Respiratory syncytial virus vaccination in older adults and patients with chronic disorders: A position paper from the Portuguese Society of Pulmonology, the Portuguese Association of General and Family Medicine, the Portuguese Society of Cardiology, the Portuguese Society of Infectious Diseases and Clinical Microbiology, the Portuguese Society of Endocrinology, Diabetes and Metabolism, and the Portuguese Society of Internal Medicine

BACKGROUND

Respiratory syncytial virus (RSV) is an important cause of lower respiratory tract infection, hospitalisation and death in adults.

METHODS

Based on evidence regarding the impact of RSV on adult populations at risk for severe infection and the efficacy and safety of RSV vaccines, the Portuguese Society of Pulmonology, the Portuguese Association of General and Family Medicine, the Portuguese Society of Cardiology, the Portuguese Society of Infectious Diseases and Clinical Microbiology, the Portuguese Society of Endocrinology, Diabetes and Metabolism, and the Portuguese Society of Internal Medicine endorses this position paper with recommendations to prevent RSV-associated disease and its complications in adults through vaccination.

CONCLUSION

The RSV vaccine is recommended for people aged ≥50 years with risk factors (chronic obstructive pulmonary disease, asthma, heart failure, coronary artery disease, diabetes, chronic kidney disease, chronic liver disease, immunocompromise, frailty, dementia, and residence in a nursing home) and all persons aged ≥60 years. If it cannot be made available to this population, then the vaccine should be prioritised for individuals aged ≥75 years and those aged ≥50 years with risk factors. The vaccine should preferably be given between September and November and can be co-administered with the influenza vaccine. Ongoing studies on RSV vaccines may justify extending these recommendations in the future.

Issue 3-The occupational burden of respiratory diseases, an update

INTRODUCTION AND AIMS

Workplace exposures are widely known to cause specific occupational diseases such as silicosis and asbestosis, but they also can contribute substantially to causation of common respiratory diseases. In 2019, the American Thoracic Society (ATS) and the European Respiratory Society (ERS) published a joint statement on the occupational burden of respiratory diseases. Our aim on this narrative review is to summarise the most recent evidence published after the ATS/ERS statement as well as to provide information on traditional occupational lung diseases that can be useful for clinicians and researchers.

RESULTS

Newer publications confirm the findings of the ATS/ERS statement on the role of workplace exposure in contributing to the aetiology of the respiratory diseases considered in this review (asthma, COPD, chronic bronchitis, idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, infectious pneumonia). Except for COPD, chronic bronchitis and infectious pneumonia, the number of publications in the last 5 years for the other diseases is limited. For traditional occupational lung diseases such as silicosis and asbestosis, there are old as well as novel sources of exposure and their burden continues to be relevant, especially in developing countries.

CONCLUSIONS

Occupational exposure remains an important risk factor for airways and interstitial lung diseases, causing occupational lung diseases and contributing substantially in the aetiology of common respiratory diseases. This information is critical for public health professionals formulating effective preventive strategies but also for clinicians in patient care. Effective action requires shared knowledge among clinicians, researchers, public health professionals, and policy makers.

The role of MicroRNAs as early biomarkers of asbestos-related lung cancer: A systematic review and meta-analysis

BACKGROUND

Asbestos is still the leading cause of occupational cancer mortality worldwide. Asbestos-related lung cancer (LC) and malignant pleural mesothelioma (MPM) prognosis is still poor especially at advanced stage, so early diagnosis biomarkers are needed. MicroRNAs (miRNAs) have been proposed as potential early diagnostic biomarkers of asbestos-related LC and MPM.

AIM

To evaluate the role of miRNAs as diagnostic and prognostic biomarkers of asbestos-related LC and MPM by performing a literature systematic review and meta-analysis.

METHODS

MEDLINE, EMBASE via Ovid, PUBMED and Cochrane library databases were systematically searched up to April 2023 to identify relevant articles. A grey literature search was also conducted using the Google Scholar platform. MeSH and free text terms for 'asbestos', 'occupational exposure', 'lung cancer', 'mesothelioma' and 'miRNAs' were used to search the literature. Our systematic review protocol was registered in the PROSPERO database. Study quality was assessed via the Newcastle-Ottawa Scale.

RESULTS

From the search, 331 articles were retrieved, and, after applying our selection criteria, and exclusion of one study for poor quality, 27 studies were included in the review. Most of the studies were hospital-based case-control, conducted in Europe, and evaluated MPM among men only. MiRNAs expression was measured mainly in plasma or serum. MiR-126, miR-132-3p, and miR-103a-3p were the most promising diagnostic biomarkers for MPM, and we estimated a pooled area under the curve (AUC) of 85 %, 73 %, and 50 %, respectively. In relation to MPM prognosis, miR-197‑3p resulted associated with increased survival time. MiR-126, alone and combined with miR-222, was confirmed associated also to LC diagnosis, together with miR-1254 and miR-574-5p; no miRNA was found associated to LC prognosis.

CONCLUSION

Based on our systematic literature review there is suggestive evidence that the expression of specific miRNAs in the blood serum or plasma are associated with asbestos-related LC and MPM diagnosis and prognosis. Further large longitudinal studies are urgently needed to validate these findings and elucidate the underlying mechanisms given the potential important implications for patients' survival.

Global, regional, and national progress towards the 2030 global nutrition targets and forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

The six global nutrition targets (GNTs) related to low birthweight, exclusive breastfeeding, child growth (ie, wasting, stunting, and overweight), and anaemia among females of reproductive age were chosen by the World Health Assembly in 2012 as key indicators of maternal and child health, but there has yet to be a comprehensive report on progress for the period 2012 to 2021. We aimed to evaluate levels, trends, and observed-to-expected progress in prevalence and attributable burden from 2012 to 2021, with prevalence projections to 2050, in 204 countries and territories.

METHODS

The prevalence and attributable burden of each target indicator were estimated by age group, sex, and year in 204 countries and territories from 2012 to 2021 in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, the most comprehensive assessment of causes of death, disability, and risk factors to date. Country-specific relative performance to date was evaluated with a Bayesian meta-regression model that compares prevalence to expected values based on Socio-demographic Index (SDI), a composite indicator of societal development status. Target progress was forecasted from 2021 up to 2050 by modelling past trends with meta-regression using a combination of key quantities and then extrapolating future projections of those quantities.

FINDINGS

In 2021, a few countries had already met some of the GNTs: five for exclusive breastfeeding, four for stunting, 96 for child wasting, and three for child overweight, and none met the target for low birthweight or anaemia in females of reproductive age. Since 2012, the annualised rates of change (ARC) in the prevalence of child overweight increased in 201 countries and territories and ARC in the prevalence of anaemia in females of reproductive age decreased considerably in 26 countries. Between 2012 and 2021, SDI was strongly associated with indicator prevalence, apart from exclusive breastfeeding (|r-|=0·46-0·86). Many countries in sub-Saharan Africa had a decrease in the prevalence of multiple indicators that was more rapid than expected on the basis of SDI (the differences between observed and expected ARCs for child stunting and wasting were -0·5% and -1·3%, respectively). The ARC in the attributable burden of low birthweight, child stunting, and child wasting decreased faster than the ARC of the prevalence for each in most low-income and middle-income countries. In 2030, we project that 94 countries will meet one of the six targets, 21 countries will meet two targets, and 89 countries will not meet any targets. We project that seven countries will meet the target for exclusive breastfeeding, 28 for child stunting, and 101 for child wasting, and no countries will meet the targets for low birthweight, child overweight, and anaemia. In 2050, we project that seven additional countries will meet the target for exclusive breastfeeding, five for low birthweight, 96 for child stunting, nine for child wasting, and one for child overweight, and no countries are projected to meet the anaemia target.

INTERPRETATION

Based on current levels and past trends, few GNTs will be met by 2030. Major reductions in attributable burden for exclusive breastfeeding and anthropometric indicators should be recognised as huge scientific and policy successes, but the comparative lack of progress in reducing the prevalence of each, along with stagnant anaemia in women of reproductive age and widespread increases in child overweight, suggests a tenuous status quo. Continued investment in preventive and treatment efforts for acute childhood illness is crucial to prevent backsliding. Parallel development of effective treatments, along with commitment to multisectoral, long-term policies to address the determinants and causes of suboptimal nutrition, are sorely needed to gain ground.

FUNDING

Bill & Melinda Gates Foundation.

Association between methylmalonic acid and prevalence of depression in US adults: evidence from NHANES 2011-2014

Background: Depression is a prevalent mental disorder with high morbidity and mortality globally. Methylmalonic acid (MMA) is involved in the pathogenesis of numerous diseases. However, it is unclear whether there is an association between MMA and the prevalence of depression.Methods: This study enrolled 7866 US adults from the 2011-2014 survey of the National Health and Nutrition Examination Survey (NHANES). Individuals were categorized into depression group and non-depression group based on Patient's Health Questionnaire-9 (PHQ-9) score. The association between MMA concentrations and prevalence of depression was analysed by multivariate logistic and linear regression, restricted cubic spline regression, and subgroup analysis. Mediation analysis was used to explore the role of inflammation in the relationship between MMA and depression.Results: MMA concentrations were higher in participants with depression than those without depression. There was a positive and linear relationship of MMA concentrations with PHQ-9 score and depression risk, respectively. Moreover, the association was stable in most subgroups. Furthermore, inflammatory factors were positively correlated to MMA concentrations and prevalence of depression. In addition, white blood cell, neutrophil and alkaline phosphatase (ALP) mediated the relationship between MMA and depression.Conclusion: Our findings revealed that there was a linear and positive correlation between MMA and the prevalence of depression in US adults, which might be mediated by inflammation.

Mini-review on the therapeutic vaccines targeting chronic infectious diseases: Evaluation system of therapeutic vaccines targeting HPV and EBV-related cancers

Chronic infectious diseases are threatening human health today, and their public health severity is increasing. The efficacy issues of drugs and the increase in drug-resistant pathogens require new response strategies for chronic infectious diseases, and therapeutic vaccines have recently been proposed as an effective alternative. However, research on therapeutic vaccines is still relatively underdeveloped. To solve this problem, an accurate understanding of the status and the challenge at hand of therapeutic vaccines targeting chronic infectious diseases is needed. In the present review, we provide an overview of the latest research trends in therapeutic vaccines targeting chronic infectious diseases and summarize the development status of therapeutic vaccines currently undergoing clinical research, focusing on the cases of human papillomavirus (HPV) and Epstein-Barr virus (EBV) as representative examples. We highlight the importance of standard methods for the evaluation of therapeutic vaccine, focusing on the cell-mediated immune response, which might accelerate therapeutic vaccine development.

Recent advances in immunotherapy targeting CETP proteins for atherosclerosis prevention

Cholesteryl ester transfer protein (CETP) plays a key role in lipoprotein metabolism, and its activity has been linked to the risk of atherosclerosis (AS). CETP inhibitors, such as obicetrapib, represent a novel approach in immunotherapy to reduce the risk of atherosclerotic cardiovascular disease (ASCVD) by targeting lipid metabolism. In addition, CETP vaccines are being explored as a novel strategy for the prevention and treatment of ASCVD by inducing the body to produce antibodies against CETP, which is expected to reduce CETP activity, thereby increasing high-density lipoproteins (HDL) levels. This paper provides a comprehensive overview of the structure of CETP, the mechanisms of lipid transfer and the progress of immunotherapy in the last decade, which provides possible ideas for future development of novel drugs and optimization of immunization strategies.

Exploring socio-economic dimensions in HIV research: a comprehensive bibliometric analysis (1992-2024)

The socio-economic burden of HIV infection remains a critical global health concern. This study was conducted to perform a comprehensive bibliometric analysis of the socio-economic burden of HIV infection, highlighting research trends, collaboration networks, and the evolving focus on social determinants of health over the past 32 years. A systematic search was conducted in Scopus and Web of Science Core Collection databases, covering publications from 1992 to 2024. The analysis was performed using RStudio and Biblioshiny, focusing on 1,054 studies from 422 publications. This study revealed a steady annual growth rate of 16.72% in publications on the socio-economic burden of HIV from 1992 to 2024, with the USA and Canada leading in contributions. The University of Toronto emerged as the top institution, while 'social determinants of health' and 'HIV infections' were identified as pivotal research themes. Collaboration networks were predominantly among high-income countries, with limited engagement from high-burden regions like sub-Saharan Africa. Key journals, such as AIDS and Behavior, were identified as central to advancing the field. Thematic analysis highlighted a shift from biomedical to socio-economic factors, emphasizing the need for equitable global collaboration and research addressing disparities in HIV management. This comprehensive analysis provides valuable insights into the evolving landscape of HIV socio-economic burden research, emphasizing the need for increased collaboration with high-burden regions and a continued focus on addressing social determinants of health in HIV management.

SARS-CoV-2 epidemiology, kinetics, and evolution: A narrative review

Since winter 2019, SARS-CoV-2 has emerged, spread, and evolved all around the globe. We explore 4 y of evolutionary epidemiology of this virus, ranging from the applied public health challenges to the more conceptual evolutionary biology perspectives. Through this review, we first present the spread and lethality of the infections it causes, starting from its emergence in Wuhan (China) from the initial epidemics all around the world, compare the virus to other betacoronaviruses, focus on its airborne transmission, compare containment strategies ("zero-COVID" vs. "herd immunity"), explain its phylogeographical tracking, underline the importance of natural selection on the epidemics, mention its within-host population dynamics. Finally, we discuss how the pandemic has transformed (or should transform) the surveillance and prevention of viral respiratory infections and identify perspectives for the research on epidemiology of COVID-19.

Past, present, and future of exosomes research in cancer: A bibliometric and visualization analysis

Cancer seriously threatens the lives and health of people worldwide, and exosomes seem to play an important role in managing cancer effectively, which has attracted extensive attention from researchers in recent years. This study aimed to scientifically visualize exosomes research in cancer (ERC) through bibliometric analysis, reviewing the past, summarizing the present, and predicting the future, with a view to providing valuable insights for scholars and policy makers. Researches search and data collection from Web of Science Core Collection and clinical trial.gov. Calculations and visualizations were performed using Microsoft Excel, VOSviewer, Bibliometrix R-package, and CiteSpace. As of December 1, 2024, and March 8, 2025, we identified 8,001 ERC-related publications and 107 ERC-related clinical trials, with an increasing trend in annual publications. Our findings supported that China, Nanjing Medical University, and International Journal of Molecular Sciences were the most productive countries, institutions, and journals, respectively. Whiteside, Theresa L. had the most publications, while Théry, C was the most co-cited scholar. In addition, Cancer Research was the most co-cited journal. Spatial and temporal distribution of clinical trials was the same as for publications. High-frequency keywords were "extracellular vesicle," "microRNA" and "biomarker." Additional, "surface functionalization," "plant," "machine learning," "nanomaterials," "promotes metastasis," "engineered exosomes," and "macrophage-derived exosomes" were promising research topics. Our study comprehensively and visually summarized the structure, hotspots, and evolutionary trends of ERC. It would inspire subsequent studies from a macroscopic perspective and provide a basis for rational allocation of resources and identification of collaborations among researchers.

The real-world impact of cariprazine on short- and long-term disability outcomes among commercially insured patients in the United States

AIM

To compare all-cause and mental health (MH)-related short-term and long-term disability leaves and associated costs among patients in the United States with bipolar disorder (BP), major depressive disorder (MDD), or schizophrenia spectrum disorders (SCZ) before versus after cariprazine initiation.

METHODS

Merative MarketScan Commercial and Health and Productivity Management (HPM) databases (January 2016 to December 2021) were utilized to identify adults diagnosed with BP, MDD, or SCZ with ≥2 pharmacy cariprazine claims (first claim = index), ≥3 months of cariprazine use (adjunctively for MDD), and continuous commercial insurance coverage and HPM eligibility during baseline (12 months pre-index) and ≥3 months post-index. Observation continued until cariprazine discontinuation, insurance or HPM eligibility end, 1 year post-index, or HPM data availability end. All-cause and MH-related disability claims, days, and costs were evaluated. Baseline versus post-index rates of disability claims (events) and days were compared using rate ratios (RR); costs were compared using mean cost differences. Comparisons were calculated from generalized estimating equation models. Analyses were replicated separately across indications.

RESULTS

There were 489 patients overall (BP = 238, MDD = 233, SCZ = 18; mean age = 43.3 years; 60.7% female; mean follow-up = 7.6 months). All-cause rates of disability events and days following cariprazine initiation were 29% (RR = 0.71 [95% CI = 0.57, 0.86]) and 28% (0.72 [0.53, 0.94]) lower than baseline, respectively (both p < .05). MH-related rates of disability events and days were 40% (0.60 [0.43, 0.80]) and 43% (0.57 [0.34, 0.84]) lower, respectively (both p < .01). All-cause disability costs were $2,917 lower and MH-related disability costs were $2,482 lower than baseline (40% and 51% decrease, respectively; both p < .01). Results were similar for indication-specific analyses.

LIMITATIONS

Limited generalizability to patients who are unemployed, uninsured, or have public insurance.

CONCLUSIONS

Rates of disability events, days, and mean costs were significantly lower after versus before cariprazine initiation. These results can help contextualize cariprazine's role in managing disability for these patients.

Deciphering the interplay between SETD2 mediated H3K36me3 and RNA N6-methyladenosine in clear cell renal cell carcinoma (ccRCC)

RNA N6-methyladenosine (m6A) plays diverse roles in RNA metabolism and its deregulation contributes to tumor initiation and progression. Clear cell renal cell carcinoma (ccRCC) is characterized by near ubiquitous loss of VHL followed by mutations in epigenetic regulators PBRM1, SETD2, and BAP1. Mutations in SETD2, a histone H3 lysine 36 trimethylase (H3K36me3), are associated with reduced survival, greater metastatic propensity, and metabolic reprogramming. While m6A and H3K36me3 deregulation are separately implicated in renal tumorigenesis, H3K36me3 may participate directly in m6A targeting, but the m6A-H3K36me3 interplay has not been investigated in the context of ccRCC. Using RCC-relevant SETD2 isogenic knockout and rescue cell line models, we demonstrate a dynamic redistribution of m6A in the SETD2 depleted transcriptome, with a subset of transcripts involved in metabolic reprogramming demonstrating SETD2 dependent m6A and expression level changes. Using a panel of six histone modifications we show that m6A redistributes to regions enriched in gained active enhancers upon SETD2 inactivation. Finally, we demonstrate a reversal of transcriptomic programs involved in SETD2 loss mediated metabolic reprogramming, and reduced cell viability through pharmacologic inhibition or genetic ablation of m6A writer METTL3 specific to SETD2 deficient cells. Thus, targeting m6A may represent a novel therapeutic vulnerability in SETD2 mutant ccRCC.

Burden of female infertility in 204 countries and territories, 1990-2021: results from the Global Burden of Disease Study 2021

OBJECTIVE

To explore the global burden of female infertility from 1990 to 2021 by examining trends in prevalence and years lived with disability (YLD).

METHODS

Data from the Global Burden of Disease Study 2021 (GBD 2021) were analyzed with a focus on the prevalence and YLD of female infertility in women aged 15-49 years. Statistical models were used to estimate ASPRs and YLD across regions and countries.

RESULTS

The global prevalence of female infertility was 110.1 million in 2021, with an age-standardized rate of 2,764.6 per 100,000 population. The YLD for infertility in 2021 was 601,134, which represented a 33.1% increase since 1990. Regionally, East Asia and Eastern Europe had the highest rates of infertility, whereas Australasia had the lowest rate.

CONCLUSIONS

The study highlights a significant rise in the burden of female infertility, particularly in high-income regions. Study findings emphasize the need for targeted public health strategies and healthcare interventions to address this growing issue.

Subnational trend and driving factors for pancreatic cancer burden in China, 1990-2021: an analysis based on the Global Burden of Disease Study 2021

BACKGROUND

The mortality of pancreatic cancer in China showed an increasing trend between 2005 and 2020, with significant discrepancies in the burden of pancreatic cancer in provinces.

METHODS

We analyzed numbers of death, incidence, disability-adjusted life years (DALY) and corresponding age-standardized rates for pancreatic cancer in China using data from the Global Burden of Disease Study 2021. We conducted trend analysis in pancreatic cancer burden over time by age group and gender. Decomposition analysis was used to assess the drivers of change in cancer-related deaths in China due to three explanatory factors: population growth, population ageing and age-specific mortality.

RESULTS

In 2021, the ASMR of pancreatic cancer in China was 5.72/100,000(95%UI: 4.59, 6.91), the age-standardized incidence (ASIR) rate was 5.64/100,000(95%UI: 4.52, 6.84) and the age-standardized DALY rate was 137.23/100,000 (95%UI:108.15, 166.74). From 1990 to 2021, the ASMR of pancreatic cancer in China generally showed an increasing trend (AAPC: 0.56, 95%UI: 0.52, 0.59). The burden of pancreatic cancer was consistently higher in Chinese men compared to women during the study period.Compared with 1990, the number of deaths from pancreatic cancer has increased in all provinces of China in 2021, with the overall number of deaths increasing by 67.49%. Population ageing was the major cause of the increase in deaths from pancreatic cancer in China, accounting for 45.89%.

CONCLUSIONS

The burden of pancreatic cancer in China is still at a high level and population ageing is the main reason for the increase in pancreatic cancer deaths.

An automated software algorithm for optimizing microwave ablation parameters for treatment of liver tumors

PURPOSE

To evaluate the performance of a software algorithm developed to streamline microwave liver ablation parameter selection and to compare performance of this algorithm to that of experienced interventional radiologists.

METHODS

Patients who underwent microwave ablation for treatment of liver tumors were retrospectively identified. An automated software platform was developed to select the top three 'best fit' combinations of microwave ablation power, time, and vendor for a given tumor to achieve a 5 mm minimal ablative margin (MAM). Generalized linear modeling was used to compare the performance of the software algorithm and experienced interventional radiologists with respect to selected ablation parameters and estimates of total ablative volume (TAV) and MAM. Statistical significance was set at p < 0.05.

RESULTS

35 patients were identified who underwent single-antenna microwave ablation for liver tumors. Mean estimated TAV was not significantly different between clinical practice (24.96 cm3, 95% CI: 21.18 - 28.75 cm3) and algorithm-derived parameters (23.89 cm3, 95% CI: 20.04 - 27.74 cm3; p > 0.05), indicating agreement in overall treatment approach. However, the algorithm consistently generated ablation parameter combinations with more favorable estimated MAM metrics and significantly lower variability (first algorithm: -5.33 mm, 95% CI -5.40 - -5.26 mm; second algorithm: -5.83 mm, 95% CI -6.01 - -5.65 mm; third algorithm: -6.06 mm, 95% CI -6.30 - -5.83 mm) compared to interventional radiologists (-1.02 mm, 95% CI -2.02 - -0.03 mm).

CONCLUSION

Streamlining microwave liver ablation parameter selection using an automated software algorithm reduces variability and improves estimated MAM coverage of liver tumors.

Innate immune cells in vascular lesions: mechanism and significance of diversified immune regulation

Angiogenesis is a complex physiological process. In recent years, the immune regulation of angiogenesis has received increasing attention, and innate immune cells, which are centred on macrophages, are thought to play important roles in vascular neogenesis and development. Various innate immune cells can act on the vasculature through a variety of mechanisms, with commonalities as well as differences and synergistic effects, which are crucial for the progression of vascular lesions. In recent years, monotherapy with antiangiogenic drugs has encountered therapeutic bottlenecks because of the short-term effect of 'vascular normalization'. The combination treatment of antiangiogenic therapy and immunotherapy breaks the traditional treatment pattern. While it has a remarkable curative effect and survival benefits, it also faces many challenges. This review focuses on innate immune cells and mainly introduces the regulatory mechanisms of monocytes, macrophages, natural killer (NK) cells, dendritic cells (DCs) and neutrophils in vascular lesions. The purpose of this paper was to elucidate the underlying mechanisms of angiogenesis and development and the current research status of innate immune cells in regulating vascular lesions in different states. This review provides a theoretical basis for addressing aberrant angiogenesis in disease processes or finding new antiangiogenic immune targets in inflammation and tumor.

Multivariable prediction of returning to work among early-onset colorectal cancer survivors in China: A two-year follow-up

Objective

The number of early-onset colorectal cancer survivors (EOCRCs) is increasing. The primary aim of rehabilitation after battling cancer is to enable patients to return to work, as they constitute a significant contributor to societal productivity. A predictive model was developed to identify priority populations requiring intervention and refine responses to increase their capacity to return to work after undergoing treatment for EOCRC.

Methods

The baseline information was collected before patients were discharged at the end of their treatment course. The data of patients who returned to work were collected at 1 and 2 years after discharge. A predictive variable model was developed via binary logistic regression. The TRIPOD checklist was used.

Results

At 1 year, 64.7% of the EOCRC survivors had returned to work. Male sex, education, return to work self efficacy, re-entry readiness and social support increased the possibility of returning to work; higher levels of self-perceived fatigue and lower levels of family care decreased the possibility of returning to work within the 1-year model. At 2 years, 72.8% of the EOCRC survivors had returned to work. In the 2-year model, education, self-transcendence, return to work self efficacy, re-entry readiness and occupational environment increased the possibility of returning to work; self-perceived fatigue and psychosocial adjustment decreased the possibility of returning to work.

Conclusions

The results of this study can guide early assessment and intervention for EOCRC survivors, to facilitate their return to work.

Global burden and trends of the Clostridioides difficile infection-associated diseases from 1990 to 2021: an observational trend study

BACKGROUND

This study was aimed to explore the global burden and trends of Clostridioides difficile infections (CDI) associated diseases.

METHODS

Data for this study were obtained from the Global Burden of Disease Study 2021. The burden of CDI was assessed using the age-standardized rates of disability-adjusted life years (ASR-DALYs) and deaths (ASDRs). Trends in the burden of CDI were presented using average annual percentage changes (AAPCs).

RESULTS

The ASR-DALYs for CDI increased from 1.83 (95% UI: 1.53-2.18) per 100,000 in 1990 to 3.46 (95% UI: 3.04-3.96) per 100,000 in 2021, with an AAPC of 2.03% (95% CI: 1.67-2.4%). The ASDRs for CDI rose from 0.10 (95% UI: 0.08-0.11) per 100,000 in 1990 to 0.19 (95% UI: 0.16-0.23) per 100,000 in 2021, with an AAPC of 2.26% (95% CI: 1.74-2.79%). In 2021, higher burdens of ASR-DALYs (10.7 per 100,000) and ASDRs (0.53 per 100,000) were observed in high socio-demographic index (SDI) areas, and among age group over 70 years (31.62/100,000 for ASR-DALYs and 2.45/100,000 for ASDRs). During the COVID-19 pandemic, the global ASR-DALYs and ASDRs slightly decreased. However, in regions with low SDI, low-middle and middle SDI, those rates slightly increased.

CONCLUSION

The global burden of CDI has significantly increased, particularly in regions with high SDI and among individuals aged 70 years and above. During the COVID-19 pandemic period from 2020 to 2021, the burden of CDI further increased in regions with low, low-middle, and middle SDI. These findings underscore the need for increased attention and intervention, especially in specific countries and populations.

Causal impact of elevated body mass index on diabetic kidney disease: an integrated Mendelian randomization and Global Burden of Disease Study 2021 analysis

BACKGROUND

Elevated body mass index (BMI) has been implicated in the pathogenesis of diabetic kidney disease among patients with type 2 diabetes mellitus (T2DKD). However, establishing a causal relationship and quantifying the resultant global health impact remain challenging.

METHODS

A two-sample Mendelian randomization (MR) analysis was conducted using summary-level data obtained from the IEU database. Multiple MR approaches, including inverse variance weighted (IVW), MR-Egger regression, weighted median, weighted mode, and simple mode methods, were implemented to ensure robust causal inference. In parallel, Global Burden of Disease Study (GBD) 2021 were analyzed to determine the trends in mortality and disability-adjusted life years (DALYs) in T2DKD attributable to high BMI (HBMI-T2DKD) from 1990 to 2021. Joinpoint regression was used to estimate the average annual percent change (AAPC). Bayesian age-period-cohort (BAPC) models were then applied to project the disease burden through 2049.

RESULTS

MR analyses provided strong evidence for a causal relationship between elevated BMI and T2DKD. The GBD analysis revealed a sustained global increase in HBMI-T2DKD burden over the past three decades. Between 1990 and 2021, the result of AAPC indicated a persistent upward trend. The burden was particularly high among older adults, with the highest impact observed in East Asia and middle Socio-Demographic Index (SDI) region. By 2049, HBMI-T2DKD-related disease burden were projected to continue rising.

CONCLUSIONS

Elevated BMI is a significant causal risk factor for T2DKD. The integration of MR and GBD 2021 data underscores the urgent need for targeted public health interventions to reduce BMI levels, especially in high-risk regions and aging populations.

Decomposition analysis of lung cancer and COPD mortality attributable to ambient PM2.5 in China (1990-2021)

OBJECTIVE

This study aimed to evaluate the long-term trends in lung cancer (LC) and chronic obstructive pulmonary disease (COPD) mortality attributable to particulate matter (PM2.5) in China and to identify the contributions of population aging and other risk factors to changes in mortality rates.

METHODS

Using data from 1991 to 2021, we assessed trends in LC and COPD deaths attributable to PM2.5 through linear regression. Decomposition analysis was conducted to determine the extent to which changes in mortality rates were driven by demographic and non-demographic factors.

RESULTS

The crude mortality rates attributable to PM2.5 increased significantly for LC (500.40%) and COPD (85.26%). From 1990 to 2021, LC mortality attributable to PM2.5 increased annually by 4.11% (95% CI: 3.64%, 4.59%), while COPD mortality decreased annually by 1.23% (95% CI: -0.82%, -1.65%). Decomposition analysis revealed that 43.0% of the increase in LC mortality was due to population aging, and 57.0% was attributed to changes in other risk factors. For COPD, population aging contributed to an 18.547/100,000 increase, whereas other risk factors reduced mortality by 10.628/100,000.

CONCLUSIONS

The findings highlight the critical roles of population aging and risk factor modification in LC and COPD mortality trends. Interventions to address aging-related vulnerabilities and air pollution control are essential to mitigate future health burdens.

Stress hyperglycemia ratio as an independent predictor of acute kidney injury in critically ill patients with acute myocardial infarction: a retrospective U.S. cohort study

BACKGROUND

Acute kidney injury (AKI) is a frequent and severe complication in critically ill patients with acute myocardial infarction (AMI), significantly worsening prognosis. Identifying early risk markers for AKI in AMI patients is critical for timely intervention. The stress hyperglycemia ratio (SHR), a marker of acute glycemic response to physiological stress, has been proposed as a predictor of AKI, but its role remains unclear.

OBJECTIVE

This study investigates the association between SHR and AKI development in critically ill patients with AMI, using data from the MIMIC-III and MIMIC-IV databases.

METHODS

A total of 4,663 critically ill AMI patients were analyzed. SHR was evaluated for its association with AKI incidence using logistic regression, restricted cubic splines, and mediation analysis. Subgroup and sensitivity analyses were performed to confirm robustness. Additionally, Cox regression and Kaplan-Meier survival analysis were used to explore SHR's association with in-hospital mortality in the overall cohort and AKI subgroup.

RESULTS

Higher SHR levels were independently associated with an increased risk of AKI, demonstrating a J-shaped relationship. Mediation analysis revealed that neutrophil count and albumin partially mediated this effect. Kaplan-Meier survival curves showed significant differences in in-hospital mortality among SHR quartiles (log-rank p < 0.001). However, Cox regression analysis indicated that SHR was not an independent predictor of in-hospital mortality in either the full cohort or the AKI subgroup.

CONCLUSIONS

SHR serves as an early and independent marker for AKI risk in critically ill AMI patients, offering potential utility in clinical risk stratification. However, its role in predicting in-hospital mortality appears limited. These findings underscore the importance of glycemic monitoring and management in AMI patients at risk of AKI.

Determinants of outpatient healthcare-seeking behaviors among the rural poor affected by chronic conditions in India: a population-based cross-sectional study in seven states

BACKGROUND

A rising burden of chronic non-communicable diseases (CNCDs) increases demand for outpatient healthcare. Yet, evidence on preferences and barriers to healthcare services for India's most disadvantaged population, the target of India's largest public health insurance scheme (PM-JAY), is lacking.

OBJECTIVE

We explore determinants of outpatient healthcare-seeking behavior among PM-JAY eligible individuals with CNCDs in rural areas of seven states.

METHODS

Using cross-sectional data from a household survey (conducted between November 2019 and March 2020), we employed multilevel multinomial logistic regression to identify factors associated with seeking care from informal (home treatment, pharmacies, traditional healers), formal public, or formal private providers, compared with no care. Anderson's behavioral model informed the selection of independent variables.

RESULTS

Of 51,820 individuals, 5,061 (9.8%) reported a chronic condition. Despite their disease, 1,168 (23.1%) reported not using regular outpatient care. Another 2,421 individuals (48.0%) used formal private, 922 (18.3%) used formal public, and 535 (10.6%) used informal care. Predictors of formal private care were higher socioeconomic status (RRR = 2.441, 95% CI [1.61, 3.70]) and health insurance coverage (RRR = 1.478, 95% CI [1.12, 1.95]). Residents of Tamil Nadu, Kerala, and Gujarat were more likely to use formal public care (RRR = 23.915, 95% CI [9.01, 63.44]). Suffering from Major CNCDs or experiencing limitations in daily activities increased the probability of using healthcare across all options.

CONCLUSION

Future research should explore the reasons for non-utilization of chronic care and the preference for private providers. Policies to enhance public healthcare utilization and expand insurance for outpatient care could improve access and reduce health inequities.

Maternal consumption of urbanized diet compromises early-life health in association with gut microbiota

Urbanization has significantly transformed dietary habits worldwide, contributing to a globally increased burden of non-communicable diseases and altered gut microbiota landscape. However, it is often overlooked that the adverse effects of these dietary changes can be transmitted from the mother to offspring during early developmental stages, subsequently influencing the predisposition to various diseases later in life. This review aims to delineate the detrimental effects of maternal urban-lifestyle diet (urbanized diet) on early-life health and gut microbiota assembly, provide mechanistic insights on how urbanized diet mediates mother-to-offspring transfer of bioactive substances in both intrauterine and extrauterine and thus affects fetal and neonatal development. Moreover, we also further propose a framework for developing microbiome-targeted precision nutrition and diet strategies specifically for pregnant and lactating women. The establishment of such knowledge can help develop proactive preventive measures from the beginning of life, ultimately reducing the long-term risk of disease and improving public health outcomes.

Bidirectional association between atopic dermatitis and attention deficit hyperactivity disorder: a systematic review and meta-analysis

BACKGROUND

Our objective is to elucidate the reciprocal association between atopic dermatitis (AD) and attention deficit hyperactivity disorder (ADHD) by prespecified subgroups and determine potential modified factors.

MATERIALS AND METHODS

Adhering to PRISMA 2020, we conducted a comprehensive database search up until March 11, 2024. Observational studies reporting on AD and ADHD as either exposure or outcome variables were included. A random-effects model meta-analysis was conducted to calculate pooled estimates. Subgroup and meta-regression analyses were undertaken to explore heterogeneity. Publication bias was investigated via funnel plots and Egger's test.

RESULTS

Overall, 49 studies were determined to meet the inclusion criteria after rigorous screening. Patients with AD were more likely to have ADHD (ORs = 1.34, 95% CI 1.25-1.44, p < 0.01; HRs = 1.42, 95% CI 1.20-1.68, p < 0.01), while patients with ADHD also had an increased risk of developing AD (ORs = 1.45, 95% CI 1.21-1.73, p < 0.01). Subgroup analyses indicated that the associations were particularly pronounced among studies that assessed patients with severe AD (ORs = 2.62, 95% CI 1.76-3.92, p < 0.01), suffered from multiple allergic conditions (ORs = 2.89, 95% CI 1.18-7.10, p < 0.01) and sleep disturbances (ORs = 2.43, 95% CI 2.14-2.76, p < 0.01) simultaneously.

CONCLUSION

This review substantiates the significant bidirectional association between AD and ADHD, indicating that they serve as mutually independent risk factors and may either exacerbate each other. These findings underscore the necessity for heightened awareness and early targeted interventions, especially in individuals with severe AD manifestations, sleep problems, and multiple allergic diseases.

Overcoming immunotherapy resistance in colorectal cancer through nano-selenium probiotic complexes and IL-32 modulation

BACKGROUND AND OBJECTIVE

Colorectal cancer (CRC) is a major global health burden, with immunotherapy often limited by immune tolerance and resistance. This study introduces an innovative approach using Selenium Nanoparticles-Loaded Extracellular Vesicles combined with Interleukin-32 and Engineered Probiotic Escherichia coli Nissle 1917 (SeNVs@NE-IL32-EcN) to enhance CD8+ T cell-mediated immune responses and overcome immunotherapy resistance.

METHODS

Single-cell RNA sequencing (scRNA-seq) and transcriptomic analyses were performed to identify key immune cells and regulators involved in CRC immunotherapy resistance, focusing on CD8+ T cells and the regulatory factor IL32. A humanized xenograft mouse model was used to evaluate the impact of IL32 and SeNVs@NE-IL32-EcN on tumor growth and immune responses. The SeNVs@NE-IL32-EcN complex was synthesized through a reverse micelle method and functionalized using extracellular vesicles. Its morphology, size, antioxidant activity, and safety were characterized using electron microscopy, dynamic light scattering (DLS), and in vitro co-culture assays.

RESULTS

Single-cell analyses revealed a significant reduction in CD8+ T cell infiltration in immunotherapy-resistant CRC patients. IL32 was identified as a key regulator enhancing CD8+ T cell cytotoxic activity through granzyme B and IFN-γ secretion. Treatment with SeNVs@NE-IL32-EcN significantly improved the proliferation and activity of CD8+ T cells and reduced tumor progression in humanized mouse models. In vitro and in vivo results demonstrated the complex's biocompatibility, antioxidant properties, and ability to enhance CRC immunotherapy while mitigating immune tolerance.

CONCLUSION

SeNVs@NE-IL32-EcN offers a novel nano-biomaterial strategy that integrates nanotechnology and probiotic therapy to enhance CD8+ T cell-mediated immunity and overcome CRC immunotherapy resistance. This study lays the foundation for future therapeutic applications in cancer treatment by advancing immune-modulating biomaterials.

Tumor microenvironment pH-responsive size-transformable peptide self-assembling nanocarriers for tumor-specific treatment

Peptide-based drug carriers with exceptional biodegradability offer promising avenues for tumor-targeted therapy. Nonetheless, almost all existing drug carriers harness receptor recognition to target tumors, which ultimately fall short in addressing tumor heterogeneity. Such a strategy requires intricate chemical modifications for carriers to selectively bind to specific receptors. While these modifications may induce long-term toxicity, tumor receptors are not absolutely specific but also exist in normal cells. Thus, precision therapeutic agents may inadvertently harm healthy cells as well. Tumors possess a distinctive weak acidic (pH 6.0-6.8) tumor microenvironment (TME) that contrasts with normal tissues (pH ~7.4). Hence, we developed a TME pH-triggered multilevel self-assembling peptide with simple modifications. The drug-encapsulating self-assembled peptide is size transformable from aggregates (~1.56 μm) at pH 7.4 to positively charged nanomicelles (~100 nm) at an acidic TME by protonation, which avoids being taken up by normal cells but could readily enter tumor cells, allowing TME pH-triggered tumor-specific therapy. This study establishes a breaking strategy of using peptide for TME-based tumor-specific treatment and advances the medical applications of peptide nanomaterials.

A novel NIR-dependent IDO-inhibiting ethosomes treatment melanoma through PTT/PDT/immunotherapy synergy

Phototherapy is a treatment method that uses the characteristics of different bands of light to treat diseases. Tumor immunotherapy, on the other hand, treats tumors by regulating the body's immune system. The combination of phototherapy and immunotherapy can significantly enhance the treatment of melanoma. In this study, we prepared and characterized INEs, a novel ethosome composed of the photosensitizer IR251 and the Indoleamine-2, 3-dioxygenase (IDO) inhibitor NLG919. INEs demonstrated excellent phototherapeutic properties, strong phototoxicity, and a notable ability to inhibit IDO. Under 808 nm laser irradiation, INEs effectively induced immunogenic cell death (ICD) in melanoma cells. In vivo experiments demonstrated that INEs injection into primary tumors triggered ICD, promoted maturation of DC cells, and activated naive T cells, leading to the production of effector T cells (specifically CD4+ and CD8+ T cells) that targeted and killed tumor cells. Both primary and distant tumors were treated simultaneously with favorable biosafety. In conclusion, INEs represent a promising strategy for melanoma treatment by a combination of phototherapy and immunotherapy with high safety. This study provides new insights and a theoretical basis for the clinical treatment of melanoma.

Biomarkers of aging: from molecules and surrogates to physiology and function

Many countries face an unprecedented challenge in aging demographics. This has led to an exponential growth in research on aging, which, coupled to a massive financial influx of funding in the private and public sectors, has resulted in seminal insights into the underpinnings of this biological process. However, critical validation in humans has been hampered by the limited translatability of results obtained in model organisms, additionally confined by the need for extremely time-consuming clinical studies in the ostensible absence of robust biomarkers that would allow monitoring in shorter time frames. In the future, molecular parameters might hold great promise in this regard. In contrast, biomarkers centered on function, resilience, and frailty are available at the present time, with proven predictive value for morbidity and mortality. In this review, the current knowledge of molecular and physiological aspects of human aging, potential antiaging strategies, and the basis, evidence, and potential application of physiological biomarkers in human aging are discussed.

Epidemiological Dynamics of Burden and Health Inequalities in Metabolic Dysfunction-associated Steatotic Liver Disease in Adolescents at Global, Regional, and National Levels, 1990-2021

Background

Metabolic dysfunction-associated steatotic liver disease (MASLD) has become one of the major causes of chronic liver disease among adolescents. However, epidemiological studies on MASLD in adolescents are still insufficient. In this study, we aim to investigate the global burden and the trend of MASLD in adolescents from 1990 to 2021.

Methods

The age-standardized incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of MASLD were calculated based on the Global Burden of Disease (GBD) 2021 study and stratified by sex, socio-demographic index (SDI), GBD regions, and countries. The temporal trends were examined using the average annual percentage change (AAPC) and joinpoint regression.

Results

From 1990 to 2021, the global trends of age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) of MASLD show notable increase, and the male is significantly higher than the female in adolescents. According to the incidence and prevalence, nations with low SDI confront a higher burden of MASLD. Besides, the inequality of incidence and prevalence between different SDI regions have shrunk in 2021, but the inequality of DALYs and mortality are still exacerbated. Decomposition analysis revealed that population growth and epidemiological changes were the main reasons for the increase in the incidence of MASLD.

Conclusion

From 1990 to 2021, there is a significant upward trend in the incidence of MASLD among adolescents worldwide. Of particular note are male adolescents, East Asian regions, and groups living in high SDI countries.

Association between inequalities in mental health resources and burdens of mental health disorders in 146 countries and territories: An observational study

BACKGROUND

Mental health disorders impose a substantial social and economic burden. We conducted a comprehensive assessment of global mental health resource allocation and the associated burdens of mental health disorders, examining the relationship between these two factors.

METHODS

We utilized data from the WHO Global Health Observatory and GBD 2021 to encompass 146 countries. We employed spatial autocorrelation analysis and Lorenz curves to characterize the spatial distribution. Additionally, we examined the association between mental health resources and the burdens of mental disorders using a generalized linear regression model (GLM).

RESULTS

Countries and territories with higher income levels were more likely to have greater mental health resources (p < 0.05). Globally, the average mental health resource allocation index (IMRA) was 18.14, and Moran's I was 0.509 (p < 0.001). The Lorenz curve of mental health resources lay below the equality line, suggesting that these resources were more concentrated in countries and territories with higher HDI values. Between 2011 and 2021, the age-standardized incidence rate of all mental health disorders increased significantly (EAPC: 1.41 %, 95 % CI: 0.40 % to 2.53 %, p = 0.011). In multivariable GLM, a negative association was observed between the Index of IMRA and total mental health incidence.

CONCLUSION

Inequalities in mental health resources persist, and the burdens of mental disorders are increasing globally. Our findings underscore the critical need to reduce the overall burden of mental health disorders through enhanced allocation of prevention-oriented resources. Countries at different levels of human development face distinct challenges and priorities in mental health resource allocation.

The burden and trends of depressive disorders in adolescent and young adults aged 15-29 in China, 1990-2021 and its prediction to 2030: Findings from the Global Burden of Disease Study 2021

BACKGROUND

Depressive disorders (DDs) are the leading causes of disability among adolescents and young adults (AYAs) in China. This study estimated the trends of DDs burden among AYAs in China over the last 32 years, and further predicted to 2030.

METHODS

Based on the Global Burden of Disease Study 2021, age-standardized incidence, prevalence, and years lived with disability (YLDs) rates were used to describe the DDs burden among AYAs (aged 15-29 years) in China. Estimated annual percentage changes were used to describe the temporal trends from 1990 to 2021. Bayesian age-period-cohort model was used to predict the future burden to 2030.

RESULTS

In 2021, the age-standardized incidence, prevalence, and YLDs rates (per 100,000) for DDs among AYAs in China were 1884.11 (95 % confidence interval [CI]: 1383.84, 2540.68), 1951.57 (95 % CI: 1527.28, 2459.70), and 323.36 (95 % CI: 208.27, 474.88), respectively. The burden was heavier in females and individuals aged 25-29. From 1990 to 2021, all groups showed a downward trend of DDs burden. Males showed an increase in DDs burden (mainly dysthymia) in most groups in 2019-2021, while the increases in DDs burden among females were mainly in 2010-2019. The main attributable risk factor was bullying victimization. Notably, although the DDs burden was predicted to decrease from 2022 to 2030, the dysthymia burden was predicted to increase.

CONCLUSIONS

The DDs burden among AYAs is a significant public health challenge in China. It is crucial to consider the disparities among different demographic characteristics, when formulating and implementing prevention strategies.

Design, synthesis and biological evaluation of 2-arylbenzo[b]furan-4-vinylcarbonyl derivatives based on Salvianolic acid C as antioxidant neuroprotective agents for the treatment of ischemic stroke

Ischemic stroke is a globally recognized disease characterized by high mortality and disability rates, with limited clinical treatment options available. The development of neuroprotective agents with antioxidant properties continues to be a focal point of current research. In this study, we designed and synthesized 42 derivatives using α, β-unsaturated carbonyl and 2-arylbenzo[b]furan in Salvianolic acid C as the core skeleton, and evaluated their biological activities. Among these, compound 6p demonstrated notable antioxidant neuroprotective activity and low cytotoxicity. Furthermore, it exhibited the most potent cell protective activity and ROS scavenging capacity in t-BHP-induced PC12 cells. In a rat model of ischemia-reperfusion injury, 6p was found to reduce ROS levels and neuronal apoptosis in brain tissue, enhance neurological function, and decrease the size of cerebral infarction in rats. Additionally, 6p promotes the nuclear translocation of NRF2 and elevates the expression of the antioxidant protein HO-1. Molecular docking results indicated that 6p can bind to key sites within KEAP1 complex. In conclusion, these findings suggest that compound 6p serves as a potential neuroprotective agent for the treatment of ischemic stroke.

Porcine pericardium crosslinked with POSS-PEG-CHO possesses weakened immunogenicity and anti-calcification property

Valvular heart disease (VHD) poses a thorny problem in cardiovascular diseases. The most effective treatment for VHD is heart valve replacement. Biological heart valve (BHV) is more favored than mechanical heart valve due to the maturity of transcatheter heart valve replacement (THVR) and the absence of the need for lifelong anticoagulant use. However, traditional commercial BHV suffers degeneration within 10-15 years because of calcification caused by the cross-linking reagent, glutaraldehyde. Considering the remarkable properties of POSS, PEG, and the star-like eight-arm structure, we fabricated POSS-PEG-PP, which is a decellularized porcine pericardium (DPP) crosslinked by a star-like eight-arm cross-linker octafunctionalized POSS of benzaldehyde-terminated polyethylene glycol (POSS-PEG-CHO) based on the Schiff's base reaction. POSS-PEG-PP exhibits more intense fiber arrangement and better mechanical properties than GLUT-PP (glutaraldehyde crosslinked DPP). The results also show that the cytocompatibility, endothelialization, and hemocompatibility of POSS-PEG-PP are outstanding in vitro. Subsequently, in vivo assessments demonstrate that POSS-PEG-PP has anti-inflammatory and anti-calcification abilities. Furthermore, RNA sequencing analysis of subcutaneous implants suggests that the intervention of AMPK and IL-17 signaling pathways plays an important role in the inflammatory and immune responses regulation of POSS-PEG-PP. Therefore, POSS-PEG-PP is an excellent substitute material for BHVs and is expected to be clinically transformed.

The burden of cardiovascular disease in Latin America and the Caribbean, 1990-2019: An analysis of the global burden of disease study

INTRODUCTION

Cardiovascular disease (CVD) remains the leading cause of death globally, including the Latin America and the Caribbean (LAC) region. However, limited research has been conducted on the burden of CVD in this region. Our study aims to investigate the burden of CVD and related risk factors (RFs) in the LAC.

METHODS

We used data from the Global Burden of Disease (GBD) 2019 to examine CVD prevalence in 33 LAC countries. Prevalence, mortality, and incidence were analyzed using Bayesian regression tools, demographic methods, and mortality-to-incidence ratios. Disability-adjusted life years (DALYs) were calculated, and RFs were evaluated under the GBD's comparative risk assessment framework.

RESULTS

Between 1990 and 2019, CVD raw rates in the LAC increased by 116.7 %, while age-standardized prevalence decreased (-9.2 %). CVD raw mortality rose by 71.2 %, but age-standardized death rates fell by 69.8 %. Ischemic heart disease remained the most prevalent condition, with higher rates in men, while women had higher rates of stroke. Age-standardized DALYs decreased by 70.9 %. DALY rates varied across countries and were consistently higher in males. Leading RFs included HTN, high LDL, dietary risks, and elevated BMI.

CONCLUSIONS

Despite progress in reducing the CVD burden in the LAC region, the impact on mortality and morbidity, particularly related to ischemic heart disease, remains substantial. Tailored interventions are necessary, considering country-specific variations in socio-economic factors, healthcare infrastructure, and political stability.

Association of cardiovascular-kidney-metabolic syndrome with all-cause and cardiovascular mortality: A prospective cohort study

Background

Given evidence on the cardiovascular disease (CVD) risk conferred by comorbidity risk factors, the American Heart Association (AHA) recently introduced a novel staging construct, named cardiovascular-kidney-metabolic (CKM) syndrome. This study examined the association of CKM syndrome stages with all-cause and cardiovascular mortality among US adults.

Methods

Data were from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 at baseline linked to the 2019 National Death Index records. For each participant, the CKM syndrome was classified into five stages: stage 0 (no CKM risk factors), 1 (excess or dysfunctional adiposity), 2 (metabolic risk factors and chronic kidney disease), 3 (subclinical CVD), or 4 (clinical CVD). The main outcomes were all-cause and cardiovascular mortality.

Results

Among 34,809 participants (mean age: 46.7 years; male: 49.2 %), the prevalence of CKM stages 0 to 4 was 13.2 %, 20.8 %, 53.1 %, 5.0 %, and 7.8 %, respectively. During a median follow-up of 8.3 years, compared to participants with CKM stage 0, those with higher stages had increased risks of all-cause mortality (stage 2: HR 1.43, 95 % 1.13-1.80; stage 3, HR 2.75, 95 % CI 2.12-3.57; stage 4, HR 3.02, 95 % CI 2.35-3.89). The corresponding hazard ratios (95 % confidence interval) of cardiovascular mortality risks were 2.96 (1.39-6.30), 7.60 (3.50-16.5), and 10.5 (5.01-22.2). The population-attributable fractions for advanced (stages 3 or 4) vs. CKM syndrome stages (stages 0, 1, or 2) were 25.3 % for all-cause mortality and 45.3 % for cardiovascular mortality.

Conclusion

Higher CKM syndrome stages were associated with increased risks of all-cause and cardiovascular mortality. These findings emphasize that primordial and primary prevention efforts on promoting CKM health should be strengthened to reduce mortality risk.

Factors Associated With Social Participation Among Young and Middle-Aged Patients After Cardiac Surgery: A Cross-Sectional Study

This study aimed to investigate the level of social participation among young and middle-aged patients after cardiac surgery and its influencing factors by using a cross-sectional design. Participants were recruited from the Department of Cardiac Surgery of Guangdong Provincial People's Hospital through convenience sampling, and 237 young and middle-aged patients after cardiac surgery completed the Questionnaire on Participation and Autonomy (IPA). Data were analyzed using descriptive statistics, independent t-test, one-way analysis of variance, Pearson's correlation coefficients, and multiple stepwise linear regression analysis. A total of 237 participants, with a mean (SD) age was 47.2 (9.2). The total score (SD) of social participation among young and middle-aged patients after cardiac surgery was 52.0 (6.7), indicating a moderately low level of social participation. The results of multiple stepwise regression analysis showed that gender, age, number of comorbidities, social support, self-efficacy, kinesiophobia, and pain were the influencing factors of social participation (p < 0.05), which variables accounted for approximately 59.6% of the variance in the social participation. The social participation among young and middle-aged patients after cardiac surgery needs to be improved. TRIAL REGISTRATION: This study has been approved by the Chinese Clinical Trial Registry. (registration number: ChiCTR2400083390).

Current research on mitochondria‑associated membranes in cardiovascular diseases (Review)

The present study aimed to explore the role of mitochondria‑associated membranes (MAMs) as a key interface between mitochondria and the endoplasmic reticulum (ER) and to evaluate their importance in maintaining the physiological functions of these two organelles. MAMs not only act as a structural bridge between mitochondria and the ER but also widely participate in the regulation of mitochondrial biosynthesis and function, Ca2+ signal transduction, lipid metabolism, oxidative stress response and autophagy. In addition, the specific protein composition of MAMs is increasingly being recognized as having a profound impact on their function, and these proteins play a central role in regulating intercellular communication. Recently, the scientific community has accumulated a large amount of evidence supporting MAMs as potential targets for cardiovascular disease treatment. The present review focuses on the fine structure and multifunctional properties of MAMs and their mechanisms in the occurrence and development of cardiovascular diseases. The goal is to explore the mechanism of MAMs, therapeutic intervention points directly related to cardiovascular diseases, and feasibility of incorporating MAMs into the diagnostic strategy and treatment plan of cardiovascular diseases to provide novel insights and theoretical support for clinical practice in this field. MAMs have great potential as therapeutic targets for various cardiovascular diseases. This finding not only deepens the understanding of the interaction between organelles but also opens up a promising research path for the development of new therapeutic strategies for cardiovascular diseases.

Global, regional, and national burdens of hip fractures in elderly individuals from 1990 to 2021 and predictions up to 2050: A systematic analysis of the Global Burden of Disease Study 2021

PURPOSE

We aimed to analyse the global, regional, and national burdens of hip fractures in older adults from 1990 to 2021, with projections to 2050, on the basis of data from the GBD 2021 study.

METHODS

We employed a joinpoint model to analyse trends in the burden of hip fractures from 1990‒2021. The estimated annual percentage change (EAPC) was used to quantify temporal trends over this period. We evaluated the relationship between the social development index and the burden of hip fracture in elderly people and conducted a health inequality analysis. Additionally, we applied Long-short Term Memory (LSTM) networks to forecast burden trends of hip fractures up to 2050.

RESULTS

The global age-standardized incidence rate (ASIR) for hip fractures in older adults rose from 781.56 per 100,000 in 1990 to 948.81 in 2021. The 2021 age-standardized prevalence rate (ASPR) was 1,894.07, and the age-standardized YLD rate (ASDR) was 173.52. From 1990 to 2021, the incidence and prevalence increased by 168.71 % and 173.07 %, respectively, while the burden of DALYs decreased. Future trends were projected via the LSTM. The burden and risk factors for hip fractures varied significantly by sex, country, and region. Population and aging are primary contributors to the rising incidence of elderly hip fractures, with falls being the leading direct cause.

CONCLUSION

From 1990 to 2021, the global burden of hip fractures in the elderly population, especially among older women, steadily increased. Population ageing highlights the urgent need for targeted public health interventions and resource allocation, including early diagnosis, effective prevention strategies, and region-specific management approaches.

Reducing premature mortality from cardiovascular diseases in low and middle income countries: The role of Polypill in public health policy

Premature deaths account for about half of all fatalities in developing countries. In low- and middle-income countries, cardiovascular diseases have consistently been the primary cause of premature mortality for men and women during the past three decades. Current evidence indicates that fixed-dose combination therapy, the so-called Polypill, effectively reduces the burden of cardiovascular diseases, with greater benefits observed in combinations that include aspirin. Polypill demonstrates high adherence and an acceptable safety profile, with adverse drug events being comparable between the groups receiving treatment and those in the control group. Therefore, this paper advocates for the broader implementation of Polypill in low and middle-income countries, emphasizing its efficacy in the primary and secondary prevention of cardiovascular diseases. The strategy could also benefit high-risk groups with special conditions, such as non-alcoholic fatty liver disease and chronic kidney disease. The cost-effectiveness of Polypill and its potential to address health inequities in low and middle-income countries underscore its value as a public health strategy. Policymakers are encouraged to consider Polypill as a viable option to enhance cardiovascular health outcomes and reduce premature deaths in low-resource settings.

A state-of-the-art review of the recent advances in drug delivery systems for different therapeutic agents in periodontitis

Periodontitis (PD) is a chronic gum illness that may be hard to cure for a number of reasons, including the fact that no one knows what causes it, the side effects of anti-microbial treatment, and how various kinds of bacteria interact with one another. As a result, novel therapeutic approaches for PD treatment must be developed. Additionally, supplementary antibacterial regimens, including local and systemic medication administration of chemical agents, are necessary for deep pockets to assist with mechanical debridement of tooth surfaces. As our knowledge of periodontal disease and drug delivery systems (DDSs) grows, new targeted delivery systems like extracellular vesicles, lipid-based nanoparticles (NPs), metallic NPs, and polymer NPs have been developed. These systems aim to improve the targeting and precision of PD treatments while reducing the systemic side effects of antibiotics. Nanozymes, photodermal therapy, antibacterial metallic NPs, and traditional PD therapies have all been reviewed in this research. Medicinal herbs, antibiotics, photothermal therapy, nanozymes, antibacterial metallic NPs, and conventional therapies for PD have all been examined in this research. After that, we reviewed the key features of many innovative DDSs and how they worked for PD therapy. Finally, we have discussed the advantages and disadvantages of these DDSs.

Real-time cardiomyocyte contraction sensing via a neo-flexible magnetic sensor

Assessing heart disease and evaluating drug-induced cardiotoxicity require a deep understanding of the contractile properties of cardiac tissue, particularly at the level of individual cardiomyocytes. Traditional methods for measuring cardiomyocyte contractility present several challenges, including limitations in real-time detection, complex and costly sensing platforms, and biocompatibility issues. To address these challenges, we introduce an innovative magnetic sensor that utilizes a flexible coil cantilever, pioneering the application of electromagnetic induction for detecting cardiomyocyte contractility. This marks the first time such technology has been deployed in typical laboratory settings with straightforward configurations. When cardiomyocytes are cultured on these coils and subjected to a static magnetic field, their contractions induce oscillations in the coils, generating an electromotive force that converts mechanical pulsations into electrical signals. This advanced platform enables long-term, real-time monitoring of cardiac functional characteristics, including contractility, beating rate, and rhythm. It also enables the quantitative assessment of cardiovascular dynamics, such as in response to drugs like isoproterenol and verapamil. Offering a uniquely simple, stable, and efficient method for evaluating drug-induced cardiotoxicity, this novel detection platform underscores the transformative potential of flexible magnetic sensors in real-time cellular detection applications.

Burden of cardiometabolic disease attributable to sugar sweetened beverages consumption in North Africa and the Middle East from 1990 to 2021

Objectives

The consumption of sugar-sweetened beverages (SSBs) is recognized as a significant risk factor for chronic non-communicable diseases (NCDs). Accurate estimates of the burden of SSBs are crucial for preventing, controlling, and treating associated diseases to achieve the Third United Nations Sustainable Development Goal of reducing premature mortality from NCDs by one-third by 2030. In this study, we aim to systematically assess the regional patterns and trends in the burden of SSBs in the North Africa and the Middle East (NAME) region. By analyzing regional differences, the study identifies specific areas where SSBs consumption has a more significant impact on public health.

Methods

The study data were retrieved from the Global Burden of Disease (GBD) study 2021. This study analyzed the impact of SSBs on mortality, years lived with disability, years of life lost, and disability-adjusted life years (DALYs) in 21 countries in the NAME region from 1990 to 2021. Our analysis considered various factors, including sex, age, region, and socio-demographic index.

Results

In 2021, DALYs attributable to SSBs there were 315,312 (95% uncertainty interval, 140,854 to 503,347) in absolute terms reflecting 518.3% (424.9 to 642.2) increase over three decades. From 1990 to 2021, the age-standardized rate of DALYs attributable to SSBs increased by 118.5%, from 27.9 (11.4 to 43.9) to 61.0 (27.6 to 97.0) per 100,000 population. Qatar (246.7 [113.1 to 404.5]), Saudi Arabia (201.2 [87.1 to 314.2]), and Bahrain (180.1 [78.4 to 295.8]) had the highest age-standardized rate of DALYs. The highest attributable DALYs and mortality from SSBs consumption were due to diabetes mellitus in all countries in 1990 and 2021. In 2021, Qatar (224.7 [104.9 to 365.5]), Bahrain (167.0 [74.8 to 274.8]), and Saudi Arabia (153.1 [75.3 to 230.4]) had the three highest age-standardized rates of DALYs from diabetes mellitus attributed to SSBs.

Conclusions

NAME witnessed a substantial increase in the burden attributable to SSBs. Alarmingly, exposure to SSBs has principally contributed to the increased burden of diabetes mellitus and chronic kidney disease. Among the region's countries, exposure and attributable burden trends vary considerably. It is imperative that governments and health authorities within the NAME region work together to combat SSBs' detrimental effects. Local, socioeconomic, and educational factors need to be considered when developing prevention and treatment strategies at the individual, community, and national levels.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-025-01578-9.

The Effect of Nursing-Based Enhanced Recovery After Surgery on Quality of Life in Lung Cancer Patients Receiving Surgery: A Systematic Review and Meta-Analysis

Enhanced recovery after surgery (ERAS) is an evidence-based, multidisciplinary protocol aimed at reducing surgical stress and expediting postoperative recovery. This meta-analysis will provide a comprehensive examination of the implications of ERAS care for the quality of life (QOL) of postoperative Lung cancer (LC) patients. The literature databases were searched to identify randomized controlled trials that implemented an ERAS program for adult patients with LC who underwent surgical treatment and reported QOL results. Thirty-one studies were included in the analysis. ERAS/FTS significantly improved the overall QOL of postoperative LC patients according to the Short Form-36 (SF-36) score (mean difference (MD): 8.58; 95% confidence interval (CI): 6.17, 11.00; p < 0.001). For physical functioning, the ERAS/FTS significantly improved the SF-36 score (MD: 10.45; 95% CI: 7.41, 13.50; p < 0.001). In the role-physical dimension, the ERAS/FTS nurse strategy had a significant advantage in improving the role-physical score on the SF-36 scale (MD: 10.06; 95% CI: 7.00, 13.13; p < 0.001). The ERAS has a highly positive impact on QOL in postoperative LC patients, especially in the physical functioning and role-physical dimensions.

The fraction of cancer attributable to modifiable risk factors in Turkey in 2018

Cancer is the second leading cause of death in Turkey, with nearly one in six deaths attributed to the disease. In 2018, Turkey recorded 211,273 new cancer cases. Many cancers are linked to modifiable lifestyle risk factors, such as tobacco use, alcohol consumption, obesity, and inadequate diet and physical activity. Modifying these risk factors could potentially prevent 30%-50% of cancer cases and deaths. This study aims to estimate the population attributable fraction (PAF) of cancer cases and deaths due to various modifiable risk factors in Turkey. Modifiable cancer risk factors were identified as smoking, infections, obesity, physical inactivity, alcohol consumption, inadequate intake of fruits, vegetables, fiber, and calcium. Data on exposure prevalence and cancer incidence were sourced from national surveys and reports. Relative risks (RRs) were obtained from global studies. PAFs were calculated using Levin's equation, accounting for overlaps between risk factors. In 2018, 32% of the cancer cases were attributable to lifestyle risk factors. Smoking was the most significant factor, accounting for 28.4% of cases in men, while high BMI was the leading factor in women, contributing to 11.5% of cases. Lifestyle risk factors were responsible for 41.6% of cancer deaths, with smoking being the leading cause. Lifestyle risk factors contribute significantly to cancer incidence and mortality in Turkey. Prioritizing interventions to reduce tobacco use and obesity could substantially lower the cancer burden. These results are crucial for developing effective cancer prevention strategies and informing public health policies.

Curvilinear incidence models for parity in the entire fertility range for cancers of the breast, ovary, and endometrium: A follow-up of the Norwegian 1960 Census

The protective effect of parity has been demonstrated for cancer of the breast, ovary, and endometrium but no studies have estimated the effect of each subsequent birth in women with 10 or more children or grand-grand parity women, nor compared the linear relationship of the three cancers sites. Here, we aim to explore these relationships based on the Norwegian 1960 Census. The question of parity in present marriage was answered by 385,816 women born 1870-1915, a period with high fertility. Age at marriage has been validated as a proxy for age at first birth AFB. With high parity age at first birth will logically be restricted to early births giving structural zeros. Follow-up was based on linkages to national registers until the first of any of the three diagnoses, death, or age 90 before 31.12.2005. Included were 16,905 breast cancers, 3827 ovarian cancers, and 3834 endometrial cancers. Age- and period-specific incidence rates based on person-years, PY, were used in logit regression models. The percentage decrease for each additional child over the total parity range was for breast cancer 10.5% (95% CI; 9.6-11.4), ovarian cancer 13.2% (11.2-15.3), and endometrial cancer 10.9% (8.9-12.8), in a model without higher order terms. Adjustment for structural zeros reduced the effect of age at first birth to less than one additional child. To the best of our knowledge this is the first analysis of the curvilinear relationships for cancers of the breast, ovary, and endometrium throughout the extended fertility range.

Ultrasound-responsive nanoparticles for imaging and therapy of brain tumors

Central nervous system (CNS) cancers, particularly glioblastoma (GBM), are associated with high mortality and disability rates. Despite aggressive surgical resection, radiotherapy, and chemotherapy, patient survival remains poor. The blood-brain barrier (BBB) significantly impedes therapeutic efficacy, making BBB penetration a critical focus of research. Focused ultrasound (FUS) combined with microbubbles (MBs) can transiently open the BBB through mechanisms such as cavitation, modulation of tight junction protein expression, and enhanced vesicular transport in endothelial cells. This review highlights precision delivery and personalized treatment strategies under ultrasound visualization, including precise control of ultrasound parameters and modulation of the immune microenvironment. We discuss the applications of ultrasound-responsive nanoparticles in brain tumor therapy, including enhanced radiotherapy, gene delivery, immunotherapy, and sonodynamic therapy (SDT), with a particular emphasis on piezoelectric catalytic immunotherapy. Finally, we provide insights into the clinical translation potential of ultrasound-responsive nanoparticles for personalized and precision treatment of brain tumors.

The burden of informal family caregiving in Europe, 2000-2050: a microsimulation modelling study

Background

The demand for informal care in Europe is increasing, with family members often providing essential support. However, the future burden of informal family caregiving remains unclear. This study estimates and projects trends in the burden of family caregiving across 31 European countries from 2000 to 2050.

Methods

We developed a demographic microsimulation model to estimate and project family care burden. The model produces virtual populations with realistic kinship networks and health trajectories over time. From these kinship structures, we defined a novel metric - Years Lived Caregiving for older relatives (YLCs). It accounts for care recipients' disability severity, care dynamics within kinship networks, and national institutional care capacity. Model inputs included demographic data from UN World Population Prospects, marital statistics from Eurostat, disease prevalence from the Global Burden of Disease study, and microdata from the SHARE survey.

Findings

From 2000 to 2050, in Europe the overall burden for informal care is projected to increase by +49.7% (95% UI 45-53.6), from 7.98 (7.65-8.28) to 11.9 (11.4-12.5) million YLC. Musculoskeletal disorders are the largest cause of care burden, contributing to 2.3 (2.18-2.42) million YLC in 2050. Burden of informal care is disproportionally higher for women, although the gender gap is in a descending trend.

Interpretation

Projections indicate a substantial rise in the informal family care burden across Europe by 2050, with only limited offsetting from institutional care. These findings underscore the need for comprehensive strategies to support both caregivers and care recipients, ensuring sustainable healthcare systems across Europe.

Funding

Italian government and the European Union, National Plan for NRRP Complementary Investments (PNC).

Lipid-lowering prescription patterns after a non-fatal acute coronary syndrome: A retrospective cohort study

Background

After an acute atherosclerotic cardiovascular event, high-intensity lipid-lowering therapy (LLT) is needed to reduce recurrence risk. This study aimed to describe LLT prescription patterns and LDL-C levels change after non-fatal acute coronary syndrome (ACS) events and to determine if the recommended goals for LDL-C levels were achieved.

Methods

Retrospective cohort study using electronic health records (EHR) of Unidade Local de Saúde de Matosinhos between 2015 and 2023. Participants were adults aged 40-80 years, with a non-fatal ACS hospitalization between 2016 and 2022 (index date); ≥1 general practice appointment in the three years before ACS; and one-year follow-up post-ACS. Sub-analyses focused on gender, age (

Results

Of 544 patients, 270 (49.6 %) were under 65 years, and 164 (30.1 %) were females. Before the ACS, 71.1 % of men and 56.7 % of women had no previous LLT prescription and younger patients showed poorer LDL-C control (132(IQR 64)mg/dL) than older patients (102(IQR 50)mg/dL). One-year post-ACS, only 11.3 % of males and 8.5 % of females met LDL-C target. The proportion of patients without LLT decreased from 66.7 % at baseline to 13.6 % post-ACS. High-intensity LLT prescriptions increased from 2.4 % to 16.5 %, while moderate-intensity LLT remained predominant (65.8 %). Still, 89.5 % of patients had uncontrolled LDL-C levels.

Conclusion

Despite initiating/intensifying LLT, one year after ACS most patients did not achieve LDL-C goals. This indicates a significant gap in guideline implementation in clinical practice.

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Key Words

• Atherosclerosis
• Electronic health records
• Hydroxymethylglutaryl-CoA reductase inhibitors
• Low-density lipoprotein cholesterol

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Affiliation(s)

Cristina Gavina Cardiology Department, Hospital Pedro Hispano–Unidade Local de Saúde Matosinhos, Matosinhos, Portugal Department of Medicine, Faculty of Medicine of University of Porto, Porto, Portugal UNIC, Faculty of Medicine of University of Porto, Porto, Portugal
Daniel Seabra Carvalho Cardiology Department, Hospital Pedro Hispano–Unidade Local de Saúde Matosinhos, Matosinhos, Portugal
Marta Afonso-Silva Real World Evidence Department, Novartis Farma–Produtos Farmacêuticos SA, Porto Salvo, Portugal
Inês Costa Real World Evidence Department, Novartis Farma–Produtos Farmacêuticos SA, Porto Salvo, Portugal
Ana Sofia Freitas Medical Department, Novartis Farma–Produtos Farmacêuticos S.A., Porto Salvo, Portugal
Mariana Canelas-Pais MTG Research and Development Lab, Porto, Portugal Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
Nuno Lourenço-Silva MTG Research and Development Lab, Porto, Portugal Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
Tiago Taveira-Gomes Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal Faculty of Health Sciences, Fernando Pessoa University (FCS-UFP), Portugal CINTESIS@RISE Center for Health Technology and Services Research, Porto, Portugal SIGIL Scientific Enterprises, Dubai, United Arab Emirates
Francisco Araújo Department of Internal Medicine, Hospital Lusíadas, Lisbon, Portugal

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Design, rationale, and characterization of the mobile health based occupational cardiovascular risk intervention study (mHealth-OPEN study)

BACKGROUND

The substantial workforce and suboptimal cardiovascular health highlights the urgent need for workplace interventions. This ongoing cluster-randomized trial aims to evaluate the effectiveness, feasibility, and acceptability of a mobile health (mHealth) based comprehensive intervention program to improve cardiovascular health among employees.

METHODS AND RESULTS

We conducted a 1-year, 2-arm, parallel-group, cluster-randomized controlled multicenter trial involving 10,000 participants (aged 18-65, including 1,600 participants with high cardiovascular risk) across 20 workplaces. Workplaces were randomly assigned in a 1:1 ratio to either the intervention or control group. We established a mHealth based multifaceted cardiovascular risk management system that enables intelligent management. The intervention groups received a mHealth-based management with primary prevention inventions for all participants and additional cardiovascular risk interventions for participants with high cardiovascular risk via the system. The control groups received usual care. Primary outcomes included percentage changes in hypertension, diabetes, and dyslipidemia control rates among participants with high cardiovascular risk, and percentage changes in the rate of regular physical activity among all the participants, from baseline to 12-month follow-up. Secondary outcomes included changes in blood pressure, glucose, lipid, treatment adherence, behavioral factors, questionnaire scores, and incidence of major cardiovascular events. By now, baseline recruitment has been completed, with comparable characteristics between management and control groups.

CONCLUSIONS

This rigorous designed mHealth-based workplace intervention demonstrates potential for nationwide implementation, offering cardiovascular benefits for employees.

CLINICAL TRIAL REGISTRATION

www.chictr.org.cn. Identifier: ChiCTR2200066196.