Objective To explore the application of plasma 7 microRNA (miR7) testing in the differential diagnosis of very early-stage hepatocellular carcinoma (HCC). Methods This study is a multicenter real-world study. Patients with single hepatic lesion (maximum diameter≤2 cm) who underwent plasma miR7 testing at Zhongshan Hospital, Fudan University, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Anhui Provincial Hospital, and Peking University People’s Hospital between January 2019 and December 2024 were retrospectively enrolled. Patients were divided into very early-stage HCC group and non-HCC group, and the clinical pathological characteristics of the two groups were compared. The value of plasma miR7 levels, alpha-fetoprotein (AFP), and des-gamma-carboxy prothrombin (DCP) in the differential diagnosis of very early-stage HCC was evaluated using receiver operating characteristic (ROC) curves and area under the curve (AUC). In patients with both negative AFP and DCP (AFP＜20 ng/mL, DCP＜40 mAU/mL), the diagnostic value of plasma miR7 for very early-stage HCC was analyzed. Results A total of 64 528 patients from 4 hospitals underwent miR7 testing, and 1 682 were finally included, of which 1 073 were diagnosed with very early-stage HCC and 609 were diagnosed with non-HCC. The positive rate of miR7 in HCC patients was significantly higher than that in non-HCC patients (67.9% vs 24.3%, P＜0.001). ROC curves showed that the AUCs for miR7, AFP, and DCP in distinguishing HCC patients from the non-HCC individuals were 0.718, 0.682, and 0.642, respectively. The sensitivities were 67.85%, 43.71%, and 44.45%, and the specificities were 75.70%, 92.78%, and 83.91%, respectively. The pairwise comparison of AUCs showed that the diagnostic efficacy of plasma miR7 detection was significantly better than that of AFP or DCP (P＜0.05). Although its specificity was slightly lower than AFP and DCP, the sensitivity was significantly higher. Among patients negative for both AFP and DCP, miR7 maintained an AUC of 0.728 for diagnosing very early-stage HCC, with 67.82% sensitivity and 77.73% specificity. Conclusions Plasma miR7 testing is a potential molecular marker with high sensitivity and specificity for the differential diagnosis of small hepatic nodules. In patients with very early-stage HCC lacking effective molecular markers (negative for both AFP and DCP), miR7 can serve as a novel and effective molecular marker to assist diagnosis.

ObjectiveTo understand the seropositivity of neutralizing antibodies (NAb) and low-level NAb against SARS-CoV-2 infection in the community residents, and to explore the impact of COVID-19 vaccination and SARS-CoV-2 infection on the levels of NAb in human serum. MethodsOn the ground of surveillance cohort for acute infectious diseases in community populations in Shanghai, a proportional stratified sampling method was used to enroll the subjects at a 20% proportion for each age group (0‒14, 15‒24, 25‒59, and ≥60 years old). Blood samples collection and serum SARS-CoV-2 NAb concentration testing were conducted from March to April 2023. Low-level NAb were defined as below the 25^th percentile of NAb. ResultsA total of 2 230 participants were included, the positive rate of NAb was 97.58%, and the proportion of low-level NAb was 25.02% (558/2 230). Multivariate logistic regression analysis indicated that age, infection history and vaccination status were correlated with low-level NAb (all P<0.05). Individuals aged 60 years and above had the highest risk of low-level NAb. There was a statistically significant interaction between booster vaccination and one single infection (aOR=0.38, 95%CI: 0.19‒0.77). Compared to individuals without vaccination, among individuals infected with SARS-CoV-2 once, both primary immunization (aOR=0.23, 95%CI: 0.16‒0.35) and booster immunization (aOR=0.12, 95%CI: 0.08‒0.17) significantly reduced the risk of low-level NAb; among individuals without infections, only booster immunization (aOR=0.28, 95%CI: 0.14‒0.52) showed a negative correlation with the risk of low-level NAb. ConclusionsThe population aged 60 and above had the highest risk of low-level NAb. Regardless of infection history, a booster immunization could reduce the risk of low-level NAb. It is recommended that eligible individuals , especially the elderly, should get vaccinated in a timely manner to exert the protective role of NAb.

Objective: To understand the relationship between working hours and occupational stress among front-line employees in manufacturing enterprises, so as to provide a basis for the prevention and control of occupational stress. Methods: Front-line employees from 5 manufacturing enterprises in Hangzhou City were selected from June to November 2024 using random cluster sampling. Demographic information and occupational information such as daily average working hours and weekly working hours, were collected through questionnaires. The effort-reward imbalance questionnaire was used to investigate occupational stress. The association between working hours and occupational stress was analyzed using a multivariable logistic regression model. Results: A total of 926 people were surveyed, among whom 572 were male, accounting for 61.77%, and 354 were female, accounting for 38.23%. The average age was (32.98±8.28) years. There were 515 people (55.62%) who had a monthly personal income of more than 5 000 yuan but less than 9 000 yuan. There were 353 people (38.12%) who had a working seniority of less than 5 years. There were 784 people (84.67%) who had an average daily working hours of >8 hours and 645 people (69.65%) who had a weekly working day of more than 5 days. There were 338 people (36.50%) on the shift work system, and 331 people (35.75%) worked night shifts. A total of 707 people were detected with occupational stress, with a detection rate of 76.35%. Multivariable logistic regression analysis showed that after adjusting for gender, age, educational level, marital status, number of children, only-child status, monthly personal income, working seniority, weekly working hours, assembly-line work, shift work system and night shift, compared with employees with an average daily working hours of ≤8 hours, the risk of occupational stress increased by 118.7% for those with an average daily working hours of >8-<10 hours (OR=2.187, 95%CI: 1.434-3.336) and by 248.4% for those with an average daily working hours of ≥10 hours (OR=3.484, 95%CI: 2.034-5.966). Conclusions The detection rate of occupational stress among front-line employees in manufacturing enterprises in Hangzhou City is high. Long average daily working hours can increase the risk of occupational stress among employees in manufacturing enterprises. It is recommended to reasonably arrange work intensity and working hours.

BACKGROUND: Chronic kidney disease (CKD)-associated anemia (CKD-anemia) is associated with poor survival, and hemoglobin targets are often not achieved with current therapies. Phase 3 trials have demonstrated the treatment efficacy of roxadustat for CKD-anemia. This phase 4 study aims to evaluate the long-term (52-week) safety and effectiveness of roxadustat in a broad real-world patient population with CKD-anemia with and without dialysis in China. METHODS: This Phase 4 multicenter, open-label, prospective study, conducted from 24 November 2020 to 11 November 2022, evaluated the long-term safety and effectiveness of roxadustat for CKD-anemia in China. Patients aged ≥18 years with CKD-anemia with or without dialysis were included. The initial oral dose was 70-120 mg (weight-based followed by dose adjustment) over 52 weeks. The primary endpoint was safety based on adverse events (AEs). The secondary endpoints were hemoglobin changes from baseline and the proportion of patients who achieved mean hemoglobin ≥100 g/L. Effectiveness evaluable populations 1 (EE1) and EE2 included roxadustat-naïve and previously roxadustat-treated patients, respectively. The safety analysis set (SAF) included all patients who received ≥1 occasion. RESULTS: The EE1, EE2, and SAF populations included 1804, 193, and 2021 patients, respectively. In the SAF, the mean age was 50 ± 14 years, and 1087 patients (53.8%) were male. Mean baseline hemoglobin was 96.9 ± 14.0 g/L in EE1 and 100.3 ± 12.9 g/L in EE2. In EE1, the mean (95% confidence interval) hemoglobin changes from baseline over weeks 24-36 and 36-52 were 14.2 (13.5-14.9) g/L and 14.3 (13.5-15.0) g/L, respectively. Over weeks 24-36 and 36-52, 83.3% and 86.1% of patients in EE1 and 82.7% and 84.7% in EE2 achieved mean hemoglobin ≥100 g/L, respectively. In the SAF, 1643 (81.3%) patients experienced treatment-emergent AEs (TEAEs). Overall, 219 (10.8%) patients experienced drug-related TEAEs. Thirty-eight (1.9%) patients died of TEAEs (unrelated to the study drug). Vascular access thrombosis was uncommon. CONCLUSIONS: Roxadustat (52 weeks) increased hemoglobin and maintained the treatment target in Chinese patients with CKD-anemia with acceptable safety, supporting its use in real-world settings. REGISTRATION Chinese Clinical Trial Registry ( www.chictr.org.cn ) ChiCTR2100046322; CDE ( www.chinadrugtrials.org.cn ) CTR20201568.
Humans ; Male ; Female ; Anemia/etiology* ; Middle Aged ; Renal Insufficiency, Chronic/complications* ; Glycine/adverse effects* ; Isoquinolines/adverse effects* ; Aged ; Prospective Studies ; Adult ; Hemoglobins/metabolism* ; Treatment Outcome ; China ; Registries ; East Asian People

With the rapid proliferation of lithium-ion batteries in new energy vehicles and energy storage systems, increasing attention has been drawn to the occupational exposure risks and potential health hazards associated with their key cathode materials—nickel–cobalt–manganese (NCM) ternary compounds—throughout their entire life cycle. This review outlined the full life cycle of NCM materials and the occupational exposure risks that may arise during each stage. Based on the latest epidemiological and toxicological evidence, it summarized the health effects and toxicities associated with occupational exposure to NCM materials. The review further analyzed major challenges in current occupational health management system, including the limitations of existing occupational exposure limits, the lack of dedicated medical surveillance standards for NCM-related hazards, and the misalignment between occupational hygiene practices and the rapid expansion of the new-energy industry. Finally, future research directions were proposed with the aim of providing a scientific foundation for protecting worker health and supporting the sustainable development of lithium-ion battery industry.

The patient's right of informed consent is the key issue that must be paid attention to in the identification of medical damage cases.In judicial practice,expert opinion plays an important role in supporting the judicial judgment results of medical injury disputes.However,in terms of causality and cause force,it is not uncommon that there are discrepancies between trial results and expert opinions,and it is often related to the judgment of informed consent.By the analysis of two cases with medical damage identification and judicial judgment,it is found that the fault of diagnosis and treatment is often confused with the fault of notification in the expert opinion,and no distinction is made in causation and cause force analysis.In fact,it is against the original intention of law and judicial interpretation,and does not conform to the actual situation of difference between the two kinds of faults.It is necessary to re-understand the differences and connections between the two faults,accurately distinguish different situations and use different expression methods in the expression of expert opinion to better serve the judicial trial.

Objective:To investigate the association of serum fibroblast growth factor 23(FGF23) level with insulin resistance(IR) and sex hormone levels in patients with polycystic ovary syndrome(PCOS).Methods:A retrospective study was performed in eighty-seven patients with PCOS, fifty-seven patients with simple IR, and sixty-one healthy women who were admitted to Affiliated Hospital of Zunyi Medical University during October 2021 and November 2022. According to the homeostasis model assessment-IR index, all subjects were divided into normal control group( n=61), IR group( n=57), PCOS without IR group(PCOS group, n=15), and PCOS+ IR group( n=72). The levels of serum FGF23, adiponectin, and sex hormones in all groups were compared, and their correlations with glucose and lipid metabolism indicators were analyzed. Results:The FGF23 level was significantly elevated in the IR group, while markedly reduced in the PCOS group and PCOS+ IR group, with the PCOS group showing a significantly lower concentration. The adiponectin levels were significantly decreased in the IR group, PCOS group, and PCOS+ IR group(all P<0.05). The correlation analysis showed that FGF23 level was positively correlated with adiponectin and sex hormone binding globulin, and negatively correlated with luteinizing hormone, luteinizing hormone/follicle stimulating hormone, and free testosterone index(all P<0.05). Logistic regression results indicated that both FGF23 and adiponectin could be used as good indicators for the diagnosis of PCOS and PCOS with IR(all P<0.05). Conclusion:FGF23 is closely related to IR and androgen as well, and under certain conditions, it can reflect the severity of IR and hyperandrogenemia in PCOS patients. The cutoff value of FGF23 obtained in this study can provide a good reference for the diagnosis of PCOS diseases.

Objective:To explore the risk factors of all-cause death in hypertensive patients in the community.Methods:A cohort of 4 049 hypertensive patients who participated in annual health checkups at Xinzhuang Community Health Service Centre of Shanghai Minhang district from January to December 2012 were enrolled in the study. All-cause death was the endpoint event of this study, and patients were divided into a fatal group and a survival group. The collection date for the endpoint event was December 2022. A multivariate Cox regression model was used to analyse the independent risk factors of all-cause mortality among hypertensive patients in the community.Results:Among 4 049 patients aged (67.9±7.1) years, 1 856 (45.8%) were males. There were 610 cases in the fatal group and 3 439 cases in the survival group. Multivariate Cox proportional regression showed that male gender ( HR=1.446, 95% CI: 1.200-1.742, P<0.001), older age ( HR=1.130, 95% CI: 1.118-1.143, P<0.001), higher waist-to-height ratio ( HR=8.117, 95% CI: 2.235-29.481, P=0.001), positive urinary protein ( HR=2.974, 95% CI: 2.202-4.016, P<0.001), high fasting blood glucose ( HR=1.070, 95% CI: 1.012-1.131, P=0.017), and history of stroke ( HR=1.819, 95% CI: 1.414-2.340, P<0.001) were independent risk factors for all-cause mortality in hypertensive patients, while exercise≥1/week ( HR=0.816, 95% CI: 0.668-0.996, P=0.046) and taking lipid-lowering medications ( HR=0.459, 95% CI: 0.223-0.947, P=0.035) were protective factors for all-cause mortality. Conclusion:For hypertensive patients, male gender, older age, higher waist-to-height ratio, positive urinary protein, high fasting blood glucose, and history of stroke are risk factors for all-cause mortality, while exercise≥1/week and taking lipid-lowering medications are protective factors.

Objective:To analyze the association between sleep status and ambulatory blood pressure monitoring indicators in community-dwelling hypertensive patients.Methods:It was a cross sentional study. Hypertensive patients who underwent 24-hour ambulatory blood pressure monitoring from May 2021 to April 2023 in Shanghai Xinzhuang Town were enrolled. The demographic information and sleep status of patients were obtained from the questionnaire. A TM-2430 blood pressure monitor was used to measure 24-hour ambulatory blood pressure, and the relevant indicators, including blood pressure level and blood pressure coefficient of variation were documented. The association between sleep status and blood pressure indicators was analyzed with multivariate linear regression model.Results:A total 1 135 patients aged (65.07±12.61) years were enrolled, and 473 (41.67%) of whom were males. The sleep time was<7 hours in 76 cases, 7- 8 hours in 219 cases and >8 hours in 840 cases; the bedtime was earlier than 22∶00 in 415 cases, between 22∶00 and 23∶00 in 474 cases and later than 23∶00 in 246 cases; the wake-up time was before 6∶00 in 230 cases, between 6∶00 and 7∶00 in 521 cases and after 7∶00 in 384 cases. Multivariate linear regression analysis showed that after controlling for gender and age, the sleep time was negatively associated with diurnal, noctumal and 24-hour diastolic blood pressure levels (all P<0.05), and positively associated with diurnal and noctumal systolic blood pressure coefficient of variation, noctumal diastolic blood pressure coefficient of variation, and 24-hour systolic blood pressure coefficient of variation (all P<0.05).The bedtime was positively associated with diurnal, noctumal and 24-hour diastolic blood pressure (all P<0.05), diastolic blood pressure (all P<0.05); and negatively associated with diurnal systolic blood pressure coefficient of variation, diurnal diastolic blood pressure coefficient of variation, noctumal systolic blood pressure coefficient of variation, 24-hour systolic blood pressure coefficient of variation, and 24-hour diastolic blood pressure coefficient of variation (all P<0.05). The wake-up time was positively associated with diurnal systolic blood pressure, diurnal, noctumal and 24-hour diastolic blood pressure (all P<0.05), and positively associated with diurmal systolic blood pressure and diastolic blood pressure (both P<0.05). Conclusion:Sleep status is closely associated with ambulatory blood pressure monitoring indicators in community-dwelling hypertensive patients.