged 55 years and older in Beijing, China, while also exploring additional factors that may influence this association. Methods:This cross-sectional study was conducted at Beijing Ditan Hospital, Beijing, China, between August and December 2024. Patients aged ≥ 55 years with SARS-CoV-2 infections were included. Data on demographic characteristics, lifestyle habits, diet, serum contents of 25-hydroxyvitamin D (25-OH-VD), and other potential risk factors for osteoporosis were collected through structured questionnaires. Bone mineral density (BMD) was assessed using dual-energy X-ray absorptiometry (DXA). To identify the variables associated with osteoporosis, logistic regression analysis was employed. Results:Three hundred and eighty-eight patients were enrolled, comprising 272 individuals with a single SARS-CoV-2 infection and 116 with two or more infections. The results revealed that individuals who had reinfection revealed a considerably higher prevalence of osteoporosis (48.3% vs. 17.3%, p < 0.0001). This trend was consistent across different skeletal sites: 33.6% vs. 7.4% at the left hip, 37.9% vs. 5.5% at the right hip (p < 0.0001), and 30.2% vs. 12.9% at the lumbar spine (L1-L4) (p < 0.0001). SARS-CoV-2 reinfection remained substantially associated with osteoporosis after controlling for con-founding variables, with an OR of 3.08 (95% CI: 1.696-5.593). Conclusion:In summary, the risk of osteoporosis among individuals with SARS-CoV-2 reinfection should be carefully monitored, and greater emphasis should be placed on early, individualized prevention and treatment strategies.

The 20 μg (0–1–6 month) hepatitis B virus (HBV) vaccination is widely recommended for HBV vaccine-naïve immune adults in China. However, suboptimal protective responses may occur due to dose-series incompletion. We aim to investigate the immunogenicity of a 60 μg HB vaccine with a 0–2 month series among HBV vaccine-naïve immune adults aged 25–55 to assess potential alternative approaches for HB immunization. A two-center randomized controlled trial was carried out. Participants were randomly allocated to either the 20 μg (0–1–6 month) or the 60 μg (0–2 month) regimen. Blood samples were collected eight weeks after the final injection to measure the antibodies. A total of 583 adults (289 in the 20 μg regimen and 294 in the 60 μg regimen) were included. The seroprotection rates (SPRs) were 97.23% and 93.54% in the 20 μg and 60 μg regimens, respectively (p = 0.0261), and the geometric mean concentrations were 600.76 mIU/mL and 265.68 mIU/mL, respectively (p < 0.0001). The immunogenicity of the 60 μg regimen decreased significantly with age, particularly in adults aged 40 and older. The 60 μg regimen may be beneficial for adults under 40, especially those with poor compliance or in urgent need of immunization.

Objective: To analyze the epidemiological characteristics and related factors of hepatitis C in Beijing City from 2004 to 2021. Methods: Descriptive epidemiological method and Joinpoint regression were used to analyze the trend and other epidemiological characteristics of hepatitis C in Beijing City from 2004 to 2021 in National Notifiable Disease Reporting System. According to a 1∶1 matched case-control study design, logistic regression was used to investigate the risk factors of hepatitis C infection in 2021. Results: From 2004 to 2021, the reported incidence of hepatitis C in Beijing City ranged from 2.37/100 000 to 10.46/100 000. The reported cases were mainly aged 30-60 years, and most of them were chronic. The reported incidence of hepatitis C showed an initial increase from 2004 to 2006 (APC=45.37%, 95%CI:-1.56%-114.69%), and declined after 2006 (APC=-9.21%, 95%CI:-10.70%-7.70%). Logistic analysis showed that history of surgery (OR=1.84, 95%CI: 1.08-3.14) and previous blood transfusion (OR=34.22, 95%CI: 8.05-145.41) were risk factors for hepatitis C infection. Conclusion: The reported incidence of hepatitis C in Beijing City increases first and decreases later. It currently remains at a low level. The risk factors of infection are surgery and blood transfusion history. Safe blood supply and preventing iatrogenic transmission should be focused on the prevention of hepatitis C transmission.

目的 本研究基于真实临床数据评估乙型肝炎肝硬化患者抗病毒治疗依从性及探讨影响抗病毒治疗依从性的因素.方法 本研究数据来源于北京佑安医院电子病历数据库,回顾性收集了2008年2月14日至2012年12月31日期间的乙型肝炎肝硬化患者的门诊及住院信息、取药信息和实验室检查结果及日期.根据患者取药记录,利用药物持有率(medication possession ratio,MPR)评估患者抗病毒治疗依从性水平,并用非条件logistic回归模型分析影响良好依从性的因素.结果 研究共纳入北京市应用恩替卡韦(ETV)或阿德福韦(ADV)单药口服抗病毒治疗的患者299例,其中HBeAg阳性患者117例,HBeAg阴性患者182例;大部分入组患者MPR≥80％,约占68％;其中MPR≥95％患者约占45％,MPR≥100％患者约占26.1％,而MPR<50％的患者仅占12％.单因素分析结果显示基线白蛋白(albumin,ALB)≥35 g/L患者较ALB<35 g/L患者抗病毒治疗依从性显著增高(OR=2.27,95％CI=1.425～3.618),基线胆碱酯酶(cholinesterase,CHE)≥4000 U/L患者抗病毒治疗依从性明显高于CHE<4000 U/L患者(OR=2.601,95％CI=1.617～4.183);治疗时间较长的患者抗病毒治疗依从性偏低(OR=0.549,95％CI=0.389～0.757).在单因素分析中P<0.15的因素进入多因素校正分析模型,结果显示只有治疗时间对抗病毒治疗依从性有影响(OR=0.021,95％CI=0.005～0.088),其他因素差异均无统计学意义.结论 与其他慢性疾病相比,乙型肝炎肝硬化患者的抗病毒治疗依从性水平并不低,影响抗病毒治疗依从性的因素主要是患者的治疗时间,治疗时间越长的患者,依从性越差.

Background: The widely recommended standard schedule of hepatitis B vaccine for adults is months 0, 1 and 6, which takes 6 months to complete. Rapid completion of one vaccination schedule is important to adults because of its low compliance with follow-up doses. A new type of 60 mu g Hepatitis B vaccine, made by Shenzhen Kangtai Biological Products Co., LTD., is originally recommended for low or non-responders. The objective of this clinical trial was to test whether this 60 mu g hepatitis B vaccine could be used in primary immune population and what is its level of immunogenicity and safety compared with other hepatitis B vaccines.Methods: This is a 2-center randomized controlled study. A total of 1169 healthy adults aged between 25 and 55 who tested negative for HBsAg, anti-HBs, and anti-HBc were eligible for the study and were enrolled from relatively fixed and stable sites, such as villages, schools and large enterprises et al in Xuanhua county in Hebei province and Huaibei county in Anhui province. They were randomized to group A (20 mu g Engerix-B (R) with 0, 1, 6 month intervals), group B (20 mu g Kangtai hepatitis B vaccine with 0, 1, 6 month intervals), group C (60 mu g Kangtai hepatitis B vaccine with 0, 2 month intervals) and group D (20 mu g Huabei hepatitis B vaccine made by recombinant DNA techniques in CHO cell with 0, 1, 6 month intervals). In group A, B and D, every study object's blood sample was collected in the second month after their final injection to test the anti-HBs levels; while in group C, the blood sample was collected in the second month after the first and the second injection to test the anti-HBs levels. Adverse events were collected after each dose to assess the vaccines' safety.Results: The seroprotection rates were 93.17%, 97.23%, 93.54% and 98.98% respectively and the geometric mean titers (GMTs) were 1033.38 mIU/ml, 600.75 mIU/ml, 265.69 mIU/ml and 1627.05 mIU/ml in group A, B, C and D respectively. The difference of seroprotection rate among the 4 groups was statistically significant (chi(2) = 17.26, P < 0.05). The difference of titers of anti-HBs among the 4 groups was statistically significant (H = 162.42, P < 0.05). BMI, age (older than 40) and smoking were the influence factors of anti-HBs levels on 60 mu g hepatitis B vaccine.Conclusion: 60 mu g hepatitis B vaccine has a satisfactory safety and seroprotection rate in adult, It could be used in rapid adult hepatitis B immunization.

AIM:To determine the impact of partial reimbursement for antivirals on antiviral utilization and adherence for chronic hepatitis B patients.METHODS:This was a retrospective cohort study. Two separate cohorts were enrolled, including 14163 and 16288 chronic hepatitis B outpatients, respectively. These patients were referred to Beijing You'an Hospital before and after the new partial reimbursement for antivirals, which was implemented on July 1, 2011. Demographic characteristics (including medical insurance status), routine biochemical, virological and serology laboratory test results, and antiviral agents' prescription information were collected from an electronic database. Patients were also defined as new and existing patients according to treatment history. Antiviral utilization, medication possession ratio and persistence rate were calculated and compared among the patients with different characteristics. A questionnaire survey was conducted among 212 randomly sampled outpatients from the same hospital to confirm the validity of the electronic database. Propensity score matching was used to adjust the distribution of patient's characteristics which may influence the antiviral utilization. χ(2) test or ANOVA was adopted and multivariate logistic regression was used to determine the factors associated with antiviral utilization and good adherence.RESULTS:A total of 13364 outpatients from each cohort were enrolled after the propensity score matching. The antiviral utilization rate for the insured patients increased from 57.4% to 75.9% (P < 0.0001) after the reimbursement, and the rate among those who paid out-of-pocket increased from 54.9% to 56.7% (P = 0.028). Approximately 71% of the patients had a medication possession ratio of more than 80% in each cohort before reimbursement. This increased to 79.2% and 73.1% for insured patients and those who paid out-of-pocket, respectively (P < 0.0001). Insured patients and those who paid out-of-pocket had the similar persistence rates before reimbursement. But after reimbursement, insured patients had higher persistence rates than those who paid out-of-pocket at 6 (86.5% vs 81.5%, P < 0.0001), 9 (79.7% vs 69.9%, P < 0.0001), 12 (73.4% vs 61.9%, P < 0.0001), and 15 mo (66.6% vs 53.1%, P < 0.0001). The reimbursement could significantly improve adherence for the insured patients than those who paid out-of-pocket even after adjusting other covariates, with an interaction odds ratio of 1.422 (95%CI: 1.220-1.657, P < 0.0001). The questionnaire survey supported the validity of the electronic database.CONCLUSION:The reimbursement policy shows a positive impact on antiviral utilization as well as adherence for insured chronic hepatitis B patients.

Background: Vaccination of infants beginning at birth is recommended to prevent Hepatitis B virus (HBV) infection in China. Compared to 5 mu g/dose vaccine administered in other regions in China, a three-dose HB recombinant yeast vaccine at 10 mu g/close has been administered for infants within 24h after birth, 1 month and 6 months of age in Beijing since 2006. In a community-based retrospective cohort study, factors influencing immunologic vaccine response were evaluated.Methods: A total of 3670 infants who completed a 3-dose 10 mu g recombinant HB vaccine regimen and born to hepatitis B antigen negative mothers were included. The effect on anti-HBs titers of maternal nutrient status, infants' birth condition, growth factors, timeliness of vaccination, dosing interval and the interval until post-vaccination serologic testing (PVST) were evaluated.Results: A total of 3666 infants with no markers of HBV infection were included in analysis. The mean anti-HB titers were 1767.17 mIU/ml. Only 16.9% of the infants completed their PVST within 30-59 days after the final dose of vaccination. Multivariate linear regression analysis showed that delay in PVST (beta = -0.097, p < 0.0001) and maternal folic acid supplementation (beta = 0.067, p = 0.002) were associated with log-transformed anti-HB titers. Also a trend toward significant association was observed between the calcium supplementation of infants and log-transformed anti-HBs titers (beta = 0.062,p = 0.057). Longer interval between dose 2 and dose 3 was not observed to increase the anti-HB titers after cofactors adjustment.Conclusions: Our findings illustrate the importance of timing of PVST to avoid unnecessary revaccinadon. Multi-center large cohort studies should verify the effect and magnitude of folate and calcium supplementation on HB vaccine response. (C) 2015 Elsevier Ltd. All rights reserved.

BackgroundPartial reimbursement of antivirals for hepatitis B virus (HBV) was implemented in Beijing, China, on July 1, 2011. In previous studies, we found that partial reimbursement significantly improved antiviral drug use among insured patients with chronic HBV infection but not among patients who paid out-of-pocket. Also, after the new policy entecavir, a suggested first-line agene have replaced with adefivor, a predominantly used agents before reimbursement and become the most widely used drug. The aim of this study was to assess the effectiveness and cost-effectiveness of the reimbursement among patients with chronic HBV infection.MethodsThis retrospective cohort was based on electronic claims from Beijing You'an Hospital between Jan 14, 2008, and Dec 30, 2012. Age, sex, insurance status, antiviral drug claims, and on-study laboratory test of a retrospective cohort of 92 776 outpatients and 2774 inpatients with non-cirrhotic chronic HBV infection of Beijing residents were retrieved. We enrolled patients with chronic HBV infection who received adefovir, which was the most common used for patients with chronic HBV infection before the reimbursement, or entecavir, which was the most frequently used among insured patients after the reimbursement. Patients were not included if they were coinfected with other virus infection or severe diseases. The antiviral drug use data during an 18 month period prior to the enrollment were used to define naive patients. Medication possession ratio (MPR) was used to assess adherence, defined as the proportion of days within an observation period for which antiviral drugs were supplied. We used naive patients and applied the Markov model to assess cost-effectiveness for specific antivirals with different adherence rates. The study was approved by the Ethical Review Committee of the Institute of Basic Medical Sciences Chinese Academy of Medical Sciences and Beijing You'an Hospital of Capital Medical University.FindingsBetween Jan 1, 2009 and Dec 31, 2012, we enrolled 7665 outpatients who received adefivor and 5439 patients who received entecavir. MPR of adefivor remained constant in insured patients (84·4% [SD 23·1%] before reimbursement vs 85·8% [20.8%] after reimbursement), whereas the MPR of entecavir increased greatly from 79·7% (28·7%) before reimbursement to 89·1% (20·9%) after reimbursement among insured patients. The policy significantly improved adherence among insured patients compared with patients who paid out-of-pocket (odds ratio 1·6 [95% CI 1·2–2·4), even after adjusting for age, sex, disease severity, and antiviral drugs. Compared with MPR less than 0·5, naive patients with MPR of 0·8 or more had the highest HBV DNA response rate, with hazard ratio of 2·0 (95% CI 1·4–2·9) for HB e antigen positive patients and 1·6 (95% CI 1·2–2·1) for HB e antigen negative patients. Patients who adhered to entecavir treatment gained the longest quality-adjusted life years, and entecavir treatment was identified as the most cost-effectiveness option. Compared with patients who received adefovir or patients who adhered poorly to entecavir treatment, treatment among patients who adhered well to entecavir treatment had an incremental cost-effectiveness ratio, which was less than the common reference thresholds based on GDP per person (¥87 091).InterpretationFor patients with chronic HBV infection, the partial reimbursement of drugs to an acceptable cost might effectively improve antiviral treatment outcomes by increasing antiviral use, especially the use of first-line drugs, as well as adherence.FundingMinistry of National Science and Technology of China (2012ZX10004904, 2013ZX10002002006002).

目的 分析北京市成人高危人群乙肝疫苗免疫接种成本效果.方法 采用马尔科夫模型估计对北京市医务人员及表面抗原阳性的成人的配偶及其家庭成员进行乙肝疫苗接种的成本效用比,并对影响成本效用的因素进行敏感性分析.结果 如果采用国产试剂筛查乙肝五项,并按照20 μg国产乙肝疫苗接种3剂,接种率100％,则针对北京市医务人员接种每获得一个质量调整生存年数(quality-adjusted life-year,QALY)节省费用90.17元;针对乙肝表面抗原阳性者家庭成员接种乙肝疫苗每获得的一个QALY节省费用2 470.10元.不同的筛查方案、接种率、贴现率和QALY权重下,该结论不变.结论 北京市目前推荐的乙肝疫苗高危人群接种可获得较好的成本效用比,有必要提高上述人员乙肝疫苗接种率,从而最终降低北京市乙肝发病率和死亡率.

Objectives The aim of this study was to investigate whether 6 candidate serum miRNAs and their interactions with serum folate level were associated with the risk for pancreatic cancer (PC).Method A hospital-based case-control study including 74 incident PC cases and 74 controls was conducted. Serum folate and miRNAs were determined by radioimmunoassay and real-time quantitative polymerase chain reaction, respectively. Cell lines AsPC-1 and PANC-1 were used for in vitro study.Results MiR-16 was elevated (P = 0.030-0.043) and miR-103 was reduced (P = 0.018-0.020) in PC after adjustment for age, sex, and smoking; however, after additional adjustment for folate, only miR-103 was significantly different between cases and controls (P = 0.010). After converting the relative expression of miRNAs into binary variables and adjusting for age, sex, smoking, and folate, the subjects with low miR-103 or low miR-601 were observed to have a higher risk for PC, with odds ratios of 2.33 (95% confidence interval, 1.06-5.10) and 2.37 (95% confidence interval, 1.07-5.26), respectively. Multifactor dimensionality reduction analysis showed a significant interaction for miR-16, folate, and smoking (cross-validation consistency, 10/10; mean testing accuracy, 0.696; P = 0.013). Interaction between miR-16 and folate was also verified in the AsPC-1 cells.Conclusion Serum miR-103; miR-601; and interactions among serum miR-16, folate, and smoking are associated with PC.

Pancreatic cancer (PC) is an aggressive malignancy with extremely low 5-year survival rate (<5%). SWItch/Sucrose Non Fermentable (SWI/SNF) complex is a core factor for chromatin-remodeling that utilize energy of ATP hydrolysis to mobilize nucleosomes, and modulate gene transcription. Recent studies have identified recurrent mutations in major components of SWI/SNF in a variety of human cancers, including PC. We conducted a two-stage case-control study to investigate the associations between 14 common variants in 6 genes (SMARCA4, SMCRB1, PBRM1, BRD7, ARID1, and ARID2) encoding major components of the SWI/SNF complex and the risk of PC. Three promising variants, rs11644043, rs11085754, and rs2073389 in the discovery stage comprising 310 cases and 457 controls were further genotyped in the validation stage containing 429 cases and 585 controls. rs11644043 in BRD7 and rs11085754 in SMARCA4 showed consistent significant association with increased risk of PC in both stages, with odds ratios (ORs) and 95% confidence interval (CI) of 2.04 (1.17-3.56) and 1.64 (1.16-2.33) in stage one, and 1.97 (1.24-3.14) and 1.45 (1.04-2.02) in stage two, respectively in a recessive model. Furthermore, the accumulative effects of rs11644043, rs11085754, and rs2073389 in SMARCB1 were observed (P for trend <0.0001). Intriguingly, gene-environmental interactions analysis consistently revealed the potential interactions of rs2073389 (P-add-FDR=6.00x10(-4), P-mul-FDR=1.50x10(-2)) and rs11085754 (P-add-FDR=0.03) collaborating with smoking to modify the risk of PC. In conclusion, the current study provides evidence that genetic variants of SWI/SNF may contribute to the susceptibility of PC in the Chinese population. (c) 2014 Wiley Periodicals, Inc.

Chromatin remodeling has been newly established as an important cancer genome characterization and recent exome and whole-genome sequencing studies of hepatocellular carcinoma (HCC) showed that recurrent inactivating mutations in SWI/SNF subunits involved in the molecular basis of hepatocarcinogenesis. To test the hypothesis that genetic variants in the key subunits of SWI/SNF complexes may contribute to HCC susceptibility, we systematically assessed associations of genetic variants in SWI/SNF complexes with HCC risk using a two-staged case-control study in Chinese population. A set of 24 single nucleotide polymorphisms (SNPs) in SWI/SNF complexes were examined in stage 1 with 502 HCC patients and 487 controls and three promising SNPs (SMARCA4 rs11879293, rs2072382 and SMARCB1 rs2267032) were further genotyped in stage 2 comprising 501 cases and 545 controls for validation. SMARCA4 rs11879293 presented consistently significant associations with the risk of HCC at both stages, with an OR of 0.73 (95% CI: 0.62–0.87) using additive model in combined analysis. Moreover, the decreased risk of HCC associated with SMARCA4 rs11879293 AG/AA was more evident among HBsAg positive individuals (OR = 0.47, 95% CI: 0.27–0.80) in combined analysis. The study highlighted the potential role of the SWI/SNF complexes in conferring susceptibility to HCC, especially modified HCC risk by HBV infection.

BACKGROUND: Hepatitis B virus (HBV) infection is a significant clinical and financial burden for chronic hepatitis B (CHB) patients. In Beijing, China, partial reimbursement on antiviral agents was first implemented for the treatment of CHB patients in July 1, 2011. AIMS: In this study, we describe the medical cost and utilization rates of antiviral therapy for CHB patients to explore the impact of the new partial reimbursement policy on the medical care cost, the composition, and antivirals utilization. METHODS: Clinical and claims data of a retrospective cohort of 92,776 outpatients and 2,774 inpatients with non-cirrhotic CHB were retrieved and analyzed from You'an Hospital, Beijing between February 14, 2008 and December 31, 2012. The propensity score matching was used to adjust factors associated with the annual total cost, including age, gender, medical insurance type and treatment indicator. RESULTS: Compared to patients who paid out-of-pocket, medical cost, especially antiviral costs increased greater among patients with medical insurance after July 1, 2011, the start date of reimbursement policy. Outpatients with medical insurance had 16% more antiviral utilization; usage increased 3% among those who paid out-of-pocket after the new partial reimbursement policy was implemented. CONCLUSIONS: Direct medical costs and antiviral utilization rates of CHB patients with medical insurance were higher than those from paid out-of-pocket payments, even after adjusting for inflation and other factors. Thus, a new partial reimbursement program may positively optimize the cost and standardization of antiviral treatment.

BACKGROUND:A recent genome-wide association study has identified a new susceptibility locus, kinesin family member 1B gene (KIF1B), strongly associated with progression from chronic hepatitis B (CHB) to hepatitis B virus-related hepatocellular carcinoma (HCC) in Chinese population, this study was carried out to explore the role of the genetic variants in KIF1B in the development of chronic hepatitis B.METHODOLOGY/PRINCIPAL FINDINGS:Three KIF1B polymorphisms (rs8019, rs17401924, and rs17401966) were selected and genotyped in 473 CHB patients and 580 controls with no history of CHB. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by logistic regression model. None of these three SNPs showed association with CHBs after adjusting for age and gender. Equivalence-based method analysis confirmed the absence of association. In the further haplotype analysis, three common haplotypes were observed in this study population, but no significant effect was also found for haplotypes in the progression to CHB.CONCLUSIONS/SIGNIFICANCE:This study showed the new locus identified for HCC, KIF1B, was not associated with progression to CHB, implying distinct genetic susceptibility factor contributes to the progression from hepatitis B virus infection to HCC. Nevertheless, further comprehensive analyses are warranted to dissect the mechanism.