Persistent lipoprotein(a) exposure and its association with clinical outcomes after acute myocardial infarction: a longitudinal cohort study

AIMS

To assess the link between persistent lipoprotein(a) [Lp(a)] exposure levels and clinical outcomes in patients with acute myocardial infarction (AMI).

METHODS

This longitudinal cohort study included 1131 AMI patients, categorizing persistent Lp(a) exposure based on measurements at admission and after 1 year. Patients were segmented into four groups using a 300 mg/L Lp(a) threshold: (1) persistent low Lp(a) (lowon admission - lowat 1 year); (2) fortified Lp(a) (lowon admission - highat 1 year); (3) attenuated Lp(a) (highon admission - lowat 1 year); and (4) persistent high Lp(a) (highon admission - highat 1 year). Multivariate Cox regression, subgroup analysis and sensitivity analysis assessed the association between Lp(a) trajectories and major adverse cardiovascular and cerebrovascular events (MACCE), cardiovascular death, non-fatal MI, non-fatal stroke, unplanned revascularization, and all-cause death.

RESULTS

Over a median 50-month follow-up, 343 (35.70%) patients encountered MACCE, and 210 (18.70%) died, including 126 (11.20%) from cardiovascular causes. The group with persistent high Lp(a) faced increased risk of MACCE (HRadjusted, 1.871; 95% CI: 1.474-2.374), non-fatal stroke (HRadjusted, 1.647; 95% CI: 1.031-2.632), unplanned revascularization (HRadjusted, 1.571; 95% CI: 1.008-2.449), and both all-cause (HRadjusted, 1.546; 95% CI: 1.134-2.108) and cardiovascular death (HRadjusted, 2.163; 95% CI: 1.405-3.331), compared to the persistent low Lp(a) group.

CONCLUSIONS

In AMI patients, sustained high Lp(a) levels were significantly associated with increased risk of MACCE, non-fatal stroke, unplanned revascularization, and both all-cause and cardiovascular death.

Unveiling the ageing-related genes in diagnosing osteoarthritis with metabolic syndrome by integrated bioinformatics analysis and machine learning

Ageing significantly contributes to osteoarthritis (OA) and metabolic syndrome (MetS) pathogenesis, yet the underlying mechanisms remain unknown. This study aimed to identify ageing-related biomarkers in OA patients with MetS. OA and MetS datasets and ageing-related genes (ARGs) were retrieved from public databases. The limma package was used to identify differentially expressed genes (DEGs), and weighted gene coexpression network analysis (WGCNA) screened gene modules, and machine learning algorithms, such as random forest (RF), support vector machine (SVM), generalised linear model (GLM), and extreme gradient boosting (XGB), were employed. The nomogram and receiver operating characteristic (ROC) curve assess the diagnostic value, and CIBERSORT analysed immune cell infiltration. We identified 20 intersecting genes among DEGs of OA, key module genes of MetS, and ARGs. By comparing the accuracy of the four machine learning models for disease prediction, the SVM model, which includes CEBPB, PTEN, ARPC1B, PIK3R1, and CDC42, was selected. These hub ARGs not only demonstrated strong diagnostic values based on nomogram data but also exhibited a significant correlation with immune cell infiltration. Building on these findings, we have identified five hub ARGs that are associated with immune cell infiltration and have constructed a nomogram aimed at early diagnosing OA patients with MetS.

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.

Temporal trends in gender, etiology, severity and outcomes of acute pancreatitis in a third-tier Chinese city from 2013 to 2021

BACKGROUND

To evaluate temporal trends in gender, etiology, severity, outcomes, cost and median length of stay (MLS) in patients with acute pancreatitis (AP) in a third-tier Chinese city.

METHODS

Patients with AP admitted to a university hospital between January 2013 and December 2021. Relationships between etiology, prevalence of severe acute pancreatitis (SAP) and survey years were investigated by joinpoint regression analysis.

RESULTS

A total of 5459 (male 62.3%) patients with AP were included. Between January 2013 and December 2021, we observed: (a) the prevalence of biliary diseases-related AP was stable, while the prevalence of hypertriglyceridemia (HTG)-associated AP (Ptrend = 0.04) and alcohol-associated AP (Ptrend < 0.0001) both increased; (b) there was an increase in crude prevalence of SAP from 4.97% to 12.2% between 2013 and 2021 (Ptrend < 0.0001); (c) compared to female populations, male gender had a higher prevalence of AP; (d) there was a decrease in MLS from 11 days to 8 days (Ptrend < 0.0001) and in median cost of hospitalization (MCH) for all patients (from 20,166 to 12,845 YUAN) (Ptrend < 0.0001); (e) the overall in-hospital mortality rate was 1.28% (70/5459) for patients with AP. There was no statistically significant in the time trend of mortality during the study period (Ptrend = 0.5873). At multivariate analysis, survey year was associated with prevalence of SAP after adjustment by age and biliary diseases (OR: 1.07; 95% CI: 1.03-1.12). Based on the stratification by severity of disease, the decrease of MLS and MCH was more significant in non-SAP vs. SAP patients.

CONCLUSIONS

Over the observational period, the proportion of male patients with AP, prevalence of age-adjusted rate of HTG and alcohol-associated AP and SAP increased, while MLS and MCH for all patients decreased, and the time trend of mortality of AP was stable.

Home-based strength and balance exercises for fall prevention among older individuals of advanced age: a randomized controlled single-blind study

OBJECTIVE

This research was to explore the effectiveness, safety, and adherence of home-based strength and balance exercises for fall prevention among the self-reliant individuals of advanced age and analyzed the beneficial components.

METHOD

This randomized controlled single-blind study included 124 individuals aged 80 years and over(mean age 84.4±3.2 years). The test group (n=63) performed strength and balance exercises facilitated by sports video training (≥ 3 sessions a week, ≥ 30 minutes per session), while the control group (n=61) maintained their daily routines. We conducted a comprehensive geriatric assessment (self-care ability, muscle strength, mobility, cognition, and psychological status) at baseline and 12 months later and dynamic posture mapping for balance and gait.

RESULTS

The test group had a decreased risk of falls compared to the control group (25.4%vs.44.3%, respectively; RR = 0.747; 95% CI: 0.551-0.975; p = 0.027). There was no statistically significant difference in the fall rate between the two groups (0.48 falls per person-year vs. 0.67 falls per person-year, respectively; IRR: 0.708; 95% CI: 0.394-1.275; p = 0.251). The composite equilibrium score (SOTcom) for vestibular and integrated balance on the Sensory Organization Test (SOT) increased in the test group, while SOTcom decreased in the control group. In the test group, there was a significant improvement in the indexes pertaining to response time, movement speed, directional control, and endpoint offset in some directions. Adherence was better in the test group, with 54.0% exercised ≥ 3 times per week and 28.6% exercised 1-2 times per week on average.

CONCLUSION

Home-based strength and balance exercises improved balance and reduced the risk of falls among the individuals of advanced age. The video-guided, remotely monitored regimen demonstrated effectiveness, safety, and compliance, although scope for improvement remains.

"If you ask me … ": experienced cardiac rehabilitation patients' perspectives on maintaining regular heart-healthy physical activity

PURPOSE

Despite the proven benefits of regular exercise and physical activity (PA), engagement of cardiac patients and adherence to recommended PA remain challenging. This study aimed to interview cardiac patients who are experienced in maintaining a physically active lifestyle to gain insight into how regular PA can become part of one's life after a cardiac event.

METHODS

Twenty-five cardiac patients (18 men and 7 women; age range 39-83 years) participated in audio-recorded, semi-structured qualitative interviews. Patients were recruited from a clinical site in Salzburg, Austria, which offers ongoing weekly exercise classes under medical supervision for cardiac patients. Interview transcripts were analysed against the background of the Reasoned Action Approach and coded inductively.

RESULTS

Eight themes were generated that elucidated patients' long-term engagement with PA: well-being and physical benefits; health literacy; community, groups, and partners; attitude, expectation and mindset; professional supervision; digital technology; nice distractions; and possibility of personalized tailoring. These themes are linked to several elements of the Reasoned Action Approach, including attitude, norm, behavioural control, skills, and environment.

CONCLUSION

This study highlights important aspects with respect to shaping a positive attitude towards PA and the significance of the social environment in establishing regular PA in cardiac patients.

Trends of cause-specific cardiovascular disease mortality in China, 2009-2019: a nationwide longitudinal study

BACKGROUND

Cardiovascular disease (CVD) is the top cause of death in China. We aimed to identify trends in cause-specific CVD mortality in a rapidly developing country, thereby providing evidence for CVD prophylaxis.

MATERIALS AND METHODS

Using raw data from the Chinese National Mortality Surveillance (CNMS) system, we assessed the mortalities of all CVD and cause-specific CVD during 2009-2019. Temporal trends of crude mortality rates (CMRs) and age-standardized mortality (ASMRs) of CVD were evaluated using joinpoint regression models. Age-sex-specific CVD mortality rates were predicted by using age-period-cohort Poisson regression model.

RESULTS

A total of 10,608,402 CVD death occurred during 2009-2019, accounting for 49.8% of all-cause of death in China. The three major CVD types [cerebrovascular disease, ischemic heart disease (IHD) and hypertensive disease (HD)] accounted for 94.6% of total CVD deaths. The CMR of all CVD increased [the annual average percentage change (AAPC) = 3.4%, 95% confidence interval (CI) 2.6% to 4.1%] while the ASMR decreased (AAPC = -2.0%, 95% CI -3.5% to -0.6%). Cerebrovascular disease is predicted to be the leading cause of CVD death in men and IHD will be the top cause of CVD death in women over the period 2025-2029.

CONCLUSIONS

Although the ASMR of total CVD decreased, CVD remained the leading cause of death in China. Cerebrovascular disease, IHD and HD were the major three leading causes of CVD-related death. Inflammatory heart disease-associated death increased in the young population. Attention should be paid to premature deaths associated with cerebrovascular disease and rheumatic heart disease among rural residents.

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

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

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

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

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

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

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.

Machine learning-based analyses of contributing factors for the development of hypertension: a comparative study

OBJECTIVES

Sufficient attention has not been given to machine learning (ML) models using longitudinal data for investigating important predictors of new onset of hypertension. We investigated the predictive ability of several ML models for the development of hypertension.

METHODS

A total of 15 965 Japanese participants (men/women: 9,466/6,499, mean age: 45 years) who received annual health examinations were randomly divided into a training group (70%, n = 11,175) and a test group (30%, n = 4,790). The predictive abilities of 58 candidates including fatty liver index (FLI), which is calculated by using body mass index, waist circumference and levels of γ-glutamyl transferase and triglycerides, were investigated by statistics analogous to the area under the curve (AUC) in receiver operating characteristic curve analyses using ML models including logistic regression, random forest, naïve Bayes, extreme gradient boosting and artificial neural network.

RESULTS

During a 10-year period (mean period: 6.1 years), 2,132 subjects (19.1%) in the training group and 917 subjects (19.1%) in the test group had new onset of hypertension. Among the 58 parameters, systolic blood pressure, age and FLI were identified as important candidates by random forest feature selection with 10-fold cross-validation. The AUCs of ML models were 0.765-0.825, and discriminatory capacity was significantly improved in the artificial neural network model compared to that in the logistic regression model.

CONCLUSIONS

The development of hypertension can be simply and accurately predicted by each ML model using systolic blood pressure, age and FLI as selected features. By building multiple ML models, more practical prediction might be possible.

Circulating fibroblast growth factor 21 is associated with blood pressure in the Chinese population: a community-based study

BACKGROUND

Our research team previously found that fibroblast growth factor (FGF) 21, a circulating hormone, was significantly associated with atherosclerosis in human and animal models. The relationship between FGF21 and blood pressure (BP) is rarely studied in the Asian population. Therefore, we aimed to explore the relationship of FGF21 with BP in a Chinese population.

METHODS

We analysed data on 1051 participants from the Shenzhen-Hong Kong United Network on Cardiovascular Disease (SHUN-CVD) study.

RESULTS

The medians of FGF21 level were 355.1 pg/mL (IQR 234.3-574.8 pg/mL) for hypertensive patients and 253.5 (IQR 136.9-403.3 pg/mL) for non-hypertensive participants. Ln-transformed FGF21 level was associated with both systolic and diastolic BP (systolic BP: B = 4.45 [95% CI 3.41-5.49]; p < .001; diastolic BP: B = 2.72 [95% CI 2.03-3.42]; p < .001). After adjusting for sex, age, body mass index, hypercholesterolaemia, diabetes, alcohol consumption, smoking and physical activity, the association remained significant (systolic BP: B = 1.99 [95% CI 1.01-2.97]; p < .001; diastolic BP: B = 1.36 [95% CI 0.69-2.04]; p < .001). Serum FGF21 level was associated with hypertension (quartile 4 vs. quartile 1, OR = 4.19 [95% CI 2.65-6.61]; p for trend < .001).

CONCLUSIONS

This is the first study to elucidate the relationship of FGF21 with BP in the Asian population. FGF21 is significantly associated with BP. Besides its use as a biomarker, FGF21 may be a new drug target for hypertension treatment.

Piezo1 in microglial cells: Implications for neuroinflammation and tumorigenesis

Microglia, the central nervous system (CNS) resident immune cells, are pivotal in regulating neurodevelopment, maintaining neural homeostasis, and mediating neuroinflammatory responses. Recent research has highlighted the importance of mechanotransduction, the process by which cells convert mechanical stimuli into biochemical signals, in regulating microglial activity. Among the various mechanosensitive channels, Piezo1 has emerged as a key player in microglia, influencing their behavior under both physiological and pathological conditions. This review focuses on the expression and role of Piezo1 in microglial cells, particularly in the context of neuroinflammation and tumorigenesis. We explore how Piezo1 mediates microglial responses to mechanical changes within the CNS, such as alterations in tissue stiffness and fluid shear stress, which are common in conditions like multiple sclerosis, Alzheimer's disease, cerebral ischemia, and gliomas. The review also discusses the potential of targeting Piezo1 for therapeutic intervention, given its involvement in the modulation of microglial activity and its impact on disease progression. This review integrates findings from recent studies to provide a comprehensive overview of Piezo1's mechanistic pathways in microglial function. These insights illuminate new possibilities for developing targeted therapies addressing CNS disorders with neuroinflammation and pathological tissue mechanics.

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

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

Spatio-temporal patterns of health service delivery and access to maternal, child, and outpatient healthcare in Volta region, Ghana: a repeated cross-sectional ecological study using health facility data

BACKGROUND

To attain universal health care, health managers need to monitor progress in service uptake, changes and geographic coverage. Although routine health management information systems are now well established in many resource-constrained countries, such data have not yet been used to examine geographic access trends over time.

OBJECTIVE

This study aims to quantify changing patterns of geographic access to healthcare in the Volta Region, Ghana.

METHODS

The repeated cross-sectional ecological spatio-temporal analysis used routine health management information systems data from 2016 to 2022, and geospatial data to examine changes in healthcare accessibility and services provided for population subgroups. Changes in healthcare provision, travel time to services and population coverage were estimated.

RESULTS

Most health facilities (60.6%) provided the same range of services or added new services between 2016 and 2022. Childhood immunisation services had the highest geographic coverage within 30 min of the nearest health facility from 2016 to 2022 (minimum 97.2%), while Caesarean births had the lowest (maximum 75.2%). More health facilities provide antenatal services (2022: 59.9%) than birthing care (2022: 52.6%). Of all new health facilities, 93.2% were Community Health Planning and Services (CHPS) facilities. The majority of the population lived within 30 min of services in 2016 and 2022 for all the services studied.

CONCLUSION

The study provides a new approach to monitoring service changes through routine health data and spatial analysis. The analysis provided evidence to improve geographic accessibility, address gaps in service changes and consolidate the gains of high geographic coverage with quality care.

Cumulative associations between health behaviours, mental well-being, and health over 30 years

BACKGROUND

Both the number of risky health behaviours and the duration of exposure to these behaviours over time may increase the risk of later adverse outcomes. This study examined cumulative associations of risky health behaviours with both positive and negative aspects of mental well-being and health. It has a uniquely long follow-up period of over 30 years, from early adulthood to the beginning of late adulthood.

MATERIALS AND METHODS

The data were from the Jyväskylä Longitudinal Study of Personality and Social Development. The participants represent the Finnish age cohort born in 1959. This study utilized data collected at ages 27 (1986), 36 (1995), 42 (2001), 50 (2009), and 61 (2020-2021) (n = 206-326). Risk scores indicating the current number of risky behaviours of smoking, heavy alcohol consumption, and physical inactivity and their temporal accumulation over time were calculated. The associations of risk scores with mental well-being (depressive symptoms, psychological well-being) and health (self-rated health, number of metabolic risk factors) from age 36 onwards were analyzed with linear multilevel models adjusted for gender and education.

RESULTS

More current risky behaviours were associated with more depressive symptoms (B = 0.10, p = 0.032), lower psychological well-being (B = -0.10, p = 0.010), lower self-rated health (B = -0.45, p < 0.001), and more metabolic risk factors (B = 0.53, p = 0.013). The associations of temporal risk scores with the outcomes were even stronger (depressive symptoms: B = 0.38, p < 0.001; psychological well-being: B = -0.15, p = 0.046; self-rated health: B = -0.82, p < 0.001; metabolic risk factors: B = 1.49, p < 0.001). Among individual behaviours, the temporal risk score of alcohol consumption was negatively associated with most outcomes, while smoking was associated with poorer mental well-being and physical inactivity with poorer health.

CONCLUSIONS

The current and temporal accumulation of multiple risky health behaviours were associated with poorer mental well-being and health. Preventing these behaviours early in adulthood and midlife is crucial to avoid their accumulation and subsequent health risks.

Clinical outcomes of atrial fibrillation screening: a meta-analysis of randomized controlled trials

BACKGROUND

Several randomized controlled trials (RCTs) have investigated the benefits of atrial fibrillation (AF) screening. However, since none have shown a significant reduction in stroke rates, the impact of screening on clinical outcomes remains uncertain.

MATERIALS AND METHODS

We conducted a systematic review and meta-analysis of RCTs reporting clinical outcomes of systematic AF screening in participants without known AF. Pooled risk ratios (RRs) were computed for all-cause stroke or systemic embolism, major bleeding, and all-cause mortality, comparing screening with no screening.

RESULTS

Seven RCTs encompassing 76 458 participants were identified. One trial utilized implantable loop recorders for rhythm monitoring, while the others employed non-invasive screening methods. Pooled results indicated that AF screening was associated with a significant reduction in all-cause stroke or systemic embolism (RR 0.932, 95% CI 0.873-0.996, I2 = 0%, p = 0.037), but had no effect on major bleeding (RR 0.996, 95% CI 0.935-1.060, I2 = 0%, p = 0.876) or all-cause mortality (RR 0.987, 95% CI 0.945-1.031, I2 = 0%, p = 0.550). We estimated a number needed to screen of 148 to prevent one stroke or systemic embolism over a 10-year period in a population of 75-year-olds. When only non-invasive screening methods were considered, the reduction in strokes was not statistically significant (RR 0.942, 95% CI 0.880-1.008, I2 = 0%, p = 0.083).

CONCLUSIONS

Systematic AF screening is associated with a modest yet statistically significant 7% relative reduction in stroke and systemic embolism, with no observed impact on major bleeding or all-cause mortality.

The ESCAPER study-exploring protective mechanisms against cardiovascular disease in subjects at high risk: rationale, study protocol, and first results

Introduction. The ESCAPER project explores cardiovascular resilience in individuals who, despite a high-risk factor burden-longstanding Type 1 Diabetes (T1D), obesity, or kidney failure-avoid or delay macrovascular complications. This suggests underlying protective mechanisms. Initiated in September 2022, this exploratory study aims to uncover and define these mechanisms, potentially leading to novel therapeutic targets in preventive medicine. Research design and methods. Participants from the Skåne region, Southern Sweden, are divided into three subgroups: (1) T1D patients (>30 years duration) without macrovascular complications or macroalbuminuria, (2) obese individuals with normal cardiac function and no cardiovascular medications, and (3) kidney failure patients awaiting transplantation with no arterial calcification, alongside respective controls. Comprehensive phenotyping includes 24-h blood pressure, ECG monitoring, vascular ultrasound, cardiac MRI, and ergospirometry (in a subgroup), along with laboratory investigations, including biomarker and omics analyses. Arterial biopsies are collected from kidney failure patients. The study leverages Swedish national medical registries for detailed follow-up of healthcare utilization, diagnoses, and prescriptions, enabling longitudinal outcome assessments. Results. Initial findings from 90 T1D patients and 31 obese individuals indicate well-managed cardiovascular risk factors. The T1D subgroup shows a mean BMI of 25.6 kg/m2 and HbA1c of 52 mmol/mol, while the obesity subgroup presents a BMI of 32.9 kg/m2 with normal glucose levels. Conclusions. ESCAPER has the potential to advance understanding of cardiovascular resilience and refine prevention strategies. Its comprehensive methodology and registry-based follow-up provide robust insights into protective mechanisms and long-term outcomes.

Targeting capabilities of engineered extracellular vesicles for the treatment of neurological diseases

Recent advances in research on extracellular vesicles have significantly enhanced their potential as therapeutic agents for neurological diseases. Owing to their therapeutic properties and ability to cross the blood-brain barrier, extracellular vesicles are recognized as promising drug delivery vehicles for various neurological conditions, including ischemic stroke, traumatic brain injury, neurodegenerative diseases, glioma, and psychosis. However, the clinical application of natural extracellular vesicles is hindered by their limited targeting ability and short clearance from the body. To address these limitations, multiple engineering strategies have been developed to enhance the targeting capabilities of extracellular vesicles, thereby enabling the delivery of therapeutic contents to specific tissues or cells. Therefore, this review aims to highlight the latest advancements in natural and targeting-engineered extracellular vesicles, exploring their applications in treating traumatic brain injury, ischemic stroke, Parkinson's disease, Alzheimer's disease, amyotrophic lateral sclerosis, glioma, and psychosis. Additionally, we summarized recent clinical trials involving extracellular vesicles and discussed the challenges and future prospects of using targeting-engineered extracellular vesicles for drug delivery in treating neurological diseases. This review offers new insights for developing highly targeted therapies in this field.

Understanding the link between type 2 diabetes mellitus and Parkinson's disease: role of brain insulin resistance

Type 2 diabetes mellitus and Parkinson's disease are chronic diseases linked to a growing pandemic that affects older adults and causes significant socio-economic burden. Epidemiological data supporting a close relationship between these two aging-related diseases have resulted in the investigation of shared pathophysiological molecular mechanisms. Impaired insulin signaling in the brain has gained increasing attention during the last decade and has been suggested to contribute to the development of Parkinson's disease through the dysregulation of several pathological processes. The contribution of type 2 diabetes mellitus and insulin resistance in neurodegeneration in Parkinson's disease, with emphasis on brain insulin resistance, is extensively discussed in this article and new therapeutic strategies targeting this pathological link are presented and reviewed.

Impact of cognitive rehabilitation interventions on memory improvement in patients after stroke: A systematic review

BACKGROUND

Cognitive impairment is a major cause of disability in patients who have suffered from a stroke, and cognitive rehabilitation interventions show promise for improving memory.

AIM

To examine the effectiveness of virtual reality (VR) and non-VR (NVR) cognitive rehabilitation techniques for improving memory in patients after stroke.

METHODS

An extensive and thorough search was executed across five pertinent electronic databases: Cumulative Index to Nursing and Allied Health Literature; MEDLINE (PubMed); Scopus; ProQuest Central; and Google Scholar. This systematic review was conducted following the preferred reporting items for systematic reviews and meta-analyses guideline. Studies that recruited participants who experienced a stroke, utilized cognitive rehabilitation interventions, and published in the last 10 years were included in the review.

RESULTS

Thirty studies met the inclusion criteria. VR interventions significantly improved memory and cognitive function (mean difference: 4.2 ± 1.3, P < 0.05), whereas NVR (including cognitive training, music, and exercise) moderately improved memory. Compared with traditional methods, technology-driven VR approaches were particularly beneficial for enhancing daily cognitive tasks.

CONCLUSION

VR and NVR reality interventions are beneficial for post-stroke cognitive recovery, with VR providing enhanced immersive experiences. Both approaches hold transformative potential for post-stroke rehabilitation.

Ambient air pollution in critical windows of exposure and spontaneous miscarriage in a preconception cohort

Air pollution may increase spontaneous miscarriage risk, potentially through inflammation. Prior studies are heterogeneous, and none have used a mixtures approach. We used data from participants who conceived in a prospective time-to-pregnancy study (N = 446) in North Carolina to examine spontaneous miscarriage, defined as a positive home pregnancy test and a self-reported pregnancy loss before gestational week 20 (N = 101). We characterized average and peak exposure to PM10, PM2.5, CO, NO, NO2, SO2, and O3 through linked residential addresses with fusion and chemical transport models. We used single pollutant and exposure mixtures models (quantile-based g-computation) to estimate associations in six exposure windows including spermatogenesis, early follicle development, and the follicular and luteal phases of the conception cycle. Sensitivity analyses stratified by vitamin D level (an anti-inflammatory). Multivariable Cox proportional hazards models estimated adjusted hazard ratios (HR) and 95 % confidence intervals (CI) per interquartile range increase in pollutant concentration. In exposure mixtures models, while the confidence intervals were wide, the magnitude and direction of several estimates were consistent with increased spontaneous miscarriage risk with increasing air pollutant exposure: spermatogenesis (HR [CI]: 1.2 [0.80, 1.8]), early follicle development (1.2 [0.80, 1.8]), and luteal phase (1.2 [0.80, 1.9]). Associations were stronger among those with low vitamin D, for example, increasing ozone was associated with increased spontaneous miscarriage only among those with low vitamin D (follicular phase HR [CI]: 3.1 [1.3, 7.4] vs. 0.84 [0.46, 1.5] for high vitamin D, pinteraction = 0.002). Air pollutants may be associated with small increases in miscarriage risk, but larger mixtures studies are needed. Further study of low vitamin D and air pollution risk is important for understanding the public health implications of vitamin D supplementation.

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.

Design, synthesis, and biological evaluation of TRPV4-KCa2.3 coupling enhancers as novel therapeutic agents for hypertension

Although current treatment strategies for hypertension are well-developed, there remains a group of patients who do not respond adequately to available medications. As a result, the identification of new therapeutic targets and the design of target-specific drugs are crucial directions for the future management of hypertension. Our previous research identified the TRPV4-KCa2.3 complex as a novel target for hypertension treatment, leading to the discovery of the positive compound JNc-440. Using JNc-440 as a lead molecule, 21 compounds were designed and synthesized across five distinct series. Among these, representative compounds IB-2 and II-9 demonstrated the ability to restore the coupling of the decoupled complex under hypertensive conditions and significantly reduced blood pressure in a high salt-induced hypertensive mouse model. This work lays a foundation for the future development of novel therapeutics targeting hypertension.

PM2.5 concentration prediction algorithm integrating traffic congestion index

In this study, a strategy is proposed to use the congestion index as a new input feature. This approach can reveal more deeply the complex effects of traffic conditions on variations in particulate matter (PM2.5) concentrations. To assess the effectiveness of this strategy, we conducted an ablation experiment on the congestion index and implemented a multi-scale input model. Compared with conventional models, the strategy reduces the root mean square error (RMSE) of all benchmark models by > 6.07 % on average, and the best-performing model reduces it by 12.06 %, demonstrating excellent performance improvement. In addition, even with high traffic emissions, the RMSE during peak hours is still below 9.83 µg/m3, which proves the effectiveness of the strategy by effectively addressing pollution hotspots. This study provides new ideas for improving urban environmental quality and public health and anticipates inspiring further research in this domain.

Relationship prediction between clinical subtypes and prognosis of critically ill patients with cirrhosis based on unsupervised learning methods: A study from two critical care databases

BACKGROUND

Our objective was to identify distinct clinical subtypes among critically ill patients with cirrhosis and analyze the clinical features and prognosis of each subtype.

METHODS

We extracted routine clinical data within 24 h of ICU admission from the MIMIC-IV database. To determine the number of clinical subtypes, we employed the "elbow method," "cumulative distribution function (CDF) plot," and "consensus matrix." Consensus k-means, k-means, and SOM methods were used to identify different clinical subtypes of critically ill cirrhosis. We validated our findings using patients from the eICU database. The SHapley Additive exPlanations (SHAP) method was used to explore the features of each clinical subtype, and 28-day Kaplan-Meier curves were generated. Survival differences among the clinical subtypes were assessed using the log-rank test.

RESULTS

Our study included 2,586 patients from the MIMIC-IV database and 1,670 patients from the eICU database. Based on the clinical routine variables, we identified three clinical subtypes among patients in the MIMIC-IV database. Subtype A (N = 1424, 55.07 %) was labeled the "common subtype" and exhibited the lowest mortality. Subtype B (N = 703, 27.18 %) was classified as the "hyperinflammatory response subtype" and had a relatively high mortality. Subtype C (N = 459, 17.75 %) was identified as the "liver dysfunction subtype" and had the highest mortality. These findings were consistent with the results obtained from both the internal validation set (MIMIC-IV database) and the external validation set (eICU database).

CONCLUSIONS

Our study presents a novel and clinically applicable approach for subtyping critically ill cirrhosis.

Application and progress of hyperbaric oxygen therapy in cardiovascular diseases

Cardiovascular diseases remain the leading cause of death worldwide, underscoring the urgent need for additional therapeutic strategies to reduce their mortality rates. This review systematically outlines the historical development and recent advances of hyperbaric oxygen therapy in cardiovascular diseases, with a focus on its therapeutic mechanisms and clinical outcomes. Hyperbaric oxygen therapy enhances oxygen delivery to ischemic and reperfused tissues, promotes angiogenesis, and significantly suppresses oxidative stress, inflammatory cascades, and cardiomyocyte apoptosis, demonstrating multifaceted therapeutic potential in cardiovascular conditions. Specifically, hyperbaric oxygen therapy combined with reperfusion strategies has been shown to markedly improve left ventricular ejection fraction in acute myocardial infarction. In heart failure, it facilitates myocardial repair and enhances cardiac function. For arrhythmias, hyperbaric oxygen therapy effectively reduces the frequency and duration of premature ventricular contractions and paroxysmal tachycardia, while mitigating the risk of neurological complications following atrial fibrillation ablation. Furthermore, hyperbaric oxygen therapy preconditioning in cardiac surgery has demonstrated improvements in left ventricular stroke work, reductions in postoperative myocardial injury, and a decrease in related complications. Despite its promising applications, the widespread adoption of hyperbaric oxygen therapy remains hindered by the lack of standardized treatment protocols and high-quality evidence from rigorous clinical trials. In conclusion, this review underscores the potential value of hyperbaric oxygen therapy in the cardiovascular domain while highlighting the need for further optimization of therapeutic parameters and exploration of its synergistic effects with conventional therapies to provide clearer guidance for clinical implementation.

Egg white peptides suppress ghrelin secretion from the stomach by activating the mTOR signaling pathway in rats

Egg consumption has usually been associated with reduced food intake. This study aimed to investigate the effects of egg white-derived peptides on the plasma ghrelin levels and its secretion from the stomach in rats after oral administration. The findings revealed that egg white protein hydrolysate (EWH) generated through simulated gastrointestinal digestion significantly decreased food intake, plasma ghrelin levels, and ghrelin expression in the stomach and duodenum of normal and high-fat diet (HFD)-fed rats. EWH effectively ameliorated the glucose and lipid metabolism disorders and liver injury in HFD-fed rats. In addition, EWH directly inhibited ghrelin secretion in isolated gastric fundus tissue and gastric fundal mucosal primary cells. RNA-sequencing analysis of the gastric fundal mucosal primary cells revealed that EWH treatment induced upregulation of 1590 genes and downregulation of 2650 genes in gastric fundal mucosal primary cells with significant enrichment of the mTOR signaling pathway in KEGG analysis. Moreover, the result of the western blot showed that EWH significantly improved the phosphorylation of mTOR in the gastric fundus, suggesting that EWH might suppress ghrelin secretion by activating the mTOR signaling pathway. This study shows the suppressive effect of EWH on ghrelin secretion and its potential as a bioactive ingredient in functional foods for managing food intake and body weight.

Impact of improved air quality on lung function and blood pressure of middle-aged and older population in China

Long-term exposure to fine particulate matters (PM2.5) has been associated with respiratory and cardiovascular diseases and the burden are potentially higher in China experiencing heavy air pollution. In this study, we established the exposure-response association between long-term exposures to PM2.5 and lung function and blood pressure in Chinese middle-aged and older adults using linear mixed-effects and generalized additive mixed models based on 3 waves longitudinal health outcomes data by enrolling 19,988 participants from 121 cities across the mainland of China. We also assessed the effect of Clean Air Policy (CAP) based on a quasi-experimental difference-in-differences (DID) design. A 10 µg/m3 increase in PM2.5 concentration was associated with a 7.18 (95 % confidence interval [CI]: -8.35, -6.02) L/min decrease in PEF (peak expiratory flow) and a 0.72 (95 % [CI]: 0.53, 0.90) and a 0.30 (95 % [CI]: 0.18, 0.42) mmHg increase in systolic and diastolic blood pressure, respectively. The associations were more pronounced in males and rural areas for PEF, but similar across subgroups for blood pressure. DID results suggested that the effect of CAP on health outcomes were sensitive to magnitudes of reduction in PM2.5. A 5 µg/m3 reduction in PM2.5 or more generally led to 18.70 (95 % [CI]: 0.79, 36.61) higher PEF and -2.05 (95 % [CI]: -3.87, -0.23) lower diastolic blood pressure, respectively, compared to no reduction or increase in exposure. However, the effects were significant only in rural areas. Our analysis support CAP aiming to benefit public health and provides insights to inform future control policy for efficiently decreasing air pollution exposure burden.

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.

Scoring adherence to voluntary restriction diets (SAVoReD) in the ADAPT study

Voluntary adoption of popular food-group-restricting diets like Paleo and plant-based diets (PBDs) are often health-motivated. However, unlike the theoretical design of these diets, different levels of dietary adherence may result in different diet quality and bodyweight in real-world settings-a limitation to the efficacy of dietary interventions. Scoring Adherence to Voluntary Restriction Diets (SAVoReD) is a metric to quantify and compare adherence across food-group-restricting diets. We applied the score to four diets, whole food plant-based (WFPB), vegan, vegetarian, and Paleo to examine associations between adherence and diet quality (Healthy Eating Index; HEI), body mass index (BMI), and diet duration. We also explored the independent associations of adherence and duration with BMI. Higher adherence to WFPB and vegan diets was significantly associated with lower BMI, but no association was observed for vegetarian or Paleo diet followers. For vegan and WFPB, greater adherence was associated with lower BMI among those following their diet ≥2 years compared to <2 years. Adherence was lowest in the diet with the most restrictions (WFPB); however, the stricter fully plant-based diets (WFPB and vegan) had the healthiest HEI scores and BMIs and many long-term followers. Our results suggest that identification with fully plant-based diets is associated with better diet quality and BMI. Vegan, vegetarian, and WFPB diets are often grouped as 'plant-based diets' despite the differing diet compositions, diet quality, adherence, and BMI of followers-thus, grouping them may distort findings. Individuals may benefit from encouragement following a fully plant-based diet, even without perfect adherence.

Associations between fine particulate matter and in-home blood pressure during the 2022 wildfire season in Western Montana, USA

Wildfires continue to increase in size, intensity, and duration. There is growing evidence that wildfire smoke adversely impacts clinical outcomes; however, few studies have assessed the impact of wildfires on household air quality and subclinical cardiovascular health indicators. We measured continuous indoor and outdoor fine particulate matter (PM2.5) concentrations from July-October 2022 at 20 residences in the rural, mountainous state of Montana in the United States. We used a combination of satellite-derived smoke plume data from the National Oceanic and Atmospheric Administration's Hazard Mapping System and household-level daily mean PM2.5 concentrations to classify wildfire-impacted days. One participant from each household self-reported in-home blood pressure (BP) on weekly electronic surveys. We used linear mixed-effects regression models to assess associations between air pollution exposures (PM2.5 concentrations; number of wildfire-impacted days) and systolic BP (SBP) and diastolic BP (DBP). Models were adjusted for potential time-variant confounders including temperature, humidity, and self-reported exercise. Compared to survey periods with 0 wildfire days, SBP was 3.83 mmHg higher (95% Confidence Interval [95% CI]: 0.22, 7.44) and DBP was 2.36 mmHg higher (95% CI: -0.06, 4.78) during periods with 4+ wildfire days. Across the entire study period, a 10 µg m-3 increase in indoor PM2.5 was associated with 1.34 mmHg higher SBP (95%CI: 0.39, 2.29) and 0.71 mmHg higher DBP (95% CI: 0.07, 1.35). We observed that wildfire-impacted days and increasing household-level PM2.5 concentrations are associated with higher in-home BP. Our results support growing literature which indicates that wildfires adversely impact subclinical cardiovascular health. Clinical and public health messaging should emphasize the cardiovascular health impacts of wildfire smoke and educate on exposure-reduction strategies such as indoor air filtration.

Prevalence, genomic features, and antibiotic sensitivities of Neisseria meningitidis isolates from patients with invasive meningococcal disease and healthy carriers in Zhejiang Province, 2015-2023

OBJECTIVE

A comprehensive understanding of invasive meningococcal disease (IMD) and healthy carriers is critical to monitor, control, and prevent the disease. This study investigated the epidemiology of IMD cases and carriage, and compared population-specific genetic variations and antimicrobial susceptibility of Neisseria meningitidis (N. meningitidis) strains isolated from patients with IMD and carriers.

METHODS

Surveillance data from 2015 to 2023 on patients with epidemic meningitis and healthy carriers in Zhejiang Province, China. We successfully collected 21 isolates from meningitis patients and 16 isolates from healthy individuals during this period. Serogroups of a total of 37 N. meningitidis isolates were determined by polymerase chain reaction (PCR) and slide agglutination, as well as whole genome sequencing to assess various genes, single nucleotide polymorphisms (SNPs), and core-pan genome differences. The antibiotic susceptibility of 37 isolates to 12 antibiotics was evaluated using the E-Test on Mueller-Hinton agar supplemented with 5 % sheep blood.

RESULTS

The annual incidence of IMD and carriage rates remained relatively low from 2015 to 2023. IMD cases were primarily observed in infants under 12 months-of-age. Healthy carriers were predominantly 5-9 and 30-59 years-of-age. Population gene analysis revealed no significant difference in genes between the two groups. Strains of patient and carrier groups were both highly resistant to quinolones and sulfonamides.

CONCLUSIONS

The findings enhance the understanding of N. meningitidis carriage in the context of prevalent invasive meningococcal strains. The findings will facilitate the development and updating of the immunization program of meningitis vaccine, and are critical in understanding the spread and drug use strategies of N. meningitidis.

A new approach for small-diameter vascular grafts using combined dip-coating of silk fibroin and elastin-like recombinamers

Compliance mismatch and suboptimal hemocompatibility prevent the use of the traditional materials used for vascular prostheses or degradable synthetic polymers as small-diameter vessel bypass grafts. Here, we show the combination of silk fibroin and elastin-like recombinamers in a dip-coating multilayer setup to achieve smooth small-diameter vascular grafts with ultrathin wall thickness. We found in both FTIR and mechanical characterization that the novel material combination was successful through the double crosslinked interpenetrated network formed by elastin-like recombinamers and silk fibroin. This enabled the graft to have mechanical compliance that followed physiological behaviour, differently from the synthetic materials traditionally used in clinics. The mechanical behaviour of these grafts also achieved burst pressure (745.44 ± 102.92 mmHg) and suture retention strength (0.86 ± 0.13 N) required for clinical application. The structure proved to have low platelet adhesion in the thrombogenicity assessment (3.79 ± 3.26 % of platelet area coverage), which is essential for successful outcomes in physiological conditions. Our results demonstrate the successful combination of the two materials in a technology platform that can be adjusted in both diameter and wall thickness and possesses suitable properties as a small-diameter vascular graft. We anticipate these results to be the starting point for more in vitro and in vivo tests possibly transitioning into clinical application.

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.

Regulating peroxisome proliferator activated receptor gamma coactivator-1alpha (PGC-1α): A potential role in neurological disorder and treatment

Neurological disorders are catastrophic and challenging conditions that affect central nervous system. They constitute a major health problem worldwide and place a huge economic burden on society and individuals. Extensive evidence has shown that peroxisome proliferator-activated receptor gamma coactivator-1alpha (PGC-1α) is an essential macromolecule that could be targeted to ameliorate the pathology of neurological disorders. This review is the first to summarize studies that have used therapeutics targeted to influence PGC-1α transcription and/or protein abundance/stability to treat neurological diseases. Moreover, the therapeutic target role of PGC-1α has been clarified in neurological disorders from the potential therapeutic agent that targets PGC-1α, for example, chemical agents, proteins and peptides, nucleic acids, and natural extracts. The scientific evidence summarized in this review demonstrates that targeting PGC-1α is an effective strategy for the treatment of neurological disorders. Moreover, PGC-1α could be used as a target to screen or discover new safe and effective natural products, chemical compounds, nucleic acids, or proteins for treating neurological disorders. This review provides new insights that targeting PGC-1α is an efficient strategy for the therapy of neurological disorders and providing key protein target for developing and screening new, safe, and effective PGC-1α agonists against neurological disorders.

From bioinformatics to clinical application: A new strategy in CRP detection with peptide aptamer

C-Reactive protein (CRP) is a key biomarker for evaluating inflammation levels and estimating cardiovascular risk. However, current CRP detection methods rely on monoclonal antibodies (mAb), which possess shortcomings such as a lengthy preparation cycle, high cost, and poor repeatability. To address these challenges, we explored the potential of peptide aptamers as an alternative to mAb for CRP detection. Using some bioinformatics approaches, we designed and optimized peptide aptamers, selecting the dominant peptide aptamer C9m (KWRWRFRLSR) through experimental validation for its specific recognition of CRP. We then established a sandwich ELISA detection system combining C9m with CRP mAb. This system demonstrated a detection limit of 22.275 ng/mL CRP and exhibited excellent specificity, with no cross-reactivity observed with human serum albumin or γ-globulin. The method also showed high reproducibility, with intra- and inter-assay coefficients of variation (CV) less than 15 %, meeting laboratory testing standards. Furthermore, comparison with clinically used immunoturbidimetry revealed high consistency (r = 0.9891).

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

BACKGROUND

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

METHODS

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

RESULTS

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

LIMITATIONS

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

CONCLUSION

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

U-shaped relationship between serum phosphate levels and mortality in critically ill patients with atrial fibrillation: Insights from the MIMIC-IV database

INTRODUCTION

Atrial fibrillation (AF), a common arrhythmia in critically ill patients, significantly affects prognosis. While phosphate disturbances are strongly associated with cardiovascular risks, the impact of serum phosphate on critically ill AF patients' prognosis remains uncertain.

METHODS

Utilizing data from the MIMIC-IV database, we retrospectively analyzed 11,744 critically ill AF patients. The primary outcome was 30-day all-cause mortality, with secondary outcomes at 90 days and 1 year. Cox regression models quantified the association between serum phosphate and mortality. Nonlinear associations were evaluated using restricted cubic splines (RCS), with inflection points further characterized through segmented Cox proportional hazards model.

RESULTS

Mortality rates at 30 days, 90 days, and 1 year were 12.7 %, 14.4 %, and 15.8 %, respectively. Kaplan-Meier analysis showed higher mortality in patients with high phosphate levels. Adjusted Cox regression demonstrated that hyperphosphatemia independently predicted increased mortality at 30 days (HR: 1.55, 95 % CI: 1.36-1.78, p < 0.001), 90 days (HR: 1.55, 95 % CI: 1.37-1.76, p < 0.001), and 1 year (HR: 1.57, 95 % CI: 1.39-1.77, p < 0.001). RCS and two-piece Cox regression revealed a U-shaped nonlinear relationship between serum phosphate and mortality, with risk decreasing below a threshold and increasing above it. Similar patterns were observed across all time points.

CONCLUSION

Our findings demonstrated a U-shaped relationship between serum phosphate levels and mortality in critically ill AF patients, highlighting the importance of maintaining optimal phosphate levels in managing this population.

The association between serum Beta-2 microglobulin and cardiovascular disease in postmenopausal women

BACKGROUND

Despite evidence indicating that postmenopausal women are at a higher risk of cardiovascular diseases (CVD) than premenopausal women and men, research on monitoring and preventing CVD in this demographic remains incomplete.

METHODS

Using publicly available 1999-2004 National Health and Nutrition Examination Survey (NHANES) data, serum beta-2-microglobulin (β-2 M) was initially assessed by stratifying it into quartiles. We examined the relationship of β-2 M and other common cardiovascular predictors to CVD using ROC curves. A stratified approach was employed for multifactor weighted logistic regression analyses, followed by sensitivity analyses using propensity score matching and multiple imputation.

RESULTS

In postmenopausal women, β-2 M was positively and statistically significantly associated with cardiovascular disease (p < 0.05). ROC curves showed that the area under the curve (AUC) for β-2 M was higher than that of other common predictors of cardiovascular disease(p < 0.05). Although second only to N-terminal brain natriuretic peptide (NT-proBNP), there was no significant difference in the predictive efficacy of these two markers (p > 0.05). Subgroup analyses revealed that β-2 M was significantly correlated with an increasing risk of CVD in postmenopausal women with higher education (more than high school), poverty income ratio (PIR) of 1.30-3.50, BMI ≥30.0, and hypertension (p < 0.05). After further adjustment of model 2, sensitivity analyses yielded consistent results, maintaining statistical significance (p < 0.05).

CONCLUSIONS

In postmenopausal women, β-2 M is strongly associated with CVD, even within specific subgroups. Additionally, β-2 M is a potent indicator of CVD. Further prospective studies are needed to validate these findings in the future.

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.

Neuroprotective potential for mitigating ischemia-reperfusion-induced damage

Reperfusion following cerebral ischemia causes both structural and functional damage to brain tissue and could aggravate a patient's condition; this phenomenon is known as cerebral ischemia-reperfusion injury. Current studies have elucidated the neuroprotective role of the sirtuin protein family (Sirtuins) in modulating cerebral ischemia-reperfusion injury. However, the potential of utilizing it as a novel intervention target to influence the prognosis of cerebral ischemia-reperfusion injury requires additional exploration. In this review, the origin and research progress of Sirtuins are summarized, suggesting the involvement of Sirtuins in diverse mechanisms that affect cerebral ischemia-reperfusion injury, including inflammation, oxidative stress, blood-brain barrier damage, apoptosis, pyroptosis, and autophagy. The therapeutic avenues related to Sirtuins that may improve the prognosis of cerebral ischemia-reperfusion injury were also investigated by modulating Sirtuins expression and affecting representative pathways, such as nuclear factor-kappa B signaling, oxidative stress mediated by adenosine monophosphate-activated protein kinase, and the forkhead box O. This review also summarizes the potential of endogenous substances, such as RNA and hormones, drugs, dietary supplements, and emerging therapies that regulate Sirtuins expression. This review also reveals that regulating Sirtuins mitigates cerebral ischemia-reperfusion injury when combined with other risk factors. While Sirtuins show promise as a potential target for the treatment of cerebral ischemia-reperfusion injury, most recent studies are based on rodent models with circadian rhythms that are distinct from those of humans, potentially influencing the efficacy of Sirtuins-targeting drug therapies. Overall, this review provides new insights into the role of Sirtuins in the pathology and treatment of cerebral ischemia-reperfusion injury.

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.

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

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

Infarct-like myocarditis in adolescents: Exploring genetic insights from diagnosis through follow-up

BACKGROUND

Myocarditis has traditionally been considered an acquired condition, but recent evidence suggests a genetic contribution, primarily in complicated cases. Data on pediatric uncomplicated or infarct-like myocarditis remain scarce. This study aimed to assess the prevalence of pathogenic or likely pathogenic (P/LP) variants in adolescents with infarct-like myocarditis and their association with clinical and imaging findings.

METHODS

This prospective, multicenter study included 30 adolescents diagnosed with infarct-like myocarditis across five hospitals in Catalunya, Spain (2016-2024). Diagnosis was confirmed using the 2018 Lake Louise Criteria on cardiac magnetic resonance imaging (CMR). Follow-up CMR was performed at 12 months, and genetic testing was conducted using a next-generation sequencing panel targeting 174 genes associated with inherited cardiac diseases.

RESULTS

P/LP variants in cardiomyopathy-associated genes were identified in 22.2 % of patients. Baseline CMR showed no significant differences in ventricular function or LGE extent, but a ring-like LGE pattern was significantly associated with genetic findings (p = 0.025), while septal involvement showed a p-value of 0.056. Over a median follow-up of 3 years (IQR 2-7), 9 patients (30 %) experienced recurrent myocarditis, more frequently in genetic-positive patients (66.7 % vs. 23.8 %). At 12 months, genetic-positive patients exhibited a greater LGE burden (p = 0.047) and persistent myocardial edema on T2-STIR (p = 0.009), suggesting ongoing myocardial remodeling.

CONCLUSIONS

The high prevalence of P/LP variants in infarct-like myocarditis highlights the need for genetic testing, particularly in patients with a ring-like LGE pattern or septal involvement. Persistent CMR abnormalities and symptomatic recurrences in genetic-positive cases support long-term monitoring, even in seemingly uncomplicated presentations.

The prescribing patterns and effectiveness of sedatives and analgesics for severe traumatic brain injury patients in Taiwan

BACKGROUND

Traumatic brain injury (TBI) is a major global health challenge associated with high mortality and morbidity. Secondary brain injury caused by disrupted intracranial pressure (ICP) regulation often necessitates sedation; however, guidelines lack specificity for TBI management.

METHODS

This study analyzed sedation and analgesia prescribing patterns and their outcomes in severe TBI patients in Taiwan using National Health Insurance Research Database data (2012-2019). Severe TBI patients intubated during intensive care unit (ICU) hospitalization were included. The primary outcome was 30-day all-cause mortality, with sensitivity analyses for 14-day mortality and 30-day all-cause mortality excluding deaths within 3 days. Inverse probability of treatment weighting (IPTW) was applied to balance patient characteristics across groups. Mortality rates across groups were evaluated using Kaplan-Meier survival analysis. At the same time, the Cox proportional hazards model simultaneously assessed the impact of various risk factors, such as age and comorbidities, on mortality.

RESULTS

Among 6030 patients, sedation and analgesia patterns varied, with midazolam combined with opioids being the most common regimen. Compared to the reference group (sedatives with opioids), the risk of death was highest in the no-prescription group (HR = 2.73, 95 % CI = 2.60-2.86), followed by the sedation-only group (HR = 1.58, 95 % CI = 1.50-1.66) and the opioids-only group (HR = 1.49, 95 % CI = 1.42-1.57; all p < 0.0001). Sensitivity analyses confirmed consistent trends.

CONCLUSIONS

These findings underscore the importance of optimizing sedation practices and enhancing awareness to improve outcomes for severe TBI patients.

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

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