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An 8 weeks feeding trial was conducted to evaluate the effects of dietary n-3 LC-PUFA levels on growth performance, tissue fatty acid profiles and relative expression of genes involved in lipid metabolism of mud crab (Scylla paramamosain). Ten isonitrogenous diets were formulated to contain five n-3 LC-PUFA levels at 7 % and 12 % dietary lipid levels. Highest weight gain and specific growth rate were observed in crabs fed the diets with 19.8 and 13.2 mg g-1 n-3 LC-PUFA at 7 % and 12 % lipid, respectively. Moisture and lipid contents in hepatopancreas and muscle were significantly influenced by dietary n-3 LC-PUFA at the two lipid levels. The DHA, EPA, n-3 LC-PUFA contents and n-3/n-6 PUFA ratio in hepatopancreas and muscle significantly increased as dietary n-3 LC-PUFA levels increased at both lipid levels. The expression levels of Δ6 FAD and ACO in hepatopancreas increased significantly, and expression levels of FAS, CPTⅠ and HSL were down-regulated, with increased dietary n-3 LC-PUFA regardless of lipid level. Based on weight gain, the n-3 LC-PUFA requirements of S. paramamosain were estimated to be 20.1 mg g-1 and 12.7 mg g-1 of diet at 7 % and 12 % dietary lipid, respectively. Over all, dietary lipid level influenced lipid metabolism, and purified, high-lipid diets rich in palmitic acid reduced the n-3 LC-PUFA requirement of juvenile mud crab.
No studies have reported on how to relieve distress or relax in medical health workers while wearing medical protective equipment in coronavirus disease 2019 (COVID-19) pandemic. The study aimed to establish which relaxation technique, among six, is the most feasible in first-line medical health workers wearing medical protective equipment.
This was a two-step study collecting data with online surveys. Step 1: 15 first-line medical health workers were trained to use six different relaxation techniques and reported the two most feasible techniques while wearing medical protective equipment. Step 2: the most two feasible relaxation techniques revealed by step 1 were quantitatively tested in a sample of 65 medical health workers in terms of efficacy, no space limitation, no time limitation, no body position requirement, no environment limitation to be done, easiness to learn, simplicity, convenience, practicality, and acceptance.
Kegel exercise and autogenic relaxation were the most feasible techniques according to step 1. In step 2, Kegel exercise outperformed autogenic relaxation on all the 10 dimensions among the 65 participants while wearing medical protective equipment (efficacy: 24 v. 15, no space limitation: 30 v. 4, no time limitation: 31 v. 4, no body position requirement: 26 v. 4, no environment limitation: 30 v. 11, easiness to learn: 28 v. 5, simplicity: 29 v. 7, convenience: 29 v. 4, practicality: 30 v. 14, acceptance: 32 v. 6).
Kegel exercise seems a promising self-relaxation technique for first-line medical health workers while wearing medical protective equipment among COVID-19 pandemic.
Nucleotide plays an important role in the regulation of cellular energy and protein homeostasis. The objective of the current study was to investigate the cumulative effects of maternal supplementation with nucleotides in the form of uridine (UR) on fatty acids and amino acids constituents of neonatal piglets. A total of 52 pregnant sows with similar parity were assigned randomly and equally into the control (CON) group (fed a basal diet) or UR group (fed a basal diet with 150g/t UR). The experiment started on d 85 of gestation and ended on the day of delivery. The reproductive performance was recorded, and placenta, blood and liver samples of neonatal piglets were collected before consuming colostrum during farrowing. Results showed that supplementing with UR in sow’ diet significantly decreased the birth mortality of pigs (P = 0.05). In addition, maternal dietary UR supplementation increased serum total cholesterol (CHOL), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) of neonatal piglets (P < 0.05). Moreover, the amino acid profile of serum and liver of neonatal piglets was affected by the addition of UR in sows’ diets (P<0.05). Furthermore, an up-regulation of mRNA expression of energy metabolism-related genes, including fatty acid elongase 5 (ELOVL5), fatty acid desaturase 1 (FADS1), hormone-sensitive lipase (HSL) and cholesterol- 7a-hydroxylase (CYP7a1), was observed in the liver of neonates from the UR group. Additionally, a decrease in placental gene expression of excitatory amino acid transporters 2 (EAAT2), excitatory amino acid transporters 3 (EAAT3), neutral AA transporter 1(LAT1) in UR group was concurrently observed (P<0.05), and higher protein expression of phosphorylated protein kinase B (P-AKT), raptor, peroxisome proliferator activated receptor α (PPARα) and PPARγ in placenta from UR group was also observed, (P<0.05). Together, these results showed that maternal UR supplementation could regulate the nutrients transport of placenta, largely in response to an alteration of mTORC1-PPARs signaling, thus regulating the nutrition metabolism of neonatal piglets, and improving reproductive performance.
Corona Virus Disease 2019 (COVID-19) has presented an unprecedented challenge to the health-care system across the world. The current study aims to identify the determinants of illness severity of COVID-19 based on ordinal responses. A retrospective cohort of COVID-19 patients from four hospitals in three provinces in China was established, and 598 patients were included from 1 January to 8 March 2020, and divided into moderate, severe and critical illness group. Relative variables were retrieved from electronic medical records. The univariate and multivariate ordinal logistic regression models were fitted to identify the independent predictors of illness severity. The cohort included 400 (66.89%) moderate cases, 85 (14.21%) severe and 113 (18.90%) critical cases, of whom 79 died during hospitalisation as of 28 April. Patients in the age group of 70+ years (OR = 3.419, 95% CI: 1.596–7.323), age of 40–69 years (OR = 1.586, 95% CI: 0.824–3.053), hypertension (OR = 3.372, 95% CI: 2.185–5.202), ALT >50 μ/l (OR = 3.304, 95% CI: 2.107–5.180), cTnI >0.04 ng/ml (OR = 7.464, 95% CI: 4.292–12.980), myohaemoglobin>48.8 ng/ml (OR = 2.214, 95% CI: 1.42–3.453) had greater risk of developing worse severity of illness. The interval between illness onset and diagnosis (OR = 1.056, 95% CI: 1.012–1.101) and interval between illness onset and admission (OR = 1.048, 95% CI: 1.009–1.087) were independent significant predictors of illness severity. Patients of critical illness suffered from inferior survival, as compared with patients in the severe group (HR = 14.309, 95% CI: 5.585–36.659) and in the moderate group (HR = 41.021, 95% CI: 17.588–95.678). Our findings highlight that the identified determinants may help to predict the risk of developing more severe illness among COVID-19 patients and contribute to optimising arrangement of health resources.
Double-layer absorbers have recently been extensively studied because single-layer absorbers can hardly meet the requirements of advanced absorbing materials. However, determining how to couple the matching and absorption layers remains a challenge. In the present work, we applied the hydrothermal method to prepare an ultrasmall Fe3O4 nanoparticle and a hierarchical MXene/Fe3O4 composite and then studied the microwave attenuation capabilities of single- and double-layer absorbers containing these two materials with different thicknesses. Absorbers with well-coupled layers showed improved absorption performance on account of the excellent impedance matching behavior of the Fe3O4 layer and the high microwave attenuation capability of the MXene/Fe3O4 layer. When the thickness of the matching layer filled with Fe3O4 was 0.1 mm and that of the absorption layer filled with MXene/Fe3O4 was 1.9 mm, a maximum reflection loss of −48.7 dB was achieved at 9.9 GHz. More importantly, when the thicknesses of the matching and absorption layers were 0.9 and 1.1 mm, respectively, the effective bandwidth was nearly 3.9 GHz. The double-layer absorbers with enhanced absorption properties may be regarded as a new generation of materials for electromagnetic wave absorption.
The present study evaluated the effects of dietary Zn level on growth performance, serum and hepatopancreas metabolites, expression of genes involved in lipid and energy metabolism, and the signalling pathway of dietary Zn-induced lipolysis. Five isonitrogenous and isolipidic diets were formulated to contain different Zn levels: 46·4 (basal diet), 77·2, 87·0, 117·1 and 136·8 mg/kg, respectively. The results indicated that shrimp fed the diet containing Zn at 117·1 mg/kg had higher weight gain and specific growth rate, and the lowest feed intake and feed conversion rate, than shrimp fed the other diets. The deposition rate of Zn in whole body significantly decreased with increasing dietary Zn level. Dietary Zn prevented the accumulation of free radicals and improved antioxidant activities by increasing Cu/Zn superoxide dismutase and reducing malondialdehyde in hepatopancreas. Dietary Zn supplementation enhanced lipase activity and adiponectin, which could promote TAG breakdown and fatty acid oxidation and lead to reduced lipid in hepatopancreas. The mRNA expressions of ob-rb, adipor, camkkβ, ampk, cd36, mcd and cpt1 involved in Zn-induced lipid catabolism were up-regulated, and the expressions of srebp, acc, fas and scd1 were down-regulated. The mRNA levels of SLC39 family genes (zip3, zip9, zip11 and zip14) in hepatopancreas were up-regulated with increasing dietary Zn level. The results demonstrated that dietary Zn level could significantly affect growth performance, tissue deposition of Zn, lipid metabolites and expression of genes involved in lipogenesis and lipolysis in Litopenaeus vannamei.
The aim of the present study was to investigate the effects of dietary Zn level on growth performance, Zn bioaccumulation, antioxidant capacity and innate immunity in juvenile mud crabs (Scylla paramamosain). Six semi-purified diets were formulated to contain dietary Zn levels of 44·5, 56·9, 68·5, 97·3, 155·6 or 254·7 mg/kg. Dietary Zn level significantly influenced percentage weight gain (PWG), with the highest observed in crabs fed the diet containing 97·3 mg/kg Zn. Tissue Zn concentrations significantly increased as dietary Zn levels increased from 44·5 to 254·7 mg/kg. Retention of Zn in hepatopancreas increased with dietary Zn levels up to 68·5 mg/kg and then significantly decreased. Moreover, inadequate dietary Zn (44·5 and 56·9 mg/kg) reduced antioxidation markers including total superoxide dismutase (SOD) and Cu/Zn SOD activities and total antioxidant level. Crabs fed the diet with 44·5 mg/kg Zn also showed significantly lower expression of genes involved in antioxidant status, such as Cu/Zn SOD, glutathione peroxidase, catalase and thioredoxin than those fed diets containing 68·5 and 97·3 mg/kg Zn. The highest activities of phenoloxidase and alkaline phosphatase were recorded in crabs fed the diets containing 68·5 and 97·3 mg/kg Zn. Expression levels of prophenoloxidase and toll-like receptor 2 were higher in crabs fed the 97·3 mg/kg Zn diet compared with crabs fed the other diets. Based on PWG alone, the optimal dietary Zn level was estimated to be 82·9 mg/kg, with 68·5 to 97·3 mg/kg recommended for maintaining optimal Zn bioaccumulation, oxidation resistance and innate immune response of juvenile mud crabs.
The current study compares the effects of two types of pronunciation instruction (segmental- and suprasegmental-based) on the development of second-year Chinese undergraduate students’ English pronunciation as against a group with no specific pronunciation (NSP) instruction. The participants were 90 university-level students in the Chinese mainland, from three intact classes. One class was taught with a segmental focus (N = 30) and the second with a suprasegmental focus (N = 31), while the third received NSP instruction (N = 29). The results showed that after an 18-week period of instruction, both the segmental and suprasegmental groups made statistically significant progress in pronunciation, as measured by comprehensibility on a sentence-reading task; however, only the suprasegmental group made statistically significant progress in comprehensibility at the spontaneous level, and it was also the only group that maintained these spontaneous gains on the delayed posttest. The positive effects of explicit pronunciation instruction in general and of suprasegmental instruction in particular account for the findings.
This study aims to ascertain the long-term epidemic trends of malaria and evaluates the probability of achieving the eradication goal by 2020 in China. Data on malaria incidence and deaths were extracted from the China Information System for Disease Control and Prevention. The epidemic trends by sex, age and spatial distribution and predictions of malaria were estimated by using Joinpoint and Poisson regressions. From 1950 to 2016, 227 668 374 malaria cases were reported in China, with an annualised average incidence of 337.02 (336.98–337.07, 95% confidence interval (CI)) per 100 000 population. The incidence decreased with an average annual per cent change (AAPC) of −11.4% (−16.6 to −6.0). There were 36 085 malaria deaths, with an annualised average mortality of 0.534 (0.529–0.540) per 1 000 000 population. The mortality decreased with an AAPC of −8.7% (−13.7 to −3.4). The predicted number of malaria cases and deaths for 2020 is 2 562 and 10, respectively, and zero for indigenous cases. The disease burden of malaria dramatically decreased in China. Though, the goal of malaria elimination is realistic by 2020 in China, routine clinical and entomological surveillance should be continually conducted, especially for the cross-border areas and imported malaria cases.
To summarize characteristics and commonalities of non-technical competency frameworks for health professionals in emergency and disaster.
An electronic literature search was conducted in PubMed, MEDLINE, ERIC, Scopus, Cochrane database, and Google Scholar to identify original English-language articles related to development, evaluation or application of the nontechnical competency frameworks. Reviewers assessed identified articles for exclusion/inclusion criteria and abstracted data on study design, framework characteristics, and reliability/validity evidence.
Of the 9627 abstracts screened, 65 frameworks were identiﬁed from 94 studies that were eligible for result extraction. Sixty (63.8%) studies concentrated on clinical settings. Common scenarios of the studies were acute critical events in hospitals (44;46.8%) and nonspecified disasters (39;41.5%). Most of the participants (76; 80.9%) were clinical practitioners, and participants in 36 (38.3%) studies were multispecialty. Thirty-three (50.8%) and 42 (64.6%) frameworks had not reported evidence on reliability and validity, respectively. Fourteen of the most commonly involved domains were identified from the frameworks.
Nontechnical competency frameworks applied to multidisciplinary emergency health professionals are heterogeneous in construct and application. A fundamental framework with standardized terminology for the articulation of competency should be developed and validated so as to be accepted and adapted universally by health professionals in all-hazard emergency environment.
Freshwater habitats in China are potentially suitable for invasive alien turtle species and, consequently, raising turtles in aquaculture facilities and the trade in turtles this supplies pose risks to habitats and native wetland communities when exotic turtles escape or are released deliberately. Online trade (e-commerce) is making an increasing contribution to turtle sales in China, seemingly driving demand and thus potentially exacerbating the risk of release. We document the scale and spatial pattern of online sales of non-native turtles over 90 days on China's Taobao.com e-commerce site. The majority of sales were in the ecologically sensitive middle and lower Yangtze river basin (82.35% of > 840,000 slider turtles Trachemys scripta elegans, and 68.26% of > 100,000 snapping turtles, Chelydridae spp.). These species are native to the Americas. Concurrently, over 2008–2018, we found 104 mentions of feral turtle issues listed on Baidu News where, among the 53 prefectures mentioned, issues with invasive turtle populations also focused predominantly in the middle and lower Yangtze river basin. Although circumstantial, this association suggests that the substantial online sale of alien turtles could be having detrimental effects in China's Yangtze river basin. It is important to safeguard these wetland habitats, which are of global importance, by improving policies for detecting and regulating invasive alien turtle issues and by warning consumers about the ecological hazard of their purchases.
The fatigue behavior of a low-cost Zr52.1Ti5Cu17.9Ni14.6Al10Y0.4 (at%) (ZrCuNi-based) bulk-metallic glass (BMG) prepared by industrial-grade material was investigated under three-point bending loading modes. In order to obtain the fatigue stress-life (S-N) data, stress-controlled experiments were conducted using a computer-controlled material test system electrohydraulic testing machine at 60 Hz with a 0.1 R ratio in the air at room temperature. The fatigue limit (~174 MPa) in stress amplitude and fatigue ratio (~0.14) of this BMG is comparative to the similar BMG (Vit-105) prepared by high pure raw materials. The crack initiated from inclusions near the rectangular corners at the outer surface of the rectangular beam due to stress concentration. The striations and vein-like patterns were observed in the crack propagation region and fast fracture region, respectively.
To investigate the hypothesis that folic acid supplementation and dietary folate intake before conception and during pregnancy reduce the risk of small for gestational age (SGA) and to examine the joint effect of folic acid supplementation and dietary folate intake on the risk of SGA.
Participants were interviewed by trained study interviewers using a standardized and structured questionnaire. Information on birth outcomes and maternal complications was abstracted from medical records and dietary information was collected via a semi-quantitative FFQ before conception and during pregnancy.
A birth cohort data analysis using the 2010–2012 Gansu Provincial Maternity and Child Care Hospital.
Women (n 8758) and their children enrolled in the study.
Folic acid supplementation was associated with a reduced risk of SGA (OR = 0·72, 95 % CI 0·60, 0·86), with the reduced risk seen mainly for SGA at ≥37 weeks of gestational age (OR = 0·70, 95 % CI 0·58, 0·85) and nulliparous SGA (OR = 0·67, 95 % CI 0·54, 0·84). There was no significant association between dietary folate intake and SGA risk.
Our study suggested that folic acid supplementation was associated with a reduced risk of SGA and the risk varied by preterm status and parity.
The present study aimed to investigate whether dietary choline can regulate lipid metabolism and suppress NFκB activation and, consequently, attenuate inflammation induced by a high-fat diet in black sea bream (Acanthopagrus schlegelii). An 8-week feeding trial was conducted on fish with an initial weight of 8·16 ± 0·01 g. Five diets were formulated: control, low-fat diet (11 %); HFD, high-fat diet (17 %); and HFD supplemented with graded levels of choline (3, 6 or 12 g/kg) termed HFD + C1, HFD + C2 and HFD + C3, respectively. Dietary choline decreased lipid content in whole body and tissues. Highest TAG and cholesterol concentrations in serum and liver were recorded in fish fed the HFD. Similarly, compared with fish fed the HFD, dietary choline reduced vacuolar fat drops and ameliorated HFD-induced pathological changes in liver. Expression of genes of lipolysis pathways were up-regulated, and genes of lipogenesis down-regulated, by dietary choline compared with fish fed the HFD. Expression of nfκb and pro-inflammatory cytokines in liver and intestine was suppressed by choline supplementation, whereas expression of anti-inflammatory cytokines was promoted in fish fed choline-supplemented diets. In fish that received lipopolysaccharide to stimulate inflammatory responses, the expression of nfκb and pro-inflammatory cytokines in liver, intestine and kidney were all down-regulated by dietary choline compared with the HFD. Overall, the present study indicated that dietary choline had a lipid-lowering effect, which could protect the liver by regulating intrahepatic lipid metabolism, reducing lipid droplet accumulation and suppressing NFκB activation, consequently attenuating HFD-induced inflammation in A. schlegelii.
In this work, we studied an atomic layer deposition (ALD) process of ZrO2 with the precursors of tetrakis(dimethylamido)zirconium(IV) and water. We investigated the growth characteristics and mechanism of the ALD ZrO2 in the temperature range of 50–275 °C. Furthermore, the evolutions of film thickness and morphology were studied and discussed. It was found that the growth rate of ZrO2 decreased almost linearly with the increasing temperature from ∼1.81 Å/cycle at 50 °C to ∼0.8 Å/cycle at 225 °C. Interestingly, it was revealed that the growth of ZrO2 films ceased after a certain number of ALD cycles at a temperature higher than 250 °C. We also verified that the crystallinity of ZrO2 evolved with deposition temperature from amorphous to crystalline phase. In addition, the wettability of ZrO2 films was studied, showing a hydrophobic nature.
Animal studies have suggested that mushroom intake can alleviate non-alcoholic fatty liver disease (NAFLD) due to its anti-inflammatory and antioxidant properties. However, the association between mushroom intake and NAFLD is unknown in humans. We aimed to investigate the association of mushroom intake with NAFLD among Chinese adults. This is a cross-sectional study of 24 236 adults (mean (standard deviation) age: 40·7 (sd 11·9) years; 11 394 men (47·0 %)). Mushroom intake was assessed via a validated FFQ. Newly diagnosed NAFLD was identified based on the results of annual health examinations, including ultrasound findings and a self-reported history of the disease. Multiple logistic models were used to examine the association between mushroom intake and NAFLD. The prevalence of newly diagnosed NAFLD was 19·0 %. Compared with those consuming mushrooms less frequently (≤1 time/week), the fully adjusted OR of newly diagnosed NAFLD were 0·95 (95 % CI 0·86, 1·05) for those consuming 2–3 times/week and 0·76 (95 % CI 0·63, 0·92) for those consuming ≥4 times/week (Pfor trend = 0·01). The inverse association was consistent in subgroups defined by age, sex and BMI. In conclusion, higher mushroom intake was significantly associated with lower prevalence of NAFLD among Chinese adults. Future research is required to understand the causal association between mushroom intake and NAFLD.
The regulation of lipogenesis and lipolysis mechanisms related to consumption of lipid has not been studied in swimming crab. The aims of the present study were to evaluate the effects of dietary lipid levels on growth, enzymes activities and expression of genes of lipid metabolism in hepatopancreas of juvenile swimming crab. Three isonitrogenous diets were formulated to contain crude lipid levels at 5·8, 9·9 and 15·1 %. Crabs fed the diet containing 15·1 % lipid had significantly lower growth performance and feed utilisation than those fed the 5·8 and 9·9 % lipid diets. Crabs fed 5·8 % lipid had lower malondialdehyde concentrations in the haemolymph and hepatopancreas than those fed the other diets. Highest glutathione peroxidase in haemolymph and superoxide dismutase in hepatopancreas were observed in crabs fed 5·8 % lipid. The lowest fatty acid synthase and glucose 6-phosphate dehydrogenase activities in hepatopancreas were observed in crabs fed 15·1 % lipid, whereas crabs fed 5·8 % lipid had lower carnitine palmitoyltransferase-1 activity than those fed the other diets. Crabs fed 15·1 % lipid showed lower hepatopancreas expression of genes involved in long-chain-PUFA biosynthesis, lipoprotein clearance, fatty acid uptake, fatty acid oxidation, lipid anabolism and lipid catabolism than those fed the other diets, whereas expression of some genes of lipoprotein assembly and fatty acid oxidation was up-regulated compared with crabs fed 5·8 % lipid. Overall, high dietary lipid level can inhibit growth, reduce antioxidant enzyme activities and influence lipid metabolic pathways to regulate lipid deposition in crab.
The regeneration of human tissues with complex anatomy such as gastrointestinal (GI) tract remains greatly challenging since it requires appropriate cell microenvironments with well-defined structural and biochemical cues. In this investigation, bilayer scaffolds consisting of different polymer nanofibers with orthogonal fiber orientations were prepared, in which vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF) were encapsulated separately. The bilayer scaffolds have similar architecture to the anatomy of the GI tract and can achieve dual releases of VEGF and PDGF in sequential and sustained manners, which hold promise as appropriate cell microenvironments for promoting the regeneration of the GI tract.
Severe phase coarsening and separation in Sn–Bi alloys have brought increasing reliability concern in microelectronic packages. In this study, a phase field model is developed to simulate the microstructural evolution and evaluate the change in macroscopic physical properties of the flip chip Cu/Sn58Bi/Cu joint under the conditions of isothermal aging, as well as the coupled loads of elastic stress and electric current stressing. Results show that large-sized Bi-rich phase particles grow up at the expense of small-sized ones. Under the coupled loads, Bi atoms migrate along the electron flow direction, consequently Bi-rich phase segregates to form a Bi-rich phase layer at the anode. The current crowding ratio in the solder decreases rapidly first and then fluctuates slightly with time. Current density and von Mises stress exhibit inhomogeneous distribution, and both of them are higher in the Sn-rich phase than in the Bi-rich phase. Electric current transfers through the Sn-rich phase and detours the Bi-rich phase. As time proceeds, the resistance of the solder joint increases, and the average von Mises stress of the solder joint decreases. The Bi-rich phase coarsens much faster under the coupled loads than under the conditions of isothermal aging.
Existing data on folate status and hepatocellular carcinoma (HCC) prognosis are scarce. We prospectively examined whether serum folate concentrations at diagnosis were associated with liver cancer-specific survival (LCSS) and overall survival (OS) among 982 patients with newly diagnosed, previously untreated HCC, who were enrolled in the Guangdong Liver Cancer Cohort (GLCC) study between September 2013 and February 2017. Serum folate concentrations were measured using chemiluminescent microparticle immunoassay. Cox proportional hazards models were performed to estimate hazard ratios (HR) and 95 % CI by sex-specific quartile of serum folate. Compared with patients in the third quartile of serum folate, patients in the lowest quartile had significantly inferior LCSS (HR = 1·48; 95 % CI 1·05, 2·09) and OS (HR = 1·43; 95 % CI 1·03, 1·99) after adjustment for non-clinical and clinical prognostic factors. The associations were not significantly modified by sex, age at diagnosis, alcohol drinking status and Barcelona Clinic Liver Cancer (BCLC) stage. However, there were statistically significant interactions on both multiplicative and additive scale between serum folate and C-reactive protein (CRP) levels or smoking status and the associations of lower serum folate with worse LCSS and OS were only evident among patients with CRP > 3·0 mg/l or current smokers. An inverse association with LCSS were also observed among patients with liver damage score ≥3. These results suggest that lower serum folate concentrations at diagnosis are independently associated with worse HCC survival, most prominently among patients with systemic inflammation and current smokers. A future trial of folate supplementation seems to be promising in HCC patients with lower folate status.