Incidence and temporal trends of out-of-hospital cardiac arrest in Shenzhen, China (2011-2018)

Background

Out-of-hospital cardiac arrest (OHCA) is a significant global public health issue, few studies describe characteristics and trends in China. This study examines OHCA features and trends in Shenzhen, one of the fastest-growing cities.

Methods

This retrospective study analysed data from the Shenzhen Emergency Center database (2011-2018), including ambulance dispatch and pre-hospital medical records. Descriptive statistics and temporal trends were used to examine the incidence, patients characteristics, pre-hospital treatment, and outcome.

Results

Among 18,772 medical cause OHCA cases, the crude incidence rate was 17.4 per 100,000 population, with an age-standardised rate of 38.4. Incidence increased over time. Resuscitation was attempted in 43.8% of cases, with a median patient age of 56 years and 73.5% being male. Most arrest (69.0%) occurred at home, and 82% were presumed to be cardiac cause.The median response time was 11.2 min. Bystander cardiopulmonary resuscitation (CPR) rates increased from 4.6% in 2011 to 14.5% in 2018, while bystander automated external defibrillator (AED) use remained low (0.2%). Pre-hospital electrocardiogram (ECG) recording improved from 40.6% to 91.9%, with shockable rhythms 2.2%. Intravenous access was established in 69.7% of patients, 51.9% received epinephrine, 19.29% received pre-hospital defibrillation, and 16.4% underwent advanced airway management. The pre-hospital Return of Spontaneous Circulation (ROSC) rate increased from 2.7% to 5.8%, with a total ROSC rate of 3.11%.

Conclusions

OHCA incidence in Shenzhen is lower than both domestic and international levels but increasing. Low bystander intervention rated and prolonged response times contribute to poor outcome, underscoring the need for system improvements.

Ergonomic interventions to improve musculoskeletal disorders among vehicle assembly workers: a one-year longitudinal study

BACKGROUND

Musculoskeletal disorders (MSDs) constitute a significant challenge in the realm of occupational health, especially in the manufacturing sector, necessitating the development of efficacious intervention strategies to enhance musculoskeletal health and reduce the incidence of MSDs. The present study is designed to assess the efficacy of a comprehensive ergonomic intervention, specifically tailored to diminish ergonomic risk factors and the prevalence of MSDs among workers engaged in vehicle assembly line operations.

METHOD

This interventional study, conducted over a one-year period, was implemented among assembly line workers within a rail bound vehicle manufacturing shop. The study engaged 181 participants who were subjected to a comprehensive ergonomic intervention plan. This intervention encompassed an ergonomic training program, enhancements in auxiliary tool, and the distribution of an ergonomic educational brochure. Workstation ergonomics, including postures and movements, vibrations, and work stress, were evaluated using the Quick Exposure Check (QEC). Participants scored their postural exposure and the intensity, duration, and frequency of musculoskeletal symptoms at nine anatomical sites in the modified Nordic Musculoskeletal Questionnaire. All evaluations were conducted at baseline and after a one-year follow-up.

RESULTS

After the one-year intervention, the QEC scores for the neck, back, shoulders/arms, and wrists/hands decreased significantly (p < 0.01). The self-rated exposure scores for 22 awkward postures and repetitive movements were much lower than at baseline (p < 0.05). Moreover, the self-reported intensity, duration, and frequency of musculoskeletal symptoms in nine body areas all decreased significantly (p < 0.05).

CONCLUSIONS

The findings from this prospective study indicated enhancements in ergonomic conditions and a reduction in musculoskeletal disorders (MSDs) among vehicle assembly workers following a comprehensive ergonomic intervention.

Learning Consistent Semantic Representation for Chest X-ray via Anatomical Localization in Self-Supervised Pre-Training

Despite the similar global structures in Chest X-ray (CXR) images, the same anatomy exhibits varying appearances across images, including differences in local textures, shapes, colors, etc. Learning consistent representations for anatomical semantics through these diverse appearances poses a great challenge for self-supervised pre-training in CXR images. To address this challenge, we propose two new pre-training tasks: inner-image anatomy localization (IIAL) and cross-image anatomy localization (CIAL). Leveraging the relatively stable positions of identical anatomy across images, we utilize position information directly as supervision to learn consistent semantic representations. Specifically, IIAL adopts a coarse-to-fine heatmap localization approach to correlate anatomical semantics with positions, while CIAL leverages feature affine alignment and heatmap localization to establish a correspondence between identical anatomical semantics across varying images, despite their appearance diversity. Furthermore, we introduce a unified end-to-end pre-training framework, anatomy-aware representation learning (AARL), integrating IIAL, CIAL, and a pixel restoration task. The advantages of AARL are: 1) preserving the appearance diversity and 2) training in a simple end-to-end way avoiding complicated preprocessing. Extensive experiments on six downstream tasks, including classification and segmentation tasks in various application scenarios, demonstrate that our AARL: 1) has more powerful representation and transferring ability; 2) is annotation-efficient, reducing the demand for labeled data and 3) improves the sensitivity to detecting various pathological and anatomical patterns.

Forecasting influenza epidemics in China using transmission dynamic model with absolute humidity

Background

An influenza forecasting system is critical to influenza epidemic preparedness. Low temperature has long been recognized as a condition favoring influenza epidemic, yet it fails to justify the summer influenza peak in tropics/subtropics. Recent studies have suggested that absolute humidity (AH) had a U-shape relationship with influenza survival and transmission across climate zones, indicating that a unified influenza forecasting system could be established for China with various climate conditions.

Methods

Our study has generated weekly influenza forecasts by season and type/subtype in northern and southern China from 2011 to 2021, using a forecasting system combining an AH-driven susceptible-infected-recovered-susceptible (SIRS) model and the ensemble adjustment Kalman filter (EAKF). Model performance was assessed by sensitivity and specificity in predicting epidemics, and by accuracies in predicting peak timing and magnitude.

Results

Our forecast system can generally well predict seasonal influenza epidemics (mean sensitivity>87.5%; mean specificity >80%). The average forecast accuracies were 82% and 60% for peak timing and magnitude at 3-6 weeks ahead for northern China, higher than those of 42% and 20% for southern China. The accuracy was generally better when the forecast was made closer to the actual peak time.

Discussion

The established AH-driven forecasting system can generally well predict the occurrence of seasonal influenza epidemics in China.

The variations in the natural history of high-risk human papillomavirus infections in Chinese healthy women aged 27-45 years compared with 18-26 years: A prospective cohort study

Data investigating the natural history of high-risk human papillomavirus (HR-HPV) infection in mid-adult women compared with young adult women from regions exhibiting a bimodal distribution pattern are scarce. From November 2012 to September 2019, 3681 healthy women aged 18-45 years from the control group of a bivalent HPV vaccine Phase 3 trial in China were followed over 5.5 years. At scheduled visits (Day 0, months 7, 12, 18, 24, 30, 42, 54, and 66), cervical samples were collected for ThinPrep Pap tests and HPV DNA testing, women with abnormal cytology were referred for colposcopy. Data was analyzed using Cox regression model and a competing risk model. Sensitivity analyses were performed among participants attending all scheduled visits. The incidences of HR-HPV persistent infections (over 6 months [6mPIs]) were 35.5 and 29.0 per 1000 person-years (PYs) (hazard ratio [HR] = 1.21, 95% confidence interval [CI]: 1.00, 1.46), and HR-HPV associated CIN grade 2 or greater (CIN2+) were 4.3 and 1.9 per 1000 PYs (HR = 2.31, 95% CI: 1.25, 4.26) in women aged 18-26 and 27-45 years. Competing risk models showed that the cumulative incidence of HR-HPV infections that progressed to CIN2+ was significantly higher in women aged 18-26 than in women aged 27-45 (5.3% vs. 2.9%, Gray's test p = .0291). The cumulative clearance rates of HR-HPV infections in women aged 18-26 and 27-45 were similar (94.7% vs. 95.8%, Gray's test p = .3309) during the study period. In conclusion, although mid-adult women exhibit lower incidences of HR-HPV infection and associated cervical lesions compared to young women, this population continues to face a substantial risk of acquiring causal HPV infections, which may progress to cervical lesion.

Associations of suicidal behaviors with body weight and body weight perception in Chinese adolescents: 2007-2022

PURPOSE

To estimate the time trend in the prevalence of suicidal behaviors including ideation and attempts in Chinese adolescents; to examine the association between suicidal behaviors and overweight (OW)/obesity (OB) and self-perceived weight status.

METHODS

Data from Youth Risk Behavior Surveys conducted in Ningbo in 2007, 2012, 2017 and 2022 were used for the study. A multistage sampling procedure was used to select respondents aged 12 to 19 years who participated in each survey. Repeated cross-sectional data of anthropometry, weight perception and suicidal behaviors were collected through self-administered questionnaires. A generalized linear model was used to assess associations of ideation and attempts, and weight status and self-perceived weight status.

RESULTS

The sample sizes for each survey wave were 937, 889, 1528 and 2655. The prevalence of ideation increased from 11.95% in 2007 to 18.15% in 2022, while the prevalence of attempts remained stable (4.48%-4.26%). An increasing trend in ideation and attempts was found in adolescents who were OW/obese and self-perceived OW/OB from 2007 to 2022. Self-perceived OW/OB adolescents had a significant increase in ideation. Girls had higher likelihood of ideation and attempts for both weight status and self- perceived weight status. While, adolescents aged 12.0-15.9 years had higher odds of ideation than those aged 16.0-19.9 years.

CONCLUSION

Adolescents' self-weight perception, rather than actual weight status, is a critical risk factor of increased likelihood of ideation and attempts in Chinese adolescents. Our findings can support to promote self-esteem growth in school-based health education programmes for prevention of suicidality and psychological health problems.

Texture profile analysis and rheology of plant-based and animal meat

Plant-based meat can help combat climate change and health risks associated with high meat consumption. To create adequate mimics of animal meats, plant-based meats must match in mouthfeel, taste, and texture. The gold standard to characterize the texture of meat is the double compression test, but this test suffers from a lack of standardization and reporting inconsistencies. Here we characterize the texture of five plant-based and three animal meats using texture profile analysis and rheology, and report ten mechanical features associated with each product's elasticity, viscosity, and loss of integrity. Our findings suggest that, of all ten features, the stiffness, storage, and loss moduli are the most meaningful and consistent parameter to report, while other parameters suffer from a lack of interpretability and inconsistent definitions. We find that the sample stiffness varies by an order of magnitude, from 418.9 ± 41.7 kPa for plant-based turkey to 56.7 ± 14.1 kPa for tofu. Similarly, the storage and loss moduli vary from 50.4 ± 4.1 kPa and 25.3 ± 3.0 kPa for plant-based turkey to 5.7 ± 0.5 kPa and 1.3 ± 0.1 kPa for tofu. All three animal products, animal turkey, sausage, and hotdog, consistently rank in between these two extremes. Our results suggest that-with the right ingredients, additives, and formulation-modern food fabrication techniques can create plant-based meats that successfully replicate the full viscoelastic texture spectrum of processed animal meat.

Maternal green space exposure and congenital heart defects: A population-based study

BACKGROUND

Beneficial effects of maternal green space exposure on preterm birth and low birth weight have been documented, but few studies have investigated its protective effect on fetal congenital heart defects (CHDs). Our study aimed to investigate the association between maternal green space exposure and CHDs, and quantify the potential benefits of reducing the risk of fetal CHDs by achieving the target of green space coverage.

METHODS

The study included 4160 births with CHDs and 567,483 births without birth defects born from 2014 to 2019 in 14 cities in Liaoning Province, China. Maternal green space exposure, including periconception period (3 months before conception to 3 months into pregnancy), preconception period (3 months before conception), and the first trimester (3 months into pregnancy), was assessed using satellite-based normalized difference vegetation index (NDVI). Logistic regression models were used to estimate the associations between maternal green space exposure and the risk of fetal CHDs.

RESULTS

A 0.1-unit increase in maternal green space exposure during the periconception was significantly associated with 5% declines in the risk of CHDs (OR: 0.95, 95% CI: 0.92, 0.98). Exposure-response association suggested that continuous improvements in maternal green space exposure during the periconception had a greater protective impact on the risk of total CHDs, while attenuated benefits were identified in the area where NDVI is around 0.23. Assuming causality, 5.06% (95% CI: 1.72%, 8.28%) of the annual rate of CHDs could be avoided by increasing NDVI exposure to 0.23 during periconception period in the areas where NDVI is below 0.23. In addition, rural residents, and mothers who have parity twice or more, were more prone to the protective effect of green space exposure.

CONCLUSIONS

Our study provides evidence that maternal green space exposure is a protective factor against the risk of fetal CHDs. The findings suggest that prioritizing green space in public policy can be an effective health-promoting measure.

Investigating the risk factors for the coexistence of insomnia and its exacerbation in AECOPD

AIM

Explore the risk factors contributing to insomnia and its severity in patients experiencing Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD).

METHODS

The study included 155 patients with AECOPD from Chaohu Hospital, Anhui Medical University, treated between September 2022 and October 2023. Patients were categorized into insomnia groups (mild, moderate, severe) and a comparison group based on Insomnia Severity Index Scale (ISI) scores. Sleep quality and severity were assessed using the Pittsburgh Sleep Quality Index (PSQI), CAT score, and mMRC classification. Clinical data, pathology, and results from various laboratory tests were collected. Details of current admission treatment, including ventilator usage, medication types, and administration methods, were documented for group comparisons.

RESULTS

This study included 155 AECOPD patients, with over 70 % identified as high-risk for obstructive sleep apnea (OSA). Among them, 87 were in the insomnia group and 68 in the comparison group. The insomnia group comprised 46 mild, 36 moderate, and 5 severe cases. Female patients, those with lower education, shorter smoking history, higher CAT and PSQI scores, more frequent hospital admissions, and those using oral or intravenous glucocorticoids were more likely to experience insomnia. In the moderate insomnia subgroup, patients had higher CAT and PSQI scores and longer hospitalization than the mild insomnia group. No significant differences were found in the use of quinolones, glucocorticoid administration, ventilator use, or resuscitation behaviors among insomnia severity levels.

CONCLUSION

Insomnia coexisting with AECOPD is prevalent, with the patient's gender, educational level, smoking history, severity of clinical symptoms, and the type of treatment influencing their sleep status.

Past, present and future epidemiology of echinococcosis in China based on nationwide surveillance data 2004-2022

OBJECTIVES

We evaluated the epidemiological characteristics of echinococcosis, a global public health threat, in China to inform global control efforts.

METHODS

Descriptive, statistical, cluster, spatial, and trend analyses were used to evaluate the epidemiology at national, provincial, and county levels based on 2004-2022 nationwide surveillance data from China.

RESULTS

Between 2004 and 2022, China recorded 72,676 cystic echinococcosis (CE) cases, 11,465 alveolar echinococcosis (AE) cases, and 5703 others, with an average annual cases per million (ANpM) of 3.45. Females had a higher incidence (ANpM = 3.87) than males (3.05), with most cases (41.15%) in the 30-49 age group, mainly among herders (38.76%) and farmers (37.82%). Seven provinces (Xizang, Qinghai, Xinjiang, Ningxia, Gansu, Sichuan, and Inner Mongolia) accounted for 98.12% of cases, with the Tibetan Plateau showing the highest rates (ANpMs = 155.51 for CE, 46.95 for AE). Surgery and case fatality rates were 39.45% and 5.23% in key surveillance regions (KSRs). Prevalence among residents (0.20%), livestock (1.33%), rodents (1.30%), and dogs (1.26%) declined with increased control funding in KSRs. Between 2023 and 2030, there will be an estimated 20,096 new cases and 45,323 cases requiring treatment.

CONCLUSION

The prevalence of echinococcosis has been alleviated in China, but significant control challenges remain, requiring sustained and targeted control measures.

First insight into eosinophils as a biomarker for the early distinction of COVID-19 from influenza A in outpatients

Coronavirus disease 2019 (COVID-19) and influenza A outbreaks have spread rapidly in China. It is difficult to accurately differentiate these two different respiratory tract infections on the basis of their similar early-stage symptoms and lymphocytopenia. In the present study, the age, sex and white blood cell, neutrophil, lymphocyte, monocyte and eosinophil counts, as well as the neutrophil-to-lymphocyte ratio (NLR) of 201 outpatients with confirmed COVID-19 and 246 outpatients with influenza A were investigated and compared. A receiver operating characteristic curve was drawn to determine the thresholds in distinguishing COVID-19 from influenza A Our study found that the monocyte count and NLR were significantly elevated, while the eosinophil count/percentage was higher in outpatients with COVID-19 than in those with influenza A (0.06±0.07 vs. 0.04±0.09, P=0.002; 0.95±1.12 vs. 0.56±0.95, P<0.001, respectively). Logit(P)=-1.11 + 1.29 x eosinophil percentage -12.07 x eosinophil count +1.10 x monocyte count, deduced from the eosinophil count/percentage and monocyte count, had the largest area under the curve at 0.67, with high specificity (80.1%) and a sensitivity of 47.3%. The present study demonstrated that a higher eosinophil count/percentage may be a potential biomarker to significantly differentiate early COVID-19 from influenza A.

Economic cost of not meeting the 24-h movement guidelines in china: Research gaps and recommendations

It is well-known that not meeting the 24-hours (h) movement guidelines, including insufficient physical activity (PA), excessive sedentary behavior (SB), inadequate sleep duration, and their combinations, are independent risk factors for noncommunicable diseases (NCDs). The prevalence of not meeting the guidelines is high across the world, especially in China where has one of the largest population. Some studies have estimated the economic cost of insufficient PA in China, which is useful to guide policymakers to develop and implement effective health actions. However, several research gaps should be discussed and addressed for better evidence base and decision making. This commentary aims to provide a research insight into gaps and recommendations related to the analysis of economic cost of not meeting the 24-h movement guidelines. Some major research gaps can be indicated, including less research attention on excessive SB and inadequate sleep, limited evidence regarding NCDs associated with not meeting all 24-h movement guidelines considered in economic cost analysis, absence of evidence on estimated cost of not meeting the guidelines, and the adherence to methodological guide. Future research is required to address the gaps to guide effective health policy development in China. We hope that this commentary can play an important role in updating research evidence and advancing policy practice.

Novel drug targets for monkeypox: From viral to host proteins

Background

The ongoing threat of the monkeypox virus (MPXV) underscores the need for new antiviral treatments, yet drug targets and candidate therapies are limited.

Methods

Calculating the centrality, conservation, and immunogenicity of MPXV proteins in the network to identify viral drug targets. Constructing the MIP-human protein interaction network and identifying key human proteins as potential drug targets through network topology analysis.

Results

We constructed a comprehensive protein-protein interaction (PPI) network between MPXV and humans, using data from the P-HIPSTer database. This network included 113 viral proteins and 2 607 MPXV-interacting human proteins (MIPs). We identified three MPXV proteins (OPG054, OPG084, and OPG190) as key targets for antiviral drugs, as well as 95 critical MIPs (most interacting MIPs, MMIPs) within the MPXV-human PPI network. Further analysis revealed 31 MMIPs as potential targets for broad-spectrum antiviral agents, supported by their involvement in other viral interactions. Functional enrichment of MIPs indicated their roles in infection and immune-related pathways.

Conclusions

In total, we identified 112 drugs targeting MPXV proteins and 371 drugs targeting MMIPs, with fostamatinib, trilostane, and raloxifene being able to inhibit both viral and host proteins. This work provides critical insights into MPXV-human interactions and supports the development of targeted antiviral therapies.

Structural insights into tecovirimat antiviral activity and poxvirus resistance

Mpox is a zoonotic disease endemic to Central and West Africa. Since 2022, two human-adapted monkeypox virus (MPXV) strains have caused large outbreaks outside these regions. Tecovirimat is the most widely used drug to treat mpox. It blocks viral egress by targeting the viral phospholipase F13; however, the structural details are unknown, and mutations in the F13 gene can result in resistance against tecovirimat, raising public health concerns. Here we report the structure of an F13 homodimer using X-ray crystallography, both alone (2.1 Å) and in complex with tecovirimat (2.6 Å). Combined with molecular dynamics simulations and dimerization assays, we show that tecovirimat acts as a molecular glue that promotes dimerization of the phospholipase. Tecovirimat resistance mutations identified in clinical MPXV isolates map to the F13 dimer interface and prevent drug-induced dimerization in solution and in cells. These findings explain how tecovirimat works, allow for better monitoring of resistant MPXV strains and pave the way for developing more potent and resilient therapeutics.

Genomic diversity of mcr-carrying plasmids and the role of type IV secretion systems in IncI2 plasmids conjugation

The rapid dissemination of colistin resistance via mcr-carrying plasmids (pMCRs) poses a significant public health challenge. This study examined the genomic diversity and conjugation mechanisms of pMCRs, with a particular focus on the role of type IV secretion systems (T4SS) in IncI2 plasmids. The 868 complete plasmid sequences revealed various replicon types of pMCRs, with IncI2 as the primary epidemic type, and the co-transfer risk of multidrug resistance genes associated with IncHI2. T4SS was identified in 89.9% of pMCRs, with the T4SS sequence exclusively carried by IncI2 being conserved and typical of the VirB/D4 type, consisting of 12 subunits. Conjugation assays confirmed the essential role of the pilus subunit VirB2 and the significant impact of VirB5P3 on conjugation. This was further validated in the in vivo intra-species competitive conjugation of Escherichia coli. Structural predictions show that a hypervariable region at the C-terminus of the pentameric VirB5 co-evolves in sequence with VirB6, and the conserved N-terminal may act as a potential drug target to inhibit the plasmid transfer channel. This study will deepen the understanding of the pMCR epidemic patterns and provide additional insights for controlling the spread of resistant plasmids.

The risk assessment and burden of cancer attributable to dietary cadmium exposure in China, 2019

Dietary Cadmium (Cd) intake is essential for Cd exposure. However, the burden of cancer attributable to dietary Cd intake remains to be determined in China. To estimate the level of dietary Cd exposure, we merged the Cd concentrations in food from literature and the foods consumption from national dietary surveys. The probabilistic assessment models evaluated dietary Cd exposures across age and area groups. Incremental lifetime cancer risk (ILCR) was utilized to assess the carcinogenic risk of dietary Cd. The cancer burden attributable to dietary Cd exposure was evaluated by a two-stage model, expressed as Disability Adjusted Life Years (DALYs). The median dietary Cd exposure in Chinese residents was 0.77 μg/kg·bw. The 0-4 age group and southern areas exhibited the highest exposure of 1.59 μg/kg·bw and 1.64 μg/kg·bw. The ILCRs for the whole population, males and females were 4.99 × 10-3, 4.91 × 10-3 and 5.08 × 10-3, respectively. Grains, meats, and vegetables were identified as the primary sources of dietary Cd intake. The burden of cancer attributable to dietary Cd was 36.58 per 100,000, 6.01 per 100,000, and 4.38 per 100,000 for lung, breast and prostate cancers in China. In conclusion, dietary Cd intake contributes to a proportion of the cancer burden in China. However, excess Cd exposure in younger age groups and southern areas remains a priority for attention to reduce the cancer risk.

Mpox cases finding: Evaluation of a Primary Care detection program in the Northern Metropolitan area from Barcelona (Spain)

MAIN AIM

In July 2022, an extensive outbreak of Mpox (monkeypox) was considered by WHO as a Public Health Emergency. The objective of this study is to describe the obtained results from a Mpox case detection program in a semi-urban healthcare area where approximately 420 Primary Care physicians work.

DESIGN

An observational prospective study performed between June 01, 2022 and December 31, 2023.

SETTING

The Northern Metropolitan area of Barcelona, with 1400.000hab (Catalonia, Spain).

METHODS

An unified Mpox management procedure was agreed, including a prior online training of Primary Care professionals, to individually assess all Mpox suspected cases from a clinical and epidemiological perspective.

PARTICIPANTS

All patients who met clinical and/or epidemiological criteria of Mpox.

DATA COLLECTION

Age, gender, risk classification (suspected/probable), cluster-linked (yes/no), high-risk sexual contact (yes/no), general symptoms, genital lesion and final diagnostic.

RESULTS

A total of 68 suspected Mpox cases were included, from which 16 (26.6%) were Mpox confirmed by PCR. Up to 13 (81.2%) were male and, among them, 12 (75%) men who have sex with men (MSM). The series, however, included two minors and three women. Among MSM, 3 (18.7%) were HIV positive and 3 had no regular access to the Public Healthcare system. Among discarded patients, any infectious disease was diagnosed in 55% of cases.

CONCLUSIONS

In spite of the short series, this Primary Care community-based study identified a sub-population group showing a different profile of Mpox cases compared to other published series (lower HIV prevalence, higher representativeness of heterosexual transmission and hard to reach population).

Association between physical activity and cognitive function in a multi-ethnic Asian older adult population

Physical activity (PA) is regarded as a non-pharmacological preventive strategy against cognitive decline. This study aimed to examine the relationship between PA and cognitive function in cognitively normal older Malaysian adults from a multi-ethnic, urban-dwelling community. Participants completed a questionnaire with questions on demographic details, socioeconomic status, health conditions, and short form of the International Physical Activity Questionnaire (IPAQ). Bivariate analyses and hierarchical linear regression were conducted to examine the relationship between IPAQ and Montreal Cognitive Assessment (MoCA) scores. Among the 382 participants (median age = 66 years), 51.6% were female. Median MoCA score was 24; and IPAQ levels were 28%, 39% and 33% 'Low', 'Moderate' and 'High' respectively. Bivariate analysis showed MoCA scores significantly differed across IPAQ levels (p-value < 0.001). Pairwise comparisons showed significant differences between MoCA scores and 'High' and 'Low' (p-value < 0.001) and 'Moderate' and 'Low' (p-value = 0.001) IPAQ levels. Hierarchical regression of potential confounding factors showed that while lower PA, being older, being Malay and hypertension were initially associated with lower MoCA scores, the association was explained by the greater influence of education and savings. Additional research is required to gain a more comprehensive understanding of these relationships.

A review of epidemiology, diagnosis, and management of Mpox: The role of One Health

Human monkeypox (Mpox) is an emerging zoonotic disease. Its clinical features are similar to but less severe than those of smallpox. The etiology of this disease is the monkeypox virus. This virus is a double-stranded DNA virus that is classified into the genus Orthopoxvirus and the family Poxviridae. Human monkeypox was first identified in 1970 and mainly occurred in Central and Western Africa. In 2022, outbreaks of Mpox virus infection occurred in several non-endemic countries and caused a potential threat to humans. It is urgent to take immediate action to control and prevent the outbreak of the Mpox virus infection. This paper summarizes the current status of Mpox and generated strategies for managing the Mpox epidemic. Although progress in the diagnostic methods and treatment of Mpox produces better knowledge, we argue that the sensitive surveillance for animal and human Mpox virus infection and evidence-based response and management of Mpox outbreaks is critical. This study highlights the need for further research on preventive and control strategies for Mpox disease approached through the One Health concept.

Survey on knowledge, attitudes and practices (KAP) of malaria prevention and control among Chinese expatriates in South Sudan

BACKGROUND

Malaria is a major health risk faced by Chinese expatriates working in South Sudan. The purpose of this study is to investigate the knowledge, attitudes and practices (KAP) of Chinese expatriates in South Sudan towards malaria prevention and control, analyze the influencing factors, and provide a basis for reducing the morbidity and mortality of malaria.

METHODS

By distributing questionnaires, data on socio-demographic characteristics of Chinese expatriates in South Sudan, and information on their knowledge, attitudes, and behaviors towards malaria prevention and control were collected from April 5th to 12th, 2023.

RESULTS

The recognition degree of malaria prevention and control was better, and the accuracy of each choice in knowledge, attitude and pracice was 19.4-99.75%, 85.57-99.25% and 82.59-99.00%, respectively. Of the 402 respondents, none had a history of malaria before coming to South Sudan, the malaria infection rate was 41.29% (166/402). The results of multiple linear regression analysis suggest "Knowledge Scores" will have a significant positive impact on "Practices Scores" (B = 0.206, 95% CI: 0.045 ~ 0.367, P = 0.013). However, the remaining five independent variables do not have an impact on "Practices Scores".

CONCLUSIONS

The KAP of Chinese expatriates in South Sudan towards malaria prevention and control is good, but needs to be further strengthened. Improving knowledge about malaria prevention and control can reduce the incidence of malaria.

Metabolomic characteristics and related pathways in patients with different severity of COVID-19: a systematic review and meta-analysis

Background

Despite advances in metabolomic research on COVID-19, existing studies have small sample sizes and few have comprehensively described the metabolic characteristics of patients with COVID-19 at each stage. In this systematic review, we aimed to summarise the similarities and differences of biomarkers in patients with COVID-19 of different severity and describe their metabolic characteristics at different stages.

Methods

We retrieved studies from PubMed, Embase, Web of Science, and the Cochrane Library published by October 2022. We performed a meta-analysis on untargeted and targeted metabolomics research data, using the ratio of means as the effect size. We compared changes in metabolite levels between patients with varying severity and controls and investigated sources of heterogeneity through subgroup analyses and meta-regression analysis.

Results

We included 22 cohorts from 21 studies, comprising 2421 participants, including COVID-19 patients of varying severity and healthy controls. We conducted meta-analysis and heterogeneity analysis on the 1058 metabolites included in the study. The results indicated that, compared to the healthy control group, 23 biomarkers were associated with mild cases (P < 0.05), 3 biomarkers with moderate cases (P < 0.05), and 37 biomarkers with severe cases (P < 0.05). Pathway enrichment analysis revealed significant disturbances in amino acid metabolism, aminoacyl-tRNA biosynthesis, primary bile acid biosynthesis, pantothenate and CoA biosynthesis, the tricarboxylic acid cycle, taurine and hypotaurine metabolism, and nitrogen metabolism in patients with mild, moderate, and severe disease. Additionally, we found that each severity stage exhibited unique metabolic patterns (all P < 0.05) and that the degree of metabolic dysregulation progressively worsened with increasing disease severity (P < 0.05).

Conclusions

The results of our meta-analysis indicate the similarities and differences of biomarkers and metabolic characteristics of patients with different severity in COVID-19, thereby providing new pathways for the study of pathogenesis, the development precise treatment, and the formulation of comprehensive strategies.

Registration

PROSPERO: CRD42022369937.

Antitumor activity of gamma-irradiated Rosa canina L. against lung carcinoma in rat model: a proposed mechanism

BACKGROUND

Lung cancer is one of the most prevalent malignancies globally and is the leading cause of cancer-related mortality. Although cisplatin is a widely utilized chemotherapeutic agent, its clinical efficacy is often hampered by significant toxicity and undesirable side effects. Rosa canina, a medicinal plant, has demonstrated a range of beneficial biological activities, including anti-inflammatory, anticancer, immunomodulatory, antioxidant, and genoprotective effects.

METHODS

This study aimed to investigate the potential of Rosa canina to enhance the anticancer efficacy of cisplatin in a dimethyl benz(a)anthracene-induced lung cancer model using female rats. The animals were administered Rosa canina, cisplatin, or a combination of both treatments. The expression levels of critical signaling molecules were evaluated, including phosphoinositide-3-kinase (PI3K), Akt, mammalian target of rapamycin (mTOR), cleaved poly (ADP-ribose) polymerase (PARP-1), myeloid differentiation factor 88 (MyD88), and tumor necrosis factor receptor-associated factor (TRAF), in addition to various autophagic markers. Furthermore, we assessed the levels of toll-like receptor 2 (TLR2), nuclear factor kappa B (NF-κB), and apoptotic markers in lung tissue, complemented by histopathological examinations.

RESULTS

The combined treatment of Rosa canina extract and cisplatin significantly inhibited lung cancer cell proliferation by downregulating PARP-1 and the TLR2/MyD88/TRAF6/NF-κB signaling pathway, as well as the PI3K/Akt/mTOR pathway. Moreover, this combination therapy promoted autophagy and apoptosis, evidenced by elevated levels of autophagic and apoptotic markers.

CONCLUSION

Overall, the findings of this study suggest that Rosa canina enhances the anticancer effects of cisplatin by inhibiting cancer cell proliferation while simultaneously inducing autophagy and apoptosis. Thus, Rosa can be used as adjuvant to cisplatin chemotherapy to overcome its limitations which may be considered a new approach during lung cancer treatment strategy.

Assessing the effectiveness of the varicella vaccine in primary and secondary school students in Qingdao, China: A matched case-control study

OBJECTIVES

The effectiveness of varicella vaccination strategies needs to be further evaluated. The vaccine effectiveness (VE) of the varicella vaccine was evaluated, and changes in VE of varicella vaccination in primary and secondary school students in Qingdao, China, over time were analyzed.

PATIENTS AND METHODS

We conducted a 1:3 matched case-control study, using data from the Chinese Information System for Disease Control and Prevention, Qingdao Student Health Examination Management System, and Qingdao Immunization Program Information System. VE of the varicella vaccination was estimated using conditional logistic regression modeling.

RESULTS

A total of 3,249 varicella cases and 9,747 matched controls were included. One- and two-dose varicella vaccination had VE of 31.95 % (95 % confidence interval [CI]: 25.05 %-38.20 %) and 82.02 % (95 % CI: 78.33 %-85.07 %), respectively, and the incremental VE (two-dose versus one-dose vaccination) was 73.57 % (95 % CI: 68.26 %-78.00 %). VE remained at 71.46 % 10 years after the two-dose varicella vaccination, compared with a considerable decrease in VE to 29.73 % approximately 3-5 years after the one-dose varicella vaccination. VE of two-dose varicella vaccination was not related to the time interval between the two doses. The risk of varicella infection decreases with the number of doses of varicella vaccine received and with the age at which the first dose is given and increases with time after the last dose.

CONCLUSIONS

Two-dose varicella vaccination provides better protection for children and is therefore recommended for inclusion in China's national immunization program.

Shifting of Distribution and Changing of Antibiotic Resistance in Gram-Positive Bacteria from Bile of Patients with Acute Cholangitis

Background

Gram-negative bacteria are the predominant pathogens responsible for biliary infections; however, the prevalence of Gram-positive bacteria is currently increasing. Investigating the bacterial spectrum and evolving antibiotic resistance patterns of Gram-positive bacteria is crucial for optimizing the management of acute cholangitis, particularly in the context of the global rise in antibiotic resistance.

Methods

This retrospective analysis focused on Gram-positive bacteria isolated from the bile of patients undergoing biliary drainage with acute cholangitis at our hospital from January 1, 2018, to March 31, 2024. In total, 342 strains of Gram-positive bacteria were examined.

Results

The main Gram-positive bacteria detected included Enterococcus (57.23%), Staphylococcus (23.41%), and Streptococcus (13.01%). The most common species detected were Enterococcus faecium (36.42%), Enterococcus faecalis (14.16%), and Staphylococcus epidermidis (7.80%). Trend analysis revealed a decrease in the proportion of Enterococcus and an increase in Streptococcus. Additionally, the detection rate of methicillin-resistant Staphylococcus (MRS) showed a significant rise. Gram-positive bacteria exhibited high resistance to erythromycin and penicillin but remained highly susceptible to linezolid and vancomycin. Further, resistance to quinolones among Gram-positive bacteria was notably elevated.

Conclusion

The bacterial spectrum and antibiotic resistance patterns of Gram-positive bacteria in acute cholangitis have undergone significant changes. Penicillin is not recommended for the treatment of Gram-positive bacterial infections. Antibiotic resistance should be closely monitored when using quinolones. Particular attention is warranted regarding the markedly increasing antibiotic resistance of Enterococcus faecium.

A comparative assessment of rheumatoid arthritis burden: trends in China, the US, India, Europe, and globally from 1990 to 2021 and forecasts to 2030 utilizing GBD data

BACKGROUND

Rheumatoid arthritis (RA) is a pervasive chronic inflammatory condition exerting a substantial impact on global morbidity and mortality. This study provides an in-depth analysis of the epidemiological trends of RA across China, America, India, and Europe as well as at a global level from 1990 to 2021, with forward-looking projections extending to 2030.

METHODS

Leveraging data from the Global Burden of Disease (GBD) database, a comparative assessment of the age-standardized (AS) incidence rate (ASIR), prevalence rate (ASPR), mortality rate (ASMR), and disability-adjusted life years (DALYs) rate (ASDR) for RA was performed. Trends were evaluated and future burdens forecasted using Joinpoint regression and autoregressive integrated moving average (ARIMA) models.

RESULTS

Between 1990 and 2021, a global upsurge in RA incidence was observed, with India experiencing the most rapid growth and America consistently recording the highest ASIR, albeit with a diminishing increment rate. The prevalence escalated across all regions, with America exhibiting the highest ASPR. Mortality rates generally trended downward, with India registering the highest ASMR by 2021, contrasting with the lowest rates in America and Europe. Disability trends, quantified by ASDR, exhibited relative stability, yet a notable increase was observed in India. ARIMA model-based projections anticipate a continued rise in RA incidence and prevalence by 2030, with mortality and disability rates anticipated to exhibit minor oscillations.

CONCLUSION

The escalating burden of RA, particularly in developing nations, underscores an urgent need for enhanced healthcare policies focused on early diagnosis, intervention, and disability mitigation. The projections indicate enduring public health challenges attributed to RA in the forthcoming decade.

Associations of composite dietary antioxidant index with premature death and all-cause mortality: a cohort study

Although previous evidence indicates that the composite dietary antioxidant index (CDAI) is negatively associated with health outcomes, no studies have explored the association between CDAI and premature death. This research utilized a cohort study design with 37,301 participants from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2018. Cox proportional hazard regression was employed to analyze the association between CDAI and premature death and all-cause mortality. Restricted cubic spline (RCS) analysis was performed to examine the nonlinear relationship between variables, and Kaplan-Meier analysis was used to evaluate survival outcomes over time. Sensitivity and subgroup analyses were conducted to assess the reliability of the findings. During a median follow-up period of 8.25 years, 4487 deaths were recorded, with 1671 classified as premature. The study revealed a negative correlation between CDAI and premature death (Per-SD hazard ratio [HR] 0.91, 95% CI 0.85-0.97; quartiles [Q4:Q1] HR 0.83, 95% CI: 0.70, 0.98) as well as all-cause mortality (Per-SD HR 0.96, 95% CI 0.92-1.00; quartiles [Q4:Q1] HR 0.91, 95%CI: 0.82, 1.01). The RCS analyses indicated a 'U' shaped relationship between CDAI and premature death and all-cause mortality. The threshold effect analysis pinpointed the inflection points for CDAI relative to premature death and all-cause mortality at 1.42 and 1.48, respectively. Kaplan-Meier curves illustrated that the likelihood of individual survival increases with higher CDAI quartiles. The results highlight the significance of dietary antioxidant intake in enhancing extending lifespan. Further research is needed to investigate the underlying mechanisms and determine optimal intake levels for improving health outcomes.

Clade 2.3.4.4b H5N1 neuraminidase has a long stalk, which is in contrast to most highly pathogenic H5N1 viruses circulating between 2002 and 2020

Since 2020, H5N1 highly pathogenic avian influenza (HPAI) viruses of clade 2.3.4.4b have been rapidly spreading in wild birds but have also caused a large number of mammalian infections and more than 70 known human cases. Importantly, this H5N1 clade has also crossed the species barrier into dairy cattle in the US in late 2023/early 2024. The neuraminidase (NA) protein of the N1 subtype can feature truncations in its stalk domain, which have been identified as putative virulence factors in poultry but seem to have a negative impact on transmission in mammals. Since its emergence, the vast majority of HPAI H5N1 A/goose/Guangdong/1/1996-lineage isolates have featured this truncated version of the NA stalk domain. Here, we report that this changed with the 2020 expansion of clade 2.3.4.4b H5N1 and that the majority of isolates-including the strains circulating in dairy cattle-feature a long NA stalk domain.IMPORTANCEWhile the truncated version of the N1 neuraminidase stalk domain may be associated with increased virulence in poultry, the long version of the stalk domain has been associated with increased transmissibility in mammals. The vast majority of highly pathogenic H5N1 of clade 2.3.4.4b that is currently circulating globally features the long stalk version of the neuraminidase, which may increase the risk for these viruses to become human-to-human transmissible.

Global burden of malaria and neglected tropical diseases in children and adolescents, 1990-2019: a population-based, cross-sectional study

OBJECTIVES

To estimate the global burden of malaria and neglected tropical diseases (NTDs) in children and adolescents aged 0-19 years and to analyse trends to inform public health and policy decisions.

DESIGN

Population-based, cross-sectional study.

SETTING

Global analysis across 204 countries and territories.

PARTICIPANTS

Children and adolescents aged 0-19 years with malaria and NTDs, stratified by age, gender and location from 1990 to 2019.

MAIN OUTCOME MEASURES

Yearly incidence, prevalence, and disability-adjusted life years (DALYs) for malaria and NTDs, age-standardised incidence rates (ASIRs) and age-standardised DALY rates (ASDRs).

RESULTS

The global burden of malaria and NTDs among children and adolescents aged 0-19 years remains substantial. In 2019, 195.6 million cases of malaria and NTDs were recorded globally, resulting in 43.9 million (95% Uncertainty Interval (UI): 25.0-70.4 million) DALYs. The incidence rate increased until 2005 and then declined. Sub-Saharan Africa had the highest ASDR, while high-income regions had the lowest. Significant ASDR reductions occurred in Andean Latin America and South Asia. The burden was highest in low-Socio-Demographic Index (SDI) regions, with malaria accounting for over 93% of DALYs among children under five. Females had slightly higher incidence rates, while DALYs were evenly distributed between genders. There was an inverse association observed between SDI and ASDRs.

CONCLUSIONS

Malaria and NTDs continue to disproportionately affect children and adolescents in low-SDI regions, especially sub-Saharan Africa. Sustaining gains while accelerating control efforts is the key to successful control progress and ambiguous elimination goals for both malaria and NTDs.

Prevalence and distribution of respiratory pathogens in pediatric acute respiratory infections in Putian, China

BACKGROUND

Acute Respiratory Infections (ARIs) are a significant source of morbidity among pediatric populations. This study aimed to investigate the prevalence and distribution of respiratory pathogens in pediatric ARIs in Putian, China.

METHODS

This retrospective study included 3,790 pediatric patients with suspected ARIs, evaluated between March 2023 and February 2024. Nasopharyngeal swabs were obtained and analyzed via reverse-transcription polymerase chain reaction (RT-PCR) to detect eleven common respiratory pathogens. Statistical analyses were conducted to evaluate the distribution of these pathogens across various patient demographics, including gender, age, and season.

RESULTS

This study included 3,790 pediatric patients under 14 years (median age: 4.3 years, IQR: 1-7). Pathogen positivity was 78.9%, with higher rates in school-age children and during autumn and winter (P < 0.001), with Mycoplasma pneumoniae (Mp) as the most common pathogen (33.4%), followed by human rhinovirus (HRV; 15.0%) and human respiratory syncytial virus (HRSV; 12.1%). Single-pathogen detections dominated (81.9%), while co-detections (18.1%) were primarily dual-pathogen cases, with HRV + Mp as the leading combination. Pathogen distribution varied significantly by age: Mp detection rates escalated with age, peaking in school-age children, while HRSV and HRV predominated in infants and toddlers. Seasonal trends revealed distinct pathogen activity: Influenza A (InfA) peaked during spring, Mp during autumn and winter, and HRSV during summer (P < 0.001). Logistic regression analysis identified significant associations: InfA, human adenovirus (HADV), and Influenza B (InfB) were linked with acute upper respiratory infections (AURIs), while Mp, human metapneumovirus (HMPV), human parainfluenza virus (HPIV), and HRSV correlated with acute lower respiratory infections (ALRIs) (P < 0.05).

CONCLUSION

This study provides comprehensive insights into the prevalence and temporal patterns of respiratory pathogens among hospitalized children with ARIs in Putian, China. Mp, HRV, and HRSV were the predominant pathogens, with significant variations by age and season. Limitations include the one-year duration and the focus on hospitalized patients. Future studies should extend surveillance to outpatient and emergency settings to obtain a broader understanding of ARI epidemiology.

Global epidemiology, seasonality and climatic drivers of the four human parainfluenza virus types

OBJECTIVES

Human parainfluenza viruses (hPIV) are a common cause of acute respiratory infections, especially in children under five years and the elderly. hPIV can be subclassified as types 1-4: these showed various seasonality patterns worldwide, and it is unclear how climatic factors might consistently explain their global epidemiology.

METHODS

This study collected time-series incidence data from the literature and hPIV surveillance programs worldwide (47 locations). Wavelet analysis and circular statistics were used to detect the seasonality and the months of peak incidence for each hPIV type. Relationships between climatic drivers and incidence peaks were assessed using a generalized estimating equation.

RESULTS

The average positive rate of hPIV among patients with respiratory symptoms was 5.6% and ranged between 0.69-3.48% for different types. In the northern temperate region, the median peak incidence months for hPIV1, hPIV2, and hPIV4 were from September to October, while for hPIV3, it was in late May. Seasonal peaks of hPIV3 were associated with higher monthly temperatures and lower diurnal temperatures range throughout the year; hPIV4 peaks appeared to correlate with lower monthly temperatures and higher precipitation throughout the year. Different hPIV types exhibit different patterns of global epidemiology and transmission.

CONCLUSIONS

Climate drivers may play a role in hPIV transmission. More comprehensive and coherent surveillance of hPIV types would enable more in-depth analyses and inform the timing of preventive measures.

Mechanism of action and new developments in the study of curcumin in the treatment of osteoarthritis: a narrative review

Osteoarthritis is a degenerative joint disease that affects the aging population worldwide. It has an underlying inflammatory cause that leads to loss of chondrocytes, reducing the cartilage layer at the affected joints. Compounds with anti-inflammatory properties are potential therapeutic agents for osteoarthritis. Curcumin, derived from species of the Curcuma, is an anti-inflammatory compound. The purpose of this review is to summarize the anti-osteoarthritic effects of curcumin from clinical and preclinical studies. Many clinical trials have been conducted to determine curcumin's effectiveness in osteoarthritis patients. Available studies have shown that curcumin prevents chondrocyte apoptosis and inhibits the release of proteoglycans and metalloproteinases as well as the expression of cyclooxygenase, prostaglandin E-2, and inflammatory cytokines in chondrocytes. The mechanism of action of curcumin also involves multiple cell signaling pathways, including Nuclear factor kappa-B(NF-κB), Mitogen-activated protein kinase (MAPK), Wnt/β-catenin pathway (Wnt/β-catenin), The Janus kinase 2/signal transducer and activator of transcription 3 (JAK2/STAT3), Nuclear factor erythroid 2-related factor 2/antioxidant response elements/heme oxygenase-1(Nrf2/ARE/HO-1), and Phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (PI3K/AKT/mTOR) signaling pathways. Curcumin further reduced the release of inflammatory factors and apoptosis by inhibiting the activation of NF-κB. In addition, curcumin modulates the MAPK, Nrf2/ARE/HO-1, and PI3K/Akt/mTOR signaling pathways and affects cell proliferation and apoptosis processes, a series of effects that together promote the healthy state of chondrocytes. In conclusion, curcumin, as a natural plant compound, exhibits significant anti-inflammatory potential by modulating inflammatory factors associated with articular osteoarthritis through multiple mechanisms. Its protective effects on articular cartilage and synovium make it a promising candidate for the treatment of OA. Future studies should further explore the mechanism of action of curcumin and its optimal dosage and therapeutic regimen in clinical applications, to provide more effective therapeutic options for osteoarthritis patients.

Associations of anthropogenic activity and tributaries with the physicochemical, nutrient and microbial composition of the Ganga (Ganges) River, India

The Ganga River (known internationally as the Ganges) is one of the world's most prominent rivers, running from the Himalayas to the Bay of Bengal and supporting the livelihoods of > 40 % of India's 1.4 billion population. The Ganga River is regionally and globally important, supporting agriculture and industry, yet faces potentially detrimental water quality challenges arising from runoff and discharge from increasing urbanization, industry and agriculture. A ∼ 2700 km longitudinal survey of the nutrient and microbial water quality, including phytoplankton composition, of the Ganga River was undertaken in November 2019. The aim was to investigate if and how anthropogenic activities (e.g. urbanisation, industry, and agriculture) and tributary convergence (potentially reflecting both human activity and flow influences) affect and shift physicochemical, nutrient, and microbial water quality parameters along the river continuum. Segmented regression identified four zones of distinct nutrient/microbial characteristics along the Ganga River, with breakpoints located near Kanpur, Varanasi and downstream of the Farakka Barage, at distances of ∼ 1020, ∼ 1500 and ∼ 2350 km downstream from the Himalayan Ganga source. Population density, land use and urban cover were associated with selected water quality parameters in parts of the catchment, with elevated nutrient, microbial and chemical concentrations likely associated with agriculture, industry, and sewage inputs. Some urban areas (e.g. Kanpur and Varanasi), converging tributaries (e.g. Yamuna and Varuna) and barrages (e.g. Farakka) were associated with changes in nutrient availability, microbial activity/abundance and modelled discharge, likely driving apparent water quality changes in the relevant locations. Downstream shifts in nutrient and microbial water quality parameters were observed throughout the ∼ 2700 km Ganga River continuum. This information can help prioritize locations for targeted monitoring and/or remediation interventions and has illustrated an approach to quantify impacts of anthropogenic inputs on major river systems, such as the Ganga River.

Performance of stool-based Xpert MTB/RIF assay in the diagnosis of presumptive pulmonary tuberculosis in adults unable to expectorate sputum

This study aimed to compare the performance of stool-based Xpert MTB/RIF(Xpert) assay (Cepheid, USA) against that of smear, culture, and Xpert using respiratory tract specimens (RTS) and stool samples in the diagnosis of adult pulmonary tuberculosis (PTB). This prospective study of patients with presumptive PTB was conducted at the Beijing Chest Hospital from January 2021 to December 2021. The smear test by fluorescence microscope, MGIT 960 liquid culture, and Xpert MTB/RIF assay was performed simultaneously on the RTS and stool samples. Patients were grouped based on the RTS examination results and clinical diagnosis. A total of 434 eligible patients were enrolled. Among these, 351 patients were diagnosed as PTB, while 83 patients were diagnosed as non-TB patients. Using RTS as standard sample, the sensitivity of smear on stool, culture on stool, Xpert on stool, and Xpert on RTS was 13.39% (47/351), 22.22% (78/351), 45.30% (159/351), and 66.10% (232/351), respectively. Furthermore, the specificity of Xpert on RTS and stool was 100% (83/83) for both specimens. Among the 48 patients with PTB confirmed by bronchoalveolar lavage fluid (BALF) examination, 16 had stool specimens with positive Xpert results. Similarly, among 200 patients diagnosed through sputum examination, 133 had positive Xpert results on stool specimens. Thus, Xpert on stool specimens may be a promising and practical strategy to improve PTB diagnosis, particularly among patients unable to expectorate sputum.IMPORTANCEThis study aimed to assess the value of the Xpert MTB/RIF assay (Xpert) for diagnosing PTB using stool samples from adults in low HIV prevalence settings. Although the diagnostic yield of Xpert on stool samples is inferior to that of Xpert on RTS, stool-based Xpert may be useful in diagnosing patients with presumptive PTB who cannot expectorate sputum and do not opt for BALF collection.

GRAMEP: an alignment-free method based on the maximum entropy principle for identifying SNPs

BACKGROUND

Advances in high throughput sequencing technologies provide a huge number of genomes to be analyzed. Thus, computational methods play a crucial role in analyzing and extracting knowledge from the data generated. Investigating genomic mutations is critical because of their impact on chromosomal evolution, genetic disorders, and diseases. It is common to adopt aligning sequences for analyzing genomic variations. However, this approach can be computationally expensive and restrictive in scenarios with large datasets.

RESULTS

We present a novel method for identifying single nucleotide polymorphisms (SNPs) in DNA sequences from assembled genomes. This study proposes GRAMEP, an alignment-free approach that adopts the principle of maximum entropy to discover the most informative k-mers specific to a genome or set of sequences under investigation. The informative k-mers enable the detection of variant-specific mutations in comparison to a reference genome or other set of sequences. In addition, our method offers the possibility of classifying novel sequences with no need for organism-specific information. GRAMEP demonstrated high accuracy in both in silico simulations and analyses of viral genomes, including Dengue, HIV, and SARS-CoV-2. Our approach maintained accurate SARS-CoV-2 variant identification while demonstrating a lower computational cost compared to methods with the same purpose.

CONCLUSIONS

GRAMEP is an open and user-friendly software based on maximum entropy that provides an efficient alignment-free approach to identifying and classifying unique genomic subsequences and SNPs with high accuracy, offering advantages over comparative methods. The instructions for use, applicability, and usability of GRAMEP are open access at https://github.com/omatheuspimenta/GRAMEP .

Long-term outcomes of mesenchymal stem cell therapy in severe COVID-19 patients: 3-year follow-up of a randomized, double-blind, placebo-controlled trial

BACKGROUND

The long-term effects and outcomes of human mesenchymal stem cell (MSC) therapy in patients with severe coronavirus disease 2019 (COVID-19) remain poorly understood. This study aimed to evaluate the extended safety and efficacy of MSC treatment in severe patients with COVID-19 who participated in our earlier randomized, double-blind, placebo-controlled clinical trial, with follow-up conducted over 3 years.

METHODS

One hundred patients with severe COVID-19 were randomized to receive either an MSC infusion (n = 65, 4 × 107 cells/dose, on days 0, 3, and 6) or a placebo, with both groups receiving the standard of care. At 36 months post-MSC therapy, patients were followed up to long-term safety and efficacy, particularly the effects of MSC therapy on persistent COVID-19 symptoms. Evaluated outcomes included lung imaging results, 6-min walking distance (6-MWD), pulmonary function test results, quality of life scores based on the Short Form-36 (SF-36) health survey, Long COVID symptoms, new-onset comorbidities, tumor marker levels, and rates of COVID-19 reinfection.

RESULTS

Three years post-treatment, 46.94% (23/49) of patients in the MSC group and 34.48% (10/29) in the placebo group showed normal findings on computed tomography (CT) images (odds ratio [OR] = 1.68, 95% confidence interval [CI]: 0.65-4.34). The general health (GH) score from the SF-36 was higher in the MSC group (67.0) compared to the placebo group (50.0), with a difference of 12.86 (95% CI: 1.44-24.28). Both groups showed similar results for total lung severity scores (TSS), 6-MWD, pulmonary function tests, and Long COVID symptoms. No significant differences between groups were observed in new-onset complications (including tumorigenesis) or tumor marker levels. After adjusting for China's dynamic zero-COVID-19 strategy, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfection rates were 53.06% (26/49) in the MSC group and 67.86% (19/28) in the placebo group (OR = 0.54, 95% CI: 0.20-1.41).

CONCLUSIONS

These findings support the long-term safety of MSC therapy in patients with severe COVID-19 over 3 years. MSC treatment may offer potential benefits for lung recovery and improved quality of life in patients experiencing Long COVID symptoms.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04288102. Registered 28 February 2020, https://clinicaltrials.gov/study/NCT04288102 .

Current prevalence and therapeutic strategies for porcine Streptococcus suis in China

Porcine Streptococcus suis is a zoonotic bacterial pathogen that poses serious threats to both human and animal health. S. suis is ubiquitously transmitted from the swine industry to the environments and human communities. However, the ambiguous epidemiological patterns and the escalating risk of antimicrobial resistance render S. suis infections a considerable challenge. Here, we review the current prevalence of S. suis infection worldwide, including identified bacterial strains, routes of infection, and transformation of resistance genes. This comprehensive overview of the prevalent patterns in S. suis offers detailed insights into therapeutic approaches for porcine infections and alternative strategies to address emerging resistant strains, highlighting potential multitarget prevention and treatment options to combat S. suis infection.

Comparative analysis of clinical features of brucellosis in Kashi and Guangzhou: a retrospective multicentre study

OBJECTIVE

In this study, we conducted a comparative analysis of brucellosis cases from two distinct regions of China to investigate the similarities and differences in clinical characteristics between endemic and non-endemic areas. Our objective was to summarise the clinical characteristics of brucellosis and improve clinicians' understanding and diagnostic accuracy of the disease.

METHODS

This was a retrospective, multicentre, cross-sectional study. Patients with brucellosis admitted to the Third Affiliated Hospital of Sun Yat-sen University from 2014 to 2023 and the Kashi Affiliated Hospital of Sun Yat-sen University from 2019 to 2023, respectively, were included. The clinical data, laboratory tests, and other case data of the two groups of patients were compared and analysed. Patients with a diagnosis of brucellosis were primarily included, and cases with excessive missing clinical information (> 20%) were excluded. This study was statistically analysed using SPSS.26 software.

RESULTS

There were 658 and 126 patients with brucellosis in Kashi and Guangzhou, respectively, and the proportion of patients with complications was 316 (48.02%) and 73 (57.94%), respectively. Organ involvement was dominated by single system involvement in patients from both places, 289 cases (91.46%) in Kashi and 69 cases (94.52%) in Guangzhou, and both were dominated by osteoarticular involvement (Kashi: 226, 78.20%; Guangzhou: 54, 78.26%) and neurological involvement (Kashi: 19, 6.57%; Guangzhou: 7, 10.14%). 34.19% (225/658) and 50.79% (64/126) of the patients in Kashi and Guangzhou, respectively, had a definite history of exposure to animals and animal products. Patients with Brucellosis in Guangzhou presented mainly with fever, fatigue, and chills, while those in Kashi presented mainly fatigue, fever and low back pain. The main laboratory findings in patients with brucellosis at both sites were normal white blood cells, neutrophil ratio, lymphocyte ratio, platelets, alanine amiotransferase, and albumin-globulin ratio, with a significant increase in C-reactive protein and a decrease in creatinine. The patients at both sites were diagnosed by pathogenetic or (and) serological methods. Most of the patients at both sites were treated with anti-Brucella therapy, mainly doxycycline in combination with rifampicin.

CONCLUSION

The clinical characteristics of brucellosis patients in Guangzhou and Kashi are generally similar, but there are some differences in epidemiological history, symptoms, methods of diagnosis confirmation, and treatment options. In clinical practice, the characteristics of local cases should be combined and thoroughly analysed to reduce misdiagnosis and underdiagnosis of brucellosis.

Analysis of trends in cancer mortality and the years of life lost in six provinces in northwest China from 2013 to 2021

Cancer is a major cause of death and morbidity in China. We aimed to analyze the trends in cancer mortality in six provinces in northwest China (Xinjiang Uyghur Autonomous Region, Qinghai Province, Shaanxi Province, Gansu Province, Ningxia Hui Autonomous Region, and Inner Mongolia Autonomous Region) from 2013 to 2021 and to explore the effect of cancer on life expectancy and the years of life lost. Based on cancer mortality data and demographic data from national surveillance units in six northwestern provinces from 2013 to 2021 in the National Cause-of-Death Surveillance, we calculated crude mortality rates, age-standardized mortality rates, life expectancy, cause-eliminated life expectancy, potential gains in life expectancy (PGLEs), years of life lost (YLL), YLL rates, and average years of life lost. Joinpoint software was used to calculate the average annual percentage change and annual percentage change (APC) for cancer mortality. Arriaga's decomposition method was used to estimate the contribution of cancer to life expectancy in each age group. The age-standardized mortality rate for cancer in the six provinces in northwest China was stable overall from 2013 to 2021 but exhibited a decreasing trend from 2017 to 2021 (APC = - 5.64%, p = 0.047), male cancer age-standardized mortality rates were consistently higher than those of women and plateaued, women exhibited a decreasing trend after 2017 (APC = - 5.56%, p = 0.032), and the standardized mortality rate was higher and stable for those aged ≥ 65 years. Compared with the study area population in 2013, that in 2021 increased by 1.01 years in life expectancy, and changes in cancer mortality contributed positively to the increase in life expectancy, contributing 0.217 years or 21.38% of the increase in life expectancy. The greatest positive effect was in the 0-1 year age group (0.066 years, 6.48%), and the greatest negative effect was in the ≥ 85 years age group (- 0.026 years, - 2.56%). At a 1.06-year increase in cancer cause-eliminated life expectancy, PGLEs increased by 0.047 years, with the highest increase in PGLEs in urban areas (0.091 years) and an upward trend in YLL rates in the study area population from 2013 to 2021 (average annual percentage change = 2.16, p = 0.001). Average years of life lost presented a stable trend. Cancer age-standardized mortality rate in the study region from 2013 to 2021 was stable overall but has exhibited a decline in recent years. However, the disease burden of YLL has continued to increase. Preventive interventions targeting male groups and the elderly population need to be strengthened.

Meteorological factors and normalized difference vegetation index drivers of scrub typhus incidence in Shandong Province based on a 16-year time-frequency analysis

OBJECTIVE

Scrub typhus, a natural epidemic disease that seriously impacts the health of the population, has imposed a substantial disease burden in Shandong Province. This study aimed to determine the periodicity of the scrub typhus incidence and identify the environmental risk factors affecting scrub typhus to help prevent and control its occurrence in Shandong Province.

METHODS

Monthly cases of scrub typhus, mean air temperature, relative humidity, cumulative precipitation, and Normalized Difference Vegetation Index (NDVI) data in Shandong Province from 2006 to 2021 were collected. Wavelet analysis was used to determine the incidence period of scrub typhus and to explore the relationships between environmental factors and the incidence of scrub typhus. Additionally, partial wavelet coherence (PWC) was employed to identify whether meteorological factors affect the association between NDVI and scrub typhus incidence.

RESULTS

Our results showed that scrub typhus incidence has a predominantly one-year period, followed by a less powerful six-month period. The wavelet coherence results revealed positive correlations between scrub typhus incidence and temperature, precipitation, relative humidity, and NDVI. Meteorological factors had a lagged effect of approximately 1-2 months (The phase angles of temperature, precipitation, and relative humidity were 59.15°, 56.57°, and 47.17° respectively) on scrub typhus incidence, whereas NDVI showed a lagged effect of approximately 1-2 weeks (The phase angle of NDVI was 18.11°). On the basis of partial wavelet analysis, we found that temperature and precipitation affected the association between NDVI and scrub typhus incidence.

CONCLUSION

Meteorological factors and NDVI play important roles in the occurrence of scrub typhus in Shandong Province. Moreover, temperature and precipitation can affect the role of NDVI. This study provides valuable recommendations and resources for the timely detection, mitigation, and management of scrub typhus in Shandong Province.

Ruditapes philippinarum Polysaccharide Alleviates Hyperglycemia by Modulating Gut Microbiota in a Mouse Model of Type 2 Diabetes Mellitus

Type 2 diabetes mellitus (T2DM), a widespread chronic metabolic disorder, presents a global challenge. Metformin hydrochloride, although widely prescribed, is associated with notable side effects. This study aims to explore safer, more effective alternatives by assessing the impact of Ruditapes philippinarum polysaccharides (RPPs) on glycemic control and modulation of microbiota in T2DM mice. A T2DM mouse model was established through a high-sucrose/high-fat diet and intraperitioneal streptozotocin injection. Glycometabolism indicators, histopathological features, and gut microbiota composition in caecum samples were assessed. Following 4 weeks of RPPs intervention, fasting blood glucose (FBG), glycated serum protein (GSP), area under the curve (AUC) of oral glucose tolerance test (OGTT), total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-c) levels were reduced in T2DM mice, while AKT-1 and GLUT-2 transcription levels were significant increased. Short-chain fatty acids (SCFAs) concentrations notably increased in the RPP-L group compared to the Model group, with improvements also observed in medium-chain fatty acids (MCFAs) and secondary bile acids (SBAs). Regarding gut microbiota, the Firmicutes-to-Bacteroidetes (F/B) ratio in RPP-L was substantially lower than in the Model group. At the genus level, beneficial bacteria, such as Akkermansia, Alloprevotella, Tidjanibacter, and Faecalibaculum demonstrated increased abundance. Correlation analysis identified Muribaculum, Paramuribaculum, Lacrimispora, and Turicibacter as microbial taxa associated with T2DM progression. RPPs significantly alleviated hyperglycemic symptoms in T2DM mice while enhancing the presence of beneficial gut bacteria, leading to a marked improvement in intestinal microbiota composition. This research offers foundational insights for the potential use of R. philippinarum in biomedical and nutraceutical applications.

Acupuncture treatment of postoperative urinary retention in cervical cancer: Systematic evaluation and meta-analysis

BACKGROUND

To evaluate the efficacy of acupuncture treatment of postoperative urinary retention after cervical cancer using meta-analysis.

METHODS

Computer searches were performed on 8 common Chinese and English databases such as PubMed, EMbase, Web of Science, China National Knowledge Infrastructure, Wanfang (Wanfang Data Knowledge Service Platform), VIP (China Science and Technology Journal Database), China Biomedical Literature Database and Cochrane Library, as well as Clinical Trials for the treatment of urinary retention after cervical cancer with acupuncture. A randomized controlled trial of postoperative urinary retention after cervical cancer from the time of library construction to 01/2024. The quality of the included literature was evaluated using the Cochrane Risk of Bias Assessment Tool. Meta-analysis and risk of bias analyses were performed using RevMan 5.4, regression and sensitivity analyses were performed using Stata 17.0.

RESULTS

A total of 31 randomized controlled trials with 2179 patients were included in the study. Interventions included filiform needling, embedding needle, electroacupuncture, moxibustion, warm acupuncture, etc. The results showed that acupuncture treatment increased clinical efficiency [relative risk = 1.32, 95% confidence intervals [CI] (1.20, 1.45), P < .00001], reduced residual urine volume [standardized mean difference = -3.21, 95% CI (-4.00, -0.40), P < .00001], and shortened the time to return to spontaneous urination [MD = -1.96, 95% CI (-3.02, -0.91), P = .0003] and indwelling catheter time [mean difference (MD) = -3.76, 95% CI (-5.66, -1.86), P = .0001], and improved maximum urine flow rate [MD = 4.57, 95% CI (0.70, 8.44), P = .02] and bladder compliance [MD = 10.04, 95% CI (8.14, 11.93), P < .00001].

CONCLUSION

Acupuncture treatment promotes recovery in patients with postoperative urinary retention after cervical cancer, but high-quality studies need to be included to further compare different acupuncture interventions.

Clinical characteristics and outcomes of BCMA-targeted CAR-T cell recipients with COVID-19 during the Omicron wave: a retrospective study

Patients with relapsed or refractory multiple myeloma (R/R-MM) are more susceptible to develop severe coronavirus disease 2019 (COVID-19) for their immunocompromised states. Despite good responses to B-cell maturation antigen (BCMA)-targeted chimeric antigen receptor (CAR)-T cell therapy, deficiencies in humoral immunity following CAR-T cell infusions can still cause life-threatening complications in these patients. We conducted a comparative study to delineate the clinical characteristics and outcomes between recipients of BCMA-targeted CAR-T cell therapy who contracted COVID-19 vs. unaffected counterparts. Advanced age (odds ratio [OR] = 1.367, 95% confidence interval [CI] = 1.017-1.838, P = 0.038) was a risk factor for developing severe COVID-19, while complete remission (CR) achieved by CAR-T cell therapy (OR = 0.012, 95% CI = 0.000-0.674, P = 0.032) was protective. Male sex (hazard ratio [HR] = 5.274, 95% CI = 1.584-17.562, P = 0.007) and CR achieved by CAR-T cell therapy (HR = 3.107, 95% CI = 1.025-9.418, P = 0.045) were protective factors associated with COVID-19 duration. CR achieved by CAR-T cell therapy (HR = 0.064, 95% CI = 0.007-0.589, P = 0.015) was also a protective factor for OS, while progression disease at the time of COVID-19 diagnosis (HR = 14.206, 95% CI = 1.555-129.819, P = 0.019) was regarded as a risk factor. Thus, older patients with R/R-MM and those who do not achieve CR after CAR-T cell therapy should be most protected from COVID-19 infection by the Omicron variant.

Updated Surveillance Metrics and History of the COVID-19 Pandemic (2020-2023) in East Asia and the Pacific Region: Longitudinal Trend Analysis

BACKGROUND

This study updates the COVID-19 pandemic surveillance in East Asia and the Pacific region that we first conducted in 2020 with 2 additional years of data for the region.

OBJECTIVE

First, we aimed to measure whether there was an expansion or contraction of the pandemic in East Asia and the Pacific region when the World Health Organization (WHO) declared the end of the COVID-19 public health emergency of international concern on May 5, 2023. Second, we used dynamic and genomic surveillance methods to describe the dynamic history of the pandemic in the region and situate the window of the WHO declaration within the broader history. Finally, we aimed to provide historical context for the course of the pandemic in East Asia and the Pacific region.

METHODS

In addition to updates of traditional surveillance data and dynamic panel estimates from the original study, this study used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data to identify the appearance and duration of variants of concern. We used Nextclade nomenclature to collect clade designations from sequences and Pangolin nomenclature for lineage designations of SARS-CoV-2. Finally, we conducted a 1-sided t test to determine whether the regional weekly speed was greater than an outbreak threshold of 10. We ran the test iteratively with 6 months of data across the sample period.

RESULTS

Several countries in East Asia and the Pacific region had COVID-19 transmission rates above an outbreak threshold at the point of the WHO declaration (Brunei, New Zealand, Australia, and South Korea). However, the regional transmission rate had remained below the outbreak threshold for 4 months. In the rolling 6-month window t test for regional outbreak status, the final P value ≤.10 implies a rejection of the null hypothesis (at the α=.10 level) that the region as a whole was not in an outbreak for the period from November 5, 2022, to May 5, 2023. From January 2022 onward, nearly every sequenced SARS-CoV-2 specimen in the region was identified as the Omicron variant.

CONCLUSIONS

While COVID-19 continued to circulate in East Asia and the Pacific region, transmission rates had fallen below outbreak status by the time of the WHO declaration. Compared to other global regions, East Asia and the Pacific region had the latest outbreaks driven by the Omicron variant. COVID-19 appears to be endemic in the region, no longer reaching the threshold for a pandemic definition. However, the late outbreaks raise uncertainty about whether the pandemic was truly over in the region at the time of the WHO declaration.

Does enhanced educational intervention reduce breakthrough infection and mental health problems via improving acceptance of COVID-19 booster shots in Chinese non-healthcare workers: A randomized controlled trial?

BACKGROUND

Despite vaccination and booster shots proving more effective than workplace measures in controlling the COVID-19 pandemic, hesitancy towards compulsory booster shots remains. This study aimed to evaluate the effectiveness of an enhanced educational intervention program in improving the acceptance of COVID-19 booster shots and reducing breakthrough infections among non-healthcare workers in Hong Kong.

METHODS

In this 9-month randomized controlled trial (RCT), workers were randomly allocated to either the intervention or control group. The intervention group received educational sessions at baseline and at 3-month, covering general health and evidence-based information on the efficacy and safety of COVID-19 vaccines and booster shots. The control group received only general health information. All participants were followed up for an additional 6 months. The primary outcomes were intention and acceptance of booster shots, as well as breakthrough infections. The DASS-21 scale was used to evaluate participants' mental health status, and two-way mixed ANOVA to analyze the group effect. A difference of ≥ 5 % in booster uptake between the intervention and control group indicated a practical significance in infection control.

RESULTS

Among 310 consenting workers, 282 (91.0 %) of them completed the trial. At recruitment, the booster uptake rate was similar between the intervention and control groups (62.0 % vs. 62.1 %). After the educational intervention sessions, the intervention group showed a higher booster uptake rate (76.1 % vs. 67.9 %). A lower rate of breakthrough infection was observed in the intervention group during the latest follow-up period (23.2 % vs. 29.5 %); however, no change in the intention to get booster shots were recorded for all subjects.

CONCLUSION

This enhanced educational intervention program significantly improves booster uptake rates and reduces COVID-19 breakthrough infection rates among non-healthcare workers. (Trial registration: ClinicalTrials.gov - NCT05197673).

Study on SARS-CoV-2 infection in middle-aged and elderly population infected with hepatitis virus: a cohort study in a rural area of northeast China

Background

To investigate the symptoms, the level of antibody, the progression of liver disease after SARS-CoV-2 infection in middle-aged and elderly population infected with hepatitis virus.

Methods

The study was based on a cohort of high-risk liver cancer and the participants was recruited in April 2023. Blood sample were collected and information was obtained through questionnaires. Data on reinfection was obtained by follow-up until July 31, 2023. The SARS-CoV-2-specific neutralizing antibody and IgG were measured.

Results

A total of 599 participants infected with hepatitis virus were included and the mean age was 61.3 ± 7.4 years. The SARS-CoV-2 infection rate was 94.7%. Among the infected, 132 were asymptomatic, 435 were symptomatic, no severe cases occurred. Four months after infection, no difference was in liver function and aMAP score between the infected and uninfected. The infected had higher seropositivity rates of both antibodies than the uninfected (neutralizing antibody: uninfected: 93.7%, infected: 99.6%; IgG: uninfected: 59.4%, infected: 98.9%). The levels of both antibodies in the symptomatic were higher than those the asymptomatic and the uninfected (neutralizing antibody: uninfected: 0.75 AU/mL, asymptomatic: 15.46 AU/mL, symptomatic: 24.76 AU/mL; IgG: uninfected: 15.10 AU/mL, asymptomatic: 263.84 AU/mL, symptomatic: 291.83 AU/mL). By July 31, 2023, the incidence of reinfection was 17.5%.

Conclusions

Although the infection rate of SARS-CoV-2 was high, no severe cases occurred. Omicron infection may not aggravate progression of hepatitis. Four months after infection, the population showed high positivity rate in neutralizing antibody and IgG. Monitoring of virus mutations and targeted prevention and care strategies is crucial for vulnerable populations.

Analysis and prediction of the incidence temporal trends of echinococcosis in China from 2010 to 2021

Echinococcosis poses a significant health burden in China, yet previous studies have mainly concentrated on its prevalence rather than incidence trends. This study analyzes echinococcosis incidence from 2010 to 2021 and projects future trends to enhance prevention and control strategies. The annual percentage change (APC) and average annual percentage change (AAPC) were calculated to determine temporal trends, while the time series was decomposed to assess seasonal patterns. During this period, China documented 53,141 new echinococcosis cases (excluding Hong Kong, Macao, and Taiwan), averaging 0.320 cases per 100,000 annually. The AAPC indicated a non-significant decline of -2.718%. The analysis identified two critical inflection points in 2014 and 2017, leading to three distinct trends: a non-significant decline from 2010 to 2014, a significant rise from 2014 to 2017, and a significant decrease from 2017 to 2021. Cases peaked in December, and predictions from the Seasonal Autoregressive Integrated Moving Average (SARIMA) model suggest a slight rise in incidence from September 2022 to August 2025, advising intensified efforts in preventive measures to prevent resurgence.

A counterfactual analysis quantifying the COVID-19 vaccination impact in Sweden

BACKGROUND

Vaccination was the single most effective measure in mitigating the impact of the COVID-19 pandemic. Our study aims to quantify the impact of vaccination programmes during the initial year of vaccination (2021) by estimating the number of case fatalities avoided, using Sweden as a case study.

METHODS

Using Swedish data on age-specific reported incidence and vaccination uptake, along with vaccine efficacies, age-specific contact patterns and under-reporting from the literature, we fit a Bayesian SEIR epidemic model with time-varying community contact rate for COVID-19 incidence. Age-specific fatality rates from the literature are adjusted proportionally to fit the observed number of case fatalities in the factual analysis, resulting in 5,510 (95% PI: 5,370-5,650) matching the observed number 5,430. The estimated time-varying community contact rate is then used in a counterfactual analysis where the population is unvaccinated, leading to more infections and fatalities. A sensitivity analysis is performed to identify which parameters influence our conclusions.

FINDINGS

The counterfactual analysis result in a severe epidemic outbreak during the early autumn of 2021, resulting in about 37,100 (36,700-37,500) number of case fatalities. Consequently, the number of lives saved by the vaccination programme is estimated to be about 31,600 (31,300-32,000), out of which 5,170 are directly saved and 26,400 are indirectly saved, mainly by drastically reducing the severe outbreak in the early autumn of 2021, which would have occurred without vaccination and unchanged community contact rate.

INTERPRETATION

Our mathematical model is used to analyse the impact of COVID-19 vaccination on lives saved in Sweden during 2021, but the same methodology can be applied to other countries. The counterfactual analysis offers insights into an alternative trajectory of the pandemic without vaccination. The results show the direct impact of vaccination on reducing deaths for infected individuals and shed light on the indirect effects of reduced transmission dynamics.

Loneliness and cognitive function in older adults living in Latin America: A systematic review

English language systematic reviews with samples from high-income countries have found an inverse relationship between loneliness and cognitive function. Considering that cultural and contextual resources influence the experience of loneliness and cognitive health, we conducted a systematic review analyzing quantitative studies exploring the relationship between loneliness and cognitive function in older adults in Latin America. Following PRISMA guidelines, we used five databases (PubMed, PsycInfo, Scopus, LILACS, and SciELO). Inclusion criteria were: a) quantitative research examining the relationship between loneliness and cognitive health, b) descriptions of loneliness and measures of cognitive function, c) English or Spanish language peer-reviewed articles, and d) a sample of older adults in Latin America (≥60 years). We assessed bias using the Risk of Bias Instrument for Cross-Sectional Surveys of Attitudes and Practices. Seven of the 1,887 studies (all cross-sectional) met the inclusion criteria, comprising 26,440 participants from Brazil or Mexico. Most, but not all, found a significant inverse association between loneliness and cognitive function after controlling for salient health and psychosocial factors. Measures and conceptualizations of loneliness and cognitive function, as well as theoretical explanations linking these concepts, varied. Two studies had a high risk of bias. Current evidence suggests a possible cross-sectional association between loneliness and cognitive function in older adults in these countries. Further research is needed to examine the possible bidirectional relationship using representative samples and longitudinal designs; test pathways linking dimensions of loneliness (e.g., chronicity) to cognitive function (e.g., Alzheimer's disease continuum), and explore Latin American diversity (e.g., countries, indigenous peoples, sexual minorities).

Public health implications of diagnosing and treating acute HIV

PURPOSE OF REVIEW

The earliest months of HIV infection are characterized by high viral loads and elevated transmissibility, particularly during the acute (preseroconversion) phase. Transmission prevention during early HIV requires diagnostic tools that narrow the window between viral acquisition and reactive test, followed by rapid linkage to effective antiretroviral therapy (ART). Here, we review recent advances related to diagnosing and treating persons during early HIV, with a particular focus on acute HIV infection (AHI).

RECENT FINDINGS

Point-of-care (POC) fourth-generation antigen/antibody tests have mixed performance, often dependent on the pretest probability of early infection within the screened population. Risk score algorithms demonstrate the potential for prioritizing resource-intensive tests, such as POC HIV RNA, to those most likely to have AHI, but their predictive performance varies across populations, complicating implementation. Emerging and re-emerging infections, including SARS-CoV-2 and mpox, present opportunities for and challenges to symptom-driven AHI screening. Daily oral ART with standard first-line regimens quickly suppresses viremia during AHI, but long-acting injectable drugs are yet to be explored for this indication.

SUMMARY

Few practice-changing results related to diagnosing or treating persons with early HIV have been released in the last 18 months. Accurate POC HIV RNA tests could leapfrog fourth-generation POC assays, but they remain unavailable for routine use. Implementation science approaches are needed to guide use of evidence-based strategies for early HIV screening, and additional research on same-day ART linkage, including injectable ART, could produce dramatic impacts on forward transmission during this period.