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Cellulose nanofibers (CNF) create a physical barrier preventing contact with corrosive substances and improving corrosion prevention. Oil palm fronds (OPF), the primary source of underused biomass waste from plantations, were processed into CNF. The OPF-CNF, mixed with hydroxyethyl cellulose as the matrix, forms a nanocomposite. Corrosion analysis using electrochemical methods demonstrated that copper coated with cellulose-rich nanocomposite containing 5 % CNF had a significantly decreased corrosion rate with an efficiency of 97.92 %. This CNF-based coating, combining barrier and passivation mechanisms, enhances performance, providing a competitive, eco-friendly alternative to conventional coatings.

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PURPOSE: To investigate the effect of different post-curing light intensities on the trueness, compressive strength, and resin polymerization of 3D-printed 3-unit fixed dental prostheses (FPD). MATERIALS AND METHODS: A total of 60 specimens were prepared to support a 3-unit FDP with a deep chamfer marginal design, utilizing computer-aided design and computer-aided manufacturing (CAD-CAM) technology. Light-polymerizing FDP resin with varying light intensities (105, 210, 420, and 840 mW/cm2) was employed for 10 min. Subsequently, trueness assessment, fracture load testing, scanning electron microscopy (SEM) surface examination, and Fourier-Transform Infrared (FTIR) analysis were conducted. A one-way analysis of variance (ANOVA) was performed to ascertain the differences between the experimental groups (p < 0.05). RESULTS: The group exposed to 210 mW/cm2 showed the highest trueness (57.6 ± 2.1 µm), while the 840 mW/cm2 group had the highest deviation (79.3 ± 2.7 µm) (p < 0.001). Significant differences in fracture resistance were found between groups (p < 0.001), with mean fracture strengths of 1149.77 ± 67.81 N, 1264.92 ± 39.06 N, 1331.34 ± 53.62 N, and 1439.93 ± 34.58 N for light intensities of 105, 210, 420, and 840 mW/cm2, respectively (p < 0.001). The resin polymerization analysis shows a peak intensity surge at 3579 cm-1 for O-H and C-H stretching vibrations, except in samples exposed to 105 mw/cm2 light, with the lowest peak at 2890 cm-1. The performance of resin polymerization is most significant under the condition of 840 mW/cm2. CONCLUSION: The light intensity of 210 mW/cm2 exhibited the highest trueness, while the 840 mW/cm2 group showed the highest deviation. However, the light intensity of 840 mW/cm2 demonstrated the highest compressive strength. Furthermore, polymerization occurred at all post-treatment light intensities except 105 mW/cm2. These findings indicate that while low-intensity usage offers greater trueness, high-intensity usage provides better compressive strength and polymerization. Therefore, 210 mW/cm2 could be the recommended solution for post-curing.

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As health systems transition to ICD-11, it is essential to gauge the readiness and improve existing transition efforts. Assessing the intention to use ICD-11 and factors influencing it is imperative to encourage the use of ICD-11 among the medical record officers (MROs) and assistant medical record officers (AMROs). This study aims to develop and validate a questionnaire on the factors influencing the intention to use ICD-11 among MROs and AMROs in the Ministry of Health, Malaysia. This study comprised a questionnaire development and validation involving 292 participants nationwide from Ministry of Health Malaysia facilities. The questionnaire was developed based on items adapted from the literature. Forward and backward English-Malay translation was done. Then, the questionnaire was examined for content validity, internal consistency reliability, construct validity, face validity, convergent validity, discriminant validity and confirmatory factor analyses. The final version of the questionnaire consists of eleven domains represented by 50 items. The content validity index and modified kappa were excellent for all domains. The Kaiser-Meyer-Olkin sampling adequacy value was appropriate, with a value of 0.790. The questionnaire also demonstrated good internal consistency reliability with Cronbach's alpha values between 0.850 and 0.992. Confirmatory factor analysis showed a reasonable fit for this eleven-factor model. In conclusion, this questionnaire provides a reliable tool for investigating the intention to use ICD-11 among MROs and AMROs. Positive findings from the psychometric properties support the validity of the questionnaire. This instrument can potentially support personnel in charge of ICD codification, guide the ICD-11 transition at various levels and facilitate research on support dynamics among the MROs and AMROs.

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Municipal effluents discharged from wastewater treatment plants (WWTPs) are considered major contributors of nanoplastics (NPs) and dissolved effluent organic matter (dEfOM) to environments. Due to their small sizes, NPs can travel easily in waterways and evade wastewater treatment processes, and may directly interact with dEfOM, altering their environmental fates. However, although much research has examined the impact of natural organic matter on NPs, the interactions between NPs and dEfOM remain unexplored. This study investigated the influences of NPs on the behavior and capacity of dEfOM aggregation and surface granularity, and identified the possible aggregation mechanism. We also adjusted the salinity of water samples to simulate scenarios based on WWTP-sea continuums. Our data suggest that dEfOM can self-assemble with 55 nm polystyrene NPs to form microgels, particularly under high salinity conditions. NPs accelerates the formation speed and number of dEfOM aggregates, but the sizes of the aggregates remain largely unchanged. The relative particle counts at a salinity of 34 psu increased by 300 % compared to the control group. The potential mechanism behind NPs-microgels aggregation is likely driven by the synergistic effect of the divalent ion crosslinking and hydrophobic interactions between EfOM and NPs. Notably, NPs incorporation into microgels decreases the surface granularity, thereby possibly affecting settling velocity and colonization of aggregates, as well as microbial attachment and community diversity. Overall, our findings demonstrate the potential influence of NPs on dEfOM assembly and surface properties following effluent discharge, and can inspire further relevant studies on microorganism interactions, removal technologies, and the environmental transport of NPs.

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BACKGROUND: Individuals diagnosed with type 2 diabetes (T2D) frequently exhibit chronic kidney disease (CKD) which may be caused by environmental hazards such as exposure to air pollutants. However, limited research has explored the effects of prolonged exposure to air pollutants on CKD development in this population. This study examines the relationship between long-term exposure to air pollutants and CKD incidence in a longitudinal cohort of individuals with type 2 diabetes in Taiwan METHODS: Between 2003 and 2005, we recruited 1316 T2D patients (693 females [52.66 %]; mean age 56.16 ± 8.97 years). Patients were followed until December 31, 2012, with at least two clinical visits. Baseline demographics, medical history, and biomarker levels were collected. The development of CKD was determined by eGFR level < 60 mL/min/1.73 m2. Monthly averages of nitrogen dioxide (NO2) and fine particulate matter [PM ≤ 2.5 µm in aerodynamic diameter (PM2.5)] were acquired from 72 ambient air monitoring stations. The kriging method was employed to estimate the exposure levels to PM2.5, NO2, temperature, and relative humidity in the participants' residential areas. Cox regression with time-dependent covariates regression was applied to assess the impact of long-term exposure to air pollutants and CKD risk. RESULTS: Of 992 patients with normal renal function at baseline, 411 (41.43 %) experienced CKD occurrence over a median follow-up period of 5.45 years. The incidence of CKD was 93.96 cases per 1000 person-years. In multivariable adjusted models, patients exposed to PM2.5 levels above the third quartile of (>33.44 µg/m3) and NO2 levels above the fourth quartile (>22.55 ppb) were found to have an increased risk of CKD occurrence compared to lower exposure levels. CONCLUSIONS: This longitudinal study highlights the increased risk of CKD in individuals with type 2 diabetes due to prolonged exposure to NO2 and PM2.5, emphasizing the need for tailored air quality management strategies for this high-risk population.

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Global groundwater contamination by Arsenic (As) presents a grave danger to the health of living beings and wildlife, demanding comprehensive remediation strategies. This review delves into the complex landscape of arsenic remediation, encompassing its chemical forms, occurrences, sources, and associated health risks. Advanced techniques, notably biomass-derived adsorbents, emerge as promising and cost-effective solutions. The exploration spans preparing and modifying biomass-derived adsorbents, unraveling their adsorption capacity, influencing factors, isotherms, kinetics, and thermodynamics. Noteworthy attention is given to plant-agricultural waste, algal-fungal-bacterial, and iron-modified biomass-derived adsorbents. The comprehensive discussion of the adsorption mechanism highlights the efficacy of low-cost biomass, particularly from plant, animal, and agricultural residues, offering a sustainable remedy for arsenic removal. This insightful review contributes to the understanding of evolving technologies essential for addressing arsenic contamination in wastewater, emphasizing the potential of renewable biomaterials in advancing efficient remediation practices.

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PURPOSE: The effect of various sleep traits on the risk of lung cancer differs among pre-existing studies. This study aims to systematically review and synthesise the association between sleep duration and insomnia with the incidence of lung cancer. METHODS: PubMed, Embase and The Cochrane Library were searched from inception to 23 April 2023 for observational studies examining the effect of sleep quantity or insomnia on lung cancer incidence. We pooled maximally-adjusted hazard ratios and odds ratios separately using random effects inverse variance weighted models. The risk of bias of observational studies was assessed using the Newcastle-Ottawa Scale. RESULTS: We included 11 observational studies with a pooled cohort of 5,049,141 patients. The mean age of the patients was 49.5 ± 17.7 years, and 51.4% were males. The risk of bias ranged from low-moderate. Individuals who slept for a shorter or longer duration than the reference range of sleep per night showed an increased risk of lung cancer by 11% (HR:1.11; 95%CI:1.00-1.23) and 16% (HR:1.16; 95%CI:1.06-1.27) respectively. Furthermore, individuals with insomnia symptoms had a 9% greater risk of lung cancer than those without symptoms (HR:1.09; 95%CI:1.05-1.13). CONCLUSION: This study suggests that insufficient sleep, excessive sleep and insomnia may be associated with an increased risk of lung cancer. Physicians should be mindful of this association and encourage healthy sleep practises among patients. Given the observed heterogeneity among some pre-existing studies, future research with longer periods of follow-up, greater control for covariates and objective testing of sleep parameters may add value to this topic.

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Background and hypothesis: Published literature suggests that sleep duration and quality may be affected in adults with chronic kidney disease. However, the relationship between these two entities remains a matter of debate. The objective of this systematic review and meta-analysis is to assess the effect of sleep duration and quality on chronic kidney disease. Methods: A systematic review of the Medline/PubMed, Embase, Cochrane Library, and CINAHL databases was conducted for articles pertaining to the association between sleep duration and quality on chronic kidney disease. The main outcome was the hazard/risk ratio of chronic kidney disease in patients of varying sleep durations and quality. Results: In total, 42 studies (2 613 971 patients) with a mean age of 43.55 ± 14.01 years were included in the meta-analysis. Compared with a reference range of 7 to 8 hours of sleep, short sleep durations of ≤4 hours (RR 1.41, 95% CI: 1.16 to 1.71, P < 0.01), ≤5 hours (RR 1.46, 95% CI: 1.22 to 1.76, P < 0.01), ≤6 hours (RR 1.18, 95% CI: 1.09 to 1.29, P < 0.01), and ≤7 hours (RR 1.19, 95% CI: 1.12 to 1.28, P < 0.01) were significantly associated with an increased risk of incident chronic kidney disease. Long sleep durations of ≥8 hours (RR 1.15, 95% CI: 1.03 to 1.28, P < 0.01) and ≥9 hours (RR 1.46, 95% CI: 1.28 to 1.68, P < 0.01) were also significantly associated with an increased risk of incident chronic kidney disease. Meta-regression did not find any significant effect of age, gender, geographical region, and BMI and an association with sleep duration and risk of incident chronic kidney disease. Conclusion: Both short and long sleep durations were significantly associated with a higher risk of chronic kidney disease. Interventions targeted toward achieving an optimal duration of sleep may reduce the risk of incident chronic kidney disease.

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BACKGROUND: Patients with myocardial infarction (MI) can have disturbed sleep, but little is known about the efficacy of light therapy on sleep and prognosis of patients with MI. We conducted a randomized controlled study to investigate its efficacy. MATERIAL AND METHODS: This preliminary study included 34 patients with MI. They were randomized into the blue light and the white light groups during their stay in intensive care unit. 17 age and gender matched healthy controls were also enrolled. Actigraphy was used to evaluate objective sleep since enrollment. Delirium scales were used to screen delirium. Lab work-up including vitamin D level was performed at the baseline and discharge. We used Mann-Whitney U test or Wilcoxon signed-rank test to compare the difference between the MI group and the healthy control group, and the group difference after receiving light therapy. RESULTS: Patients with MI had significantly lower vitamin D level than healthy controls (p<0.001). They also had significantly poorer sleep, as indicated by actigraphy parameters including sleep onset latency (p=0.01), sleep efficiency (p=0.002), wake after sleep onset (p<0.001) and awake times (p=0.002). No significant group difference was found by actigraphy after light therapy except a non-significant higher relative amplitude of the blue light group (p=0.061). Besides, vitamin D level of the blue light group increased significantly (p1=0.047, p2=0.045). CONCLUSIONS: Patients with MI had poorer sleep, highlighting the needs to develop interventions. Significantly increased vitamin D level and a non-significant better rest-active rhythm after light therapy suggest its potential with sleep and prognosis which warrants further investigation.

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Quiescence is an important non-pathological state in which cells pause cell cycle progression temporarily, sometimes for decades, until they receive appropriate proliferative stimuli. Quiescent cells make up a significant proportion of the body, and maintaining genomic integrity during quiescence is crucial for tissue structure and function. While cells in quiescence are spared from DNA damage associated with DNA replication or mitosis, they are still exposed to various sources of endogenous DNA damage, including those induced by normal transcription and metabolism. As such, it is vital that cells retain their capacity to effectively repair lesions that may occur and return to the cell cycle without losing their cellular properties. Notably, while DNA repair pathways are often found to be downregulated in quiescent cells, emerging evidence suggests the presence of active or differentially regulated repair mechanisms. This review aims to provide a current understanding of DNA repair processes during quiescence in mammalian systems and sheds light on the potential pathological consequences of inefficient or inaccurate repair in quiescent cells.

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Rheumatoid arthritis (RA) is an autoimmune disease that causes persistent inflammation involving the joints, cartilage, and synovium. In individuals with RA, alterations in the composition of intestinal bacteria suggest the vital role of gut microbiota in immune dysfunction. Multiple therapies commonly used to treat RA can also alter the diversity of gut microbiota, further suggesting the modulation of gut microbiota as a prevention or treatment for RA. Therefore, a better understanding of the changes in the gut microbiota that accompany RA should facilitate the development of novel therapeutic approaches. In this study, B. coagulans BACO-17 not only significantly reduced paw swelling, arthritis scores, and hind paw and forepaw thicknesses but also protected articular cartilage and the synovium against RA degeneration, with a corresponding downregulation of TNF-α expression. The inhibition or even reversing of RA progression highlights B. coagulans BACO-17 as a novel therapeutic for RA worth investigating.

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The α-amino-3­hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) is an ionotropic glutamate receptor recognized for its active involvement in epilepsy. Through AMPAR functional alterations, multiple factors contribute to the increased susceptibility to seizures in the geriatric population. These factors include changes in the hippocampus, neuroinflammation, ischemic insults, amyloid deposition, previous seizures, alterations in the microenvironment, and neurovascular unit dysfunction. Perampanel, a noncompetitive AMPAR antagonist, has been approved for the treatment of focal and generalized epilepsy. However, a complete understanding of AMPAR's role in epileptogenesis and the pharmacotherapy of perampanel in the geriatric population remains elusive. To address this gap, we conducted a comprehensive literature review, screening 1557 articles and ultimately selecting 94 relevant ones. We provided insights into AMPAR functionality changes and perampanel's role in treating geriatric epilepsy. Various clinical trials and retrospective studies have demonstrated that the safety and efficacy of perampanel in the older population are comparable to those in the younger population, with overall good tolerability. It is also effective for treating focal and generalized onset seizures and possibly for managing status epilepticus. In conclusion, the existing body of evidence supports the safety and efficacy of perampanel in the geriatric population, indicating its potential as a valuable therapeutic option for focal and generalized epilepsy. Additional research is warranted to deepen our understanding of AMPAR's involvement in epileptogenesis and to refine the pharmacotherapeutic nuances in this specific demographic.

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BACKGROUND: Premature children with retinopathy of prematurity (ROP) have been reported to an have increased risk of visual and neurocognitive impairments, yet little is known about whether vision could affect specific neurocognition. This study aimed to clarify the correlations between neurocognition and vision in premature children. MATERIALS AND METHODS: This is a nonrandomized, cross-sectional, observational study in a pediatric cohort with five groups: (1) full-term (n = 25), (2) prematurity without ROP (n = 154), (3) prematurity with ROP but without treatment (n = 39), (4) prematurity with ROP and with bevacizumab (IVB) treatment (n = 62), and (5) prematurity with ROP and with laser/laser + IVB treatment (n = 20). Neurocognitive function was evaluated by the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV) around the age of 4 years. Visual acuity (VA) and refractive errors were tested. Correlations between WPPSI parameters and visual outcomes were analyzed across five groups. RESULTS: Among the 300 recruited children (mean age = 4.02 + 0.97 years, male = 56.3%), 297 were assessed by WPPSI-IV and 142 were assessed by vision tests. The Full-Scale Intelligence Quotient (FSIQ) index was worse in the premature groups. After adjusting for covariates, seven items, including FSIQ-Index (p = 0.047), fluid-reasoning index (p = 0.004), FR-percentile ranking (p = 0.008), object assembly (p = 0.034), picture concept (p = 0.034), zoo locations (p = 0.014) and bug search (p = 0.020), showed significant differences between groups. The better the best corrected VA (BCVA), the higher the scores on Verbal Comprehension Index (VCI), VCI-PR, and the subtest of information. CONCLUSIONS: Specific cognitive dysfunctions are related to the BCVA in this large cohort. Subtest performance profiles in WPPSI can be affected by prematurity, ROP treatment, and different ROP treatment. FSIQ is generally lower in premature children and even lower in children with ROP.

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Background and Objectives: This study explores the complex pathogenesis of pituitary adenomas (PAs), prevalent intracranial tumors in the pituitary gland. Despite their generally benign nature, PAs exhibit a diverse clinical spectrum involving hormone hypersecretion and varying invasiveness, hinting at multifaceted molecular mechanisms and abnormalities in tumorigenesis and gene regulation. Materials and Methods: The investigation focuses on the Ki-67 labeling index, SSTR2 rs2236750, SSTR5 rs34037914, and AIP rs267606574 polymorphisms, alongside serum levels of SSTR2, SSTR5, and AIP, to discern their association with PAs. The Ki-67 labeling index was assessed using immunohistochemical analysis with the monoclonal antibody clone SP6, representing the percentage of tumor cells showing positive staining. Genotyping was performed via real-time polymerase chain reaction, and serum levels were analyzed using ELISA. The study included 128 PA patients and 272 reference group subjects. Results: The results derived from binary logistic regression analysis revealed an intriguing correlation between the SSTR2 rs2236750 AG genotype and approximately a 1.6-fold increased likelihood of PA occurrence. When analyzing SSTR5 rs34037914, statistically significant differences were found between Micro-PA and the reference group (p = 0.022). Additionally, the SSTR5 rs34037914 TT genotype, compared with CC + CT, under the most robust genetic model (selected based on the lowest AIC value), was associated with a 12-fold increased odds of Micro-PA occurrence. However, it is noteworthy that after applying Bonferroni correction, these findings did not retain statistical significance. Conclusions: Consequently, while this study hinted at a potential link between SSTR2 rs2236750 and pituitary adenoma development, as well as a potential link between SSTR5 rs34037914 and Micro-PA development, it underscored the need for further analysis involving a larger cohort to robustly validate these findings.

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INTRODUCTION: The blockade of the renin-angiotensin system (RAS) has a beneficial effect on reducing the levels of proteinuria and blood pressure in patients with chronic kidney disease (CKD) and reduces the risk of developing end-stage kidney disease in CKD patients. Nonetheless, a debate persists regarding the impact of RAS inhibitors on outcomes such as mortality and graft survival in renal transplant patients. To assess the effect of RAS inhibitors on graft recipients in the past decade, we conducted a systematic review and meta-analysis. METHODS: We searched Embase, PubMed, and the Cochrane Central Register of Clinical Trials from January 1, 2012, to August 1, 2022. We included 14 articles, comprising 5 randomized controlled trials (RCTs) and 9 cohort studies, including 45,377 patients. These studies compared patient or graft survival between an RAS inhibitor treatment arm and a control arm. RESULTS: The meta-analysis revealed that RAS blockade was significantly associated with lower mortality in cohort studies (risk ratio [RR] = 0.66, 95% confidence interval [CI]: 0.55-0.79), reduced allograft loss in cohort studies (RR = 0.62, 95% CI: 0.54-0.71), and significant changes in systolic blood pressure in RCTs. Subgroup analysis of the groups of interest (interventions involving RAS blockade, follow-up period of ≥5 years) showed consistently reduced mortality (RR = 0.67, 95% CI: 0.56-0.81) and reduced allograft loss (RR = 0.61, 95% CI: 0.54-0.70). CONCLUSIONS: Our results demonstrated that the application of RAS blockade among renal transplant recipients was associated with lower mortality and allograft loss in cohort studies but not in RCTs. More powered clinical trials are needed to evaluate the effects of RAS blockade in renal transplant recipients.

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The unprecedented phenomenon that a charge density wave (CDW) emerges inside the antiferromagnetic (AFM) phase indicates an unusual CDW mechanism associated with magnetism in FeGe. Here, we demonstrate that both the CDW and magnetism of FeGe can be effectively tuned through postgrowth annealing treatments. Instead of the short-range CDW reported earlier, a long-range CDW order is realized below 110 K in single crystals annealed at 320 °C for over 48 h. The CDW and AFM transition temperatures appear to be inversely correlated with each other. The onset of the CDW phase significantly reduces the critical field of the spin-flop transition, whereas the CDW transition remains stable against minor variations in magnetic orders such as annealing-induced magnetic clusters and spin-canting transitions. Single-crystal x-ray diffraction measurements reveal substantial disorder on the Ge1 site, which is characterized by displacement of the Ge1 atom from the Fe_{3}Ge layer along the c axis and can be reversibly modified by the annealing process. The observed annealing-tunable CDW and magnetic orders can be well understood in terms of disorder on the Ge1 site. Our study provides a vital starting point for the exploration of the unconventional CDW mechanism in FeGe and of kagome materials in general.

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Indigo is widely used in textile industries for denim garments dyeing and is mainly produced by chemical synthesis which, however, raises environmental sustainability issues. Bio-indigo may be produced by fermentation of metabolically engineering bacteria, but current methods are economically incompetent due to low titer and the need for an inducer. To address these problems, we first characterized several synthetic promoters in E. coli and demonstrated the feasibility of inducer-free indigo production from tryptophan using the inducer-free promoter. We next coupled the tryptophan-to-indigo and glucose-to-tryptophan pathways to generate a de novo glucose-to-indigo pathway. By rational design and combinatorial screening, we identified the optimal promoter-gene combinations, which underscored the importance of promoter choice and expression levels of pathway genes. We thus created a new E. coli strain that exploited an indole pathway to enhance the indigo titer to 123 mg/L. We further assessed a panel of heterologous tryptophan synthase homologs and identified a plant indole lyase (TaIGL), which along with modified pathway design, improved the indigo titer to 235 mg/L while reducing the tryptophan byproduct accumulation. The optimal E. coli strain expressed 8 genes essential for rewiring carbon flux from glucose to indole and then to indigo: mFMO, ppsA, tktA, trpD, trpC, TaIGL and feedback-resistant aroG and trpE. Fed-batch fermentation in a 3-L bioreactor with glucose feeding further increased the indigo titer (≈965 mg/L) and total quantity (≈2183 mg) at 72 h. This new synthetic glucose-to-indigo pathway enables high-titer indigo production without the need of inducer and holds promise for bio-indigo production.

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Trichomonas tenax, an oral commensal parasite commonly found in the human mouth, is associated with periodontitis and poor oral hygiene. However, it has also been identified in the bronchoalveolar lavage fluid (BALF) of individuals with lung diseases. Notably, significant quantities of T. tenax have been isolated following bronchoscopy in cases of empyema and acute respiratory distress syndrome (ARDS). Furthermore, research has demonstrated its ability to induce inflammation in pulmonary epithelial cells. To comprehend the potential role of T. tenax in pneumonia, it is crucial to elucidate the relationship between the parasite and the disease. We investigated the clinical factors associated with T. tenax infection in patients with pneumonia. Employing nested polymerase chain reactions, we amplified nucleic acids from BALF and analyzed the relationships between T. tenax and various clinical factors. Our data revealed a significant association between T. tenax and bacterial infections, high pneumonia severity index (PSI) scores, nasogastric tube feeding, and pulmonary complications. Logistic regression analyses also showed strong associations between T. tenax and these clinical factors in pneumonia patients. These findings suggest that T. tenax infection in pneumonia is accompanied by bacterial infection and severe clinical manifestations.

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The COVID-19 pandemic may have a significant impact on patients with narcolepsy, yet a long-term follow-up study is currently lacking. This study aims to investigate changes in symptom severity and the quality of life of patients with narcolepsy during and after the pandemic. Patients with type 1 or type 2 narcolepsy (NT1, NT2) were retrospectively recruited and prospectively followed from 2020 to 2023. They received evaluations including the Epworth Sleepiness Scale (ESS), the visual analog scale (VAS) for hypersomnolence, the VAS for cataplexy, the Short-form 36 Health Survey questionnaire (SF-36), and a sleep diary. We compared the differences between the pre-lockdown, the lockdown, the post-lockdown, and the post-pandemic periods by repeated measures ANOVA or the Friedman test, with the Bonferroni test for post hoc analysis. A total of 100 patients completed the 4-year study (mean age, 24.06 ± 7.00 years; 55% male). We observed significant differences in the ESS (p = 0.037), total nighttime sleep (p = 0.03), total sleep time (p = 0.035), and sleep efficiency (p = 0.035) during the study period. There was also significantly worse physical role functioning in the post-pandemic period (p = 0.014). In particular, the NT1 group had significantly decreased VAS-C scores (p < 0.001) but experienced worse physical role functioning in the post-pandemic period (p = 0.009). Patients with narcolepsy continue to face challenges after the pandemic. A more flexible lifestyle with an adequate sleep time may be beneficial, and medication adherence should be emphasized.

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BACKGROUND: Chronic hepatitis C (CHC) increases the risk of liver cirrhosis (LC) and hepatocellular carcinoma (HCC). This nationwide cohort study assessed the effectiveness of viral eradication of CHC. METHODS: The Taiwanese chronic hepatitis C cohort and Taiwan hepatitis C virus (HCV) registry are nationwide HCV registry cohorts incorporating data from 23 and 53 hospitals in Taiwan, respectively. This study included 27,577 individuals from these cohorts that were given a diagnosis of CHC and with data linked to the Taiwan National Health Insurance Research Database. Patients received either pegylated interferon and ribavirin or direct-acting antiviral agent therapy for > 4 weeks for new-onset LC and liver-related events. RESULTS: Among the 27,577 analyzed patients, 25,461 (92.3%) achieved sustained virologic response (SVR). The mean follow-up duration was 51.2 ± 48.4 months, totaling 118,567 person-years. In the multivariable Cox proportional hazard analysis, the hazard ratio (HR) for incident HCC was 1.39 (95% confidence interval [CI]: 1.00-1.95, p = 0.052) among noncirrhotic patients without SVR compared with those with SVR and 1.82 (95% CI 1.34-2.48) among cirrhotic patients without SVR. The HR for liver-related events, including HCC and decompensated LC, was 1.70 (95% CI 1.30-2.24) among cirrhotic patients without SVR. Patients with SVR had a lower 10-year cumulative incidence of new-onset HCC than those without SVR did (21.7 vs. 38.7% in patients with LC, p < 0.001; 6.0 vs. 18.4% in patients without LC, p < 0.001). CONCLUSION: HCV eradication reduced the incidence of HCC in patients with and without LC and reduced the incidence of liver-related events in patients with LC.