Background: The severe acute respiratory syndrome (SARS) outbreak in 2003 affected 29 countries. The SARS outbreak was unique in its rapid transmission and it resulted in heavy stress in first-line healthcare workers, particularly in the emergency department. Aim: : To determine the influence of SARS on the psychological status, including post-traumatic stress disorder (PTSD) symptoms, of the staff in the emergency department. Methods: To investigate whether different working conditions in the hospital led to different psychological effects on healthcare workers, the psychological effect on emergency department staff in the high-risk ward was compared with that on psychiatric ward staff in the medium-risk ward. Davidson Trauma Scale-Chinese version (DTS-C) and Chinese Health Questionnaire-12 (CHQ-12) items were designed to check the psychological status of the staff in the month after the end of the SARS outbreak. Results: 86 of 92 (93.5%) medical staff considered the SARS outbreak to be a traumatic experience. The DTS-C scores of staff in the emergency department and in the psychiatric ward were significantly different (p = 0.04). No significant difference in CHQ score was observed between the two groups. Emergency department staff had more severe PTSD symptoms than staff in the psychiatric ward. Conclusion: SARS was a traumatic experience for healthcare providers in Taiwan. Most staff in the emergency department and in the psychiatric ward had PTSD. Emergency department staff had more severe PTSD symptoms than staff in the psychiatric ward.

Background/Aims: Benefits of the Mediterranean diet (MD) in reducing hepatic steatosis among individuals with metabolic dysfunction–associated steatotic liver disease (MASLD) have been well established. This study aims to evaluate the relationship between MD adherence and liver fibrosis among the MASLD population. Methods: This cross‐sectional study analyzed data from the National Health and Nutrition Examination Survey 2017 to March 2020. Individuals with MASLD were identified based on the vibration‐controlled transient elastography–defined steatosis. Participants' MD adherence was evaluated using the alternate Mediterranean diet (aMED) score, with higher scores indicating greater adherence. Risk of significant liver fibrosis was compared between low, moderate, and high aMED groups. Results: Of 2672 MASLD participants, 27.2%, 42.3%, and 30.6% were categorized into low, moderate, and high aMED groups, respectively. After adjusting for the number of cardiometabolic risk factors (CMRFs), physical activity, and other covariates, participants in the high aMED group were associated with a lower risk of significant liver fibrosis compared with those in the low aMED group (aMED 5–9 vs. aMED 0–2: OR = 0.662, 95% confidence interval [CI]: 0.660–0.663; p for trend < 0.0001). In the sensitivity analyses, the protective association of higher MD adherence against the risk of significant liver fibrosis weakened with higher cardiometabolic burden (aMED 5–9: aOR 0.582, 95% CI: 0.580–0.584 [4–5 CMRFs] vs. aOR 0.383, 95% CI: 0.380–0.386 [1 CMRF]). Conclusions: In MASLD patients, higher MD adherence was associated with lower risk of significant liver fibrosis. Our findings support the recommendation of the MD as a crucial lifestyle intervention to lower the risk of liver fibrosis in this population.

Background: The CRAFITY score, integrating baseline C-reactive protein (CRP) and alpha-fetoprotein (AFP), has been validated as a prognostic biomarker in hepatocellular carcinoma (HCC) treated with immunotherapy, but many patients present with non-elevated AFP, limiting its accuracy. This study evaluated a composite model incorporating the CRAFITY score with AFP/PIVKA-II kinetic changes. Methods: We retrospectively enrolled 69 patients with unresectable HCC (BCLC stage B/C) receiving immunotherapy between September 2021 and June 2023. Baseline CRP, AFP, and PIVKA-II, as well as 4-week changes, were recorded. The CRAFITY-100 RULE combined CRAFITY (0–2) with AFP/PIVKA-II kinetics (0–3), yielding three risk levels (I–III). Clinical outcomes included objective response (OR) and overall survival (OS). Results: Of the cohort, 10 (14.5%), 29 (42%), and 30 (43.5%) patients had CRAFITY scores 0, 1, and 2, respectively, but this score did not clearly stratify OS (median 24, 12, and 15 months; p = 0.267). In contrast, the CRAFITY-100 RULE classified 5 (7.3%), 35 (50.7%), and 29 (42%) patients into levels I–III, respectively, with significantly different survival (median OS 24, 15, and 7 months; p = 0.048). OR rates were lowest at level III (17%). Time-dependent ROC analysis confirmed superior discrimination of CRAFITY-100 RULE over CRAFITY scores at 6 months (AUROC 0.673 vs. 0.604) and 12 months (0.732 vs. 0.656). Conclusions: The CRAFITY-100 RULE provided clearer stratification and higher discrimination. This simple model integrating baseline and dynamic biomarkers may assist clinical decision-making in unresectable HCC treated with immunotherapy.

Cyclooxygenase-2 (COX-2) and interleukin-8 (IL-8) are two important inflammatory mediators in ovulation. Ghrelin may modulate inflammatory signaling via growth hormone secretagogue receptors. We investigated the role of ghrelin in KGN human ovarian granulosa cells using protein kinase C (PKC) activator phorbol 12, 13-didecanoate (PDD) and synthetic ghrelin analog growth hormone releasing peptide-2 (GHRP-2). GHRP-2 attenuated PDD-induced expression of protein and mRNA, the promoter activity of COX-2 and IL-8 genes, and the secretion of prostaglandin E2 (PGE₂) and IL-8. GHRP-2 promoted the degradation of PDD-induced COX-2 and IL-8 proteins with the involvement of proteasomal and lysosomal pathways. PDD-mediated COX-2 production acts via the p38, c-Jun N-terminal kinase (JNK), extracellular signal-regulated kinase (ERK) and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) pathways; PDD-mediated IL-8 production acts via the p38, JNK and ERK pathways. GHRP-2 reduced the PDD-induced phosphorylation of p38 and JNK and activator protein 1 (AP-1) reporter activation and PDD-induced NF-κB nuclear translocation and reporter activation. The inhibitors of mitogen-activated protein kinase phosphatase-1 (MKP-1) and protein phosphatase 2 (PP2A) reduced the inhibitory effect of GHRP-2 on PDD-induced COX-2 and IL-8 expression. Our findings demonstrate an anti-inflammatory role for ghrelin (GHRP-2) in PKC-mediated inflammation of granulosa cells, at least in part, due to its inhibitory effect on PKC-induced activation of p38, JNK and NF-κB, possibly by targeting to MKP-1 and PP2A.

Background: Tenofovir alafenamide (TAF) and entecavir (ETV) are recommended alternatives to tenofovir disoproxil fumarate (TDF) for patients with chronic hepatitis B (CHB) at increased risk of kidney injury. However, data from direct head-to-head comparisons of their long-term renal safety and antiviral efficacy after switching from TDF are lacking. We aimed to compare these outcomes between TAF and ETV. Methods: This multicenter retrospective cohort study included consecutive CHB patients who switched from TDF to either TAF or ETV between January 2012 and December 2021. Inverse probability of treatment weighting using the propensity score was applied to balance the baseline characteristics. Changes in estimated glomerular filtration rate (eGFR) were assessed using a linear mixed-effects model. Renal dysfunction was defined as a decline of at least one GFR category. Results: A total of 235 patients were included (TAF, n = 168; ETV, n = 67). After adjustment for key risk factors, the mean eGFR decline over 36 months was not significantly different between the TAF and ETV groups (−3.21 mL/min/1.73 m² [95% CI, −4.98 to −1.44] vs. −3.49 mL/min/1.73 m² [95% CI, −9.49 to −2.50]; p = 0.856). The 3-year cumulative incidence of renal dysfunction was also not significantly different between groups (16.6% [95% CI, 10.5–23.3] vs. 7.8% [95% CI, 2.7–16.2]; p = 0.135). Alanine aminotransferase normalization rates (83.0% vs. 78.8%; p = 0.575) and virological suppression rates (97.8% vs. 97.1%; p = 1.000) were similarly high in both groups. Conclusions: TAF and ETV demonstrated similar long-term renal safety and antiviral efficacy, supporting both agents as reasonable switch options for CHB patients requiring TDF discontinuation because of renal safety concerns.