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BACKGROUND: Interpersonal violence is a leading cause of morbidity, with potentially severe adverse consequences for the mental health of the injured persons. The extent to which violent injury is associated with subsequent suicidal behavior, however, remains unclear. This study aimed to examine how violent injury was associated with subsequent deliberate self-harm and death by suicide. METHODS: This retrospective cohort study used nationwide longitudinal registry data from Norway to identify all individuals presenting to emergency services in 2010-2018 with a violence-related injury, along with sex- and age-matched control individuals from the general population. The primary outcomes were any emergency visit for deliberate self-harm (DSH) and suicide death, observed through 31 December 2018. Rates of each outcome were compared between violence-injured patients and comparison individuals using stratified multivariable Cox regression models, controlling for sociodemographic characteristics as well as history of psychiatric treatment and DSH. Secondary analyses tested for moderation by sex, age, and prior psychiatric treatment. FINDINGS: Violence-injured patients (n = 28,276) had substantially higher rates of DSH (946.7 per 100,000 person-years) and suicide death (74.5 per 100,000) when compared to controls (n = 282,760; 90.0 and 15.2 per 100,000, respectively). The hazard ratios (HRs) remained significantly higher even after accounting for covariates (HRadj for DSH: 5.11; 95% CI: 4.62, 5.66; HRadj for suicide: 2.40; 95% CI: 1.78, 3.24). Sex differences in this association were negligible, but the association between violence injury and DSH increased with age. Violence-injured patients with prior psychiatric treatment had the highest risk of suicidal behavior. INTERPRETATION: Violence-injured patients experience significantly excess rates of suicidal behavior, a finding with potential to inform both clinical intervention and population-level suicide prevention strategies. FUNDING: Fulbright Norway Scholarship.

ObjectivePatient presentations to the emergency department (ED) for alcohol-involved injury represent a growing public health burden, but their characteristics and sequelae remain understudied. This study examined mortality rates among ED patients presenting with alcohol-involved injuries and assessed how mortality varied by injury intent and other characteristics.MethodThis retrospective cohort study used statewide, longitudinally linked ED patient record and mortality data from California. Participants comprised all residents presenting to a licensed ED in 2009-2012 with a nonfatal injury that involved comorbid diagnosis of alcohol use disorder (AUD; n = 261,222; 59.3% male). Injury intent was defined using International Classification of Diseases, 9th Revision, Clinical Modification external cause-of-injury codes. Cox regression was used to investigate factors associated with 12-month all-cause mortality rates. Age-, sex-, and race/ethnicity-adjusted standardized mortality ratios (SMRs) were calculated using statewide mortality data.ResultsMost ED injury visits involving an AUD diagnosis were coded as unintentional (75.9%). Following the index ED visit, all-cause mortality among AUD-involved injury patients was 5,205 per 100,000 person-years, five times higher than the demographically matched population (SMR = 5.3; 95% confidence interval [5.2, 5.4]). Adjusted Cox regression models indicated that patients whose index injury was unintentional, and whose AUD was for acute intoxication, had significantly higher mortality. Most deaths among unintentionally injured patients were from natural causes, whereas external-cause deaths were relatively more common in the other patient groups.ConclusionsAUD-involved injury presentations to the ED in California are common and associated with high patient mortality burden, which varies by injury intent. Interventions are needed to reduce excess mortality in these patients.

Highlights TCGA molecular classification has advantages over ProMisE classification for accurate diagnosis of endometrial carcinoma. Comparison among the four TCGA types (POLE, Low-CN, High-CN, and MSI-H) and age was statistically significant. Patients with POLE mutations and low-CN had higher PFS and overall survival, whereas those with high-CN had the lowest overall survival periods.

Abstract Background Biomphalaria glabrata is one of the main intermediate hosts of Schistosoma mansoni, the most widespread species of Schistosoma. Our previous studies proved that alternative oxidase (AOX), the terminal oxidase in the mitochondrial respiratory chain, widely exists in several species of intermediate host snails of Schistosoma. Meanwhile, inhibition of AOX activity in Oncomelania hupensis snails could dramatically enhance the molluscicidal effect of niclosamide. As a hermaphroditic aquatic mollusc, the high fecundity and population density of B. glabrata increase the difficulty of snail control, which is one of the critical strategies for schistosomiasis elimination. The present study aimed to investigate the possible role of AOX in the development and fecundity of B. glabrata snail, which could be manipulated more manageable than other species of intermediate host snails of Schistosoma. Methods The dynamic expression of the AOX gene was investigated in different developmental stages and tissues of B. glabrata, with morphological change and oviposition behaviour observed from juvenile to adult snails. Furtherly, dsRNA-mediated knockdown of BgAOX mRNA and the AOX protein activity inhibiting was performed to investigate the effect of AOX on the development and oviposition of snails. Results The BgAOX gene expression profile is highly related to the development from late juveniles to adults, especially to the reproductive system of snails, with a positive correlation of 0.975 between egg production and BgAOX relative expression in ovotestis of snails. The inhibition of BgAOX at the transcriptional level and AOX activity could efficiently inhibit snail growth. However, the interference at the BgAOX protein activity level led to more severe tissue damage and more significant inhibition of oviposition than at the transcriptional level. This inhibition of growth and oviposition decreased gradually with the increase in the snail size. Conclusions The inhibition of AOX could efficiently disrupt the development and oviposition of B. glabrata snails, and the intervention targeting AOX at the juvenile stage is more effective for snails. This investigation explored the role of AOX in the growth and development of snails. It would benefit snail control in the future by providing a potential target while using molluscicides more efficiently. Graphical abstract

ObjectiveTo evaluate the efficiency and practical significance of different diabetes screening methods in community population and to provide evidences for the establishment of community diabetes screening process. MethodsUsing multistage cluster random sampling, we recruited 23 940 permanent residents aged ≥ 35 years and without acute or serious chronic diseases/type I diabetes in urban communities and rural villages of 7 districts of Shanghai for a questionnaire survey, physical examination and blood glucose measurement during October – December, 2017. The effectiveness and operability of an early-detecting process, risk score assessment and fast plasma glucose (FPG) screening for type 2 diabetes (T2DM) were evaluated by comparing the three methods′ sensitivity, specificity, Youden index , area under the receiver operating characteristic curve (AUROC), the proportion of abnormal FPG and oral glucose tolerance test (OGTT). ResultsOf the 17 981 previously undiagnosed diabetics identified among the residents and included in the analysis, 4 129 prediabetics and 2 213 diabetes were detected, with the prevalence rates of 22.96% and 12.31%, respectively. For the three methods (early-detecting process vs. risk score assessment vs. FPG screening) in detections of diabetes/prediabetic in previously undiagnosed diabetic population, the sensitivities (%) were 87.3/61.0 vs. 96.7/93.3 vs. 82.5/47.8; the specificities (%) were 60.2/58.9 vs. 15.2/15.8 vs. 87.5/86.0; the Youden indexes were 0.479/0.199 vs. 0.119/0.091 vs. 0.700/0.338, and the values of AUROC were 0.858/0.620 vs. 0.680/0.602 vs. 0.922/0.708; also for the three methods, the proportions (%) of the examinees requiring FPG/2-hour plasma glucose detection of OGTT were 45.7/42.6 vs. 86.3/86.3 vs. 100/21.1, respectively. ConclusionIn diabetes screening among community residents, early-detecting process could achieve a higher detection rate of abnormal glucose metabolism with a minimum number of venous blood glucose detection and simplified on-site implementation procedures and the process could be adopted effectively in large-scale prediabetics and diabetes screening in community populations.