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Degradable film mulching increases soil carbon sequestration in major Chinese dryland agroecosystems

Nature Communications Zihan Liu, Chenxu Zhao, Nanhai Zhang et al. May 30, 2025 DOI: 10.1038/s41467-025-60036-5

Violence victimization and perpetration within the caregiver-patient relationship in schizophrenia: A cross-sectional study in Tunisia

PLoS ONE Feten Fekih-Romdhane, Bochra Nourhène Saguem, Manel Stambouli et al. May 30, 2025 DOI: 10.1371/journal.pone.0323312

Background Family caregivers represent an integral part of the mental health care system in Tunisia, as well as in most of the low-to-middle-income countries and collectivist cultural backgrounds (i.e., communities that prioritizes the group over the individual). However, their task is burdensome, often associated with both experienced and perpetrated violence toward the patient. We aimed to shed light on the caregiver-patient relationship by investigating the prevalence and correlates of both violence victimization and violence perpetration in a Tunisian sample of caregivers of patients with schizophrenia. Method A paper-and-pencil self-administered questionnaire was used to collect data from participants. Caregivers (N = 110, aged 39.7 ± 12.5 years, 63.6% females) were asked questions about their experience of violence perpetration and victimization involving their relative with schizophrenia in the past 12 months. The Depression Anxiety and Stress Scales (DASS-21) and the abridged version of the Zarit Burden Interview (ZBI) were administered to all participants. Results Verbal violence was the most reported type of violence victimization (35.5%), followed by threat (25.5%), and physical violence (25.5%). In addition, 54.5% of caregivers disclosed having perpetrated verbal violence at least once against their ill relative. The most endorsed causes of violence victimization were symptoms of illness (57.3%) and refusal to adhere to treatment (49.1%). Multivariable analysis (logistic regression) revealed that caregivers’ levels of burden remained significantly associated with violence victimization occurrence (OR = 1.48; 95% CI 1.05; 2.09; p = .026), while having another person in charge of caring represented a significant factor associated with perpetration of any form of violence against patients (OR = .17; 95% CI.05;.62; p = .007). Conclusion Although preliminary and based on cross-sectional data and a relatively small sample size, our findings draw attention to the high prevalence of both violence perpetration and victimization within the caregiver-patient relationship in schizophrenia. Findings also identified caregivers’ burden and having another person in charge of caring as factors significantly associated with occurrence of any violence victimization and violence perpetration, respectively. These factors are potentially malleable, and may be helpful in targeting an at-risk population and developing appropriate prevention strategies.

A robust multiplex-DIA workflow profiles protein turnover regulations associated with cisplatin resistance and aneuploidy

Nature Communications Barbora Salovska, Wenxue Li, Oliver M. Bernhardt et al. May 30, 2025 DOI: 10.1038/s41467-025-60319-x

Mechanical and thermal efficiency of a single drill system for bone-anchored hearing implants

PLoS ONE Marsel Ganeyev, Furqan A. Shah, Peter Thomsen et al. May 30, 2025 DOI: 10.1371/journal.pone.0311026

Purpose This study aimed to evaluate the mechanical performance, heat generation, bone distortion, and characteristics of bone chips generated during drilling using a novel one-step guided drill system (MONO) for installing the bone-anchored hearing system (BAHS). A comparison was made with an existing three-stage drill system (MIPS). Materials and Methods Drill force and torque were measured during drilling in cow tibia at different feed rates. Compact artificial bone was utilized to determine temperature increases using thermocouples placed at specific positions around the osteotomy site during drilling with the two systems at different feed rates and levels of irrigation. The effects of drilling on osteotomy characteristics and the formation of bone fragments were evaluated through micro-CT, Raman spectroscopy, and histology. Results Force and torque increased with the feed rate in both systems, whereas the total work required to perform the osteotomy significantly decreased as the feed rate increased. Compared to the three-stage MIPS system, the MONO system required less work for one-step osteotomy creation, generated equal or less heat, and exhibited greater tolerance for procedural deviations in irrigation and drilling sequence. Additionally, heat generation for both systems decreased when drilling at higher feed rates. Compositional changes within the osteotomy were primarily observed under reduced irrigation protocols, while no differences were identified in bone chips across drilling protocols. Conclusion Compared with a multistep conventional drilling procedure, MONO drilling is less affected by variations in the drilling protocol, particularly in flapless and blind procedures, resulting in safer and more efficient osteotomy creation. The MONO system demonstrated superior performance in terms of energy efficiency and temperature control.

Spontaneous water dissociation on intermetallic electride LaCu0.67Si1.33 enhances electrochemical methanization of CO2

Nature Communications Luming Zhang, Huan Ma, Yongfang Sun et al. May 30, 2025 DOI: 10.1038/s41467-025-60353-9

Drone-based observations of scarring patterns in humpback whales (Megaptera novaeangliae) in the New York Bight provide insight into foraging behavior and anthropogenic threats

PLoS ONE Siobhan E. Keeling, Chelsi Napoli, Joshua Meza-Fidalgo et al. May 30, 2025 DOI: 10.1371/journal.pone.0324121

Large whales face a range of threats, including vessel strikes and entanglement in fishing gear. Elevated humpback whale mortality, predominantly in juveniles, has occurred in the Northeast US since 2016. The New York Bight, a region with dense shipping and fishing vessel traffic, has become a hotspot for these strandings. Scarring patterns can provide information on anthropogenic threats, as well as predation and behavior. We used drone imagery to examine scarring reflective of entanglements, vessel strikes, killer whale interactions and bottom feeding in both juvenile and adult humpback whales in the New York Bight. The vast majority of both adult (87.1%) and juvenile (86.8%) humpbacks showed entanglement scars, indicating that humpbacks frequently interact with fishing gear across age classes. Vessel strike scars were observed more frequently in juvenile whales (14.2%) than in adults (2.2%), in contrast to prior observations north of our study area in the Gulf of Maine, though the difference was of borderline significance (mean p-value 0.051, Fisher’s Exact tests on 1000 bootstrapped populations incorporating uncertainty in length measurements). These results support previous suggestions that juvenile humpbacks in the New York Bight may be particularly vulnerable to vessel strike due to inshore and surface feeding, and suggest that vessel strike scars may be obtained locally. Killer whales are thought to primarily target young animals, and killer whale scars were observed more often in juveniles (11.6%) than adults (4.4%), though this difference was not significant (mean p-value 0.26). Jaw scuffing indicative of bottom feeding was observed more frequently in adults (68.9%) than in juveniles (27.4%; mean p-value 3.47 x 10−5), suggesting that this behavior is acquired as whales mature. Our findings underscore differences in behavior between adult and juvenile humpback whales and highlight the exposure of humpback whales to anthropogenic threats in heavily urbanized coastal regions.

Regional restructuring in planktic foraminifera communities through Pliocene-early Pleistocene climate variability

Nature Communications Ekaterina Larina, Adam Woodhouse, Anshuman Swain et al. May 30, 2025 DOI: 10.1038/s41467-025-60362-8

Traffic flow prediction based on spatiotemporal encoder-decoder model

PLoS ONE Yuanming Ding, Wei Zhao, Lin Song et al. May 30, 2025 DOI: 10.1371/journal.pone.0321858

To more effectively capture the periodic and dynamic changes in urban traffic flow and the spatiotemporal correlation of complex road networks, a new traffic flow prediction method, the Enhanced Spatiotemporal Graph Convolutional Network Encoder-Decoder Model (ESGCN-EDM), is proposed. The model achieves a significant enhancement in prediction accuracy through the introduction of the attention-based Personalized-enhanced Fusion Graph Convolutional Network (aPFGCN) and the Temporal Convolutional Bidirectional Long Short-Term Memory (TCBiL) module. The aPFGCN module effectively reduces the dimensionality of features and decreases model complexity to obtain the final node feature representation by personalizing the adjustment of node influence coefficients and applying Fourier transform and inverse transform techniques. Additionally, by incorporating an attention mechanism, it enhances the model’s ability to focus on important information and effectively captures the spatial topological relationships within the traffic network. The TCBiL module integrates 1D convolution with BiLSTM to form a unified temporal feature extraction module. The 1D convolution is utilized to extract local features from the time series, while the BiLSTM captures long-term dependencies within the time series. This allows for simultaneous feature extraction and temporal modeling, thereby enhancing the model’s efficiency and performance, and strengthening its ability to model time series. In the encoder part of the ESGCN-EDM, the aPFGCN is combined with the TCBiL to handle the spatiotemporal coupling interactions of the road network. The decoder part then performs multi-step predictions based on spatiotemporal sequences using the TCBiL and CNN, generating high-dimensional representations. Extensive experiments conducted on two real-world road traffic datasets demonstrate that the ESGCN-EDM model consistently outperforms other benchmark models in 1-hour, 30-minute, and 15-minute traffic flow predictions. Specifically, on the PeMSD8 dataset, the model achieves reductions in MAE, RMSE, and SMAPE by 7.9%, 2.1%, and 16.9%, respectively, compared to the AMRGCN model for 1-hour predictions. Similarly, on the PeMSD4 dataset, the model reduces MAE, RMSE, and MAPE by 1.8%, 1.1%, and 3.0%, respectively. These results validate the efficacy of the proposed model and its ability to significantly enhance the accuracy of traffic flow forecasting.

Pseudo-linear summation explains neural geometry of multi-finger movements in human premotor cortex

Nature Communications Nishal P. Shah, Donald Avansino, Foram Kamdar et al. May 30, 2025 DOI: 10.1038/s41467-025-59039-z

How have urban housing preferences developed in response to the COVID-19 pandemic? A case study of Vienna

PLoS ONE Fabian Braesemann, Jan Kluge, Hanno Lorenz May 30, 2025 DOI: 10.1371/journal.pone.0322629

The digitisation of economic activity in response to the COVID-19 pandemic has reshaped housing demands, potentially leading to the hollowing out of inner cities due to reduced reliance on traditional office spaces. Vienna, renowned for its progressive and diverse housing structures, offers a compelling case study to dissect the interplay between digitisation and flexibilisation of work trends and local housing preference dynamics. In this study, we investigated a data set of more than 120,000 apartment listings from a large online real estate platform to unveil broader patterns shaping residential preferences caused by the COVID-19 pandemic. In analysing rent premiums, we find that amenities related to work-from-home routines have risen in importance while others remained stagnant or saw declining rent premiums. These findings point towards shifted housing preferences to accommodate the need to work from home. This trend is likely to influence housing preferences long after the end of the pandemic, which demands adjusted city planning and housing policies to build sustainable urban environments for a future of hybrid working.

Cleavage of CAD by caspase-3 determines the cancer cell fate during chemotherapy

Nature Communications Jingsong Ma, Jiabao Zhao, Chensong Zhang et al. May 30, 2025 DOI: 10.1038/s41467-025-60144-2

Abstract Metabolic heterogeneity resulting from the intra-tumoral heterogeneity mediates massive adverse outcomes of tumor therapy, including chemotherapeutic resistance, but the mechanisms inside remain largely unknown. Here, we find that the de novo pyrimidine synthesis pathway determines the chemosensitivity. Chemotherapeutic drugs promote the degradation of cytosolic Carbamoyl-phosphate synthetase II, Aspartate transcarbamylase, and Dihydroorotase (CAD), an enzyme that is rate-limiting for pyrimidine synthesis, leading to apoptosis. We also find that CAD needs to be cleaved by caspase-3 on its Asp1371 residue, before its degradation. Overexpressing CAD or mutating Asp1371 to block caspase-3 cleavage confers chemoresistance in xenograft and Cldn18-ATK gastric cancer models. Importantly, mutations related to Asp1371 of CAD are found in tumor samples that failed neoadjuvant chemotherapy and pharmacological targeting of CAD-Asp1371 mutations using RMY-186 ameliorates chemotherapy efficacy. Our work reveals the vulnerability of de novo pyrimidine synthesis during chemotherapy, highlighting CAD as a promising therapeutic target and biomarker.

How should artificial intelligence be used in breast screening? Women’s reasoning about workflow options

PLoS ONE Diana Popic, M. Luke Marinovich, Nehmat Houssami et al. May 30, 2025 DOI: 10.1371/journal.pone.0323528

Studies show that breast screening participants are open to artificial intelligence (AI) in breast screening, but hold concerns about AI performance, governance, equitable access, and dependence on technology. Little is known of consumers’ views on how AI should be used in breast screening practice. Our study aims to determine what matters most to women regarding AI use in the workflow of publicly funded breast screening programs, and how women choose between workflow options. We recruited forty women of screening age to learn about AI, the Australian breast screening program, and four possible workflows that include AI – one where AI works alone, and three different combinations of humans and AI. Participants then joined one of eight 90-minute dialogue groups to discuss their normative judgements on workflow options. Women proposed four conditions on AI deployment: preserving human control, evidence to assure AI performance, time to become familiar with AI, and clearly justifying the need for implementation. These informed women’s unified rejection of AI working alone, and divided preferences across the other three workflows, as they traded off workflow attributes. Current evidence on AI performance convinced some women, but not others. Most women believed humans mitigate risk the best, so workflows should continue to be designed around them. Public breast screening services are trusted and valued by women, so significant changes require careful attention to outcomes relevant to women. Our results – women’s detailed judgements on workflow design options – are new to the research literature. We conclude that women expect that AI only be deployed to do tasks it can do well, only where necessary, and only to fill gaps that radiologists cannot meet. Advancements in AI accuracy alone are unlikely to influence all women to accept AI making final decisions, if clinicians are available to perform the same task.

A cowpea mosaic virus adjuvant conjugated to liposomes loaded with tumor cell lysates as an ovarian cancer vaccine

Nature Communications Zhongchao Zhao, Debbie K. Ledezma, Jessica Fernanda Affonso de Oliveira et al. May 30, 2025 DOI: 10.1038/s41467-025-60239-w

Abstract Current treatment options for ovarian cancer are limited to surgery to remove tumor tissues and chemotherapy. Although such treatments could provide a short period of remission, most patients still experience recurrent metastatic diseases. Here we present a nanotechnology-based personalized cancer vaccine that can be administrated to patients during the remission stage to prevent recurrent diseases. Autologous tumor cell lysates (TCL) are intriguing, personalized antigens that could be extracted from surgically recovered tumor tissues from patients containing all neoantigens. As proof of concept, we use TCL isolated from a murine ovarian cancer cell line. TCL are first encapsulated in liposomes (TCL-Lip), which are then attached to cowpea mosaic virus (CPMV), a plant virus as a potent adjuvant. Using the ID8-Defb29/Vegf-a-Luc tumor model in female mice, the TCL-Lip-CPMV conjugate vaccine protects mice from tumor challenge by improving antigen processing and presentation, priming an adaptive anti-tumor immunity. Using ovalbumin (OVA) as a model antigen, OVA-Lip-CPMV vaccination protects mice from lung metastasis post-surgical removal of the primary B16F10-OVA dermal tumors. This research establishes a platform by combining two nanoparticle technologies into a single formulation for the simultaneous delivery of antigens and adjuvants, advancing the development of cancer vaccines and immunotherapies.

Assessing the influence of maternal vitamin D deficiency in early pregnancy and subsequent improvement on perinatal outcomes and long-term child development: a retrospective cohort study

PLoS ONE Ji Yeon Lee, Sang Hee Jung, Eun Hee Ahn et al. May 30, 2025 DOI: 10.1371/journal.pone.0323146

This study examined perinatal and long-term outcomes where maternal vitamin D deficiency was present in early pregnancy but normalized in mid-pregnancy and deficiency during both early and mid-pregnancy. In this retrospective study, we reviewed the clinical records of 5,169 singleton pregnant women who received a test of serum 25-hydroxy-vitamin D [25(OH)D] two times in the first and second trimester in our hospital from 2016 to 2022. The level of 25(OH)D was categorized into deficiency (<10ng/mL), insufficiency (10–20ng/mL), and sufficiency (≥20ng/mL). Women were grouped based on 25(OH)D status across both trimesters: consistently deficient (DD), initially deficient then sufficient in the second trimester (DS), and consistently sufficient (SS). We evaluated obstetric and neonatal outcomes, including long-term neurodevelopmental assessments. Measurements in the first trimester indicated that 21.7% (n = 1,120) of women were vitamin D deficient, 41.1% (n = 2,127) insufficient, and 37.2% (n = 1,922) sufficient. There were no significant differences in the incidence of gestational hypertension and diabetes among the DD, DS, and SS groups. The rates of preterm birth before 34 weeks (aOR = 2.42, 95%CI[1.24–4.71], p = 0.010), necrotizing enterocolitis (aOR = 22.26, 95%CI[4.16–119.34], p < 0.001), and developmental delay (aOR = 4.46, 95%CI[2.41–8.27], p < 0.001) were elevated in the DD group compared to the SS group. These risks didn’t diminish even when vitamin D deficiency in the second trimester was corrected (DS). In conclusion, associations between low first-trimester 25(OH)D levels and heightened risks of preterm birth and long-term developmental outcomes are observed. As subsequent normalization of 25(OH)D levels may not fully mitigate these risks, incorporating vitamin D screening and intervention before pregnancy as part of routine preconception care could be beneficial in optimizing maternal and offspring outcomes.

Birch reductive arylation by mechanochemical anionic activation of polycyclic aromatic compounds

Nature Communications Yoshifumi Toyama, Akiko Yagi, Kenichiro Itami et al. May 30, 2025 DOI: 10.1038/s41467-025-60318-y

Unraveling the global landscape of Elizabethkingia antibiotic resistance: A systematic review and meta-analysis

PLoS ONE Saade Abdalkareem Jasim, Jaafaru Sani Mohammed, Rangaswamy Roopashree et al. May 30, 2025 DOI: 10.1371/journal.pone.0323313

Background The emergence of antibiotic-resistant Elizabethkingia strains poses a significant challenge in clinical settings. This systematic review and meta-analysis provide a comprehensive assessment of the prevalence of antibiotic resistance among Elizabethkingia isolates across different regions worldwide. Methods A systematic literature search was conducted across PubMed, Embase, Web of Science, and Scopus from 1998 to January 9, 2024, using predefined search strategies. Eligible studies reporting antibiotic resistance in Elizabethkingia were included. A random-effects model was applied to estimate resistance proportions and assess heterogeneity. Additional analyses, including meta-regression, subgroup evaluations, and assessments of outliers and influential studies, were performed to explore resistance trends and evaluate publication bias. Study quality was assessed using the Joanna Briggs Institute Checklist, and all statistical analyses were conducted using R with the metafor package. Results A total of 1,016 articles were identified, of which 34 studies (47 reports) met the inclusion criteria. The pooled analysis indicated high resistance to ceftazidime (88.5% of isolates, 95% CI: 21.1%–99.5%) with no significant heterogeneity. Resistance to rifampin was 12.5% (95% CI: 5.9%–24.7%), showing substantial heterogeneity, while ciprofloxacin resistance was 27.9% (95% CI: 13.8%–48.4%) with considerable heterogeneity. Among specific antibiotics, cefotaxime resistance was 96.1% (220 isolates), meropenem resistance was 92.4% (353 isolates), and gentamicin resistance was 77.7% (356 isolates). Additionally, sulfamethoxazole resistance was 46.1% (176 out of 360 isolates, 95% CI: 23.5%–70.4%), displaying significant heterogeneity. Conclusion This study highlights the widespread antibiotic resistance in Elizabethkingia, underscoring the urgent need for targeted treatment strategies and enhanced surveillance programs. The findings emphasize the importance of monitoring local resistance patterns to guide clinical decision-making. Future research should focus on elucidating resistance mechanisms and genetic diversity to develop practical therapeutic approaches and mitigate the global health impact of Elizabethkingia infections.

Septin higher-order structure on yeast membranes in vitro

Nature Communications James A. Goodchild, Brandy N. Curtis, Yangang Pan et al. May 30, 2025 DOI: 10.1038/s41467-025-60344-w

Assessing the impacts of inter-basin water transfer projects on ecosystem services in water source areas: Evidence from the Hanjiang River Basin

PLoS ONE Nana Zhuang, Min Wang, Chenyi Shi et al. May 30, 2025 DOI: 10.1371/journal.pone.0323068

Inter-basin water transfer projects (IBWT) are a key strategy for alleviating regional water shortages. However, studies on the long-term effects of such projects on ecosystem services (ESs) in water source areas, as well as their spatiotemporal evolution, remain insufficient. In particular, the specific impacts of the entire project lifecycle (project initiation, dam heightening, project operation, and ecological restoration) on ESs need further exploration. This study focuses on the Middle Route of the South-to-North Water Diversion Project in China, utilizing multi-source datasets (land use and land cover, meteorological data, soil texture, digital elevation models, normalized difference vegetation index, and net primary productivity), applying the biophysical model method to examine the spatiotemporal variations in ESs across the Hanjiang River Basin over the past three decades, and investigates the impact of IBWT on the ESs of water source areas. The findings reveal: (1) During the project initiation phase (2000–2010), vegetation restoration strategies enhanced soil retention by over 60%, demonstrating that simultaneous project-ecological implementation can mitigate habitat degradation risks. (2) The dam heightening phase (2005–2010) drove spatial reconfiguration of water-energy fluxes, leading to declines in water conservation and carbon sequestration in the midstream region, while enhancing flood mitigation and climate regulation in the reservoir area, unveiling the reshaping mechanisms of dam heightening on ESs supply patterns. (3) The operation phase exhibited significant temporal heterogeneity: initial operation (2010–2015) saw a sharp decline in water conservation (>40%) and soil retention (>60%) due to hydrological disturbances, whereas sustained operation (2015–2020) restored water conservation by nearly 70% and soil retention by over 40% through ecological restoration, alongside a net increase of 14.14% in carbon sequestration, confirming the time-lag compensation effects of restoration measures and the dynamic interplay between ecological restoration and project interventions. This research presents empirical evidence supporting the sustainable management and ecological restoration of IBWT, emphasizing the need to balance spatial water allocation with ecological conservation.

Non-trivial stimuli-responsive collective behaviours emerging from microscopic dynamic complexity in supramolecular polymer systems

Nature Communications Martina Crippa, Claudio Perego, Giovanni M. Pavan May 30, 2025 DOI: 10.1038/s41467-025-60150-4

Abstract Supramolecular polymers are composed of monomers that self-assemble non-covalently generating distributions of fibres in continuous exchange-and-communication with each other and the surroundings. Intriguing collective properties may emerge in such molecular-scale complex systems, following mechanisms often difficult to ascertain. Here we show how non-trivial collective behaviours may emerge in dynamical supramolecular polymer systems already at low-complexity levels. We combine minimalistic models, simulations, and advanced statistical analyses investigating how cooperative and non-cooperative supramolecular polymer systems respond to a specific stimulus: i.e., the addition of molecular sequestrators perturbing their equilibrium. Our data show how, while in a non-cooperative system all assemblies populating the system suffer uniformly the perturbation, in a cooperative system the larger/stronger assemblies survive at the expense of the smaller/weaker entities. Collective behaviours typical of larger-scale and more complex (social, economic, etc.) systems may thus emerge even in relatively simple self-assembling systems from the internal (microscopic) dynamic heterogeneity of their ensembles.

Risk of HBV reactivation in HBV/HCV-co-infected HCV-treated patients: A single-center study

PLoS ONE Young Joo Park, Ki Youn Yi, Hyun Young Woo et al. May 30, 2025 DOI: 10.1371/journal.pone.0324019

Hepatitis B virus (HBV) reactivation in patients with HBV/hepatitis C virus (HCV) co-infection due to direct-acting antiviral agent (DAA) therapy is a growing concern. This study focused on 47 patients with chronic hepatitis C (CHC) and positivity for HBV surface antigen (HBsAg) who were treated with interferon (IFN)-based therapy, DAA, or DAA after IFN-based therapy failure and followed for a median of 53 months. Here, we aimed to determine HBV reactivation rates and associated factors, the incidence of HBV and liver-related events, and the rate of sustained virologic response (SVR) for HCV. Fifteen (15/47, 31.9%) patients experienced HBV reactivation during or after HCV treatment. This reactivation occurred significantly more frequently in patients who received DAA treatment after IFN-based treatment failure than in those who received IFN-based treatment (IFN-based vs. DAA vs. DAA treatment after IFN-based treatment failure 11.8% vs. 35.3% vs. 53.8%, respectively; p = 0.046). The interval from HCV treatment initiation to HBV reactivation was shortest in the DAA group (4.2 months), followed by the DAA after IFN-based treatment failure group (6.4 months) and the IFN-based treatment group (44.5 months) (p < 0.001). One case of HBV-related hepatitis spontaneously resolved after 4 weeks. The rate of SVR for the entire cohort was 87.2%, with no significant difference in this regard among the IFN-based treated, DAA-treated, and DAA-treated after IFN-based treatment failure arms at 82.4%, 88.2%, and 92.3%, respectively. HBV reactivation in HBsAg-positive CHC patients is more common and occurs earlier in those who receive DAA treatment after IFN-based treatment failure than in those with IFN-based treatment. Therefore, all patients with CHC should be tested for HBV exposure prior to DAA treatment. In addition, HBsAg positive patients, especially those among whom have previously experienced IFN-based treatment failure, should be closely monitored for HBV reactivation during DAA therapy.