Background/Aims: The World Health Organization set the goal of eliminating hepatitis C virus (HCV) by 2030, with 80% and 65% reductions in HCV incidence and mortality rates, respectively. We aimed to evaluate the health benefits, cost-effectiveness and return on investment (ROI) of HCV elimination. Methods: Using an HCV transmission compartmental model, we evaluated the benefits and costs of different strategies combining screening and treatment for Chinese populations. We identified strategies to achieve HCV elimination and calculated the incremental cost-effectiveness ratios (ICERs) per disability-adjusted life year (DALY) averted for 2022–2030 to identify the optimal elimination strategy. Furthermore, we estimated the ROI by 2050 by comparing the required investment with the economic productivity gains from reduced HCV incidence and deaths. Results: The strategy that results in the most significant health benefits involves conducting annual primary screening at a rate of 14%, re-screening people who inject drugs annually and the general population every five years, and treating 95% of those diagnosed (P14-R4-T95), preventing approximately 5.75 and 0.44 million HCV infections and deaths, respectively, during 2022–2030. At a willingness-to-pay threshold of $12,615, the P14-R4-T95 strategy is the most cost-effective, with an ICER of $5,449/DALY. By 2050, this strategy would have a net benefit of $120,997 million (ROI=0.868). Conclusions Achieving HCV elimination in China by 2030 will require significant investment in large-scale universal screening and treatment, but it will yield substantial health and economic benefits and is cost-effective.

Objective To investigate the effects of low background radiation environments in deep underground settings on the biological behavior of NP69 human nasopharyngeal epithelial cells(NP69 cells)and the underlying molecular mechanisms.Methods A parallel control experimental design was adopted and NP69 cells were synchronously cultured in settings of three underground depths at the China in situ Deep-Underground Facility&Life Observatory(DeUFO)—ground level(DeUFO-0 m),1 000 m underground(DeUFO-1 000 m),and 1 500 m underground(DeUFO-1 500 m).Changes in cell proliferation and migration capabilities were assessed using the Cell Counting Kit-8(CCK-8)assay and scratch assay,respectively.High-throughput RNA sequencing(RNA-Seq)was performed to identify differentially expressed genes(DEGs).Functional annotation and pathway enrichment analysis of the DEGs were performed using the Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)databases.Results CCK-8 assay revealed that,after 72 h of culture,the absorbance value of the DeUFO-0 m group was 1.35 times and 1.27 times those of the those of the DeUFO-1 000 m and DeUFO-1 500 m groups,respectively(both P<0.000 1).After 96 h of culture,the absorbance value of the DeUFO-0 m group was 1.52 times and 1.41 times those of the DeUFO-1 000 m and DeUFO-1 500 m groups,respectively(both P<0.000 1).Colony formation assays revealed that the number of cell colonies in the DeUFO-0 m group was 1.59 times and 1.27 times those in the DeUFO-1 000 m group and DeUFO-1 500 m group,respectively(both P<0.001).The scratch assay revealed that the 36-hour wound healing rate of the DeUFO-0 m group was 2.22 times and 4.00 times those of the DeUFO-1 000 m group and DeUFO-1 500 m group,respectively(both P<0.000 1).Transwell assays revealed that the number of migrating cells in the DeUFO-0 m group was 2.08 times and 2.56 times those in the DeUFO-1 000 m group and DeUFO-1 500 m group,respectively(both P<0.000 1).Transcriptome sequencing analysis revealed consistent upregulation of CELF2,CELF4,CGB8,GRHL2,and DMRTA2 genes in the DeUFO-1 000 m and DeUFO-1 500 m groups.Pathway enrichment analysis indicated significant enrichment of extracellular matrix(ECM)remodeling-associated pathways and gene expression regulation pathways in the experimental groups(false discovery rate[FDR]<0.05).Conclusion The low background radiation environment in deep underground settings suppresses the proliferation and migration activities of NP69 cells by mediating ECM remodeling and post-transcriptional regulatory mechanisms through the regulation of target genes such as the CELF family.This study provides experimental evidence for establishing a dose-response relationship between environmental radiation and cellular effects.

Background/Aims: The World Health Organization set the goal of eliminating hepatitis C virus (HCV) by 2030, with 80% and 65% reductions in HCV incidence and mortality rates, respectively. We aimed to evaluate the health benefits, cost-effectiveness and return on investment (ROI) of HCV elimination. Methods: Using an HCV transmission compartmental model, we evaluated the benefits and costs of different strategies combining screening and treatment for Chinese populations. We identified strategies to achieve HCV elimination and calculated the incremental cost-effectiveness ratios (ICERs) per disability-adjusted life year (DALY) averted for 2022–2030 to identify the optimal elimination strategy. Furthermore, we estimated the ROI by 2050 by comparing the required investment with the economic productivity gains from reduced HCV incidence and deaths. Results: The strategy that results in the most significant health benefits involves conducting annual primary screening at a rate of 14%, re-screening people who inject drugs annually and the general population every five years, and treating 95% of those diagnosed (P14-R4-T95), preventing approximately 5.75 and 0.44 million HCV infections and deaths, respectively, during 2022–2030. At a willingness-to-pay threshold of $12,615, the P14-R4-T95 strategy is the most cost-effective, with an ICER of $5,449/DALY. By 2050, this strategy would have a net benefit of $120,997 million (ROI=0.868). Conclusions Achieving HCV elimination in China by 2030 will require significant investment in large-scale universal screening and treatment, but it will yield substantial health and economic benefits and is cost-effective.

Background/Aims: The World Health Organization set the goal of eliminating hepatitis C virus (HCV) by 2030, with 80% and 65% reductions in HCV incidence and mortality rates, respectively. We aimed to evaluate the health benefits, cost-effectiveness and return on investment (ROI) of HCV elimination. Methods: Using an HCV transmission compartmental model, we evaluated the benefits and costs of different strategies combining screening and treatment for Chinese populations. We identified strategies to achieve HCV elimination and calculated the incremental cost-effectiveness ratios (ICERs) per disability-adjusted life year (DALY) averted for 2022–2030 to identify the optimal elimination strategy. Furthermore, we estimated the ROI by 2050 by comparing the required investment with the economic productivity gains from reduced HCV incidence and deaths. Results: The strategy that results in the most significant health benefits involves conducting annual primary screening at a rate of 14%, re-screening people who inject drugs annually and the general population every five years, and treating 95% of those diagnosed (P14-R4-T95), preventing approximately 5.75 and 0.44 million HCV infections and deaths, respectively, during 2022–2030. At a willingness-to-pay threshold of $12,615, the P14-R4-T95 strategy is the most cost-effective, with an ICER of $5,449/DALY. By 2050, this strategy would have a net benefit of $120,997 million (ROI=0.868). Conclusions Achieving HCV elimination in China by 2030 will require significant investment in large-scale universal screening and treatment, but it will yield substantial health and economic benefits and is cost-effective.

Objective To investigate the association between extensive perivascular space(EPVS)burden in different locations and ischemic stroke(IS),its subtypes,and transient ischemic attack(TIA)through Mendelian randomization(MR)analysis.Methods The summary data from large-scale Genome-wide Association Studies(GWAS)and various MR methods were employed.We applied multivariable MR to mitigate potential confounding factors and conduct sensitivity analyses to enhance result robustness.Subsequently,meta-analysis was utilized to integrate causal relationships between EPVS burden in different locations and IS from various sources.Additionally,reverse MR was employed to observe the impact of various IS types on EPVS burden.Finally,linkage disequilibrium score regression was conducted to assess genetic correlations between exposures and outcomes.Results EPVS burden in both the white matter(OR=1.12,95％CI:1.01-1.25;P=0.04)and basal ganglia(OR=1.57,95％CI:1.30-1.89;P＜0.01)are significant risk factors for IS.EPVS burden in the basal ganglia is also a risk for IS(small-vessel)(OR=4.56,95％CI:2.57-8.27;P=5.95× 10-7).After IS and TIA there seems to be a potential increase in extensive basal ganglia perivascular space burden.Conclusions Extensive white matter perivascular space burden and extensive basal ganglia perivascular space burden may serve as important indicators to predict IS.

Objective:To conduct a comprehensive global review of research on toxic leadership behavior among nursing managers and to analyze the current research status.Methods:Literature related to toxic leadership behavior among nursing managers was retrieved from PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, VIP Chinese Science and Technology Journal Database, and China Biomedical Literature Database. The search period extended from the inception of each database to February 15, 2025. The included literature was then organized, analyzed, and summarized.Results:A total of 28 studies were included. There were 23 studies reported the occurrence of toxic leadership behavior among nursing managers, the incidence of toxic leadership behavior was almost at a moderately low level. There were 8 studies reported the influencing factors of toxic leadership behavior, its influencing factors encompassed three primary aspects: the organizational level, the personal characteristics of nursing managers, and characteristics of the nursing staff group. Assessment tools of toxic leadership behavior included the Toxic Leadership Behaviors of Nurse Managers, the Abuse Management Questionnaire, etc. The adverse consequences included increased nurse turnover intention, decreased nursing quality, and reduced organizational trust, etc. Interventions were planned and implemented from three perspectives: the hospital managers, nursing managers, and the nurses.Conclusions:The factors influencing toxic leadership behavior among nursing managers and its adverse consequences require further exploration. Therefore, more intervention studies are warranted to provide new insights and methods for preventing and reducing toxic leadership behavior.

OBJECTIVE To analyze pathogens of multiple drug-resistant organism(MDRO)infection and its risk factors during the recovery period of patients with traumatic brain injury,and to construct and validate the predic-tion model for MDRO lung infection.METHODS Patients who were admitted to the Shanxi Second People's Hos-pital for traumatic brain injury(TBI)and developed hospital-acquired pneumonia(HAP)during their hospitaliza-tion between Aug.2019 and Aug.2023 were selected as the study subjects,their clinical data were retrospectively collected,and the patients were randomly divided into a modeling group(n=270)and a verification group(n=90)at a ratio of 3∶1,and they were further categorized into the MDRO infection group(148 cases)and the non-infection group(122 cases)based on whether they developed pneumonia caused by MDRO infections.Clinical data of the patients were collected for analysis,with pathogen identification performed for all patients.The risk factors for MDRO infection in TBI patients with HAP were analyzed by multivariate Logistic regression analysis,a pre-diction model for MDRO infections during the hospitalization and recovery period of TBI patients with HAP was constructed using a formula-based method,the goodness-of-fit of the model was assessed using Hosmer-Leme-show test,and its predictive ability was evaluated using receiver operating characteristic(ROC)curves.RESULTS There was no significant differences in the baseline characteristics of TBI patients with HAP between the modeling group and the verification group.The incidence of MDRO infections among TBI patients with HAP in modeling group was 54.81％(148/270),with Klebsiella pneumoniae(25.27％)being the predominant pathogen.Mechan-ical ventilation duration(OR=5.789,95％CI:2.164-15.486,P=0.001),ICU length of stay(OR=5.441,95％CI:2.153-13.751,P＜0.001),combined kidney diseases(OR=2.770,95％CI:1.321-5.812,P=0.007),duration of antibiotics use(OR=7.486,95％CI:1.928-29.059,P=0.004),occurrence of impaired consciousness(OR=5.720,95％CI:2.586-12.652,P＜0.001)and use of aminoglycoside antibiotics(OR=3.861,95％CI:1.608-9.273,P=0.003)were risk factors for MDRO infections.The Hosmer-Lemeshow for the risk prediction model showed that x2=5.013 and P=0.496.ROC curves analysis showed The area under the curve(AUC)for the modeling group by ROC curve analysis was 0.80(95％CI:0.773-0.877),with a sensitivi-ty of 83.33％and a specificity of 73.60％respectively,and the AUC for the verification group were 0.800(95％CI:0.670-0.895),with a sensitivity of 81.82％and a specificity of 77.27％respectively.CONCLUSION The prediction model constructed in this study,based on the risk factors for MDRO infection pneumonia during the re-covery period in hospitalized patients with traumatic brain injury,demonstrated high goodness-of-fit,as well as satisfactory sensitivity and specificity,and its application in clinical practice may help identify patients at high risk of MDRO infections.

OBJECTIVE To analyze pathogens of multiple drug-resistant organism(MDRO)infection and its risk factors during the recovery period of patients with traumatic brain injury,and to construct and validate the predic-tion model for MDRO lung infection.METHODS Patients who were admitted to the Shanxi Second People's Hos-pital for traumatic brain injury(TBI)and developed hospital-acquired pneumonia(HAP)during their hospitaliza-tion between Aug.2019 and Aug.2023 were selected as the study subjects,their clinical data were retrospectively collected,and the patients were randomly divided into a modeling group(n=270)and a verification group(n=90)at a ratio of 3∶1,and they were further categorized into the MDRO infection group(148 cases)and the non-infection group(122 cases)based on whether they developed pneumonia caused by MDRO infections.Clinical data of the patients were collected for analysis,with pathogen identification performed for all patients.The risk factors for MDRO infection in TBI patients with HAP were analyzed by multivariate Logistic regression analysis,a pre-diction model for MDRO infections during the hospitalization and recovery period of TBI patients with HAP was constructed using a formula-based method,the goodness-of-fit of the model was assessed using Hosmer-Leme-show test,and its predictive ability was evaluated using receiver operating characteristic(ROC)curves.RESULTS There was no significant differences in the baseline characteristics of TBI patients with HAP between the modeling group and the verification group.The incidence of MDRO infections among TBI patients with HAP in modeling group was 54.81％(148/270),with Klebsiella pneumoniae(25.27％)being the predominant pathogen.Mechan-ical ventilation duration(OR=5.789,95％CI:2.164-15.486,P=0.001),ICU length of stay(OR=5.441,95％CI:2.153-13.751,P＜0.001),combined kidney diseases(OR=2.770,95％CI:1.321-5.812,P=0.007),duration of antibiotics use(OR=7.486,95％CI:1.928-29.059,P=0.004),occurrence of impaired consciousness(OR=5.720,95％CI:2.586-12.652,P＜0.001)and use of aminoglycoside antibiotics(OR=3.861,95％CI:1.608-9.273,P=0.003)were risk factors for MDRO infections.The Hosmer-Lemeshow for the risk prediction model showed that x2=5.013 and P=0.496.ROC curves analysis showed The area under the curve(AUC)for the modeling group by ROC curve analysis was 0.80(95％CI:0.773-0.877),with a sensitivi-ty of 83.33％and a specificity of 73.60％respectively,and the AUC for the verification group were 0.800(95％CI:0.670-0.895),with a sensitivity of 81.82％and a specificity of 77.27％respectively.CONCLUSION The prediction model constructed in this study,based on the risk factors for MDRO infection pneumonia during the re-covery period in hospitalized patients with traumatic brain injury,demonstrated high goodness-of-fit,as well as satisfactory sensitivity and specificity,and its application in clinical practice may help identify patients at high risk of MDRO infections.

Objective:To conduct a comprehensive global review of research on toxic leadership behavior among nursing managers and to analyze the current research status.Methods:Literature related to toxic leadership behavior among nursing managers was retrieved from PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, VIP Chinese Science and Technology Journal Database, and China Biomedical Literature Database. The search period extended from the inception of each database to February 15, 2025. The included literature was then organized, analyzed, and summarized.Results:A total of 28 studies were included. There were 23 studies reported the occurrence of toxic leadership behavior among nursing managers, the incidence of toxic leadership behavior was almost at a moderately low level. There were 8 studies reported the influencing factors of toxic leadership behavior, its influencing factors encompassed three primary aspects: the organizational level, the personal characteristics of nursing managers, and characteristics of the nursing staff group. Assessment tools of toxic leadership behavior included the Toxic Leadership Behaviors of Nurse Managers, the Abuse Management Questionnaire, etc. The adverse consequences included increased nurse turnover intention, decreased nursing quality, and reduced organizational trust, etc. Interventions were planned and implemented from three perspectives: the hospital managers, nursing managers, and the nurses.Conclusions:The factors influencing toxic leadership behavior among nursing managers and its adverse consequences require further exploration. Therefore, more intervention studies are warranted to provide new insights and methods for preventing and reducing toxic leadership behavior.

Objective To investigate the association between extensive perivascular space(EPVS)burden in different locations and ischemic stroke(IS),its subtypes,and transient ischemic attack(TIA)through Mendelian randomization(MR)analysis.Methods The summary data from large-scale Genome-wide Association Studies(GWAS)and various MR methods were employed.We applied multivariable MR to mitigate potential confounding factors and conduct sensitivity analyses to enhance result robustness.Subsequently,meta-analysis was utilized to integrate causal relationships between EPVS burden in different locations and IS from various sources.Additionally,reverse MR was employed to observe the impact of various IS types on EPVS burden.Finally,linkage disequilibrium score regression was conducted to assess genetic correlations between exposures and outcomes.Results EPVS burden in both the white matter(OR=1.12,95％CI:1.01-1.25;P=0.04)and basal ganglia(OR=1.57,95％CI:1.30-1.89;P＜0.01)are significant risk factors for IS.EPVS burden in the basal ganglia is also a risk for IS(small-vessel)(OR=4.56,95％CI:2.57-8.27;P=5.95× 10-7).After IS and TIA there seems to be a potential increase in extensive basal ganglia perivascular space burden.Conclusions Extensive white matter perivascular space burden and extensive basal ganglia perivascular space burden may serve as important indicators to predict IS.