RESUMO
Chronic hepatitis B virus ( HBV) infection is a principal risk factor for liver cirrhosis and hepatocellular carcinoma in China , representing one of the major public health problems .Horizontal trans-mission of HBV in vaccinated children was greatly reduced due to widespread HBV vaccination in mainland China, which had limited effects on vertical transmission .Thus, vertical transmission became one of the main causes of HBV chronic infection .High HBV load (≥10 6 copies/mL ) and hepatitis B e antigen ( HBeAg )-positivity in maternal peripheral blood were independent risk factors for HBV intrauterine infection .Compared to HBV infection in early childhood and in adult , intrauterine HBV infection was more prone to developing chronic infection .To decrease vertical transmission of HBV , we recommend that young pregnant women with sero-positive for HBeAg and high serum HBV DNA level should receive antiviral treatment with nucleotide analogues since the 28 th gestation weeks .For newborns born to HBeAg-positive mother , hepatitis B immunoglobulin ( HBIG ) injection should be administrated in combination with HBV vaccination .
RESUMO
Objective] To study hepatitis B virus ( HBV) mother-to-child transmission and the impact factors, providing the basis for preventive strategies. [ Methods ] A total of 154 hepatitis B surface antigen ( HBsAg ) -positive pregnant women and 297 HBsAg -negative pregnant women from Baoshan District Centers for Disease Control and Prevention in Shanghai were enrolled and received an epidemiological survey regarding mother-to-child transmission.Mothers'peripheral blood and newborns'cord blood were collected to be tested for HBV serological markers and HBV DNA load.HBsAg positivity and HBV DNA≥103 copies/mL in cord blood of newborns born of HBsAg-positive mothers was defined as trans-placental HBV transmission. [ Results] The trans-placental transmission rate was found to be 8.4%for HBsAg-positive mothers.Trans-placental transmission rate was significantly higher among both HBsAg and HBeAg -positive women compared to those only with HBsAg -positiveness ( 20.0% vs. 3.7%, relative risk was 5.41, P <0.05), and increased with HBV DNA load in mothers'peripheral blood. [ Conclusion] HBeAg can directly transmit through the placenta, while HBsAg is“filtered” to a certain degree.HBeAg positiveness and high HBV DNA load of the mother are risk factors in trans-placental transmission, and possibly lead to the failure of newborn immunoprophylaxis.
RESUMO
Objective] To investigate the relationship between hepatitis B virus( HBV) genotype and their mutations on the development of hepatocellular carcinoma ( HCC ) . [ Methods ] A cohort study on patients with chronic HBV infection was followed up.HBV genotypes were identified by nested multiplex PCR and multiplex PCR.And HBV mutations in the basic core promoter region were sequencing by PCR amplification. [ Results] The patients infected with genotype B were followed up for an average of 8.52 years (IQR:6.67-10.75), of whom the incidence of HCC was 6.55/1 000 person-years.After follow up with an average of 8.87 years (IQR:6.85-11.33), the incidence of HCC was 11.63/1 000 person-years for the patients infected with genotype C, which were significantly higher than those infected with genotype B (P=0.006).In genotype B HBV infected patients, age (≥60 years), cirrhosis can in-crease the risk of HCC, and in genotype C patients, male, age (≥40 years), cirrhosis, C1653T, T1753V, A1762T/G1764A mutation as well.Interferon therapy can reduce the risk of HCC.In genotype C group, interferon treatment reduced HCC risk in patients carrying A1762T/G1764A mutation (HR=0.21, P=0.008) and in those without T1753V ( HR=0.08, P=0.012) and C1653T mutation ( HR=0.17, P=0.013). [Conclusion] HBV genotypes and mutation are closely associated with HCC.Patients infected with genotype C, carrying 1762T/G1764A mutation should be given priority of receiving antiviral treatments in order to prevent HCC;those carrying C1653T or T1753V mutation should be monitored closely to detect early HCC and receive timely surgical resection.
RESUMO
Objective] To explore disaster response capability and the vulnerability as well as the current level and training needs of disaster medicine knowledge in urban populations . [ Methods] Five communities in Yangpu District of Shanghai were randomly enrolled in this study .The study populations were then stratified by age groups .A total of 1700 residents were recruited , 1643 of which completed a structured questionnaire designed by the investigators . [ Results] Eight-nine percent of the residents be-lieved the importance of understanding disaster medicine -related knowledge .The correct answer rates of “pro-tective measures of nuclear leakage issues” and “self-rescue measures in a high building fire” reached over 80%;however , the overall correct answer rate of “cardiorespiratory resuscitation operation” was less than 40%.The main channels of community residents accessing disaster medicine knowledge were mainly news -papers, magazines, and internet (52.1%);whereas only 5.3%of them obtained the knowledge from school education .Community residents most liked to obtain “first aid skills”and“basic theory of disaster medicine”through formal lectures (72.4%). [Conclusion] School education lacks disaster-related knowledge , pos-sibly resulting in the fact that community residents have a limited ability to save both oneself and others in disaster .There are significant differences between residents with different education levels .Community resi-dents have limited knowledge of disaster occurrence and development , and lack capabilities of self-rescue and mutual aid .Colleges should increase the contents of disaster medicine education in their curriculum .Disaster education should be enforced in school education .Continued education and simulation of disaster-related knowledge should be regularly offered to community residents to greatly reduce their vulnerability to disasters .
RESUMO
Hepatitis B virus (HBV) infection has always been one of the most important public health issues in mainland China, causing a huge disease burden. It often takes decades for the chronic process of malignant transformation from HBV infection to different stages of liver diseases. Mutations associated with virus survival are eventually selected by the chronic infection process and under the immune pressure of host. These selected HBV mutations further promote the malignant transformation of liver diseases. A large amount of somatic mutations are produced in the HBV-related chronic inflammatory micro-environment, and those survival-related mutations will then be selected. The selected HBV mutations and host somatic mutations work together to promote the malignant transformation, which can be termed as an evolutionary process of “mutation-selection-adaptation”. In addition, genetic variations of individual hosts also play an important role in HBV related disease progression. For example, single-nucleotide polymorphisms of STAT pathway and HLA can interact with important HBV mutations and therefore affect HBV-related disease progression.