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The problem of the competition between tort compensation and work-related injury insurance in the case of third-party injury is due to the different evaluations and norms of the modern relief system for the same damage. In comparative law, there are four legislative models: choice, substitution, both, and supplementation. China's relevant legislation presents the problems of decentralization, principle, contradiction and localization, which aggravates the complexity of the problem. Focusing on the protection of workers' rights and interests, the current situation of China's social development and the original intention of the design of relevant systems, China should adopt a \"limited and beneficial model\" in dealing with such competition and cooperation issues in the future.

Background Abnormal glycemic variability is common in the intensive care unit (ICU) and is associated with increased in-hospital mortality and major adverse cardiovascular events, but little is known about whether adverse outcomes are partly mediated by ventricular arrhythmias (VA). We aimed to explore the association between glycemic variability and VA in the ICU and whether VA related to glycemic variability mediate the increased risk of in-hospital death. Methods We extracted all measurements of blood glucose during the ICU stay from The Medical Information Mart for Intensive Care IV (MIMIC-IV) database version 2.0. Glycemic variability was expressed by the coefficient of variation (CV), which was calculated by the ratio of standard deviation (SD) and average blood glucose values. The outcomes included the incidence of VA and in-hospital death. The KHB (Karlson, KB & Holm, A) is a method to analyze the mediation effect for nonlinear models, which was used to decompose the total effect of glycemic variability on in-hospital death into a direct and VA-mediated indirect effect. Results Finally, 17,756 ICU patients with a median age of 64 years were enrolled; 47.2% of them were male, 64.0% were white, and 17.8% were admitted to the cardiac ICU. The total incidence of VA and in-hospital death were 10.6% and 12.8%, respectively. In the adjusted logistic model, each unit increase in log-transformed CV was associated with a 21% increased risk of VA (OR 1.21, 95% CI: 1.11–1.31) and a 30% increased risk (OR 1.30, 95% CI: 1.20–1.41) of in-hospital death. A total of 3.85% of the effect of glycemic variability on in-hospital death was related to the increased risk of VA. Conclusion High glycemic variability was an independent risk factor for in-hospital death in ICU patients, and the effect was caused in part by an increased risk of VA.

Liver fibrosis is a chronic liver disease with the presence of progressive wound healing response caused by liver injury. Currently, there are no approved therapies for liver fibrosis. Exosomes derived from human adipose mesenchymal stem cells (hADMSCs-Exo) have displayed a prominent therapeutic effect on liver diseases. However, few studies have evaluated therapeutic effect of hADMSCs-Exo in liver fibrosis and cirrhosis, and its precise mechanisms of action remain unclear. Herein, we investigated anti-fibrotic efficacy of hADMSCs-Exo in vitro and in vivo, and identified important metabolic changes and the detailed mechanism through transcriptomic and metabolomic profiling. We found hADMSCs-Exo could inhibit the proliferation of activated hepatic stellate cells through aggravating apoptosis and arresting G1 phase, effectively inhibiting the expression of profibrogenic proteins and epithelial-to-mesenchymal transition (EMT) in vitro. Moreover, it could significantly block collagen deposition and EMT process, improve liver function and reduce liver inflammation in liver cirrhosis mice model. The omics analysis revealed that the key mechanism of hADMSCs-Exo anti-hepatic fibrosis was the inhibition of PI3K/AKT/mTOR signaling pathway and affecting the changes of metabolites in lipid metabolism, and mainly regulating choline metabolism. CHPT1 activated by hADMSCs-Exo facilitated formation and maintenance of vesicular membranes. Thus, our study indicates that hADMSCs-Exo can attenuate hepatic stellate cell activation and suppress the progression of liver fibrosis, which holds the significant potential of hADMSCs-Exo for use as extracellular nanovesicles-based therapeutics in the treatment of liver fibrosis and possibly other intractable chronic liver diseases. Graphical Abstract

Individuals living in rural areas have a higher incidence rate of stroke than their urban counterparts in China. However, few studies have investigated the association between blood malondialdehyde (MDA), an end product of lipid oxidation caused by reactive oxygen species (ROS), and stroke risk in rural populations. We aimed to investigate whether blood MDA levels contribute to a higher stroke risk in a Chinese elderly population from rural areas. Data from 2011 to 2012 from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a national cohort of older adults in China, were analyzed. Smooth curve and multivariable correction analyses were used to evaluate the association between blood MDA levels and stroke risk in elderly populations from rural and urban areas, respectively. The median age of all included participants (N = 1598) was 84.04 years. The results of the smooth curve model revealed a gradual upward trend in the association of blood MDA levels with stroke risk in rural participants but not in urban participants. Similarly, the conditional logistic regression analysis suggested a significant association between MDA levels and stroke risk in rural participants but not in urban participants after adjustments for related confounding factors (age, sex, current smoker, current drinker, regular exercise, BMI and cardiovascular diseases (hypertension, heart disease, atrial fibrillation and diabetes)) were made. In brief, among the elderly population in China, elevated blood MDA levels were associated with increased stroke risk in rural participants but not in urban participants.

To avoid the problem of wind-induced resonance damage in a dish concentrating solar thermal power system (DCSTPS), a fluid dynamics model and a finite element analysis model of the DCSTPS were established separately. The wind load was mapped onto the surface of the concentrator of the DCSTPS using the sequential coupling method, and the static analysis and modal analysis of the DCSTPS were established based on the fluid–structure coupling (FSC) method and the validity of the established model was verified. Based on the results, it can be concluded that the upper edge of the dish solar concentrator (DSC) of the DCSTPS and the three cantilever beams near the Stirling generator are the most vulnerable to being damaged, the DCSTPS will not experience strong resonance phenomena, and effects of the FSC will decrease the natural frequencies of each order. The results of the safety grade catastrophe evaluation of the DCSTPS showed that the safety grade of the DCSTPS was 0.2586 and 0.2819 under case 1 (α = 30°, β = 90°) and case 2 (α = 60°, β = 90°), where it was found that the membership value of the moment load was low, resulting in the stress on the connection seat of the altitude angle and the steering device of the base approaching the allowable stress of the material.

In order to effectively reveal the nonlinear characteristics of a dish concentrating solar thermal power system (DCSTPS) under pulsating wind-induced loads, a fluid simulation model of the DCSTPS was established, and the simulated pulsating winds were developed via the user-defined function (UDF) combined with the autoregressive (AR) model using MATLAB (R2015b). And based on the fluid simulation calculations of the DCSTPS, the time-range data of the relevant wind vibration coefficients under different working conditions were obtained. The research results show the following: (1) When the altitude angle α is 0° or 180° due to the azimuth angle β = 0°, the maximum values of their drag coefficient Cx, lateral force coefficient Cy, and lift coefficient Cz are similar, and the maximum of rolling moment coefficient CMx is significantly smaller than the values at the other two angles; the maximum of the pitch moment coefficient CMy and maximum of the azimuth moment coefficient CMz are significantly larger than the values of the other two angles. (2) The increase in altitude angle α leads to a reduction in the drag coefficient Cx, an increase in the lift force coefficient Cz, and an increase of the pitch moment CMx. Moreover, an improved phase space delay reconstruction method was developed to calculate the delay time, Lyapunov exponent, and Kolmogorov entropy of the DCSTPS, and the research results show that (1) the maximum Lyapunov exponent and Kolmogorov entropy of the DCSTPS are greater than zero under the action of pulsating wind; (2) the action of pulsating wind will cause increases in the maximum Lyapunov exponent and Kolmogorov entropy of the DCSTPS and will accelerate the divergence speed of the DCSTPS trajectory; and (3) the time for the DCSTPS to enter the chaotic state will be shortened, while the time of entering a chaotic state and degree of subsequent chaotic states will be significantly affected by relevant wind vibration coefficients but without regularity.

Advances in conformal and image-guided external-beam radiotherapy have expanded its application in hepatocellular carcinoma (HCC); however, the benefit of neoadjuvant radiotherapy before resection for HCC with vascular invasion remains uncertain. A systematic review and meta-analysis were conducted comparing neoadjuvant radiotherapy plus hepatectomy vs. hepatectomy alone in resectable HCC with vascular invasion. Databases were searched through August 1, 2024. Primary outcomes were overall survival (OS) and disease-free survival (DFS). A total of four studies (n=362) were included. In the overall pooled analysis, neoadjuvant radiotherapy was not associated with a statistically significant improvement in 1-year OS [risk ratio (RR) 1.62; 95% confidence interval (CI) 0.71-3.69] or 2-year OS (RR 2.64; 95% CI 0.57-12.27), with considerable heterogeneity ([I.sup.2] 97 and 94%, respectively). Similarly, 1-year DFS was not significantly different between groups (RR 2.68; 95% CI 0.50-14.43; [I.sup.2] 95%). In subgroup analyses by vascular invasion type, patients with portal vein tumor thrombus (PVTT) showed a higher 1-year and 2-year OS compared with surgery alone, and two studies reporting time-to-event outcomes suggested lower recurrence and mortality; however, these findings are based on a small number of studies and should be interpreted with caution. Reported radiotherapy-related toxicities were generally manageable. Overall, current evidence is limited and heterogeneous; neoadjuvant radiotherapy may benefit selected patients with resectable HCC and PVTT, but adequately powered multicenter randomized trials with standardized protocols are needed. Key words: hepatocellular carcinoma, vascular invasion, neoadjuvant radiotherapy, meta-analysis

Background Pancreatic cancer (PC) exhibits dismal outcomes and an immune-excluded microenvironment that blunts immunotherapy. Robust, immune-anchored biomarkers are needed to stratify risk and inform treatment design. Methods We integrated The Cancer Genome Atlas (TCGA) and Genotype-Tissue Expression (GTEx) dataset and validated findings in Gene Expression Omnibus (GEO) dataset (GSE57495). Immune infiltration, survival modeling, pathway activity, tumor microenvironment, and immunotherapy responses were analyzed. Single-cell RNA sequencing (GSE212966) informed CD4⁺ T-cell differentially expressed genes (DEGs), pseudotime, and intercellular communication (CellChat). Quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot in H6C7, CAPAN-1, and PANC-1 cell lines were performed. Results Among 28 immune subsets, CD4⁺ T-cell populations most strongly associated with overall survival (OS). A six-gene signature ( KLF3 , EZR , SMDT1 , JPT1 , ISG15 , MT1X ) derived from 111 CD4⁺ T-cell DEGs successfully stratified OS with time-dependent AUCs ranging from 0.637 to 0.838 across the training and validation cohorts. The high-risk group showed significantly poorer OS, higher stromal scores, broad checkpoint upregulation, and greater immune exclusion ( P  < 0.05), indicating an immune–stromal ecosystem favoring tolerance. Single-cell RNA sequencing localized model genes to fibroblasts, ductal cells, and CD4⁺ T cells subsets. CellChat revealed globally intensified crosstalk in PC and strengthened CD4⁺ T-cell interactions with myeloid and stromal compartments. Western blot and qRT-PCR results confirmed up-expression of all model gene except SMDT1 in PC cell lines. Conclusions CD4⁺ T-cell subsets serve as central determinant of the immune landscape and clinical outcome in PC. The CD4⁺ T cell–anchored six-gene signature enables risk stratification, links immune contexture to stromal ecology, and motivates biomarker-guided trials and rational combinations that alleviate immunosuppression while targeting metabolic-stress pathways.

Background: Advanced liver fibrosis (LF) is a major determinant of prognosis across chronic liver diseases. Current biomarkers are often etiology-specific and lack cross-cohort robustness. Shared molecular drivers across etiologies remain incompletely defined, and effective anti-fibrotic therapies are limited. Methods: We developed a multi-algorithm consensus machine-learning framework to derive a robust LF progression signature. In the training non-alcoholic fatty liver disease (NAFLD) cohort GSE213621 (n = 368), samples were formulated as a binary classification task (mild fibrosis, F0–F2; advanced fibrosis, F3–F4). Candidate genes were screened in parallel using Boruta, Least Absolute Shrinkage and Selection Operator (LASSO), random forest, and eXtreme Gradient Boosting (XGBoost). Genes selected by at least two algorithms were defined as a high-consensus pool, and genes consistently selected by all four algorithms were prioritized to construct a core signature. Model performance was evaluated by stratified cross-validation in the training cohort and externally validated in four independent cohorts of different etiologies (GSE49541, GSE84044, GSE130970, and GSE276114). Cellular sources of signature genes were characterized using single-cell RNA sequencing (scRNA-seq) datasets GSE136103 (human) and GSE172492 (mouse). For therapeutic discovery, the high-consensus expression profile was queried against the Connectivity Map (CMap) to prioritize compounds predicted to reverse the fibrotic transcriptional program. Withaferin A (WFA) was selected for experimental validation in a carbon tetrachloride (CCl4)-induced mouse LF model and in the transforming growth factor-β1 (TGF-β1)-stimulated human hepatic stellate cell line LX-2. Bulk liver RNA-seq profiling was performed to interrogate WFA-associated molecular changes in vivo. Results: We identified a six-gene signature (CLEC4M, COL25A1, ITGBL1, NALCN, PAPPA, and PEG3) that discriminated advanced from mild fibrosis, achieving a mean AUC of 0.890 in internal cross-validation and an average AUC of 0.864 across external validation cohorts. scRNA-seq analysis revealed cell-type-specific expression with prominent enrichment in fibroblast populations. In vivo, WFA markedly attenuated CCl4-induced fibrosis (p < 0.05) and reversed 1314 fibrosis-associated differentially expressed genes (adjusted p < 0.05), which were enriched in fatty acid metabolism and PPAR signaling, as well as extracellular matrix (ECM)–receptor interaction and focal adhesion (adjusted p < 0.05). In vitro, WFA suppressed TGF-β1-induced LX-2 activation, reducing α-SMA and Fibronectin expression (p < 0.05). Conclusions: We report a six-gene signature that robustly predicts advanced LF across etiologies, define its cellular context using single-cell atlases, and validate the anti-fibrotic activity of WFA in both in vivo and in vitro models. Bulk liver RNA-seq and cellular evidence further suggest that WFA-associated effects are linked to lipid metabolic programs, ECM remodeling, and attenuation of hepatic stellate cell activation.

Objective Liver function, tumor burden, inflammation level, and nutritional status are critical factors influencing tumor onset, progression, and metastasis. This study sought to investigate the prognostic significance and clinical relevance of biomarkers associated with these factors to develop a novel liver function-tumor burden-inflammation-nutrition (LTIN) score for patients with hepatocellular carcinoma (HCC) who received hepatectomy. Methods A retrospective analysis was conducted on 285 patients with HCC undergoing hepatectomy at two medical centers between July 2019 and July 2023. The patients were divided into a training set ( n  = 200) and a validation set ( n  = 85). The study evaluated the prognostic significance of eight relevant clinical indicators and developed an LTIN score using Least Absolute Shrinkage and Selection Operator (LASSO) regression. Kaplan-Meier survival curves and multivariate Cox regression analysis were utilized to determine the prognostic value of the LTIN score. Time-dependent receiver operating characteristic (ROC) analyses were used to compare the predictive performance of various prognostic factors. Results The LTIN score, derived from the albumin-bilirubin (ALBI) grade, tumor burden score (TBS), prognostic nutritional index (PNI), and prognostic inflammatory index (PII), effectively classified patients into high- and low-risk groups based on the optimal cut-off value. Patients with low-risk scores exhibited significantly better overall survival (OS) and recurrence-free survival (RFS) than those with high-risk groups in both the training and validation sets ( P  < 0.001). Furthermore, the LTIN score was identified as a significant independent prognostic factor for both OS ( P  < 0.001) and RFS ( P  < 0.001). The LTIN score also exhibited superior prognostic capabilities compared to the other indicators, Tumor-Node-Metastasis (TNM) staging system, and Barcelona Clinic Liver Cancer (BCLC) staging system. Conclusion Our findings indicated that the preoperative LTIN score has significant potential as a reliable predictor of OS and RFS for HCC patients underwent radical surgery. The LTIN score could further effectively guide treatment decisions and optimize follow-up strategies to enhance patients prognosis.