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Background Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) is widely practiced to palliate cancer pain in patients with inoperable abdominal malignancy. During CPN, the dehydrated alcohol is injected to ablate neural tissue and local anesthetics is to minimize the discomfort from alcohol injection. This study aims to compare the efficacy and safety of bupivacaine and ropivacaine in EUS-CPN. Methods We retrospectively pooled and analyzed two large EUS centers' 150 consecutive patients underwent EUS-CPN from January 2012 to March 2019. Patients were divided into 3 groups based on the selection of anesthetics: 0.5% ropivacaine (ROPI, n=23), 0.375% bupivacaine (0.375% BUPI, n=21), 0.75% bupivacaine (0.75% BUPI, n=106). Visual analogue scale (VAS) was used to measure pre/post-operative pain at 11 observation points. Additional data were collected from medical records. Results The incidence of procedure-related pain within 12 hours after CPN was significantly different among the three groups, 10.38% in 0.75% BUPI [OR =0.26 (95% CI: 0.07-0.94); P=0.04], 26.09% in ROPI and 23.81% in 0.375% BUPI group, respectively. The risk of post-procedural arrhythmia was similar between the 0.375% and 0.75% BUPI groups (19.05% versus 18.87%), while relatively lower in ROPI group (13.04%). No patients in any group developed symptoms of CNS toxicity related to anesthetics. Conclusions Compared with 0.375% bupivacaine and 0.5% ropivacaine, 0.75% bupivacaine in CPN can reduce post-procedural pain. Ropivacaine shows a tendency of less arrhythmogenic effect in CPN. more...

In early April 2020, the 3-month-long city-wide lockdown was lifted in Wuhan, the epicenter of China during Coronavirus Disease 2019 (COVID-19) global pandemic. However, continuing precautions are still practiced considering the risk of transmission from asymptomatic carriers. Given that COVID-19 is spread via airborne droplets, including aspiration of oral and fecal material through endoscopes, our endoscopy center has strategically assigned health-care providers to ensure triage workflow and to minimize concomitant exposure from potential asymptomatic carriers. Here, we share the experience of performing EUS-FNA during the COVID-19 pandemic and postendemic periods. We illustrate our workflow using a patient with a left adrenal mass as an example and followed a biosafety level-2 standard. We believe all endoscopy centers need to focus on these three directions: (1) pre-EUS patients risk assessment and triage, (2) Personal protective equipment (PPE), and (3) dressing code modalities. We fully adopted them in our hospital to reduce COVID-19 resurgence risk. more...

Background and Purpose: Cancer stem cells (CSCs) are a type of cancer cell owning the characteristic of self-renew and differentiation.We hypothesize that the stemness properties in CD44v6+ hepatocellular carcinoma cells (HCC) is promoted via the Met/cjun/Nanog signaling pathway, thus, serves as a valuable target for HCC therapy. Experimental Approach: We use lentiviral shMet and selective Met inhibitor PHA665752 to explore the function of Met/cjun/Nanog axi in CD44v6+ cells. The orthotopic liver xenograft tumor model was used to detect self-renewal ability of CD44v6+ cells. Furthermore, a luciferase reporter assay and chromatin immunoprecipitation (ChIP) assay were carried out to find the exact binding site of cjun in the Nanog promoter. Key Results: In this study, we demonstrated that CD44v6+ CSCs not only facilitate the properties of cancer stemness, but also represent the high expression of the HGF/MET signal pathway. Inhibiting the activation of Met in CD44v6+ HCC cells in vidvo and in vitro significantly decrease the expression of cjun and Nanog. Furthermore, we found a binding site of cjun in 1700bp before the transcription start site of Nanog. Conclusion and Implications: The stemness properties of CD44v6+ cells is promoted by the Met/cjun/Nanog signaling pathway. And the cjun is binding in 1700bp before the transcription start site of Nanog. KEYWORDS：Hepatocellular Carcinoma, Cancer Stem Cells, HGF/MET, CD44v6, cjun more...

Background: Whether probiotics helped the Helicobacter pylori (H. pylori) eradication was still highly controversial. The non-bacterial Saccharomyces boulardii (S. boulardii) has demonstrated its efficacy in the treatment of antibiotic-associated and infectious diarrhea. We aimed to evaluate the effects of S. boulardii combined with quadruple therapy for H. pylori eradication and associated side effects.Methods: Three hundred and sixty H. pylori-infected patients were recruited in this multicenter, randomized controlled trial. The patients who underwent H. pylori eradication treatment were randomized in a ratio of 1:1 into two separate groups that received standard quadruple therapy (Group A) and quadruple therapy plus S. boulardii sachets (Group B) for 14 days. The everyday medication and side-effect records were collected for compliance and adverse effect analysis. All patients accepted 13C/14C-urea breath tests 4 weeks after the therapy completion.Results:Saccharomyces boulardii and quadruple therapy-combined intervention significantly reduced the incidences of overall side effects (27.8 vs. 38.5%, p = 0.034) and diarrhea (11.2 vs. 21.2%, p = 0.012) in Group B compared with quadruple therapy alone in Group A, especially reduced the diarrhea duration (5.0 days vs. 7.7 days, p = 0.032) and incidence of severe diarrhea (4.7 vs. 10.1%, p = 0.040). Intention-to-treat (ITT) analysis and per-protocol (PP) analysis both indicated no statistical differences of eradication rate between Groups A and B (ITT: 82.7 vs. 85.8%, p = 0.426; PP: 89.7 vs. 94.2%, p = 0.146). The joint use of S. boulardii and quadruple therapy markedly improved the overall pre-eradication alimentary symptoms (hazard ratio (HR): 2.507, 95% CI: 1.449–4.338) recovery.Conclusion:Saccharomyces boulardii ameliorated H. pylori eradication-induced antibiotic-associated side effects especially reduced the incidence of severe diarrhea and the duration of diarrhea. However, there was no significant effect of S. boulardii on the rate of H. pylori eradication.Trial Registration: The protocol had retrospectively registered at ClinicalTrails.gov, Unique identifier: NCT03688828, date of registration: September 27, 2018; https://clinicaltrials.gov/show/NCT03688828 more...

Purpose: Because many hepatocellular carcinoma (HCC) cases develop from fibrotic or cirrhotic livers, fibroblasts are abundant in the microenvironment of HCC. Although the contribution of cancer-associated fibroblasts (CAFs) to the progression of HCC is well established, the role of fibroblasts has not been comprehensively revealed. Patients and methods: The RayBio Human Cytokine Antibody Array was used to elucidate the role of peri-tumor fibroblasts (PTFs) in promoting malignant properties of HCC. IL-6 and STAT3 signaling were inhibited in both HCC cell lines and non-tumor L-02 liver cells to further determine its role in the progression of HCC. Moreover, the expression of IL-6 and pTyr705 STAT3 was detected in HCC samples and peri-tumor liver tissues by immunohistochemical staining. Results: PTFs not only promoted the proliferation, invasion, and metastasis of liver cancer cells, but also stimulated the permanent malignant transformation of human non-tumor L-02 liver cells, resulting in hepatocarcinogenesis in vivo. The RayBio Human Cytokine Antibody Array indicated that PTFs secreted a higher level of soluble IL-6 than CAFs. IL-6 derived from PTFs greatly activated STAT3 Tyr705 phosphorylation in both non-tumor L-02 cells and HCC cells. IL-6-neutralizing antibody and STAT3 Tyr705 phosphorylation inhibitor, cryptotanshinone, largely abolished the positive effects of PTFs on HCC carcinogenesis and progression. Moreover, high expression of pTyr705 STAT3 in peri-tumor tissues was significantly correlated with tumor recurrence rate after three years in a postsurgical follow-up with patients with HCC. Conclusion: These results indicated that PTFs induce carcinogenesis and development of HCC via IL-6 and STAT3 signaling. more...

Background: Due to the lack of effective interference options, early metastasis remains a major cause of pancreatic ductal adenocarcinoma (PDAC) recurrence and mortality. However, the molecular mechanism of early metastasis is largely unknown. We characterize the function of eukaryotic translation initiation factors (eIFs) in Pancreatic cancer cell epithelial mesenchymal-transition (EMT) and metastasis, to investigate whether it is effective to inhibit EMT and metastasis by joint interference of eIFs and downstream c-MYC. Methods: We used the data of The Cancer Genome Atlas (TCGA) and Genome Tissue Expression (GTEx) to analyze the expression level of eIF4A1 in PDAC tissues, and further validated in a microarray containing 53 PDAC samples. Expression regulation and pharmacological inhibition of eIF4A1/c-MYC was performed to determine their role in migration, invasion, and metastasis in pancreatic cancer cells in vitro and in vivo.Results: Elevated expression of eIF4A1 was positively correlated with lymph node infiltration, tumor size, and indicated a poor prognosis. eIF4A1 decreased E-cadherin expression through c-MYC/miR-9 axis. Ablation of eIF4A1 and c-MYC decreased the EMT and metastasis capabilities of pancreatic cancer cells. Upregulation of eIF4A1 could attenuate the inhibition of EMT and metastasis induced by c-MYC downregulation. Single-use of eIF4A1 inhibitor Rocaglamide (RocA) or c-MYC inhibitor Mycro3 and joint intervention all significantly the EMT level of pancreatic cancer cells in vitro. However, the efficiency and safety of RocA single-use were not inferior to joint use in vivo. Conclusion: The results demonstrated that overexpression of eIF4A1 downregulated E-cadherin through c-MYC/miR-9 axis, which promoted EMT and metastasis of pancreatic cancer cells. Despite the potential loop between eIF4A1 and c-MYC existing, RocA single strategy was a promising therapy for the inhibition of eIF4A1 induced PDAC metastasis. more...

Background The optimal sampling techniques for endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) remain unclear and have not been standardized. The aim of this study was to compare the wet-suction and dry-suction techniques for sampling solid lesions in the pancreas, mediastinum, and abdomen. Methods This was a multicenter, crossover, randomized controlled trial with randomized order of sampling techniques. The 296 consecutive patients underwent EUS-FNA with 22G needles and were randomized in a ratio of 1:1 into two separate groups that received the dry-suction and wet-suction techniques in a different order. The primary outcome was to compare the histological diagnostic accuracy of dry suction and wet suction for malignancy. The secondary outcomes were to compare the cytological diagnostic accuracy and specimen quality. Results Among the 269 patients with pancreatic (n = 161) and non-pancreatic (n = 108) lesions analyzed, the wet-suction technique had a significantly better histological diagnostic accuracy (84.9 % [95 % confidence interval (CI) 79.9 % – 89.0 %] vs. 73.2 % [95 %CI 67.1 % – 78.7 %]; P = 0.001), higher specimen adequacy (94.8 % vs. 78.8 %; P Conclusions The wet-suction technique in EUS-FNA generates better histological diagnostic accuracy and specimen quality than the dry-suction technique. Furthermore, sampling non-pancreatic lesions with two passes of EUS-FNA with wet suction may provide a definitive histological diagnosis when rapid on-site evaluation is not routinely available. more...

Cancer stem cells (CSCs), which support tumor progress in hepatocellular carcinoma (HCC) developed in fibrotic or cirrhotic livers, are regulated by the tumor microenvironment. Cancer-associated fibroblasts (CAFs) are the major component of the tumor stroma in HCC; however, the mechanisms by which CAFs contribute to stemness maintenance remain largely unknown. Here, we found that the expression of CD24 was high in HCC tissues compared with adjacent normal liver tissues, and positively correlated with the poor prognosis and α-SMA expression in CAFs. CD24+ cells isolated from HCC cell lines exhibited stemness properties of self-renewal, chemotherapy resistance, metastasis, and tumorigenicity in NOD/SCID mice. Moreover, CAF-derived HGF and IL6 enhanced the stemness properties of CD24+ cells via activating STAT3 Tyr705 phosphorylation. Blockade of HGF/c-Met or IL6/IL6R signaling significantly abolished the effect of CAFs on stemness properties, which compromised the activation of STAT3 pathway in CD24+ cells. Meanwhile, knockdown of STAT3 in CD24+ cells notably attenuated CAF-induced stemness characteristics of CD24+ cells. Furthermore, in HCC patients, higher expression of phospho-STAT3 was also demonstrated to be positively correlated with poor clinical outcomes. In summary, HGF and IL6 secreted by CAFs promoted the stemness properties of CD24+ cells through the phosphorylation of STAT3 signaling, and targeting the paracrine pathways may provide a new therapeutic strategy for HCC. KEY MESSAGES: CD24, identified as a marker for HCC CSCs, was positively correlated with the poor prognosis and α-SMA expression in CAFs. CAFs promoted self-renewal, chemotherapy resistance, metastasis, and tumorigenicity of CD24+ HCC cells. HGF and IL6 secreted by CAFs promoted the stemness properties of CD24+ HCC cells through the phosphorylation of STAT3. more...

The ability of carbohydrate antigen 19-9 (CA19-9) to differentiate pancreatic cancer from other benign pancreatic lesions is unsatisfactory. This study explored the diagnostic value of KRAS gene mutations and plasma circulating tumor DNA (ctDNA) in patients with pancreatic cancer.The prospective cohort study comprised 149 consecutive patients with solid pancreatic lesions who underwent endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). KRAS subtype mutations were analyzed by digital droplet PCR (ddPCR) in EUS-FNA histopathology tissue samples, and blood samples were sent for plasma ctDNA analysis. The final diagnosis was based on surgical resection pathology or follow-up for at least 2 years.Adding KRAS mutation ddPCR increased the sensitivity and accuracy of EUS-FNA from 71.4% to 91.6% (P0.001) and 75.8% to 88.6% (P0.001), respectively. By comparison, the sensitivities of circulating biomarkers ctDNA and CA19-9 were only 35.2% and 71.2%. The area under the curve of the receiver operating characteristic curve (AUC) of EUS-FNA and KRAS ddPCR combination was0.90 for distinguishing pancreatic cancer from benign lesions, whereas the AUC of EUS-FNA and CA19-9 combination was 0.83. The median survival time was significantly shorter in patients with G12D KRAS mutations than that in patients with other mutations (180 vs 240 days, P0.001).FNA tissue sample KRAS mutation analysis in tissues significantly improves the diagnostic accuracy of cyto/histopathological evaluation in EUS-FNA samples. The combination of EUS-FNA and tissue sample KRAS ddPCR provided a more accurate method for pancreatic cancer diagnosis, superior to the combination of EUS-FNA and CA19-9/ctDNA. G12D KRAS mutations in pancreatic cancer were independently associated with poor overall survival. more...

Background Endoscopic ultrasound (EUS)-guided radiofrequency ablation (RFA) is a novel modality in the treatment of solid tumours. The aim of the study is to evaluate the technical feasibility, safety and efficacy of multiple-round EUS-RFA with low ablation power for unresectable pancreatic cancer. Methods We conducted a retrospective analysis of eleven cases with unresectable pancreatic cancer who underwent EUS-RFA between November 2013 and November 2018. For each lesion, RITA 1500X radiofrequency generator was used to deliver 5-10 watts ablation power for 90 seconds, repeatedly. Eight cases underwent the same procedure one week later. Additionally, one patient with the lesion size of 29.7 mm underwent 8 total sessions of RFA every other week. Results The procedure was successful in all cases and no major adverse events were observed. The post procedure imaging studies and serum CA19-9 level were performed 1 month after procedure, showing two patients had decreased lesion sizes and five patients had decreased serum CA19-9 level. Follow-up duration ranged 2 to 12 months. The patient who underwent 8 total sessions of RFA survived 12 months after followup and showed increased tumour apparent diffusion coefficient (ADC) value and 20% ablated area inside the tumour. Conclusions A multiple-round ablation with optimal RFA energy could be a technically feasible, safe and short-term efficacy option for those patients with unresectable pancreatic cancer. more...

BACKGROUND: Cancer stemness contributes to hepatocellular carcinoma (HCC) initiation, metastasis, drug resistance, and recurrence. The spindle and kinetochore-associated (SKA) complex has been shown to be involved in tumor progression; however, its effects on cancer stem cell-like properties have not yet been examined. This research sought to study each subunit of the SKA complex in HCC systematically. METHODS: Bioinformatic analyses were carried out to examine the expression and clinical data of the SKA complex’s each subunit in HCC. The expression of the target genes was detected by quantitative reverse transcription-polymerase chain reaction and Western blot assays. Clone formation and Transwell assays were performed to assess the proliferation and migration abilities of the SKA complex’s each subunit. Sphere formation assays and subcutaneous xenograft experiments were performed to investigate the effects of SKA complex subunit 3 (SKA3) on the self-renewal and tumorigenic abilities of HCC. RESULTS: Each subunit of the SKA complex was highly expressed in HCC, but only SKA complex subunit 1 (SKA1) and SKA3 were associated with the poor overall survival of HCC patients. Additionally, the HCC cells overexpressing SKA3 exhibited increased migration, invasion, proliferation, self-renewal, Sorafenib resistance and tumorigenic abilities. Notch signaling played a vital role in the process by which SKA3 promoted HCC stemness. CONCLUSIONS: SKA3 promotes HCC stem cell-like properties via the Notch signaling pathway. As SKA3 appears to act as a regulator of stemness in HCC, it might be a potential molecular target for HCC. more...

Cholangiocarcinoma (CCA) is the second most common type of primary malignancy of the liver. Certain long non-coding RNAs (lncRNAs) have been demonstrated to have key roles in tumor pathogenesis by binding to microRNAs (miRNAs). However, the competing endogenous RNA (ceRNA) network of CCA remains to be fully determined. In the present study, the RNA expression profiles for CCA were downloaded from The Cancer Genome Atlas and further analyzed. A total of 318 differentially expressed (DE) lncRNAs, 87 DE miRNAs and 3,851 DE mRNAs were identified from 36 CCA samples and 9 adjacent non-tumor samples (for lncRNAs and miRNAs, fold change ≥2.5 and P more...

Additional file 3: Figure S5 A. Western blot showed that the expression of Numb had no significant difference when MSI2 was down-regulated in CD44v6+ cells or up-regulated in CD44v6- cells. B. Significantly differential expression genes (fold change ≥2, p≤0.05) between MSI2 shRNA 1 group and control group. Blue histogram represented down-regulated genes and the red represented up-regulated genes in the MSI2 shRNA 1 group compared to the control group. C. Western blot showed that overexpression of LFNG in CD44v6- HCC cells increased the expression of key components of Notch1 pathway (including Notch1, NICD, Hey1 and Hes1) but MSI2 had no significant change. β-actin was used as a normalized control. D. Western blot showed that the activation of Notch1 signaling caused by MSI2 overexpression could be inhibited by LFNG silencing in CD44v6- cells. E. LFNG protein levels in LFNG shRNA cells compared with corresponding control cells. β-actin was used as a normalized control. Figure S6 The result of positive control (SNRNP70) and negative control (U1) of RIP assays. more...

Background: The optimal sampling techniques for endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) remain unclear and have not been standardized. The aim of the study was to compare modified wet suction technique (MWST) and dry suction technique (DRST) for sampling the solid lesions in the pancreas, mediastinum, and abdomen. Methods: We performed a randomised controlled trial at four tertiary care centers in China. Consecutive patients with solid lesions referred for EUS-FNA were randomised in a ratio of 1:1 to receive either DRST or MWST as the first pass. For Group A, the pass sequence was DRST - MWST - DRST - MWST versus MWST - DRST - MWST - DRST for Group B. The outcome measures were the diagnostic yield and specimen quality. Findings: Between May 2016 and January 2018, 364 patients were screened for eligibility. 296 patients were recruited, 269 of whom (134 in Group A versus 135 in Group B) completed the trial. We demonstrated that the MWST group had a significantly better overall histological diagnostic accuracy (84·85%) than DRST group (73·19%, P =0·0013) for all solid lesions (n=269). In subgroup analysis, the MWST group reached a 91·59% histological diagnostic accuracy for non-pancreatic lesions (n=108). Furthermore, the MWST provided better specimen adequacy and less blood contamination than DRST. Interpretation: In this prospective study of sampling solid masses, we found that using MWST resulted in significantly better histological diagnostic accuracy and specimen quality than DRST. For many institutions where rapid on-site evaluation is not routinely available, the MWST within 2 passes of FNA reached a definitive histological diagnosis with no requirement of fine needle biopsy. Trial Registration: The study is registered on ClinicalTrials.gov (NCT02789371) and is completed. Funding Statement: National Natural Science Foundation of China. Declaration of Interests: All authors have declared that no competing interests exist. Ethics Approval Statement: The study was approved by the institutional review boards of all participating centers. Patients provided informed consent for participation in the study. more...

Background: Liver cancer stem cells (LCSCs) contribute to hepatocellular carcinoma (HCC) development, metastasis, and drug resistance. MSI2 and Notch1 signaling are involved in the promotion and maintenance of CSCs. However, it is ambiguous if they are involved in the maintenance of CD44v6+ LCSCs. Therefore, we investigate the clinical significance and mechanism of MSI2 in the maintenance of stemness properties of CD44v6+ LCSCs. Methods: The expression and correlation of MSI2 and CD44v6 were analyzed by a tissue microarray containing 88 HCC samples. CD44v6+/- cells were isolated using microbeads sorting. We explored the roles of MSI2 and Notch1 signaling in CD44v6+ LCSCs by sphere formation assay, transwell assay, clone formation assay in vitro, and xenograft tumor models in vivo. A Notch RT² PCR Array, Co-immunoprecipitation, and RNA-immunoprecipitation were used to further investigate the molecular mechanism of MSI2 in activating Notch1 signaling. Findings: MSI2 was positively correlated with CD44v6, highly expressed in HCC tissues, and correlated with tumor differentiation and lymph node metastasis. Furthermore, MSI2 and Notch1 signaling pathway were elevated in sorted CD44v6+ cells than CD44v6- cells and played essential roles in the maintenance of self-renewal, invasion and tumorigenic capacity of CD44v6+ LCSCs. Mechanically, MSI2 could directly bind to Lunatic fringe (LFNG) mRNA and protein, and increase the stability of LFNG resulting in activating Notch1 signaling pathway. Interpretation: Our results demonstrated that MSI2 maintained the stemness of CD44v6+ LCSCs by activating Notch1 signaling pathway through LFNG. MSI2 could probably be a potential molecular target for stem cell-targeted therapy of HCC. Funding: This work was supported by the National Natural Science Foundation of China (81172063, 81372352 and 81802418). Funders had no influence on study design, data collection, data analysis, interpretation, writing of the report. Funding Statement: This work was supported by the National Natural Science Foundation of China (81172063, 81372352 and 81802418). Funders had no influence on study design, data collection, data analysis, interpretation, writing of the report. Declarations of Interests: The authors declare no conflict of interest. Ethics Approval Statement: This project was approved by the ethics committee of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST, Wuhan, China). more...

Background Mediastinal cystic lesions account for approximately 15–20% of all mediastinal masses and are difficult to differentiate because of similar imaging manifestation. The aim of this study was to differentiate mediastinum cystic lesions through endoscopic ultrasound‐guided‐fine needle aspiration (EUS‐FNA) and parameters from cyst‐fluid analysis. Methods Over a period of eight years, 37 patients suspected with mediastinal cystic lesions were assessed. Cyst fluid was collected via EUS‐FNA and further examined using cytological and biochemical techniques. Definitive diagnosis was established based on cytology, surgical pathology, and/or clinical follow‐up. Results Based on the final pathological reports or long‐term follow‐up, 19 patients were diagnosed with benign cysts, 14 with benign or malignant tumors, 2 with tuberculosis, 1 with an abscess, and 1 with a pancreatic pseudocyst. Computed tomography or magnetic resonance imaging mistakenly distinguished eight cases as solid masses (27.03%), but EUS revealed cystic characteristics. Carcinoembryonic antigen and lactate dehydrogenase (LDH) were evaluated from the cyst fluid obtained by EUS‐FNA. There was no statistically significant difference in carcinoembryonic antigen values between benign and malignant cysts; however the average LDH value in the malignancy group was significantly higher than in the benign group. Conclusion EUS‐FNA showed great potential for differentiating mediastinal lesions by combining imaging manifestation and cytological examination. The elevated LDH value from cyst fluid chemical analysis could be used as an auxiliary indicator for diagnosing malignancy. more...

Cancer stem cells (CSCs), which support tumor progress in hepatocellular carcinoma (HCC) developed in fibrotic or cirrhotic livers, are regulated by the tumor microenvironment. Cancer-associated fibroblasts (CAFs) are the major component of the tumor stroma in HCC; however, the mechanisms by which CAFs contribute to stemness maintenance remain largely unknown. Here, we found that the expression of CD24 was high in HCC tissues compared with adjacent normal liver tissues, and positively correlated with the poor prognosis and α-SMA expression in CAFs. CD24 more...

Using a cross-sectional survey design from 11 public tertiary hospitals (a specialist hospital, four Chinese medicine hospitals, and six general hospitals) in the urban areas of Heilongjiang, we determined the nature of workplace violence that medical staff have encountered in Chinese hospitals and identified factors associated with those experiences of violence. A total of 1129 health workers participated. The specialist hospital had the highest prevalence of physical violence (35.4%), while the general hospitals had the highest prevalence of non-physical violence (76%). Inexperienced medical staff (p &lt, 0.001) were more likely to suffer non-physical violence than physical violence in Chinese medicine hospitals compared to experienced staff. Medical units (p = 0.001) had a high risk of non-physical violence, while surgical units (p = 0.005) had a high risk of physical violence. In general hospitals, staff with higher levels of anxiety about workplace violence were more vulnerable to both physical violence (1.67, 95% CI 1.36–2.10) and non-physical violence (1.309, 95% CI 1.136–1.508) compared to those with lower levels of anxiety, while rotating shift workers had a higher odds of physical violence (2.2, 95% CI 1.21–4.17) and non-physical violence (1.65, 95% CI 1.13–2.41) compared to fixed day shift workers. Thus, prevention should focus not only on high-risk sections of hospitals, but also on the nature of the hospital itself. more...

Workplace violence in Chinese township hospitals is a major public health problem. We identified the risk factors of healthcare workers' worry about experiencing workplace violence in 90 Chinese township hospitals and determined specific measures for differing stages of violence (based on crisis management theory). Participants were 440 general practitioners and 398 general nurses from Heilongjiang Province, China (response rate 84.6%). One hundred and six (12.6%) respondents reported being physically attacked in their workplace in the previous 12 months. Regarding psychological violence, the most common type reported was verbal abuse (46.0%). While most (85.2%) respondents had some degree of worry about suffering violence, 22.1% were worried or very worried. Ordinal regression analysis revealed that being ≤35 years of age, having a lower educational level, having less work experience, and working night shifts were all associated with worry about workplace violence. Furthermore, those without experience of such violence were more likely to worry about it. Respondents' suggested measures for controlling violence included "widening channels on medical dispute solutions," "improving doctor-patient communication," and "advocating for respect for medical workers via the media." Results suggest the target factors for reducing healthcare workers' worry by according to the type of education and training and possible measures for limiting workplace violence in township hospitals. more...