Mixed-Genotype HCV Direct Acting Antiviral Outcomes: A CANUHC Analysis.

The prevalence of mixed hepatitis C virus (HCV) genotype infection in a representative Canadian HCV cohort is reported and virological response with direct acting antiviral (DAA) treatment was evaluated. 3272 HCV-positive participants were enrolled, of which 2945 (90.0%) initiated DAA therapy. 0.8% were identified with mixed genotype infection. Overall sustained virological response (SVR) was 99.1% and did not differ based on mixed genotype status. Any historical disadvantage to achieving cure with HCV treatment in mixed genotype infection has been overcome by current DAA regimens.

Developing evidence-based clinical imaging guidelines for the diagnosis of vertically fractured teeth.

OBJECTIVES: This study aimed to develop an evidence-based clinical imaging guideline for teeth suspected with vertical root fractures. METHODS: An adaptation methodology based on the Korean Clinical Imaging Guidelines (K-CIG) was used in the guideline development process. After searching for guidelines using major databases such as Ovid-Medline, Elsevier-Embase, National Guideline Clearinghouse, and Guideline International Network, as well as domestic databases such as KoreaMed, KMbase, and KoMGI, two reviewers analyzed the retrieved articles. The retrieved articles were included in this review using well-established inclusion criteria. RESULTS: Twenty articles were identified through an online search, of which three were selected for guideline development. Based on these three guidelines, this study developed specific recommendations concerning the optimal imaging modality for diagnosing teeth suspected of vertical root fractures. CONCLUSIONS: Periapical radiography is the preferred method for assessing teeth with mastication-related pain and suspected vertical root fractures. However, if intraoral radiographs do not provide sufficient information about root fractures, a small FOV CBCT may be considered. However, the use of CBCT in endodontically treated teeth is significantly constrained by the presence of artificial shading.

The Effect of Exercise on Mesenchymal Stem Cells and their Application in Obesity Treatment.

Mesenchymal stem cells (MSCs) have demonstrated considerable potential in tissue repair and the treatment of immune-related diseases, but there are problems with homing efficiency during MSCs transplantation. Exercise, as an intervention, has been shown to have an important impact on the properties of MSCs. This review summarizes the effects of exercise on the properties (including proliferation, apoptosis, differentiation, and homing) of bone marrow-derived MSCs and adipose-derived MSCs. Studies indicated that exercise enhances bone marrow-derived MSCs proliferation, osteogenic differentiation, and homing while reducing adipogenic differentiation. For adipose-derived MSCs, exercise enhances proliferation and reduces adipogenic differentiation. In addition, studies have investigated the therapeutic effects of combined therapy of MSCs transplantation with exercise on diseases of the bone, cardiac, and nervous systems. The combined therapy improves tissue repair by increasing the homing of transplanted MSCs and cytokine secretion (such as neurotrophin 4). Furthermore, MSCs transplantation also has potential for the treatment of obesity. Although the effect is not significant in weight loss, MSCs transplantation shows effects in controlling blood glucose, improving dyslipidemia, reducing inflammation, and improving liver disease. Finally, the potential role of combined MSCs transplantation and exercise therapy in addressing obesity is discussed.

Primary malignant melanoma of the parotid gland, a rare case arising from a duct: a case report and literature review.

Malignant melanoma of the parotid gland is an unusual tumor in the head and neck region, and most parotid melanoma is reported as a metastatic lesion of cutaneous malignant melanoma. We report a case of primary malignant melanoma arising in the parotid gland duct with diagnostic challenge. The patient was a 68-year-old man who complained of repeated right facial swelling that presented 3 months prior. Swelling was detected along the Stensen's duct of the cheek, and brown-colored saliva-like fluid was aspirated. On MR and CT images, a fluid-filled duct with small nodule and heterogeneously enhancing mass in the parotid parenchyma was detected. The nodular mass on the ductal wall grew rapidly, and the hyperintense T1 signal became significant on follow-up images. The final diagnosis via histopathologic examination using biopsy and parotidectomy specimen revealed the lesion as malignant melanoma of the duct and pleomorphic adenoma of the parenchyma. Even if the incidence of primary malignant melanoma is very low among tumors occurring in the parotid gland, efforts supporting an early diagnosis using imaging characteristics are important.

CACSNet for automatic robust classification and segmentation of carotid artery calcification on panoramic radiographs using a cascaded deep learning network.

Stroke is one of the major causes of death worldwide, and is closely associated with atherosclerosis of the carotid artery. Panoramic radiographs (PRs) are routinely used in dental practice, and can be used to visualize carotid artery calcification (CAC). The purpose of this study was to automatically and robustly classify and segment CACs with large variations in size, shape, and location, and those overlapping with anatomical structures based on deep learning analysis of PRs. We developed a cascaded deep learning network (CACSNet) consisting of classification and segmentation networks for CACs on PRs. This network was trained on ground truth data accurately determined with reference to CT images using the Tversky loss function with optimized weights by balancing between precision and recall. CACSNet with EfficientNet-B4 achieved an AUC of 0.996, accuracy of 0.985, sensitivity of 0.980, and specificity of 0.988 in classification for normal or abnormal PRs. Segmentation performances for CAC lesions were 0.595 for the Jaccard index, 0.722 for the Dice similarity coefficient, 0.749 for precision, and 0.756 for recall. Our network demonstrated superior classification performance to previous methods based on PRs, and had comparable segmentation performance to studies based on other imaging modalities. Therefore, CACSNet can be used for robust classification and segmentation of CAC lesions that are morphologically variable and overlap with surrounding structures over the entire posterior inferior region of the mandibular angle on PRs.

Reinforcement of a Subcutaneous Pocket for Implantable Cardioverter Defibrillator Insertion Using Acellular Dermal Matrix: A Case Report.

Pediatric patients who undergo implant insertion into the chest wall face a high risk of implant exposure to the external environment. Five months after an 8-year-old boy underwent implantable cardioverter-defibrillator (ICD) implantation in a subcutaneous pocket in the left anterolateral chest wall to manage long QT syndrome, ICD replacement became necessary owing to exposure risk from distal and lateral thinning of the ICD pocket. Pocket rupture and exposure would increase the risk of infection; therefore, we performed ICD removal and primary pocket closure. Two weeks later, a new suprafascial pocket was created, an acellular dermal matrix (ADM) was attached to the inner wall to prevent ICD protrusion, and a new ICD was inserted. One year postoperatively, the ADM was engrafted, and no complications were observed. A thin subcutaneous layer increases the risk of ICD implantation complications. Inner wall strengthening with an ADM can help prevent pocket rupture.

Automatic segmentation and classification of frontal sinuses for sex determination from CBCT scans using a two-stage anatomy-guided attention network.

Sex determination is essential for identifying unidentified individuals, particularly in forensic contexts. Traditional methods for sex determination involve manual measurements of skeletal features on CBCT scans. However, these manual measurements are labor-intensive, time-consuming, and error-prone. The purpose of this study was to automatically and accurately determine sex on a CBCT scan using a two-stage anatomy-guided attention network (SDetNet). SDetNet consisted of a 2D frontal sinus segmentation network (FSNet) and a 3D anatomy-guided attention network (SDNet). FSNet segmented frontal sinus regions in the CBCT images and extracted regions of interest (ROIs) near them. Then, the ROIs were fed into SDNet to predict sex accurately. To improve sex determination performance, we proposed multi-channel inputs (MSIs) and an anatomy-guided attention module (AGAM), which encouraged SDetNet to learn differences in the anatomical context of the frontal sinus between males and females. SDetNet showed superior sex determination performance in the area under the receiver operating characteristic curve, accuracy, Brier score, and specificity compared with the other 3D CNNs. Moreover, the results of ablation studies showed a notable improvement in sex determination with the embedding of both MSI and AGAM. Consequently, SDetNet demonstrated automatic and accurate sex determination by learning the anatomical context information of the frontal sinus on CBCT scans.

Deep learning-based automatic segmentation of the mandibular canal on panoramic radiographs: A multi-device study.

Purpose: The objective of this study was to propose a deep-learning model for the detection of the mandibular canal on dental panoramic radiographs. Materials and Methods: A total of 2,100 panoramic radiographs (PANs) were collected from 3 different machines: RAYSCAN Alpha (n=700, PAN A), OP-100 (n=700, PAN B), and CS8100 (n=700, PAN C). Initially, an oral and maxillofacial radiologist coarsely annotated the mandibular canals. For deep learning analysis, convolutional neural networks (CNNs) utilizing U-Net architecture were employed for automated canal segmentation. Seven independent networks were trained using training sets representing all possible combinations of the 3 groups. These networks were then assessed using a hold-out test dataset. Results: Among the 7 networks evaluated, the network trained with all 3 available groups achieved an average precision of 90.6%, a recall of 87.4%, and a Dice similarity coefficient (DSC) of 88.9%. The 3 networks trained using each of the 3 possible 2-group combinations also demonstrated reliable performance for mandibular canal segmentation, as follows: 1) PAN A and B exhibited a mean DSC of 87.9%, 2) PAN A and C displayed a mean DSC of 87.8%, and 3) PAN B and C demonstrated a mean DSC of 88.4%. Conclusion: This multi-device study indicated that the examined CNN-based deep learning approach can achieve excellent canal segmentation performance, with a DSC exceeding 88%. Furthermore, the study highlighted the importance of considering the characteristics of panoramic radiographs when developing a robust deep-learning network, rather than depending solely on the size of the dataset.

Rural-specific identity and associations with lifestyle behaviors and well-being among rural cancer survivors.

BACKGROUND: Disparities in rural cancer survivors' health outcomes are well-documented, yet the role of sociocultural aspects of rurality, such as rural identity, attitudes toward rurality, and social standing on health beliefs and behaviors remain unclear. This study aimed to address these gaps. METHODS: Rural cancer survivors (N = 188) completed a mailed/online survey. Regression analyses identified relationships among rural identity, negative attitudes toward rurality, and social standing with health outcomes, quality of life, cancer fatalism, and cancer information overload. RESULTS: Higher rural identity was associated with believing everything causes cancer (OR = 1.58, p = 0.048), believing "there's not much you can do to lower your chances of getting cancer" (OR = 2.22, p = 0.002), and higher odds of being overloaded with cancer information (OR = 2.05, p  = 0.008). Negative attitudes toward rurality was linked with higher levels of perceived stress (B = 0.83, p = 0.001), and chronic pain (OR = 1.47, p = 0.039). Higher subjective social status was associated with perceived social support (B = 0.09, p = 0.016), better overall health (B = 0.13, p < 0.001), lower levels of perceived stress (B = -0.38, p = 0.007), and chronic pain (OR = 0.80, p = 0.027). CONCLUSION: Sociocultural factors of rurality were associated with indicators of quality of life, cancer fatalism, and information overload. Further exploration of the underlying mechanisms that drive these associations can help improve intervention targets for rural cancer survivors.

Radiological manifestations and clinical findings of patients with oncologic and osteoporotic medication-related osteonecrosis of the jaw.

Medication-related osteonecrosis of the jaw (MRONJ) poses a challenging form of osteomyelitis in patients undergoing antiresorptive therapies in contrast to conventional osteomyelitis. This study aimed to compare the clinical and radiological features of MRONJ between patients receiving low-dose medications for osteoporosis and those receiving high-dose medications for oncologic purposes. The clinical, panoramic radiographic, and computed tomography data of 159 patients with MRONJ (osteoporotic group, n = 120; oncologic group, n = 39) who developed the condition after using antiresorptive medications for the management of osteoporosis or bone malignancy were analyzed. The osteoporotic group was older (75.8 vs. 60.4 years, p < 0.01) and had a longer duration of medication usage than the oncologic group (58.1 vs. 28.0 months, p < 0.01). Pus discharge and swelling were more common in the osteoporotic group (p < 0.05), whereas bone exposure was more frequent in the oncologic group (p < 0.01). The mandibular cortical index (MCI) in panoramic radiographs was higher in the osteoporotic group (p < 0.01). The mean sequestra size was larger in the oncologic group than in the osteoporotic group (15.3 vs. 10.6 mm, p < 0.05). The cured rate was significantly higher in the osteoporotic group (66.3% vs. 33.3%, p < 0.01). Oncologic MRONJ exhibited distinct clinical findings including rapid disease onset, fewer purulent signs, and lower cure rates than osteoporotic MRONJ. Radiological features such as sequestrum size on CT scan, and MCI values on panoramic radiographs, may aid in differentiating MRONJ in osteoporotic and oncologic patients.

Automatic and robust estimation of sex and chronological age from panoramic radiographs using a multi-task deep learning network: a study on a South Korean population.

Sex and chronological age estimation are crucial in forensic investigations and research on individual identification. Although manual methods for sex and age estimation have been proposed, these processes are labor-intensive, time-consuming, and error-prone. The purpose of this study was to estimate sex and chronological age from panoramic radiographs automatically and robustly using a multi-task deep learning network (ForensicNet). ForensicNet consists of a backbone and both sex and age attention branches to learn anatomical context features of sex and chronological age from panoramic radiographs and enables the multi-task estimation of sex and chronological age in an end-to-end manner. To mitigate bias in the data distribution, our dataset was built using 13,200 images with 100 images for each sex and age range of 15-80 years. The ForensicNet with EfficientNet-B3 exhibited superior estimation performance with mean absolute errors of 2.93 ± 2.61 years and a coefficient of determination of 0.957 for chronological age, and achieved accuracy, specificity, and sensitivity values of 0.992, 0.993, and 0.990, respectively, for sex prediction. The network demonstrated that the proposed sex and age attention branches with a convolutional block attention module significantly improved the estimation performance for both sex and chronological age from panoramic radiographs of elderly patients. Consequently, we expect that ForensicNet will contribute to the automatic and accurate estimation of both sex and chronological age from panoramic radiographs.

Temporal variations in the gut microbial diversity in response to high-fat diet and exercise.

High-fat diet-induced obesity is a pandemic caused by an inactive lifestyle and increased consumption of Western diets and is a major risk factor for diabetes and cardiovascular diseases. In contrast, exercise can positively influence gut microbial diversity and is linked to a decreased inflammatory state. To understand the gut microbial variations associated with exercise and high-fat diet over time, we conducted a longitudinal study to examine the effect of covariates on gut microbial diversity and composition. Young mice were divided into four groups: Chow-diet (CHD), high-fat diet (HFD), high-fat diet + exercise (HFX), and exercise only (EXE) and underwent experimental intervention for 12 weeks. Fecal samples at week 0 and 12 were collected for DNA extraction, followed by 16S library preparation and sequencing. Data were analyzed using QIIME 2, R and MicrobiomeAnalyst. The Bacteroidetes-to-Firmicutes ratio decreased fivefold in the HFD and HFX groups compared to that in the CHD and EXE groups and increased in the EXE group over time. Alpha diversity was significantly increased in the EXE group longitudinally (p < 0.02), whereas diversity (Shannon, Faith's PD, and Fisher) and richness (ACE) was significantly reduced in the HFD (p < 0.005) and HFX (p < 0.03) groups over time. Beta diversity, based on the Jaccard, Bray-Curtis, and unweighted UniFrac distance metrics, was significant among the groups. Prevotella, Paraprevotella, Candidatus arthromitus, Lactobacillus salivarius, L. reuteri, Roseburia, Bacteroides uniformis, Sutterella, and Corynebacterium were differentially abundant in the chow-diet groups (CHD and EXE). Exercise significantly reduced the proportion of taxa characteristic of a high-fat diet, including Butyricimonas, Ruminococcus gnavus, and Mucispirillum schaedleri. Diet, age, and exercise significantly contributed to explaining the bacterial community structure and diversity in the gut microbiota. Modulating the gut microbiota and maintaining its stability can lead to targeted microbiome therapies to manage chronic and recurrent diseases and infections.

Automatic detection of posterior superior alveolar artery in dental cone-beam CT images using a deeply supervised multi-scale 3D network.

OBJECTIVES: This study aimed to develop a robust and accurate deep learning network for detecting the posterior superior alveolar artery (PSAA) in dental cone-beam CT (CBCT) images, focusing on the precise localization of the centre pixel as a critical centreline pixel. METHODS: PSAA locations were manually labelled on dental CBCT data from 150 subjects. The left maxillary sinus images were horizontally flipped. In total, 300 datasets were created. Six different deep learning networks were trained, including 3D U-Net, deeply supervised 3D U-Net (3D U-Net DS), multi-scale deeply supervised 3D U-Net (3D U-Net MSDS), 3D Attention U-Net, 3D V-Net, and 3D Dense U-Net. The performance evaluation involved predicting the centre pixel of the PSAA. This was assessed using mean absolute error (MAE), mean radial error (MRE), and successful detection rate (SDR). RESULTS: The 3D U-Net MSDS achieved the best prediction performance among the tested networks, with an MAE measurement of 0.696 ± 1.552 mm and MRE of 1.101 ± 2.270 mm. In comparison, the 3D U-Net showed the lowest performance. The 3D U-Net MSDS demonstrated a SDR of 95% within a 2 mm MAE. This was a significantly higher result than other networks that achieved a detection rate of over 80%. CONCLUSIONS: This study presents a robust deep learning network for accurate PSAA detection in dental CBCT images, emphasizing precise centre pixel localization. The method achieves high accuracy in locating small vessels, such as the PSAA, and has the potential to enhance detection accuracy and efficiency, thus impacting oral and maxillofacial surgery planning and decision-making.

Clinical and radiological features of malformed mesiodens in the nasopalatine canal: an observational study.

OBJECTIVES: The purpose of this study is to investigate the morphological changes that occur when mesiodens is located within the nasopalatine canal, as well as clinical characteristics. METHODS: Clinical records and CT images of patients who had mesiodens in the nasopalatine canal were retrospectively analysed. In addition to demographic information, clinical symptoms and complications associated with extraction of mesiodens were recorded. Using CT images, number, location, size, and tooth morphology were evaluated. RESULTS: This study included 32 patients and 38 mesiodens within the nasopalatine canal. Supernumerary teeth exhibited a characteristic feature of thin and elongated shape in the canal (narrow width and elongation were observed in 96.6% and 53.3% of the patients, respectively). Fusion was found in 4 patients and dilaceration in 12. A complication occurred in 2 patients, which was tooth remnant, not a neurologic complication. Only 5 mesiodens could be detected in the nasopalatine canal on panoramic images. CONCLUSIONS: Morphological abnormalities in mesiodens within the nasopalatine canal were frequently detected, and these could be effectively diagnosed through 3D imaging analysis.

Automatic detection and classification of nasopalatine duct cyst and periapical cyst on panoramic radiographs using deep convolutional neural networks.

OBJECTIVE: The aim of this study was to evaluate a deep convolutional neural network (DCNN) method for the detection and classification of nasopalatine duct cysts (NPDC) and periapical cysts (PAC) on panoramic radiographs. STUDY DESIGN: A total of 1,209 panoramic radiographs with 606 NPDC and 603 PAC were labeled with a bounding box and divided into training, validation, and test sets with an 8:1:1 ratio. The networks used were EfficientDet-D3, Faster R-CNN, YOLO v5, RetinaNet, and SSD. Mean average precision (mAP) was used to assess performance. Sixty images with no lesion in the anterior maxilla were added to the previous test set and were tested on 2 dentists with no training in radiology (GP) and on EfficientDet-D3. The performances were comparatively examined. RESULTS: The mAP for each DCNN was EfficientDet-D3 93.8%, Faster R-CNN 90.8%, YOLO v5 89.5%, RetinaNet 79.4%, and SSD 60.9%. The classification performance of EfficientDet-D3 was higher than that of the GPs' with accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 94.4%, 94.4%, 97.2%, 94.6%, and 97.2%, respectively. CONCLUSIONS: The proposed method achieved high performance for the detection and classification of NPDC and PAC compared with the GPs and presented promising prospects for clinical application.

Palmar reconstruction using full-thickness skin grafts from the groin and lateral malleolus regions: A comparison of long-term outcomes.

Using the skin of the lateral malleolus region for reconstruction of smaller areas of the palm may yield better outcomes than using the skin of the groin region. However, no previous study has provided long-term data comparing the groin and lateral malleolus regions as donor sites for full-thickness skin grafts (FTSGs) in palmar reconstruction. Therefore, this study aimed to compare the groin and lateral malleolus regions as donor sites for FTSGs in palmar reconstruction over a long-term follow-up period. The patients were classified into groin and lateral malleolus region groups (n = 15 each). Measurements were obtained at the graft site, the contralateral site corresponding to the graft site, and the donor site. A chromameter was used to measure skin color, and the Patient and Observer Scar Assessment Scale (POSAS) was used to evaluate the scar at the skin graft site. Compared to the groin region group, the lateral malleolus region group showed skin colors that were closer to the original color of the palm in terms of lightness and red/green values. Additionally, the lateral malleolus region group received better esthetic ratings in the POSAS. Our results revealed that using the lateral malleolus region for FTSGs in palmar reconstruction resulted in better outcomes than using the groin region, even over a long period.

Development and validation of a clinical phantom reproducing various lesions for oral and maxillofacial radiology research.

Purpose: The objective of this study was to propose a method for developing a clinical phantom to reproduce various diseases that are clinically prevalent in the field of dentistry. This could facilitate diverse clinical research without unnecessarily exposing patients to radiation. Material and Methods: This study utilized a single dry skull, which was visually and radiographically examined to evaluate its condition. Existing lesions on the dry skull were preserved, and other relevant lesions were artificially created as necessary. These lesions were then documented using intraoral radiography and cone-beam computed tomography. Once all pre-existing and reproduced lesions were confirmed by the consensus of 2 oral and maxillofacial radiologists, the skull was embedded in a soft tissue substitute. To validate the process, cone-beam computed tomography scans and panoramic radiographs were obtained of the fabricated phantom. All acquired images were subsequently evaluated. Results: Most lesions could be identified on panoramic radiographs, although some sialoliths and cracked teeth were confirmed only through cone-beam computed tomographic images. A small gap was observed between the epoxy resin and the bone structures. However, 2 oral and maxillofacial radiologists agreed that this space did not meaningfully impact the interpretation process. Conclusion: The newly developed phantom has potential for use as a standardized phantom within the dental field. It may be utilized for a variety of imaging studies, not only for optimization purposes, but also for addressing other experimental issues related to both 2- and 3-dimensional diagnostic radiography.

Isolated unilateral temporalis muscle hypertrophy of unknown etiology: a case report and literature review.

The initial instance of isolated unilateral temporalis muscle hypertrophy (IUTMH) was reported in 1990. Since then, only few cases have been documented. The cause of this condition remains ambiguous; however, it is presumed to be linked to compensatory and stress-induced hypertrophy. We introduce a rare case of the diagnosis and treatment of IUTMH. A 39-year-old woman presented with a steadily enlarging pain-free swelling on the left side of her face, first noticed a month ago. Apart from a hyperthyroidism medication regimen her medical history was unremarkable. She had no history of temporomandibular joint disease, bruxism, surgery, or trauma. However, she complained of having been under substantial stress lately. Contrast-enhanced magnetic resonance imaging revealed asymmetric temporalis muscle hypertrophy. The treatment plan consisted of administering type A botulinum toxin injections into left temporalis muscle, supplemented by lifestyle changes and relaxation techniques. At a follow-up visit 9 months after the injections, the muscle contour was normalized both in physical and in radiologic examinations. While further supportive evidence is needed, it can be anticipated that cosmetic treatment with botulinum toxin, rather than surgical interventions, will become the standard treatment of IUTMH.

Real-world tertiary referral centre experience stopping nucleos(t)ide analogue therapy in patients with chronic hepatitis B.

BACKGROUND: Identifying strategies for stopping nucleos(t)ide analogues (NUC) in patients with chronic hepatitis B (CHB) is a major goal in CHB management. Our study describes our tertiary-centre experience stopping nucleos(t)ide analogues (NUC) in CHB. METHODS: We conducted a retrospective cohort study of all individuals with CHB seen at the Calgary Liver Unit between January 2009 and May 2020 who stopped NUC. We collected baseline demographics and HBV lab parameters before and after stopping NUC with results stratified by off-treatment durability. Clinical flare was defined as alanine aminotransferase (ALT) over twice the upper limit of normal and virological flare as HBV DNA >2000 IU/mL. RESULTS: Forty-seven (3.5%) of the 1337 individuals with CHB stopped NUC therapy. During follow-up, six patients (12.8%) restarted NUCs because of a flare. All flares occurred within six months of discontinuation. Median time to restart treatment was 90 days (Q1 65, Q3 133). Upon restarting, all showed suppression of HBV DNA and ALT normalization. Factors associated with restarting NUC therapy included hepatitis B e antigen (HBeAg) positive status at first appointment and longer NUC consolidation therapy. Age, sex, ethnicity, liver stiffness measurement, choice of NUC, and quantitative hepatitis B surface antigen (qHBsAg) level at stopping were not associated with sustained response off-treatment. Six patients had functional cure with HBsAg loss. CONCLUSIONS: Stopping long-term NUC is feasible in HBeAg negative CHB. Hepatic flares can occur despite low levels of qHBsAg. Finite NUC therapy can be considered in eligible patients who are adherent to close monitoring and follow-up, particularly in the first six months after stopping NUC therapy.