Topical administration of GLP-1 eyedrops improves retinal ganglion cell function by facilitating presynaptic GABA release in early experimental diabetes

JOURNAL/nrgr/04.03/01300535-202602000-00048/figure1/v/2025-05-05T160104Z/r/image-tiff Diabetic retinopathy is a prominent cause of blindness in adults, with early retinal ganglion cell loss contributing to visual dysfunction or blindness. In the brain, defects in γ-aminobutyric acid synaptic transmission are associated with pathophysiological and neurodegenerative disorders, whereas glucagon-like peptide-1 has demonstrated neuroprotective effects. However, it is not yet clear whether diabetes causes alterations in inhibitory input to retinal ganglion cells and whether and how glucagon-like peptide-1 protects against neurodegeneration in the diabetic retina through regulating inhibitory synaptic transmission to retinal ganglion cells. In the present study, we used the patch-clamp technique to record γ-aminobutyric acid subtype A receptor-mediated miniature inhibitory postsynaptic currents in retinal ganglion cells from streptozotocin-induced diabetes model rats. We found that early diabetes (4 weeks of hyperglycemia) decreased the frequency of GABAergic miniature inhibitory postsynaptic currents in retinal ganglion cells without altering their amplitude, suggesting a reduction in the spontaneous release of γ-aminobutyric acid to retinal ganglion cells. Topical administration of glucagon-like peptide-1 eyedrops over a period of 2 weeks effectively countered the hyperglycemia-induced downregulation of GABAergic mIPSC frequency, subsequently enhancing the survival of retinal ganglion cells. Concurrently, the protective effects of glucagon-like peptide-1 on retinal ganglion cells in diabetic rats were eliminated by topical administration of exendin-9-39, a specific glucagon-like peptide-1 receptor antagonist, or SR95531, a specific antagonist of the γ-aminobutyric acid subtype A receptor. Furthermore, extracellular perfusion of glucagon-like peptide-1 was found to elevate the frequencies of GABAergic miniature inhibitory postsynaptic currents in both ON- and OFF-type retinal ganglion cells. This elevation was shown to be mediated by activation of the phosphatidylinositol-phospholipase C/inositol 1,4,5-trisphosphate receptor/Ca 2+ /protein kinase C signaling pathway downstream of glucagon-like peptide-1 receptor activation. Moreover, multielectrode array recordings revealed that glucagon-like peptide-1 functionally augmented the photoresponses of ON-type retinal ganglion cells. Optomotor response tests demonstrated that diabetic rats exhibited reductions in visual acuity and contrast sensitivity that were significantly ameliorated by topical administration of glucagon-like peptide-1. These results suggest that glucagon-like peptide-1 facilitates the release of γ-aminobutyric acid onto retinal ganglion cells through the activation of glucagon-like peptide-1 receptor, leading to the de-excitation of retinal ganglion cell circuits and the inhibition of excitotoxic processes associated with diabetic retinopathy. Collectively, our findings indicate that the γ-aminobutyric acid system has potential as a therapeutic target for mitigating early-stage diabetic retinopathy. Furthermore, the topical administration of glucagon-like peptide-1 eyedrops represents a non-invasive and effective treatment approach for managing early-stage diabetic retinopathy.

Microglial polarization pathways and therapeutic drugs targeting activated microglia in traumatic brain injury

Traumatic brain injury can be categorized into primary and secondary injuries. Secondary injuries are the main cause of disability following traumatic brain injury, which involves a complex multicellular cascade. Microglia play an important role in secondary injury and can be activated in response to traumatic brain injury. In this article, we review the origin and classification of microglia as well as the dynamic changes of microglia in traumatic brain injury. We also clarify the microglial polarization pathways and the therapeutic drugs targeting activated microglia. We found that regulating the signaling pathways involved in pro-inflammatory and anti-inflammatory microglia, such as the Toll-like receptor 4 /nuclear factor-kappa B, mitogen-activated protein kinase, Janus kinase/signal transducer and activator of transcription, phosphoinositide 3-kinase/protein kinase B, Notch, and high mobility group box 1 pathways, can alleviate the inflammatory response triggered by microglia in traumatic brain injury, thereby exerting neuroprotective effects. We also reviewed the strategies developed on the basis of these pathways, such as drug and cell replacement therapies. Drugs that modulate inflammatory factors, such as rosuvastatin, have been shown to promote the polarization of anti-inflammatory microglia and reduce the inflammatory response caused by traumatic brain injury. Mesenchymal stem cells possess anti-inflammatory properties, and clinical studies have confirmed their significant efficacy and safety in patients with traumatic brain injury. Additionally, advancements in mesenchymal stem cell-delivery methods-such as combinations of novel biomaterials, genetic engineering, and mesenchymal stem cell exosome therapy-have greatly enhanced the efficiency and therapeutic effects of mesenchymal stem cells in animal models. However, numerous challenges in the application of drug and mesenchymal stem cell treatment strategies remain to be addressed. In the future, new technologies, such as single-cell RNA sequencing and transcriptome analysis, can facilitate further experimental studies. Moreover, research involving non-human primates can help translate these treatment strategies to clinical practice.

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.

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.

TGF-β: elusive target in diabetic kidney disease

Transforming growth factor-beta (TGF-β), a cytokine with near omnipresence, is an integral part of many vital cellular processes across the human body. The family includes three isoforms: Transforming growth factor-beta 1, 2, and 3. These cytokines play a significant role in the fibrosis cascade. Diabetic kidney disease (DKD), a major complication of diabetes, is increasing in prevalence daily, and the classical diagnosis of diabetes is based on the presence of albuminuria. The occurrence of nonalbuminuric DKD has provided new insight into the pathogenesis of this disease. The emphasis on multifactorial pathways involved in developing DKD has highlighted some markers associated with tissue fibrosis. In diabetic nephropathy, TGF-β is significantly involved in its pathology. Its presence in serum and urine means that it could be a diagnostic tool while its regulation provides potential therapeutic targets. Completely blocking TGF-β signaling could reach untargeted regions and cause unanticipated effects. This paper reviews the basic details of TGF-β as a cytokine, its role in DKD, and updates on research carried out to validate its candidacy.

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.

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.

Analysis of outcomes from a geriatrician-led evidence-based falls prevention clinic: a retrospective study from Qatar

BACKGROUND

Falls are an important health concern among older persons. This study attempted to evaluate the characteristics and risk factors of falls in older persons attending a geriatric falls clinic in Qatar, with a particular emphasis on the impact of the COVID-19 epidemic.

METHODS

A retrospective analysis was performed on 265 patients aged ≥ 65 years who visited the Falls Clinic between January 1, 2019, and November 28, 2021.

RESULTS

The study population showed a significant prevalence of chronic diseases, with hypertension (94.3%) and diabetes (87.5%) being the most common diseases. A substantial percentage of people reported functional difficulties, such as falls during the recent year and injuries. Interestingly, people recruited during the pandemic used assistive devices at a far higher proportion (46.9% vs. 5.5% previously). This group also reported higher rates of dizziness (54.9% vs. 26.7%, respectively) and pain (50.2% vs. 20.0%, respectively). Participants recruited during the epidemic had significantly elevated systolic blood pressure.

CONCLUSION

This study showed an increased incidence of comorbidities and functional impairments in older adults who visited a fall prevention clinic in Qatar. These findings suggest that the pandemic may exacerbate population vulnerability.

Triggers of treatment interruption and resumption among individuals with type 2 diabetes: a narrative cross-sectional qualitative study

PURPOSE

Treatment interruption and resumption are common among people with type 2 diabetes mellitus (T2D), but the triggers of resumption, according to the reasons for interruption, remain underexplored. This study examined patterns of treatment interruption and resumption.

METHODS

Narratives from 13 T2D patients with a history of treatment interruption were analysed through semi-structured interviews.

RESULTS

Four patterns were identified: 1) "Economic rationality", where financial barriers caused interruptions, but resumption was facilitated by low-cost check-ups and updated patient mindsets to manage medical expenses within the constraints of a limited household budget; 2) "Proactive information seeking", where doubts about treatment effectiveness led to interruptions, followed by resumption through active health risk reassessment by the patient's self-directed efforts; 3) "Health professional-patient relationship", where conflicts with healthcare providers prompted interruptions, but trustful encounters encouraged resumption; and 4) "Sustained partnerships with community health professionals", where personal challenges caused interruptions, but non-coercive partnerships with community health professionals fostered resumption through strengthened patient commitment.

CONCLUSION

This study highlights the need for tailored medical support and local policy development for T2D patients, emphasizing subjective interpretations of their experiences on treatment interruption and resumption. Recognizing these patterns can guide resource allocation and the design of community-based diabetes care interventions.

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.

Maternal probiotic exposure enhances CD8 T cell protective neonatal immunity and modulates offspring metabolome to control influenza virus infection

Maternal gut microbiota composition contributes to the status of the neonatal immune system and could influence the early life higher susceptibility to viral respiratory infections. Using a novel protocol of murine maternal probiotic supplementation, we report that perinatal exposure to Lacticaseibacillus rhamnosus (L.rh) or Bifidobacterium animalis subsp. lactis (B.lac) increases the influenza A/PR8 virus (IAV) clearance in neonates. Following either supplementation, type 1 conventional dendritic cells (cDC1) were amplified in the lymph nodes leading to an enhanced IAV antigen-experienced IFN-γ producing effector CD8 T cells in neonates and IAV-specific resident memory CD8 T cells in adulthood. This was compatible with a higher protection of the offspring upon a secondary infection. Interestingly, only mice born to L.rh supplemented mothers further displayed an increased activation of IFN-γ producing virtual memory CD8 T cells and a production of IL-10 by CD4 and CD8 T cells that could explain a better control of the lung damages upon infection. In the offspring and the mothers, no disturbance of the gut microbiota was observed but, as analyzed through an untargeted metabolomic approach, both exposures modified neonatal plasma metabolites. Among them, we further demonstrated that genistein and 3-(3-hydroxyphenyl)propionic acid recapitulate viral clearance or cDC1 activation in neonates exposed to IAV. We conclude that maternal L.rh or B.lac supplementation confers the neonates specific metabolomic modulations with a better CD8 T cell-mediated immune protection against IAV infection.

Genetic insights into blood urea nitrogen as a risk factor for coronary artery disease: a Mendelian randomization study in East Asians

BACKGROUND

Previous studies have reported the association between blood urea nitrogen (BUN) and cardiovascular diseases (CVDs) but the causality has not yet been proved. Our study aimed to assess the causal effect of BUN levels on several CVDs using the two-sample Mendelian randomization (MR) method. This is the first MR study examining causal relationships between BUN and multiple cardiovascular diseases.

METHODS

Using data from genome-wide association studies (GWAS) of East Asians, we identified single nucleotide polymorphisms (SNPs) associated with BUN levels as instrumental variables. Specifically, SNPs reaching genome-wide significance (p < 5 × 10-8) were selected from a large-scale BUN dataset comprising (n = 148,767). To ensure robustness, multiple MR methods, including MR-Egger, weighted median, inverse variance weighting (IVW), simple mode, and weighted mode, were employed to evaluate the causal relationship between BUN levels and CVDs. Sensitivity analyses were conducted to assess the reliability and stability of the results.

RESULT

The IVW approach showed that a higher level of BUN was associated with an increased risk of coronary artery disease (CAD) (OR = 1.42, 95% CI = 1.226 - 1.644, p = 2.89 × 10-6). For atrial fibrillation (OR = 0.868, 95% CI = 0.678 - 1.110, p = 0.258), arrhythmia (OR = 0.907, 95% CI = 0.777 - 1.059, p = 0.216), and congestive heart failure (OR = 0.924, 95% CI = 0.781 - 1.092, p = 0.353), no significant associations were found. Sensitivity analyses indicated the results were robust.

CONCLUSION

This MR work shows that elevated BUN levels are a potential biomarker for CAD risk but lack causal associations with other CVDs. These findings suggest avenues for risk stratification and CAD prevention strategies, emphasizing the clinical utility of BUN monitoring in at-risk populations.

Association between renal function and memory-related disease: evidence from the China Health and Retirement Longitudinal Study

BACKGROUND

Previous studies have reported that renal function is associated brain structure and cognitive dysfunction. However, the association between renal function and memory-related disease was not well characterized.

METHODS

Altogether, 5,282 individuals were included in this study based on China Longitudinal Study of Health and Retirement. Four estimated glomerular filtration rate indicators (eGFR), including CG, CKD-EPIscr, CKD-EPIscr-cys, and CKD-EPIcys were used to evaluate the association between renal function and memory-related disease.

RESULTS

The multivariable-adjusted HRs (95% CIs) of the memory-related disease in the low eGFR group (eGFR < 90 mL/min/1.73m2) were 1.56 (1.13-2.16) for CG, 1.56 (1.19-2.06) for CKD-EPIscr, 1.45 (1.06-1.99) for CKD-EPIscr-cys and 1.27 (0.91-1.77) for CKD-EPIcys, respectively. Similarly, each SD increase of eGFR was associated with reduced risk of memory-related disease on continuous analyses. Subgroup analyses further confirmed these associations. Moreover, the addition of eGFR to conventional risk factors improved the predictive power for memory-related disease (net reclassification improvement: 13.90% for CG, 19.83% for CKD-EPIscr and 30.65% for CKD-EPIscr-cys).

CONCLUSIONS

In conclusion, impaired renal function was associated with the increasing risk of memory-related disease, indicating that renal function may be a potential indicator for memory-related disease. Further studies from other races and populations are needed to replicate our findings and to clarify the potential mechanisms.

Gut-brain axis and environmental factors in Parkinson's disease: bidirectional link between disease onset and progression

Parkinson's disease has long been considered a disorder that primarily affects the brain, as it is defined by the dopaminergic neurodegeneration in the substantia nigra and the brain accumulation of Lewy bodies containing α-synuclein protein. In recent decades, however, accumulating research has revealed that Parkinson's disease also involves the gut and uncovered an intimate and important bidirectional link between the brain and the gut, called the "gut-brain axis." Numerous clinical studies demonstrate that gut dysfunction frequently precedes motor symptoms in Parkinson's disease patients, with findings including impaired intestinal permeability, heightened inflammation, and distinct gut microbiome profiles and metabolites. Furthermore, α-synuclein deposition has been consistently observed in the gut of Parkinson's disease patients, suggesting a potential role in disease initiation. Importantly, individuals with vagotomy have a reduced Parkinson's disease risk. From these observations, researchers have hypothesized that α-synuclein accumulation may initiate in the gut and subsequently propagate to the central dopaminergic neurons through the gut-brain axis, leading to Parkinson's disease. This review comprehensively examines the gut's involvement in Parkinson's disease, focusing on the concept of a gut-origin for the disease. We also examine the interplay between altered gut-related factors and the accumulation of pathological α-synuclein in the gut of Parkinson's disease patients. Given the accessibility of the gut to both dietary and pharmacological interventions, targeting gut-localized α-synuclein represents a promising avenue for developing effective Parkinson's disease therapies.

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.

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.

Exploring novel therapeutic strategies: Could psychedelic perspectives offer promising solutions for Alzheimer's disease comorbidities?

The increasing prevalence of dementia within an ageing global population, combined with prolonged life expectancy, accentuates Alzheimer's disease (AD) as a multifaceted healthcare challenge. This challenge is further compounded by the limited therapeutic options currently available. Addressing the intricacies of AD management, the mitigation of comorbidities has emerged as a pivotal facet of treatment. Comorbid conditions, such as neurobehavioral symptoms, play a role in shaping the clinical course, management, and outcomes of this pathology; highlighting the importance of comprehensive care approaches for affected individuals. Exploration of psychedelic compounds in psychiatric and palliative care settings has recently uncovered promising therapeutic potential, enhancing neuroplasticity, emotional processing and connection. These effects are particularly relevant in the context of AD, where psychedelic therapy offers hope not only for mitigating core symptoms but also for addressing the array of comorbidities associated with this condition. The integration of this comprehensive method offers a chance to significantly enhance the care provided to those navigating the intricate landscape of AD. Therefore, the current paper reviews the intricate link between more frequent additional health conditions that may coexist with dementia, particularly in the context of AD, and explores the therapeutic potential of psychedelic compounds in addressing these concurrent conditions.

Associations of parental labour migration and childhood maltreatment with psychosocial health among adolescents and young adults in China

Background: Few studies have simultaneously considered the impacts of parental labour migration and childhood maltreatment on psychosocial health.Objective: To estimate the complex associations of parental labour migration and childhood maltreatment with psychosocial health among adolescents and young adults in China.Method: This cross-sectional study was conducted among undergraduates aged 17 to 24 years from sixty colleges and universities across 10 provinces of China. Childhood maltreatment was assessed using the Childhood Trauma Questionnaire-Short Form, and psychosocial health was measured using the Strengths and Difficulties Questionnaire (SDQ). Weighted linear mixed regression models, multiplicative interactions, and joint and mediation analyses were performed.Results: Of the 28,810 participants included (mean [SD] age, 19.87 [1.62] years), 12035 (41.8%) were male. In the fully adjusted model, participants who experienced parental migration were more likely to report higher levels of SDQ total difficulties (e.g. β = 0.16 [95% CI, 0.05 to 0.28]) compared with those with non-migrant parents. A positive association was found between the cumulative number of childhood maltreatment and SDQ total difficulties (β = 0.54 [95% CI, 0.49 to 0.60]), with a dose-response relationship observed for the levels of childhood maltreatment and SDQ total difficulties. Compared with individuals without exposure to both parental migration and childhood maltreatment, those exposed to both parental migration and at least 2 numbers of childhood maltreatment had the highest magnitude of psychosocial health difficulties (β = 1.12 [95% CI, 0.91 to 1.33]). Moreover, childhood maltreatment may partially mediate the association between parental migration and psychosocial health, with the mediation proportion being 58.8%.Conclusion: Exposure to parental labour migration or childhood maltreatment was positively associated with psychosocial health among adolescents and young adults. Parental migration and childhood maltreatment may jointly aggravate psychosocial health problems. These findings indicate the necessity of comprehensive interventions targeting adversity stressors to improve psychosocial health, especially for left-behind children experiencing maltreatment.

Efficacy of probiotic supplementation in preventing necrotizing enterocolitis in preterm infants: a systematic review and meta-analysis

BACKGROUND

Necrotizing enterocolitis (NEC) is a severe condition in preterm infants, involving intestinal inflammation and bacterial invasion, leading to high morbidity and mortality. Probiotics may reduce NEC by promoting beneficial gut bacteria, but the role of Bifidobacterium bifidum G001 (BBG001) is not well understood. This meta-analysis evaluates the effectiveness of BBG001 versus placebo in preventing NEC, late-onset sepsis, and all-cause mortality in preterm infants.

METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) from 2014 to 2024. Databases searched included PubMed, Cochrane Central Register, MEDLINE, and EMBASE. Inclusion criteria encompassed RCTs involving preterm infants (<37 weeks gestation and/or <2500 g birth weight) receiving enteral probiotics, including BBG001, compared to placebo. Outcomes assessed were incidence of NEC (≥stage II), late-onset sepsis, and all-cause mortality. Data extraction and quality assessment were independently performed.

RESULTS

From 430 identified records, nine studies involving 7180 preterm infants met the inclusion criteria. BBG001 significantly reduced the risk of NEC stage >2 (OR = 0.66; 95% CI [0.47, 0.94], p = .02), mortality and morbidity (OR = 0.74; 95% CI [0.62, 0.89], p = .001), and sepsis (OR = 0.71; 95% CI [0.53, 0.93], p = .01). It also lowered the odds of periventricular leukomalacia (OR = 0.61; 95% CI [0.47, 0.78], p < .0001) and intraventricular hemorrhage (OR = 0.48; 95% CI [0.33, 0.69], p < .0001). Additionally, BBG001 showed a protective effect against infection-related outcomes, reducing the odds of death attributed to infection (OR = 0.80; 95% CI: 0.65, 0.99; p = .04).

CONCLUSIONS

Probiotic supplementation with BBG001 appears effective in reducing NEC incidence, bloodstream infections, and infection-related deaths in preterm infants. Despite promising results, variability in study designs necessitates further large-scale RCTs to confirm these findings and establish BBG001's role in neonatal care.

Advances in the acting mechanism and treatment of gut microbiota in metabolic dysfunction-associated steatotic liver disease

Metabolic Dysfunction-Associated Steatotic Liver Disease(MASLD) is increasing in prevalence worldwide and has become the greatest potential risk for cirrhosis and hepatocellular liver cancer. Currently, the role of gut microbiota in the development of MASLD has become a research hotspot. The development of MASLD can affect the homeostasis of gut microbiota, and significant changes in the composition or abundance of gut microbiota and its metabolite abnormalities can influence disease progression. The regulation of gut microbiota is an important strategy and novel target for the treatment of MASLD with good prospects. In this paper, we summarize the role of gut microbiota and its metabolites in the pathogenesis of MASLD, and describe the potential preventive and therapeutic efficacy of gut microbiota as a noninvasive marker to regulate the pathogenesis of MASLD based on the "gut-hepatic axis", which will provide new therapeutic ideas for the clinic.

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.

Machine learning algorithms for diabetic kidney disease risk predictive model of Chinese patients with type 2 diabetes mellitus

BACKGROUND

Diabetic kidney disease (DKD) is a common and serious complication of diabetic mellitus (DM). More sensitive methods for early DKD prediction are urgently needed. This study aimed to set up DKD risk prediction models based on machine learning algorithms (MLAs) in patients with type 2 DM (T2DM).

METHODS

The electronic health records of 12,190 T2DM patients with 3-year follow-ups were extracted, and the dataset was divided into a training and testing dataset in a 4:1 ratio. The risk variables for DKD development were ranked and selected to establish forecasting models. The performance of models was further evaluated by the indexes of sensitivity, specificity, positive predictive value, negative predictive value, accuracy, as well as F1 score, using the testing dataset. The value of accuracy was used to select the optimal model.

RESULTS

Using the importance ranking in the random forest package, the variables of age, urinary albumin-to-creatinine ratio, serum cystatin C, estimated glomerular filtration rate, and neutrophil percentage were selected as the predictors for DKD onset. Among the seven forecasting models constructed by MLAs, the accuracy of the Light Gradient Boosting Machine (LightGBM) model was the highest, indicated that the LightGBM algorithms might perform the best for predicting 3-year risk of DKD onset.

CONCLUSIONS

Our study could provide powerful tools for early DKD risk prediction, which might help optimize intervention strategies and improve the renal prognosis in T2DM patients.

Evolving perspectives on evaluating obesity: from traditional methods to cutting-edge techniques

Objective: This review examines the evolution of obesity evaluation methods, from traditional anthropometric indices to advanced imaging techniques, focusing on their clinical utility, limitations, and potential for personalized assessment of visceral adiposity and associated metabolic risks.

Methods: A comprehensive analysis of existing literature was conducted, encompassing anthropometric indices (BMI, WC, WHR, WHtR, NC), lipid-related metrics (LAP, VAI, CVAI, mBMI), and imaging technologies (3D scanning, BIA, ultrasound, DXA, CT, MRI). The study highlights the biological roles of white, brown, and beige adipocytes, emphasizing visceral adipose tissue (VAT) as a critical mediator of metabolic diseases.

Conclusion: Although BMI and other anthropometric measurements are still included in the guidelines, indicators that incorporate lipid metabolism information can more accurately reflect the relationship between metabolic diseases and visceral obesity. At the same time, the use of more modern medical equipment, such as ultrasound, X-rays, and CT scans, allows for a more intuitive assessment of the extent of visceral obesity.

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.

Digging deeper into necrotizing enterocolitis: bridging clinical, microbial, and molecular perspectives

Necrotizing Enterocolitis (NEC) is a severe, life-threatening inflammatory condition of the gastrointestinal tract, especially affecting preterm infants. This review consolidates evidence from various biomedical disciplines to elucidate the complex pathogenesis of NEC, integrating insights from clinical, microbial, and molecular perspectives. It emphasizes the modulation of NEC-associated inflammatory pathways by probiotics and novel biologics, highlighting their therapeutic potential. We further critically examine dysbiotic alterations within the gut microbiota, with a particular focus on imbalances in bacterial and viral communities, which may contribute to the onset of NEC. The intricate interactions among toll-like receptor 4 (TLR4), microvascular integrity, immune activation, and the inflammatory milieu are meticulously summarized, offering a sophisticated understanding of NEC pathophysiology. This academic review aims to enhance the etiological comprehension of NEC, promote the development of targeted therapeutic interventions, and impart the significant impact of perinatal factors on the formulation of preventive and curative strategies for the disease.

The regulatory effect of chitooligosaccharides on islet inflammation in T2D individuals after islet cell transplantation: the mechanism behind Candida albicans abundance and macrophage polarization

Islet cell transplantation (ICT) represents a promising therapeutic approach for addressing diabetes mellitus. However, the islet inflammation during transplantation significantly reduces the surgical outcome rate, which is related to the polarization of macrophages. Chitooligosaccharides (COS) was previously reported which could modulate the immune system, alleviate inflammation, regulate gut microecology, and repair the intestinal barrier. Therefore, we hypothesized COS could relieve pancreatic inflammation by regulating macrophage polarization and gut microbiota. First, 18S rDNA gene sequencing was performed on fecal samples from the ICT population, showing abnormally increased amount of Candida albicans, possibly causing pancreatic inflammation. Functional oligosaccharides responsible for regulating macrophage polarization and inhibiting the growth of Candida albicans were screened. Afterwards, human flora-associated T2D (HMA-T2D) mouse models of gut microbiota were established, and the ability of the selected oligosaccharides were validated in vivo to alleviate inflammation and regulate gut microbiota. The results indicated that ICT significantly decreased the alpha diversity of gut fungal, altered fungal community structures, and increased Candida albicans abundance. Moreover, Candida albicans promoted M1 macrophage polarization, leading to islet inflammation. COS inhibited Candida albicans growth, suppressed the MyD88-NF-κB pathway, activated STAT6, inhibited M1, and promoted M2 macrophage polarization. Furthermore, COS-treated HMA-T2D mice displayed lower M1 macrophage differentiation and higher M2 macrophage numbers. Additionally, COS also enhanced ZO-1 and Occludin mRNA expression, reduced Candida albicans abundance, and balanced gut microecology. This study illustrated that COS modulated macrophage polarization via the MyD88/NF-κB and STAT6 pathways, repaired the intestinal barrier, and reduced Candida albicans abundance to alleviate islet inflammation.

Human induced pluripotent stem cell-derived therapies for regeneration after central nervous system injury

In recent years, the progression of stem cell therapies has shown great promise in advancing the nascent field of regenerative medicine. Considering the non-regenerative nature of the mature central nervous system, the concept that "blank" cells could be reprogrammed and functionally integrated into host neural networks remained intriguing. Previous work has also demonstrated the ability of such cells to stimulate intrinsic growth programs in post-mitotic cells, such as neurons. While embryonic stem cells demonstrated great potential in treating central nervous system pathologies, ethical and technical concerns remained. These barriers, along with the clear necessity for this type of treatment, ultimately prompted the advent of induced pluripotent stem cells. The advantage of pluripotent cells in central nervous system regeneration is multifaceted, permitting differentiation into neural stem cells, neural progenitor cells, glia, and various neuronal subpopulations. The precise spatiotemporal application of extrinsic growth factors in vitro, in addition to microenvironmental signaling in vivo, influences the efficiency of this directed differentiation. While the pluri- or multipotency of these cells is appealing, it also poses the risk of unregulated differentiation and teratoma formation. Cells of the neuroectodermal lineage, such as neuronal subpopulations and glia, have been explored with varying degrees of success. Although the risk of cancer or teratoma formation is greatly reduced, each subpopulation varies in effectiveness and is influenced by a myriad of factors, such as the timing of the transplant, pathology type, and the ratio of accompanying progenitor cells. Furthermore, successful transplantation requires innovative approaches to develop delivery vectors that can mitigate cell death and support integration. Lastly, host immune responses to allogeneic grafts must be thoroughly characterized and further developed to reduce the need for immunosuppression. Translation to a clinical setting will involve careful consideration when assessing both physiologic and functional outcomes. This review will highlight both successes and challenges faced when using human induced pluripotent stem cell-derived cell transplantation therapies to promote endogenous regeneration.

Exploring the interaction between the gut microbiota and cyclic adenosine monophosphate-protein kinase A signaling pathway: a potential therapeutic approach for neurodegenerative diseases

The interaction between the gut microbiota and cyclic adenosine monophosphate (cAMP)-protein kinase A (PKA) signaling pathway in the host's central nervous system plays a crucial role in neurological diseases and enhances communication along the gut-brain axis. The gut microbiota influences the cAMP-PKA signaling pathway through its metabolites, which activates the vagus nerve and modulates the immune and neuroendocrine systems. Conversely, alterations in the cAMP-PKA signaling pathway can affect the composition of the gut microbiota, creating a dynamic network of microbial-host interactions. This reciprocal regulation affects neurodevelopment, neurotransmitter control, and behavioral traits, thus playing a role in the modulation of neurological diseases. The coordinated activity of the gut microbiota and the cAMP-PKA signaling pathway regulates processes such as amyloid-β protein aggregation, mitochondrial dysfunction, abnormal energy metabolism, microglial activation, oxidative stress, and neurotransmitter release, which collectively influence the onset and progression of neurological diseases. This study explores the complex interplay between the gut microbiota and cAMP-PKA signaling pathway, along with its implications for potential therapeutic interventions in neurological diseases. Recent pharmacological research has shown that restoring the balance between gut flora and cAMP-PKA signaling pathway may improve outcomes in neurodegenerative diseases and emotional disorders. This can be achieved through various methods such as dietary modifications, probiotic supplements, Chinese herbal extracts, combinations of Chinese herbs, and innovative dosage forms. These findings suggest that regulating the gut microbiota and cAMP-PKA signaling pathway may provide valuable evidence for developing novel therapeutic approaches for neurodegenerative diseases.

Epigenetic regulation of the inflammatory response in stroke

Stroke is classified as ischemic or hemorrhagic, and there are few effective treatments for either type. Immunologic mechanisms play a critical role in secondary brain injury following a stroke, which manifests as cytokine release, blood-brain barrier disruption, neuronal cell death, and ultimately behavioral impairment. Suppressing the inflammatory response has been shown to mitigate this cascade of events in experimental stroke models. However, in clinical trials of anti-inflammatory agents, long-term immunosuppression has not demonstrated significant clinical benefits for patients. This may be attributable to the dichotomous roles of inflammation in both tissue injury and repair, as well as the complex pathophysiologic inflammatory processes in stroke. Inhibiting acute harmful inflammatory responses or inducing a phenotypic shift from a pro-inflammatory to an anti-inflammatory state at specific time points after a stroke are alternative and promising therapeutic strategies. Identifying agents that can modulate inflammation requires a detailed understanding of the inflammatory processes of stroke. Furthermore, epigenetic reprogramming plays a crucial role in modulating post-stroke inflammation and can potentially be exploited for stroke management. In this review, we summarize current findings on the epigenetic regulation of the inflammatory response in stroke, focusing on key signaling pathways including nuclear factor-kappa B, Janus kinase/signal transducer and activator of transcription, and mitogen-activated protein kinase as well as inflammasome activation. We also discuss promising molecular targets for stroke treatment. The evidence to date indicates that therapeutic targeting of the epigenetic regulation of inflammation can shift the balance from inflammation-induced tissue injury to repair following stroke, leading to improved post-stroke outcomes.

Independent and combined effects of depressive symptoms and cardiometabolic risk factors on dementia incidence: a cross-country comparison in England, the United States and China

BACKGROUND

Depression and cardiometabolic conditions are suggested as modifiable risk factors for dementia, yet their combined impact remains unclear. This study assessed the independent and combined effects of depressive symptoms and cardiometabolic conditions on dementia incidence in England, the US and China.

METHODS

The sample comprised 4472 participants aged 50 and older from the English Longitudinal Study of Ageing (ELSA), 5021 from Health and Retirement Study (HRS), and 8925 from China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms were assessed using the Center for Epidemiological Studies-Depression scale. Cardiometabolic factors included central obesity, low high-density-lipoprotein (HDL) cholesterol, systolic and diastolic blood pressure (BP), hyperglycemia, diabetes, and inflammation. Dementia incidence was estimated using confounder-adjusted Cox proportional hazards regressions, and pooled estimates were obtained using random-effects meta-analysis.

RESULTS

A total of 1218 individuals developed dementia over a median of 6.8-12.2 years. Depressive symptoms (ELSA: HR = 1.47 [95 % CI = 1.09-2.00]; HRS: HR = 1.68 [95 % CI = 1.33-2.13]; CHARLS: HR = 1.35 [95 % CI = 1.12-1.64]) and elevated systolic BP (ELSA: HR = 1.51 [95 % CI = 1.17-1.95]; HRS: HR = 1.48 [95 % CI = 1.24-1.79]; CHARLS: HR = 1.26 [95 % CI = 1.05-1.52]) were linked to dementia risk in all countries. While cardiometabolic multimorbidity (≥2 conditions) was not associated with dementia risk, those with the highest cardiometabolic index (≥4 conditions) had a greater risk of dementia in all samples (ELSA: HR = 1.82 [95 % CI = 1.01-3.26]; HRS: HR = 1.85 [95 % CI = 1.02-3.35]; CHARLS: HR = 1.65 [95 % CI = 1.18-2.30]).

CONCLUSION

Depressive symptoms are independently linked to dementia risk, while having multiple cardiometabolic conditions further increases this risk, especially when co-occurring with depressive symptoms in both Western and Chinese populations.

Loneliness and social isolation, mediating lifestyle factors, and incidence of COPD: A prospective cohort study

BACKGROUND

Limited information exists regarding the associations and pathways of loneliness and social isolation with chronic obstructive pulmonary disease (COPD). Our goal was to investigate the associations of loneliness and social isolation with COPD, as well as to analyze how lifestyle factors may play a role in mediating these effects.

METHODS

In the UK Biobank, 293,864 participants were included in this study. The study assessed five lifestyle factors: physical activity, eating habits, smoking, alcohol consumption, and body mass index (BMI). Incident COPD was detected through algorithms based on electronic health records. We used Cox proportional models to explore the association. Cause mediation analyses were applied to estimate the effect of various lifestyle factors.

RESULTS

In the fully adjusted model, the lonely participants had a greater risk of developing COPD (HR: 1.31; 95 % CI: 1.20-1.43) compared with those participants without loneliness. Similarly, the HR of social isolation on incident COPD was 1.39 (95 % CI: 1.30-1.48) after adjusting for potential confounders. Current smokers (21.9 %), unhealthy dietary characteristics (4.8 %), BMI (4.0 %), unhealthy drinking habits (1.4 %), and physical activity (0.7 %) explained 32.8 % of the association between loneliness and COPD. Likewise, current smokers, physical activity, and unhealthy drinking habit mediated 46.1 %, 4.7 %, and 4.2 % of the effect of social isolation on incident COPD.

LIMITATIONS

Despite extensive adjustment for potential confounders and several sensitivity analyses, residual confounding and reverse causality could not be ruled out.

CONCLUSION

Individuals with loneliness or social isolation have a higher risk of COPD, partly mediated through lifestyle factors.

Childhood maltreatment affects posttraumatic stress symptoms, posttraumatic growth, and prosocial behavior in emerging adulthood: A developmental cascade model

BACKGROUND

Childhood maltreatment has a significant impact on posttraumatic stress symptoms (PTSS), posttraumatic growth (PTG), and prosocial behavior in emerging adults. However, the mechanisms underlying the enduring effect and the impact of maltreatment types remain unclear.

OBJECTIVE

This study aims to explore the effects of childhood abuse and neglect on PTSS, PTG, and prosocial behavior and examine the developmental cascade among them.

PARTICIPANTS AND SETTING

The sample consisted of 794 college students (51.6 % male, Mage = 19.05 ± 1.31 years) from two universities in China.

METHODS

Four waves of longitudinal data were utilized to investigate the developmental cascade linking childhood abuse and neglect to PTSS, PTG, and prosocial behavior in emerging adulthood.

RESULTS

Childhood abuse was positively associated with PTSS and prosocial behavior, while childhood neglect was negatively associated with PTSS, PTG, and prosocial behavior. Over time, PTSS and prosocial behavior exhibited a bidirectional negative lagged relationship, while prosocial behavior had a unidirectional positive lagged effect on PTG.

CONCLUSION

Childhood abuse and neglect generally exert negative effects on PTSS, PTG and prosocial behavior. These impacts can engender a vicious cycle through the mutual predictive effect among PTSS, PTG, and prosocial behavior.

Diabetic peripheral neuropathy and neuromodulation techniques: a systematic review of progress and prospects

Neuromodulation for diabetic peripheral neuropathy represents a significant area of interest in the management of chronic pain associated with this condition. Diabetic peripheral neuropathy, a common complication of diabetes, is characterized by nerve damage due to high blood sugar levels that lead to symptoms, such as pain, tingling, and numbness, primarily in the hands and feet. The aim of this systematic review was to evaluate the efficacy of neuromodulatory techniques as potential therapeutic interventions for patients with diabetic peripheral neuropathy, while also examining recent developments in this domain. The investigation encompassed an array of neuromodulation methods, including frequency rhythmic electrical modulated systems, dorsal root ganglion stimulation, and spinal cord stimulation. This systematic review suggests that neuromodulatory techniques may be useful in the treatment of diabetic peripheral neuropathy. Understanding the advantages of these treatments will enable physicians and other healthcare providers to offer additional options for patients with symptoms refractory to standard pharmacologic treatments. Through these efforts, we may improve quality of life and increase functional capacity in patients suffering from complications related to diabetic neuropathy.

Longitudinal comparative analysis of antidepressants and anti-anxiety medications in Alzheimer's and Parkinson's diseases: insights from French and British health records

BACKGROUND

Depression and anxiety coexist with Alzheimer's disease (AD) and Parkinson's disease (PD), yet their progression trajectories vary, necessitating a thorough examination of prescription patterns for antidepressants and anti-anxiety drugs pre- and post-diagnosis.

OBJECTIVES

To systematically compare the prescriptions of antidepressant and anti-anxiety drugs across AD and PD over 10 years before and after initial diagnosis in the UK and France.

METHODS

Data on 19,954 patients with AD, 25,267 with PD from the UK, 17,463 with AD, 10,333 with PD from France were extracted from The Health Improvement Network database. For both countries, we compared the odds of prescribed antidepressants and anti-anxiety drugs for each diagnosis group, over 10 years before and after diagnosis, using logistic regressions adjusting for age, sex, and drug prescriptions for chronic diseases.

RESULTS

Antidepressant prescriptions showed a significant rise from 25 % 5-10 years before the initial AD diagnosis to 50 % within the first 5 years post-diagnosis. AD Patients were more likely to be prescribed antidepressants than PD patients [Odds ratios ranging from 1.02 to 1.13 in the UK and 1.09-1.36 in France] and conversely PD patients were more likely to be prescribed anti-anxiety drugs [0.83-0.84 in the UK and 0.85-0.90 in France] several years before their diagnosis. AD patients sustained elevated antidepressant prescriptions up to 5 years after diagnosis.

CONCLUSION

These findings offer insights into disease-specific psychological impacts and underscore the necessity for further investigation into prescription patterns and their implications on patient outcomes.

Interconnections between diabetic corneal neuropathy and diabetic retinopathy: diagnostic and therapeutic implications

Diabetic corneal neuropathy and diabetic retinopathy are ocular complications occurring in the context of diabetes mellitus. Diabetic corneal neuropathy refers to the progressive damage of corneal nerves. Diabetic retinopathy has traditionally been considered as damage to the retinal microvasculature. However, growing evidence suggests that diabetic retinopathy is a complex neurovascular disorder resulting from dysfunction of the neurovascular unit, which includes both the retinal vascular structures and neural tissues. Diabetic retinopathy is one of the leading causes of blindness and is frequently screened for as part of diabetic ocular screening. However, diabetic corneal neuropathy is commonly overlooked and underdiagnosed, leading to severe ocular surface impairment. Several studies have found that these two conditions tend to occur together, and they share similarities in their pathogenesis pathways, being triggered by a status of chronic hyperglycemia. This review aims to discuss the interconnection between diabetic corneal neuropathy and diabetic retinopathy, whether diabetic corneal neuropathy precedes diabetic retinopathy, as well as the relation between the stage of diabetic retinopathy and the severity of corneal neuropathy. We also endeavor to explore the relevance of a corneal screening in diabetic eyes and the possibility of using corneal nerve measurements to monitor the progression of diabetic retinopathy.

Determinants of shared decision-making between people with dementia and informal caregivers: A systematic review

OBJECTIVES

Shared decision-making (SDM) between people with dementia and their caregivers is essential for home care arrangements. However, systematic understanding of influencing factors remains limited. This study aimed to identify modifiable determinants of shared decision-making and explore underlying theoretical mechanisms.

METHODS

A comprehensive search across seven databases yielded fourteen studies, extracted using Covidence, including study design, decision topics, determinants, primary outcome, and theoretical frameworks. Quality assessment was based on the Critical Appraisal Skills Programme Qualitative Checklists and Cohort Study Checklists.

RESULTS

Results showed that twelve studies used qualitative or mixed methods, with determinants primarily focusing on individual factors (e.g., PwD symptoms, caregiver burden), while interpersonal, community, and societal levels were overlooked. Care arrangement decisions were underexplored, and research lacked robust theoretical foundations.

CONCLUSIONS

Current research focuses predominantly on individual-level factors while paying less attention to modifiable determinants from broader levels. The insufficient attention to care arrangement decisions and theoretical frameworks calls for a more comprehensive approach.

PRACTICE IMPLICATIONS

Using Social Ecological Model, SDM interventions should simultaneously address individual needs, prioritize modifiable interpersonal factors, and incorporate broader environmental determinants to create comprehensive support systems on dementia caregiving.

Indole alkaloids from Uncaria rhynchophylla and their inhibitory activities against α-glucosidase

Sixteen indole alkaloids were isolated from the hook-bearing stems of Uncaria rhynchophylla (Rubiaceae family), including seven undescribed ones, uncarialines F-L (1-5, 7, and 8), and a naturally occurring alkaloid, 3-epicorynanthine (6). Among them, alkaloids 1 and 2 were identified as rare quaternary ammonium alkaloids, and alkaloid 7 exhibited an unprecedented indole alkaloid framework. Their structures were characterized by a comprehensive analysis of NMR, MS, ECD and single-crystal X-ray diffraction. Notably, alkaloid 5 demonstrate potent inhibitory activity against α-glucosidase, with an IC50 value of 18.45 ± 0.77 μM. Furthermore, the inhibitory kinetics of α-glucosidase revealed that alkaloid 5 belong to the mix inhibition type. Molecular docking analysis showed that alkaloid 5 possessed superior binding affinity with α-glucosidase (-10.7 kcal/mol).

Leptin attenuates diabetic cardiomyopathy-induced cardiac remodeling via regulating cGAS/STING signaling and Opa1-mediated mitochondrial fusion

PURPOSE

This investigation seeks to elucidate the contribution of leptin to the pathogenesis of diabetic cardiomyopathy (DCM).

METHODS

Mice were rendered diabetic through the administration of streptozotocin (STZ). Leptin was delivered via subcutaneously implanted osmotic pumps. Assessments of cardiac performance, hypertrophy, and fibrosis were conducted using echocardiography, Hematoxylin and Eosin (H&E), Wheat Germ Agglutinin (WGA), and Masson trichrome staining. Myocardial apoptosis and oxidative stress were quantified through TUNEL assay and biochemical markers of oxidative stress, including Malondialdehyde (MDA), 4-Hydroxynonenal (4-HNE), and 3-Nitrotyrosine (3NT). Mitochondrial structure was examined using Transmission Electron Microscopy (TEM). Primary neonatal cardiomyocytes were subjected to high glucose (HG) conditions. The fluorescent indicators MitoTracker Green and MitoSOX Red were employed to evaluate mitochondrial morphology and function within the cardiomyocytes.

RESULTS

Mice with diabetes displayed marked cardiac hypertrophy and fibrosis, as indicated by H&E, WGA, and Masson staining. The administration of leptin significantly mitigated the cardiac pathological manifestations in diabetic mice. Leptin increased the expression of Opa1 and enhanced mitochondrial fusion and function in cardiomyocytes exposed to HG. The cGAS/STING signaling pathway may serve as a pivotal intermediary for leptin to facilitate Opa1-driven mitochondrial fusion.

CONCLUSIONS

Leptin appears to safeguard against hyperglycemia-induced mitochondrial oxidative damage and DCM by modulating the cGAS/STING signaling cascade and Opa1-mediated mitochondrial fusion. These results propose that leptin could be a promising agent for promoting mitochondrial fusion and preventing diabetes-associated cardiac pathologies.

Falls in people with Alzheimer's disease: Exploring the role of inhibitory control

On average, people with dementia fall more often than their age-matched peers, with serious consequences, yet the underlying reasons remain poorly understood. This narrative review explores relevant psychological, physiological and neuroimaging studies to discuss whether diminished inhibitory control contributes to poor balance and falls in people with Alzheimer's Disease (AD), the most common form of dementia. Inhibitory control, a component of executive function, plays a vital role in suppressing dominant impulses or actions and regulating attention in favour of a desired outcome. Although objective tests of inhibitory control are not routinely used in clinical settings, research suggests inhibitory control declines early, and progressively, in AD. Postural tasks that require inhibitory control can improve the accuracy of distinguishing fallers from non-fallers beyond known factors. Neuroimaging studies link the prefrontal cortex to both inhibitory and postural control, and this region exhibits neuronal loss early in AD. Thus, emerging evidence suggests that accurately assessing inhibitory control could not only improve falls risk predictions but also aid AD detection.

Imaging probes for the detection of brain microenvironment

The brain microenvironment (BME) is a highly dynamic system that plays a critical role in neural excitation, signal transmission, development, aging, and neurological disorders. BME consists of three key components: neural cells, extracellular spaces, and physical fields, which provide structures and physicochemical properties to synergistically and antagonistically regulate cell behaviors and functions such as nutrient transport, waste metabolism and intercellular communication. Consequently, monitoring the BME is vital to acquire a better understanding of the maintenance of neural homeostasis and the mechanisms underlying neurological diseases. In recent years, researchers have developed a range of imaging probes designed to detect changes in the microenvironment, enabling precise measurements of structural and biophysical parameters in the brain. This advancement aids in the development of improved diagnostic and therapeutic strategies for brain disorders and in the exploration of cutting-edge mechanisms in neuroscience. This review summarizes and highlights recent advances in the probes for sensing and imaging BME. Also, we discuss the design principles, types, applications, challenges, and future directions of probes.

Estimating depression severity in narrative clinical notes using large language models

BACKGROUND

Depression treatment guidelines emphasize measurement-based care using patient-reported outcome measures, yet their impact on narrative documentation quality remains underexplored.

METHODS

We sampled 15,000 narrative clinical outpatient notes from the electronic health record of a large academic medical center, reflecting visits between January 2, 2019 and January 30, 2024, for which a 9-item Patient Health Questionnaire (PHQ-9) was completed at the same time. After censoring PHQ-9 scores from notes, we estimated severity of depressive symptoms with a foundational large language model (gpt4o-08-06) in a HIPAA-compliant enclave. We estimated correlation between true PHQ-9 and model-estimated score and examined the predictive performance of the model for moderate or greater depressive symptoms.

RESULTS

Mean age was 46.3 years (SD 14.9); 9083 (60.6 %) identified as female. 925 (6.2 %) identified as Asian, 638 (4.3 %) as Black, 853 (5.7 %) as another race, and 12,187 (81.2 %) as White. A total of 1044 (7.0 %) identified as Hispanic ethnicity, while 12,699 (84.7 %) were non-Hispanic. Mean measured PHQ-9 score was 1.23 (SD 3.45); 721 (4.8 %) met criteria for moderate or greater depressive symptoms. LLM-predicted PHQ-9 scores were modestly correlated with actual scores (r2 = 0.264 (95 % CI 0.252-0.276)); PPV for moderate or greater depression was 0.309 (95 % CI 0.302-0.317). Performance was consistent across demographic subgroups, with modest differences identified by race, ethnicity, and sex.

CONCLUSION

A foundational LLM performed poorly but consistently across subgroups in imputing PHQ-9 scores from notes when actual PHQ-9 reporting was ablated. This result suggests the extent to which inclusion of PROMs may impoverish documentation of psychiatric symptoms.

Exploring the association between air pollution and urogenital congenital anomalies: a global ecological analysis

The relationship between air pollution and urogenital congenital anomalies (UCAs) remains poorly understood. This study performed an ecological analysis of air pollution emissions and the burden of UCAs, aiming to offer new global insights for air pollution control. Data were obtained from the Global Burden of Disease Study (2021) and Emission Database for Global Atmospheric Research. Joinpoint regression assessed temporal trends in burden of UCAs, mixed-effects, nonlinear lag and time-varying effect models were used to investigate potential associations between air pollution emissions and burden. The burden indicators were incidence, deaths and disability-adjusted life years. From 1990 to 2021, the global incidence of UCAs generally declined, with a significant increase observed since 2016. Our analysis identified a positive correlation between burden of UCAs and several air pollutants. Sulfur dioxide(SO2), ammonia and nitrogen oxides(NOX) are significantly associated with the incidence of UCAs, while SO2, NOX, and non-methane volatile organic compounds are significantly associated with the mortality and disability-adjusted life years rate of UCAs. Sex-specific subgroup analysis indicated differing responses to these pollutants. However, the effect of sulfur dioxide on burden was consistent across sex. Notably, we also found that some pollutants have hysteresis effects that contradict the immediate effects. Additionally, the relationship between air pollution and burden displayed distinct variations over years. This study enhances our understanding of the health impacts on UCAs associated with air pollution, suggested that pregnant women should stay away from ammonia and SO2. It also emphasizes that strengthening air pollution control should be a key monitoring policy.

Rationale and design of a randomized controlled trial evaluating the effects of blueberry consumption versus placebo on brain health in older adults

BACKGROUND

Age-related cognitive decline results in significant clinical and public health costs. Cognitive decline predisposes individuals to dementia and leads to difficulties with activities of daily living and increased hospitalizations. While a few dietary interventions have shown considerable promise at delaying cognitive decline, studies of the effects of long-term blueberry consumption on brain health among older adults have been limited and equivocal.

OBJECTIVE

To test the hypothesis that a 24-week intervention with blueberry powder versus placebo will improve (i) plasma biomarkers of brain health and (ii) cognitive performance in older adults.

METHODS

This randomized, double-blind, placebo-controlled trial will be conducted in older Americans aged 65-99 years old. Sixty-seven participants will be randomly assigned to receive either blueberry powder (20 g/d - equivalent of one (1) cup of fresh blueberries) or a placebo powder (20 g/d) for 24 weeks. Participants will undergo four clinic visits (baseline and 8 weeks, 16 weeks, and 24 weeks after randomization) for cognitive assessments, blood pressure measurements, and blood sample collections. Primary outcomes will be plasma levels of neurofilament light chain (NFL) and phosphorylated tau protein (pTau-181). Secondary outcomes will be plasma levels of glial fibrillary acidic protein (GFAP) and non-esterified fatty acids (NEFA); blood pressure during visits; and cognitive function.

CONCLUSION

Findings from this trial will answer the question whether a long-term intervention with blueberry powder can improve (i) plasma biomarkers of brain health and (ii) cognitive function in older adults.

Global trends and geographical disparities in the incidence of uterine cancer from 1990 to 2021

BACKGROUND

Social and economic factors play significant roles in the incidence of uterine cancer. This study examined how age, time period and birth cohort affect incidence patterns across various regions.

METHODS

Data on the incidence of uterine cancer from 1990 to 2021 were obtained from the Global Burden of Disease Study 2021. An age-period-cohort (APC) model was applied to evaluate the effects and geographical variations.

RESULTS

In 2021, there were 473,614 [95 % uncertainty interval (UI) 429,916-513,667] cases of uterine cancer globally, resulting in an age-standardized incidence rate (ASIR) of 10.4/100,000 (95 % UI 9.4-11.2). ASIR was highest in High-income North America and Europe (high-income regions), and lowest in South Asia and most African regions. The incidence of uterine cancer has surged disproportionately over time, especially in high-income regions and areas with rapid socio-economic changes. High-income Asia Pacific saw the fastest growth, with an annual net drift of 2.43 % (95 % confidence interval 2.29-2.57). Age is a critical determinant of the incidence of uterine cancer, with notable regional variation. Globally, the peak incidence of uterine cancer occurs at 70-74 years of age, or older, in most regions. However, earlier peaks in incidence are observed in East Asia and Asia Pacific (both 55-59 years), as well as Central Asia (60-64 years).

CONCLUSION

The incidence of uterine cancer is increasing globally, with marked geographical disparities in age distribution, temporal trends and cohort effects. While Europe and North America have the highest incidence rates globally, Asia faces a triple challenge: rising incidence, disproportionate caseloads, and younger age at diagnosis. Addressing geographical disparities is crucial in tackling the surge in cases of uterine cancer.

Role of light walking pace on cognition: Findings from the Maine-Syracuse Longitudinal Study

Moderate- to vigorous intensities of physical activity are recommended for health promotion, including brain health. Regular physical activity is considered a modifiable factor to delay -perhaps prevent- onset of dementias such as Alzheimer's disease. Little is known about the benefits of light physical activity. We analyzed data from a 998 community-dwelling, cognitively unimpaired participants from the Maine-Syracuse Longitudinal Study (MSLS) and investigated the role of light physical activity, defined by walking pace, across two time points. Results revealed light levels of walking pace were associated with higher performance at the first timepoint and less decline by time 2 in the domains of verbal abstract reasoning and visual scanning and tracking, which includes both processing speed and executive function skills. When examining change over time (N = 583), increasing walking pace was associated with less decline at time two for the domains of visual scanning and tracking, working memory, visual spatial ability, and working memory, but not verbal abstract reasoning. These findings highlight the relevance of light physical activity and the need to investigate its contribution to cognitive function. From a public health perspective, this may encourage more adults to adopt a light level of exercise and still reap health benefits.

Preparation and NMR characterization of Aβ peptides at pathological pH

Alzheimer's disease (AD) is a neurodegenerative disorder marked by the progressive deterioration of cognitive function. Its pathological hallmarks include the formation of amyloid plaques, which are primarily due to the abnormal aggregation of Aβ peptides. However, the propensity of Aβ peptides for aggregation makes the in vitro preparation very challenging, often resulting in low yield, instability, and impurities. Here in this study, we developed an in vitro method for preparing monomeric Aβ peptides to achieve stable and high-purity samples. Specifically, three strategies including the uses of high concentration of protein denaturant urea, alkaline buffer (ammonium carbonate buffer), and organic solvents (acetonitrile, hexafluoroisopropanol) were applied to prevent Aβ aggregation during the purification. Through an optimized production process, we successfully obtained stable and highly pure 15N, 13C-doubly labeled monomeric Aβ40 and Aβ42 peptides suitable for NMR data collection at the pathological acidic pH. Overall, the preparation method presented here offer a robust approach for in vitro production of monomeric Aβ peptides with satisfying purity and reproducibility. Meanwhile, the NMR characterization results for Aβ40 and Aβ42 at pH 6.5 provide useful information for the further biophysical studies involving these two peptides.

Development and validation of a convenient dementia risk prediction tool for diabetic population: A large and longitudinal machine learning cohort study

BACKGROUND

Diabetes mellitus has been shown to increase the risk of dementia, with diabetic patients demonstrating twice the dementia incidence rate of non-diabetic populations. We aimed to develop and validate a novel machine learning-based dementia risk prediction tool specifically tailored for diabetic population.

METHODS

Using a prospective from 42,881 diabetic individuals in the UK Biobank, a rigorous multi-stage selection framework was implemented to optimize feature-outcome associations from 190 variables, and 32 predictors were final retained. Subsequently, eight data analysis strategies were used to develop and validate the dementia risk prediction model. Model performance was assessed using area under the curve (AUC) metrics.

RESULTS

During a median follow-up of 9.60 years, 1337 incident dementia cases were identified among diabetic population. The Adaboost classifier demonstrated robust performance across different predictor sets: full model with 32 predictors versus streamlined simplified model with 13 predictors selected through forward feature subset selection algorithm (AUC: 0.805 ± 0.005 vs. 0.801 ± 0.005; p = 0.200) in model development employing an 8:2 data split (5-fold cross-validation for training). To facilitate community generalization and clinical applicability, the simplified model, named DRP-Diabetes, was deployed to a visual interactive web application for individualized dementia risk assessment.

LIMITATIONS

Some variables were based on self-reported.

CONCLUSIONS

A convenient and reliable dementia risk prediction tool was developed and validated for diabetic population, which could help individuals identify their potential risk profile and provide guidance on precise and timely actions to promote dementia delay or prevention.

Computational modelling for risk assessment of neurological disorder in diabetes using Hodgkin-Huxley model

BACKGROUND

Diabetes mellitus, characterized by chronic glucose dysregulation, significantly increases the risk of neurological disorders such as cognitive decline, seizures, and Alzheimer's disease. As neurons depend on glucose for energy, fluctuations in glucose levels can disrupt sodium (Na⁺) and potassium (K⁺) ion channel dynamics, leading to altered membrane potential. Modeling these ionic changes enables the simulation of neuronal responses under glycemic extremes, providing valuable insights for risk assessment and personalized treatment.

METHOD

The methodology utilizes Support Vector Machines (SVM) and Convolutional Neural Networks (CNN) to classify hyperglycemic and hypoglycemic events based on variations in blood glucose levels. A glucose-sensing neuron model is developed using the Hodgkin-Huxley (HH) framework to examine how glycemic fluctuations influence Na⁺ and K⁺ channel conductance. The study uniquely alters maximal conductance values to precisely simulate the effects of hyper- and hypoglycemia on ion channel behaviour and neuronal excitability.

RESULTS

The blood glucose classification results indicate that the CNN classifier effectively detects hyperglycemia and hypoglycemia, achieving an accuracy of 90.23 %, sensitivity of 87.45 %, specificity of 88.56 %, and precision of 89.31 %. Computational modeling shows that hyperglycemia decreases Na⁺ currents and increases K⁺ conductance, reducing neuronal excitability. In contrast, hypoglycemia increases Na⁺ activity and decreases K⁺ conductance, leading to excessive neuronal firing and rapid action potentials.

CONCLUSION

The proposed glucose-sensing neuron model captures how glycemic variations affect Na⁺ and K⁺ conductance and neuronal excitability. Integrating machine learning with HH modeling enables risk assessment of hypoglycemia-induced neuronal hyperexcitability and seizures, as well as hyperglycemia-associated insulin resistance and long-term risk of cognitive decline and Alzheimer's disease.

Association between frailty and the progression trajectories of stroke and dementia comorbidity: insights from observational and genetic analyses

BACKGROUND

The relationship between frailty and the progression trajectories of stroke-dementia comorbidity remains inconclusive. This study aimed to determine whether there are associations between frailty and the progression trajectories of stroke-dementia comorbidity, including the transitions from enrollment to incident stroke/dementia, progression to stroke-dementia comorbidity, and ultimately to mortality.

METHODS

This prospective study was conducted based on the UK Biobank cohort. Frailty was assessed using the frailty index (FI) and categorized as robust (FI ≤ 0.10), prefrail (0.10 < FI ≤ 0.25), or frail (FI > 0.25). We used multi-state models and one-sample Mendelian randomization (MR) to investigate the relationships between frailty and the progression trajectories of stroke-dementia comorbidity. Population attributable fraction (PAF) analyses were conducted to assess the attributable risks of frailty and its components.

RESULTS

The final analysis included 459,924 participants. In comparison to the robust, the frail group significantly elevated the risk of transitioning from enrollment to stroke [HR(95 %CI): 2.32(2.19-2.45)], from enrollment to dementia [2.56(2.31-2.83)], from enrollment to mortality [2.32(2.23-2.42)], from stroke to stroke-dementia comorbidity [1.59(1.23-2.05)], from dementia to stroke-dementia comorbidity [1.79(1.29-2.48)], and from stroke to mortality [1.25(1.11-1.40)]. MR analyses revealed that genetically predicted FI was causally associated with higher risks of stroke-dementia comorbidity. PAF analyses indicated that hypertension, diabetes, lung disease, and visual impairment were significant contributors to the risk of progression to stroke-dementia comorbidity.

CONCLUSION

Our findings revealed that frailty status increases the risk of post-stroke dementia, offering important insights for the clinical management and public health strategies.