Relationship Between Hepatic Iron Concentration and Glycemic Metabolism, Prediabetes, and Type 2 Diabetes: A Systematic Review

CONTEXT

Emerging research has suggested a potential link between high iron levels, indicated by serum ferritin levels, and the development of type 2 diabetes (T2D). However, the role of hepatic iron concentration (HIC) on T2D development and progression is not well understood.

OBJECTIVES

This study aims to systematically review the literature on HIC and/or the degree of hepatic iron overload (HIO) in individuals with prediabetes and/or diagnosed T2D, and to analyze associations between HIC and markers of glucose metabolism.

DATA SOURCES

The databases Medline, PubMed, Embase, CINAHL, and Web of Knowledge were searched for studies published in English from 1999 to March 2024. This review followed the Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.

DATA EXTRACTION

Data were extracted following the established eligibility criteria. Study characteristics and biomarkers related to prediabetes, T2D, and HIO were extracted. The risk of bias was analyzed using the Newcastle-Ottawa Scale. Data were stratified by the exposure and analyzed in subgroups according to the outcome. Data regarding the HIC values in controls, individuals with prediabetes, and individuals with T2D and the association estimates between HIC or HIO and markers of glycemic metabolism, prediabetes, or T2D were extracted.

DATA ANALYSIS

A total of 12 studies were identified, and data from 4110 individuals were analyzed. HIO was not consistently observed in prediabetic/T2D populations; however, elevated HIC was frequently observed in prediabetic and T2D individuals, and was associated with the disruption of certain glycemic markers in some cases.

CONCLUSION

The extent of iron overload, as indicated by hepatic iron load, varied among the prediabetic and T2D populations studied. Further research is needed to understand the distribution and regulation of iron in T2D pathology.

Efficacy of Mitochondrial Transfer in Healing Toxin-Induced Damage to Neuromuscular Junction, an Empirical Study

Neuromuscular diseases and damage affect many people of all ages and are responsible for an exorbitant medical cost, more than $200 million annually. Accordingly, finding an appropriate model to investigate potential curative interventions is necessary. One currently used involves the application of toxic agents on skeletal muscle followed by mitochondrial transplant therapy. A question regarding this model is whether such toxins impact not only muscle tissue but also the neuromuscular junctions (NMJs) responsible for exciting the muscle tissue. This question was addressed here by forming four experimental groups of C57BL/six mice (10-14 per group) that were 8-12 weeks of age: 1) controls whose muscles had not been injured or treated, 2) muscles taken from mice that were injured and then treated with mitochondrial supplement, 3) muscles that had not been injured but were still treated with mitochondria, and 4) muscles that were injured and received no mitochondrial treatment. Several pre- and postsynaptic features of NMJs were subject to immunofluorescent staining procedures before having morphological features assessed with confocal microscopy. Results revealed that only postsynaptic acetylcholine (ACh) receptors showed any significant (p < 0.05) between-group differences, including decreased area size and perimeter length around ACh receptor clusters in injured NMJs. However, presynaptic nerve terminal branching was not different (p > 0.05) among treatment groups, and structural features were not different between groups with the exception of dispersion of postsynaptic receptors. Overall, these results suggest that skeletal muscles damaged with toxin accurately mimic what occurs during toxin-induced damage and post-injury recovery and can be used as a faithful model of occurrences during damage to NMJs as a result of muscle damage along with recovery from that insult.

Psychosis associated with dementia: evaluation and management

Dementia is one of the most common neurodegenerative disorders in the world, and 34-63 % of individuals with dementia have psychotic symptoms. Neurobiological correlates of dementia with psychosis include significantly increased densities of senile plaques and neurofibrillary tangles and higher D3 receptor density. Limitations of proposed diagnostic criteria include a lack of specificity for psychotic symptoms in individuals with dementia, a lack of consistent differentiation between symptoms, late recognition, and not accounting for comorbid depression or agitation that may be the primary symptom, which makes diagnosis challenging. This review aims to provide clinicians, researchers, and policymakers with a comprehensive evaluation of psychosis in dementia, covering its epidemiology, neurobiology, diagnosis, and treatment strategies. We review both psychosocial and pharmacological interventions for dementia-related psychosis. Psychosocial treatments such as meaningful communication between persons with dementia and their caregivers, simplifying the living environment, and optimizing tasks can help reduce the adverse impact of psychosis. Evidence from meta-analyses indicates modest efficacy for cholinesterase inhibitors, antidepressants, and antipsychotics for psychosis in dementia. The use of antipsychotic medications is limited by increased risks for serious adverse effects including cerebrovascular events and death. Emerging therapies such as xanomeline-trospium present promising avenues for treatment. By synthesizing current evidence and clinical guidelines, this review provides a framework for improving diagnosis and treatment of psychosis in dementia, helping clinicians and researchers refine patient care strategies while informing future research directions.

Obesity and its management in primary care setting

Obesity is a worldwide epidemic affecting adults and children, regardless of their socioeconomic status. Significant progress has been made in understanding the genetic causes contributing to obesity, shedding light on a portion of cases worldwide. In young children with severe obesity however, recessive mutations, i.e., leptin or leptin receptor deficiency should be sought. Much more has been learned about the far-reaching impact of obesity on complications, including cardiovascular disease, liver and kidney dysfunction, diabetes, inflammation, hypertension, sleep, cancer, and the eye. Preventive strategies, particularly in children, are crucial for reducing obesity rates and mitigating its long-term complications. While dietary modifications and lifestyle changes remain the cornerstone of obesity prevention or treatment, recent advancements have introduced highly effective pharmacological options complementing weight-reduction surgery. Newer medications, like incretin-based therapies including glucagon-like peptide-1 agonists (GLP-1RA), have demonstrated remarkable efficacy in promoting weight loss, offering new insights into margining obesity-related conditions. Primary care providers, whether treating adults or children, play a pivotal role in preventing obesity, initiating treatment, and making onward referrals to specialists to assist in managing obesity and obesity-related complications.

Senility-Related Mortality in the United States During the COVID-19 Pandemic

CONTEXT

Senility has been shown to negatively impact health outcomes. While national stressors have altered death trajectories for numerous diseases, little is known about the impact of the COVID-19 pandemic on senility-related outcomes.

OBJECTIVE

To evaluate the impact of the COVID-19 pandemic on senility-related mortality in the United States.

DESIGN, SETTING, AND PARTICIPANTS

This is a retrospective analysis of US decedents with documented senility-related death using the CDC WONDER database. We estimated annual trends in senility-related age-adjusted mortality rates (AAMR) from 1999 to 2020 using log-linear regression models. Calculation of excess deaths attributable to the COVID-19 pandemic was completed by comparison of actual 2020 mortality rates and estimated 2020 mortality using average annual percentage changes.

RESULTS

A total of 510 819 senility-related deaths were identified. AAMR declined by 9.76%, from 7.48 in 1999 to 6.75 deaths per 100 000 in 2020. Year 2020 showed a marked increase in mortality, with 1.13 excess deaths per 100 000 population attributable to the COVID-19 pandemic. The COVID-19 pandemic contributed to an additional burden of mortality across both sexes, resulting in an estimated 1.18 and 0.99 per 100 000 excess deaths among females and males, respectively. The excess death rates per 100 000 for Black, White, Asian/Pacific Islander, and American Indian/Alaska Native populations were 1.84, 1.05, 0.99, and 1.16, respectively. The impact on US census regions was reflected in excess death rates, with the Northeastern, Midwestern, Southern, and Western regions seeing 1.27, 1.27, 1.39, and 0.31 excess deaths per 100 000, respectively.

CONCLUSIONS

These findings suggest that the pandemic had an association with excess senility-related mortality. Further investigation is warranted to identify factors that impact senility-related outcomes.

Biomarkers of aging: from molecules and surrogates to physiology and function

Many countries face an unprecedented challenge in aging demographics. This has led to an exponential growth in research on aging, which, coupled to a massive financial influx of funding in the private and public sectors, has resulted in seminal insights into the underpinnings of this biological process. However, critical validation in humans has been hampered by the limited translatability of results obtained in model organisms, additionally confined by the need for extremely time-consuming clinical studies in the ostensible absence of robust biomarkers that would allow monitoring in shorter time frames. In the future, molecular parameters might hold great promise in this regard. In contrast, biomarkers centered on function, resilience, and frailty are available at the present time, with proven predictive value for morbidity and mortality. In this review, the current knowledge of molecular and physiological aspects of human aging, potential antiaging strategies, and the basis, evidence, and potential application of physiological biomarkers in human aging are discussed.

Institutional Capacity and Practices for Maternal Anemia in China

In China, a range of anemia prevention and treatment measures have been developed and implemented in recent decades. These measures provide a regulatory basis for implementing standardized maternal anemia prevention and treatment services in China. However, little is known about the adoption of these interventions by health professionals, the capacity of health facilities to screen for iron deficiency and anemia, or the level of compliance among pregnant and lactating women (PLW). Thus, this study explored the alignment between maternal anemia prevention and control services provided and generated evidence for potential policy and program revisions and updates. A cross-sectional survey was conducted between November 2019 and January 2020. A total of 11 counties from 6 provinces across eastern, central and western regions of China were selected for the survey. In the surveyed sites, a total of 42 health institutions were enrolled in the survey, and a total of 201 health providers and 1714 PLW were enrolled in the suervey and completed the questionnaires. The results of this study showed that iron supplements containing 30 and 60 mg of iron were available in one third of the health facilities surveyed. All obstetricians reported ordering the Hb test for pregnant women receiving antenatal care (ANC) services, and 87.6% ordered the ferritin test. The proportion of obstetricians who ordered the ferritin test at the township level facilities (79.4%) was significantly lower than that at the provincial (100%), prefectural (87.5%) and county (87.1%) level facilities (p < 0.05). Around 89.6% and 90.5% of obstetricians prescribed iron to pregnant women when they were diagnosed with anemia and ID, respectively. 41.3% of obstetricians advised women to take preventive iron throughout their pregnancy. The proportion of obstetricians from township level hospitals that advised women to take preventative iron throughout their pregnancy (61.5%) was significantly lower than that from provincial facilities (23.5%) (p < 0.05). A total of 95.2% and 47.9% of PLW reported receiving the Hb test and the serum ferritin test during their pregnancy, respectively. There are some barriers and bottlenecks in the effective implementation of anemia intervention measures for pregnant women in China. Therefore, to achieve international and national targets on further reducing maternal anemia prevalence, comprehensive actions need to be taken.

Association between fat-soluble vitamins in breast milk and neonatal gut microbiome in Tibetan mother-infant dyads during the first month postnatal

The Tibetan Plateau is a high-altitude environment characterized by hypoxic conditions, strong ultraviolet rays, and significant temperature variations that affect the well-being of local residents, including mother-infant dyads. Adaptive evolution through lifestyle and dietary patterns plays an important role in nutrition during the maternal lactation period, which offers unique merits for investigation at the intersection of environmental and nutritional fields. Specifically, changes in the nutrient composition of human milk among Tibetan lactating mothers and their associated consequences for infants provide insight into early nutrition research and infant food production. In this study, the concentrations of vitamins A, D, E, and β-carotene in the human milk of Tibetan mothers, as well as the fecal microbiome profiles of their infants, were analyzed within the first month postnatal. The results showed that the fat-soluble vitamins in Tibetan human milk were at satisfactory levels, particularly during the colostrum stage, which may be attributed to the advantages of their dietary pattern and dwelling environment. Dynamic changes in the gut microbiota composition of Tibetan infants were observed, with the phyla Firmicutes, Proteobacteria, Bacteroidetes, and Actinobacteria being relatively abundant. The abundance of Bifidobacterium increased as infants aged within the first month postnatal. Correlations were found between the fat-soluble vitamin composition in human milk and the characteristics of the infant gut microbiota, including alpha (α)-diversity indices and microbial abundances. These findings will help enhance the understanding of early nutrition under harsh natural conditions and will guide relevant innovations and improvements in the maternal and infant food industry.

Temporal trends in prevalence for depressive disorders among women of childbearing age: Age-period-cohort analysis 2021

BACKGROUND

Depressive disorders (DD) are significant mood disorders with a notable female preference, especially affecting the well-being of women of childbearing age (WCBA). This population with DD was notably associated with severe complications during the perinatal period, leading to unfavourable maternal mortality and morbidity.

METHODS

This study extracted data from the Global Burden of Disease Study (GBD) 2021. We analysed the number of cases, calculated the age-standardized prevalence rate, and performed the age-period-cohort (APC) model to estimate prevalence trends and age, period, and cohort effects from 1992 to 2021.

RESULTS

From 1992 to 2021, the global number of WCBA with DD surged by 59.46 %, reaching 121 million cases up to 2021. India, China, and the USA had over 40 million prevalence cases, accounting for 36.17 % of global prevalence. The global net drift of DD prevalence among WCBA was -0.13 % per year (95 % CI: -0.17 % to -0.09 %). Age effects demonstrated similar patterns that the prevalence risk rose with age. All SDI regions showed unfavourable prevalence risks surging in the period of 2017-2021. The cohort risk of prevalence increased globally in younger generations after the 1987-1996 cohort.

CONCLUSION

Although the overall temporal trend (net drift) presented a downward trend in DD prevalence among WCBA over the past three decades, the prevalence cases had continued to rise with unfavourable period and cohort effects. Since COVID-19 triggered a massive increase in the prevalence of depressive disorders worldwide, there is an urgent need for stakeholders and policy makers to strengthen mental health-care systems.

Mediation Analyses Link Cardiometabolic Factors and Liver Fat With White Matter Hyperintensities and Cognitive Performance: A UK Biobank Study

Background

Liver fat is associated with cardiometabolic disease, cerebrovascular disease, and dementia. Cerebrovascular disease, most often cerebral small vessel disease, identified by magnetic resonance imaging as white matter hyperintensities (WMHs) often contributes to dementia. However, liver fat's role in the relationship between cardiometabolic risk, WMHs, and cognitive performance is unclear.

Methods

In the UK Biobank cohort (N = 32,461, 52.6% female; mean age 64.2 ± 7.7 years; n = 23,354 in the cognitive performance subsample), we used linear regression to investigate associations between cardiometabolic factors measured at baseline and liver fat, WMHs, and cognitive performance measured at follow-up, which was 9.3 ± 2.0 years later on average. We used structural equation modeling to investigate whether liver fat mediated associations between cardiometabolic factors and WMHs and whether WMHs mediated associations between liver fat and cognitive performance.

Results

Nearly all cardiometabolic factors were significantly associated with liver fat (|r| range = 0.03-0.41, p = 3.4 × 10-8 to 0) and WMHs (|r| = 0.04-0.15, p = 5.8 × 10-13 to 7.0 × 10-159) in regression models. Liver fat was associated with WMHs (r = 0.11, p = 4.3 × 10-82) and cognitive performance (r = -0.03, p = 1.6 × 10-7). Liver fat mediated the associations between cardiometabolic factors and WMHs (|βmediation| = 0.003-0.027, p mediation = 1.9 × 10-8 to 0), and WMHs mediated the associations between liver fat and cognitive performance (βmediation = -0.01, p mediation = 0).

Conclusions

Our findings indicate that liver fat mediates associations between cardiometabolic factors and WMHs and that WMHs mediate the association between liver fat and cognitive performance. This suggests that liver fat may be important for understanding the effects of cardiometabolic factors on cerebrovascular disease and cognitive function. Experimental studies are warranted to determine relevant targets for preventing vascular-driven cognitive impairment.

Rhein alleviates diabetic cardiomyopathy by inhibiting mitochondrial dynamics disorder, apoptosis and hypertrophy in cardiomyocytes

BACKGROUND

Diabetic cardiomyopathy (DCM) is a significant cardiovascular complication in diabetic patients, and treatment regimens are limited. Rhein, a compound extracted from the herb rhubarb, was investigated in this study for its efficacy on DCM and the potential mechanism.

METHODS

Streptozotocin-induced DCM mice, high-glucose (HG)-treated neonatal rat cardiomyocytes (NRCMs), and H9c2 cells with ClpP knockdown were used for the study. We performed phenotypic and molecular mechanistic studies using immunoblotting, quantitative polymerase chain reaction, transmission electron microscopy, cardiac echocardiography, and histopathological analysis.

RESULTS

Rhein improved the cardiac function and myocardial fibrosis, and decreased the cross-sectional area of cardiomyocytes in the DCM mice. It also improved mitochondrial dynamic disorder as evidenced by a decreased ratio of mitochondrial fission-related proteins p-Drp1S616/ Drp1 and increased expression of mitochondrial fusion proteins (Opa1, Mfn1 and Mfn2). Rhein mitigated apoptosis as indicated by decreased apoptosis-related proteins (caspase 9, cleaved-caspase 3 and Bax) and increased anti-apoptosis protein Bcl2 in the heart tissue of DCM mice. Upregulations of cardiac hypertrophy associated genes (ANP, BNP and β-MHC) were significantly inhibited by Rhein treatment. In addition, the level of ClpP, a mitochondrial protease, was increased in DCM, but was normalized by Rhein treatment. However, ClpP knockdown exacerbated cardiomyocyte injury in the presence or absence of HG in H9c2 cells, indicating that a normal level of ClpP is essential for cardiomyocytes to survive.

CONCLUSIONS

Our results suggest that Rhein protects DCM by ameliorating mitochondrial dynamics disorder, inhibiting cardiomyocyte apoptosis, and myocardial hypertrophy. These protective effects of Rhein may be mediated by preventing ClpP upregulation.

Epidemiological Dynamics of Burden and Health Inequalities in Metabolic Dysfunction-associated Steatotic Liver Disease in Adolescents at Global, Regional, and National Levels, 1990-2021

Background

Metabolic dysfunction-associated steatotic liver disease (MASLD) has become one of the major causes of chronic liver disease among adolescents. However, epidemiological studies on MASLD in adolescents are still insufficient. In this study, we aim to investigate the global burden and the trend of MASLD in adolescents from 1990 to 2021.

Methods

The age-standardized incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of MASLD were calculated based on the Global Burden of Disease (GBD) 2021 study and stratified by sex, socio-demographic index (SDI), GBD regions, and countries. The temporal trends were examined using the average annual percentage change (AAPC) and joinpoint regression.

Results

From 1990 to 2021, the global trends of age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) of MASLD show notable increase, and the male is significantly higher than the female in adolescents. According to the incidence and prevalence, nations with low SDI confront a higher burden of MASLD. Besides, the inequality of incidence and prevalence between different SDI regions have shrunk in 2021, but the inequality of DALYs and mortality are still exacerbated. Decomposition analysis revealed that population growth and epidemiological changes were the main reasons for the increase in the incidence of MASLD.

Conclusion

From 1990 to 2021, there is a significant upward trend in the incidence of MASLD among adolescents worldwide. Of particular note are male adolescents, East Asian regions, and groups living in high SDI countries.

Effects of Fermented Kimchi Consumption on Anthropometric and Blood Cardiometabolic Indicators: A Systematic Review and Meta-Analysis of Intervention Studies and Prospective Cohort Studies

CONTEXT

Increasing global kimchi consumption has prompted interest in its health impact. However, comprehensive reviews of the influence of kimchi on cardiometabolic risk factors, especially meta-analyses, remain limited.

OBJECTIVE

This review assessed the impact of fermented kimchi consumption on cardiometabolic risk factors by systematically reviewing human intervention and prospective cohort studies, and conducting a meta-analysis of intervention studies.

DATA SOURCES

A literature search of PubMed, EMBASE, Scopus, Web of Science, RISS, KISS, and ScienceON databases was conducted through April 30, 2024. The inclusion criteria encompassed studies that examined the effects of fermented kimchi, without any added ingredients or lactic acid bacteria, on health outcomes, including anthropometric measures, blood pressure, cardiometabolic and glycemic indicators, inflammatory cytokines, and the incidence of related chronic diseases.

DATA EXTRACTION

Data extraction and quality evaluation were conducted independently by 3 researchers.

DATA ANALYSIS

Pooled effect sizes were calculated as weighted mean differences (WMDs) with 95% CIs employing random-effects models.

RESULTS

Five intervention studies (205 participants) and 4 prospective cohort studies (42 455 participants) were selected. A meta-analysis of the intervention studies revealed a significant reduction in fasting blood glucose (WMD: -1.93 mg/dL; 95% CI: -3.82, -0.03; I2 = 17.4%) following the consumption of fermented kimchi. After excluding studies that contributed to increased heterogeneity, significant inverse associations were observed between fermented kimchi consumption and triglycerides (WMD: -28.9 mg/dL; 95% CI: -53.2, -4.5; I2 = 0.0%), systolic blood pressure (WMD: -3.48 mmHg; 95% CI: -5.95, -1.01, I2 = 0.0%), and diastolic blood pressure (WMD: -2.68 mmHg; 95% CI: -4.75, -0.62; I2 = 0.0%). Prospective cohort studies linked higher kimchi intake with a lower incidence of cancer and metabolic syndrome and an increased likelihood of achieving normal body weight.

CONCLUSION

This review supports beneficial effects of fermented kimchi on cardiometabolic health. However, due to the limited number of studies, these findings should be interpreted cautiously, highlighting the need for further research in diverse populations.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration No. CRD42024532020.

The mediating role of childhood maltreatment in the association between being left-behind and adolescent anxiety

BACKGROUNDS

Left-behind and separated from parents are common among Chinese adolescents and many developing countries, which may cause maltreatment and mental disorders, especially anxiety. Nevertheless, the comprehensive study in the prevalence of childhood maltreatment and its role in anxiety among left-behind adolescents is still insufficient.

METHODS

A nationally representative middle school sample of 32,620 adolescents participated the pen-paper survey regarding demographics, left-behind status and the source of abuse. The Generalized Anxiety Disorder-7 and Chinese version of the Childhood Trauma Questionnaire were used to assess anxiety symptoms and maltreatment experience. The analyses in prevalence, risk factors and mediating effects were preformed in SPSS 27.

RESULTS

30,174 valid questionnaires were collected, of which 2748 were left-behind adolescents. 46.4 % of left-behind and 35.6 % of non-left-behind adolescents reported anxiety, and left-behind increased risk of anxiety (OR = 1.180, 95%CI: 1.180-1.286, p < 0.001). In left-behind adolescents, female sex, older age, and maltreatment experience were risk factors of anxiety. Additionally, left-behind adolescents were more likely to suffer serious abuse and all abuse subtypes. The maltreatment almost completely mediated the association between left-behind and anxiety (0.857, 95%bootstrap CI = 0.743, 0.976), of which emotional abuse played the largest role (0.648, CI = 0.547, 0.751), followed by physical neglect, emotional neglect, and sexual abuse.

CONCLUSION

This study revealed the prevalence of anxiety and maltreatment in Chinese left-behind adolescents, and suggested that the maltreatment might significantly mediate the anxiety of left-behind adolescents. This may shed a light on other developing countries where the phenomenon of left-behind adolescents exists.

Global trends and burden of age-related hearing loss: 32-year study

BACKGROUND

Age-related hearing loss (ARHL) is a major cause of disability and diminished quality of life in older adults. This study uses data from the 2021 Global Burden of Disease (GBD) study to assess global ARHL.

METHODS

We evaluated ARHL prevalence, DALYs (Disability-Adjusted Life Years), ASPR (Age-Standardized Prevalence Rate), and ASDR (Age-Standardized DALYs Rate). Trend analysis was conducted using Estimated Annual Percentage Change (EAPC), with projections to 2050.

RESULT

From 1990 and 2021, global ARHL prevalence cases and DALYs increased by 109 %, reaching 1.55 billion and 44.45 million, respectively. The ASPR increased from 17,106.88 to 18,070.26, while the crude prevalence rate significantly from 13,890.66 to 19,587.14. Both ASPR and ASDR demonstrated significant age-related increases, particularly for moderate and moderately severe ARHL, with EAPC values of 1.39 and 1.49 for ASDR, respectively. Among individuals aged over 85 years, the ASPR of ARHL is expected to reach 80 %. Prevalence cases peaked in the 55-69 age group, with the highest number of cases (179.43 million) observed in the 55-59 subgroup. High-middle SDI regions and East Asia exhibited the most rapid growth. By 2050, ARHL cases are projected to reach 2.31 billion, with ASPR and ASDR expected to continue rising.

CONCLUSION

ARHL has increased globally over the past three decades, largely due to population aging. The burden is most severe in middle SDI regions, East Asia, and the 55-69 age group, primarily due to their substantial population bases. Addressing this escalating challenge requires enhanced public awareness, early screening initiatives, and targeted interventions.

A glycopeptide-based pH-responsive hydrogel promotes diabetic wound healing via antimicrobial and remodeling microenvironment

Treating bacterium-infected diabetic wounds remains a major medical challenge. Antimicrobial activity, remodeling of oxidative stress-heavy and angiogenesis-impaired microenvironments are critical factors for effective wound healing. Hydrogels can function as drug delivery systems that encompass all these capabilities to enhance wound healing. In this study, we developed a glycopeptide-based hydrogel (DA/bF@OD-PL) composed of oxidized dextran (OD), polylysine (PL), dopamine (DA), and basic fibroblast growth factor (bF). This hydrogel exhibits excellent structural integrity, injectability, adhesion properties, swelling capacity, and degradability. Notably, the hydrogel is responsive to acidic conditions due to the presence of Schiff base bonds, enabling it to respond to the acidic environment characteristic of bacterium-infected wounds and release its encapsulated drugs accordingly. Among these components, PL has a strong antibacterial effect and can easily kill S. aureus and E. coli. DA effectively scavenges multiple reactive oxygen species (ROS) and induces macrophage polarization to M2 macrophages to alleviate oxidative stress. bF upregulates the expression of CD31 and vascular endothelial growth factor (VEGF) to promote angiogenesis. Finally, we validated the ability of this hydrogel to promote rapid wound healing in an S. aureus-infected diabetic mouse wound model.

Phytochemical and biological studies on rare and endangered plants endemic to China. Part XLIV. Integrated NMR/EI-MS/LC-PDA-ESIMS approach for dereplication and targeted isolation of fortunefuroic acids from Keteleeria fortunei across diverse geographical origins

Secondary metabolites in plants of the same species, though originating from distinct geographical regions, frequently display both similarities and notable variations. A prior study on the vulnerable Chinese endemic conifer Keteleeria fortunei, collected from Yunnan province (KFYN), led to the isolation of fortunefuroic acids (FFAs) A-I. These compounds represent a unique class of triterpenoids characterized by a rare furoic acid moiety within the lateral chain. The distinct 23,27-epoxy-23,25(27)-dien-26-oic acid unit present in FFAs can be readily identified by characteristic proton NMR signals (δH-24: ca 6.36 ppm; δH-27: ca 7.97 ppm), a prominent ion fragment at m/z 125 in the EI-MS, and typical UV absorption peak around λmax 245 nm. In this study, an integrated approach was employed to dereplicate and isolate FFA-type compounds from K. fortunei collected from Fujian Province (KFFJ). This approach combined NMR, EI-MS, and LC-PDA-ESIMS data to detect and analyze compounds with molecular weights in the range of 464-468 Da, a distinguishing feature of FFA-type compounds. Consequently, six previously undescribed FFAs K-P (1-6) were obtained, alongside the re-isolation of FFAs A-D and H. Compound 1 exhibits a rare 17,14-friedo-cyclaorane type skeleton, while compound 2 is characterized as a 3,4-seco-cyclaorane-3,26-dioic acid. Compounds 3-6 are identified as derivatives of 9βH-lanost-26-oic FFAs. Additionally, a previously unreported lanost-26-oic acid derivative (7) was also identified, exhibiting an inhibitory effect on ATP-citrate lyase. Their chemical structures and absolute configurations were determined through spectroscopic analysis, GIAO NMR calculations combined with DP4+ probability analyses, and electronic circular dichroism calculations. The isolated FFAs have the potential to serve as chemotaxonomic markers for the genus Keteleeria within the Pinaceae family. This study marks the first application of integrated NMR/EI-MS/LC-PDA-ESIMS methods for both dereplication and the discovery of new natural products. Notably, the KFFJ samples were collected from a location approximately 1500 km away from that of KFYN. Understanding the impact of geographical origins on specialized metabolites may provide valuable insights into the sustainable utilization and conservation of endangered plant species.

Insomnia and its risk factors in patients with type 2 diabetes: A cross-sectional study

AIMS

Insomnia is notably prevalent among individuals with type 2 diabetes and adversely affects both glycemic control and overall quality-of-life. The objective of this study was to evaluate the possible risk factors for insomnia in patients diagnosed with type 2 diabetes and co-morbid insomnia.

METHODS

This is a baseline study analyzing cross-sectional data at baseline timepoint collected in a randomized controlled trial study. A total of 227 participants with type 2 diabetes and insomnia were recruited. The diagnosis of insomnia was based on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and the total score of Insomnia Severity Index. Multiple linear regression model was used to analyze the possible biomedical and mental health risk factors for insomnia severity, total sleep time, sleep efficiency and sleep onset latency.

RESULTS

Factors significantly associated with insomnia severity included fasting blood glucose and depression. Blood magnesium level was related to total sleep time. Sleep efficiency was associated with blood phosphorus. Factors related to sleep onset latency were depression and fatigue.

CONCLUSION

Factors related to high insomnia severity and poor sleep quality in type 2 diabetes patients with insomnia included fasting blood glucose, blood magnesium, blood phosphorus, depression and fatigue.

Latin American RAND/UCLA modified Delphi consensus recommendations for management and treatment of adult MOGAD patients in clinical practice

INTRODUCTION

Over the last decade, myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) has seen significant advancements, with new diagnostic criteria and emerging biomarkers, increased recognition of more diverse clinical phenotypes, and new insights into disease prognosis and therapeutic strategies. Consequently, the management of MOGAD patients in Latin America (LATAM) has become more complex in clinical settings. This consensus was established to assess the best practices and treatment approaches for MOGAD in LATAM, with the goal of improving long-term outcomes for these populations. It encompasses both practical guidance and theoretical definitions to ensure a comprehensive and regionally relevant framework for diagnosis and management.

METHODS

A panel of expert neurologists specializing in demyelinating diseases in LATAM met virtually from 2023 to 2024 to establish consensus recommendations for the management of MOGAD. A list of 59 statements and recommendations developed by the steering group was submitted to the rating group in the form of a questionnaire. Statements were organized into 5 categories as follows: 1-Diagnosis and serological tests; 2-Imaging and other complementary tests; 3- Prognostic factors; 4- Acute and 5- Long-term treatment. The RAND/UCLA modified Delphi panel process was utilized to achieve a formal consensus.

RESULTS

All statements reached strong or relative agreement during the first round, and additional rounds of votes were not conducted. The panel deliberated on various aspects such as diagnosis, differential diagnoses, disease prognosis, personalized treatment strategies, and identification of inadequate treatment responses, incorporating published evidence and expert opinions.

CONCLUSIONS

These recommendations outlined in this consensus seek to enhance the management and specific treatment protocols tailored for MOGAD patients in LATAM, with the aim of optimizing patient outcomes over long term.

Changes Over 10 Years in Peripheral Nerve Function in People With Well-Controlled Type 2 Diabetes and Those With Normal Glucose Tolerance

BACKGROUND AND OBJECTIVES

There is a lack of knowledge on the changes in peripheral nerve function in people with well-controlled, recently diagnosed type 2 diabetes compared with those with normal glucose tolerance (NGT). In this study, we aimed to investigate the natural course of the function of lower extremity small and large nerve fibers in people with NGT and its decline in those with well-controlled type 2 diabetes.

METHODS

This prospective observational study assessed changes in nerve function in participants of the German Diabetes Study with recently diagnosed (≤1 year) type 2 diabetes and age-matched and sex-matched individuals with NGT after 5 years and in a larger group of participants with type 2 diabetes after 5 and 10 years. Reference tests of lower extremity peripheral nerve function included peroneal motor nerve conduction velocity (MNCV) and sural sensory nerve conduction velocity (SNCV), sural sensory nerve action potential (SNAP), malleolar vibration perception threshold (VPT), and thermal detection thresholds (TDTs). Data were analyzed using multiple linear or logistic regression analyses.

RESULTS

At baseline, all 5 nerve function measures showed impairment in the 52 individuals in the diabetes group (33% female, median age 51.7 years) compared with the 52 individuals in the matched NGT group (33% female, median age 51.4 years). After 5 years, 2 nerve indices declined in the diabetes group (peroneal MNCV and VPT) and 3 in the NGT group (peroneal MNCV, VPT, and TDT for cold), with similar 5-year declines observed in both groups after adjustment for baseline values and pairwise matching. In addition, the Neuropathy Disability Score increased in the NGT group but not in the diabetes group. Comparable patterns of decline after 5 and 10 years were found in the larger diabetes cohort of 141 individuals (39% female, median baseline age 53.6 years). The observed 10-year prevalence of abnormal NCVs closely matched estimates based on natural aging-related decline (14.2% vs 12.8% for peroneal MNCV and 30.2% vs 31.0% for sural SNCV).

DISCUSSION

These findings suggest that nerve function deterioration in well-controlled type 2 diabetes is primarily influenced by nerve function status at diagnosis and physiologic aging, rather than diabetes-related progression.

Beyond glycemic control: Roles for sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists in diabetic kidney disease

The global prevalence of diabetes has surged in recent years, with diabetic kidney disease (DKD) emerging as a major complication. Traditional therapies have had limited success in slowing progression to end-stage kidney disease. However, novel therapies, particularly sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists, which were initially developed for hyperglycemia management, have transformed the treatment of obesity, heart failure, cardiovascular disease, and more recently, DKD. SGLT2 inhibitors have consistently and significantly reduced cardiovascular events, albuminuria, and glomerular filtration rate, highlighting their efficacy across diverse clinical presentations for patients with kidney impairment. Although fewer studies have specifically investigated GLP-1 receptor agonists in patients with kidney disease, existing evidence underscores their potential to slow renal disease progression, reduce albuminuria, and improve clinically relevant outcomes. However, further research is needed to better identify patients most likely to benefit from treatment. Together, these therapies represent valuable advancements for DKD, offering significant reductions in morbidity and mortality and shifting the management of the disease by becoming essential pillars for the treatment of these patients.

Lipid metabolism of Acetobacter pasteurianus and its main components with hypoglycemic effects

BACKGROUND

Probiotic Acetobacter pasteurianus is used to treat diabetes, but its specific hypoglycemic substances and mechanisms remain unclear.

AIM

To investigate the components for lipid metabolism of A. pasteurianus and its hypoglycemic effects, providing a basis for its broader application.

METHODS

The lipid metabolism of A. pasteurianus under different growth conditions was analyzed using lipidomics. Neutral lipid staining in A. pasteurianus cells and the formation of lipid droplet-like structures were observed using a confocal laser scanning microscope. The neutral lipid components were also analyzed using thin layer chromatography. A diabetic mouse model was established to evaluate the hypoglycemic effects of the main lipid components of A. pasteurianus and their role in repairing tissues such as the pancreas.

RESULTS

After comparing the effects of three culture media, namely, brain heart infusion (BHI) medium with 2% glucose, chromium-rich and zinc-rich medium, and mineral salt medium, A. pasteurianus grew well in BHI containing 2% glucose and produced the most lipids. A total of 583 lipid metabolic products was identified, with higher levels of coenzyme Q9 (CoQ9), oleic acid (OA), and wax ester, but no triacylglycerol was observed. It was found that the components that affected lipid metabolism in A. pasteurianus were mainly CoQ9 and OA. They exhibited hypoglycemic effects comparable to metformin in diabetic mice, repaired damaged pancreatic tissues, and did not cause damage to the liver and spleen.

CONCLUSION

Under high-nutrient growth conditions, A. pasteurianus contains abundant lipid components, such as CoQ9 and OA, with good hypoglycemic effects.

The burden and trends of depressive disorders in adolescent and young adults aged 15-29 in China, 1990-2021 and its prediction to 2030: Findings from the Global Burden of Disease Study 2021

BACKGROUND

Depressive disorders (DDs) are the leading causes of disability among adolescents and young adults (AYAs) in China. This study estimated the trends of DDs burden among AYAs in China over the last 32 years, and further predicted to 2030.

METHODS

Based on the Global Burden of Disease Study 2021, age-standardized incidence, prevalence, and years lived with disability (YLDs) rates were used to describe the DDs burden among AYAs (aged 15-29 years) in China. Estimated annual percentage changes were used to describe the temporal trends from 1990 to 2021. Bayesian age-period-cohort model was used to predict the future burden to 2030.

RESULTS

In 2021, the age-standardized incidence, prevalence, and YLDs rates (per 100,000) for DDs among AYAs in China were 1884.11 (95 % confidence interval [CI]: 1383.84, 2540.68), 1951.57 (95 % CI: 1527.28, 2459.70), and 323.36 (95 % CI: 208.27, 474.88), respectively. The burden was heavier in females and individuals aged 25-29. From 1990 to 2021, all groups showed a downward trend of DDs burden. Males showed an increase in DDs burden (mainly dysthymia) in most groups in 2019-2021, while the increases in DDs burden among females were mainly in 2010-2019. The main attributable risk factor was bullying victimization. Notably, although the DDs burden was predicted to decrease from 2022 to 2030, the dysthymia burden was predicted to increase.

CONCLUSIONS

The DDs burden among AYAs is a significant public health challenge in China. It is crucial to consider the disparities among different demographic characteristics, when formulating and implementing prevention strategies.

Long-term ambient ozone exposure and lung cancer mortality: A nested case-control study in Korea

The link between long-term exposure to tropospheric ozone (O3) and risk of lung cancer mortality remains uncertain. We aimed to provide new insights into the association between long-term O3 exposure and lung cancer mortality in Korea. A nested case-control study was conducted within a cancer-free cohort of 1,731,513 individuals who underwent health screenings provided by the National Health Insurance Service in 2006-2007. A total of 7133 lung cancer deaths that occurred from January 1, 2012, to December 31, 2021, were matched to 28,532 controls at a 1:4 ratio based on propensity scores. Daily 24-h and 8-h maximum O3 concentrations, averaged year-round and during the warm season from 2006 to 2010, were estimated for participants based on their residential addresses using the Community Multiscale Air Quality model. O3 concentrations rise during the daytime, also exhibiting seasonal variations, with the highest levels occurring in the warm season. Elevated risk of lung cancer mortality was observed among participants in the highest quartile of O3 exposure compared with those in the lowest quartile, yielding odds ratios ranging from 1.15 to 1.27. However, when exposure to particulate matter with an aerodynamic diameter of 2.5 μm or less (PM2.5) was further adjusted for, the adverse risk of long-term O3 exposure was attenuated, even tending to be protective. Notably, participants with both high O3 and high PM2.5 exposures had an increased risk of lung cancer mortality. Furthermore, regional differences were observed, with a significantly higher risk in rural areas. Findings of this study suggest that long-term exposure to O3, especially in combination with PM2.5 exposure, is associated with an excess risk of lung cancer mortality, underscoring the importance of addressing the O3 and PM2.5 interaction in lung cancer prevention.

Association of the Appendicular Skeletal Muscle Mass-to-Visceral Fat Area Ratio with Cause-Specific Mortality in Diabetes

The relationship between muscle mass and visceral fat with mortality risk in diabetes has been extensively studied. This study investigates the association between the appendicular skeletal muscle mass-to-visceral fat area ratio (SVR) and cardiovascular and cancer-related mortality in diabetic patients in the United States. A nationwide cohort study was conducted using NHANES data (2011-2018), including 1439 diabetic patients with dual-energy X-ray absorptiometry (DXA) measurements. Weighted Cox proportional hazards models and restricted cubic splines (RCS) were employed to evaluate the association between SVR and cause-specific mortality rates. Weighted receiver operating characteristic (ROC) curves were used to assess the diagnostic performance of SVR and other conventional indicators in predicting mortality. After adjusting for multiple confounding factors, SVR showed a linear negative association with cardiovascular and cancer-related mortality in diabetes. Each 0.01-unit increase in SVR was associated with a 3% reduction in the risk of cardiovascular death and a 2% reduction in cancer-related death. However, SVR demonstrated weak diagnostic performance for both cardiovascular and cancer mortality, with weighted AUCs of 0.520 and 0.527, respectively, compared to other metrics including BMI, WC, ASM, and VFA. Although SVR was significantly associated with cardiovascular and cancer mortality, its predictive performance was not superior to that of simpler or more established indicators, suggesting that it has limited clinical utility for predicting mortality in diabetic patients.

Therapeutic Potential and Translational Challenges for Bacterial Extracellular Vesicles in Inflammatory Bowel Disease

Despite the availability of numerous new immune-directed therapeutics, the major constituents of inflammatory bowel disease (IBD)-ulcerative colitis (UC) and Crohn's disease (CD)-continue to afflict millions worldwide, resulting in significant morbidity and long-term health risks. IBD results from a triad of immune, environmental (eg, gut microbiome), and genetic (including epigenetic) mechanisms, and therefore has been subject to a wide variety of therapeutic strategies. Among these, the administration of probiotics, particularly Gram-positive lactic acid bacteria (LAB), targeting both immune and environmental factors, has shown promising potential for efficacy in selected populations in early clinical trials. However, knowledge gaps and inconsistent efficacy currently prevent recommendations for the use of probiotics in larger IBD patient populations. The inconsistent efficacy of probiotics is likely due to variable cell viability and potency after administration, further exacerbated by IBD patient heterogeneity. Thus, an alternative to live probiotics for IBD has emerged in the form of bacterial extracellular vesicles (BEVs)-cell-secreted nanovesicles containing abundant bioactive cargo that, like live probiotics, can regulate immune and environmental factors but with fewer viability limitations and safety concerns. In this review, we summarize the work done to date establishing the potential of BEVs to provide the therapeutic benefits in IBD and discuss the hurdles BEVs must overcome to achieve clinical translation. We also consider future directions for BEV therapeutics, especially treatment potential for necrotizing enterocolitis (NEC), which shares similarities in pathophysiology with IBD.

Murine maternal microbiome modifies adverse effects of protein undernutrition on offspring neurobehaviour

Protein undernutrition results in impaired growth and neurobehavioural development in children. However, the impact of timing, environmental factors and maternal versus neonatal influences are unclear. Here, using a mouse model of fetal growth restriction where maternal protein intake is limited during pregnancy, we show that adult offspring exhibit cognitive and anxiety-like behavioural abnormalities. Cross-fostering newborn mice to dams previously exposed to either low protein or standard diet reveals that behavioural impairments in adult offspring require diet-induced conditioning of both fetal development and maternal peripartum physiology. Maternal gut microbiome diversity is reduced, maternal immune, milk, and serum metabolomic profiles are altered, and widespread changes in fetal brain transcriptomic and metabolomic profiles are observed, including subsets of microbiome-dependent metabolites. Finally, we show that dam treatment with a cocktail of ten diet- and microbiome-dependent metabolites results in differential effects on fetal development and postnatal behaviour. Our study highlights the impact of prenatal maternal protein undernutrition on offspring neurobehavioural trajectories and the role of the maternal microbiome.

Emerging Strategies of Cell and Gene Therapy Targeting Tumor Immune Microenvironment

Immunotherapy has profoundly transformed the landscape of cancer treatment and offered therapeutic opportunities to reverse the immunosuppressive microenvironment. However, intratumoral heterogeneity and the evolution toward immune evasion present significant challenges that demand innovative solutions beyond immune checkpoint inhibitors. In this context, cell and gene therapy (CGT) emerges as a promising frontier in the new immunotherapy era with its remarkable flexibility, diversity, and compatibility. In this review, we begin with a foundational overview of the classification of CGT in treating solid tumors and explore how it targets the cross-talk between cancer cells and the tumor immune microenvironment from cellular and molecular perspectives. CGT not only remodels the local tumor immune microenvironment but also has long-term effects on the systemic immune response. Furthermore, this review summarizes current challenges and strategic approaches, drawing on insights gained from clinical practice. By bridging mechanistic research with clinical insights, this review underscores the positive feedback from the research bench to clinical scenarios. More importantly, we propose that the development of CGT marks the evolution of the cancer treatment paradigm: from targeting tumor tissues alone to restoring the disrupted cancer-immune balance as a whole.

Portable ultra-low-field MRI in acute stroke care: A pilot study

INTRODUCTION

Neuroimaging is a prerequisite for treatment of stroke patients, but it is not available all over the globe. Portable ultra-low field (pULF) MRI has the potential to improve access to neuroimaging and thus stroke care worldwide. In a pilot study, we were the first to utilise pULF-MRI in a European tertiary stroke centre and to evaluate its diagnostic value compared to high-field (HF) MRI.

PATIENTS AND METHODS

Consecutive patients admitted for suspected ischaemic stroke underwent pULF-MRI using the 0.064 Tesla Swoop® portable MR imaging system in addition to standard imaging. HF-MRI and pULF-MRI scans were blindly assessed to compare the diagnostic accuracy and imaging-based therapeutic decisions based on pULF-MRI to HF-MRI.

RESULTS

Seventeen patients underwent pULF-MRI, 12 of whom had ischaemic lesions on HF-MRI. Ischaemic lesions were detected on pULF-MRI in 8/12 cases. The four infarcts not identified on pULF-MRI were all smaller than 6 mm in diameter. In all cases, a virtual treatment decision based on pULF-MRI by a blinded team matched the actual clinical decisions.

CONCLUSION

This single-centre study demonstrates that pULF-MRI is a promising tool in acute stroke care, providing reliable imaging for treatment decision and follow-up monitoring. pULF-MRI may support acute stroke care if HF-MRI is unavailable and may be particularly helpful in resource-limited settings. Limitations of pULF-MRI include long acquisition times and the lack of vessel imaging and haemorrhage-sensitive sequences.

Nose to brain delivery of nanostructured lipid carriers loaded with rivastigmine and nilotinib for treating Alzheimer's disease: preparation, cell line study, and in vivo evaluation

Alzheimer's disease (AD) is a complex neurodegenerative that affects over 55 million people worldwide, a number expected to double by 2050 due to aging populations. This growing prevalence imposes immense societal and economic burdens on healthcare systems and caregivers. AD is challenging to treat with monotherapy, making combination therapy a more effective approach. This study focuses on delivering Rivastigmine tartrate (RIV), and Nilotinib hydrochloride monohydrate (NIL), to the brain to achieve synergistic effects against AD. The optimal ratio of the drug combination was determined using the combination index that was performed using the Neuro2a cells line. It was found to be 1:1, emphasizing the synergistic effect against the cell lines. So, nanostructured lipid carriers (NLCs) were loaded with RIV and NIL, both individually and in combination, developed and optimized in this study. The developed formulations were thoroughly characterized for globule size, polydispersity index (PDI), and entrapment efficiency (EE) for each drug and the combination. The globule size was > 200 nm, PDI > 0.3; EE < 85% in all the developed formulations. On performing an in vitro cell availability study it was found that developed NLCs showed a 1.3 to 1.4-fold increase in the viability of the cells. On conducting an in vivo study, the concentration in the brain following administration of different formulations was in the order of RIV-NIL-NLC > NIL-NLC > RIV-NLC > RIV-NIL SUS > NIL-SUS > RIV-SUS. There was a 3.5 to 5-fold increase in the concentration of RIV and NIL in the brain when administered as RIV-NIL-NLC. So, it can be concluded that the NLCs with combined drugs showed promising results, enhancing drug permeability through the intranasal route, therefore could be used for treating AD.

Failure modes and mitigations for Bayesian optimization of neuromodulation parameters

Objective.Precision medicine holds substantial promise for tailoring neuromodulation techniques to the symptomatology of individual patients. Precise selection of stimulation parameters for individual patients requires the development of robust optimization techniques. However, standard optimization approaches, like Bayesian optimization, have historically been assessed and developed for applications with far less noise than is typical in neuro-psychiatric outcome measures and with minimal focus on parameter safety.Approach.We conducted a literature review of individual effects in neurological and psychiatric applications to build a series of simulated patient responses of varying signal to noise ratio. Using these simulations, we assessed whether existing standards in Bayesian optimization are sufficient for robustly optimizing such effects.Main results.For effect sizes below a Cohen's d of 0.3, standard Bayesian optimization methods failed to consistently identify optimal parameters. This failure primarily results from over-sampling of the boundaries of the space as the number of samples increases, because the variance on the edges becomes disproportionately greater than in the remainder of parameter space. Using a combination of an input warp and a boundary avoiding Iterated Brownian-bridge kernel we demonstrated robust Bayesian optimization performance for problems with a Cohen's d effect size as low as 0.1.Significance.Our results demonstrate that caution should be taken when applying standard Bayesian optimization in neuromodulation applications with potentially low effect sizes, as standard algorithms are at high risk of converging to local rather than global optima. Mitigating techniques, like boundary avoidance, are effective and should be used to improve robustness.

Physiological microbial exposure normalizes memory T cell surveillance of the brain and modifies host seizure outcomes

Recent studies have highlighted the presence of memory T cells in human brains, some of which are specific for peripheral infections. To address their potential origins, we used two models of polymicrobial exposure to 'normalize' the immune systems of specific pathogen-free mice and queried the impact on brain T cell biology. Here, we show that cohousing and sequential infection induce marked enhancement of memory T cells in the brain tissue of mice. These resident and circulating memory T cells localized to diverse brain regions where dynamic interactions with myeloid cells occurred. Following an induced seizure, brain-localized memory T cells were functionally altered in microbe-experienced mice. Microbial exposure also induced T cell-dependent changes in seizure duration. These data not only suggest a potential origin for memory T cells in human brains but also reveal the ability of these cells to modulate brain biology, prompting the future utilization of microbe-experienced mice in studies of neurological health and disease.

Adherence to asthma and COPD therapies in low- and middle-income countries: a narrative review

INTRODUCTION

In low-income and middle-income countries (LIMCs), defined based on the World Bank classification, non-adherence to respiratory therapies contributes to increasing mortality and morbidity due to chronic respiratory diseases. To address this issue, it is essential to identify and tackle underlying factors such as cultural beliefs, socioeconomic disparities, and limited access to healthcare resources and infrastructures. The absence of strategies that integrate community involvement, healthcare professional's training, economic policies, and educational programs exacerbates the disproportionate burden of chronic respiratory diseases in LIMCs.

AREAS COVERED

This review is based on a structured literature search across PubMed, Scopus, and Google Scholar (2000-2023) using terms relevant to asthma, COPD, adherence, and LMICs. The review examines key factors that hinder patients' adherence to Asthma and COPD medications in LIMCs, providing some insights into the issue and proposing concrete solutions.

EXPERT OPINION

Addressing non-adherence requires a multifaceted approach involving community engagement, educational initiatives, and improved healthcare infrastructure. Future research should focus on tailored interventions to enhance adherence and ultimately improve health outcomes for patients with chronic respiratory diseases in LMICs.

[Bariatric surgery versus GLP-1 and dual GIP/GLP-1 receptor agonists : Effects on weight, risk factors and prognosis]

To overcome the increasing prevalence of obesity and associated secondary diseases, effective treatment strategies are required. While bariatric surgery (BS) is an established method for significant and sustainable weight reduction, drug treatment with glucagon-like peptide 1 (GLP-1), GLP‑1 receptor agonists (GLP‑1 RA) and dual glucose-dependent insulinotropic peptide (GIP)/GLP‑1 RA has gained increasing importance in recent years. This article highlights the effects of these both treatment approaches on body weight, cardiometabolic risk factors and long-term prognosis, particularly with respect to cardiovascular events and remission of type 2 diabetes. While BS shows more robust weight loss and greater improvement in metabolic parameters, GLP‑1 RA and dual GIP/GLP‑1 RA offer a conservative treatment alternative with a good safety profile. The choice of treatment should be individualized based on the patient risk profile and preferences.

Avoidable premature mortality and effectiveness of the health system to reduce it during the 21st century in Spain by region

OBJECTIVES

To assess inter-regional inequalities in avoidable mortality and in the effectiveness of the health system to reduce it during 2001-2022 in Spain.

MATERIALS AND METHOD

An observational time trends study was performed, obtaining the following measures by region: age- and sex-standardized avoidable, preventable, treatable and non-avoidable mortality rates per 100,000 person-years, inter-annual rate differences (ARDs) in these mortalities, differences between the annual percentage changes (APCs) of avoidable and non-avoidable mortality (health system effectiveness against avoidable mortality), standard deviation and coefficient of variation (CV) of national mortality rates (absolute and relative inter-regional inequality, respectively), and difference between CVs in avoidable and non-avoidable mortality (health system contribution to inequality in avoidable mortality).

RESULTS

In 2022, the highest avoidable mortality rates were observed in Asturias (218), the Canary Islands (208) and Andalusia (200), and the lowest in Madrid (142), Navarra (161) and La Rioja (165). During 2001-2022, avoidable mortality decreased in all communities, with the most unfavourable ARDs in Aragon (-2.8), Castile and Leon (-3.1), and Asturias (-3.2), and the lowest health system effectiveness in Castile-La Mancha, Madrid, Asturias and Aragon. The standard deviation of avoidable mortality also decreased (from 29.4 in 2001 to 20.2 in 2022), as well as the health system contribution to this inequality.

CONCLUSIONS

In Spain, important inter-regional inequalities in avoidable mortality persist, although during 2001-2022 its absolute inequality decreased. During this period, all regional health systems were effective in reducing avoidable mortality, and their contribution to inter-regional inequalities in such mortality decreased.

Longitudinal assessment of the association between pesticide exposure and lifestyle with Parkinson's disease motor severity

Longitudinal investigations on the relationship between lifestyle exposures and motor severity are lacking. In this longitudinal study, we included patients with idiopathic Parkinson's disease (iPD) (N = 5139) and LRRK2-related PD (N = 81) from PPMI-Online and Fox Insight. Motor aspects were followed for up to five years. We investigated the association between environmental exposure, lifestyle factors and motor aspect severity over time by applying linear mixed effects models. In LRRK2-PD, black tea consumption was associated with less severe motor aspects (β = -0.51, p = 0.028). In patients with iPD, pesticide exposure was associated with more severe motor aspects over time in PPMI-Online (β = 0.23, p = 3.56 × 10-9). Lastly, caffeinated soda was associated with more severe motor aspects in patients with iPD from PPMI-Online (β = 0.15, p = 3.84 × 10-8) and Fox Insight (β = 0.09, p = 0.031). We suggest that pesticide exposure and lifestyle factors may affect motor severity in patients with LRRK2-PD and iPD, demonstrating the impact on patients even after disease onset.

Umbilical Artery Wall Shear Stress and Control of the Feto-placental Circulation

The aim of this paper is to review the area of wall shear stress (WSS) in umbilical arteries and to present a new theory for the short-term (seconds) control of placental resistance, which could be mediated by WSS. The endothelium senses changes in WSS, and a series of biological changes ensues with timescales of seconds to weeks. Wall shear stress mediates a control mechanism in which the arterial diameter changes in order to maintain WSS within a narrow range. Umbilical artery WSS has been estimated using a combination of ultrasound measurement of diameter and blood velocity (from maximum Doppler frequency shift), and computational fluid dynamics. The measurement of maximum blood velocity using commercial ultrasound systems is overestimated by typically 20%-40% in clinical ultrasound and 40%-60% in pre-clinical ultrasound. Measurements of WSS that use an estimate of maximum velocity from maximum Doppler frequency will also be overestimated by similar amounts. The overestimation of maximum velocity is due to geometric spectral broadening, which can be corrected at the time of data collection using measurements made from a string or similar phantom. A new hypothesis is described, which is that placental resistance is controlled on a timescale of a few seconds in order to maintain the umbilical artery flow rate constant. This hypothesis originates from observations made in a 1989 paper that investigated the relationship between the umbilical artery heart rate and resistance index. The key observation was that changes in heart rate were followed a few seconds later by changes in resistance index. It is proposed that the basis for the control could be endothelial detection of changes in WSS. Modern ultrasound systems have the technical capability to further investigate this hypothesis.

Global, regional and national level burden of bulimia nervosa from 1990 to 2021 and their projections to 2030: analysis of the global burden of disease study

Background

Bulimia nervosa (BN) is increasingly recognized as a significant public health issue worldwide. This study aims to explore the effects of BN on global, regional, and national scales by analyzing data from the Global Burden of Disease (GBD) Study 2021.

Methods

We obtained the age-standardized rates (ASRs) of prevalence, incidence, and disability-adjusted life years rates (DALYs), along with their 95% uncertainty intervals (UIs) for BN from the GBD 2021 dataset, covering the period from 1990 to 2021. And estimated annual percentage changes (EAPCs) was used to represent the changing trend of BN burden. The Long-term trends of the burden of BN were quantified by Age-period-cohort (APC) analysis. Furthermore, an evaluation of inequality and a prospective prediction concerning the worldwide impact of BN is performed.

Results

From 1990 to 2021, the global burden of BN showed a continuous increase. In 2021, the highest burden of BN was observed in regions with a high socio-demographic index (SDI), particularly in Australasia (ASPR was 811.9 per 100,000 individuals; 95% UI: 629.68 to 1041.59). The most substantial increase in the burden of BN was observed in Asia. In the national level, Equatorial Guinea experienced the most significant increase in the burden of BN from 1990 to 2021 (EAPC of ASPR was 3.48; 2.86 to 4.11). In contrast, burden of BN in High-income North America recorded a substantial decrease from 1990 to 2021 (EAPC of ASPRs was − 0.26; -0.39 to -0.13). The growth rate of male BN burden was higher than that of female. The relative inequality of the BN burden decreased between 1990 and 2021. Further forecasts from the GBD indicated that the global burden of BN would continue to rise by 2030.

Conclusion

These results can help governments across the globe in developing suitable health and medical policies focused on the prevention and early intervention of BN. Moreover, the differences in BN burden should be analyzed based on region, nation, gender, and year when setting international health goals.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40337-025-01289-9.

Analyses of prevalence, incidence, and disability-adjusted life years (DALYs) for bulimia nervosa (BN) revealed a sustained increase in BN’s global burden from the year of 1990 to 2021. Regionally and nationally, BN burden correlated positively with socioeconomic development levels, with Australia exhibiting the highest burden in 2021. The most pronounced growth occurred in East and South Asia, while high-income North America experienced a decline. Notably, although females bore a higher burden, males demonstrated faster growth rates in BN cases. Inequality analyses showed widening absolute disparities in BN burden between high- and low-income nations, whereas relative inequality decreased due to accelerated burden growth in lower-income regions. Projections indicate a continuing global rise in BN burden through 2030, underscoring the need for targeted interventions.

Dose- and pattern- physical activity is associated with lower risk of dementia

BACKGROUND

The amount and pattern of physical activity that benefits cognitive health remain unclear.

METHODS

Participants from the UK Biobank cohort who had a full week of accelerometer-based moderate-to-vigorous physical activity (MVPA) and light physical activity (LPA) data were included in the analysis. The data for dementia diagnosis were collected from 2006 to 2024. Associations between the incidence of all-cause dementia, Alzheimer's disease (AD), vascular dementia (VaD), and PA amounts and patterns were assessed using Cox proportional hazards regression models. The analysis included 1) comparing MVPA gradients with reference group performing less than 150 min/week; 2) classifying MVPA patterns as effective intensive (≥300 min/week with ≥50 % of MVPA in 1-2 days), effective regular (≥300 min/week not up to effective intensive), and ineffective (<300 min/week); 3) performing stratified analyses by age, sex, and APOE ε4 carrier status; and 4) evaluating the association between LPA and dementia risk among participants classified as ineffective MVPA levels.

RESULTS

91,512 individuals (mean [SD] age, 56.03[7.8] years; 55.9 % female) were included. Compared with participants performing <150 min of MVPA per week, those accumulating 150-299 min/week, whether through concentrated (1-2 days) or regular pattern, did not show significantly lower dementia incidence. However, accumulating >300 min/week of MVPA was associated with a reduced risk. When stratified at 300 min/week of MVPA, hazard ratios for dementia were 0.73 (95 % CI: 0.60-0.89) for the weekend pattern and 0.79 (95 % CI: 0.64-0.98) for the regular pattern. For ineffective MVPA, engaging in >840 min/week of LPA was associated with lower dementia incidence.

CONCLUSIONS

Accumulating >300 min/week of MVPA, whether concentrated within 1-2 days or distributed evenly across the week, was associated with a decreased risk of dementia. Additionally, higher levels of LPA partially compensated for low MVPA in lowering dementia risk.

Cigarette Smoke-Induced PPAR Signaling Dysregulation Accelerates Alzheimer's Disease Pathogenesis and Cognitive Decline in 5xFAD Mice

BACKGROUND

Smoking is harmful to health. Cigarette smoke (CS) contains a variety of toxic substances. Studies have found that nicotine, tar, polycyclic aromatic hydrocarbons, etc. in CS can pass through the blood-brain barrier and enter the brain to exert their effects. Moreover, some existing studies have pointed out that CS exposure is closely related to the accelerated pathology of Alzheimer's disease (AD).

METHODS

Transgenic mice with the five familial AD mutations (5xFAD), which are 1-month-old, were used for chronic CS exposure for 100 days. Subsequently, cognitive function and behavioral changes were evaluated through morris water maze and new object recognition tests. The acceleration of pathological changes due to CS exposure was assessed by HE, Tunel and Aβ immunohistochemical staining. Differential expression proteins and metabolites were screened through hippocampal proteomics and metabolomics analyses. Finally, the expression levels of key proteins were verified by western blot.

RESULTS

Compared with unexposed 5xFAD mice, the behavioral results of mice showed that FAD mice after CS exposure exhibited poorer cognitive abilities, with longer latencies in the Morris water maze, and decreased time spent and entries in the target quadrant. The results of pathological sections indicated that the total nuclei density in the DG and CA3 regions of the hippocampus of 5xFAD mice decreased significantly after chronic CS exposure, the number of TUNEL-positive cells increased, and the expression of Aβ42 increased. Multi - omics analysis revealed that CS exposure up - regulated the expression of 46 proteins and down - regulated the expression of 80 proteins in the hippocampus of 5xFAD mice, and caused changes in 92 metabolites. Analysis of the correlation between differential proteins and differential metabolites revealed six key cross-node proteins: Kng1, Hbb-b1, Fabp3, Apoa1, Ilk, and Apoa4.

CONCLUSIONS

CS exposure may accelerate pathological changes and cognitive impairment in 5xFAD mice by affecting energy metabolism through the PPAR signaling pathway.

Burden of bacterial antimicrobial resistance in China: a systematic analysis from 1990 to 2021 and projections to 2050

INTRODUCTION

Antimicrobial resistance (AMR) has emerged as a critical health challenge; however, there is a paucity of in-depth reports outlining its burden and trends in China.

OBJECTIVES

This study aimed to systematically assess the burden of bacterial AMR in China from 1990 to 2021 and project future trends up to 2050, providing critical insights for AMR control and policy-making.

METHODS

We analyzed data from the Global Burden of Disease Study 2021, encompassing 12 infectious syndromes, 64 pathogens (including 22 with AMR), and 84 pathogen-drug combinations. The burden was quantified by deaths and disability-adjusted life years under two counterfactual scenarios: deaths associated with AMR and those attributable to AMR, respectively. Trends were assessed using joinpoint regression analysis, and future projections up to 2050 were modeled using an autoregressive integrated moving average approach.

RESULTS

In 2021, AMR was attributable to approximately 160,268 (95% uncertainty intervals [UI]: 132,375-188,160) deaths in China, with up to 711,852 (95% UI: 586,447-837,256) fatalities associated with AMR. The most lethal infectious syndrome was bloodstream infections, with key pathogen-drug combinations including methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Streptococcus pneumoniae, and carbapenem-resistant Acinetobacter baumannii. Between 1990 and 2021, there was a substantial decrease in the burden among children under the age of five, primarily due to a decline in fatalities caused by carbapenem-resistant S. pneumoniae. In contrast, the burden increased among individuals aged 45 and older, with MRSA identified as the principal contributor. Projections indicate that by 2050, AMR could be associated with 769,432 deaths in China, of which 180,123 directly attributable to AMR.

CONCLUSION

Our findings provide a comprehensive evaluation of AMR burden in China, highlighting the urgent need for targeted interventions to prevent and control resistant infections, particularly among older adults.

Health conditions among women in prisons: a systematic review

Despite rapidly rising incarceration rates, the health needs of women in custody are overlooked. This Review aims to summarise the current evidence on the health of women in prisons around the world. In this systematic review, we searched peer-reviewed and grey literature databases for quantitative studies published between Jan 1, 2003, and Jan 29, 2025. Our population of interest was people detained in carceral spaces designated for women as part of the criminal-legal system worldwide. We included studies that reported the prevalence of health conditions (based on the Global Burden of Disease Study, or in the International Classification of Disease 11th revision) among women in custody. We assessed risk of bias using the JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data. We identified 18 008 unique records, 247 studies (including more than 452 261 women) were included for analysis. Nearly all studies had a high risk of bias in at least one domain. Communicable diseases and mental health conditions were the most frequently described topics. Prevalence of many conditions varied widely between studies and across geographical regions. We identified gaps in the literature, particularly around non-communicable conditions and in the geographical representation of data. Globally, women in custody experience a high burden of health conditions but there are substantial gaps in current evidence and a need for improved data collection and reporting. Additionally, limitations found in some studies included the exclusion of people with complex health-care needs and the use of measures such as self-reporting, which depend on previous access to health care, and it is likely that the true burden of health conditions among incarcerated women is even greater. The findings of this Review call the correctional, health, and research communities to act to reduce the health inequities faced by women in prison.

The effect of flavan-3-ols on ovariectomy-induced bone loss in mice and the potential mechanisms

Flavan-3-ols (FLOs) have been reported to confer various health benefits, the majority of which reaching the colon for fermentation by gut microbiota. This study sought to examine the effects of FLOs on bone health and to evaluate the influence of gut microbiota on these effects. Using an ovariectomy-induced bone loss model in mice, the animals were administered either a low or high dose of FLOs, or a combination of FLOs with an antibiotic cocktail (Abs+FLOs). Compared to the control group, serum markers of bone formation, as well as bone quality as determined by micro-CT, were elevated in the groups supplemented with FLOs, particularly when combined with Abs. Furthermore, both FLOs and Abs+FLOs interventions significantly improved the levels of estrogen. However, no additional influence of FLOs on these markers was detected compared to the group supplemented with Abs alone. Analysis of 16S rRNA sequencing data revealed that the abundance of certain operational taxonomic units, such as s__unclassified_Clostridia_UCG_014, s__unclassified_Ruminococcus, and s__unclassified_Lachnospiraceae, was significantly reduced in osteoporotic mice but effectively reversed following the administration of FLOs. Transcriptomic analysis coupled with KEGG enrichment analysis indicated that Adrb3, Gdf10 (BMP3), Fosb, and Cxcl2, along with the PPARα/PGC-1/UCP1 signaling pathway, may potentially mediate the regulation of bone metabolism by flavanols. Collectively, the study uncovers the osteoprotective properties of flavan-3-ols, indicating that these effects may depend on the presence of gut microbiota.

Immunogenicity and Safety of Influenza and COVID-19 Multicomponent Vaccine in Adults ≥50 Years: A Randomized Clinical Trial

Importance

Uptake of recommended seasonal influenza and COVID-19 vaccines remains suboptimal.

Objective

To assess the immunogenicity and safety of an investigational mRNA-1083 vaccine against seasonal influenza and SARS-CoV-2 in adults 50 years and older.

Design, Setting, and Participants

This phase 3, randomized, observer-blinded trial was conducted across 146 US sites in adults 50 years and older enrolled between October 19, 2023, and November 21, 2023. Data extraction was complete on April 9, 2024.

Interventions

Participants in 2 age cohorts (≥65 years and 50-64 years) were randomly assigned (1:1) to receive mRNA-1083 plus placebo or coadministered licensed quadrivalent seasonal influenza (≥65 years: high-dose quadrivalent inactivated influenza vaccine [HD-IIV4]; 50-64 years: standard-dose IIV4 [SD-IIV4]) and COVID-19 (all ages: mRNA-1273) vaccines.

Main Outcomes and Measures

The primary objectives were to demonstrate the noninferiority of humoral immune responses following mRNA-1083 vs comparators against vaccine-matched strains at day 29 and to evaluate the reactogenicity and safety of mRNA-1083. Secondary objectives included demonstration of superiority of humoral immune responses elicited by mRNA-1083 relative to comparators at day 29.

Results

Overall, 8015 participants were enrolled and vaccinated (4017 aged ≥65 y and 3998 aged 50-64 y). Among adults 65 years and older and 50 to 64 years, the median age was 70 and 58 years, 54.2% and 58.8% were female, 18.4% and 26.7% were Black or African American, and 13.9% and 19.3% were Hispanic or Latino, respectively. Noninferior immunogenicity of mRNA-1083 was demonstrated against all vaccine-matched influenza and SARS-CoV-2 strains based on lower bound of the 97.5% CI of the geometric mean ratio greater than 0.667 and lower bound of the 97.5% CI of the seroconversion/seroresponse rate difference greater than -10%. mRNA-1083 elicited higher immune responses than SD-IIV4 (50-64 years) for all 4 influenza strains and HD-IIV4 (≥65 years) for 3 influenza strains (A/H1N1, A/H3N2, B/Victoria) and against SARS-CoV-2 (all ages). Solicited adverse reactions were numerically higher in frequency and severity after mRNA-1083 vaccination than comparators in both age cohorts (≥65 y: 83.5% and 78.1%; 50-64 y: 85.2% and 81.8%); most were grade 1 or 2 in severity and of short duration. No safety concerns were identified.

Conclusions and Relevance

In this study, mRNA-1083 met noninferiority criteria and induced higher immune responses than recommended standard care influenza (standard and high dose) and COVID-19 vaccines against all 4 influenza strains (among those ages 50-64 y), the 3 clinically relevant influenza strains (among those aged ≥65 y), and SARS-CoV-2 (all ages), with an acceptable tolerability and safety profile.

Trial Registration

ClinicalTrials.gov Identifier: NCT06097273.

Global Changes in Ischemic Stroke Burden Attributable to Ambient PM2.5: Trends From 1990 to 2020 and Projections to 2050

BACKGROUND AND OBJECTIVES

Ischemic stroke (IS) is a leading cause of disability and mortality worldwide, with ambient fine particulate matter (PM2.5) exposure being a significant modifiable risk factor. While PM2.5 concentrations have declined in some regions, global assessments examining how these changes affect the IS burden remain limited. The aim of this study was to quantify changes in IS burden attributable to PM2.5 from 1990 to 2020 and project future trends to 2050.

METHODS

We used data from the 2021 Global Burden of Disease study, including population estimates, IS incidence rates, and PM2.5 concentrations, for 204 countries and World Bank regions. The Environmental Benefits Mapping and Analysis Program algorithm was applied to estimate IS cases attributable to PM2.5. Future projections were calculated using an autoregressive integrated moving average model.

RESULTS

Between 1990 and 2020, global PM2.5 concentrations decreased by 8.18 μg/m3. This reduction was associated with approximately 920,245 avoided IS cases, equivalent to 12.11% of the global IS incidence in 2020. The East Asia and Pacific region experienced the greatest benefit, with 699,218 IS cases avoided (19.09% of the region's IS incidence in 2020). By 2050, PM2.5 concentrations are projected to decline by 33.64 μg/m3 relative to 1990, potentially preventing an additional 6,004,854 IS cases. However, significant disparities persist, particularly in low-income regions where PM2.5 exposure and limited health care infrastructure continue to pose challenges.

DISCUSSION

Our findings highlight the substantial public health benefits of PM2.5 reductions in mitigating the IS burden. While high-income regions have seen substantial gains due to stringent air quality regulations, low-income regions remain disproportionately affected. Addressing these disparities requires targeted pollution control policies and equitable health care resource allocation. Sustained efforts in air quality management are critical to reducing the global IS burden and improving health outcomes, particularly in vulnerable populations.

Adverse Outcomes Associated With Short-Acting Beta-Agonist Overuse in Asthma: A Systematic Review and Meta-Analysis

INTRODUCTION

The 2019 Global Initiative for Asthma (GINA) report no longer recommended short-acting beta-agonists (SABA) monotherapy due to associated complications and a lack of anti-inflammatory properties. This systematic review and meta-analysis aimed to evaluate adverse outcomes associated with SABA overuse in patients with asthma.

METHODS

PubMed, Cochrane Library, EMBASE, and Web of Science databases were searched for studies on SABA overuse (≥ 3 SABA canisters/year) in patients with asthma, from 1981 to November 2023. Randomized controlled trials (RCTs), cohort studies, and cross-sectional studies were included. Pooled risk ratios (RRs) were calculated for dichotomous measures of all-cause mortality and acute exacerbations using random-effects models and Mantel-Haenszel weighting. Subgroup analyses were conducted based on study design.

RESULTS

Out of 626 records, 27 studies (2 RCTs, 1 prospective cohort study, 12 retrospective cohort studies, and 12 cross-sectional studies) were included. SABA overuse (≥ 3 SABA canisters/year) was associated with significantly higher mortality (2743 of 130,629 in the overuse group versus 3534 of 300,451 in controls; RR = 2.04, 95% confidence interval, CI = 1.37-3.04; p < 0.001) and a significantly higher rate of acute exacerbations (60,320 of 165,271 in the overuse group versus 84,439 of 376,845 in controls; RR = 1.93, 95% CI = 1.24-3.03; p < 0.001). An increased risk of acute exacerbations was observed in retrospective cohort studies (RR = 1.88, 95% CI = 1.43-2.47; p < 0.001) and cross-sectional studies (RR = 2.23, 95% CI = 1.04-4.77; p < 0.001).

CONCLUSIONS

SABA overuse was associated with increased rates of mortality and acute exacerbations in patients with asthma, supporting guidelines that advise against SABA monotherapy in asthma management.

Stimulus-responsive hydrogels for diabetic wound management via microenvironment modulation

Diabetic wounds, a major complication of diabetes mellitus, pose a significant clinical challenge. The treatment of diabetic wounds requires comprehensive interventions tailored to their pathophysiological characteristics, such as recurring bacterial infection, persistent inflammation, excessive oxidative stress, and impaired angiogenesis. The development of stimulus-responsive hydrogel dressings offers new strategies for diabetic wound treatment. By responding to various physical and biochemical signals, these smart hydrogels enable real-time monitoring and precise modulation of the wound microenvironment to accelerate diabetic wound healing. In this review, we provide an overview of the disease characteristics of chronic diabetic wounds and introduce the current clinical treatment approaches. We summarize the cutting-edge applications of physical and biochemical signal-responsive hydrogels for diabetic wound treatment by modulating the wound microenvironment.