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A recent study from the United States reported that nearly 12% of hepatocellular carcinomas (HCCs) occurred in patients without cirrhosis. Non-alcoholic fatty liver disease (NAFLD) was the most common liver disease in these patients. We aim to evaluate the characteristics, etiologies, and outcomes of cases of non-cirrhotic HCC in East Asia, where there is a higher prevalence of hepatitis B virus (HBV)-associated non-cirrhotic HCC. This retrospective study consecutively enrolled de novo HCC patients managed at our institution from 2011 to 2017. The presence of cirrhosis was assessed by histology; if histology was not available, it was assessed by image study. 2055 patients with HCC were enrolled in this study. Among them, 529 (25.7%) were non-cirrhotic. The non-cirrhotic patients were younger (60.9 vs. 62.5 years, p = 0.006), included a greater proportion of males (78.1% vs. 71.3%, p = 0.002), and had a lower body mass index (24.3 vs. 25.3 kg/m2, p<0.001) than the cirrhotic patients. Among the non-cirrhotic patients, HBV was the most common liver disease (49.0%). The patients with non-cirrhotic HCC had larger tumors (5.9 vs. 4.7 cm, p<0.001), underwent liver resection at a higher rate (66.0% vs. 17.4%, p<0.001), and had better overall survival than the cirrhotic HCC patients (median 5.67 vs. 2.83 years, p<0.001). Nearly 26% of the HCCs occurred in patients without cirrhosis. HBV was the most common liver disease in these patients, and the survival was better in the non-cirrhotic patients than the cirrhotic patients.

This study examined both the mediation effects of basic psychological needs and depression on the relationship between gratitude and suicidal ideation in late adolescence. Two hundred and eighty-seven Taiwanese university students completed measures of gratitude, basic psychological needs, depressive symptoms, and suicidal ideation. A cross-sectional design was conducted in the present study. Path analyses indicated that basic psychological needs and depression acted as full mediators of the association between gratitude and suicidal ideation. The identified model revealed a significant and sequential mediational path from gratitude through basic psychological needs, depression, and suicidal ideation. The current work is an incremental advancement in understanding the complex relationship between selected resiliency and risk factors of suicidal thinking.

This main purpose of this study tests whether a higher-order gratitude compassing multi-components (e.g., thank others, thank God, cherish blessings, appreciate hardship, and cherish the moment) explains variances in subjective well-being including life satisfaction and positive affect after controlling for gender, age, religion, the Big Five personality traits (e.g., openness, conscientiousness, extraversion, agreeableness, and neuroticism), and a single gratitude. A total of 504 undergraduate participants were recruited to completed five inventories measuring the variables of interest. The higher-order gratitude made a significant unique contribution to life satisfaction (10 % of the variance, p < .001) and positive affect (2 % of the variance, p < .001) beyond th effects e of demographic variables, the Big Five personality traits, and a single gratitude. This is consistent with the theoretical stance that the higher-order gratitude is more than just the Big Five personality traits or a single gratitude and is important in its own right for subjective well-being. Furthermore, it implies a multi-components gratitude is in deed different from a unifactorial gratitude and it seems more reasonable that trait gratitude is a higher-order construct including lower-order components.

The current study investigated the interrelationships among parental attachment, gratitude, and life satisfaction during late adolescence, including the mediation effect of gratitude in the relationship between parental attachment and life satisfaction. Specifically, analyses have been conducted considering both paternal and maternal roles. A sample of two hundred and eighty-five college students participated and completed measures of paternal attachment, maternal attachment, gratitude, and life satisfaction. A cross-sectional design was conducted in the present study. The results showed statistically significant relationships among all study variables, and gratitude partially mediated the relationship between life satisfaction and attachment to one’s father and mother. The current work advances the understanding of the effects of parents of different gender on individuals’ development.

The gut microbiota plays a role in nonalcoholic fatty liver disease (NAFLD), but data about gut dysbiosis in Asians with NAFLD remains scarce. We analyzed the differences in fecal microbiota between adults with and without NAFLD. This cross-sectional study examined adults with histology-proven NAFLD (25 nonalcoholic fatty liver (NAFL) patients, 25 nonalcoholic steatohepatitis (NASH) patients, and 25 living liver donors (healthy controls)). The taxonomic composition of the gut microbiota was determined by 16S ribosomal RNA gene sequencing of stool samples. The NAFL and NASH groups showed lower total bacterial diversity and richness than the controls. NAFLD patients had higher levels of the phylum Bacteroidetes and lower levels of Firmicutes than controls. The genus Ruminococcaceae UCG-010, family Ruminococcaceae, order Clostridiales, and class Clostridia were less abundant in patients with NAFL or NASH than healthy individuals. The lipopolysaccharide biosynthesis pathway was differentially enriched in the NASH group. This study examined the largest number of Asian patients with biopsy-proven NAFL and NASH in terms of dysbiosis of the gut microbiota in NAFLD patients. NAFLD patients had higher levels of Bacteroidetes and lower levels of Firmicutes. These results are different from research from western countries and could provide different targets for therapies by region.

To determine the impact of microvascular invasion (MVI) on outcome in patients with solitary hepatocellular carcinoma (HCC) of ≤ 2 cm undergoing liver resection (LR). This retrospective study enrolled consecutive patients between 2007-2019 with newly diagnosed solitary HCC ≤ 2 cm who were undergoing LR at our institution. Overall survival (OS) and recurrent-free survival (RFS) were compared between patients with or without MVI. Of the 229 patients included in this study, 71 had MVI. The median follow-up period was 28.8 months (interquartile range: 13.5-70.1). Although the 90-day mortality rate was 0, 18 deaths occurred during the study, and the 5-year survival rate was 87.1%. Tumor recurrence occurred in 45 cases, and 5-year RFS was 71.9%. The presence or absence of MVI did not significantly affect the OS and RFS rates (log rank test, p = 0.10 and 0.38, respectively). In univariate and multivariate analysis, the presence of MVI was not associated with OS and RFS. The presence of MVI was not associated with OS and RFS in patients with solitary HCC ≤ 2 cm who underwent LR in this cohort.

Fishermen operating in pelagic fisheries often experience significant barriers to medical care due to geographic isolation, harsh environmental conditions, and the absence of onboard healthcare personnel. Telemedicine offers an effective approach to overcome these limitations by enabling remote diagnosis, monitoring, and treatment through satellite-based communication systems. This review summarizes the progress and applications of telemedicine in maritime and other austere environments, focusing on technological advancements, clinical implementations, and emerging trends in artificial intelligence-driven healthcare. Evidence from pilot and retrospective studies highlights the growing use of wearable devices, telementored ultrasound, digital photography, and cloud-based monitoring systems for managing acute and chronic medical conditions at sea. The integration of machine learning and deep learning algorithms has further improved fatigue, stress, and motion detection, enhancing early risk assessment among seafarers. Despite challenges such as limited connectivity, data privacy concerns, and training requirements, the adoption of telemedicine significantly improves health outcomes, reduces emergency evacuations, and promotes occupational safety. Future directions emphasize the development of 5G-enabled Internet of Medical Things networks and predictive AI tools to establish comprehensive maritime telehealth ecosystems for fishermen in pelagic operations.

We aimed to develop a preoperative model to predict overall survival (OS) in patients with hepatoma undergoing liver resection (LR). Patients who underwent LR for Barcelona Clinic Liver Cancer (BCLC) stage 0, A, or B hepatoma were enrolled. Tumor burden score (TBS) scores were determined using the following equation: TBS (Pinna et al., 2018) 2 = (largest tumor size [in cm])(Pinna et al., 2018) 2 ​+ ​(tumor number) (Pinna et al., 2018) 22. The cutoff values for radiographic TBS were based on our recently published paper: low, <2.6; medium, 2.6–7.9; high, >7.9. Multivariate analysis showed that radiographic TBS (low: referent; medium: HR ​= ​2.89; 95 ​% CI: 1.60–5.21; p ​< ​0.001; high, HR ​= ​7.60; 95 ​% CI: 3.80–15.2; p ​< ​0.001), AFP (<400 ​ng/mL: referent; ≧400 ​ng/mL: HR ​= ​1.67, 95 ​% CI: 1.11−2.52, p ​= ​0.014), and cirrhosis (absence: referent; presence: HR ​= ​1.88, 95 ​% CI: 1.30–2.72, p ​< ​0.001) were associated with OS. A simplified risk score was superior to BCLC system in concordance index (0.688 vs. 0.623). We have developed a preoperative model that performs better in predicting OS than the BCLC system. •Tumor size, number, AFP, and cirrhosis are prognostic factors in patients with hepatoma undergoing resection.•A simple model was developed based on these variables that performs better in predicting survival than BCLC system.

Although the role of autophagy in sepsis has been characterized in several organs, its role in the adaptive immune system remains to be ascertained. This study aimed to investigate the role of autophagy in sepsis-induced T cell apoptosis and immunosuppression, using knockout mice with T cell specific deletion of autophagy essential gene Atg7. Sepsis was induced in a cecal ligation and puncture (CLP) model, with T-cell-specific Atg7-knockout mice compared to control mice. Autophagic vacuoles examined by electron microscopy were decreased in the spleen after CLP. Autophagy proteins LC3-II and ATG7, and autophagosomes and autolysosomes stained by Cyto-ID Green and acridine orange were decreased in CD4+ and CD8+ splenocytes at 18 h and 24 h after CLP. This decrease in autophagy was associated with increased apoptosis of CD4+ and CD8+ after CLP. Moreover, mice lacking Atg7 in T lymphocytes showed an increase in sepsis-induced mortality, T cell apoptosis and loss of CD4+ and CD8+ T cells, in comparison to control mice. This was accompanied by suppressed cytokine production of Th1/Th2/Th17 by CD4+ T cells, reduced phagocytosis in macrophages and decreased bacterial clearance in the spleen after sepsis. These results indicated that sepsis led to down-regulation of autophagy in T lymphocytes, which may result in enhanced apoptosis induction and decreased survival in sepsis. Autophagy may therefore play a protective role against sepsis-induced T lymphocyte apoptosis and immunosuppression.

To assess preoperative image tumor characteristics and alpha-fetoprotein (AFP) levels to predict early recurrence after liver resection (LR) for hepatocellular carcinoma (HCC). This retrospective study's enrolled patients underwent LR for newly diagnosed HCC between 2011 and 2018. Multivariate logistic regression analyses using the Akaike information criterion were adopted to construct a nomogram to predict early recurrence (i.e. recurrence within 1 year). The performance of this nomogram was evaluated using calibration plots with bootstrapping. Early recurrence was identified in 99 patients (11.2%). Four predictive factors, namely an AFP level of >400 ng/mL; image-diagnosed tumor characteristics, including a tumor size of > 5 cm; vascular invasion; and multiple tumors were adopted in the final model of the early recurrence nomogram, with a concordance index of 0.67. The calibration plots showed good agreement between the nomogram predictions and the actual observations of early recurrence. We have developed a simple nomogram with preoperative image tumor characteristics and AFP levels to predict the early recurrence of HCC after LR. 1.Early recurrence after liver resection (LR) for patients with hepatocellular carcinoma (HCC) carries a poor prognosis.2.We have developed a simple nomogram with preoperative image tumor characteristics and alpha-fetoprotein (AFP) levels to predict the early recurrence of HCC after LR.