Inverse Association of Parkinson Disease With Systemic Lupus Erythematosus: A Nationwide Population-based Study

The effects of the inflammatory mediators involved in systemic lupus erythematous (SLE) on subsequent Parkinson disease have been reported, but no relevant studies have focused on the association between the 2 diseases. This nationwide population-based study evaluated the risk of Parkinson disease in patients with SLE.We identified 12,817 patients in the Taiwan National Health Insurance database diagnosed with SLE between 2000 and 2010 and compared the incidence rate of Parkinson disease among these patients with that among 51,268 randomly selected age and sex-matched non-SLE patients. A Cox multivariable proportional-hazards model was used to evaluate the risk factors of Parkinson disease in the SLE cohort.We observed an inverse association between a diagnosis of SLE and the risk of subsequent Parkinson disease, with the crude hazard ratio (HR) being 0.60 (95% confidence interval 0.45-0.79) and adjusted HR being 0.68 (95% confidence interval 0.51-0.90). The cumulative incidence of Parkinson disease was 0.83% lower in the SLE cohort than in the non-SLE cohort. The adjusted HR of Parkinson disease decreased as the follow-up duration increased and was decreased among older lupus patients with comorbidity.We determined that patients with SLE had a decreased risk of subsequent Parkinson disease. Further research is required to elucidate the underlying mechanism.

Localization of nonpalpable pulmonary nodules using CT-guided needle puncture

Background

Surgical resection of small pulmonary nodule is challenging via thoracoscopic procedure. We describe our experience of computed tomography (CT)-guided needle puncture localization of indeterminate pulmonary nodules prior to video-assisted thoracoscopic surgery (VATS).

Methods

From January 2011 to July 2014, 78 consecutive patients underwent CT-guided marking for the localization of 91 small pulmonary nodules. We retrospectively reviewed the clinical data, technical details, surgical findings and pathologic results, and complications associated with CT-guided localization.

Results

Seventy-eight consecutive patients (36 men and 42 women) underwent CT-guided marking localization of 91 indeterminate pulmonary nodules (62 pure ground-glass opacity nodules, 27 part-solid nodules, and 2 solid nodules). The mean size of the nodules was 8.6 mm (3.0–23.0 mm). The mean pleural distance between the nodule and lung surface was 11.5 mm (3.0–31.3 mm). The mean procedure time of CT-guided localization was 15.2 min (8–42 min). All patients stood the procedures well without requiring conversion to open thoracotomy. Twenty-four patients (30.77 %) developed pneumothorax after the procedures. Only one patient required retention of the puncture needle introducer for air drainage. The mean visual assessment pain score was 1.7 (0–3). Fifty-seven nodules (62.63 %) were confirmed as malignances, including 45 primary lung cancer, and 34 nodules (37.37 %) were confirmed as benign lesions.

Conclusions

CT-guided needle puncture can be an effective and safe procedure prior to VATS, enabling accurate resection and diagnosis of small pulmonary nodules.

Bio-inspired terpolymers containing dopamine, cations and MPC: a versatile platform to construct a recycle antibacterial and antifouling surface

A new kind of bio-inspired terpolymer was synthesized by a conventional free radical terpolymerization of dopamine methacrylamide (DMA), 2-(dimethylamino)-ethyl methacrylate (DMAEMA) and 2-methacryloyloxyethyl phosphorylcholine (MPC) with azobisisobutyronitrile (AIBN) as an initiator. DMA consists of a biomimetic adhesive side chain covalently linked to a polymerizable methacrylate monomer. 1H NMR and gel permeation chromatography confirmed the successful synthesis of P(DMA-co-MPC-co-DMAEMA). The terpolymer could self-assemble on the macroscopic planar substrates with DMA as an anchor. After being quaternized by 1-bromo-heptane, terpolymers of P(DMA-co-MPC-co-DMAEMA+) with bactericidal function were obtained. The self-assembly terpolymer on the substrate was confirmed by X-ray photoelectron spectroscopy, water contact angle, spectroscopic ellipsometry and atomic force microscopy. The hydrophilicity and antifouling properties of the self-assembly coating increased greatly against bacteria, protein and cells with the increase of MPC content. As the existence of bactericidal cations for electrostatic targeting of bacteria as well as membrane lysis, the terpolymer coating showed excellent bactericidal function against E. coli and S. aureus. Biofilm inhibition assay showed that terpolymer coating was very efficient to resist bacterial adhesion and biofilm formation in a nutrient environment. Bacteria could be continuously "captured" and killed by the terpolymer coating, and then bacteria corpse was released into the solution. Importantly, this work provides a versatile strategy for the fabrication of a recycle antibacterial and antifouling surface to modify biomaterials.

Pneumoconiosis increases the risk of peripheral arterial disease: a nationwide population-based study

This nationwide population-based retrospective cohort study was used to evaluate the association between pneumoconiosis and peripheral arterial disease (PAD). We identified 3374 patients with pneumoconiosis from the catastrophic illness registry who were newly diagnosed from 2000 to 2005; 13,496 patients without pneumoconiosis from Longitudinal Health Insurance Database 2000 (LHID2000) were randomly frequency matched according to sex, age, and index year and used as a nonpneumoconiosis group. Multivariate Cox proportional hazards regression was used to calculate adjusted hazard ratios (HRs) of PAD in the pneumoconiosis group compared with the nonpneumoconiosis group. The mean follow-up years were 7.44 years in the pneumoconiosis group and 8.17 years in the nonpneumoconiosis group. The incidence density rate of PAD was 1.25 times greater in the pneumoconiosis group than in the nonpneumoconiosis group (8.37 vs 6.70 per 1000 person-years). After adjusting for sex, age, and comorbidities, the adjusted HRs of PAD for the pneumoconiosis group were 1.30 (95% CI = 1.08-1.57), compared with the nonpneumoconiosis group. The combined impacts of patients with pneumoconiosis and diabetes, hyperlipidemia, hypertension, ischemic heart disease, chronic obstructive pulmonary disease, and asthma showed a significant by joint association with PAD risk compared with patients with no pneumoconiosis and no counterpart comorbidity. Patients with pneumoconiosis have an independently higher risk of developing PAD. Physicians should include pneumoconiosis in evaluating PAD risk.

Association between pneumoconiosis and pulmonary emboli. A Nationwide Population-Based Study in Taiwan

Studies on the association between pneumoconiosis and deep-vein thrombosis (DVT) and pulmonary thromboembolism (PE) are few. This study was based on data obtained from the Taiwan National Health Insurance Database from 2000 to 2006, with a follow-up period extending to the end of 2011. We identified 3719 pneumoconiosis patients and 14876 non-pneumoconiosis patients who were selected by frequency matched based on sex, age, and the index year. We analysed the risks of DVT and PE by using Cox proportional hazards regression models by including sex, age, and CCI score. The risk of developing PE was 1.90-fold in the patients with pneumoconiosis compared with the comparison cohort after adjustments for age, sex, and CCI score. By contrast, we did not observe significant effect of pneumoconiosis on DVT. However, the cumulative incidence curves for DVT were similar in the pneumoconiosis patients and non-pneumoconiosis patients. The multiplicative increased risks of PE were significant in patients with pneumoconiosis and CCI score of one and more. In conclusion, physicians should include pneumoconiosis in evaluating pulmonary embolism risk.

Epstein-Barr Virus Infection Mimicking Drug-Induced Hepatitis in a Critically ill Patient During Antituberculosis Therapy

INTRODUCTION

Although hepatitis is frequently observed during antituberculosis (anti-TB) therapy, acute viral hepatitis should be ruled out first, especially in the endemic areas. In addition to common types of viral hepatitis, ie, hepatitis A, hepatitis B, and hepatitis C viruses, Epstein-Barr virus (EBV) may result in hepatitis in some cases.

CASE PRESENTATION

Herein, we reported a critically ill patient who developed cholestatic hepatitis in the intensive care unit during the anti-TB therapy, which was misdiagnosed as anti-TB agents-induced hepatitis in the beginning. Further serologic tests and liver biopsy confirmed the diagnosis of EBV hepatitis. In contrast to previously reported hepatitis by EBV, which had presented with transient liver dysfunction and self-limiting illness, hepatitis with progressive jaundice was followed by coagulopathy and encephalopathy in our case and the patient died of hepatic failure complications.

CONCLUSIONS

According to the presented case and subsequent literature review on fatal EBV hepatitis, clinicians should consider EBV infection in the differential diagnosis when hepatitis occurs in critically ill patients during the anti-TB therapy. Although hepatitis caused by EBV is mostly self-limited, some might be fetal.

Predicting duration of mechanical ventilation in patients with carbon monoxide poisoning: a retrospective study

PURPOSE

Patients with severe carbon monoxide (CO) poisoning may develop acute respiratory failure, which needs endotracheal intubation and mechanical ventilation (MV). The objective of this study was to identify the predictors for duration of MV in patients with severe CO poisoning and acute respiratory failure.

MATERIALS AND METHODS

This is a retrospective observational study of 796 consecutive patients diagnosed with acute CO poisoning that presented to the emergency department. Patients who received MV were divided into 2 groups: the early extubation (EE) consisting of patients who were on MV for less than 72 hours and the nonearly extubation (NEE) consisting of patients who were on MV for more than 72 hours. Demographic and clinical data of the two groups were extracted for analysis.

RESULTS

The intubation rate of all CO-poisoned patients was 23.4%. A total of 168 patients were enrolled in this study. The main source of CO exposure was intentional CO poisoning by charcoal burning (137 patients). Positive toxicology screening result was found in 104 patients (61.9%). The EE group had 105 patients (62.5%). On arriving at the emergency department, high incidence of hypotension; high white blood cell count; and elevation of blood urea nitrogen, creatinine, aspartate aminotransferase, alanine aminotransferase, creatine kinase, and troponin-I levels were statistically significant in the NEE group (P < .05). Positive toxicology screening result was statistically significant in the EE group (P < .05). In a multivariate analysis, elevation of troponin-I level was an independent factor for NEE (odds ratio, 1.305; 95% confidence interval, 1.024-1.663; P = .032). Positive toxicology screening result was an independent factor for EE (odds ratio, 0.222; 95% confidence interval, 0.101-0.489; P = .001).

CONCLUSIONS

A positive toxin screen predicts extubation within the first 72 hours for patients with severe CO poisoning and acute respiratory failure. On the other hand, elevation of initial troponin-I level is a predictor for a longer duration of MV.

Primary extranodal NK/T-cell lymphoma of the lung: Mimicking bronchogenic carcinoma

Primary extranodal natural killer/T- cell lymphoma, nasal type (NK/TCL) in the lung is extremely rare and associated with Epstein-Barr virus (EBV) infection. An 80-year-old male presented with hemoptysis, which had lasted three days. Physical examination revealed inspiratory crackles at the left lung base and massive splenomegaly. Chest radiograph shows a mass-like lesion in the left lower lung but no active lesion six months earlier. Computed tomography demonstrated a soft tissue mass (size: 6.6 × 5.1 cm) with increased ground-glass opacities in the left lower lobe, several pulmonary nodules, and mediastinal lymphadenopathy. Transthoracic needle biopsy of the left-lower-lobe lung mass was performed. The pathology revealed atypical lymphoid cell infiltration, which is immunoreactive for cytoplasmic CD3, CD30 and CD56, but not reactive for CK and CD20. EBV-encoded RNA (EBER) was also detected in these atypical lymphoid cells. The serum EBV DNA level was 7.03 × 10(6) copies/mL and subtype 1 EBV was identified. No evidence of lymphoma involvement was found in the extrathoracic site. Primary pulmonary lymphoma showing nasal-type NK/T-cell subtype was diagnosed. Chemotherapy with cyclophosphamide and prednisolone was initiated immediately but the patient deteriorated and died three weeks later. In conclusion, patients presenting with rapidly growing lung mass and massive splenomegaly raise the possibility of aggressive pulmonary lymphoma. Extranodal NK/T-cell lymphoma with high baseline plasma EBV DNA levels signifies poor prognosis. Identifying young high-risk patients may have benefits for early aggressive and successful treatment.

Efficient simulation of the spatial transmission dynamics of influenza

Early data from the 2009 H1N1 pandemic (H1N1pdm) suggest that previous studies over-estimated the within-country rate of spatial spread of pandemic influenza. As large spatially resolved data sets are constructed, the need for efficient simulation code with which to investigate the spatial patterns of the pandemic becomes clear. Here, we present a significant improvement to the efficiency of an individual-based stochastic disease simulation framework commonly used in multiple previous studies. We quantify the efficiency of the revised algorithm and present an alternative parameterization of the model in terms of the basic reproductive number. We apply the model to the population of Taiwan and demonstrate how the location of the initial seed can influence spatial incidence profiles and the overall spread of the epidemic. Differences in incidence are driven by the relative connectivity of alternate seed locations. The ability to perform efficient simulation allows us to run a batch of simulations and take account of their average in real time. The averaged data are stable and can be used to differentiate spreading patterns that are not readily seen by only conducting a few runs.

Efficient simulation of the spatial transmission dynamics of influenza

Early data from the 2009 H1N1 pandemic (H1N1pdm) suggest that previous studies over-estimated the within-country rate of spatial spread of pandemic influenza. As large spatially-resolved data sets are constructed, the need for efficient simulation code with which to investigate the spatial patterns of the pandemic becomes clear. Here, we describe a significant improvement in the efficiency of an individual-based stochastic disease simulation framework that has been used for multiple previous studies. We quantify the efficiency of the revised algorithm and present an alternative parameterization of the model in terms of the basic reproductive number. We apply the model to the population of Taiwan and demonstrate how the location of the initial seed can influence spatial incidence profiles and the overall spread of the epidemic. Differences in incidence are driven by the relative connectivity of alternate seed locations.

Structural transformation of LiVOPO4 to Li3V2(PO4)3 with enhanced capacity

In the present investigation, we report the transformation of alpha-LiVOPO 4 to alpha-Li 3V 2(PO 4) 3, leading to an enhancement of capacity. The alpha-LiVOPO 4 sample was synthesized by a sol-gel method, followed by sintering at 550-650 degrees C in a flow of 5% H 2/Ar. The structural transformation of a triclinic alpha-LiVOPO 4 structure to a monoclinic alpha-Li 3V 2(PO 4) 3 structure was observed at higher sintering temperatures (700-800 degrees C in a flow of 5% H 2/Ar). The alpha-Li 3V 2(PO 4) 3 phase was characterized by X-ray diffraction, scanning electron microscopy, transmission electron microscopy, thermal gravimetric analysis, and X-ray absorption near edge spectrum (XANES) techniques. The valence shift of vanadium ions from +4 to +3 states was observed using in situ XANES experiments at V K-edge. The structural transformation is ascertained by the shape changes in pre-edge and near edge area of X-ray absorption spectrum. It was observed that the capacity was enhanced from 140 mAh/g to 164 mAh/g via structural transformation process of LiVOPO 4 to Li 3V 2(PO 4) 3.

Application of MVBC equation to predict mixed venous blood concentrations of sevoflurane in cardiac anaesthesia

We have proposed an equation for estimating the real-time mixed venous blood concentration (MVBC) of isoflurane in cardiac anaesthesia. However, information related to the application of our method to sevoflurane is lacking. We studied 12 patients undergoing cardiac surgery and anaesthetised with sevoflurane. At different time points, pulmonary arterial blood samples were collected for gas chromatography-mass spectrometry (GC-MS) to determine the real mixed venous concentrations of sevoflurane. The inspired and expired concentrations of sevoflurane, measured by a gas monitor, were used for the MVBC calculations. Using Bland-Altman analyses, we found that the calculated MVBCs accurately represent the actual concentrations of sevoflurane in pulmonary arterial blood, as shown by a near-zero percentage bias with a 0.14% precision between the two concentrations. The results demonstrated that our equation could be a useful method for estimating the pulmonary blood concentration of sevoflurane.

Thermal chip fabrication with arrays of sensors and heaters for micro-scale impingement cooling heat transfer analysis and measurements

The design and fabrication for a thermal chip with an array of temperature sensors and heaters for study of micro-jet impingement cooling heat transfer process are presented. This thermal chip can minimize the heat loss from the system to the ambient and provide a uniform heat flux along the wall, thus local heat transfer processes along the wall can be measured and obtained. The fabrication procedure presented can reach a chip yield of 100%, and every one of the sensors and heaters on the chip is in good condition. In addition, micro-jet impingement cooling experiments are performed to obtain the micro-scale local heat transfer Nusselt number along the wall. Flow visualization for the micro-impinging jet is also made. The experimental results indicate that both the micro-scale impinging jet flow structure and the heat transfer process along the wall is significantly different from the case of large-scale jet impingement cooling process.

Identification and characterization of mutations underlying Sanfilippo syndrome type A (mucopolysaccharidosis type IIIA)

Sanfilippo syndrome type A (mucopolysaccharidosis type IIIA; MPS IIIA) is caused by a deficiency of the lysosomal enzyme haparan N-sulphatase (NS). The genomic DNA segments of the NS gene from two Chinese patients with MPS IIIA were amplified by polymerase chain reaction, followed by DNA sequencing to study the molecular lesions. Four mutations (i.e. N42K, D235N, P293S and R377C) and five polymorphisms (i.e. IVS2-72A --> G, IVS2-26T --> C, IVS5+17C --> T, IVS5-37GC --> CTGT and R456H) were identified. Transfection of COS-7 cells with cDNA mutagenized to the corresponding mutations did not yield active enzyme, demonstrating the deleterious nature of the mutations. Western blot analysis revealed a 62-kDa precursor and 56-kDa mature forms for cells transfected with wild-type and polymorphic R456H enzymes. For cells transfected with mutant enzymes, the reduction in precursor and mature forms suggests an increased degradation of the mutant enzymes. The polymorphic DNA haplotype of the NS gene was analysed in 52 unrelated subjects. All five polymorphisms were in Hardy-Weinberg equilibrium. The strong non-random association among the five polymorphisms suggests little or no recombination in the NS gene.

Primary cerebral anaplastic large cell lymphoma containing abundant reactive histiocytes and eosinophils. A case report and literature review

Primary cerebral anaplastic large cell lymphoma (ALCL) is very rare. We report on our experience with such a case and review the literature. A 46-year-old Taiwanese woman presented with headache, weakness of her right extremity, and limited eye movement. A solid mass (5 cm x 4 cm) at the left occipital lobe was almost completely removed. The neoplastic cells, some of which had reniform or embryo-like nuclei, were large and were admixed with abundant eosinophils, histiocytes, and some small lymphocytes. These neoplastic cells expressed CD30, CD43, granzyme B and T-cell intracellular antigen-1, but not ALK1, CD3, CD20, CD45, CD79a, cytokeratin, and EMA. They were positive for Epstein-Barr virus-encoded mRNA by in situ hybridization. Polymerase chain reaction study of formalin-fixed tissue showed a clonal gene arrangement of the T-cell receptor-gamma chain. ALCL of T-cell lineage with cytotoxic phenotype was diagnosed. The patient received cranial irradiation and has remained with no evidence of disease for 25 months of follow-up.

DNA sequence plays a major role in determining nucleosome positions in yeast CUP1 chromatin

The role of DNA sequence in determining nucleosome positions in vivo was investigated by comparing the positions adopted by nucleosomes reconstituted on a yeast plasmid in vitro using purified core histones with those in native chromatin containing the same DNA, described previously. Nucleosomes were reconstituted on a 2.5 kilobase pair DNA sequence containing the yeast TRP1ARS1 plasmid with CUP1 as an insert (TAC-DNA). Multiple, alternative, overlapping nucleosome positions were mapped on TAC-DNA. For the 58 positioned nucleosomes identified, the relative positioning strengths and the stabilities to salt and temperature were determined. These positions were, with a few exceptions, identical to those observed in native, remodeled TAC chromatin containing an activated CUP1 gene. Only some of these positions are utilized in native, unremodeled chromatin. These observations suggest that DNA sequence is likely to play a very important role in positioning nucleosomes in vivo. We suggest that events occurring in yeast CUP1 chromatin determine which positions are occupied in vivo and when they are occupied.

Simultaneous determination of fluorinated inhalation anesthetics in blood by gas chromatography-mass spectrometry combined with a headspace autosampler

Although the fluorinated inhalation anesthetics, including desflurane, sevoflurane, isoflurane, enflurane, and halothane are commonly used, fatal cases resulting from their abuse or misuse have been reported. To date, gas chromatography (GC) equipped with different kinds of detectors has been utilized to analyze inhalation anesthetics. However, none of them can detect desflurane reliably or analyze all five common anesthetics simultaneously. The purpose of the present work is to further modify the previously developed headspace (HS) GC-MS method for blood isoflurane determination to analyze and distinguish five common clinical inhalation anesthetics, simultaneously. The modified HS-GC-MS method adopts a 60 m x 0.25 mm I.D., 0.25 microm film thickness DB-5 capillary column along with an adequate GC temperature program, which gives the five inhalation anesthetics, including isoflurane and its isomer, enflurane, a high resolution. The method also takes both the volatility and the influence of the top space on the obtained concentration into consideration and therefore keeps the sample loss acceptable even for analyzing the highly volatile desflurane. Within a certain concentration range of the calibration standard (about 20-300 microg/ml), this method shows a good linearity with correlation coefficients greater than 0.999. In addition, both within- and between-run precision and accuracy results meet the validation requirements as well as the tested results of practical blood samples of desflurane. In summary, this is a reliable analytical method to simultaneously determine the concentration of five common inhalation anesthetics in blood. Such a method is very practical for both clinical and occupational monitoring, as well as for analytical toxicology.

Activation of the mouse Ig germline epsilon promoter by IL-4 is dependent on AP-1 transcription factors

Induction of germline (GL) epsilon transcripts, an essential step preceding Ig isotype switching to IgE, requires activation of transcription factors by IL-4 and a B cell activator, e.g., CD40 ligand or LPS. We demonstrate that AP-1 (Fos and Jun), induced transiently by CD40 ligand or LPS, binds a DNA element in the mouse GL epsilon promoter. AP-1 synergizes with Stat6 to activate both the intact GL epsilon promoter and a minimal heterologous promoter driven by the AP-1 and Stat6 sites of the mouse GL epsilon promoter. By contrast, C/EBP beta, which trans-activates the human GL epsilon promoter, inhibits IL-4 induction of the mouse promoter, probably by attenuating the synergistic interaction between AP-1 and Stat6. Furthermore, AP-1 does not trans-activate the human GL epsilon promoter. Thus, induction of GL epsilon transcripts in mice and humans may be regulated differently. In addition, although mouse GL epsilon transcripts have a half-life of approximately 100 min, the RNA level continues to increase for up to 24 h, and the promoter appears to be active for at least 2 days after B cell activation. Altogether, these data suggest that induction of AP-1 activity, although transient, is required for activation of the mouse GL epsilon promoter by IL-4-induced Stat6.

Remodeling of yeast CUP1 chromatin involves activator-dependent repositioning of nucleosomes over the entire gene and flanking sequences

The yeast CUP1 gene is activated by the copper-dependent binding of the transcriptional activator, Ace1p. An episome containing transcriptionally active or inactive CUP1 was purified in its native chromatin structure from yeast cells. The amount of RNA polymerase II on CUP1 in the purified episomes correlated with its transcriptional activity in vivo. Chromatin structures were examined by using the monomer extension technique to map translational positions of nucleosomes. The chromatin structure of an episome containing inactive CUP1 isolated from ace1Delta cells is organized into clusters of overlapping nucleosome positions separated by linkers. Novel nucleosome positions that include the linkers are occupied in the presence of Ace1p. Repositioning was observed over the entire CUP1 gene and its flanking regions, possibly over the entire episome. Mutation of the TATA boxes to prevent transcription did not prevent repositioning, implicating a chromatin remodeling activity recruited by Ace1p. These observations provide direct evidence in vivo for the nucleosome sliding mechanism proposed for remodeling complexes in vitro and indicate that remodeling is not restricted to the promoter but occurs over a chromatin domain including CUP1 and its flanking sequences.

Identification and characterization of a prevalent hepatitis B virus X protein mutant in Taiwanese patients with hepatocellular carcinoma

The aim of this study was to investigate whether there was a particular hepatitis B virus (HBV) X protein (HBx) mutant associated with Taiwanese patients with hepatocellular carcinoma (HCC). Initially, the entire coding region of HBx gene from the serum samples of 14 Taiwanese patients were sequenced. A novel mutant, HBx-A31, was preferentially found in patients with HCC. Sera from 67 patients with HCC and 100 patients with chronic hepatitis B were thus subjected for codon 31 analysis using a dual amplification created restriction site method. HBx-A31 was detected more frequently in patients with HCC (52% versus 12%; P<0.001) and in patients with liver cirrhosis (44% versus 6%; P<0.001). Site directed mutagenesis experiment revealed that HBx-A31 was less effective in transactivating HBV enhancer I-X promoter complex, less efficient in supporting HBV replication, and less potent in enhancing TNF-alpha induced increment of CPP32/caspase 3 activities in HepG2 cells. In conclusion, a prevalent HBx mutant was identified in Taiwanese patients with hepatocellular carcinoma. Development of this mutant might represent a strategy of the virus to escape immune surveillance and thus contribute to the process of multiple-step hepatocarcinogenesis.