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Skin biomechanical parameters (dynamic stiffness, frequency, relaxation time, creep, and decrement) measured using a myotonometer (MyotonPRO) could inform the management of sclerotic disease. To determine which biomechanical parameter(s) can accurately differentiate patients with sclerotic chronic graft-versus-host disease from post–hematopoietic cell transplant controls, 15 patients with sclerotic chronic graft-versus-host disease and 11 post–hematopoietic cell transplant controls were measured with the myotonometer on 18 anatomic sites. Logistic regression and two machine learning algorithms (least absolute shrinkage and selection operator regression and random forest) were developed to classify subjects. In univariable analysis, frequency had the highest overfit-corrected area under the curve (0.91). Backward stepwise selection and random forest machine learning identified frequency and relaxation time as the optimal parameters for differentiating patients with sclerotic chronic graft-versus-host disease from post–hematopoietic cell transplant controls. Least absolute shrinkage and selection operator regression selected the combination of frequency and relaxation time (overfit-corrected area under the curve = 0.87). Discriminatory ability was maintained when only the sites accessible while the patient is supine (12 sites) were used. We report the distribution of values for these highly discriminative biomechanical parameters, which could inform the assessment of disease severity in future quantitative biomechanical studies of sclerotic chronic graft-versus-host disease.

Background: Ontario is 1 of 5 provinces that immunize adolescents for hepatitis B virus (HBV), despite the World Health Organization recommendation for universal birth dose vaccination. One rationale for not vaccinating at birth is that universal prenatal screening and related interventions prevent vertical transmission. The aims of our study were to evaluate the uptake and epidemiology of prenatal HBV screening, and to determine the number of children in Ontario with a diagnosis of HBV before adolescent vaccination., Methods: We extracted data from ICES, Public Health Ontario and Better Outcomes & Registry Network (BORN) Ontario databases. We assessed prenatal screening uptake and prevalence of prenatal hepatitis B surface antigen (HBsAg) from 2012 to 2016, as well as subsequent hepatitis B e-antigen (HBeAg) and HBV DNA testing and percent positivity. We used age and region to subcategorize the results. In a separate unlinked analysis, we evaluated the number of children positive for HBV aged 0-11 years who were born in Ontario from 2003 to 2013., Results: From 2012 to 2016, 93% of pregnant women were screened for HBV, with an HBsAg prevalence of 0.6%. Prevalence of HBsAg increased with age, peaking at older than 45 years at 3%. North Toronto had the highest overall prevalence of 1.5%, whereas northern Ontario had the lowest. Of women who were HBsAg positive, HBeAg and HBV DNA tests were subsequently ordered in 13% and 38%, respectively. Of children born in Ontario between 2003 and 2013, 139 of 23 759 tested positive for HBV., Interpretation: Prenatal HBV screening is not universal and subsequent evaluation is poor, limiting optimal intervention and possibly contributing to some Ontario-born children being given a diagnosis of HBV before age 12 years. These findings underscore the limitations of the province's adolescent vaccination strategy., Competing Interests: Competing interests: Tony Mazzulli reports serving as a speaker, consultant or advisory board member for Merck, Pfizer, Qvella, Microbix, Roche, Verity Pharmaceuticals and Cipher Pharmaceuticals, and receiving research funding from Qvella and bioMérieux. Harry Janssen reports serving as a speaker, consultant or advisory board member for AbbVie, Arbutus, Benitec, Bristol Myers Squibb, Gilead Sciences, Glaxo, Janssen, Medimmune, Merck, Roche and Vir Biotechnology, and receiving research funding from AbbVie, Bristol Myers Squibb, Gilead Sciences, Janssen, Medimmune, Merck and Roche. Jordan Feld reports receiving research support or consulting fees from Abbott, AbbVie, Enanta, Gilead, Janssen, Roche, Arbutus and GlaxoSmithKline. No other competing interests were declared., (© 2020 Joule Inc. or its licensors.)