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Abstract Evidence-based data regarding the timing of the application of invasive mechanical ventilation among adults with septic shock is insufficient. The guidelines fail to provide clear advice about the optimal time to initiate this support. Consequently, we aimed to investigate whether early intubation could improve survival rates in septic shock patients. We conducted a retrospective analysis of the MIMIC-IV database to evaluate the effectiveness of early intubation on mortality in a cohort of septic shock patients. Adults diagnosed with septic shock, according to the Sepsis-3 definition, were included. They were categorized into an early intubation group (first 8 h after vasopressor initiation) and a non-early intubation group (unexposed). A propensity score matching (PSM) analysis was used to balance the baseline characteristics between the two groups. The primary outcomes were 30-day and 90-day all-cause mortality rates. In addition, we employed the restricted cubic spline to analyze the potential non-linear relationship between the timing of intubation and 30-day or 90-day all-cause mortality. A total of 6864 adult patients, of whom 2048 were intubated in the first 8 h, were evaluated in the final cohort. Following a 1:1 PSM procedure, 2786 patients were successfully paired. At 30 days, 288 of 1393 patients (20.7%) in the early intubation group and 381 of 1393 patients (27.4%) in the non-early intubation group had died (hazard ratio [HR] 0.717; 95% confidence interval [CI] 0.616–0.836; p

Multifunctional metastructure integrated broadband microwave absorption and effective mechanical resistance has attracted much attention. However, multifunctional performance is limited by the lack of theoretical approaches to integrated design. Herein, a multi-layer impedance gradient honeycomb (MIGH) was designed through theoretical analysis and simulation calculation, and fabricated using 3D printing technique. A theoretical calculation strategy for impedance gradient structure was established based on the electromagnetic parameter equivalent method and the multi-layer finite iterative method. The impedance of MIGH was analyzed by the theoretical calculation strategy to resolve the broadband absorption. Intrinsic loss mechanism of matrix materials and distributions of electric fields, magnetic fields and power loss were analyzed to investigate the absorption mechanism. Experimental results indicated that a 15 ​mm thick designed metastructure can achieve the absorption more than 88.9% in the frequency range of 2-18 ​GHz. Moreover, equivalent mechanical parameters of MIGH was calculated by integral method according to the Y-shaped model. Finite Element analysis of stress distributions were carried out to predict the deformation behavior. Mechanical tests demonstrate that MIGH achieved the compression modulus of 22.89 ​MPa and flexure modulus of 17.05 ​MPa. The integration of broadband electromagnetic absorption and effective mechanical resistance was achieved by the proposed design principle and fabrication methodology.

Fish swim bladders are considered a traditional marine aquatic food that has medicinal and nutritional properties. Sulfate glycosaminoglycans (SBSG) obtained from fish swim bladders may have anti-angiogenic activity. However, the anti-angiogenic activity of SBSG and its mechanism has not been reported. Therefore, the present study investigated the effect of SBSG on angiogenesis and examined molecular pathways in human umbilical vein endothelial cells (HUVECs) using cell viability, chicken chorioallantoic membrane (CAM) assay, tube formation assay, and proteomic analyses. The results demonstrated that the SBSG significantly (P

Brominated flame retardants (BFRs) are environmental pollutants linked to health risks, including increased platelet (PLT) levels that may elevate the risk of thrombosis and cardiovascular diseases. This study examined the association between BFR exposure and PLT levels among 5831 adult participants from the National Health and Nutrition Examination Survey (NHANES) (2007–2016). Of the 12 BFRs analyzed, BB153, BDE17, BDE85, BDE154, BDE183, and BDE209 showed significant positive correlations with PLT levels (p < 0.05), with BDE17 demonstrating the strongest correlation (Spearman’s coefficient = 0.122). After adjusting for confounders, all BFRs except BDE153 remained significantly associated with elevated PLT levels. Restricted cubic spline analysis indicated varying associations, with BDE99, BDE183, and BDE209 showing an ''S''-shaped relationship, while BB153, BDE17, and BDE66 presented an inverted ''J''-shaped relationship. BDE153 exhibited a ''U''-shaped relationship with PLT level. Both weighted quantile sum regression and quantile-based g-computation confirmed that BFR mixtures positively correlated with PLT levels, with BDE17 as the most significant contributor. Our findings suggest that BFR exposure is associated with increased PLT levels, indicating a potential risk for thrombosis and related cardiovascular conditions.

ObjectiveEffective and secure pain management following video-assisted thoracoscopic surgery (VATS) is crucial for rapid postoperative recovery. This study evaluated analgesic and sedative effects of sufentanil and promethazine in patient-controlled intravenous analgesia (PCIA) post-thoracic surgery, along with potential adverse reactions.MethodsIn this prospective, randomized, controlled, double-blind, clinical study, 60 patients (American Society of Anesthesiologists status I–III) undergoing VATS were enrolled. The patients were randomized into experimental (Group P) or control (Group C) groups. PCIA was administered post-general anesthesia using a double-blind method. Group P received sufentanil (3 μg/kg) + promethazine (1 mg/kg) + 0.9% sodium chloride solution (100 mL total), while Group C received sufentanil (3 μg/kg) + 0.9% sodium chloride solution (100 mL total). PCIA settings included a 1-mL bolus and 15-min locking time. The primary outcomes were the visual analog scale (VAS) at rest and during coughing and sedation (Ramsay) scores at 6, 12, 24, and 48 h. The secondary outcomes were rescue drug use rate, hemodynamic parameters (mean arterial pressure and heart rate), percutaneous oxygen saturation, respiratory rate, and occurrence of adverse reactions.ResultsGroup P exhibited lower resting and coughing VAS scores at 6, 12, 24, and 48 h, plus decreased incidence of nausea and vomiting within 48 h post-surgery compared with Group C (p 0.05).DiscussionThe combination of sufentanil and promethazine for postoperative intravenous analgesia could effectively reduce adverse effects such as nausea and vomiting, contributing to postoperative pain relief.

Objective Fitness technologies, such as smartphone applications and wearable tracking devices, have gained widespread popularity. This study had two main objectives: 1) to examine whether fitness technology use is associated with increased physical activity (PA) levels and 2) to investigate whether communication behaviors on social media mediated the association between fitness technology use and PA. Methods Data were from the U.S. Health Information National Trends Survey 2022 ( N = 6,252, weighted N = 258,418,467). Weighted linear regressions were conducted to examine the associations between fitness technology usage, physical activities, and communication behaviors on social media. Mediations were tested using PROCESS macro, a path-analysis based tool. Results Controlling for demographic and other known influences on PA, the findings revealed that users of fitness technology reported higher levels of both moderate PA ( β = .41, p

Despite significant recent advances in precision medicine, pancreatic ductal adenocarcinoma (PDAC) remains near uniformly lethal. Although immune-modulatory therapies hold promise to meaningfully improve outcomes for patients with PDAC, the development of such therapies requires an improved understanding of the immune evasion mechanisms that characterize the PDAC microenvironment. Here, we show that cancer cell-intrinsic glutamic-oxaloacetic transaminase 2 (GOT2) shapes the immune microenvironment to suppress antitumor immunity. Mechanistically, we find that GOT2 functions beyond its established role in the malate-aspartate shuttle and promotes the transcriptional activity of nuclear receptor peroxisome proliferator-activated receptor delta (PPARδ), facilitated by direct fatty acid binding. Although GOT2 is dispensable for cancer cell proliferation in vivo, the GOT2-PPARδ axis promotes spatial restriction of both CD4+ and CD8+ T cells from the tumor microenvironment. Our results demonstrate a noncanonical function for an established mitochondrial enzyme in transcriptional regulation of immune evasion, which may be exploitable to promote a productive antitumor immune response.SignificancePrior studies demonstrate the important moonlighting functions of metabolic enzymes in cancer. We find that the mitochondrial transaminase GOT2 binds directly to fatty acid ligands that regulate the nuclear receptor PPARδ, and this functional interaction critically regulates the immune microenvironment of pancreatic cancer to promote tumor progression. See related commentary by Nwosu and di Magliano, p. 2237.. This article is highlighted in the In This Issue feature, p. 2221.

Abstract The causal relationships between plasma metabolites and cholelithiasis/cholecystitis risks remain elusive. Using two-sample Mendelian randomization, we found that genetic proxied plasma campesterol level showed negative correlation with the risk of both cholelithiasis and cholecystitis. Furthermore, the increased risk of cholelithiasis is correlating with the increased level of plasma campesterol. Lastly, genetic colocalization study showed that the leading SNP, rs4299376, which residing at the ABCG5/ABCG8 gene loci, was shared by plasma campesterol level and cholelithiasis, indicating that the aberrant transportation of plant sterol/cholesterol from the blood stream to the bile duct/gut lumen might be the key in preventing cholesterol gallstone formation.

Abstract Bacillus thuringiensis Cry2Ab toxin was a widely used bioinsecticide to control lepidopteran pests all over the world. In the present study, engineering of Bacillus thuringiensis Cry2Ab toxin was performed for improved insecticidal activity using site-specific saturation mutation. Variants L183I were screened with lower LC50 (0.129 µg/cm2) against P. xylostella when compared to wild-type Cry2Ab (0.267 µg/cm2). To investigate the molecular mechanism behind the enhanced activity of variant L183I, the activation, oligomerization and pore-formation activities of L183I were evaluated, using wild-type Cry2Ab as a control. The results demonstrated that the proteolytic activation of L183I was the same as that of wild-type Cry2Ab. However, variant L183I displayed higher oligomerization and pore-formation activities, which was consistence with its increased insecticidal activity. The current study demonstrated that the insecticidal activity of Cry2Ab toxin could be assessed using oligomerization and pore-formation activities, and the screened variant L183I with improved activity might contribute to Cry2Ab toxin’s future application.

Abstract Background and objective Numerous previous studies have assessed the prognostic role of 18F-fluorodeoxyglucose positron-emission tomography (18F FDG PET) in patients with biliary tract cancer (BTC), but those results were inconsistent. The present study aims to determine the predictive value of 18F FDG PET in BTC patients via a meta-analysis. Methods The underlying studies related to 18F FDG PET and BTC patients` outcomes were searched and identified in the online databases. The interested parameters include total lesion glycolysis (TLG), metabolic tumor volume (MTV), primary tumor and metastatic lymph node (LN) maximum standardized uptake value (SUVmax), as well as change of SUVmax (ΔSUVmax) during treatment. Overall survival (OS), disease-free survival (DFS), and progression-free survival (PFS) were considered as the primary endpoints. Hazard ratio (HR) and corresponding 95% confidence intervals (CIs) were defined as the effective measure and calculated by a pooled analysis. Publication bias was assessed by funnel plot, Bagg’s and Egger’s tests. Results Totally, 23 studies involving 1478 patients were included in the present meta-analysis. After a pooled analysis, it revealed that a high SUVmax was significantly associated with a poor OS (HR:2.07, 95%CI: 1.74–2.46, P = 0.000) and DFS (HR: 2.28, 95%CI: 1.53–3.41, P = 0.000). In addition, an increased TLG level contributed to a shorter OS (HR:1.91, 95%CI: 1.26–2.90, P = 0.002) and DFS (HR: 4.34, 95%CI: 1.42–13.27, P = 0.01). Moreover, we confirmed that an elevated MTV was significantly associated with increased mortality (HR:2.04, 95%CI:1.26–3.31, P = 0.004) and disease relapse (HR: 3.88, 95%CI:1.25–12.09, P = 0.019) risks. Besides, the present study uncovered that increased ΔSUVmax could predict poor OS (HR:1.26, 95%CI:1.06–1.50, P = 0.008) instead of PFS (HR: 1.96, 95%CI: 0.82–4.72, P = 0.280). Lastly, we found that LN SUVmax did not link to OS (HR: 1.49, 95%CI: 0.83–2.68, P = 0.178). No obvious publication bias was detected in the present study. Conclusion 18F FDG PET parameters, including SUVmax, TLG, MTV, and ΔSUVmax, could be applied as convenient and reliable factors for predicting BTC patients` outcomes.

The application of antibiotics has advanced modern medicine significantly. However, the abuse and discharge of antibiotics have led to substantial antibiotic residues in water, posing great harm to natural organisms and humans. To address the problem of antibiotic degradation, this study developed a novel catalytic membrane by depositing Co catalysts onto MXene nanosheets and fabricating the polyethersulfone composite (Co@MXene/PES) using vacuum-assisted self-assembly. The dual role of MXene as both a carrier for Co atoms and an enhancer of interlayer spacing led to improved flux and catalytic degradation capabilities of the membrane. Experimental results confirmed that the Co@MXene/PES membrane effectively degraded antibiotics through peroxymonosulfate activation, achieving up to 95.51% degradation at a cobalt concentration of 0.01 mg/mL. The membrane demonstrated excellent antibacterial properties, minimal flux loss after repeated use, and robust anti-fouling performance, making it a promising solution for efficient antibiotic removal and stable water treatment.

The androgen receptor (AR) signaling inhibitor enzalutamide (enza) is one of the principal treatments for metastatic castration-resistant prostate cancer (CRPC). Several emergent enza clinical resistance mechanisms have been described, including lineage plasticity in which the tumors manifest reduced dependency on the AR. To improve our understanding of enza resistance, herein we analyze the transcriptomes of matched biopsies from men with metastatic CRPC obtained prior to treatment and at progression (n = 21). RNA-sequencing analysis demonstrates that enza does not induce marked, sustained changes in the tumor transcriptome in most patients. However, three patients' progression biopsies show evidence of lineage plasticity. The transcription factor E2F1 and pathways linked to tumor stemness are highly activated in baseline biopsies from patients whose tumors undergo lineage plasticity. We find a gene signature enriched in these baseline biopsies that is strongly associated with poor survival in independent patient cohorts and with risk of castration-induced lineage plasticity in patient-derived xenograft models, suggesting that tumors harboring this gene expression program may be at particular risk for resistance mediated by lineage plasticity and poor outcomes.

Abstract Emotions shared by posters on social media can have a profound impact on individuals and society. This was particularly evident during the COVID-19 pandemic. To examine the types, trends, and dynamics of emotions communicated by the public, government, and media, this study collected 67,689 public posts, 36,740 government posts, and 126,988 media posts on Sina Weibo during the first 6 months of the COVID-19 pandemic. The vector autoregression model and Granger causality analysis were used to measure affective agenda networks and examine affective agenda dynamics. The findings show that the public, government, and media predominantly expressed positive emotions on Sina Weibo. The findings also reveal the significant influence of government emotions on media emotions, which subsequently affects public emotions. This study extends agenda-setting theory by integrating the dimension of emotional contagion. It underscores the potential for government and media to shape public emotions during health crises in order to maintain social order and increase compliance with emergency policies.

ABSTRACT Introduction Lymphatic malformations (LMs) are rare vascular anomalies predominantly affecting infants, which can be debilitating or life‐threatening when complicated with intralesional bleeding or infection. Effective and safe management strategies are essential in such cases. Case presentation We report a case series involving four Chinese neonates with life‐threatening LMs, initially treated with oral sirolimus. All patients achieved rapid relief and sustained remission, using a lower sirolimus dosage than previously recommended. Furthermore, adverse events were rarely recorded during follow‐up. Conclusion Sirolimus can be considered a promising choice for neonates with intricate and life‐threatening LMs. Initiation with a reduced sirolimus dose is advisable.

A smart museum is a new form of a museum, which uses devices or technologies including the Internet of things (IoT) and artificial intelligence (AI) to build the information interaction channels between people, things, and space.Sign language recognition not only assists the visitors who have hearing or speech impairment to visit the museum without barriers but also helps study the visitors’ natural gesture interaction.However, the methods based on cameras and wearable devices mayhave issues like privacy or usability when applied to museum spaces.Therefore, a robust sign language recognition method based on millimeter-wave radar was proposed.Different features of distance and velocity changes relative to the radar device were firstly extracted in this method, then a physical data enhancement method was adopted to expand the training data.Finally, a ResNet based on the pre-processed distance time features and Doppler time features was designed to further remove the environment-related information and perform feature fusion for classification.Experimental results show that this method can effectively recognize sign language and achieve an averaged recognition accuracy of over 90% when the testing environment and the user＇s location change, providing a new method for smart museum wireless sign language and gesture recognition.

To monitor the moisture content of agricultural products in the drying process in real time, this study applied a model combining multi-sensor fusion and convolutional neural network (CNN) to moisture content online detection. This study built a multi-sensor data acquisition platform and established a CNN prediction model with the raw monitoring data of load sensor, air velocity sensor, temperature sensor, and the tray position as input and the weight of the material as output. The model’s predictive performance was compared with that of the linear partial least squares regression (PLSR) and nonlinear support vector machine (SVM) models. A moisture content online detection system was established based on this model. Results of the model performance comparison showed that the CNN prediction model had the optimal prediction effect, with the determination coefficient (R2) and root mean square error (RMSE) of 0.9989 and 6.9, respectively, which were significantly better than those of the other two models. Results of validation experiments showed that the detection system met the requirements of moisture content online detection in the drying process of agricultural products. The R2 and RMSE were 0.9901 and 1.47, respectively, indicating the good performance of the model combining multi-sensor fusion and CNN in moisture content online detection for agricultural products in the drying process. The moisture content online detection system established in this study is of great significance for researching new drying processes and realizing the intelligent development of drying equipment. It also provides a reference for online detection of other indexes in the drying process of agricultural products.

Chronic Pseudomonas aeruginosa (PA) infection significantly contributes to morbidity and mortality in bronchiectasis patients. Initiating antibiotics early may lead to the eradication of PA. Here we outline the design of a trial (ERASE; NCT06093191) assessing the efficacy and safety of inhaled tobramycin, alone or with oral ciprofloxacin, in bronchiectasis patients with a new isolation of PA. This multicentre, 2×2 factorial randomised, double-blind, placebo-controlled, parallel-group trial includes a 2-week screening period, a 12-week treatment phase (with a combination of ciprofloxacin or a placebo at initial 2 weeks) and a 24-week follow-up. 364 adults with bronchiectasis and a new PA isolation will be randomly assigned to one of four groups: placebo (inhaled saline and ciprofloxacin placebo twice daily), ciprofloxacin alone (750 mg ciprofloxacin and inhaled saline twice daily), inhaled tobramycin alone (inhaled 300 mg tobramycin and ciprofloxacin placebo twice daily) or a combination of both drugs (inhaled 300 mg tobramycin and 750 mg ciprofloxacin twice daily). The primary objective of this study is to assess the proportion of patients successfully eradicating PA in each group by the end of the study. Efficacy will be evaluated based on the eradication rate of PA at other time points (12, 24 and 36 weeks), the occurrence of exacerbations and hospitalisations, time to first pulmonary exacerbations, patient-reported outcomes, symptom measures, pulmonary function tests and the cost of hospitalisations. To date no randomised trial has evaluated the benefit of different PA eradication strategies in bronchiectasis patients. The ERASE trial will therefore generate crucial data to inform future clinical guidelines.

Abstract Background The main subtypes of idiopathic inflammatory myopathies (IIMs)—polymyositis (PM) and dermatomyositis (DM)—are often presented as interstitial lung disease (ILD) in clinical practice; therefore, many researchers have combined the three studies into PM/DM with ILD. Methods Using bibliometrics, the research status, progress, and hotspots of PM/DM with ILD between 2000 and 2022 were studied. Literature data on PM/DM with ILD were retrieved from the Web of Science (WoS) database for the research period. Visualization software, including VOSviewer, Pajek, CiteSpace, and Scimago Graphica were used for bibliometric analysis. Results A total of 1555 relevant articles were obtained, and the overall research in this field showed an increasing trend. Regarding contributing countries and venues, Japan published the most articles while Rheumatology was the most prolific journal. Regarding authors, the most published article was by Wang Guochun from Changchun University of Technology in China. Keyword analysis and cocited literature cluster analysis showed that diagnosis, classification, autoantibodies, antibodies, prognosis, complications, and treatment of PM/DM with ILD have been hot topics in this field recently. Moreover, our study shows that anti‐mda5 antibody, mortality, gene 5 antibody, IIMs, double‐blind, and prognostic factors, among others, may be new hot topics. Conclusion This study found that research on PM/DM with ILD has increased over time, and scholars are paying more attention to this field. The development of new drugs for the management, treatment, and prevention of PM/DM with ILD is the primary task of researchers and a direction for future research in this field.

This study investigates the association between social media use and attitudes toward AI technologies. A nationally representative two-wave longitudinal survey (N=5110) examined the mediating roles of perceived AI fairness and threat concerning three AI technologies: algorithms, facial recognition technology, and driverless passenger vehicles. Hypotheses were derived from media effect theories and the heuristic and systematic model of human-AI adoption. The results showed that social media use predicted more positive attitudes toward the three AI technologies indirectly through increased perceived AI fairness and reduced perceived AI threat. The findings contribute to our understanding of social media effects on attitudes toward AI and the underlying psychological mechanisms, providing valuable theoretical insights and practical implications.

A Kalman filter fusion algorithm was proposed, and an online monitoring system was developed for real-time monitoring of the moisture content of materials in an air-impingement dryer. The Kalman filter algorithm was used to estimate the optimal state of the original detection values of the weighting sensor and air velocity sensor. A backpropagation (BP) neural network fusion model was established, where the weight detection value, elastic substrate temperature, air velocity, and impingement distance were considered inputs and the real weight of the material was the output. The optimal topology of the BP neural network was selected, and the initial weights and thresholds of the BP neural network were optimized using a genetic algorithm. The coefficient of determination (R2) and root mean square error (RMSE) of the optimized BP neural network fusion model were 0.9995 and 4.9, respectively. The Kalman filter fusion algorithm, which can realize online monitoring of moisture content, was established using the Kalman filter algorithm and fusion model. Moreover, an online monitoring system for material moisture content was developed, validation experiments were carried out, and the R2 and RMSE of the nine sets of validation experiments were 0.9963 and 0.78, respectively. The monitoring system satisfied the requirements of material moisture content detection accuracy in the drying process. The developed monitoring system is greatly important for improving the automation level of the drying equipment for fruits and vegetables. The proposed Kalman filter fusion algorithm also provides a reference for other multifactor fusion detection.

Objective: AST-3424 is a novel specific aldo-keto reductase 1C3 (AKR1C3) prodrug that releases a DNA alkylating reagent upon reduction by AKR1C3. This study aimed to evaluate the efficacy and safety of AST-3424 in patient-derived tumor xenograft (PDTX) model and orthotopic model against hepatocellular carcinoma (HCC). Materials and method: PDTX models derived from three HCC patients and orthotopic mice models using HepG2 cells were developed. The mice were treated with AST-3424 alone or combined with other drugs (oxaliplatin, apatinib, sorafenib and elemene in PDTX models, oxaliplatin and 5- fluorouracil in orthotopic models). The tumor volume and weight, as well as the mice weight were assessed. The liver tumor and transplanted tumor were removed for histological, immunohistochemical and Western blot detection in orthotopic model experiments. Results: AST-3424 could inhibit tumor growth in HCC PDTX models and orthotopic models, with no difference in safety compared with other marketed drugs, and the drug combination did not increase toxicity. The inhibitory effect of combination treatment was more obvious than which used alone. The reduction of AKR1C3 expression was negatively correlated with AST-3424 dose. Conclusion: AST-3424 had a promising effect against HCC in PDTX model and orthotopic model with good safety. It could promote the sensitivity of other drugs without increasing toxicity. Clinical trials are warranted to further certify its antitumor effect and safety.

Abstract Background vasopressin is commonly used as a second-line vasopressor for patients with septic shock, but the optimal timing of initiation is uncertain. This study was designed to investigate when vasopressin initiation may be beneficial for 28-day mortality in septic shock patients. Methods This was a retrospective observational cohort study from the MIMIC-III v1.4 and MIMIC-IV v2.0 databases. All adults diagnosed with septic shock according to Sepsis-3 criteria were included. Patients were stratified into two groups based on norepinephrine (NE) dose at the time of vasopressin initiation, defined as the low doses of NE group (NE

Given that there is limited evidence concerning the psychometric properties of DASS-21 when applied to primary school students, the present study undertook a comprehensive exploration of the psychometric evidence supporting the use of the DASS-21 within this demographic. The research comprised three studies. In Study 1, the basic psychometric properties of internal consistency and construct validity were examined. A total of 3138 primary school students from three provinces in mainland China participated. The internal reliability of the overall scale was 0.93, and for all the subscales, it was higher than 0.80. Construct validity was partially supported. Both exploratory and confirmatory factor analyses upheld the factorial validity of the original three-factor structure. While convergent validity was established, the results showed unsatisfactory discriminant validity. The bifactor model showed that DASS-21 raw scores predominantly indicated the general factor, evidenced by the high explained common variance and omega-hierarchical values. However, the contributions from the three specific factors were minimal, with their omega hierarchical values all below 0.15. In Study 2, a longitudinal design was adopted, tracking 1366 primary school students from Southwest China over a three-month interval. The results further confirmed that the DASS-21 exhibited scalar time-invariance. The latent mean analysis showed that there were no statistically significant differences in the latent means of depression, anxiety, and stress between Time 1 and Time 2. In Study 3, which included 364 college students and 483 enterprise workers, the results demonstrated that the DASS-21 had measurement invariance across different populations. The latent mean analysis further confirmed that, in terms of the latent mean of all three subscales, both college students and enterprise workers had significantly higher scores than primary school students. Overall, the findings indicated that the DASS-21 is a suitable tool for screening schoolchildren for general psychological distress, but it is not suitable for discerning distinct negative mood state disorders.