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

Migraine is a risk factor for dementia: a systematic review and meta-analysis of cohort studies

Background

Migraine affects more than one billion people worldwide, and there is growing concern about the burden of migraine. Migraine affects cognitive function during an attack, but reports are inconsistent on whether the effect of migraine on cognitive function persists and increases the risk of developing dementia. This systematic review and meta-analysis aimed to examine whether migraine is a risk factor for dementia.

Methods

We searched six databases and included cohort studies with participants without dementia and with migraine at baseline, the outcome of interest was the risk of dementia, expressed in adjusted hazard ratios and 95% confidence intervals. Subgroup analyses and meta-regression were used to explore the sources of heterogeneity.

Results

A total of 11 cohort studies containing 6,964,353 participants were included. Migraine increased the risk of all-cause dementia (HR = 1.26; 95% CI = 1.09–1.46), AD (HR = 1.32; 95% CI = 1.26–1.38), and VaD (HR = 1.28; 95% CI = 1.24–1.32). Subgroup analyses revealed migraine with aura had an increased risk of all-cause dementia compared to migraine without aura. The pooled results showed that migraine significantly increase the risk of all-cause dementia in studies with high quality and studies with sample sizes more than 2000. The results of meta-regression analyses revealed that region, migraine type, diagnostic criteria for dementia, gender, Newcastle-Ottawa Scale score, sample size, controls and mean follow-up time were not significant sources of study heterogeneity.

Conclusions

This meta-analysis suggest migraine as a risk factor for dementia. Due to significant heterogeneity between studies, residual confounding factors and bias, the results should be cautiously interpreted.

Supplementary Information

The online version contains supplementary material available at 10.1186/s10194-025-02078-0.

Integrated network toxicology, machine learning and molecular docking reveal the mechanism of benzopyrene-induced periodontitis

BACKGROUND

Environmental pollutants, particularly from air pollution and tobacco smoke, have emerged as significant risk factors. Benzopyrene (BaP), a Group 1 carcinogen, is ubiquitously present in these pollutants, yet its molecular mechanisms in periodontitis remain largely unexplored.

METHODS

We investigated these mechanisms through an integrated approach combining network toxicology, machine learning, and molecular docking analyses. Data from SwissTargetPrediction, CTD databases, and GEO datasets were analyzed to identify potential targets. Three machine learning algorithms (Support Vector Machine, Random Forest, and LASSO regression) were applied for core target identification, followed by Molecular docking analyses.

RESULTS

We identified 11 potential targets associated with BaP-induced periodontitis, primarily involved in cellular response to lipopolysaccharide, endoplasmic reticulum function, and cytokine activity, particularly in IL-17 and TNF signaling pathways. Machine learning analysis identified three core targets: CXCL12, CYP24A1, and HMGCR. Molecular docking demonstrated strong binding affinities between BaP and these targets (binding energies <-5.0 kcal/mol). A diagnostic nomogram based on these core targets achieved high prediction accuracy (AUC = 0.922).

CONCLUSIONS

This first comprehensive analysis of BaP-induced periodontitis using an integrated computational approach elucidates potential molecular mechanisms and identifies specific therapeutic targets. The diagnostic nomogram developed offers a promising tool for clinical periodontitis risk assessment, providing new perspectives on understanding the impact of environmental pollutants on periodontal health.

Burden of ischemic stroke attributable to high low-density lipoprotein cholesterol in China from the global burden of disease study 2021

High low-density lipoprotein cholesterol are a significant risk factor for ischemic stroke. This study aims to analyze the burden of disease and temporal trends of ischemic stroke attributable to high LDL-C (IS-hLDL-C) in China, thereby providing a scientific basis for the development of effective prevention and intervention strategies. This study extracted the age-standardized mortality rates (ASMRs) and age-standardized disability-adjusted life years rates (ASDRs) of IS-hLDL-C from the global burden of disease (GBD) 2021. Stratified analysis was performed by gender and age groups. Joinpoint regression models were used to calculate average annual percentage changes (AAPC) to assess trends in IS-hLDL-C burden between 1990 and 2021. Age-period-cohort (APC) model to estimate the independent effects of age, period, and cohort on IS-hLDL-C burden. In 2021, the total number of IS-hLDL-C deaths in China was 300,052 (95% UI 92,515-527,456), and disability-adjusted life years (DALYs) was 6,850,565 (95% UI 2,313,203 - 11,418,167). From 1990 to 2021, ASMRs changed from 18.23 (95% CI 5.52-33.43) to 15.93 (95% CI 4.83-28.08), and the AAPC was -0.47 (95% CI -0.83 to -0.10). The ASDRs decreased from 385.65 (95% CI 129.83 to 647.51) in 1990 to 335.59 (95% CI 112.75 to 566.25) in 2021, with an AAPC of -0.49 (95% CI -0.83 to -0.10). Sex-stratified analysis showed that male had greater ASMRs and ASDRs than female. Age-stratified analysis showed that the burden was greatest among the elderly. In the age-period-cohort analysis, the age effect of IS-hLDL-C showed a continuous increasing trend during the study period. The period effect generally showed a positive trend during the study period. From 1990 to 2021, while the ASMRs and ASDRs related to IS-hLDL-C have decreased in China, the absolute numbers of deaths and DALYs remain substantial. The burden of IS-hLDL-C disease is disproportionately higher among male and the elderly. Given large population and the ongoing trend of population aging, it is essential to consider various lipid-lowering strategies in the future to allocate healthcare resources effectively and reduce the disease burden associated with IS-hLDL-C.

Trends and future burden of other musculoskeletal diseases in China (1990-2041): a comparative analysis with G20 countries using GBD data

BACKGROUND

Other musculoskeletal diseases (OMSDs), as a critical component of the global public health challenge, remain understudied in China. This study aims to systematically analyze the epidemiological characteristics and future trends of OMSDs in China from 1990 to 2021.

METHODS

Based on data from the Global Burden of Disease Study(GBD) 2021, this research focused on prevalence and years lived with disability (YLDs), which were compared with G20 countries. Joinpoint regression was used to identify trend breakpoints, age-period-cohort analysis evaluated the independent effects of age, period, and cohort, and the Autoregressive Integrated Moving Average (ARIMA) model predicted the disease burden through 2041.

RESULTS

Between 1990 and 2021, both age-standardized prevalence rates (ASPR) and YLDs rates(ASYR) of OMSDs in China showed upward trends. Two critical turning points in ASPR occurred during 2000-2005 (APC = 1.5%, 95% CI: 1.4-1.6) and 2005-2009 (APC = 0.9%, 95% CI: 0.7-1.0). Age effects indicated that relative risk (RR) first increased and then decreased with age, peaking at 60-64 years (RR = 3.62, 95% CI: 3.62-3.63). Period effects showed a rising trend, while cohort effects revealed declining prevalence and YLDs rates. Projections suggest a gradual increase in burden indicators through 2041. Compared to other G20 countries, China ranked eighth from the bottom in disease burden, approaching the level of Germany.

CONCLUSION

The burden of OMSDs in China continues to rise, particularly among women and the elderly. Although the current burden is at a mid-range level among G20 nations, population aging will exacerbate future challenges. To address this, advocating for healthy lifestyles, strengthening health education, and optimizing healthcare strategies are essential.

Identifying factors related to sertraline concentrations in child/adolescent and adult patients: insights from a therapeutic drug monitoring service

INTRODUCTION

Sertraline, a widely prescribed antidepressant, has considerable variability in serum concentrations. This retrospective study aimed to identify key determinants influencing sertraline concentrations, with a special focus on age-related differences.

METHODS

We conducted a retrospective analysis of TDM data from 1076 patients (474 children/adolescents and 602 adults) collected between 2018 and 2024. Multivariable generalized linear regression and restricted cubic spline models were used to examine the relationships between clinical parameters and sertraline concentrations.

RESULTS

The daily dose and aspartate aminotransferase (AST) level were positively correlated with the sertraline concentration in both age groups. Sex had a significant effect, with women exhibiting 43% (P = 0.001) and 37% (P = 0.001) higher concentrations than men in the child/adolescent and adult groups, respectively. In children and adolescents, the albumin (Alb) level and neutrophil (NEUT) count also considerably influence concentrations. CYP2C19 poor metabolizers (PMs) tended to be present at relatively high concentrations, but the difference was not statistically significant. Among child and adolescent patients, significant differences in dose-adjusted serum concentration (C/D) values (P = 0.0291) were observed across different CYP2C19 phenotypes, with PMs exhibiting higher C/D values. In a cohort of 593 patients who underwent high-sensitivity C-reactive protein (hsCRP) testing, a nonlinear, U-shaped correlation between hsCRP levels and sertraline concentrations was identified in children and adolescents.

DISCUSSION

By identifying key factors such as daily dose, sex and AST levels, clinicians can develop tailored treatment plans for individual patients. These findings underscore the need for further research to elucidate the interplay between sertraline metabolism and patients' physiological and pathological characteristics.

DAGSLAM: causal Bayesian network structure learning of mixed type data and its application in identifying disease risk factors

BACKGROUND

Identifying and understanding disease risk factors is crucial in epidemiology, particularly for chronic and noncommunicable diseases that often have complex interrelationships. Traditional statistical methods struggle to capture these complexities, necessitating more sophisticated analytical frameworks. Bayesian networks and directed acyclic graphs (DAGs) provide powerful tools for exploring the complex relationships between variables. However, existing DAG structure learning algorithms still have limitations in handling mixed-type data (including continuous and discrete variables), which restricts their practical utility. Therefore, developing DAG structure learning methods that can effectively handle mixed data is highly important for obtaining an in-depth understanding of disease risk factors and pathogenic mechanisms.

METHODS

This study proposes an extension of the NOTEARS algorithm, termed DAGSLAM, which is designed for Bayesian network structure learning with mixed-type data. The algorithm integrates continuous and categorical variables through a tailored loss function, enhancing its applicability to real-world epidemiological datasets.

RESULTS

Extensive simulations were conducted across eight distinct scenarios, specifically, variations in the number of nodes, changes in the proportion of categorical nodes, different sample sizes, levels of categorical nodes, variations in edge sparsity, adjustments to the weight scale, different graph types, and diverse noise distributions. These scenarios demonstrate that DAGSLAM consistently outperforms existing methods such as HC, TABU, mDAG, and DAGBagM across key metrics, including precision, recall, F1 score, and structural Hamming distance (SHD). Furthermore, the robustness of DAGSLAM is validated through its application to the National Health and Nutrition Examination Survey (NHANES) dataset, revealing critical causal relationships among risk factors for CHD and diabetes.

CONCLUSIONS

DAGSLAM provides a powerful and scalable tool for uncovering causal relationships in complex disease networks, with significant implications for risk factor identification and public health research.

Exploratory analysis of the economically justifiable price of reslizumab for asthma severe in Colombia

INTRODUCTION

Asthma severe imposes important economic burden for health systems, especially with the incorporation of new drugs. Recently, reslizumab has been approved to prevent exacerbations in patients with eosinophilic asthma. This study evaluates the price at which reslizumab would be considered economically justified for patients with severe asthma in Colombia.

MATERIALS AND METHODS

A model was developed using the microsimulation to estimate the quality-adjusted costs and life years of two interventions: reslizumab versus not applying standard treatment without reslizumab. This analysis was made during a time horizon of 50 year and from a third payer perspective.

RESULTS

Based on thresholds of U$4828, U$ 5128, and U$19 992 per QALY evaluated in this study, we established economically justifiable drug acquisition prices at each WTP were U$ 106, U$ 165, and U$ 349 per dose of reslizumab. Reslizumab not was cost-effective using a WTP of U$4828, U$ 5128 and U$19 992 per QALY.

CONCLUSION

The economically justifiable cost for reslizumab in Colombia is between U106 to U$349per dose, depending on the WTP used to decide its implementation. This result should encourage more studies in the region that optimize decision-making processes when incorporating this drug into the health plans of each country.

Global, regional, and national burden of breast cancer in young women from 1990 to 2021: findings from the global burden of disease study 2021

AIM

The issue of breast cancer in young women (BCYW) has gained increasing attention over the past few decades. However, a notable gap exists in the literature concerning the comparison of the disease burden of BCYW with that of other age groups. This study presents a comprehensive analysis of the disparities in global, regional, and national burden between BCYW and their middle-aged and elderly counterparts.

METHODS

The breast cancer data in this study were collected from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021). The age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), age-standardized prevalence rate (ASPR), and age-standardized disability-adjusted life years rate (ASDR), and the Average Annual Percent Change (AAPC) were employed to assess the disease burden of BCYW. The Bayesian Age-Period-Cohort model was used to forecast disease burden from 2022 to 2030.

RESULTS

The AAPC of ASIR of BCYW from 1990 to 2021 was 0.91 (95% CI: 0.77 to 1.05), exceeding the global average (0.49, 95% CI: 0.40 to 0.58) as well as both middle-aged (0.60, 95% CI: 0.47 to 0.73) and elderly groups (0.30, 95% CI: 0.21 to 0.39). The AAPC for ASMR of BCYW experienced a marginal increase of 0.02 (95%CI: -0.07 to 0.11) from 1990 to 2021, surpassing the rates observed in both the middle-aged group (-0.40, 95%CI: -0.47 to -0.32) and the elderly group (-0.50, 95%CI: -0.62 to -0.38). The ASIR in BCYW significantly increased in regions with low (AAPC = 1.87), low-middle (AAPC = 2.32), middle (AAPC = 1.84), and high-middle SDI (AAPC = 0.98), while it remained unchanged in regions with high SDI (AAPC = -0.02). This trend was also observed among middle-aged and older groups. The ASMR in BCYW significantly increased in regions with low (AAPC = 1.01) and low-middle SDI (AAPC = 1.25), but remained unchanged in regions with middle SDI (AAPC = 0.02), while it decreased in regions with high-middle (AAPC = -1.10) and high SDI (AAPC = -1.60). Among the middle-aged and elderly populations, there was an increase in ASMR rates observed in regions with low, low-middle, and middle SDI groups (all AAPC > 0), whereas a decrease was noted in the regions with high-middle and high SDI (all AAPC < 0). The BAPC predicts a consistent annual increase in ASIR, ASMR, ASPR, and ASDR of BCYW globally and in China from 2022 to 2030. Notably, China has higher ASIR and ASPR rates compared to the global average, while its ASMR and ASDR rates are lower.

CONCLUSION

The burden of BCYW was particularly significant in regions with low-SDI, low-middle SDI, and middle SDI. Despite the progress made, China still faces considerable challenges in effectively addressing this issue. The prevention and control of BCYW must remain a priority. Different countries and regions should develop personalized, targeted intervention strategies for this population and establish public health policies tailored to the specific needs of each region.

Urban-rural disparities in mortality due to stroke subtypes in China and its provinces, 2015-2020

BACKGROUND

Death burden of stroke is severe with over one-third rural residents in China, but there is still a lack of specific national and high-quality reports on the urban-rural differences in stroke burden, especially for subtypes. We aimed to update the understanding of urban-rural differences in stroke deaths.

METHODS

This is a descriptive observational study. Data from the national mortality surveillance system, which covers 323.8 million with 605 disease surveillance points (DSPs) across all 31 provinces, municipalities, and autonomous regions in China. All deaths from stroke as the underlying cause from 2015 to 2020 according to DSPs. Crude mortality rate and age-standardized mortality rate (ASMR) were estimated through DSPs. Average annual percentage change was used to explain the change in mortality rate.

RESULTS

From 2015 to 2020, the majority of deaths from all stroke subtypes occurred in rural areas. There were significant differences between the changes of urban and rural ASMRs. On the whole, the changes in urban areas were evidently better, and the ASMR differences were basically expanding. Stroke ASMR in urban China decreased by 15.5%. The rural ASMR of ischemic stroke increased by 12.9%. The rural and urban ASMRs of intracerebral hemorrhage decreased by 24.9% and 27.4%, and those of subarachnoid hemorrhage decreased by 29.5% and 40.4%, respectively. The highest ASMRs of all stroke subtypes and the increasing trend of ischemic stroke ASMR make rural males the focus of stroke management.

CONCLUSIONS

The death burden of stroke varies greatly between urban and rural China. Rural residents face unique challenges.

Global burden of non-communicable diseases attributable to kidney dysfunction with projection into 2040

BACKGROUND

Spatiotemporal disparities exist in the disease burden of non-communicable diseases (NCDs) attributable to kidney dysfunction, which has been poorly assessed. The present study aimed to evaluate the spatiotemporal trends of the global burden of NCDs attributable to kidney dysfunction and to predict future trends.

METHODS

Data on NCDs attributable to kidney dysfunction, quantified using deaths and disability-adjusted life-years (DALYs), were extracted from the Global Burden of Diseases Injuries, and Risk Factors (GBD) Study in 2019. Estimated annual percentage change (EAPC) of age-standardized rate (ASR) was calculated with linear regression to assess the changing trend. Pearson's correlation analysis was used to determine the association between ASR and sociodemographic index (SDI) for 21 GBD regions. A Bayesian age-period-cohort (BAPC) model was used to predict future trends up to 2040.

RESULTS

Between 1990 and 2019, the absolute number of deaths and DALYs from NCDs attributable to kidney dysfunction increased globally. The death cases increased from 1,571,720 (95% uncertainty interval [UI]: 1,344,420-1,805,598) in 1990 to 3,161,552 (95% UI: 2,723,363-3,623,814) in 2019 for both sexes combined. Both the ASR of death and DALYs increased in Andean Latin America, the Caribbean, Central Latin America, Southeast Asia, Oceania, and Southern Sub-Saharan Africa. In contrast, the age-standardized metrics decreased in the high-income Asia Pacific region. The relationship between SDI and ASR of death and DALYs was negatively correlated. The BAPC model indicated that there would be approximately 5,806,780 death cases and 119,013,659 DALY cases in 2040 that could be attributed to kidney dysfunction. Age-standardized death of cardiovascular diseases (CVDs) and CKD attributable to kidney dysfunction were predicted to decrease and increase from 2020 to 2040, respectively.

CONCLUSION

NCDs attributable to kidney dysfunction remain a major public health concern worldwide. Efforts are required to attenuate the death and disability burden, particularly in low and low-to-middle SDI regions.

Reporting and incorporation of social risks in low back pain and exercise studies: A scoping review

BACKGROUND

Exercise is a common intervention for low back pain, but its effect sizes are small to modest. Social risk factors significantly influence health outcomes, yet their consideration in randomized controlled trials on exercise for low back pain is often neglected. Determining their relationship to outcomes may provide better insight into exercise effectiveness.

OBJECTIVES

To assess the reporting of social risk factors (SRFs) in randomized controlled trials (RCTs) of exercise interventions for low back pain (LBP) in adults and explore associations between SRFs and outcomes.

DESIGN

Scoping Review.

METHODS

The databases MEDLINE, CINAHL and Cochrane were searched for studies published between January 2014 to March 2025. RCTs were included if exercise was the primary intervention for LBP treatment and had a minimum follow-up of 12 weeks. A planned analysis of SRF and outcome associations was not conducted due to insufficient data.

RESULTS

A total of 10,292 studies were identified and 157 studies included. Fewer than half (47.1 %) reported any SRFs at baseline. Socioeconomic position (42.7 %) was most frequently reported, followed by social relationships (17.8 %), race/ethnicity/cultural context (8.3 %), residential/community context (1.3 %), and gender (0.6 %). Four studies incorporated SRFs in their outcome analyses; one examined associations with outcomes and found no significant association.

CONCLUSION

SRFs are underreported in RCTs of exercise interventions for LBP and are rarely analyzed in relation to primary outcomes, limiting our understanding of their impact. Future trials should prioritize collecting and reporting SRFs at baseline and incorporating them in outcome analyses to assess their influence on outcomes.

Disentangling the effects of nicotine versus non-nicotine constituents of tobacco smoke on major depressive disorder: A multivariable Mendelian randomisation study

BACKGROUND AND AIMS

There is growing evidence that tobacco smoking causes depression, but it is unclear which constituents of tobacco smoke (e.g. nicotine, carbon monoxide) may be responsible. We used Mendelian randomisation (MR) to measure the independent effect of nicotine on depression, by adjusting the effect of circulating nicotine exposure [via nicotine metabolite ratio (NMR)] for the overall effect of smoking heaviness [via cigarettes per day (CPD)] to account for the non-nicotine constituents of tobacco smoke.

DESIGN

Univariable MR and multivariable MR (MVMR) were used to measure the total and independent effects of genetic liability to NMR and CPD on major depressive disorder (MDD). Our primary method was inverse variance weighted (IVW) regression, with other methods as sensitivity analyses.

SETTING AND PARTICIPANTS

For the exposures, we used genome-wide association study (GWAS) summary statistics among European ancestry individuals for CPD (n = 143 210) and NMR (n = 5185). For the outcome, a GWAS of MDD stratified by smoking status was conducted using individual-level data from UK Biobank (n = 35 871-194 881).

MEASUREMENTS

Genetic variants associated with NMR (n = 6) and CPD (n = 53).

FINDINGS

Univariable MR-IVW indicated a causal effect of CPD on MDD [odds ratio (OR) = 1.13, 95% confidence interval (CI) = 1.04-1.23, P = 0.003] but no clear evidence for an effect of NMR on MDD (OR = 0.98, 95% CI = 0.97-1.00, P = 0.134). MVMR indicated a causal effect of CPD on MDD when accounting for NMR (IVW: OR = 1.19, 95% CI = 1.03-1.37, P = 0.017; Egger: OR = 1.13, 95% CI = 0.89-1.43, P = 0.300) and weak evidence of a small effect of NMR on MDD when accounting for CPD (IVW: OR = 0.98, 95% CI = 0.96-1.00, P = 0.057; Egger: OR = 0.98, 95% CI = 0.96-1.00, P = 0.038).

CONCLUSIONS

The role of nicotine exposure in risk of depression cannot be entirely dismissed. However, the causal effect of tobacco smoking increasing depression risk appears to be largely independent of circulating nicotine exposure, which implies the role of alternative causal pathways.

Trends and cross-country inequalities in the global, regional, and national burden of gallbladder and biliary tract cancer from 1990 to 2021, along with the predictions for 2035

BACKGROUND

The global burden of gallbladder and biliary tract cancer (GBTC) is on the rise.

METHODS

The incidence, mortality, and disability-adjusted life years (DALYs) of GBTC from 1990 to 2021 were obtained from the Global Burden of Diseases Study (GBD) 2021. The Bayesian Age-Period-Cohort (BAPC) model was also employed to project disease trends for the next 15 years.

RESULTS

In 2021, new GBTC cases observed globally amounted to 216,768, with 171,961 mortality and 3732,121 DALYs. From 1990-2021, a notable surge was recorded in the incidence of GBTC by 101 %, mortality by 74.26 %, and DALYs by 60.45 %. Regions with superior Socio-Demographic Index (SDI) reflected elevated incidence and mortality rates. However, a significant decrease was noticed in the age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR). Despite a reduction in health disparities among countries, differences remain. Prognostications predict a continual decline in global ASIR and ASMR through 2035.

CONCLUSIONS

The study found that the burden of GBTC in incidences, mortalities, and DALYs has been on the rise, with some correlation with socio-economic development.

The effects and mechanisms of far-infrared ray on depression-like behavior induced by CRS in mice

PURPOSE

Far-infrared ray (FIR) is an electromagnetic wave known to impart health benefits against various pathophysiological conditions, including diabetes mellitus, renocardiovascular disorders, stress, and depression, among others. However, the precise impact of FIR on major depressive disorder (MDD) and the underlying molecular mechanisms remain unclear. Here, we aimed to investigate the effects and elucidate the molecular mechanisms of FIR on depression-like behavior in mice.

METHODS

A mouse model of depression was established using chronic restraint stress (CRS). Behavioral tests were performed to assess alterations in depression-like behaviors. Biochemical methods were employed to measure the levels of IL-1β, IL-6, TNF-α, S100β, IL-17, melatonin (MT), 5-hydroxytryptamine (5-HT), glutathione (GSH), malondialdehyde (MDA), brain-derived neurotrophic factor (BDNF), and corticosterone (CORT) in mice serum. Similarly, the levels of IL-1β, IL-6, TNF-α, S100β, IL-17, and MT in mice brains were measured using biochemical methods. Hematoxylin-eosin and Nissl staining were utilized to detect morphological changes in the mice hippocampus. In addition, the structure and mitochondrial morphology of hippocampal neurons and microglia were studied using transmission electron microscopy (TEM).

RESULTS

The results of behavioral tests revealed that FIR mitigated the depression-like behaviors induced by CRS. FIR also reversed the levels of IL-1β, IL-6, TNF-α, and related cytokines in the periphery and brain. The results of hematoxylin-eosin and Nissl staining showed that FIR improved the damage of mice's hippocampus. Additionally, TEM revealed that FIR alleviated the damage of CRS to hippocampal neurons and microglia.

CONCLUSION

Our findings suggest that FIR can ameliorate depression-like behavior induced by CRS in mice. FIR can reverse the levels of related cytokines in the periphery and brain, and alleviate damage to neurons and microglia, which may constitute its underlying molecular mechanism.

Musculoskeletal triage physiotherapists' perspectives on their role, the patient journey and implementation of interface triage clinics in primary care in Ireland

OBJECTIVES

To explore musculoskeletal triage clinical specialist physiotherapists' (CSPs) perspectives on the patient journey and their perspectives on the acceptability of implementing MSK triage interface clinics in primary care in Ireland.

METHODS

A qualitative descriptive study design using a thematic approach was conducted. Semi-structured focus groups were conducted with 11 CSPs in 8 hospitals with urban and rural catchment areas across Ireland. Data analysis involved a two-stage framework; thematic analysis, followed by exploration of the findings on interface clinic implementation through the lens of Normalisation Process Theory (NPT).

RESULTS

Four themes were identified: (1) Development of MSK pathways; (2) Clinical governance; (3) Implementation of interface clinics and (4) Physiotherapy role and identity. Interface clinics achieved some degree of 'coherence' (i.e. made sense) and 'cognitive participation' (i.e. fostered engagement) for CSPs with the expectation of patients receiving expert MSK care earlier in their journey. However, this was less beneficial to CSPs if interface clinics were not implemented as part of a wider integrated care pathway, and if clinics were established near the main hospital instead of primary care locations in the wider catchment area. CSPs conveyed strong recommendations on 'collective action' such as development and resourcing of integrated care pathways and primary care physiotherapy, investing in information technology infrastructure (electronic health records) and obtaining the ability to order investigations (e.g. MRI/x-ray).

CONCLUSIONS

These findings contribute new knowledge about MSK triage CSPs' perspectives on the patient journey through MSK services in Ireland, which can inform future implementation phases of MSK triage interface clinics.

Global, Regional, and National Levels and Trends in the Burden of Pressure Ulcer from 1990 to 2019: A Systematic Analysis for the Global Burden of Disease 2019

Pressure ulcer (PU) is a type of chronic ulcer, placing a high burden not only on patients' families but also on national healthcare systems globally. To determine the level, trends, and burden of PU worldwide and to provide an essential foundation for building targeted public policies on PUs at the national, regional, and global levels, data on PU were obtained from the Global Burden of Disease (GBD) 2019 Study. The incidence, disability-adjusted life years (DALYs), and deaths of PUs in 204 countries and regions from 1990 to 2019 were calculated and stratified by sex, age, geographical location, and sociodemographic index (SDI). The estimated annual percentage change (EAPC) of incidence, DALYs, and deaths was calculated to evaluate the temporal trends. A total of 3,170,796 new cases (95% uncertainty interval (UI), 3,499,729-2,875,433 cases) of PU were identified globally in 2019, more than 55% of which were among male individuals, and most of the new cases were concentrated in those 75-90 years of age. The burden of PU measured in DALYs was 481 423 (95% UI, 583 429-374 334) in 2019, 73% and 27% of which could be attributed to years of life lost (YLLs) and years lived with disability (YLDs), respectively. The burden increased gradually from 1990 to 2019 (from 267 846 [360 562-211 024] to 481 423 [95% UI, 583 429-374 334]). A total of 24 389 deaths were attributed to PU (95% UI, 31 260.82-17 299). The EAPC of incidence, DALYs, and deaths were negative in most regions, the age-standardized rate (ASR) of incidence, DALYs, and deaths were considered to be decreasing in most of the regions, and the EAPCs were negatively correlated with the SDI levels, universal health coverage (UHC), and gross domestic product (GDP), which shows that the ASRs of PU decreased as the economy developed and countries' healthcare system performances improved.

Advancing Cardiovascular, Kidney, and Metabolic Medicine: A Narrative Review of Insights and Innovations for the Future

Cardiovascular, kidney and metabolic (CKM) conditions are interrelated, significantly contributing to morbidity, mortality and healthcare burden. Despite therapeutic advances, traditional disease-specific approaches often fail to address their complex interplay. Key therapeutic agents-including glucagon-like peptide-1 receptor agonists (GLP-1 RAs), dual GLP-1/glucose-dependent insulinotropic polypeptide RAs, sodium glucose co-transporter inhibitors and the nonsteroidal mineralocorticoid receptor antagonist (MRA) finerenone-offer multi-organ benefits. Emerging therapies, such as triple receptor agonists and second-generation MRAs, target new pathways further expanding treatment options for CKM conditions. A holistic CKM management approach must address and recognise that conditions such as metabolic dysfunction-associated steatotic liver disease, metabolic dysfunction-associated steatohepatitis, obstructive sleep apnoea and obesity are part of the CKM spectrum. Frailty assessment is also important alongside CKM conditions, warranting comprehensive geriatric assessment and deprescribing when appropriate. Multidisciplinary care-including lifestyle interventions, pathway redesign, pharmacological advances and novel technologies-is essential for improving outcomes. As the CKM landscape evolves, future strategies should prioritise early intervention, personalised treatment and addressing unmet needs in high-risk populations. This review advocates for an integrated CKM framework, exploring treatment strategies, emerging therapies and technological innovations. It also examines the role of artificial intelligence and digital health tools in risk stratification, early diagnosis and long-term condition management, alongside ethical and regulatory considerations.

The burden and trends of road injuries in Afghanistan (1990-2021): A joinpoint analysis of data from the global burden of diseases, 2021 study

Objective

Road injuries pose a major public health challenge, particularly in low-income, conflict-affected regions like Afghanistan. Despite issues like poor infrastructure and weak traffic regulations, no national study has assessed the road injury burden. This study examines Afghanistan's road injury burden from 1990 to 2021.

Method

This epidemiological study utilized the global burden of diseases (GBD) 2021 data. Key metrics included age-standardized mortality rate (ASMR), age-standardized disability-adjusted life-years rate (ASDR), years of life lost (YLL), and years lived with disability (YLD) per 100,000 population. Trends were analyzed using joinpoint analysis to determine annual and average annual percent changes (APC and AAPC). Estimates were presented with a 95 % uncertainty Interval, and statistical significance was assessed via permutation tests (p < 0.05).

Results

Between 1990 and 2021, Afghanistan's road injury burden declined across all indicators (ASMR: -1.2 %, ASDR, YLL, YLD). Males (1.2 %) and children (AAPC: -3.1 %) saw the steepest declines, while the elderly (-0.7 %) had the slowest. Motor vehicle injuries dropped most (1.3 %), followed by pedestrian (1.0 %) and motorcyclist (0.9 %) injuries.Period-specific trends showed fluctuations: ASMR, ASDR, and YLL rose (1990-1997), then declined, except YLD, which increased post-2018 (+0.5 %). From 2017 to 2021, YLD rose across all age groups (except 0-14 years). Post-2014, motorcycle-related ASMR increased (+0.3 % APC), while from 2017 to 2021, ASDR and YLD increased across all injury types (+0.4 % to +1.3 % APC).

Conclusion

Despite progress, rising DALYs and YLDs, especially from 2017 onward, highlight a growing disability road injury burden, necessitating targeted interventions to address long-term disability and mitigate its public health impact.

Attenuated symptoms are associated with connectedness and emotional expression in narratives based on emotional pictures in a Brazilian clinical high-risk cohort

Natural language processing tools have been applied to identify symptoms through the analysis of narratives. Here we use this strategy to map attenuated symptoms when applied to prodromal stages of psychosis. We assessed narratives in a population-based prodromal screen-positive Brazilian cohort of individuals confirmed through structured interview as at clinical high-risk for psychosis (CHR) (N = 42) or as controls (N = 29) to identify language markers predictive of transition to diagnosis or remission. Participants were identified by screening >4500 individuals with the Prodromal Questionnaire-Brief and the Perceptual and Cognitive aberrations scale, followed by the Structured Interview for Psychosis-Risk Syndromes. After 2.5 years of follow-up, 23 CHR individuals were found to have transitioned to mood and anxiety disorders and 4 to psychosis. We assessed word-recurrence graph connectedness and emotional content in baseline narratives elicited with affective pictures, finding CHR markers and associations with mood symptoms. Specifically, greater recurrence (vs. randomness) in reciprocal connectedness was associated with dysphoric mood (ρ=0.64), social anhedonia (ρ=0.56), and perseveration (ρ=0.53), suggesting these may be related to rumination related to depression in individuals with psychosis risk. Language markers combined with years of education explained 58 %, 57 %, and 44 % of dysphoric mood, social anhedonia, and perseveration severity variance, respectively.

Global scenario of silica-associated diseases: A review on emerging pathophysiology of silicosis and potential therapeutic regimes

Silicosis is an occupational fibrotic lung disease caused by exposure to respirable crystalline silica dust particles produced during industrial activities. Other crystalline silica-induced pulmonary disorders include a predisposition to mycobacterial infections, obstructive airway diseases, idiopathic pulmonary fibrosis, and lung cancer. This review paper discusses the burden of silicosis and associated co-morbidities in developed as well as developing countries globally using the published data of various government agencies, related organizations, and epidemiological findings. Moreover, it sheds light on diverse mechanisms of silicosis, outlining molecular events and peculiar alterations in lung parenchyma leading to this occupational lung disease. Evaluation of pathophysiological mechanisms could aid in the identification of novel target molecules and treatments; to date, there is no curative treatment for silicosis. In recent periods, a lot of attention has been focused on the development and fabrication of suitable nanocarriers for improved and sustained drug delivery in the pulmonary system. Nanoparticle-based therapeutic modality has been evaluated in in-vitro and ex-vivo silicosis models for prolongation of drug activity and improved therapeutic outcomes. The preclinical findings open the doors to clinical trials for operational and regenerative nanoformulations, which eventually create a positive change in medical practice. The following review summarizes various therapeutic approaches available and in the pipe line for silicosis and also stresses the preventive practices for effectively combating this occupational hazard.

Understanding the role of positive body image in chronic low back pain: A path-analytic model

Chronic low back pain (CLBP) is a prevalent and disabling condition that significantly affects individuals' quality of life. Recently, the cognitivebehavioral model of body image and chronic pain has emphasized the influence of body image on the course of this condition. Nevertheless, the role of positive body image constructs, such as body appreciation and appreciation of body functionality, in CLBP remains underexplored. This study examined associations between body appreciation and functionality appreciation with pain intensity and interference in individuals with CLBP, with pain catastrophizing and kinesiophobia as potential mediators. A sample of 99 Spanish adults suffering from CLBP completed self-report measures. The path-analytic model showed an acceptable fit. While body appreciation showed no significant associations, functionality appreciation was negatively associated with pain catastrophizing, which in turn was positively associated with both pain intensity and interference. Indirect associations revealed that pain catastrophizing mediated the relationships between functionality appreciation and both pain outcomes. These results suggest the potential role of functionality appreciation in relation to pain outcomes in CLBP, with pain catastrophizing mediating these associations, highlighting the need for research examining whether targeting positive body image constructs, especially functionality appreciation, in pain management interventions could influence CLBP outcomes.

FIGO-IPPS consensus statement: Addressing the global unmet needs of women with chronic pelvic pain

Chronic pelvic pain (CPP), a debilitating condition affecting an estimated 25% of women worldwide, represents a significant yet understudied global health crisis. Existing research is limited and likely fails to capture the true impact of CPP on global health. What is known is that CPP results in a profound health, societal, and economic burden on women. Our inability to fully understand this burden is a critical gap in women's healthcare. To address this urgent need, the International Federation of Gynecology and Obstetrics (FIGO) and the International Pelvic Pain Society (IPPS) have partnered to develop this consensus statement where we examine the key challenges to accessing CPP care and propose a framework for overcoming these barriers. We emphasize that effective global strategies for addressing the negative health consequences of living with CPP must prioritize the lived experiences of patients, empower healthcare professionals with the necessary tools and training, and drive meaningful policy change. This call to action is grounded in a comprehensive vision of women's health and rights to address the full spectrum of conditions women experience throughout their lives. Given its high prevalence, CPP must be a central focus of this expanded vision.

Safety and efficacy of praziquantel 40 mg/kg versus 80 mg/kg in preschool-aged children with intestinal schistosomiasis in Uganda: a 2 × 2 factorial, double-blind, placebo-controlled, phase 2 randomised trial

BACKGROUND

Optimal dosing of praziquantel for schistosomiasis for children younger than 5 years is not established and some studies suggest this age group might need a higher dosing per kilogram. Our aim was to assess the safety and efficacy of a split dose of 80 mg/kg of praziquantel tablets given in a single day to preschool children versus the recommended single dose of 40 mg/kg for treatment of Schistosoma mansoni.

METHODS

We did a 2 × 2 factorial design, placebo-controlled, phase 2 randomised trial in Uganda. Children aged 12-47 months infected with Schistosoma mansoni were randomly assigned in a 1:1:1:1 ratio to receive crushed praziquantel tablets at single standard (40 mg/kg) versus double standard dosing (80 mg/kg delivered as two 40 mg/kg doses 3 hours apart) and same dose or placebo at 6 months. Coprimary outcomes were parasitological cure and egg reduction rate at 4 weeks. Secondary outcomes included antigenic cure at 4 weeks, adverse events and clinical toxicity 12 h after treatment, and key morbidity markers at 6 months and 12 months. This trial is registered with ClinicalTrials.gov (NCT03640377).

FINDINGS

Between Feb 18 and Dec 14, 2021, 354 children were randomly assigned to either praziquantel 40 mg/kg at baseline and placebo at 6 months (n=88); 40 mg/kg at baseline and 40 mg/kg at 6 months (n=86); 80 mg/kg at baseline and placebo at 6 months (m=89); or 80 mg/kg at baseline and 80 mg/kg at 6 months (n=91). 181 (51%) of 354 participants were boys. The median age was 36 months (28-42). Cure rate at 4 weeks was 67% in the 40 mg/kg group and 90% in the 80 mg/kg group (absolute difference 23% [95% CI 14-31]; p<0·001); for egg reduction rate the difference was 2% (95% CI 1-3; p<0·001) based on geometric mean and 22% (5-59; p<0·001) based on arithmetic mean. There were no differences in adverse event rates between the trial groups. At 12 months, biannual versus annual treatment reduced prevalence of faecal occult blood and 80 mg/kg dose reduced prevalence of faecal calprotectin. No severe adverse events related to the study drug were reported.

INTERPRETATION

Two 40 mg/kg doses given 3 hours apart are safe, well tolerated, and more effective in achieving parasitic cure than the current proposed single 40 mg/kg dose. Until a paediatric formulation of praziquantel is available in endemic areas, the use of crushed tablets with this dosing strategy can be recommended for young children living in S mansoni endemic areas. In addition, twice-a-year treatment compared with once-a-year treatment affected some intestinal morbidity markers.

FUNDING

US National Institutes of Health's National Institute of Child Health and Human Development.

TRANSLATION

For the Alur translation of the abstract see Supplementary Materials section.

The burden of type 2 diabetes in China from 1990 to 2021: A comparative analysis with G20 countries using the global burden of disease study 2021

OBJECTIVES

The study aims to evaluate the burden of Type 2 Diabetes (T2D) in China from 1990 to 2021, and compare to it across G20 countries.

METHODS

We utilized data from the Global Burden of Disease Study 2021 to examine the burden of T2D in China from 1990 to 2021. Prevalence, mortality, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) were calculated. Comparative analyses were conducted with other G20 countries.

RESULTS

T2D prevalence in China increased between 1990 and 2021, with rates rising from 3519.8 (3138.3-3910.1) to 6055.5 (5510.1-6614.3) per 100,000. The death rates slightly decreased from 9.3 (8.2-10.5) per 100,000 to 8.7 (7.3-10.3). The DALYs rate increased from 438.7 (358.5-531.5) to 569.8 (435.4-734.2), with increases observed in YLDs and YLLs. Males had a heavier disease burden in China. Compared to G20 countries, China ranked high in prevalence but had relatively better mortality outcomes in older age groups.

CONCLUSION

This study reveals the enormous burden and remarkable control efforts of T2D in China. Comparative analysis emphasizes the importance of tailored public health interventions to address this growing health crisis.

The burden of cardiovascular disease in Latin America and the Caribbean, 1990-2019: An analysis of the global burden of disease study

INTRODUCTION

Cardiovascular disease (CVD) remains the leading cause of death globally, including the Latin America and the Caribbean (LAC) region. However, limited research has been conducted on the burden of CVD in this region. Our study aims to investigate the burden of CVD and related risk factors (RFs) in the LAC.

METHODS

We used data from the Global Burden of Disease (GBD) 2019 to examine CVD prevalence in 33 LAC countries. Prevalence, mortality, and incidence were analyzed using Bayesian regression tools, demographic methods, and mortality-to-incidence ratios. Disability-adjusted life years (DALYs) were calculated, and RFs were evaluated under the GBD's comparative risk assessment framework.

RESULTS

Between 1990 and 2019, CVD raw rates in the LAC increased by 116.7 %, while age-standardized prevalence decreased (-9.2 %). CVD raw mortality rose by 71.2 %, but age-standardized death rates fell by 69.8 %. Ischemic heart disease remained the most prevalent condition, with higher rates in men, while women had higher rates of stroke. Age-standardized DALYs decreased by 70.9 %. DALY rates varied across countries and were consistently higher in males. Leading RFs included HTN, high LDL, dietary risks, and elevated BMI.

CONCLUSIONS

Despite progress in reducing the CVD burden in the LAC region, the impact on mortality and morbidity, particularly related to ischemic heart disease, remains substantial. Tailored interventions are necessary, considering country-specific variations in socio-economic factors, healthcare infrastructure, and political stability.

Effect of intra-articular corticosteroid injections for osteoarthritis on the subsequent use of pain medications: a UK CPRD cohort study

OBJECTIVES

To estimate the effect of intra-articular corticosteroid injection (IACI) for osteoarthritis on longer-term incidence of pain medications.

METHODS

We conducted a cohort study of patients registered in the UK Clinical Practice Research Datalink (CPRD) GOLD primary care database with an incident diagnosis of knee, hip, hand or shoulder osteoarthritis between 2005 and 2019. Exposure of interest was single or repeated use of IACI (analysed separately). Main outcome measures were five-year incidence of uncombined opioids, opioid-nonopioid analgesic combinations, oral corticosteroids, paracetamol, oral non-steroidal anti-inflammatory drugs (NSAIDs) and topical NSAIDs. Instrumental variable (IV) analysis was used, given this methodology can account for strong and unmeasured confounding. Secondary analyses used propensity-score matching and Cox regression.

RESULTS

Amongst 74 527 knee osteoarthritis patients, IACI use was associated with lower subsequent prescribing of most pain medications studied, including opioid-nonopioid analgesic combinations following single IACI [number needed to treat (NNT) = 5 (95% CI: 5-6), P < 0.001] and uncombined opioids following repeat IACI [NNT = 12 (8-546), P = 0.049]. Amongst 15 092 hand osteoarthritis patients, single IACI was associated with reduced use of opioid-nonopioid combinations, paracetamol and oral NSAIDs. Secondary analyses confirmed lower incidence rates of opioid-nonopioid combinations after single IACI for knee [hazard ratio (HR) = 0.88 (0.81-0.96)], hip [HR = 0.76 (0.62-0.92)], hand [HR = 0.77 (0.61-0.98)] or shoulder [HR = 0.72 (0.53-0.99)] osteoarthritis.

CONCLUSIONS

IACI for knee or hand osteoarthritis showed lower incidence of several pain medications over the longer-term relative to no IACI use. Secondary findings suggest IACI may be effective in reducing longer-term use of opioid-nonopioid analgesic combinations for patients with knee, hip, hand or shoulder osteoarthritis.

MXene-Based Photothermal-Responsive Injectable Hydrogel Microsphere Modulates Physicochemical Microenvironment to Alleviate Osteoarthritis

Osteoarthritis (OA) is a physical lubrication microenvironment-inadequate disease accompanied by a sustained chronic chemical inflammation microenvironment and the progression of articular cartilage destruction. Despite the promising OA treatment outcomes observed in the enhancement of lubrication inspired by ball bearings to reduce friction and support loads, the therapeutic effect of near-infrared (NIR) irradiation-based photothermal-responsive controlled release "smart hydrogel microspheres" on OA remains unclear. Here, we prepared MXene/NIPIAM-based photothermal-responsive injectable hydrogel microspheres encapsulating diclofenac sodium using a microfluidic system. Consequently, NIR irradiation-based photothermal-responsive controlled release "smart hydrogel microspheres" demonstrate beneficial therapeutic effects in the treatment of OA by modulating the physical lubrication and chemical chronic inflammation microenvironment, laying the foundation for the application of smart hydrogel microsphere delivery systems loaded with bioactive factors (including agents, cells, and factors) to regulate multiple pathological microenvironments in regenerative medicine.

Attributable risk factors and trends in global burden of falls from 1990 to 2021: A comprehensive analysis based on Global Burden Of Disease Study 2021

BACKGROUND

Falls are a leading cause of disability-adjusted life years (DALYs) and mobility difficulties. Previous estimates have relied on restricted regional scope and lack a thorough global study. This study, for the first time, examines the evolving trends in the global burden of falls from 1990 to 2021, focusing on geographic variation in disease burden and risk factors, predicting the development of burden of falls. Our aim was to provide information for allocating medical resources, taking health policies into action, and making patient management systems operate better.

METHOD

Data on incident cases, deaths, and DALYs were collected for countries, regions, ages, and sexes worldwide from the Global Burden Disease (GBD) 2021 database. Using R (version 4.3.2), we calculated estimated annual percent changes (EAPCs) for assessing trends in age-standardized rates, visualized risk factors, and predicted the global burden of falls. Joinpoint regression (version 4.9.1.0) was used to identify significant temporal trends and change points.

RESULTS

In 2021, 548.8 million people were affected by falls. There were 215 million incidence, 43.8 million DALYs, and 800,000 deaths caused by falls. The incidence rate of falls increases with age, and sex inequalities exist. Compared with 1990, the age-standardized incidence rate (ASIR), death rate (ASDR), and DALY rate (ASDALYsR) declined despite an increase in absolute numbers. The ASDR and ASDALYsR of falls are expected to decline in the future, whereas the ASIR is expected to rise. The fall burden varied significantly according to region and its sociodemographic index (SDI). Both ASIR (R = 0.510, p < 0.001) and ASDALYsR (R = 0.2762, p < 0.001) were positively correlated with SDI. In contrast, ASDR (R=-0.536, p < 0.001) showed a consistently negative association with SDI. Low bone mineral density, occupational injuries, alcohol use, and smoking emerged as the top factors associated with fall-related DALYs and deaths.

CONCLUSIONS

The overall burden of falls declined between 1990 and 2021, but the future incidence is expected to increase. The global burden of falls remains unchanged and shows significant regional and sex-based differences. Effective prevention and strategies against risk factors are imperative for reducing the future burden.

The impact and projection of the COVID-19 pandemic on the burden of stroke at global, regional, and national levels: A comprehensive analysis for the Global Burden of Disease Study 2021

BACKGROUND

We aim to estimate impact and projection of the COVID-19 pandemic on the burden of stroke at global, regional, and national levels METHODS: Utilizing standardized GBD methodologies, we conducted a comprehensive analysis of the prevalence, incidence, mortality, and disability-adjusted life years (DALYs) associated with stroke across 204 countries and regions spanning the periods from 1990 to 2019, 2019 to 2021, and 1990 to 2021. Our study provides detailed estimates accompanied by corresponding 95% uncertainty intervals (UIs), stratified by age and sex. To elucidate the temporal trends in stroke burden, we calculated the Estimated Annual Percentage Change (EAPC). Additionally, we explored the relationship between stroke burden and sociodemographic index (SDI) levels. The DALYs attributable to various risk factors for stroke were also analyzed. The burden of stroke in the next 20 years was also predicted.

RESULTS

From 2019 to 2021, the age-standardized prevalence rates (ASPR), incidence rates (ASIR), mortality rates (ASMR), and DALYs rates for stroke remained stable, diverging from the declining trends observed from 1990 to 2019 and from 1990 to 2021 at global, regional, and national levels, as indicated by both percent change analysis and EAPC analysis. This pattern was similarly reflected in the global burden of intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), and ischemic stroke (IS). The changes in the burden of stroke, ICH, and IS from 2019 to 2021 were consistent between males and females. Importantly, the impact of COVID-19 on stroke burden remains substantial, irrespective of variations in the SDI. The IS burden increased in the next 20 years, and more attention should be paid on the stroke burden in young people.

CONCLUSIONS

Throughout the COVID-19 pandemic, the burden of stroke exhibited a stable trajectory, in contrast to the declining trend observed from 1990 to 2019 and from 1990 to 2021. The increased burden was observed in IS and young people in the next 20 years. These observations highlight the disparities in stroke burden that exist across different levels of socioeconomic development. The longitudinal epidemiological data presented in this study provide valuable insights into the significant shifts brought about by the COVID-19 pandemic, offering crucial information for researchers, policymakers, healthcare professionals, and other stakeholders.

Global evaluation of the impact of food fortification with folic acid on rates of schizophrenia

BACKGROUND

Low folate status is one of the multiple factors thought to contribute to the development of schizophrenia. As of 2023, over 70 countries have implemented mandatory fortification of foods with folic acid, a public health measure aimed at reducing neural tube defects; however, the impact of such policy on schizophrenia has not been comprehensively investigated.

METHOD

We assessed the impact of mandatory folic acid fortification on changes in the schizophrenia rates in 194 jurisdictions between 1990 and 2019 using publicly available data. We used weighted regression models adjusted for sociodemographic and sociopolitical factors, experience of natural disasters, and baseline schizophrenia rate.

RESULTS

Age-adjusted prevalence and incidence of schizophrenia increased marginally between 1990 and 2019. In all geographic regions, schizophrenia prevalence and incidence per 100,000 positively correlated with countries' sociodemographic index and were lower with fortification. Schizophrenia burdens were higher among males compared to females. Lower prevalence and incidence of schizophrenia were associated with having mandatory fortification with modest magnitudes. Duration of fortification or the fortification dose did not appear to have a strong impact. However, in the 15-39 year age-group, both mandatory fortification (β = -13·14 (-22·60, -3·68)) and duration of fortification (β = -0·82 (-1·40, -0·23)) were significantly associated with lower schizophrenia with larger magnitude in both sexes. The highest dose tertile was reported to have the lowest incidence and the smallest increase in prevalence in this age-group.

CONCLUSION

Folic acid fortification may be a beneficial intervention in lowering schizophrenia among adolescents and young adults.

Effect of a 5-Year Exercise Intervention on Objectively Measured Physical Activity and Sedentary Time in Older Adults-The Generation 100 Study

BACKGROUND

Interventions promoting increased physical activity (PA) and limited sedentary time in older adults are urgently required. This study examines how 5 years of supervised high-intensity interval training (HIIT), or moderate-intensity continuous training (MICT) affects PA and sedentary time measured objectively, during, and 5 years after the intervention, compared to an unsupervised control group.

METHODS

In total, 1405 participants with a mean age of 72.8 years, consisting of 51% females, were randomized 1:1:2 to 5 years of 2 weekly sessions of HIIT (90% of peak heart rate), MICT (70% of peak heart rate), or as controls asked to follow national PA recommendations. Total PA, number of steps, sedentary time, light PA, moderate PA, and vigorous PA were measured with ActiGraph GT3X+ monitors at baseline, years 1, 3, 5, and 10.

RESULTS

There were no significant between-group differences throughout the study. However, HIIT, MICT, and control demonstrated significant changes after 1 year, including decreased total PA (-10%, -9%, and -9%, respectively), increased sedentary time (164, 163, and 163 min/d, respectively), and increased moderate PA (21, 21, and 19 min/d, respectively). Furthermore, after 10 years, pooled moderate to vigorous PA was maintained or increased in all groups (5.7, 1.9, and 1.5 min/d in HIIT, MICT, and control, respectively).

CONCLUSION

HIIT, MICT, and control exhibited a similar long-term effect on objective PA and sedentary time in a general population of older adults. Notably, both supervised and unsupervised exercise combined with regular follow-up hindered the expected age-related decline in moderate to vigorous PA over 10 years.

Exploring the therapeutic potential of beetroot juice in patients with peripheral artery disease: A Narrative review

Peripheral artery disease (PAD) is a circulatory disorder caused by atherosclerosis, leading to the narrowing or blockage of peripheral arteries, often affecting the arteries in the lower limbs. This condition can result in intermittent claudication and severe limb ischemia, significantly reducing patients' quality of life. In recent years, increasing evidence suggests that dietary interventions play a crucial role in the prevention and management of PAD, offering a safe and non-invasive treatment option. Beetroot, a natural root vegetable, demonstrates significant health benefits through its various bioactive compounds. It is rich in nitrate and betaine, which are metabolized in the body via the nitrate-nitrite- nitric oxide (NO) pathway, increasing the bioavailability of NO. NO is an important vasodilator that can improve blood flow and lower blood pressure. Additionally, the active compounds in beetroot may further enhance its health effects by altering the activity of the oral microbiome. This review explores the potential therapeutic effects of beetroot juice (BRJ) in the management of PAD. The findings indicate that BRJ can improve exercise performance, lower blood pressure, improve endothelial function, enhance skeletal muscle microvascular function and central autonomic nervous system function. Based on these findings, beetroot and its rich bioactive compounds hold promise as a novel supportive therapy for improving PAD.

Lipid metabolism in women: A review

The menopausal transition, defined by the cessation of menstruation due to declining ovarian follicular function, results in a marked decrease in endogenous estrogen levels. This phase is associated with significant metabolic changes and a shift towards a more atherogenic lipid profile. Specifically, there are increases in total cholesterol, low-density lipoprotein cholesterol, and triglycerides and unfavorable alterations in high-density lipoprotein cholesterol and lipoprotein(a) levels. These lipid changes, which contribute to an increased risk of atherosclerotic cardiovascular disease, are influenced by diminished estrogen levels and chronological aging. However, the specific mechanisms driving this increased risk are not fully understood. A thorough understanding of these lipid profile alterations is important for developing strategies to reduce cardiovascular disease risk in women. This review provides an overview of how lipid metabolism is affected during the menopausal transition and the resulting implications for cardiovascular risk.

Comprehensive investigation of network pharmacology, computational modeling, and pharmacokinetic assessment to evaluate the efficacy of flavonoids in rheumatoid arthritis

Rheumatoid arthritis is a chronic autoimmune disease characterized by inflammation and joint damage, imposing a significant burden on affected individuals worldwide. Flavonoids, a class of natural compounds abundant in various plant-based foods, have shown promising anti-inflammatory and immunomodulatory effects, suggesting their potential as therapeutic agents for RA. In this study, we conducted a comprehensive investigation of identified LCMS compounds utilizing network pharmacology, computational modeling, in silico approaches, and pharmacokinetic assessment to evaluate the efficacy of flavonoids in RA treatment. The study identified 5 flavonoid structures with common targets via LCMS and Integration of network pharmacology approaches enabled a comprehensive evaluation of the pharmacological profile of flavonoids in the context of RA treatment, guiding the selection of promising candidates for further experimental validation and clinical development. The top 10 targets were AKT1, PI3KR1, CDK2, EGFR, CDK6, NOS2, FLT3, ALOX5, CCNB1, and PTPRS via PPI network. The investigation emphasized several pathways, including the AGE-RAGE signaling pathway, resistance to EGFR tyrosine kinase inhibitors, the PI3K-AKT signaling network, and the Rap 1 signaling pathway. In silico studies estimated binding affinities that ranged from - 7.0 to - 10.0 kcal/mol. Schaftoside and Vitexin showed no toxicity in computational approach and found suitable for further investigations. Overall, our study underscores the potential of flavonoids as therapeutic agents for RA and highlights the utility of integrative approaches combining network pharmacology, computational modeling, in silico methods, and pharmacokinetic assessment in drug discovery and development processes.

The Association of Physiotherapy Continuity of Care with Duration of Time Loss Among Compensated Australian Workers with Low Back Pain

PURPOSE

The aims of this study are to determine how continuous the care provided by physiotherapists to compensated workers with low back pain is, what factors are associated with physiotherapy continuity of care (CoC; treatment by the same provider), and what the association between physiotherapy CoC and duration of working time loss is.

METHODS

Workers' compensation claims and payments data from Victoria and South Australia were analysed. Continuity of care was measured with the usual provider continuity metric. Binary logistic regression examined factors associated with CoC. Cox regression models examined the association between working time loss and CoC.

RESULTS

Thirty-six percent of workers experienced complete CoC, 25.8% high CoC, 26.1% moderate CoC, and 11.7% low CoC. Odds of complete CoC decreased with increased service volume. With decreasing CoC, there was significantly longer duration of compensated time loss.

CONCLUSION

Higher CoC with a physiotherapist is associated with shorter compensated working time loss duration for Australian workers with low back pain.

A time-motion study on impact of spatial separation for empiric airborne precautions in emergency department length of stay

AIMS

To evaluate the impact of spatial separation on patient flow in the emergency department.

DESIGN

This was a retrospective, time-and-motion analysis conducted from 15 to 22 August, 2022 at the emergency department of a tertiary hospital in Kuala Lumpur, Malaysia. During this duration, spatial separation was implemented in critical and semi-critical zones to separate patients with symptoms of respiratory infections into respiratory area, and patients without into non-respiratory area. This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

METHODS

Patients triaged to critical and semi-critical zones were included in this study. Timestamps of patient processes in emergency department until patient departure were documented.

RESULTS

The emergency department length-of-stay was longer in respiratory area compared to non-respiratory area; 527 min (381-698) versus 390 min (285-595) in critical zone and 477 min (312-739) versus 393 min (264-595) in semi-critical zone. In critical zone, time intervals of critical flow processes and compliance to hospital benchmarks were similar in both areas. More patients in respiratory area were managed within the arrival-to-contact ≤30 min benchmark and more patients in non-respiratory area had emergency department length-of-stay ≤8 h.

CONCLUSIONS

The implementation of spatial separation in infection control should address decision-to-departure delays to minimise emergency department length of stay.

IMPACT

The study evaluated the impact of spatial separation on patient flow in the emergency department. Emergency department length-of-stay was significantly prolonged in the respiratory area. Hospital administrators and policymakers can optimise infection control protocols measures in emergency departments, balancing infection control measures with efficient patient care delivery.

REPORTING METHOD

STROBE guidelines.

NO PATIENT OR PUBLIC CONTRIBUTION

None.

TRIAL AND PROTOCOL REGISTRATION

The study obtained ethics approval from the institution's Medical Ethics Committee (MREC ID NO: 20221113-11727).

STATISTICAL ANALYSIS

The author has checked and make sure our submission has conformed to the Journal's statistical guideline. There is a statistician on the author team (Noor Azhar).

Global trends in staphylococcus aureus-related lower respiratory infections from 1990 to 2021: findings from the 2021 global burden of disease report

BACKGROUND

Lower respiratory infections (LRIs) represent a significant global health issue, especially affecting low- and middle-income countries. In this study, we explored the mortality and disability-adjusted life years (DALYs) associated with Staphylococcus aureus-related LRIs from 1990 to 2021, highlighting trends by age, sex, and Socio-Demographic Index (SDI).

METHODS

Data were derived from the 2021 Global Burden of Disease (GBD) database. Temporal trends in age-standardized mortality rates (ASMR) and disability-adjusted life years (DALYs) rates (ASDR) for S. aureus-related LRIs were analyzed based on the average annual percent change (AAPC), in terms of sex, 20-age groups, 21 regions, 204 countries, and 5 SDI quintiles.

RESULTS

In 2021, S. aureus-related LRIs contributed to 423,837 deaths (95% UI: 382,183-458,926), a 67.56% increase since 1990. In comparison, the global ASMR was 5.43 per 100,000 (95% UI: 4.89-5.90), and the ASDR was 156.80 per 100,000 (95% UI: 139.44-176.08), both exhibiting a declining trend compared to 1990. Rates were higher in low SDI regions, with Central Sub-Saharan Africa reporting the highest ASMR, while Eastern Europe had the lowest. Among the 204 countries analyzed, Zimbabwe recorded high ASMR and ASDR, at 24.84 (95% UI: 19.44-30.16) and 754.34 (95% UI: 591.05-923.06), respectively.

CONCLUSIONS

Although the global ASMR and ASDR decreased in 2021, the number of deaths from S. aureus-related LRIs significantly increased driven by the growing population and proportion of aged individuals. Additionally, the emergence of multidrug-resistant strains has made treatment more complex, particularly in low SDI regions, highlighting the urgent need for more targeted strategies, therapies, and vaccines.

Differential aging trends among candidates for liver transplant with and without HCC

HCC has become a leading indication for liver transplant (LT), with HCC registrants increasing more than 6-fold in the past 2 decades, accompanied by a significant rise in older candidates. Given this trend and the influence of hepatitis C (HCV) treatments, updated data on aging and changing etiologies in older patients with HCC are needed. This study examines age trends, clinical characteristics, and transplant outcomes by comparing older (70+), younger patients with HCC, and patients without HCC. All adult candidates for LT (18+) in the UNOS/OPTN registry (2012-2022) were analyzed and categorized by HCC status and age (<70 or 70+). Regression coefficients compared HCC and non-HCC registrants and recipients by age group. The aging trend among LT registrants was more pronounced in patients with HCC. From 2012 to 2022, the mean age of HCC registrants rose from 58.7 to 62.9, with those aged 70+ increasing from 4.2% to 15.0%. Non-HCC registrants saw minimal change, with a stable mean age of 53 years and a modest rise in those 70+ from 2.1% to 4.7%. HCV prevalence among patients with HCC decreased from 37.5% to 27.4%, while patients without HCC dropped from 14.8% to 5%. Posttransplant outcomes for older HCC recipients remained favorable, with 1-year and 5-year survival rates of 91% and 71%, respectively, comparable to older patients without HCC (87% and 69%). Among over 132,000 LT registrants from 2012 to 2022, the age of HCC candidates increased, with a growing proportion aged 70 and older, while the age and proportion of older adults among non-HCC registrants remained stable. This demographic shift underscores the importance of enhanced frailty assessments to improve outcomes for older patients with HCC.

Burdens and trends of age-related macular degeneration at global, regional, and national levels,1990-2021: findings from the 2021 global burden of disease study

OBJECTIVES

To assess global, regional, and national burdens and trends of age-related macular degeneration (AMD) from 1990 to 2021.

METHODS

Data from the Global Burden of disease Study 2021(GBD 2021) were used. The primary measurement were prevalent cases, years lived with disability (YLDs), age-standardised prevalence rate (ASPR) and age-standardised YLDs rate (ASYR), categorized by age and sociodemographic index (SDI). Trend analysis was measured by calculating average annual percentage change (AAPC) of ASPR and ASYR.

RESULTS

Globally, the prevalent AMD cases increased to 8,057,520.459 (95% uncertainty interval [UI], 6,705,283.83 to 9,823,237.34) in 2021, with associated YLDs rising to 577,984.5004 (95% UI, 401,188.20 to 797,657.63). AMD burdens varied across regions and countries, as well as level of SDI development. China, India, and the United States of America (USA) were the top three countries with AMD cases. Caribbean regions have significant lower ASPR and ASYR of AMD. The AMD burden peaked between ages 65-69. Females had a significantly higher burden of AMD compared to males. From 1990 to 2021, the global ASPR and ASYR showed downward trend (AAPC = -0.15, 95% confidence interval [CI], -0.19 to -0.12, P < 0.001; AAPC = -0.69, 95% CI, -0.71 to -0.67, P < 0.001) respectively. The USA is the only developed country showed decreasing AAPCs of ASPR and ASYR from 1990 to 2021 but increasing AAPCs of ASPR and ASYR from 2012 to 2021.

CONCLUSIONS

AMD burdens increased over 30 years, varying by age, sex, and SDI, guiding global strategies and public health interventions.

A 5000-year overview of the history of pain through ancient civilizations to modern pain theories

Pain and its management have been a predominant issue since the dawn of humanity. Pain has been the subject of much controversy and has constantly evolved across societies. The objective of this review is to trace the historical evolution of the concept of pain through the ages and to attempt to understand how modern theories of pain represent a legacy of ancestral knowledge passed down from culture to culture. We conducted a comprehensive review of primary and secondary sources across 6 major historical periods, including Pre-history, Antiquity, the Middle Ages, the Renaissance, the Modern, and Contemporary eras, using academic databases, specialized libraries, and historical archives. Results shows that during ancient civilizations, the understanding of pain oscillated between religious beliefs and medical advances. Antiquity societies made significant contributions to the understanding of pain mechanisms and management. Contrary to popular belief, significant advances were made during the Middle Ages despite the important impact of religion on the era's conceptualization of pain. During the Renaissance, the influence of religion waned, and secular medicine made significant progress. The development of pain theories peaked in the 19th century with technological advances. Long considered an expression of internal suffering, pain has fascinated humanity throughout history. The way pain has been perceived, understood, and treated has changed greatly over the centuries. This historical scientific review allows us to keep in mind that the vision we have of pain in Western society is predominantly based on the concrete heritage of ancient civilizations.

Association between cardiometabolic index and the incidence of stroke: a prospective nationwide cohort study in China

Objectives

Cardiometabolic index (CMI), based on triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C) ratio and waist-to-height ratio (WHtR), has been recognized as a novel and practical marker for the assessment of cardiometabolic risk. However, the relationship between CMI and the incidence of stroke remains to be elucidated. This investigation aimed to explore the association between CMI and stroke incidence.

Methods

The investigation included 6,633 individuals aged over 45 years from the China Health and Retirement Longitudinal Study. Logistic regressions and restricted cubic spline regression were uitilized to determine the relationship between CMI and the incidence of stroke. Weighted quantile sum regression was used to offer a comprehensive explanation of the CMI by calculating the weights of triglyceride-glucose (TG), high-density lipoprotein cholesterol (HDL-C), weight, and height.

Results

During the 9-year follow-up, 827 (12%) incident stroke participants were identified. With CMI as a continuous variable, the OR (95% CI) for the risk of incident stroke was 1.09 (1.01-1.19) (p = 0.047) after adjusting for potential confounders, indicating a significant link between increased CMI and an elevated incidence of stroke. Additionally, when CMI was categorized into quartiles, compared to the first quartile, the incident stroke was significantly higher in the fourth quartile (OR 1.57, 95%CI 1.22-2.04, p <0.001). The association between CMI and stroke incidence was nonlinear (p overall=0.002, p non-linear = 0.006). TG emerged as the primary contributor when the weights were assigned to the constituent elements of the CMI (weight = 0.645).

Conclusions

The CMI was independently associated with stroke incidence in middle-aged and elderly Chinese populations. Long-term CMI monitoring is of great importance for early identification and prevention of stroke, with significant implications for clinical practice.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-024-01530-3.

Sun Exposure and Anorexia Nervosa: A Potential Environmental-Biological Interaction?

OBJECTIVE

Despite first being described in 1888, anorexia nervosa continues to be the deadliest of all psychiatric illnesses. Although efforts have been made to elucidate the aetiological factors involved in the illness, little progress has been made in uncovering what contributes to the development and maintenance of anorexia nervosa. A particular shortcoming of the current literature has been the investigation of interactions between environmental and biological factors. One such interaction which has yet to receive attention in anorexia nervosa is that of sun exposure. Exposure to the sun-including levels of ultraviolet radiation (UVR) and vitamin D-in the pathogenesis of other mental illnesses has long been investigated (with lower levels of vitamin D reportedly involved in the pathogenesis of conditions such as schizophrenia, for example) but is yet to be explored in anorexia nervosa.

CONCLUSIONS

The current paper proposes a novel hypothesis for the potential contribution of reduced sun exposure in the aetiology of anorexia nervosa for future investigation, and possible mechanisms for how this relationship may operate.

Neural correlates of psychotherapy in mental disorders: A meta-analysis of longitudinal resting-state fMRI studies

BACKGROUND

Psychotherapy is a crucial approach in the treatment of mental disorders. However, how psychotherapy modulate spontaneous brain activity and finally take therapeutic effects remain unknown. Among countless number of analytic methods of resting-state functional magnetic resonance imaging (rs-fMRI), Regional Homogeneity (ReHo), Degree Centrality (DC), and Amplitude of Low Frequency Fluctuation (ALFF), are commonly used voxel-wise whole-brain (VWWB) metrics, and these studies could be used for coordinate-based meta-analysis. In order to reveal the underlying neural mechanisms of psychotherapy in patients with mental disorders, serving for future precise targeting intervention, we conducted a systematic review and meta-analysis based on rs-fMRI studies at VWWB level.

MATERIAL AND METHODS

A systematic literature search was conducted in PubMed, PsycINFO, and Web of Science following PRISMA criteria (registration number CRD42023432388) to investigate the differences between pre- and post-psychotherapy. To investigate whether changes in spontaneous brain activity differ across different metrics, distinct psychotherapy approaches or specific patient populations, subgroup analyses were performed.

RESULTS

Nine studies involving a total of 192 patients were included. We observed a significant decrease in spontaneous activity within the left insular after treatment with psychotherapy. Moreover, the subgroup analysis revealed significantly decreased ReHo in the right inferior frontal gyrus.

CONCLUSIONS

The current study indicates that the clinical efficacy of psychotherapy may be modulated by insular and right inferior frontal gyrus through neurological perspective. This contributes to our understanding of the neurobiological mechanisms of psychotherapy and provides valuable insights into improving precise targeting interventions for individuals with mental disorders.

Point-of-care testing reduces antibiotic prescribing in acute exacerbations of chronic obstructive pulmonary disease: A systematic review and meta-analysis

BACKGROUND

Challenges in identifying the causes of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have led to overuse of antibiotics. The advantages of point-of-care testing (POCT) may help to identify pathogens and use antibiotics more appropriately.

METHODS

We conducted a systematic review to evaluate the effect of POCT to guide antibiotic prescriptions for AECOPD. Adhering to a protocol (CRD42024555847), we searched eligible studies. The outcomes included antibiotic-related and clinical outcomes. We evaluated the risk of bias and performed meta-analyses with subgroup based on the type and testing timing of POCT.

RESULTS

A total of 18 studies evaluating 4346 AECOPD patients were included. Overall, POCT significantly reduced the number of AECOPD patients given antibiotic prescriptions by 16% (P < 0.001). Additionally, antibiotic treatment was reduced by 1.19 days (P = 0.04). There was no detrimental impact on clinical outcomes, such as the length of hospital stay (P = 0.19). Our results proved robust to sensitivity analyses.

CONCLUSION

We offered reasonable evidence for using POCT to reduce antibiotic exposure for AECOPD without adversely affecting clinical outcomes. As diagnostic techniques become increasingly important in combating antimicrobial resistance, the use of POCT should be encouraged.

Comprehensive analysis of stroke epidemiology in Vietnam: Insights from GBD 1990-2019 and RES-Q 2017-2023

Background

Stroke is a significant health burden in Vietnam, with substantial impacts on mortality, morbidity, and healthcare resources. An up-to-date report on stroke epidemiology and associated risk factors in Vietnam was missing.

Method

We analyzed the data published in the Global Burden of Disease (GBD) 2019, in combination with the first-time analysis of the Registry of Stroke Care Quality Improvement (RES-Q) initiative in Vietnam from 2017 to 2023.

Findings

Comparative analysis globally revealed that Vietnam had one of the highest stroke incidence and prevalence rates in Southeast Asia and ranked 4th in stroke mortality among 11 neighbouring countries. In the RES-Q dataset, 95,696 patients (77 %) were ischemic stroke, 23,203 (18 %) were intracerebral haemorrhage, and 2816 (2 %) were subarachnoid haemorrhage. In GBD 2019, stroke was the leading cause of death among cardiovascular diseases in Vietnam, accounting for 135,999 fatalities. The incidence of stroke was 222 (95 % UIs 206-242) per 100,000 population, with a prevalence of 1541 (1430-1679) per 100,000. Results align with the report from the RES-Q dataset in two megacities of Vietnam: Hanoi (incidence rate of 168.9, prevalence rate of 1182.2) and Ho Chi Minh City (incidence rate of 207.1, prevalence rate of 1221.8). Key risk factors for stroke mortality are high systolic blood pressure (79,000 deaths), unhealthy dietary (43,000 deaths), high fasting plasma glucose (35,000 deaths), and air pollution (33,000 deaths). Incidence is lower in rural Vietnam, but availability and quality of care are higher in megacities.

Interpretation

The results promote a further understanding of stroke and risk factors for the Vietnamese population and suggest prevention and treatment strategies for the Vietnamese government, including facility and capacity improvement and applications of advanced technologies.

Piperazine ferulate impact on diabetes-induced testicular dysfunction: unveiling genetic insights, MAPK/ERK/JNK pathways, and TGF-β signaling

Diabetic testicular dysfunction (DTD) poses a significant threat to male reproductive health. This study delves into the potential of piperazine ferulate (PF), a natural phenolic compound, in alleviating DTD and sheds light on its underlying mechanisms in rats. Animals were divided into the control, PF, diabetic, and diabetic plus PF groups. Diabetes was induced in rats with a single intraperitoneal (i.p.) injection of streptozotocin (STZ) at 50 mg/kg. PF was administered at 50 mg/kg/day via i.p. injection for four weeks. Significant changes in sexual behavior were observed in diabetic rats, which additionally revealed lower serum levels of testosterone, FSH, and LH. The abnormalities in sperm count, viability, motility, and morphology occurred along with the demonstrated suppression of genes and protein expression related to spermatogenesis. Atrophy of the seminiferous tubules and extensive degeneration and necrosis of the germ and Leydig cells were highlighted by histopathological examination. The testicular function of diabetic rats was significantly improved after PF administration, evidenced by normalized testicular histology, increased testosterone levels, and enhanced sperm quality. In addition to reducing inflammatory cytokines, COX2, and NF-κB expression, pf administration elevated the antioxidant levels and Nrf2/HO-1 expression. Furthermore, key signaling pathways involved in testicular degeneration are regulated by PF. It promoted cell survival and tissue repair by activating the protective TGF-β signaling pathway and attenuating the MAPK/ERK/JNK signaling cascade, which in turn reduced inflammation and apoptosis. PF suppressed the expression of INSL3, SPHK1, CD62E, ANGPTL2, and miR-148a-5p, while increasing the expression of testicular genes like HSD17B1, DAZL, and S1P, addressing DTD. This study highlights the potential of PF to restore testicular function and fertility in diabetic males by modulating genetic and signaling pathways.

Feasibility of human ethomic biomarkers for the diagnosis and monitoring of hip osteoarthritis

Radiographic imaging is typically used to diagnose osteoarthritis (OA). However, patients would typically be sent for imaging after they present to a physician because of joint pain. By this time, the condition is likely irreversible. This study aims to determine if human ethomics (i.e. behavior) defined by whole-body kinematics during walking, can be used as a diagnostic biomarker of hip OA. Three-dimensional motion capture was performed on 106 participants with unilateral hip OA and 80 asymptomatic participants (N = 80) during walking. Sixteen sagittal plane joint angle variables were extracted and used as inputs into the prediction model. The categorical outcome was the radiographic severity of hip OA using the Kallgren-Lawrence (KL) scale (0 [no OA], 2, 3, 4[worse]). Functional data boosting was used for statistical modelling with bootstrap resampling. Our ethomics approach to hip OA diagnosis had positive likelihood ratio (LR+) values ranging from 4.79 (95 %CI 3.20, 7.42) to detect the presence of KL3, to 43.95 (95 % CI 14.9, 76.08) to detect the presence of any OA. The present approach had negative likelihood ratio (LR-) values ranging from 0.56 (95 %CI 0.33, 0.79) of 0.07 (95 %CI 0.04, 0.11) to detect the absence of KL4, to 0.07 (95 %CI 0.04, 0.11) to detect the absence of any OA. Human ethomics represents an ideal candidate for OA biomarkers that could overcome many of the logistical challenges of traditional imaging and biochemical biomarkers.

Stair climb muscle power is associated with gait speed, sit-to-stand performance, patient-reported outcomes and objective measures of mechanical muscle function in individuals with knee osteoarthritis - secondary analysis from an RCT

BACKGROUND

Mechanically measured leg extensor muscle power (LEP) predicts functional performance, patient-reported outcomes (PROMs) and mechanical muscle function in patients with knee osteoarthritis (OA). The stair climb test (SCT) have been used to assess LEP in clinical populations, but the relationship between SCT derived LEP and functional- and self-reported outcome measures in patients with knee-OA remains unknown.

OBJECTIVES

To investigate the relationship between LEP derived from SCT, and patient-reported outcomes (PROMs), functional performance, knee extensor muscle strength (MVIC), rate of force development (RFD) and Nottingham LEP in individuals with knee-OA.

DESIGN

Cross-sectional study.

METHOD

SCT power was obtained in 96 knee-OA patients (age 56.9 ± 7.7 yr. males n = 47, females n = 49). The dependent variable was SCT power, while independent variables included 4 × 10 m fast-paced walk (4x10m-FWT), sit-to-stand (STS), STS power, KOOS, Oxford Knee Score (OKS), LEP, MVIC, and RFD.

RESULTS

There were strong correlations (r = 0.72-0.80, p < 0.01) between SCT power and 4x10m-FWT and STS. There were weak-to-moderate correlations (r = 0.22-0.42, p < 0.05) between SCT power versus OKS and all KOOS subscales. Moderate correlations were observed between SCT power and Nottingham LEP, MVIC, and RFD (r = 0.53-0.64, p < 0.01).

CONCLUSIONS

SCT power correlates positively with functional performance, PROMs and mechanical lower limb muscle function in male and female individuals with knee-OA.

The Fremantle Back Awareness Questionnaire: Cross-cultural adaptation, validity and reliability of the Polish version

BACKGROUND

Body image disturbance is observed in individuals with chronic low back pain (CLBP) and is a potential treatment target. The Fremantle Back Awareness Questionnaire (FreBAQ) is designed to identify disrupted body image specific to the low back. This study aimed to develop and assess the measurement properties of a Polish language version of this questionnaire (FreBAQ-PL).

METHODS

Following the translation process, cognitive interviews were carried out as a qualitative assessment of content validity. Subsequently a quantitative assessment of content validity was undertaken among in a study sample with CLBP and experts. Measurement properties were assessed in 114 participants with CLBP and 53 pain-free participants. The CLBP sample repeated the FreBAQ-PL assessment within 14-days. The measurement properties assessed in this study were content validity, internal consistency, frequency of responses, known-groups validity, convergent validity and test-retest reliability.

RESULTS

Content validity was supported, affirming relevance and comprehensiveness. Known-groups validity was confirmed by significant differences in FreBAQ-PL scores between participants with CLBP and pain-free participants (p < 0.05). Convergent validity was established through moderate associations between FreBAQ-PL scores and pain variables (intensity and duration) (ρ's = 0.24-0.27, p's < 0.01), disability (ρ = 0.34, p < 0.01), kinesiophobia (ρ = 0.37, p < 0.01), depression (ρ = 0.30, p < 0.01) and anxiety (ρ = 0.24, p < 0.01). The scale was internally consistent (Cronbach's alpha 0.81). Test-retest reliability was good (ICC 0.90).

CONCLUSIONS

The FreBAQ-PL is a reliable, internally consistent, and valid measure that can be used in clinical and research settings to assess the presence of body image disturbance in Polish-speaking individuals with CLBP.