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.

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.

Smoking-attributable mortality in Portugal and its regions in 2019

INTRODUCTION AND OBJECTIVES

Timely regional-specific estimates of smoking-attributable mortality (SAM) are crucial for healthcare planning and tobacco control advocacy. Currently, this information is lacking in Portugal. The aim of this study was to estimate SAM by region in 2019 among the Portuguese population aged ≥35 years.

METHODS

SAM was estimated using an independent-prevalence method. Observed mortality was obtained from Portugal Statistics; lung cancer mortality rates in smokers and never-smokers from the Cancer Prevention Study I-II and updated relative risks from five contemporary US cohort studies. SAM was estimated for each NUTS-II region by sex, age, and cause of death. Crude SAM rates, sex and age-specific rates, and age-adjusted rates were calculated using the direct method.

RESULTS

In 2019, tobacco consumption caused 13,847 deaths, representing 12.3% of total mortality among the Portuguese population aged ≥35 years. Of the total SAM, 71.2% occurred in men and 22.2% in those under 65 years; 42.5% was due to cancer, 35.4% to cardiovascular and metabolic diseases, and 22.2% to respiratory diseases. SAM greatly varied among regions from 2.1% in Madeira to 36.2% in the North region. In men, cancer was the leading cause of death in all regions, while in women it was cardiovascular and metabolic diseases.

CONCLUSION

In Portugal, tobacco-mortality burden is high and varies significantly by region, sex and age. Therefore, estimates disaggregated by sociodemographic data and region may better support decision-makers while tailoring and implementing tobacco control policies addressing health population needs. The apparent lower tobacco burden among women and in some Portuguese regions may dramatically rise in the near future. This and the high SAM in Portugal, particularly in some regions, highlights the need to accelerate tobacco control both at national and regional levels.

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

BACKGROUND

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

BACKGROUND

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

METHODS

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

FINDINGS

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

INTERPRETATION

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

FUNDING

Bill & Melinda Gates Foundation.

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.

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

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

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

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

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

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

Closer adult child-parent relations the stronger the vaccine hesitancy: A cross-sectional study of adult Children's attitudes toward pneumococcal vaccination of elderly parents and its determinants in Guangzhou, China

Pneumococcal disease (PD) has a serious effect on older people aged 60 years and above. However, pneumococcal vaccination rates for older people in China remain low. This study aimed to explore adult children's perspectives on the vaccination of their parents and to examine the determinants of vaccine hesitancy. In October 2022, a cross-sectional survey was conducted in Guangzhou, China. The questionnaire assesses data on the sociodemographic characteristics of adult children and their parents, health beliefs about vaccination, and variables measuring adult child-parent relationships. Adult child-parent relationships types were identified by Latent Class Analysis (LCA). Binary logistic regression was employed to examine the factors associated with vaccine hesitancy. A total of 1,597 respondents were enrolled in the study, and 59.8% of the adult children expressed hesitancy about vaccinating their elderly parents. The LCA model identified three distinct types of adult child-parent relations: detached, intimate but distant, and tight-knit. Binary logistic regression analyses revealed that respondents with intimate but distant (OR = 3.04) and tight-knit (OR = 3.01) adult child - parent relationships, high literacy (OR = 2.63), and high perceived barriers of vaccine (OR = 1.18) were more likely to be hesitant. Conversely, those with high income (OR = 0.35) and parents with difficulties in activities of daily living (OR = 0.44) were less likely to exhibit vaccine hesitancy. Close adult child-parent relations were positively associated with vaccine hesitancy. Health education related to the vaccination of older persons should be extended to adult children.

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

AIM

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

METHODS

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

RESULTS

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

LIMITATIONS

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

CONCLUSIONS

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

Global, regional, and national burden of chronic kidney disease among adolescents and emerging adults from 1990 to 2021

BACKGROUND AND AIMS

There are limited studies on the epidemiology of chronic kidney disease (CKD) burden among adolescents and emerging adults. We aimed to assess the global, regional, and national trends in CKD burden among adolescents and emerging adults.

METHODS

The Global Burden of Disease 2021 study was utilized to evaluate the incidence, prevalence, mortality, disability-adjusted life years (DALYs) and average annual percentage changes (AAPC) in CKD among populations aged 15 to 29 years from 1990 to 2021.

RESULTS

From 1990 to 2021, age-standardized incidence (AAPC: 0.85%, 95% uncertainty interval [95% UI]: 0.81%-0.88%), prevalence (AAPC: 0.22%, 95% UI: 0.19%-0.25%), and mortality (AAPC: 0.18%, 95% UI: 0.04%-0.32%) rates of CKD have risen globally among adolescents and emerging adults. In 2021, Southeast Asia had the highest age-standardized prevalence (5370.39 [95% UI: 4060.97-6929.79] per 100,000 population), while Central sub-Saharan Africa had the highest mortality rate (5.05 [95% UI: 3.49-7] per 100,000 population). In 2021, glomerulonephritis and 'other and unspecified causes' accounted for 94% of new cases, 83% of prevalent cases, and 92% of mortality cases. Frontier analyses suggest that regions at varying stages of development still hold substantial potential for further improvements in addressing CKD.

CONCLUSION

Globally, the burden of CKD among adolescents and emerging adults continues to rise, with Southeast Asia and sub-Saharan Africa bearing a disproportionate burden. Nevertheless, there remain substantial opportunities across all levels of the development spectrum to alleviate the CKD burden through enhanced health interventions and resource allocation.

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.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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.

The transformative terrain: An in-depth analysis of trends in self-managed abortion in India using NFHS-5 national data

In 2022, the World Health Organization endorsed self-managed abortion (SMA) with medical abortion pills as a safe abortion method. This study utilises India's National Family Health Survey Round 5 (2019-2021) data from 724,115 women to estimate state-level self-managed abortion (SMA). It examines SMA characteristics, trends over time, and self-reported complications in India using descriptive and multivariate analysis. This study finds significant regional disparities, with a higher proportion of self-managed abortions in the eastern (45%), central (39%), and north-eastern (31%) regions. A rising trend in SMA was observed, increasing from 19% in 2014-45% in 2021. There were higher odds of SMA among economically disadvantaged, less educated, and employed women. The study found no increased odds of self-reported complications in SMA, suggesting its safety and effectiveness, especially at early gestational ages. These findings underscore the importance of supporting reproductive choices, including access to quality drugs and information, while highlighting the continued relevance of provider-assisted care, particularly for surgical abortions and later gestational needs. This study offers crucial insights on SMA for programmatic and policy advocacy while underscoring the need for more research in the SMA field.

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.

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

Objective

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

Methods

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

Results

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

Conclusions

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

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.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Knowledge, attitudes and practices of women regarding breast and cervical cancer screening: a qualitative study in India

In this study, we aimed to understand the factors that influence the use of breast and cervical cancer screening services in India. Purposive sampling was applied - and 64 participants with different characteristics based on their literacy, screening status, and rural or urban setting were classified into eight groups. The Knowledge, Attitudes and Practices (KAP) framework was used to conduct focus group discussions with each group. Data was analysed using directed content analysis. Regarding knowledge, our findings indicated that women who had previously undergone screening had some knowledge about the causes, risk factors, and symptoms of breast and cervical cancer. Most women were unaware of the screening procedure types and their costs, eligibility criteria, and frequency. None were aware of the link between cervical cancer and the human papillomavirus (HPV) infection. Regarding attitudes, all participants expressed that screening would be beneficial;when questioned if they would undergo screening without symptoms or physicians recommendations their opinions varied. The influence of their spouses or male children influenced their decision to undergo screening. Regarding practices, participants were unaware of and even overestimated the actual costs of screening services. They agreed that they would require subsidisation or fixed pricing from the government to undergo screening.

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.

Global, regional and national burden of pancreatitis in children and adolescents, 1990-2021: a systematic analysis for the global burden of disease study 2021

BACKGROUND

Pancreatitis poses a significant global health burden, disproportionately affecting children and adolescents. This study uses the global burden of disease (GBD) 2021 dataset to evaluate pancreatitis epidemiology in this demographic, focusing on disparities by age, sex, and region.

OBJECTIVE

To assess global trends in pediatric pancreatitis, identify risk factors, and forecast disease burden to 2035.

METHODS

We analysed GBD 2021 data on deaths and disability-adjusted life years (DALYs) for pancreatitis in individuals under 20. The socio-demographic index (SDI) assessed the link between societal development and health outcomes. Bayesian age-period-cohort (BAPC) modelling and Poisson's linear models were applied to project future burdens and estimate annual percentage changes (EAPCs) in age-standardized rates.

RESULTS

In 2021, pancreatitis caused 1120.09 deaths in children and adolescents, comprising 2% of all pancreatitis-related deaths. Age-standardized death rate (ASDR) and DALYs rate declined from 1990 to 2021 (EAPC -0.92 and -0.86, respectively). Low-middle SDI regions, notably Andean and Central Latin America and Eastern Europe, faced the highest burden. Alcohol was a leading risk factor, accounting for 3.51% of related deaths, and males had higher death and DALYs rate.

CONCLUSIONS

Despite declining pancreatitis-related mortality and DALYs, the disease remains a challenge, particularly in low-middle SDI regions. Alcohol consumption is a key risk factor, underscoring the need for targeted public health interventions. Gender-, age-, and region-specific strategies are essential to mitigate pancreatitis impact in children and adolescents.

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.

Mechanism and different roles of metal-N sites on ZIF-8 for efficient antibacterial

Bacterial pollution poses a serious threat to human health, making it essential to design and utilize efficient non-antibiotic antibacterial materials. Here, ZIF-8 with different metal-N sites is successfully prepared by introducing divalent metals (Mg2+, Mn2+, Co2+ and Cu2+) directly into the ZIF-8 framework. ZIF-8 with Cu-Nx sites has the best antibacterial activity, with antibacterial rates of 99.8 % and 81.1 % against Escherichia coli and Staphylococcus aureus after 1 h at a concentration of 10 µg/mL, respectively. More importantly, an antibacterial rate of more than 86.7 % can be achieved against multidrug-resistant bacteria MRSA, much higher than Vancomycin. The results show that the introduction of copper could significantly improve the electron transfer, the generation of reactive oxygen species (ROS), the binding affinity with bacteria, and eventually achieve excellent antibacterial activity. DFT calculations show easier oxygen activation at the unsaturated Cu-Nx site. The revealed oxygen activation mechanism sheds light on understanding the high antibacterial activity of the active site of the nanoparticles. Cu-ZIF-8 offers significant advantages in the field of air disinfection.

A simple two-dimensional metal-organic framework-based phototherapy nanoplatform with a triple-synergistic mechanism for enhanced wound infection treatment

Selecting an appropriate treatment for bacterial infections is critical. However, the rising prevalence of antimicrobial resistance has rendered many existing therapies less effective, highlighting the urgent need for novel antimicrobial strategies that are less prone to inducing antimicrobial resistance. Herein, we propose a simple, energy-efficient, photoresponsive antibacterial strategy based on metal-organic frameworks. Specifically, we developed an Au@Cu-THQ system activated by near-infrared laser irradiation, capable of exerting a synergistic triple-mode antibacterial effect-photothermal, photodynamic, and glutathione (GSH) depletion for the effective treatment of bacterial infections. The photothermal effect notably enhances the generation of reactive oxygen species and accelerates GSH depletion within bacterial cells, leading to a substantial disruption of their antioxidant defense systems and significantly amplifying the photodynamic therapeutic effect. Moreover, this material demonstrated excellent and stable photothermal performance both in vitro and in vivo, characterized by high photothermal conversion efficiency and effective GSH depletion activity. These features contribute to its potent antibacterial and anti-inflammatory effects, offering a promising multimodal strategy for the future development of in vivo anti-infective formulations.

A 3D-printed integrated maneuverable device for sensitive colorimetry of Pseudomonas aeruginosa

Timely and sensitive monitoring of pathogens in clinical specimen is highly demanded for efficient control and precise treatment of infectious diseases. Herein, a 3D-printed maneuverable device integrating incubation, washing, and detection functions was manufactured for colorimetry of Pseudomonas aeruginosa (P. aeruginosa) using transparent resin. The device combined with magnetic beads (MBs) can achieve specific separation and efficient enrichment of P. aeruginosa. Furthermore, it can be directly fixed onto a 96-well plate holder for colorimetry. Specifically, a P. aeruginosa bacteriophage termed as JZ1 acquired from river water was applied as a recognition reagent to functionalize the separation vectors MBs. Then, a nanoconfinement MOFs material termed as PCN-222(Pt) with remarkable peroxidase-like activity was conjugated with polymyxin B to act as a signal tracer. With the formation of target bacterial complexes, the bound PCN-222(Pt) catalyzed the color reaction of 3,3',5,5'-tetramethylbenzidine to enable quantitative colorimetry of P. aeruginosa by the maneuverable device. With this device, P. aeruginosa can be quantified within 40 min, with a dynamic range of 1.9 × 102 ∼ 1.9 × 106 cfu mL-1. The results for colorimetry of P. aeruginosa in diverse sample matrixes demonstrated its satisfactory practicability. This work provides a facile, timely, and cost-effective technique for point-of-care testing of pathogens.

Discovery of a novel sea snake antimicrobial peptide Hydrostatin-AMP3 with dual-mechanism against multidrug-resistant Klebsiella pneumoniae

Klebsiella pneumoniae (K. pneumoniae) has ranked in the top three pathogens responsible for bacteria-related mortal infections. The emergence of multi-drug resistant (MDR) K. pneumoniae strains highlights an urgent need for novel antimicrobial agents. In this study, a series of antimicrobial peptides (AMPs) were screened based on gene annotation and sequence profiling via high-quality whole genome maps of sea snakes Hydrophis curtus and Hydrophis cyanocinctus. The most potent Hydrostatin-AMP3 showed efficient antimicrobial capacity against a panel of pathogenic bacteria, particularly MDR K. pneumoniae strains. Moreover, Hydrostatin-AMP3 exhibited remarkable efficacy in infection models of MDR K. pneumoniae, while demonstrating favourable profiles in safety and resistance development both in vitro and in vivo studies. Mechanistically, Hydrostatin-AMP3 exerted a bactericidal effect through a unique dual-mechanism: bacterial membrane disruption and DNA-targeting. Overall, this study presented Hydrostatin-AMP3 as the potential antimicrobial candidate for the treatment of MDR K. pneumoniae infection.

Prophage transduction promotes the transmission of phage resistance interfering with adsorption among Chinese foodborne Staphylococcus aureus

Although bacteriophages have proven to be efficient biocontrol agents for foodborne Staphylococcus aureus, the transmission of phage resistance resulting in the reduced efficacy of phage therapy remains to be explored. In this study, phage resistance and adsorption of 91 Chinese foodborne S. aureus isolates by 18 phages were estimated, and the distribution and transmission of phage resistance genes were investigated. The isolated 91 S. aureus comprised 50 multidrug-resistance isolates, all of which showed sensitivity to more than two phages. However, 9.9 % (9/91) of S. aureus isolates were resistant to all 18 phages, and the majority of phages (83.3 %, 15/18) did not adsorb to all foodborne S. aureus strains. Whole-genome analysis revealed that the 91 isolates comprised 101 phage resistance genes, including 24 genes were found in prophages (intact prophages, 19.8 %, 20/101; incomplete prophages, 16.8 %, 17/101). Notably, a temperate phage SapYZUs631 was successfully induced and exhibited better biological characteristics compared to other isolated S. aureus temperate phages, including higher titre (6.2 × 109 PFU/mL), stronger pH (4-11) and thermal (60 °C for 60 min) stability, and a wider host range (80.2 %, 73/91). The SapYZUs631 genome contained phage resistance gene tarP interfering with adsorption and virulence genes. The lysogeny of SapYZUs631 into S. aureus strains YZUstau27, YZUstau31, and YZUstau35 resulted in increased phage resistance and decreased adsorption. Therefore, our analysis suggests that the interruption of adsorption is the main reason for the phage resistance of foodborne S. aureus in China, which resulted from the transmission of phage resistance by prophage transduction.

Ultra-rapid, quantitative, label-free antibiotic susceptibility testing via optically detected purine metabolites

In order to facilitate the best antimicrobial prescribing practices and to help reduce the increasing global threat of antibiotic resistance, there is an urgent need for the development of novel and truly rapid (≤1 h) antibiotic susceptibility testing (AST) platforms. A 785 nm surface enhanced Raman spectroscopy (SERS) based phenotypic methodology is described that results in accurate minimum inhibitory concentration (MIC) determinations for all tested strain/antibiotic pairs. The SERS-AST procedure results in accurate MICs in ∼1 h, including a 30-min incubation period, and is effective for both Gram positive and negative species, and for antibiotics with different initial primary targets of antibiotic activity, and for both bactericidal and bacteriostatic antibiotics. The molecular level mechanism of this methodology is described. Bacterial SERS spectra are due to secreted purine nucleotide degradation products (principally adenine, guanine, xanthine and hypoxanthine) resulting from water washing induced bacterial stringent response and the resulting (p)ppGpp alarmone mediates nucleobase formation from unneeded tRNA and rRNA. The rewiring of metabolic responses resulting from the secondary metabolic effects of antibiotic exposure during the 30-min incubation period accounts for the dose dependence of the SERS spectral intensities which are used to accurately yield the MIC. This is the fastest demonstrated AST method yielding MICs.

Mucus-penetrating nanomotor system strengthens mucosal immune response to in situ bacterial vaccine against severe bacterial pneumonia

Pathogens causing major infectious diseases primarily invade through mucosal tissues. Promptly killing these pathogens at the mucosal site and constructing mucosal vaccines in situ can prevent further infections and induce robust mucosal immune responses and memory to prevent reinfection. In this study, we utilized chemotherapy, sonodynamic therapy, and gas therapy to eliminate Streptococcus pneumoniae (S. pneumoniae) colonizing the nasal mucosa. Simultaneously, an in situ pneumococcal vaccine was constructed to elicit specific immune responses and memory. Poly-l-arginine (PArg)-modified ZIF-8 metal-organic frameworks (MOFs) loaded with the ultrasonic sensitizer protoporphyrin IX (PpIX) killed S. pneumoniae in the nasal cavity by multiple mechanisms in the presence of ultrasound. When stimulated by ultrasound, PpIX not only generates reactive oxygen species (ROS) for antimicrobial effect, but these ROS also catalyze the release of nitric oxide (NO) from PArg. NO exerts a motor-like effect that facilitates more efficient passage of nanoparticles through the mucus layer of the alveoli. The immunogenic bacterial debris formed a vaccine formulation by complexing with PArg, which adhered electrostatically to the mucosal surface, facilitating in situ vaccination and inducing mucosal immune responses and memory. This cascade-based combination therapy enabled rapid bacterial eradication and long-term immune prevention. It shortens the traditional vaccine development process, eliminates the spatial distance from pathogen invasion to vaccine development, significantly cuts costs, and addresses vaccine failure due to pathogen mutations. This approach offers a groundbreaking strategy for mucosal vaccine development and the prevention of major infectious diseases.

Association between community environment and depression: Evidence from a population-based study in China

OBJECTIVE

Less is known about the association between community environment and depression. To bridge this gap, the aim of this research is to explore the association between community environment and depression using panel data.

METHODS

The data of the present study were sourced from 2016 and 2020 waves of China Family Panel Studies. Panel data regression models were exploited to identify the association between community environment and depression. The present study employed Karlson-Holm-Breen method to analyze the mediation roles of physical exercise and smoking on the association between community environment and depression.

RESULTS

The panel data regression results suggest that community public facility is negatively associated with CES-D score (coefficient = -0.1399, p < 0.001). Community surrounding environment is negatively correlated with CES-D score (coefficient = -0.1618, p < 0.001). Moreover, physical exercise mediates the association between community environment and CES-D score (p < 0.01). In addition, there is no evidence indicating that smoking mediates the association between community environment and CES-D score (p > 0.05).

CONCLUSION

Community public facility and surrounding environment are negatively associated with depression of the adults. In addition, physical exercise mediates the association between community environment and depression. The findings highlight the importance of optimizing community environment. It is necessary to understand depression from a multi-dimensional perspective.

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.

Marine natural products as potential anti-Pseudomonas aeruginosa agents: challenges and advances

Antimicrobial resistance (AMR) has become a pressing need to address in the major global public health challenges, posing a serious threat to human health. Pseudomonas aeruginosa (PA) is one of the most concerning Gram-negative pathogens and is typically treated with broad-spectrum antibiotics. PA exhibits resistance to multiple antibiotics, multifactorial virulence, and dynamic hyperadaptation, which results in a particularly formidable challenge in eliminating PA from patients. The problem of drug resistance is becoming increasingly serious, and the development of new antibiotics is extremely lagging behind, resulting in no drug with a new structure and mechanism being approved for the treatment of infections caused by drug-resistant Gram-negative bacteria over the past half-century. Consequently, the development of new antibiotics is of utmost urgency and importance. Marine natural products (MNPs) have become an important source for developing new antibiotics due to their unique properties. So far, 44 potential molecules with significant anti-PA activity have been isolated from marine organisms, of which 19 have been reported as quorum-sensing system inhibitors (QSIs) with potential for further development. In this review, we provide a comprehensive summary of the current status of drug resistance, pathogenic mechanisms, and resistance mechanisms associated with PA infections. We also highlight the challenges and opportunities presented by MNPs in the development of anti-PA drugs, and offer recommendations to accelerate the antibiotic development process, thereby providing valuable insights for the study and exploitation of novel antibiotics.

Design and synthesis of benzothiazole aryl urea derivatives as potent anti-staphylococcal agents targeting autolysin-mediated peptidoglycan hydrolases

Novel benzothiazole aryl ureas were designed and synthesized as anti-MRSA agents targeting peptidoglycan (PG) hydrolases (autolysins). Structural simplification of prior benzothiazole-urea hybrids yielded compounds 4a, 7a and 11a bearing p-CF3 on phenyl ring demonstrating narrow-spectrum activity against Gram-positive bacteria including clinical methicillin-resistant S. aureus (MRSA). The primary autolysin in S. aureus, AtlA, mediates peptidoglycan hydrolase activity critical for bacterial growth, division, and cell wall remodeling. Mechanistic studies revealed that 4a down-regulated autolysin-related genes RNAIII and walR, disrupting peptidoglycan homeostasis. Knockout of atlA (a key autolysin gene) impaired 4a's efficacy, confirming autolysins as critical targets. Docking indicated that 4a binds to AtlA via hydrogen bonds, Pi-Pi, and hydrophobic interactions. In vivo, 4a significantly reduced bacterial load in a murine abdominal infection model, outperforming vancomycin at 10 mg/kg with lower cytotoxicity. Additionally, 4a disrupted MRSA biofilms, suppressed hemolytic toxin production, and alleviated inflammation in infected mice. These findings underscore AtlA as a promising therapeutic target and highlight benzothiazole phenyl urea as a scaffold for developing innovative anti-staphylococcal agents.

Exploring the correlation of linker structure and antimicrobial activities of pyridinium-based cationic biocides: Aromatic versus aliphatic architectures

Cationic biocides, particularly quaternary ammonium compounds (QACs), play a vital role in controlling microbial infections across various industries, healthcare facilities and households. As their widespread use increased drastically in the last few years due to COVID-19, there is growing concern about the development of resistance among microorganisms exposed to cationic biocides. It is crucial to recognize this threat in advance and respond by modifying and replacing the old generation of commercial biocides. Reported here is the pyridinium-based bis-QACs tuning via combination of two simple synthesis approaches to achieve novel biocide's architectures with mixed linkers. The obtained compounds were subjected to a broad bioactivity assay against a panel of 26 microbial pathogens, including multi-resistant bacterial ESKAPEE strains, fungi and biofilms. Novel hit-compounds showed improved antibacterial and antibiofilm action, rapid bacterial eradication within 15-30 min of exposure and 4.5-fold lower hemotoxicity, as well as lower potential for the development of bacterial resistance compared to commercial lead antiseptic octenidine. Highlighted findings and insights will serve as a good basis for further studies of bis-QACs as highly effective biocides.

Fibrosis of the infrapatellar fat pad induces gradual cartilage degeneration in a rat model

Knee osteoarthritis (OA), a degenerative joint disease, causes pain and reduced activity levels, with prevalence increasing with age. Knee OA is recognized as a "joint organ disease," where interactions between the articular cartilage, meniscus, synovium, and infrapatellar fat pad (IFP) are critical. Obesity contributes to OA not only through mechanical stress but also via systemic and local inflammation mediated by adipose tissue. Adiponectin, an adipokine with anti-inflammatory and chondroprotective effects, shows levels negatively correlated with obesity and positively correlated with OA severity. This study explored the role of IFP in OA progression using a rat model of monoiodoacetic acid-induced IFP fibrosis. In vivo, IFP and cartilage degeneration were assessed via histological analysis, real-time PCR, and RNA sequencing. Ex vivo, the effects of conditioned media from synovial cells and IFP on chondrocytes were evaluated. Findings revealed that fibrosis reduced adiponectin expression and accelerated OA progression. Gene sequencing showed significant metabolic pathway changes, particularly in fatty acid β-oxidation, indicating impaired IFP function. Conditioned media from inflamed IFP negatively affected chondrocytes by reducing anabolic factors and increasing cartilage-degrading enzymes. These results suggest that IFP degeneration contributes to OA by promoting inflammation and cartilage degradation. Targeting IFP fibrosis and fatty acid metabolism may offer therapeutic potential to mitigate OA progression.

Global, regional, and national burden of vertebral fractures due to falls from 1990 to 2021 and predictions for the next 15 years: A systematic analysis of the global burden of disease 2021 study

OBJECTIVES

This study utilized the latest data from the 2021 Global Burden of Disease Study to analyze the incidence, prevalence, and years lived with disability due to vertebral fractures from 1990 to 2021, providing information for effective management and prevention strategies.

METHODS

This study describes the trends in incidence, prevalence, and years lived with disability (YLDs) due to vertebral fractures caused by falls. It employs methods such as the Age-Period-Cohort (APC) model, joinpoint regression analysis, and decomposition analysis for further investigation, and calculates the ASIR, ASPR, and ASYR. Finally, it predicts the incidence trend for the next 15 years using the Autoregressive Integrated Moving Average (ARIMA) model.

RESULTS

In 2021, the number of new cases of vertebral fractures due to falls globally reached 4.7 million, with a total prevalence of 3.67 million cases, and years lived with disability (YLDs) amounted to 370,000. Compared to 1990, the estimated annual percentage change (EAPC) was -0.37 (-0.41, -0.32), -0.35 (-0.39, -0.31), and -0.37 (-0.41, -0.33) respectively, indicating a declining trend. There are significant differences in the disease burden among different countries and regions. The APC model, Joinpoint model, and ARIMA forecasting model indicate a global declining trend in the disease burden of vertebral fractures.

CONCLUSIONS

Although the burden of vertebral fractures is on a downward trend, it continues to increase in low and middle SDI regions, as well as among the elderly population. Therefore, targeted preventive measures are still necessary to address the health outcomes related to vertebral fractures.

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.

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.

METTL3‑mediated m6A methylation and its impact on OTUD1 expression in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation and chronic inflammation, often exacerbated by cigarette smoke exposure. Ovarian tumor protease domain‑containing protein 1 (OTUD1), a deubiquitinase, has previously been identified as a negative regulator of inflammation through its suppression of NF‑κB signaling. The present study explored the role of OTUD1 in COPD and the regulatory effects of N6‑methyladenosine (m6A) methylation on OTUD1 expression. The expression of OTUD1 in COPD was analyzed using public datasets (GSE38974 and GSE69818). In addition, BEAS‑2B cells were exposed to cigarette smoke extract (CSE) to investigate OTUD1 expression changes. OTUD1 overexpression and knockdown models were also constructed, and the levels of inflammation‑related genes and proteins, inflammatory cytokines and cell pyroptosis were measured using reverse transcription‑quantitative PCR, western blotting, ELISA and flow cytometry. The role of methyltransferase‑like 3 (METTL3)‑mediated m6A methylation in regulating OTUD1 was also examined. Notably, OTUD1 expression was significantly reduced in advanced COPD compared with that in the earlier stage. Furthermore, CSE exposure suppressed OTUD1 expression, which was associated with increased cell pyroptosis and elevated levels of the inflammatory cytokines IL‑1β and IL‑18. OTUD1 overexpression mitigated these effects, indicating its protective role against CSE‑induced cellular damage. Furthermore, METTL3‑mediated m6A methylation inhibited OTUD1 expression, with YTH m6A RNA binding protein 2 (YTHDF2) acting as the reader of this modification. Knockdown of METTL3 or YTHDF2 reduced m6A methylation and restored OTUD1 expression, highlighting a potential mechanism by which cigarette smoke suppresses OTUD1 through enhanced m6A methylation. In conclusion, OTUD1 may serve a protective role in COPD by inhibiting inflammation and reducing cell damage caused by cigarette smoke exposure. The suppression of OTUD1 through METTL3‑mediated m6A methylation and YTHDF2 interaction represents a novel mechanism contributing to COPD pathogenesis, suggesting potential therapeutic targets for mitigating disease progression.

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).

Antibiotic resistance and bacterial spectrum in cerebrospial fluid cultures: Initial insights from Pakistan

Antimicrobial resistance (AMR) is a rising global health concern, especially in resource-limited countries like Pakistan, where indiscriminate and unregulated use of antibiotics has significantly worsened this problem. The study aimed to analyze the bacterial spectrum and antimicrobial resistance patterns in cerebrospinal fluid (CSF) cultures from patients with suspected bacterial meningitis, providing crucial insights for better infection control and treatment strategies.This retrospective study analyzed 1107CSF cultures were between 2019 and 2024 at the Lady Reading Hospital, MTI, Khyber Pakhtunkhwa, Pakistan, to assess bacterial profiles in patients with suspected bacterial meningitis and investigate the AMR patterns. Among the 106 positive growth cultures, gram-negative bacteria accounted for 84.9 %. Alarmingly, Acinetobacter baumannii was found to be completely resistant to all the nine antibiotics tested, while Salmonella typhi showed resistance to six out of seven tested antibiotics, highlighting their severe multi-drug resistance profile. Moreover, notable resistance was observed in Citrobacter freundii, Enterobacter species, and Staphylococcus aureus. The distribution results indicated that the Klebsiella pneumoniae is more prevalent in males and the 1-13 years age group. These findings highlight the necessity for urgent action on antibiotic stewardship, improved surveillance, and public awareness to mitigate the spread of AMR pathogens, particularly in life-threatening infections such as bacterial meningitis. Strengthening infection control measures and regulating antibiotic usage policies is imperative to curb the growing AMR crisis.

Knowledge and attitude of pharmacists about Alzheimer's disease: A systematic review

BACKGROUND

To identify studies that explored pharmacists' knowledge and attitudes regarding Alzheimer's Disease (AD).

METHODS

A comprehensive literature search was conducted in Scopus, Medline (via Pubmed), Latin American and Caribbean Literature in Health Sciences (LILACS), and PsycINFO databases until July 2024. Cross-sectional studies that measured pharmacists' knowledge and attitudes toward AD using structure instruments were included. Two reviewers independently performed the selection of studies, data extraction, and methodological assessment.

RESULTS

Ten studies published between 2016 and 2024, involving 7810 participants, were included. Most studies were conducted in Asia (n = 5), in community pharmacies (n = 8), and used the Alzheimer's Disease Knowledge Scale (n = 8). The response rate varied from 8 % to 100 %, while the percentage of correct responses about AD ranged from 50.1 % to 85.3 %. A knowledge gap was identified in areas such as recognizing symptoms, understanding risk factors for AD development, and providing effective patient care. Pharmacists demonstrated greater expertise in the pharmacological management of AD.

IMPLICATIONS

The findings suggest the need for training programs and interventions targeting pharmacists working in services that care for patients with AD.

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.

F-box only protein 10 protects against kidney tubulointerstitial fibrosis by inhibiting ACSL4-mediated lipid peroxidation and ferroptosis

Renal tubular epithelial cell ferroptosis is significantly linked to kidney tubulointerstitial fibrosis, a critical pathological condition in chronic kidney disease. F-box only protein 10 (FBXO10), a newly identified ferroptosis-regulating gene, plays a role in various pathological contexts; however, its involvement in kidney tubulointerstitial fibrosis is not yet fully understood. This research sought to investigate whether FBXO10 regulates ferroptosis in kidney tubular epithelial cells and its relationship with kidney tubulointerstitial fibrosis in both animal and cellular models. We observed a significant decrease in FBXO10 levels in mice with unilateral ureteral obstruction (UUO) and HK-2 cells exposed to TGF-β1. FBXO10 overexpression inhibited the EMT process and counteracted the typical ferroptosis features evoked by TGF-β1 or erastin in HK-2 cells. Compared with those in wild-type (WT) mice, kidney injury, inflammation, and fibrosis are exacerbated in FBXO10-knockout (KO) mice, with elevated ferroptosis levels. Conversely, FBXO10 overexpression reversed these symptoms, alleviating kidney fibrosis and ferroptosis in both WT and FBXO10 KO mice with UUO. Mechanistically, FBXO10 directly interacted with ACSL4 and promoted its ubiquitination and degradation. Overexpression of ACSL4 reversed the inhibitory effect of FBXO10 overexpression on TGF-β1-induced ferroptotic death and fibrosis in HK-2 cells. In summary, FBXO10 mitigates ferroptosis in renal tubular epithelial cells by inhibiting ACSL4-mediated lipid peroxidation, thereby hindering the progression of kidney tubulointerstitial fibrosis. FBXO10 is proposed as a promising target for treating kidney disorders related to tubulointerstitial fibrosis.

Biliverdin alleviates cerebral ischemia-reperfusion injury by regulating the P4hb/MAPK/mTOR pathway to inhibit autophagy

BACKGROUND

Biliverdin (BV) exhibits anti-inflammatory and antioxidative effects. Autophagy activation is crucial in the pathogenesis of cerebral ischemia-reperfusion injury (CIRI). This study aimed to investigate whether BV could ameliorate CIRI by regulating autophagy.

METHODS

A middle cerebral artery occlusion-reperfusion (MCAO/R) model in Sprague-Dawley (SD) rats and an oxygen-glucose deprivation/reoxygenation (OGD/R) model in PC12 cells were employed to explore the neuroprotective effects of BV and its underlying mechanisms. In these rats, once BV was administered post-MCAO/R, its treatment efficacy and underlying mechanisms were evaluated through behavioral, morphological, and molecular analyses. Alternatively, for PC12 cells, following successful OGD/R modeling, BV, autophagy activator rapamycin, prolyl 4-hydroxylase beta (P4hb) knockdown or overexpression, and the specific inhibitors of three classic autophagy pathways were applied. Cell viability (using CCK8 assay), Calcein/PI staining, autophagosome staining (using MDC assay), reverse transcription quantitative polymerase chain reaction, and western blot were subsequently carried out to investigate the mechanisms by which BV ameliorates CIRI.

RESULTS

BV alleviated CIRI by inhibiting autophagy. Further investigation suggested that BV downregulated P4hb expression. In vitro experiments showed that P4hb knockdown reduced autophagy in post-CIRI cells, while its overexpression reversed the effects of BV. Rescue experiments indicated that MAPK pathway inhibitors counteracted the effects of P4hb overexpression on autophagy post-CIRI.

CONCLUSION

BV improves CIRI by regulating the P4hb/MAPK/mTOR signaling pathway to inhibit autophagy, offering a novel therapeutic strategy for ischemic stroke.