Optimising telecommunicator recognition of out-of-hospital cardiac arrest: A scoping review

Aim

To summarize existing literature and identify knowledge gaps regarding barriers and enablers of telecommunicators' recognition of out-of-hospital cardiac arrest (OHCA).

Methods

This scoping review was undertaken by an International Liaison Committee on Resuscitation (ILCOR) Basic Life Support scoping review team and guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Studies were eligible for inclusion if they were peer-reviewed and explored barriers and enablers of telecommunicator recognition of OHCA. We searched Ovid MEDLINE® and Embase and included articles from database inception till June 18th, 2024.

Results

We screened 9,244 studies and included 62 eligible studies on telecommunicator recognition of OHCA. The studies ranged in methodology. The majority were observational studies of emergency calls. The barriers most frequently described to OHCA recognition were breathing status and agonal breathing. The most frequently tested enabler for recognition was a variety of dispatch protocols focusing on breathing assessment. Only one randomized controlled trial (RCT) was identified, which found no difference in OHCA recognition with the addition of machine learning alerting telecommunicators in suspected OHCA cases.

Conclusion

Most studies were observational, assessed barriers to recognition of OHCA and compared different dispatch protocols. Only one RCT was identified. Randomized trials should be conducted to inform how to improve telecommunicator recognition of OHCA, including recognition of pediatric OHCAs and assessment of dispatch protocols.

Natural products derived from traditional Chinese medicines targeting ER stress for the treatment of kidney diseases

Various factors, both internal and external, can disrupt endoplasmic reticulum (ER) homeostasis and increase the burden of protein folding, resulting in ER stress. While short periods of ER stress can help cells return to normal function, excessive or prolonged ER stress triggers a complex signaling network that negatively affects cells. Numerous studies have demonstrated the significant role of ER stress in various kidney diseases, such as immune-related kidney injury, diabetic kidney diseases, renal ischemia reperfusion injury, and renal fibrosis. To date, there is a severe shortage of medications for the treatment of acute and chronic kidney diseases of all causes. Natural products derived from various traditional Chinese medicines (TCM), which are a major source of new drugs, have garnered considerable attention. Recent research has revealed that many natural products have renoprotective effects by targeting ER stress-mediated events, such as apoptosis, oxidative stress, inflammation, autophagy, and epithelial-mesenchymal transition. This article provides a comprehensive review of the current research progress on natural products targeting ER stress for the treatment of kidney diseases.

Efficacy and safety of an oral complementary medicine combination in people with symptomatic knee osteoarthritis: Protocol for the double-blind, randomized, placebo-controlled ATLAS trial

Objective

To investigate the efficacy and safety of an oral complementary medicine combination formulation relative to placebo, on changes in pain intensity from baseline to week 12, in people with knee osteoarthritis (OA).

Design

A placebo-controlled, double-blind, two-arm, superiority, phase II, Randomized Controlled Trial (RCT) (ACTRN12623000380695). We will recruit 82 participants (∼41 per arm), aged ≥40 years, with a clinical diagnosis of symptomatic knee OA and radiographic change on x-ray (Kellgren-Lawrence Grade ≥2). Participants will be randomly allocated to receive either a complementary medicine formulation containing a daily dose of Boswellia serrata extract (Boswellin® Super, 250 ​mg/day), pine bark extract (Fenoprolic™ 70 Organic 100 ​mg/day), curcumin (500 ​mg/day), piperine (5 ​mg/day), and methylsulfonylmethane (MSM, 1500 ​mg/day), or placebo, for 12-weeks. The primary endpoint will be change from baseline in average knee pain intensity at 12-weeks (visual analogue scale). Secondary endpoints will include change in knee pain from baseline to 12-weeks in the Knee Injury and Osteoarthritis Outcome Score (KOOS), global assessment of disease activity, global rating of change, and health-related quality of life (AQoL-8D).

Ethics and dissemination

This protocol has been approved by the University of Sydney Human Research Ethics Committee (#2021/877). Dissemination will occur through lay summaries, infographics, conference abstracts, oral presentations, theses, and scientific publications.

Conclusion

This RCT will provide credible evidence about the efficacy and safety of this complementary medicine combination and inform updates to international clinical practice standards on the use of complementary medicines in the management of symptomatic knee OA.

CDK: A novel high-performance transfer feature technique for early detection of osteoarthritis

Knee osteoarthritis (OA) is a prevalent condition causing significant disability, particularly among the elderly, necessitating advancements in diagnostic methodologies to facilitate early detection and treatment. Traditional OA diagnosis, relying on radiography and physical exams, faces limitations in accuracy and objectivity. This underscores the need for more advanced diagnostic methods, such as machine learning (ML) and deep learning (DL), to improve OA detection and classification. This research introduces a novel ensemble learning approach for image data feature extraction which ingeniously combines the strengths of 2 advanced (ML) models with a (DL) method to substantially improve the accuracy of OA detection from radiographic images. This innovative strategy aims to address the limitations of traditional diagnostic tools by leveraging the enhanced sensitivity and specificity of combined ML and DL models. The methodology deployed in this study encompasses the application of 10 ML models to a comprehensive publicly available Kaggle dataset with a total of 3615 samples of knee X-ray images. Through rigorous k-fold cross-validation and meticulous hyperparameter optimization, we also included evaluation metrics like accuracy, receiver operating characteristic, precision, recall, and F1-score to assess our models' performance effectively. The proposed novel CDK (convolutional neural network, decision tree, K-nearest classifier) ensemble approach for feature extraction is designed to synergize the predictive capabilities of individual models, thereby significantly improving the detection accuracy of OA indicators within radiographic images. We applied several ML and DL approaches to the newly created feature set to evaluate performance. The CDK ensemble model outperformed state-of-the-art studies with a high-performance score of 99.72% accuracy. This remarkable achievement underscores the model's exceptional capability in the early detection of OA, highlighting its superiority in comparison to existing methods.

Risk factors and outcomes in patients who switched from peritoneal dialysis to physician-oriented or patient-oriented kidney replacement therapy

BACKGROUND

We aimed to compare the cardiovascular events and mortality in patients who underwent either physician-oriented or patient-oriented kidney replacement therapy (KRT) conversion due to discontinuation of peritoneal dialysis (PD).

METHODS

Patients with end-stage kidney disease who were receiving PD and required a switch to an alternative KRT were included. They were divided into physician-oriented group or patient-oriented group based on the decision-making process. Logistic regression analysis was used to explore the influencing factors related to KRT conversion in PD patients. The association of physician-oriented or patient-oriented KRT conversion with outcomes after the conversion was assessed by using Cox proportional hazards models.

RESULTS

A total of 257 PD patients were included in the study. The median age at catheterization was 35 years. 69.6% of the participants were male. The median duration of PD was 20 months. 162 participants had patient-oriented KRT conversion, while 95 had physician-oriented KRT conversion. Younger patients, those with higher education levels, higher income, and no diabetes were more likely to have patient-oriented KRT conversion. Over a median follow-up of 39 months, 40 patients experienced cardiovascular events and 16 patients died. Physician-oriented KRT conversion increased nearly 3.8-fold and 4.0-fold risk of cardiovascular events and death, respectively. After adjusting for confounders, physician-oriented KRT conversion remained about a 3-fold risk of cardiovascular events.

CONCLUSION

Compared to patient-oriented KRT conversion, PD patients who underwent physician-oriented conversion had higher risks of cardiovascular events and all-cause mortality. Factors included age at catheterization, education level, annual household income, and history of diabetes mellitus.

Risk and protective factors for postpartum depression among Polish women - a prospective study

This prospective study conducted at a single center in 2022 aims to identify risk and protective factors for postpartum depression (PPD) in Polish women and to assess the impact of pregnancy, delivery, the postpartum period, and psychosocial factors on PPD. After delivery and 4 weeks later, 311 women filled out two questionnaires of our design related to risk factors for PPD. Immune Power Personality Questionnaire, Walsh Family Resilience Questionnaire, and Edinburg Postnatal Depression Scale were also applied. The predictors of PPD identified at two time points included: use of antidepressants, previous depressive episodes, family history of depression, risk of preterm delivery, anxiety about child's health, and breastfeeding and sleep problems. Risk factors for PPD found only after delivery were: suicidal ideation before pregnancy, stressful life events, premature rupture of the membranes, and cesarean section. Inhalation analgesia during labor reduced the PPD frequency. At 4 weeks' postpartum, regular physical activity was also predictive of PPD, while breastfeeding, financial satisfaction, and sufficient sleep duration were protective factors. PPD after delivery was negatively correlated with capacity to confide, hardiness, assertiveness, self-complexity, and communication. PPD at 4 weeks postpartum decreased belief systems, organization patterns, and communication. Two proposed self-designed questionnaires can be useful for effectively screening PPD in the Polish population.

Role of astrocytes in Alzheimer's disease pathogenesis and the impact of exercise-induced remodeling

Alzheimer's disease (AD) is a prevalent and debilitating brain disorder that worsens progressively with age, characterized by cognitive decline and memory impairment. The accumulation of amyloid-beta (Aβ) leading to amyloid plaques and hyperphosphorylation of Tau, resulting in intracellular neurofibrillary tangles (NFTs), are primary pathological features of AD. Despite significant research investment and effort, therapies targeting Aβ and NFTs have proven limited in efficacy for treating or slowing AD progression. Consequently, there is a growing interest in non-invasive therapeutic strategies for AD prevention. Exercise, a low-cost and non-invasive intervention, has demonstrated promising neuroprotective potential in AD prevention. Astrocytes, among the most abundant glial cells in the brain, play essential roles in various physiological processes and are implicated in AD initiation and progression. Exercise delays pathological progression and mitigates cognitive dysfunction in AD by modulating astrocyte morphological and phenotypic changes and fostering crosstalk with other glial cells. This review aims to consolidate the current understanding of how exercise influences astrocyte dynamics in AD, with a focus on elucidating the molecular and cellular mechanisms underlying astrocyte remodeling. The review begins with an overview of the neuropathological changes observed in AD, followed by an examination of astrocyte dysfunction as a feature of the disease. Lastly, the review explores the potential therapeutic implications of exercise-induced astrocyte remodeling in the context of AD.

Implication of locus coeruleus dysfunction in Prader-Willi syndrome: Insights from a mouse model

Prader-Willi syndrome (PWS) is a multisystemic disorder. Notably, many characteristic symptoms of PWS are correlated with locus coeruleus norepinephrine system (LC-NE) dysfunction, including impairment in arousal, learning, pain modulation, and stress-induced negative affective states. Although electrophysiological experiments in necdin-deficient mice, an established PWS animal model, have revealed decreased spontaneous neuronal firing activity in the LC and impaired excitability, the behavioral phenotypes related to LC-NE dysfunction remain unexplored. In this study, heterozygous necdin-deficient mice (B6.Cg-Ndntm1ky) were bred from wild-type (WT) females to generate WT (+m/+p) and heterozygous (+m/-p) animals. Compared to WT mice, Ndn + m/-p mice demonstrated impaired visual-spatial memory in the Y-maze test, reduced social interaction, impaired sexual recognition, and shorter falling latency on the Rotarod. Using the open field test (OFT) and elevated plus maze (EPM), we observed similar locomotion activity of Ndn + m/-p and WT mice, but Ndn + m/-p mice were less anxious. After acute restraint, Ndn + m/-p mice exhibited significant impairment in stress-induced anxiety. Additionally, the plasma norepinephrine surge following exposure to acute restraint stress was also impaired. Pretreatment with atomoxetine, a norepinephrine reuptake inhibitor aimed to enhance LC function, restored Ndn + m/-p mice to exhibit a normal response to acute restraint stress. Furthermore, by employing chemogenetic approaches to facilitate LC neuronal firing, post-stress anxious responses were also partially rescued in Ndn + m/-p mice. These data strongly suggest that LC dysfunction is implicated in the pathogenesis of stress-related neuropsychiatric symptoms in PWS. Manipulation of LC activity may hold therapeutic potential for patients with PWS.

Targeting TGR5 to mitigate liver fibrosis: Inhibition of hepatic stellate cell activation through modulation of mitochondrial fission

Chronic hepatitis B virus (HBV) infection continues to be a prominent cause of liver fibrosis and end-stage liver disease in China, necessitating the development of effective therapeutic strategies. This study investigated the potential of targeting TGR5 to alleviate liver fibrosis by impeding the activation of hepatic stellate cells (HSCs), which play a pivotal role in fibrotic progression. Using the human hepatic stellate cell line LX-2 overexpressing hepatitis B virus X protein (HBX), this study revealed that TGR5 activation through INT-777 inhibits HBX-induced LX-2 cell activation, thereby ameliorating liver fibrosis, which is associated with the attenuation of mitochondrial fission and introduces a novel regulatory pathway in liver fibrosis. Additional experiments with mitochondrial fission inducers and inhibitors confirm the crucial role of mitochondrial dynamics in TGR5-mediated effects. In vivo studies using TGR5 knockout mice substantiate these findings, demonstrating exacerbated fibrosis in the absence of TGR5 and its alleviation with the mitochondrial fission inhibitor Mdivi-1. Overall, this study provides insights into TGR5-mediated regulation of liver fibrosis through the modulation of mitochondrial fission in HSCs, suggesting potential therapeutic strategies for liver fibrosis intervention.

MoCab: A framework for the deployment of machine learning models across health information systems

BACKGROUND AND OBJECTIVE

Machine learning models are vital for enhancing healthcare services. However, integrating them into health information systems (HISs) introduces challenges beyond clinical decision making, such as interoperability and diverse electronic health records (EHR) formats. We proposed Model Cabinet Architecture (MoCab), a framework designed to leverage fast healthcare interoperability resources (FHIR) as the standard for data storage and retrieval when deploying machine learning models across various HISs, addressing the challenges highlighted by platforms such as EPOCH®, ePRISM®, KETOS, and others.

METHODS

The MoCab architecture is designed to streamline predictive modeling in healthcare through a structured framework incorporating several specialized parts. The Data Service Center manages patient data retrieval from FHIR servers. These data are then processed by the Knowledge Model Center, where they are formatted and fed into predictive models. The Model Retraining Center is crucial in continuously updating these models to maintain accuracy in dynamic clinical environments. The framework further incorporates Clinical Decision Support (CDS) Hooks for issuing clinical alerts. It uses Substitutable Medical Apps Reusable Technologies (SMART) on FHIR to develop applications for displaying alerts, prediction results, and patient records.

RESULTS

The MoCab framework was demonstrated using three types of predictive models: a scoring model (qCSI), a machine learning model (NSTI), and a deep learning model (SPC), applied to synthetic data that mimic a major EHR system. The implementations showed how MoCab integrates predictive models with health data for clinical decision support, utilizing CDS Hooks and SMART on FHIR for seamless HIS integration. The demonstration confirmed the practical utility of MoCab in supporting clinical decision making, validated by its application in various healthcare settings.

CONCLUSIONS

We demonstrate MoCab's potential in promoting the interoperability of machine learning models and enhancing its utility across various EHRs. Despite facing challenges like FHIR adoption, MoCab addresses key challenges in adapting machine learning models within healthcare settings, paving the way for further enhancements and broader adoption.

Minimally invasive interventional procedures for osteoarthritis and inflammatory arthritis: A systematic review and meta-analysis

OBJECTIVE

to summarize the evidence on the efficacy of minimally invasive interventional procedures such as radiofrequency ablation (RFA) and transcatheter arterial embolization (TAE) in patients with osteoarthritis or inflammatory arthritis.

METHODS

a literature search was conducted in PubMed and Web of Science databases. Both randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSI) were included. The results were organized according to the treated anatomical site: knee, hip, foot and ankle, shoulder, hand and wrist, sacroiliac joints. Data about treatment efficacy were extracted. The main outcome was change in pain intensity using the 0-10 visual analog scale (VAS) from baseline to 1 month. Additional timepoints at 3, 6 and 12 months were assessed. Change in functional status was evaluated. Pooled estimates were calculated as the mean difference (MD) and 95 % confidence interval relative to baseline. The meta-analyses of RCTs and NRSI were conducted separately.

RESULTS

of the 4599 retrieved articles, 164 were included in the review and, considering all the established timepoints, 111 (38 RCTs and 73 NRSI) were selected for the meta-analysis. Only one article described patients with inflammatory arthritis. In the meta-analysis of RCTs, one month after the procedure, MD in VAS was -3.98 (-4.41 to -3.55; k = 21) for knee RFA, and -3.18 (-3.96 to -2.39; k = 8) for sacroiliac joints RFA. In the meta-analysis of NRSI, MD in VAS was -4.12 (-4.63 to -3.61; k = 23) for knee RFA, -3.84 (-4.77 to -2.92; k = 7) for knee TAE, -4.34 (-4.96 to -3.71; k = 2) for hip RFA, -3.83 (-4.52 to -3.15; k = 3) for shoulder RFA and -4.93 (-5.58 to -4.28; k = 14) for sacroiliac joints RFA. Significant decrease in pain intensity was found also at 3, 6 and 12 months. Additionally, functional status improved at all the assessed timepoints.

CONCLUSION

minimally invasive interventional procedures can improve pain and functional status of patients affected by OA or chronic sacroiliac pain of degenerative origin. Further research is warranted in the field of inflammatory rheumatic diseases.

Generation of induced pluripotent stem cells from an HLA-B27 positive ankylosing spondylitis patient with syndesmophyte formation

Human leukocyte antigen (HLA)-B27 is the genetic marker for ankylosing spondylitis (AS). Here, we generated induced pluripotent stem cells (iPSCs) from peripheral blood mononuclear cells of a male AS patient carrying HLA-B27 with syndesmophyte formation by using the Sendai-virus delivery system. The resulting iPSCs had a normal karyotype, expressed pluripotent markers, and could differentiate into three germ layers. This cellular model will provide a platform for studying pathological mechanisms of new bone formation in HLA-B27 positive AS patients.

Interprofessional interventions that impact collaboration and quality of care across inpatient trauma care continuum: A scoping review

INTRODUCTION

Despite the recognized importance of interprofessional collaboration (IPC) in trauma care, healthcare professionals often work in silos. Interprofessional (IP) interventions are crucial for optimizing IPC and delivering high-quality care across clinical contexts, yet their effectiveness throughout the inpatient trauma care continuum is not well understood. Thus, this review aimed to examine the literature on the effectiveness of IP interventions on collaboration processes and related outcomes in inpatient trauma care.

METHODS

We conducted a scoping review following Joanna Briggs Institute's methodology. We searched six databases for studies from the last decade on IP interventions in inpatient trauma care. Two independent reviewers categorized IP interventions (education, practice, organization) and extracted their impact on IPC processes and related outcomes (team performance, patient, organization).

RESULTS

Of the 17,397 studies screened, 148 met the inclusion criteria. Most were cohort designs (72%), conducted in level I trauma centers (57%) and emergency departments (51%), and involved surgeons (56%) and nurses (53%). Studies focused on IP organization interventions (51%), such as clinical pathways; IP practice interventions (35%), such as trauma team activation protocols; and IP education interventions (14%) including multi-method education. IP practice interventions most effectively improved team performance results, while IP education interventions primarily improved IPC processes. Positive patient outcomes were limited, with few studies examining organizational effects.

CONCLUSIONS

Significant advancements are still required in IP interventions and trauma care research. Future studies should rigorously explore the effectiveness of interventions throughout the inpatient trauma care continuum and focus on developing robust measures for patient and organizational outcomes.

Efficacy and complication of keyhole surgery and open surgery for repairing fibular collateral ligament in the persistent lateral ankle joint instability treatment: A protocol for systematic review and meta analysis

BACKGROUND

Over the past few years, there has been growing interest in identifying and treating persistent lateral ankle joint instability. Many medical professionals believe that early intervention is important to address this instability.

METHODS

Four databases on the outcomes of open and keyhole surgery for repairing the fibular collateral ligament in the treatment of chronic lateral ankle joint instability were acquired from the computer during controlled trials. Data analysis was conducted after the rigorous literature quality evaluation using Stata software.

RESULTS

This meta-analysis finally included 11 articles. Eleven studies reported complications were significantly lower in the treated group (odds ratio: 0.55; 95% confidence interval [CI]: 0.32-0.94; P < .05) compared to the untreated group, as were American Orthopedic Foot and Ankle Society scores (standard mean difference [SMD]: 3.77; 95% CI: 1.17-6.37; P < .01), visual analog scale scores (SMD: -0.69; 95% CI: -1.24 to -0.14; P < .05), Karlsson scores (SMD: 2.78; 95% CI: 0.35-5.21; P < .05), and Tegner scores (SMD: 0.41; 95% CI: -0.13 to 0.95; P = .139).

CONCLUSION

According to complications, American Orthopedic Foot and Ankle Society scores, visual analog scale scores, and Karlsson scores, the study findings suggested that keyhole surgery may be beneficial in patients with persistent lateral ankle joint instability. Following this, the growing number of high-quality studies needs to confirm the results reported in this study.

Efficacy of jing Si herbal tea in functional dyspepsia: A double-blind, randomized, placebo-controlled study

BACKGROUND

Functional dyspepsia (FD) is prevalent worldwide and is associated with gastrointestinal inflammation, mucosal anomalies, and shifts in microbiota metabolites like short chain fatty acids. This study assesses the efficacy of Jing Si herbal tea (JSHT) in alleviating FD symptoms, psychological distress, and influencing metabolites.

METHODS

Adults with FD based on Rome IV criteria were included. Participants underwent physical and psychological evaluations, pre-treatment blood sampling, and were randomly assigned to JSHT or placebo groups for four weeks. Post-treatment, evaluations and Liquid Chromatography-Mass Spectrometry for gut metabolites were done. Successful response was defined by a 50% symptom reduction. Symptom intensity, sleep, depression, anxiety, and stress were measured using questionnaires.

RESULTS

26 patients (median age 55.5 years, range 22-77 years, 60.6% female) were studied. Both JSHT and placebo groups were similar at baseline. JSHT showed a higher response rate (69.2%) than placebo (23.1%, P = 0.018). JSHT recipients experienced notable reduction in upper gastrointestinal symptoms and anxiety (P = 0.005; P = 0.037). Increased serum butyrate was observed in improved patients (P = 0.01), whereas no major changes were detected in the placebo group.

CONCLUSION

Four weeks of JSHT treatment ameliorated FD symptoms and anxiety, potentially linked to increased serum butyrate. This study suggests that JSHT has potential therapeutic role in patients with FD.

Association between the atherogenic index of plasma and abdominal aortic calcification in adults: a cross-sectional study

BACKGROUND

Atherogenic index of plasma (AIP) index is an important marker of insulin resistance and a significant risk factor for cardiovascular disease. Abdominal aortic calcification (AAC) is significantly associated with subclinical atherosclerotic disease. However, there are no studies that have examined the relationship between AIP index and AAC, so we investigated the potential association between them in the general population.

METHODS

This was a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES, 2013-2014). The association of AIP with AAC was estimated by multivariable regression analysis.

RESULTS

After adjusting for confounders, the odds of extensive AAC doubled per unit increase in the AIP index (OR = 2.00, 95% CI: 1.05, 3.83; P = 0.035). The multivariable OR and 95% CI of the highest AIP index tertile compared with the lowest tertile was significantly different. (OR = 1.73, 95% CI: 1.05, 2.83; P = 0.031). The subgroup analyses indicated that the association was consistent irrespective of age, sex, hypertension, diabetes, smoking status, eGFR and hypercholesteremia.

CONCLUSIONS

The AIP index was independently associated with the presence of extensive AAC in the study population. Further studies are required to confirm this relationship.

Jing-Si Herbal Tea Suppresses H2O2-Instigated Inflammation and Apoptosis by Inhibiting Bax and Mitochondrial Cytochrome C Release in HIG-82 Synoviocytes

Inflammation is an intrinsic protective mechanism against various forms of cellular injuries in humans; however, its undesired activation results in tissue damage and cell death. The onset of chronic inflammation and oxidative stress are the key characteristics of autoimmune inflammatory diseases such as rheumatoid arthritis (RA), for which an effective treatment is yet to be developed. Therefore, in this study, we investigated the protective effects and molecular mechanisms of a novel herbal preparation, Jing-Si herbal tea (JS), against H2O2-induced inflammation and cellular damage in HIG-82 synoviocytes. We found that JS did not show any significant alterations in cell viability at <188 μg/mL; however, a cytotoxic effect was observed at 188-1883 μg/mL concentrations tested. We found that expressions of inflammation associated extracellular matrix (ECM)-degrading proteases MMP-13, ADAMTS-2, -8, and -17 were abnormally enhanced under H2O2-induced pathological oxidative stress (ROS) in HIG-82 cells. Interestingly, JS treatment not only reduced the ROS levels but also significantly repressed the protein expressions of collagen degrading proteases in a dose-dependent manner. Treatment with JS showed enhanced cell viability against H2O2-induced toxic ROS levels. The expressions of cell protective aggrecan, Collagen II, and Bcl-2 were increased, whereas MMP-13, ADAMTS-2, Cytochrome C, and cleaved Caspase 3 were decreased by JS under inflammatory agents H2O2, MIA, LPS, and TNF-α treatment, respectively, in HIG-82 cells. Interestingly, the cytoprotective effect of JS treatment was attributed to a decreased mitochondrial localization of Bax and a reduction of Cytochrome C release into the cytoplasm of H2O2-treated HIG-82 cells. Collectively, our results suggest a novel protective mechanism of JS for RA treatment, which could be potentially applied as a complementary treatment or as an alternative therapeutic approach to mitigate inflammatory diseases.

Associations between blood nickel and lung function in young Chinese: An observational study combining epidemiology and metabolomics

Prior research has explored the relationship between occupational exposure to nickel and lung function. Nonetheless, there is limited research examining the correlation between blood nickel levels and lung function among young adults in the general population. The metabolomic changes associated with nickel exposure have not been well elucidated. On August 23, 2019, we enrolled 257 undergraduate participants from the Chinese Undergraduates Cohort to undergo measurements of blood nickel levels and lung function. The follow-up study was conducted in May 2021. A linear mixed-effects model was employed to assess the relationship between blood nickel levels and lung function. We also conducted stratified analyses by home address. In addition, in order to explore the biological mechanism of lung function damage caused by nickel exposure, we performed metabolomic analyses of baseline serum samples (N = 251). Both analysis of variance and mixed linear effect models were utilized to assess the impact of blood nickel exposure on metabolism. Our findings from cross-sectional and cohort analyses revealed a significant association between blood nickel levels and decreased forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) among young adults in the general population. Furthermore, we found stronger associations in urban areas. In metabolomics analysis, a total of nine metabolites were significantly changed under blood nickel exposure. The changed metabolites were mainly enriched in six pathways including carbohydrate, amino acid, and cofactor vitamin metabolism. These metabolic pathways involve inflammation and oxidative stress, indicating that high concentrations of nickel exposure can cause inflammation and oxidative stress by disrupting the above metabolism of the body.

Oridonin Attenuates Diabetes‑induced Renal Fibrosis via the Inhibition of TXNIP/NLRP3 and NF‑κB Pathways by Activating PPARγ in Rats

INTRODUCTION

Oridonin possesses remarkable anti-inflammatory, immunoregulatory properties. However, the renoprotective effects of oridonin and the underlying molecular mechanisms in diabetic nephropathy (DN). We hypothesized that oridonin could ameliorate diabetes‑induced renal fibrosis.

METHODS

Streptozocin (STZ)-induced diabetic rats were provided with a high-fat diet to establish a type 2 diabetes mellitus (T2DM) animal model, and then treated with Oridonin (10, 20 mg/kg/day) for two weeks. Kidney function and renal fibrosis were assessed. High glucose-induced human renal proximal tubule epithelial cells (HK-2) were also treated with oridonin. The expression of inflammatory factors and fibrotic markers were analyzed.

RESULTS

Oridonin treatment preserved kidney function and markedly limited the renal fibrosis size in diabetic rats. The renal fibrotic markers were inhibited in the oridonin 10 mg/kg/day and 20 mg/kg/day groups compared to the T2DM group. The expression of thioredoxin-interacting proteins/ nod-like receptor protein-3 (TXNIP/NLRP3) and nuclear factor (NF)‑κB pathway decreased, while that of peroxisome proliferator-activated receptor-gamma (PPARγ) increased in the oridonin treatment group compared to the non-treated group. In vitro, PPARγ intervention could significantly regulate the effect of oridonin on the high glucose-induced inflammatory changes in HK-2 cells.

CONCLUSION

Oridonin reduces renal fibrosis and preserves kidney function via the inhibition of TXNIP/NLRP3 and NF‑κB pathways by activating PPARγ in rat T2DM model, which indicates potential effect of oridonin in the treatment of DN.

Complication rates rise with age and Haller index in minimally invasive correction of pectus excavatum: A high-volume, single-center retrospective cohort study

OBJECTIVES

The study objectives were to describe the compounded complication rate of minimally invasive repair of pectus excavatum, identify predisposing risk factors, and evaluate the optimal timing of correction. Minimally invasive repair of pectus excavatum is the standard treatment for pectus excavatum and consists of 2 invasive procedures, for example, correction with bar insertion followed by bar removal after 2 to 3 years.

METHODS

A retrospective cohort study identifying children, adolescents, and adults of both genders corrected for pectus excavatum with minimally invasive repair of pectus excavatum between 2001 and 2022. Information on complications related to bar insertion and removal procedures for each individual patient was compiled into a compounded complication rate. Complication severities were categorized according to the Clavien-Dindo classification.

RESULTS

A total of 2013 patients were corrected by minimally invasive repair of pectus excavatum with a median age (interquartile range) for correction of 16.6 (5) years. Overall compounded complication rate occurred at a frequency of 16.4%, of which 9.3% required invasive reinterventions (Clavien-Dindo classification ≥IIIa). The complication rate related to bar insertion was 2.6-fold higher compared with bar removal (11.8% vs 4.5%, respectively). Multivariable analysis revealed age (adjusted odds ratio, 1.05; P < .001), precorrection Haller Index (adjusted odds ratio, 1.10; P < .033), and early-phase institutional experience (adjusted odds ratio, 1.59; P < .002) as independent predisposing risk factors. The optimal age of correction was 12 years, and the compounded complication rate correlated exponentially with age with a doubling time of 7.2 years. Complications increased 2.2-fold when the Haller index increased to 5 or more units.

CONCLUSIONS

Minimally invasive repair of pectus excavatum is associated with a high compounded complication rate that increases exponentially with age and high Haller Index. Consequently, we recommend repair during late childhood and early adolescence, and emphasize the importance of informing patients and relatives about the significant risks of adult correction as well as the need of 2 consecutive procedures taking the complication profile into account before planning surgery.

Roles of m6A modification in regulating PPER pathway in cadmium-induced pancreatic β cell death

Cadmium can lead to the death of pancreatic β cells, thus affecting the synthesis and secretion of insulin. However, the specific mechanisms underlying the cadmium-induced pancreatic β cell death have not been fully understood. In this study, roles of m6A modification in regulating protein processing in endoplasmic reticulum (PPER) pathway in cadmium-induced pancreatic β cell death were explored. Our results demonstrated that cell viability and RNA m6A modification level were decreased, while apoptosis rates increased after CdSO4 treatment in pancreatic β cells (NIT-1). In addition, expressions of Bcl-2, Xbp1, Col3a1, Bax, Chop, Dnajb1, and Hsp90aa1 were all significantly changed in CdSO4 treatment cells. The m6A agonist entacapone (Ent) can prominently reverse the cytotoxicity effects of CdSO4 and alleviate the changes of protein expression induced by CdSO4 treatment. By contrast, m6A inhibitor 3-Deazaadenosine (DAA) can synergistically enhance the cytotoxicity of CdSO4 and aggravate the disorder of protein levels caused by CdSO4 treatment. Interestingly, the results of the immunoprecipitation experiment indicate that Ythdc2, one of m6A binding proteins, may regulate the PPER pathway molecules in an m6A-dependent manner. In summary, our findings provide new directions for the prevention and treatment of the impairment of pancreatic β cell function induced by cadmium.

"A systematic review of risk factors of postpartum depression. Evidence from Asian culture "

OBJECTIVES

One of the largest health concerns, postpartum depression (PPD), has detrimental effects on new mothers, their child, and their family. Investigating under-researched risk factors for postpartum depression in Asian women is the goal of this review of the literature.

METHODS

The literature was searched using a number of electronic research databases. This review included studies that meet the following requirements: (a) they evaluated risk variables; (b) they were conducted in Asian countries using quantitative or qualitative methods; and (c) they were published in English in peer-reviewed journals between 2007 and 2023. A total of 90 studies from 14 different countries were reviewed, compiled, and synthesized.

RESULTS

In Asian countries, where rates ranged from 0.82 % to 93 %, South Korea and Japan had the lowest and highest rates of postpartum depression, respectively. The risk factors for postpartum depression were divided into five main categories: biological/physical (e.g., ABO blood group, oxytocin level), psychological (e.g., antenatal depression, body dissatisfaction, child care stress), obstetric/pediatric (e.g., loss of baby, abortions, pain), socio-demographic (e.g., low social support, poverty, loss of autonomy), and cultural (e.g., gender preference).

CONCLUSION

This phenomenon is prevalent in Asian cultures as it is in European Countries. The repercussions of untreated postpartum depression can lead to long-term psychological and developmental issues in children and strain the familial bonds essential for a nurturing environment. Moreover, understanding the specific risk factors faced by Asian women can pave the way for culturally sensitive interventions and support systems designed to address and mitigate these challenges effectively.

Focus on brain-lung crosstalk: Preventing or treating the pathological vicious circle between the brain and the lung

Recently, there has been increasing attention to bidirectional information exchange between the brain and lungs. Typical physiological data is communicated by channels like the circulation and sympathetic nervous system. However, communication between the brain and lungs can also occur in pathological conditions. Studies have shown that severe traumatic brain injury (TBI), cerebral hemorrhage, subarachnoid hemorrhage (SAH), and other brain diseases can lead to lung damage. Conversely, severe lung diseases such as acute respiratory distress syndrome (ARDS), pneumonia, and respiratory failure can exacerbate neuroinflammatory responses, aggravate brain damage, deteriorate neurological function, and result in poor prognosis. A brain or lung injury can have adverse effects on another organ through various pathways, including inflammation, immunity, oxidative stress, neurosecretory factors, microbiome and oxygen. Researchers have increasingly concentrated on possible links between the brain and lungs. However, there has been little attention given to how the interaction between the brain and lungs affects the development of brain or lung disorders, which can lead to clinical states that are susceptible to alterations and can directly affect treatment results. This review described the relationships between the brain and lung in both physiological and pathological conditions, detailing the various pathways of communication such as neurological, inflammatory, immunological, endocrine, and microbiological pathways. Meanwhile, this review provides a comprehensive summary of both pharmacological and non-pharmacological interventions for diseases related to the brain and lungs. It aims to support clinical endeavors in preventing and treating such ailments and serve as a reference for the development of relevant medications.

Editor's Choice - Prognostic Factors and Models to Predict Mortality Outcomes in Patients with Peripheral Arterial Disease: A Systematic Review

OBJECTIVE

Predicting adverse outcomes in patients with peripheral arterial disease (PAD) is a complex task owing to the heterogeneity in patient and disease characteristics. This systematic review aimed to identify prognostic factors and prognostic models to predict mortality outcomes in patients with PAD Fontaine stage I - III or Rutherford category 0 - 4.

DATA SOURCES

PubMed, Embase, and Cochrane Database of Systematic Reviews were searched to identify studies examining individual prognostic factors or studies aiming to develop or validate a prognostic model for mortality outcomes in patients with PAD.

REVIEW METHODS

Information on study design, patient population, prognostic factors, and prognostic model characteristics was extracted, and risk of bias was evaluated.

RESULTS

Sixty nine studies investigated prognostic factors for mortality outcomes in PAD. Over 80 single prognostic factors were identified, with age as a predictor of death in most of the studies. Other common factors included sex, diabetes, and smoking status. Six studies had low risk of bias in all domains, and the remainder had an unclear or high risk of bias in at least one domain. Eight studies developed or validated a prognostic model. All models included age in their primary model, but not sex. All studies had similar discrimination levels of > 70%. Five of the studies on prognostic models had an overall high risk of bias, whereas two studies had an overall unclear risk of bias.

CONCLUSION

This systematic review shows that a large number of prognostic studies have been published, with heterogeneity in patient populations, outcomes, and risk of bias. Factors such as sex, age, diabetes, hypertension, and smoking are significant in predicting mortality risk among patients with PAD Fontaine stage I - III or Rutherford category 0 - 4.

Exploring the impact of curcumin on osteoarthritis symptomatology: correlations and insights from a Bulgarian cohort

INTRODUCTION

Osteoarthritis is a prevalent degenerative joint disorder associated with pain and functional impairment. Curcumin, a natural anti-inflammatory compound, has garnered attention for its potential therapeutic benefits in osteoarthritis management.

The significance of ferroptosis in renal diseases and its therapeutic potential

Kidney diseases are significant global public health concern, with increasing prevalence and substantial economic impact. Developing novel therapeutic approaches are essential for delaying disease progression and improving patient quality of life. Cell death signifying the termination of cellular life, could facilitate appropriate bodily development and internal homeostasis. Recently, regulated cell death (RCD) forms such as ferroptosis, characterized by iron-dependent lipid peroxidation, has garnered attention in diverse renal diseases and other pathological conditions. This review offers a comprehensive examination of ferroptosis, encompassing an analysis of the involvement of iron and lipid metabolism, the System Xc - /glutathione/glutathione peroxidase 4 signaling, and additional associated pathways. Meanwhile, the review delves into the potential of targeting ferroptosis as a therapeutic approach in the management of acute kidney injury (AKI), chronic kidney disease (CKD), diabetic nephropathy, and renal tumors. Furthermore, it emphasizes the significance of ferroptosis in the transition from AKI to CKD and further accentuates the potential for repurposing drug and utilizing traditional medicine in targeting ferroptosis-related pathways for clinical applications. The integrated review provides valuable insights into the role of ferroptosis in kidney diseases and highlights the potential for targeting ferroptosis as a therapeutic strategy.

High incidence of post-operative re-sprain following suture tape implantation for anterior talofibular ligament insufficiency and risk factors for post-operative re-sprain

PURPOSE

Anterior talofibular ligament (ATFL) insufficiency encompasses situations in which (i) frequent sprains cause ATFL loss, as evidenced by ATFL non-visualization on preoperative magnetic resonance imaging; or (ii) minimal healthy ATFL tissue for repair is left after the removal of the large os subfibulare. Suture tape implantation can be indicated for these cases rather than conventional ligament repair. This study was designed to investigate the incidence of post-operative re-sprain in patients who underwent suture tape implantation for ATFL insufficiency, and risk factors influencing the occurrence of post-operative re-sprain were identified.

METHODS

A total of 68 patients who underwent suture tape implantation for ATFL insufficiency from January 2016 to December 2021 were retrospectively evaluated. The minimum follow-up duration for inclusion was 2 years after surgery. All included patients were divided into two groups according to the presence of post-operative re-sprain during the follow-up period. Multiple clinico-radiographic parameters were measured, and binary logistic regression analysis was performed to determine the factors influencing post-operative re-sprain.

RESULTS

Post-operative re-sprain occurred in 19 of the 68 patients (27.9%), and multiple re-sprains persisted in 7 patients (10.3%). Post-operative re-sprain was more likely to occur in patients who smoked after surgery (odds ratio [OR], 3.510), had generalized ligament laxity (OR, 4.364) and engaged in occupations requiring high physical activity levels (OR, 4.421), including soldiers, professional athletes, student-athletes and mailmen.

CONCLUSION

The incidence of multiple post-operative re-sprains was high after suture tape implantation for ATFL insufficiency. Caution is particularly warranted in patients with risk factors, necessitating meticulous attention to their care. Careful consideration of strategies to mitigate risks when performing the surgery is also recommended.

LEVEL OF EVIDENCE

Level III.

Cilostazol after endovascular therapy for femoropopliteal peripheral arterial disease: A systematic review and meta-analysis

BACKGROUND

Endovascular therapy (ET) outcomes for femoropopliteal peripheral arterial disease (FP-PAD) remain suboptimal. Cilostazol therapy may improve patency rates and decrease major adverse limb events after ET for FP-PAD. Our goal was to analyze published studies evaluating the use of cilostazol after ET for FP-PAD.

METHODS

We searched MEDLINE, EMBASE, and CENTRAL for randomized and observational studies (OSs) evaluating cilostazol therapy after ET for FP-PAD. We only included OSs adjusting for confounding variables. We analyzed observational and randomized studies separately and explored heterogeneity by estimating an I2 statistic. A fixed-effects model was chosen if the I2 statistic was low. If the two-sided probability of observing the difference between groups under a true null hypothesis was <5%, we considered this difference statistically significant.

RESULTS

We screened 2171 studies and included 26 papers in our analysis (5 randomized controlled trials and 21 OSs). All randomized studies were open label. In randomized studies, the odds of restenosis were lower in patients treated with cilostazol (pooled odds ratio, 0.28; 95% confidence interval [CI], 0.18-0.43; P < .01; I2 = 0%). The odds of target lesion revascularization (TLR) were also lower in patients treated with cilostazol (pooled odds ratio, 0.35; 95% CI, 0.22-0.65; P < .01; I2 = 0%). In OSs, we also identified associations between peri-interventional treatment with cilostazol and lower rates of restenosis (pooled hazard ratio [pHR], 0.57; 95% CI, 0.51-0.65; P < .01; I2 = 34%), TLR (pHR, 0.53; 95% CI, 0.36-0.79; P < .01; I2 = 0%), and amputation (pHR, 0.54; 95% CI, 0.32-0.90; P = .02; I2 = 30%).

CONCLUSIONS

In randomized open-label studies, peri-interventional treatment with cilostazol after ET for FP-PAD decreased the odds of restenosis and TLR (Level 1A). Similarly, in OSs that adjusted for confounding, peri-interventional cilostazol therapy was associated with lower rates of restenosis, TLR, and amputation (Level 2A).

Novel SARS-CoV-2 inhibition properties of the anti-cancer Kang Guan Recipe herbal formula

The ongoing COVID-19 pandemic is a persistent challenge, with continued breakthrough infections despite vaccination efforts. This has spurred interest in alternative preventive measures, including dietary and herbal interventions. Previous research has demonstrated that herbal medicines can not only inhibit cancer progression but also combat viral infections, including COVID-19 by targeting SARS-CoV-2, indicating a multifaceted potential to address both viruses and cancer. Here, we found that the Kang Guan Recipe (KGR), a novel herbal medicine formula, associates with potent inhibition activity against the SARS-CoV-2 viral infection. We demonstrate that KGR exhibits inhibitory activity against several SARS-CoV-2 variants of concern (VOCs). Mechanistically, we found that KGR can block the interaction of the viral spike and human angiotensin-converting enzyme 2 (ACE2). Furthermore, we assessed the inhibitory effect of KGR on SARS-CoV-2 viral entry in vivo, observing that serum samples from healthy human subjects having taken KGR exhibited suppressive activity against SARS-CoV-2 variants. Our investigation provides valuable insights into the potential of KGR as a novel herbal-based preventive and therapeutic strategy against COVID-19.

Gandouling Regulates Ferroptosis and Improves Neuroinflammation in Wilson's Disease Through the LCN2/NLRP3 Signaling Pathway

Purpose

Neuroinflammation is a main cause of neurological damage in Wilson's disease (WD). Ferroptosis is present in the WD pathological process, which is also closely related to the neuroinflammation. LCN2, a ferroptosis-related gene in WD, is linked with the activation of NLRP3 inflammasome. Our group has previously demonstrated that Gandouling (GDL) can effectively improve neuroinflammation in WD. This study aims to investigate the protective effect of GDL on neuroinflammation in animal and cell models of WD, and whether the pharmacological mechanism is related to the LCN2/NLRP3 signaling pathway.

Methods

Toxic milk (TX) mice and HT22 cells stimulated by copper ions were selected as models. The pathology of hippocampal tissues in TX mice were observed by HE staining and transmission electron microscopy. High-throughput sequencing analysis was conducted to screen ferroptosis-related genes in WD. The expression of LCN2 and GPX4 in hippocampus of TX mice were detected by immunohistochemical. The expression of LCN2, NLRP3, GPX4, and SLC7A11 was determined in TX mice and HT22 cells by Western blotting and RT-qPCR. The levels of Fe2+, inflammatory factor indicators TNF-α, IL-1β and IL-6 and oxidative stress indicators 4-HNE, MAD, SOD, GSH and ROS were detected in each group by ELISA.

Results

The results showed that GDL ameliorated pathological and mitochondrial damages in hippocampus of TX mice. The analysis of bioinformatics showed that LCN2 was a differential gene associated with ferroptosis in WD. The results of Western blotting and RT-qPCR indicated that GDL reduced the expression of LCN2 and NLRP3, and enhanced the expression of GPX4 and SLC711 in TX mice and HT22 cells. The ELISA results showed that GDL decreased the expression of Fe2+ and inflammatory factors TNF-α, IL-1β and IL-6 in TX mice with ferroptosis inducer intervention and copper ion-loaded HT22 cells. GDL decreased the expression of oxidative stress indicators ROS, 4-HNE and MDA, and increased the expression of oxidative stress indicators GSH and SOD in TX mice and copper ion-loaded HT22 cells.

Conclusion

GDL has anti-inflammatory and antioxidant effects. LCN2 is a differential gene associated with ferroptosis in WD. GDL may alleviate ferroptosis by inhibiting the LCN2/NLPR3 signaling pathway, thereby improving neuroinflammatory responses and exerting neuroprotective effects in WD.

Connexin 43 regulates pyroptosis by influencing intracellular calcium levels in X-ray induced vascular endothelial cell damage

OBJECTIVE

Our prior research has established that X-ray exposure induces pyroptosis in human umbilical vein endothelial cells (HUVECs), with Cx43 playing a regulatory role in this process. However, the precise mechanism by which Cx43 regulates pyroptosis remains unclear. The objective of this study is to assess the involvement of the calcium signaling pathway in Cx43-mediated regulation of X-ray-induced pyroptosis in HUVECs.

METHODS

HUVECs were exposed to 10 Gy X-ray radiation either alone or combined with Cx43 overexpression or knockdown. Calcium ions (Ca2+) were stained using Fluo-4/AM and analyzed via flow cytometry and confocal microscopy. Pyroptosis was assessed through flow cytometry by staining with FLICA (fluorescent-labeled inhibitor of caspase) and propidium iodide (PI). Calcium signaling was inhibited using BAPTA/AM, 2-APB, or nifedipine. Protein expression levels were assessed by western blotting.

RESULTS

X-ray irradiation induced an increase in intracellular calcium levels in HUVECs in a dose- and time-dependent manner. The results demonstrated that regulating calcium release with BAPTA/AM, 2-APB, or nifedipine significantly reduced pyroptosis. Also, the overexpression of Cx43 significantly attenuated the increase in intracellular calcium. Conversely, Cx43 knockdown via siRNA significantly increased the intracellular calcium levels. Also, interfering with calcium signaling using BAPTA/AM, 2-APB, or nifedipine reduced the raised pyroptosis levels induced by Cx43 knockdown.

CONCLUSION

Individual HUVECs exposed to high-dose X-ray irradiation exhibited an increase in intracellular calcium, leading to pyroptosis. Also, upregulating Cx43 expression reduced the pyroptosis levels by inhibiting intracellular calcium concentration. This study introduces new concepts for identifying targets for the prophylaxis and therapy of radiation-induced damage.

Effectiveness of an Acupuncture Steam-Warming Eye Mask on Dry Eye Disease in Visual Display Terminal Users: A Prospective Randomized Controlled Trial

We aim to evaluate the effectiveness of an acupuncture steam-warming eye mask (ASEM) on dry eye disease (DED) in visual display terminal (VDT) users. This prospective randomized clinical trial included VDT users with DED-related features who were randomly assigned to the ASEM group (ASEM for 2 weeks, 20 participants) or the steam-warming eye mask (SEM) group (SEM for 2 weeks, 20 participants). The tear film break-up time (TBUT), Schirmer test, tear meniscus height, ocular surface staining scores, eyelid and meibomian gland exam, subjective symptoms, and quality of life (QoL) scores before and after treatment were collected. A generalized linear mixed model was applied to compare the improvement of symptoms and signs between the two groups. After the 2-week treatment, all the subjective symptoms and questionnaire scores in the ASEM group improved significantly (all p < 0.05), whereas the feelings of relaxation, comfortable, and refreshment did not change in the SEM group (both p > 0.05). The TBUT, tear meniscus height, and meibum quality in the lower eyelid were significantly better in the ASEM group than the SEM group (all p < 0.05), whereas no significant changes were observed in the Schirmer test and ocular surface staining scores. Compared with the SEM group, the ASEM group experienced a stronger feeling of refreshment (p = 0.013), lower sensation of ocular discharge (p = 0.031), higher TBUT (p = 0.045), better meibomian gland expressibility of both eyelids (both p < 0.05), and better meibum quality of both eyelids (both p < 0.05), even after adjustments for age and sex. In conclusion, comparing with SEM, ASEM can improve some subjective DED symptoms, tear film stability, and meibum status in VDT users.

Application of methylation in the diagnosis of ankylosing spondylitis

Ankylosing spondylitis (AS) is a chronic inflammatory autoimmune disease, mainly characterized by perifibrocartilage osteitis of the sacroiliac joints and spinal enthesitis. To date, the exact pathogenesis of AS remains elusive. It is generally believed that AS is a multifactorial disease involving genetics, infection, environment, and immunity. Among them, genetic factors are the primary determinants of disease risk and severity. In recent years, epigenetic mechanisms such as DNA methylation have been extensively surveyed with respect to the pathogenesis of AS. This review summarizes the latest research progress of methylation in AS, from whole-genome sequencing to individual differentially methylated gene. And finally, the role of methylase in AS inflammation, autophagy, and osteogenic differentiation was explored. In summary, the results of this review attempt to explain the role of methylation in the occurrence and development of AS and point out the shortcomings of current methylation research, providing directions for subsequent methylation research in AS.

The Use of Deep Learning and Machine Learning on Longitudinal Electronic Health Records for the Early Detection and Prevention of Diseases: Scoping Review

BACKGROUND

Electronic health records (EHRs) contain patients' health information over time, including possible early indicators of disease. However, the increasing amount of data hinders clinicians from using them. There is accumulating evidence suggesting that machine learning (ML) and deep learning (DL) can assist clinicians in analyzing these large-scale EHRs, as algorithms thrive on high volumes of data. Although ML has become well developed, studies mainly focus on engineering but lack medical outcomes.

OBJECTIVE

This study aims for a scoping review of the evidence on how the use of ML on longitudinal EHRs can support the early detection and prevention of disease. The medical insights and clinical benefits that have been generated were investigated by reviewing applications in a variety of diseases.

METHODS

This study was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search was performed in 2022 in collaboration with a medical information specialist in the following databases: PubMed, Embase, Web of Science Core Collection (Clarivate Analytics), and IEEE Xplore Digital Library and computer science bibliography. Studies were eligible when longitudinal EHRs were used that aimed for the early detection of disease via ML in a prevention context. Studies with a technical focus or using imaging or hospital admission data were beyond the scope of this review. Study screening and selection and data extraction were performed independently by 2 researchers.

RESULTS

In total, 20 studies were included, mainly published between 2018 and 2022. They showed that a variety of diseases could be detected or predicted, particularly diabetes; kidney diseases; diseases of the circulatory system; and mental, behavioral, and neurodevelopmental disorders. Demographics, symptoms, procedures, laboratory test results, diagnoses, medications, and BMI were frequently used EHR data in basic recurrent neural network or long short-term memory techniques. By developing and comparing ML and DL models, medical insights such as a high diagnostic performance, an earlier detection, the most important predictors, and additional health indicators were obtained. A clinical benefit that has been evaluated positively was preliminary screening. If these models are applied in practice, patients might also benefit from personalized health care and prevention, with practical benefits such as workload reduction and policy insights.

CONCLUSIONS

Longitudinal EHRs proved to be helpful for support in health care. Current ML models on EHRs can support the detection of diseases in terms of accuracy and offer preliminary screening benefits. Regarding the prevention of diseases, ML and specifically DL models can accurately predict or detect diseases earlier than current clinical diagnoses. Adding personally responsible factors allows targeted prevention interventions. While ML models based on textual EHRs are still in the developmental stage, they have high potential to support clinicians and the health care system and improve patient outcomes.

Epidemiological features of suicidal ideation among the elderly in China based meta-analysis

BACKGROUND

Studies on the prevalence of suicidal ideation (SI) and its associated factors among the elderly in China show considerable variability. This meta-analysis aims to clarify the epidemiological features of SI in this population.

METHODS

We systematically searched English and Chinese databases for relevant literature up to September 15, 2022. The extracted data facilitated the calculation of prevalence and odds ratios (ORs) for factors associated with SI among China's elderly.

RESULTS

We analyzed 31 cross-sectional studies, comprising a total of 79,861 participants from over 20 provinces and municipalities. The pooled prevalence of SI was found to be 11.47% [95% confidence interval (CI): 7.82-15.71%]. Significant variations in prevalence were influenced by residence, physical health (including chronic diseases and daily living capabilities), mental health (depressive symptoms and life satisfaction), economic status, and time-specific assessment tools. Notably, the prevalence from 2011-2020 (15.59%, 95% CI: 9.08-23.44%) was almost double that of 2001-2010 (7.85%, 95% CI: 5.08-11.16%). The SI prevalence in the eastern region (8.06%, 95% CI 5.59-10.94%) was significantly lower than in the central and western regions (16.97%, 95% CI 12.04-22.53%). Fourteen factors exhibited a significant pooled OR greater than 1 (p < 0.05), and two factors had ORs less than 1 (p < 0.05), indicating notable association with SI among the elderly.

CONCLUSION

SI among China's elderly showed relatively high prevalence and considerable heterogeneity across different characteristics and associated factors. This underscores the need for targeted intervention strategies and standardized temporal assessments of SI to effectively address suicide risk in this population.

Plant-Derived Terpenoids: A Plethora of Bioactive Compounds with Several Health Functions and Industrial Applications-A Comprehensive Overview

Terpenoids are a large class of natural secondary plant metabolites which are highly diverse in structure, formed from isoprene units (C-5), associated with a wide range of biological properties, including antioxidant, antimicrobial, anti-inflammatory, antiallergic, anticancer, antimetastatic, antiangiogenesis, and apoptosis induction, and are considered for potential application in the food, cosmetics, pharmaceutical, and medical industries. In plants, terpenoids exert a variety of basic functions in growth and development. This review gives an overview, highlighting the current knowledge of terpenoids and recent advances in our understanding of the organization, regulation, and diversification of core and specialized terpenoid metabolic pathways and addressing the most important functions of volatile and non-volatile specialized terpenoid metabolites in plants. A comprehensive description of different aspects of plant-derived terpenoids as a sustainable source of bioactive compounds, their biosynthetic pathway, the several biological properties attributed to these secondary metabolites associated with health-promoting effects, and their potential industrial applications in several fields will be provided, and emerging and green extraction methods will also be discussed. In addition, future research perspectives within this framework will be highlighted. Literature selection was carried out using the National Library of Medicine, PubMed, and international reference data for the period from 2010 to 2024 using the keyword "terpenoids". A total of 177,633 published papers were found, of which 196 original and review papers were included in this review according to the criteria of their scientific reliability, their completeness, and their relevance to the theme considered.

Impact of pulmonary rehabilitation on exercise capacity, health-related quality of life, and cardiopulmonary function in lung surgery patients: a retrospective propensity score-matched analysis

Background

Pulmonary rehabilitation is considered beneficial for patients undergoing lung surgery, yet its specific impacts on exercise capacity, health-related quality of life (HRQL), and cardiopulmonary function require further elucidation. This study aimed to evaluate the effect of PR on these outcomes in patients undergoing lung surgery using a retrospective propensity score-matched analysis.

Methods

We retrospectively analyzed 420 patients with non-small cell lung cancer (NSCLC) who underwent lung surgery from January 2022 to May 2024. Among these, 84 patients received PR while 336 did not (control group). Propensity score matching (PSM) at a 1:1 ratio yielded 46 patients in each group. Baseline characteristics, spirometry, cardiopulmonary exercise testing, respiratory muscle strength, HRQL, and muscle measurements were assessed pre-and post-surgery.

Results

Before PSM, significant differences existed between groups, with the PR group being older and having different pulmonary function baselines. After PSM, groups were well-balanced. Postoperatively, the PR group showed significant improvements in FEV1/FVC (64.17% vs. 50.87%, p < 0.001), FEV1 (2.31 L/min vs. 1.75 L/min, p < 0.001), and predicted FVC percentage (88.75% vs. 68.30%, p < 0.001). Cardiovascular responses showed a lower CI during exercise in the PR group post-PSM (6.24 L/min/m2 vs. 7.87 L/min/m2, p < 0.001). In terms of exercise capacity, the PR group had higher maximal WR percentage (104.76% vs. 90.00%, p = 0.017) and peak VO2 (1150.70 mL/min vs. 1004.74 mL/min, p = 0.009). PR also resulted in less leg soreness and lower total CAT scores postoperatively. Muscle measurements indicated significantly smaller reductions in ΔHUESMCSA and percentage change in the PR group.

Conclusion

Pulmonary rehabilitation significantly enhances exercise capacity, HRQL, and cardiopulmonary function in patients undergoing lung surgery. It also mitigates postoperative muscle loss, underscoring its importance in the postoperative management of lung surgery patients.

Global prevalence of overweight and obesity among healthcare workers: a systematic review

OBJECTIVE

This systematic review aims to determine the global pooled prevalence of overweight and obesity among health care workers in the 6 World Health Organization (WHO) regions.

INTRODUCTION

The escalating prevalence of overweight and obesity among health care workers significantly affects both individual health and the quality of health care services. Understanding this global prevalence is crucial to be able to implement informed interventions, policies, and for the overall optimization of health care delivery.

INCLUSION CRITERIA

Systematic reviews with prevalence data for overweight and obesity among health care workers in both private and public health care facilities will be considered for inclusion. Transparent documentation of anthropometric measurements and adherence to established overweight and obesity criteria by the WHO, Asia Pacific standards, or Asian criteria are required to be eligible for inclusion. The review will focus on observational study designs, including cross-sectional, survey, case-control, and cohort studies.

METHODS

MEDLINE (PubMed), Scopus, and Web of Science will be searched for records with predefined keywords, including MeSH terms. Records found through hand-searching and reference lists will be added. Two researchers will independently screen studies, resolving any discrepancies with a third researcher. Standardized critical appraisal and data extraction forms will be used. If suitable, pooled prevalence for overweight and obesity based on the 6 WHO regions will be calculated using the DerSimonian-Laird random-effects model. Statistical analysis will be performed and publication bias will be assessed through funnel plot analysis and Egger's test.

REVIEW REGISTRATION

PROSPERO CRD42023452330.

Aqueous extract of Descuraniae Semen attenuates lipopolysaccharide-induced inflammation by inhibiting ER stress and WNK4-SPAK-NKCC1 pathway

Sepsis causes systemic inflammatory responses and acute lung injury (ALI). Despite modern treatments, sepsis-related ALI mortality remains high. Aqueous extract of Descuraniae Semen (AEDS) exerts anti-endoplasmic reticulum (ER) stress, antioxidant and anti-inflammatory effects. AEDS alleviates inflammation and oedema in ALI. Sodium-potassium-chloride co-transporter isoform 1 (NKCC1) is essential for regulating alveolar fluid and is important in ALI. The NKCC1 activity is regulated by upstream with-no-lysine kinase-4 (WNK4) and STE20/SPS1-related proline/alanine-rich kinase (SPAK). This study aimed to investigate the effects of AEDS on lipopolysaccharide (LPS)-induced ALI model in A549 cells, considering the regulation of ER stress, WNK4-SPAK-NKCC1 cascades, inflammation and apoptosis. Cell viability was investigated by the CCK-8 assay. The expressions of the proteins were assessed by immunoblotting analysis assays. The levels of pro-inflammatory cytokines were determined by ELISA. The expression of cytoplasmic Ca2+ in A549 cells was determined using Fluo-4 AM. AEDS attenuates LPS-induced inflammation, which is associated with increased pro-inflammatory cytokine expression and activation of the WNK4-SPAK-NKCC1 pathway. AEDS inhibits the WNK4-SPAK-NKCC1 pathway by regulating of Bcl-2, IP3R and intracellular Ca2+. WNK4 expression levels are significantly higher in the WNK4-overexpressed transfected A549 cells and significantly decrease after AEDS treatment. AEDS attenuates LPS-induced inflammation by inhibiting the WNK4-SPAK-NKCC1 cascade. Therefore, AEDS is regarded as a potential therapeutic agent for ALI.

Efficacy and Safety of Excision Combination Therapies for Earlobe Keloids: A Systematic Review and Meta-analysis

BACKGROUND

Different combinations of excision and adjuvant therapies have been applied to improve outcomes for earlobe keloids, though evidence in this field is still lacking.

OBJECTIVES

This study sought to systematically investigate efficacy and safety of these treatments.

METHODS

We conducted a systematic search on PubMed, Embase, Web of Science, and Cochrane Library to find all relevant studies. Meta-analysis of recurrence rates (RRs) and adverse event rates with 95% confidence intervals, and individual participants data (IPD) were calculated for each intervention when possible. Otherwise, narrative syntheses were performed.

RESULTS

A total of 85 articles, covering 23 treatments for earlobe keloids, were included, indicating a preference for multiple combination therapy. The estimated RRs for 6 interventions (i.e., excision monotherapy, combinations of excision with imiquimod, pressure therapy, radiotherapy, steroids, and steroids with pressure therapy) appeared to be comparable. Electron radiotherapy was found to have potential advantages over X-ray treatment, contributing to the observed heterogeneity. Further meta-analysis using IPD revealed that both combination therapies of excision plus steroid therapy (p=0.003) and excision plus radiotherapy (p=0.003) yielded better recurrence-free survival compared to excision alone. The median recurrence-free interval for combination therapy was 10 months. Adverse event rates were similar among different intervention groups.

CONCLUSIONS

This study suggests that combining excision with radiotherapy or perioperative steroid therapy has the potential to improve prognosis of earlobe keloids without increasing the risk of adverse events. Overall evaluation of patients' conditions and further studies with sufficient follow-up are warranted for clinical practice.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Systematic review of approaches to detection and classification of skin cancer using artificial intelligence: Development and prospects

In recent years, there has been a significant improvement in the accuracy of the classification of pigmented skin lesions using artificial intelligence algorithms. Intelligent analysis and classification systems are significantly superior to visual diagnostic methods used by dermatologists and oncologists. However, the application of such systems in clinical practice is severely limited due to a lack of generalizability and risks of potential misclassification. Successful implementation of artificial intelligence-based tools into clinicopathological practice requires a comprehensive study of the effectiveness and performance of existing models, as well as further promising areas for potential research development. The purpose of this systematic review is to investigate and evaluate the accuracy of artificial intelligence technologies for detecting malignant forms of pigmented skin lesions. For the study, 10,589 scientific research and review articles were selected from electronic scientific publishers, of which 171 articles were included in the presented systematic review. All selected scientific articles are distributed according to the proposed neural network algorithms from machine learning to multimodal intelligent architectures and are described in the corresponding sections of the manuscript. This research aims to explore automated skin cancer recognition systems, from simple machine learning algorithms to multimodal ensemble systems based on advanced encoder-decoder models, visual transformers (ViT), and generative and spiking neural networks. In addition, as a result of the analysis, future directions of research, prospects, and potential for further development of automated neural network systems for classifying pigmented skin lesions are discussed.

Mitochondrial DNA variants, haplogroups and risk of Parkinson's disease: A systematic review and meta-analysis

BACKGROUND

Growing evidence has shown that mitochondrial dysfunction is part of the pathogenesis of Parkinson's disease (PD). However, the role of mitochondrial DNA (mtDNA) variants on PD onset is unclear.

OBJECTIVES

The present study aims to evaluate the effect of mtDNA variants and haplogroups on risk of developing PD.

METHODS

Systematic review and meta-analysis of studies investigating associations between PD and mtDNA variants and haplogroups.

RESULTS

A total of 33 studies were eligible from 957 screened studies. Among 13,640 people with PD and 22,588 control individuals, the association with PD was consistently explored in 13 mtDNA variants in 10 genes and 19 macrohaplogroups. Four mtDNA variants were associated with PD: m.4336C (odds ratio [OR] = 2.99; 95 % confidence interval [CI] = 1.79-5.02), m.7028T (OR = 0.80; 95 % CI = 0.70-0.91), m.10398G (OR = 0.92; 95 % CI = 0.85-0.98), and m.13368A (OR = 0.74; 95 % CI = 0.56-0.98). Four mtDNA macrohaplogroups were associated with PD: R (OR = 2.25; 95 % CI = 1.92-2.65), F (OR = 1.18; 95 % CI = 1.01-1.38), H (OR = 1.12; 95 % CI = 1.06-1.18), and B (OR = 0.77; 95 % CI = 0.65-0.92).

CONCLUSIONS

Despite most studies may be underpowered by the underrepresentation of people without dominant European- and Asian-ancestry, low use of next-generation sequencing for genotyping and small sample sizes, the identification of mtDNA variants and macrohaplogroups associated with PD strengthens the link between the disease and mitochondrial dysfunction and mtDNA genomic instability.

The Association Between the Triglyceride to High-Density Lipoprotein Cholesterol Ratio and the Incidence of Type 2 Diabetes Mellitus in the Japanese Population

Abstract Aims: To explore whether the triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) was independently associated with the risk of incident type 2 diabetes mellitus (T2DM) in a large Japanese cohort. Methods: A secondary analysis was performed using open-access data from a retrospective cohort study. A total of 12,716 eligible participants who had standard medical examinations at the Murakami Memorial Hospital were included in this study. New-onset T2DM was the main outcome during follow-up. The risk of T2DM based on the TG/HDL-C ratio was evaluated using Cox regression analysis and Kaplan-Meier analysis. Subgroup analysis was performed to understand further the significance of the TG/HDL-C ratio in particular populations. To assess the potential of the TG/HDL-C ratio for predicting T2DM, a receiver operating characteristic (ROC) analysis was performed. Results: One hundred fifty new-onset T2DM cases were observed during a median follow-up of 5.39 years. The incidence of T2DM increased with a rise in the TG/HDL-C ratio based on the Kaplan-Meier curves (P < 0.0001). After controlling for potential confounding variables, the TG/HDL-C ratio was positively related to incidence of T2DM (hazard ratio = 1.08, 95% confidence interval: 1.01-1.15, P = 0.0239). In subgroup analysis, those with a body mass index of ≥18.5 and <24 kg/m2 showed a significantly positive relationship. The area under the ROC curve for the TG/HDL-C ratio as a T2DM predictor was 0.684. The optimal TG/HDL-C ratio cutoff value for T2DM was 1.609, with a sensitivity of 54.7% and a specificity of 73.6%. Conclusion: The authors' results showed a significant relationship between the TG/HDL-C ratio and the incidence of T2DM in the Japanese population.

Efficacy and Safety of Omega-3 Fatty Acids in Ameliorating Pruritus in Adult Patients With Chronic Kidney Disease: A Meta-Analysis of Randomized Controlled Trials

Chronic kidney disease-associated pruritus (CKD-aP) represents a common distressing problem in patients with end-stage renal disease. This study aimed to assess the efficacy and safety of omega-3 supplementation in the treatment of CKD-aP. MEDLINE/PubMed, Cochrane Central Register of Controlled Trials, Web of Science, ProQuest, and Scopus databases were searched systematically for articles published from inception until May 21, 2024. Outcomes were pruritus severity at the end of the study or its change from baseline (primary) and intervention-related adverse effects (secondary). Results were pooled as standardized mean difference (SMD) and risk ratio (RR) for numeric and dichotomous outcomes, respectively, along with their 95% confidence intervals (CIs). Eight studies were included. Treatment with omega-3 fatty acids showed a significantly lower severity of CKD-aP at the end of treatment (pooled SMD (95% CI) = -1.03 (-1.85, -0.22), p = 0.024) and changed from baseline (pooled SMD (95% CI) = -0.93 (-1.57, -0.28), p = 0.014). Omega-3 supplementation reduced the risk of CKD-aP (pooled RR (95% CI) = 0.68 (0.12, 3.81), p = 0.661). Omega-3 fatty acid supplementation appears to be a promising effective and safe treatment for CKD-aP. However, the included studies had several limitations that warrant further high-quality studies to elucidate its effect and investigate the causes of non-response in patients who did not improve.

Use of Shock Index, Modified Shock Index, and Age-Adjusted Shock Index for Detection of Postpartum Hemorrhage

PURPOSE

The aim of this study is to evaluate the role of shock index (SI), modified shock index (MSI), and delta shock index (ΔSI) in predicting postpartum hemorrhage (PPH) and adverse maternal outcomes.

MATERIAL AND METHODS

In this cross-sectional cohort study, a study group consisting of 416 pregnant women who delivered at our hospital and had postpartum hemorrhage was compared with 467 control patients with normal follow-up. SI (pulse/systolic blood pressure), MSI (pulse/mean arterial pressure), ΔSI (input SI - 2nd- or 6th-hour SI) values were calculated.

RESULTS

A total of 883 postpartum women were included in the study. The study group had higher peripartum, 2nd-hour, and 6th-hour SI values (p=0.011, p=0.001, p<0.001, respectively). Peripartum MSI values (p=0.004), 2nd-hour MSI values (p<0.001), and 6th-hour MSI values (p<0.001) were significantly lower in the control group than in the PPH group. When the groups were evaluated, the cut-off value of the 2nd-hour SI parameter was>0.8909 (sensitivity 30%, specificity 84%), and the 6th-hour SI parameter was>0.8909 (sensitivity 40%, specificity 80%) for predicting postpartum hemorrhage requiring blood transfusion and surgical intervention. The cut-off value of the 2nd-hour MSI parameter was>1.2 (sensitivity 34%, specificity 82%), and the cut-off value of the 6th-hour MSI parameter was>1.2652 (sensitivity 32%, specificity 90%).

CONCLUSION

The 2nd- and 6th-hour SI and 2nd- and 6th-hour MSI values were significantly higher in patients with postpartum hemorrhage. Values greater than 0.89 for SI and 1.2 for MSI were considered significant for predicting postpartum hemorrhage with maternal impairment.

Exploring the Usage Effectiveness of a Nursing Charge System

The nursing charge system for inpatient accounting has been utilized in healthcare institutions for years. However, the level of its effectiveness in meeting the needs of nursing services, including further development, has not been systematically evaluated. A cross-sectional study based in Delone and McLean's information system success model was applied to explore the level of effective nursing charge system usage across the five dimensions of system quality, information quality, service quality, user satisfaction, and net benefits. We conducted a survey of the inpatient units of a medical center in Taiwan from June 23, 2021, to July 23, 2021. A total of 214 valid questionnaires were collected. Using a 5-point Likert scale, the dimension with the highest score was information quality (3.71), followed by service quality (3.37), user satisfaction (3.36), net benefits (3.31), and system quality (3.23). Older nurses ( r = -0.176) and those with more clinical experience ( r = -0.151) viewed the nursing charge system as having less information quality. The comfort level with using the computer was positively associated with system quality ( r = 0.396), information quality ( r = 0.378), service quality ( r = 0.275), user satisfaction ( r = 0.417), and net benefits ( r = 0.355). The opinions of nurses are vital. User feedback and advice should be investigated regularly to achieve system optimization.

Imaging diagnostics of pulmonary ground-glass nodules: a narrative review with current status and future directions

Background and Objective

The incidence rate of lung cancer, which also has the highest mortality rates for both men and women worldwide, is increasing globally. Due to advancements in imaging technology and the growing inclination of individuals to undergo screening, the detection rate of ground-glass nodules (GGNs) has surged rapidly. Currently, artificial intelligence (AI) methods for data analysis and interpretation, image processing, illness diagnosis, and lesion prediction offer a novel perspective on the diagnosis of GGNs. This article aimed to examine how to detect malignant lesions as early as possible and improve clinical diagnostic and treatment decisions by identifying benign and malignant lesions using imaging data. It also aimed to describe the use of computed tomography (CT)-guided biopsies and highlight developments in AI techniques in this area.

Methods

We used PubMed, Elsevier ScienceDirect, Springer Database, and Google Scholar to search for information relevant to the article's topic. We gathered, examined, and interpreted relevant imaging resources from the Second Affiliated Hospital of Nanchang University's Imaging Center. Additionally, we used Adobe Illustrator 2020 to process all the figures.

Key Content and Findings

We examined the common signs of GGNs, elucidated the relationship between these signs and the identification of benign and malignant lesions, and then described the application of AI in image segmentation, automatic classification, and the invasiveness prediction of GGNs over the last three years, including its limitations and outlook. We also discussed the necessity of conducting biopsies of persistent pure GGNs.

Conclusions

A variety of imaging features can be combined to improve the diagnosis of benign and malignant GGNs. The use of CT-guided puncture biopsy to clarify the nature of lesions should be considered with caution. The development of new AI tools brings new possibilities and hope to improving the ability of imaging physicians to analyze GGN images and achieving accurate diagnosis.

Causal associations of physical activity and leisure sedentary behaviors with age at onset of Huntington's disease: A mendelian randomization study

BACKGROUND

Huntington's disease (HD) is a neurodegenerative disorder for which effective therapies are currently lacking. Studies suggest that increasing physical activity (PA) and reducing leisure sedentary behavior (LSB) mitigate the progression of HD, but their causal relationship with the age at onset (AAO) of HD remains uncertain. To investigate this, we conducted the Two-sample Mendelian Randomization (MR).

METHODS

Exposure were retrieved from the UK BioBank's (UKB) Genome-Wide Association Study (GWAS). PA included accelerometer-based average PA, vigorous PA, self-reported moderate-to-vigorous PA (MVPA), and light do-it-yourself activity. LSB included television (TV) time, computer time, and driving time. Outcome came from the GWAS of the GEM-HD Consortium. We applied several MR methods such as inverse variance weighted (IVW), MR-Egger regression, weighted median (WM) for sensitivity analysis.

RESULTS

Increases in light PA (β = 8.53 years, 95 % CI = 10.64 to 44.09, P = 0.001) and accelerometer-based vigorous PA (β = 5.18, 95 % CI = 0.92 to 9.43, P = 0.017) delayed AAO of HD, while longer TV time was associated with earlier AAO of HD (β = -2.88 years, 95 % CI = -4.99 to -0.77, P = 0.007). However, other PA and LSB phenotypes did not significantly affect AAO of HD.

CONCLUSION

The study revealed a unidirectional causality between PA, LSB and the AAO of HD. Increasing PA and reducing TV time delay HD onset. Therefore, we recommend increasing physical activity and reducing sedentary behavior to delay the occurrence of motor symptoms for premanifest HD individuals.

Study on the recovery of bladder function in patients with cervical cancer after operation by portable ultrasound combined

BACKGROUND

Postoperative urination dysfunction is a common complication after surgery in patients with cervical cancer. Portable bladder ultrasound are commonly utilized in clinical practice for measuring residual urine volume. This study aimed to the effect of bladder function training combined with portable ultrasound monitoring on bladder function recovery in patients with cervical cancer after training.

METHODS

A total of 40 postoperative patients with cervical cancer were randomly divided into a control group (A) and an experimental group (B) of 20 cases each. Group A was given routine postoperative care, while group B was given bladder function training. Urgent urine bladder volume were taken twice daily after removal of the urinary catheter and monitored for five consecutive days. The difference of urgent urine bladder volume and bladder filling rate were compared by t-test and chi-square test respectively. The 36-item Short Form Health Survey (SF-36) was used to evaluate the quality of life of patients before and after intervention, and compared by Mann-Whitney U test.

RESULTS

There was no significant difference in preoperative urgent urine volume between the two groups. After catheter removal, the bladder volume of patients in the B increased, while the bladder volume of patients in the A increased less and fluctuated greatly. The bladder filling rate in the A was significantly lower than that in the B (5/15 vs 17/18, p < 0.05). After intervention, the quality of life of the experimental group was better than that of the control group, including scores of general health, mental health, vitality, and physical role (p < 0.05).

CONCLUSION

Postoperative cervical cancer patients trained to hold urine by portable ultrasound monitoring are able to recover bladder function.

Ferroptosis-Modulating Natural Products for Targeting Inflammation-Related Diseases: Challenges and Opportunities in Manipulating Redox Signaling

Significance: Numerous disorders are linked to ferroptosis, a form of programmed cell death triggered by lipid peroxidation accumulation rather than apoptosis. Inflammation is the body's defensive response to stimuli and is also caused by inflammatory chemicals that can harm the body. The treatment of inflammatory diseases by focusing on the signaling pathways and mechanisms of ferroptosis has emerged as a new area worthy of extensive research. Recent Advances: Studies in cellular and animal models of inflammatory diseases have shown that ferroptosis markers are activated and lipid peroxidation levels are increased. Natural products (NPs) are gaining importance due to their ability to target ferroptosis pathways, particularly the Nuclear factor E2-related factor 2 signaling pathway, thereby suppressing inflammation and the release of pro-inflammatory cytokines. Critical Issues: This article provides an overview of ferroptosis, focusing on the signaling pathways and mechanisms connecting it to inflammation. It also explores the potential use of NPs as a treatment for inflammatory diseases and ferroptosis. Future Directions: NPs offer unique advantages, including multicomponent properties, multi-bio-targeting capabilities, and minimal side effects. Further research may facilitate the early clinical application of NPs to develop innovative treatment strategies.