Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

Prevalence of asthma in Portuguese adults - the EPI-ASTHMA study, a nationwide population-based survey

INTRODUCTION

In 2010, 6.8% of the Portuguese adults had asthma. Contemporary studies employing more accurate methods are needed. We aimed to assess asthma prevalence in Portugal and to identify associated-factors.

METHODS

A population-based nationwide study was conducted from May 2021 to March 2024. A multistage random sampling approach was applied to select adults from primary care. Stage 1 involved a telephone screening interview to collect socio-demographic and clinical data. Patients with an Adult Asthma Score (A2 Score) ≥1 were eligible for Stage 2, and 5% of those with an A2 Score = 0 were also invited to participate in Stage 2, which consisted of a diagnostic visit with a physical examination and diagnostic tests. We computed weighted asthma prevalence estimates and multivariable logistic regression models were used.

RESULTS

A total of 7,556 participants completed Stage 1 and 1,857 Stage 2. The prevalence of asthma was 7.1% (95%CI = 6.3-8.0%), with slight differences by sex, age, and region. Education, family history of asthma, inhaler prescription, nasal/ocular symptoms, food allergies, and previous allergy skin tests were associated with an increased risk of asthma (R2 = 33%). Asthma diagnosis could also be predicted by the A2 score, either on its own (R2 = 43%) or in combination with family history and previous allergy skin tests (R2 = 45%).

DISCUSSION

Asthma affects 7.1% of Portuguese adults. Family history of asthma, nasal/ocular symptoms, and comorbid food allergy are associated with increased risk of asthma.

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

INTRODUCTION AND AIMS

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

RESULTS

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

CONCLUSIONS

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

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.

CEACAM5 exacerbates asthma by inducing ferroptosis and autophagy in airway epithelial cells through the JAK/STAT6-dependent pathway

OBJECTIVES

Asthma, a prevalent chronic disease, poses significant health threats and burdens healthcare systems. This study focused on the role of bronchial epithelial cells in asthma pathophysiology.

METHODS

Bioinformatics was used to identify key asthmarelated genes. An ovalbumin-sensitized mouse model and an IL-13-stimulated Beas-2B cell model were established for further investigation.

RESULTS

Carcinoembryonic antigen-related cell adhesion molecule 5 (CEACAM5) was identified as a crucial gene in asthma. CEACAM5 expression was elevated in asthmatic mouse lung tissues and IL-13-stimulated Beas-2B cells, primarily in bronchial epithelial cells. CEACAM5 induced reactive oxygen species (ROS), lipid peroxidation, and ferroptosis. Interfering with CEACAM5 reduced ROS, malondialdehyde levels, and enhanced antioxidant capacity, while inhibiting iron accumulation and autophagy. Overexpression of CEACAM5 in IL-13-stimulated cells activated the JAK/STAT6 pathway, which was necessary for CEACAM5-induced autophagy, ROS accumulation, lipid peroxidation, and ferroptosis.

CONCLUSION

CEACAM5 promotes ferroptosis and autophagy in airway epithelial cells via the JAK/STAT6 pathway, exacerbating asthma symptoms. It represents a potential target for clinical treatment.

Finite element models of intervertebral disc: recent advances and prospects

OBJECTIVES

The incidence rate of intervertebral disc degeneration (IVDD) is increasing year by year, which brings great harm to our health. The change of biomechanical factors is an important reason for IVDD. Therefore, more and more studies use finite element (FE) models to analyze the biomechanics of spine.

METHODS

In this review, literatures which reported the FE model of intervertebral disc (IVD) were reviewed. We summarized the types and constructional methods of the FE models and analyzed the applications of some representative FE models.

RESULTS

The most widely used model was the nonlinear model which considers the behavior of porous elastic materials. As more advanced methods, More and more models which involve penetration parameters were used to simulate the biological behavior and biomechanical properties of IVD.

CONCLUSIONS

Personalized modeling should be carried out in order to better provide accurate basis for the diagnosis and treatment of the disease. In addition, microstructure, cell behavior and complex load should be considered in the process of model construction to build a more realistic model.

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.

Social determinants of hazardous alcohol use in a Ugandan population cohort

BACKGROUND

There is a limited population-based data on hazardous alcohol use and associated social determinants in many African countries.

OBJECTIVES

To examine patterns of hazardous alcohol use across a range of social determinants of health in Uganda, with a particular focus on gender differences.

METHODS

This cross-sectional study used data collected in 2021-2022 from an open population cohort spanning urban, semi-urban, and rural communities. Alcohol use was assessed with the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). Covariates were selected according to the WHO's Social Determinants of Health framework. Poisson regression with robust variance was used for data analysis.

RESULTS

Of the 3459 participants, 2085 (60%) were women. Overall, the prevalence of hazardous alcohol use was 5% among women and 18% among men. Strong positive associations with hazardous use were found for individuals residing in semi-urban areas (female aPR 2.1 [95% CI 1.3-3.3], male aPR 1.8 [95% CI 1.4-2.5]), past-year perpetration of intimate partner violence (female aPR 2.2 [95% CI 0.8-5.6], male aPR 1.4 [95% CI 0.9-2.2]), smoking, middle age for men (aPR 1.6 [95% CI 1.2-2.2]), and employment as a vendor in a restaurant or bar for women (aPR 1.5 [95% CI 1.0-2.2]). Strong negative associations were found for high educational attainment, Muslim or Pentecostal religion, and living in a marriage or union for women (aPR 0.7 [95% CI 0.5-1.0]).

CONCLUSIONS

Hazardous alcohol use was prevalent, especially among men, in a representative Ugandan population sample. Specific target groups for public health and clinical interventions were identified, such as women working in the hospitality sector. Residents of semi-urban communities may encounter unique risks for hazardous alcohol use, compared with rural and highly urban populations.

Educating women to prevent and treat low back and pelvic girdle pain during and after pregnancy: a systematized narrative review

PURPOSE

This review evaluated the effectiveness of patient education and information on low back pain (LBP) and pelvic girdle pain (PGP) in pregnant and postpartum women and evaluated their alignment with modern pain education principles rooted in the biopsychosocial model.

METHOD

A systematized narrative review was performed, including a systematic search of three databases and reference screening from relevant systematic reviews. The methodological quality of the included randomized controlled trials (RCT) was evaluated using the PEDro scale.

RESULTS

Eighteen studies, including nine RCTs with PEDro scores ranging from to 2-8, indicated that patient education during pregnancy can help reduce pain and related disability. Most studies did not differentiate between LBP and PGP, which limits the specificity and targeted approach of educational interventions. Education alone is less effective without accompanying active treatment. Current programs primarily emphasize biomechanics, covering anatomy and physical changes, but often neglect lifestyle factors, such as stress and sleep.

CONCLUSION

Although patient education is important for managing pregnancy-related LBP and PGP, its effectiveness may be improved by tailoring programs to specific pain conditions and integrating a biopsychosocial perspective on pain.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

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

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.

UPLC-Q-TOF/MS-based study on chemical composition, in vivo metabolites, and tissue distribution of ethanol extract of Ganoderma lucidum

Ganoderma lucidum (G. lucidum), a medicinal fungus, exhibits diverse pharmacological effects against many diseases. Studies have shown that the ethanol extract of G. lucidum (GLEE), which is rich in triterpenoids, possesses significant anti-carcinogenic effects. Early research focused solely on the pharmacokinetics and metabolism of individual triterpenoids in normal rodents. However, no research has examined the distribution of prototype compounds and metabolites of GLEE in multiple tissues, plasma, or tumor tissue. In this study, ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF/MS), combined with the Global Natural Products Social Molecular Networking (GNPS) platform and UNIFI software, was employed to identify and quantify the chemical composition of GLEE. A total of 105 compounds were identified, including 100 triterpenoids and 5 fatty acids, with 18 high-content monomers quantitatively analyzed. Following six weeks of GLEE administration in tumor-bearing nude mice, 42 prototype compounds and 24 metabolites were identified across plasma, tumors, and eight tissues, including small intestine, stomach, liver, heart, lung, kidney, spleen, and colon. Notably, ganoderic acids A, B, C1, F, and H were the most widely distributed compounds across these tissues. The metabolism of GLEE involves both phase I and phase II reactions. This study is the first to provide a comprehensive profile of GLEE's chemical composition, distribution, and metabolism, revealing the potential active triterpenoids responsible for its anti-cancer effects. Our findings provide a foundation for future studies focused on the pharmacological mechanisms of these compounds, offering new insights into the therapeutic potential of G. lucidum in cancer treatment.

Association between per- and polyfluoroalkyl substances with serum hepatobiliary system function biomarkers in patients with acute coronary syndrome

Previous studies have suggested that abnormal hepatobiliary system function may contribute to poor prognosis in patients with acute coronary syndrome (ACS) and that abnormal hepatobiliary system function may be associated with per- and polyfluoroalkyl substances (PFAS) exposure. However, there is limited evidence for this association in cardiovascular subpopulations, particularly in the ACS patients. Therefore, we performed this study to evaluate the association between plasma PFAS exposure and hepatobiliary system function biomarkers in patients with ACS. This study included 546 newly diagnosed ACS patients at the Second Hospital of Hebei Medical University, and data on 15 hepatobiliary system function biomarkers were obtained from medical records. Associations between single PFAS and hepatobiliary system function biomarkers were assessed using multiple linear regression models and restricted cubic spline model (RCS), and mixture effects were assessed using the Quantile g-computation model. The results showed that total bile acids (TBA) was negative associated with perfluorohexane sulfonic acid (PFHxS) (-7.69 %, 95 % CI: -12.15 %, -3.01 %). According to the RCS model, linear associations were found between TBA and PFHxS (P for overall = 0.003, P for non-linear = 0.234). We also have observed the association between between PFAS congeners and liver enzyme such as aspartate aminotransferase (AST) and α-l-Fucosidase (AFU), but it was not statistically significant after correction. In addition, Our results also revealed an association between prealbumin (PA) and PFAS congeners as well as mixtures. Our findings have provided a piece of epidemiological evidence on associations between PFAS congeners or mixture, and serum hepatobiliary system function biomarkers in ACS patients, which could be a basis for subsequent mechanism studies.

A case of cutaneous leishmaniasis by a needlestick injury: an occupational infection or "experimental infection"?

Leishmaniasis is a Neglected Tropical Disease caused by unicellular parasitic kinetoplastids of the genus Leishmania spp., with 20 species associated with human infections. This case report describes an accidental inoculation of Leishmania major suffered by a graduate student in a research and education institution laboratory. Eight months after the occupational accident, the student developed an erythematous, painless papule at the needlestick injury site. Within a week, the lesion worsened, showing ulceration and an increase in size. The diagnosis of cutaneous leishmaniasis was based on clinical observations and confirmed by histopathological analysis, immunohistochemistry, and parasite culture. Following diagnosis, the patient was referred for treatment with a dosage of 81 mg SbV/kg of Glucantime, administered slowly via intravenous infusion diluted in 100 ml of 5 % glucose saline solution, every 24 h for 20 consecutive days. Furthermore, this case report emphasises the critical need for periodic training for research professionals to ensure their knowledge of protocols guiding prevention and response to occupational infections.

Global burden of depression and anxiety disorders in older adults, 1990-2019: An analysis of age-period-cohort and temporal-spatial patterns

BACKGROUND

Mental disorders are the leading causes of the global health-related burden and account for 10.6% of total disability (in disability adjusted life years, DALYs) among older adults, with depression and anxiety disorders being the most common contributors to this burden. This study provided a comprehensive epidemiological update on their global burden in older populations, analyzing evolving temporal trends, spatial distribution shifts, and identifying high-risk subgroups and geographic regions.

METHOD

Prevalence rates and disability-adjusted life years (DALYs) for depression and anxiety disorders in older adults from 1990 to 2019 were estimated using the GBD 2019. The Age-period-cohort (APC) modeling was applied to investigate the reasons behind these trends. In addition, we assessed the spatial patterns in different regions using the global and local Moran Index.

RESULTS

In 2019, 57.78 million (95 % UI 50.04, 66.30) older adults experienced depression and 46.26 million (95 % UI 59.93, 36.57) suffered from anxiety disorders globally. Depression accounted for 9.21 million DALYs (rate: 908.94, 95 % UI 625.45, 1234.56), while anxiety disorders contributed to 4.08 million DALYs (rate: 402.95, 95 % UI 264.96, 581.75). From 1990 to 2019, the depression prevalence increased (EAPC = 0.0424, 95 % CI 0.0261, 0.0587), and DALYs rates rose slightly (EAPC = 0.0142, 95 % CI -0.0071, 0.035). In contrast, the anxiety disorders prevalence and DALYs rate declined over the same period [EAPC = -0.1476 (95 % CI -0.1924,-0.1027) and -0.1476 (95 % CI -0.1917,-0.1035)]. Age-specific trends revealed inverted U-shaped depression trajectories, peaking among individuals aged 70-74 years, whereas anxiety disorders exhibited a U-shaped decline with the steepest reductions occurring at the extremes and slower declines in middle age groups. Males exhibited faster-growing depression burdens and rising late-life rates of anxiety disorders, contrasting with the declining trend observed in females. Socio-demographic disparities highlighted low-SDI regions with the highest depression burden (e.g., sub-Saharan Africa) versus high-SDI clusters for anxiety disorders (e.g., Western Europe). Spatial analyses identified depression hotspots in sub-Saharan Africa and anxiety clusters in Latin America and Western Europe, emphasizing divergent geographic patterns.

CONCLUSION

Combining temporal and spatial patterns, we explored temporal trends and five spatial patterns in global depression and anxiety disorders. The prevalence of depression and anxiety disorders was significantly elevated in regions exhibiting both fluctuating and stable high-aggregation patterns, particularly in Eastern/Western sub-Saharan Africa and Southern Latin America. National governments prioritize implementing targeted interventions to alleviate these burdens, while future studies should validate findings through comprehensive datasets and individual-level data to refine prevention strategies for high-risk populations and regions.

Intranasal administration of exosomes derived from adipose mesenchymal stem cells ameliorates depressive-like behaviors and inhibits inflammation via AMPK/mTOR-mediated autophagy

BACKGROUND

Major depressive disorder (MDD) is a severe, and often treatment-resistant, psychiatric disorder. Mesenchymal stem cell-derived exosomes have been shown to be neuroprotective. Here we employed adipose-derived mesenchymal stem cell exosomes (ADSC-Exos) as a novel therapeutic approach for depressive-like behavior in mice and explored the underlying mechanisms.

METHODS

ADSC-Exos were administered intranasally to mice subjected to chronic restraint stress to assess behavioral changes and neuroprotection in terms of apoptosis, AMPK-mTOR signaling, and NLRP3 pathway activation by western blotting, microglial activation by immunofluorescence, and changes in serum inflammatory factors by ELISA. The effects of ADSC-Exos were also studied in vitro in HT22 cells.

RESULTS

ADSC-Exos significantly improved depressive-like behavior, anxiety-like behavior, and cognitive function in mice. ADSC-Exos had significant neuroprotective effects, including reducing neuronal apoptosis and promoting autophagy by activating AMPK-mTOR signaling, ultimately reducing neuroinflammation. In vitro, ADSC-Exos inhibited corticosterone-induced apoptosis, activated autophagy in an AMPK pathway-dependent manner, and inhibited NLRP3 inflammasome activation.

CONCLUSION

ADSC-Exos may be a potential treatment for MDD by alleviating depressive-like behaviors and protecting against tissue injury, possibly through activation of AMPK-mTOR signaling and inhibition of NLRP3 inflammasome-mediated neuroinflammation.

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.

Estimation of therapeutic threshold for tuberculosis using adapted nominal group technique and clinical vignettes in clinical and community settings in Southern Africa

Background

When confronted with diagnostic uncertainty and a decision on whether to start treatment or not, clinicians consider the potential harm and benefit of offering versus withholding treatment. Treatment can be offered if the probability of tuberculosis (TB) in the patient is above the "therapeutic threshold" (ThT): the probability of disease at which the expected utility of treating and not treating is the same. We estimated ThT for TB in clinical and community settings in Southern Africa using two methods: an adapted nominal group technique (aNGT), and decisions made based on clinical vignettes (CVs).

Methods

We enrolled health professionals involved in the routine management of TB patients in South Africa and Lesotho. The participants elicited, discussed and refined the harms of false positive (FP) and false negative (FN) treatment decisions for stable ambulatory patients in the clinical and community settings. They weighed all harms according to their importance in treatment decisions by distributing 100 points. ThT, calculated as the sum of the weights of the harms of the FP decision divided by the total weight, was estimated using a hierarchical Beta regression model. For the CVs, participants were presented with ten hypothetical TB cases in each setting and asked to indicate whether they would offer TB treatment or not. ThT was estimated using the generalized linear model for binary outcomes.

Results

We enrolled 138 health professionals (aNGT: 123, CVs: 130 and 115 in both). Using aNGT, the overall ThT was 37.7% (95% credible intervals (95% CrI): 35.8-39.8) and 38.2% (95% CrI: 35.9-40.6) in the clinical and community settings, respectively. Compared to aNGT, CVs produced a significantly lower estimate in the clinical setting (27.7%; 95% CrI: 23.8-31.3) but similar in the community setting (37.7%; 95% CrI: 33.1-41.7). We did not find significant differences across the subgroups defined by the measured covariates.

Conclusion

The aNGT produced a reliable estimate of ThT. The difference in the estimates of ThT between the aNGT and CVs may have a limited impact on clinical decisions. Factors influencing ThT and the acceptability of results by healthcare workers will be explored in focus group discussions and in-depth interviews.

C-reactive protein-to-albumin ratio is associated with increased depression: An exploratory cross-sectional analysis

BACKGROUND

Depression, prevalent globally, significantly impacts psychological and physical health. As a burgeoning biomarker, C-reactive protein-to-albumin ratio (CAR) offers insights into metabolism-immune status and disease diagnosis. This exploratory investigation seeks to elucidate the relationship between CAR and depression.

METHODS

This cross-sectional investigation utilized data from the National Health and Nutrition Examination Survey (NHANES). Depression was assessed using the PHQ-9 questionnaire. To examine the relationship between CAR and depression risk, we employed a multivariable logistic regression analysis and a restricted cubic spline (RCS) approach. Furthermore, subgroup analyses were performed to validate the consistency of the findings across specific populations.

RESULTS

This investigation enrolled 13,159 adult participants, comprising 8.15 % with depression. Compared with participants without depression, those diagnosed with depression showed a significantly higher CAR level. Each one - unit increase in log10-transformed CAR (log-CAR) was associated with an 58 % increase in the incidence of depression (Odds Ratio = 1.58, 95 % Confidence Interval: 1.33-1.88). A non-linear dose-response relationship was detected between CAR and depression risk (non-linear p < 0.001). Furthermore, the strength of this association persisted undiminished throughout multiple subgroup analyses. Notably, among individuals with a prior history of metabolic diseases, the observed association remained consistent.

CONCLUSIONS

A distinct positive correlation was observed between CAR and depression in U.S. adults. Further large-scale, well-controlled studies are needed to validate the reliability and establish the generalizability of these findings.

Long-term exposure to major constituents of fine particulate matter and sleep disorders among children and adolescents: A population-based survey in Guangdong province, China

Long-term exposure to PM2.5 is associated with sleep health in adults, but its impact on children and adolescents remains unclear. This cross-sectional study analyzed 64,203 children and adolescents (6-18 years) from four cities in Guangdong, China, to assess the impact of PM2.5 and its major constituents on sleep disorders. Sleep disorders were assessed using the Sleep Disturbance Scale for Children. Generalized linear mixed models and weighted quantile sum regression were applied to assess the joint effects of PM2.5 constituents. The results indicated a positive association between PM2.5 and sleep disorders. For example, the odds of sleep disorder increased with per interquartile range (IQR) increase in PM2.5 concentrations [odds ratio (OR): 1.15, 95 % confidence interval (CI):1.06, 1.26). Black carbon (BC) and organic matter (OM) increase the odds by 16 % (95 % CI: 9, 24 %) and 23 % (95 % CI: 9, 39 %), respectively. Notably, combustion-related BC (44.3 %) and OM (24.3 %) contributed the key contributors to the mixture risk. Children and adolescents with limited outdoor activity (< 2 hours/day) were more vulnerable to PM2.5 exposure (P for interaction = 0.028). These findings highlight that stricter air pollution regulations and targeted measures to reduce children's exposure to combustion-derived pollutants are essential for protecting sleep health and overall well-being.

Subchronic ozone exposure leads to multi-organ injuries with differential reversibility in male C57BL/6 J mice

Ozone, a prevalent environmental pollutant, poses significant risks to human health. This study systematically evaluates the impact of subchronic ozone exposure on multiple organs using three-month-old male C57BL/6 J mice exposed to 0.5 or 2.0 ppm ozone for 12 weeks, followed by 4-week recovery period. Subchronic ozone exposure caused systemic damage, including weight loss, inflammation, oxidative stress, and dyslipidemia, with varying degrees of reversibility. Comprehensive histopathological and functional analyses revealed dose-dependent injuries, organ-specific response patterns, and varying recovery capacities within a 4-week cessation of exposure. The lung demonstrated the highest susceptibility with dose-dependent damage and high reversibility. In contrast, the liver, kidneys, and brain, exhibited milder yet largely irreversible damage, particularly at 2.0 ppm. Transcriptomic analyses identified high reversibility in lung inflammation pathways, persistent metabolic dysregulation in the liver and kidneys, neurodegeneration-related perturbations in the brain with minimal recovery capacity. Furthermore, common molecular drivers, such as oxidative stress and inflammation, were identified across all organs, revealing both unique and shared mechanisms of injury and recovery. These findings underscore the systemic nature of ozone toxicity and the need for targeted interventions. Persistent dyslipidemia and metabolic dysregulation in the liver and kidneys emphasize the necessity for ongoing monitoring and potential interventions for individuals exposed to elevated ozone levels.

Inhalers or nebulisation of salbutamol in childhood asthma exacerbations in emergency departments

PURPOSE

Asthma exacerbations often lead to paediatric emergency department (PED) visits, but evidence for paediatric management remains limited, and recommendations under discussion. This study compared salbutamol delivered via nebulisation and pressurised metered dose inhalers (pMDI) with a holding chamber in children with mild to severe asthma exacerbations.

METHODS

A two-centre study was conducted during eight months, comparing hospitalisation rates, clinical improvement, side effects, and PED visit length in the overall population and in children under and over 6 years old.

RESULTS

A total of 384 patients were included, primarily with mild and moderate exacerbations of similar severity between groups. The discharge rate was comparable between groups in the overall population (82.7 % without any nebulisation in the pMDI group versus 81.6 %, p = 0.93), but higher for children under 6 years old treated with pMDI (98.1 % versus 76.9 %, p < 0.001). The pMDI group exhibited significantly lower hospitalisation rates (p < 0.001) and shorter PED visits (1.7 [1.2-2.6] hours versus 4.0 [2.6-5.3] hours, p < 0.001) while receiving lower salbutamol doses (0.10 [0.05-0.16] mg/kg versus 0.81 [0.55-1.18] mg/kg, p < 0.001) with less ipratropium and oral corticosteroids (p < 0.001 and p < 0.001). The pMDI group demonstrated fewer side effects, particularly oxygen dependence, especially in children under 6 (p < 0.001).

CONCLUSION

The study suggests that salbutamol via pMDI with a holding chamber is as effective as nebulisation for treating mild to moderate childhood asthma exacerbations. This approach results in fewer hospitalisations, reduced side effects, and shorter PED visits. Educating patients on pMDI use and efficacy could further decrease emergency visits for asthma exacerbation.

Status and Opportunities for Improvement in Pain Education in Europe: A European Pain Federation EFIC Multiple-Methods Study

BACKGROUND

Pain is one of the most prevalent health issues in Europe, yet the quality of pain education for healthcare professionals remains unclear. This study assessed the status of undergraduate and postgraduate pain education for nurses, physicians, psychologists, and physiotherapists across Europe, identifying key strategies to enhance training and improve healthcare outcomes.

METHODS

A study using multiple methods was conducted, comprising a scoping review, an online survey of educators, and qualitative interviews with EFIC chapters and professional educational bodies.

RESULTS

The scoping review of 11 studies revealed a paucity of evidence, with significant heterogeneity in the hours dedicated to pain training and inconsistencies in both content, teaching, and assessment methods across European curricula. The survey of educators (n = 511) showed wide variability in pain education coverage, with psychology curricula particularly underrepresented compared to the more structured programmes in medicine and physiotherapy. The interviews highlighted curriculum constraints, lack of resources, and limited specialised staff as key barriers. They also underscored the importance of integrating pain education across all disciplines through international and interdisciplinary collaboration to enhance training efforts.

CONCLUSIONS

Significant gaps persist in the depth, consistency, and delivery of pain education for undergraduate and postgraduate health professionals across Europe. The absence of standardised, evidence-based curricula underscores the need for consistent pain education across all disciplines. Implementing targeted educational standards, increasing interdisciplinary training, and supporting qualified educators are essential to address this fragmented landscape. Standardising pain education has the potential to greatly improve patient outcomes by equipping healthcare professionals with more effective pain management skills.

SIGNIFICANCE STATEMENT

This multiple method study provides an updated and comprehensive overview of the current state of pain education for healthcare professionals in Europe at undergraduate and postgraduate levels. Substantial gaps remain in the depth, consistency, and delivery of pain education for both undergraduate and postgraduate healthcare professionals across Europe. This underscores the need to enhance pain education at the undergraduate level, with EFIC's existing medicine and physiotherapy resources offering potential models, alongside wider efforts to implement comprehensive postgraduate training. Standardising the delivery of targeted pain education has the potential to greatly improve patient outcomes by equipping healthcare professionals with more effective pain management skills.

High local type-2 inflammation is linked to response in severe asthma treated with anti-Interleukin-5 receptor

BACKGROUND

Benralizumab is an anti-IL-5 receptor (IL-5R) therapy linked to a huge improvement of the condition of patients with severe eosinophilic asthma. The goal of this study was to identify baseline airway markers of remission and response after anti-IL5R therapy.

METHODS

This observational study included 45 patients initiated with an anti-IL-5R. Remission was defined as: no oral corticosteroids intake, no exacerbation, a good asthma control (ACQ <1.5 and/or ACT >19) and a good lung function (FEV1 ≥ 80 % predicted and/or an improvement ≥10 %). Components of remission were also assessed individually to evaluate the response of patients. Sputum levels of mediators implicated in inflammation and remodeling were measured before treatment.

RESULTS

Among the 45 patients, 12 were classified in remission. These patients were younger at baseline, had a lower smoking exposure, better asthma control and quality of life and a higher FeNO compared to the others. Moreover, baseline blood eosinophil counts were similar but sputum IL-6 and IL-8 levels were significantly higher in the non-remission group. Finally, patients who only improved their ACT or ACQ score had higher baseline FeNO values or sputum eosinophil percentage respectively. Those who increased their FEV1 ≥ 10 % presented a higher baseline sputum eosinophil percentage, sputum eotaxin-3 level and a trend for a higher sputum IL-5 level.

CONCLUSION

High baseline airway T2 markers appeared to be associated with response to anti-IL-5R therapy. Lower sputum IL-6 and IL-8 levels were linked to remission. These results need to be validated in a bigger cohort.

Socioeconomic position and type 2 diabetes: Examining the mediating role of social cohesion-The Maastricht Study

The relationship between socioeconomic position and type 2 diabetes is well-established; individuals of lower socioeconomic position experience substantially higher rates of the disease. This study investigated the mediating role of perceived and ecometric area-level social cohesion in the association between socioeconomic position and incident type 2 diabetes. In a prospective population-based cohort, The Maastricht Study, we analyzed data from 6,604 participants (age¯ = 58.6 years, 55% female) with a median follow-up of 8.1 (IQR 5.1-10.1) years. We examined whether perceived or area-level social cohesion (in 500 m squares, five-character postal code areas, and neighborhood areas) mediated the association between socioeconomic position (represented by educational attainment, occupational status, or income) and incident type 2 diabetes. We employed a causal mediation approach based on linear regression and Cox proportional hazards models. Individuals with lower socioeconomic position were more likely to perceive lower social cohesion and to live in areas with diminished social cohesion. Lower area-level social cohesion was associated with an increased risk of developing type 2 diabetes. The mediating effect of social cohesion was more pronounced in urban areas. In urban areas, the total effect of education (contrasting the 83rd and 17th percentiles) on type 2 diabetes incidence was a hazard ratio (HR) of 2.03 (95% CI: 1.62-2.58), with area-level social cohesion mediating 24.4% (11.1%-40.3%) of this effect. In less urban areas, social cohesion mediated 12.6% (5.2%-23.0%) of a HR of 1.89 (1.50-2.40). Similar findings were observed with occupational status and income, and across other aggregation levels. Socioeconomic position is linked to lower social cohesion, which is associated with an increased risk of type 2 diabetes. Enhancing social cohesion in disadvantaged areas may help reduce diabetes-related health disparities, particularly in urban settings. Further research is needed to better understand the mechanisms underlying these relationships.

Intestinal IL-17 family orchestrates microbiota-driven histone deacetylation and promotes Treg differentiation to mediate the alleviation of asthma by Ma-Xing-Shi-Gan decoction

BACKGROUND

Gut microbiota imbalance is well-known as one important trigger of allergic asthma. Ma-Xing-Shi-Gan decoction (MXSG) is a traditional Chinese medicine prescription with ideal clinical efficacy on asthma. However, whether and how MXSG exerts its efficacy on asthma through gut microbiota remains unclear.

PURPOSE

To investigate the underlying mechanism of MXSG against asthma using multi-omics technologies.

METHODS

An asthma model was established using 8-week-old C57BL/6 J mice, after which they were daily administrated with high-, medium- and low-dose MXSG for 7 days. Histopathological examinations and flow cytometry were performed to evaluate the effects of MXSG on lung immune injury. Key regulatory pathways were predicted via network pharmacology and verified using 16S rRNA sequencing, metagenomics, metabolomics, and in vivo experiments including the knockout of the targeting gene.

RESULTS

MXSG alleviated asthma symptoms, elevated intestinal microbial diversities, and enriched potential beneficial microbes such as Lactococcus, Lactobacillus, and Limosilactobacillus. Network pharmacology and experimental validation highlighted the IL-17/Treg signaling as crucial for asthma treatment. IL-17 knockout experiments revealed its necessity for Treg differentiation during asthma. Moreover, IL-17-deficient asthmatic mice exhibited lower levels of Lactobacillus and significant changes in microbial genes involving histone deacetylases (HDAC) and short-chain fatty acids (SCFAs). Finally, MXSG significantly boosted SCFA production and reduced HDAC9 expression, which were correlated with Treg cell ratios.

CONCLUSION

Our study delineates a novel mechanism where MXSG synergizes with the IL-17 family to enrich intestinal beneficial microbes (e.g. Lactobacillus) and SCFAs. This inhibits the expression of SCFA-downstream HDAC9 to promote Treg differentiation, and thus potentially alleviates asthma.

Children and adolescents' demand for psychiatric services: Insight from the a nine-year-period visits population change in Nanjing, China

BACKGROUND

The prevalence of mental health issues among children and adolescents has been increasing. The objective of this study is to delineate the evolving characteristics of psychiatric visits among this demographic, including sex differences in service utilization, and to evaluate the capacity of existing medical resources to meet their needs for such visits.

METHODS

The data were sourced from Nanjing Brain Hospital and retrieved from outpatient and inpatient records of individuals aged 18 and below who visited the psychiatric department between the dates of July 2015 and June 2024. A descriptive analysis of the temporal changes in clinical features and general data was conducted, and an ETS time series model was employed to forecast whether visit demands are being met.

RESULTS

A total of 594,510 visits were recorded across both outpatient and inpatient systems. The overall number of visits increased year by year, with the fastest growth rate among patients with mood disorders. Furthermore, the growth rate of boys was significantly slower than that of girls (outpatient: OR = 0.93, P < 0.001; inpatient: OR = 0.91, P < 0.001). The ETS time series analysis indicated that future visit trends are expected to stabilize, with a significant proportion of children and adolescents still requiring N-CAP visits (outpatient: 31 %; inpatient: 44 %). In the inpatient system, the majority of this population is concentrated in the 17-18 age group (73 %).

CONCLUSION

The number of psychiatric visits for children and adolescents has been increasing on an annual basis. The current medical resources are insufficient to meet the growing demand.

Association of whole and refined grains food consumption with coronary artery disease in a multi-center, case-control study of Iranian adults: Iran Premature Coronary Artery Disease (IPAD)

BACKGROUND AND AIMS

Low whole grain food consumption is the leading cause of coronary artery disease (CAD) burden in middle-East countries. However, investigations examining the association of whole and refined grain foods and CAD are scarce in this region. We aimed to investigate the association of whole and refined grain foods with CAD in Iranians with different ethnicities.

METHODS AND RESULTS

This was a multi-center case-control study among Iranian ethnicities consisting of Fars, Azari, Kurd, Arab, Lor, Gilak, Qashqaei, and Bakhtiari within the framework of the Iran premature coronary artery disease (IPAD) project. The data were collected from hospitals with catheterization laboratories. Cases were 2099 patients with a stenosis ≥75 % in at least one vessel or ≥50 % in the left main artery. Control group were 1168 individuals with normal angiography test. Grains intake was assessed using a validated semi-quantitative food frequency questionnaire. Compared with those with the lowest intake of whole grain foods, subjects in the top quartile had lower risk of CAD (OR = 0.54, 95 % CI: 0.40, 0.72; P < 0.001) after full adjustment. However, a significant direct link was found between higher refined grain foods consumption and the risk of CAD (OR = 1.43, 95 % CI: 0.91-1.84; P = 0.013).

CONCLUSION

Our findings support dietary recommendations to increase whole grain foods and mitigating refined grain food consumption to reduce the risk of CAD and its severity.

Advancing network meta-analysis in non-invasive brain stimulation: Optimizing post-stroke mood through combined therapies

BACKGROUND

Post-stroke depression and anxiety significantly impact recovery and quality of life. Non-invasive brain stimulation (NIBS) techniques, including transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and transcranial ultrasound stimulation (TUS), have emerged as promising therapeutic options. However, the relative efficacy of single and combined NIBS therapies remains unclear. This network meta-analysis aims to identify the most effective combination therapies for optimizing post-stroke mood disorders.

NEW METHOD

A systematic search was conducted across PubMed, Embase, Cochrane Library, Web of Science, and key Chinese databases to identify randomized controlled trials (RCTs) published up to March 2023. Two independent reviewers screened the studies, extracted relevant data, and assessed the risk of bias using the Cochrane Handbook. A network meta-analysis was performed using Stata SE version 15.1 and R software version 4.2.3 to evaluate the comparative effectiveness of different NIBS interventions.

RESULTS

A total of 50 RCTs involving 3852 participants and 18 different interventions (including 11 combination therapies) were analyzed. The findings revealed: COMPARISON WITH EXISTING METHODS: Unlike previous studies focusing on single-modality interventions, this network meta-analysis systematically evaluates the comparative effectiveness of various combined NIBS strategies. Results indicate that combination therapies significantly outperform single-modality treatments, with TMS-based protocols showing the greatest overall benefit in improving both mood disorders and functional independence.

CONCLUSIONS

The findings suggest that optimized combination NIBS therapies offer superior outcomes for post-stroke depression and anxiety. HFrTMS_LFrTMS_WM was the most effective for depression and independence in activities of daily living (ADLs), while tDCS_psychotherapy and TUS_WM were particularly effective for anxiety. These results highlight the clinical potential of integrated NIBS strategies for post-stroke mood optimization and call for further research to refine treatment protocols for enhanced patient outcomes.

Specialized Pro-Resolving Mediators as Emerging Players in Cardioprotection: From Inflammation Resolution to Therapeutic Potential

AIM

Timely myocardial reperfusion is essential for restoring blood flow to post-ischemic tissue, thereby reducing cardiac injury and limiting infarct size. However, this process can paradoxically result in additional, irreversible myocardial damage, known as myocardial ischemia-reperfusion injury (MIRI). The goal of this review is to explore the role of specialized pro-resolving mediators (SPMs) in atherosclerosis and MIRI, and to assess the therapeutic potential of targeting inflammation resolution in these cardiovascular conditions.

METHODS

This review summarizes current preclinical and clinical evidence on the involvement of SPMs in the pathogenesis of atherosclerosis and MIRI, acknowledging that several cellular and molecular aspects of their mechanisms of action remain to be fully elucidated.

RESULTS

MIRI is a complex phenomenon in which inflammation, initially triggered during ischemia and further amplified upon reperfusion, plays a central role in its pathogenesis. Various cellular and molecular players mediate the initial pro-inflammatory response and the subsequent anti-inflammatory reparative phase following acute myocardial infarction (AMI), contributing both to ischemia- and reperfusion-induced damage as well as to the healing process. SPMs have emerged as key endogenous immunoresolvents with potent anti-inflammatory, antioxidant, and pro-resolving properties that contribute to limit excessive acute inflammation and promote tissue repair. While dysregulated SPM-related signaling has been linked to various cardiovascular diseases (CVD), their precise role in AMI and MIRI remains incompletely understood.

CONCLUSION

Targeting inflammation resolution may represent a promising therapeutic strategy for mitigating atheroprogression and addressing a complex condition such as MIRI.

Calcitonin Gene-Related Peptide Levels in Children and Adolescents With Primary Headache Disorder

ObjectiveThis study aimed to investigate calcitonin gene-related peptide (CGRP) levels in children and adolescents with primary headache.MethodsAll patients underwent blood sampling regardless of their headache state (ictal or interictal) on the day of examination. The patients were grouped based on their headache diagnosis (migraine, tension-type headache, or mixed).ResultsNinety-two patients aged 5-18 years were included (29 diagnosed with migraine and 31 with tension-type headache). In the comparisons between the patients with migraine and the patients with tension-type headache, interictal CGRP levels in blood from the cubital vein showed no significant difference. Ictal samples were collected in the tension-type headache group only, and no significant difference was observed between the ictal and interictal phases. Variables such as headache diagnosis, sex, age, family history with primary headache, headache frequency, time since last headache, medication usage, and body mass index did not significantly influence CGRP levels.ConclusionNo significant difference in interictal CGRP levels between patients with migraine and patients with tension-type headache were found. In patients with tension-type headache, there were no significant differences between CGRP levels in the ictal and interictal state. We were not able to draw conclusions about differences in ictal levels of CGRP in patients with migraine compared with patients with tension-type headache, or in differences between ictal and interictal levels in patients with migraine. Future studies should aim to replicate these results in a larger study cohort.

Impact of triglyceride glucose - Body mass index on depression risk in Chinese middle-aged and elderly adults: Evidence from a large-scale study

BACKGROUND

Current literature lacks evidence to characterize the relationship between the triglyceride glucose - body mass index (TyG-BMI) and depression. Therefore, this study aimed to elucidate the potential association between TyG-BMI and depression risk in a Chinese middle-aged and elderly population.

METHODS

The study utilized data from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2011, which included 17,708 participants. We used multifactorial logistic regression modeling to investigate the relationship between TyG-BMI and depression in Chinese adults, using smoothed curve fitting to assess the nonlinear relationship between them. In addition, we performed sensitivity and subgroup analyses to verify the robustness of the results.

RESULTS

A total of 9328 participants were included in our study, After adjusting for all potential covariates, participants with higher levels of TyG-BMI had a lower risk of depression compared to Q1, the adjusted OR (95 % CI) values were Q2 (OR: 0.84, 95 % CI: 0.74-0.96, p = 0.009), Q3 (OR: 0.75, 95 % CI: 0.65-0.86, p < 0.001), and Q4 (OR: 0.67, 95 % CI: 0.57-0.79, p < 0.001). The association between TyG-BMI and depression exhibited an L-shaped curve (nonlinear, p = 0.004). When TyG-BMI <200, Increased TyG-BMI was associated with a significantly lower risk of depression (OR = 0.87 [95 %CI:0.82-0.93], p < 0.001). However, there was no association between TyG-BMI and depression when TyG-BMI ≥200 (OR = 0.96 [95 %CI:0.91-1.02], p = 0.22).

CONCLUSION

The connection between TyG-BMI and depression in Chinese adults is L-shaped, with an inflection point around 200.

Predicted plasma proteomics from genetic scores and treatment outcomes in major depression: a meta-analysis

Proteomics has been scarcely explored for predicting treatment outcomes in major depressive disorder (MDD), due to methodological challenges and costs. Predicting protein levels from genetic scores provides opportunities for exploratory studies and the selection of targeted panels. In this study, we examined the association between genetically predicted plasma proteins and treatment outcomes - including non-response, non-remission, and treatment-resistant depression (TRD) - in 3559 patients with MDD from four clinical samples. Protein levels were predicted from individual-level genotypes using genetic scores from the publicly available OmicsPred database, which estimated genetic scores based on genome-wide genotypes and proteomic measurements from the Olink and SomaScan platforms. Associations between predicted protein levels and treatment outcomes were assessed using logistic regression models, adjusted for potential confounders including population stratification. Results were meta-analysed using a random-effects model. The Bonferroni correction was applied. We analysed 257 proteins for Olink and 1502 for SomaScan; 111 proteins overlapped between the two platforms. Despite no association was significant after multiple-testing correction, many top results were consistent across phenotypes, in particular seven proteins were nominally associated with all the analysed outcomes (CHL1, DUSP13, EVA1C, FCRL2, KITLG, SMAP1, and TIM3/HAVCR2). Additionally, three proteins (CXCL6, IL5RA, and RARRES2) showed consistent nominal associations across both the Olink and SomaScan platforms. The convergence of results across phenotypes is in line with the hypothesis of the involvement of immune-inflammatory mechanisms and neuroplasticity in treatment response. These results can provide hints for guiding the selection of protein panels in future proteomic studies.

Bracing in Osteoarthritis

Bracing options for the therapeutic and preventative treatment of cartilage injury and osteoarthrosis have traditionally been understudied and underutilized due to poor patient compliance and a lack of published clinical efficacy data. However, recent advancements in 3-dimensional printing, biomechanical analysis of the joint, and dynamic joint unloading technologies are re-establishing bracing as an effective, low-cost, and low-risk non-surgical treatment option. When combined with other operative and non-operative methods in a data-based approach, bracing may offer improved outcomes in therapeutic, palliative, and prophylactic applications for cartilage disease and injury.

Pathogens and drug resistance or virulence genes from animals and surrounding environment in Shenzhen, 2023 using targeted next-generation sequencing

Identifying the pathogen spectrum of animals and surrounding environment is essential for the prevention and control of zoonotic diseases. From February 1 to June 30, 2023, we randomly collected respiratory and intestinal samples from animals and swab samples from surrounding environment in 33 units in Shenzhen, and carried out pathogen/gene screening using pathogen targeted next-generation sequencing technology. A total of 2000 samples were collected and mixed to obtain 415 samples for detection. The detection rate of respiratory pathogens (76.9 %, χ2 = 15.892, P < 0.001), drug resistance genes (59.0 %, χ2 = 52.888, P < 0.001), the co-detection proportion of intestinal pathogens (87.0 %, χ2 = 9.605, P = 0.002) in livestock and poultry, and drug resistance genes in surrounding environment (30.5 %, χ2 = 14.932, P < 0.001) were higher than dogs and cats, and wild animals. Escherichia coli (37.3 %, 30.5 %) and β-lactamase-resistance NDM genes (31.3 %, 27.1 %) were the main respiratory pathogens in livestock and poultry, and surrounding environment. The detection rate of Pasteurella multocide was 25.0 % in dogs and cats. The detection rates of intestinal pathogens Campylobacter coli and Clostridium perfringens in livestock and pourtry were 23.9 % and 17.9 %, and Clostridium perfringens in dogs and cats and wild animal was 18.2 % and 15.7 %. The total detection rate of intestinal pathogens of wild animals in wildlife parks (44.0 %) and indoor pet parks (38.9 %) was higher than that in animal nature reserves (χ2 = 15.686, P = 0.001). The respiratory/intestinal pathogens in animals and surrounding environment was common in Shenzhen. The drug resistance genes in livestock and poultry, and intestinal pathogens of wild animals in indoor pet parks needed more attention.

Work-related musculoskeletal pain among orthopaedic surgeons: A systematic literature search and narrative synthesis

Background

Performing surgery is associated with physical demands and musculoskeletal hazards. Orthopaedic surgery is a particularly physically demanding surgical discipline. We aimed to systematically examine the literature characterizing the prevalence and nature of work-related musculoskeletal (MSK) pain among orthopaedic surgeons.

Methods

Systematic search and narrative synthesis methodology of studies on MSK pain among orthopaedic surgeons was conducted in MEDLINE, Embase, and CINAHL. Data extraction of study characteristics was performed and further analyzed for prevalence, pain outcome measures, and anatomical location of MSK pain. This review is registered in PROSPERO CRD420250650511.

Results

25 studies met our inclusion criteria. 14 studies were published since 2019, with no articles before 1995. 11 papers studied surgeons in the USA and the remaining from other countries. The range of overall MSK pain prevalence was 51.7-97.0 %. 11 studies reported on pain in 1-2 anatomical regions, while 9 studies reported on >3 regions. MSK pain was most frequently reported in the lower back (prevalence of 17.1-77.0 %); neck (10.4-74.4 %); and shoulder (12.8-66.7 %). 13 studies determined MSK pain via author-made or unspecified instruments while 12 papers used validated tools for surveying MSK pain. 17 studies specified a time period in which MSK pain reports were captured.

Conclusion

Orthopaedic surgeons report a high frequency of MSK pain, in the lower back, neck and shoulder regions. There was considerable heterogeneity of research methods and outcome measures utilized. Further research is needed to better understand the role of preventive measures and the potential influence of MSK pain on surgeon occupational function, and the orthopaedic surgeon workforce.

Malignancy risk stratification for pulmonary nodules: comparing a deep learning approach to multiparametric statistical models in different disease groups

OBJECTIVES

Incidentally detected pulmonary nodules present a challenge in clinical routine with demand for reliable support systems for risk classification. We aimed to evaluate the performance of the lung-cancer-prediction-convolutional-neural-network (LCP-CNN), a deep learning-based approach, in comparison to multiparametric statistical methods (Brock model and Lung-RADS®) for risk classification of nodules in cohorts with different risk profiles and underlying pulmonary diseases.

MATERIALS AND METHODS

Retrospective analysis was conducted on non-contrast and contrast-enhanced CT scans containing pulmonary nodules measuring 5-30 mm. Ground truth was defined by histology or follow-up stability. The final analysis was performed on 297 patients with 422 eligible nodules, of which 105 nodules were malignant. Classification performance of the LCP-CNN, Brock model, and Lung-RADS® was evaluated in terms of diagnostic accuracy measurements including ROC-analysis for different subcohorts (total, screening, emphysema, and interstitial lung disease).

RESULTS

LCP-CNN demonstrated superior performance compared to the Brock model in total and screening cohorts (AUC 0.92 (95% CI: 0.89-0.94) and 0.93 (95% CI: 0.89-0.96)). Superior sensitivity of LCP-CNN was demonstrated compared to the Brock model and Lung-RADS® in total, screening, and emphysema cohorts for a risk threshold of 5%. Superior sensitivity of LCP-CNN was also shown across all disease groups compared to the Brock model at a threshold of 65%, compared to Lung-RADS® sensitivity was better or equal. No significant differences in the performance of LCP-CNN were found between subcohorts.

CONCLUSION

This study offers further evidence of the potential to integrate deep learning-based decision support systems into pulmonary nodule classification workflows, irrespective of the individual patient risk profile and underlying pulmonary disease.

KEY POINTS

Question Is a deep-learning approach (LCP-CNN) superior to multiparametric models (Brock model, Lung-RADS®) in classifying pulmonary nodule risk across varied patient profiles? Findings LCP-CNN shows superior performance in risk classification of pulmonary nodules compared to multiparametric models with no significant impact on risk profiles and structural pulmonary diseases. Clinical relevance LCP-CNN offers efficiency and accuracy, addressing limitations of traditional models, such as variations in manual measurements or lack of patient data, while producing robust results. Such approaches may therefore impact clinical work by complementing or even replacing current approaches.

Association of Prenatal Exposure to Triptans, Alone or Combined With Other Migraine Medications, and Neurodevelopmental Outcomes in Offspring

BACKGROUND AND OBJECTIVES

The long-term reproductive safety of migraine medications remains uncertain. This study sought to examine the effect of different intensities and durations of prenatal exposure to triptans, alone and combined with other preventive migraine medications, on neurodevelopmental disorders (NDDs) in children.

METHODS

This nationwide health registry study in Norway included pregnancies of women with migraine before pregnancy and followed up their children up to 14 years of age. Single and multiple group-based trajectory models and group-based multitrajectory models were applied to cluster triptan exposure alone and combined with preventive antimigraine medications. Child outcomes, based on specialist outpatient and inpatient diagnoses, included autism spectrum and behavioral disorders, learning and intellectual disabilities, speech/language and developmental coordination disorders, and attention-deficit hyperactivity disorders (ADHDs). We fit adjusted and weighted pooled logistic regression models and standardized risk curves using propensity score-based overlap weighting.

RESULTS

We included 26,210 pregnancies of women with migraine; 4,929 and 21,281 were, respectively, nonmedicated and medicated with triptans in the year of prepregnancy. In the latter group, we identified 4 group-based trajectories of triptans alone and combined with preventive medications: discontinuers before (low use) (41.5%, 47.0%), early discontinuers (short-term low use) (31.3%, 28.8%), late discontinuers (moderate use) (21.3%, 9.1%), and late discontinuers (high use) (5.9%, 15.2%). Overall, 1,140 children (4.3%) had a NDD (mean follow-up time: 8 years). Children born to women with any triptan trajectory had a slightly higher risk of NDD compared with children of nonmedicated women (magnitude range of the weighted hazard ratio [wHR]: 1.05-1.16). These risks decreased to the null when discontinuers before (low use) acted as a comparator (magnitude of wHR: 0.94-1.01) or when analyzing speech/language disorders or ADHD (magnitude of wHR: 0.82-1.14). There was a slightly elevated risk of autism disorders with both triptan late discontinuation trajectories (wHR 1.24, 95% CI [0.78-1.97]; wHR 1.30, 95% CI [0.66-2.56]), but the 95% CI crossed the null and the weighted risk difference remained low.

DISCUSSION

Our findings indicate that prenatal exposure to triptans, alone or combined with other migraine medications, does not substantially increase the risk of a broad range of neurodevelopmental outcomes in children up to adolescence.

Prevalence and risk factors of depressive and anxiety symptoms and functional constipation among university students in Eastern China

BACKGROUND

Depression and anxiety are prevalent among university students worldwide, often coexisting with functional constipation (FC). Family relationships have been identified as crucial factors affecting mental health, yet the gender-specific associations between these conditions remain underexplored.

AIM

To assess prevalence of depressive symptoms, anxiety symptoms, and FC among Chinese university students and explore their associations.

METHODS

Using a cross-sectional survey design, data were collected from 12721 students at two universities in Jiangsu Province and Shandong Province. Depressive symptoms were assessed using the Patient Health Questionnaire-9, anxiety symptoms using the Generalized Anxiety Disorder-7 scale, and FC using the ROME IV. Gender-stratified analyses and population attributable risk proportions were calculated to evaluate risk factor patterns and population impact.

RESULTS

The prevalence of self-reported depressive, anxiety, and comorbid depressive and anxiety symptoms was 16.3%, 24.9%, and 13.3%, respectively, whereas that of FC was 22%. Students with depressive symptoms were 1.811 times more likely to have FC than those without. Female gender, parental relationships, and lower household income were significant risk factors for both mental health conditions. For depressive symptoms, females experienced stronger effects from both parental conflict [odds ratio (OR) = 8.006 vs OR = 7.661 in males] and FC (OR = 1.954 vs OR = 1.628 in males). For anxiety symptoms, conflicted parental relationships had stronger effects in males (OR = 5.946) than females (OR = 4.262). Overall, poor parental relationships contributed to 38.6% of depressive and 33.5% of anxiety symptoms.

CONCLUSION

Family relationships significantly impact student mental health, with gender-specific patterns. Targeted interventions addressing family dynamics could reduce mental health burden in university settings.

Working life patterns after sickness absence due to depression: A 15-year register-based prospective cohort study

AIM

To identify working life patterns after sickness absence (SA) due to depression and sociodemographic, work, and health-related factors associated with them.

METHODS

The study cohort included 9139 Swedish residents, aged 25-40, with a new SA spell due to depression in 2005. We followed the cohort for 15 years analyzing their yearly dominant labor market outcomes. Sequence analysis was used to identify distinct labor market sequences and cluster analysis - to group similar sequences into working life typologies. For the sociodemographic, work, and health-related factor analysis, we used multinomial logistic regression.

RESULTS

We identified 4373 sequences and seven typologies: 1) "Predominant Economic Activity (EA)" (70.7 %), 2) "Predominant EA with Intermittent SA/Disability Pension (DP)" (14.4 %), 3) "Predominant Long-Term SA/DP" (8.0 %), 4) "Long-Term SA/DP Followed by No EA" (2.2 %), 5) "SA/DP with Some EA" (1.6 %), 6) "Emigration" (1.7 %), and 7) "Death" (1.4 %). Factors associated with the predominant long-term SA/DP typology included birth outside Sweden (OR = 1.61, 95 % CI: 1.29-2.01), lower educational attainment (OR = 3.20, 95 % CI: 2.42-4.22), prolonged index SA spell due to depression (OR = 4.81, 95 % CI: 3.71-6.25), prior long-term SA (OR = 3.60, 95 % CI: 2.87-4.50) and unemployment (OR = 2.00, 95 % CI: 1.61-2.48). Living with children (OR = 0.68, 95 % CI: 0.56-0.82) was associated with lower odds of belonging to this typology.

CONCLUSIONS

Most individuals after SA due to depression maintained their engagement in the labor market suggesting that Sweden's welfare system is supportive of their workforce participation. However, some individuals belonged to long-term SA, DP, and lack of EA typologies indicating a potential path to labor market marginalization.

Association between cardiovascular comorbidities and psychological anxiety & depression in the elderly

BACKGROUND

Limited research examining the relationship between cardiovascular comorbidities and psychological anxiety & depression in the elderly, and the conclusions are inconsistent. This study aimed to investigate the intricate relationships between them among the pariticipants aged 60 years and above.

METHODS

Utilizing multivariate logistic regression and stratified analysis to analyze the association between cardiovascular comorbidities and psychological anxiety & depression. Trend analysis was performed to evaluate the risk of developing depression and anxiety as the number of diseases increased. Interaction analysis was utilized to explore potential factors underlying the comorbidity of cardiovascular diseases and depression.

RESULTS

Among 11,960 elder participants (mean age 82 years, 46.5 % male), the prevalences of psychological anxiety, depression, and ≥2 types of cardiovascular diseases are 11.7 %, 25.8 %, and 24.7 %, respectively. Compared to subjects without cardiovascular diseases, those with 2, 3, and 4 types of cardiovascular diseases respectively have increased risk of depression, with corresponding ORs (95 % CI) being 1.23 (1.08-1.40), 1.50 (1.24-1.81), and 1.91 (1.42-2.56), respectively. Trend analysis shows that for each additional cardiovascular comorbidity, the risk of depression increases by 15 % (OR 1.15, 95%CI 1.10-1.20). The interaction effect showed that social activities were both additive and multiplicative factors affecting cardiovascular comorbidity and depression. The association between the risk of anxiety and the complexity of cardiovascular comorbidities is not strong (P > 0.05).

CONCLUSION

As the complexity of cardiovascular comorbidity increases, the risk of depression skyrockets among older adults, social activities may serve as a remedy.

Evaluation of behavioural and neurochemical effects of psilocybin in mice subjected to chronic unpredictable mild stress

Depression and anxiety are disabling and high incidence mental disorders characterized by phenotypic heterogeneity. Currently available treatments show severe limitations. Thus, there is an urgent need for effective treatments in this population. In the search for novel rapid-acting antidepressants, the psychedelic psilocybin has emerged as a promising therapy in several clinical trials. However, its antidepressant mechanism of action is still not well understood. The aim of the present study was to evaluate the therapeutic potential of psilocybin in ameliorating the adverse behavioural and neurochemical consequences of chronic stress. To this end, a chronic unpredictable mild stress (CUMS) animal model was used, and psilocybin treatment was administered (two doses of 1 mg/kg, i.p., administered 7 days apart). Psilocybin reversed impairments in anhedonia and behavioural despair dimensions of depressive phenotype but not in apathy-related behaviour. Psilocybin administration was also able to exert an anxiolytic-like effect on treated animals. Physiological alterations caused by stress, indicative of a hyperactive hypothalamic-pituitary-adrenal axis (HPA), were not reversed by psilocybin. When neuroplasticity-related proteins were assessed in cerebral cortex, brain-derived neurotrophic factor (BDNF) was found to be decreased in stressed animals, and treatment did not reverse such impairment. Psilocybin administration increased the expression and function of serotonin-2A-receptor (5HT2AR) in brain cortex of control and CUMS groups. Furthermore, psilocybin treatment caused a selective increase in the expression of glucocorticoid-receptor (GR) in brain cortex of CUMS mice. In conclusion, psilocybin was able to rescue impairments in the depressive phenotype, and to induce anxiolytic-like effects. Furthermore, an enhancement in sensitivity to psilocybin-induced HTR was observed following a booster dose. Altogether, this work provides new knowledge on the putative benefit/risk actions of psilocybin and contributes to the understanding of the therapeutic mechanism of action of psychedelics.

Time to inclusion of selected medicines for priority diseases in National Essential Medicines Lists compared with the WHO Model List

INTRODUCTION

The WHO maintains a Model List of Essential Medicines, which guides countries in developing their National Essential Medicines List (NEML) to improve access to medicines. We aimed to assess the time it took for countries to adjust their NEMLs when medicines were added or deleted from the WHO Model List and if this differed between priority diseases.

METHODS

We extracted medicines added or deleted from the WHO Model List (2007-2021) for selected priority diseases: diabetes, hepatitis C, HIV, oncology and tuberculosis. These medicines were compared with NEMLs from 20 countries; reimbursement lists (RLs) were used in the absence of an NEML. The time to inclusion in NEMLs/RLs and the percentage of included medicines in the most recent NEML/RL were assessed.

RESULTS

90 medicines were added, and 15 medicines were deleted from the WHO Model List. Low-income and middle-income countries (LMICs) mostly included medicines in NEMLs after their addition to the WHO Model List (median: 1 year), and high-income countries prior to addition (median: -9 years). Medicines for HIV (62%) and tuberculosis (59%) were most frequently included in the most recent NEML/RL. High-income countries included the most medicines for diabetes (86%) and oncology (67%).

CONCLUSIONS

The WHO Model List may be a guiding tool for selecting medicines in LMICs, although it is applied differently between the priority diseases included in the present study. More medicines could be included in NEMLs for non-communicable diseases, which impose a large health burden on LMICs, as a first step to ensure their sustainable access.

Vascular effects of perivascular adipose tissue-derived chemerin in obesity-associated cardiovascular disease

Perivascular adipose tissue (PVAT) is a unique and metabolically active adipose tissue that is adjacent to most systemic blood vessels. Healthy PVAT exerts anticontractile and anti-inflammatory effects, contributing to vascular protection. However, during obesity, PVAT becomes proinflammatory and profibrotic, exacerbating vascular dysfunction. Chemerin, a multifunctional adipokine, has emerged as a key regulator of vascular tone, inflammation, and remodeling. Although liver-derived chemerin dominates the circulating chemerin pool, PVAT-derived chemerin plays a more localized and functionally important role in vascular pathophysiology because of its proximity to the vessel wall. This review highlights the role of PVAT-derived chemerin in vascular health, the mechanistic involvement of PVAT-derived chemerin in certain aspects of obesity-associated cardiovascular diseases, and the therapeutic potential of targeting PVAT-derived chemerin.

Association between metabolic score for insulin resistance and hypertension in middle-aged and older adults: a nationwide cross-sectional and longitudinal study

INTRODUCTION

Metabolic score for insulin resistance (METS-IR) is a promising and reliable non-insulin-based method for assessing insulin resistance and cardiovascular disease risk. Through cross-sectional and longitudinal analyses, we evaluated the predictive ability of METS-IR for hypertension risk, aiming to provide a basis for early screening and intervention strategies to reduce hypertension-related complications.

METHODS

Data were utilized from the China Health and Retirement Longitudinal Study (CHARLS), involving participants aged 45 and above with complete METS-IR and self-reported hypertension records. A combination of cross-sectional (waves 1 and 3) and longitudinal designs was used to track hypertension incidence, with 10,738 participants in the cross-sectional analysis and 6,788 participants in the longitudinal analysis. Data collection included health behaviors, physical measurements, and blood tests. METS-IR was calculated using a standardized formula, and hypertension was defined according to established criteria. Statistical analyses assessed associations, with a significance level set at p < 0.05.

RESULTS

The cross-sectional analysis, after adjusting for confounders, showed that each unit increase in METS-IR was associated with a threefold increase in the risk of hypertension (adjusted OR = 3.48, 95% CI: 2.87, 4.21, P < 0.0001). A significant nonlinear relationship between METS-IR and hypertension risk was observed, particularly beyond a value of 2.0, where the risk significantly increased. Subgroup analysis revealed that smoking and sex significantly affected this association. Longitudinal analysis demonstrated that each unit increase in METS-IR was significantly associated with increased hypertension incidence at 2 years (OR = 1.54, 95% CI: 1.09, 2.18, P < 0.05), 5 years (OR = 1.52, 95% CI: 1.17, 1.97, P < 0.05), and 7 years (OR = 1.71, 95% CI: 1.38, 2.12,, P < 0.0001), respectively.

CONCLUSION

Using CHARLS data, we found that higher METS-IR independently predicts hypertension incidence and prevalence in Chinese older adults.

Cardiac ischaemia/reperfusion in pigs and mice increases cardiomyocyte Krüppel-like factor 5 that aggravates tissue injury and remodelling

AIMS

Activation of the transcriptional factor Krüppel-like factor 5 (KLF5) is detrimental to chronic heart failure. We explored the involvement of KLF5 in myocardial ischaemia/reperfusion injury.

METHODS AND RESULTS

Yorkshire pigs underwent 75' of ischaemia, followed by 3 or 24 h of reperfusion. C57BL/6J mice underwent 30' of ischaemia, followed by 10', 2, 12, 24 h, or 4 weeks of reperfusion. Hearts and isolated cardiomyocytes (CMs) were analysed for gene expression. We assessed cardiac function, infarct size (IS), oxidative stress, and fibrosis in mice subjected to pharmacologic or genetic KLF5 inhibition, as well as pharmacologic inhibition of NADPH oxidases or glucose transporter (GLUT)1 and GLUT4. Bulk RNA sequencing, untargeted 1H-NMR metabolomics, and LC-MS lipidomics were performed. Isolated primary murine CMs were infected with recombinant adenovirus expressing KLF5. During reperfusion, CM KLF5 expression was increased in porcine and murine hearts. Pharmacologic or CM-specific genetic inhibition of KLF5 reduced IS and improved cardiac function in mice. Importantly, acute KLF5 inhibition during early reperfusion suppressed fibrosis and preserved systolic cardiac function 4 weeks post-ischaemia/reperfusion. This improvement was associated with lower NADPH-oxidase 4 (NOX4) expression, less oxidative stress, and suppressed inflammation and cell apoptosis. Pharmacologic inhibition of NOX4 conferred the same benefit. Metabolomic analysis indicated that KLF5 inhibition lowered glucose-derived metabolites (UDP-glucose and lactate) at early reperfusion. Accordingly, cardiac GLUT1 and GLUT4 levels were increased with ischaemia/reperfusion, which was reverted by KLF5 inhibition. Pharmacologic inhibition of both GLUT1 and GLUT4 reduced IS. Finally, myocardial KLF5 overexpression increased GLUT1 mRNA levels and mouse mortality.

CONCLUSION

Ischaemia/reperfusion increases CM KLF5 expression in pigs and mice. This constitutes a central element of myocardial injury pathophysiology and is associated with stimulation of GLUT1 and GLUT4 expression, activation of NOX4, oxidative stress, inflammation, and apoptosis. Acute KLF5 inhibition during reperfusion constitutes a novel therapeutic approach against myocardial ischaemia/reperfusion injury.

Secular Trends in the Incidence, Prevalence, and Disability-Adjusted Life Years of Caries in Permanent Teeth in Six Asian Countries: 1990 to 2021

INTRODUCTION AND AIMS

Untreated dental caries in permanent teeth is a significant public health problem, particularly in Asia. This study compared the long-term trends in the incidence, prevalence, and disability-adjusted life year (DALY) rates of untreated dental caries in permanent teeth between China, India, Japan, South Korea, Thailand, and Singapore from 1990 to 2021. This selection provides a comprehensive representation of economic, healthcare, and demographic diversity in Asia, making our findings widely applicable.

METHODS

Data were obtained from the Global Burden of Disease Study 2021. Changes in both the annual percentage and average annual percentage were calculated using joinpoint regression analysis. Independent age, period, and cohort effects were estimated by age-period-cohort analysis.

RESULTS

From 1990 to 2021, the overall age-standardized incidence rate showed an increasing trend in China, India, and Thailand and a decreasing trend in Japan, Korea, and Singapore. The standardized prevalence and DALY rates decreased among countries, with Korea having the highest prevalence rate and India and Thailand having the highest prevalence and DALY rates. On age-period-cohort analysis, (1) the 20 to 24-year age group carried the highest caries risk, which declined with increasing age (age effect); (2) an overall decreasing or flat trend was observed (period effect); and (3) Japan, Singapore, and South Korea showed increasing incidence, prevalence, and DALY rates, whereas China, India, and Thailand exhibited decreasing prevalence and DALY rates (cohort effect).

CONCLUSION

This study revealed notable regional variations in the burden of untreated dental caries in permanent teeth across Asia from 1990 to 2021. These findings provide valuable insights for policymakers and healthcare professionals to develop targeted and evidence-based oral health strategies in the region.

CLINICAL RELEVANCE

These findings underscore the need to develop targeted oral health solutions in Asia.

Construction and validation of a multi-mRNA panel and genetic scores for Krüppel-like factors for acute ischemic stroke

Cellular and animal experiments suggest that Krϋppel-like factors (KLFs) may be involved in the pathological mechanisms of acute ischemic stroke (AIS), but epidemiological research on KLFs in AIS is still limited. Therefore, we conducted two AIS case-control studies, and three prospective cohort studies to elucidate the contribution of 14 KLFs' distinct leukocytes mRNA expression (360 AIS cases vs. 363 controls) and 21 genetic tagSNPs (3651 AIS cases vs. 3900 controls) to the etiology and prognosis of AIS. We found KLFs mRNA score constructed by differentially expressed mRNAs significantly enhances the discriminative value for AIS compared to the traditional risk factors [the area under the curve (AUC) increased from 0.724 to 0.871]. Additionally, the KLFs polygenetic risk score could effectively stratify the susceptibility to AIS incidence (Ptrend < 0.001) and the highest PRS group has an increased 42.4 % risk of AIS onset in the cohort study. Furthermore, KLF12 mRNA negatively related to modified Rankin Scale (mRS) both at admission and discharge and KLF12 variants contributed to an elevated risk of IS death after AIS. In conclusion, this study provides new insights into the novel contribution of KLFs mRNA and genetic variants to the incidence risk and prognosis of AIS.

ICS use trajectories in severe asthma patients on benralizumab: real-life data from 3-years follow-up

BACKGROUND

Inhaled steroids dose reduction is a relevant goal in severe asthma management.

RESEARCH QUESTION

We aimed to investigate ICS use trajectories and their clinical impact in severe asthma patients on benralizumab over 36 months.

STUDY DESIGN AND METHODS

We conducted a retrospective real-life observational study including clinical and inflammatory parameters. Patients were stratified according to ICS dose trends over time: "stable" (same dose at ≥80% of visits), "decreasing" (≥50% of visits with lower ICS dose vs baseline), and "increasing" (≥50% of visits with higher ICS dose vs baseline).

RESULTS

92 patients were included. Post-bronchodilation FEV1 significantly increased over 36 months, while pre-bronchodilation FEV1 remained stable. An overall statistically significant improvement was observed also for ACT, ACQ, AQLQ and annual exacerbation rate. The probability of decreasing ICS dose was 19.0% at 12 months and 37.4% at 36 months. In the decreasing group (30% of the cohort), baseline blood eosinophil count (BEC) was higher than in the stable group, and BEC suppression over time was greater. The decreasing group was also less frequently treated with OCS at baseline. At 24 months, the stable group showed a greater reduction in OCS use compared to the decreasing group. Across all groups, OCS use dropped from 89.8% to 4.9% at 36 months.

INTERPRETATION

The findings suggest that ICS tapering is feasible and safe in selected patients under benralizumab therapy.

CONCLUSIONS

To the best of our knowledge, this is the first real-life study specifically supporting the ICS-sparing effect of benralizumab over a 36-month period.