Construction of an Axial Charge Transfer Channel Between Single-Atom Fe Sites and Nitrogen-Doped Carbon Supports for Boosting Oxygen Reduction.

The introduction of axial-coordinated heteroatoms in Fe─N─C single-atom catalysts enables the significant enhancement of their oxygen reduction reaction (ORR) performance. However, the interaction relationship between the axial-coordinated heteroatoms and their carbon supports is still unclear. In this work, a gas phase surface treatment method is proposed to prepare a series of X─Fe─N─C (X = O, P, and S) single-atom catalysts with axial X-coordination on graphitic-N-rich carbon supports. Synchrotron-based X-ray absorption near-edge structure spectra and X-ray photoelectron spectroscopy indicate the formation of an axial charge transfer channel between the graphitic-N-rich carbon supports and single-atom Fe sites by axial O atoms in O─Fe─N─C. As a result, the O─Fe─N─C exhibits excellent ORR performance with a half-wave potential of 0.905 V versus RHE and a high specific capacity of 884 mAh g-1 for zinc-air battery, which is superior to other X─Fe─N─C catalysts without axial charge transfer and the commercial Pt/C catalyst. This work not only demonstrates a general synthesis strategy for the preparation of single-atom catalysts with axial-coordinated heteroatoms, but also presents insights into the interaction between single-atom active sites and doped carbon supports.

Impact of occupational noise exposure on the hearing level in hospital staffs: a longitudinal study.

The study aimed to evaluate the impact of occupational noise on hearing loss among healthcare workers using audiometry. A longitudinal study was conducted with a six-month follow-up period in a hospital with 21 participants, divided into high-noise-exposure (HNE) and low-noise-exposure (LNE) groups. Mean noise levels were higher in the HNE group (70.4 ± 4.5 dBA), and hearing loss was measured using pure-tone audiometry at baseline and follow-up. The HNE group had significantly higher mean threshold levels at frequencies of 0.25 kHz, 0.5 kHz, 4.0 kHz, and an average of 0.5, 1, 2, and 4 kHz (all p-values < 0.05) after the follow-up period. After adjusting for confounding factors, the HNE group had significantly higher hearing loss levels at 0.25 kHz, 0.5 kHz, and average frequencies of 0.5, 1, 2, and 4 kHz compared to the LNE group at the second measurement. Occupational noise levels above 65 dBA over six months were found to cause significant threshold changes at frequencies of 0.25 kHz, 0.5 kHz, and an average of 0.5-4.0 kHz. This study highlights the risk of noise-induced hearing loss among healthcare workers and emphasizes the importance of implementing effective hearing conservation programs in the workplace. Regular monitoring and assessment of noise levels and hearing ability, along with proper use of personal protective equipment, are crucial steps in mitigating the impact of occupational noise exposure on the hearing health of healthcare workers.

Endoscopic Versus Microscopic Type I Tympanoplasty: An Updated Systematic Review and Meta-analysis.

OBJECTIVE: Our objective was to perform a systematic review and meta-analysis comparing the clinical outcomes after endoscopic and microscopic type I tympanoplasty. STUDY DESIGN: Randomized controlled trials, two-arm prospective studies, and retrospective studies were included. SETTING: Medline, Cochrane, EMBASE, and Google Scholar databases were searched until March 1, 2022 using the combinations of search terms: "endoscopic," "microscopic," and "tympanoplasty." METHODS: Two independent reviewers utilized the abovementioned search strategy to identify eligible studies. If any uncertainty existed regarding eligibility, a third reviewer was consulted. Primary outcome measures were graft success rate, air-bone gap (ABG) improvement, and operative time. Secondary outcomes were the rate of need for canalplasty, the proportion of self-rated excellent cosmetic results, and pain visual analog scale (VAS). RESULTS: Forty-three studies enrolled a total of 3712 patients who were undergoing type I tympanoplasty and were finally included. The pooled result showed endoscopic approach was significantly associated with shorter operative time (difference in means: -20.021, 95% confidence interval [CI]: -31.431 to -8.611), less need for canalplasty (odds ratio [OR]: 0.065, 95% CI: 0.026-0.164), more self-rated excellent cosmetic results (OR: 87.323, 95% CI: 26.750-285.063), and lower pain VAS (difference in means: -2.513, 95% CI: -4.737 to -0.228). No significant differences in graft success rate or ABG were observed between the two procedures. CONCLUSION: Endoscopic type I tympanoplasty provides a similar graft success rate, improvement in ABG, and reperforation rate to microscopic tympanoplasty with a shorter operative time, better self-rated cosmetic results, and less pain. Unless contraindicated, the endoscopic approach should be the procedure of choice in type I tympanoplasty.

A new strategy for the treatment of heavily pretreated metastatic breast cancer: A case report and review of the literature.

BACKGROUND: Breast cancer is one of the most common type of cancers worldwide and remains a critical health issue. Although there are numerous treatment options for advanced metastatic breast cancer, the results are not satisfactory, particularly for triple-negative breast cancer. New treatment modalities need to be explored. CASE PRESENTATION: We present the case of a breast cancer patient with multiple metastases who achieved a good response and tolerance to the combination treatment of utidelone plus capecitabine. After being treated with 10 cycles of combined treatment, the patient is now in a good general condition with a progression-free survival time of 10 months. CONCLUSION: To our knowledge, this is the first report of utidelone plus capecitabine successfully treating a patient with heavily pretreated metastatic breast cancer. This combined treatment offers a new option for patients with multi-drug resistant breast cancer.

TCM as adjunctive therapy improves risks of respiratory hospitalizations in persons with type 2 diabetes: A retrospective cohort study.

Patients with type 2 diabetes are at a higher risk of chronic obstructive pulmonary disease (COPD) and asthma than the general population. In addition, emerging evidence suggests that traditional Chinese medicine (TCM) might be beneficial for patients with type 2 diabetes. We investigated whether TCM use was associated with a reduced risk of respiratory hospitalizations in patients with type 2 diabetes. Conducting a retrospective cohort study, we used data retrieved from the NDCMP database. Among 56,035 patients, 5226 were classified as TCM users; 50,809 were classified as TCM nonusers. Both groups were analyzed until the end of 2011 to examine the incidence of respiratory hospitalizations by using a Cox proportional hazards model to evaluate effects of TCM use on respiratory hospitalizations. During the 6-year study follow-up period, the incidence density rates of COPD- and asthma-related hospitalization were estimated to be 13.03 and 4.47 per 10,000 patient-years for TCM nonusers and 10.08 and 3.28 per 10,000 patient-years for TCM users, respectively. The HR of COPD-related hospitalization in TCM users was 0.88 (95% CI = 0.79-0.99); and the HR of asthma-related hospitalization in TCM users was 0.81 (95% CI = 0.66-1.00). Stratified analyses revealed that effects of TCM use were stronger among individuals who had diabetes for <3 years. As a part of Integrative Medicine, our study results demonstrate that TCM use was associated with a significant reduced risk of respiratory hospitalizations, especially in patients with diabetes for <3 years.

Adverse impacts of high-density microplastics on juvenile growth and behaviour of the endangered tri-spine horseshoe crab Tachypleus tridentatus.

The impacts of high-density microplastics, namely polyamine 6,6 (nylon), polymethyl methacrylate (PMMA) and polyethylene terephthalate (PET), on growth and behaviour of the endangered tri-spine horseshoe crab Tachypleus tridentatus were investigated for 100 days. Negative changes in wet weight and prosomal width of the juveniles were observed in all treatments of microplastics, but significant difference was only detected in prosomal width between control and PMMA. T. tridentatus became significantly less active upon exposure to nylon and PET. The extent of burrowing by T. tridentatus did not significantly differ among the treatments but was overall significantly reduced towards day 100. T. tridentatus exposed to PET significantly showed the lowest survival probability (30 %), compared to the other treatments (70-90 %). In conclusion, high-density microplastics compromised growth and behaviour of juvenile horseshoe crabs. Among the polymers that were tested, PET was considered more harmful and associated with higher mortality.

Epidemiological characteristics of hand, foot and mouth disease clusters in kindergartens and schools in Jinshan District / 预防医学

Objective@#To investigate the epidemiological characteristics of clusters of hand, foot and mouth disease (HFMD) in kindergartens and schools in Jinshan District, Shanghai Municipality from 2016 to 2021, so as to provide insights into improving the prevention and control measurements of HFMD in Jinshan District.@*Methods@#Data of HFMD cases in Jinshan District from 2016 to 2021 were collected through Chinese Disease Prevention and Control Information System, and data pertaining to HFMD clusters in kindergartens and schools were also collected. The scale, temporal distribution, regional distribution and distribution of cluster places were descriptively analyzed. @*Results@#Totally 338 HFMD clusters involving 974 cases were identified in kindergartens and schools in Jinshan District from 2016 to 2021, with an average attack rate of 9.89%. The number of cases in each cluster ranged from 2 to 12 cases, with a median number of 2 (interquartile range, 1) cases, and there were 223 clusters involving 2 cases, accounting for 65.98%. The duration of clusters ranged from 1 to 16 days, with a median duration of 4 (interquartile range, 3) days. HFMD peaked from April to June (136 clusters, 40.24%) and from September to December (176 clusters, 52.07%). All the 11 streets and towns (high-tech zones) were reported HFMD clusters, and the three largest number of clusters were reported in Zhujing Town (72 clusters, 21.30%), Shanyang Town (63 clusters, 18.64%) and Tinglin Town (40 clusters, 11.83%). There were 268 HFMD clusters in kindergartens (79.29%) and 70 in schools (20.71%), and the prevalence of HFMD clusters was higher in kindergartens than in schools (35.51% vs. 17.03%; χ2=31.507, P<0.001). @*Conclusions@#HFMD clusters in kindergartens and schools showed seasonal characteristics from 2016 to 2021 in Jinshan District, which predominantly occurred in Zhujing Town, Shanyang Town and Tinglin Town, and kindergartens were the main places.

[Analysis of withdrawal status and influencing factors in patients receiving methadone maintenance treatment in Hubei province].

Objective: To analyze the withdrawal in patients receiving methadone maintenance treatment (MMT) and its related influencing factors in Hubei province. Methods: The patients receiving MMT in clinics in Hubei province were selected from June 2006 to December 2021. The general demographic data, drug abuse history, and MMT information were collected. The survival data of patients with MMT were analyzed by the Kaplan-Meier method, and the Cox proportional hazards model was used for multivariate analysis. Results: A total of 26 716 patients receiving MMT were included in this study, and the gender ratio between men and women was 3.34∶1(20 557∶6 159). The duration of MMT was 0.01-15.72 years, and the median duration was 2.21 (95%CI: 2.16-2.26) years. At the end of the follow-up, the withdrawal proportion was 86.75% (23 175/26 716). MMT's 0-year, 2-year, 4-year, 9-year and 14-year cumulative probabilities appeared as 67.61%, 40.24%, 30.03%, 15.49% and 6.56%, respectively. Results from the Cox proportional hazards regression model showed that the factors of the withdrawal risk were higher in patients receiving MMT, including minority nationality (HR=1.66,95%CI:1.52-1.82), having jobs (HR=1.05, 95%CI:1.01-1.08), no history of compulsory isolation or detoxification (HR=1.04, 95%CI:1.01-1.09) and the enrollment in 2016-2021 (HR=1.46,95%CI:1.35-1.58). The factors of the withdrawal risk were lower in patients receiving MMT, including 60-year-olds or above (HR=0.56,95%CI:0.42-0.75), college degree or above education level (HR=0.83, 95%CI:0.75-0.91), outpatient services of other cities (HR=0.90, 95%CI:0.87-0.93), drug use for 20 years or more (HR=0.72, 95%CI:0.66-0.80), 90 mg or more per daily dosage (HR=0.73,95%CI:0.69-0.78) and the enrollment in 2011-2015 (HR=0.93,95%CI:0.89-0.97). Conclusions: The withdrawal proportions of patients receiving MMT were high in Hubei province. The withdrawal influencing factors were complex. The daily dose was an essential factor that can be intervened under the safe MMT condition, and a higher dose should be appropriately prescribed.

A comprehensive finite-element human ear model to estimate noise-induced hearing loss associated with occupational noise exposure.

BACKGROUND AND OBJECTIVE: Noise is a common occupational and environmental hazard; however, little is known about the use of computational tools to quantitively analyze data on basilar membrane (BM) damage in noise-induced hearing loss (NIHL). Here, we established a comprehensive three-dimensional finite-element human ear model to quantify the impact of noise exposure on BM and perilymph fluid. METHODS: We used auditory risk units (ARUs) to evaluate the BM damage for subjects (3 men and 5 women; mean age, 32.75 ± 8.86 years; age range, 24-44 years). A 90-dB sound pressure level (SPL) was normally applied at the external auditory canal (EAC) entrance to simulate sound transmission from the EAC to the cochlea at frequencies of 0.2-10.0 kHz. RESULTS: The pressure distribution of perilymph fluid is totally different on frequency responses under low and high sound-evoked (0.013-10.0 kHz). The highest ARUs were 18.479% at the distance of 1 mm from the base, and the second-highest to fourth-highest ARUs occurred at distances of 5-7 mm from the base, where their ARUs were 9.749%, 9.176%, and 11.231%. The total of the ARUs reached 81.956% at external frequencies' sounds of 3.2-5.0 kHz. Among these, the 3.8-kHz and 3.6-kHz frequencies yielded the highest and second-highest ARUs of 20.325% and 19.873%, respectively. CONCLUSIONS: This study would inform our understanding of NIHL associated with occupational noise exposure. We present a FE modelling and describe how it might provide a unique way to unravel mechanisms that drive NIHL due to loud noises.

Ways of HIV transmission in China: The effect of age, period, and cohort.

Background: Acquired immunodeficiency syndrome (AIDS) is a global pandemic caused by human immunodeficiency virus (HIV), which is transmitted through human behaviors, such as sexual intercourse, intravenous drug injection, and blood transfusion. Rare studies have focused on the evaluation of the effects of culture, society, and HIV-related policies in adjusting people's HIV-related behaviors, i.e., ways of HIV transmission. Methods: By taking the new HIV infections in Hubei Province each year from 1995 to 2020 as the sample, our study used the Hierarchical Age-Period-Cohort (HAPC) model to analyze the effects of age, period, and cohort on the trends of ways of HIV transmission. Results: From 1995 to 2020, the number of new HIV infections in Hubei presented a general upward trend. A total of 34,636 HIV infections were reported during this period. According to the statistics of the new HIV infections in Hubei Province between 1995 and 2020, there is a negative correlation between age (-0.099, p < 0.001), squared age (-0.002, p < 0.001), and the rate of blood transmission. While there is a positive correlation between age (0.143, p < 0.001), squared age (0.002, p < 0.001), and the rate of HIV infection through sexual transmission. The significant period and cohort effects on ways of HIV transmission were also observed in the Chinese population. Conclusion: Sexual and blood transmission are the two main ways of HIV infection in China and Hubei. The trend of blood transmission is in accordance with the wave of blood trade in the early 1990s in China. The trend of sexual transmission indicates an increasing need to promote safer sexual behavior among the older population and later generations and design more tailored, innovative, and diverse HIV prevention strategies, especially for the high-risk groups.

Hypothyroidism and related comorbidities on the risks of developing tinnitus.

This is a retrospective longitudinal study that uses data from the National Health Insurance Research Database (NHIRD) of Taiwan of which hypothyroid patients who received a diagnosis between 2000 and 2010 were selected and followed up until 2011. The primary outcome of this study was the occurrence of tinnitus (ICD-9-CM code 388.3). The relevant comorbidities were selected as potential confounders according to the literature, which included vertigo (ICD-9-CM code 386), insomnia (ICD-9-CM code 780), anxiety (ICD-9-CM code 300.00), and hearing loss (ICD-9-CM code 388-389). The overall incidence of tinnitus was significantly higher in the hypothyroidism cohort than in the non-hypothyroidism cohort (9.49 vs. 6.03 per 1000 person-years), with an adjusted HR of 1.35 (95% CI 1.18-1.54) after adjusting potential confounders. The incidences of tinnitus, as stratified by gender, age, comorbidity, and follow-up time, were all significantly higher in the hypothyroidism cohort than those in the non-hypothyroidism cohort. The incidence of tinnitus significantly increased with age (aHR = 1.01, 95% CI 1.01-1.02). In conclusion, we report the relationship between hypothyroidism and the increased risk for tinnitus. We also found that hypothyroidism patients are at increased risk of developing tinnitus when associated with comorbidities including vertigo, hearing loss, and insomnia.

Effects of age-related tympanic-membrane material properties on sound transmission in the middle ear in a three-dimensional finite-element model.

BACKGROUND AND OBJECTIVES: The Young's modulus of the tympanic membrane (TM) is an important modeling parameter in computer simulations of the sound transmission in the ear. Understanding the material mechanics of the TM is essential to improve the coupling between the tympanic membrane and the auditory ossicles. However, the impact of the age-related Young's modulus of the TM on sound transmission is not well known. The objective of this study was to use a comprehensive finite element (FE) model to assess the impact of Young's modulus on sound transmission from the ear canal to the stapes footplate over acoustic frequencies. METHODS: The FE model of the ear canal, the middle ear, and the inner ear, was constructed. The model was constructed with identical geometries and boundary conditions, but with three different Young's moduli for the TMs. The auditory ossicles, suspensory ligaments and tendons, and manubrium were also modeled as isotropic elastic materials. Beside, we evaluated the age-related Young's moduli of the TMs on sound transmission with the FE element fluid-structural interaction (FSI) model under acoustic loading conditions. RESULTS: The impact of the age-related Young's moduli on the sound pressure distributions in the ear canal was significant over two frequency ranges of 1.4-3.2 and 8.6-10 kHz. Meanwhile, the significant differences of the displacement of the stapes occurred at around 1.6 kHz, where the displacement of the stapes decreased from 0.352 nm to 0.287 nm. CONCLUSIONS: The FSI model could demonstrate the influence of Young's modulus of the TM on the transfer of sound-induced vibrations form the ear canal to the stapes footplate. The FE model may provide appropriate information to the medical device development of artificial ossicles and hearing aids.

Design of non-metallic crown for primary molars and analyzation of stress distribution: a finite element study / 中华口腔医学杂志

Objectives: To study the design of nonmetallic crowns for deciduous molars by means of computer aided design and to analyze the key parameters of the nonmetallic crowns of deciduous molars using finite element method. Methods: The three-dimensional model of a mandibular second primary molar was constructed by using a micro-CT system. The thickness of the crown was limited to 0.5 mm and four different crown shapes (chamfer+anatomic, chamfer+non-anatomic, knife edge+anatomic and knife edge+non-anatomic) were designed. Then, the crown shape was limited as chamfer+non-anatomic and five different thicknesses of the crown (0.50, 0.75, 1.00, 1.25, 1.50 mm) were designed, and three different materials, including polyetherketoneketone (PEKK), polymethylmethacrylate (PMMA) resin and resin-infiltrated ceramic, were applied to make the crown. Stress distribution and fatigue of each component of the model under vertical and oblique loadings were analyzed by using finite element method. Non-axial retention analysis was performed on chamfer+non-anatomic crowns, made of PMMA resin, with thicknesses of 0.50, 0.75, 1.00, 1.25 and 1.50 mm. Results: Among the four crown shape designs, the chamfer+non-anatomic type crown showed the lowest von Mises stress and the highest safety factor. By comparing three different materials, the resin-infiltrated ceramic group showed obvious stress concentration on the buccal edge of the crown and the PEKK group showed stress concentration in the adhesive layer. Results of non-axial retention analysis showed that the torques required by the crowns with five thicknesses at the same rotation angle were as follows: 4 856.1, 4 038.1, 3 497.3, 3 256.3 and 3 074.3 N⋅m, respectively. The comparison of areas of the adhesives fracture among groups were as follows: 0.5 mm group < 0.75 mm group < 1.00 mm group < 1.25 mm group < 1.50 mm group. Conclusions: In the design of nonmetallic crowns for primary molars, the edge of the crown should be designed as chamfer, the shape of the inner crown should be non-anatomical and the minimum preparation amount of the occlusal surface should be 1.00 mm. Among the three materials, PMMA resin, of which elastic modulus is similar to the dentin and the dental adhesive, might be the most suitable material for the crowns of primary molars.

Association between exposure to road traffic noise and hearing impairment: a case-control study.

PURPOSE: Noise pollution in urban areas is increasing steadily, and the study of road traffic noises and their effects on the auditory system was rare. This study investigated the potential effects of road traffic noise on auditory systems and hearing. METHODS: A case-control study recruited outpatients from the Otolaryngology department. The case group (n = 41) had binaural hearing loss (HL) of standard pure-tone average(PTA) ≥ 25 dB or high frequency PTA ≥ 25 dB, while the control group (n = 39) had binaural hearing level of any frequency < 25 dB. Detailed otologic evaluations were performed. Between-group data were evaluated using logistic regression analysis. Case or control group was identified based on the audiogram. RESULTS: A total of 80 subjects were recruited, including 41 with hearing impairment and 39 as control. The mean exposure level of road traffic noise was significantly higher in the case group than the control group (p = 0.005). A crude OR of 5.78 showed an increased risk of greater than 70 dB of road traffic noise on hearing impairment and tinnitus (p < 0.001). The aOR of 9.24 (p = 0.002) from a multiple variate analysis suggested that road traffic noise levels greater than 70 dB may have a damaging effect on hearing. Damaging effects on hearing persisted even after adjusting for confounders in the full multivariate model (aOR of 9.24 [95% CI: 2.198-38.869]; p = 0.002). CONCLUSIONS: Exposing to road traffic noise greater than 70 dB showed an increased risk of damage to the auditory system. These results might help public health administrators and physicians to develop programs that address the health dangers of noise.

Increased Incidence of Tinnitus Following a Hyperthyroidism Diagnosis: A Population-Based Longitudinal Study.

Background: An association between thyroid disease and tinnitus has been described previously but further longitudinal, population-based studies are limited. Objective: To investigate the incidence of tinnitus in patients with hyperthyroidism in a national sample, and to identify risk level and associated factors for tinnitus in hyperthyroidism patients. Design: Retrospective cohort study. Patient data were collected from the Longitudinal Health Insurance Database (LHID 2000), which includes national claims data of patient expenditures for admissions or ambulatory care from 1996 to 2011. Setting: Taiwan hospitals and clinics providing healthcare nationwide. Participants: Patients aged 20 years and older with newly diagnosed hyperthyroidism (ICD-9-CM code 242) between 2000-2010 were selected as the study cohort. Hyperthyroidism patient cohort were identified from the LHID2000. Those with tinnitus history (ICD-9-CM code 388.3) before the index date (first hyperthyroidism diagnosis), younger than 20 years, and with incomplete demographic data were excluded. The non-hyperthyroidism cohort included patients with no history of hyperthyroidism and no documented tinnitus. Main Outcomes and Measures: Incidence of tinnitus was the primary outcome. Baseline demographic factors and comorbidities possibly associated with tinnitus, including age, sex, and comorbidities of hearing loss, vertigo, insomnia and anxiety, were retrieved from the LHID 2000. Patients were followed until end of 2011. Results: During the study period, 780 (4.9%) hyperthyroidism patients and 2007 (3.2%) non-hyperthyroidism controls developed tinnitus. Incidence rate of tinnitus in the hyperthyroidism cohort was significantly higher in hyperthyroidism cohort (7.86 vs. 5.05 per 1000 person-years) than that in non-hyperthyroidism cohort. A higher proportion of patients with hyperthyroidism had comorbid insomnia (45.1% vs. 30.9%) and anxiety (14.0% vs. 5.73%) than those without hyperthyroidism. After adjusting for age, gender and comorbidities (vertigo, insomnia, anxiety, hearing loss), hyperthyroidism patients had 1.38-fold higher risk of tinnitus (95% CI = 1.27-1.50) than those without hyperthyroidism. Conclusions: This large population-based study suggests patients with diagnosed hyperthyroidism was more prone to develop tinnitus. Our findings suggest evaluation for comorbid vertigo, insomnia, anxiety and/or hearing loss may identify patients who are at high risk of developing tinnitus in patients with hyperthyroidism.

Radiologic Response Combined with Dermatologic Toxicities is the Most Robust Predictor of Survival Benefits in Patients with Inoperable Hepatocellular Carcinoma After Transarterial Chemoembolization Plus Sorafenib Therapy.

PURPOSE: The survival benefits of patients with inoperable hepatocellular carcinoma (HCC) who undergo transarterial chemoembolization (TACE) and receive sorafenib therapy remain controversial. We aimed to identify clinical predictors in patients with inoperable HCC undergoing TACE and receiving sorafenib. METHODS: Between January 2014 and December 2017, 148 consecutive patients with inoperable HCC who were treated with TACE plus sorafenib were retrospectively analyzed. Critical clinical factors associated with overall survival (OS) were identified by Cox regression model analysis. Kaplan-Meier methods were used to calculate the survival times, which were compared with the log-rank test. RESULTS: Macrovascular invasion (MVI), radiologic response and sorafenib-related dermatologic toxicities were identified as independent factors associated with OS. MVI is a known prognostic factor before treatment. The median OS of patients with either radiologic response or dermatologic toxicities was significantly improved compared with that of patients without it (both 23.0 vs. 7.0 months, P < 0.001). The median OS of patients with a combination of radiologic response and dermatologic toxicities was significantly longer than that of patients with either radiologic response or dermatologic toxicities, as well as no response (25.0 vs. 14.0 vs. 6.0 months, respectively, P < 0.001), and the predictive value was confirmed across patients with different baseline characteristics in terms of MVI, α-fetoprotein level, performance status and liver function. CONCLUSION: The combination of radiologic response and sorafenib-related dermatologic toxicities is the most robust predictor of survival benefits for HCC patients after TACE plus sorafenib therapy. LEVEL OF EVIDENCE: Level 3.

Etiological and epidemiological characteristics of severe acute respiratory infection caused by multiple viruses and Mycoplasma pneumoniae in adult patients in Jinshan, Shanghai: A pilot hospital-based surveillance study.

BACKGROUND: Severe acute respiratory infection (SARI) results in a tremendous disease burden worldwide. Available research on active surveillance among hospitalized adult patients suffering from SARI in China is limited. This pilot study aimed to identify associated etiologies and describe the demographic, epidemiological and clinical profiles of hospitalized SARI patients aged over 16 years in Jinshan, Shanghai. METHODS: Active surveillance was conducted at 1 sentinel hospital in Jinshan district, Shanghai, from April 2017 to March 2018. Hospitalized SARI patients aged over 16 years old were enrolled, and nasopharyngeal swabs were collected within 24 hours of admission and tested for multiple respiratory viruses (including 18 common viruses) and Mycoplasma pneumoniae with real-time polymerase chain reaction. Demographic, epidemiological and clinical information was obtained from case report forms. RESULTS: In total, 397 SARI patients were enrolled; the median age was 68 years, and 194 (48.9%) patients were male. A total of 278 (70.0%) patients had at least one underlying chronic medical condition. The most frequent symptoms were cough (99.2%) and sputum production (88.4%). The median duration of hospitalization was 10 days. A total of 250 infection patients (63.0%) were positive for at least one pathogen, of whom 198 (49.9%) were positive for a single pathogen and 52 (13.1%) were positive for multiple pathogens. The pathogens identified most frequently were M. pneumoniae (23.9%, 95/397), followed by adenovirus (AdV) (11.6%, 46/397), influenza virus A/H3N2 (Flu A/H3N2) (11.1%, 44/397), human rhinovirus (HRhV) (8.1%, 32/397), influenza virus B/Yamagata (Flu B/Yamagata) (6.3%, 25/397), pandemic influenza virus A/H1N1 (Flu A/pH1N1) (4.0%, 16/397), parainfluenza virus (PIV) type 1 (2.0%, 8/397), human coronavirus (HCoV) type NL63 (2.0%, 8/397), HCoV 229E (1.5%, 6/397), HCoV HKU1 (1.5%, 6/397), PIV 3 (1.5%, 6/397), human metapneumovirus (HMPV) (1.5%, 6/397), PIV 4 (1.3%, 5/397), HCoV OC43 (1.0%, 4/397), influenza virus B/Victoria (Flu B/Victoria) (0.5%, 2/397), respiratory syncytial virus (RSV) type B (0.5%, 2/397), and human bocavirus (HBoV) (0.3%, 1/397). The seasonality of pathogen-confirmed SARI patients had a bimodal distribution, with the first peak in the summer and the second peak in the winter. Statistically significant differences were observed with respect to the rates of dyspnea, radiographically diagnosed pneumonia and the presence of at least one comorbidity in patients who were infected with only M. pneumoniae, AdV, HRhV, Flu A/H3N2, Flu A /pH1N1 or Flu B/Yamagata. The differences in the positivity rates of the above 6 pathogens among the different age groups were nonsignificant. CONCLUSIONS: M. pneumoniae, AdV and Flu A/H3N2 were the main pathogens detected in hospitalized SARI patients aged over 16 years old in Jinshan district, Shanghai. Our findings highlight the importance of sustained multipathogen surveillance among SARI patients in sentinel hospitals, which can provide useful information on SARI etiologies, epidemiology, and clinical characteristics.

A thematic analysis of experiences of HIV risks among female sex workers in the Yunnan-Vietnam Chinese border region.

BACKGROUND: The Yunnan province is located near the "Golden Triangle" border region between China, Myanmar and Thailand, which has the highest HIV/AIDS prevalence in China. Female sex workers (FSWs) in the Yunnan province are highly vulnerable to HIV infection. The objective of this study was to examine the experiences of FSWs in the Yunnan to better understand the risk of infection and the potential for transmission of HIV. METHODS: Semi-structured interviews were conducted between May 2018 and June 2018 with 20 FSWs recruited in Hekou County, Yunnan Province, China. Thematic analysis was conducted to identify themes that highlighted increased exposure of FSWs to the risk of HIV infection and transmission. RESULTS: The findings showed that FSWs' primary source for HIV information was gynecologists, with few visiting the local HIV charity Red Ribbon. FSWs reported infrequent visits for check-ups with some seeing a gynecologist once a year. FSWs felt that the onus was on them to prevent STI/HIV infection by using a condom during sex, regardless of their ability to negotiate use. FSWs were also reluctant to see a gynecologists for treatment. Instead, they resorted to douching as a way of preventing HIV/STIs and treating vaginal health problems, such as leucorrhea. Most FSWs worked without the influence of alcohol and drugs. A small number of FSWs reported heroin addiction and injecting drug use. CONCLUSION: The findings suggest a need for innovative HIV prevention strategies among FSWs and their clients in the Chinese border region. Governmental agencies should continue to implement practical strategies in terms of HIV prevention education and condom use through tailored interventions that are localized. Such strategies should include localized tailored interventions that dispel myths about douching as a method of HIV/STI prevention and incorporate a mobile outreach approach, similar to the 'roadside restaurant' outreach that has been successful in rural China.