Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

Metabolic reprogramming and immunological changes in the microenvironment of esophageal cancer: future directions and prospects

Background

Esophageal cancer (EC) is the seventh-most prevalent cancer worldwide and is a significant contributor to cancer-related mortality. Metabolic reprogramming in tumors frequently coincides with aberrant immune function alterations, and extensive research has demonstrated that perturbations in energy metabolism within the tumor microenvironment influence the occurrence and progression of esophageal cancer. Current treatment modalities for esophageal cancer primarily include encompass chemotherapy and a limited array of targeted therapies, which are hampered by toxicity and drug resistance issues. Immunotherapy, particularly immune checkpoint inhibitors (ICIs) targeting the PD-1/PD-L1 pathway, has exhibited promising results; however, a substantial proportion of patients remain unresponsive. The optimization of these immunotherapies requires further investigation. Mounting evidence underscores the importance of modulating metabolic traits within the tumor microenvironment (TME) to augment anti-tumor immunotherapy.

Methods

We selected relevant studies on the metabolism of the esophageal cancer tumor microenvironment and immune cells based on our searches of MEDLINE and PubMed, focusing on screening experimental articles and reviews related to glucose metabolism, amino acid metabolism, and lipid metabolism, as well their interactions with tumor cells and immune cells, published within the last five years. We analyzed and discussed these studies, while also expressing our own insights and opinions.

Results

A total of 137 articles were included in the review: 21 articles focused on the tumor microenvironment of esophageal cancer, 33 delved into research related to glucose metabolism and tumor immunology, 30 introduced amino acid metabolism and immune responses, and 17 focused on the relationship between lipid metabolism in the tumor microenvironment and both tumor cells and immune cells.

Conclusion

This article delves into metabolic reprogramming and immune alterations within the TME of EC, systematically synthesizes the metabolic characteristics of the TME, dissects the interactions between tumor and immune cells, and consolidates and harnesses pertinent immunotherapy targets, with the goal of enhancing anti-tumor immunotherapy for esophageal cancer and thereby offering insights into the development of novel therapeutic strategies.

Global, regional, and national burden of low back pain for adults aged 55 and older 1990-2021: an analysis for the global burden of disease study 2021

BACKGROUND

Low back pain (LBP) is a widespread condition that increasingly affects the older adults, highlighting the need for a detailed examination of its global impact. Our research aimed to evaluate the LBP's burden and trends in individuals over 55 years of age across 204 countries and territories from 1990 to 2021.

METHODS

We analyzed the data from the Global Burden of Disease 2021, focusing on LBP prevalence, incidence, and years lived with disability (YLDs), along with associated risk factors.

RESULTS

In 2021, a total of 271,680,057 individuals aged 55 and older globally suffered from LBP. The age-standardized prevalence rate was 18,282.8 per 100,000 population, marking a 10.4% decrease since 1990. The age-standardized incidence and YLD rates had decreased by 9.4% and 11.0%, respectively. Central and Eastern Europe and Australasia had the highest burden, while Andean Latin America, Caribbean, and East Asia had the lowest. Notably, there were significant gender differences, with males experiencing lower rates than females. Occupational ergonomic factors, smoking, and high body mass index were identified as major contributors to the LBP burden.

CONCLUSION

This study analyzed the global burden of LBP in adults aged 55 and older, noting a decrease in age-standardized rates but an increase in total cases and regional disparities. It stressed the need to tackle modifiable risk factors like occupational ergonomics, smoking, and obesity to lessen LBP's impact. The study also called for region-specific, gender-sensitive healthcare policies to ensure fair health outcomes for all adults aged 55 and older.

Efficacy and safety of PD-1 inhibitors as second-line treatment for advanced squamous esophageal cancer: a systematic review and network meta-analysis with a focus on PD-L1 expression levels

Background

PD-1 inhibitors have shown promising efficacy in enhancing OS and AEs as second-line therapies for patients with advanced esophageal squamous cell carcinoma (ESCC). However, there remains no clear consensus on which PD-1 inhibitor provides the best balance between efficacy and safety. To address this key issue in the second-line treatment of ESCC, we conducted a network meta-analysis (NMA) with a focus on OS benefits, particularly in patients with different levels of PD-L1 expression.

Methods

A systematic search of relevant literature was conducted in Web of Science, Embase, PubMed, and Cochrane Library, covering publications from the inception of these database to June 2024. The evaluated endpoints included OS, progression-free survival (PFS), objective response rate (ORR), AEs, and Grade ≥ 3 adverse events (Grade ≥ 3 AEs). A systematic review and Bayesian network meta-analysis were performed to assess the efficacy and safety of various immunotherapy regimens in patients with advanced ESCC. To ensure transparency, novelty, and reliability, this study was prospectively registered in the systematic review registry (CRD42024540581).

Results

Five randomized controlled trials (RCTs), encompassing 2,078 patients and six treatment regimens, were included in this study. Among advanced ESCC patients not selected based on PD-L1 expression, Sintilimab demonstrated the greatest OS benefit (HR = 0.70, 95% CI: 0.50-0.98). Camrelizumab showed the most favorable improvement in PFS compared to chemotherapy (HR = 0.64, 95% CI: 0.47-0.87) and also achieved the best ORR benefit (OR = 3.72, 95% CI: 1.98-6.99). In terms of safety, Nivolumab (OR = 0.10, 95% CI: 0.05-0.19) and Tislelizumab (OR = 0.18, 95% CI: 0.10-0.33) exhibited significant safety advantages over chemotherapy concerning AEs. Moreover, Nivolumab (OR = 0.13, 95% CI: 0.08-0.20) was associated with a markedly lower risk of Grade ≥ 3 AEs compared to chemotherapy. Subgroup analysis based on PD-L1 expression revealed that Tislelizumab (HR = 0.53, 95% CI: 0.37-0.76) offered the greatest OS benefit for patients with PD-L1 ≥ 10%, while Camrelizumab (HR = 0.71, 95% CI: 0.57-0.89) was the most likely regimen to provide an OS advantage for patients with PD-L1 < 10%.

Conclusion

Compared to chemotherapy, PD-1 inhibitors may provide improved survival outcomes for patients with advanced ESCC. Among patients not selected based on PD-L1 expression, Sintilimab is most likely to deliver the best survival benefit. For patients with PD-L1 expression ≥ 10%, Tislelizumab is expected to offer the greatest efficacy, while Camrelizumab appears to be the most effective for those with PD-L1 < 10%.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024540581.

Correlation between Osteal Kneading and Carotid Artery Atherosclerotic Plaque

BACKGROUND

Adjacent bony structures may directly rub the carotid artery during swallowing or head and neck movement. Long-term repeated stimulation might be considered to be a potential risk factor for carotid atherosclerotic plaque formation, development, and hazard. We defined the process as "osteal kneading".

METHODS

A total of 192 consecutive (384 carotid arteries) neck computed tomography angiographies and cerebral magnetic resonance imaging performed within 1 month were analyzed. Ipsilateral bones (thyroid cartilage and hyoid bone), carotid arteries, and plaque were characterized using the computed tomography angiography images. Cerebral ischemic lesions were analyzed using the magnetic resonance images. According to the relationship between the position of the plaque and the bony structures, the vessels were divided into the osteal kneading positive group (OK+) and the osteal kneading negative group (OK-). The effects of osteal kneading on plaque formation, development, and hazard were then explored.

RESULTS

As seen, 95.7% of the OK+ plaques were located in the common carotid artery. The thyroid cartilage and hyoid bone were significantly closer to the carotid artery wall (P < 0.001), and the vascular radius was significantly larger (P < 0.001) in the OK+ group. The distance from the thyroid cartilage and hyoid bone to the ipsilateral carotid arteries was negatively correlated with plaque thickness, carotid artery stenosis rate, and calcified plaque occurrence (P < 0.05).

CONCLUSION

This pilot study provides preliminary evidence for the hypothesis of "osteal kneading" of the carotid artery and also suggests that osteal kneading may play some role in carotid artery plaque formation and development. Further research is required to provide more concrete evidence for the hypothesis, such as the inclusion of samples from multiple centers, precise outcome observation, artificial intelligence-assisted image analysis, and dynamic evaluation methods.

Identification and Evaluation of Hub Long Non-Coding RNAs and mRNAs in PM2.5-Induced Lung Cell Injury

Exposure to air pollution, especially fine particulate matter (PM2.5), is closely linked to various adverse health effects, particularly in the respiratory system. The present study was designed to investigate the lncRNA-mRNA interactions in PM2.5-induced lung cell injury using weighted gene co-expression network analysis (WGCNA). We downloaded the gene expression data of GSE138870 from the Gene Expression Omnibus (GEO) database and screened for differentially expressed lncRNAs and mRNAs. We constructed co-expression modules with WGCNA. Furthermore, functional enrichment analysis was also performed. We also constructed lncRNA-mRNA co-expression networks and lncRNA-mRNA-pathway networks to identify key regulatory relationships. The results revealed several modules significantly correlated with PM2.5-induced lung injury, such as the turquoise and blue modules. Genes within these modules were enriched in pathways related to signal transduction, metabolism, and cancer. Hub lncRNAs in the turquoise module, including LOC100129034 and CROCCP2, were found to be co-expressed with mRNAs involved in apoptosis and proliferation regulation. In the blue module, lnc-CLVS2-2 and GARS1-DT were connected to genes related to cell migration, invasion, and lung injury. These findings contribute novel perspectives to the molecular mechanisms involved in PM2.5-induced lung injury and suggest that WGCNA could be a valuable tool for predicting and understanding this disease process.

Dietary inflammatory index and disability among older adults in Guangzhou: a cross-sectional analysis

Objective

This study aims to evaluate factors linked to the degree of disability among older adults and explore the relationship between the dietary inflammatory index (DII) and the degree of disability among older adults in southern China.

Methods

Conducted in two districts of Guangzhou, China, this cross-sectional study included 262 older adults with mild-to-severe disabilities. Disability levels were assessed using the "Assessment Standard for Long-term Care Disability" from the Medical Insurance Bureau, including Activities of Daily Living (ADL), Cognitive Ability, and Sensory Perception and Communication Skills (SPCS). Dietary data were collected via Food Frequency Questionnaire (FFQ) and used to calculate the DII and intake of nutrients (e.g., Protein, Carbohydrate and Fat). A multivariable ordinal logistic regression model was employed to analyze the influence of various factors and the DII on the degree of disability among older adults. Restricted cubic spline and sensitivity analyses were used to assess the association between DII and the degree of disability of the older adult population.

Results

Inactivity (never exercising, OR = 8.48, 95% CI = 2.30-31.31) and reduced activity (formerly exercising, OR = 4.85, 95% CI = 1.39-16.96), stroke (OR = 2.78, 95% CI = 1.61-4.80), and dementia (OR = 2.69, 95% CI = 1.26-5.78) were significantly associated with increased disability. After adjusting for confounding factors, a higher DII was linked to a greater degree of disability, with the highest DII quartile showing a notably higher risk (OR = 2.61, 95% CI = 1.21-5.61) compared to the lowest quartile.

Conclusion

Lack of exercise, previous exercise, stroke, and dementia are correlated with increased disability among older adults. Additionally, a higher DII is associated with a more severe degree of disability.

Mapping the Scientific Research on Nutrition and Mental Health: A Bibliometric Analysis

BACKGROUND/OBJECTIVES

The connection between nutrition and mental health has become a point of growing interest. In response, nutritional psychiatry research has emerged as a field dedicated to understanding these interactions. A bibliometric analysis was conducted to map the growth and trends in this area, providing insights into its evolving scope and key research contributions.

METHODS

A literature search was conducted within the Web of Science Core Collection. Data analysis was performed using the result analysis and citation report options of Web of Science as well as the visualization software VOSviewer (Version 1.6.20).

RESULTS

A total of 31,556 articles on nutrition and mental health were published from 2000 to 2024 across various WoS categories, mainly in "Psychiatry", "Public, Environmental & Occupational Health", and "Nutrition & Dietetics". The most prolific research groups are based in North America. Recent publications mainly cover seven clusters: (1) public health and social factors, (2) interventions and biological mechanisms, (3) the health of the elderly, (4) nutrition-related illnesses, (5) lifestyle behavior, (6) observational studies, and (7) pregnancy and the postpartum period.

CONCLUSIONS

In view of the increasing research activities and growing allocation of resources in nutritional psychiatry research, it is important to define research priorities in close collaboration with service users and stakeholders. Research should be approached in a holistic manner through multidisciplinary research consortia to ensure comprehensive and impactful outcomes.

Efficacy of Nebulized Budesonide and Systemic Corticosteroids During Hospitalization on All-Cause Mortality in AECOPD Patients: A Real-World Study

BACKGROUND

Guidelines specify steroids as therapy for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, the duration of survival benefit associated with steroids and the optimal dosage of nebulized budesonide (NB) during hospitalization remain unclear.

METHODS

We conducted a retrospective study of hospitalized AECOPD patients. The primary endpoint was all-cause mortality after discharge. Cox regression analysis was used to determine the impact of steroid therapy on survival.

RESULTS

Wilcoxon analysis showed the positive impact of systemic corticosteroids (SCs) therapy on survival during the early stage of follow-up (P = 0.038). NB therapy was associated with a significantly reduced risk of death within six months after discharge (adjusted Hazard ratio (HR), 0.36; 95% confidence interval (CI) 0.15-0.88). Subgroup analysis suggested that fewer than two AEs in the previous year (adjusted HR 0.05; 95% CI 0.01-0.38), age >  = 65 years (adjusted HR 0.31; 95% CI 0.11-0.90), body mass index (BMI) < 25 kg/m2 (adjusted HR 0.33; 95% CI 0.12-0.92), and smoking index > 40 packets/year (adjusted HR 0.17; 95% CI 0.04-0.79) were involved in this association. Finally, treatment with a total dose of NB <  = 60 mg during hospitalization reduced six-month mortality compared to treatment without steroids (adjusted HR 0.39; 95% CI 0.17-0.92), but not the total dose of NB > 60 mg.

CONCLUSIONS

NB therapy for hospitalized AECOPD patients significantly reduced six-month mortality. Subgroup analysis showed that certain populations benefited more from NB therapy, and <  = 60 mg NB might be suitable treatment for hospitalized AECOPD patients.

Knowledge, attitude, and practice toward coronary heart disease secondary prevention among coronary heart disease patients in Shanghai, China

BACKGROUND

This study aimed to investigate knowledge, attitude, and practice (KAP) toward coronary heart disease (CHD) secondary prevention among CHD patients.

METHODS

This web-based cross-sectional study enrolled patients with CHD who visited the Yangpu District Central Hospital in Shanghai (China) between October 18, 2022, and March 25, 2023. The administered questionnaire assessed demographic information and KAP; factors associated with good practice were identified by multivariate logistic regression.

RESULTS

A total of 507 participants were included in the study, with 361 (71.2%) being male. In terms of education, 125 (24.7%) had a junior high school level or below. The mean scores for knowledge, attitudes, and practices were 31.28 ± 7.30 (possible range: 0-42), 54.09 ± 3.33 (possible range: 12-60), and 35.48 ± 3.36 (possible range: 11-55), respectively. For specific knowledge items on CHD, 57.6% of participants correctly identified that women are more susceptible to CHD. Physical labor and emotional excitement as triggers for CHD were correctly recognized by 94.1%. The need for long-term medication and follow-up after a CHD diagnosis had the highest correctness rate at 98.8%. Additionally, 84.6% correctly understood that recurrence of CHD is possible after PCI surgery. Multivariate analysis indicated that smoking and diabetes status were significantly associated with Practice scores. Current smokers reported lower practice levels than never smokers (OR = 2.858, 95% CI: 1.442-5.662, P = 0.003). Participants with diabetes reported higher practice levels than those without diabetes (OR = 4.169, 95% CI: 2.329-7.463, P < 0.001).

CONCLUSIONS

Patients with CHD in Shanghai, China, demonstrated good knowledge and positive attitudes toward CHD secondary prevention, although there were some gaps in actual practice behaviors. Enhancing targeted educational interventions and support systems in clinical settings may help bridge these gaps and improve adherence to recommended preventive practices.

Association of intratumoral microbiome diversity with hepatocellular carcinoma prognosis

The evidence that intratumoral microbiomes, as a rising hallmark of cancer, have a profound impact on cancer phenotypes is increasingly compelling. However, the impact of the composition and diversity of the intratumoral microbiome on the prognosis of patients undergoing surgical resection for hepatocellular carcinoma (HCC) remains incompletely understood. In this study, we revealed a high abundance of bacteria in the neoplastic tissues. The presence of bacterial lipopolysaccharide and lipoteichoic acid was detected alongside tumor-associated immune cells. By utilizing 16S rRNA gene sequencing, we identified a specific intratumoral microbiome signature that was highly predictive of the prognosis for HCC patients who underwent surgical resection. Specifically, the presence of Intestinimonas, Brachybacterium, and Rothia were identified as independent risk factors for the overall survival of HCC patients who underwent surgical resection.IMPORTANCEAlthough some studies have shown an abundance of bacteria in hepatocellular carcinoma (HCC), there is still limited understanding of the composition and diversity of the intratumoral microbiome that is favorable or adverse to the prognosis of HCC patients. Our results indicated that a greater abundance of bacteria could be observed in the neoplastic tissues than in nonneoplastic tissues. Bacterial cell wall components largely coincided with tumor-associated immune cells. The bacteria in the long overall survival (LOS) group were associated with metabolism and cytokine‒cytokine receptor interaction pathways, while bacteria in the short overall survival (SOS) group were associated with proinflammatory and cell proliferation pathways. Notably, specific taxa could independently predict HCC prognosis. Based on these findings, intratumoral microbiomes facilitate the use of precision medicine in clinical practice.

Stomach cancer epidemic in Chinese mainland: Current trends and future predictions

BACKGROUND

China is one of the countries with the highest burdens of stomach cancer. The objective of this study was to analyze long-term trends in the incidence and mortality of stomach cancer in Chinese mainland from 1990 to 2019 and to make projections until 2030.

METHODS

Data on stomach cancer were extracted from the Global Burden of Diseases Study 2019. Population data were extracted from the Global Burden of Diseases Study 2019 and World Population Prospects 2019. An age-period-cohort framework and decomposition analysis were used in this study.

RESULTS

The net drift for the incidence of stomach cancer was 0.2% (95% confidence interval [CI]: 0, 0.4%) per year for men and -1.8% (95% CI: -2.0%, -1.6%) for women. The net drift for mortality was -1.6% (95% CI: -1.8%, -1.3%) per year for men and -3.3% (95% CI: -3.5%, -3.1%) for women. In the last 10-15 years, the risk of stomach cancer occurrence and death has continued to decline for both sexes. Regarding birth cohorts, although the risk of stomach cancer death decreased in general among women and men born after 1920, the risk of occurrence increased in recent birth cohorts (men born after 1970 and women born after 1985). It is expected that the age-standardized incidence will increase among men and decrease among women, and age-standardized mortality will decrease for both sexes. The largest contributor to the projected increase in incident cases and deaths is population aging, and elderly individuals are projected to have an increased proportion of occurrence and death.

CONCLUSIONS

In the past three decades, the incidence of stomach cancer among men has increased in Chinese mainland, and this trend is projected to continue. Aging will be the main contributor to future increased stomach cancer occurrence and deaths. To reduce the health impact of stomach cancer, more efforts are needed.

Does Nonsteroidal Anti-inflammatory Drug Use Modify All-Cause and Cause-Specific Mortality Associated with PM2.5 and Its Components? A Nationally Representative Cohort Study (2007-2017)

Several studies reported that nonsteroidal anti-inflammatory drug (NSAID) use could alleviate subclinical effects of short-term exposure to fine particulate matter (PM2.5). However, whether chronic NSAID use could mitigate the long-term effects of PM2.5 and its components on population mortality has been unknown. Based on a national representative survey of 47,086 adults (2007-2010) with follow-up information on the primary cause of death (until 2017), we investigated the long-term associations of PM2.5 and its major components, including black carbon (BC), ammonium (NH4 +), nitrate (NO3 -), organic matter (OM), and sulfate (SO4 2-), with all-cause and cause-specific mortality using the Cox proportional hazards model. We also evaluated the effect modification by NSAID use (including broad NSAIDs, aspirin, or ibuprofen) on the associations using interaction models. Long-term exposures to PM2.5 and its components were associated with increased risks of all-cause and cause-specific mortality, where BC, OM, and SO4 2- showed stronger associations. Ibuprofen use could mitigate the associations of PM2.5 and its components with mortality risks, while no significant modifying effects of aspirin were observed. For instance, along with per interquartile range increment in PM2.5 concentration (34.8 μg/m3), the hazard ratios (HRs) of all-cause mortality were 1.21 (95% CI: 1.19, 1.22) and 1.10 (95% CI: 1.01, 1.19) in nonibuprofen and ibuprofen use groups (P for interaction = 0.026), respectively. Cause-specific analyses indicated that ibuprofen use could mainly mitigate risks of cardiovascular disease (CVD) especially ischemic heart disease (IHD) mortality attributable to PM2.5 components. Stratified analyses found more apparent mitigating effects of ibuprofen use among participants without chronic diseases, participants ≤50 years, female participants, rural residents, and those with lower education levels. Our findings suggested potential implications in reducing population mortality caused by long-term exposures to PM2.5 and its components through personalized interventions.

Artificial biomarker-based feedback-regulated personalized and precise thrombolysis with lower hemorrhagic risk

The body weight-based thrombolytic medication strategy in clinical trials shows critical defects in recanalization rate and post-thrombolysis hemorrhage. Methods for perceiving thrombi heterogeneity of thrombolysis resistance is urgently needed for precise thrombolysis. Here, we revealed the relationship between the thrombin heterogeneity and the thrombolysis resistance in thrombi and created an artificial biomarker-based nano-patrol system with robotic functional logic to perceive and report the thrombolysis resistance of thrombi. The nano-patrols are contrallable and are able to accomplish thrombolysis resistance-matched personalized and precise therapy according to the feedback signal from artificial biomarkers. This nano-patrol system depicted more enhanced thrombolytic efficiency (elevated by 25%) than alteplase for mini pig model and clinical thrombi and achieved recanalization in thrombotic model where alteplase encountered failure. Moreover, the nano-patrol remarkably reduced the infarct volume and the hemorrhagic transformation risk (0.12-fold of alteplase) of cerebral thrombosis. Therefore, we developed a unique tool for diagnosing thrombolysis resistance and achieving personalized and precise thrombolysis.

Healthcare-seeking delays and associated factors among immigrant patients with acute ischaemic stroke in Shenzhen: a retrospective observational study

OBJECTIVE

To examine healthcare-seeking delays among immigrant patients with acute ischaemic stroke (AIS), identifying key factors contributing to these delays and proposing evidence-based interventions for policy formulation and research.

DESIGN

A retrospective observational study analysing healthcare-seeking behaviours and delay times among immigrant patients with AIS treated at the Department of Neurology, Longhua District People's Hospital, Shenzhen, from December 2021 to October 2023. The study included 1356 patients with AIS, all part of the immigrant population as defined by Shenzhen Statistical Yearbook criteria. The study investigated sociodemographic, clinical data and stroke-specific scales (modified Rankin Scale, National Institutes of Health Stroke Scale, Glasgow Coma Scale) to identify factors influencing delays.

SETTING

The study was conducted in Shenzhen, a city characterised by a significant immigrant population, providing insights applicable to urban regions with similar demographics.

RESULTS

Of the 1356 patients studied, 82.6% (n=1120) experienced healthcare-seeking delays, with a median delay of 12.67 hours (IQR: 3.5-28.8). Factors associated with prolonged delays included lack of stroke awareness (92.96% delay rate), low educational attainment, self-transportation to the hospital (adjusted OR (aOR): 2.36, 95% CI: 1.57 to 3.54) and wake-up strokes (aOR: 4.37, 95% CI: 2.28 to 8.36). Conversely, factors associated with shorter delays included cardioembolic strokes (aOR: 0.50, 95% CI: 0.28 to 0.90) and atrial fibrillation (aOR: 0.45, 95% CI: 0.23 to 0.89). Delay rates were significantly lower among patients referred by emergency medical services compared with those self-transporting. These findings highlight the influence of clinical, socioeconomic and demographic factors on delays in seeking care.

CONCLUSION

Healthcare-seeking delays in stroke care among immigrants, shaped by awareness, socioeconomic and clinical factors, necessitate urgent educational, policy and healthcare reforms. Enhancing early symptom recognition and promoting emergency service utilisation are essential for improving access to care and outcomes in this vulnerable group.

Chinese burden of depressive disorders from 1990 to 2021 and prediction for 2030: analysis of data from the global burden of disease study 2021

BACKGROUND

This study aims to examine the temporal changes in the incidence, prevalence, and disability-adjusted life years (DALYs) of depressive disorders as well as its association with age, period, and birth cohort among Chinese from 1990 to 2021, and forecast the future trends of incidence rates and numbers from 2022 to 2030.

METHODS

Data for analysis were obtained from the Global Burden of Disease (GBD) 2021. Joinpoint analysis was used to calculate the annual percentage change (APC) and average annual percent change (AAPC) to describe the rates of depressive disorders. Age, period, and cohort model was utilized to disentangle age, period, and birth cohort effects on rates of depressive disorders. Bayesian age-period-cohort (BAPC) analysis was capitalized to forecast the incidence rates and numbers for different sexes and age groups from 2022 to 2030.

RESULTS

The age-standardized incidence (ASIR, AAPC: -0.35 [95%CI: -0.65, -0.04]), prevalence (ASPR, AAPC: -0.20 [95%CI: -0.24, -0.16]), and DAYLs (AAPC: -0.28 [95%CI: -0.51, -0.05]) rates of both sexes showed a downward trend from 1990 to 2021, despite a volatility growth in recent years (APC in 2019-2021 of ASPR: 0.96 [95%CI: 0.70, 1.23]). Females exhibited a higher burden of depressive disorders compared to males but experienced a more rapid rate of reduction changes. The burden of depressive disorders was most owing to the age effect and period effect in recent years. The ASIR was predicted to decrease in the whole population (males in 2030: 1,546.3 per 100,000 people; females in 2030: 2,465.8 per 100,000 people), but in children, adolescents, and the elderly demonstrate unfavorable trends in the future.

CONCLUSION

The burden of depressive disorders decreased in China from 1990 to 2021 in terms of age-standardized rates, but increased in recent years. Children, adolescents, and the elderly are the risk groups for future depressive disorders. Considering the large population, the increasing fewer children, and the aging trend, as well as the possible long-term effects of COVID-19 on human psychological burden, more sex-age-sensitive social healthcare programs should be considered in the future to minimize the burden of depressive disorders in China.

Insight into interplay between PANoptosis and autophagy: novel therapeutics in ischemic stroke

PANoptosis is a novelly defined mode of programmed cell death that involves the activation of multiple cellular death pathways, including pyroptosis, apoptosis, and necroptosis, triggering robust inflammatory reactions. Autophagy is a crucial cellular process that maintains cellular homeostasis and protects cells from various stresses. PANoptosis and autophagy, both vital players in the intricate pathological progression of ischemic stroke (IS), a brain ailment governed by intricate cell death cascades, have garnered attention in recent years for their potential interplay. While mounting evidence hints at a crosstalk between these two processes in IS, the underlying mechanisms remain elusive. Therefore, this review delves into and dissects the intricate mechanisms that underpin the intersection of PANoptosis and autophagy in this devastating condition. In conclusion, the crosstalk between PANoptosis and autophagy in IS presents a promising target for the development of novel stroke therapies. Understanding the interplay between these two pathways offers a much-needed insight into the underlying mechanisms of IS and opens the possibility for new therapeutic strategies.

Development and validation of a prognostic nomogram for predicting outcomes in brainstem hemorrhage patients

Brainstem hemorrhage is a severe neurological condition with high mortality and poor prognosis. This study aims to develop and validate a prognostic model for brainstem hemorrhage to facilitate early prediction of patient outcomes, thereby supporting clinical decision-making. Clinical data from 140 patients with brainstem hemorrhage were collected. A prognostic model was constructed through multivariate logistic regression analysis, and a nomogram was developed for clinical use. The model's performance was evaluated using ROC curves, PR curves, and calibration curves, and was validated through cross-validation and an independent validation cohort. Additionally, decision curve analysis was conducted to assess the model's clinical benefit. The study identified hematoma expansion (adjusted OR = 12.92, 95% CI: 2.39-69.79, P = 0.003), GCS score (adjusted OR = 0.77, 95% CI: 0.63-0.93, P = 0.008), hematoma type (OR = 8.01, 95% CI: 2.02-31.78, P = 0.003), and hematoma volume (OR = 1.75, 95% CI: 1.26-2.43, P = 0.001) as independent risk factors for poor prognosis in patients with brainstem hemorrhage. The nomogram prognostic model demonstrated excellent performance in predicting clinical outcomes, with an AUC of 0.95, outperforming individual predictors (volume: 0.94, type: 0.8, GCS: 0.78, expansion: 0.59). Calibration curves showed a high degree of agreement between the model and the ideal curve. Moreover, decision curve analysis indicated that the model provided significant net clinical benefit. This nomogram can effectively provide a basis for prognostic judgment in brainstem hemorrhage, helping clinicians optimize treatment decisions and improve patient outcomes.

Construction of a 'civilised smoking environment': a novel strategy undermining tobacco control efforts in China

OBJECTIVE

In 2018, the Chinese tobacco industry initiated the nationwide 'civilised smoking environment' campaign via a 5-year action plan. The goal of this study was to analyse content of reports regarding this topic as evidence to policy-makers to prevent interference from the tobacco industry.

METHODS

A search of WiseNews, a Chinese media information service provider, for reports regarding the 'civilised smoking environment' between January 2018 and December 2022. Reports were coded separately by two trained researchers using a codebook developed by the team, including four sections with 19 items.

RESULTS

A total of 1062 reports were included, of which 66.5% were from general media. Key themes include mention of approaches to promote the civilised smoking environment (59.8%), primarily by establishing civilised smoking areas (86.1%). A majority of reports (72.9%) disclosed key promoters of these initiatives, including the Tobacco Monopoly Administration (69.5%), Tobacco Corporation (52.3%) and other government agencies (20.4%). Funders were mentioned in 252 reports (23.7%), primarily the Tobacco Monopoly Administration (60.3%) and Tobacco Corporation (50.8%). Most reports (92.8%) supported these initiatives, while only 45 (4.2%) opposed it.

CONCLUSIONS

'Civilised smoking environment' in China was promoted and financed primarily by tobacco industry and widely supported by media. This undermines smoke-free environments and violates the WHO Framework Convention on Tobacco Control. China's government should cease its involvement in these initiatives, and government agencies should refrain from agreeing, supporting, cooperating or participating in these activities.

Long-term trends in the burden of pulmonary arterial hypertension in China and worldwide: new insights based on GBD 2021

Background

Pulmonary arterial hypertension (PAH) poses a significant health challenge globally, with China experiencing a notable increase in its burden. Understanding the trends and factors contributing to PAH is crucial for developing effective public health strategies.

Methods

This study utilized data from the Global Burden of Disease (GBD) 2021 database to estimate the burden of PAH in China and worldwide from 1990 to 2021. A Bayesian age-period-cohort (BAPC) model was employed to analyze differences in PAH burden across age, gender, and time periods, and to project global epidemiological trends until 2036.

Results

From 1990 to 2021, the incidence and prevalence of PAH in China increased by 80.59% and 86.74%, respectively. The age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) showed an annual percentage change (AAPC) of -0.07% and 0.25%, respectively. Conversely, the age-standardized disability-adjusted life year (DALY) rate and age-standardized mortality rate (ASMR) have been declining since 1990, with AAPC of -1.90% and -1.26%, respectively. Females and the 50-70 years age group experienced a higher PAH burden compared to males. Projections indicate that ASPR, ASMR, and age-standardized death rate (ASDR) will stabilize with minimal variation over the next decade.

Discussion

The findings highlight the age-related burden of PAH in China, particularly affecting older populations and women. The projected stabilization of PAH metrics over the next decade underscores the need for continued monitoring and targeted interventions. This study's comprehensive analysis of PAH burden over three decades provides valuable insights for policymakers and healthcare providers, necessitating concerted efforts to address this critical health issue.

Natural phenol carbamates: Selective BuChE/FAAH dual inhibitors show neuroprotection in an Alzheimer's disease mouse model

FAAH inhibition can indirectly enhance endocannabinoid signaling to therapeutic levels, effectively preventing or slowing its progression of Alzheimer's disease (AD). Hence, the search for effective dual FAAH/cholinesterase inhibitors is considerable need for disease-modifying therapies. To this aim, we designed, synthesized, and tested three series of natural phenol carbamates. The majority of carbamates proved to be potent on a single target, amongst them, compound D12 containing paeonol motif was identified as an effective dual BuChE/FAAH inhibitor, with well-balanced nanomolar activity (IC50 = 81 and 400 nM for hBuChE and hFFAH, respectively). D12 possessed BBB penetrating ability, benign safety, neuroprotection and pseudo-irreversible BuChE inhibition (Kd = 2.11 μM, k2 = 2.27 min-1), showing good drug-like properties. D12 also modulated the BV2 microglial polarization to inhibit neuroinflammation. In vivo study verified that D12 improved Aβ1-41-induced learning impairments in AD mouse model for both short- and long-term memory responses. Thus, the dual activity of D12 could lead to a potentially more effective treatment for the counteraction of AD progression.

Changing patterns of cardiovascular diseases and subtypes induced by kidney dysfunction among 25-64 years in China from 1992 to 2021

BACKGROUND

Cardiovascular diseases (CVD) remain a significant global health burden, particularly in China, where kidney dysfunction (KD) is a key risk factor. This study analyzed trends in the burden of KD-induced CVD and subtypes among the working-age population (25-64 years) in China over the past 30 years and explored its association with age, period, and birth cohort.

METHODS

This study extracted data from the Global Burden of Disease (GBD) 2021, focusing on deaths and disability-adjusted life years (DALYs) caused by KD-induced CVD and subtypes, including ischemic heart disease (IHD), stroke, and lower extremity peripheral artery disease (LEPAD) among 25-64 years globally and in China from 1992 to 2021. Trends in disease burden were described by calculating age-standardized mortality rates (ASMR) and age-standardized DALYs rates (ASDR). Additionally, an age-period-cohort (APC) model was employed to estimate the overall annual percentage change in mortality (net drift), the annual percentage change for specific age groups (local drift), the relative risks of period and cohort effects, and the age-specific rates adjusted for period bias (age effect).

RESULTS

From 1992 to 2021, the number of deaths and DALYs caused by KD-induced IHD and LEPAD among 25-64 years globally and in China showed an upward trend, while the number caused by stroke decreased. However, the ASMR and ASDR demonstrated a declining trend, with the disease burden in China being lower than the global level. Notably, the ASMR for IHD and LEPAD in Chinese males showed an upward trend. The declines in ASMR and ASDR were more pronounced in females than in males. The net drift for CVD and subtypes showed a downward trend, with differing patterns between males and females. Mortality rates from stroke in males was increasingly affecting younger populations, while LEPAD was more prevalent in older individuals. Aside from male IHD, the relative risks for CVD and subtypes across cohort and period analyses showed a slight decline. Females exhibited higher relative risks in earlier periods, but their decline in both period and cohort analyses was faster than that of males. Mortality rates for IHD and stroke increased with age, with males exhibiting higher mortality rates across all age groups compared to females.

CONCLUSION

Our findings provide strong evidence that from 1992 to 2021, KD-induced CVD and subtypes still require attention among the working population in China. There were notable differences across subtypes, genders, and age groups, with males experiencing higher mortality rates and cohort-period risks than females. Our study highlights the need for China's public health authorities to develop tailored guidelines targeting specific CVD subtypes, genders, and age groups to prevent the further escalation of the KD-induced CVD burden.

The Burden of Multiple Myeloma in China: Trends from 1990 to 2021 and Forecasts for 2050

This study updates the disease burden of multiple myeloma (MM) in thirty-three provincial administrative units in China from 1990 to 2021 and forecast the disease burden for 2050. Data from the 2021 Global Burden of Disease (GBD) database was used for analysis. In 2021, there were an estimated 17,250 new MM cases and 12,984 deaths in China. The age-standardized incidence, mortality, and prevalence rates per 100,000 population were 0.8, 0.6, and 2.2, respectively. The highest disease burden was observed in provinces with the highest per capita GDP. From 1990 to 2021, the age-standardized incidence and mortality increased by 3.1% and 2.2%, respectively, while prevalence increased disproportionately by 5.8%, reflecting improved treatment efficacy and extended patient survival. The age-standardized disability-adjusted life years rate increased by 2.2%. A more rapid rise in the disease burden was observed in younger populations compared to the elderly. In 2021, 5.5% of MM deaths were attributed to high body mass index. Over the past three decades, the MM burden in China has steadily increased. Forecasts for 2050 also indicated this upward trend will likely continue into the future. This study provided comprehensive estimates that can potentially inform efforts toward management of MM in China.

Perillaldehyde pretreatment alleviates cerebral ischemia-reperfusion injury by improving mitochondrial structure and function via the Nrf2/Keap1/Trx2 axis

BACKGROUND

Perilladehyde, an extract of perillae in the Labiatae family, can produce significant anti-inflammatory and antioxidant effects. Although literature evidences the favorable effect of perillaldehyde on ischemic stroke, the exact mechanism remains blurred.

PURPOSE

This study attempted to explore the impact of perillaldehyde on cerebral ischemia-reperfusion injury and the related action mechanism.

METHODS

The rat tMCAO and neuronal OGD/R models were established to simulate cerebral ischemia-reperfusion injury. Lentiviruses were used to interfere with the expression of Nrf2 and Trx2 in neurons. The effects and action mechanisms of perillaldehyde were explored by various experimental methods, including chromatin immunoprecipitation assay, Western Blot, flow cytometry, dual-luciferase reporter gene assay, transmission electron microscopy, MRI, RNA-seq, and immunofluorescence staining.

RESULTS

Perillaldehyde pretreatment effectively mitigated the tMCAO-induced brain injury in rats by reducing cerebral infarction, improving neuromotor function, and attenuating cell apoptosis in the ischemic penumbra. In vitro, perillaldehyde pretreatment alleviated cell death and excessive oxidative stress, preserved the mitochondrial membrane integrity, enhanced mitochondrial energy metabolism, and facilitated the restoration of mitochondrial ultrastructure after OGD/R. The mechanism probe revealed that perillaldehyde activated the Nrf2/Keap1/Trx2 signaling axis, thus promoting the transcription of Trx2 and improving mitochondrial structure and function. The aforementioned impacts of perillaldehyde were somewhat counteracted by disrupting the expression of Nrf2 and Trx2, suggesting that the neuroprotection of perillaldehyde partially involves the activation of the Nrf2/Keap1/Trx2 axis.

CONCLUSIONS

This study firstly demonstrates the existence of the Nrf2/Keap1/Trx2 signaling axis in cerebral ischemia-reperfusion injury and evidences that perillaldehyde pretreatment can promote the restoration of neuronal mitochondrial structure and function by activating the Nrf2/Keap1/Trx2 axis after cerebral ischemia-reperfusion injury. These findings signify that perillaldehyde holds great promises for clinical management of ischemic stroke.

Polymer-Formulated Nerve Growth Factor Shows Effective Therapeutic Efficacy for Cerebral Microinfarcts

Cerebral microinfarcts represent the most prevalent form of ischemic brain injury in the elderly, particularly among those suffering from dementia, Alzheimer's disease, and vascular risk factors. Despite their commonality, effective treatments have remained elusive. Herein, a novel treatment utilizing a polymer-formulated nerve growth factor capable of crossing the blood-brain barrier is reported, which effectively reduced oxidative stress and neuronal apoptosis, reshaped microglia polarization at infarct sites, and decreased the overall microinfarct burden, leading to notable improvements in behavioral and cognitive functions in a mouse model. This work provides a promising new avenue for the treatment of cerebral microinfarcts and other neurodegenerative diseases.

Sources of PM2.5 exposure and health benefits of clean air actions in Shanghai

Estimating PM2.5 exposure and its health impacts in cities involves large uncertainty due to the limitations of model resolutions. Consequently, attributing the sources of PM2.5-related health impacts at the city level remains challenging. We characterize the health impacts associated with chronic PM2.5 exposure and anthropogenic emissions in Shanghai using a chemical transport model (GEOS-Chem) and its adjoint. By incorporating high-resolution satellited-derived PM2.5 estimates into the calculation, we investigate the response of PM2.5 exposure and its related health impacts in Shanghai to changes in anthropogenic emissions from each individual region, species, sector, and month. We estimate that a 10% decrease in anthropogenic emissions throughout China avoids over 752 (506-1,044) PM2.5-related premature deaths in Shanghai, with changes in local emissions potentially saving 241 (161-334) lives. Ammonia (NH3) emissions are identified as the marginal dominant contributor to the health impacts due to the NH3-limited PM2.5 formation within the city, thus controlling NH3 emissions at both the local and regional scales are effective at reducing the population's exposure to PM2.5. A negative response of the PM2.5 exposure to local nitrogen oxides (NOx) emission changes is detected in winter. Even so, controlling NOx emissions is still justified since the negative impacts decrease as anthropogenic emissions decline and NOx emission reductions benefit the public health on average. The anthropogenic emission changes due to Clean Air Actions helped avoid 3,132 (2,108-4,346) PM2.5-related premature deaths in 2019 relative to 2013, most of which are associated with emission reductions in the agricultural and industrial sectors.

Maintenance of Cardiac Microenvironmental Homeostasis: A Joint Battle of Multiple Cells

Various cells such as cardiomyocytes, fibroblasts and endothelial cells constitute integral components of cardiac tissue. The health and stability of cardiac ecosystem are ensured by the action of a certain type of cell and the intricate interactions between multiple cell types. The dysfunctional cells exert a profound impact on the development of cardiovascular diseases by involving in the pathological process. In this paper, we introduce the dynamic activity, cell surface markers as well as biological function of the various cells in the heart. Besides, we discuss the multiple signaling pathways involved in the cardiac injury including Hippo/YAP, TGF-β/Smads, PI3K/Akt, and MAPK signaling. The complexity of different cell types poses a great challenge to the disease treatment. By characterizing the roles of various cell types in cardiovascular diseases, we sought to discuss the potential strategies for preventing and treating cardiovascular diseases.

Association between leisure-time physical activity and stroke in patients with chronic obstructive pulmonary disease: A population-based study

BACKGROUND

Stroke is the second leading cause of death worldwide. It remains unclear whether chronic obstructive pulmonary disease (COPD) increases the risk of stroke. The purpose of this study was to evaluate the association between COPD and stroke. As physical activity may prevent strokes, we examined whether leisure-time physical activity (LTPA) moderates stroke risk in COPD patients.

METHODS

13,524 participants from the 2009-2018 National Health and Nutrition Examination Survey (NHANES). We used the Global Physical Activity Questionnaire (GPAQ) questionnaire to obtain self-reported data from LTPA. We used a binary logistic regression model to analyze the association between LTPA, COPD, and stroke risk.

RESULTS

The prevalence of COPD in the present study was 5.54%. The risk of stroke in COPD patients is 1.84 times higher than that in those without COPD, with a 95% confidence interval (95%CI) of 1.32,2.56 and P < 0.001. A lower stroke risk was observed in COPD patients who adhered to LTPA than those who did not (OR, 0.50; 95%CI, 0.26, 0.95; P = 0.03). As shown by the restricted cubic spline (RCS), the duration of LTPA in COPD patients was inversely related to the risk of stroke, which decreased as the duration of weekly LTPA increased.

CONCLUSION

COPD is positively associated with stroke risk. LTPA reduces the risk of stroke in patients with COPD, suggesting that it may be a promising measure for preventing stroke in this population.

Voluntary running exercise promotes maturation differentiation and myelination of oligodendrocytes around Aβ plaques in the medial prefrontal cortex of APP/PS1 mice

BACKGROUND

Previous studies have reported that running exercise could improves myelinization in hippocampus. However, the effects of running exercise on the differentiation and maturation of oligodendrocytes, and myelination surrounding Aβ plaques in the medial prefrontal cortex (mPFC) of the Alzheimer's disease (AD) brain have not been reported.

METHODS

Forty 10-month-old male APP/PS1 AD mice were randomly divided into the AD group and the AD running (AD+RUN) group, while 20 age-matched wild-type littermate mice were included in the WT group. The running group received three-month voluntary running exercise in a running cage, while the AD and WT groups were untreated. After the exercise intervention, all mice were given behavioral tests. The total number of mature oligodendrocytes (CC1+) in the mPFC of mice was precisely quantified using unbiased stereology. Myelin basic protein (MBP) and Aβ plaque, as well as the fluorescence area of MBP surrounding Aβ plaques, and the density and morphology of PDGFα+ cells in the mPFC were analyzed using immunofluorescence.

RESULTS

The levels of working memory, cognitive memory, spatial learning and memory ability were decreased significantly in the AD group compared to the WT group, while these functions were significantly improved in the AD+RUN group compared to the AD group. The Aβ plaques in the mPFC were significantly reduced in the AD+RUN group compared to the AD group. The total number of CC1+ cells and the percentage of MBP fluorescence area surrounding Aβ plaques in the mPFC were significantly lower in the AD group compared to the WT group, but they were significantly higher in the AD+RUN group compared to the AD group. The density and branching complexity of PDGFα+ cells surrounding Aβ plaques in the mPFC were significantly higher in the AD group than in the WT group, while the AD+RUN group showed significantly lower density and branching complexity than the AD group. Changes in MBP expression around Aβ plaques, cell density and cell branching complexity of PDGFα+ cells around Aβ plaques were closely related to the number of Aβ plaques in mPFC, and they were also closely related to behavioral changes in mice.

CONCLUSIONS

Voluntary running exercise could reduce Aβ plaque deposition and promote the maturation and myelination capacity of oligodendrocytes surrounding Aβ plaques in the mPFC of AD mice, thereby improving the learning and memory abilities of APP/PS1 transgenic AD mice.

In-hospital outcomes of intravenous recombinant tissue plasminogen activator treatment for acute ischemic stroke in patients aged >80 years: Findings from the Chinese Stroke Center Alliance

BACKGROUND

Intravenous (IV) recombinant plasminogen activator (rt-PA) within 4.5 hours of symptom onset has established benefit for patients with acute ischemic stroke (AIS); however, evidence on the use of IV rt-PA in elderly Chinese patients is limited. This study evaluated the patient characteristics and in-hospital clinical outcomes of Chinese patients aged >80 years who received IV rt-PA within 4.5 h of symptom onset, using patients aged 18-80 years as a reference group. (NCT05395351).

METHODS

This study analyzed adult Chinese patients with AIS who arrived at the hospital within 4.5 hours of symptom onset between August 2015 and July 2019 and were registered in the nationwide, hospital-based Chinese Stroke Center Alliance platform. Patients were categorized by treatment (IV rt-PA versus no IV rt-PA) and age (>80 years versus 18-80 years). In-hospital outcomes were evaluated in IV rt-PA-treated patients. Primary outcome was all-cause mortality during hospitalization; secondary outcomes included proportion of patients with intracranial hemorrhage (ICH) during hospitalization, change in National Institutes of Health Stroke Scale (NIHSS) before and 24 h after IV rt-PA, modified Rankin Scale (mRS) at discharge, proportion of patients with stroke recurrence during hospitalization, and duration of hospital stay.

RESULTS

Of 113,035 patients with AIS included in the study, 31,418 patients received IV rt-PA within 4.5 hours after symptom onset (aged >80 years: n=3,332; 18-80 years: n=28,086). Among IV rt-PA-treated patients, all-cause mortality was 2.6 % (95 % CI 2.1-3.2 %) and 0.8 % (95 % CI 0.7-0.9 %) in patients aged >80 years and 18-80 years, respectively. Intracranial hemorrhage occurred in 6.7 % (95 % CI 5.8-7.5 %) and 3.1 % (95 % CI 2.9-3.3 %) of patients; mean±SD change in NIHSS score was 2.8±5.0 and 2.5±4.3; mRS 0-1 at discharge in 42.8 % (95 % CI 40.8 %-44.8 %) and 63.6 % (95 % CI 62.9 %-64.3 %); stroke recurrence in 11.1 % (95 % CI 10.0-12.1 %) and 7.3 % (95 % CI 7.0-7.6 %). Median duration of hospital stay was 11 days in both age groups.

CONCLUSIONS

Chinese patients aged >80 years with AIS who received IV rt-PA within 4.5 hours after symptom onset had higher all-cause mortality during hospitalization than those aged 18-80 years.

Paeoniflorin ameliorates reperfusion injury in H9C2 cells through SIRT1-PINK1/parkin-mediated mitochondrial autophagy

Myocardial ischemia-reperfusion injury (MIRI) injury is a serious health problem, which can seriously affect the recovery of patients with myocardial infarction and even lead to death. Paeoniflorin (PF) is a potential therapeutic drug to prevent reperfusion injury. However, the mechanism of PF in MIRI is not clear. Compared with other cells, cardiomyocytes have the largest number of mitochondria. Therefore, this study researched the protective mechanism of paeoniflorin pretreatment on myocardial ischemia-reperfusion injury (AMI) from the perspective of mitochondrial autophagy. Paeoniflorin was given or not given to H9C2 cells 12 h before reperfusion. Pretreatment of paeoniflorin can significantly increase the viability of H9C2 cells and inhibit the increase of ROS secretion induced by OGD/R. The increase of MDC autophagy fluorescence and mitochondrial membrane potential (MMP) suggested that the myocardial protective effect of paeoniflorin may also be related to mitochondrial autophagy. Next, we detected the related signals in the classical mitochondrial autophagy pathway of PINK1/parkin by Q-PCR and Western blots. The results showed that the pretreatment of paeoniflorin could promote the levels of SIRT1, Beclin1, PINK1, parkin and LC3, inhibit the level of P62. In order to further clarify whether paeoniflorin-induced SIRT1 activation is necessary for autophagy and its potential mechanism, we detected the autophagy level of H9C2 cells with SIRT1 inhibitor (EX527). The results showed that after pretreatment of EX527, the protective effect of paeoniflorin on oxidative damage and autophagy pathway was significantly decreased. The mechanism may relate to SIRT1-PINK1/parkin mitochondrial autophagy pathway. In summary, these results suggested that paeoniflorin may protect H9C2 cells from OGD/R damage by activating SIRT1-PINK1/parkin pathway. This provides new experimental basis for paeoniflorin in the treatment of MIRI.

Exposure to submicron particulate matter and long-term survival: Cross-cohort analysis of 3 Chinese national surveys

BACKGROUND

Cohort evidence linking increased mortality with airborne fine particulate matter (PM2.5, particulate matter [PM] with aerodynamic diameter ≤2.5 μm) exposure was extensively validated worldwide. Nevertheless, long-term survival associated with submicron particulate matter (PM1, PM with aerodynamic diameter ≤1 μm) exposure remained largely unstudied, particularly in highly exposed populations.

METHODS

We performed a population-based investigation involving 86844 adults aged 16+ years from 3 national dynamic cohorts spanning from 2005 to 2018. Residential annual exposure to PM1 and PM2.5 was assigned for each follow-up year using satellite-derived spatiotemporal estimates at a 1-km2 resolution. The concentration of PM1-2.5 (PM with aerodynamic diameter between 1 and 2.5 μm) was calculated by subtracting PM1 from PM2.5. Time-independent Cox proportional hazards regression models were applied to assess the associations of all-cause mortality with long-term exposure to size-specific particles. To investigate the effect of PM1 on PM2.5-mortality associations, we categorized participants into low, medium, and high groups based on PM1/PM2.5 ratio and examined the risk of PM2.5-associated mortality in each stratum. Effect modifications were checked via subgroup analyses.

RESULTS

A total of 18722 deaths occurred during 497069.2 person-years of follow-up (median 5.7 years). Participants were exposed to an average annual concentration of 31.8 μg/m³ (range: 7.6-66.8 μg/m³) for PM1, 56.3 μg/m³ (range: 19.8-127.2 μg/m³) for PM2.5, and 24.5 μg/m³ (range: 7.3-60.3 μg/m³) for PM1-2.5. PM1, PM2.5, and PM1-2.5 were consistently associated with elevated mortality risks, with a hazard ratio (HR) of 1.029 (95% confidence interval [CI]: 1.013-1.046), 1.014 (95% CI: 1.005-1.023), and 1.019 (95% CI: 1.001-1.038) for each 10-μg/m3 increase in exposure, respectively. Compared with low (HR = 0.986, 95% CI: 0.967-1.004) and medium (HR = 1.015, 95% CI: 1.002-1.029) PM1/PM2.5 ratio groups, PM2.5-related risk of mortality was more pronounced in high PM1/PM2.5 ratio stratum (HR = 1.041, 95% CI: 1.019-1.064). Greater risks of mortality associated with size-specific particles were found among the elderly (>80 years old), southeastern participants, and those living in warmer areas.

CONCLUSIONS

This study demonstrated that long-term exposure to PM1, PM2.5, and PM1-2.5 was associated with heightened mortality, and PM1 may play a predominant role in PM2.5-induced risk. Our results emphasized the population health implications of establishing ambient PM1 air quality guidelines to mitigate the burden of premature mortality stemming from particulate air pollution.

Research Trends and Dynamics in Single-cell RNA Sequencing for Musculoskeletal Diseases: A Scientometric and Visualization Study

Background: Worldwide, approximately 1.7 billion people are afflicted with musculoskeletal (MSK) diseases, posing significant health challenges. The introduction of single-cell RNA sequencing (scRNA-seq) technology provides novel insights and approaches to comprehend the onset, progression, and treatment of MSK diseases. Nevertheless, there is a remarkable lack of analytical and descriptive studies regarding the trajectory, essential research directions, current research situation, pivotal research focuses, and upcoming perspectives. Therefore, the aim of this research is to present a comprehensive overview of the advancements made in scRNA-seq for MSK disorders over the past 15 years. Methods: It utilizes a robust dataset derived from the Web of Science Core Collection, encompassing January 1, 2009, through September 6, 2024. To achieve this, advanced analytical methodologies were applied to conduct thorough scientometric and visual analyses. Results: The findings underscore the preeminent role of China, which contributes 63.49% of the total publications, thereby exerting a substantial impact within this research domain. Notable contributions came from institutions such as Shanghai Jiao Tong University, Sun Yat-sen University, and Harvard Medical School, with Liu Yun being the leading contributor. Frontiers in Immunology published the greatest number of research papers in this field. This study identified joint diseases, bone neoplasms, bone fractures, and intervertebral disc degeneration as the main research focuses. Conclusion: This extensive scientometric analysis provides substantial benefits to both experienced and novice researchers by facilitating immediate access to critical data, thereby fostering innovation within this field.

Risk-stratified lifetime risk and incidence of hip fracture and falls in middle-aged and elderly Chinese population: The China health and retirement longitudinal study

Background

Hip fracture (HF) is one of the most prevalent orthopedic conditions among the elderly, with falls being the primary risk factor for HF. With the surge of aged population, China is facing great challenges from HF and falls. However, a comprehensive long-term observation of risk factors affecting HF and falls and their association are little reported at a national level.

Methods

The longitudinal cohort was established using the China Health and Retirement Longitudinal Study (CHARLS) data from 2011 to 2018. The incidence density and multi-risk-stratified lifetime risk (up to 90 years of age) of falls and HF were studied at index ages of 50, 60, and 70, as well as the lifetime risk stratified by six regions in China, based on the modified Kaplan-Meier method with Statistical Analysis System (SAS).

Results

This study identified 17 705 subjects aged 50-89. The incidence density of falls was 65.07 and 47.53 per 1000 person-years in women and men, respectively. The incidence density of HF was also higher in women at 5.58 per 1000 person-years than in men at 4.88. By age 50, the lifetime risk of experiencing a HF was 18.58 % for women and 13.72 % for men. Vision and hearing abilities were significantly related to the lifetime risk of both falls and HF. Obesity-related factors presented age-relevant relationships with lifelong risks. Lack of naps, poor lower limb strength, and physical capabilities were indicative of HF risk. The north-western region of China had the lowest lifetime risk of falls but highest risk of HF, while other regions showed a consistent trend between falls and HF.

Conclusion

The aging population worldwide faces a considerable risk of falls and HF. Several risk factors were identified in this study using a Chinese population, relating to disease history, lifestyle habits, health status and physical function, and the risks differed among six regions in China. Future precautionary management programs, as well as patient self-awareness are necessary for improving the prevention of falls and HF to reduce their incidence in the aging population.

The translational potential of this article

With the greatest aged population worldwide, China faces the unparalleled challenge on public health. The study poses the lifetime risk of hip fracture and falls stratified by multiple risk factors in people from 45 to 90 in a national scale, which would shed a light on the early and continuous prevention of such injury.

Predictive value of near-term prediction models for severe immune-related adverse events in malignant tumor PD-1 inhibitor therapy

Immune-related adverse events (irAEs) impact outcomes, with most research focusing on early prediction (baseline data), rather than near-term prediction (one cycle before the occurrence of irAEs and the current cycle). We aimed to explore the near-term predictive value of neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), absolute eosinophil count (AEC) for severe irAEs induced by PD-1 inhibitors. Data were collected from tumor patients treated with PD-1 inhibitors. NLR, PLR, and AEC data were obtained from both the previous and the current cycles of irAEs occurrence. A predictive model was developed using elastic net logistic regression Cutoff values were determined using Youden's Index. The predicted results were compared with actual data using Bayesian survival analysis. A total of 138 patients were included, of whom 47 experienced grade 1-2 irAEs and 18 experienced grade 3-5 irAEs. The predictive model identified optimal α and λ through 10-fold cross-validation. The Shapiro-Wilk test, Kruskal-Wallis test and logistic regression showed that only current cycle data were meaningful. The NLR was statistically significant in predicting irAEs in the previous cycle. Both NLR and AEC were significant predictors of irAEs in the current cycle. The model achieved an area under the ROC curve (AUC) of 0.783, with a sensitivity of 77.8% and a specificity of 80.8%. A probability ≥ 0.1345 predicted severe irAEs. The model comprising NLR, AEC, and sex may predict the irAEs classification in the current cycle, offering a near-term predictive advantage over baseline models and potentially extending the duration of immunotherapy for patients.

Gut Microbiome and Stroke: a Bidirectional Mendelian Randomisation Study in East Asian and European Populations

BACKGROUND AND AIMS

Observational studies have implicated the involvement of gut microbiome in stroke development. Conversely, stroke may disrupt the gut microbiome balance, potentially causing systemic infections exacerbated brain infarction. However, the causal relationship remains controversial or unknown. To investigate bidirectional causality and potential ethnic differences, we conducted a bidirectional two-sample Mendelian randomisation (MR) study in both East Asian (EAS) and European (EU) populations.

METHODS

Leveraging the hitherto largest genome-wide association study (GWAS) summary data from the MiBioGen Consortium (n=18 340, EU) and BGI (n=2524, EAS) for the gut microbiome, stroke GWAS data from the GIGASTROKE Consortium(264 655 EAS and 1 308 460 EU), we conducted bidirectional MR and sensitivity analyses separately for the EAS and EU population.

RESULTS

We identified nominally significant associations between 85 gut microbiomes taxa in EAS and 64 gut microbiomes taxa in EU with stroke or its subtypes. Following multiple testing, we observed that genetically determined 1 SD increase in the relative abundance of species Bacteroides pectinophilus decreased the risk of cardioembolic stroke onset by 28% (OR 0.72 (95% CI 0.62 to 0.84); p=4.22e-5), and that genetically determined 1 SD increase in class Negativicutes resulted in a 0.76% risk increase in small vessel stroke in EAS. No significant causal association was identified in the EU population and the reverse MR analysis.

CONCLUSION

Our study revealed subtype-specific and population-specific causal associations between gut microbiome and stroke risk among EAS and EU populations. The identified causality holds promise for developing a new stroke prevention strategy, warrants further mechanistic validation and necessitates clinical trial studies.

Effectiveness and compliance of telemedicine on blood pressure management in poststroke patients: a systematic review and meta-analysis of randomised controlled trials

OBJECTIVE

To examine the effectiveness of telemedicine on blood pressure control and compliance.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

A search of PubMed, Web of Science, Embase and Cochrane Library for studies of randomised controlled trials (RCTs) of telemedicine on blood pressure control in poststroke survivors from the time of their construction until November 2023. Inclusion criteria were as follows: (1) studies that were RCTs; (2) enrolment of patients who were stroke survivors; (3) studies that compared subjects who received telemedicine with usual care treatment. Exclusion criteria were as follows: (1) studies in which telemedicine was used for other diseases; (2) study protocols with no data; (3) non-English language articles and (4) case reports, conference papers, letters or articles with incomplete data. Quality assessment of included studies was performed using the Cochrane Risk of Bias Tool.

PRIMARY OUTCOME MEASURES

The primary outcomes was the systolic blood pressure (SBP) (mm Hg), diastolic blood pressure (DBP) (mm Hg), patient compliance and the proportion of patients achieving target blood pressure.

RESULTS

A total of 11 studies with 2903 patients were included in this paper. There were 1453 cases in the telemedicine group and 1450 cases in the usual care group. Meta-analysis showed a statistically significant decrease in SBP (mm Hg) in the telemedicine group compared with the usual care group at weeks 3, 6 and 12 of follow-up (week 3: mean difference (MD), -8.8; 95% CI, -12.05 to -5.56; p<0.00001; week 6: MD, -5.13; 95% CI, -8.07 to -2.18; p=0.0007; week 12: MD, -2.78; 95% CI, -4.68 to -0.89; p=0.004). At week 12 of follow-up, there was a statistically significant decrease in DBP (mm Hg) in the telemedicine group compared with the usual care group (MD, -1.57; 95% CI, -2.59 to -0.55; p=0.003). In addition, patient compliance was better in the telemedicine group than in the usual care group (OR, 1.61; 95% CI, 1.29 to 2.01; p<0.0001), and the proportion of patients achieving target blood pressure was higher than in the usual care group (OR, 3.49; 95% CI, 2.64 to 4.63; p<0.00001).

CONCLUSIONS

Compared with usual care, telemedicine interventions can better improve blood pressure control in poststroke survivors and increase patient compliance.

TRIAL REGISTRATION NUMBER

CRD42022382001.

Association between pulmonary ventilation function and cognitive function among middle-aged and older adults: an observational study from Southwest China

BACKGROUND

Despite the significant prevalence of chronic obstructive pulmonary disease (COPD) in Southwest China, cognitive function among middle-aged and elderly individuals in this area surpasses the national average. This study aims to reveal the overall pulmonary ventilation function status of this population, and investigate whether pulmonary ventilation dysfunction is a risk factor for mild cognitive impairment (MCI) in this region, as suggested by previous researches.

METHODS

Data were obtained from the 2019-2021 baseline survey of a natural population cohort study conducted in Southwest China. Pulmonary function was tested by experienced and well-trained medical personnel using a spirometer. The Mini-Mental State Examination was used to evaluate cognitive function. Subsequently, multiple logistic regression analysis was employed to examine the associations between pulmonary function and cognitive levels.

RESULTS

A total of 2,337 middle-aged and elderly adults were included in this study, with 10.18% (238 individuals) classified as having mild cognitive impairment. According to the Chinese experts' consensus on the standardization of adult lung function diagnosis, approximately 41.16% (962/2,337) of middle-aged and elderly individuals in Southwest China suffer from pulmonary ventilation dysfunction, predominantly mild (37.53%, 877/2,337), with the primary type being obstructive ventilation dysfunction (38.60%, 902/2,337; COPD: 14.21%, 332 participants). And 81.56% participants (1,906/2,337) were found to have small airway dysfunction. Multiple logistic regression analyses showed that individuals with poor pulmonary ventilation function (PPF) were associated with an increased risk of MCI (OR [95% CI]: 1.38 [1.04, 1.83], P = 0.026). Moreover, the more severe the pulmonary ventilation dysfunction, the higher the risk of cognitive impairment (P for trend = 0.009). Similar association were found between PPF and MCI when we use ATS/ERS technical standards. No significant association was observed between small airway dysfunction and cognitive impairment (OR [95% CI]: 1.05 [0.72, 1.56], P = 0.819).

CONCLUSIONS

The pulmonary function status of middle-aged and elderly individuals in Southwest China requires attention, particularly regarding obstructive pulmonary ventilation dysfunction. We recommend integrating pulmonary health assessments into routine care for these populations to raise awareness of lung health, improve lung function, and ultimately enhance cognitive function.

Disease burden of biliary tract cancer in 204 countries and territories, 1990-2021: A comprehensive demographic analysis of the Global Burden of Disease Study 2021

BACKGROUND

Biliary tract carcinomas (BTCs) are relatively rare but lethal primary malignant tumors derived from the biliary tract system. The burden of BTCs varies according to sex, age, region, and country, but limited attention has been paid to the burden of BTCs. We sought to explore the up-to-date data from the Global Burden of Disease Study (GBD) and expand findings by accessing the demographic features of BTC disease burden.

METHODS

Using the latest data from the GBD 2021, we evaluated and analyzed the distributions and patterns of BTC disease burden in various age groups, sexes, regions, and countries.

RESULTS

The number of incident cases, deaths, and disability-adjusted life-years (DALYs) tended to increase and peaked at 216,770 (95% uncertainty interval [UI]: 181,890-245,240), 171,960 (95% UI: 142,350-194,240), and 3,732,100 (95% UI: 3,102,900-4,317,000) person-years, respectively, in 2021. However, the average global age-standardized rates (ASRs) of incident cases, deaths, and DALYs shrunk by -11.46% (95% UI: -21.91 to 3.35%), -24.09% (95% UI: -33.19 to 16.88%), and -26.25% (95% UI: -35.53 to 18.36%), respectively, from 1990 to 2021. Meanwhile, the male/female ratio (male per 100 female) of incidence, deaths, and DALYs changed from 76.40, 75.41, and 74.72 to 86.89, 79.11, and 82.29, respectively. In 2021, the highest number of incident cases, deaths, and DALYs occurred in East Asia. The top three highest incidences, deaths, and DALYs were observed in China, India, and Japan, and the highest ASRs were observed in Chile in 2021. Analysis of the Human Development Index along with disease burden estimates of BTCs also suggests that the burden of the disease is related to the level of comprehensive development of the society.

CONCLUSION

This study provided a comprehensive comparison of differences in the burden of disease across populations and over time, and further presented evidence concerning the formulation of prevention and control policies and etiologic studies for BTCs and proposed logical hypotheses to investigate.

Effect of Baduanjin exercise on health and functional status in patients with chronic obstructive pulmonary disease: a community-based, cluster-randomized controlled trial

Baduanjin has been shown to be an effective method of exercise for promoting body function in patients with chronic obstructive pulmonary disease (COPD). However, this method is rarely used by rural doctors in rural communities. The aim of this study was to compare the therapeutic effects of Baduanjin exercise with those of conventional pulmonary rehabilitation (CPR) implemented by rural doctors in patients with COPD. A total of 472 COPD patients from 18 village clinics were randomly allocated to the Baduanjin group (n = 158), CPR group (n = 154), or control group (n = 160). The Baduanjin group received six months of Baduanjin training, the CPR group received six months of rehabilitation training, and the control group received usual care. The primary outcomes were changes in health status, as measured by the COPD Assessment Test (CAT), and dyspnoea, as assessed via the modified Medical Research Council (mMRC) dyspnoea scale. The secondary outcomes included six-minute walking distance (6MWD) performance and anxiety and depression scores on the Hospital Anxiety and Depression Scale (HADS-A and HADS-D, respectively). Baseline data were collected before randomization, and outcomes were ascertained at the six-month follow-up by blinded assessors. After six months of training, compared with the control group, the Baduanjin group presented significant improvements in CAT scores (t = 5.121, P < 0.001), mMRC scale scores (t = 5.719, P < 0.001), 6MWD performance (t = 12.608, P < 0.001), HADS-A scores (t = 6.210, P < 0.001), and HADS-D scores (t = 2.945, P = 0.010). The CPR group also presented significant improvements in CAT scores (t = 4.725, P < 0.001), mMRC scale scores (t = 5.499, P < 0.001), 6MWD performance (t = 11.662, P < 0.001), HADS-A scores (t = 5.697, P < 0.001), and HADS-D scores (t = 2.671, P = 0.023). In contrast, the control group participants showed no significant changes in CAT scores (t = -0.252, P = 0.801), mMRC scale scores (t = -0.085, P = 0.932), 6MWD performance (t = -0.463, P = 0.644), HADS-A scores (t = -2.75, P = 0.783), or HADS-D scores (t = -0.281, P = 0.779). No adverse events were reported during the study. The positive effects of Baduanjin exercise on the subjective symptoms of COPD patients are similar to those of CPR. The trial was registered with the Chinese Clinical Trials Registry (reference: ChiCTR-TRC-12001958) (22/02/2012).

Associations of Low-density Lipoprotein Cholesterol With All-cause and Cause-specific Mortality in Older Adults in China

CONTEXT

Limited information was available on detailed associations of low-density lipoprotein cholesterol (LDL-C) with all-cause and cause-specific mortality in older adults.

METHODS

This prospective cohort study included a representative sample of 211 290 adults aged 65 or older who participated in Shenzhen Healthy Aging Research 2018-2019. The vital status of the participants by December 31, 2021, was determined. We estimated the hazard ratios (HR) with 95% confidence intervals for all-cause or cause-specific mortality using multivariable Cox proportional hazards models and Cox models with restricted cubic spline (RCS).

RESULTS

The median follow-up time was 3.08 years. A total of 5333 participants were confirmed to have died. Among them, 2037 cardiovascular disease (CVD) deaths and 1881 cancer deaths occurred. Compared to those with LDL-C of 100 to 129 mg/dL, the all-cause mortality risk was significantly higher for individuals with LDL-C levels that were very low (<70 mg/dL) or low (70-99 mg/dL). Compared with individuals with the reference LDL-C level, the multivariable-adjusted HR for CVD-specific mortality was 1.338 for those with very low LDL-C levels (< 70 mg/dL), 1.437 for those with high LDL-C levels (160 mg/dL ≤ LDL-C < 190 mg/dL), and 1.489 for those with very high LDL-C levels (≥190 mg/dL). Low LDL-C levels (70-99 mg/dL) and very low LDL-C levels (<70 mg/dL) were also associated with increased cancer mortality and other-cause mortality, respectively. The results from an RCS curve showed similar results.

CONCLUSION

Considering the risk of all-cause mortality and cause-specific mortality, we recommended 100 to 159 mg/dL as the optimal range of LDL-C among older adults in China.

Characteristics of Mortality After Endovascular Thrombectomy in Patients with Acute Ischemic Stroke

Purpose

Despite significant advancements in the treatment of acute ischemic stroke (AIS) with endovascular thrombectomy (EVT), post-EVT mortality remains a considerable concern. However, there is a lack of real-world epidemiological data delineating the characteristics of mortality for EVT, particularly in recent years following the widespread promotion of EVT treatment for stroke patients.

Methods

This multicenter, retrospective study collected data from 721 AIS patients who died following EVT across 33 hospitals in Sichuan Province, China, from January 2019 to September 2022. The analysis sought to identify the primary causes of death within 30 days post-EVT and explore their related clinical features.

Results

The leading causes of death were malignant cerebral edema (MCE) in 365 patients (50.6%), pneumonia in 180 patients (25%), and symptomatic intracranial hemorrhage (sICH) in 94 patients (13%). MCE was the predominant cause of death in anterior circulation strokes, while pneumonia prevailed in posterior circulation strokes. MCE was also the primary cause of death within one week post-EVT, but pneumonia became increasingly dominant over time. Large vessel occlusion and lower reperfusion success rate were significantly correlated with MCE. Advanced age increases the risk of death from pneumonia. Tandem occlusion and procedural complications tend to correlate with mortality from sICH.

Conclusion

This study revealed that the principal causes of death after EVT included MCE, sICH, and pneumonia. MCE was found to be correlated with unsuccessful reperfusion. sICH was associated with procedural complications and the operators' experience. Pneumonia was linked to post-EVT management, particularly for those who survived for one week.

Exosomes in esophageal cancer: a promising frontier for liquid biopsy in diagnosis and therapeutic monitoring

Esophageal cancer is a common and lethal digestive system malignancy, and both treatment efficacy and patient survival rates face significant challenges. In recent years, exosomes have emerged as crucial mediators of intercellular communication, demonstrating tremendous clinical potential, particularly in the diagnosis, treatment, and prognostic evaluation of esophageal cancer. These exosomes not only serve as biomarkers for early diagnosis and prognosis but also modulate tumor growth, metastasis, and drug resistance by delivering bioactive molecules. Importantly, exosomes can act as carriers for esophageal cancer-related therapeutic agents, optimizing gene therapy strategies to enhance efficacy while reducing toxicity and side effects. Despite facing challenges in clinical applications such as purification, enrichment, and standardization of analytical methods, exosomes maintain broad prospects for application in esophageal cancer treatment, with the potential to significantly improve patient outcomes and quality of life. This review focuses on the innovative role of exosomes in the early diagnosis of esophageal cancer, exploring their application value and safety in disease monitoring and assessment of treatment response. Furthermore, this study outlines the challenges and limitations of transitioning exosome research from basic studies to clinical applications, as well as potential solutions and future research directions to address these obstacles.

Biomedical applications of the engineered AIEgen-lipid nanostructurein vitroandin vivo

Since the concept of aggregation-induced emission (AIE) was first coined by Tang and co-workers, AIE-active luminogens (AIEgens) have drawn widespread attention among chemists and biologists due to their unique advantages such as high fluorescence efficiency, large Stokes shift, good photostability, low background noise, and high biological visualization capabilities in the aggregated state, surpassing conventional fluorophores. A growing number of AIEgens have been engineered to possess multifunctional properties, including near-infrared emission, two-photon absorption, reactive oxygen species (ROS) generation and photothermal conversion, making them suitable for deep-tissue imaging and phototherapy. AIEgens show great potential in biomedical applicationsin vitroandin vivo. However, despite the favorable photophysical stability and ROS/heat generation capability in the aggregated state, limitations including uncontrolled size, low targeting efficiency, and unexpected dispersion in physiological environments have hindered their biomedical applications. The combination of AIEgens with lipids offers a simple, promising, and widely adopted solution to these challenges. This review article provides an overview of the synthesis methods of AIEgen-lipid nanostructures and their applications in the biomedical engineering field, aiming to serve as a guideline for developing these AIEgens-lipid nanostructures with promising biological applications.

Associations between multiple metals exposure and cognitive function in the middle-aged and older adults from China: A cross-sectional study

The rapidly rising risk of cognitive decline is a serious challenge for the elderly. As the wide-distributed environmental chemicals, the effects of metals exposure on cognitive function have attracted much attention, but the results remain inclusive. This study aimed to investigate the roles of multiple metals co-exposure on cognition. We included a total of 6112 middle-aged and older participants, detected their plasma levels of 23 metals by using inductively coupled plasma mass spectrometry, and assessed their cognitive function by using the Mini-Mental State Examination (MMSE). The results showed that increased plasma levels of iron (Fe) and zinc (Zn) were positively associated with MMSE score, but the increased levels of nickel (Ni) and lead (Pb) were associated with decreased MMSE score (all FDR < 0.05). Subjects exposed to both high levels of Ni and Pb showed the lowest MMSE score [β (95% CI) = -0.310 (-0.519, -0.100)], suggesting that Ni and Pb had a synergistic toxic effect on cognitive function. In addition, the hazardous roles of Ni and Pb were mainly found among subjects with low plasma level of Zn, but were not significant among those with high-Zn level [Ni: β (95% CI) = -0.281 (-0.546, -0.015) vs. -0.146 (-0.351, 0.058); Pb: β (95% CI) = -0.410 (-0.651, -0.169) vs. -0.060 (-0.275, 0.155)], which suggested that Zn could attenuate the adverse effects of Pb and Ni on cognitive function. The cognitive function was gradually decreased among subjects with increased number of adverse exposures to the above four metals (Ptrend < 0.001). In conclusion, our findings revealed the individual, interactive, and combined effects of Fe, Ni, Pb, and Zn on cognitive function, which may provide new perspectives on cognitive protection, but further prospective cohort studies and biological researches are needed to validate these findings.

Electroacupuncture extends the time window of thrombolytic therapy in rats by reducing disruptions of blood-brain barrier and inhibiting GSDMD-mediated pyroptosis

OBJECTIVE

Thrombolytic therapy is the primary treatment for acute ischemic stroke. Extending the therapeutic time window can effectively reduce the harmful side effects associated with thrombolytic therapy. Although electroacupuncture (EA) has been shown to extend this time window, the specific mechanisms remain unclear.

METHODS

We developed an embolic stroke model in rats and administered EA during thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) either 4.5 or 6 h after stroke onset. Neurological deficits were evaluated at 2 and 24 h post-stroke. Brain tissue was collected for analysis using 2,3,5-triphenyl tetrazolium chloride (TTC) staining, water content measurement, blood-brain barrier (BBB) permeability assessment, electron microscopy, and TUNEL assay. Immunofluorescence staining, western blotting, and enzyme-linked immunosorbent assays were employed to quantify the expression of proteins related to BBB integrity and pyroptosis.

RESULTS

Neuronal damage and BBB disruption along with increased expression of pyroptosis-related proteins were observed following thrombolytic therapy at the 6-hour mark. EA treatment improved neurological outcomes, reduced infarct volume, and alleviated BBB disruption. EA also inhibited the expression of matrix metalloproteinase 9 (MMP9) and enhanced the expression of tissue inhibitor of metalloproteinases 1 (TIMP1), helping to maintain BBB integrity. Furthermore, EA reduced the expression of pyroptosis-related proteins, including gasdermin D (GSDMD), interleukin-1β (IL-1β), and interleukin-18 (IL-18). EA also reduced the co-expression of GSDMD and MMP9 in brain tissues.

CONCLUSIONS

EA may be a promising therapeutic approach for extending the thrombolytic therapy window by protecting the BBB and inhibiting GSDMD-mediated pyroptosis.

Mediating Effects of Serum Lipids and Physical Activity on Hypertension Management of Urban Elderly Residents in China

Background/Objectives: Investigating the importance and potential causal effects of serum lipid biomarkers in the management of hypertension is vital, as these factors positively impact the prevention and control of cardiovascular disease (CVD). Methods: We surveyed 3373 urban residents using longitudinal data from the CHARLS database, collected between 2015 and 2020. Pearson correlation methods were employed to explore the relationships among the numerical variables. A logistic regression model was utilized to identify the risk factors for hypertension. The dose-effect relationship between serum lipids and BP was assessed using restricted cubic splines (RCS). Additionally, piecewise structural equation modeling (PiecewiseSEM) was conducted to further elucidate the direct and indirect pathways involving individual body indices, serum lipids, and PA on BP responses at different levels of physical activity (PA). Results: The four serum lipids showed significant differences between hypertensive and non-hypertensive residents (p < 0.05). All lipids, except for HDL cholesterol, demonstrated extremely significant positive correlations with both systolic blood pressure (SBP) and diastolic blood pressure (DBP) (p < 0.001). All serum lipid variables were significantly associated with the incidence of hypertension. Specifically, triglycerides (bl_tg), HDL (bl_hdl), and low-density lipoprotein LDL cholesterol were identified as significant risk factors, with odds ratios (ORs) of 1.56 (95% CI: 1.33-1.85, p < 0.001), 1.16 (95% CI: 1.02-1.33, p < 0.05), and 1.62 (95% CI: 1.23-2.15, p < 0.001), respectively. Conversely, cholesterol (bl_cho) was a protective factor for hypertension, with an OR of 0.60 (95% CI: 0.42-0.82, p < 0.01). PA showed weak relationships with blood pressure (BP); however, PA levels had significant effects, particularly at low PA levels. The four serum lipids had the most mediating effect on BP, especially under low PA level conditions, while PA exhibited a partly weak mediating effect on BP, particularly under high PA level conditions. Conclusions: Serum lipids have significant nonlinear relationships with BP and PA levels exert different influences on BP. The significant mediating effects of serum lipids and the weak mediating effects of PA on individual body indices related to SBP and DBP demonstrate significant differences across varying levels of PA, highlighting the importance of low PA levels in hypertension management. This study could provide valuable recommendations and guidance in these areas.

Efficacy and Safety of Erzhu Jiedu Decoction Granules in Treating Mid-advanced Hepatitis B Virus-Associated Primary Liver Cancer Patients with Pi (Spleen)-Deficiency and Dampness-Heat Syndrome

OBJECTIVE

To assess the efficacy and safety of Erzhu Jiedu Decoction (EZJDD) Granules in treating mid-advanced hepatitis B virus-associated primary liver cancer (HBV-PLC) patients with Pi (Spleen)-deficiency and dampness-heat syndrome.

METHODS

From January 2021 to June 2023, a cohort of 132 patients were enrolled and randomly assigned to a control group or a EZJDD group according to the random numbers, with 66 patients in each group. The patients in the control group received conventional treatment for 3 months, followed by a 3-month follow-up. In addition to the conventional treatment, patients in the EZJDD group were administered EZJDD Granules (10.9 g/pack, 2 packs twice per day) orally for same duration. Progression-free survival (PFS) as primary outcome was evaluated by Kaplan Meier method. Karnofsky performance status (KPS) scores were used to assess the quality of life in two groups before and after treatment, and survival rates were determined as well. The efficacy of Chinese medicine syndrome was calculated with Nimodipine method. Liver function, tumor indicators and T lymphocyte subsets were measured, respectively. Safety indicators were recorded and assessed.

RESULTS

Of the 116 patients who completed the study, 57 were in the control group and 59 in the EZJDD group. The median PFS was 3.53 months (106 days) in the EZJDD group compared to 2.33 months (70 days) in the control group (P=0.005). Six-month survival rate was 52.63% (30/57) in the control group and 69.49% (41/59) in the EZJDD group (P=0.039). The median KPS score in the EZJDD group [70(63, 90)] was higher than that in the control group [70(60, 80)] (P=0.013). The total effective rate of CM syndrome was 52.63% (30/57) in the control group and 77.97% (46/59) in the EZJDD group (P=0.005). The levels of alpha fetoprotein, alpha fetoprotein-L3, alpha-L-fucosidase and protein induced by Vitamin K absence or antagonist- II in the EZJDD group increased less than the control group (P>0.05). CD8+ levels were decreased, while CD3+ and CD4+ levels, as well as CD4+/CD8+ ratio were significantly increased in the EZZJD group (P<0.05). No treatment-related adverse reactions were observed during the study.

CONCLUSION

EZJDD Granules significantly prolonged the median PFS and improved 6-month survival rate in patients with mid-advanced HBV-PLC (Registration No. ChiCTR2200056922).

Patient-Centric Mobile Medical Services Accessed Through Smartphones in the Top 100 Chinese Public Hospitals: Cross-Sectional Survey Study

BACKGROUND

Smartphone-based technology has been used to enhance the delivery of health care services to the public in numerous countries.

OBJECTIVE

This study aims to investigate the application of patient-centric mobile medical services accessed through smartphones in the top 100 Chinese public hospitals.

METHODS

Data on 124 tertiary public hospitals, ranked among the top 100 by the China Hospital Science and Technology Evaluation Metrics of the Chinese Academy of Medical Sciences (2019) and China's Hospital Rankings of the Hospital Management Institute of Fudan University (2019), were collected from the WeChat platform (Tencent Inc), mobile phone apps, and official websites until February 10, 2021.

RESULTS

A total of 124 tertiary public hospitals, all of which were among the top 100 hospitals according to the 2 ranking lists, were selected for this study. Almost all (122/124, 98.39%) of the hospitals offered basic services such as appointment scheduling, registration, and health education. The majority also provided online access to test reports (95/124, 76.61%), consultations (72/124, 58.06%), and prescriptions (61/124, 49.19%). Among the hospitals offering online prescriptions, the majority (54/61, 88.52%) supported home delivery through third-party carriers. Slightly less than half (57/124, 45.97%) used artificial intelligence for medical guidance. Only a small fraction (8/124, 6.45%) managed chronic diseases through online monitoring and supervision by experienced doctors. Approximately half (60/124, 48.39%) of the included hospitals were officially licensed as internet hospitals approved to provide full online services. Hospitals with official internet hospital licenses provided more extensive digital health offerings. A significantly higher proportion of approved hospitals offered online consultations (29.69% vs 88.33%, r=43.741; P<.001), test reports (62.5% vs 91.67%, r=14.703; P<.001), and chronic disease management (1.56% vs 11.67%, r=5.238; P<.05). These officially approved hospitals tended to provide over 6 mobile medical services, mainly in the regions of Shanghai and Guangdong. This geographic distribution aligned with the overall layout of hospitals included in the study.

CONCLUSIONS

Patient-centric mobile medical services offered by the top 100 Chinese public hospitals accessed through smartphones primarily focus on online appointment scheduling, registration, health education, and accessing test reports. The most popular features include online consultations, prescriptions, medication delivery, medical guidance, and early-stage chronic disease management. Approved internet hospitals offer a significantly greater variety of patient-centric mobile medical services compared with unapproved ones.

Adjuvant sorafenib for hepatocellular carcinoma after radiofrequency ablation versus radiofrequency ablation: analysis of its efficacy and safety

Objectives

For the treatment of early hepatocellular carcinoma, we compared the efficacy and safety of radiofrequency ablation (RFA) alone and radiofrequency ablation combined with sorafenib (RFA+Sor).

Methods

A total of 164 patients with early HCC were included in the study. There were 87 patients who underwent RFA alone, and 77 patients who underwent RFA+Sor treatment. Overall survival (OS) was the primary endpoint of the study, and recurrence-free survival (RFS) and safety were the secondary endpoints.

Results

According to the RFA group, the RFS rates were 74.7%, 29.9%, and 11.5% at 1, 2, and 3 years, whereas in the RFA+Sor group, the RFS rates were 72.7%, 19.5%, and 11.7% at 1, 2, and 3 years (P>0.05). RFA and RFA+Sor groups had median OS of 35.0 and 41.0 months, respectively (P>0.05). For the RFA and RFA+Sor groups, the median RFS was 17.0 and 16.0 months, respectively (P>0.05). Based on the univariate regression analysis, there was no statistically significant difference between the subgroups (P>0.05). Skin rashes only occurred in the RFA+Sor group, and other adverse effects were not significantly different between the two groups (P>0.05).

Conclusions

Treatment with RFA+Sor treatment did not result in a longer OS than treatment with only RFA, however, the adverse effects of adjuvant Sorafenib were acceptable.

Gr-1 blockade remodels the immunosuppressive microenvironment induced by incomplete microwave ablation of hepatocellular carcinoma

BACKGROUND

Ablation is one of the main methods for local treatment of hepatocellular carcinoma (HCC). Different from radiofrequency ablation (RFA), microwave ablation (MWA) is not limited by tissue conductivity, and can use multiple electrodes at the same time to improve ablation efficiency. In addition, MWA can form a larger ablation area, which makes it possible to completely ablate large HCC. However, MWA may be incomplete due to factors such as larger tumors or tumors in high-risk areas. The mechanism by which the cellular and tumor immune microenvironment (TIME) is involved in the in vitro effects of incomplete microwave ablation (iMWA) needs to be further elucidated.

METHODS

H22 tumor-bearing C57BL/6 mice were treated with iMWA with several combinations of ablation power and time duration. The effects of iMWA on the genes of HCC cancer cells and the TIME were investigated by RNA sequencing, mass cytometry, immunohistochemistry, and immunofluorescence. The effect of iMWA in combination with anti-Gr-1 on HCC tumor growth was also evaluated.

RESULTS

Thermal stress generated by iMWA induced coagulative necrosis and apoptosis in the region of the ablation center of HCC. RNA sequencing analysis showed that iMWA can boost chemokine CXCL5, which was further confirmed by quantitative real time polymerase chain reaction (qRT-PCR). Mass cytometry results showed that relative to Ctrl group, iMWA-treated led to decreased CD4+ T, CD8+ T, Natural killer (NK), macrophages including both M1 and M2 types but increased monocytes and bone marrow-derived suppressor cells (MDSC). Therefore, inhibiting MDSC is the main target in the later stage of iMWA. In vivo results showed that the tumor volume and weight of iMWA+ anti-Gr-1 group were significantly reduced compared with iMWA+ anti-IgG group. In addition, the merged expressions of CD11b and Gr-1 proteins were found reduced in the iMWA+ anti-Gr-1 group compared with the iMWA+ anti-IgG group by immunofluorescence staining. Immunohistochemistry suggested that CD8 was enriched in the iMWA+ anti-Gr-1 group but not in the iMWA+ anti-IgG group.

CONCLUSION

Our data suggests that iMWA and Gr-1 blocking combined therapy can further inhibit HCC growth and significantly improve the CD8+ T cells in the mouse subcutaneous tumor model, which brings good news to HCC patients.