Whether 3.0 g cefuroxime (CXM) prophylaxis before cardiac surgeries effectively avoided postoperative pneumonia (POP) and fever (POF) compared with 1.5 g is debatable, which needed to be confirmed by evidence-base medicine. A total of 301 patients who underwent CXM perioperative prophylaxis before cardiac surgeries from Jan 2023 to Dec 2023 at the First Affiliated Hospital of Nanjing Medical University were incorporated in a nested case-control study. The patients were divided into the 1.5 g (n = 170) and 3.0 g (n = 131) groups according to the first dosage of prophylactic CXM. Outcomes included POP and POF. Risk and stratification analysis was performed for the effect and modification of different dosages of CXM on outcomes. The risk of POF in 3.0 g group (67, 51.15%) was higher than 1.5 g group (52, 30.59%) unadjusted (OR = 2.38, 95%CI:1.48 ~ 3.81, P < 0.001) or adjusted (OR = 2.38, 95%CI:1.36 ~ 4.14, P = 0.002) for the confounding variables. There was no significant difference in POP between the two groups unadjusted (OR = 1.26, 95%CI:0.62 ~ 2.55, P = 0.522) or adjusted (OR = 1.03., 95%CI:0.48 ~ 2.20, P = 0.945) for the confounding variables. The results of stratification analysis showed two different dosages of CXM didn’t generate modification on the other risk factors of POF. 3.0 g CXM prophylaxis before cardiac surgeries didn’t decrease the incidence of POP but increased the risk of POF compared with 1.5 g. However, limited by underpowered sample size and the overly broad research population, the conclusions needed to be validated by a prospective cohort study.

There is a lack of a universally accepted standard or guideline for the frequency of disinfection in purified water pipelines. Furthermore, there is no standardized method for detecting microorganisms in the final rinse water utilized for endoscope cleaning.This study aims to examine the current management and microbial monitoring practices concerning the final rinse water used for flexible endoscope cleaning in medical institutions. A questionnaire was designed using a convenience sampling method to gather data on the maintenance and microbial monitoring of final rinse water for flexible endoscopes in 290 medical institutions across Jiangsu Province, China. Purified water is used for endoscope rinsing by 93.45

Objectives Whether 3.0 g CXM prophylaxis before cardiac surgery can effectively avoid POP and persistent POFcompared with 1.5 g is debatable, which needs to be confirmed by evidence medical research. Methods A total of 301 patients who underwent CXM prophylaxis before cardiac surgery from Jan 2023 to Dec 2023 at the First Affiliated Hospital of Nanjing Medical University were incorporated in a nested case-control study. The patients were divided into the 1.5 g (n=170) and 3.0 g (n=131) groups according to the dosage of prophylactic CXM. Outcomes included POP and persistent POF. Risk andstratification analysis was performed for the effect andmodification of different doses of CXM on outcomes. Results The incidence of persistent POF in 1.5 g group (52, 30.59%) was lower than that in 3.0 g group (67, 51.15%) unadjusted (OR=2.38, 95%CI:1.48~3.81, P<0.001) or adjusted (OR=2.38, 95%CI:1.36~4.14, P=0.002) for the confounding variables. There was no significant difference in POP between the two groups unadjusted (OR=1.26, 95%CI:0.62~2.55, P=0.522) or adjusted (OR=1.03., 95%CI:0.48~2.20, P=0.945) for the confounding variables. The results of stratification analysis defined that two different dosages of prophylactic CXM didn’t generate effect modification on the risk factors of persistent POF. Conclusions 3.0 g CXM prophylaxis before cardiac surgery didn’t decrease the incidence of POP but increased the risk of persistent POF compared with 1.5 g. Given the facts, this study may point the solution of CXM preoperative prophylaxis for cardiac surgery.

Epidemiological data are scarce regarding the association of exposure to mixtures of per- and polyfluoroalkyl substances (PFASs) with liver injury in the general population. In the current study, therefore, we examined data from the National Health and Nutrition Examination Survey (2009-2018). The PFAS exposure levels were defined by the serum concentrations of PFASs with over 70% detection in samples, namely perfluorooctanoic acid, perfluorononanoic acid, perfluorohexane sulfonic acid, perfluorodecanoic acid, and perfluorooctane sulfonic acid (PFOS). We evaluated liver injury from two aspects: first, the degree of liver inflammation was determined based on levels of the serum alanine aminotransferase, aspartate aminotransferase, glutamyltransferase, and total bilirubin; second, the degree of liver fibrosis was determined based on the fibrosis-4 index. We assessed the associations of individual or total PFAS exposure with these liver injury outcomes using multivariable linear and logistic regression models, restricted cubic splines, and weighted quantile sum regression. Among the samples of 7484 American adults, the median concentration of PFOS was the highest, followed by perfluorooctanoic acid and perfluorohexane sulfonic acid. Using multivariable linear regression, we observed positive correlations between all PFAS exposure and liver enzyme levels, such as alanine aminotransferase, aspartate aminotransferase, and total bilirubin. Additionally, the weighted quantile sum model indicated an overall positive association between exposure to the five PFASs and liver injury risk. For liver function biomarkers and liver fibrosis, perfluorononanoic acid and PFOS were the most heavily weighted chemicals, respectively. Our findings provide new epidemiological evidence indicating potential associations between PFAS exposure and adverse effects on liver injury biomarkers, highlighting the potentially harmful effects of PFAS exposure on human liver health.

Background and Aims: It is unclear whether a healthy lifestyle impacts mortality in the presence of non-alcoholic fatty liver disease (NAFLD). The present study aimed to examine the joint association of several modifiable lifestyle factors with mortality risk for NAFLD patients. Methods: We collected lifestyle behavior data form the National Health and Nutrition Examination Survey (NHANES) III from 1988 to 1994 and follow-up data form NHANES III-linked mortality data through 2015. We estimated joint association between four healthy lifestyle factors (non-smoking, non-drinking, regular physical activity, a healthy diet) after NAFLD diagnosis and mortality using Cox proportional hazards regression models. Results: During a median of 22.83 years of follow-up, 2932 deaths occurred. The risk of all-cause mortality decreased significantly with the healthy lifestyle scores increasing (p < 0.001). NAFLD patients with a favorable lifestyle (3 or 4 healthy lifestyle factors) reduced 36% of all-cause mortality and 43% of cardiovascular disease (CVD) mortality compared with those with an unfavorable lifestyle (0 or 1 healthy lifestyle factor) (HR, 0.64 [95% CI, 0.50–0.81], 0.57 [95% CI, 0.37–0.88]). Compared with the non-NAFLD group, the number of NAFLD patients required to adhere to a favorable lifestyle to prevent one cardiovascular disease death in 20 years was fewer (77 vs. 125). Conclusions: For the NAFLD patients, adopting a healthy lifestyle could significantly reduce their risk of death.

目的 探讨急性Stanford A型主动脉夹层(AAAD)术后患者发生呼吸机相关肺炎(VAP)的危险因素,分析感染病原菌分布.方法 选取南京医科大学第一附属医院2015年4月-2020年10月行A型夹层标准术且术后使用机械通气的139例患者,根据是否出现VAP分为感染组(n=35)和非感染组(n=104),对年龄、性别、住院天数、呼吸机支持天数、使用呼吸机次数、是否行急诊手术等多项临床病例资料进行病例对照分析,探索危险因素,分析病原菌分布特点.结果 单因素分析显示高龄、长时间机械通气、频繁气管插管可能会增加术后VAP感染概率;多因素分析显示机械通气时间延长(OR=1.197,95％CI:1.102～1.299)是A型夹层标准术后发生VAP的独立危险因素.机械通气时间越长,感染风险越高,尤其是>10 d的患者,VAP发生率>70％.术后发生VAP的病原菌主要为鲍氏不动杆菌、肺炎克雷伯菌、嗜麦芽寡养单胞菌,耐药菌主要为泛耐药鲍氏不动杆菌(MDR-AB)、耐碳青霉烯铜绿假单胞菌(CR-PA)和肺炎克雷伯菌(CR-KP).结论 临床需积极采取预防措施,降低VAP感染风险,防治多药耐药菌感染,尤其尽可能缩短机械通气时间,改善预后.

目的 比较4种消毒方式对医疗机构物体表面消毒效果.方法 随机选取医疗机构常见物体表面40份,每份分4个区域,以4种消毒方式进行现场试验,比较消毒效果.方式1:一次性纸巾蘸取次氯酸消毒液直接擦拭物表;方式2:一次性纸巾蘸取清水擦拭物表达到去污效果后,再使用次氯酸消毒液喷洒消毒物表;方式3:一次性纸巾蘸取84泡腾片溶液擦拭物表;方式4:使用复合双链季铵盐化合物消毒湿巾擦拭物表.结果 消毒方式1～4回收菌量对数值由消毒前1.67(1.31～2.26)、1.87(1.26～2.47)、1.49(1.23～2.05)、1.77(1.25～1.97)降至消毒后的 0.15(0～0.84)、0(0～0.53)、0(0～0.78)、0(0～0.78),差异均有统计学意义(P值均＜0.05).消毒前、后各组回收菌量对数值分布差异均无统计学意义(P值均＞0.05).消毒方式2和方式3平均杀灭对数值＞1,为消毒合格,方式1和方式4均＜1,为不合格.结论 采用去污后再使用次氯酸喷洒消毒与84泡腾片消毒液擦拭消毒均合格,优于直接使用次氯酸消毒液擦拭消毒及使用复合双链接铵盐化合物消毒湿巾擦拭消毒.

Background: To investigate the associations of weight change patterns across adulthood with the risk of non-alcoholic fatty liver disease (NAFLD). Methods: Using data from the National Health and Nutrition Examination Survey (NHANES) 2017–2018 cycle, we performed a retrospective cohort study with 2212 non-obese participants aged 36 years old over. Weight change patterns were categorized as “stable non-obese”, “early adulthood weight gain”, “middle and late adulthood weight gain” and “revert to non-obese” according to the body mass index (BMI) at age 25, 10 years prior and at baseline. Vibration-controlled transient elastography (VCTE) was performed to diagnose NAFLD. Modified Poisson regression was used to quantify the associations of weight change patterns with NAFLD. Results: Compared with participants in the “stable non-obese” group, those who gained weight at early or middle and late adulthood had an increased risk of NAFLD, with an adjusted rate ratio (RR) of 2.19 (95% CI 1.64–2.91) and 1.92 (95% CI 1.40–2.62), respectively. The risk of NAFLD in “revert to the non-obese” group showed no significant difference with the stable non-obese group. If the association of weight change and NAFLD was causal, we estimated that 73.09% (95% CI 55.62–82.93%) of incident NAFLD would be prevented if the total population had a normal BMI across adulthood. Conclusions: Weight gain to obese at early or middle and late adulthood was associated with an evaluated risk of NAFLD. A large proportion would have been prevented with effective weight intervention.

Objective:To explore the effect of "four step" training mode for all staff in hospital infection control on monitoring indicators of nosocomial infection.Methods:From June 25 to September 30, 2019, the whole staff of the First Affiliated Hospital of Nanjing Medical University (Jiangsu Provincial People's Hospital) were trained on the knowledge and skills of infection prevention and control by the "four step" training mode. The training contents include basic knowledge of nosocomial infection, hand hygiene, occupational exposure prevention and disposal, disinfection and sterilization, medical waste management, standardized inspection, multi drug resistant bacteria prevention and control, infectious disease management, etc. Monitoring indicators included hospital infection rate, hospital infection case rate, surgical incision infection rate, three tube infection rate of ICU patients, microbial sample submission rate before the use of therapeutic antibiotics, hand hygiene compliance and accuracy rate.Results:After the implementation of the "four step" sensing and control full staff training, the incidence of nosocomial infection in the whole hospital, internal medicine, surgery, geriatrics and ICU ward decreased (P<0.05), the infection rate of surgical site in the whole hospital decreased from 0.66% to 0.42%, and the infection rate of class I and class II surgical incision was also lower than that before the implementation of the training (P<0.05). There was no significant difference in the infection rate of class III surgical incision before and after the implementation of the training, The infection rate of three tubes in intensive care unit (ICU) patients did not change after the implementation of "four step" full staff training. The submission rates of all kinds of antibiotics, restricted antibiotics and special antibiotics in the whole hospital were improved (P<0.05), and the hand hygiene compliance and accuracy of nurses were improved (P<0.05), Although the compliance of hand hygiene was improved after the implementation of the training, there was no statistical difference in the correct rate (P>0.05).Conclusion:The "four step" training and assessment mode for all staff of infection control and prevention has a positive feedback effect on the monitoring indicators of nosocomial infection, and the level of nosocomial infection prevention and control has been significantly improved.

To develop and validate a reference equation (RE) for prediction of VO2peak in Chinese adults and compare the equation cited by Wasserman, Edvardsen, Nevil and Itoh. we reviewed the data of 554 adults with treadmill Bruce protocol of CPET (breath by breath) from R+ clinic in Chengdu. Ultimately, 313 adults (aged from 20-59 years) including smokers, obese, were judged to have normal cardiorespiratory system without vascular disease (CVD), hypertension, diabetes and other chronic pulmonary disease based on case history, physical, electrocardiogram during rest and exercise, and exercise performance. The 313 sample was divided into 80% construction group (CG) and 20% validation group (VG) using a case random method. Oxygen consumption, Maximal heart rate (HRmax) and respiratory exchange ratio (RER) were collected in the state of exhaustion. The influence of potential confounding factors, such as age, sex, weight, height and BMI were analyzed for their influencing power at the RE. The equation was predicted by regression analyses. RE was also tested in the VG. Simultaneously, we compared measure VO2peak with predicted values calculated with four equations from Wasserman, Edvardsen, Nevil and Itoh. The line chart that predicted VO2max changes in BMI, height classification and measured among equations was plotted. The mean age and VO2max were 36.63±9.49 years and 32.82 ± 6.01 ml.kg-1.min-1, respectively. For model construction, two prediction equations with acceptable accuracy were developed (R2 = 0.67 - 0.71; SEE = 0.02028 - 0.02033). In VG, the difference was not significant between measured and predicted VO2peak from model 2 and model 1 (P > 0.05). However, difference came up between the average VO2peak predicted by cited equation and the CPET measured VO2peak, as well as the difference gotten from the RE (P < 0.001). RE presents VO2max values close to those directly measured by CPET, while Europe and America equations overestimated the VO2max. The predicted values of VO2max calculated from Itoh equation revealed a very good consistence among normal and low weight.

目的 通过感控专职人员对基层卫生人才三阶段的专项培训,全面提升基层卫生人才感染预防与控制水平.方法 于2020年11月5-19日从江苏省基层卫生人员实训指导中心选派师资,在全省5个基地对江苏省乡镇卫生院和社区卫生服务中心骨干人员进行感染预防与控制同步线下培训,培训内容主要包括以下部分:(1)医院感染防控基础知识,包括标准预防、职业防护、手卫生与感染防控、无菌操作、消毒灭菌、医疗废物管理、传染病管理等;(2)现场演示,包括手卫生、职业暴露处置、消毒剂配置与使用、个人防护用品穿脱、环境采样等;(3)案例分析与分享,包括院感病例诊断、不同类型院感暴发事件处置、感控措施分享等;(4)现场答疑;(5)现场考核,考核分为感控基础知识考核、防护服穿脱考核以及应急处置能力考核3个部分.结果 共有120名基层卫生人才参与本次培训,包括76名男性学员及44名女性学员,年龄26 ～ 58岁,主要以30 ～ 39岁(40.83％)年龄段居多,职称分布以初级及中级为主.学员最终基础知识考核得分[(89.44±11.06)分]高于摸底阶段得分[(54.85±12.74)分],分数提高(P＜0.001).个人防护用品考核中佩戴医用防护口罩及脱医用防护服步骤得分较低.培训学员摸底考核及最终考核得分在性别、年龄、职称、医疗机构等级及基地之间的差异均无统计学意义(均P＞0.05).结论 所有学员感染预防与控制能力得到很大提高,培训取得了较好成效.

In this prospective cohort study, we aimed to evaluate the association between dietary habits and the risk of developing hepatocellular carcinoma (HCC) in hepatitis B surface antigen (HBsAg)-positive carriers in Qidong, an hepatitis B virus (HBV)-epidemic area in China. A total of 3199 HBsAg carriers aged 30-70 years in a prospective cohort in Qidong, China from 2007 to 2011 were included in the study. At baseline, all participants self-reported their dietary habits in a questionnaire interview. A follow-up check-up was performed every 6 months to identify HCC cases until November 2017. Cox’s regression analysis and an interaction analysis were performed to estimate the relative risks of HCC in terms of baseline diet. Among 3199 HBsAg-positive participants, 270 developed HCC (143.86/100 000 person-years [PYs]). Compared with participants who rarely consume garlic, the risk of HCC in those who consumed it ≥ once per week decreased along with the increase in frequency (HR = 1.00, 0.90 and 0.62 in those who consumed it rarely vs those who consumed it 1-6 times per week and ≥ 7 times per week, respectively). This study found a synergistic effect between garlic and tea consumption on the risk of HCC ( P = 0.039 for a multiplicative interaction). HBsAg carriers should improve their diet. Regular consumption of garlic and tea drinking may reduce the HCC incidence in HBsAg carriers.

The relationship between hepatitis B virus (HBV) and nonhepatocellular cancers remains inconclusive. This large case‐control study aimed to assess the associations between HBV infection status and multiple cancers. Cases (n = 50 392) and controls (n = 11 361) were consecutively recruited from 2008 to 2016 at the First Affiliated Hospital of Nanjing Medical University. Multivariable adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) were estimated using logistic regression by adjusting age and gender. A meta‐analysis based on published studies was also performed to verify the associations. Of these, 12.1% of cases and 5.5% of controls were hepatitis B surface antigen (HBsAg) seropositive. We observed significant associations between HBsAg seropositivity and esophagus cancer (aOR [95% CI] = 1.32 [1.13‐1.54]), stomach cancer (1.46 [1.30‐1.65]), hepatocellular carcinoma (HCC; 39.11 [35.08‐43.59]), intrahepatic and extrahepatic bile duct carcinoma (ICC and ECC; 3.83 [2.58‐5.67] and 1.72 [1.28‐2.31]), pancreatic cancer (PaC; 1.37 [1.13‐1.65]), non‐Hodgkin lymphoma (NHL; 1.88 [1.61‐2.20]) and leukemia (11.48 [4.05‐32.56]). Additionally, compared to participants with HBsAg−/anti‐HBs−/anti‐HBc−, participants with HBsAg−/anti‐HBs−/anti‐HBc+, indicating past HBV‐infected, had an increased risk of esophagus cancer (aOR [95% CI] = 1.46 [1.24‐1.73]), stomach cancer (1.20 [1.04‐1.39]), HCC (4.80 [3.95‐5.84]) and leukemia (15.62 [2.05‐119.17]). Then the overall meta‐analysis also verified that HBsAg seropositivity was significantly associated with stomach cancer (OR [95% CI] = 1.23 [1.14‐1.33]), ICC (4.05 [2.78‐5.90]), ECC (1.73 [1.30‐2.30]), PaC (1.26 [1.09‐1.46]), NHL (1.95 [1.55‐2.44]) and leukemia (1.54 [1.26‐1.88]). In conclusion, both our case‐control study and meta‐analysis confirmed the significant association of HBsAg seropositivity with stomach cancer, ICC, ECC, PaC, NHL and leukemia. Of note, our findings also suggested that the risk of stomach cancer elevated for people whoever exposed to HBV.

ObjectiveIn this prospective cohort study, we aimed to evaluate the association between dietary habits and the risk of developing hepatocellular carcinoma (HCC) in hepatitis B surface antigen (HBsAg)‐positive carriers in Qidong, an hepatitis B virus (HBV)‐epidemic area in China.MethodsA total of 3199 HBsAg carriers aged 30‐70 years in a prospective cohort in Qidong, China from 2007 to 2011 were included in the study. At baseline, all participants self‐reported their dietary habits in a questionnaire interview. A follow‐up check‐up was performed every 6 months to identify HCC cases until November 2017. Cox’s regression analysis and an interaction analysis were performed to estimate the relative risks of HCC in terms of baseline diet.ResultsAmong 3199 HBsAg‐positive participants, 270 developed HCC (143.86/100 000 person‐years [PYs]). Compared with participants who rarely consume garlic, the risk of HCC in those who consumed it ≥ once per week decreased along with the increase in frequency (HR = 1.00, 0.90 and 0.62 in those who consumed it rarely vs those who consumed it 1‐6 times per week and ≥ 7 times per week, respectively). This study found a synergistic effect between garlic and tea consumption on the risk of HCC (P = 0.039 for a multiplicative interaction).ConclusionsHBsAg carriers should improve their diet. Regular consumption of garlic and tea drinking may reduce the HCC incidence in HBsAg carriers.

PURPOSE:To explore the molecular genetic mechanisms underlying different responsiveness to Enterovirus 71 (EV71) vaccine.METHODS:We recruited 10,245 healthy children into a phase 3 clinical trial to evaluate the efficacy of EV71 vaccine in 2012. Fifty subjects from the trial were divided into the potent immune response group (20 subjects) and the ineffective immune response group (30 subjects). Whole-exome sequencing was performed for these 50 samples and we conducted bioinformatics analyses based on online public database.RESULTS:A total of 222,180 germline variants were detected across 50 subjects. Single nucleotide variant (SNV)-based screening of the subjects with potent or ineffective immune response allowed the identification of a potentially detrimental heterozygous missense variant (c.3784C>T) in EEA1. We also retained TRIM59 and ABCA7 genes that contain different loss of function (LoF) variants shared in two cases and involved in the immune response process. Then, we conducted high-resolution typing of 9 classical HLA genes, HLA-DRB1*03:01, HLA-DQA1*05:01 and HLA-DQB1*02:01 alleles were frequently (recurrence ≥5) observed only in ineffective immune responders.CONCLUSIONS:Our study is a meaningful attempt on the comparison of genomic profiles between potent and ineffective immune responders induced by EV71 vaccine, and several candidate potentially detrimental genes were identified.

BACKGROUND:Genetic variation has an important role in the development of non-small-cell lung cancer (NSCLC). However, genetic factors for lung cancer have not been fully identified, especially in Chinese populations, which limits the use of existing polygenic risk scores (PRS) to identify subpopulations at high risk of lung cancer for prevention. We therefore aimed to identify novel loci associated with NSCLC risk, and generate a PRS and evaluate its utility and effectiveness in the prediction of lung cancer risk in Chinese populations. METHODS:To systematically identify genetic variants for NSCLC risk, we newly genotyped 19 546 samples from Chinese NSCLC cases and controls from the Nanjing Medical University Global Screening Array Project and did a meta-analysis of genome-wide association studies (GWASs) of 27 120 individuals with NSCLC and 27 355 without NSCLC (13 327 cases and 13 328 controls of Chinese descent as well as 13 793 cases and 14 027 controls of European descent). We then built a PRS for Chinese populations from all reported single-nucleotide polymorphisms that have been reported to be associated with lung cancer risk at genome-wide significance level. We evaluated the utility and effectiveness of the generated PRS in predicting subpopulations at high-risk of lung cancer in an independent prospective cohort of 95 408 individuals from the China Kadoorie Biobank (CKB) with more than 10 years' follow-up. FINDINGS:We identified 19 susceptibility loci to be significantly associated with NSCLC risk at p≤5·0 × 10-8, including six novel loci. When applied to the CKB cohort, the PRS of the risk loci successfully predicted lung cancer incident cases in a dose-response manner in participants at a high genetic risk (top 10%) than those at a low genetic risk (bottom 10%; adjusted hazard ratio 1·96, 95% CI 1·53-2·51; ptrend=2·02 × 10-9). Specially, we observed consistently separated curves of lung cancer events in individuals at low, intermediate, and high genetic risk, respectively, and PRS was an independent effective risk stratification indicator beyond age and smoking pack-years. INTERPRETATION:We have shown for the first time that GWAS-derived PRS can be effectively used in discriminating subpopulations at high risk of lung cancer, who might benefit from a practically feasible PRS-based lung cancer screening programme for precision prevention in Chinese populations. FUNDING:National Natural Science Foundation of China, the Priority Academic Program for the Development of Jiangsu Higher Education Institutions, National Key R&D Program of China, Science Foundation for Distinguished Young Scholars of Jiangsu, and China's Thousand Talents Program.

AbstractBackgroundAccompanied by HBV infection, HBV mutations gradually occur because HBV polymerase appears proofread deficiencies. In our previous study, we have identified that EnhII/BCP/PC mutations and genotype C of HBV DNA were associated with hepatocellular carcinoma (HCC) risk. In this study, we extend our research to explore HCC prognosis associated genotype and mutations in EnhII/BCP/PC regions.MethodsWe designed a case‐cohort study of 331 HCC patients to evaluate the effects of the HBV genotypes and mutations on HCC survival. Log‐rank test and Cox proportional hazard models were used for the analyses.ResultsResults showed that genotype C, which was more frequent in HBV‐related HCC (77.4%), presented a negative signal with HCC survival. Interestingly, we detected a significant association between EnhII/BCP/PC mutation nt1753 and HCC prognosis (Log‐rank P = 0.034). Subgroup analysis revealed that this risk effect was more pronounced in non‐B genotype (P = 0.090 for heterogeneity test). We also detected a borderline multiplicative interaction between genotypes of nt1753 and HBV genotype on HCC survival (P for interaction = 0.069).ConclusionsThese findings indicated that, in Chinese population, nt1753 in EnhII/BCP/PC region might be a novel marker for HCC prognosis.

Key Points Question Is chronic hepatitis B virus infection associated with a higher risk of any cancer type when compared with individuals without hepatitis B virus? Findings This population-based cohort study of 496 732 Chinese individuals found that hepatitis B surface antigen seropositivity was associated with the risk of hepatocellular carcinoma, stomach cancer, colorectal cancer, oral cancer, pancreatic cancer, and lymphoma. The associations were validated in an independent population and tissue-based studies. Meaning Chronic hepatitis B virus infection was associated with nonliver cancer, especially digestive system cancers.

SummarySeroclearance of hepatitis B surface antigen (HBsAg) has been widely studied; however, seroconversion of HBsAg and characteristics of viral load among hepatitis B e antigen (HBeAg)‐negative chronic infection patients after HBsAg lost is not clear. We performed a large‐scale study in a HBeAg‐negative chronic infection cohort to evaluate spontaneous HBsAg seroclearance incidence from October 2012 to April 2017 in Jiangsu province, China. We also elucidated the characteristics of HBsAg seroconversion and hepatitis B virus (HBV) DNA detectability among patients who cleared HBsAg. A total of 2997 HBeAg‐negative chronic infection patients (mean age 52.3 ± 12.9 years at baseline) were included. With 10 519 person‐years of follow‐up, 348 patients successfully spontaneously cleared HBsAg, with an incidence rate of 3.31 per 100 person‐years. Patients with HBV DNA detectable ~1999 IU/mL at baseline had a lower probability of HBsAg seroclearance relative to those with undetectable HBV DNA, with a hazard ratio of 0.31 (95% CI = 0.23, 0.41). HBsAg seroconversion occurred in 37.3% of those patients who cleared HBsAg. The geometric mean of anti‐HBs among those with HBsAg conversion was 79.4 mIU/mL. Female had a higher HBsAg seroconversion rate (P = 0.011). Among those with HBsAg seroclearance, 11.2% still had HBV DNA levels of higher than 100 IU/mL. Patients with higher HBV DNA at baseline had a higher risk of detectable HBV DNA levels even after HBsAg seroclearance (P < 0.001). This study reveals HBsAg seroconversion rates and HBV DNA undetectability epidemiological characteristics of patients with HBsAg seroclearance and suggests that monitoring HBV DNA is needed when managing HBeAg‐negative chronic patients, even after clearing HBsAg.

Hepatoma Research is an open access journal and focuses on all topics related to hepatoma. The following articles are especially welcome: pathogenesis, clinical examination and early diagnosis of hepatoma, complications of hepatoma, and their preventions and treatments, etc.