Redefining global health in the 21st century: Towards a more equitable global health agenda

Global health is at a critical juncture, with significant achievements in reducing deaths from HIV and under-five mortality since 2000. However, progress in other areas, such as maternal mortality and tuberculosis, remains uneven, and cardiovascular diseases continue to rise. Compounding these challenges is the emerging threat of climate change, which is predicted to cause millions of health-related deaths by the end of the century. This commentary proposes a new global health model inspired by Kate Raworth's 'doughnut' framework, which emphasizes maintaining ecological and social boundaries to foster sustainable health. The inner boundary focuses on ensuring equitable access to essential health services, particularly for underserved populations. The outer boundary addresses the health impacts of environmental degradation and climate change, advocating for adaptive and resilient health systems. This model calls for a reorientation of global health priorities to balance human well-being with environmental sustainability, urging international collective action at platforms like COP29. By addressing both health equity and ecological stability, this framework aims to guide the global health community towards a more equitable and sustainable future.

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

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSION

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

Perspectives on advanced care planning of adolescent and young adult cancer patients, families, and healthcare providers: A qualitative study based on the health belief model

Objective

Adolescents and young adults (AYAs) cancer patients face higher long-term and late-stage risks, so advance care planning (ACP) is an important way for them to participate autonomously in healthcare decision-making. However, in Chinese culture, discussing ACP with AYAs is challengeable due to their role as their family's hope, contributing to insufficient attention to this group in cancer care. This study aimed to explore the perceptions of AYA patients, their families, and healthcare providers about ACP based on the health belief model.

Methods

This study was a qualitative descriptive research using a phenomenological approach. 7 AYA patients and their 7 family members, as well as 8 healthcare providers from Hunan Province, China, underwent three focus group interviews. In addition, 15 AYA patients were recruited for semi-structured interviews, with data saturation being achieved. NVivo Pro 12.0 software was used for data management, and thematic analysis method was used for data analysis.

Results

Six main themes emerged from the data: perceived severity, perceived susceptibility, perceived benefits, perceived barriers, perceived self-efficacy, and action cues. These themes highlight how AYA cancer patients, their families, and healthcare providers perceive the threats of cancer, the potential advantages of engaging in ACP, the challenges they were facing, and the supportive actions needed to facilitate ACP discussions.

Conclusions

ACP can enhance patient autonomy, alleviate anxiety, improve family communication, and optimize resource utilization. However, promoting ACP in China need overcome cultural barriers, enhance education, and provide strong family and social support to encourage more active participation among young patients.

Stage specific immune responses to schistosomes may explain conflicting results in malaria-schistosome coinfection studies

Malaria and schistosomiasis are two of the most clinically important human parasitic diseases in terms of morbidity and mortality, collectively causing approximately 800,000 deaths annually. Coinfection with their causative parasites, Plasmodium spp. and Schistosoma spp., is common, particularly in sub-Saharan Africa. These parasites may interact with each other via their effects on the host immune system, but studies to date report conflicting consequences of such interactions, some suggesting that schistosomes are associated with reduced parasitaemia in malaria infection while others report increased parasitaemia. Schistosomes stimulate different immune components in early versus late infection. Using agent-based modelling we explore whether stage of infection could be a factor explaining the conflicting coinfection outcomes. Effects of schistosomes on blood stage malaria were modelled by adjusting the immune components within the model according to the response provoked by each schistosome stage. We find the dynamics of malaria infections are greatly influenced by the stage of schistosomes, with acute and chronic schistosome infections having opposite effects on both peak infected erythrocyte counts and duration. Our findings offer a possible explanation for the apparent contradictions between studies and highlight the importance of considering the stage of schistosome infection when exploring the relationship between these two parasites.

Stress hyperglycemia ratio as an independent predictor of acute kidney injury in critically ill patients with acute myocardial infarction: a retrospective U.S. cohort study

BACKGROUND

Acute kidney injury (AKI) is a frequent and severe complication in critically ill patients with acute myocardial infarction (AMI), significantly worsening prognosis. Identifying early risk markers for AKI in AMI patients is critical for timely intervention. The stress hyperglycemia ratio (SHR), a marker of acute glycemic response to physiological stress, has been proposed as a predictor of AKI, but its role remains unclear.

OBJECTIVE

This study investigates the association between SHR and AKI development in critically ill patients with AMI, using data from the MIMIC-III and MIMIC-IV databases.

METHODS

A total of 4,663 critically ill AMI patients were analyzed. SHR was evaluated for its association with AKI incidence using logistic regression, restricted cubic splines, and mediation analysis. Subgroup and sensitivity analyses were performed to confirm robustness. Additionally, Cox regression and Kaplan-Meier survival analysis were used to explore SHR's association with in-hospital mortality in the overall cohort and AKI subgroup.

RESULTS

Higher SHR levels were independently associated with an increased risk of AKI, demonstrating a J-shaped relationship. Mediation analysis revealed that neutrophil count and albumin partially mediated this effect. Kaplan-Meier survival curves showed significant differences in in-hospital mortality among SHR quartiles (log-rank p < 0.001). However, Cox regression analysis indicated that SHR was not an independent predictor of in-hospital mortality in either the full cohort or the AKI subgroup.

CONCLUSIONS

SHR serves as an early and independent marker for AKI risk in critically ill AMI patients, offering potential utility in clinical risk stratification. However, its role in predicting in-hospital mortality appears limited. These findings underscore the importance of glycemic monitoring and management in AMI patients at risk of AKI.

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.

A tombus-like virus in patients with lower respiratory tract infection: an observational study based on meta-transcriptomic sequencing

The identification of a novel virus related to the family Tombusviridae, provisionally named human tombus-like virus (hTLV), is significant in the context of ongoing surveillance for respiratory pathogens. Meta-transcriptomic sequencing was utilized to detect respiratory pathogens in patients with lower respiratory tract infections (LRIs) in Jinan, China, from 2022 to 2023. The additional hTLV infections were identified through retrospective analysis of meta-transcriptome data collected in Beijing, China, from 2016 to 2019, prior to the COVID-19 outbreak. Phylogenetic analyzes indicated that hTLVs were clustered with a Jingmen tombus-like virus 2 but in a distinct clade. The hTLVs genomes consist of a single-stranded positive-sense RNA genomes of 4.7-4.8 kb in size, and contained four putative open reading frames (ORF1-4). The RNA-dependent RNA polymerase protein of hTLV shared significant sequence similarity containing three conserved motifs with 15, 24, and 15 amino acids, respectively. The hTLV genome included the canonical Gly376-Asp377-Asp378 (GDD) catalytic residues, which were a unifying feature of viruses in the family Tombusviridae. The main clinical manifestations of the 23 patients were fever, cough, expectoration and dyspnea, with varying degrees of lung infection or abnormalities in other laboratory indicators. Serological studies showed that fourfold rise in IgG titers in sera of a patient between acute and convalescent phase by ELISA. Identification of the pathogens for acute respiratory tract infections is essential for timely public health interventions and clinical management. The discovery of a novel virus, hTLV, in patients with LRIs highlights the continuous emergence of new respiratory pathogens in humans.

Faecal metaproteomics analysis reveals a high cardiovascular risk profile across healthy individuals and heart failure patients

The gut microbiota is a crucial link between diet and cardiovascular disease (CVD). Using fecal metaproteomics, a method that concurrently captures human gut and microbiome proteins, we determined the crosstalk between gut microbiome, diet, gut health, and CVD. Traditional CVD risk factors (age, BMI, sex, blood pressure) explained < 10% of the proteome variance. However, unsupervised human protein-based clustering analysis revealed two distinct CVD risk clusters (low-risk and high-risk) with different blood pressure (by 9 mmHg) and sex-dependent dietary potassium and fiber intake. In the human proteome, the low-risk group had lower angiotensin-converting enzymes, inflammatory proteins associated with neutrophil extracellular trap formation and auto-immune diseases. In the microbial proteome, the low-risk group had higher expression of phosphate acetyltransferase that produces SCFAs, particularly in fiber-fermenting bacteria. This model identified severity across phenotypes in heart failure patients and long-term risk of cardiovascular events in a large population-based cohort. These findings underscore multifactorial gut-to-host mechanisms that may underlie risk factors for CVD.

Pneumococcal vaccines in China

Invasive pneumococcal disease (IPD) is a serious global public health problem and the leading cause of morbidity and mortality in children and adults in China. Thus, developing and administering pneumococcal vaccines are important for disease prevention. The PPV23 and PCV13 vaccines are available in the Chinese market and are primarily produced by domestic manufacturers. The potential risk of increased IPD caused by non-vaccine serotypes should be considered. Here, we review the current status of IPD, pneumococcal vaccines, and their quality control in China. We also address the challenges and future directions for making progress in controlling IPD, emphasizing the need for further evaluation of the disease burden and monitoring the effectiveness of vaccination efforts.

Novel compounds of Taiwanese green propolis induce apoptosis of human glioblastoma cells by daylight photodynamic action

BACKGROUND

Glioblastoma, an aggressive brain cancer, has limited treatment options and poor prognosis. Taiwanese green propolis, known for its tumor-inhibitory properties, shows promise when combined with photodynamic therapy (PDT), a targeted, low-toxicity treatment. This study investigated a novel Taiwanese green propolis-based compound for inducing apoptosis in glioblastoma cells and its synergistic potential with daylight PDT.

METHODS

Ethanol extracts of green propolis, wheatgrass, and mulberry leaves were combined and analyzed using High-Performance Liquid Chromatography (HPLC). Apoptosis induction in U87 glioblastoma cells was assessed via the MTT assay following treatment with the compound alone and in combination with daylight PDT at 570 nm.

RESULTS

We identified Artepillin C as the main active component in the compound by HPLC, which significantly induced apoptosis in glioblastoma cells. Combined with daylight PDT, it demonstrated enhanced efficacy, with cell viability reduced from 95.2% at 0.25 µL to 11.3% at 8 µL of the compound extract. The EC50 decreased, indicating greater apoptotic activity compared to the extract alone.

CONCLUSION

This study provides the first in vitro evidence of synergistic anti-tumor effects of a Taiwanese green propolis-based compound daylight PDT (GPDT), highlighting a promising novel therapeutic approach that warrants further clinical investigation.

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.

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.

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.

Hepatocellular carcinoma: what are the differential costs compared to the general population?

INTRODUCTION

Hepatocellular carcinoma (HCC), which accounts for about 90% of all primary liver cancer cases, is the fifth most common malignancy and the second leading cause of cancer-related mortality worldwide. This study aims to analyse the differential costs of HCC-related hospital admissions compared to the general population in Spain.

METHODS

A retrospective multicenter study analyzed inpatient admissions from a Spanish national discharge database, covering 90% of hospitals between 2010 and 2022. HCC-related admissions were identified using ICD-9 and ICD-10 codes, while control admissions were selected from the general population in the same database without an HCC diagnosis. The direct hospitalization cost was included, covering medical examinations, procedures, medications, surgeries, personnel and equipment. Statistical methods, including nearest-neighbor matching, propensity score matching, and a generalized linear model, were used to estimate differential costs and to ensure comparability based on age, gender, and Charlson Comorbidity Index (CCI).

RESULTS

A total of 199,670 HCC-related hospital admissions and 200,000 control admissions were analyzed. Most HCC-related admissions involved male patients (78%) aged 66-85 years, with an average CCI of 5.18. HCC-related admissions incurred significantly higher costs, with an estimated differential cost of €1,303.68 using GLM, €1,804.25 via propensity score matching, and €1,767.77 using nearest-neighbor matching. Total costs per HCC admission ranged between €1,000 and €31,000.

CONCLUSIONS

HCC-related hospital admissions impose a significantly higher economic burden due to the complexity of care. Given the high mortality and resource utilization, advancements in early detection, treatment, and cost-effective interventions are needed to improve patient outcomes and reduce healthcare costs.

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.

Virome drift in ulcerative colitis patients: faecal microbiota transplantation results in minimal phage engraftment dominated by microviruses

Ulcerative colitis (UC) is an inflammatory bowel disease characterized by recurrent colonic inflammation. Standard treatments focus on controlling inflammation but remain ineffective for one-third of patients. This underscores the need for alternative approaches, such as fecal microbiota transplantation (FMT), which transfers healthy donor microbiota to patients. The role of viruses in this process, however, remains underexplored. To address this, we analyzed the gut virome using metagenomic sequencing of enriched viral particles from 320 longitudinal fecal samples of 44 patients enrolled in the RESTORE-UC FMT trial. Patients were treated with FMTs from healthy donors (allogenic, treatment) or themselves (autologous, control). We found that colonic inflammation, both its presence and location, had a greater impact on the gut virome than FMT itself. In autologous FMT patients, the virome was unstable and showed rapid divergence over time, a phenomenon we termed virome drift. In allogenic FMT patients, the virome temporarily shifted toward the healthy donor, lasting up to 5 weeks and primarily driven by microviruses. Notably, two distinct virome configurations were identified and linked to either healthy donors or patients. In conclusion, inflammation strongly affects the gut virome in UC patients, which may lead to instability and obstruct the engraftment of allogeneic FMT.

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

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

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

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

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.

Epigenetic regulation of the inflammatory response in stroke

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

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.

The binding investigation of ziprasidone with calf thymus DNA by multiple spectrums and molecular docking

Ziprasidone (Zi) is a 2-indolone drug that has been recommended as first-line medication for schizophrenic treatment by major guides of China and America. In this paper, the binding mode of Zi and calf thymus (ctDNA) was investigated for the first time. Fluorescence spectrum studies preliminary verified that Zi bound to groove region of ctDNA. UV-vis spectra showed obvious hyperchromicity at 260 nm for ctDNA-Zi system compared to the absorption sum of ctDNA and Zi, which also could be concluded that the interaction mode of Zi to ctDNA was probably groove binding. In 1H NMR of Zi, the addition of ctDNA had no influence on its spectrum, and the viscosity of ctDNA was also unaffected by the addition of Zi. These phenomenon proved once again that Zi interacted with ctDNA at groove region. Besides, molecular docking results reflected that Zi indeed bound to minor groove region of ctDNA with hydrogen bonds as main acting force. This study elaborated detailedly the groove binding mode of antipsychotic drug Zi interacting with ctDNA, and provided effective information for the design and development of new-type antipsychotic drugs.

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

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

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.

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

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

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.

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

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

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

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

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

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

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

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

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.

Bacteriophage therapy for critical antibiotic-resistant Gram-positive bacteria: A systematic review of clinical researches

The emergence of antibiotic-resistant bacteria compromises medical interventions and poses a significant threat to global public health systems. Bacteriophage (phage) therapy offers a promising, natural, safe, and effective antimicrobial alternative, particularly advantageous for combating Gram-positive bacteria with increasing resistance. This systematic review synthesizes clinical cases published in recent 15 years, evaluating the safety and efficacy of phage therapy in treating Gram-positive bacterial infections. It details the mechanisms of action and applications of phages in treating Gram-positive bacterial infections, critically assessing phage cocktail, phage-assisted regimens, and phage-derived agents. The review further studies phage's interaction with human host, commensal microbiota, and immune system. Through the rigorous analysis, it identifies phage therapy's potential implementation obstacles, and provides valuable perspectives for future research and clinical treatment.

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.

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.

A feasibility study of an add-on psychomotor body-image protocol during CBT-E in female patients with an eating disorder

BACKGROUND AND OBJECTIVES

Disturbed body image is a potential precursor and maintaining factor when it comes to eating disorders. One of the dominant treatment approaches for eating disorders, enhanced cognitive-behaviour therapy (CBT-E), includes the cognitive-affective body image dimension as a core treatment target. Adding a component that focuses on the lived body dimension, could improve body image. In the current study, the feasibility of a psychomotor body image treatment as an add-on to CBT-E was examined.

METHODS

In this pilot study, 115 primarily female patients with different eating disorders in outpatient CBT-E treatment participated. They were asked to complete questionnaires examining body image before and after the psychomotor body image treatment.

RESULTS

Results showed good satisfaction with the treatment, and a significant improvement in body attitude and body satisfaction after the psychomotor body image treatment, with large effect sizes and clinical relevance. Results also showed that, overall, pre-treatment levels and changes over the course of treatment in body attitude and body satisfaction did not differ between patients within anorexia nervosa, bulimia nervosa or binge eating disorder diagnostic subgroups.

LIMITATIONS

Limitations were lack of a control group, and the fact that the body image treatment was complementary to CBT-E. This means that it is unclear whether other factors contributed to the change in body image as shown in the current study.

CONCLUSIONS

These results indicate that an experiential psychomotor approach in addition to a more cognitive-behavioral approach is feasible, and warrants future research.

Interpretable machine learning model for prediction functional cure in chronic hepatitis B patients receiving Peg-IFN therapy: A multi-center study

BACKGROUND

Functional cure is the ideal treatment goal for chronic hepatitis B (CHB) treatment. We developed and validated machine learning (ML) models to predict functional cure in CHB patients.

METHODS

This study retrospectively recruited 534 CHB patients who received Peg-IFN treatment to construct model and 269 patients for external validation. We analyzed three strategies: baseline, week 12, week 24. Seven ML models were constructed using selected variables by Boruta and least absolute shrinkage and selection operator regression algorithm, and performance metrics, including area under the curve (AUC), sensitivity, specificity, and F1 score were applied to determine the best model. We utilized SHapley Additive exPlanation to visualize and interpret the best model and built a website to conveniently predict functional cure of CHB.

RESULTS

A total of 272 participants were cured in our study. Compared to baseline and week 12 strategies, week 24 using Support Vector Machine (SVM) model can better predict functional cure of CHB, with reliable predictive performance (AUC = 0.981), calibration and clinical applicability in external validation cohort. Age, ALT ratio at week 12, HBsAg at week 24 and HBsAg ratio at week 24 were important features. In order to enhance clinical convenience and effectiveness of the constructed model, a web-based dynamic nomogram was created (Dynamic Nomogram (shinyapps.io)).

CONCLUSION

This study developed SVM model to predict functional cure in CHB patients treated with Peg-IFN. Furthermore, we also built a website that clinicians can individualized predict the efficacy of Peg-IFN therapy in CHB patients.

Increased dietary acid load May elevate the risk of coronary artery disease severity: Findings from a cross-sectional study

Background

Chronic low-grade metabolic acidosis appears to play a role in the development of chronic disorders. This study aims to examine the relationship between Potential Renal Acid Load (PRAL) and Net Endogenous Acid Production (NEAP) and the risk of severe coronary artery disease (CAD) in participants undergoing elective angiography.

Methods

In this cross-sectional study, the data of 895 participants from the Nutrition Heshmat Registry (NUTHER) was collected. Dietary data were obtained using a validated food frequency questionnaire to calculate PRAL and NEAP. Participants were categorized into severe CAD (Gensini score≥60; n = 526) and non-severe CAD (Gensini score<60; n = 369). Logistic regression was conducted to evaluate the odds ratio (OR) and 95 % confidence interval (95 %CI). Restricted cubic spline (RCS) regression was employed to explore potential nonlinear associations between PRAL, and NEAP and severe-CAD risk.

Results

After adjusting for potential confounding factors, participants in the third to fourth quartiles of energy-adjusted PRAL and NEAP exhibited higher odds of severe CAD that were approximately 1.62-1.80 times and 1.67-2.76 times greater, respectively, compared to those in the 1stquartiles (4thquartile ORs(95 %CI) for: PRAL: 1.62 (1.05, 2.51); and NEAP: 1.67 (1.07, 2.61) (P-for-trend<0.021). RCS analysis showed a linear dose-response relationship between elevated PRAL and severe CAD risk (P-for-overall-trend = 0.0176; P-for-nonlinearity = 0.1552), and a nonlinear association between higher NEAP and increased severe CAD risk (P-for-overall-trend = 0.0001; P-for-nonlinearity = 0.006).

Conclusion

The findings indicate a significant association between higher dietary acid load and increased risk of severe CAD, suggesting that a more acidic diet may contribute to the progression of atherosclerosis. However, further prospective studies are necessary to validate these observations.

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.

Overcoming immunotherapy resistance in colorectal cancer through nano-selenium probiotic complexes and IL-32 modulation

BACKGROUND AND OBJECTIVE

Colorectal cancer (CRC) is a major global health burden, with immunotherapy often limited by immune tolerance and resistance. This study introduces an innovative approach using Selenium Nanoparticles-Loaded Extracellular Vesicles combined with Interleukin-32 and Engineered Probiotic Escherichia coli Nissle 1917 (SeNVs@NE-IL32-EcN) to enhance CD8+ T cell-mediated immune responses and overcome immunotherapy resistance.

METHODS

Single-cell RNA sequencing (scRNA-seq) and transcriptomic analyses were performed to identify key immune cells and regulators involved in CRC immunotherapy resistance, focusing on CD8+ T cells and the regulatory factor IL32. A humanized xenograft mouse model was used to evaluate the impact of IL32 and SeNVs@NE-IL32-EcN on tumor growth and immune responses. The SeNVs@NE-IL32-EcN complex was synthesized through a reverse micelle method and functionalized using extracellular vesicles. Its morphology, size, antioxidant activity, and safety were characterized using electron microscopy, dynamic light scattering (DLS), and in vitro co-culture assays.

RESULTS

Single-cell analyses revealed a significant reduction in CD8+ T cell infiltration in immunotherapy-resistant CRC patients. IL32 was identified as a key regulator enhancing CD8+ T cell cytotoxic activity through granzyme B and IFN-γ secretion. Treatment with SeNVs@NE-IL32-EcN significantly improved the proliferation and activity of CD8+ T cells and reduced tumor progression in humanized mouse models. In vitro and in vivo results demonstrated the complex's biocompatibility, antioxidant properties, and ability to enhance CRC immunotherapy while mitigating immune tolerance.

CONCLUSION

SeNVs@NE-IL32-EcN offers a novel nano-biomaterial strategy that integrates nanotechnology and probiotic therapy to enhance CD8+ T cell-mediated immunity and overcome CRC immunotherapy resistance. This study lays the foundation for future therapeutic applications in cancer treatment by advancing immune-modulating biomaterials.

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

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

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.

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.

Liver function improvement after human placental extract injections in patients with chronic liver disease: Thirty case reports

BACKGROUND

This case report describes a protocol developed by Danaun Medical Clinic for the introduction of a pioneering intervention comprising intravenous human placental extract (HPE) therapy to improve the liver function of patients with chronic liver disease (CLD).

CASE SUMMARY

This study involved data from patients whose chief complaint was reduced quality of life attributable to CLD. The new treatment approach resulted in improvements in the liver function and fatty liver of 30 patients with CLD. Improvements were observed using abdominal ultrasonography. Unlike traditional methods, this protocol provided more sustainable and meaningful results. Treatment with 10 mL of HPE administered intravenously once or twice per week significantly improved liver function. The observed improvements in fatty liver and liver function suggest the utility of this approach for the management of patients with CLD.

CONCLUSION

This case series highlights the potential of innovative treatments for patients with CLD that could improve the quality of life of the patients.

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.

Neglected role of virus-host interactions driving antibiotic resistance genes reduction in an urban river receiving treated wastewater

Treated wastewater from wastewater treatment plants (WWTPs) is a major contributor to the transfer of antibiotic resistance genes (ARGs) into urban rivers. However, the role of viral communities in this process remains poorly understood. This study focused on North Canal in Beijing, China, which receives over 80 % of its water from treated wastewater, to investigate the impact of viral communities on ARGs transfer. Results showed significant seasonal variation in the abundance and composition of ARGs, with 30 high-risk ARGs detected, accounting for 1.50 % ± 1.28 % of total ARGs. The assembly of ARGs in North Canal followed a stochastic process of homogenizing dispersal, with conjugative mobility playing a key role in horizontal gene transfer with Pseudomonas as primary host for HGT. The potential conjugative mobility of ARGs is significantly higher in wet season (69.4 % ± 17.3 %) compared to dry season (42.9 % ± 17.1 %), with conjugation frequencies ranging from 1.18 × 10-6 to 2.26 × 10-4. Viral species accumulation curves approaching saturation indicated the well captured viral diversity, and no phages carrying ARGs were found among 27,523 non-redundant viral operational taxonomic units. Most of the phages (89.2 % ± 3.8 %) were lytic in North Canal, which were observed to contribute to ARGs reduction by lysing their host bacteria, reflected by higher virus-host ratio and demonstrated by the phage lysis assays in treated wastewater and receiving river. We provided compelling evidence that phage-host interactions can reduce ARGs through host lysis, highlighting their potential role in mitigating ARG transmission in urban rivers receiving treated wastewater.