BackgroundIn China, patients with somatoform disorders (SFD) often seek medical treatment repeatedly in outpatient clinics of general hospitals, which increases unreasonable medical expenses. It is imperative to provide early screening to these patients and specialized treatment to reduce the unnecessary cost. This study aimed to screen patients with SFD in general hospitals using a new Chinese questionnaire and explore the characteristics and economic burden of these patients.MethodsPatients (n = 1497) from the outpatient department of neurology, cardiology and gastroenterology of three large general hospitals were included. Participants were screened using a newly developed questionnaire, the Self-screening Questionnaire for Somatic Symptoms (SQSS), to identify the patients with SFD (total SQSS score ≥ 29 points). We compared the demographics and clinical information of patients with and without SFD. Logistic regression was used to explore potential factors related to medical expenses, visits to doctors and sick leave days taken.ResultsThe frequency of detection of patients with SFD was 17.03%. There were significant differences in employment, doctor visits, symptom duration, medical expenses, sick leave days, PHQ-15 scores, and PHQ-9 scores between patients with SFD and without SFD. General nonspecific somatic symptoms were frequently present in patients with SFD. Several potential factors were associated with higher medical expenses, repeated doctor visits, and sick leave days taken in the regression analysis.ConclusionThe findings indicate that patients with SFD are common in general hospitals, and their direct and indirect economic burden is higher than that of non-SFD patients, which indicates that more screening effort should be made to this group to early identify their problems. Certain characteristics were identified among patients with SFD and several factors were associated with negative consequences of SFD, all of which might be prevented by developing a preventive intervention program to reduce the economic burden of the patients.

ObjectiveDermatomyositis (DM) positive with anti-melanoma differentiation-associated gene 5 (anti-MDA5-DM) is a systemic autoimmune disease with high mortality. This study aimed to explore the risk factors of death in anti-MDA5-DM and validate a prediction model for all-cause mortality in anti-MDA5-DM.MethodWe conducted a retrospective study using a single-centre cohort of patients with newly onset anti-MDA5-DM from June 1, 2018 to August 31, 2021. Patients were divided into four groups according to baseline ground-glass opacity (GGO) score: Group A, GGO ≤ 1; Group B, 1 < GGO ≤ 2; Group C, 2 < GGO ≤ 3; Group D, GGO > 3. The primary outcome was death during the follow-up. Secondary outcomes included death within 3, 6, 12 months, severe infection, and remission during the first 12 months.ResultsA total of 200 patients were included in the study. Based on multivariable Cox regression, the prognostic factors at baseline were identified as CRP > 5 mg/L, serum ferritin (SF) > 600ng/ml, positive anti-Ro52 antibody, prophylactic use of compound sulfamethoxazole (SMZ Co), four-category GGO score: GGO ≤ 1, 1 < GGO ≤ 2, 2 < GGO ≤ 3, GGO > 3. The final mortality of four groups was 16.4, 22.2, 48.5, 92.0%, respectively. Compared with Group A, the Hazards Ratio (HR) of Group B was 1.408, (p = 0.408), HR of Group C was 3.433 (p = 0.005), HR of Group D was 4.376 (p = 0.001).ConclusionsGGO score is a reliable predictor for risk stratification in anti-MDA5-DM and may provide guidance for individualized managements of patients.

BackgroundRecently, it has been reported that long non-coding RNA (lncRNA) cancer susceptibility candidate 2 (CASC2), a novel tumor suppressor, participates in regulating the carcinogenesis and suppresses tumor progression by sponging microRNAs (miRNAs). However, the expression and function of CASC2 in hepatocellular carcinoma (HCC) remain unclear.MethodsThe expression of CASC2 and miR-367 in HCC specimens and cell lines were detected by real-time PCR. Western blotting and immunohistochemistry were carried out for detection of epithelial-to-mesenchymal transition (EMT) markers in HCC. Transwell assays were used to determine migration and invasion of HCC cells. A mouse model for lung metastasis was established to evaluated HCC metastasis in vivo. The correlation among CASC2, miR-367 and F-box and WD repeat domain containing 7 (FBXW7) were disclosed by a dual-luciferase reporter assay, RIP assay and biotin pull-down assay.ResultsHere, CASC2 expression was significantly downregulated in HCC tissues, especially in aggressive and recurrent cases. In accordance, CASC2 underexpression was observed in HCC cell lines compared to LO2. In vitro and in vivo experiments revealed that CASC2 inhibited migration and invasion of HCC cells. Additionally, CASC2 repressed EMT process of HCC cells. Further studies demonstrated that CASC2 could function as a competing endogenous RNA (ceRNA) by sponging miR-367 in HCC cells. Functionally, gain- and loss-of-function studies showed that miR-367 promoted migration, invasion and EMT progression of HCC cells. Moreover, further investigations disclosed that FBXW7 was a downstream target of miR-367 and CASC2 prohibited EMT progression and subsequently exerted its anti-metastatic effects via CASC2/miR-367/FBXW7 axis in HCC cells. Clinically, CASC2 underexpression and miR-367 overexpression were closely correlated with the metastasis-associated clinicopathologic features. Notably, CASC2 low-expressing and miR-367 high-expressing HCC patients showed the poorest clinical outcome.ConclusionsOverall, we conclude that the CASC2/miR-367/FBXW7 axis may be a ponderable and promising therapeutic target for HCC.