Immediate Versus 5-Year Risk-Guided Initiation of Treatment for Primary Prevention of Cardiovascular Disease for Australians Aged 40 Years: A Health Economic Analysis

BACKGROUND AND OBJECTIVE

Current Australian cardiovascular disease (CVD) prevention guidelines calculate 5-year CVD risk and recommend treatment when risk crosses specific thresholds. This may leave risk factors untreated for people with a low short-term (i.e. 5 years), but high long-term (i.e. lifetime), risk of CVD. We aimed to evaluate the cost effectiveness of intervention for risk factor control at age 40 years (regardless of calculated risk) compared to intervention for risk factor control at the age recommended by contemporary Australian CVD prevention guidelines (when the 5-year CVD risk reaches 10%) across a range of individual risk factor profiles.

METHODS

We used a causal microsimulation model populated with 108 different risk factor profiles, each replicated 10,000 times. Model data were derived from the UK Biobank study and published sources. The primary causal relationships factored in were those of low-density lipoprotein-cholesterol and systolic blood pressure with CVD (defined as myocardial infarction or stroke). The model simulated the ageing of individuals from 40 to 85 years. We calculated years of life lived, quality-adjusted life-years gained, incremental healthcare costs and the incremental cost-effectiveness ratio when low-density lipoprotein-cholesterol and blood pressure were controlled from age 40 years compared to initiation of treatment as recommended by Australian guidelines. The main side effect in the model was an increased risk of type 2 diabetes mellitus from statin use. The trade-off between reduced CVD and increased type 2 diabetes was summarised via quality-adjust life-years. Incremental cost-effectiveness ratios were compared to the Australian willingness-to-pay threshold of AU$28,000 per quality-adjust life-year gained. We adopted a healthcare perspective (2022 AUD) and discounted results at 3% annually.

RESULTS

An earlier intervention meaningfully prevented CVD in all but the lowest risk individuals. Intervention at age 40 years versus age when the 5-year CVD risk reaches 10% led to an increase in quality-adjust life-years for 37/54 female individuals and 44/54 male individuals simulated and an increase in years of life lived (i.e. life expectancy) for 46/54 female individuals and 47/54 male individuals simulated. Earlier intervention was also cost effective in 5/54 female individuals and 17/54 male individuals.

CONCLUSIONS

Current guidelines may result in certain individuals with a lower 5-year, but higher lifetime, risk of CVD being overlooked for earlier cost-effective interventions to prevent CVD.

Integrative approaches to atrial fibrillation prevention and management: Leveraging gut health for improved cardiovascular outcomes in the aging population

Atrial fibrillation (AF) is a prevalent clinical arrhythmia associated with a high incidence and severe complications such as cerebral embolism and heart failure. While the etiology and pathogenesis of AF involve numerous factors, recent research emphasizes the significant role of intestinal microbiota imbalance in the emergence and progression of AF, particularly among older adults. This review investigates the mechanisms by which intestinal flora and their metabolites contribute to the onset of AF in the elderly, highlighting novel interactions between gut health and cardiac function. Current literature often overlooks these critical connections, indicating a substantial research gap in understanding how dysbiosis may exacerbate AF and hinder recovery. Furthermore, exploring the bidirectional relationship between the gut microbiome and systemic inflammation in the context of AF provides a unique perspective that has yet to be thoroughly investigated. Future research should focus on longitudinal studies assessing gut microbiota composition and function in AF patients and consider probiotics or prebiotics as potential adjunctive therapies for mitigating AF. This comprehensive approach may pave the way for innovative treatments integrating cardiology with gastroenterology, enhancing patient outcomes through a holistic understanding of health.

Dysphagia development in heart failure patients: A scoping review

OBJECTIVE

Dysphagia significantly affects older adults, particularly those with heart failure (HF). This scoping review aimed to delineate the development of dysphagia and its contributing factors in patients with HF.

METHODS

We systematically searched MEDLINE, EMBASE, CINAHL, and CENTRAL databases up to September 2023, focusing on studies involving HF patients aged 60 and above, particularly those assessing post-hospitalization dysphagia.

RESULTS

Of 1,076 identified studies, nine were relevant. The prevalence of dysphagia at admission was 23.6 % (14.1 - 32.9), with 9.4 % (4.5 - 13.8) persisting until discharge. The evaluation of dysphagia primarily relies on oral intake assessments, highlighting several risk factors, including high inflammation, low energy intake, advanced age, low Barthel Index scores, poor oral health, antipsychotic usage, and low maximum tongue pressure. It is important to note potential author bias and overlap among study populations.

CONCLUSIONS

This review highlights the significant development of dysphagia in patients with HF, and the prevalence of newly developed dysphagia was 23.6 % (14.1 - 32.9). Key risk factors include older age, high inflammation, low activities of daily living, and sarcopenia, which is suggested as a pathogenic mechanism in dysphagia. Future research should focus on diverse samples, investigate the impact of sarcopenia and cachexia, and objectively assess swallowing function.

Analysis of the haemodynamic changes caused by surgical and transcatheter aortic valve replacements by means fluid-structure interaction simulations

Aortic valve replacements, both surgical and transcatheter, are nowadays widely employed treatments. Although clinically effective, these procedures are correlated with potentially severe clinical complications which can be associated with the non-physiological haemodynamics that they establish. In this work, the fluid dynamics changes produced by surgical and transcatheter aortic valve replacements are analysed and compared with an ideal healthy native valve configuration, employing advanced fluid-structure interaction (FSI) simulations. The aim of the study is to investigate how existing treatments may affect the aortic valve function, and giving indications about how to improve current therapies. Simulations were performed using the commercial software LS-DYNA, where the FSI strategy is based on the coupling of a Lagrangian approach for the structures and a Eulerian approach for the fluid, whilst the coupling between the two domains is reached through a hybrid arbitrary-Lagrangian-Eulerian algorithm. Idealised geometries are used for the aortic root and leaflets. The aortic wall was modelled as linear elastic material, whilst leaflets were modelled as hyperelastic incompressible, using an Ogden's constitutive model. A combination of physiological flow velocity and pressure differences are applied as boundary conditions to model realistically the whole cardiac cycle. Results are analysed throughout the cardiac cycle in terms of leaflets kinematics, flow dynamics, pressure and valve performance parameters. Globally, surgical valves presented worse performance than transcatheter counterparts (reduced effective orifice area, increased transvalvular pressure drop and increased opening and closing times). The clinical parameters of transcatheter devices were improved and closer to those of the healthy native valve, although the vortical activity within the Valsalva's sinuses was substantially altered. Here, the presence of the partition obstructed the washing out, resulting in higher degree of blood stasis and potential blood damage. The implantation of prosthetic devices produces major haemodynamic changes which alters the valve dynamics and leads to diminished performance. Currently, the design of these substitutes is not optimised to mimic realistic native conditions, particularly in terms of valve opening behaviour. Although transcatheter devices provide systolic performance similar to that estimated for the healthy native aortic model, none of the prosthetic solutions appeared to be able to fully restore healthy physiological conditions.

RGS12 is a target of penehyclidine hydrochloride that enhances oxidative stress and ferroptosis in a model of myocardial ischemia/reperfusion injury by inhibiting the Nrf2 pathway

Regulator of G‑protein signaling 12 (RGS12) is a regulatory factor that is involved in various physiological processes. However, the role of RGS12 in myocardial ischemia/reperfusion injury (MIRI) currently remains unclear. The present study established a mouse model of MIRI by ligating the left main coronary artery followed by reperfusion. In addition, mouse HL‑1 cells were cultured in a hypoxic and serum‑free medium, followed by reoxygenation to establish an in vitro cell model of hypoxia/reoxygenation (H/R). Adenoviruses targeting RGS12 were subsequently used to either overexpress or silence RGS12 expression. RGS12 was highly expressed in both the myocardial tissues of mice with MIRI and HL‑1 cells subjected to H/R. The results from the in vitro experiments demonstrated that the knockdown of RGS12 reduced oxidative stress under a pathological environment, as indicated by decreased reactive oxygen species (ROS) levels and malondialdehyde activity and increased activities of superoxide dismutase and catalase. Furthermore, mice with MIRI and HL‑1 cells that underwent H/R stimulation exhibited increased ferroptosis, whereas RGS12 knockdown reversed these changes. These results showed that post‑RGS12 silencing the levels of Fe2+ and lipid ROS were decreased, the expression levels of glutathione peroxidase 4 and cystine transporter solute carrier family 7 member 11 were increased and mitochondrial structure was improved by preventing the loss of the mitochondrial crest. Mechanistically, the nuclear factor erythroid 2‑related factor 2 (Nrf2) pathway with anti‑ferroptosis and anti‑oxidative stress capacities was activated by RGS12 knockdown. Conversely, RGS12 overexpression exerted the opposite effects both in vivo and in vitro. Notably, it was demonstrated that penehyclidine hydrochloride (PHC), known to block the MIRI process, decreased RGS12 expression levels both in vivo and in vitro, and RGS12 overexpression inhibited the therapeutic effects of PHC on MIRI. In conclusion, the present study demonstrated that RGS12, a target of PHC, potentially enhanced the progression of MIRI by promoting oxidative stress and ferroptosis, and this effect may involve the regulation of the Nrf2 pathway.

Predicting the likelihood of readmission in patients with ischemic stroke: An explainable machine learning approach using common data model data

BACKGROUND

Ischemic stroke affects 15 million people worldwide, causing five million deaths annually. Despite declining mortality rates, stroke incidence and readmission risks remain high, highlighting the need for preventing readmission to improve the quality of life of survivors. This study developed a machine-learning model to predict 90-day stroke readmission using electronic medical records converted to the common data model (CDM) from the Regional Accountable Care Hospital in Gangwon state in South Korea.

METHODS

We retrospectively analyzed data from 1,136 patients with ischemic stroke admitted between August 2003 and August 2021 after excluding cases with missing blood test values. Demographics, blood test results, treatments, and comorbidities were used as key features. Six machine learning models and three deep learning models were used to predict 90-day readmission using the synthetic minority over-sampling technique to address class imbalance. Models were evaluated using threefold cross-validation, and SHapley Additive exPlanations (SHAP) values were calculated to interpret feature importance.

RESULTS

Among 1,136 patients, 196 (17.2 %) were readmitted within 90 days. Male patients were significantly more likely to experience readmission (p = 0.02). LightGBM achieved an area under the curve of 0.94, demonstrating that analyzing stroke and stroke-related conditions provides greater predictive accuracy than predicting stroke alone or all-cause readmissions. SHAP analysis highlighted renal and metabolic variables, including creatinine, blood urea nitrogen, calcium, sodium, and potassium, as key predictors of readmission.

CONCLUSION

Machine-learning models using electronic health record-based CDM data demonstrated strong predictive performance for 90-day stroke readmission. These results support personalized post-discharge management and lay the groundwork for future multicenter studies.

Associations of glycemic status with dynamic disease trajectories of atrial fibrillation and dementia

BACKGROUND

Atrial fibrillation (AF) has been associated with elevated dementia risk, while few studies have examined the role of the optimal glycemic status in disease trajectories of AF and dementia.

OBJECTIVES

We aim to evaluate associations between glycemic status with disease trajectories of AF and dementia, as well as major dementia subtypes, including Alzheimer's disease and vascular dementia.

DESIGN

Population-based cohort study.

SETTING

UK Biobank.

PARTICIPANTS

A total of 458 368 participants who were free of prevalent dementia and AF at baseline, with complete glycemic status assessment.

MEASUREMENTS

Based on clinical recommendations, we categorized glycemic status as low-normal (glycated hemoglobin [HbA1c] <5.5 %), normal (HbA1c 5.5 to 5.9 %), pre-diabetes (HbA1c 6.0 to 6.4 %), diabetes with HbA1c<7 %, and diabetes with HbA1c≥7 %. Outcomes including AF, dementia (all-cause and sub-type dementia), and death were ascertained via linkage to external registry databases. A multi-state survival analysis was conducted to evaluate disease trajectories of AF and dementia.

RESULTS

Better glycemic status was consistently associated with decreased hazards of trajectories of AF and dementia, including progression from AF to the comorbidity of AF and dementia. Among people with diabetes, those with HbA1c<7 % had a 31 % lower hazard (hazard ratio [HR], 0.69; 95 % confidence intervals [CI], 0.51-0.93) of progression from incident AF to dementia comorbidity, compared to those with HbA1c≥7 %. Similar risk reductions were found in individuals with pre-diabetes, normal HbA1c, and low-normal HbA1c, respectively. Strong dose-response associations were observed, with each 1 % increment in HbA1c related to a 28 % higher hazard of progression from AF to dementia comorbidity (HR,1.28; 95 % CI, 1.19-1.37). The glycemic status was most relevant for associations with disease trajectories of AF and vascular dementia, compared to trajectories of AF and Alzheimer's disease.

CONCLUSIONS

The better glycemic status was consistently associated with lower hazards of disease trajectories of AF and dementia, including the reduced risk of progression from incident AF to comorbidity of AF and dementia. These findings support the significance of reaching optimal glycemic status to alleviate the huge disease burden of both AF and dementia simultaneously.

Relationship between lifestyle factors and cardiovascular disease prevalence in Somaliland: A supervised machine learning approach using data from Hargeisa Group Hospital, 2024

BACKGROUND

Cardiovascular diseases (CVDs) are leading contributors to global morbidity and mortality, with low- and middle-income countries experiencing disproportionately high burdens. In Somaliland, urbanization and lifestyle transitions have increased the prevalence of CVDs, necessitating an in-depth exploration of associated risk factors.

OBJECTIVE

This study investigated the relationship between lifestyle factors and CVD prevalence among adult patients in Somaliland using data from the Hargeisa Group Hospital in 2024.

METHODS

A cross-sectional design was employed, enrolling 411 adults aged ≥ 18 years. Data were collected through structured questionnaires and analyzed using traditional statistical methods and seven supervised machine learning models: Logistic Regression, Random Forest, Support Vector Machine (SVM), Probit Regression, KNN and Decision Tree. The study assessed associations between sociodemographic variables, lifestyle factors, and CVD prevalence while evaluating the predictive model performance.

RESULTS

Age and smoking were the most significant predictors of CVD prevalence across all models, with individuals aged ≥ 60 years exhibiting the highest risk. Urban residence was associated with lower CVD prevalence, while behaviors such as khat chewing and physical inactivity increased the risk. Machine learning models, notably SVM, demonstrated robust predictive performance, achieving an accuracy of 63.4 % and an AUC of 67.1 %.

CONCLUSION

Lifestyle factors, particularly smoking, khat chewing, and dietary habits, are critical drivers of the CVD prevalence in Somaliland. These findings underscore the need for targeted public health interventions focusing on smoking cessation, dietary improvements, and culturally sensitive awareness campaigns. Machine learning techniques offer valuable tools for enhancing the predictive accuracy and guiding tailored health strategies.

World Health Organization priority antimicrobial resistance in Enterobacterales, Acinetobacter baumannii, Pseudomonas aeruginosa, Staphylococcus aureus and Enterococcus faecium healthcare-associated bloodstream infections in Brazil (ASCENSION): a prospective, multicentre, observational study

Background

Carbapenem-resistant Enterobacterales (CRE), Acinetobacter baumannii (CRAB), Pseudomonas aeruginosa (CRPA), methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecium (VRE) are listed by World Health Organization (WHO) as priority antimicrobial-resistant bacteria. Data on WHO Priority Antimicrobial resistance Phenotype (WPAP) bacteria from low- and middle-income countries are scarce. In this study, we investigated the occurrence of WPAP in healthcare-associated bloodstream infections (BSI) in Brazil, an upper-middle-income country in South America.

Methods

ASCENSION was a prospective, multicentre, observational study conducted in 14 hospitals from four of five Brazilian regions. Enterobacterales, A. baumannii, P. aeruginosa, S. aureus and E. faecium BSIs in hospitalised patients were analysed. The primary outcome was the frequency of WPAP among all bacteria of interest. Secondary outcomes were incidence-density of bacteria isolates in hospitalised patients, WPAP proportions within bacterial species, and 28-day mortality. PCR for carbapenemase genes was performed in carbapenem-resistant Gram-negative bacteria.

Findings

Between August 15, 2022, and August 14, 2023, 1350 isolates (1220 BSI episodes) were included. WPAP accounted for 38.8% (n = 524; 95% Confidence Interval 32.0-46.1) of all isolates, with CRE (19.3%) as the most frequent, followed by CRAB (9.6%), MRSA (4.9%), VRE (2.7%), and CRPA (2.4%). Incidence-density of all and WPAP isolates were 1.91 and 0.77/1000 patients-day, respectively. Carbapenem-resistant Klebsiella pneumoniae (CRKP) was the most common CRE, corresponding to 14.2% of all BSIs. A. baumannii isolates presented the highest proportion of WPAP (87.8%). Mortality rates were higher in patients with BSIs by WPAP than non-WPAP isolates. KPC (64.4%) was the predominant carbapenemase in CRE, followed by NDM (28.4%) and KPC + NDM co-production (7.1%). OXA-23 was the most frequent in CRAB.

Interpretation

A high frequency of WPAP bacteria, particularly CRKP and CRAB, were found in healthcare-associated BSIs in Brazil, posing them as a major public health problem in this country.

Funding

National Council for Scientific and Technological Development, Brazil.

Delayed atorvastatin delivery promotes recovery after experimental spinal cord injury

Spinal cord injury (SCI) significantly alters gene expression, potentially impeding functional recovery. This study investigated the effects of atorvastatin, a widely prescribed cholesterol-lowering drug, on gene expression and functional recovery in a chronic murine SCI model. Female C57BL/6J mice underwent moderate 0.25 ​mm lateral compression SCI and received daily atorvastatin (10 ​mg/kg) or vehicle-only injections from two weeks post-injury for four weeks. Sensorimotor functions were assessed using the Basso Mouse Scale (BMS), its subscore, and the inclined plane test. RNA sequencing of spinal cord tissues identified robust transcriptomic changes from SCI and a smaller subset from atorvastatin treatment. Atorvastatin enhanced sensorimotor recovery within two weeks of treatment initiation, with effects persisting to the experimental endpoint. Pathway analysis showed atorvastatin enriched neural regeneration processes including Fatty Acid Transport, Axon Guidance, and the Endocannabinoid Developing Neuron Pathway; improved mitochondrial function via increased TCA Cycle II and reduced Mitochondrial Dysfunction; and decreased Inhibition of Matrix Metalloproteases. Key gene drivers included Fabp7, Unc5c, Rest, and Klf4. Together, these results indicate atorvastatin's potential in chronic SCI recovery, especially where already indicated for cardiovascular protection.

Cost effectiveness analysis of three colorectal cancer screening modalities in Kuwait

Colorectal cancer (CRC) poses a significant health challenge in Kuwait, ranking as the second most common cancer with the incidence rate 13.2 cases per 100,000 people in year 2019. This study aims to determine the cost-effectiveness of three colorectal cancer (CRC) screening methods in Kuwait from the perspective of Kuwait's healthcare providers. Using a Decision Tree Analysis Model, the study compared three screening modalities: Fecal Occult Blood Test (FOBT) followed by colonoscopy or sigmoidoscopy, colonoscopy alone, sigmoidoscopy alone and alongside no screening. Over a 10-year period post-diagnosis, the model tracked costs and outcomes based on CRC patients' life expectancy, expressing results using Incremental Cost Effectiveness Ratios (ICERs). Colorectal cancer screening using FOBT followed by colonoscopy or sigmoidoscopy resulted in 7.7 quality-adjusted life years (QALYs) at a cost of USD 3,573. In contrast, no screening achieved 7.2 QALYs but was more expensive, costing USD 4,084. Screening with only sigmoidoscopy or only colonoscopy provided 6.8 QALYs each, at costs of USD 4,905 and USD 5,002, respectively. Sensitivity analyses explored uncertainties in cost and outcome estimates. FOBT followed by colonoscopy or sigmoidoscopy can be considered as an efficient and effective approach towards early detection of CRC. This approach can be used by healthcare policymakers in Kuwait, in the development of population-based CRC screening programs to optimize resource allocation and improve public health outcomes.

HFpEF correlated with better improvement of left atrial function in post-ablation patients with paroxysmal atrial fibrillation

The extent of improvement in left atrial (LA) function after radiofrequency catheter ablation (RFCA) in patients with paroxysmal atrial fibrillation (PxAF) and its association with heart failure with preserved ejection fraction (HFpEF) remain unclear. This study aims to explore whether there is a difference in the improvement of LA function after RFCA in patients with PxAF combined with HFpEF compared to those without HFpEF. Patients with PxAF receiving RFCA were enrolled. LA volume index (LAVI), LA emptying fraction (LAEF), and LA peak reservoir strain (LA RS) were assessed using echocardiography at baseline and three months after RFCA. Changes in these parameters were compared between patients with a high probability of HFpEF (hp-HFpEF) and those with a medium or low probability of HFpEF (lp-HFpEF), as determined by the H2FPEF score. A total of 147 patients (mean age 62.6 years; 63.3% males) were recruited (hp-HFpEF = 30). Baseline LA function differed significantly between patients with hp-HFpEF and those with lp-HFpEF. Differences included LAVI, LAEF, and LA RS (all P < 0.01). The improvement in LA function 3 months after RFCA was significantly different between the two groups, even after adjusting for confounding factors. Specifically, patients with hp-HFpEF experienced greater reductions in LAVI, more improvement in LAEF, and greater improvement in LA RS compared to patients with lp-HFpEF. A high probability of HFpEF was correlated with greater improvement in LA function following RFCA in patients with PxAF. The clinical trial registration number: ClinicalTrials.gov NCT05266144.

[Endovascular therapy of aorto-iliac occlusive disease]

BACKGROUND

Arterial occlusive disease of the central arteries involving the abdominal aorta and iliac arteries leads to multiple symptoms such as intermittent claudication, including of the gluteus muscle, and erectile dysfunction.

OBJECTIVES

A description of the indications, technique and clinical outcomes of the endovascular therapy of aorto-iliac artery occlusive disease.

RESULTS

Due to new endovascular techniques and improved stents and stent grafts developed over the last two decades, the endovascular therapy of aorto-iliac obstructions has become the standard method for the treatment of intermittent claudication in experienced centers. Open surgical bypass revascularisation is mainly indicated after a failed endovascular attempt or in the case of unfavourable anatomy for endovascular therapy, including flush occlusions distal to the renal artery origins. A less frequently used revascularisation technique, the hybrid revascularisation, combines open surgical thromboendarterectomy of the common femoral artery and stent implantation of the ipsilateral iliac artery or aorta. Obstructions of the internal iliac artery resulting in, among other things, erectile dysfunction and hip claudication are ever more frequently treated with either drug-eluting stents or balloons.

CONCLUSION

In the case of appropriate operator experience and suitable anatomy, endovascular therapy has become the first-line revascularisation strategy for aorto-iliac occlusive disease involving the internal iliac artery.

Novel metabolic indicators and the risk of cardiovascular disease in patients with hypertension: A primary-care cohort study

BACKGROUND AND AIMS

Data are limited on whether several easily measured indices serve as effective tools for Cardiovascular disease (CVD) risk assessment in hypertensive patients. This study aimed to assess the associations of metabolic score for insulin resistance (METS-IR), lipid accumulation product (LAP), and visceral adiposity index (VAI) with CVD risk in hypertensive patients.

METHODS AND RESULTS

Our data were drawn from the medical records of primary-care institutions in China. The present study included 306,680 individuals with hypertension attending primary healthcare centers. Cox regression analyses were applied to assess the associations of novel metabolic indicators with the risk of CVD. During a median follow-up of 1.98 years, 5820 participants developed CVD. When comparing with the lowest quartile of the indices, the highest quartile of METS-IR, LAP, and VAI was associated with 1.25-fold (95 % CI: 1.16-1.35), 1.15-fold (95 % CI: 1.05-1.25), and 1.19-fold (95 % CI: 1.10-1.28) risk of CVD after adjusting for potential confounders.

CONCLUSION

This study provided additional evidence that novel metabolic indicators like METS-IR, LAP, and VAI were associated with the risk of CVD. These results suggest that proactive assessment of visceral adiposity and insulin resistance could be helpful for the effective clinical management of the hypertensive population.

Development of machine learning-based models to predict congenital heart disease: A matched case-control study

BACKGROUND

The current congenital heart disease (CHD) prediction tools lack adequate interpretability and convenience, hindering the development of personalized CHD management strategies. We developed a machine learning-based risk stratification model for CHD prediction.

METHODS

This study utilized data from 1,759 participants in a case-control study of CHD conducted across six birth defects surveillance hospitals located in Xi'an, Shaanxi Province, Northwest China, spanning from January 2014 to December 2016. The data was partitioned into training and testing datasets with a ratio of 7:3. Predictors were selected from a total of 47 input variables through the Least Absolute Shrinkage and Selection Operator (LASSO). Five machine learning algorithms were used to build the CHD risk prediction models. Model performance was assessed based on a range of learning metrics, including the area under the receiver operating characteristic curve (AUROC), F1 score, and Brier score. Permutation feature importance was employed to elucidate the prediction model. The best-performing model was used to conduct the risk scores.

RESULTS

The eXtreme Gradient Boosting (XGB) model demonstrated superior performance among CHD prediction models, achieving an AUROC of 0.772 (95 % CI 0.728, 0.817) in the testing dataset and 0.738 (0.699, 0.775) in the external validation dataset. The pivotal predictors (top 3) identified by the model included living in rural areas, the low wealth index, and folic acid supplements (<90 days). The resultant risk score exhibited robust calibration capabilities. Utilizing the risk scores, participants were stratified into low, moderate, and high-risk categories, signifying substantial variations in CHD risk.

CONCLUSION

This study underscores the feasibility and efficacy of employing a machine learning-based approach for CHD prediction. The risk scores exhibited potential in identifying pregnant women at high risk for fetal CHD, offering valuable insights for guiding primary prevention and CHD management.

Global burden of non-rheumatic valvular heart disease in older adults (60-89 years old), 1990-2019: Systematic analysis of the Global Burden of Disease Study 2019

BACKGROUND

Understanding the global burden and risk factors of non-rheumatic valvular heart disease (NRVHD) in older adults is important for effective disease control. We wanted to analyze the prevalence, incidence, disability-adjusted life years (DALY) rate, mortality rate, and risk factors of NRVHD in older adults aged 60-89 years.

METHODS

Global Burden of Disease Study (GBD) 2019 was used as the data source. Age standardized incidence rate, prevalence, DALY rate, and mortality rate of NRVHD among older adults aged 60-89 years from 1990 to 2019. We analyzed different age groups, genders, regions, sociodemographic index (SDI) across 204 countries/territories. Proportional DALY and mortality attributable to risk factors were calculated.

RESULTS

Globally, age-standardized DALY rate (per 100,000 population) for NRVHD in older adults decreased significantly from 44.46 (95 % confidence interval 39.95 to 49.18) in 1990 to 35.94 (32.32 to 40.19) in 2019 with an average annual percent change (AAPC) of -0.19 % (-0.24 % to -0.14 %), and the mortality rate also decreased significantly from 2.48 (2.21 to 2.64) to 2.25 (1.89 to 2.47) with an AAPC of -0.09 % (-0.16 % to -0.03 %,). However, the age-standardized incidence rate (per 100,000 population) increased from 18.37 (17.41 to 19.35) in 1990 to 19.77(18.62 to 20.95) in 2019 with an AAPC of 0.08 % (0.05 % to 0.10 %), and the age-standardized prevalence rate significantly increased from 391.40 (372.71 to 411.20) to 399.50 (378.31 to 420.75) with an AAPC of 0.02 % (0.00 % to 0.05 %). At the regional level, the greatest burden of NRVHD was seen in parts of high-income North America. At the national level, the highest age standardized incidence rate, age standardized DALY rate, and age standardized mortality rate in 2019 were all from Niger, Philippines and Belarus, making it the region with the greatest burden of NRVHD. The age standardized incidence and DALY rate were higher in women 20.83 (19.68 to 22.02) than in men 18.64 (17.39 to 19.88) globally, while the mortality rate was similar in different genders. The differences between men and women in incidence, DALY and mortality were mainly found in age groups of 80-84 and 85-89 years. A significant negative association was found between estimated annual percentage change (EAPCs) and age standardized rate (q=-0.19, p = 0.00). A significant positive relation was detected between EAPCs and human development index (q = 0.17, p = 0.02). The main attributable risk factor for DALY was high body mass index in all regions by SDI.

CONCLUSION

There is a substantial global burden of NRVHD in older adults in 2019, which is varied by age, gender, SDI and region. NRVHD in older people should be paid attention to. Risk factors described here should provide more evidence and clues for disease prevention in the future.

Research progress of circular RNA FOXO3 in diseases (review)

Circular RNAs (circRNAs) are a newly discovered class of endogenous non-coding RNAs with a closed-loop structures, and they exert crucial regulatory functions in diverse biological processes and disease development through the modulation of linear RNA transcription, downstream gene expression, and protein translation, among others. Circular RNA FOXO3(circFOXO3, Hsa_circ_0006404) originates from exon 2 of the FOXO3 gene and exhibits widespread cytoplasmic expression in eukaryotic cells. It shows specific expression in different tissues or cells. Recent research has associated circFOXO3 with various diseases such as cancer, cardiovascular diseases, neurological disorders, senescence, and inflammation. However, a comprehensive review of the research progress of circFOXO3 in human diseases has not been conducted. In this paper, we provide a systematic review of the latest advances in circFOXO3 research in diseases, elucidate its biological functions and potential molecular mechanisms, and discuss the future directions and challenges in circRNAs research to provide valuable references and inspiration for research in this field.

Persisting Chronic Periodontal Disease as a Risk Factor for Cardiovascular Disease: A Nationwide Population-Based Cohort Study

AIMS

Epidemiological studies have consistently established a positive association between periodontal disease (PD) and cardiovascular disease (CVD). However, large-scale investigations exploring the impact of changes in PD status on CVD risk are scarce. This study aimed to investigate the association between the dynamics in PD and the risk of incident CVD in a nationally representative population.

METHODS

Utilising data from the Korean National Health Insurance Service, a cohort of 1,242,570 participants who underwent oral health exams in 2003 and a follow-up exam in 2005-2006 was analysed. Participants were categorized into groups based on changes in PD status: absent, improvement, onset and persistent. Cox proportional hazard models were employed to assess the multivariate-adjusted hazard ratios (HRs) for composite CVD outcomes, including death, myocardial infarction and stroke.

RESULTS

Over a mean follow-up of 14.4 years, 79,810 (6.4%) cases of composite CVD occurred, including 14,296 (1.2%) myocardial infarctions, 3247 (0.3%) hemorrhagic strokes and 8900 (0.7%) ischemic strokes. Individuals with persistent PD showed the highest risk of CVD (HR: 1.04, 95% CI: 1.03-1.06, p < 0.001). In the pairwise comparisons, the PD improvement group exhibited a lower composite CVD risk than the PD persistent group (HR: 0.97, 95% CI: 0.96-0.99, p = 0.010); similarly, the PD onset group showed a lower risk than the PD persistent group (HR: 0.94, 95% CI: 0.93-0.96, p < 0.001). This pattern was consistent in the risk of death, with both the PD improvement and PD onset groups showing a lower risk of death than the PD persistent group.

CONCLUSION

This study suggests the dynamic nature of PD as a potential modifiable risk factor for CVD. Individuals with chronically persistent PD showed an elevated incidence risk of CVD, emphasizing the importance of managing PD in preventive strategies.

Relationship between older coronary heart disease patients' phase II cardiac rehabilitation intentions, illness perceptions, and family caregivers' illness perceptions

BACKGROUND

Intention is an important factor in encouraging patients to receive cardiac rehabilitation. Illness perceptions of patients and individuals around them, such as family caregivers, may influence intention. However, no study has explored how family caregivers' illness perceptions enhance older coronary heart disease (CHD) patients' phase II cardiac rehabilitation intentions.

OBJECTIVES

To describe older CHD patients' phase II cardiac rehabilitation intentions and their relationship with family caregivers' illness perceptions and to examine the mediating role of patients' illness perceptions.

METHODS

A descriptive cross-sectional study was conducted among 202 older CHD patient‒family caregiver dyads. The Chinese versions of the Revised Illness Perception Questionnaire, Willingness to Participate in Cardiac Rehabilitation Questionnaire (WPCRQ), and Cardiac Rehabilitation Inventory (CRI) were adopted. Data analysis included descriptive statistics, Pearson correlations, and structural equation modeling. Reporting followed the STROBE checklist.

RESULTS

Patients were 69.81 years and mostly male (64.85 %); family caregivers were 52.58 years and mostly female (55.94 %). Family caregivers' personal control had a direct effect on patients' phase II cardiac rehabilitation intentions (βWPCRQ = -0.217, βCRI = -0.228; P = 0.001). Family caregivers' personal control, treatment control, and timeline acute/chronic had indirect effects on patients' cardiac rehabilitation intentions through patients' corresponding dimensions of illness perceptions (|β|WPCRQ = 0.086∼0.098, |β|CRI = 0.062∼0.097; P < 0.05).

CONCLUSION

Family caregivers' illness perceptions can affect patients' phase II cardiac rehabilitation intentions directly and indirectly through patients' illness perceptions. Interventions targeting illness perceptions in both older CHD patients and their family caregivers could be provided to improve patients' phase II cardiac rehabilitation intentions.

Clinical Trials in Hypertension: A Mathematical Endorsement for Diagnosis and Treatment

Elevated blood pressure (BP) remains the leading cause of mortality globally, and efforts to control it have been disappointing. Meta-analyses of antihypertensive randomized controlled trials reveal a near-exact reversal of the BP-related risks identified in cohort studies. For an observed increase in cardiovascular disease risk of 12.5%, 25%, 50%, and 75% with a 5, 10, 20, or 40 mm Hg higher level of BP, respectively, the corresponding BP reductions in antihypertensive randomized controlled trial meta-analyses document a reversal of risks by 7%, 17% of 22%, 54%, and 64%, respectively, providing almost perfect mathematical concordance between the observed and expected benefit of antihypertensive treatment. Treatment benefits have been demonstrated across a wide range of baseline BPs and in individuals with and without prior established cardiovascular disease. Meta-analyses of antihypertensive treatment randomized controlled trials also indicate that the treatment benefits far outweigh any potential risks for adverse effects. The mathematical evidence of the effectiveness of BP-lowering in reducing the incidence of BP-related cardiovascular disease without imposing relevant adverse effects should be considered by clinicians and guideline committees in defining the diagnosis of hypertension and establishing antihypertensive treatment goals. Setting lower BP values for the diagnosis and treatment of hypertension could yield a substantial reduction in the global burden of disease due to high BP.

A digital tool for self-reporting cardiovascular risk factors: The RADICAL study

Aims

Cardiovascular diseases remain the leading cause of death worldwide. Risk stratification and early interventions are essential to overcome this reality. The RADICAL Study ( R isk A ssessment via D igital I nput for C ardiovascular A nd L ifestyle Factors) aimed to evaluate the prevalence of self-reported cardiovascular risk factors in individuals without known cardiovascular disease using a digital tool.

Methods and results

A digital self-reported cardiovascular risk stratification tool, comprising 23 questions about classical and lifestyle cardiovascular risk factors, was completed by 4149 individuals aged 40-69 years (median age 53.0 [47.0; 60.0] years; 78 % women). Among the cardiovascular risk factors, 40.9 % reported hypercholesterolemia, 26.8 % hypertension, 17.3 % smoking, 5.8 % diabetes, 58.4 % physical inactivity, 19.4 % obesity, 33.7 % sleep less than 7 h/night, and 12.1 % had composite dietary risk factors. Most of the participants (89.9 %) referred having at least one of the eight cardiovascular risk factors. Women had 27 % higher odds of having at least one cardiovascular risk factor compared to men (OR = 1.27, 95 % CI [1.00, 1.60]). Participants aged 50-59 years also had higher odds of having at least one CV risk factor compared to those aged 40-49 years (OR = 1.35, 95 % CI [1.07, 1.70]).

Conclusion

The RADICAL Study reveals a high prevalence of cardiovascular risk factors in adults without known cardiovascular disease. Beyond the relevance of traditional risk factors, such as hypercholesterolemia and hypertension, the results regarding physical activity, dietary and sleeping habits are concerning. A self-reported cardiovascular risk identification digital tool could be feasible and help to improve cardiovascular prevention.

Kappa opioid receptor internalisation-induced p38 nuclear translocation suppresses glioma progression

BACKGROUND

Recent studies have implicated a role for perioperative medications in determining patient outcomes after surgery for malignant tumours, including relapse and metastasis.

METHODS

A combined approach spanned molecular, cellular, and organismal levels, including bioinformatics, immunohistochemical staining of clinical and animal samples, RNA sequencing of glioblastoma multiforme (GBM) cells with Ingenuity Pathway Analysis, lentiviral-mediated gene expression modulation, in vitro cell experiments, and in vivo orthotopic tumour transplantation.

RESULTS

We observed a significant correlation between increased kappa opioid receptor (KOP receptor) expression and better prognosis in patients with glioma. Exogenous KOP receptor overexpression in GBM cells in vitro induced cell cycle arrest, suppressed cell growth, and promoted apoptosis. Conversely, reducing KOP receptor expression in GBM cells reduced the proportion of cells in S and G2/M phases, accelerating cell growth. KOP receptor overexpression inhibited glioma cell growth and prolonged survival in mice in vivo, while KOP receptor knockdown had the opposite effect. Mechanistically, internalised KOP receptors were found to bind cytoplasmic p38, facilitating its nuclear translocation and phosphorylation, which influences downstream gene expression. The selective KOP receptor agonist TRK-820 triggered KOP receptor internalisation, activated the p38 pathway, and diminished glioma cell viability in vitro.

CONCLUSIONS

This combined molecular, cellular, and in vivo approach supports use of KOP receptor agonists as potential adjuvant therapeutics for glioma.

Toxicity and efficacy study of a combination of two retinoic acids in an ApoE knockout mouse model of atherosclerosis

Atherosclerosis is a major contributor to cardiovascular disease, characterized by inflammation and lipid accumulation in arterial walls, leading to plaque formation. Elevated low-density lipoprotein cholesterol is a primary risk factor for atherosclerosis. All-trans retinoic acid (ATRA), a metabolite of vitamin A, has demonstrated anti-inflammatory effects and potential in regulating vascular injury. 9-cisretinoic acid (9cRA) is an active metabolite of vitamin A and activates the retinoid X receptor. This study investigates whether potassium retinoate (PA9RA), a synthetic combination of ATRA and 9cRA, offers superior efficacy in treating atherosclerosis compared to established treatments such as clopidogrel and atorvastatin. Male ApoE-/- mice were fed a Western-type diet and treated with PA9RA, clopidogrel, or atorvastatin for 10 weeks. The body weight, organ weight, serum biochemistry, and histopathology, including atherosclerotic lesion area and liver steatosis were assessed. PA9RA treatment led to a significant reduction in body weight and inguinal fat, with the 45 mg/kg/day dose showing marked efficacy in decreasing atherosclerotic lesion size and ameliorating liver steatosis. Histopathological evaluation revealed decreased foam cell formation and improved liver histology in PA9RA-treated groups compared to controls. Notable side effects included epidermal hyperplasia and gastric hyperplasia at high doses of PA9RA. PA9RA exhibits superior efficacy over clopidogrel and atorvastatin in ameliorating atherosclerosis and fatty liver in ApoE-/- mice. This study highlights PA9RA's potential as a promising therapeutic agent for atherosclerosis. Further research is needed to elucidate its mechanisms of action and assess long-term safety and efficacy.

Potential of SIRT6 modulators in targeting molecular pathways involved in cardiovascular diseases and their treatment-A comprehensive review

Cardiovascular disease (CVD) is the leading cause of mortality and morbidity, accounting for major public health concerns worldwide. CVD poses an immense burden on the global healthcare system and economy. Ischemic heart disease, stroke, heart failure, atherosclerosis, and hypertension are the major diseases belonging to CVDs and ischemic heart diseases and stroke contribute to most CVD-induced deaths. Previously published review articles focused on the role of SIRT6 in CVDs but did not focus on the important role of SIRT6 in modulating the signaling pathways involved in CVDs and targeting them to treat CVDs. Thus, this review aims to identify and delineate the major signaling pathways that are involved in CVDs and whether SIRT6 can modulate those pathways to improve and treat CVDs. Alongside possible applications of small molecule modulators of SIRT6 in cardiovascular disease treatment have been comprehensively analyzed.

Low Back Pain Incidence Trends Globally, Regionally, and Nationally, 1990-2019: An Age-Period-Cohort Analysis, Cross-Sectional Studies

INTRODUCTION

Low back pain (LBP) imposes a significant burden on global health, yet it remains deficient in comprehensive investigations pertaining to its incidence patterns. The aim of this study was to analyse global, regional and national trends and associated factors in the incidence of LBP from 1990-2019.

METHODS

In order to examine global and country-specific 30-year incidence patterns of LBP, data were obtained from the 2019 Global Burden of Disease Study. An age-period cohort (APC) model was utilised to determine annual percent changes, age-specific changes, and period/cohort effects.

RESULTS

The age-standardized global LBP incidence rate significantly declined from 1990-2019. However, the absolute number of cases increased by 2.39 billion, predominantly in middle-, low-middle- and low-socio-demographic index (SDI) regions, affecting mostly 50-69 years old with a higher incidence in women. LBP incidence increased progressively from low to high SDI regions. Period and cohort effects trended downward in all regions except high-SDI countries, which had the lowest incidence decline and a slight rebound after 2012.

CONCLUSIONS

Our study updates global and regional LBP incidence from 1990-2019 using APC modelling, showing declining age-standardized rates globally but increased case numbers due to population growth and ageing. Prevention likely helped reduce incidence, but more health strengthening and minimally invasive treatments are still needed, especially where LBP has plateaued or rebounded recently.

Role of MicroRNAs in regulating sarcoplasmic reticulum calcium handling and their implications for cardiomyocyte function and heart disease

The regulation of calcium signaling within cardiomyocytes is pivotal for maintaining cardiac function, with disruptions in sarcoplasmic reticulum (SR) calcium handling linked to various heart diseases. This review explores the emerging role of microRNAs (miRNAs) in modulating SR calcium dynamics, highlighting their influence on cardiomyocyte maturation, function, and disease progression. We present a comprehensive overview of the mechanisms by which specific miRNAs, such as miR-1, miR-24, and miR-22, regulate key components of calcium handling, including ryanodine receptors, SERCA, and NCX. Notably, we identify critical research gaps, particularly the inconsistent findings regarding miRNA expression in heart disease and the need for standardized experimental conditions. Furthermore, we emphasize the potential of miRNAs as therapeutic targets, given their ability to influence calcium handling pathways and cardiac remodeling. The review also discusses the challenges in translating miRNA research into clinical applications, including the need for safe and effective delivery methods. By synthesizing current knowledge and identifying areas for future investigation, this review aims to provide insights into the therapeutic potential of miRNAs in diagnosing and treating heart diseases, ultimately contributing to improved patient outcomes.

Success rate of fiducial marker placement for treatment of esophageal or rectal cancers: a prospective multicenter study (FIDECHO study) (with video)

BACKGROUND AND AIMS

EUS-guided placement of fiducial markers in patients with esophageal or rectal cancer who have been referred for radiation therapy lacks data regarding its feasibility and safety. The aim of this study was to assess the success rate of EUS-guided fiducial marker placement in these indications.

METHODS

This prospective multicenter study enrolled patients with rectal or esophageal tumors who were treated between March 2017 and June 2021. The primary endpoint was the success of fiducial marker placement under EUS guidance utilizing the preloaded 22-gauge EchoTip Ultra Fiducial Needle (Cook Medical, Limerick, Ireland), defined by the ability to release fiducials at least at the proximal and distal ends of the tumor. Secondary endpoints were the adverse events, length of procedure, and fiducial markers remaining throughout radiation therapy.

RESULTS

A total of 33 patients were included in this study, with a mean age of 64.2 ± 11.3 years; 66.7% were male. Twenty patients had rectal adenocarcinoma, and 13 had esophageal malignancies. The success rate of fiducial marker placement was 93.9%. Markers could only be released at the proximal end of the tumor in 2 cases. The average procedure time (±SD) was 12.5 ± 4.8 minutes. The number of fiducial markers placed for each patient was 3.8 ± .5. No adverse events were reported. At the end of radiotherapy, markers were still visible on imaging in all patients.

CONCLUSIONS

This prospective multicenter study highlights the safety and high success of the placement of fiducial markers under EUS guidance for rectal and esophageal tumors, with no adverse events and with a short procedure time. Fiducial markers remained in place over time during radiation therapy. (Clinical trial registration number: NCT03057288.).

Is the triglyceride-glucose index ready for cardiovascular risk assessment?

AIMS

Insulin resistance is a major risk factor for cardiovascular disease. Thus, early identification of insulin resistance is important for classifying individuals at high cardiovascular risk. All the tools commonly used in epidemiological studies and clinical practice to assess insulin resistance require measuring insulin levels, which is a limitation. Hence, simpler methods have been proposed to overcome these limitations. One of the most promising is the triglyceride-glucose index. Therefore, this narrative review focuses on the most significant epidemiological findings concerning the relationship between the triglyceride-glucose index and cardiovascular risk. Furthermore, it also highlights this new tool's strengths, limitations, and perspectives for assessing cardiovascular risk.

DATA SYNTHESIS

Even though the assessment of this index is relatively recent, there are numerous papers on this topic, and their number is constantly increasing. Observational studies have shown a substantial positive association between the triglyceride-glucose index and cardiovascular risk, although some conflicting results have been observed.

CONCLUSIONS

The index is strongly associated with cardiovascular mortality and cardiovascular risk factors. However, some gaps need to be addressed.

Walking the VLDL tightrope in cardiometabolic diseases

Very-low-density lipoprotein (VLDL), a triglyceride-rich lipoprotein secreted by hepatocytes, is pivotal for supplying peripheral tissues with fatty acids for energy production. As if walking on a tightrope, perturbations in the balance of VLDL metabolism contribute to cardiometabolic dysfunction, promoting pathologies such as cardiovascular disease (CVD) or metabolic dysfunction-associated steatotic liver disease (MASLD). Despite the advent of lipid-lowering therapies, including statins and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, risks for cardiovascular events persist. With limitations to currently available CVD therapeutics and no US Food and Drug Administration (FDA)-approved treatment for MASLD, this review summarizes the current understanding of VLDL metabolism that sheds light on novel therapeutic avenues to pursue for cardiometabolic disorders.

Rate Versus Rhythm Control for Atrial Fibrillation with Heart Failure

Atrial fibrillation with Heart Failure is a constellation of co-morbid conditions that now constitutes a major cardiovascular epidemic, with HF now the most common complication of AF. Mechanistically, both conditions promote substrate disease in the atrium and ventricle. AF is an independent rixk factor in HF progression and pump failure death. While early studies comparing rhythm control antiarrhythmic drugs and rate control drugs showed no significant benefit in cardiovascular outcomes, AF did promote HF emergence and hospitalizations. Newer rhythm control strategies with present day antiarrhythmic drugs and catheter ablation support benefits in cardiovascular outcomes in AF with HF. Catheter ablation improved HF outcomes in HF with reduced ejection fraction but further and larger studies are needed, especially for AF with HF with preserved ejection fraction.

Role of circRNAs in regulating cell death in cancer: a comprehensive review

Despite multiple diagnostic and therapeutic advances, including surgery, radiation therapy, and chemotherapy, cancer preserved its spot as a global health concern. Prompt cancer diagnosis, treatment, and prognosis depend on the discovery of new biomarkers and therapeutic strategies. Circular RNAs (circRNAs) are considered as a stable, conserved, abundant, and varied group of RNA molecules that perform multiple roles such as gene regulation. There is evidence that circRNAs interact with RNA-binding proteins, especially capturing miRNAs. An extensive amount of research has presented the substantial contribution of circRNAs in various types of cancer. To fully understand the linkage between circRNAs and cancer growth as a consequence of various cell death processes, including autophagy, ferroptosis, and apoptosis, more research is necessary. The expression of circRNAs could be controlled to limit the occurrence and growth of cancer, providing a more encouraging method of cancer treatment. Consequently, it is critical to understand how circRNAs affect various forms of cancer cell death and evaluate whether circRNAs could be used as targets to induce tumor death and increase the efficacy of chemotherapy. The current study aims to review and comprehend the effects that circular RNAs exert on cell apoptosis, autophagy, and ferroptosis in cancer to investigate potential cancer treatment targets.

Characteristics of genomic alterations and heavy metals in hypertensive patients with non‑small cell lung cancer

Both lung cancer and cardiovascular disease (CVD) are prevalent diseases that contribute to global mortality rates. Although individuals with CVD may face an elevated risk of cancer based on the presence of shared risk factors (such as tobacco smoking and excessive body weight), the roles of somatic mutations and heavy metal distributions remain unknown. The present study aimed to explore the differences in somatic mutations and heavy metal distributions between hypertensive patients and non-hypertensive patients in a cohort of patients with non-small cell lung cancer (NSCLC). Tumor tissue samples from 64 patients were analyzed using a next-generation sequencing panel consisting of 82 tumor-related genes through hybrid capture. Serum samples were also analyzed to determine the levels of 18 heavy metals using inductively-coupled plasma mass spectrometry. Among the 16 hypertensive patients, all patients (16/16; 100.00%) harbored 47 somatic mutations in 14 mutant genes, whereas 45 patients without hypertension (45/48; 93.75%) harbored 113 somatic mutations across 26 mutant genes (no mutations were detected in the remaining 3 patients). Among the 32 identified mutant genes in these two groups, FBXW7, CBR3, CDKN2A, HRAS, SMO and UGT1A1 were exclusively observed in patients with hypertension, while 18 mutant genes were only observed in patients without hypertension. No significant mutually exclusive interactions were found in hypertensive patients, but mutually exclusive interactions were observed between EGFR and STK11 (P=0.0240) and between STK11 and KRAS (P=0.0169) in non-hypertensive patients. 'Non-small cell lung cancer' was the top Kyoto Encyclopedia of Genes and Genomes pathway in hypertensive patients, whereas 'central carbon metabolism in cancer' was the top pathway in patients without hypertension. Moreover, the proportions of altered key signaling pathways and biological function categories shared between these two groups were 54.37% (56/103) and 21.62% (8/37), respectively. Furthermore, the levels of chromium (Cr) in the serum of hypertensive patients were notably elevated compared with those in patients without hypertension. In addition, significant negative correlations were observed between Cr and CEA, between CYFRA21-1 and Zn, and between NSE and As in hypertensive patients but not in non-hypertensive patients, indicating differing interactive profiles among the traditional serum biomarkers and heavy metals between these two patient groups. In summary, there were differences in genomic alterations, somatic interactions and the serum levels of Cr between patients with NSCLC with hypertension and patients with NSCLC without hypertension. Furthermore, patients with hypertension exhibited significant negative correlations between Cr and CEA, between CYFRA21-1 and Zn, and between NSE and As, suggesting that heavy metals may contribute to the occurrence of NSCLC with different hypertensive status.

Factors related to the treatment burden of patients with coronary heart disease: A cross-sectional study

BACKGROUND

Treatment burden is a significant barrier to patient adherence that may lead to deterioration of health.

OBJECTIVES

The purpose of this study was to understand the treatment burden of Chinese patients with coronary heart disease (CHD) and its associations with demographic, capacity, and workload-related factors.

METHODS

We conducted an observational cross-sectional study. We recruited 396 patients with CHD in a tertiary hospital in Shandong Province, China. Self-report questionnaires were used to measure patients' sociodemographic information, clinical information, treatment burden, health literacy, illness perception, and chronic illness resources. Descriptive statistics and t-tests, one-way analysis of variance, Pearson's correlation analysis, and multiple linear regression analysis were used for data analysis.

RESULTS

A total of 396 participants were included, of whom 273 were male (68.9 %) and 123 were female (31.1 %). The mean age of the participants was 63.10 ± 9.75. The predictors for treatment burden included smoking, taking ≥ 6 kinds of medications/day, health literacy, illness perception, and chronic illness resources, which explained 50.9 % of the variance (p < 0.05).

CONCLUSION

Our findings indicate an association between treatment burden and factors such as smoking, taking ≥ 6 kinds of medications/day, health literacy, illness perception, and chronic illness resource survey. Healthcare staff should develop targeted interventions based on relevant factors and optimize treatment strategies to improve patient adherence.

The use of virtual reality-assisted interventions on psychological well-being and treatment adherence among kidney transplant recipients: A randomized controlled study

This randomized controlled trial aims to investigate the effects of educational and psychological interventions on the health outcomes of patients suffering from chronic diseases. We recruited 372 patients and randomly assigned them to one of two intervention arms during the trial, which lasted for a year. Both groups participated in a 12-month intervention program, where the intervention group received health education and supportive psychological therapy utilizing virtual reality (VR) technology, while the control group received conventional health education guidance. Statistical analysis showed that compared to the control group, the intervention group demonstrated significant improvements (p < 0.05) in depression assessment scores, compliance scores, and Barthel functional scoring. However, the two groups had no significant difference in the incidence of complications and health knowledge mastery. Additionally, the intervention group had fewer hospitalization days than the control group, with statistically significant differences. The research results prove that targeted intervention effectively improves medication adherence, patient awareness, and reduces patient hospitalization days, which is particularly important for managing chronic diseases.

The monogenic landscape of human infectious diseases

The spectrum of known monogenic inborn errors of immunity is growing, with certain disorders underlying a specific and narrow range of infectious diseases. These disorders reveal the core mechanisms by which these infections occur in various settings, including inherited and acquired immunodeficiencies, thereby delineating the essential mechanisms of protective immunity to the corresponding pathogens. These findings also have medical implications, facilitating diagnosis and improving the management of individuals at risk of disease.

Immersive virtual reality reduces depression, anxiety and stress in patients with cardiovascular diseases undergoing cardiac rehabilitation: A systematic review with meta-analysis

BACKGROUND

Current literature suggests that immersive virtual reality (IVR) could be an efficacious therapeutic approach for patients with cardiovascular diseases (CVD) undergoing cardiac rehabilitation program (CRP). However, this has only been affirmed in individual studies and is yet to be confirmed by a systematic review.

OBJECTIVES

To determine the efficacy of IVR interventions on depression, anxiety, and stress symptoms in patients with CVD.

METHODS

A meta-analysis was performed in line with PRISMA guidelines following a literature search between inception and June 2024 in PubMed, SCOPUS, WOS, CINAHL and PEDro for retrieving randomized controlled trials (RCTs) that compared the efficacy of IVR versus conventional CRPs on depression, anxiety and stress in patients with CVD. The PEDro scale was used to evaluate the methodological quality of the studies. Pooled effects were calculated using the Cohen's standardized mean difference (SMD) and its 95% confidence interval (95% CI), or mean difference (MD) if studies used the same measure.

RESULTS

Eight RCTs, providing data from 510 patients with CVD (63.8±5.4 years, 60% men), were included. The methodological quality was moderate (M=5.1±1 points). A large rehabilitative effect of IVR was found for reducing depression (SMD=-0.54; 95% CI -0.77 to -0.31; p<0.001), anxiety (SMD=-0.43; 95% CI -0.74 to -0.12; p=0.006) and stress (MD=-14.96; 95% CI -20.1 to -9.8; p<0.001). The findings suggest that combine IVR and CRP is the most appropriate approach for reducing depression, anxiety and stress.

CONCLUSION

IVR, especially when combined with a traditional CRP, reduces depression, anxiety and stress in patients with CVD.

Goal attainment, medication adherence and guideline adherence in the treatment of hypertension and dyslipidemia in Irish populations: A systematic review and meta-analysis

Background

The appropriate treatment high blood pressure (BP) and low-density lipoprotein cholesterol.(LDL-C), according to clinical guidelines, reduces a patient's risk of a cardiovascular event.

Aim

This systematic review aims to evaluate the attainment of BP and LDL-C goals among the Irish population in both primary and secondary prevention of cardiovascular diseases, the level of adherence to prescribing guidelines by doctors and the level of medication adherence among patients.

Methods

Five databases were searched in March 2024. Quantitative articles reporting levels of goals attainment, medication adherence or guideline adherence for LDL-C and BP among Irish adults aged ≥18 years were included. The proportion of patients attaining their LDL-Cor BP goals were statistically combined using the random effect model.

Results

Following screening, 23 eligible articles were identified. The achievement of LDL-C <1.8 mmol/L was 41 % (95 % CI 31,52), compared to 69 % of people (95 % CI 62,76) reported to have achieved the less stringent goal of LDL-C < 3 mmol/L. The achievement of BP < 140/90 mmHg was 56 % (95 % CI 46,65). Medication adherence levels ranged between 27 % and 92 %. Guideline adherence findings demonstrated that not all patients who should be on lipid-lowering therapy are and that choice of antihypertensive is not always in line with the guidelines.

Conclusion

Approximately one-third of deaths in Ireland annually are caused by cardiovascular disease, despite being preventable. There is room for improvement in goal attainments in people at risk of CVDs and optimization of medication adherence and guideline adherence may be beneficial in this population.

Mechanism and nanotechnological-based therapeutics for tolerance and resistance of bacterial biofilms

Bacterial biofilms are one of the most relevant drivers of chronic and recurrent infections and a significant healthcare problem. Biofilms were formed by cross-linking of hydrophobic extracellular polymeric substances (EPS), such as proteins, polysaccharides, and eDNA, which were synthesized by bacteria themselves after adhesion and colonization on biological surfaces. They had the characteristics of dense structure and low drug permeability, leading to tolerance and resistance of biofilms to antibiotics and to host responses. Within a biofilm, microbial cells show increased tolerance to both immune system defense mechanisms and antimicrobials than the same cells in the planktonic state. It is one of the key reasons for the failure of traditional clinical drug to treat infectious diseases. Currently, no drugs are available to attack bacterial biofilms in the clinical setting. The development of novel preventive and therapeutic strategies is urgently needed to allow an effective management of biofilm-associated infections. Based on the properties of nanomaterials and biocompatibility, nanotechnology had the advantages of specific targeting, intelligent delivery and low toxicity, which could realize efficient intervention and precise treatment of biofilm-associated infections. In this paper, the mechanisms of bacterial biofilm resistance to antibiotics and host response tolerance were elaborated. Meanwhile, This paper highlighted multiple strategies of biofilms eradication based on nanotechnology. Nanotechnology can interfere with biofilm formation by destroying mature biofilm, modulating biofilm heterogeneity, inhibiting bacterial metabolism, playing antimicrobial properties, activating immunity and enhancing biofilm penetration, which is an important new anti-biofilm preparation. In addition, we presented the key challenges still faced by nanotechnology in combating bacterial biofilm infections. Utilization of nanotechnology safely and effectively should be further strengthened to confirm the safety aspects of their clinical application.

Cardiovascular and Risk Factor Outcomes for Ethnic Minorities From Cardiac Rehabilitation: A Systematic Review and Meta-Analysis

PURPOSE

To determine the benefits of cardiac rehabilitation (CR) among ethnic minorities for cardiovascular risk factors (systolic blood pressure [BP], exercise capacity, lipids, body fat), mortality, and morbidity, and compare outcomes to majority reference groups.

REVIEW METHODS

We searched electronic databases (Medline, EMBASE, CINAHL, Scopus, Cochrane Library) from inception until September 2023 for studies reporting CR outcomes of ethnic minorities. Meta-analyses were conducted for data that could be pooled using random effects model. Data that were not suitable for meta-analysis were synthesized and reported narratively.

SUMMARY

Thirteen studies with a total of 132 109 participants (10 494 from ethnic minorities [8% of total participants]) were included. Patients from ethnic minority groups made improvements in several outcomes post-CR. These outcomes were equivalent to majority groups for systolic BP (Mean Difference [MD] = -0.69: 95% CI, -1.62 to 0.24 mmHg), maximal exercise capacity (MD = -0.10: 95% CI, -0.63 to 0.44 metabolic equivalents of task), total cholesterol (MD = 0.16: 95% CI, -0.01 to 0.33 mmol/L), and low-density lipoprotein cholesterol (MD = 0.25: 95% CI, -0.04 to 0.54 mmol/L). However, ethnic minorities achieved less improvements than the majority for body mass index (MD = -0.31: 95% CI, -0.47 to -0.14 kg/m2) and waist circumference (MD = -1.50: 95% CI, -2.33 to -0.68 cm). Narrative synthesis indicated equivalent outcomes for minorities for all-cause mortality and mean cholesterol, with worse risk of hospitalization at 1 year. Patients from ethnic minorities attending CR achieve equivalent benefits to majority counterparts for multiple risk factors and potentially mortality and morbidity, therefore CR should be strongly promoted. Individual tailoring may be needed to address adiposity and exercise capacity.

Association Between Skin Autofluorescence and Coronary Heart Disease in Chinese General Population: A Cross-Sectional Study

OBJECTIVE

The aim of this study was to investigate the relationship between SAF and CHD in the general population of China and to assess the feasibility of SAF used as a predictor of CHD.

METHODS

This study was nested within the prospective study REACTION (Cancer Risk Assessment in Chinese Diabetic Population) which included a total of 5806 eligible participants from two communities located in urban Beijing in 2018. SAF were measured using a fluorescence detector (DM Scan). CHD was the study endpoint and was determined by a face-to-face clinical survey. Pearson's correlation analysis, linear regression analysis, and binary logistic regression analysis were used to examine the association between SAF and CHD.

RESULTS

The overall prevalence of CHD in the general population was 12.1%. Logistic analysis showed that after full adjustment for confounding factors, the risk of CHD increased significantly with increasing lnSAF quartiles (p-trend < 0.05). Compared to Q1 group, the multivariate adjusted ORs of Q2 and Q3 groups were 1.071 (0.817, 1.404), 1.025 (0.781, 1.344), respectively, and the OR was markedly increased at Q4 (OR = 1.377 [1.043, 1.817]). When lnSAF was a continuous variable, the risk of CHD increased with the elevation of lnSAF level. Stratified analysis showed that in subgroups with overweight (24-28 kg/m2), eGFR < 60 mL/min/1.73 m2, and diabetes mellitus (DM), lnSAF was still significantly correlated with CHD.

CONCLUSIONS

In Chinese general population, higher lnSAF is independently associated with increased risk of CHD, and noninvasive SAF holds the potential to be a biomarker for CHD risk evaluation and stratification.

Measuring health-related quality of life in cardiovascular disease using a novel patient-centred and disease-specific patient-reported outcome measure

Background

Assessment of health-related quality of life (HRQoL) in patients with cardiovascular disease (CVD) is impaired by limitations of current patient-reported outcome measures (PROMs). We developed the first cardiovascular disease (CVD) specific electronic PROM for which health items were derived by a fully patient-centered method. This paper reports on the measurement of HRQoL in CVD patients by a novel developed electronic patient-centred PROM based on a preference-based measurement model.

Methods and results

In an earlier patient-based study nine health items were selected as most important to CVD patients. These items were assessed in the novel preference-based PROM of this study. CVD patients registered with a Dutch patient organization were asked to rate their health state. We compared HRQoL between subgroups of age, gender and CVD. A total of 554 patients participated in this study. The patient reported health items "worry", "self-reliance" and "sexuality" had the highest impact on HRQoL of CVD patients. Median HRQoL was better for men compared to woman (-17.04, IQR: 31.47 to -3.91 vs. -25.22; IQR: 42.06 to -9.53, p = 0.003). Best and worst HRQoL were observed in patients with an unknown or other CVD disease (-15.61, IQR: 28.52 to -3.91) followed by individuals with coronary artery disease (-16.99, IQR: 38.08 - 0.00) and heart failure (-24.27, IQR: 42.64 to -12.98).

Conclusions

This novel patient-centred, preference-based, CVD-specific PROM accurately measures HRQoL by taking individual health preferences into account and tackling limitations of current PROMs. This PROM is therefore promising to evaluate interventions and optimize personalized therapies.

Effectiveness of acupuncture on glycolipid metabolism in patients with coronary heart disease: A systematic review and meta-analysis

OBJECTIVE

Disorders of glycolipid metabolism are important pathogenic factors leading to coronary artery disease, and there is no safe and effective comprehensive treatment, while acupuncture has a certain efficacy in heart disease and disorders of glycolipid metabolism. To assess the effects of acupuncture on glycolipid metabolism in patients with coronary heart disease, we conducted a systematic review and meta-analysis.

METHODS

From the time of library construction to August 18, 2023, Searches were conducted in eight databases, with no language restriction. Only RCTs that included acupuncture as a sole or secondary effect on glucose-lipid metabolism in coronary heart disease were included.Our primary outcome indicators were Low-density lipoprotein cholesterol(LDL-C), Hemoglobin A1c(HbA1c). Our analyses were conducted in strict accordance with the PRISMA statement, and the researchers used the Cochrane Handbook for literature screening and data extraction, the "Risk of Bias" tool (ROB.2) for assessing risk of bias, and RevMan (version 5.3) for meta-analysis of outcome metrics, and the GRADE criteria for assessing quality of evidence. Assessing the quality of acupuncture literature using the Standards for reporting interventions in clinical trials of acupuncture.

RESULTS

Our analysis included 18 eligible RCTs (N = 1346 participants). For the primary outcome metrics, acupuncture combined with standard treatment was effective in reducing LDL-C (SMD =-0.56; 95 % CI, -0.75 to -0.38; P < 0.00001), and HbA1c (MD = -1.15; 95 % CI, -1.73 to -0.58; P < 0.0001). For secondary outcome measures, combination therapy improved TC (SMD = -0.97; 95 % CI, -1.44 to -0.51; P < 0.0001), TG (MD = -0.39; 95 % CI, -0.58 to -0.20; P < 0.0001), hs-CRP (MD = -0.98; 95 % CI, -1.43 to -0.52; P <0.0001), 2hPG (MD = -1.45; 95 % CI, -1.74 to -1.16; P < 0.00001), and ORR (RR, 1.27; 95 % CI, 1.19-1.36; P < 0.00001) levels more than standard therapy alone.However, the combination therapy did not prevail in lowering HDL-C (MD = 0.11; 95 % CI, 0.07-0.14; P < 0.00001) compared with standard therapy alone. Meanwhile heterogeneity analysis showed that After coronary heart disease intervention, acupuncture was able to reduce TC (SMD = -0.85; 95 % CI, -1.37 to -0.33; P = 0.001), TG (MD = -0.14; 95 % CI, -0.24 to -0.04; P = 0.004) levels, but did not dominate in lowering LDL-C.

CONCLUSIONS

Acupuncture effectively regulates glycolipid metabolism in coronary artery disease, serving as an adjuvant treatment. It may aid post-PCI healing via lipid metabolism regulation, but rigorous, large-scale, long-term RCTs are needed for validation.

Vagus nerve stimulation: A targeted approach for reducing tissue-specific ischemic reperfusion injury

Vagus Nerve Stimulation (VNS), a neuromodulation technique of applying controlled electrical impulses to the vagus nerve, has now emerged as a potential therapeutic approach for ischemia-reperfusion insults. It provides a pivotal link in improving functional outcomes for the central nervous system and multiple target organs affected by ischemia-reperfusion injury (I/RI). Reduced blood flow during ischemia and subsequent resumption of blood supply during reperfusion to the tissue compromises cellular health because of the combination of mitochondrial dysfunction, oxidative stress, cytokine release, inflammation, apoptosis, intracellular calcium overload, and endoplasmic reticulum stress, which ultimately leads to cell death and irreversible tissue damage. Furthermore, inflammation and apoptosis also play critical roles in the acute progression of ischemic injury pathology. Emerging evidence indicates that VNS in I/RI may act in an anti-inflammatory capacity, reducing oxidative stress and apoptosis, while also improving endothelial and mitochondrial function leading to reduced infarct sizes and cytoprotection in skeletal muscle, gastrointestinal tract, liver, kidney, lung, heart, and brain tissue. In this review, we attempt to shed light on the mechanistic links between tissue-specific damage following I/RI and the therapeutic approach of VNS in attenuating damage, considering both direct and remote I/RI scenarios. Thus, we want to advance the understanding of VNS that could further warrant its clinical implementation, especially as a treatment for I/RI.

Perioperative respiratory muscle exercise in patients undergoing cardiac surgery: An evidence-based review

BACKGROUND

Enhanced respiratory muscle management is imperative in cardiac surgery patients due to their universal risk of decreased perioperative respiratory muscle strength.

OBJECTIVES

Most existing articles primarily examine respiratory muscle exercise during either the preoperative, postoperative, or at-home phases. Consequently, there is a crucial need to consolidate the evidence for respiratory muscle exercise throughout the perioperative period of cardiac surgery.

METHODS

A literature search was performed, encompassing guideline networks and databases up until July 2023. The literature was classified into seven thematic categories: preoperative assessment, patient education, trainers, training plans, quality control, safety monitoring, and outcome assessment. The quality of the included literature was assessed using the GRAGE evidence grading system to ascertain the level of recommendation associated with each piece of evidence.

RESULTS

Nineteen papers were reviewed, encompassing 24 suggestions. These consisted of two suggestions on preoperative assessment, four on patient education, two on trainers, six on training programs, seven on quality control, two on safety monitoring, and one on outcome assessment. All 24 suggestions were categorized as strong recommendations, with 14 classified as high-quality evidence and ten as moderate-quality evidence.

CONCLUSIONS

Our study presents a succinct synthesis of the most robust evidence available on perioperative respiratory muscle exercise in cardiac surgery patients. We identified ten high-quality suggestions while an additional 14 moderate-quality suggestions. In the context of perioperative exercise, we recommend that moderate-intensity inspiratory muscle exercises be provided during the preoperative and postoperative phases upon transfer to the ward. We advocate for the implementation of low-intensity inspiratory muscle exercises during the postoperative phase while patients are in the intensive care unit.

Sarcopenia and Cardiovascular Diseases in Individuals With Diabetes or Prediabetes

Sarcopenia is a known risk factor for cardiovascular disease (CVD) in individuals with diabetes or prediabetes, but the impact of changes in sarcopenia status on CVD risk remains unclear. This study aimed to examine how changes in sarcopenia status between baseline and the second follow-up survey, conducted 2 years later, influence the risk of developing incident CVD. Incident CVD was identified based on self-reported physician diagnoses of heart disease, such as angina, myocardial infarction, heart failure, or stroke. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for potential confounders. The results showed that participants who progressed from non-sarcopenia to possible sarcopenia or sarcopenia had a higher risk of developing CVD. Their risk was significantly greater compared to those who remained non-sarcopenic (HR 1.37, 95% CI 1.08-1.73). Conversely, individuals who recovered from sarcopenia to non-sarcopenia or possible sarcopenia had a lower risk of CVD. Their risk was lower than those who remained sarcopenic (HR 0.40, 95% CI 0.20-0.82). Among individuals with possible sarcopenia at baseline, those who recovered to non-sarcopenia had a reduced CVD risk. This reduction was significant compared to those who remained in possible sarcopenia (HR 0.62, 95% CI 0.46-0.84). These findings suggest that changes in sarcopenia status have a significant impact on CVD risk, with worsening sarcopenia increasing the likelihood of CVD and recovery lowering the risk in individuals with diabetes or prediabetes.

Development and Validation of a Cardiovascular Disease Risk Prediction Model for the Japanese Working Population: The Japan Epidemiology Collaboration on Occupational Health Study

AIMS

This study aimed to develop a cardiovascular disease (CVD) risk model using data from a large occupational cohort.

METHODS

A risk prediction model was developed using the routine health checkup data of 96,117 Japanese employees (84.0% men) who were 30-64 years of age and had no CVD at baseline. Cox proportional hazards regression models were employed to develop a risk model for assessing the 10-year CVD risk. Measures of discrimination and calibration were used to assess the predictive performance of the model and internal validation was used to examine potential overfitting.

RESULTS

During a mean follow-up period of 6.7 years (range, 0.1-11.0 years), 422 cases of incident CVD were confirmed. The final model, which included predictor variables of age, smoking, diabetes, systolic blood pressure, and low- and high-density lipoprotein cholesterol levels, demonstrated a good predictive ability (Harrell's C-statistic, 0.796; 95% confidence interval, 0.775-0.817) with excellent calibration between observed and predicted values. Internal validation revealed minimal overfitting.

CONCLUSIONS

The developed model can accurately predict the 10-year CVD risk. Because it is based on routine health checkup data, the prediction model can be easily implemented in the workplace. Further studies are required to assess the external validity and transferability of the proposed CVD risk model.

Health determinants among participants in targeted health dialogues offered to all 40-year-old individuals in a metropolitan region of 1.4 million people

OBJECTIVE

To examine cardiovascular risk factors in 40-year-old participants in the health screening program targeted health dialogues (THDs).

DESIGN

Cross-sectional study.

SETTING

99 Swedish healthcare centers.

INTERVENTION

Metabolic risk factors and health behaviors were assessed. THDs were provided.

SUBJECTS

1831 (62.3%) THD participants that consented to take part in the research project.

MAIN OUTCOME MEASURES

(1) Prevalence of metabolic risk factors (blood pressure, LDL cholesterol, fasting plasma glucose, BMI, waist-hip ratio) and unhealthy behaviors (tobacco, alcohol, diet, physical activity) by sex, education, and place of birth. (2) Associations between different health behaviors and between the number of unhealthy behaviors and prevalence of metabolic risk factors. (3) THD participation by sociodemographics compared to age-matched controls.

RESULTS

Men had a higher prevalence of all metabolic risk factors, excessive alcohol use and tobacco use than women. Lower educated individuals had a higher prevalence of metabolic risk factors (except for LDL cholesterol) and tobacco use than highly educated. Participants born outside Sweden had a higher prevalence of obesity, high waist-hip ratio, and tobacco use. Participants with 3-4 unhealthy behaviors had significantly higher prevalence of each of the metabolic risk factors except BMI. Women, highly educated and Swedish-born participants were slightly over-represented in the THDs.

CONCLUSION

Considering the associations between unhealthy behaviors and metabolic risk factors, the THD method, covering lifestyle as well as objective health measures, may be an appropriate method for early identification of individuals at risk for future non-communicable diseases in the whole population with a specific focus on certain groups.

CLINICALTRIALS.GOV

NCT04912739.

Unraveling tetracycline and its degradation product: Induction mechanisms of antibiotic resistance in Escherichia coli

In aquatic environments, antibiotics degrade into byproducts, potentially enhancing bacterial resistance. However, the specific mechanisms by which these byproducts induce bacterial resistance remain elusive. This study conducted experimental evolution experiments to explore how E. coli adapts to tetracycline (TC) and its primary degradation products-anhydrotetracycline (ATC), epitetracycline (ETC), and 4-epianhydrotetracycline (EATC)-through evolution experiments. Prolonged exposure to TC and its byproducts significantly increased frequency of resistant mutants in E. coli ATCC25922, with a maximum 106-fold increase. Resistant mutants exhibited markedly elevated minimum inhibitory concentrations (MICs) for TC, ampicillin (AMP), and ciprofloxacin (CIP), indicating multidrug resistance. Transcriptomic analysis showed that the antibiotic resistance phenotype could be related to enhanced target protection, metabolic adaptations, and reduced membrane permeability. The induction pathways between TC and its byproducts were distinct. Specifically, TC20d (where TC20d represents the mutants collected after 20 days of continuous exposure to TC) was associated with more alterations in ribosome-associated genes, which was correlated with an enhanced defensive response as shown by the data. Moreover, variations in energy metabolism gene expression suggest a robust metabolic defense in ATC20d and ETC20d. When TC and its byproducts-ATC, ETC, and EATC-act together, they induce antibiotic resistant mutants at rates of 29.8 %, 18.9 %, 18.3 %, and 31.9 %, respectively. This study provides a descriptive overview of the possible adaptive mechanisms and pathways that may be involved in antibiotic resistance due to environmental exposure.

Comparison of triglyceride glucose index and modified triglyceride glucose indices in predicting cardiovascular diseases incidence among populations with cardiovascular-kidney-metabolic syndrome stages 0-3: a nationwide prospective cohort study

BACKGROUND

Cardiovascular-kidney-metabolic (CKM) syndrome has been recently proposed by American Heart Association recently. The triglyceride glucose (TyG) index and TyG-related indices combined with obesity indicators have proven to be associated with the incidence of cardiovascular diseases (CVD). However, there are few studies to explore whether these associations exist among people with CKM syndrome stages 0-3.

METHODS

A total of 7,364 participants from the China Health and Retirement Longitudinal Study were included. Cox hazard regression and restricted cubic spline regression were used to analyze the associations of these indices with CVD incidence. To compare predictive performance, time-dependent Harrell's C-indices, net reclassification index and integrated discrimination improvement were conducted.

RESULTS

The CVD incidence was 20.55% over nine years. The TyG single index and all the modified TyG indices were capable of predicting CVD incidence. RCS regression analyses showed that all indicators had linear relationships with CVD incidence and these linear relationships of TyG combined with waist circumference (TyG-WC) or waist-to-height ratio (TyG-WHtR) still existed in CKM stage 1, stage 2 and stage 3. TyG-WC (C-index: 0.621, p < 0.001) and TyG-WHtR (C-index: 0.621, p < 0.001) almost had the highest C-indices in predicting CVD incidence, compared to single TyG index (C-index: 0.611, p < 0.001) and TyG combined with body mass index (C-index: 0.616, p < 0.001).

CONCLUSION

The TyG index and all the modified TyG indices were independent predictors of CVD incidence among people with CKM syndrome stages 0-3. It was found that modified indices had better predictive performance, especially TyG combined with waist circumference or waist-to-height ratio.

Characterization and host range prediction of Staphylococcus aureus phages through receptor-binding protein analysis

Bacteriophages are crucial in bacterial communities and can be used for therapy of multidrug-resistant pathogens such as Staphylococcusaureus. However, the host range of new phages remains difficult to predict. We identified the receptor-binding proteins (RBPs) of 335 S. aureus-infecting phages, yielding 8 distinct RBP clusters. Recombinant representative RBPs of all clusters, including several subclusters, were analyzed for binding to S. aureus strains differing in potential phage receptor structures. Notably, most of the phages encoded two separate RBPs, and all RBPs used S. aureus wall teichoic acid (WTA) polymers as receptors, albeit with varying preference for WTA glycosylation patterns and backbone structures. Based on these findings, a sequence-based tool for predicting the adsorption of new phages was developed. Moreover, one of the RBPs proved useful for identifying S. aureus-type WTA in other bacterial species. These findings facilitate the characterization of phage and bacterial isolates and the development of phage therapies.