Impact of the hepatitis B virus genotype and genotype mixtures on the course of liver disease in Vietnam

C1 - Journal Articles RefereedEight genotypes (A-H) of hepatitis B virus (HBV) have been identified. However, the impact of different genotypes on the clinical course of hepatitis B infection remains controversial. We investigated the frequency and clinical outcome of HBV genotypes and genotype mixtures in HBV-infected patients from Vietnam, Europe, and Africa. In addition, we analyzed the effects of genotype mixtures on alterations in in vitro viral replication. In Asian patients, seven genotypes (A-G) were detected, with A, C, and D predominating. In European and African patients, only genotypes A, C, D, and G were identified. Genotype mixtures were more frequently encountered in African than in Asian (P = .01) and European patients (P = .06). In Asian patients, the predominant genotype mixtures included A/C and C/D, compared to C/D in European and A/D in African patients. Genotype A was more frequent in asymptomatic compared with symptomatic patients (P < .0001). Genotype C was more frequent in patients with hepatocellular carcinoma (HCC; P = .02). Genotype mixtures were more frequently encountered in patients with chronic hepatitis in comparison to patients with acute hepatitis B (P = .015), liver cirrhosis (P = .013), and HCC (P = .002). Viral loads in patients infected with genotype mixtures were significantly higher in comparison to patients with a single genotype (P = .019). Genotype mixtures were also associated with increased in vitro HBV replication. In conclusion, infection with mixtures of HBV genotypes is frequent in Asia, Africa, and Europe. Differences in the replication-phenotype of single genotypes compared to genotype-mixtures suggest that co-infection with different HBV-genotypes is associated with altered pathogenesis and clinical outcome

Reducing Diesel Engine Drive Cycle Fuel Consumption through Use of Cylinder Deactivation to Maintain Aftertreatment Component Temperature during Idle and Low Load Operating Conditions

Modern on-road diesel engine systems incorporate flexible fuel injection, variable geometry turbocharging, high pressure exhaust gas recirculation, oxidation catalysts, particulate filters, and selective catalytic reduction systems in order to comply with strict tailpipe-out NOx and soot limits. Fuel consuming strategies, including late injections and turbine-based engine exhaust throttling, are typically used to increase turbine-outlet temperature and flow rate in order to reach the aftertreatment component temperatures required for efficient reduction of NOx and soot. The same strategies are used at low load operating conditions to maintain aftertreatment temperatures. This paper demonstrates that cylinder deactivation (CDA) can be used to maintain aftertreatment temperatures in a more fuel-efficient manner through reductions in airflow and pumping work. The incorporation of CDA to maintain desired aftertreatment temperatures during idle conditions is experimentally demonstrated to result in fuel savings of 3.0% over the HD-FTP drive cycle. Implementation of CDA at non-idle portions of the HD-FTP where BMEP is below 3 bar is demonstrated to reduce fuel consumption further by an additional 0.4%, thereby resulting in 3.4% fuel savings over the drive cycle

Implementation and evaluation of a nurse-led decision-coaching program for healthy breast cancer susceptibility gene (BRCA1/2) mutation carriers: a study protocol for the randomized controlled EDCP-BRCA study

BackgroundFemale BRCA mutation carriers have an increased lifetime risk for breast and ovarian cancer compared to the general population. Women who carry this mutation have several options to deal with their cancer risk, such as risk-reducing surgeries or intensified breast cancer screening. Previous research has shown that preferences in this scenario are highly dependent on affected women's personalities and value systems. To support these women in the decision-making process, a structured decision support consisting of decision coaching combined with a decision aid might be helpful.Methods/designA randomized controlled trial will be conducted in order to compare usual care with structured decision support alongside usual care. The decision support program entails nurse-led decision coaching as well as an evidence-based patient decision aid. Nurses are qualified by a 4-day training program in informed decision-making and decision coaching. Six centers for Familial Breast and Ovarian Cancer in Germany will be included in the study, with a planned sample size of 398 women.The primary outcome is the congruence between the preferred and the actual played role in the decision-making process as measured by the Control Preferences Scale. It is hypothesized that the structured decision support will enable women to play the preferred role in the decision-making process. Secondary outcomes include the knowledge and attitudes about preventive options, decisional conflict, depression and anxiety, coping self-efficacy, impact of event, and self-concept. A process evaluation will accompany the study.DiscussionThe EDCP-BRCA study is the first study to implement and evaluate decision coaching combined with a decision aid for healthy BRCA mutation carriers worldwide.Trial registration {2a}DRKS-ID: DRKS00015527. Registered 30 October 2019