County Hospital

Introduction: This study aims to investigate the access to leadership development opportunities among European psychiatric trainees and early career psychiatrists (ECPs) and their perceptions and needs related to leadership skills training.

Circular RNAs (circRNAs) emerged as promising non-invasive cancer biomarkers due to their stability, abundance in body fluids, and regulatory potential. However, circRNA differential expression analysis (DEA) remains challenging, largely owing to lack of consensus on important preprocessing strategies such as filtering and normalization. While well-established bulk RNA-sequencing frameworks are commonly applied to circRNA data, newer approaches such as CIRI-DE (part of CIRI3 suite) integrate both linear and circular transcript information to improve detection. Despite developments, an assessment of these integrative strategies is lacking, and the critical impact of filtering on DEA model performance has not been comprehensively evaluated. Results: In this study, we evaluated the impact of multiple normalization and filtering strategies on circRNA DEA using five experimental datasets, including two in-house blood platelet sets and semi-parametric simulated in silico datasets. Our results emphasize the importance of selecting an appropriate filtering threshold, as overly lenient filtering substantially reduced model performance across datasets. We found edgeR's filterByExpr() strategy particularly effective in handling zero counts in circRNA data, while also generating the most reliable results across most datasets. Furthermore, by incorporating linear and circular information as described in CIRI-DE, most methods identified a higher number of differentially expressed (DE) circRNAs compared to circular counts alone. Notably, circRNAs identified by both CIRI-DE and the modified bulk RNA-sequencing pipelines showed substantial overlap. Conclusion: Our findings demonstrate that automated filtering combined with linear-aware normalization significantly enhances the sensitivity and reproducibility of circRNA DEA, providing a standardized framework for more reliable biomarker discovery in transcriptomic research.

This study aims to analyze the risk factors for wound infection in patients after burn plastic surgery and explore corresponding intervention measures to provide evidence for reducing infection rates in clinical practice. A retrospective study was conducted on 320 patients who underwent burn plastic surgery at SanTai County People’s Hospital from January 2022 to December 2023. Patients were divided into an infection group (86 cases) and a noninfection group (234 cases) based on the occurrence of wound infection postoperatively. Data on age, gender, comorbidities (e.g., diabetes, hypertension), burn type, burn area and depth, surgical duration, antibiotic use, postoperative wound healing status, nutritional status, and lifestyle habits were collected and compared between the 2 groups. Univariate analysis was initially used to screen variables associated with infection, followed by a multivariate logistic regression model to identify independent risk factors for wound infection. The overall infection rate was 26.88%. Univariate analysis indicated that diabetes, surgery duration ≥ 200 minutes, third-degree burns, burn area ≥ 40%, use of 2 or more antibiotics, residual wound presence postoperatively, and malnutrition were significantly different between the 2 groups (P < .05). Multivariate analysis further confirmed that the aforementioned factors were independent risk factors for wound infection after burn plastic surgery, with OR values of 3.571, 2.759, 7.092, 6.775, 3.287, 6.125, and 3.229, respectively, all of which were statistically significant (P < .05). The occurrence of postoperative wound infection is closely associated with multiple factors, particularly diabetes, prolonged surgery duration, deep II–III degree burns, extensive tissue damage, use of multiple antibiotics, incomplete wound healing postoperatively, and malnutrition. Comprehensive perioperative assessment and intervention should be strengthened, and individualized preventive strategies targeting high-risk factors should be developed to reduce infection risk and promote wound healing.

BackgroundIntertrochanteric fractures in older adults are associated with substantial blood loss, but the optimal tranexamic acid (TXA) regimen remains unclear. Most hip fracture studies have evaluated single-route intravenous TXA versus placebo, with limited data on combined regimens, particularly in the very old.MethodsWe conducted a multicentre retrospective cohort study of patients aged ≥65 years with intertrochanteric fractures who underwent closed reduction and intramedullary nailing at four hospitals. Patients were classified into four groups by intraoperative TXA regimen: combined intravenous plus topical, intravenous only, topical only, or no TXA. Inverse probability weighting was used to address confounding and between-group imbalances. The primary outcome was total blood loss; intraoperative and hidden blood loss were also assessed. Secondary outcomes included transfusion status and volume and 90 day complications. Prespecified age strata (65–74, 75–84, and ≥85 years) were analysed for total blood loss and transfusion rate, and treatment-by-age interaction terms tested age-related differences in treatment effects.ResultsWe included 1,228 patients; weighting achieved good baseline balance between treatment groups. All TXA regimens significantly reduced total blood loss compared with no TXA, with the largest reduction in the intravenous-plus-topical group, which had the lowest transfusion rate and volume. TXA was not associated with higher rates of thrombotic events or other major complications, and postoperative length of stay was shorter in the intravenous-plus-topical and topical-only groups than in controls. Age-stratified analyses showed a significant treatment-by-age interaction for total blood loss; TXA reduced blood loss across all age strata, and its transfusion-sparing effect did not diminish with age.ConclusionIn older adults undergoing intramedullary fixation for intertrochanteric fractures, TXA reduces blood loss without increasing complications, with greatest benefit from combined intravenous plus topical use. These findings support TXA as a key component of perioperative blood management in this population.

BackgroundDecidualization deficiency is a key pathological feature of pre-eclampsia (PE) and is closely associated with aberrant regulation of cell fate. PANoptosis is a recently characterized form of inflammatory programmed cell death that has been implicated in several pregnancy-related disorders. However, its potential involvement in decidualization deficiency in PE remains poorly understood. This study aimed to explore the association between PANoptosis-related genes and decidualization deficiency in PE, and to identify candidate biomarkers and potential therapeutic targets related to PANoptosis.MethodsDatasets containing decidual tissue samples derived from women with PE and normal controls were acquired in the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) were identified and subjected to enrichment analysis. After that, PANoptosis-related genes were intersected with DEGs derived from the decidual tissue of PE, followed by protein–protein interaction (PPI) network construction and correlation analysis. Next, the immune infiltration landscape and its association with PANoptosis-related DEGs were assessed. Furthermore, three machine learning algorithms, including support vector machine-recursive feature elimination (SVM-RFE), the least absolute shrinkage and selection operator (LASSO), and the random forest (RF) algorithms, were adopted to identify potential diagnostic biomarkers for PE. Artificial neural network (ANN) and nomogram models were then constructed and evaluated in testing datasets, which included decidual stromal cell samples derived from women with PE and normal controls. Additionally, the expression of PANoptosis-related signature genes and decidualization-related markers was experimentally validated in primary human decidual stromal cells (HDSCs) derived from PE patients and healthy controls. In addition, consensus clustering analysis was conducted on the basis of signature genes, and immune infiltration landscape analysis of different subtypes of PE was performed. Ultimately, the candidate compounds targeting the signature genes were screened and then further verified in vivo and in vitro models.Results430 DEGs were determined, and enrichment analysis indicated that these DEGs were mainly involved in inflammation, apoptosis, and dysfunction of decidual tissue in PE. Then, 10 PANoptosis-related DEGs in PE were further screened. Following that, immune landscape analysis revealed an aberrant abundance of various immunocytes and the levels of immune checkpoints in the decidual tissue of PE, which were closely associated with the PANoptosis-related DEGs. Next, through machine learning, nine PANoptosis-related signature genes (MAPK3, RIPK1, RIPK3, PYCARD, BAX, TUG1, CDK1, MAPK1, and TAB2) were identified with favorable predictive performance. Besides, the ANN and nomogram models were constructed, and demonstrated high discriminative ability in the training dataset (AUC = 0.999, 95% CI: 0.995–1.000). Consistently, validation in primary HDSCs derived from PE patients and healthy controls confirmed dysregulated expression of these signature genes, accompanied by reduced decidualization markers (PRL, IGFBP1). Furthermore, on the basis of the analysis of nine signature genes, two different subtypes of PE were acquired, in which subtype B showed an immune hyperactivity state compared to subtype A. Furthermore, melatonin was identified as a candidate compound targeting PANoptosis-related genes and showed protective effects in vivo and in vitro, including improved blood pressure, reduced proteinuria, partial restoration of decidualization markers (PRL, IGFBP1, and F-actin), and declined expressions of PANoptosis-related signature genes (BAX, MAPK1, and MAPK3). Importantly, functional experiments demonstrated that MAPK3 knockdown markedly attenuated PANoptosis-associated inflammatory cytokine production, reduced BAX expression, and partially restored F-actin organization and decidualization markers under PANoptosis-inducing conditions.ConclusionThis study suggests a potential association between PANoptosis-related molecular dysregulation and decidualization deficiency in PE. The identified PANoptosis-related signature genes may serve as candidate biomarkers with predictive relevance, and melatonin may represent a potential therapeutic candidate targeting PANoptosis-related pathways. These findings provide a foundation for future mechanistic and translational studies on PE.

THEMIS2, a protein that plays a role in immune regulation, has recently been identified as a key factor in breast cancer progression. This study aimed to identify novel oncogenic regulators in circulating tumor cells (CTCs) that contribute to breast cancer metastasis and chemoresistance, elucidating the regulatory axis involving THEMIS2, VEGFR2 and microRNAs (miRNAs), specifically miR-125b-5p. Using RNA-sequencing of breast cancer CTCs, THEMIS2 was identified as a significantly upregulated gene. miRNA target predictions and expression profiling in primary tumors and normal breast specimens were conducted to evaluate candidate regulators. Functional assays including sphere formation, migration, luciferase reporter activity, VEGFR phosphorylation analysis and in vivo tumor models were employed to investigate the roles of THEMIS2 and miR-125b-5p in metastasis and drug sensitivity. THEMIS2 was found upregulated in CTCs and breast cancer cell lines with metastatic potential. miR-125b-5p, but not miR-125a-5p, was significantly down-regulated in metastatic models and identified as a direct post-transcriptional suppressor of THEMIS2. THEMIS2 enhanced VEGFR2 phosphorylation and promoted metastatic traits and resistance to docetaxel and bevacizumab. miR-125b-5p suppressed metastasis and restored chemosensitivity by targeting 3'UTR of THEMIS2, an effect reversible with anti-miR-125b or ectopic THEMIS2 expression. We unraveled a novel miR-125b-5p-THEMIS2-VEGFR2 signaling axis as a key modulator of breast cancer metastasis and chemoresistance. These findings provide mechanistic insight and suggest that miR-125b-5p or THEMIS2 may serve as therapeutic targets or prognostic biomarkers in aggressive breast cancers.