Dear Editor,We present a case of acute zonal occult outer retinopathy(AZOOR)complex in a myopic patient with angioid streaks(ASs).A 19-year-old female has been experiencing visual field defects in her left eye for mor...Dear Editor,We present a case of acute zonal occult outer retinopathy(AZOOR)complex in a myopic patient with angioid streaks(ASs).A 19-year-old female has been experiencing visual field defects in her left eye for more than 3y.She was diagnosed with ASs and choroiditis at a local hospital.She has a seven-year history of bilateral high myopia.A fundus examination confirmed the presence of ASs and myopic fundus changes in both eyes.Multimodal imaging revealed an AZOOR complex in the left eye.展开更多
Occult hepatitis B infection(OBI) is characterized by hepatitis B virus(HBV) DNA in serum in the absence of hepatitis B surface antigen(HBsAg) presenting HBsAg-negative and anti-HBc positive serological patterns.Occul...Occult hepatitis B infection(OBI) is characterized by hepatitis B virus(HBV) DNA in serum in the absence of hepatitis B surface antigen(HBsAg) presenting HBsAg-negative and anti-HBc positive serological patterns.Occult HBV status is associated in some cases with mutant viruses undetectable by HBsAg assays;but more frequently it is due to a strong suppression of viral replication and gene expression.OBI is an entity with world-wide diffusion.The failure to detect HBsAg,despite the persistence of the viral DNA,is due in most cases to the strong suppression of viral replication and gene expression that characterizes this"occult"HBV infection;although the mechanisms responsible for suppression of HBV are not well understood.The majority of OBI cases are secondary to overt HBV infection and represent a residual low viremia level suppressed by a strong immune response together with histological derangements which occurred during acute or chronic HBV infection.Much evidence suggests that it can favour the progression of liver fibrosis and the development of hepatocellular carcinoma.展开更多
Objective:The neglect of occult lymph nodes metastasis(OLNM)is one of the pivotal causes of early non-small cell lung cancer(NSCLC)recurrence after local treatments such as stereotactic body radiotherapy(SBRT)or surge...Objective:The neglect of occult lymph nodes metastasis(OLNM)is one of the pivotal causes of early non-small cell lung cancer(NSCLC)recurrence after local treatments such as stereotactic body radiotherapy(SBRT)or surgery.This study aimed to develop and validate a computed tomography(CT)-based radiomics and deep learning(DL)fusion model for predicting non-invasive OLNM.Methods:Patients with radiologically node-negative lung adenocarcinoma from two centers were retrospectively analyzed.We developed clinical,radiomics,and radiomics-clinical models using logistic regression.A DL model was established using a three-dimensional squeeze-and-excitation residual network-34(3D SE-ResNet34)and a fusion model was created by integrating seleted clinical,radiomics features and DL features.Model performance was assessed using the area under the curve(AUC)of the receiver operating characteristic(ROC)curve,calibration curves,and decision curve analysis(DCA).Five predictive models were compared;SHapley Additive exPlanations(SHAP)and Gradient-weighted Class Activation Mapping(Grad-CAM)were employed for visualization and interpretation.Results:Overall,358 patients were included:186 in the training cohort,48 in the internal validation cohort,and 124 in the external testing cohort.The DL fusion model incorporating 3D SE-Resnet34 achieved the highest AUC of 0.947 in the training dataset,with strong performance in internal and external cohorts(AUCs of 0.903 and 0.907,respectively),outperforming single-modal DL models,clinical models,radiomics models,and radiomicsclinical combined models(DeLong test:P<0.05).DCA confirmed its clinical utility,and calibration curves demonstrated excellent agreement between predicted and observed OLNM probabilities.Features interpretation highlighted the importance of textural characteristics and the surrounding tumor regions in stratifying OLNM risk.Conclusions:The DL fusion model reliably and accurately predicts OLNM in early-stage lung adenocarcinoma,offering a non-invasive tool to refine staging and guide personalized treatment decisions.These results may aid clinicians in optimizing surgical and radiotherapy strategies.展开更多
BACKGROUND In our day-to-day practice,constipation is a common problem in the pediatric population and cause of frequent visit in outpatient and emergency department.But occult constipation(OC)remains as the most unad...BACKGROUND In our day-to-day practice,constipation is a common problem in the pediatric population and cause of frequent visit in outpatient and emergency department.But occult constipation(OC)remains as the most unaddressed problem.AIM To investigate the clinical profile of OC in children.METHODS It was a prospective observational study,done in Bangladesh from January 2022 to December 2024.It included all consecutive children diagnosed as OC and were treated accordingly.Before diagnosis,secondary causes of the presenting symptoms were excluded with appropriate investigations.They were followed up monthly for 4 months and treatment response were measured by improvement of symptoms.RESULTS A total of 404 children were included in this study with mean age group of 76.50±36.62 months,and male-female ratio of 1.67:1.The most common presenting complaint was abdominal pain(66%),followed by anorexia(49%),vomiting(24%),nausea(17%),frequent defecation with small volume stool(17%),altered bowel habit(16%),failure to thrive(14%)and recurrent helminthiasis(12%).Interestingly,2.5%children presented with persistent diarrhea.CONCLUSION Abdominal pain is the most common presentation of OC.When symptoms cannot be explained by other etiology,OC should be kept in mind.展开更多
BACKGROUND Some patients with resectable or borderline resectable pancreatic ductal adenocarcinoma(PDAC)may have distant metastases,undetected on preoperative imaging or early recurrence,within 6 months after surgery....BACKGROUND Some patients with resectable or borderline resectable pancreatic ductal adenocarcinoma(PDAC)may have distant metastases,undetected on preoperative imaging or early recurrence,within 6 months after surgery.Occult metastases(OMs)must be accurately predicted to optimize multidisciplinary treatment.AIM To investigate the efficacy of circulating tumor DNA(ctDNA)in predicting OM.METHODS Two Japanese institutions prospectively collected preoperative plasma samples from PDAC patients between July 2019 and September 2021 and evaluated ctDNA using a targeted next-generation sequencing panel covering 52 cancer-related genes.RESULTS Among 135 PDAC patients,38 had OM and 35 were positive for ctDNA.The ctDNA positivity rate was significantly higher in patients with OM than in patients without OM.ctDNA-positive patients had significantly shorter median recurrence-free survival than ctDNA-negative patients.Logistic multivariate regression revealed ctDNA positivity as an independent predictor of OM.CONCLUSION Preoperative ctDNA in resectable PDAC is an independent predictor of OM and indicates poor prognosis following pancreatectomy and may be a useful biomarker in determining multidisciplinary patient care.展开更多
BACKGROUND Occult intraocular foreign bodies(IOFBs)can present with atypical symptoms and clinical signs,making diagnosis challenging.We describe a case of an undetected IOFB that was missed on both computed tomograph...BACKGROUND Occult intraocular foreign bodies(IOFBs)can present with atypical symptoms and clinical signs,making diagnosis challenging.We describe a case of an undetected IOFB that was missed on both computed tomography and B-ultrasound,ulti-mately leading to ocular siderosis and secondary glaucoma.CASE SUMMARY A 55-year-old male patient presented to our clinic reporting a one-month history of right ocular discomfort and progressive visual deterioration.The patient had previously received a glaucoma diagnosis at a local healthcare facility.His ocular history included blunt trauma to the affected eye five years prior to presentation.Slit-lamp examination revealed corneal and iris lesions in the right eye.Pupillary dilation facilitated the identification of traumatic lens opacities.Diagnostic imaging modalities,including B-scan ultrasonography and computed tomo-graphy,showed no evidence of retained intraocular foreign material.The patient subsequently underwent uncomplicated pars plana vitrectomy,during which the occult foreign body was successfully extracted.The procedure was completed without intraoperative or immediate postoperative complications.CONCLUSION Awareness of IOFBs in individuals who work in high-risk occupations and prompt referral to a retinal surgeon are very important.展开更多
BACKGROUND Occult pancreaticobiliary reflux(OPBR)is characterized by the absence of congenital anomalies at the pancreaticobiliary junction yet leads to altered bile composition and an increased incidence of gallbladd...BACKGROUND Occult pancreaticobiliary reflux(OPBR)is characterized by the absence of congenital anomalies at the pancreaticobiliary junction yet leads to altered bile composition and an increased incidence of gallbladder stones.AIM To explore the computed tomography(CT)imaging characteristics of gallbladder stones in patients diagnosed with OPBR.METHODS We analyzed 362 patients undergoing cholecystectomy(November 2020 to January 2022).Intraoperative bile samples were assayed for amylase(>110 U/L indicated OPBR).CT features,including stone density and visibility,were compared between 54 OPBR and 308 controls.Stone attenuation(HU)was measured under standardized conditions(uCT-780,120 kVp,160 mAs).Logistic regression and receiver operating characteristic curve analysis identified independent OPBR predictors,forming a validated nomogram.RESULTS OPBR patients exhibited significantly higher rates of CT-invisible stones(35.2%vs 12.3%)and uniform stones(87%vs 73.1%)along with lower overall stone density(P=0.01).Logistic regression identified stone visibility,uniformity,and density as independent predictors.A nomogram integrating these features with patient age achieved high diagnostic accuracy(area under the curve=0.71).CONCLUSION CT imaging distinctly identifies gallbladder stone density,indicating a heightened risk of OPBR in patients with uniform and CT-invisible stones.Such imaging is crucial for preoperative assessments to evaluate potential recurrent biliary pathologies post-cholecystectomy.展开更多
BACKGROUND Sessile serrated lesions(SSLs)are premalignant polyps implicated in up to 30%of colorectal cancers.Australia reports high SSL detection rates(SSL-DRs),yet with marked variability(3.1%-24%).This substantial ...BACKGROUND Sessile serrated lesions(SSLs)are premalignant polyps implicated in up to 30%of colorectal cancers.Australia reports high SSL detection rates(SSL-DRs),yet with marked variability(3.1%-24%).This substantial variation raises concerns about missed lesions and post-colonoscopy colorectal cancer.This study investigates determinants associated with SSL-DR variation in regional Australia.AIM To study how patient,clinical,and colonoscopy factors are associated with SSL detection in a regional Australian practice.We aimed to contribute high-detection data to the literature by analyzing the association of SSL detection with various determinants.METHODS This retrospective,cross-sectional analysis examined 1450 colonoscopies performed at Port Macquarie Gastroenterology during 2023.Sigmoidoscopies and repeat procedures were excluded.Multivariate logistic regression analyzed associations between SSL detection and patient demographics,clinical indications,procedural factors,and comorbidities.RESULTS The overall SSL-DR was 30.7%.Multivariate analysis identified several independent predictors:Clinical indication,bowel preparation quality,inflammatory bowel disease status,and serrated polyposis syndrome.The faecal occult blood test positive(FOBT)(+)cohort showed the highest predicted SSL detection probability(39.8%),while clinical symptoms showed the lowest(22.3%).After adjustment,SSL detection odds were 2.3 times greater among FOBT(+)patients than those with clinical symptoms(adjusted odds ratio=2.30,95%confidence interval:1.20-4.40,P=0.004).CONCLUSION SSL-DR as a quality indicator requires contextualization regarding clinical indications,bowel preparation quality,and comorbidities.There was a significantly higher prevalence of SSLs in FOBT(+)patients.Despite comprehensive adjustment,this study cannot fully explain the wide SSL-DR variation in Australia,highlighting the need for standardized detection protocols and further research to ensure optimal cancer prevention outcomes.展开更多
BACKGROUND This report describes a rare case of a small gastric cancer lesion with widespread bone metastases and markedly elevated alkaline phosphatase levels that was initially misdiagnosed as rheumatoid arthritis,a...BACKGROUND This report describes a rare case of a small gastric cancer lesion with widespread bone metastases and markedly elevated alkaline phosphatase levels that was initially misdiagnosed as rheumatoid arthritis,as the patient’s sole clinical manifestation was chronic bone pain persisting for 1 year.CASE SUMMARY An 83-year-old man was admitted due to worsening generalized joint pain over 1 year.Serum alkaline phosphatase levels were markedly elevated,and technetium-99m methylene diphosphonate single-photon emission computed tomography(CT)and fluorine-18 sodium fluoride positron emission tomography(PET)/CT images showed symmetrical diffuse uptake of the radiotracers throughout the skeleton.Initially,Paget’s disease was suspected,but abnormal hematologic tumor markers and bone biopsy confirmed metastatic adenocarcinoma.Fluorine-18-fluorodeoxyglucose PET/CT did not reveal a primary tumor.The patient had a history of colon polypectomy and tubulovillous adenoma with atypical hy-perplasia on pathological examination 10 years prior.Further investigation using gallium-68-labeled fibroblast-activation protein inhibitor PET/CT images showed increased punctate uptake in the gastric antrum.Gastroscopy demonstrated a 1.0 cm ulcerated mass in the prepyloric region,and histopathological evaluation of the biopsy specimen revealed poorly differentiated adenocarcinoma.The incidence of bone metastases from gastric cancer is very low,especially with such extensive involvement.CONCLUSION Occult gastric carcinomas with bone metastases necessitate proactive high-risk surveillance and multidisciplinary integration to improve diagnostic accuracy and clinical outcomes.展开更多
BACKGROUND Occult hepatitis B virus infection(OBI)is defined by the detection of replication-competent hepatitis B virus(HBV)DNA in the liver and/or blood despite the ab-sence of detectable hepatitis B surface antigen...BACKGROUND Occult hepatitis B virus infection(OBI)is defined by the detection of replication-competent hepatitis B virus(HBV)DNA in the liver and/or blood despite the ab-sence of detectable hepatitis B surface antigen(HBsAg)using conventional ser-ological assays.Although OBI has been well-documented in individuals with resolved HBV infection or those receiving immunosuppressive therapy,reports of its occurrence during sequential antiviral treatment remain scarce.This report describes a case of chronic hepatitis B(CHB)transitioning through OBI during sequential combination therapy before ultimately achieving a functional cure.This case provides new insights into the emergence of OBI as a transitional phase during CHB treatment and emphasizes the importance of monitoring its clinical significance.CASE SUMMARY A 33-year-old Chinese male was diagnosed with HBV infection in 2001.The patient first presented in 2012 with abnormal liver function tests and received initial treatment with conventional interferon therapy,which failed to achieve a virological response.Antiviral therapy was subsequently switched to entecavir monotherapy.By August 2019,the patient exhibited an HBsAg level of 29.93 IU/mL with undetectable HBV DNA(<25 IU/mL).At this point,combination therapy with entecavir and pegylated interferonα(PEG-IFNα)was initiated.Remarkably,while HBsAg declined to 0.42 IU/mL by April 2020,a paradoxical HBV DNA rebound to 173 IU/mL was observed.The regimen was consequently modified to tenofovir alafenamide and PEG-IFNα.By October 2020,the patient achieved HBsAg seroconversion(HBsAg 0.01 IU/mL,hepatitis B surface antibody 52.18 mIU/mL)for the first time,while maintaining low-level viremia(37 IU/mL),consistent with transition to OBI.The patient was then switched to PEG-IFNαmonotherapy.In November 2021,he discontinued PEG-IFNαtherapy,and one month later,both HBV DNA(<10 IU/mL)and HBsAg(<0.05 IU/mL)were negative.This response has been sustained through follow-up.CONCLUSION This case study illustrates the efficacy of sequential combination therapy in achieving functional cure in CHB patients,including those with a prolonged infection history.It highlights OBI as a transitional yet underrecognized phase during sequential antiviral therapy.While the patient ultimately achieved functional cure,the transient persistence of HBV DNA despite HBsAg clearance suggests the need for continued monitoring.This case provides new insights into OBI development during treatment and underscores the importance of further research into its long-term implications.展开更多
AIM:To comprehensively examine the clinical presentations,multimodal images,and long-term follow-up of Chinese patients with acute zonal occult outer retinopathy(AZOOR),a rare inflammatory disorder.METHODS:This was a ...AIM:To comprehensively examine the clinical presentations,multimodal images,and long-term follow-up of Chinese patients with acute zonal occult outer retinopathy(AZOOR),a rare inflammatory disorder.METHODS:This was a retrospective study.A total of 20 patients(32 eyes)were included.The medical records and multimodal imaging,including wide-field fundus photography,wide-field fundus autofluorescence(FAF),and swept-source optical coherence tomography(SS-OCT)were analyzed.RESULTS:The study included 20 patients with a mean age of 38.2±10.9y,and females accounted for 60%.Lesions could involve peripapillary areas,macular region,and peripheral retina.The mean best-corrected visual acuity(BCVA)at presentation was 0.38±0.60 logMAR,with no significant difference in visual acuity between acute cases(within 6mo of onset)and chronic cases(beyond 6mo of onset;P=0.390).There was no statistically significant difference in visual acuity between eyes of acute case(within 6mo of onset)and the chronic case(beyond 6mo of onset).In some chronic case,FAF examination revealed the presence of a hyperautofluorescent(hyperAF)ring around the macular area(6/18),a phenomenon not observed in the acute case(P=0.024).A higher proportion of chronic cases showed predominantly hypoautofluorescent(hypoAF)lesions compared to the acute case(13/18 vs 2/14,P=0.0016).SS-OCT examination showed that both acute and chronic cases exhibited hyperreflective dots above the retinal pigment epithelium(RPE),and ellipsoid zone(EZ)and RPE damage.In the chronic case,eyes with hyperreflective dots above the RPE were more likely to exhibit EZ and RPE damage in the macular region compared to those without these dots.CONCLUSION:Multimodal imaging plays a crucial role in the follow-up of patients with AZOOR.In chronic cases of AZOOR,the presence of hyperreflective dots above the RPE indicates a higher likelihood of outer retinal involvement in the macular region.This study provides critical insights into the complex presentation and progression of AZOOR.展开更多
Occult hepatitis B virus (HBV) infection (OBI), alternatively defined as occult hepatitis B (OHB), is a challenging clinical entity. It is recognized by two main characteristics: absence of HBsAg, and low viral replic...Occult hepatitis B virus (HBV) infection (OBI), alternatively defined as occult hepatitis B (OHB), is a challenging clinical entity. It is recognized by two main characteristics: absence of HBsAg, and low viral replication. The previous two decades have witnessed a remarkable progress in our understanding of OBI and its clinical implications. Appropriate diagnostic techniques must be adopted. Sensitive HBV DNA amplification assay is the gold standard assay for detection of OBI. Viral as well as host factors are implicated in the pathogenesis of OBI. However, published data reporting the infectivity of OBI by transfusion are limited. Several aspects including OBI transmission, infectivity and its relation to the development of chronic liver diseases and hepatocellular carcinoma have to be resolved. The aim of the present review is to highlight recent data on OBI with a focus on its virological diagnosis and clinical outcome.展开更多
Hepatitis B virus (HBV) is a highly pathogenic virus that causes chronic liver diseases in millions of people globally. In addition to a symptomatic, serologically evident infection, occult persistent HBV carriage has...Hepatitis B virus (HBV) is a highly pathogenic virus that causes chronic liver diseases in millions of people globally. In addition to a symptomatic, serologically evident infection, occult persistent HBV carriage has been identified since nucleic acid amplification assays of enhanced sensitivity became introduced for detection of hepadnaviral genomes and their replicative intermediates. Current evidence indicates that occult HBV infection is a common and long-term consequence of resolution of acute hepatitis B. This form of residual infection is termed as secondary occult infection (SOI). The data from the woodchuck model of HBV infection indicate that exposure to small amounts of hepadnavirus can also cause primary occult infection (POI) where virus genome, but no serological makers of exposure to virus, are detectable, and the liver may not be involved. However, virus replicates at low levels in the lymphatic system in both these forms. We briefly summarize the current understanding of the nature and characteristics of occult hepadnaviral persistence as well as of its documented and expected pathological consequences.展开更多
Occult hepatitis B virus infection(OBI), characterized as the persistence of hepatitis B virus(HBV) surface antigen(HBs Ag) seronegativity and low viral load in blood or liver, is a special form of HBV infection. OBI ...Occult hepatitis B virus infection(OBI), characterized as the persistence of hepatitis B virus(HBV) surface antigen(HBs Ag) seronegativity and low viral load in blood or liver, is a special form of HBV infection. OBI may be related mainly to mutations in the HBV genome, although the underlying mechanism of it remains to be clarified. Mutations especially within the immunodominant "α" determinant of S protein are "hot spots" that could contribute to the occurrence of OBI via affecting antigenicity and immunogenicity of HBs Ag or replication and secretion of virion. Clinical reports account for a large proportion of previous studies on OBI, while functional analyses, especially those based on full-length HBV genome, are rare.展开更多
AIM:To elucidate the molecular mechanisms underlying hepatitis B virus(HBV)occult infection of genotype C.METHODS:A total of 10 types of hepatitis B surface antigen(HBs Ag)variants from a Korean occult cohort were use...AIM:To elucidate the molecular mechanisms underlying hepatitis B virus(HBV)occult infection of genotype C.METHODS:A total of 10 types of hepatitis B surface antigen(HBs Ag)variants from a Korean occult cohort were used.After a complete HBV genome plasmid mutated such that it does not express HBs Ag and plasmid encoding,each HBs Ag variant was transiently co-transfected into Hu H-7 cells.The secretion capacity and intracellular expression of the HBV virions and HBs Ags in their respective variants were analyzed using real-time quantitative polymerase chain reaction assays and commercial HBs Ag enzyme-linked immunosorbent assays,respectively.RESULTS:All variants exhibited lower levels of HBs Ag secretion into the medium compared with the wild type.In particular,in eight of the ten variants,very low levels of HBs Ag secretion that were similar to the negative control were detected.In contrast,most variants(9/10)exhibited normal virion secretion capacities comparable with,or even higher than,the wild type.This provided new insight into the intrinsic nature of occult HBV infection,which leads to HBs Ag sero-negativeness but has horizontal infectivity.Furthermore,most variants generated higher reactive oxidative species production than the wild type.This finding provides potential links between occult HBV infection and liver disease progression.CONCLUSION:The presently obtained data indicate that deficiency in the secretion capacity of HBs Ag variants may have a pivotal function in the occult infections of HBV genotype C.展开更多
Transfusion-transmitted infections including hepatitis B virus(HBV) have been a major concern in transfusion medicine. Implementation of HBV nucleic acid testing(NAT) has revealed occult HBV infection(OBI) in blood do...Transfusion-transmitted infections including hepatitis B virus(HBV) have been a major concern in transfusion medicine. Implementation of HBV nucleic acid testing(NAT) has revealed occult HBV infection(OBI) in blood donors. In the mid-1980 s, hepatitis B core antibody(HBc) testing was introduced to screen blood donors in HBV non-endemic countries to prevent transmission of non-A and non-B hepatitis. That test remains in use for preventing of potential transmission of HBV from hepatitis B surface antigen(HBs Ag)-negative blood donors, even though anti-hepatitis C virus testshave been introduced. Studies of anti-HBc-positive donors have revealed an HBV DNA positivity rate of 0%-15%. As of 2012, 30 countries have implemented HBV NAT. The prevalence of OBI in blood donors was estimated to be 8.55 per 1 million donations, according to a 2008 international survey. OBI is transmissible by blood transfusion. The clinical outcome of occult HBV transmission primarily depends on recipient immune status and the number of HBV DNA copies present in the blood products. The presence of donor anti-HBs reduces the risk of HBV infection by approximately five-fold. The risk of HBV transmission may be lower in endemic areas than in non-endemic areas, because most recipients have already been exposed to HBV. Blood safety for HBV, including OBI, has substantially improved, but the possibility for OBI transmission remains.展开更多
Insulinomas continue to pose a diagnostic challenge to physicians, surgeons and radiologists alike. Most are intrapancreatic, benign and solitary. Biochemical diagnosis is obtained and imaging techniques to localize l...Insulinomas continue to pose a diagnostic challenge to physicians, surgeons and radiologists alike. Most are intrapancreatic, benign and solitary. Biochemical diagnosis is obtained and imaging techniques to localize lesions continue to evolve. Surgical resection is the treatment of choice. Despite all efforts, an occult insulinoma (occult insulinoma refers to a biochemically proven tumor with indeterminate anatomical site before operation) may still be encountered. New localization preoperative techniques decreases occult cases and the knowledge of the site of the mass before surgery allows to determine whether enucleation of the tumor or pancreatic resection is likely to be required and whether the tumor is amenable to removal via a laparoscopic approach. In absence of preoperative localization and intraoperative detection of an insulinoma, blind pancreatic resection is not recommended.展开更多
The development of sensitive assays to detect small amounts of hepatitis B virus(HBV) DNA has favored the identification of occult hepatitis B infection(OBI), a virological condition characterized by a low level of HB...The development of sensitive assays to detect small amounts of hepatitis B virus(HBV) DNA has favored the identification of occult hepatitis B infection(OBI), a virological condition characterized by a low level of HBV replication with detectable levels of HBV DNA in liver tissue but an absence of detectable surface antigen of HBV(HBs Ag) in serum. The gold standard to diagnose OBI is the detection of HBV DNA in the hepatocytes by highly sensitive and specific techniques, a diagnostic procedure requiring liver tissue to be tested and the use of non-standardized non-commercially available techniques. Consequently, in everyday clinical practice, the detection of anti-hepatitis B core antibody(antiHBc) in serum of HBs Ag-negative subjects is used as a surrogate marker to identify patients with OBI. In patients with chronic hepatitis C(CHC), OBI has been identified in nearly one-third of these cases. Considerable data suggest that OBI favors the increase of liver damage and the development of hepatocellular carcinoma(HCC) in patients with CHC. The data from other studies, however, indicate no influence of OBI on the natural history of CHC, particularly regarding the risk of developing HCC.展开更多
The event of mutations in the surface antigen gene of hepatitis B virus(HBV) results in undetectable hepatitis B surface antigen with positive/negative anti-hepatitis B core(anti-HBc) antibody status in serum and this...The event of mutations in the surface antigen gene of hepatitis B virus(HBV) results in undetectable hepatitis B surface antigen with positive/negative anti-hepatitis B core(anti-HBc) antibody status in serum and this phenomenon is named occult hepatitis B infection(OBI). The presence of anti-HBc antibody in serum is an important key for OBI tracking, although about 20% of OBI cases are negative for anti-HBc antibody. The diagnosis of OBI is mainly based on polymerase chain reaction(PCR) and real-time PCR assays. However, real-time PCR is a more reliable method than PCR. OBI is a great issue for the public health problem and a challenge for the clinical entity worldwide. The persistence of OBI may lead to the development of cirrhosis and hepatocellular carcinoma. With regard to OBI complications, the screening of HBV DNA by the highly sensitive molecular means should be implemented for:(1) patients with a previous history of chronic or acute HBV infection;(2) patients co-infected with hepatitis C virus/human immunodeficiency virus;(3) patients undergoing chemotherapy or anti-CD20 therapy;(4) recipients of organ transplant;(5) blood donors;(6) organ transplant donors;(7) thalassemia and hemophilia patients;(8) health care workers;(9) patients with liver related disease(cryptogenic);(10) hemodialysis patients;(11) patients undergoing lamivudine or interferon therapy; and(12) children in time of HBV vaccination especially in highly endemic areas of HBV. Active HBV vaccination should be implemented for the close relatives of patients who are negative for OBI markers. Thus, the goal of this review is to evaluate the rate of OBI with a focus on status of high risk groups in different regions of the world.展开更多
AIM:To assess the hepatitis B virus(HBV)-DNA and the prevalence of occult HBV infection in end-stage renal failure(ESRF)patients from Central Greece. METHODS:Sera from 366 ESRF patients attending five out of six dialy...AIM:To assess the hepatitis B virus(HBV)-DNA and the prevalence of occult HBV infection in end-stage renal failure(ESRF)patients from Central Greece. METHODS:Sera from 366 ESRF patients attending five out of six dialysis units from Central Greece were investigated for HBV-DNA by real-time polymerase chain reaction.Only serum samples with repeatedly detectable HBV-DNA were considered positive.IgG antibodies to hepatitis C virus(anti-HCV)were tested by a third generation enzyme linked immunosorbent assay(ELISA),while IgG antibodies to hepatitis E virus (anti-HEV)were tested by two commercially available ELISAs.RESULTS:HBV-DNA was detected in 15/366 patient (4.1%)and HBsAg in 20/366(5.5%).The prevalenc of occult HBV infection was 0.9%(3/346 HBsAg negative patients).Occult HBV was not associate with a specific marker of HBV infection or anti-HCV o anti-HEV reactivity.There was no significant differenc in HBV-DNA titres,demographic and biochemica features,between patients with occult HBV infectio and those with HBsAg-positive chronic HBV infection. CONCLUSION:In central Greece,4%of ESRF patient had detectable HBV-DNA,though in this setting,th prevalence of occult HBV seems to be very low(0.9%).展开更多
基金Supported by the National Natural Science Foundation of China(No.82171073).
文摘Dear Editor,We present a case of acute zonal occult outer retinopathy(AZOOR)complex in a myopic patient with angioid streaks(ASs).A 19-year-old female has been experiencing visual field defects in her left eye for more than 3y.She was diagnosed with ASs and choroiditis at a local hospital.She has a seven-year history of bilateral high myopia.A fundus examination confirmed the presence of ASs and myopic fundus changes in both eyes.Multimodal imaging revealed an AZOOR complex in the left eye.
文摘Occult hepatitis B infection(OBI) is characterized by hepatitis B virus(HBV) DNA in serum in the absence of hepatitis B surface antigen(HBsAg) presenting HBsAg-negative and anti-HBc positive serological patterns.Occult HBV status is associated in some cases with mutant viruses undetectable by HBsAg assays;but more frequently it is due to a strong suppression of viral replication and gene expression.OBI is an entity with world-wide diffusion.The failure to detect HBsAg,despite the persistence of the viral DNA,is due in most cases to the strong suppression of viral replication and gene expression that characterizes this"occult"HBV infection;although the mechanisms responsible for suppression of HBV are not well understood.The majority of OBI cases are secondary to overt HBV infection and represent a residual low viremia level suppressed by a strong immune response together with histological derangements which occurred during acute or chronic HBV infection.Much evidence suggests that it can favour the progression of liver fibrosis and the development of hepatocellular carcinoma.
基金supported by the National Natural Science Foundation of China(No.82272845)the Natural Science Foundation of Shandong(No.ZR2023ZD26).
文摘Objective:The neglect of occult lymph nodes metastasis(OLNM)is one of the pivotal causes of early non-small cell lung cancer(NSCLC)recurrence after local treatments such as stereotactic body radiotherapy(SBRT)or surgery.This study aimed to develop and validate a computed tomography(CT)-based radiomics and deep learning(DL)fusion model for predicting non-invasive OLNM.Methods:Patients with radiologically node-negative lung adenocarcinoma from two centers were retrospectively analyzed.We developed clinical,radiomics,and radiomics-clinical models using logistic regression.A DL model was established using a three-dimensional squeeze-and-excitation residual network-34(3D SE-ResNet34)and a fusion model was created by integrating seleted clinical,radiomics features and DL features.Model performance was assessed using the area under the curve(AUC)of the receiver operating characteristic(ROC)curve,calibration curves,and decision curve analysis(DCA).Five predictive models were compared;SHapley Additive exPlanations(SHAP)and Gradient-weighted Class Activation Mapping(Grad-CAM)were employed for visualization and interpretation.Results:Overall,358 patients were included:186 in the training cohort,48 in the internal validation cohort,and 124 in the external testing cohort.The DL fusion model incorporating 3D SE-Resnet34 achieved the highest AUC of 0.947 in the training dataset,with strong performance in internal and external cohorts(AUCs of 0.903 and 0.907,respectively),outperforming single-modal DL models,clinical models,radiomics models,and radiomicsclinical combined models(DeLong test:P<0.05).DCA confirmed its clinical utility,and calibration curves demonstrated excellent agreement between predicted and observed OLNM probabilities.Features interpretation highlighted the importance of textural characteristics and the surrounding tumor regions in stratifying OLNM risk.Conclusions:The DL fusion model reliably and accurately predicts OLNM in early-stage lung adenocarcinoma,offering a non-invasive tool to refine staging and guide personalized treatment decisions.These results may aid clinicians in optimizing surgical and radiotherapy strategies.
文摘BACKGROUND In our day-to-day practice,constipation is a common problem in the pediatric population and cause of frequent visit in outpatient and emergency department.But occult constipation(OC)remains as the most unaddressed problem.AIM To investigate the clinical profile of OC in children.METHODS It was a prospective observational study,done in Bangladesh from January 2022 to December 2024.It included all consecutive children diagnosed as OC and were treated accordingly.Before diagnosis,secondary causes of the presenting symptoms were excluded with appropriate investigations.They were followed up monthly for 4 months and treatment response were measured by improvement of symptoms.RESULTS A total of 404 children were included in this study with mean age group of 76.50±36.62 months,and male-female ratio of 1.67:1.The most common presenting complaint was abdominal pain(66%),followed by anorexia(49%),vomiting(24%),nausea(17%),frequent defecation with small volume stool(17%),altered bowel habit(16%),failure to thrive(14%)and recurrent helminthiasis(12%).Interestingly,2.5%children presented with persistent diarrhea.CONCLUSION Abdominal pain is the most common presentation of OC.When symptoms cannot be explained by other etiology,OC should be kept in mind.
基金Supported by the Council for Science,Technology,and Innovation(CSTI)Cross-Ministerial Strategic Innovation Promotion Program(SIP)“Innovative AI Hospital System”(National Institute of Biomedical Innovation,Health and Nutrition),No.SIPAIH18C03the Japan Society for the Promotion of Science(JSPS)KAKENHI,No.JP19K09179 and No.JP23K08158.
文摘BACKGROUND Some patients with resectable or borderline resectable pancreatic ductal adenocarcinoma(PDAC)may have distant metastases,undetected on preoperative imaging or early recurrence,within 6 months after surgery.Occult metastases(OMs)must be accurately predicted to optimize multidisciplinary treatment.AIM To investigate the efficacy of circulating tumor DNA(ctDNA)in predicting OM.METHODS Two Japanese institutions prospectively collected preoperative plasma samples from PDAC patients between July 2019 and September 2021 and evaluated ctDNA using a targeted next-generation sequencing panel covering 52 cancer-related genes.RESULTS Among 135 PDAC patients,38 had OM and 35 were positive for ctDNA.The ctDNA positivity rate was significantly higher in patients with OM than in patients without OM.ctDNA-positive patients had significantly shorter median recurrence-free survival than ctDNA-negative patients.Logistic multivariate regression revealed ctDNA positivity as an independent predictor of OM.CONCLUSION Preoperative ctDNA in resectable PDAC is an independent predictor of OM and indicates poor prognosis following pancreatectomy and may be a useful biomarker in determining multidisciplinary patient care.
基金Supported by The Tianjin Health Research Project,No.ZC20069the Foundation of the Committee of Integrated Traditional Chinese and Western Medicine,No.2021011the Science and Technology Foundation of Tianjin Eye Hospital,No.YKYB1901.
文摘BACKGROUND Occult intraocular foreign bodies(IOFBs)can present with atypical symptoms and clinical signs,making diagnosis challenging.We describe a case of an undetected IOFB that was missed on both computed tomography and B-ultrasound,ulti-mately leading to ocular siderosis and secondary glaucoma.CASE SUMMARY A 55-year-old male patient presented to our clinic reporting a one-month history of right ocular discomfort and progressive visual deterioration.The patient had previously received a glaucoma diagnosis at a local healthcare facility.His ocular history included blunt trauma to the affected eye five years prior to presentation.Slit-lamp examination revealed corneal and iris lesions in the right eye.Pupillary dilation facilitated the identification of traumatic lens opacities.Diagnostic imaging modalities,including B-scan ultrasonography and computed tomo-graphy,showed no evidence of retained intraocular foreign material.The patient subsequently underwent uncomplicated pars plana vitrectomy,during which the occult foreign body was successfully extracted.The procedure was completed without intraoperative or immediate postoperative complications.CONCLUSION Awareness of IOFBs in individuals who work in high-risk occupations and prompt referral to a retinal surgeon are very important.
基金Supported by Key Specialty Construction Project of Shanghai Pudong New Area Health Commission,No.PWZzk2022-17Shanghai East Hospital Clinical Research Project,No.DFLC2022019the Featured Clinical Discipline Project of Shanghai Pudong District,No.PWYts2021-06.
文摘BACKGROUND Occult pancreaticobiliary reflux(OPBR)is characterized by the absence of congenital anomalies at the pancreaticobiliary junction yet leads to altered bile composition and an increased incidence of gallbladder stones.AIM To explore the computed tomography(CT)imaging characteristics of gallbladder stones in patients diagnosed with OPBR.METHODS We analyzed 362 patients undergoing cholecystectomy(November 2020 to January 2022).Intraoperative bile samples were assayed for amylase(>110 U/L indicated OPBR).CT features,including stone density and visibility,were compared between 54 OPBR and 308 controls.Stone attenuation(HU)was measured under standardized conditions(uCT-780,120 kVp,160 mAs).Logistic regression and receiver operating characteristic curve analysis identified independent OPBR predictors,forming a validated nomogram.RESULTS OPBR patients exhibited significantly higher rates of CT-invisible stones(35.2%vs 12.3%)and uniform stones(87%vs 73.1%)along with lower overall stone density(P=0.01).Logistic regression identified stone visibility,uniformity,and density as independent predictors.A nomogram integrating these features with patient age achieved high diagnostic accuracy(area under the curve=0.71).CONCLUSION CT imaging distinctly identifies gallbladder stone density,indicating a heightened risk of OPBR in patients with uniform and CT-invisible stones.Such imaging is crucial for preoperative assessments to evaluate potential recurrent biliary pathologies post-cholecystectomy.
文摘BACKGROUND Sessile serrated lesions(SSLs)are premalignant polyps implicated in up to 30%of colorectal cancers.Australia reports high SSL detection rates(SSL-DRs),yet with marked variability(3.1%-24%).This substantial variation raises concerns about missed lesions and post-colonoscopy colorectal cancer.This study investigates determinants associated with SSL-DR variation in regional Australia.AIM To study how patient,clinical,and colonoscopy factors are associated with SSL detection in a regional Australian practice.We aimed to contribute high-detection data to the literature by analyzing the association of SSL detection with various determinants.METHODS This retrospective,cross-sectional analysis examined 1450 colonoscopies performed at Port Macquarie Gastroenterology during 2023.Sigmoidoscopies and repeat procedures were excluded.Multivariate logistic regression analyzed associations between SSL detection and patient demographics,clinical indications,procedural factors,and comorbidities.RESULTS The overall SSL-DR was 30.7%.Multivariate analysis identified several independent predictors:Clinical indication,bowel preparation quality,inflammatory bowel disease status,and serrated polyposis syndrome.The faecal occult blood test positive(FOBT)(+)cohort showed the highest predicted SSL detection probability(39.8%),while clinical symptoms showed the lowest(22.3%).After adjustment,SSL detection odds were 2.3 times greater among FOBT(+)patients than those with clinical symptoms(adjusted odds ratio=2.30,95%confidence interval:1.20-4.40,P=0.004).CONCLUSION SSL-DR as a quality indicator requires contextualization regarding clinical indications,bowel preparation quality,and comorbidities.There was a significantly higher prevalence of SSLs in FOBT(+)patients.Despite comprehensive adjustment,this study cannot fully explain the wide SSL-DR variation in Australia,highlighting the need for standardized detection protocols and further research to ensure optimal cancer prevention outcomes.
文摘BACKGROUND This report describes a rare case of a small gastric cancer lesion with widespread bone metastases and markedly elevated alkaline phosphatase levels that was initially misdiagnosed as rheumatoid arthritis,as the patient’s sole clinical manifestation was chronic bone pain persisting for 1 year.CASE SUMMARY An 83-year-old man was admitted due to worsening generalized joint pain over 1 year.Serum alkaline phosphatase levels were markedly elevated,and technetium-99m methylene diphosphonate single-photon emission computed tomography(CT)and fluorine-18 sodium fluoride positron emission tomography(PET)/CT images showed symmetrical diffuse uptake of the radiotracers throughout the skeleton.Initially,Paget’s disease was suspected,but abnormal hematologic tumor markers and bone biopsy confirmed metastatic adenocarcinoma.Fluorine-18-fluorodeoxyglucose PET/CT did not reveal a primary tumor.The patient had a history of colon polypectomy and tubulovillous adenoma with atypical hy-perplasia on pathological examination 10 years prior.Further investigation using gallium-68-labeled fibroblast-activation protein inhibitor PET/CT images showed increased punctate uptake in the gastric antrum.Gastroscopy demonstrated a 1.0 cm ulcerated mass in the prepyloric region,and histopathological evaluation of the biopsy specimen revealed poorly differentiated adenocarcinoma.The incidence of bone metastases from gastric cancer is very low,especially with such extensive involvement.CONCLUSION Occult gastric carcinomas with bone metastases necessitate proactive high-risk surveillance and multidisciplinary integration to improve diagnostic accuracy and clinical outcomes.
文摘BACKGROUND Occult hepatitis B virus infection(OBI)is defined by the detection of replication-competent hepatitis B virus(HBV)DNA in the liver and/or blood despite the ab-sence of detectable hepatitis B surface antigen(HBsAg)using conventional ser-ological assays.Although OBI has been well-documented in individuals with resolved HBV infection or those receiving immunosuppressive therapy,reports of its occurrence during sequential antiviral treatment remain scarce.This report describes a case of chronic hepatitis B(CHB)transitioning through OBI during sequential combination therapy before ultimately achieving a functional cure.This case provides new insights into the emergence of OBI as a transitional phase during CHB treatment and emphasizes the importance of monitoring its clinical significance.CASE SUMMARY A 33-year-old Chinese male was diagnosed with HBV infection in 2001.The patient first presented in 2012 with abnormal liver function tests and received initial treatment with conventional interferon therapy,which failed to achieve a virological response.Antiviral therapy was subsequently switched to entecavir monotherapy.By August 2019,the patient exhibited an HBsAg level of 29.93 IU/mL with undetectable HBV DNA(<25 IU/mL).At this point,combination therapy with entecavir and pegylated interferonα(PEG-IFNα)was initiated.Remarkably,while HBsAg declined to 0.42 IU/mL by April 2020,a paradoxical HBV DNA rebound to 173 IU/mL was observed.The regimen was consequently modified to tenofovir alafenamide and PEG-IFNα.By October 2020,the patient achieved HBsAg seroconversion(HBsAg 0.01 IU/mL,hepatitis B surface antibody 52.18 mIU/mL)for the first time,while maintaining low-level viremia(37 IU/mL),consistent with transition to OBI.The patient was then switched to PEG-IFNαmonotherapy.In November 2021,he discontinued PEG-IFNαtherapy,and one month later,both HBV DNA(<10 IU/mL)and HBsAg(<0.05 IU/mL)were negative.This response has been sustained through follow-up.CONCLUSION This case study illustrates the efficacy of sequential combination therapy in achieving functional cure in CHB patients,including those with a prolonged infection history.It highlights OBI as a transitional yet underrecognized phase during sequential antiviral therapy.While the patient ultimately achieved functional cure,the transient persistence of HBV DNA despite HBsAg clearance suggests the need for continued monitoring.This case provides new insights into OBI development during treatment and underscores the importance of further research into its long-term implications.
文摘AIM:To comprehensively examine the clinical presentations,multimodal images,and long-term follow-up of Chinese patients with acute zonal occult outer retinopathy(AZOOR),a rare inflammatory disorder.METHODS:This was a retrospective study.A total of 20 patients(32 eyes)were included.The medical records and multimodal imaging,including wide-field fundus photography,wide-field fundus autofluorescence(FAF),and swept-source optical coherence tomography(SS-OCT)were analyzed.RESULTS:The study included 20 patients with a mean age of 38.2±10.9y,and females accounted for 60%.Lesions could involve peripapillary areas,macular region,and peripheral retina.The mean best-corrected visual acuity(BCVA)at presentation was 0.38±0.60 logMAR,with no significant difference in visual acuity between acute cases(within 6mo of onset)and chronic cases(beyond 6mo of onset;P=0.390).There was no statistically significant difference in visual acuity between eyes of acute case(within 6mo of onset)and the chronic case(beyond 6mo of onset).In some chronic case,FAF examination revealed the presence of a hyperautofluorescent(hyperAF)ring around the macular area(6/18),a phenomenon not observed in the acute case(P=0.024).A higher proportion of chronic cases showed predominantly hypoautofluorescent(hypoAF)lesions compared to the acute case(13/18 vs 2/14,P=0.0016).SS-OCT examination showed that both acute and chronic cases exhibited hyperreflective dots above the retinal pigment epithelium(RPE),and ellipsoid zone(EZ)and RPE damage.In the chronic case,eyes with hyperreflective dots above the RPE were more likely to exhibit EZ and RPE damage in the macular region compared to those without these dots.CONCLUSION:Multimodal imaging plays a crucial role in the follow-up of patients with AZOOR.In chronic cases of AZOOR,the presence of hyperreflective dots above the RPE indicates a higher likelihood of outer retinal involvement in the macular region.This study provides critical insights into the complex presentation and progression of AZOOR.
文摘Occult hepatitis B virus (HBV) infection (OBI), alternatively defined as occult hepatitis B (OHB), is a challenging clinical entity. It is recognized by two main characteristics: absence of HBsAg, and low viral replication. The previous two decades have witnessed a remarkable progress in our understanding of OBI and its clinical implications. Appropriate diagnostic techniques must be adopted. Sensitive HBV DNA amplification assay is the gold standard assay for detection of OBI. Viral as well as host factors are implicated in the pathogenesis of OBI. However, published data reporting the infectivity of OBI by transfusion are limited. Several aspects including OBI transmission, infectivity and its relation to the development of chronic liver diseases and hepatocellular carcinoma have to be resolved. The aim of the present review is to highlight recent data on OBI with a focus on its virological diagnosis and clinical outcome.
基金operating research grants from the Canadian Institutes of Health Research, Canada and the Canada Research Chair Program, and the Canada Foundation for Innovation
文摘Hepatitis B virus (HBV) is a highly pathogenic virus that causes chronic liver diseases in millions of people globally. In addition to a symptomatic, serologically evident infection, occult persistent HBV carriage has been identified since nucleic acid amplification assays of enhanced sensitivity became introduced for detection of hepadnaviral genomes and their replicative intermediates. Current evidence indicates that occult HBV infection is a common and long-term consequence of resolution of acute hepatitis B. This form of residual infection is termed as secondary occult infection (SOI). The data from the woodchuck model of HBV infection indicate that exposure to small amounts of hepadnavirus can also cause primary occult infection (POI) where virus genome, but no serological makers of exposure to virus, are detectable, and the liver may not be involved. However, virus replicates at low levels in the lymphatic system in both these forms. We briefly summarize the current understanding of the nature and characteristics of occult hepadnaviral persistence as well as of its documented and expected pathological consequences.
基金Supported by the Specialized Research Fund for the Doctoral Program of Higher Education of ChinaNo.20093420120005+1 种基金the National Science Foundation of ChinaNo.81273142
文摘Occult hepatitis B virus infection(OBI), characterized as the persistence of hepatitis B virus(HBV) surface antigen(HBs Ag) seronegativity and low viral load in blood or liver, is a special form of HBV infection. OBI may be related mainly to mutations in the HBV genome, although the underlying mechanism of it remains to be clarified. Mutations especially within the immunodominant "α" determinant of S protein are "hot spots" that could contribute to the occurrence of OBI via affecting antigenicity and immunogenicity of HBs Ag or replication and secretion of virion. Clinical reports account for a large proportion of previous studies on OBI, while functional analyses, especially those based on full-length HBV genome, are rare.
基金Supported by National Research Foundation of Korea grant funded by the Korean Government(Ministry of Education,Science,and Technology),Grant No.2013-005810
文摘AIM:To elucidate the molecular mechanisms underlying hepatitis B virus(HBV)occult infection of genotype C.METHODS:A total of 10 types of hepatitis B surface antigen(HBs Ag)variants from a Korean occult cohort were used.After a complete HBV genome plasmid mutated such that it does not express HBs Ag and plasmid encoding,each HBs Ag variant was transiently co-transfected into Hu H-7 cells.The secretion capacity and intracellular expression of the HBV virions and HBs Ags in their respective variants were analyzed using real-time quantitative polymerase chain reaction assays and commercial HBs Ag enzyme-linked immunosorbent assays,respectively.RESULTS:All variants exhibited lower levels of HBs Ag secretion into the medium compared with the wild type.In particular,in eight of the ten variants,very low levels of HBs Ag secretion that were similar to the negative control were detected.In contrast,most variants(9/10)exhibited normal virion secretion capacities comparable with,or even higher than,the wild type.This provided new insight into the intrinsic nature of occult HBV infection,which leads to HBs Ag sero-negativeness but has horizontal infectivity.Furthermore,most variants generated higher reactive oxidative species production than the wild type.This finding provides potential links between occult HBV infection and liver disease progression.CONCLUSION:The presently obtained data indicate that deficiency in the secretion capacity of HBs Ag variants may have a pivotal function in the occult infections of HBV genotype C.
文摘Transfusion-transmitted infections including hepatitis B virus(HBV) have been a major concern in transfusion medicine. Implementation of HBV nucleic acid testing(NAT) has revealed occult HBV infection(OBI) in blood donors. In the mid-1980 s, hepatitis B core antibody(HBc) testing was introduced to screen blood donors in HBV non-endemic countries to prevent transmission of non-A and non-B hepatitis. That test remains in use for preventing of potential transmission of HBV from hepatitis B surface antigen(HBs Ag)-negative blood donors, even though anti-hepatitis C virus testshave been introduced. Studies of anti-HBc-positive donors have revealed an HBV DNA positivity rate of 0%-15%. As of 2012, 30 countries have implemented HBV NAT. The prevalence of OBI in blood donors was estimated to be 8.55 per 1 million donations, according to a 2008 international survey. OBI is transmissible by blood transfusion. The clinical outcome of occult HBV transmission primarily depends on recipient immune status and the number of HBV DNA copies present in the blood products. The presence of donor anti-HBs reduces the risk of HBV infection by approximately five-fold. The risk of HBV transmission may be lower in endemic areas than in non-endemic areas, because most recipients have already been exposed to HBV. Blood safety for HBV, including OBI, has substantially improved, but the possibility for OBI transmission remains.
文摘Insulinomas continue to pose a diagnostic challenge to physicians, surgeons and radiologists alike. Most are intrapancreatic, benign and solitary. Biochemical diagnosis is obtained and imaging techniques to localize lesions continue to evolve. Surgical resection is the treatment of choice. Despite all efforts, an occult insulinoma (occult insulinoma refers to a biochemically proven tumor with indeterminate anatomical site before operation) may still be encountered. New localization preoperative techniques decreases occult cases and the knowledge of the site of the mass before surgery allows to determine whether enucleation of the tumor or pancreatic resection is likely to be required and whether the tumor is amenable to removal via a laparoscopic approach. In absence of preoperative localization and intraoperative detection of an insulinoma, blind pancreatic resection is not recommended.
文摘The development of sensitive assays to detect small amounts of hepatitis B virus(HBV) DNA has favored the identification of occult hepatitis B infection(OBI), a virological condition characterized by a low level of HBV replication with detectable levels of HBV DNA in liver tissue but an absence of detectable surface antigen of HBV(HBs Ag) in serum. The gold standard to diagnose OBI is the detection of HBV DNA in the hepatocytes by highly sensitive and specific techniques, a diagnostic procedure requiring liver tissue to be tested and the use of non-standardized non-commercially available techniques. Consequently, in everyday clinical practice, the detection of anti-hepatitis B core antibody(antiHBc) in serum of HBs Ag-negative subjects is used as a surrogate marker to identify patients with OBI. In patients with chronic hepatitis C(CHC), OBI has been identified in nearly one-third of these cases. Considerable data suggest that OBI favors the increase of liver damage and the development of hepatocellular carcinoma(HCC) in patients with CHC. The data from other studies, however, indicate no influence of OBI on the natural history of CHC, particularly regarding the risk of developing HCC.
文摘The event of mutations in the surface antigen gene of hepatitis B virus(HBV) results in undetectable hepatitis B surface antigen with positive/negative anti-hepatitis B core(anti-HBc) antibody status in serum and this phenomenon is named occult hepatitis B infection(OBI). The presence of anti-HBc antibody in serum is an important key for OBI tracking, although about 20% of OBI cases are negative for anti-HBc antibody. The diagnosis of OBI is mainly based on polymerase chain reaction(PCR) and real-time PCR assays. However, real-time PCR is a more reliable method than PCR. OBI is a great issue for the public health problem and a challenge for the clinical entity worldwide. The persistence of OBI may lead to the development of cirrhosis and hepatocellular carcinoma. With regard to OBI complications, the screening of HBV DNA by the highly sensitive molecular means should be implemented for:(1) patients with a previous history of chronic or acute HBV infection;(2) patients co-infected with hepatitis C virus/human immunodeficiency virus;(3) patients undergoing chemotherapy or anti-CD20 therapy;(4) recipients of organ transplant;(5) blood donors;(6) organ transplant donors;(7) thalassemia and hemophilia patients;(8) health care workers;(9) patients with liver related disease(cryptogenic);(10) hemodialysis patients;(11) patients undergoing lamivudine or interferon therapy; and(12) children in time of HBV vaccination especially in highly endemic areas of HBV. Active HBV vaccination should be implemented for the close relatives of patients who are negative for OBI markers. Thus, the goal of this review is to evaluate the rate of OBI with a focus on status of high risk groups in different regions of the world.
基金Supported by Gilead Sciences Hellas Ltd.partially
文摘AIM:To assess the hepatitis B virus(HBV)-DNA and the prevalence of occult HBV infection in end-stage renal failure(ESRF)patients from Central Greece. METHODS:Sera from 366 ESRF patients attending five out of six dialysis units from Central Greece were investigated for HBV-DNA by real-time polymerase chain reaction.Only serum samples with repeatedly detectable HBV-DNA were considered positive.IgG antibodies to hepatitis C virus(anti-HCV)were tested by a third generation enzyme linked immunosorbent assay(ELISA),while IgG antibodies to hepatitis E virus (anti-HEV)were tested by two commercially available ELISAs.RESULTS:HBV-DNA was detected in 15/366 patient (4.1%)and HBsAg in 20/366(5.5%).The prevalenc of occult HBV infection was 0.9%(3/346 HBsAg negative patients).Occult HBV was not associate with a specific marker of HBV infection or anti-HCV o anti-HEV reactivity.There was no significant differenc in HBV-DNA titres,demographic and biochemica features,between patients with occult HBV infectio and those with HBsAg-positive chronic HBV infection. CONCLUSION:In central Greece,4%of ESRF patient had detectable HBV-DNA,though in this setting,th prevalence of occult HBV seems to be very low(0.9%).
