Portable ultra-low-field MRI in acute stroke care: A pilot study

INTRODUCTION

Neuroimaging is a prerequisite for treatment of stroke patients, but it is not available all over the globe. Portable ultra-low field (pULF) MRI has the potential to improve access to neuroimaging and thus stroke care worldwide. In a pilot study, we were the first to utilise pULF-MRI in a European tertiary stroke centre and to evaluate its diagnostic value compared to high-field (HF) MRI.

PATIENTS AND METHODS

Consecutive patients admitted for suspected ischaemic stroke underwent pULF-MRI using the 0.064 Tesla Swoop® portable MR imaging system in addition to standard imaging. HF-MRI and pULF-MRI scans were blindly assessed to compare the diagnostic accuracy and imaging-based therapeutic decisions based on pULF-MRI to HF-MRI.

RESULTS

Seventeen patients underwent pULF-MRI, 12 of whom had ischaemic lesions on HF-MRI. Ischaemic lesions were detected on pULF-MRI in 8/12 cases. The four infarcts not identified on pULF-MRI were all smaller than 6 mm in diameter. In all cases, a virtual treatment decision based on pULF-MRI by a blinded team matched the actual clinical decisions.

CONCLUSION

This single-centre study demonstrates that pULF-MRI is a promising tool in acute stroke care, providing reliable imaging for treatment decision and follow-up monitoring. pULF-MRI may support acute stroke care if HF-MRI is unavailable and may be particularly helpful in resource-limited settings. Limitations of pULF-MRI include long acquisition times and the lack of vessel imaging and haemorrhage-sensitive sequences.

Adherence to asthma and COPD therapies in low- and middle-income countries: a narrative review

INTRODUCTION

In low-income and middle-income countries (LIMCs), defined based on the World Bank classification, non-adherence to respiratory therapies contributes to increasing mortality and morbidity due to chronic respiratory diseases. To address this issue, it is essential to identify and tackle underlying factors such as cultural beliefs, socioeconomic disparities, and limited access to healthcare resources and infrastructures. The absence of strategies that integrate community involvement, healthcare professional's training, economic policies, and educational programs exacerbates the disproportionate burden of chronic respiratory diseases in LIMCs.

AREAS COVERED

This review is based on a structured literature search across PubMed, Scopus, and Google Scholar (2000-2023) using terms relevant to asthma, COPD, adherence, and LMICs. The review examines key factors that hinder patients' adherence to Asthma and COPD medications in LIMCs, providing some insights into the issue and proposing concrete solutions.

EXPERT OPINION

Addressing non-adherence requires a multifaceted approach involving community engagement, educational initiatives, and improved healthcare infrastructure. Future research should focus on tailored interventions to enhance adherence and ultimately improve health outcomes for patients with chronic respiratory diseases in LMICs.

[Bariatric surgery versus GLP-1 and dual GIP/GLP-1 receptor agonists : Effects on weight, risk factors and prognosis]

To overcome the increasing prevalence of obesity and associated secondary diseases, effective treatment strategies are required. While bariatric surgery (BS) is an established method for significant and sustainable weight reduction, drug treatment with glucagon-like peptide 1 (GLP-1), GLP‑1 receptor agonists (GLP‑1 RA) and dual glucose-dependent insulinotropic peptide (GIP)/GLP‑1 RA has gained increasing importance in recent years. This article highlights the effects of these both treatment approaches on body weight, cardiometabolic risk factors and long-term prognosis, particularly with respect to cardiovascular events and remission of type 2 diabetes. While BS shows more robust weight loss and greater improvement in metabolic parameters, GLP‑1 RA and dual GIP/GLP‑1 RA offer a conservative treatment alternative with a good safety profile. The choice of treatment should be individualized based on the patient risk profile and preferences.

Global, regional and national level burden of bulimia nervosa from 1990 to 2021 and their projections to 2030: analysis of the global burden of disease study

Background

Bulimia nervosa (BN) is increasingly recognized as a significant public health issue worldwide. This study aims to explore the effects of BN on global, regional, and national scales by analyzing data from the Global Burden of Disease (GBD) Study 2021.

Methods

We obtained the age-standardized rates (ASRs) of prevalence, incidence, and disability-adjusted life years rates (DALYs), along with their 95% uncertainty intervals (UIs) for BN from the GBD 2021 dataset, covering the period from 1990 to 2021. And estimated annual percentage changes (EAPCs) was used to represent the changing trend of BN burden. The Long-term trends of the burden of BN were quantified by Age-period-cohort (APC) analysis. Furthermore, an evaluation of inequality and a prospective prediction concerning the worldwide impact of BN is performed.

Results

From 1990 to 2021, the global burden of BN showed a continuous increase. In 2021, the highest burden of BN was observed in regions with a high socio-demographic index (SDI), particularly in Australasia (ASPR was 811.9 per 100,000 individuals; 95% UI: 629.68 to 1041.59). The most substantial increase in the burden of BN was observed in Asia. In the national level, Equatorial Guinea experienced the most significant increase in the burden of BN from 1990 to 2021 (EAPC of ASPR was 3.48; 2.86 to 4.11). In contrast, burden of BN in High-income North America recorded a substantial decrease from 1990 to 2021 (EAPC of ASPRs was − 0.26; -0.39 to -0.13). The growth rate of male BN burden was higher than that of female. The relative inequality of the BN burden decreased between 1990 and 2021. Further forecasts from the GBD indicated that the global burden of BN would continue to rise by 2030.

Conclusion

These results can help governments across the globe in developing suitable health and medical policies focused on the prevention and early intervention of BN. Moreover, the differences in BN burden should be analyzed based on region, nation, gender, and year when setting international health goals.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40337-025-01289-9.

Analyses of prevalence, incidence, and disability-adjusted life years (DALYs) for bulimia nervosa (BN) revealed a sustained increase in BN’s global burden from the year of 1990 to 2021. Regionally and nationally, BN burden correlated positively with socioeconomic development levels, with Australia exhibiting the highest burden in 2021. The most pronounced growth occurred in East and South Asia, while high-income North America experienced a decline. Notably, although females bore a higher burden, males demonstrated faster growth rates in BN cases. Inequality analyses showed widening absolute disparities in BN burden between high- and low-income nations, whereas relative inequality decreased due to accelerated burden growth in lower-income regions. Projections indicate a continuing global rise in BN burden through 2030, underscoring the need for targeted interventions.

Qingfei Litan decoction alleviated Klebsiella pneumoniae-induced pneumonia by targeting the TLR4/MyD88/NF-κB axis via miR-146a-5p

ETHNOPHARMACOLOGICAL RELEVANCE

Klebsiella pneumoniae (Kp) is a significant pathogen responsible for various clinical bacterial infections, including pneumonia, sepsis, and even death. However, effective treatment options remain limited due to the rising prevalence of antimicrobial resistance. Traditional Chinese medicine (TCM) has shown potential in the treatment of bacterial pneumonia. Qingfei Litan decoction (QFLT) has been reported to alleviate symptoms in patients with bacterial pneumonia, though its precise mechanisms in regulating pulmonary inflammation remain unclear.

AIM OF THE STUDY

This study aimed to investigate the therapeutic potential of QFLT in Kp-induced pneumonia and to elucidate its underlying molecular mechanisms.

MATERIAL AND METHODS

In vivo, a murine pneumonia model was established through intratracheal instillation of Kp, and QFLT was administered by oral gavage. miR-146a-5p expression was downregulated by tail vein injection of an antagomir. The therapeutic effects of QFLT on pulmonary pathology, inflammatory factors, and miR-146a-5p expression were evaluated using qRT-PCR, flow cytometry, and other methods. Bioinformatics tools were employed to predict miR-146a-5p targets and associated inflammatory pathways. In vitro, an alveolar macrophage inflammation model was established by stimulating MH-S cells with heat-inactivated Klebsiella pneumoniae (iKp), followed by QFLT treatment. Inhibition of miR-146a-5p was achieved through transfection with specific inhibitors. The effects of QFLT on inflammatory responses, miR-146a-5p expression, and TLR4/MyD88/NF-κB signaling were assessed using qRT-PCR, Western blotting (WB) and other methods.

RESULTS

Kp infection significantly exacerbated pulmonary inflammation and downregulated miR-146a-5p expression in both lung tissues and MH-S cells. QFLT treatment alleviated inflammatory responses and upregulated miR-146a-5p expression. Bioinformatics analysis demonstrated that miR-146a-5p targeted TRAF6, a key mediator of the TLR4/MyD88/NF-κB pathway. Western blot analysis further confirmed that QFLT reduced Kp-induced upregulation of the TLR4/MyD88/NF-κB pathway in MH-S cells. Moreover, inhibition of miR-146a-5p exacerbated inflammatory responses in both lung tissues and MH-S cells, whereas QFLT treatment effectively attenuated these inflammatory effects. Furthermore, miR-146a-5p suppression resulted in elevated expression of proteins in the TLR4/MyD88/NF-κB signaling pathway in MH-S cells, while QFLT administration significantly reduced the expression levels of these signaling components.

CONCLUSIONS

These findings demonstrated that QFLT ameliorated Kp-induced pneumonia by modulating the TLR4/MyD88/NF-κB axis via miR-146a-5p.

Genomic insights into antibiotic-resistant non-typhoidal Salmonella isolates from outpatients in Minhang District in Shanghai

BACKGROUND

Salmonella enterica (S. enterica) causes tens of thousands of cases of diarrheal disease worldwide each year. However, our understanding of the genome and transmission dynamics of S. enterica in Minhang District in Shanghai, China is still insufficient. This study is aimed to better understand the population structure, antibiotic resistance patterns, and evolution dynamics of local strains.

METHODS

We sequenced 458 S. enterica strains from outpatients at Minhang District Central Hospital in Shanghai, China, from 2012 to 2021. Bioinformatics analyses on antibiotic resistance genes, virulence factors, mobile genetic elements, pathogenic islands, and phylogenetic relationships were performed.

RESULTS

Here we show that two dominant serovars are S. Enteritidis and S. Typhimurium isolated from outpatients in Minhang District in Shanghai, China. A total of 40 serovars and 53 sequence types (STs) are identified, two S. Montevideo strains isolated in 2013 belong to a newly identified ST10844, which is firstly identified in Minhang District in Shanghai, China. More than half of the isolates show resistance to fluoroquinolones and beta-lactams. Notably, 259 (56.6%) of the 458 isolates exhibit a multidrug-resistant pattern. Third-generation cephalosporin resistance gene blaCTX-M-55 is identified in 15 (3.3%) isolates, and fluoroquinolone resistance gene qnrS1 is identified in 42 (9.2%) isolates, both of which are strongly correlated with IS26. Mutations of T57S in ParC and D87Y in GyrA are observed in 149 (32.5%) and 133 (29.0%) isolates, respectively. In addition, phylogenetic analysis confirms the presence of outbreaks caused by S. Enteritidis and S. Typhimurium, respectively.

CONCLUSIONS

These results suggest local expansion and evolution in Salmonella occurred in Shanghai, China, and the underlying emergence of the undefined multidrug-resistant clone. Our findings enlarge the knowledge of local epidemics of Salmonella, especially S. Enteritidis and S. Typhimurium in Shanghai, and provide a piece of useful baseline information for future whole-genome sequencing surveillance.

Burden of bacterial antimicrobial resistance in China: a systematic analysis from 1990 to 2021 and projections to 2050

INTRODUCTION

Antimicrobial resistance (AMR) has emerged as a critical health challenge; however, there is a paucity of in-depth reports outlining its burden and trends in China.

OBJECTIVES

This study aimed to systematically assess the burden of bacterial AMR in China from 1990 to 2021 and project future trends up to 2050, providing critical insights for AMR control and policy-making.

METHODS

We analyzed data from the Global Burden of Disease Study 2021, encompassing 12 infectious syndromes, 64 pathogens (including 22 with AMR), and 84 pathogen-drug combinations. The burden was quantified by deaths and disability-adjusted life years under two counterfactual scenarios: deaths associated with AMR and those attributable to AMR, respectively. Trends were assessed using joinpoint regression analysis, and future projections up to 2050 were modeled using an autoregressive integrated moving average approach.

RESULTS

In 2021, AMR was attributable to approximately 160,268 (95% uncertainty intervals [UI]: 132,375-188,160) deaths in China, with up to 711,852 (95% UI: 586,447-837,256) fatalities associated with AMR. The most lethal infectious syndrome was bloodstream infections, with key pathogen-drug combinations including methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Streptococcus pneumoniae, and carbapenem-resistant Acinetobacter baumannii. Between 1990 and 2021, there was a substantial decrease in the burden among children under the age of five, primarily due to a decline in fatalities caused by carbapenem-resistant S. pneumoniae. In contrast, the burden increased among individuals aged 45 and older, with MRSA identified as the principal contributor. Projections indicate that by 2050, AMR could be associated with 769,432 deaths in China, of which 180,123 directly attributable to AMR.

CONCLUSION

Our findings provide a comprehensive evaluation of AMR burden in China, highlighting the urgent need for targeted interventions to prevent and control resistant infections, particularly among older adults.

Minibinders targeting Staphylococcus aureus α-toxin exert protective effects in vivo

Staphylococcus aureus is a leading bacterial pathogen worldwide. It secrets α-toxin, a pore-forming cytotoxin that significantly contributes to the pathogenesis of pneumonia, skin necrosis, and lethal infections. Targeting α-toxin has emerged as a promising strategy for developing therapeutics against S. aureus infections. In this study, we employed a de novo computational design pipeline to generate minibinder proteins specifically targeting to α-toxin. Three top-ranked designs were expressed in E. coli, purified, and characterized. The minibinders exhibited thermostable α-helical structures and specific binding to α-toxin, with Binder2 showing the highest affinity (KD = 40.2 ± 3.1 μM). All designs effectively inhibited α-toxin's hemolytic and cytotoxic activities in vitro. Notably, Binder2 attenuated α-toxin-induced cytokine expression in A549 and THP-1 cells. Mechanistically, binders neutralized α-toxin cytolytic activity by blocking its cell binding and heptamer formation. In a murine model, co-injection of minibinders with α-toxin significantly extended the survival times of mice challenged with α-toxin, and Binder2 exhibited the most potent protective effects. These findings highlight Binder2 as a promising lead molecule for further development as an α-toxin antagonist. Our study demonstrates the potential of computationally designed minibinders as a novel therapeutic approach against S. aureus infections.

Cataract-causing variant G119R impaired the oligomeric homeostasis of βB2-crystallin with lower structural stability and more sensitivity to the environmental stress

Congenital cataract is a significant cause of blindness in children, primarily associated with genetic factors. βB2-crystallin, the principal structural protein of the lens, is essential for preserving lens transparency and stabilizing the intracellular environment. Numerous mutations in βB2-crystallin are identified as contributors to cataract; however, the underlying pathogenic mechanisms remain unclear. Our study focused on a Chinese family with a new G119R mutation associated with congenital nuclear cataract, investigating the molecular mechanism of βB2-G119R in the pathogenesis of congenital cataracts at the protein, cellular, and molecular levels. We purified the mutant protein and analyzed its structural changes using size-exclusion chromatography (SEC), fluorescence spectroscopy, and circular dichroism (CD) spectroscopy. As a result, this mutation disrupted the oligomerization balance of βB2-crystallin and reduced both its structural and thermal stability. Furthermore, the mutant protein exhibited decreased resistance under the environmental stress, which was confirmed by the cell model demonstrating heightened sensitivity to the stress. Additionally, molecular dynamics simulation results indicated that the G119R mutation adversely affected the advanced structure of βB2-crystallin. Consequently, our findings underscored the importance of G119 in maintaining the structural stability of crystallin, offering new insights for further investigation into the pathogenesis of cataracts.

Immunogenicity and Safety of Influenza and COVID-19 Multicomponent Vaccine in Adults ≥50 Years: A Randomized Clinical Trial

Importance

Uptake of recommended seasonal influenza and COVID-19 vaccines remains suboptimal.

Objective

To assess the immunogenicity and safety of an investigational mRNA-1083 vaccine against seasonal influenza and SARS-CoV-2 in adults 50 years and older.

Design, Setting, and Participants

This phase 3, randomized, observer-blinded trial was conducted across 146 US sites in adults 50 years and older enrolled between October 19, 2023, and November 21, 2023. Data extraction was complete on April 9, 2024.

Interventions

Participants in 2 age cohorts (≥65 years and 50-64 years) were randomly assigned (1:1) to receive mRNA-1083 plus placebo or coadministered licensed quadrivalent seasonal influenza (≥65 years: high-dose quadrivalent inactivated influenza vaccine [HD-IIV4]; 50-64 years: standard-dose IIV4 [SD-IIV4]) and COVID-19 (all ages: mRNA-1273) vaccines.

Main Outcomes and Measures

The primary objectives were to demonstrate the noninferiority of humoral immune responses following mRNA-1083 vs comparators against vaccine-matched strains at day 29 and to evaluate the reactogenicity and safety of mRNA-1083. Secondary objectives included demonstration of superiority of humoral immune responses elicited by mRNA-1083 relative to comparators at day 29.

Results

Overall, 8015 participants were enrolled and vaccinated (4017 aged ≥65 y and 3998 aged 50-64 y). Among adults 65 years and older and 50 to 64 years, the median age was 70 and 58 years, 54.2% and 58.8% were female, 18.4% and 26.7% were Black or African American, and 13.9% and 19.3% were Hispanic or Latino, respectively. Noninferior immunogenicity of mRNA-1083 was demonstrated against all vaccine-matched influenza and SARS-CoV-2 strains based on lower bound of the 97.5% CI of the geometric mean ratio greater than 0.667 and lower bound of the 97.5% CI of the seroconversion/seroresponse rate difference greater than -10%. mRNA-1083 elicited higher immune responses than SD-IIV4 (50-64 years) for all 4 influenza strains and HD-IIV4 (≥65 years) for 3 influenza strains (A/H1N1, A/H3N2, B/Victoria) and against SARS-CoV-2 (all ages). Solicited adverse reactions were numerically higher in frequency and severity after mRNA-1083 vaccination than comparators in both age cohorts (≥65 y: 83.5% and 78.1%; 50-64 y: 85.2% and 81.8%); most were grade 1 or 2 in severity and of short duration. No safety concerns were identified.

Conclusions and Relevance

In this study, mRNA-1083 met noninferiority criteria and induced higher immune responses than recommended standard care influenza (standard and high dose) and COVID-19 vaccines against all 4 influenza strains (among those ages 50-64 y), the 3 clinically relevant influenza strains (among those aged ≥65 y), and SARS-CoV-2 (all ages), with an acceptable tolerability and safety profile.

Trial Registration

ClinicalTrials.gov Identifier: NCT06097273.

Colonization dynamics of Streptococcus pneumoniae are determined by polymorphisms in the BlpAB transporter

Colonization of the human airways, the first step in the pathogenesis of Streptococcus pneumoniae (Spn), is the determining factor in the ecological spread of the bacterium. Since co-colonization by multiple strains is common, within-host bacterial competition contributes to the success of Spn strains. Competition both between and within strains is mediated by bacteriocin gene clusters, notably the quorum sensing-regulated bacteriocin-like peptide (blp) locus. A key component of this system is the BlpAB transporter that exports pheromones and bacteriocins expressed by the blp locus. However, ~75% of Spn strains lack a functional BlpAB transporter and instead rely on the paralogous ComAB transporter for this export, raising questions about the evolutionary persistence of BlpAB(+) strains. Using molecular barcoding, we demonstrate that BlpAB(+) and BlpAB(-) strains show major differences in population dynamics during colonization modeled in mice. The BlpAB(+) strains exhibit slower loss of clonal diversity as a consequence of intrastrain competition relative to their isogenic BlpAB(-). The contribution of a functional BlpAB transporter was then examined in an association study of >2,000 human carriage isolates from a highly colonized population. The median carriage duration was ~177 days longer for BlpAB(+) relative to BlpAB(-) strains. This increased duration of natural carriage correlates with a competitive advantage for BlpAB(+) strains when tested in the murine model. Thus, our work provides insight into how differences in the population dynamics of Spn mediated by bacterial competition impact host colonization.IMPORTANCESpn is a frequent colonizer of the human upper respiratory tract. Success during colonization is dictated by the arsenal of weapons these bacteria possess, which provides them with an advantage over their competitors. A key example includes the blp bacteriocins that are exported by the cell through both BlpAB and ComAB transporters. While most Spn strains lack a functional BlpAB, a subset of the strains retains it. Given this redundancy in export systems, our study questioned the evolutionary advantage of retaining BlpAB. Herein, we show that a functional BlpAB transporter causes a slower loss of clonal diversity in vivo. This correlates with longer Spn carriage duration in the human population and a competitive advantage during experimental co-colonization. Our work highlights the reasons behind the persistence of Spn with a functional BlpAB. These findings reveal how genetic variability in the blp locus shapes Spn colonization and evolutionary success.

Parenteral vaccination with recombinant EtpA glycoprotein impairs enterotoxigenic E. coli colonization

Enterotoxigenic E. coli (ETEC) causes hundreds of millions of cases of acute diarrheal illness in low- and middle-income regions, disproportionately in young children. To date, there is no licensed, broadly protective vaccine against these common but antigenically heterogeneous pathogens. One of the more highly conserved antigens of ETEC, EtpA, is an extracellular glycoprotein adhesin that preferentially binds to A blood group glycans on intestinal epithelia. EtpA contributes to increased severity of illness in A blood group individuals, elicits robust serologic and fecal antibody responses following infection, and has been associated with protection against subsequent infection. However, its utility as a protective antigen needs further examination. In the present studies, we examined whether parenteral vaccination with recombinant EtpA (rEtpA) could afford protection against intestinal colonization in a murine model of ETEC infection. Here, we demonstrate that intramuscular vaccination with rEtpA, adjuvanted with double mutant LT (dmLT), primes IgG predominant mucosal antibody responses to ETEC challenge. Notably, however, both antibody levels and avidity, as well as protection, were dependent on the vaccination schedule. Likewise, through electron microscopy polyclonal epitope mapping (EMPEM), we observed a different repertoire of epitopes targeted by antibodies after a more protracted vaccination schedule. Next, we explored the utility of IM immunization with alum-adjuvanted rEtpA. This elicited strong serologic and fecal IgG responses. Although accompanied by negligible IgA mucosal responses, EtpA alum-adjuvanted IM vaccination nevertheless protected against ETEC intestinal colonization. Collectively, these data suggest that EtpA could expand the portfolio of antigens targeted in ETEC subunit vaccine development.

Metallo-β-lactamase NDM-1 serves as a universal vaccine candidate for combatting antimicrobial resistance

The rapid emergence and spread of antimicrobial resistance have become critical global health issues, leading to significant morbidity and mortality worldwide. With the increase in resistance to multiple drugs, especially frontline clinical antibiotics, there is an urgent need for novel and effective alternative strategies. Herein, we developed a vaccine targeting the antimicrobial resistance enzyme NDM-1, which was first identified in Klebsiella pneumoniae and has quickly spread to other gram-negative bacteria. Our results demonstrate that NDM-1 primarily triggers a humoral immune response and effectively protects mice from lethal Klebsiella pneumoniae infection, as evidenced by increased survival rates, reduced bacterial loads, and decreased lung inflammation in mice. The specific antibodies generated were able to inhibit the enzymatic activity of NDM-1, bacterial growth, and exhibit opsonophagocytic activity against Klebsiella pneumoniae in vitro. Both active and passive immunization with NDM-1 showed an additive effect when combined with meropenem therapy. Furthermore, NDM-1 immunization induced cross-reactivity with NDM-1 variants, potentially providing broad protection against bacteria carrying different NDM genes. Additionally, heptamerization of NDM-1 improved its immunogenicity and protective efficacy in mice. These results highlight the potential of vaccine development based on antibiotic resistance candidates for broadly combatting antimicrobial resistance.

Xenopus laevis as an infection model for human pathogenic bacteria

Animal infection models are essential for understanding bacterial pathogenicity and corresponding host immune responses. In this study, we investigated whether juvenile Xenopus laevis could be used as an infection model for human pathogenic bacteria. Xenopus frogs succumbed to intraperitoneal injection containing the human pathogenic bacteria Staphylococcus aureus, Pseudomonas aeruginosa, and Listeria monocytogenes. In contrast, non-pathogenic bacteria Bacillus subtilis and Escherichia coli did not induce mortality in Xenopus frogs. The administration of appropriate antibiotics suppressed mortality caused by S. aureus and P. aeruginosa. Strains lacking the agr locus, cvfA (rny) gene, or hemolysin genes in S. aureus, LIPI-1-deleted mutant of L. monocytogenes, which attenuate virulence within mammals, exhibited reduced virulence in Xenopus frogs compared with their respective wild-type counterparts. Bacterial distribution analysis revealed that S. aureus persisted in the blood, liver, heart, and muscles of Xenopus frogs until death. These results suggested that intraperitoneal injection of human pathogenic bacteria induces sepsis-like symptoms in Xenopus frogs, supporting their use as a valuable animal model for evaluating antimicrobial efficacy and identifying virulence genes in various human pathogenic bacteria.

Global Changes in Ischemic Stroke Burden Attributable to Ambient PM2.5: Trends From 1990 to 2020 and Projections to 2050

BACKGROUND AND OBJECTIVES

Ischemic stroke (IS) is a leading cause of disability and mortality worldwide, with ambient fine particulate matter (PM2.5) exposure being a significant modifiable risk factor. While PM2.5 concentrations have declined in some regions, global assessments examining how these changes affect the IS burden remain limited. The aim of this study was to quantify changes in IS burden attributable to PM2.5 from 1990 to 2020 and project future trends to 2050.

METHODS

We used data from the 2021 Global Burden of Disease study, including population estimates, IS incidence rates, and PM2.5 concentrations, for 204 countries and World Bank regions. The Environmental Benefits Mapping and Analysis Program algorithm was applied to estimate IS cases attributable to PM2.5. Future projections were calculated using an autoregressive integrated moving average model.

RESULTS

Between 1990 and 2020, global PM2.5 concentrations decreased by 8.18 μg/m3. This reduction was associated with approximately 920,245 avoided IS cases, equivalent to 12.11% of the global IS incidence in 2020. The East Asia and Pacific region experienced the greatest benefit, with 699,218 IS cases avoided (19.09% of the region's IS incidence in 2020). By 2050, PM2.5 concentrations are projected to decline by 33.64 μg/m3 relative to 1990, potentially preventing an additional 6,004,854 IS cases. However, significant disparities persist, particularly in low-income regions where PM2.5 exposure and limited health care infrastructure continue to pose challenges.

DISCUSSION

Our findings highlight the substantial public health benefits of PM2.5 reductions in mitigating the IS burden. While high-income regions have seen substantial gains due to stringent air quality regulations, low-income regions remain disproportionately affected. Addressing these disparities requires targeted pollution control policies and equitable health care resource allocation. Sustained efforts in air quality management are critical to reducing the global IS burden and improving health outcomes, particularly in vulnerable populations.

Adverse Outcomes Associated With Short-Acting Beta-Agonist Overuse in Asthma: A Systematic Review and Meta-Analysis

INTRODUCTION

The 2019 Global Initiative for Asthma (GINA) report no longer recommended short-acting beta-agonists (SABA) monotherapy due to associated complications and a lack of anti-inflammatory properties. This systematic review and meta-analysis aimed to evaluate adverse outcomes associated with SABA overuse in patients with asthma.

METHODS

PubMed, Cochrane Library, EMBASE, and Web of Science databases were searched for studies on SABA overuse (≥ 3 SABA canisters/year) in patients with asthma, from 1981 to November 2023. Randomized controlled trials (RCTs), cohort studies, and cross-sectional studies were included. Pooled risk ratios (RRs) were calculated for dichotomous measures of all-cause mortality and acute exacerbations using random-effects models and Mantel-Haenszel weighting. Subgroup analyses were conducted based on study design.

RESULTS

Out of 626 records, 27 studies (2 RCTs, 1 prospective cohort study, 12 retrospective cohort studies, and 12 cross-sectional studies) were included. SABA overuse (≥ 3 SABA canisters/year) was associated with significantly higher mortality (2743 of 130,629 in the overuse group versus 3534 of 300,451 in controls; RR = 2.04, 95% confidence interval, CI = 1.37-3.04; p < 0.001) and a significantly higher rate of acute exacerbations (60,320 of 165,271 in the overuse group versus 84,439 of 376,845 in controls; RR = 1.93, 95% CI = 1.24-3.03; p < 0.001). An increased risk of acute exacerbations was observed in retrospective cohort studies (RR = 1.88, 95% CI = 1.43-2.47; p < 0.001) and cross-sectional studies (RR = 2.23, 95% CI = 1.04-4.77; p < 0.001).

CONCLUSIONS

SABA overuse was associated with increased rates of mortality and acute exacerbations in patients with asthma, supporting guidelines that advise against SABA monotherapy in asthma management.

Stimulus-responsive hydrogels for diabetic wound management via microenvironment modulation

Diabetic wounds, a major complication of diabetes mellitus, pose a significant clinical challenge. The treatment of diabetic wounds requires comprehensive interventions tailored to their pathophysiological characteristics, such as recurring bacterial infection, persistent inflammation, excessive oxidative stress, and impaired angiogenesis. The development of stimulus-responsive hydrogel dressings offers new strategies for diabetic wound treatment. By responding to various physical and biochemical signals, these smart hydrogels enable real-time monitoring and precise modulation of the wound microenvironment to accelerate diabetic wound healing. In this review, we provide an overview of the disease characteristics of chronic diabetic wounds and introduce the current clinical treatment approaches. We summarize the cutting-edge applications of physical and biochemical signal-responsive hydrogels for diabetic wound treatment by modulating the wound microenvironment.

The characterization of Klebsiella pneumoniae associated with neonatal sepsis in low- and middle-income countries to inform vaccine design

Klebsiella pneumoniae is the leading cause of neonatal sepsis, strongly associated to antimicrobial resistance, with no vaccine available. K-antigens (KAg) have been identified as potential targets, but their diversity makes vaccine development challenging. Alternatively, the use of subcapsular O-antigens (OAg) raises questions about antibodies accessibility. We characterized clinical isolates from the BARNARDS study, designed to identify the burden of neonatal sepsis in low-middle income countries. Genomic prediction was verified through structural analysis of polysaccharides. Antibodies generated against common KAg and OAg bound all homologous organisms, regardless of specific polysaccharide structural features. Interestingly, anti-KAg antibodies exhibited bactericidal activity against a comparable number of isolates as anti-OAg antibodies. There was no association between polysaccharide characteristics and K. pneumoniae susceptibility to killing. Antibody cross-reactivity among different KAg was observed, together with extensive cross-reactivity among OAg antibodies. This study aids in defining an optimal vaccine composition to prevent neonatal sepsis caused by K. pneumoniae.

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.

Small-area spatio-temporal analysis of cancer risk to support effective and equitable cancer prevention

Cancer is rapidly increasing worldwide and urgent global action towards cancer control is required. Consistent with global trends, Canada is expected to experience a near doubling in new cases and cancer deaths between 2020-2040; population growth and ageing being the primary drivers. The projected increased cancer incidence and its associated costs is expected to further exacerbate socioeconomic inequities. Focused actions to prevent cancer, to detect it earlier when more treatable, and, to lower the risk of recurrence, must be prioritized. Almost half of all cancers are preventable, caused by risk factors that are potentially avoidable and modifiable. Integrating cancer prevention with care-based models is necessary and represents the most cost-effective and sustainable approach to control cancer. To be effective, prevention efforts must consider the cancers impacting local populations and understand how community and individual factors interact within the spatial and temporal contexts in which people live. This study is part of the Nova Scotia Community Cancer Matrix project which profiles the cancers impacting communities over time; measuring associations between cancer and socioeconomic status (SES); and determining how the joint spatial distribution of cancers can be used to address inequities, identify priority populations and strengthen prevention efforts. Using Bayesian inference to model spatio-temporal variations in 58,206 cases diagnosed in 301 communities between 2001-2017, across 10 preventable cancer types, we report significant disparities in cancer risk across communities based on sex and community SES. The work highlights the utility of small-area mapping to identify at-risk communities and understand how community-SES impacts risk. It also uncovers significant inequities rooted in the differential distribution of material and social capacity, operating beyond the control of individuals. The approach is implementable to other regions to inform and strengthen prevention efforts aiming at reducing the burden of cancer or that of other diseases.

Sepsis in liver failure patients: Diagnostic challenges and recent advancements

Acute liver failure (ALF) and acute-on-chronic LF (ACLF) are prevalent hepatic emergencies characterized by an increased susceptibility to bacterial infections (BI), despite significant systemic inflammation. Literature indicates that 30%-80% of ALF patients and 55%-81% of ACLF patients develop BI, attributed to immunological dysregulation. Bacterial sepsis in these patients is associated with adverse clinical outcomes, including prolonged hospitalization and increased mortality. Early detection of bacterial sepsis is critical; however, distinguishing between sterile systemic inflammation and sepsis poses a significant challenge due to the overlapping clinical presentations of LF and sepsis. Conventional sepsis biomarkers, such as procalcitonin and C-reactive protein, have shown limited utility in LF patients due to inconsistent results. In contrast, novel biomarkers like presepsin and sTREM-1 have demonstrated promising discriminatory performance in this population, pending further validation. Moreover, emerging research highlights the potential of machine learning-based approaches to enhance sepsis detection and characterization. Although preliminary findings are encouraging, further studies are necessary to validate these results across diverse patient cohorts, including those with LF. This article provides a comprehensive review of the magnitude, impact, and diagnostic challenges associated with BI in LF patients, focusing on novel advancements in early sepsis detection and characterization.

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.

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.

Incidence of catheter-related infection in cancer patients receiving parenteral nutrition: A retrospective cohort study of French administrative claims data

Data confirming parenteral nutrition (PN) as an independent risk factor for catheter-related infection (CRI) are scarce and not recent. This study aims to estimate the effect of PN on CRI in cancer patients after catheter placement. A retrospective cohort analysis of the French National Health Data System was conducted. A total of 5300 gastric, 5975 pancreatic, and 15,102 lung cancer patients with central venous catheter insertion between 2012 and 2016 were included. Potential confounders for CRI were evaluated using Poisson regression. Incidence rates (IRs) of CRI were calculated. Incidence rate ratio (IRR) was estimated to assess the effect of exposure to PN on infection occurrence in all patients and among patients receiving chemotherapy (CT). The independent risk factors found to be associated with CRI were age, sex, Charlson Comorbidity Index, PN, CT, metastasis, and history of infection. After adjustment, there was an increased risk of CRI in patients with versus without PN in gastric (IRR: 1.1165; 95% confidence interval [95% CI]: 1.0119-1.2319), pancreatic (IRR: 1.2071; 95% CI: 1.0985-1.3265), and lung cancer (IRR: 1.1850; 95% CI: 1.0832-1.2962). In patients who received PN, IRs of CRI were higher than in those who did not, for gastric (34.84% vs 29.69%, respectively; P = .0001), pancreatic (38.89% vs 28.58%, respectively; P < .0001), and lung (23.64% vs 22.13%, respectively; P = .0967) cancer cohorts. The results of this National administrative claims database analysis suggested that PN might be one of the independent risk factors for CRI. However, the risk was smaller than previously reported, regardless of whether the patient was receiving CT or not.

Bactericidal effect of plasma-activated water generated by a novel super-potable plasma device as a novel antibacterial method: an in vitro study

BACKGROUND

A continuous risk from bacterial infection poses a major environmental and public health challenge. As an emerging strategy for inhibiting bacterial infections, plasma-activated water (PAW) has proved highly effective, environment-friendly, and non-drug resistant to many bacteria. However, the plasma device is too big and requires specialists to operate, which inevitably limits its real-life application. It has been confirmed that the bactericidal effect of traditional PAW would be significantly reduced in the organic-rich environments. To better resolve the limitations, a novel super-portable plasma device was applied, and the low concentration of H2O2 was added to enhance the bactericidal effect of PAW in the organ-rich environments.

METHODS

A super-portable plasma device, weighing only 1 kg, was applied to generate PAW. Staphylococcus aureus (S. aureus), Escherichia coli (E. coli) and Porphyromonas gingivalis (P. gingivalis) were selected as the test bacteria. Colony-forming units (CFU) counting and bactericidal rate were employed to evaluate the bactericidal effect of PAW. Optical emission spectroscopy (OES) was used to identify the major reactive species in PAW. Different concentration of H2O2 was added to PAW (H2O2/PAW), and the pH, oxidation-reduction potential (ORP), conductivity, H2O2 and NO content of HP/PAW were measured to explore the bactericidal mechanisms. CCK-8 assay was used to assess the cytotoxicity of 0.1% H2O2/PAW on human periodontal ligament fibroblasts (hPDLFs).

RESULTS

The 20 mL of PAW generated by the novel super-portable plasma device achieved the bactericidal rate of 98.94% against S. aureus (t = 10 min) and 99.66% (t = 20 min). When the PAW was prepared with a volume of 20 mL, activation times of 6 min and 8 min, and the treatment time was 30 min, the bactericidal rates all exceeded 98% against P. gingivalis. The addition of 0.1% H2O2 significantly enhanced the antibacterial effect of PAW in the presence of Bovine Serum Albumin (BSA) (p<0.05). The addition of 0.1% H2O2 lowered the pH, increased the ORP and conductivity, and raised the content of H2O2 and NO in the solution. Cytotoxicity evaluation indicated that 0.1% H2O2/PAW had moderate cytotoxicity only after 20 min of preparation and 48 h of treatment, while other preparation and treatment times showed mild or no cytotoxicity.

CONCLUSIONS

The PAW generated by the novel super-portable plasma device exhibited an excellent bactericidal effect. The addition of low concentrations of H2O2 to PAW, specifically 0.1% H2O2/PAW, maintained an effective antibacterial effect in complex environments in the presence of BSA with non-cytotoxicity.

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.

Removal of antibiotic resistance from wastewater in aquatic ecosystems dominated by submerged macrophytes

Submerged macrophytes in constructed wetlands (CWs) can effectively improve wastewater quality. However, the effectiveness of different submerged macrophytes in removing antibiotic-resistant genes (ARGs) from wastewater remains unexplored. Additionally, wastewater loading in wetlands can fluctuate due to climate change, potentially affecting ARG removal efficiency. In this study, we systematically constructed microscale wetlands using three submerged plants: Vallisneria natans (VN), Sagittaria pygmaea (SP), and Myriophyllum spicatum (MS). Their effectiveness in ARGs removal was analyzed at hydraulic retention times (HRTs) of 0, 3, 6, and 9 days under high (HWL) and low (LWL) wastewater loading. The results indicated that under LWL conditions, all ecosystems exhibited a higher reduction rate of ARG diversity and relative abundance (RS) compared to HWL conditions. The efficiency of all ecosystems in reducing ARG diversity and abundance followed the order: MS > VN > SP. The sul resistance gene exhibited the highest RS and was degraded most rapidly in all samples. Additionally, sulfadimidine concentrations significantly decreased under LWL conditions, which was significantly correlated with sul reduction. Chemical oxygen demand, total phosphorus, total nitrogen, ammonium nitrogen, and nitrate nitrogen were identified as key factors influencing bacterial and ARG profiles. The increase in rhizobial bacteria and decrease in aerobic denitrifying bacteria likely contributed significantly to ARGs removal. This study offers new insights into ARG removal by submerged macrophytes in CWs, emphasizing the role of wastewater loading and the potential of MS in enhancing ARG degradation. These findings enhance CW design and management to mitigate ARG contamination in wastewater.

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.

Design, synthesis and biological evaluation of 2-arylbenzo[b]furan-4-vinylcarbonyl derivatives based on Salvianolic acid C as antioxidant neuroprotective agents for the treatment of ischemic stroke

Ischemic stroke is a globally recognized disease characterized by high mortality and disability rates, with limited clinical treatment options available. The development of neuroprotective agents with antioxidant properties continues to be a focal point of current research. In this study, we designed and synthesized 42 derivatives using α, β-unsaturated carbonyl and 2-arylbenzo[b]furan in Salvianolic acid C as the core skeleton, and evaluated their biological activities. Among these, compound 6p demonstrated notable antioxidant neuroprotective activity and low cytotoxicity. Furthermore, it exhibited the most potent cell protective activity and ROS scavenging capacity in t-BHP-induced PC12 cells. In a rat model of ischemia-reperfusion injury, 6p was found to reduce ROS levels and neuronal apoptosis in brain tissue, enhance neurological function, and decrease the size of cerebral infarction in rats. Additionally, 6p promotes the nuclear translocation of NRF2 and elevates the expression of the antioxidant protein HO-1. Molecular docking results indicated that 6p can bind to key sites within KEAP1 complex. In conclusion, these findings suggest that compound 6p serves as a potential neuroprotective agent for the treatment of ischemic stroke.

Circulating Aryl Hydrocarbon Receptor Is Associated with Latent Tuberculosis Infection in Patients with Type 2 Diabetes

Latent tuberculosis infection (LTBI) is prevalent in patients with type 2 diabetes. We aimed to examine the relationship between serum levels of aryl hydrocarbon receptor (AhR) and LTBI in patients with type 2 diabetes. In this cross-sectional study, patients with type 2 diabetes were screened for LTBI using the QuantiFERON-TB (QFT) test. Of 543 patients screened for LTBI, 133 (24.5%) were QFT-positive. The QFT-positive patients had higher AhR levels than the QFT-negative patients (44.6 [interquartile range: 25.4-58.6] pg/mL vs. 37.8 [interquartile range: 17.4-55.0] pg/mL; p = 0.004). According to the receiver operating characteristic curve, the area under the curve was 0.584 (95% confidence interval: 0.528-0.639; p = 0.004) and the optimal cutoff value for serum AhR levels was of 37.7 pg/mL for differentiating a QFT-positive result. By a multivariable logistic regression analysis, the patients with high AhR levels had a greater risk of being QFT positive than those with low AhR levels (odds ratio = 1.902, 95% confidence interval: 1.254-2.886; p = 0.003). In conclusion, in patients with type 2 diabetes, a high serum AhR level was associated with LTBI.

Chemical composition, in vitro and in silico activity of the methanolic extract derived from Vassobia breviflora against clinically relevant bacteria

This study aimed to identify chemical compounds derived from Vassobia breviflora methanolic extract using ESI-ToF-MS and their antioxidant potential activity utilizing the following methods: total phenols, DPPH, and ABTS•+. The MTT assay measured cytotoxic activity, while DCFH-DA and nitric oxide assays were employed to determine reactive oxygen species (ROS) and reactive nitrogen species (RNS) levels using African green monkey kidney (VERO) and human keratinocyte (HaCat) cell lines. The minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) were assessed in seven clinical isolates and nine ATCC strains. Biofilm inhibition was tested against four biofilm-forming strains. The antioxidant properties of the methanolic extract were identified as follows: 35.74 mg GAE/g (gallic acid equivalents)/g for total phenols, 10.5 µg/ml for DPPH, and 50.68 µmol trolox/µg for ABTS•+. The mean inhibitory concentration (IC50) values were 622.86 µg/ml (VERO) and 784.33 µg/ml (HaCat). These concentrations did not markedly alter levels of ROS and RNS. Conversely, Bacillus cereus β-hemolytic displayed higher sensitivity to the extract, with MIC of 64 µg/ml and MBC of 128 µg/ml. Enterococcus faecium exhibited the lowest biofilm formation among the tested bacteria. The studied plant exhibited activity against all bacterial strains at concentrations lower than the IC50 VERO and HaCat cells, suggesting potential for future studies. Data present a comprehensive molecular docking analysis against the HlyIIR protein (PDB ID: 2FX0) and determined antimicrobial and endocrine-modulating potentials. Notably, lancifodilactone I and nicandrin B demonstrated the strongest binding affinities, with binding energies of -9.8 kcal/mol and -8.3 kcal/mol, respectively, and demonstrated significant antimicrobial effects against B. cereus. In addition, several compounds showed potential interactions with nuclear receptors, indicating potential endocrine-modulating effects. These findings provide insights into developing target-specific antimicrobial therapies and endocrine-modulating agents.

Survey methods contributing to the difference of dentin hypersensitivity prevalence among publications between 1998 and 2022: a research-on-research study

BACKGROUND

The prevalence of dentin hypersensitivity (DH) differed significantly among previous reports, which may confuse clinicians and public health practitioners. This study aimed to identify which survey methods contributed to the difference in reported DH prevalence.

METHODS

A systematic search was performed in Medline, Embase, ProQuest, CNKI, and ClinicalTrial.gov databases up to November 2022. Two authors extracted the basic characteristics and survey methods independently. A random-effect meta-analysis was performed to estimate the effects of survey methods on estimated DH prevalence. The Newcastle-Ottawa Scale (NOS) was employed to appraise the methodological quality of the studies included in the analysis.

RESULTS

Thirty-nine studies were included. The average estimate of DH prevalence was 32% (95% CIs: 27 - 37%). The statistical heterogeneity was very high among studies (I2 = 99.7%, P < 0.001), especially in the field of survey methods. Variables were observed in sampling approaches, study settings, and inclusion criteria. Besides, clinical examination protocols and reporting of inter-examiner reliability remained inconsistent. Meta-regression analysis showed that the DH prevalence might be underestimated when the clinical examinations were conducted only for participants with positive subjective symptoms (P = 0.001). The included studies scored 5.74 ± 1.7 on the NOS, indicating relatively low methodological quality. The lower study quality was primarily attributed to insufficient elaboration on representativeness of the exposed cohort, comparability of cohorts on the basis of the design or analysis controlled for confounders, and follow-up procedures.

CONCLUSION

The included studies demonstrated substantial heterogeneity in survey methods. Conducting clinical examinations for all participants enhanced detection rates. The reliability of our pooled prevalence estimates was substantially compromised due to the studies' low methodological quality and high heterogeneity. It is recommended to propose the instructive detailed guideline to standardize the design and improve the quality of studies.

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.

Oxidative Stress and Endothelial Dysfunction: The Pathogenesis of Pediatric Hypertension

Pediatric hypertension is increasingly recognized as a complex condition shaped by both systemic and cellular factors, with oxidative stress emerging as a key driver of vascular dysfunction. In both their primary and secondary forms, reactive oxygen species (ROS) disrupt redox homeostasis, impair endothelial signaling, and promote inflammation and tissue remodeling. Metabolic dysregulation, renal pathology, and early-life stressors contribute to the accumulation of ROS through pathways involving NADPH oxidases, mitochondrial dysfunction, xanthine oxidase activity, and altered arginine metabolism. These mechanisms converge on the vasculature, diminishing nitric oxide bioavailability and promoting hypertensive phenotypes. Beyond disease initiation, redox imbalance influences the response to treatment, surgical outcomes, and long-term cardiovascular risk. By further elucidating these mechanisms, the complex relationship between oxidative stress, vascular biology, and blood pressure regulation in children may be more clearly defined and more effectively targeted in clinical management.

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.

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.

Mass spectrometry-based identification reveals the polymicrobial nature of canine urinary tract infections

Canine urinary tract infections (UTIs) are common in veterinary practice and often have a complex etiology. Typically, diagnoses rely on classical phenotypic tests or are limited to identifying the genus of the pathogen. Treatments are frequently administered without prior in vitro antimicrobial susceptibility testing. This study analyzed 389 urine samples from dogs with clinical signs of UTI, collected by cystocentesis, through microbiological culture. Species-level identification of bacteria and yeasts was performed using mass spectrometry, while bacterial isolates underwent antimicrobial susceptibility testing via the disk diffusion method. Of the 389 samples, 170 (43.7%) showed microbial growth, with 192 microorganisms identified. Among these, 98.4% (189/192) were bacteria, and 1.6% (3/192) were fungi/yeasts. The predominant pathogens included Enterobacteria (116/192 = 60%), enterococci (26/192 = 13.5%), and staphylococci (24/192 = 12.5%). Novel pathogens, such as Lactobacillus murinus and Stenotrophomonas maltophilia, were identified as primary agents of canine UTIs. Coinfections commonly involved E. coli with either E. faecalis (5/21 = 23.8%) or S. canis (4/21 = 19%). Amoxicillin/clavulanic acid was the most effective antimicrobial (≥ 70%), followed by amikacin and marbofloxacin (≥ 60%). Observed antimicrobial resistance rates included enterobacteria (18%), enterococci (> 40%), staphylococci (18%), streptococci (30%), Pseudomonas aeruginosa (60%), and other organisms (> 30%). Multidrug resistance affected 18% (34/189) of bacterial isolates. This study highlights the polymicrobial nature of canine UTIs and emphasizes concerns about multidrug-resistant bacteria. These findings contribute to improving molecular diagnostics and monitoring antimicrobial resistance in domestic animals, a critical global issue.

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.

Can we cure rheumatoid arthritis?

Rheumatoid arthritis (RA) persists as a chronically progressive autoimmune disorder, notwithstanding significant advancements in early intervention and precision-targeted therapeutics. While treat-to-target paradigms and disease-modifying antirheumatic drugs ameliorate clinical outcomes, sustained drug-free remission (SDFR) or even cure remains elusive, underscoring the need for innovative strategies addressing underlying immunopathogenic mechanisms. Prolonged SDFR implies cure or eradication of disease, but there is no consensus definition of cure because it has rarely been contemplated in RA. Pathogenic immune circuit resilience, stromal hyperactivation, persistent structural abnormalities, and genetic susceptibilities constitute multifactorial barriers to a cure. Emerging therapies - including novel biologics, cellular interventions, and gene editing - aim to reprogram pathogenic immune responses rather than suppress symptoms and may have the potential for both SDFR and possibly cure. Whereas preclinical and early clinical data suggest the potential to modify disease trajectories, durable resetting of the RA immune system toward normal has not yet been conclusively demonstrated or uniformly achieved in RA. The 'window of opportunity' paradigm postulates that early-stage immunomodulatory interventions may alter the disease trajectory. However, the optimal therapeutic approaches for capitalizing on this temporal window remain debated, particularly regarding the integration of personalized biomarkers and mechanistic targets. This review summarizes advancements in RA therapeutics, evaluating whether emerging modalities can pivot the clinical paradigm from symptomatic management to the induction of persistent immunological normalization and cure. Although definitive cure remains on the far horizon, the rapid convergence of precision medicine, next-generation immunotherapy, and translational research underscores a paradigm shift toward curative strategies.

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

BACKGROUND AND AIMS

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

DESIGN

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

SETTING AND PARTICIPANTS

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

MEASUREMENTS

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

FINDINGS

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

CONCLUSIONS

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

Bidirectional associations between adiposity and mental health: a prospective cohort study of the UK Biobank

OBJECTIVE

This study aimed to examine the bidirectional associations between indicators of adiposity and mental health.

METHODS

Using longitudinal data from 60,319 UK Biobank participants, we explored the bidirectional associations between mental health (including neuroticism, recent depressive symptoms, probable depression status, stress, mania, life satisfaction, and happiness) and adiposity indicators (including BMI, waist circumference, body fat percentage, and different obesity types).

RESULTS

The multivariate logistic regressions and mixed-effects models revealed the following: 1) BMI and general obesity were bidirectionally associated with recent depressive symptoms, having probable depression status, experiencing at least one type of stress (especially stress from serious illness, injury, or assault to oneself or financial difficulties), and life satisfaction (especially health satisfaction and financial situation satisfaction); 2) waist circumference and abdominal obesity were bidirectionally associated with recent depressive symptoms and financial situation satisfaction; and 3) body fat percentage and high body fat percentage were bidirectionally associated with recent depressive symptoms, experiencing stress from financial difficulties, health satisfaction, and financial situation satisfaction.

CONCLUSIONS

The bidirectional associations between specific indicators of adiposity and mental health depend on the types of adiposity.

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.

Leveraging artificial intelligence chatbots for anemia prevention: A comparative study of ChatGPT-3.5, copilot, and Gemini outputs against Google Search results

Aim

This study evaluated the understandability, actionability, and readability of text on anemia generated by artificial intelligence (AI) chatbots.

Methods

This cross-sectional study compared texts generated by ChatGPT-3.5, Microsoft Copilot, and Google Gemini at three levels: "normal," "6th grade," and "PEMAT-P version." Additionally, texts retrieved from the top eight Google Search results for relevant keywords were included for comparison. All texts were written in Japanese. The Japanese version of the PEMAT-P was used to assess understandability and actionability, while jReadability was used for readability. A systematic comparison was conducted to identify the strengths and weaknesses of each source.

Results

Texts generated by Gemini at the 6th-grade level (n = 26, 86.7 %) and PEMAT-P version (n = 27, 90.0 %), as well as ChatGPT-3.5 at the normal level (n = 21, 80.8 %), achieved significantly higher scores (≥70 %) for understandability and actionability compared to Google Search results (n = 17, 25.4 %, p < 0.001). For readability, Copilot and Gemini texts demonstrated significantly higher percentages of "very readable" to "somewhat difficult" levels than texts retrieved from Google Search (p = 0.000-0.007).

Innovation

This study is the first to objectively and quantitatively evaluate the understandability and actionability of educational materials on anemia prevention. By utilizing PEMAT-P and jReadability, the study demonstrated the superiority of Gemini in terms of understandability and readability through measurable data. This innovative approach highlights the potential of AI chatbots as a novel method for providing public health information and addressing health disparities.

Conclusion

AI-generated texts on anemia were found to be more readable and easier to understand than traditional web-based texts, with Gemini demonstrating the highest level of understandability. Moving forward, improvements in prompts will be necessary to enhance the integration of visual elements that encourage actionable responses in AI chatbots.