Advancements in defensive medicine research: Based on current literature.

To investigate and comprehend the evolving research hotspots, cutting-edge trends, and frontiers associated with defensive medicine. The original data was collected from the Web of Science core collection and then subjected to a preliminary retrieval process. Following screening, a total of 654 relevant documents met the criteria and underwent subsequent statistical analysis. Software CiteSpace was employed for conducting a customized visual analysis on the number of articles, keywords, research institutions, and authors associated with defensive medicine. The defensive medicine research network was primarily established in Western countries, particularly the United States, and its findings and conceptual framework have significantly influenced defensive medicine research in other regions. Currently, quantitative methods dominated most studies while qualitative surveys remained limited. Defensive medicine research mainly focused on high-risk medical specialties such as surgery and obstetrics. Research on defensive medicine pertained to the core characteristics of its conceptual framework. An in-depth investigation into the factors that give rise to defensive medicine is required, along with the generation of more generalizable research findings to provide valuable insights for improving and intervening in defensive medicine.

Analysis of factors influencing the job satisfaction of medical staff in tertiary public hospitals, China: A cross-sectional study.

Introduction: Since the outbreak of the novel coronavirus pneumonia (COVID-19), China has entered normalization phase of its epidemic prevention and control measures that emphasizes 'precise prevention and control,' 'dynamic zeroing', and 'universal vaccination'. However, medical staff continue to face physical and mental stress. The present study aimed to investigate the job satisfaction of medical staff in China, as well as any associated factors. Methods: 2,258 medical staff completed a questionnaire specially designed for this study. Independent samples t-tests, one-way analysis of variance, and binary logistic regression were used to analyze associated factors. Results: Overall, 48.4% of the participants expressed satisfaction with their job; the highest-scoring dimension was interpersonal relationships (3.83 ± 0.73), while the lowest scoring dimension was salary and benefits (3.13 ± 0.94). The logistic regression model indicated that job satisfaction among medical staff is associated with being aged 40-49 years [odds ratio (OR) = 2.416] or > 50 years (OR = 2.440), having an above-undergraduate education level (OR = 1.857), holding a position other than doctor [i.e., nurse (OR = 3.696) or 'other' (OR = 2.423)], having a higher income (OR = 1.369), and having fewer monthly overtime shifts (OR = 0.735-0.543). Less than half of the medical staff expressed satisfaction with their job, indicating that the overall level is not high. Discussion: This research enriches the study of medical workers' job satisfaction during periods when epidemic prevention and control has become familiar and routine. To improve medical workers' job satisfaction, administrators should seek to enhance medical staff's remuneration, reduce their work pressure, and meet their needs (where reasonable).

The role of meteorological factors in suicide mortality in Wuhu, a humid city along the Yangtze River in Eastern China.

As the climate continues to change, suicide is becoming more frequent. In this study, absolute humidity (AH) was included for the first time and Wuhu, a typical subtropical city along the Yangtze River, was taken as the research object to explore the impact of suicide death risk on meteorological factors. The daily meteorological factors and suicide mortality data of Wuhu city from 2014 to 2020 were collected. Guided by structural equation model (SEM), a time series analysis method combining distributed lag nonlinear model (DLNM) and generalized additive model (GAM) was adopted. To investigate the correlation among different populations, we stratified age and gender at different meteorological levels. A total of 1259 suicide deaths were collected in Wuhu. The results indicated that exceedingly low and low levels of AH short-term exposure increased suicide mortality, with the maximum effect occurring at lag 14 for both levels of exposure, when the relative risk (RR) was 1.131 (95% CI: 1.030, 1.242) and 1.065 (95% CI: 1.006, 1.127), respectively. Exposure to exceedingly high and exceedingly low levels of temperature mean (T mean) also increased suicide mortality, with maximum RR values of 1.132 (lag 14, 95% CI: 1.015, 1.263) and 1.203 (lag 0, 95% CI: 1.079, 1.340), sequentially. As for diurnal temperature range (DTR), low-level exposure decreased the risk of suicide, while high-level exposure increased this risk, with RR values of 0.955 (lag 0, 95% CI: 0.920, 0.991, minimum) and 1.060 (lag 0, 95% CI: 1.018, 1.104, maximum), sequentially. Stratified analysis showed that AH and DTR increased the suicide death risk in male and elderly people, while the risk effect of T mean have no effect on young people only. In summary, male and elderly people appear to be more vulnerable to adverse weather effects.

The status and influencing factors of adolescents' mental health in a province of China: A cross-sectional study.

OBJECTIVE: To understand the mental health status of adolescents in China and its influencing factors. METHODS: The stratified cluster sampling method was used to evaluate the mental health status of 5633 adolescents using the Symptom Checklist (SCL-90). RESULTS: There were statistically significant differences in the overall mean score of SCL-90 and the mean score of each subscale among adolescents in gender, grade, family, and region. The mean score of the interpersonal sensitivity and phobic anxiety subscales of the adolescents with rural household registration was higher than that of the urban household registration. Except for hostility and phobic anxiety subscales, there was a significant difference between junior high school and senior high school students in the remaining subscales. There were significant differences between only children and non-only children in the obsessive-compulsive symptoms and phobic anxiety subscales. The mean scores of depression, phobic anxiety, and other subscales of left-behind adolescents were significantly different from those of non-left-behind adolescents. Female gender (OR = 1.789), different-grade (junior high school sophomore: OR = 2.201; junior high school third grade: OR = 2.004; high school freshman: OR = 2.279; high school sophomore: OR = 2.947; high school senior: OR = 2.112), different-region (central region: OR = 1.302; southern region: OR = 1.925) and high school (OR = 1.281) adolescents had a higher risk of mental health problems, while those from two-parent families (OR = 0.68) had a lower risk. LIMITATIONS: This study is a cross-sectional study and not widely representative. CONCLUSION: Gender, grade, region, and academic period are risk factors, and a two-parent family is a protective factor for adolescents' mental health.

Clinicopathological and prognostic significance of the long non-coding RNA HOTAIR high expression in head and neck squamous cell carcinoma: a systematic review and meta-analysis.

Background: Long non-coding RNAs (lncRNAs) have been demonstrated to possess critical biological functions that regulate occurrence and progression of tumors. The HOX transcript antisense intergenic RNA (HOTAIR) is one of the most studied lncRNAs. This study was designed to investigate the association of HOTAIR expressions with clinicopathologic features and prognosis in head and neck squamous cell carcinoma (HNSCC). Methods: The PubMed, Web of Science, Embase, Cochrane Library and SCOPUS databases were searched. The studies published before September 10, 2021 were screened. Two authors independently screened the literature and extracted data based on inclusion and exclusion criteria. Meta-analysis, bias assessment, sensitivity analysis and subgroup analysis were performed to improve accuracy and reliability. Results: Seven studies comprising 546 patients were analysed to clarify the relationship between clinicopathologic features and HOTAIR expression, and six studies with 856 patients were applied to evaluate the effects of HOTAIR expressions on the prognosis. After removing those outliers through Galbraith plots and/or sensitivity analysis, the pooled results showed high HOTAIR expressions were associated with high T stage [odds ratio (OR) =2.32, 95% confidence interval (CI): 1.38-3.89, P=0.001], lymphnode metastasis (OR =2.71, 95% CI: 1.57-4.67, P=0.0003), high TNM stage (OR =3.92, 95% CI: 2.28-6.72, P<0.00001), poor histological grade (OR =2.21, 95% CI: 1.02-4.83, P=0.046), poor overall survival (OS) [hazard ratio (HR) =1.74, 95% CI: 1.19-2.56, P=0.005] and poor disease-free survival (DFS) (HR =1.64, 95% CI: 1.09-2.47, P=0.02). Subgroup analyses of T stage, lymphnode metastasis and histological grade identified possible heterogeneity sources, respectively ethnicity, cut-off, and detection methods. Conclusions: These findings suggest HOTAIR might serve as an excellent prognostic biomarker and predictor of clinicopathologic features in HNSCC.

The regulatory mechanism and potential application of IL-23 in autoimmune diseases.

IL-23 is a heterodimeric pro-inflammatory cytokine secreted by dendritic cells and macrophages that belongs to the IL-12 family. It has pro-inflammatory effects and is a key cytokine and upstream regulatory cytokine involved in protective immune responses, stimulating the differentiation and proliferation of downstream effectors such as Th17 cells. It is expressed in various autoimmune diseases such as psoriasis, systemic lupus erythematosus (SLE), rheumatoid arthritis (RA). The IL-23/TH17 axis formed by IL-23 and TH17 has been confirmed to participate in autoimmune diseases pathogenesis. IL-23R is the receptor for IL-23 and plays an activating role. Targeting IL-23 is currently the main strategy for the treatment of various autoimmune diseases. In this review we summarized the mechanism of action and clinical application potential of IL-23 in autoimmune diseases by summarizing the latest research results and reviewing the literature, which would help to further understand IL-23 and provide a theoretical basis for future clinical targeting and drug development.

FOXO3a Alleviates the Inflammation and Oxidative Stress via Regulating TGF-ß and HO-1 in Ankylosing Spondylitis.

This study aimed to investigate whether Forkhead box O3a (FOXO3a) modulates inflammation and oxidative stress in ankylosing spondylitis (AS). We applied bioinformatics analysis, quantitative real-time polymerase chain reaction, immunoblotting, enzyme linked immunosorbent assay, chromatin immunoprecipitation, and dual-luciferase reporter assay. Gene overexpression and knockdown of FOXO3a were conducted via lentivirus and small interfering RNA, respectively. Downregulated FOXO3a expression was first confirmed in AS patients. Interleukin-8 (IL-8) and IL-17A were highly expressed and negatively related with FOXO3a in AS. Total antioxidant capacity (T-AOC) were markedly decreased and positively associated with FOXO3a in AS. Overexpression of FOXO3a inhibited the secretion of inflammatory cytokines and promoted the production of antioxidant enzymes in Jurkat cells. Transforming growth factor-ß (TGF-ß) and heme oxygenase 1 (HO-1), which had binding sites to FOXO3a based on bioinformatics analysis, were abnormally expressed and positively related with FOXO3a. Accordingly, FOXO3a obviously elevated the protein and transcription levels of TGF-ß and HO-1 in Jurkat cells. The above results were verified by silencing FOXO3a. Moreover, FOXO3a directly interacted with and promoted the transcription of TGF-ß and HO-1. In summary, the modulation of cellular inflammation and oxidative stress via FOXO3a-mediated TGF-ß and HO-1 activation is partly involved in the pathogenesis of AS.

DNA Methylation and mRNA Expression of B7-H3 Gene in Ankylosing Spondylitis: A Case-Control Study.

BACKGROUND: Ankylosing spondylitis (AS) is a common inflammatory arthritis, with a high prevalence in patients in their mid-20s. Its pathogenesis is not well understood; however, genetic factors likely play a critical role. Epigenetic DNA changes may be involved in the pathogenesis of AS. In this study, we explored the methylation and transcription levels of the B7-H3 gene and its association with AS in an eastern Chinese Han population. METHODS: Peripheral blood of AS patients and healthy controls was used to extract genomic DNA and B7-H3 methylation levels were analyzed using sodium bisulfite followed by multiplex polymerase chain reaction. SPSS software was used to determine the statistical significance of the results. RESULTS: Hypomethylation of the promoter of the B7-H3 gene was observed in AS patients, whereas the B7-H3 gene expression was significantly enhanced in AS patients. CONCLUSION: Epigenetic modifications of B7-H3 were associated with susceptibility to AS. Hypomethylation of the B7-H3 promoter, which leads to B7-H3 overexpression, may be involved in the pathogenesis of AS.

Relationship between meteorological factors and mortality from respiratory diseases in a subtropical humid region along the Yangtze River in China.

As the health impacts of climate change take on a more serious form, this study for the first time investigates the effect of meteorological factors on the risk of death from respiratory diseases (RD) in Wuhu, a representative city along the Yangtze River in subtropical humid region. Daily meteorological element data and RD deaths in Wuhu City were collected from 2014 to 2020. Time series analysis was conducted using distributed lagged nonlinear model (DLNM) combined with generalized additive model (GAM), and stratified by age and gender. In 7 years, a total of 8016 RD death cases were collected in Wuhu, China. The results demonstrated that the maximum impacts of short-term exposure to exceedingly low temperatures mean (Tmean) were at lag 9, with the maximum relative risk (RR) of 1.044 (lag 1, 95% CI: 1.001, 1.098). The risk of exceedingly high Tmean reached its maximum at lag 0 (RR = 1.070, 95% CI: 1.018, 1.125). Low relative humidity (RH) was negatively associated with the risk of RD death, with the lowest RR values occurring at lag 12 (RR = 0.987, 95% CI: 0.975, 0.999). No significant correlation was found for diurnal temperature range (DTR). Stratified analysis showed that Tmean exposure remained statistically significant for male, female and elderly, while RH and DTR only seemed to increase the mortality risk in the young. In a word, short-term exposure to extreme temperatures may increase the RD mortality risk in the population, and young people needed to be aware that exposure to exceedingly high RH and DTR also increased the risk.

Associations between IL-23R gene polymorphism (rs10889677 A/C) and ankylosing spondylitis and rheumatoid arthritis susceptibility: A meta-analysis with trial sequential analysis.

OBJECTIVES: Autoimmune diseases are a kind of chronic diseases for which the immune system loses tolerance to autoantigens. This meta-analysis' purpose is to determine whether there exists a correlation between IL-23R polymorphism and common autoimmune diseases like ankylosing spondylitis (AS) and rheumatoid arthritis (RA). METHODS: We searched the relevant literatures up to September 2021 and used different effect models for meta-analysis. 95% confidence interval (95% CI) and odds ratio (OR) were used to determine the relationship between rs10889677 (A/C) polymorphism and AS as well as RA. Finally, to promote the reliability of results, the trial sequential analysis (TSA) has also been applied and we searched the data related to autoimmune diseases (AS, RA) on genome-wide association studies (GWAS). RESULTS: Generally, 31 studies were included. Rs10889677 (A/C) was significantly correlated with the susceptibility to AS and RA among the general individuals (p < .05). Moreover, there existed a relevance between allele A and AS as well as RA in Caucasians (p < .05). AA genotype increased the risk of autoimmune diseases in Mongolians. As a result, the robustness of meta-analysis has further been proved by TSA. CONCLUSION: IL-23R (rs10889677 A/C) A allele was a risk gene for AS and RA in the general population, especially in Caucasians. AA genotype increased the risk of AS and RA in Mongolians.

Clinical Evaluation and Therapeutic Effects of Combination Treatment with Mecobalamin + Vitamin E in Recurrent Oral Ulcer.

PURPOSE: Recurrent oral ulcer is one of the most prevalent inflammatory ulcerative disorders of the oral mucosa. Due to the indeterminant cause and unpredictable course of the disease, clinical treatment of patients with recurrent oral ulcer is focused on relieving the pain, shortening the course of the disease, and prolonging the intermission period. Numerous chemical and biologic agents have been characterized as beneficial in the treatment of patients with recurrent oral ulcer, but there is currently no definitive therapy available. This study aimed to investigate the clinical effects and tolerability of combined mecobalamin tablets and vitamin E capsules in the treatment of recurrent oral ulcer. METHODS: A total of 58 patients with recurrent oral ulcer admitted to our hospital were allocated to receive mecobalamin tablets + vitamin E soft capsules (test group) or Fe complex enzyme gargle only (control group) (n = 29 per group). Changes in parameters such as pain level, as measured on a 10-point visual analog scale (VAS); ulcer status and number of ulcers; proinflammatory cytokine levels; and quality of life, as measured using SF-36, from before to after treatment were measured. Mean intermission time and mean ulcer healing time were calculated. Total effectiveness rate was also calculated. The occurrences of adverse reactions in the two groups were quantified. FINDINGS: The total intermission time interval was significantly longer, the mean ulcer healing time was considerably shorter, the total number of ulcers was appreciably less, and the total effectiveness rate was significantly greater in the test group compared to the control group (all, P < 0.05). The VAS scores were significantly greater after treatment than before treatment in both the test and control groups (mecobalamin + vitamin E, 2.16 [1.09] vs 7.87 [0.51]; control, 3.72 [1.15] vs 7.94 [0.56]; both, P < 0.05). Interleukin (IL)-8, tumor necrosis factor α, and C-reactive protein levels were appreciably down-regulated in both groups when compared to before treatment. In addition, IL-2 concentration and SF-36 scores were much greater after treatment in the test group with respect to the control group. Levels of IL-8, TNF-α, and CRP were significantly lesser in the test group than in the control group (all, P < 0.05). IMPLICATIONS: The combination of mecobalamin tablets and vitamin E soft capsules was effective in the treatment of recurrent oral ulcer. This combination can be used as an adjunctive therapy, offering effective pain control and improving quality of life in patients with oral ulcers.

Short-term effect of meteorological factors on the risk of rheumatoid arthritis hospital admissions: A distributed lag non-linear analysis in Hefei, China.

Rheumatoid arthritis (RA) is an autoimmune disease, mainly characterized by erosional arthritis. The proportion of adults suffering from RA is about 0.5%-1%. There have been reports on the association of rainfall and traffic-related air pollutants with RA hospitalization rates. However, there have been no studies on the association of diurnal temperature range (DTR) and relative humidity (RH) with RA hospitalization rates. This study aimed to examine the short-term association of DTR, RH and other meteorological factors with the hospital admission rate of RA patients, while excluding the interference of PM2.5, SO2, NO2, CO and O3 atmospheric pollutants. We collected daily RA occupancy rate and meteorological factor data in Hefei city from 2015 to 2018 and used the generalized additive model (GAM) combined with the distributed lag nonlinear model (DLNM) for time series analysis, and further stratified analysis by gender and age. Single-day and cumulative-day risk estimates of RA admissions were expressed as relative risk (RR) and its 95% confidence interval (95% CI). For the cumulative-day lag model, high RH was statistically significant after cumulative lag 0-8 days, and the effect gradually increases. Stratified analysis shows that females seem to be more susceptible to high or extremely high DTR and RH exposure, and extremely high DTR exposure may increase the risk of RA admission in all populations. In conclusion, this study found that high DTR and high RH exposure increased the risk of hospitalization in RA patients and provided clues to the potential association between other meteorological factors and RA.

The Pathological Mechanism and Potential Application of IL-38 in Autoimmune Diseases.

Interleukin-38 (IL-38), a new cytokine of interleukin-1 family (IL-1F), is expressed in the human heart, kidney, skin, etc. Recently, new evidence indicated that IL-38 is involved in the process of different autoimmune diseases. Autoimmune diseases are a cluster of diseases accompanied with tissue damage caused by autoimmune reactions, including rheumatoid arthritis (RA), psoriasis, etc. This review summarized the links between IL-38 and autoimmune diseases, as well as the latest knowledge about the function and regulatory mechanism of IL-38 in autoimmune diseases. Especially, this review focused on the differentiation of immune cells and explore future prospects, such as the application of IL-38 in new technologies. Understanding the function of IL-38 is helpful to shed light on the progress of autoimmune diseases.

The Prognostic Value and Mechanisms of TMEM16A in Human Cancer.

As a calcium ion-dependent chloride channel transmembrane protein 16A (TMEM16A) locates on the cell membrane. Numerous research results have shown that TMEM16A is abnormally expressed in many cancers. Mechanically, TMEM16A participates in cancer proliferation and migration by affecting the MAPK and CAMK signaling pathways. Additionally, it is well documented that TMEM16A exerts a regulative impact on the hyperplasia of cancer cells by interacting with EGFR in head and neck squamous cell carcinoma (HNSCC), an epithelial growth factor receptor in head and neck squamous cell carcinoma respectively. Meanwhile, as an EGFR activator, TMEM16A is considered as an oncogene or a tumor-promoting factor. More and more experimental data showed that down-regulation of TMEM16A or gene targeted therapy may be an effective treatment for cancer. This review summarized its role in various cancers and research advances related to its clinical application included treatment and diagnosis.

Epigenetics of ankylosing spondylitis: Recent developments.

Ankylosing spondylitis (AS) is a chronic inflammatory autoimmune disease which mainly affects the spine, sacroiliac joint and peripheral joints. To date, the exact causes and pathogenesis of AS still remain unknown. It is considered that the pathogenesis of AS is associated with genetic, infection, environment, immunity and other factors. Among them, the role of genetic factors in the pathogenesis of AS has been studied most deeply. However, over the past few years, the function of environmental predisposition and epigenetic modification in the pathogenesis of AS has received extensive attention. This paper summarizes the recent progress in the epigenetics of AS, including abnormal epigenetic modifications at AS-associated genomic loci, such as DNA methylation, histone modification, microRNA, and so on. In summary, the findings of this review attempt to explain the role of epigenetic modification in the occurrence and development of AS. Nevertheless, there are still unknown and complicated aspects worth exploring to deepen our understanding of the pathogenesis of AS.

Prognostic Role of Prothrombin Time Activity, Prothrombin Time, Albumin/Globulin Ratio, Platelets, Sex, and Fibrinogen in Predicting Recurrence-Free Survival Time of Renal Cancer.

BACKGROUND: To help with the clinical practice of renal cancer patients, prognostic models are urgently warranted. We hunted and identified prognostic variables associated with recurrence-free survival (RFS) for renal cancer patients. PATIENTS AND METHODS: In this retrospective study, 187 renal cancer patients who had received curative radical/partial nephrectomy between November 2011 and January 2017 were enrolled in the current study. These patients were randomly split into the training (n = 95) and validation sets (n = 92) by the ratio of 1:1. Univariate and multivariable Cox regression analyses were used to establish the nomogram, which was then evaluated by receiver operating characteristic (ROC) and Kaplan-Meier (K-M) analyses. RESULTS: Patient characteristics and outcomes were well balanced between the training and validation sets; the median RFS values were 54.1 months and 58.9 months for the training and validation cohorts, respectively. The final nomogram included six independent prognostic variables (prothrombin time (%), prothrombin time (second), albumin/globulin ratio, platelets, sex and fibrinogen). The mean values of RFS for the low- and high-risk groups defined by a prognostic formula were 56.22 ± 18.50 months and 49.54 ± 23.57 months, respectively, in the training cohort and were 59.00 ± 19.50 months and 53.32 ± 19.95 months, respectively, in the validation cohort. The significance and stability of the model were tested by the time-dependent K-M model and ROC curves, respectively. CONCLUSION: Our validated prognostic model incorporates variables routinely collected from renal cancer patients, identifying subsets of patients with different survival outcomes, which provides useful information for patient care and clinical trial design.

The influence of birth month on total and cardiovascular mortality: a population-based surveillance study.

There is little evidence about the impact of birth month on total and cardiovascular disease mortality in developing countries. We evaluated these associations using the population health registration data of Hefei City, China from 2014 to 2017. After controlling for the fixed effects of gender, education, and occupation, we fitted the Cox proportional hazard regression model to assess the relationship between birth month and mortality. Hazard ratio (HR) with corresponding 95% confidence interval (CI) was calculated. All data analyses were performed by R 3.6.0 software. The data of 44 665 participants were analyzed in the study. Compared to people born in January, people born between May and October had higher total and cardiovascular mortality, being highest in June, respectively, HR: 1.130 (95%CI: 1.074 to 1.190) and HR: 1.200 (95%CI: 1.115 to 1.290). After stratification by gender, males born in June had highest risk total and cardiovascular mortality, with an increase in risk of 14.8% and 24.7%, respectively. For females, highest risk of total mortality was increased by 11.1% in those born in July, while those born in December had highest increase in cardiovascular mortality risk by 15.7%. Our results indicate in Hefei City, China month of birth is associated with total and cardiovascular disease mortality.

Emerging role and therapeutic implication of Wnt signaling pathways in liver fibrosis.

Activation of hepatic stellate cells (HSCs) is a pivotal cellular event in liver fibrosis. Therefore, improving our understanding of the molecular pathways that are involved in these processes is essential to generate new therapies for liver fibrosis. Greater knowledge of the role of the Wnt signaling pathway in liver fibrosis could improve understanding of the liver fibrosis pathogenesis. The aim of this review is to describe the present knowledge about the Wnt signaling pathway, which significantly participates in liver fibrosis and HSC activation, and look ahead on new perspectives of Wnt signaling pathway research. Moreover, we will discuss the different interactions with Wnt signaling pathway-regulated liver fibrosis. The Wnt signaling pathway modulates several important aspects of function, including cell proliferation, activation and differentiation. Targeting the Wnt signaling pathway can be a promising direction in liver fibrosis treatment. We discuss new perspectives of Wnt signaling pathway activation in liver fibrosis. For example, antagonist to Wnt and Wnt ligands could inhibit liver fibrosis by regulating Wnt/ß-catenin signaling pathway. These findings identify the Wnt signaling pathway as a potentially important for therapeutic targets in liver fibrosis. Future studies are needed in order to find safer and more effective Wnt-based drugs.