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Should the methodological tools and review protocols required of biomedical researchers become the default for social science meta-researchers? And should these reporoducibility standards then be used to gatekeep and police "methodological expertise?" This seems to be the judgmental sub-text of the Bakker et al commentary on our paper. In this response, we make the case for critical accountability research to cultivate forms of methodological rigor that are aligned with the research questions and design. Our paper, based on a systematic topographical review of research into retraction, sought to show the limits of the existing research base. Our survey highlighted how most existing work was quantitative, rarely interview-based, and often failed to explore why journals and publishers were so slow to retract. There is too little attention to the politics, economics, and sociology of research integrity.
Patients with refractory post-traumatic shoulder periarthritis(PTSP) have markedly reduced quality of life owing to persistent pain and functional restrictions. Thus, exploring a safe, effective treatment regimen is essential. This study compared the efficacy and safety of TAE plus early rehabilitation versus rehabilitation alone for conservatively refractory post-traumatic shoulder periarthritis. This study enrolled patients with conservatively refractory post-traumatic shoulder periarthritis admitted between September 2023 and January 2025. Using 1:1 propensity score matching, 60 patients were selected and divided into two groups: the control group (n = 30) received 12 weeks of structured rehabilitation, while the study group (n = 30) received TAE and the same systematic rehabilitation training for 12 weeks from the second day after TAE. Primary outcomes included nocturnal pain (NRS) and Constant-Murley scores; secondary measures were active ROM (forward flexion, external rotation), EQ-5D index, periarticular effusion on MRI, and adverse events. After PSM, the baseline data of the two groups were balanced and comparable (P > 0.05). At all postoperative time points, the study group had notably greater improvements in all indicators than the control group (P < 0.05). At 6 months, its NRS score dropped to 1.8 ± 1.2, significantly lower than the control group's 4.5 ± 1.8 (P < 0.001); Constant-Murley score rose to 86.3 ± 8.7, much higher than the control's 69.8 ± 11.4 (P < 0.001). Forward flexion/external rotation ROM reached 148° ± 18°/75.0° ± 10.3°,significantly better than the control's 132.5° ± 20.1°/62.0° ± 9.8° (P < 0.001); EQ-5D index hit 0.82 ± 0.12, higher than the control's 0.65 ± 0.14 (P < 0.001).MRI showed 89.8% of the study group had effusion reduction/disappearance, versus 52.3% in the control (P < 0.001). No serious adverse events occurred. In this exploratory retrospective study, TAE plus early systematic rehabilitation was associated with greater pain relief, improved joint function, and better quality of life compared with rehabilitation alone. These findings are hypothesis-generating and require confirmation in prospective studies.
Preoperative distinction between uncomplicated and complicated appendicitis is important when treatment pathways diverge, including non-operative management for adults. Several adult prediction models exist, but validation remains limited. We performed a single-centre validation study using a dataset from Nhan Dan Gia Dinh Hospital. Adults undergoing appendectomy after contrast-enhanced computed tomography were included. Complicated appendicitis was the primary outcome. Atema 2015, the Appendicitis Severity Index and Mori 2024 were prespecified for formal external validation. Because the pain score was unavailable, SAS 2.0 was not formally validated; instead, a modified SAS 2.0 using a surrogate abdominal examination variable was explored. Discrimination was assessed with area under the receiver operating characteristic curve, and threshold metrics at cut-offs. The cohort comprised 496 adults; 200 (40.3%) had complicated appendicitis. Mori 2024 showed the highest discrimination (area under the receiver operating characteristic curve 0.783, 95% confidence interval: 0.741-0.826), followed by Atema 2015 (0.760, 0.715-0.804) and the Appendicitis Severity Index (0.731, 0.686-0.776). Mori outperformed the Appendicitis Severity Index (p = 0.0146). At published cut-offs, sensitivity/specificity were 51.6%/89.7% for Atema, 22.0%/98.6% for the Appendicitis Severity Index and 75.0%/65.4% for Mori. In 474 complete cases, modified SAS 2.0 achieved an apparent area under the receiver operating characteristic curve of 0.850 and optimism-corrected area under the curve of 0.833. In this restricted-spectrum cohort, Mori performed best among the formal models, whereas the Appendicitis Severity Index was most specific but poorly sensitive. None of the formal models should be used alone to exclude complicated appendicitis in this setting.
Porcine reproductive and respiratory syndrome (PRRS) remains one of the most significant health and welfare challenges in global pig production. The disease is associated with substantial economic losses, impaired herd health, increased antimicrobial use, and ongoing animal welfare concerns. Despite widespread implementation of vaccination, biosecurity, and herd stabilization strategies, PRRS continues to persist endemically in many production systems, highlighting the need for additional disease-control approaches. Recent advances in genome editing have enabled the development of host-directed resistance strategies in pigs. In particular, targeted editing of the scavenger receptor CD163, a key host factor required for PRRS virus entry into macrophages, using CRISPR-Cas9 has demonstrated resistance to several PRRSV strains in experimental models. Deletion of the SRCR5 domain of CD163 prevents viral infection while largely preserving normal receptor function, representing a more targeted approach compared with complete gene knockout. Current evidence suggests resistance to both major PRRSV genotypes, although most data derive from controlled experimental studies rather than commercial field conditions. Important considerations remain regarding long-term health and welfare outcomes, immune competence under production environments, ethical considerations surrounding germline genome editing, and differences in regulatory frameworks that may influence adoption. From a pig health management perspective, genome-edited PRRS resistance should be viewed as a complementary strategy rather than a replacement for established control measures such as vaccination, biosecurity, and herd health management. Careful evaluation, veterinary oversight, and coordinated regulatory guidance will be necessary to determine how this technology may be integrated responsibly into future PRRS control programs.
Longitudinal patient-reported outcomes comparing radical prostectomy (RP) and radiation (RT) for localized prostate cancer (CaP) in low- to middle- income countries are limited. We examined the comparative course of depression and anxiety and their association with health related quality of life (HRQOL) in men treated with RP or RT over a year post-treatment. Data from 161 South African (SA) men with CaP were analysed. Depression, Anxiety, HRQOL, and relevant covariates were measured at baseline, 3, 6, 9, and 12 months. We used the following validated scales: Centre for Epidemiologic Studies Depression (CES-D), State Trait Anxiety Inventory (STAI-S), European Organisation for Research and Treatment in Cancer Quality of Life (EORTC QLQ-PR25), Multidimensional Scale of Perceived Social Support (MSPSS), Memorial Anxiety Scale for Prostate Cancer (MAX-PC), Connor-Davidson Resilience Scale (CD-RISC), and Decisional Conflict Scale (DCS). Depressive symptoms (CES-D ≥ 16) remained elevated 12 months post-RP (baseline: 43%; 3-month: 37%; 6-month: 47%; 12-month: 42%), while RT prevalence declined (39% to 29%). Similarly, anxiety (STAI-S ≥ 39) was more prevalent and persistent in the RP group (29% to 23%; 6-month peak: 28%) compared to the RT group (26% to 15%), where scores consistently declined throughout the first year. Overall urinary morbidity was marked in the first six months (β = 11.828; 95% CI: 7.931to 15.73; p < 0.001). More men in the RP group exhibited higher incontinence aids use (β = -21.477; 95% CI: to 33.261 to 9.694; p < 0.001). Sexual function in RP was lower (β = 18.006; 95% CI: 6.881 to 29.131; p = 0.002) with increased sexual activity from month nine onwards (β = -13.203; 95% CI: -23.489 to -2.916; p = 0.012). RT was associated with bowel symptoms in the latter half of follow-up. (4.681; 95% CI: 0.702 to 8.659; p = 0.021). Depression and anxiety adversely affected all HRQOL functional and symptom domains except sexual activity. The high prevalence of depression and anxiety reflects marked psychological morbidity in men treated for CaP in the first year post-treatment. Given the substantial association between psychological impairment and HRQOL, integrating mental health screening, management and referral into uro-oncology protocols is critical.
The development of complex urban societies in Mesopotamia fundamentally shaped human history, yet the genetic dynamics underlying this process remain poorly understood. Here, we sequence DNA from 17 individuals spanning the Bronze and Iron Ages at Bakr Awa, one of northeastern Iraq's largest ancient settlements located at the border between Mesopotamia and Iran. Genome-wide analyses reveal substantial genetic heterogeneity during the Bronze Age, characterized by influences of Anatolian, Levantine, and Caucasus/Yamnaya-related ancestries on the local background - complementing archaeological and textual reconstructions of a diverse ethnolinguistic presence at Bakr Awa. This Bronze Age ancestry heterogeneity marks a notable shift from the local Pre-Pottery Neolithic composition - represented by previously published samples from Bestansur, which possess a close affinity to Neolithic central Zagros-related ancestry. The integration of ancient DNA with stable-isotope analysis of 12 individuals reveals multigenerational dynamics and identifies the Zagros Mountains as the most parsimonious recent origin for one of the Bronze Age individuals with Caucasus/Yamnaya-related ancestry. Following the Late Bronze Age site abandonment, reoccupation during the Iron Age involves integrating the preceding Bronze Age divergent ancestries rather than a process of population replacement. Our findings reveal that heterogeneous ancestries characterize Bronze Age population structure at Bakr Awa, directly mirroring the diverse cultural landscape observed in historical and archaeological sources. Because the subsequent Iron Age transition integrated, rather than replaced, these divergent ancestries, we demonstrate that cultural transitions need not entail large-scale ancestry transformations. Together, these findings capture Mesopotamia's role as a "melting pot" of ancient Near Eastern ethnolinguistic groups.
Z. B. Hu, X. H. Liao, Z. Y. Xu, X. Yang, C. Dong, A. M. Jin and H. Lu, "PLK2 Phosphorylates and Inhibits Enriched TAp73 in Human Osteosarcoma Cells," Cancer Medicine 5, no. 1 (2016): 74-87, https://doi.org/10.1002/cam4.558. The above article, published online on 02 December 2015 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor-in-Chief, Stephen Tait; and John Wiley and Sons Ltd. The retraction has been agreed upon following concerns raised by a third party. An investigation identified the duplication of bands within Figure 3F. Further duplications were observed between panels presented in Figure 8. An additional duplication was observed between the IB TAp73, 15 μg/mL Cis bands shown in Figure 2A and bands presented in another article published elsewhere by some of the same authors. In this case, the duplicate bands are shown to represent different proteins. The authors were contacted for their comments and supporting data but did not respond. The editors consider the results and conclusions to be compromised. The authors did not respond to our notice of retraction.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Secukinumab, an interleukin-17 A inhibitor widely used in psoriasis and related disorders, has been linked to opportunistic infections. Candida infections are a key safety concern, yet their real-world clinical profiles, risk distribution, and onset patterns remain insufficiently characterized. To evaluate the clinical characteristics, severity, onset patterns, and risk factors of Candida infections associated with secukinumab, thereby informing risk stratification and patient management. A retrospective pharmacovigilance analysis was performed using the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) from Q1 2004 to Q1 2025. Secukinumab reports were retrieved, and Candida-related adverse events were identified using a predefined Candida-specific MedDRA Preferred Term dictionary. Disproportionality analyses were conducted using reporting odds ratios (RORs) with 95% confidence intervals (CIs). Event severity, subgroup characteristics, and time-to-onset were assessed, and Weibull shape parameter modeling was used to characterize risk patterns. We identified 1,075 Candida events (0.8% of all secukinumab reports). Oral, esophageal, and vulvovaginal candidiasis predominated. All eight focal PTs showed significant disproportionality, with genital candidiasis yielding the strongest signal (ROR 19.85; 95% CI 12.91-30.53). Over half of events met criteria for serious outcomes. Stronger reporting signals were observed in females and adults aged 18-64 years. Median onset was 2-3 months, and Weibull β < 1 indicated an early-failure pattern, suggesting heightened risk shortly after treatment initiation. Candida infections during secukinumab therapy are uncommon but often severe, particularly in defined high-risk groups. Early onset highlights the importance of vigilant monitoring during initial treatment months. Real-world pharmacovigilance remains essential for optimizing biologic safety. Not applicable.
Burn care frequently relies on extensive documentation, including graphic photographic images and detailed clinical records. While these materials are essential for diagnosis, treatment planning, and research, their use after a patient's death raises complex ethical questions. The emergence of new technologies such as artificial intelligence training, alongside the increased visibility of burn images in education and public health campaigns, challenges traditional notions of confidentiality and consent. This narrative review examines the ethical boundaries of using burn patient records and images post-mortem, with a focus on emerging concerns around digital remains and posthumous consent. A narrative review of peer-reviewed literature, professional guidelines, and position statements published between 2000 and 2025 was conducted. Sources included PubMed, Scopus, and Google Scholar, using search terms such as "burn injuries," "medical photography," "post-mortem consent," "digital remains," and "medical ethics." Relevant publications addressing clinical practice, teaching, research, and social media use in burn care were synthesized to identify key ethical themes and gaps. The literature reveals that while ethical frameworks for consent, privacy, and confidentiality are well established during life, guidance becomes inconsistent once the patient has died. A small but growing body of scholarship identifies posthumous privacy as an emerging domain of bioethics. Across studies, concerns included dignity after death, risks of re-identification on digital platforms, and the absence of explicit patient directives regarding posthumous use of images and data. Current medical guidelines provide minimal direction, leaving ambiguity for clinicians and researchers. The ethical use of burn patient images and records after death remains underexplored, particularly in the context of AI training datasets and social media awareness campaigns. The absence of consensus underscores the need for professional societies to establish clearer policies and protocols that honor patient dignity beyond life. Establishing standards for posthumous consent will help clinicians, educators, and researchers navigate the evolving landscape of digital medicine responsibly.
This study aims to systematically examine global research on digital human resource management (HRM) in healthcare using bibliometric analysis of 61 documents published between 1988 and 2024. This number reflects the emerging and highly specialized nature of digital HRM in healthcare research. VOSviewer software was utilized to map co-authorship networks and keyword co-occurrences and to generate overlay and density visualizations. A threshold-based approach was applied to identify key themes and research patterns across the literature. There has been significant publication growth, especially after 2018, with the United States, United Kingdom, and India emerging as the leading contributors. Results reveal four thematic clusters representing technological, organizational, demographic, and governance perspectives. These insights illuminate underexplored areas, such as leadership integration and equity, which are essential for guiding digital transformation in healthcare workforce management. Healthcare managers and policymakers should prioritize the strategic integration of digital HRM tools into system-level planning. Emphasis should be placed on aligning digital solutions with organizational leadership, workforce development, and public health goals, particularly in resource-constrained settings.
This letter to the editor offers a constructive commentary on a recently published multivariate analysis of predictors of complications in abdominoplasty. The authors commend the original study for its rigorous surgical standardization, consecutive patient enrollment, and single‑surgeon design, and agree that high body mass index and active smoking are independent risk factors, while preservation of Scarpa's fascia appears protective. However, three methodological limitations are identified. First, the sample size and number of events barely meet the minimum recommended events‑per‑variable ratio for multivariate regression. Second, treating seroma, necrosis, and dehiscence as independent outcomes ignores competing risks among these complications, which may bias risk estimates. Third, the single‑center, single‑surgeon design limits external validity, and the finding that diabetes is not a risk factor contradicts some existing literature. The letter suggests that future analyses adopt competing‑risk models and include multicenter external validation. It also notes that no new patient data are provided, so the proposed statistical refinements await empirical verification.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Aim To synthesise epidemiological and clinical evidence on in-flight barodontalgia in professional aircrew.Methods We searched Scopus, PubMed, Web of Science, and Google Scholar for cross-sectional studies of in-flight barodontalgia. Seven studies (2013-2024) met the inclusion criteria. Data were extracted in duplicate, and risk of bias was assessed with the JBI cross-sectional checklist. Given heterogeneity in case definitions, a narrative synthesis (no meta-analysis) was performed.Results Barodontalgia events occurred predominantly during descent (and also on some ascents). Prevalence varied widely across studies (~6% to 55%). Acute dental pain was the leading symptom, sometimes accompanied by headache or transient concentration loss. Overall study quality was moderate.Conclusions In-flight barodontalgia is a relevant occupational health issue for aircrew. Harmonised case definitions and prospective validation of reports are needed. Preventive measures such as routine pre-flight dental check-ups and appropriate return-to-flight restrictions after recent dental treatment (as determined by aeromedical/occupational policy) may help reduce in-flight occurrences.
Systemic cervical cancer management continues to be challenging. Numerous chemotherapies have been approved, but predicting response is difficult due to the lack of biomarkers. Here, we analyze the genetic and protein profiles of 20 cervical cancer cell lines (CCCLs) and explore their correlation with drug response patterns to commonly used drugs, aiming to identify novel biomarkers of treatment response or resistance. Twenty cell lines (CLs) were characterized for HPV type, for genetic alterations, and protein expression profiles. Pharmacoprofiling in 10 selected CLs was carried out against 34 drugs used in the clinic, assessing drug concentrations needed to reach half maximal inhibitory concentration (IC50) in nanomolar and micromolar ranges. Subtractive bioinformatics analyses aimed to identify genetic alterations (609 genes of clinical interest), associated with CL drug resistance or on the contrary with synthetic lethality. Despite a small sample size, genetic alteration frequencies and types of CCCLs were in line with those in clinical samples, except for the detection of a higher frequencyin specific genetic alterations such as NBPF1 and STK11 in CLs. Pharmacological screening identified drugs exhibiting therapeutic activity in most CLs while others were highly selective. Bioinformatics analyses suggested, loss-of-function (LoF) alterations in PAPBC3 in CLs sensitive to microtubule interfering agentsin addition to 50 variably present alterations in the microtubule pathway. LoF alterations in CSMD3, OBSCN, ZNF 717, ALPK2, CLDND1, GTF3A, NLRP1, SI, and TRIM66 were associated with Epigenetic acting drug activity and LoF of OSBPL1A with Eprenetapopt (APR-246) activity. Drug synergistic effects were observed with certain drug combinations. This paper reports genetic variants in 20 CLs as well as the results of the assessment on whether those variants may help predict response or resistance to certain drug families. With a few exceptions, genetic alteration frequency in CCCLs, conducted in the same analytical batches, compares favorably with published patient data. Results need confirmation in independent larger studies both in CLs and in clinical settings.
Dry eye disease poses a significant global public health concern, with notable implications for populations in Africa. Individuals affected by this condition experience symptoms such as ocular discomfort, dryness, burning, irritation, reflex tearing, and visual disturbances. Despite numerous studies investigating the prevalence and risk factors of symptomatic dry eye across African populations, findings remain inconsistent and fragmented, lacking a comprehensive synthesis of its overall burden and determinants within the region. To address this gap, the present systematic review and meta-analysis aims to estimate the pooled prevalence of symptomatic dry eye and to elucidate its principal associated factors across Africa. We conducted a comprehensive literature search across multiple databases, including PubMed, Google Scholar, EMBASE, Scopus, and the Cochrane Library, as well as by reviewing references from relevant articles following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The methodological quality was evaluated using the Joanna Briggs Institute critical appraisal checklist. Publication bias was assessed using both Funnel Plot visualization and Egger's regression test. Heterogeneity was quantified using Higgins' I² statistics. Subgroup and sensitivity analyses were performed, and a random-effects model was applied to estimate the pooled prevalence of symptomatic dry eye. All statistical analyses were performed with STATA version 17. A systematic review of 5,044 studies published from 2016 to 2025 identified 12 eligible for meta-analysis. The pooled prevalence of symptomatic dry eye among African adults was 61.29% (95% CI: 51.41-71.17). Subgroup analyses revealed the highest prevalence in South Africa (92%; 95% CI: 87.66-96.34), in community settings (76.08%; 95% CI: 62.66-89.51), and among studies conducted from 2016 to 2021 (67.99%; 95% CI: 54.23-81.75). The lowest prevalence was reported in Ethiopia (43.64%; 95% CI: 36.94-50.34). Significant associated factors included visual display use for more than 5 h (OR: 3.95; 95% CI: 2.20-7.10), diabetes duration of 11 years or more (OR: 2.85; 95% CI: 2.04-3.97), poor glycemic control (OR: 2.57; 95% CI: 1.91-3.47), allergic conjunctivitis (OR: 2.79; 95% CI: 1.66-4.70), and ophthalmic drop use (OR: 3.05; 95% CI: 1.53-6.11). PROSPERO CRD420251043328.
Non‑communicable diseases (NCDs) pose a significant health challenge in Saudi Arabia, where 18.95% of adults report at least one chronic condition, including diabetes (9.1%), hypertension (7.9%), and cardiovascular diseases (1.5%). This burden highlights the need for reliable, national‑level estimation of dietary intake and nutrient adequacy to inform evidence‑based nutrition policy. Therefore, this study aimed to estimate dietary intake, nutrient exposure, and adequacy among Saudi adults using an updated, locally developed probabilistic model (NNC‑v2). This modeling study was developed a model using nationally published data from Saudi Arabia starting in 2010. The model was designed to generate probabilistic estimates that account for uncertainty and variability by linking food supply data to population-level intake and nutrient exposure. Model parameters were specified as statistical distributions rather than fixed values, allowing variability and uncertainty to propagate through the estimation process. Age-related intake adjustment and routine variation were incorporated within the model structure. Nutrient adequacy was evaluated using a Monte Carlo-based Average Requirement cut-point approach (10,000 iterations). Predictive performance was assessed indirectly by comparing model-derived food expenditure with national survey data. Grains estimated intake (mean 278 g/day), followed by protein foods (120 g/day). Median energy intake was 2399 kcal/day in males and 2366 kcal/day in females. Estimated intake levels were evaluated against the Average Requirement (AR) values of 320 µg/day for folate and 75-90 mg/day for vitamin C. Among individuals with intake below the AR, the mean intake gaps were approximately 97 µg/day for folate and 27 mg/day for vitamin C. Magnesium intake was evaluated relative to AR values of 350 mg/day for males and 255 mg/day for females. Model-estimated monthly food expenditure closely aligned with national data (7% difference in 2018; 2% in 2023). NNC-v2 offers a probabilistic framework for estimating dietary intake and nutrient adequacy at the national level in Saudi Arabia within the available data sources.
Cirrhosis remains a major public health challenge in China and has historically been driven mainly by chronic viral hepatitis. However, alcohol-related liver disease and metabolic liver disease have received increasing attention in recent decades. Changes in hepatitis B vaccination, antiviral therapy, blood safety, alcohol consumption, and metabolic risk factors may have altered the reported etiological profile of cirrhosis. Existing evidence remains largely region-specific, hospital-based, or limited to particular time periods. This systematic review and meta-analysis aimed to characterize the reported etiological spectrum of cirrhosis in mainland China and to describe temporal and regional patterns. We searched PubMed, Scopus, Embase, Web of Science, CNKI, Wanfang Data, and Sinomed for studies published from January 1990 to December 2025. Observational studies reporting the etiological distribution of cirrhosis in adults or children in mainland China were included. For adults, the principal etiological ranking was based on mutually exclusive categories, with single reported etiologies and explicitly reported mixed etiologies analyzed separately. Temporal and regional analyses used inclusive factor-related groupings, in which mixed etiologies contributed to each relevant etiological factor. For children, broad reported etiological categories were summarized because many pediatric studies did not fully subclassify post-hepatitic cirrhosis by viral subtype. Pooled proportions were estimated using random-effects models, and heterogeneity was assessed using the I² statistic. A total of 71 studies were included, comprising 59 studies contributing adult data and 12 studies contributing pediatric data. In adults, hepatitis B virus (HBV)-only cirrhosis was the most frequently reported single etiology, with a pooled proportion of 54.5% (95% CI: 51.2-57.8), followed by alcohol-only cirrhosis at 11.8% (95% CI: 10.1-13.6) and hepatitis C virus (HCV)-only cirrhosis at 5.9% (95% CI: 4.3-7.7). Cryptogenic cirrhosis accounted for 5.3% (95% CI: 4.1-6.6), and schistosomiasis-related cirrhosis accounted for 3.9% (95% CI: 0.7-9.4). In children, viral/post-hepatitic cirrhosis was the most frequently reported broad category, accounting for 47.9% (95% CI: 33.3-62.6). In inclusive temporal and regional analyses among adults, HBV-related cirrhosis remained the most frequently reported factor-related grouping across study periods and regions, while alcohol-related cirrhosis showed non-monotonic temporal variation and was highest in 2020-2025. HBV remains the leading reported etiology of cirrhosis in mainland China, although the reported etiological profile has become more diverse over time. Alcohol-related cirrhosis, HCV-related regional burden, and under-recognized metabolic liver disease warrant further attention. Given substantial heterogeneity, these estimates should be interpreted as descriptive summaries rather than nationally uniform proportions. These findings support continued HBV prevention and treatment, expanded HCV screening, linkage to care, and direct-acting antivirals (DAAs) treatment coverage, improved ascertainment of metabolic liver disease, and more standardized reporting of mixed-etiology cirrhosis.
Antidepressants are widely prescribed group of medications frequently associated with xerostomia. Although alterations in salivary flow among antidepressant users have been extensively investigated, there is a paucity of data regarding the structural and vascular ultrasonographic characteristics of the major salivary glands. This study aimed to evaluate the echogenicity, parenchymal structure, margin characteristics, blood supply characteristics, and dimensions of the parotid and submandibular glands in antidepressant users compared with systemically healthy controls using ultrasonography (USG). In this study, both right and left parotid and submandibular salivary glands of 102 individuals (51 healthy and 51 antidepressant users) were examined by USG. Data normality was evaluated using the Kolmogorov-Smirnov test. Group comparisons were performed using independent samples t-tests or Mann-Whitney U tests, as appropriate, and categorical variables were analyzed using the chi-square test. A p-value < 0.05 was considered statistically significant. There is no significant differences between antidepressant users and healthy individuals in terms of echogenicity, parenchymal structure, margin and blood supply characteristics of the submandibular and parotid salivary glands. However, the mean supero-inferior dimension of the right submandibular gland was significantly higher in the patient group than in the control group. The median medio-lateral dimension of the left submandibular gland was significantly lower in patients compared with controls. Additionally, the mean medio-lateral dimensions of both the right and left parotid glands were significantly lower in the patient group than in the control group. The ultrasonographic appearance of the major salivary glands did not differ significantly between antidepressant users and healthy controls in terms of tissue characteristics and vascularity, despite limited dimensional differences. These findings suggest that antidepressant use does not markedly alter the ultrasonographic appearance of the salivary glands. Further studies with larger sample sizes, incorporating salivary flow measurements and elastography, are warranted to elucidate the functional and biomechanical effects of antidepressant use on the salivary glands.