Comparison of depressive symptoms among emergency physicians and the general population in China: a cross-sectional study based on national data.

BACKGROUND: While physicians are considered to be more susceptible to developing depressive symptoms, empirical data are lacking. The study aims to compare the risk of depressive symptoms between emergency physicians and the general population in China based on national data. METHODS: This was a national cross-sectional study. 10 457 emergency physicians and 101 120 participants from the general population were investigated from July 2018 to August 2018 and January 2019 to February 2019, respectively. PHQ-9 was used to measure depressive symptoms, and a score ≥ 10 indicates major depression. Propensity score matching was adopted to balance the characteristics between emergency physicians and the general population. Multinomial logistic regression model was used to examine the association between occupational groups and the severity of depressive symptoms. Binary logistic regression model was performed to explore the risk factors of major depression among emergency physicians. RESULTS: The prevalence of major depression among emergency physicians was 35.7%, whereas among the general population was 13.9%. Emergency physicians had a 3.65 times higher risk of major depression than the general population. And emergency physician was significantly associated with mild (OR: 3.12, 95% CI 2.95-3.30), moderate (OR: 4.94, 95% CI 4.60-5.30), moderately severe (OR: 9.48, 95% CI 8.61-10.44), and severe depressive symptoms (OR: 14.18, 95% CI 12.47-16.13) compared with none depressive symptoms. Even after matching, the results remained consistent. Factors associated with major depression among emergency physicians included bachelor degree or above (OR: 1.22, 95% CI 1.06-1.40), worked long years (OR: 1.26, 95% CI 1.08-1.46 for 1-5 years; OR: 1.56, 95% CI 1.32-1.84 for ≥ 6 years), experienced workplace violence (OR: 2.51, 95% CI 2.16-2.94), worked more night shifts per month (OR: 1.33, 95% CI 1.16-1.51 for 6-10 times; OR: 1.83, 95% CI 1.58-2.11 for ≥ 11 times), smoked (OR: 1.64, 95% CI 1.47-1.84), and effort-reward imbalance (OR: 4.18, 95% CI 3.62-4.85). CONCLUSIONS: Emergency physicians had a higher risk of depressive symptoms than the general population. There is a need for greater awareness of the mental health issues faced by emergency physicians.

Is self-medication with antibiotics among the public a global concern: a mixed-methods systematic review.

BACKGROUND: Irrational use of antibiotics is a major driver of antimicrobial resistance. Self-medication with antibiotics (SMA) may exacerbate antimicrobial resistance in the community without professional diagnosis by physicians, due to the complexity of the pharmacological mechanisms. There is still a lack of assessment of the global prevalence of SMA. We have evaluated the global prevalence of SMA and its associated factors, which could provide more reliable data to support global action. METHODS: We searched PubMed, Embase, Web of Science, and EBSCO CINAHL Plus. Quantitative studies were combined using meta-analysis with random-effects models, and qualitative synthesis was performed using interpretive meta-ethnographic methods. RESULTS: A total of 242 studies were included in this study. The pooled prevalence of SMA was 27.7% (95%CI: 24.9%-30.5%). Quantitative studies indicate that high income level, having family members working in the healthcare system, storing antibiotics at home, and purchasing antibiotics without prescriptions were associated with a greater likelihood of SMA. Qualitative findings revealed the following four factors: individual characteristics, healthcare, pharmacy, and social networks. CONCLUSIONS: The prevalence of global SMA among the public remains high level. Multisectoral and community-based interventions are needed to reduce SMA, including targeted health education, improved access to healthcare, and regulation of antibiotics sales in pharmacies. REGISTRATION: PROSPERO (CRD42023402206).

Association of hemoglobin-to-red blood cell distribution width ratio and bone mineral density in older adults.

BACKGROUND: Hemoglobin-to-Red Cell Distribution Width Ratio (HRR) represents novel prognostic markers for diseases. However, there remains a lack of systematic research into the relationship between HRR and Bone Mineral Density (BMD) or osteoporosis in older adults. METHODS: This study utilized information from the NHANES database, selecting individuals over 50 years of age with complete femoral DXA scans and full blood counts. The relationship between HRR and femoral BMD was investigated using weighted linear models and restricted cubic spline (RCS) models. Moreover, the association between HRR and osteoporosis was further explored using logistic regression models and RCS models, with subgroup analysis conducted to test the robustness of the results. RESULTS: This study included a total of 7,149 participants, and the BMD of the group with higher HRR was significantly greater than that of the group with lower HRR. Weighted linear regression analysis found a linear positive correlation between HRR and femoral BMD. When HRR was converted from a continuous variable to a categorical variable, this relationship remained stable. In addition, multivariate logistic regression analysis showed that for each 1-unit increase in HRR, the prevalence of osteoporosis significantly decreased (OR = 0.25, 95% CI: 0.12-0.51), further confirming the findings of this study. Subgroup analysis showed that this association was not significantly affected by confounding factors across different populations. CONCLUSION: HRR may serve as one of the potential indicators for evaluating BMD and assessing the prevalence of osteoporosis in the elderly. Elevating HRR levels may play a crucial role in the prevention and slowing of osteoporosis progression.

Characterization of NLRP3 inflammasome components in the endangered Chinese giant salamander (Andrias davidianus).

Chinese giant salamander (Andrias davidianus) is the largest extant urodela species and has unique evolutionary position. Studying the immune system of Chinese giant salamander contributes to understanding the evolution of immune systems of vertebrates. The NLR-related protein 3 (NLRP3) inflammasome comprised of NLRP3, ASC and caspase-1 play important roles in the host innate immunity. However, little is know about the NLRP3 inflammasome components in Chinese giant salamander. In this study, the NLRP3, apoptosis-associated speck-like protein (ASC) and caspase-1 (adaNLRP3, adaASC and adaCaspase-1) were characterized from Chinese giant salamander. The proteins of these three genes shared similar motifs and structures with their mammalian counterparts, with a PYD motif, a nucleotide-binding domain (NACHT) motif, and four leucine-rich repeat domain (LRR) motifs identified in adaNLRP3, a pyrin domain (PYD) motif and a caspase recruitment domain (CARD) motif in adaASC, and a CARD motif and a CASc motif in adaCaspase-1. These three genes were constitutively expressed in the skin, heart, lung, kidney, muscle, brain, spleen, and liver of Chinese giant salamander. Following Aeromonas hydrophia infection, all the three genes were up-regulated in various tissues. Molecular docking analysis revealed that the key residues involved in forming the adaNLRP3/adaASC complex were located in the PYD motifs, and that involved in forming the adaASC/adaCaspase-1 complex were located in the CARD motifs. Further analysis revealed that the hydrogen bonds and salt bridges had crucial roles in the formation of adaNLRP3/acaASC and adaASC/adaCaspase-1 complexes. To the best of our knowledge, this is the first report on the NLRP3 inflammasome components in Chinese giant salamander which will be helpful in further understanding the function of the NLRP3 inflammasome and in elucidating its role in the immune response to microbes.

Radiotherapy with Targeted Therapy or Immune Checkpoint Inhibitors for Hepatocellular Carcinoma with Hepatic Vein and/or Inferior Vena Cava Tumor Thrombi.

Purpose: This study evaluated the clinical outcomes of patients with hepatocellular carcinoma (HCC) with hepatic vein tumor thrombus (HVTT) and/or inferior vena cava tumor thrombus (IVCTT) receiving radiotherapy (RT) combined with systemic therapies. Patients and Methods: Patients with HCC with HVTT and/or IVCTT who received RT were identified at our institution. The prescription doses were 30-65 Gy for planning target volume and 40-65 Gy for the gross tumor volume. Targeted therapy and immune checkpoint inhibitors were used concurrently if patients were at a high risk of or already had distant metastasis. After RT completion, follow-up was performed at 1, 3, 6, and 12 months, and 3 to 6 months thereafter. The objective response rate (ORR), overall survival (OS), progression-free survival (PFS) and toxicity were recorded. Results: Thirty-four patients were retrospectively enrolled between January 2016 and September 2021. Most patients received concurrent targeted therapy (70.6%) and/or post-RT (79.4%). The in-field ORR and disease control rates were 79.4% and 97.1%, respectively. The OS rates were 77.6% at 1 year and 36.3% at 2 years (median OS, 15.8 months). The median PFS and median in-field PFS were 4.2 months and not reached, respectively. The PFS and in-field PFS rates were 24.6% and 79.2% at 1 year, 19.7% and 72.0% at 2 years, respectively. An alpha-fetoprotein level >1000 ng/mL was a significant prognostic factor for worse OS (HR, 5.674; 95% CI, 1.588-20.276; p=0.008); in-field complete/partial response was a significant prognostic factor for better OS (HR, 0.116; 95% CI, 0.027-0.499; p=0.004). The most common site of first failure was the lungs (13/34 patients, 38.2%), followed by the liver (7/34 patients, 20.6%). No patients developed radiation-induced liver disease or pulmonary embolism during follow-up. Conclusion: Combining RT and systemic therapy was safe and effective in treating patients with HCC with HVTT and IVCTT.

Long-term outcome of adjuvant radiotherapy upon postoperative relapse of centrally located hepatocellular carcinoma: a real-world study.

Despite that surgical resection is widely regarded as the most effective approach to the treatment of liver cancer, its safety and efficacy upon centrally located hepatocellular carcinoma (HCC) remain unsatisfactory. In consequence, seeking an integrated treatment, like combined with adjuvant radiotherapy, to enhance the prognosis of patients is of critical importance. By recruiting patients undergoing surgical resection for centrally located HCC ranging from June 2015 to 2020, they were divided into liver resection combined with adjuvant radiotherapy (LR + RT) and mere liver resection (LR) groups. The calculation of propensity score and model of Cox proportional hazards regression were utilized. 193 patients were recruited in aggregation, containing 88 ones undergoing LR + RT, while 105 handled with LR. RT was verified to be an independent factor of prognosis for relapse (HR 0.60). In propensity-score analyses, significant association existed between adjuvant radiotherapy and better disease-free survival (DFS) (Matched, HR 0.60; Adjustment of propensity score, HR 0.60; Inverse probability weighting, HR 0.63). The difference of DFS was apparent within two groups (p value = 0.022), and RT significantly down-regulated early relapse (p value < 0.05) in subgroup analysis. The calculation of E-value revealed robustness of unmeasured confounding. The combination of liver surgical resection with RT is safe and effective towards patients with centrally located HCC, which would notably enhance the prognosis and decrease the early relapse of HCC.

[Hydrochemical Characteristics and Its Origin of Surface Water and Groundwater in Dianbu River Basin].

Chaohu lake is a key water body for water pollution prevention and treatment in our country. However， it has been at a higher eutrophication level recently. Here， the surface water and groundwater in the Dianbu River Basin， a secondary tributary of Chaohu Lake， were taken as the research object. In order to test the hydrochemical composition and hydrogen and oxygen isotope values of different water bodies， 30 groups of surface water samples， 36 groups of groundwater samples， 16 groups of hydrogen and oxygen stable isotope samples， and 18 groups of groundwater hydrogen and oxygen stable isotope samples were collected in August 2021 （wet season）， November 2021 （normal season）， and February 2022 （dry season）. The seasonal and spatial variation characteristics were analyzed to explore the hydrochemical characteristics and formation mechanism of water bodies by means of mathematical statistics， Piper triangular diagram， Gibbs figures， and ion ratios. The following results were obtained： ① precipitation was the main source of surface water and groundwater in Dianbu River Basin， and the evaporation fractionation effect of surface water was more significant than that of groundwater. At different periods， the surface water was more enriched with stable isotopes of hydrogen and oxygen than groundwater. The stable isotopes of hydrogen and oxygen in water showed seasonal variation， relative enrichment in the wet season， and depletion in the dry season. ② Both surface water and groundwater in the Dianbu River Basin were weakly alkaline， and the concentration of ions in surface water was significantly lower than that in groundwater. Ca2+ and Na+ were the main cations in surface water， Ca2+ was the main cation in groundwater， and the dominant anion in all water was HCO3-. The hydrochemical typology of surface water was mainly HCO3·Cl-Na·Ca， and that of groundwater was mainly HCO3-Na·Ca. ③ The concentrations of the main hydrochemical indexes of surface water and groundwater showed certain seasonal and spatial differences. From the wet season to the dry season， the concentrations of TDS， K+， Na+， Ca2+， Mg2+， Cl-， and SO42- in surface water showed an increasing trend on the whole. The concentrations of Na+， Ca2+， and Mg2+ in groundwater showed little change but increased slightly， whereas the concentrations of Cl-， SO42-， and NO3- showed an increasing trend on the whole. The concentrations of Cl-， SO42-， and NO3- in the water showed relatively large seasonal fluctuations. From upstream to downstream， the concentrations of the main hydrochemical indexes in surface water first decreased and then increased， among which the concentration of NO3- increased the most. The concentrations of the main hydrochemical indexes of groundwater in the direction of runoff changed little overall， but the concentration in the discharge area was higher than that in the recharge area. ④ The formation of hydrochemical characteristics of the water was mainly controlled by water-rock interaction but was also influenced by human factors. The water-rock action was mainly the weathering dissolution of silicate rock， salt rock， and carbonate rock. Man-made pollutants such as sewage from a sewage treatment plant， domestic sewage， and feces had obviously changed the hydrochemical characteristics of the local water. ⑤ Compared with that in 2016， the concentration of NO3- in surface water showed a certain degree of reduction. The nitrogen pollution control work carried out by the local government had achieved certain results， but it was still necessary to strengthen the pollution prevention and control of sewage and feces in the downstream of the Dianbu River， some tributaries （such as the Dingguang River and Maqiao River）， and some residential areas.

Prevalence of self-medication with antibiotics and its related factors among the general public and health professionals during the COVID-19 pandemic: A cross-sectional study in China.

BACKGROUND: Self-medication with antibiotics (SMA) is a common public health concern. This study aimed to assess the prevalence of SMA in the general public and health professionals during the COVID-19 pandemic and identify the associated factors. METHODS: A cross-sectional study was conducted from October 28, 2022, to November 6, 2022. Logistics regression analysis was used to examine the associated factors. RESULTS: The rate of SMA was 10.25% in the general public and 12.69% in health professionals. For the public, those who perceived themselves as average or good health, had moderate antibiotic knowledge, and had easy access to nearby health facilities were less likely to SMA; while those who live in rural areas, found it easy to purchase antibiotics without prescriptions, and those who frequently encountered antibiotics recommended by pharmacy staff were more likely to SMA. For health professionals, those who were female, perceived themselves as good health, had moderate or high antibiotic knowledge, and had easy access to health facilities were less likely to SMA; while those who found it easy to purchase antibiotics without prescriptions were more likely to SMA. CONCLUSIONS: SMA is prevalent in both the general public and health professionals. Promoting the rational use of antibiotics requires joint participation and effort.

HBV integrations reshaping genomic structures promote hepatocellular carcinoma.

OBJECTIVE: Hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC), mostly characterised by HBV integrations, is prevalent worldwide. Previous HBV studies mainly focused on a few hotspot integrations. However, the oncogenic role of the other HBV integrations remains unclear. This study aimed to elucidate HBV integration-induced tumourigenesis further. DESIGN: Here, we illuminated the genomic structures encompassing HBV integrations in 124 HCCs across ages using whole genome sequencing and Nanopore long reads. We classified a repertoire of integration patterns featured by complex genomic rearrangement. We also conducted a clustered regularly interspaced short palindromic repeat (CRISPR)-based gain-of-function genetic screen in mouse hepatocytes. We individually activated each candidate gene in the mouse model to uncover HBV integration-mediated oncogenic aberration that elicits tumourigenesis in mice. RESULTS: These HBV-mediated rearrangements are significantly enriched in a bridge-fusion-bridge pattern and interchromosomal translocations, and frequently led to a wide range of aberrations including driver copy number variations in chr 4q, 5p (TERT), 6q, 8p, 16q, 9p (CDKN2A/B), 17p (TP53) and 13q (RB1), and particularly, ultra-early amplifications in chr8q. Integrated HBV frequently contains complex structures correlated with the translocation distance. Paired breakpoints within each integration event usually exhibit different microhomology, likely mediated by different DNA repair mechanisms. HBV-mediated rearrangements significantly correlated with young age, higher HBV DNA level and TP53 mutations but were less prevalent in the patients subjected to prior antiviral therapies. Finally, we recapitulated the TONSL and TMEM65 amplification in chr8q led by HBV integration using CRISPR/Cas9 editing and demonstrated their tumourigenic potentials. CONCLUSION: HBV integrations extensively reshape genomic structures and promote hepatocarcinogenesis (graphical abstract), which may occur early in a patient's life.

Postoperative radiotherapy following null-margin hepatectomy in patients with hepatocellular carcinoma adhering to the major vessels: A propensity score-matched survival analysis cohort study.

Background & Aims: This study aims to analyze the prognosis of null-margin (≤1.0 mm) hepatectomy (NH) in patients with hepatocellular carcinoma (HCC) adhering to the major vessels and explore the value of postoperative radiotherapy (RT) in these patients. Methods: HCC patients who underwent null-margin or wide-margin (≥1.0 cm) hepatectomy (WH) by our team from January 2008 to March 2016 were recruited and analyzed retrospectively. The patients were divided into the NH, NH + RT, and WH groups. Propensity score matching (PSM) was performed to balance baseline characteristics. Results: A total of 357 patients were recruited. Of these, 84, 49, and 224 patients were given NH alone, NH plus RT, and WH, respectively. After PSM, the 5-year overall survival (OS) and disease-free survival (DFS) rates of the NH group were significantly worse than those of the WH group (51.5 % vs. 71.4 %, P = 0.003; 32.2 % vs. 50.9 %, P = 0.005). The OS and DFS rates of the NH + RT group were significantly higher than those of the NH group (75.6 % vs. 56.1 %, P = 0.012; 46.6 % vs. 30.2 %, P = 0.015) and similar to those of the WH group (75.6 % vs. 75.1 %, P = 0.354; 46.6 % vs. 56.6 %, P = 0.717). In addition, patients in the NH + RT group experienced significantly lower early (P = 0.023) and intrahepatic (P = 0.015) recurrences than those in the NH group. Conclusions: Patients with HCC adhering to the major vessels who underwent NH alone had a poorer prognosis, and the addition of RT to NH provide a significant survival benefit for these patients, which may yield outcomes comparable to the efficacy of WH.

Prevalence of occupational injury and its associated factors among emergency department physicians in China: A large sample, cross-sectional study.

BACKGROUND: Medical personnel, particularly emergency department (ED) physicians, face a variety of occupational hazards. However, the current state of occupational injuries among ED physicians remains unknown. This study aimed to assess the occupational injury of Chinese ED physicians and to identify its associated factors. METHODS: From July to August 2018, a cross-sectional survey was conducted in Chinese emergency departments. A structured questionnaire covering sociodemographic characteristics, individual health behaviours, and work-related characteristics was completed by 10,457 ED physicians. Binary logistic regression was used to analyse the factors associated with occupational injuries. RESULTS: In this study, 81.13% of ED physicians reported occupational injuries in the previous 12 months. All participants who had experienced occupational injuries had suffered verbal violence. Among physicians who experienced at least one injury, 76.57% and 71.30% reported injuries sustained while moving patients and from falls, slips, and sprains during office visits, respectively. Occupational injuries were significantly associated with gender, education level, drinking behaviour, sleep quality, the frequency of night shifts per month, self-perceived physician shortage, and work-family conflict. Physicians who experienced effort-reward imbalance were at a higher risk of occupational injury. CONCLUSION: In China, occupational injuries are common among ED physicians. Individual factors as well as work-related factors are independently linked to occupational injuries. To reduce the rate of occupational injuries among ED physicians, health policymakers and healthcare facility managers should consider multi-injury interventions.

Long-term outcome of centrally located hepatocellular carcinoma treated by neoadjuvant radiotherapy and radical resection: a propensity score matched study.

Objective: Centrally located hepatocellular carcinoma (HCC) typically presents challenges in surgical intervention and is associated with a bleak prognosis. In order to address this pressing issue, it is imperative to identify a comprehensive treatment approach, such as neoadjuvant radiotherapy (neoRT), that can enhance the prognosis of patients diagnosed with centrally located HCC. Methods: Patients who had surgical resections for HCC between March 2015 and December 2020 were included in the study. Patients were assigned to either the neoRT combined with liver resection (neoRT+LR) group or the liver resection alone (LR) group. The study employed propensity-score analysis and Cox proportional-hazards regression models as research methodologies. Using the Kaplan-Meier method, overall survival (OS) and disease-free survival (DFS) were estimated in patients. Results: During the study, 162 patients were enrolled, with 41 receiving neoRT+LR and 121 receiving LR. The duration of the median follow-up period was 45 months. The 1-year, 3-year, and 5-year OS rates were 95, 70, and 70% for patients in the neoRT+LR group, and 82, 64, and 54% for patients in the LR group, respectively. The 1-year, 3-year, 5-year DFS rates were 71, 53, and 37% for patients in the neoRT+LR group, and 52, 38, and 34% for patients in the LR group, respectively. A successful matching of 37 patients was achieved through propensity-score analysis. OS and DFS after matching analysis was statistically different between the two groups ( P=0.0099, P=0.034, respectively). neoRT was an independent prognostic factor for OS and DFS [hazard ratio (HR)=0.47, 95% CI: 0.24-0.93; HR=0.56, 95% CI: 0.34-0.92, respectively]. According to matching analysis, there were no statistically significant differences observed in terms of baseline characteristics, surgical safety, and complications between the groups. Conclusion: Liver resection and neoRT can be advantageous for patients with centrally located HCC.

Clinical benefits of intraoperative radiotherapy for the recurrence of centrally located hepatocellular carcinoma with microvascular invasion.

BACKGROUND: Although the efficacy and safety of intraoperative radiotherapy (IORT) in the treatment of malignant tumours, such as breast cancer, have been documented, it remains unclear whether this treatment is effective for centrally located hepatocellular carcinoma (HCC) with microvascular invasion (MVI). AIMS: This study aimed to explore the efficacy and safety of IORT in the treatment of centrally located HCC with MVI. METHODS AND RESULTS: Patients with centrally located HCC, who underwent surgery between January 2016 and January 2020, were enrolled. The patient cohort was then allocated to two groups: those who underwent IORT combined with liver resection (IORT+LR); or LR alone (LR). Propensity score matching and Cox proportional hazards regression analyses were performed. The Kaplan-Meier method was used to estimate recurrence-free survival (RFS), and the log-rank test was used to determine whether RFS differed between the groups. Subgroup analysis was performed to evaluate differences in RFS and early recurrence rates in patients with different MVI grades. E-values were generated to measure the sensitivity to unmeasured confounding factors. In total, 97 patients were enrolled, 27 of whom underwent IORT+LR and 70 underwent LR alone. The 1-, 3-, and 5-year RFS rates in the IORT+LR group were 66%, 50%, and 32%, respectively, whereas those in the LR group were 54%, 37%, and 26%, respectively. After matching analysis, 23 patients were successfully matched, and RFS was found to be significantly different between the two groups (p = .04). IORT was an independent prognostic factor for RFS (hazard ratio 0.46 [95% confidence interval 0.21-0.99]). In subgroup analysis, RFS between the IORT+LR and LR groups was significantly different in patients with MVI (M1 grade) (p = .0067). The postoperative early recurrence rate was significantly reduced with IORT (p < .05). No serious complications were reported in either group following surgery. Based on E-values, the results appeared to be robust against unmeasured confounding factors. CONCLUSION: IORT+LR provided safe, feasible treatment for patients with centrally located HCC with MVI, along with an improvement in prognosis and lower early recurrence rates.

Prevalence and associated factors for depressive symptoms among the general population from 31 provinces in China: The utility of social determinants of health theory.

BACKGROUND: Depression is one of the most common types of mental disorders. Guided by the theory of social determinants of health (SDH), the study aimed to assess the prevalence of depressive symptoms and to identify factors related to depressive symptoms in the general population of China. METHODS: A cross-sectional, online survey was conducted among 101,392 residents from 31 provinces of mainland China from January to March 2019, and 97,126 survey responses were included in the final analysis. Multilevel linear regression models were used to identify SDH associated with depressive symptoms. RESULTS: The prevalence of depressive symptoms (PHQ-9 scores ≥10) in Chinese residents was 15.81 %. The results of the multilevel analysis demonstrated that depressive symptoms were affected by various factors on five levels, including individual characteristics, behavioral lifestyle, community support network, social structural factors, and macro social factors. LIMITATIONS: The cross-sectional design of the study makes it difficult to establish causality between variables. CONCLUSIONS: The prevalence of depressive symptoms is high among general population in China. According to the theory of SDH, the study shows that the depressive symptoms are complex and involves all areas of social life. Therefore, adopting a multi-level, cross-sectoral intervention approach will be instrumental to improving the mental health of residents in China.

Noninvasive urinary protein signatures combined clinical information associated with microvascular invasion risk in HCC patients.

BACKGROUND: Microvascular invasion (MVI) is the main factor affecting the prognosis of patients with hepatocellular carcinoma (HCC). The aim of this study was to identify accurate diagnostic biomarkers from urinary protein signatures for preoperative prediction. METHODS: We conducted label-free quantitative proteomic studies on urine samples of 91 HCC patients and 22 healthy controls. We identified candidate biomarkers capable of predicting MVI status and combined them with patient clinical information to perform a preoperative nomogram for predicting MVI status in the training cohort. Then, the nomogram was validated in the testing cohort (n = 23). Expression levels of biomarkers were further confirmed by enzyme-linked immunosorbent assay (ELISA) in an independent validation HCC cohort (n = 57). RESULTS: Urinary proteomic features of healthy controls are mainly characterized by active metabolic processes. Cell adhesion and cell proliferation-related pathways were highly defined in the HCC group, such as extracellular matrix organization, cell-cell adhesion, and cell-cell junction organization, which confirms the malignant phenotype of HCC patients. Based on the expression levels of four proteins: CETP, HGFL, L1CAM, and LAIR2, combined with tumor diameter, serum AFP, and GGT concentrations to establish a preoperative MVI status prediction model for HCC patients. The nomogram achieved good concordance indexes of 0.809 and 0.783 in predicting MVI in the training and testing cohorts. CONCLUSIONS: The four-protein-related nomogram in urine samples is a promising preoperative prediction model for the MVI status of HCC patients. Using the model, the risk for an individual patient to harbor MVI can be determined.

Prevalence and related factors of non-adherence to antibiotics among the general public: a cross-sectional study in China.

OBJECTIVES: This study aims to assess the prevalence and associated factors of non-adherence to antibiotics (NAA) during COVID-19. METHODS: A cross-sectional study was conducted from 28 October 2022 to 6 November 2022. A structured questionnaire was widely distributed on an online survey platform. Of the 8664 respondents, 7730 were included in the final analysis. Logistic regression analysis was used to examine the associated factors of NAA. RESULTS: Of the 7730 participants, 17.83% reported antibiotic use in the past month, of which 53.05% had NAA. Those who aged over 60 years old, perceived their economy as good, had moderate or good antibiotic knowledge, and with high convenience to medical services and medicines were less likely to NAA (p < 0.05); while those with chronic diseases, living in Western or Northeastern China, and those who used non-prescription antibiotics were more likely to NAA (p < 0.05). CONCLUSION: The prevalence of NAA remains at high levels in the general public. Targeted health education needs to be conducted in communities, pharmacies and health facilities to overcome misconceptions about antibiotics and to encourage people to seek formal medical care when ill, in order to improve public adherence to antibiotics.

High spindle and kinetochore-associated complex subunit-3 expression predicts poor prognosis and correlates with adverse immune infiltration in hepatocellular carcinoma.

BACKGROUND: Spindle and kinetochore-associated complex subunit 3 (SKA3) is a malignancy-associated gene that plays a critical role in the regulation of chromosome separation and cell division. However, the molecular mechanism through which SKA3 regulates tumor cell proliferation in hepatocellular carcinoma (HCC) has not been fully elucidated. AIM: To investigate the molecular mechanisms underlying the role of SKA3 in HCC. METHODS: SKA3 expression, clinicopathological, and survival analyses were performed using multiple public database platforms, and the results were verified by Western blot and immunohistochemistry staining using collected clinical samples. Functional enrichment analyses were performed to evaluate the biological functions and molecular mechanisms of SKA3 in HCC. Furthermore, the Tumor Immune Estimation Resource and single-sample Gene Set Enrichment Analysis (ssGSEA) algorithms were utilized to investigate the abundance of tumor-infiltrating immune cells in HCC. The response to chemotherapeutic drugs was evaluated by the R package "pRRophetic". RESULTS: We found that upregulated SKA3 expression was significantly correlated with poor prognosis in patients with HCC. Multivariable Cox regression analysis indicated that SKA3 was an independent risk factor for survival. GSEA revealed that SKA3 expression may facilitate proliferation and migratory processes by regulating the cell cycle and DNA repair. Moreover, patients with high SKA3 expression had significantly decreased ratios of CD8+ T cells, natural killer cells, and dendritic cells. Drug sensitivity analysis showed that the high SKA3 group was more sensitive to sorafenib, sunitinib, paclitaxel, doxorubicin, gemcitabine, and vx-680. CONCLUSION: High SKA3 expression led to poor prognosis in patients with HCC by enhancing HCC proliferation and repressing immune cell infiltration surrounding HCC. SKA3 may be used as a biomarker for poor prognosis and as a therapeutic target in HCC.

Prevalence of sleep disturbances and associated factors among Chinese residents: A web-based empirical survey of 2019.

Background: To identify the prevalence of sleep disorders in China through a large sample study. To explore the relevant social determinants affecting residents' sleep status at both individual and provincial levels based on the theoretical framework of the Dahlgren-Whitehead model. Methods: A nationwide cross-sectional web-based survey was conducted from January 20 to February 28, 2019 across 31 provinces of China. The Pittsburgh Sleep Quality Index was used to evaluate residents' sleep quality. Multilevel linear regression analysis was used to analyse the influencing factors of sleep disorder. Results: A sample of 107 650 residents completed the survey, and 94 454 questionnaires were included in the final analysis. The crude incidence rate and the age-adjusted rate of sleep disorder in Chinese residents were 19.16% and 21.25%, respectively. Those who were older, female, smokers, drinkers, married, divorced, or widowed, retired, more educated (regression coefficient (b) = 0.172, P < 0.05), had worse self-perceived economic status, and lived far away from community health services (b = 0.758, P < 0.05) were more likely to have sleep problems. Physical exercise, social support (b = -1.705, P < 0.05), and greening coverage of residential areas (b = -1.769, P < 0.05) were protective factors for residents' sleep quality. Conclusions: Sleep disorders are prevalent in the Chinese population, with varying incidence rates across provinces. To improve sleep quality, the Chinese government and health management departments should pay more attention to vulnerable groups and promote healthy lifestyles through education. Additionally, the social network can be utilized to provide social support. Improving the ecological environment and daily living environment is also essential.

The safety and efficacy of remimazolam tosylate combined with propofol in upper gastrointestinal endoscopy: A multicenter, randomized clinical trial.

INTRODUCTION: Hypotension is the most common adverse event under propofol-mediated sedation and is possible to cause varying degrees of damage to patients. Whereas remimazolam has a poorer sedative effect than propofol. AIM: The aim of this study was to explore the advantages of the combination of remimazolam tosylate and propofol. METHODS: 304 patients were divided into the remimazolam tosylate group (RT group), the propofol group (P group), and the remimazolam tosylate plus propofol group(R+T group). The primary outcome was the incidence of hypotension. Secondary outcomes included the results of sedation and recovery. The safety results mainly include the incidence of Hypotension, adverse respiratory events, postoperative nausea and vomiting, hiccup, cough, body movement and bradycardia. RESULTS: The incidence of hypotension was 56.7% in the P group, 12.6% in the RT group, and 31.3% in the R+P group, three groups of pairwise comparisons showed statistical differences, with P< 0.001. The incidence of body movement was significantly higher in the RT group (26.1%) than in the P group (10.3%) and the R+P group (12.5%), P = 0.004. The endoscopist satisfaction was higher in the P (3.87±0.44) and R+P (3.95±0.22)groups than in the RT(3.53±0.84) group. The incidence of adverse events, in descending order, was P group, RT group, and R+P group (93.8%vs.61.3%vs.42.7%). CONCLUSION: Co-administration had fewer adverse events than propofol monotherapy, also had a better sedative effect and higher endoscopist satisfaction than remimazolam monotherapy. TRIAL REGISTRATION: Clinical trial registration number: NCT05429086.

Tumor-derived proliferative CTCs and CTC clusters predict aggressiveness and early recurrence in hepatocellular carcinoma patients.

BACKGROUND: Circulating tumor cells (CTCs), an indispensable liquid biopsy classifier, can provide extra information for the diagnosis and prognosis of hepatocellular carcinoma (HCC). METHODS: We systematically analyzed the peripheral blood of preoperative HCC patients (n = 270) for CTC number, Ki67 index reflecting the proliferative CTC percentage (PCP), and CTC clusters correlated with the characteristics of malignant HCC tumors. RESULTS: Driver gene mutations were found with high levels of consistency between CTCs and primary tumors (n = 73). CTC number and PCP were associated with tumor size, microvascular invasion (MVI), presence or absence of multiple tumors, and thrombosis significantly. CTC number and PCP robustly separated patients with and without relapse, with a sensitivity of 88.89%/81.48% and a specificity of 72.73%/94.81% in the training set (n = 104) and corresponding values of 80.00%/86.67% and 78.38%/89.19% in the validation set (n = 52), showing a better performance than that associated with the alpha-fetoprotein (AFP) level. CTC number, PCP, CTC clusters, and MVI were independent significant risk factors for HCC recurrence (P = 0.0375, P < 0.0001, P = 0.0017, and P = 0.0157). A nomogram model based on these risk factors showed a considerable prediction ability for HCC recurrence (area under the curve = 0.947). PCP (training: log-rank P < 0.0001; hazard ratio [HR] 30.13, 95% confidence interval [CI] = 11.12-81.62; validation: log-rank P < 0.0001; HR 25.73, 95% CI = 5.28-106.60) and CTC clusters (training: log-rank P < 0.0001; HR 17.34, 95% CI = 7.46-40.30; validation: log-rank P < 0.0001; HR 9.92, 95% CI = 2.55-38.58) were more significantly correlated with worse recurrence-free survival than CTC number (training: log-rank P < 0.0001; HR 14.93, 95% CI = 4.48-49.78; validation: log-rank P = 0.0007; HR 9.03, 95% CI = 2.53-32.24). CONCLUSION: PCP and CTC clusters may predict HCC recurrence and improve the performance of the serum biomarker AFP.