The Association of Food Security Status with Transactional Sex Engagement Among Female Adolescents Aged 15-24: Evidence from Cameroon

Transactional sex has been identified as a risk factor for HIV acquisition. While studies have investigated the various factors associated with transactional sex among women, its association with food security status in sub-Saharan African countries remains largely unexplored. To address this gap, we utilized data from the 2018 Cameroon Demographic and Health Survey and applied multivariate logit models to examine the relationship between food security status and engagement in transactional sex among unmarried adolescent girls and young women in Cameroon. Our results indicated that unmarried adolescent girls and young women (aged 15-24 years) experiencing moderate (OR = 3.00, p < 0.001, 95% CI = 1.66, 5.42) and severe (OR = 3.33, p < 0.001, 95% CI = 1.82, 6.11) food insecurity were more likely to engage in transactional sex in the previous 12 months before the DHS survey was conducted, compared to those without any experience of food insecurity. Based on these findings, we propose several implications for policymakers and offer directions for future research.

Dual-Active Nanoimmunomodulators for the Synergistic Enhancement of the Antitumor Efficacy of Photodynamic Immunotherapy

Photodynamic immunotherapy, which combines photodynamic therapy (PDT) with immunotherapy, has become an important and effective treatment for cancer. However, most photodynamic immunotherapy systems for cancer do not allow for the precise release of immunomodulators, leading to systemic side effects and poor patient prognosis. This study reports a dual-activatable nanoimmunomodulator (CPPM), whose photodynamic effect and agonist release are both activated in response to specific stimuli, which can be used for precise photodynamic immunotherapy of cancer. CPPM has a half-life of 119 min in circulation and accumulates in tumor tissue 4 h after injection (23.8%). In addition, CPPM is able to achieve tumor localization of nanomedicines through PD-L1-targeting peptides, blocking the specific binding of PD-L1 to PD-1, exposing tumor surface antigens, and reinvigorating the activity of T cells in combination with macitentan to promote T-cell proliferation. Meanwhile, under laser irradiation, CPPM was able to increase intracellular oxidative stress, inhibit cell proliferation through PDT, and trigger immunogenic cell death, further enhancing tumor immunogenicity through synergistic treatment. Ultimately, CPPM enhanced the immunotherapeutic efficiency against tumors by improving the tumor immunosuppressive microenvironment, synergistically inhibiting the growth of primary and distant tumors while activating systemic antitumor immunity to eliminate lung metastases without obvious side effects. This study presents an uncomplicated and multifunctional strategy for the precise modulation of tumor photodynamic immunotherapy with a dual-activatable smart nanoimmunomodulator that can improve the efficacy of PDT, enhance systemic antitumor immunity, and potentially extend it to a wide range of cancers.

Clinical outcomes of patients with Polyvascular disease admitted with an acute diabetic foot ulcer

AIMS

Diabetic foot ulcer (DFU) is a common cause of admission in patients with diabetes. Diabetes increases the likelihood of inpatient Major Adverse Cardiovascular Events (MACE), and the presence of polyvascular disease (PD), defined by the presence of atherosclerosis in two or more arterial beds, further amplifies this risk. We assessed the impact of PD on outcomes in patients admitted due to a DFU.

METHODS

In this retrospective single-center study, we enrolled adult patients admitted to the diabetic foot unit between 2014 and 2019. The primary outcome was a composite of inpatient MACE or death. Secondary outcomes included amputations, leg revascularization, duration of admission and 1-year mortality. We additionally collected survival data till the end of 2023.

RESULTS

A total of 537 patients were enrolled in the study, 264 suffering of PD. The primary endpoint occurred in 12.5 % and 4.4 % of patients with vs. without PD (p = 0.001). Patients with PD had an increased incidence of vascular interventions (42 % vs. 19.4 %, p < 0.001), any amputation (67.4 % vs. 48.4 %, p < 0.001) and major amputation (35.6 % vs. 13.2 %, p < 0.001). They had longer admissions (median 19 vs. 17 days, p = 0.002) and higher 1-year mortality rates (33.0 % vs. 12.1 %, p < 0.001). During 10-year follow up (median 3.3 years) median survival was 2.0 vs. 5.9 years for patients with vs. without PD (p < 0.001).

CONCLUSIONS

PD in patients admitted with a DFU is associated with poor inpatient and long-term outcomes. This highlights the need for comprehensive risk assessment, optimization of in-patient management and long-term control of cardiovascular risk factors.

Analysis of the mortality trends of laryngeal cancer attributable to smoking worldwide from 1990 to 2021 and projections up to 2036

OBJECTIVE

This study aims to examine the global trends in the disease burden of laryngeal cancer (LC) attributable to smoking from 1990 to 2021, including mortality, and disability-adjusted life years (DALYs), and to predict trends for 2036.

METHODS

Data on LC attributable to smoking were obtained from the 2021 Global Burden of Disease (GBD) online database. Joinpoint regression analysis was used to calculate the average annual percent change (AAPC) to evaluate trends in LC attributable to smoking. Additionally, an Autoregressive Integrated Moving Average (ARIMA) model was applied to forecast future disease burden over the next 15 years.

RESULTS

From 1990 to 2021, the global age-standardized mortality rate (ASMR) of LC attributable to smoking decreased from 1.61 to 0.89 per 100,000 with an AAPC of -1.87%. The male mortality rate is significantly higher than that of females. In 2021, specific regions within the Balkans, the Middle East, and South Asia demonstrated notably higher compared to other global regions. According to the ARIMA model, the ASMR for LC attributable to smoking among males is projected to decline gradually from 2022 to 2036, while the decline in females is more gradual.

CONCLUSION

From 1990 to 2021, the global mortality rate of LC attributable to smoking has declined, indicating a relative reduction in disease burden. However, the burden remains disproportionately higher among older adults, with males at a greater risk of mortality than females. Although the disease burden from LC attributable to smoking is expected to decline gradually over the next 15 years, it remains imperative to enhance smoking cessation efforts to further alleviate the disease burden.

Characterizing trajectories of diabetes-related health parameters before diabetes diagnosis in diabetes subtypes: analysis of a 20-year long prospective cohort study in Sweden

BACKGROUND

Evidence is limited on whether alterations in diabetes-related health parameters are detectable before clinical diagnosis in novel diabetes subtypes. We investigated trajectories of diabetes-related health parameters in individuals with recently diagnosed type 2 diabetes (T2D).

METHODS

Using data from the Stockholm Diabetes Prevention Programme cohort (SDPP) participants (n = 215) with recent onset T2D were classified as having severe insulin-deficient diabetes (SIDD, 9%), severe insulin-resistant diabetes (SIRD, 15%), mild obesity-related diabetes (MOD, 14%) and mild age-related diabetes (MARD, 62%). Participants without a family history of diabetes who remained diabetes-free throughout the study served as the controls (n = 2531). Multilevel longitudinal mixed-effects models were used to analyse the trajectories of fasting plasma glucose (FPG) and insulin, body mass index (BMI), homeostasis model assessment estimates of beta-cell function (HOMA2-B) and insulin resistance (HOMA2-IR), waist-to hip-ratio (WHR), diastolic blood pressure (DBP) and systolic blood pressure (SBP) up to 20 years before and 10 years after T2D diagnosis. Pairwise comparisons of the estimated marginal means were used to assess differences between all groups.

RESULTS

Individuals with SIDD consistently exhibited the highest FPG concentrations (P < 0.001) and the steepest decline in HOMA2-B levels among all subtypes. BMI was higher in MOD and SIRD than in SIDD and MARD throughout the study period (P < 0.01). Individuals with SIRD showed the highest fasting insulin concentrations and higher HOMA2-IR than those with MOD and MARD (P < 0.001). WHR and DBP were comparable between subgroups, while SIDD had higher SBP than MOD (P = 0.03). The control group exhibited the mildest trajectories across all parameters except for HOMA2-B. Notably, these changes were visible up to 20 years prior to diagnosis.

CONCLUSIONS

In a Swedish population, trajectories of diabetes-related health parameters differed up to 20 years before diagnosis between the T2D-related subtypes and controls. This might support early prediction of subtype-specific risks for long-term complications, allowing early initiation of personalized treatment strategies.

A study on the factors influencing mortality risk in sepsis-induced acute kidney injury based on analysis of the MIMIC database

Sepsis-induced acute kidney injury (SA-AKI) significantly increases mortality and healthcare burdens. Identifying key mortality risk factors is crucial for improving patient outcomes. This study aims to identify the primary factors affecting mortality in SA-AKI patients using the MIMIC-III database. A retrospective analysis was conducted on 4868 SA-AKI patients from the MIMIC-III database. Clinical data from the first 24 h of ICU admission were analyzed using logistic regression to identify mortality predictors. Key mortality predictors included advanced age (OR = 1.015, 95% CI: 1.006-1.024), severe AKI stages (OR = 1.470, 95% CI: 1.285-1.676), low serum albumin (OR = 0.606, 95% CI: 0.506-0.722), delayed antibiotics (OR = 1.001, 95% CI: 1.000-1.002), high AST (OR = 1.035, 95% CI: 1.027-1.083), and bilirubin (OR = 1.055, 95% CI: 1.037-1.083). The area under the curve (AUC) of the combined predictors for mortality risk was 0.796, indicating high predictive accuracy. Conclusions: Early intervention and monitoring of identified risk factors such as age, AKI stage, albumin levels, and antibiotic timeliness can enhance survival rates in SA-AKI patients.

Global and regional trends in the burden of surgically confirmed endometriosis from 1990 to 2021

BACKGROUND

endometriosis as a common gynecologic finding significantly affects the quality of life of many women. An accurate understanding of the epidemiological characteristics of endometriosis is essential for disease control and prevention. We aimed to use the latest data from the Global Burden of Disease (GBD) 2021 to comprehensively analyze the various epidemiological indicators of surgically confirmed endometriosis and their changing trends to better measure the disease burden and help improve health management.

METHODS

We delineated incidence, prevalence, and years lived with disability (YLDs) of surgically confirmed endometriosis at the global, regional, and national levels. The estimated annual percentage change (EAPC) was calculated to assess temporal trends in the age-standardized rate (ASR). In addition, we used joinpoint regression models to describe local trends in these indicators, assessed the correlation between disease burden and Socio-demographic index (SDI) levels, and used decomposition analysis to quantitatively analyze the driving factors leading to changes in disease burden.

RESULTS

Globally, the age-standardized rate of incidence, prevalence, and YLDs of surgically confirmed endometriosis all showed a decreasing trend from 1990 to 2021. The burden of surgically confirmed endometriosis is mainly concentrated in women aged 20-30 years and declines with increasing SDI levels. The results of the decomposition analysis indicated that population growth is the main driving factor for the upward in the number of incidence, prevalence, and YLDs cases of endometriosis worldwide.

CONCLUSIONS

The overall burden of endometriosis has decreased globally from 1990 to 2021, but there are regional disparities. Managing this condition remains a major challenge, and more refined policies and interventions are needed to effectively address the burden of endometriosis.

Quantitative image analysis of nailfold capillaries during an in-hospital education program for type 2 diabetes or obesity

Nailfold capillaries are small U-shaped vessels located beneath the skin at the proximal part of the fingernail, and their morphology changes owing to various diseases. This study quantitatively analyzed nailfold capillaries using microscopy in patients hospitalized for 2 weeks for education and treatment of type 2 diabetes (T2D) or obesity. Our results suggest that nailfold arterial diameter and smoking history are useful predictors of diabetic neuropathy. An elevated urinary albumin-to-creatinine ratio correlated with decreased venous diameter during hospitalization, reflecting latent intravascular hypoalbuminemia in patients with diabetic nephropathy. Both body mass index and short-term weight reduction during hospitalization correlated with the color contrast between the capillaries and the perivascular zone, defined as delta E. These results suggest that the morphology of nailfold capillaries in T2D and obesity could be useful indicators of diabetic neuropathy and nephropathy, with delta E being a useful indicator of extracellular water volume in these populations. This is the first study to observe short-term changes in nailfold capillary morphology in relation to interventions for lifestyle-related diseases.

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

Background

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

Methods

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

Results

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

Conclusions

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

Supplementary Information

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

Efficacy and safety of Chinese medicine in treating risk window of AECOPD: A multicenter randomized controlled trial

BACKGROUND

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) significantly accelerate disease progression and substantially increase mortality risk. The risk window of AECOPD (AECOPDRW) represents a time between acute exacerbation and recovery to a stable stage. Chinese medicine (CM) has shown significant therapeutic efficacy in COPD but CM treatment for AECOPDRW has not been validated by high-quality clinical studies.

PURPOSE

To assess the clinical effect of CM syndrome differentiation treatment for patients with AECOPDRW.

STUDY DESIGN

A multicenter, randomized, double-blind, placebo-controlled parallel trial.

METHODS

336 eligible participants were included to the study. Both groups were based on the conventional treatment as the baseline therapy. The experimental group was administered Chinese herbal medicine granules based on CM syndrome differentiation, whereas the control group received a placebo in the form of Chinese herbal medicine granules. The intervention course lasted for 8-week, while the follow-up for 26-week. Primary outcomes were incidences of acute exacerbation and COPD Assessment Test (CAT) scores recorded during AECOPDRW. Secondary outcomes were the timing of the first acute exacerbation, incidence of exacerbations, acute exacerbation readmission rate, severity of exacerbation, and CAT scores during follow-up, pulmonary function, mMRC scale, clinical symptom scale, and the quality of life assessment tools.

RESULTS

At 8-week, the risk of acute exacerbations and CAT score were significantly reduced in the experimental group between-group analysis with a risk ratio (RR) of 0.375(95 % confidence interval [CI]: 0.150 to 0.935; p = 0.027), and a mean difference (MD) of -2.476 score (95 % CI: -3.281 to -1.671; p < 0.001). At 26-week, experimental group showed statistically lower risk of acute exacerbation between-group analysis (RR: 0.519; 95 % CI: 0.282 to 0.953; p = 0.030). The first exacerbation time in the experimental group (97.63 ± 35.90) was statistically longer than in the control group (66.11 ± 25.25) (MD: 31.517 (95 % CI: 14.720 to 48.314; p < 0.001). The rates of acute exacerbation readmission were similar for both the groups during the risk window and follow-up period. After 26 weeks of follow-up, experimental group CAT score was reduced by 2.046 between-group analysis (p < 0.001). Furthermore, during the whole study, the experimental group showed significantly reduced in mMRC score, as well as FEV1 and FVC values (all p < 0.05). During study period, the experimental group had a significant reduce in clinical symptom scores, including cough, expectoration, and fatigue, than the control group (p < 0.05). Regarding to SGRQ, mCOPD-PRO and mESQ-COPD, our results demonstrated that CM had better advantages in many aspects.

CONCLUSION

Treatment of AECOPDRW with CM showed high efficacy and safety in significantly reducing further incidences of acute exacerbation, prolonging the interval to the initial acute exacerbation, alleviating the clinical symptoms, and improving the quality of life.

Functional disability in basic and instrumental activities of daily living among older adults globally: a systematic review and meta-analysis

INTRODUCTION

Functional disability in older adults refers to difficulties in performing daily activities. It is usually evaluated based on an individual's ability to carry out basic activities of daily living and instrumental activities of daily living. Although existing studies provide valuable insights, comprehensive global data on functional disability in basic and instrumental activities of daily living among older adults remain limited. This study aims to review existing research worldwide to estimate the overall pooled prevalence of functional disability in these areas.

METHODS

Systematic searches were conducted across EMBASE, Scopus, PubMed/MEDLINE, and Google Scholar from May 5 to July 11, 2024. Cross-sectional studies worldwide on functional disability in basic and instrumental activities of daily living among adults aged 60 and older, published in English up to July 11, 2024 were included. Studies were excluded if they did not report the outcomes of interest, were inaccessible, case reports, low quality, review articles, or published in languages other than English. Data extraction and cleaning were performed using Microsoft Excel, and STATA version 17 was used to compute the pooled effect size with 95% confidence intervals (CIs) for functional disability in both basic activities of daily living and instrumental activities of daily living among older adults. To derive these estimates, we used weighted averages, where each study's prevalence was weighted by the inverse of its variance. Study heterogeneity was assessed using the Cochrane I² statistic and its associated p-value. Subgroup analysis and meta-regression were conducted to identify sources of heterogeneity. Sensitivity analysis was used to evaluate the impact of individual studies on the overall results. Publication bias was assessed with Egger's test and funnel plots, and was addressed through trim-and-fill analysis.

RESULTS

This review includes 35 studies with a total of 133,827 participants. The pooled prevalence of functional disability in basic activities of daily living was estimated at 26.07% (95% CI: 19.04-32.74), while on instrumental activities of daily living, it was estimated at 45.15% (95% CI: 36.02-54.29). After applying the trim-and-fill method, the adjusted overall prevalence of disability in basic activities of daily living was 15.12%, (a 95% CI: 11.25-19.13%). Subgroup analysis showed highest prevalence in Africa (BADL: 42.91%, IADL: 69.34%) and lowest in Asia (BADL: 19.15%, IADL: 32.66%). Participants aged 65 and above, those in institutional settings, and studies with smaller sample sizes tended to report higher levels of functional disability.

CONCLUSIONS

Nearly one-fourth of the study participants had functional disability related to basic activities of daily living, while about half experienced disability in instrumental activities of daily living. This emphasizes the need for continued effort in improving the quality of life and support systems for individuals facing functional disability, particularly in instrumental activities.

Training for dementia care and support in rural and remote Australia: appraisals from a nationwide workforce survey

BACKGROUND

Dementia is a growing challenge to health and aged care worldwide and is the leading cause of disease burden in older Australians. High-quality person-centred care of people with dementia and support for their family caregivers require a trained multidisciplinary health and aged care workforce. Compared with major cities in Australia, rural and remote areas encounter greater challenges in workforce recruitment and retention. Moreover, these areas have distinctive distance-related barriers to workforce training and a higher proportion of aged and First Nations people at elevated risk of developing dementia. We designed and distributed a survey to investigate the perspectives on training among rural and remote health and aged care workers providing dementia care in diverse occupations and settings.

METHODS

After piloting, the online survey was promoted to rural and remote organisations and professional networks nationwide. The instrument included multiple-choice and ordered-scale items on respondents' dementia care self-rating and appraisal of their current workplace dementia care training, as well as items categorising their demographic characteristics, main work role, main workplace setting, and geographical site. Analysis incorporated description of respondent characteristics and estimation along with graphical presentation of response proportions for ordered-scale items, with differences among key respondent subgroups (i.e., workplace setting, remoteness, and main role) investigated using crude and multivariable robust Poisson regression models.

RESULTS

There were 558 respondents from residential aged care, community/primary care and hospital settings across all Australian states and territories. The majority (61.7%) were from degree-requiring health professional/management positions, and 27.4% were certificate-requiring workers (predominantly personal care assistants and enrolled nurses). A majority considered that the dementia care provided in their current workplace was inadequate overall and specifically in relation to First Nations and culturally and linguistically diverse clients. Respondents noted organisational resource limitations impeding workers' participation in training, and insufficient opportunities for input into determining priorities for training content and delivery. Hospital/acute care-based workers had the least favourable self-ratings and represented the highest proportion of respondents reporting shortcomings of training.

CONCLUSIONS

Health and aged care workers in rural and remote Australia perceive substantial shortcomings in the dementia care training provided by their workplace.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

INTRODUCTION

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

METHODS

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

RESULTS

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

DISCUSSION

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

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

Burden of pulmonary arterial hypertension in Asia from 1990 to 2021: Findings from Global Burden of Disease Study 2021

BACKGROUND

Pulmonary arterial hypertension (PAH) presents a significant health burden in Asia and remains a critical challenge. This study aims to delineate the PAH burden in Asia from 1990 to 2021.

METHODS

Using the latest data from the Global Burden of Disease 2021, we evaluated and analyzed the distributions and patterns of PAH disease burden among various age groups, sexes, regions, and countries in Asia. Additionally, we examined the associations between PAH disease burden and key health system indicators, including the socio-demographic index (SDI) and the universal health coverage (UHC) index.

RESULTS

In 2021, there were 25,989 new PAH cases, 103,382 existing cases, 13,909 PAH-associated deaths, and 385,755 DALYs attributed to PAH in Asia, which accounted for approximately 60% of global PAH cases. The age-standardized rates (ASRs) for prevalence and deaths were 2.05 (95% uncertainty interval [UI]: 1.66-2.52) per 100,000 population and 0.31 (95% UI: 0.23-0.38) per 100,000 population, respectively. From 1990 to 2021, Asia reported the lowest ASRs for PAH prevalence but the highest ASRs for deaths compared to other continents. While the ASRs for prevalence increased slightly, ASRs for mortality and DALYs decreased over time. This increasing burden of PAH was primarily driven by population growth and aging. The burden was especially pronounced among individuals aged ≥60 years and <9 years, who collectively accounted for the majority of deaths and DALYs. Moreover, higher SDI and UHC levels were linked to reduced incidence, but higher prevalence rates.

CONCLUSIONS

Although progress has been made in reducing PAH-related mortality and DALYs, the disease continues to impose a substantial burden in Asia, particularly among older adults and young children. Region-specific health policies should focus on improving early diagnosis, expanding access to treatment, and effectively addressing the growing PAH burden in the region.

The balancing act between lipid droplets and lysosomes for membrane functionality in age-related neurodegeneration and inflammation

Age-related neurodegenerative disorders are often associated with disruptions in lipid metabolism. A critical aspect is the impairment of the interaction between lipid droplets (LDs) and lysosomal function, leading to the accumulation of toxic lipid species. This accumulation triggers cellular stress, inflammation, and defective waste processing within cells, disrupting cellular homeostasis and amplifying neuroinflammatory processes. Recent studies have shown that alterations in phospholipid and fatty acid homeostasis drive neuroinflammation and oxidative stress, exacerbating neurodegenerative processes. This review focuses on the role of neuropathy target esterase (PNPLA6/NTE) and NTE-related esterase (PNPLA7/NRE) in lipid metabolism, highlighting how dysregulation of these enzymes contributes to neurodegeneration, inflammation, and lysosomal dysfunction. Additionally, we discuss the involvement of lipid rafts, sphingolipids, and phospholipase enzymes, particularly PLA2 family members, in cellular signaling and membrane dynamics. By examining the relationship between lipid metabolism, inflammatory signaling, and lysosomal storage disorders, we aim to provide a comprehensive understanding of how LDs and lysosomes interact to influence cellular homeostasis in neurodegenerative conditions, which could lead to new therapeutic strategies addressing lipid dysregulation in age-related neurological disorders.

Platelet-Rich Plasma for Knee Osteoarthritis: A Comprehensive Narrative Review of the Mechanisms, Preparation Protocols, and Clinical Evidence

BACKGROUND

Platelet-rich plasma (PRP) is increasingly utilized for managing knee osteoarthritis (KOA), yet its clinical value remains debated due to the variability in preparation protocols and outcome measures.

METHODS

This narrative review synthesizes current evidence from 40 high-quality studies published between 2013 and March 2025, including randomized controlled trials, systematic reviews, and meta-analyses. The biological mechanisms, clinical effectiveness, safety, and implementation challenges of PRP therapy in KOA are examined.

RESULTS

PRP injections-particularly leukocyte-poor PRP-demonstrate superior pain relief and functional improvement compared to hyaluronic acid and corticosteroids, especially in patients with mild to moderate KOA (Kellgren-Lawrence grades I-III). However, heterogeneity in PRP formulations (platelet/leukocyte content and activation protocols), injection regimens, and follow-up durations limits direct comparability across studies. Evidence from high-quality placebo-controlled trials shows inconsistent long-term benefits, with some failing to demonstrate superiority over saline beyond 6-12 months. The GRADE assessment rates the overall certainty of evidence as moderate. PRP appears safe, with few adverse events reported, but remains costly and variably reimbursed. Guidelines from major societies remain cautious or inconclusive.

CONCLUSIONS

PRP is a promising, safe, and well-tolerated option for early to moderate KOA. However, the standardization of preparation protocols, patient selection criteria, and outcome reporting is essential to improve comparability and guide clinical practice.

Comparison of triglyceride-glucose related indices in prediction of cardiometabolic disease incidence among US midlife women

The effects of triglyceride-glucose (TyG) related indices on cardiometabolic disease (CMD) are still unclear. Our study aimed to investigate the relationship between the TyG-related indices and CMD risk among midlife women. This retrospective observational cohort study utilized data from the 2020 SWAN participants. The TyG index was computed as Ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. Modified TyG indices were created by integrating TyG with body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR). Multivariate Cox proportional hazards regression and receiver operating characteristic (ROC) analyses were conducted to assess the associations and predictive capacities of TyG and its related indices with CMD incidences. The mean age of participants was 45.7 years, comprising 420 (20.8%) Black, 184 (9.1%) Chinese, 225 (11.1%) Japanese, and 1191 (58.9%) Caucasian or Hispanic women. Over a 10-year follow-up, 837 women (41.4%) developed CMD. Compared to the lowest quartile, the adjusted hazard ratios (95% confidence intervals) for incident CMD in the highest quartile for TyG, TyG-BMI, TyG-WC, and TyG-WHtR were 1.78 (1.41-2.25), 3.26 (2.51-4.24), 3.13 (2.41-4.06), and 3.19 (2.47-4.12), respectively. The area under the ROC curve for modified TyG indices was significantly higher than that for the TyG index alone. Both the TyG and modified TyG indices were significantly associated with new-onset CMD, with modified TyG indices showing superior performance in identifying individuals at risk for CMD.

Now and the Future: Medications Changing the Landscape of Cardiovascular Disease and Heart Failure Management

Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality worldwide. Epidemiological data demonstrate that the overlap between CVD, Type 2 Diabetes (T2DM), chronic kidney disease (CKD) and heart failure (HF) is becoming increasingly apparent, with aging populations making these patient cohorts more difficult to treat. In the last decade, three standout drug classes have emerged with the potential to broaden the treatment options for patients with multi-morbid CVD and heart failure. These are sodium-glucose cotransporter 2 (SGLT2) inhibitors, non-steroidal mineralocorticoid receptor antagonists (MRAs), e.g., Finerenone, and glucagon-like peptide 1 receptor agonists (GLP-1RAs). These medications are now entering UK and European guidelines for the treatment of CVDs including HF whilst crucially providing associated prognostic benefits for patients with T2DM and CKD. The future of these agents for CVD risk stratification may involve primary care at the forefront, alongside tailored, patient-specific medication regimens. This review article aims to discuss these three main drug classes (SGLT2 inhibitors, GLP-1RAs and non-steroidal MRAs) in detail by exploring their current evidence base across heart failure (HF) and CVD management and future clinical implications of their usage as mainstream medical therapies.

Determination of the Stage of Periodontitis with 20 ng/mL Cut-Off aMMP-8 Mouth Rinse Test and Polynomial Functions in a Mobile Application

Background: We propose a framework for determining the stage of periodontitis in a personalized medicine context, building on our previously developed model for periodontitis detection. In this study, we improved the earlier model by incorporating additional components to form a comprehensive system for identifying both the presence and stage of periodontitis. Central to the home-use application is an active-matrix metalloproteinase-8 (aMMP-8) mouth rinse test (cut-off: 20 ng/mL), integrated with software delivered via a mobile application. Methods: First, using all the data, we modeled a single polynomial function to distinguish healthy and stage I periodontitis patients from stage II and III patients. Second, we used an already published periodontitis detection function to separate stage I patients from healthy patients. Third, one more function was created that divided stage II and III patients from each other. All functions were modeled by multiple logistic regression analysis from the patient data, which consisted of 149 adult patients visiting dental offices in Thessaloniki, Greece. Results: The complete model demonstrated a sensitivity of 95.8% (95% CI: 92.1-99.4%) and a specificity of 71.0% (95% CI: 55.0-86.9%) for detecting periodontitis. Among those identified with periodontitis, the correct stage was determined in 61.1% of cases, with stage-specific accuracies of 64.3% for stage I, 60.5% for stage II, and 60.9% for stage III. All testing was performed on patient data with which the complete model was formed. Conclusions: The results of this study showed that with sufficient data and using multiple logistic regression analysis, a model can be created to simultaneously identify the presence and stage of periodontitis. Overall, in the complete model generated, a mouth rinse aMMP-8 test result with a cut-off value of 20 ng/mL, Visible Plaque Index (VPI) and information of patient's teeth number present were found to be important factors to determine the stage of periodontitis in a personalized medicine manner for everyone to use.

Multimodal neuroimaging insights into the neurobiology of healthy aging across the lifespan

PURPOSE

The purpose of this study was to advance our understanding of the neurobiology of healthy aging, which is crucial for improving quality of life and preventing age-related diseases. Despite its importance, a comprehensive investigation of this process has yet to be fully characterized.

METHODS

We used a hybrid PET/MRI scanner to assess neurophysiological parameters in 80 healthy individuals aged 20-78. Cerebral amyloid-beta (Aβ) deposition and glucose metabolism were assessed using PET scans, while participants underwent simultaneous MRI scans.

RESULTS

We found a positive correlation between Aβ-deposition and aging, and a negative correlation between glucose metabolism and aging. The insula showed the strongest negative correlation between glucose metabolism and age (Spearman's r = -0.683, 95% CI [-0.79, -0.54], p < 0.0001), while the posterior cingulate cortex had the strongest positive correlation between Aβ-deposition and age (Spearman's r = 0.479, 95% CI [0.28, 0.64], p < 0.0001). These results suggest a spatially dependent link between Aβ-deposition and metabolism in healthy older adults, indicating a compensatory mechanism in early Alzheimer's. Additionally, Aβ-deposition was linked to changes in interregional neural communication.

CONCLUSIONS

Our study confirms previous findings on aging and offers new insights, particularly on the role of Aβ-deposition in healthy aging. We observed a linear increase in Aβ-deposition, alongside decreases in white matter integrity, cerebral blood flow, and glucose metabolism. Additionally, we identified a complex regional relationship between Aβ-deposition, glucose metabolism, and neural communication, possibly reflecting compensatory mechanisms.

High-Dose Semaglutide (Up to 16 mg) in People With Type 2 Diabetes and Overweight or Obesity: A Randomized, Placebo-Controlled, Phase 2 Trial

OBJECTIVE

Studies have demonstrated dose-dependent efficacy of glucagon-like peptide 1 receptor agonists for glycemic control and body weight. The aim of this trial was to characterize the dose-dependent effects of semaglutide (up to 16 mg/week) in people with type 2 diabetes and overweight or obesity.

RESEARCH DESIGN AND METHODS

In this parallel-group, participant- and investigator-blinded, phase 2 trial, 245 individuals with type 2 diabetes and BMI ≥27 kg/m2 on metformin were randomized to weekly semaglutide (2, 8, or 16 mg s.c.) or placebo for 40 weeks. Doses were escalated every 4 weeks, followed by a maintenance period. Dose modifications were not allowed. Primary and secondary efficacy end points included change from baseline to week 40 in HbA1c and body weight, respectively.

RESULTS

Estimated treatment difference between 16 and 2 mg was -0.3 percentage points (%-points) (95% CI -0.7 to 0.2; P = 0.245) for HbA1c change and -3.4 kg (-6.0 to -0.8; P = 0.011) for weight change for the treatment policy estimand and -0.5%-points (-1.0 to -0.1; P = 0.015) and -4.5 kg (-7.6 to -1.4; P = 0.004), respectively, for the hypothetical estimand. Dose-response modeling confirmed these findings. Treatment-emergent adverse events (AEs) and treatment discontinuations due to AEs, primarily gastrointestinal, were more frequent in the semaglutide 8 and 16 mg groups than in the 2 mg group. No severe hypoglycemic episodes were reported.

CONCLUSIONS

Higher semaglutide doses for type 2 diabetes and overweight or obesity provide modest additional glucose-lowering effect, with additional weight loss, at the expense of more AEs and treatment discontinuations. A study for evaluating high-dose semaglutide in obesity is currently underway.

Estimation of the population atributable fraction due a to excess body fat in primary care patients: IBERICAN study

The burden of disease attributable to excess body fat (EBF) in type 2 diabetes mellitus (T2DM) may be underestimated due to problems correlating BMI with body fat. The aim of this study is to compare the population attributable fraction (PAF) of EBF in T2DM assessed with various parameters.

MATERIAL AND METHODS

Prevalence study based on the baseline visit of the IBERICAN study. Mixed unconditional logistic regression models were used to estimate the risk of T2DM for the various categories of BMI, of the estimation of EBF according to the CUN-BAE (Clínica Universidad de Navarra-Body Adiposity Estimator) and of waist circumference (WC), stratifying by sex. The PAF was calculated for each of the EBF estimates.

RESULTS

A total of 7752 patients from IBERICAN study were eligible, of them 1536 (19.8 %) achieved T2DM criterion, The prevalence of diabetes was higher in men, in those with a lower level of education, and in those who reported a low level of physical activity. Subjects with diabetes were older, had a higher BMI, a higher CUN-BAE-estimated body fat percentage (eBFP) and a higher waist circumference. One in three cases T2DM risk was attributed to elevated BMI, whereas in the CUN-BAE case it was attributed to 9 out of 10 men and 2 out of 3 women. One out of two cases of T2DM in women, and less in men, was attributed to an excess WC.

CONCLUSIONS

The burden of disease attributable to EBF in the case of T2DM may be underestimated. Therefore, EBF should be used, together with BMI, WC -especially in women-, and the CUN-BAE to better estimate the risk of T2DM and to adapt dietary or lifestyle recommendations in daily clinical practice.

Understanding behaviour change maintenance after attending a self-management education and support programme for type 2 diabetes: A longitudinal qualitative study

AIMS

This study aimed to explore behaviour change maintenance experiences of adults with type 2 diabetes over 15 months following attendance at a diabetes self-management education and support (DSMES) programme and their needs for post-programme support.

METHODS

A longitudinal qualitative study using four interviews and experience sampling (written notes and photographs) was conducted. Data were analysed through a deductive analysis based on an existing framework combined with an inductive thematic analysis approach.

RESULTS

Twenty-one adults (67% women, aged 39-74) participated; seventeen completed all interviews. Analysis resulted in the refined Supporting Understanding and Strategies for Type 2 Diabetes Maintenance Self-Management (SUSTAIN) framework and three themes capturing key trends and changes over time: (1) integrating the changes amidst the constant ebb and flow of life; (2) consolidating the changes: moving towards independent maintenance; and (3) building bridges to self-maintenance: the role of support post-programme.

CONCLUSIONS

People may experience difficulties in maintaining behavioural changes post-DSMES programmes. Programmes should address the role of emotions, psychological and physical resources and environmental and social influences in behaviour change maintenance and promote the development of skills for longer-term management, including self-regulation, behavioural autonomy, intrinsic motivation and habit formation. As some people may also benefit from longer-term, ongoing support, digitally delivered with occasional sessions involving peers and educators beyond 12 months should be considered. Suggestions for ongoing support include progress monitoring, expert guidance, educational updates, troubleshooting opportunities and encouragement and motivational support.

Regulating islet stress responses through CD47 activation

AIMS/HYPOTHESIS

Diabetes is a global health burden characterised by incremental beta cell loss. Islet transplantation is a recognised treatment for individuals with type 1 diabetes and hypoglycaemia unawareness but broader application is constrained by limited islet survival and function post-transplantation. The underlying molecular mechanisms that induce beta cell dysfunction and demise remain unclear, and therapeutic agents that protect against cellular loss and maintain insulin secretion are in demand as potential treatment options. CD47 is a cell surface protein implicated in cellular stress responses but its role in beta cell function remains relatively unexplored. We hypothesised that modulating CD47 expression would demonstrate a cytoprotective effect in beta cells.

METHODS

We used primary murine islets with/without genetic deletion of CD47, as well as human islets and MIN6 cells subjected to pharmacological disruption of CD47 signalling (siRNA or blocking antibody). Metabolic stress was induced in cells by exposure to hypoxia, hyperglycaemia or thapsigargin, and markers of the unfolded protein response, cell survival and insulin secretory function were assessed. Human pancreases from individuals with and without diabetes were examined for evidence of CD47 signalling.

RESULTS

Expression of CD47 and its high affinity ligand thrombospondin-1 (TSP1) was robustly upregulated by exogenous stressors. Limiting CD47 signalling improved markers of senescence, apoptosis, endoplasmic reticulum stress, unfolded protein response, self-renewal and autophagy, and maintained insulin secretory responses. We also found concurrent upregulated expression of CD47 and senescence markers in the endocrine pancreas of aged donors and those with type 2 diabetes. Both CD47 and TSP1 expression were increased in pancreases of humans with type 1 diabetes, as were plasma levels of TSP1.

CONCLUSIONS/INTERPRETATION

Our study provides key insights into the essential role of CD47 as a novel regulator of islet dysfunction, regulating cytoprotective responses to stress. CD47 may contribute to beta cell damage during the development of diabetes and failure of islet transplant function. Therefore, limiting CD47 activation may be a potential therapeutic tool in conditions where islet function is inadequate.

Telomerase activity and telomere homeostasis in major depressive disorder, schizophrenia and bipolar disorder: a systematic review

INTRODUCTION

Life expectancy is decreased in individuals diagnosed with Major depressive disorder (MDD), Schizophrenia (SCZ) or Bipolar disorder (BD), which suggests cellular ageing. Telomere length (TL), a biomarker of cellular ageing, has been consistently reported as shorter in these individuals, but the mechanisms involved remain unknown.

METHOD

A literature search was conducted which included studies focusing on telomerase activity and markers involved in telomere homeostasis (Single nucleotide polymorphisms, gene expression, protein levels). We also searched for articles investigating the impact of psychotropic medications and other interventions on any of these markers.

RESULTS

We identified 25 articles among which individuals with MDD were overrepresented (n = 16). Telomerase was the most studied marker in terms of activity and gene expression, and few studies included analyses of other markers. Five studies out of seven reported an elevated telomerase activity in individuals with MDD. Seven of the twelve clinical trials identified, measured the impact of interventions in MDD (antidepressants, electroconvulsive therapy and yoga) with heterogeneous designs.

CONCLUSION

Literature suggests that telomerase activity is increased in MDD, with no major changes following exposure to antidepressants. Case-control and clinical intervention studies in BD and SCZ are too scarce to conclude. Furthermore, this review highlights that the complexity of telomere homeostasis has been overlooked in the literature thus limiting the understanding of the underlying molecular mechanisms. Future research should include larger and trans-nosographic samples, adopt more homogeneous designs for clinical trials, and perform more comprehensive analyses of the TL homeostasis markers.

Impact of COVID-19 pandemic-related restrictive measures on overall mental and physical health and well-being, specific psychopathologies and emotional states in representative adult Greek population: Results from the largest multi-wave, online national survey in Greece (COH-FIT)

BACKGROUND

Greece faced particular COVID-19-pandemic-related challenges, due to specific socio-cultural-economic/public-health factors and drastic restrictive policies.

OBJECTIVES

To understand trajectories of overall mental and physical health, well-being, emotional states and individual psychopathology in response to pandemic-related restrictive measures within general adult Greek population across the first two pandemic waves.

METHODS

Using multiple time-point cross-sectional data from the "Collaborative Outcomes study on Health and Functioning during Infection Times" (COH-FIT), we examined changes in outcomes from retrospective pre-pandemic ratings (T0) to three distinct intra-pandemic time points (lockdown 1: T1, between lockdowns: T2, lockdown 2: T3). Primary outcomes included WHO-5 well-being scores and a composite overall psychopathology "P-score", followed by a wide range of secondary outcomes.

RESULTS

10,377 participant responses were evaluated, including 2737 representative-matched participants. Statistically significant differences in well-being and overall psychopathology before and after quarantine (T0 vs. T1-T3), as well as across the assessed time frames (T1, T2, and T3) emerged in both samples. Global mental and physical health, individual psychopathology scores (anxiety, depression, PTSD, OCD, panic, mania, mood swings, sleep and concentration problems), emotional states (anger, helplessness, fear of infection, boredom, frustration, loneliness and overall stress scores), BMI and pain scores also showed statistically significant time differences in both samples, with the exemption of self-injury and suicidal attempt scores, showing lower intra-pandemic scores.

CONCLUSIONS

This is the largest multi-wave report on well-being, mental and physical health across different pandemic restriction periods in Greece, suggesting a substantial negative effect of lockdowns on most outcomes at least during the acute pandemic waves.

Microglial NLRP3 Inflammasomes in Alzheimer's Disease Pathogenesis: From Interaction with Autophagy/Mitophagy to Therapeutics

The nucleotide-binding oligomerization domain-like receptor pyrin domain-containing 3 (NLRP3) inflammasome, discovered 20 years ago, is crucial in controlling innate immune reactions in Alzheimer's disease (AD). By initiating the release of inflammatory molecules (including caspases, IL-1β, and IL-18), the excessively activated inflammasome complex in microglia leads to chronic inflammation and neuronal death, resulting in the progression of cognitive deficiencies. Even though the involvement of NLRP3 has been implicated in neuroinflammation and widely explored in several studies, there are plenty of controversies regarding its precise roles and activation mechanisms in AD. Another prominent feature of AD is impairment in microglial autophagy, which can be either the cause or the consequence of NLRP3 activation and contributes to the aggregation of misfolded proteins and aberrant chronic inflammatory state seen in the disease course. Studies also demonstrate that intracellular buildup of dysfunctional and damaged mitochondria due to defective mitophagy enhances inflammasome activation, further suggesting that restoration of impaired autophagy and mitophagy can effectively suppress it, thereby reducing inflammation and protecting microglia and neurons. This review is primarily focused on the role of NLRP3 inflammasome in the etiopathology of AD, its interactions with microglial autophagy/mitophagy, and the latest developments in NLRP3 inflammasome-targeted therapeutic interventions being implicated for AD treatment.

Alterations in cerebral perfusion and substrate metabolism in type 2 diabetes: interactions with APOE-ε4

AIMS/HYPOTHESIS

Epidemiological studies indicate that type 2 diabetes increases the risk for Alzheimer's disease. Alterations in cerebral metabolism have been proposed as a potential mechanism underlying this association. A better understanding of these metabolic changes may elucidate potential pathways linking type 2 diabetes to Alzheimer's disease. The aim of the current exploratory study was to investigate whether cerebral metabolism, including glucose and fatty acid uptake as well as cerebral blood flow, is altered in individuals with type 2 diabetes compared with both overweight individuals and lean control individuals.

METHODS

This exploratory study included 38 participants (ten with type 2 diabetes, 13 overweight individuals and 15 lean control individuals). Brain metabolism was assessed using multiple imaging techniques: [18F]fluorodeoxyglucose and [18F]fluoro-6-thiaheptadecanoic acid positron emission tomography for glucose and fatty acid uptake; arterial spin-labelling MRI for cerebral perfusion; and 1H-magnetic resonance spectroscopy for specific metabolites. Neurodegeneration markers were evaluated from lumbar puncture samples. Group comparisons were assessed using one-way ANOVA and unpaired t tests, and correlations were assessed with linear regression.

RESULTS

Individuals with type 2 diabetes exhibited lower cerebral glucose uptake compared with both lean and overweight groups (p<0.01). Cerebral perfusion was reduced in both participants with type 2 diabetes and overweight participants relative to lean control participants (p<0.01). Both glucose uptake and perfusion correlated negatively with HOMA-IR, insulin and HbA1c levels (p<0.001-p<0.05). White matter fatty acid uptake was elevated in the diabetes group compared with the lean group (p<0.05). Post hoc analyses revealed that lean APOE-ε4 carriers had increased fatty acid uptake in the entire brain relative to lean non-carriers. Among non-carriers of APOE-ε4, those with type 2 diabetes showed higher fatty acid uptake than lean control individuals (p<0.01-p<0.05), and this uptake correlated positively with HOMA-IR, insulin and HbA1c levels (p<0.05).

CONCLUSIONS/INTERPRETATION

Type 2 diabetes was associated with decreased cerebral perfusion and glucose uptake but increased fatty acid uptake in white matter. The elevated fatty acid uptake observed both in individuals with type 2 diabetes and in APOE-ε4 carriers suggests a common metabolic dysfunction for these Alzheimer's disease risk factors and suggests that targeting cerebral metabolic dysfunction, particularly fatty acid metabolism, could be a potential strategy for reducing the risk for neurodegeneration in individuals with type 2 diabetes.

Disability level and use of long-term care services in Norway: a nation-wide registry study

AIMS

In Norway, disability level is an important criterion when deciding the type and level of long-term care services. Each care recipient can be scored on 20 different disability level measures. Our aims were to investigate completeness in disability level information in the Norwegian Registry of Primary Health Care (NRPHC), to group disability level measures into meaningful groups, and to study the relationship between grouped disability scores and the type of services received.

METHODS

We retrieved information on type of care and disability level from the NRPHC on individuals who received long-term care services in 2022. Type of care was divided into hierarchical and mutually exclusive groups, with long-term institutional care as the most complex service group. We used principal components analysis to summarise and visualise the information in the 20 different disability level measures, and to create grouped scores.

RESULTS

A total of 386,697 persons aged 0-104 years were registered as recipients of long-term care services in Norway on 31 December 2022. Information on disability measures were of high completeness (72.4 % of the population were registered with all 20 measures) but was lower for younger age groups in which the number of recipients was lower. Principal components analyses identified two groups of measures, which we termed physical and cognitive functioning. Physical and cognitive functioning were poorest for individuals receiving the most complex and extensive services.

CONCLUSIONS

NRPHC disability data are reasonably complete, the 20 measures readily fall into two distinct categories, and seem to reflect real life differences in disability.

Unveiling the relationship between heat-resistant structure characteristics and inhibitory activity in colored highland barley proteinaceous α-amylase inhibitors

Natural α-amylase inhibitors (α-AIs) serve as food processing additives, capable of mitigating postprandial blood glucose levels, but heat resistance limits their application in high-temperature processing. This study delved into the correlation between protein structural characteristics and heat-resistance of colored highland barley (CHB) α-AIs and evaluated the inhibitory activity during chemical modification and in vitro digestion. Results demonstrated that CHB α-AIs were glycoproteins, the inhibitory activity retention rate of black highland barley α-AI salted-out with 0-60 % (NH4)2SO4 (BK1 α-AI) was 56.23 % ± 0.64 %. The protein structure analysis revealed that the preservation of three-dimensional structure was attributed to hydrogen bonds and hydrophobic interactions, and disulfide bonds played a crucial role in maintaining protein folding and activity. Succinylation increased the content of disulfide bonds after heating, and the inhibitory activity retention rate of α-AI noodles increased from 37.72 % ± 2.49 % to 42.79 % ± 0.39 %. These findings provide a theoretical foundation for the application of α-AI in thermally processed foods.

Evaluation and comparison of machine learning algorithms for predicting discharge against medical advice in injured inpatients

BACKGROUND

Whether the application of machine learning algorithms offers an advantage over logistic regression in forecasting discharge against medical advice occurrences needs to be evaluated.

METHODS

This retrospective study included all inpatient records from January 1, 2018, to December 31, 2023. The foundational data set (2018-2021) was divided into a training set (80%) and a test set (20%) for model construction and internal validation. The temporal validation data set (2022-2023) was used to assess the model's prospective performance. Feature selection was performed using the BorutaShap method. Techniques including random oversampling, random undersampling, synthetic minority oversampling technique, and edited nearest neighbors were applied to address data imbalance. Model performance was evaluated using metrics including the area under the receiver operating characteristic curve, accuracy, specificity, sensitivity, F1 score, and geometric mean. The Shapley Additive Explanations analysis provided interpretation for the best machine learning model.

RESULTS

A total of 48,394 inpatient records for injured patients met the study criteria, of which 44,119 were discharged following medical advice and 4,275 chose discharge against medical advice, resulting in a ratio of 10.32:1. Among injury inpatients, 8.8% opted for discharge against medical advice. Based on the results of feature selection and multicollinearity analysis, 16 variables were ultimately selected for the construction and evaluation of the discharge against medical advice model. The light gradient boosting machine + edited nearest neighbors model showed the best generalization, with areas under the curves of 0.820 for internal validation and 0.837 for temporal validation. The Shapley Additive Explanations method was used to interpret the model, indicating that the grade of surgery is the most important variable.

CONCLUSIONS

The study is the first to use machine learning models to predict discharge against medical advice in injured inpatients, demonstrating its feasibility. In the future, health care institutions can learn from these models to optimize patient management and reduce discharge against medical advice incidents.

Exploring Engagement in Exercise-Based Rehabilitation for Patients With Stroke: A Qualitative Study Using the Patient Health Engagement Model

Engagement in exercise-based rehabilitation is crucial for patients with stroke to improve well-being and quality of life. This study aimed to explore the attitudes, perceptions, and experiences of community-dwelling patients with stroke related to engagement in exercise-based rehabilitation. Using the Patient Health Engagement (PHE) model as a theoretical framework, we conducted interviews with patients with stroke. A purposive sampling technique was used to recruit the participants. Data were analyzed using a deductive thematic analysis approach. A total of 20 patients with stroke participated in this study. Based on participant perspectives, four major themes and twelve subthemes were identified. The major themes were: Blackout, Arousal, Adhesion, and Eudaimonic Project. These four stages represent a shift in patient engagement in exercise rehabilitation, from initial disconnection due to denial or unawareness of rehabilitation options to long-term commitment to rehabilitation aligned with identity and future goals. This study demonstrated that engagement in exercise-based rehabilitation for patients with stroke is both a process and a state. Future research should enhance the evaluation and implementation of interventions for patients with stroke engagement in exercise-based rehabilitation.

Neutrophil extracellular traps in cancer: From mechanisms to treatments

Neutrophil extracellular traps (NETs) are reticular ultrastructures released by activated neutrophils. As the reaction products of neutrophils, NETs have been identified as crucial effectors in pathogen defence and autoimmune diseases. Recently, increasing evidence suggest that this process also occurs in cancer. The formation and clearance of NETs are dynamically influenced by the tumour microenvironment, while NETs reciprocally play a dual role in either promoting or inhibiting tumour progression through their DNA scaffold, proteases and other granule-derived proteins. Given the interplay between NETs and tumours, active exploration is currently underway to harness their potential as tumour biomarkers and therapeutic targets. Here, we delve into the biochemical and immunological mechanisms underlying NETs formation within the tumour microenvironment, along with recent advances elucidating their multifaceted roles in tumourigenesis, metastasis and tumour-associated co-morbidities. Furthermore, we present emerging strategies for NETs-based tumour diagnostic approaches and therapeutics, with a special focus on the challenging questions that need to be answered within this field. KEY POINTS: The formation and clearance of NETs are dynamically influenced by the tumor microenvironment. NETs are engaged in tumorigenesis, formation, metastatic spread, and cancer-associated co-morbidities. NETs-based tumor biomarkers and therapeutic strategies warrant significant attention.

Social prescribing in the USA: emerging learning and opportunities

The global prevalence of chronic diseases and high costs of health care are complex challenges that are driving countries to focus on addressing the social determinants of health and downstream social needs. These challenges require innovative health-care practices that integrate disease prevention, treatment, and management with salutogenic initiatives to promote population health. Many countries have turned to social prescribing as a promising approach. Social prescribing connects people with non-clinical support and services within their communities. While social prescribing has more commonly been adopted in countries with government-funded national health services, in this Viewpoint, we share learning from examples in the USA. We argue that social prescribing in the USA is unique given the heterogeneity of the country and its health systems, and that this aspect influences programme activities, target-populations, and models. These examples offer valuable lessons about the barriers and enablers to implementing social prescribing in different contexts, including privatised health-care systems. Ultimately, we call upon US stakeholders to recognise the benefits that social prescribing could bring to public health and take action to support its development. We also invite stakeholders from other countries to consider learnings from the USA and how social prescribing can be successfully implemented in their contexts.

Non-Cell-Based Extracorporeal Artificial Liver Systems: Historic Perspectives, Approaches and Mechanisms, Current Applications, and Challenges

BACKGROUND

Liver disease is a growing burden. Transplant organs are scarce. Extracorporeal liver support systems (ELSS) are a bridge to transplantation for eligible patients. For transplant-ineligible patients the objective becomes liver recovery.

METHODS

We review seven decades of non-cell-based ELSS research in humans. Where possible, we emphasize randomized controlled trials (RCTs). When RCTs are not available, we describe the available human clinical data.

RESULTS

There are three broad cell-free approaches to remove protein-bound toxins (PBTs) and treat liver failure. The first is a dialysate binder suspension. A material that binds the PBT (the binder) is added to the dialysate. Binders include albumin, charcoal, and polystyrene sulfonate sodium. The unbound fraction of the PBT crosses the dialyzer membrane along a chemical gradient and binds to the binder. The second approach is using grains of sorbent fixed in a plastic housing to remove PBTs. Toxin-laden blood or plasma flows directly through the column. Toxins are removed by binding to the sorbent. The third approach is exchanging toxin-laden blood, or fractions of blood, for a healthy donor blood product. Most systems lack widespread acceptance, but plasma exchange (PE) is recommended in many guidelines. The large donor plasma requirement of PE creates demand for systems to complement or replace it.

CONCLUSIONS

Now that PE has become recommended in some, but not all, jurisdictions, we discuss the importance of reporting precise PE protocols and dose. Our work provides an overview of promising new systems and lessons from old technologies to enable ELSS improvement.

An enhanced harmonic densely connected hybrid transformer network architecture for chronic wound segmentation utilising multi-colour space tensor merging

Chronic wounds and associated complications present ever growing burdens for clinics and hospitals world wide. Venous, arterial, diabetic, and pressure wounds are becoming increasingly common globally. These conditions can result in highly debilitating repercussions for those affected, with limb amputations and increased mortality risk resulting from infection becoming more common. New methods to assist clinicians in chronic wound care are therefore vital to maintain high quality care standards. This paper presents an improved HarDNet segmentation architecture which integrates a contrast-eliminating component in the initial layers of the network to enhance feature learning. We also utilise a multi-colour space tensor merging process and adjust the harmonic shape of the convolution blocks to facilitate these additional features. We train our proposed model using wound images from light skinned patients and test the model on two test sets (one set with ground truth, and one without) comprising only darker skinned cases. Subjective ratings are obtained from clinical wound experts with intraclass correlation coefficient used to determine inter-rater reliability. For the dark skin tone test set with ground truth, when comparing the baseline results (DSC=0.6389, IoU=0.5350) with the results for the proposed model (DSC=0.7610, IoU=0.6620) we demonstrate improvements in terms of Dice similarity coefficient (+0.1221) and intersection over union (+0.1270). Measures from the qualitative analysis also indicate improvements in terms of high expert ratings, with improvements of >3% demonstrated when comparing the baseline model with the proposed model. This paper presents the first study to focus on darker skin tones for chronic wound segmentation using models trained only on wound images exhibiting lighter skin. Diabetes is highly prevalent in countries where patients have darker skin tones, highlighting the need for a greater focus on such cases. Additionally, we conduct the largest qualitative study to date for chronic wound segmentation. All source code for this study is available at: https://github.com/mmu-dermatology-research/hardnet-cws.

Update in the molecular mechanism and biomarkers of diabetic retinopathy

Diabetic retinopathy (DR) is a serious complication of diabetes caused by long-term hyperglycemia that leads to microvascular and neuronal damage in the retina. The molecular mechanisms of DR involve oxidative stress, inflammatory responses, neurodegenerative changes, and vascular dysfunction triggered by hyperglycemia. Oxidative stress activates multiple metabolic pathways, such as the polyol, hexosamine, and protein kinase C (PKC) pathways, resulting in the production of, which in turn promote the formation of advanced glycation end products (AGEs). These pathways exacerbate vascular endothelial damage and the release of inflammatory factors, activating inflammatory signaling pathways such as the NF-κB pathway, leading to retinal cell damage and apoptosis. Additionally, DR involves neurodegenerative changes, including the activation of glial cells, neuronal dysfunction, and cell death. Research on the multiomics molecular markers of DR has revealed complex mechanisms at the genetic, epigenetic, and transcriptional levels. Genome-wide association studies (GWASs) have identified multiple genetic loci associated with DR that are involved in metabolic and inflammatory pathways. Noncoding RNAs, such as miRNAs, circRNAs, and lncRNAs, participate in the development of DR by regulating gene expression. Proteomic, metabolomic and lipidomic analyses have revealed specific proteins, metabolites and lipid changes associated with DR, providing potential biomarkers for the early diagnosis and treatment of this disease. This review provides a comprehensive perspective for understanding the molecular network of DR and facilitates the exploration of innovative therapeutic approaches.

Cost-effectiveness analysis of tube feeding among older adults with advanced dementia in Japan: A net benefit regression approach

BACKGROUND

This study aims to assess the cost-effectiveness of percutaneous endoscopic gastrostomy (PEG) and nasogastric tube (NGT) in older adults with advanced dementia, compared with non-artificial nutrition.

METHODS

Retrospective cohort study. Medical claims data and long-term care claims data from Fukuoka Prefecture, Japan, were used. We identified 3,882 older adults (≥75 years) with advanced dementia who were hospitalized between April 2016 and March 2019 due to dysphagia, malnutrition, or aspiration pneumonia. Using propensity score matching, we matched 192 patients in the PEG group with 192 in the non-artificial nutrition group, and 490 patients in the NGT group with 490 in the non-artificial nutrition group. We examined the survival years and total costs of each patient from the date of admission to March 31, 2020, and thereby estimated the cost-effectiveness of PEG and NGT, respectively, versus non-artificial nutrition. The net benefit regression model was employed to estimate the incremental net benefits (INB) with varying values of willingness-to-pay (WTP) for PEG and NGT. Furthermore, cost-effectiveness acceptability curve was used to present the probability of the cost-effectiveness of each intervention.

RESULTS

As WTP increased from JPY 7,747,909 (equivalent to US$51,546) to JPY 28,163,651 (equivalent to US$187,371), the probability of PEG being cost-effective increased from 50 % to nearly100 %. The NGT group had negative INB estimates.

CONCLUSIONS

Both PEG and NGT are less likely to provide economic values for patients with advanced dementia. However, this conclusion should be further refined through detailed cost-effectiveness analysis from multiple perspectives.

Bioinformatics-led identification of pathophysiological hallmark genes in diabesotension via graph clustering method

Background

Diabesotension, an overlapping triad of diabetes, hypertension, and obesity, remains a diagnostic challenge due to its complex underlying molecular mechanisms. Individuals with diabesotension face twice the risk of microvascular and macrovascular complications compared to those with either condition alone. However, the complexity of diabesotension poses significant diagnostic challenges due to limited knowledge of this disease trifecta.

Methods

The protein network was constructed, and the DPClusOST algorithm was applied to determine the protein clusters with a density ranging from 0.1 to 1.0 and those relevant to the pathophysiology of diabesotension. The significance score (SScore) was computed using the p-value from Fisher's exact test to evaluate each cluster, and the clusters containing proteins associated with diabesotension were classified using receiver operating characteristic (ROC) analysis. The significant density of the cluster, as indicated by the AUC, was determined and subsequently subjected to pathway enrichment analysis using ShinyGO.

Results

At densities of 0.6 and 0.8, 14 proteins (STX3, VAMP2, STX4, SYT1, DNAJC5, HSD17B10, DLD, AIFM1, PDHA1, PDHB, DLAT, PDHX, OGDH, and STAT5A) from clusters 13 and 53 were significantly identified as potential diabesotension-related proteins. Key pathways associated with the tripartite interplay of the three pathologies were found to involve amino acid metabolism, glycolysis/gluconeogenesis, SNARE-mediated vesicle transport, insulin and salivary secretion, and the glucagon and HIF-1 signaling pathways, thus identifying novel candidates for diabesotension biomarkers and therapeutic targets.

Conclusions

This study highlights the use of graph clustering to identify potential biomarkers for the comorbid triad, which could enhance personalized future treatment strategies.

Clinical Application Guideline of Combination With Traditional Chinese Medicine and Western Medicine in the Prevention and Treatment of Chronic Obstructive Pulmonary Disease (2024)

AIM

Chronic Obstructive Pulmonary Disease (COPD) is a common chronic airway disease that can lead to decreased lung function in patients. It places a heavy economic burden on patients and society. Traditional Chinese medicine (TCM) and Western medicine have played important roles in managing COPD. We aimed to develop an evidence-based guideline for treating COPD with Chinese and Western Medicine.

METHODS

We formed a guideline panel of multidisciplinary experts. The clinical questions were identified based on two rounds of issue solicitation and expert demonstration. We searched the literature for direct evidence on the management of COPD and assessed its certainty-generated evidence using the grading of recommendations, assessment, development, and evaluation (GRADE) approach. The recommendations and their strengths were formulated using the Delphi method.

RESULTS

Our guideline covers aspects of the diagnosis and treatment of COPD such as principles and commonly used medications for both traditional Chinese medicine and Western medicine, complications, and the high-risk populations. 9 clinical questions and 35 recommendations were identified, which covered the combinations of YuPingFeng granule, Buzhong Yiqi decoction, Gushen Dingchuan Pill, Bufei Huoxue Capsules, Runfei cream, Bailing Capsule, Tanyin Pills, etc., and nonpharmacological therapy of TCM such as combined acupoint application, electroacupuncture, and Chinese exercise techniques (Tai Chi, Baduanjin), etc. Recommendations were either high or low or in the form of ungraded consensus-based statements.

CONCLUSIONS

This is a comprehensive and systematic evidence-based guideline and we hope it can systematically and effectively guide clinicians in managing COPD and improve overall medical care.

MCNEL: A multi-scale convolutional network and ensemble learning for Alzheimer's disease diagnosis

BACKGROUND AND OBJECTIVE

Alzheimer's disease (AD) significantly threatens community well-being and healthcare resource allocation due to its high incidence and mortality. Therefore, early detection and intervention are crucial for reducing AD-related fatalities. However, the existing deep learning-based approaches often struggle to capture complex structural features of magnetic resonance imaging (MRI) data effectively. Common techniques for multi-scale feature fusion, such as direct summation and concatenation methods, often introduce redundant noise that can negatively affect model performance. These challenges highlight the need for developing more advanced methods to improve feature extraction and fusion, aiming to enhance diagnostic accuracy.

METHODS

This study proposes a multi-scale convolutional network and ensemble learning (MCNEL) framework for early and accurate AD diagnosis. The framework adopts enhanced versions of the EfficientNet-B0 and MobileNetV2 models, which are subsequently integrated with the DenseNet121 model to create a hybrid feature extraction tool capable of extracting features from multi-view slices. Additionally, a SimAM-based feature fusion method is developed to synthesize key feature information derived from multi-scale images. To ensure classification accuracy in distinguishing AD from multiple stages of cognitive impairment, this study designs an ensemble learning classifier model using multiple classifiers and a self-adaptive weight adjustment strategy.

RESULTS

Extensive experiments on the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset validate the effectiveness of our solution, which achieves average accuracies of 96.67% for ADNI-1 and 96.20% for ADNI-2, respectively. The results indicate that the MCNEL outperforms recent comparable algorithms in terms of various evaluation metrics, demonstrating superior performance and robustness in AD diagnosis.

CONCLUSIONS

This study markedly enhances the diagnostic capabilities for AD, allowing patients to receive timely treatments that can slow down disease progression and improve their quality of life.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Porcine pericardium crosslinked with POSS-PEG-CHO possesses weakened immunogenicity and anti-calcification property

Valvular heart disease (VHD) poses a thorny problem in cardiovascular diseases. The most effective treatment for VHD is heart valve replacement. Biological heart valve (BHV) is more favored than mechanical heart valve due to the maturity of transcatheter heart valve replacement (THVR) and the absence of the need for lifelong anticoagulant use. However, traditional commercial BHV suffers degeneration within 10-15 years because of calcification caused by the cross-linking reagent, glutaraldehyde. Considering the remarkable properties of POSS, PEG, and the star-like eight-arm structure, we fabricated POSS-PEG-PP, which is a decellularized porcine pericardium (DPP) crosslinked by a star-like eight-arm cross-linker octafunctionalized POSS of benzaldehyde-terminated polyethylene glycol (POSS-PEG-CHO) based on the Schiff's base reaction. POSS-PEG-PP exhibits more intense fiber arrangement and better mechanical properties than GLUT-PP (glutaraldehyde crosslinked DPP). The results also show that the cytocompatibility, endothelialization, and hemocompatibility of POSS-PEG-PP are outstanding in vitro. Subsequently, in vivo assessments demonstrate that POSS-PEG-PP has anti-inflammatory and anti-calcification abilities. Furthermore, RNA sequencing analysis of subcutaneous implants suggests that the intervention of AMPK and IL-17 signaling pathways plays an important role in the inflammatory and immune responses regulation of POSS-PEG-PP. Therefore, POSS-PEG-PP is an excellent substitute material for BHVs and is expected to be clinically transformed.

Artificial intelligence based predictive tools for identifying type 2 diabetes patients at high risk of treatment Non-adherence: A systematic review

AIMS

Several Artificial Intelligence (AI) based predictive tools have been developed to predict non-adherence among patients with type 2 diabetes (T2D). Hence, this study aimed to describe and evaluate the methodological quality of AI based predictive tools for identifying T2D patients at high risk of treatment non-adherence.

METHODS

A systematic search was conducted across multiple databases including, EMBASE, Cochrane Library, MedLine, and Google Scholar search. The Prediction model Risk Of Bias ASsessment Tool (PROBAST) was used to assess the quality of studies. The performances of tools were assessed by Area Under the Curve (AUC), precision, recall, C-index, accuracy, sensitivity, specificity or F1 score.

RESULTS

Most studies measured predictive ability using AUC (75 %), and some only reported precision (25 %), recall (12.5 %), C-index (12.5 %), accuracy (37.5), sensitivity (12.5 %), specificity (12.5 %) or F1 score (25 %). All tools had moderate to high predictive ability (AUC > 0.70). However, only one study conducted external validation. Demographic characteristics, HbA1c, glucose monitoring data, and treatment details were typical factors used in developing tools.

CONCLUSIONS

The existing AI based tools holds significant promise for improving diabetes care. However, future studies should focus on refining the existing tools, validating in other settings, and evaluating the cost-effectiveness of AI-supported interventions.

Association of cardiovascular-kidney-metabolic syndrome with all-cause and cardiovascular mortality: A prospective cohort study

Background

Given evidence on the cardiovascular disease (CVD) risk conferred by comorbidity risk factors, the American Heart Association (AHA) recently introduced a novel staging construct, named cardiovascular-kidney-metabolic (CKM) syndrome. This study examined the association of CKM syndrome stages with all-cause and cardiovascular mortality among US adults.

Methods

Data were from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 at baseline linked to the 2019 National Death Index records. For each participant, the CKM syndrome was classified into five stages: stage 0 (no CKM risk factors), 1 (excess or dysfunctional adiposity), 2 (metabolic risk factors and chronic kidney disease), 3 (subclinical CVD), or 4 (clinical CVD). The main outcomes were all-cause and cardiovascular mortality.

Results

Among 34,809 participants (mean age: 46.7 years; male: 49.2 %), the prevalence of CKM stages 0 to 4 was 13.2 %, 20.8 %, 53.1 %, 5.0 %, and 7.8 %, respectively. During a median follow-up of 8.3 years, compared to participants with CKM stage 0, those with higher stages had increased risks of all-cause mortality (stage 2: HR 1.43, 95 % 1.13-1.80; stage 3, HR 2.75, 95 % CI 2.12-3.57; stage 4, HR 3.02, 95 % CI 2.35-3.89). The corresponding hazard ratios (95 % confidence interval) of cardiovascular mortality risks were 2.96 (1.39-6.30), 7.60 (3.50-16.5), and 10.5 (5.01-22.2). The population-attributable fractions for advanced (stages 3 or 4) vs. CKM syndrome stages (stages 0, 1, or 2) were 25.3 % for all-cause mortality and 45.3 % for cardiovascular mortality.

Conclusion

Higher CKM syndrome stages were associated with increased risks of all-cause and cardiovascular mortality. These findings emphasize that primordial and primary prevention efforts on promoting CKM health should be strengthened to reduce mortality risk.