From bioinformatics to clinical application: A new strategy in CRP detection with peptide aptamer

C-Reactive protein (CRP) is a key biomarker for evaluating inflammation levels and estimating cardiovascular risk. However, current CRP detection methods rely on monoclonal antibodies (mAb), which possess shortcomings such as a lengthy preparation cycle, high cost, and poor repeatability. To address these challenges, we explored the potential of peptide aptamers as an alternative to mAb for CRP detection. Using some bioinformatics approaches, we designed and optimized peptide aptamers, selecting the dominant peptide aptamer C9m (KWRWRFRLSR) through experimental validation for its specific recognition of CRP. We then established a sandwich ELISA detection system combining C9m with CRP mAb. This system demonstrated a detection limit of 22.275 ng/mL CRP and exhibited excellent specificity, with no cross-reactivity observed with human serum albumin or γ-globulin. The method also showed high reproducibility, with intra- and inter-assay coefficients of variation (CV) less than 15 %, meeting laboratory testing standards. Furthermore, comparison with clinically used immunoturbidimetry revealed high consistency (r = 0.9891).

Loneliness and social isolation, mediating lifestyle factors, and incidence of COPD: A prospective cohort study

BACKGROUND

Limited information exists regarding the associations and pathways of loneliness and social isolation with chronic obstructive pulmonary disease (COPD). Our goal was to investigate the associations of loneliness and social isolation with COPD, as well as to analyze how lifestyle factors may play a role in mediating these effects.

METHODS

In the UK Biobank, 293,864 participants were included in this study. The study assessed five lifestyle factors: physical activity, eating habits, smoking, alcohol consumption, and body mass index (BMI). Incident COPD was detected through algorithms based on electronic health records. We used Cox proportional models to explore the association. Cause mediation analyses were applied to estimate the effect of various lifestyle factors.

RESULTS

In the fully adjusted model, the lonely participants had a greater risk of developing COPD (HR: 1.31; 95 % CI: 1.20-1.43) compared with those participants without loneliness. Similarly, the HR of social isolation on incident COPD was 1.39 (95 % CI: 1.30-1.48) after adjusting for potential confounders. Current smokers (21.9 %), unhealthy dietary characteristics (4.8 %), BMI (4.0 %), unhealthy drinking habits (1.4 %), and physical activity (0.7 %) explained 32.8 % of the association between loneliness and COPD. Likewise, current smokers, physical activity, and unhealthy drinking habit mediated 46.1 %, 4.7 %, and 4.2 % of the effect of social isolation on incident COPD.

LIMITATIONS

Despite extensive adjustment for potential confounders and several sensitivity analyses, residual confounding and reverse causality could not be ruled out.

CONCLUSION

Individuals with loneliness or social isolation have a higher risk of COPD, partly mediated through lifestyle factors.

Global burden of depression and anxiety disorders in older adults, 1990-2019: An analysis of age-period-cohort and temporal-spatial patterns

BACKGROUND

Mental disorders are the leading causes of the global health-related burden and account for 10.6% of total disability (in disability adjusted life years, DALYs) among older adults, with depression and anxiety disorders being the most common contributors to this burden. This study provided a comprehensive epidemiological update on their global burden in older populations, analyzing evolving temporal trends, spatial distribution shifts, and identifying high-risk subgroups and geographic regions.

METHOD

Prevalence rates and disability-adjusted life years (DALYs) for depression and anxiety disorders in older adults from 1990 to 2019 were estimated using the GBD 2019. The Age-period-cohort (APC) modeling was applied to investigate the reasons behind these trends. In addition, we assessed the spatial patterns in different regions using the global and local Moran Index.

RESULTS

In 2019, 57.78 million (95 % UI 50.04, 66.30) older adults experienced depression and 46.26 million (95 % UI 59.93, 36.57) suffered from anxiety disorders globally. Depression accounted for 9.21 million DALYs (rate: 908.94, 95 % UI 625.45, 1234.56), while anxiety disorders contributed to 4.08 million DALYs (rate: 402.95, 95 % UI 264.96, 581.75). From 1990 to 2019, the depression prevalence increased (EAPC = 0.0424, 95 % CI 0.0261, 0.0587), and DALYs rates rose slightly (EAPC = 0.0142, 95 % CI -0.0071, 0.035). In contrast, the anxiety disorders prevalence and DALYs rate declined over the same period [EAPC = -0.1476 (95 % CI -0.1924,-0.1027) and -0.1476 (95 % CI -0.1917,-0.1035)]. Age-specific trends revealed inverted U-shaped depression trajectories, peaking among individuals aged 70-74 years, whereas anxiety disorders exhibited a U-shaped decline with the steepest reductions occurring at the extremes and slower declines in middle age groups. Males exhibited faster-growing depression burdens and rising late-life rates of anxiety disorders, contrasting with the declining trend observed in females. Socio-demographic disparities highlighted low-SDI regions with the highest depression burden (e.g., sub-Saharan Africa) versus high-SDI clusters for anxiety disorders (e.g., Western Europe). Spatial analyses identified depression hotspots in sub-Saharan Africa and anxiety clusters in Latin America and Western Europe, emphasizing divergent geographic patterns.

CONCLUSION

Combining temporal and spatial patterns, we explored temporal trends and five spatial patterns in global depression and anxiety disorders. The prevalence of depression and anxiety disorders was significantly elevated in regions exhibiting both fluctuating and stable high-aggregation patterns, particularly in Eastern/Western sub-Saharan Africa and Southern Latin America. National governments prioritize implementing targeted interventions to alleviate these burdens, while future studies should validate findings through comprehensive datasets and individual-level data to refine prevention strategies for high-risk populations and regions.

Marine natural products as potential anti-Pseudomonas aeruginosa agents: challenges and advances

Antimicrobial resistance (AMR) has become a pressing need to address in the major global public health challenges, posing a serious threat to human health. Pseudomonas aeruginosa (PA) is one of the most concerning Gram-negative pathogens and is typically treated with broad-spectrum antibiotics. PA exhibits resistance to multiple antibiotics, multifactorial virulence, and dynamic hyperadaptation, which results in a particularly formidable challenge in eliminating PA from patients. The problem of drug resistance is becoming increasingly serious, and the development of new antibiotics is extremely lagging behind, resulting in no drug with a new structure and mechanism being approved for the treatment of infections caused by drug-resistant Gram-negative bacteria over the past half-century. Consequently, the development of new antibiotics is of utmost urgency and importance. Marine natural products (MNPs) have become an important source for developing new antibiotics due to their unique properties. So far, 44 potential molecules with significant anti-PA activity have been isolated from marine organisms, of which 19 have been reported as quorum-sensing system inhibitors (QSIs) with potential for further development. In this review, we provide a comprehensive summary of the current status of drug resistance, pathogenic mechanisms, and resistance mechanisms associated with PA infections. We also highlight the challenges and opportunities presented by MNPs in the development of anti-PA drugs, and offer recommendations to accelerate the antibiotic development process, thereby providing valuable insights for the study and exploitation of novel antibiotics.

Design and synthesis of benzothiazole aryl urea derivatives as potent anti-staphylococcal agents targeting autolysin-mediated peptidoglycan hydrolases

Novel benzothiazole aryl ureas were designed and synthesized as anti-MRSA agents targeting peptidoglycan (PG) hydrolases (autolysins). Structural simplification of prior benzothiazole-urea hybrids yielded compounds 4a, 7a and 11a bearing p-CF3 on phenyl ring demonstrating narrow-spectrum activity against Gram-positive bacteria including clinical methicillin-resistant S. aureus (MRSA). The primary autolysin in S. aureus, AtlA, mediates peptidoglycan hydrolase activity critical for bacterial growth, division, and cell wall remodeling. Mechanistic studies revealed that 4a down-regulated autolysin-related genes RNAIII and walR, disrupting peptidoglycan homeostasis. Knockout of atlA (a key autolysin gene) impaired 4a's efficacy, confirming autolysins as critical targets. Docking indicated that 4a binds to AtlA via hydrogen bonds, Pi-Pi, and hydrophobic interactions. In vivo, 4a significantly reduced bacterial load in a murine abdominal infection model, outperforming vancomycin at 10 mg/kg with lower cytotoxicity. Additionally, 4a disrupted MRSA biofilms, suppressed hemolytic toxin production, and alleviated inflammation in infected mice. These findings underscore AtlA as a promising therapeutic target and highlight benzothiazole phenyl urea as a scaffold for developing innovative anti-staphylococcal agents.

Exploring the correlation of linker structure and antimicrobial activities of pyridinium-based cationic biocides: Aromatic versus aliphatic architectures

Cationic biocides, particularly quaternary ammonium compounds (QACs), play a vital role in controlling microbial infections across various industries, healthcare facilities and households. As their widespread use increased drastically in the last few years due to COVID-19, there is growing concern about the development of resistance among microorganisms exposed to cationic biocides. It is crucial to recognize this threat in advance and respond by modifying and replacing the old generation of commercial biocides. Reported here is the pyridinium-based bis-QACs tuning via combination of two simple synthesis approaches to achieve novel biocide's architectures with mixed linkers. The obtained compounds were subjected to a broad bioactivity assay against a panel of 26 microbial pathogens, including multi-resistant bacterial ESKAPEE strains, fungi and biofilms. Novel hit-compounds showed improved antibacterial and antibiofilm action, rapid bacterial eradication within 15-30 min of exposure and 4.5-fold lower hemotoxicity, as well as lower potential for the development of bacterial resistance compared to commercial lead antiseptic octenidine. Highlighted findings and insights will serve as a good basis for further studies of bis-QACs as highly effective biocides.

Fibrosis of the infrapatellar fat pad induces gradual cartilage degeneration in a rat model

Knee osteoarthritis (OA), a degenerative joint disease, causes pain and reduced activity levels, with prevalence increasing with age. Knee OA is recognized as a "joint organ disease," where interactions between the articular cartilage, meniscus, synovium, and infrapatellar fat pad (IFP) are critical. Obesity contributes to OA not only through mechanical stress but also via systemic and local inflammation mediated by adipose tissue. Adiponectin, an adipokine with anti-inflammatory and chondroprotective effects, shows levels negatively correlated with obesity and positively correlated with OA severity. This study explored the role of IFP in OA progression using a rat model of monoiodoacetic acid-induced IFP fibrosis. In vivo, IFP and cartilage degeneration were assessed via histological analysis, real-time PCR, and RNA sequencing. Ex vivo, the effects of conditioned media from synovial cells and IFP on chondrocytes were evaluated. Findings revealed that fibrosis reduced adiponectin expression and accelerated OA progression. Gene sequencing showed significant metabolic pathway changes, particularly in fatty acid β-oxidation, indicating impaired IFP function. Conditioned media from inflamed IFP negatively affected chondrocytes by reducing anabolic factors and increasing cartilage-degrading enzymes. These results suggest that IFP degeneration contributes to OA by promoting inflammation and cartilage degradation. Targeting IFP fibrosis and fatty acid metabolism may offer therapeutic potential to mitigate OA progression.

Intranasal administration of exosomes derived from adipose mesenchymal stem cells ameliorates depressive-like behaviors and inhibits inflammation via AMPK/mTOR-mediated autophagy

BACKGROUND

Major depressive disorder (MDD) is a severe, and often treatment-resistant, psychiatric disorder. Mesenchymal stem cell-derived exosomes have been shown to be neuroprotective. Here we employed adipose-derived mesenchymal stem cell exosomes (ADSC-Exos) as a novel therapeutic approach for depressive-like behavior in mice and explored the underlying mechanisms.

METHODS

ADSC-Exos were administered intranasally to mice subjected to chronic restraint stress to assess behavioral changes and neuroprotection in terms of apoptosis, AMPK-mTOR signaling, and NLRP3 pathway activation by western blotting, microglial activation by immunofluorescence, and changes in serum inflammatory factors by ELISA. The effects of ADSC-Exos were also studied in vitro in HT22 cells.

RESULTS

ADSC-Exos significantly improved depressive-like behavior, anxiety-like behavior, and cognitive function in mice. ADSC-Exos had significant neuroprotective effects, including reducing neuronal apoptosis and promoting autophagy by activating AMPK-mTOR signaling, ultimately reducing neuroinflammation. In vitro, ADSC-Exos inhibited corticosterone-induced apoptosis, activated autophagy in an AMPK pathway-dependent manner, and inhibited NLRP3 inflammasome activation.

CONCLUSION

ADSC-Exos may be a potential treatment for MDD by alleviating depressive-like behaviors and protecting against tissue injury, possibly through activation of AMPK-mTOR signaling and inhibition of NLRP3 inflammasome-mediated neuroinflammation.

Association between remnant cholesterol and arterial stiffness: Evidence from NHANES 1999-2018

BACKGROUND AND AIM

Remnant cholesterol (RC), an emerging cardiovascular risk factor, has garnered increasing attention in atherosclerotic cardiovascular disease (ASCVD) research, though its relationship with arterial stiffness remains incompletely understood. This study investigated the association between RC and estimated pulse wave velocity (ePWV), a reliable marker of arterial stiffness, with the goal of enhancing our understanding of RC's role in cardiovascular risk assessment.

METHODS AND RESULTS

This study utilized the National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2018, including 12,505 participants aged 20 years and above. Weighted linear regression, restricted cubic splines (RCS), and subgroup analyses were used to explore the association between RC levels and ePWV. Analysis revealed a significant positive association between RC levels and ePWV, with participants in the highest RC quintile (Q5) exhibiting substantially elevated ePWV compared to those in the lowest quintile (Q1). Notably, RCS analysis demonstrated a non-linear relationship characterized by a saturation effect (p-nonlinear <0.05). Subgroup analyses indicated stronger associations among specific demographic groups, including individuals under 40 years, females, non-Hispanic whites, and those above the poverty level (all interaction p < 0.05). Furthermore, mediation analysis found that various inflammatory markers such as neutrophil count (NEU), neutrophil-to-lymphocyte ratio (NLR), and monocyte-to-lymphocyte ratio (MLR) played a mediating role in this association.

CONCLUSION

Increased arterial stiffness is associated with higher RC levels, demonstrating a saturation effect at elevated concentrations. This association is partially mediated by NLR, MLR, and NEU, and was stronger among younger, females, non-Hispanic whites, and non-impoverished individuals.

Global, regional, and national burden of vertebral fractures due to falls from 1990 to 2021 and predictions for the next 15 years: A systematic analysis of the global burden of disease 2021 study

OBJECTIVES

This study utilized the latest data from the 2021 Global Burden of Disease Study to analyze the incidence, prevalence, and years lived with disability due to vertebral fractures from 1990 to 2021, providing information for effective management and prevention strategies.

METHODS

This study describes the trends in incidence, prevalence, and years lived with disability (YLDs) due to vertebral fractures caused by falls. It employs methods such as the Age-Period-Cohort (APC) model, joinpoint regression analysis, and decomposition analysis for further investigation, and calculates the ASIR, ASPR, and ASYR. Finally, it predicts the incidence trend for the next 15 years using the Autoregressive Integrated Moving Average (ARIMA) model.

RESULTS

In 2021, the number of new cases of vertebral fractures due to falls globally reached 4.7 million, with a total prevalence of 3.67 million cases, and years lived with disability (YLDs) amounted to 370,000. Compared to 1990, the estimated annual percentage change (EAPC) was -0.37 (-0.41, -0.32), -0.35 (-0.39, -0.31), and -0.37 (-0.41, -0.33) respectively, indicating a declining trend. There are significant differences in the disease burden among different countries and regions. The APC model, Joinpoint model, and ARIMA forecasting model indicate a global declining trend in the disease burden of vertebral fractures.

CONCLUSIONS

Although the burden of vertebral fractures is on a downward trend, it continues to increase in low and middle SDI regions, as well as among the elderly population. Therefore, targeted preventive measures are still necessary to address the health outcomes related to vertebral fractures.

Estimation of therapeutic threshold for tuberculosis using adapted nominal group technique and clinical vignettes in clinical and community settings in Southern Africa

Background

When confronted with diagnostic uncertainty and a decision on whether to start treatment or not, clinicians consider the potential harm and benefit of offering versus withholding treatment. Treatment can be offered if the probability of tuberculosis (TB) in the patient is above the "therapeutic threshold" (ThT): the probability of disease at which the expected utility of treating and not treating is the same. We estimated ThT for TB in clinical and community settings in Southern Africa using two methods: an adapted nominal group technique (aNGT), and decisions made based on clinical vignettes (CVs).

Methods

We enrolled health professionals involved in the routine management of TB patients in South Africa and Lesotho. The participants elicited, discussed and refined the harms of false positive (FP) and false negative (FN) treatment decisions for stable ambulatory patients in the clinical and community settings. They weighed all harms according to their importance in treatment decisions by distributing 100 points. ThT, calculated as the sum of the weights of the harms of the FP decision divided by the total weight, was estimated using a hierarchical Beta regression model. For the CVs, participants were presented with ten hypothetical TB cases in each setting and asked to indicate whether they would offer TB treatment or not. ThT was estimated using the generalized linear model for binary outcomes.

Results

We enrolled 138 health professionals (aNGT: 123, CVs: 130 and 115 in both). Using aNGT, the overall ThT was 37.7% (95% credible intervals (95% CrI): 35.8-39.8) and 38.2% (95% CrI: 35.9-40.6) in the clinical and community settings, respectively. Compared to aNGT, CVs produced a significantly lower estimate in the clinical setting (27.7%; 95% CrI: 23.8-31.3) but similar in the community setting (37.7%; 95% CrI: 33.1-41.7). We did not find significant differences across the subgroups defined by the measured covariates.

Conclusion

The aNGT produced a reliable estimate of ThT. The difference in the estimates of ThT between the aNGT and CVs may have a limited impact on clinical decisions. Factors influencing ThT and the acceptability of results by healthcare workers will be explored in focus group discussions and in-depth interviews.

Rationale and design of the TeleClinical Care Cardiac (TCC-Cardiac) trial: A pragmatic randomized trial of adjunctive virtual models of care in the secondary prevention of cardiovascular events

BACKGROUND

Digital health interventions have potential to improve outcomes in high risk cardiac patients through remote monitoring and patient education but introduce accessibility issues among patients who lack suitable smartphones. We will evaluate the effectiveness and scalability of the TeleClinical Care Cardiac (TCCCardiac) platform, that aims to reduce hospital readmissions and improve adherence to care.

METHODS

A pragmatic, all-comers trial with nested randomization, where patients being discharged home following an admission with acute myocardial infarction (MI) or decompensated heart failure (HF) are divided into 3 cohorts pragmatically, based on their access to technology. Cohort 1 participants are randomized to either the TCCCardiac model of care or usual care alone. The intervention includes a smartphone app, blood pressure monitor, weight scales, and a pulse oximeter, with remote monitoring of daily inputs by clinicians. Cohort 2 participants, with incompatible mobile phones, are randomized to receive educational content by SMS (TCC-Text) or usual care alone. Cohort 3 participants with no mobile phone receive usual care alone. The primary objective is to compare six-month readmission rates (primary end point) in Cohort 1. Secondary objectives include comparing the primary end point, evaluating the cost-effectiveness and overall impact across all cohorts and interventions, and process evaluation to understand the reach, adoption, and effectiveness of the full intervention. Follow-up includes 6-month interview for Cohort 1 and data linkage for all cohorts for 12-month outcomes.

RESULTS

The trial began in July 2021. Recruitment was slower than expected due to delays and interruptions related to COVID-19 and the final enrolment date was set for October 2023, by which time 873 participants had been enrolled: 553 in Cohort 1 (63.3%), 161 in Cohort 2 (18.4%), and 159 in Cohort 3 (18.2%). Data linkage is anticipated in May 2025, which includes a 6-month delay to ensure 12-month data will be available for all study patients, followed by the analysis of results.

CONCLUSIONS

TCCCardiac is the first large-scale study to assess smartphone-based messaging and remote monitoring in high-risk cardiac patients post-hospitalization. The study's pragmatic design and process evaluation aim to enhance future implementation.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry Number ACTRN12621000754842.

The prescribing patterns and effectiveness of sedatives and analgesics for severe traumatic brain injury patients in Taiwan

BACKGROUND

Traumatic brain injury (TBI) is a major global health challenge associated with high mortality and morbidity. Secondary brain injury caused by disrupted intracranial pressure (ICP) regulation often necessitates sedation; however, guidelines lack specificity for TBI management.

METHODS

This study analyzed sedation and analgesia prescribing patterns and their outcomes in severe TBI patients in Taiwan using National Health Insurance Research Database data (2012-2019). Severe TBI patients intubated during intensive care unit (ICU) hospitalization were included. The primary outcome was 30-day all-cause mortality, with sensitivity analyses for 14-day mortality and 30-day all-cause mortality excluding deaths within 3 days. Inverse probability of treatment weighting (IPTW) was applied to balance patient characteristics across groups. Mortality rates across groups were evaluated using Kaplan-Meier survival analysis. At the same time, the Cox proportional hazards model simultaneously assessed the impact of various risk factors, such as age and comorbidities, on mortality.

RESULTS

Among 6030 patients, sedation and analgesia patterns varied, with midazolam combined with opioids being the most common regimen. Compared to the reference group (sedatives with opioids), the risk of death was highest in the no-prescription group (HR = 2.73, 95 % CI = 2.60-2.86), followed by the sedation-only group (HR = 1.58, 95 % CI = 1.50-1.66) and the opioids-only group (HR = 1.49, 95 % CI = 1.42-1.57; all p < 0.0001). Sensitivity analyses confirmed consistent trends.

CONCLUSIONS

These findings underscore the importance of optimizing sedation practices and enhancing awareness to improve outcomes for severe TBI patients.

Exploring associations between dual sensory impairment and neuropsychiatric disorders: Insights from a prospective cohort study in the UK Biobank

BACKGROUND

Evidence of dual sensory impairment (DSI) characterized by comorbid hearing impairment (HI) and visual impairment (VI) is limited in neuropsychiatric disorders. Moreover, the underlying mechanisms remain elusive.

METHODS

Using data from 169,165 UK Biobank participants, we compared cognition and mental health across the no sensory impairment, HI, VI, and DSI groups and investigated the association between the number of sensory impairments and neuropsychiatric disorders in longitudinal COX analyses. We also analyzed the associations of sensory function and its interaction with brain structure, functional connectivity, inflammatory markers, and metabolites and explored their mediating roles.

RESULTS

DSI participants exhibited poor cognition and mental health, and had a higher risk of neuropsychiatric disorders compared to those with HI/VI alone. Both HI and VI were linked to atrophic changes in the hippocampus, thalamus, precuneus, parietal cortex, middle temporal gyrus, etc., and reduced white matter integrity. Brain regions associated with HI and VI exhibited decreased functional connectivity with other cortexes. Hearing and visual performance exhibit a significant interaction in relation to cognitive function, mental health, and metabolites. Brain structures, inflammation, and metabolic biomarkers significantly associated with HI and VI mediated the relationship between sensory impairments and cognition/mental health.

CONCLUSION

Compared to HI/VI alone, DSI is associated with poorer cognitive function, mental health, and a higher risk of neuropsychiatric disorders, potentially driven by the interaction between HI and VI. Additionally, HI and VI are linked to brain atrophy, reduced white matter integrity, and altered functional connectivity. Furthermore, brain structure, inflammation, and metabolic biomarkers mediate the relationship between sensory impairments and cognition/mental health.

METTL3‑mediated m6A methylation and its impact on OTUD1 expression in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation and chronic inflammation, often exacerbated by cigarette smoke exposure. Ovarian tumor protease domain‑containing protein 1 (OTUD1), a deubiquitinase, has previously been identified as a negative regulator of inflammation through its suppression of NF‑κB signaling. The present study explored the role of OTUD1 in COPD and the regulatory effects of N6‑methyladenosine (m6A) methylation on OTUD1 expression. The expression of OTUD1 in COPD was analyzed using public datasets (GSE38974 and GSE69818). In addition, BEAS‑2B cells were exposed to cigarette smoke extract (CSE) to investigate OTUD1 expression changes. OTUD1 overexpression and knockdown models were also constructed, and the levels of inflammation‑related genes and proteins, inflammatory cytokines and cell pyroptosis were measured using reverse transcription‑quantitative PCR, western blotting, ELISA and flow cytometry. The role of methyltransferase‑like 3 (METTL3)‑mediated m6A methylation in regulating OTUD1 was also examined. Notably, OTUD1 expression was significantly reduced in advanced COPD compared with that in the earlier stage. Furthermore, CSE exposure suppressed OTUD1 expression, which was associated with increased cell pyroptosis and elevated levels of the inflammatory cytokines IL‑1β and IL‑18. OTUD1 overexpression mitigated these effects, indicating its protective role against CSE‑induced cellular damage. Furthermore, METTL3‑mediated m6A methylation inhibited OTUD1 expression, with YTH m6A RNA binding protein 2 (YTHDF2) acting as the reader of this modification. Knockdown of METTL3 or YTHDF2 reduced m6A methylation and restored OTUD1 expression, highlighting a potential mechanism by which cigarette smoke suppresses OTUD1 through enhanced m6A methylation. In conclusion, OTUD1 may serve a protective role in COPD by inhibiting inflammation and reducing cell damage caused by cigarette smoke exposure. The suppression of OTUD1 through METTL3‑mediated m6A methylation and YTHDF2 interaction represents a novel mechanism contributing to COPD pathogenesis, suggesting potential therapeutic targets for mitigating disease progression.

Brain-derived neurotrophic factor (BDNF) as biomarker in stem cell-based therapies of preclinical spinal cord injury models: A systematic review

Stem cell-based therapies offer promising treatment for spinal cord injury (SCI) by reducing inflammation, restoring plasticity, and supporting neuroprotection and nerve regeneration. Brain-derived neurotrophic factor (BDNF) is crucial in SCI pathophysiology. This study reviews the impact of stem cells on BDNF expression in preclinical SCI models. A thorough search was performed in PubMed, Scopus, and Web of Science until June 2023, identifying studies on the effects of stem cells on BDNF in SCI. Two researchers reviewed and extracted data from relevant studies. This review is registered in the Prospective Register of Systematic Reviews (PROSPERO) with the registration number [CRD42023441466]. Out of 923 records, 51 studies met the inclusion criteria, involving rats (46 studies) and mice (5 studies). The contusion or compression model was used in 40 studies, and the transection model in 11. The most common stem cell types were bone marrow mesenchymal stem cells (BM-MSCs), neural stem cells (NSCs), and adipose-derived stem cells (ADSCs). BM-MSCs increased BDNF expression in 16 studies, NSCs in 9 studies, and ADSCs in only one study. This review highlights that BM-MSCs and NSCs are effective in enhancing BDNF expression in preclinical SCI models, while other stem cell types may not significantly affect BDNF levels. These findings suggest variability in the effectiveness of different stem cell therapies in modulating BDNF production for SCI treatment.

Prevalence of thoracic degenerative MRI findings and association with pain and disability: a systematic review

OBJECTIVES

To systematically review the literature on the prevalence of degenerative MRI findings in the thoracic spine and their association with pain and disability.

MATERIALS AND METHODS

The Medline, EMBASE, CINAHL, and CENTRAL databases were searched. Two independent reviewers screened the articles, extracted the data, and assessed the risk of bias (RoB) using a modified version of the Hoy tool for articles on prevalence and QUADAS-2 for articles on associations.

RESULTS

The review included 23 articles describing 20 study populations: 5 general populations, 2 populations of asymptomatic volunteers, and 13 clinical populations. As the articles were highly heterogeneous, especially regarding study populations and the MRI findings assessed, a meta-analysis was not possible, and the results were presented descriptively. Prevalence estimates were reported in 21 articles, and 5 (3 study populations) had low RoB. The most frequently reported prevalence rates concerned the intervertebral discs, vertebral endplates, and the ligamentum flavum. Estimates varied considerably, with the prevalence of thoracic disc degeneration ranging from 0.2%-89% and vertebral endplate signal changes ranging from 0%-82%, depending on MRI definitions, population characteristics, and recruitment settings. Four articles investigated the association between MRI findings and spinal pain, with the RoB mainly considered low or unclear. Only two of these studies specifically examined thoracic spinal pain. None assessed the association with disability.

CONCLUSION

Due to heterogeneity, few high-quality studies and few studies on individual MRI findings, no definitive conclusions could be drawn about the prevalence of thoracic degenerative MRI findings or their association with pain and disability.

Factors for dissemination and implementation of community reinforcement and family training in Japan: A pilot study

BACKGROUND

Community Reinforcement and Family Training (CRAFT) is an evidence-based training-program, specifically geared to assist family members of identified patients with problems in the area of substance use, autism, psychosis, "hikikomori", etc. The purpose of this qualitative research is to examine therapists' barriers and facilitators to apply CRAFT in general practice, by means of interviews and questionnaire surveys.in Japan.

METHOD

By using snowball sampling techniques, nine Japanese therapists were recruited. Subsequently, these therapists had the ambition to enroll the CRAFT certification process, according an advance therapist-expert feedback system based on audio-tapes. Assessment about therapists' barriers and facilitators aimed to disseminate and implement CRAFT were completed online during a 30-60 minutes semi-structured interview. Furthermore, implementation outcomes measures were also collected.

RESULT

Data of nine therapists were collected showing multiple aspects that promote or impede the application of CRAFT in daily routine practice. In general, it was shown that private costs for attending expert training and coding, working with a protocol, may impede the dissemination of CRAFT in Japan.

CONCLUSION

CRAFT is well-received by Japanese therapists, although some barriers remain that need to be addressed to promote a more widely dissemination.

Bioinspired smart dentin ECM-chitosan hydrogels for dentin-pulp complex regeneration

OBJECTIVES

Approximately two-thirds of the world's population suffers from dental caries, and clinical treatment of the resulting lesions varies from dental fillings to devitalization. Despite recent advances in regenerative endodontic therapy, scaffolds intended for the regeneration of the dentin-pulp complex with innate odontogenic potential and microarchitecture similar to these dental tissues are still scarce. Taking advantage of the physio-biological properties of demineralized dentin extracellular matrix (ECM), we developed a functional hydrogel that combines insoluble molecules of dentin with chitosan.

METHODS

Dentin powder obtained from extracted teeth was partially demineralized with acetic acid. Demineralized dentin and chitosan powder were separately dissolved in acetic acid to form suspensions that were then mixed in volume ratios of 25/75 or 50/50 (v/v %). The extrudability and gelation time of hydrogel precursors were assessed. Three-dimensional constructs were fabricated following pre-hydrogels pH-adjustment, injection into custom-made molds and incubation at 37 °C. Constructs were characterized for infrared spectral analysis, relative sol-gel fraction, degree of porosity, flexural elastic modulus, in-vitro biodegradability, in-vitro bioactivity, antimicrobial properties against Enterococcus faecalis and biocompatibility for OD-21 cells.

RESULTS

For most of the tested properties, the two proposed hydrogels showed differences, but regardless of these differences, both materials presented morphology, biomechanical attributes, cytocompatibility, and antibacterial properties to serve as dental pulp cell-inducing scaffolds.

CONCLUSIONS

Dentin ECM-chitosan hydrogels exhibited in-vitro bioactivity, biocompatibility, and antimicrobial properties to be considered as promising candidates for application as injectable scaffolds for dentin-pulp complex regeneration.

CLINICAL SIGNIFICANCE

Extracellular matrices (ECMs) from native tissues have long been considered ideal scaffolds for tissue regeneration. Here, we describe the physicochemical, mechanical, and biological attributes of newly developed hydrogels derived from the functionalization of demineralized dentin ECM with chitosan. The proposed dentin-ECM-chitosan hydrogels have demonstrable microarchitecture, biophysical characteristics, biocompatibility, and antibacterial capacity to produce cell-inducing scaffolds for use in regenerative dentistry.

Antibiotic resistance and bacterial spectrum in cerebrospial fluid cultures: Initial insights from Pakistan

Antimicrobial resistance (AMR) is a rising global health concern, especially in resource-limited countries like Pakistan, where indiscriminate and unregulated use of antibiotics has significantly worsened this problem. The study aimed to analyze the bacterial spectrum and antimicrobial resistance patterns in cerebrospinal fluid (CSF) cultures from patients with suspected bacterial meningitis, providing crucial insights for better infection control and treatment strategies.This retrospective study analyzed 1107CSF cultures were between 2019 and 2024 at the Lady Reading Hospital, MTI, Khyber Pakhtunkhwa, Pakistan, to assess bacterial profiles in patients with suspected bacterial meningitis and investigate the AMR patterns. Among the 106 positive growth cultures, gram-negative bacteria accounted for 84.9 %. Alarmingly, Acinetobacter baumannii was found to be completely resistant to all the nine antibiotics tested, while Salmonella typhi showed resistance to six out of seven tested antibiotics, highlighting their severe multi-drug resistance profile. Moreover, notable resistance was observed in Citrobacter freundii, Enterobacter species, and Staphylococcus aureus. The distribution results indicated that the Klebsiella pneumoniae is more prevalent in males and the 1-13 years age group. These findings highlight the necessity for urgent action on antibiotic stewardship, improved surveillance, and public awareness to mitigate the spread of AMR pathogens, particularly in life-threatening infections such as bacterial meningitis. Strengthening infection control measures and regulating antibiotic usage policies is imperative to curb the growing AMR crisis.

Efficacy of cranial electrotherapy stimulation for treating primary and secondary depression in adults: A meta-analysis of randomized controlled trials

BACKGROUND

Antidepressants use is linked to poor response, treatment discontinuation, and treatment-resistant depression. However, evidence regarding efficacy of cranial electrotherapy stimulation (CES) in treating depression is limited. Therefore, we conducted the first meta-analysis to explore efficacy of CES in treating primary and secondary depression in adults.

METHODS

PubMed, Embase, CINAHL, Web of Science, EBSCOHost, and Cochrane Library were comprehensively searched. Dersimonian-Lard random-effects model in Comprehensive Meta-Analysis 4.0 was used, presenting Hedges' g with corresponding 95 % confidence interval (CI) for depressive symptoms and Quality of life (QoL) while odds ratio (OR) for safety and acceptability of CES. Heterogeneity was examined using Cochrane's Q and I2 statistics with moderator analysis determining sources of variation.

RESULTS

Sixteen randomized controlled trials involving 1148 adults were included. CES significantly reduced depressive symptoms with small effect (g = -0.33 [95%CI -0.46, -0.20]) compared to non-CES treatment; it was safe (OR = 0.84 [95%CI 0.32, 2.18]) and acceptable (OR = 0.72 [95%CI 0.41, 1.27]). CES revealed non-significant effect on improving QoL (g = 0.13 [95%CI -0.05, 0.31]). Substantial improvement of CES were observed for females (β = -0.010 [95%CI -0.019, -0.0003]), secondary depression (g = -0.42 [95%CI -0.58, -0.27]), current >100 μA (g = -0.38 [95%CI -0.58, -0.18]), frequency > 100 Hz (g = -0.50 [95%CI -0.81, -0.20]), length ≤ 30 min (g = -0.39 [95%CI -0.64, -0.14]), sessions/week ≤5times (g = -0.34 [95%CI -0.49, -0.19]), and duration ≤5 weeks (g = -0.45 [95%CI -0.63, -0.27]).

CONCLUSIONS

CES, a safe adjunctive therapy, demonstrates small effect in the treatment of depression. Future research should explore long-term effects of CES for treating adults with depression.

Knowledge and attitude of pharmacists about Alzheimer's disease: A systematic review

BACKGROUND

To identify studies that explored pharmacists' knowledge and attitudes regarding Alzheimer's Disease (AD).

METHODS

A comprehensive literature search was conducted in Scopus, Medline (via Pubmed), Latin American and Caribbean Literature in Health Sciences (LILACS), and PsycINFO databases until July 2024. Cross-sectional studies that measured pharmacists' knowledge and attitudes toward AD using structure instruments were included. Two reviewers independently performed the selection of studies, data extraction, and methodological assessment.

RESULTS

Ten studies published between 2016 and 2024, involving 7810 participants, were included. Most studies were conducted in Asia (n = 5), in community pharmacies (n = 8), and used the Alzheimer's Disease Knowledge Scale (n = 8). The response rate varied from 8 % to 100 %, while the percentage of correct responses about AD ranged from 50.1 % to 85.3 %. A knowledge gap was identified in areas such as recognizing symptoms, understanding risk factors for AD development, and providing effective patient care. Pharmacists demonstrated greater expertise in the pharmacological management of AD.

IMPLICATIONS

The findings suggest the need for training programs and interventions targeting pharmacists working in services that care for patients with AD.

A systematic review and meta-analysis of acupuncture's impact on hemiplegic gait recovery after stroke

OBJECTIVE

This systematic review aims to evaluate the efficacy and safety of acupuncture in alleviating gait disturbances in post-stroke hemiplegia, focusing on various gait parameters.

METHODS

A comprehensive search was conducted across PubMed, EMBASE, Cochrane Library, Web of Science, AMED, CINAHL, CBM, CNKI, and WanFang databases to identify relevant randomized controlled trials (RCTs). The included studies were independently evaluated for risk of bias using Cochrane's risk of bias tool. RevMan 5.3 was used for meta-analysis, and adverse events were collected through full-text review.

RESULTS

A total of 21 RCTs involving 1463 participants were included. Results showed that acupuncture combined with rehabilitation therapy (RT) significantly improved stride and step length (MD = 7.79, 95 % CI: 5.62-9.96, Z = 7.03, P < 0.00001, I² = 72 %), cadence (MD = 10.43, 95 % CI: 6.22-14.65, Z = 4.85, P < 0.00001, I² = 95 %), walking speed (MD = 12.27, 95 % CI: 9.22-15.31, Z = 7.90, P < 0.00001, I² = 91 %), hip peak flexion angle (MD = 2.71, 95 % CI: 0.94-4.49, Z = 2.99, P = 0.003, I² = 82 %), and ankle peak plantarflexion angle (MD = 2.08, 95 % CI: 1.11-3.06, Z = 4.19, P < 0.0001, I² = 0 %) compared to RT alone. It also reduced gait cycle time (MD = -0.61, 95 % CI: -0.96 to -0.26, Z = 3.44, P = 0.0006, I² = 98 %) and the proportion of double support phase (MD = -7.16, 95 % CI: -9.08 to -5.25, Z = 7.33, P < 0.00001, I² = 0 %). These improvements in gait parameters suggest enhanced mobility and functional independence for post-stroke patients. However, heterogeneity in participant characteristics and study methodologies was noted, such as variations in stroke types, curses, severity, and acupuncture protocols. The majority of RCTs exhibited moderate to high risk of bias regarding allocation concealment and blinding. Only two RCTs reported no adverse events, while the rest 19 studies did not mention adverse events.

CONCLUSION

Acupuncture appears to enhance specific aspects of hemiplegic gait, though further high-quality research is needed to fully validate its effects. Current evidence is limited by methodological weaknesses and potential biases in the included studies. Rigorous, well designed studies are needed to further validate the comprehensive effects of acupuncture on post-stroke hemiplegic gait.

F-box only protein 10 protects against kidney tubulointerstitial fibrosis by inhibiting ACSL4-mediated lipid peroxidation and ferroptosis

Renal tubular epithelial cell ferroptosis is significantly linked to kidney tubulointerstitial fibrosis, a critical pathological condition in chronic kidney disease. F-box only protein 10 (FBXO10), a newly identified ferroptosis-regulating gene, plays a role in various pathological contexts; however, its involvement in kidney tubulointerstitial fibrosis is not yet fully understood. This research sought to investigate whether FBXO10 regulates ferroptosis in kidney tubular epithelial cells and its relationship with kidney tubulointerstitial fibrosis in both animal and cellular models. We observed a significant decrease in FBXO10 levels in mice with unilateral ureteral obstruction (UUO) and HK-2 cells exposed to TGF-β1. FBXO10 overexpression inhibited the EMT process and counteracted the typical ferroptosis features evoked by TGF-β1 or erastin in HK-2 cells. Compared with those in wild-type (WT) mice, kidney injury, inflammation, and fibrosis are exacerbated in FBXO10-knockout (KO) mice, with elevated ferroptosis levels. Conversely, FBXO10 overexpression reversed these symptoms, alleviating kidney fibrosis and ferroptosis in both WT and FBXO10 KO mice with UUO. Mechanistically, FBXO10 directly interacted with ACSL4 and promoted its ubiquitination and degradation. Overexpression of ACSL4 reversed the inhibitory effect of FBXO10 overexpression on TGF-β1-induced ferroptotic death and fibrosis in HK-2 cells. In summary, FBXO10 mitigates ferroptosis in renal tubular epithelial cells by inhibiting ACSL4-mediated lipid peroxidation, thereby hindering the progression of kidney tubulointerstitial fibrosis. FBXO10 is proposed as a promising target for treating kidney disorders related to tubulointerstitial fibrosis.

Imaging probes for the detection of brain microenvironment

The brain microenvironment (BME) is a highly dynamic system that plays a critical role in neural excitation, signal transmission, development, aging, and neurological disorders. BME consists of three key components: neural cells, extracellular spaces, and physical fields, which provide structures and physicochemical properties to synergistically and antagonistically regulate cell behaviors and functions such as nutrient transport, waste metabolism and intercellular communication. Consequently, monitoring the BME is vital to acquire a better understanding of the maintenance of neural homeostasis and the mechanisms underlying neurological diseases. In recent years, researchers have developed a range of imaging probes designed to detect changes in the microenvironment, enabling precise measurements of structural and biophysical parameters in the brain. This advancement aids in the development of improved diagnostic and therapeutic strategies for brain disorders and in the exploration of cutting-edge mechanisms in neuroscience. This review summarizes and highlights recent advances in the probes for sensing and imaging BME. Also, we discuss the design principles, types, applications, challenges, and future directions of probes.

Biliverdin alleviates cerebral ischemia-reperfusion injury by regulating the P4hb/MAPK/mTOR pathway to inhibit autophagy

BACKGROUND

Biliverdin (BV) exhibits anti-inflammatory and antioxidative effects. Autophagy activation is crucial in the pathogenesis of cerebral ischemia-reperfusion injury (CIRI). This study aimed to investigate whether BV could ameliorate CIRI by regulating autophagy.

METHODS

A middle cerebral artery occlusion-reperfusion (MCAO/R) model in Sprague-Dawley (SD) rats and an oxygen-glucose deprivation/reoxygenation (OGD/R) model in PC12 cells were employed to explore the neuroprotective effects of BV and its underlying mechanisms. In these rats, once BV was administered post-MCAO/R, its treatment efficacy and underlying mechanisms were evaluated through behavioral, morphological, and molecular analyses. Alternatively, for PC12 cells, following successful OGD/R modeling, BV, autophagy activator rapamycin, prolyl 4-hydroxylase beta (P4hb) knockdown or overexpression, and the specific inhibitors of three classic autophagy pathways were applied. Cell viability (using CCK8 assay), Calcein/PI staining, autophagosome staining (using MDC assay), reverse transcription quantitative polymerase chain reaction, and western blot were subsequently carried out to investigate the mechanisms by which BV ameliorates CIRI.

RESULTS

BV alleviated CIRI by inhibiting autophagy. Further investigation suggested that BV downregulated P4hb expression. In vitro experiments showed that P4hb knockdown reduced autophagy in post-CIRI cells, while its overexpression reversed the effects of BV. Rescue experiments indicated that MAPK pathway inhibitors counteracted the effects of P4hb overexpression on autophagy post-CIRI.

CONCLUSION

BV improves CIRI by regulating the P4hb/MAPK/mTOR signaling pathway to inhibit autophagy, offering a novel therapeutic strategy for ischemic stroke.

C-reactive protein-to-albumin ratio is associated with increased depression: An exploratory cross-sectional analysis

BACKGROUND

Depression, prevalent globally, significantly impacts psychological and physical health. As a burgeoning biomarker, C-reactive protein-to-albumin ratio (CAR) offers insights into metabolism-immune status and disease diagnosis. This exploratory investigation seeks to elucidate the relationship between CAR and depression.

METHODS

This cross-sectional investigation utilized data from the National Health and Nutrition Examination Survey (NHANES). Depression was assessed using the PHQ-9 questionnaire. To examine the relationship between CAR and depression risk, we employed a multivariable logistic regression analysis and a restricted cubic spline (RCS) approach. Furthermore, subgroup analyses were performed to validate the consistency of the findings across specific populations.

RESULTS

This investigation enrolled 13,159 adult participants, comprising 8.15 % with depression. Compared with participants without depression, those diagnosed with depression showed a significantly higher CAR level. Each one - unit increase in log10-transformed CAR (log-CAR) was associated with an 58 % increase in the incidence of depression (Odds Ratio = 1.58, 95 % Confidence Interval: 1.33-1.88). A non-linear dose-response relationship was detected between CAR and depression risk (non-linear p < 0.001). Furthermore, the strength of this association persisted undiminished throughout multiple subgroup analyses. Notably, among individuals with a prior history of metabolic diseases, the observed association remained consistent.

CONCLUSIONS

A distinct positive correlation was observed between CAR and depression in U.S. adults. Further large-scale, well-controlled studies are needed to validate the reliability and establish the generalizability of these findings.

Global, regional and national ischemic heart disease burden attributable to a high-sodium diet in 204 countries, 1990-2019: A systematic analysis for the global burden of disease study

BACKGROUND AND AIM

Globally, the prevalence of poor diets poses a serious threat to public health and development. This research set out to evaluate the worldwide impact of high-sodium diet-related ischemic heart disease(IHD) from 1990 to 2019.

METHODS AND RESULTS

The present study employed data on the mortality of IHD that were sourced from the Global Burden of Disease (GBD) 2019 survey, which encompassed 204 countries. Age-standardized mortality rates (ASMR) and age-standardized disability-adjusted life-year rates (ASDR) were evaluated at several levels, including age, sex, region, and sociodemographic index (SDI). In 2019, 777,200 mortalities worldwide from IHD were linked to high-sodium diets [95 % uncertainty interval (UI): 185.3-1773.1]. There were 29.8 (95 % UI: 2.3-22.6) and 210.4 (95 % UI: 56.5-449.3) ASMR and ASDR per 100,000 people, respectively. Men were more affected by IHD than women, and older people were more affected than younger people. Regions with higher SDI had lower ASDR and ASMR compared to areas with lower SDI. The estimated annual percentage change(EAPC) for ASMR and ASDR between 1990 and 2019 was -1.09 % (95 % CI: 1.15 % to -1.03 %) and -1.02 % (95 % CI: 1.07 % to -0.96 %), respectively.

CONCLUSIONS

As a result of excessive sodium diets, there is an increasing global burden of IHD, which is impeding social and economic development globally, even though ASMR and ASDR have declined over time. Furthermore, these results will be useful in helping to create policies and carry out focused initiatives to reduce high-sodium diets around the world.

Review of research advances in microbial sterilization technologies and applications in the built environment

As globalization accelerates, microbial contamination in the built environment poses a major public health challenge. Especially since Corona Virus Disease 2019 (COVID-19), microbial sterilization technology has become a crucial research area for indoor air pollution control in order to create a hygienic and safe built environment. Based on this, the study reviews sterilization technologies in the built environment, focusing on the principles, efficiency and applicability, revealing advantages and limitations, and summarizing current research advances. Despite the efficacy of single sterilization technologies in specific environments, the corresponding side effects still exist. Thus, this review highlights the efficiency of hybrid sterilization technologies, providing an in-depth understanding of the practical application in the built environment. Also, it presents an outlook on the future direction of sterilization technology, including the development of new methods that are more efficient, energy-saving, and targeted to better address microbial contamination in the complex and changing built environment. Overall, this study provides a clear guide for selecting technologies to handle microbial contamination in different building environments in the future, as well as a scientific basis for developing more effective air quality control strategies.

Graded chronic noncancer pain distribution using the Graded Chronic Pain Scale-Revised framework: a cross-sectional study

Introduction

Chronic noncancer pain affects approximately one-fourth in population-based studies calling for more nuanced insights by applying the Graded Chronic Pain Scale-Revised (GCPS-R) framework for classifying graded chronic noncancer pain distribution in national disease surveillance. Objectives: The GCPS-R framework was included in the comprehensive questionnaire repeatedly used in the Danish National Health and Morbidity Surveillance program to provide more distinct measures for chronic non-malignant pain disease manifestation in Denmark.

Methods

A cross-sectional study inviting randomly 25,000 adults 16 years and older to self-report questionnaires comprising the GCPS-R framework as part of the nationwide Danish National Health Survey 2023. Prevalences (%) and multivariate-adjusted odds ratios (ORs) with 95% confidence intervals (95% CI) by ordinal logistic regression were calculated for GCPS-R by sex, area of living, age, country of origin, socioeconomic factors, body mass index, and Charlson Comorbidity Index.

Results

The prevalence of chronic noncancer pain was overall 28.1% (95% CI 27.2%-29.0%) in 8,643 included individuals without cancer diagnosis counting 7.4% (6.9%-8.0%) with mild-impact, 7.1% (6.6%-7.6%) with bothersome-impact, and 13.6% (12.9%-14.4%) with high-impact chronic noncancer pain. Women had 66% (odds ratio (OR) 1.66; 95% CI 1.50-1.84) elevated odds of more severely graded chronic noncancer pain referenced to men. Socioeconomic factors influenced odds inversely. Body mass index was related to GCPS-R by dose-response effects of more than doubled elevated odds in World Health Organization obese class II (2.42; 1.92-3.06) and obese class III (4.43; 3.30-5.93) referenced to normal body mass index individuals. Comorbidity elevated odds of more severely graded chronic noncancer pain by 86% (1.86; 1.57-2.19) referenced to individuals without comorbidity.

Conclusions

More than one-quarter individuals reported chronic noncancer pain characterized particularly by high-impact graded chronic noncancer pain when applying the GCPS-R framework for classifying graded chronic noncancer pain distribution in national disease surveillance for rational health care administration.

Traditional Chinese medicine in cerebral infarction: Integrative strategies and future directions

BACKGROUND

Cerebral infarction is a predominant cause of global disability and mortality, characterized by pathogenesis that includes vascular stenosis, thrombosis, ischemic necrosis, and neuroinflammation. Despite progress in medical science, effective treatments for cerebral infarction are still constrained, prompting the investigation of alternative therapeutic strategies.

PURPOSE

The objective of this review is to assess the efficacy of Traditional Chinese Medicine (TCM) as a treatment for cerebral infarction, emphasizing its mechanisms of action, effectiveness, and clinical relevance.

STUDY DESIGN

An extensive review of the existing literature regarding the role of TCM in the management of cerebral infarction, encompassing investigations on specific remedies, Chinese medicinal formulations, and contemporary advancements in preparation methodologies.

METHODS

This review analyzes diverse TCM remedies recognized for their antioxidant, anti-inflammatory, and neuroprotective properties. Furthermore, it examines the synergistic effects of Chinese medicine formulations in modulating inflammation, enhancing blood circulation, and facilitating neural repair. Contemporary technological advancements that improve the accuracy and efficacy of Chinese medicine are also taken into account.

RESULTS

TCM has shown considerable promise in tackling the complex aspects of cerebral infarction. Specific remedies and formulations have demonstrated potential in modulating inflammatory responses, enhancing cerebral blood flow, and promoting neural repair mechanisms. Contemporary formulations have enhanced these effects, facilitating more precise and effective treatment.

CONCLUSION

While TCM presents a promising multi-faceted and multi-tiered strategy for addressing cerebral infarction, obstacles such as elucidating mechanisms and achieving standardization must be addressed. Continued research and clinical trials are crucial to fully exploit the therapeutic potential of TCM in the management of cerebral infarction.

Food biodiversity and mortality in older Mediterranean adults with high cardiovascular risk

The food system is a key determinant of population and planetary health. As the "one planet, one health" approach gains momentum, evaluating "food biodiversity" and its association with mortality in high-risks populations is increasingly important. Hence, we evaluated the associations of food biodiversity with all-cause and cause-specific mortality in a Spanish cohort of older adults at high cardiovascular risks. Food biodiversity was defined using dietary species richness (DSR), the count of unique plants and animal species consumed by an individual. DSR was cumulatively calculated over the PREDIMED study follow-up, using yearly food frequency questionnaire data. The association of food biodiversity with all-cause and cause-specific mortality was assessed using Cox regression, while controlling for confounders. We analyzed data from 7210 participants (58 % women), with a median age of 67 years. DSR in the cohort ranged between 16 and 57 (median: 48). Over a median follow-up of 6 years, 425 deaths were recorded (103 deaths from cardiovascular diseases (CVD), 169 cancer deaths, and 153 deaths due to other-causes). DSR was only moderately correlated with adherence to the Mediterranean diet. On average, when fully adjusted, every additional species over the follow-up period was associated with a Hazard Ratio (HR (95 % Confidence Interval) of 0.91(0.90,0.93) for all-cause mortality, 0.93(0.90,0.96) for CVD mortality, 0.92 (0.89,0.94) for cancer deaths, and a 0.91(0.89,0.94) for deaths from other causes. Dietary recommendations to improve food biodiversity may increase longevity.

Jian-pi Qu-tan Hua-yu Decoction improves oxidative stress-induced inflammation in endothelial cells in atherosclerotic ApoE-/- mice through the NOX1-ROS-ERK1/2 pathway

BACKGROUND

Atherosclerosis (AS) is a key mechanism in cardiovascular diseases and a major target for interventions. Jian-pi Qu-tan Hua-yu Decoction (JPQTHYD), a herbal formula, has been shown to alleviate AS.

OBJECTIVE

This study aimed to evaluate the therapeutic effect of JPQTHYD on AS and explore its molecular mechanisms.

MATERIALS AND METHODS

In vivo, we established a mouse model through a high-fat diet for 16 weeks combined with a 4-week exhaustive swimming experiment. The body weight and food intake of the mice were measured every 4 weeks. At the end of the 16 weeks, the moisture content of the mice's feces was measured, the morphology of the thoracic aorta and myocardium was observed using HE staining, and lipid deposition in the aorta and myocardium was assessed using Oil Red O staining. The ultrastructure of myocardial tissue was observed via transmission electron microscopy. Levels of TC, TG, and LDL-C were measured using an automatic biochemical analyzer. ELISA was used to detect the levels of ROS, IL-6, IL-10, TNF-α, hs-CRP, VCAM-1, and ICAM-1. In vitro, we induced HUVECs injury using 700 nM of Ang II. Cell viability was assessed using the CCK-8 assay, while ROS levels were measured by a ROS detection kit. NOX1 gene suppression was achieved using a NOX1 inhibitor. Protein expression levels of NOX1, ERK1/2, P-ERK1/2, VCAM-1, and ICAM-1 were measured by Western blot both in vivo and in vitro.

RESULTS

1. JPQTHYD improved fecal water content and exercise capacity in ApoE-/- mice. 2. JPQTHYD reduced TC, TG, LDL-C levels, decreased arterial intimal thickness, and inhibited atherosclerotic plaque formation. 3. JPQTHYD decreased proinflammatory factors and adhesion molecules by inhibiting the NOX1-ROS-ERK1/2 pathway. 4. In vitro, JPQTHYD suppressed endothelial inflammation by reducing NOX1-ROS-ERK1/2 signaling.

CONCLUSION

JPQTHYD reduced blood lipids, inhibited oxidative stress-induced inflammation, and alleviated AS in ApoE-/- mice, likely through the NOX1-ROS-ERK1/2 pathway. This study offers a novel investigation into the mechanisms and regulatory pathways through which traditional Chinese medicine contributes to the prevention and treatment of atherosclerosis.

Guiding precision medicine strategy for intravenous ginsenosides via pharmacokinetic-informed bioinformatic approaches: a study on XueShuanTong

BACKGROUND

Intravenous ginsenosides, derived from Panax species, are widely used in China. XueShuanTong injection, enriched with ginsenosides Rb1 and Rg1, is recommended for unstable angina treatment. Although effective, it may cause adverse effects, especially in patients with renal or hepatic impairment, as these organs are vital in ginsenosides' systemic exposure.

PURPOSE

This investigation aimed to inform precision medicine by employing a physiologically based pharmacokinetic (PBPK) model to evaluate transporter-mediated interactions between both ginsenosides and their systemic exposure in patients with organ impairment, thereby ensuring safety.

METHODS

Interactions between ginsenosides Rb1 and Rg1, mediated by human and rat transporters, were characterized at both cellular and vesicular levels. Their interactions with human organic anion-transporting polypeptide (OATP)1B3 and rat Oatp1b2 were evaluated when administered together or as part of XueShuanTong in both rats and humans. PBPK models incorporating OATP-mediated hepatobiliary excretion were developed to characterize their interactions and pharmacokinetics, providing guidance for precision medicine in these patients.

RESULTS

Ginsenoside Rb1 was demonstrated to inhibit human OATP1B3 (Oatp1b2 in rats)-mediated cellular uptake, significantly increasing exposure levels of ginsenoside Rg1 in rats by impairing hepatobiliary elimination. Mechanistic models effectively replicated the pharmacokinetic profiles and the interactions of ginsenosides Rb1 and Rg1. These validated models revealed that decreases in GFR, hematocrit, hepatic volume, and/or OATP1B3 expression and activity in patients with renal or hepatic impairment significantly increased the systemic exposure levels of both ginsenosides. Moreover, the models provided valuable insights into the mechanism of "albumin-facilitated dissociation" associated with ginsenoside Rb1, an OATP1B3 inhibitor. This understanding is crucial for predicting the risk of drug-drug interactions involving drugs with high plasma protein binding.

CONCLUSIONS

By incorporating these key patient-specific physiological parameters into the models, this investigation provides practical guidance for optimizing dosing strategies and improving the therapeutic efficacy of ginsenoside-containing injections, including XueShuanTong, in patients with complex conditions.

Ciprofloxacin-loaded electrosprayed lactose particles

Bacterial infections persist as a major global health challenge, underscoring the need for the development of advanced drug delivery systems. This study firstly explored the use of electrospraying to generate lactose microparticles loaded with ciprofloxacin (cipro), using polyvinyl alcohol (PVA) as an additive to enhance particle formation. Following optimization, spherical electrosprayed (ES) lactose microparticles were successfully produced with various cipro loadings (in the range of 0.25 %-1.07 % w/w). The electrosprayed particles did not contain any detectable crystalline material. Additionally, it was observed that the ES particles contained residual water, primarily originating from the production process. In terms of drug release, the ES particles exhibited rapid release kinetics within 5 h, suggesting their potential utility in treating acute bacterial infections. Notably, the formulations displayed concentration-dependent antibacterial activity against both Staphylococcus aureus and Pseudomonas aeruginosa, effectively delaying and inhibiting bacterial growth.

Long-term exposure to major constituents of fine particulate matter and sleep disorders among children and adolescents: A population-based survey in Guangdong province, China

Long-term exposure to PM2.5 is associated with sleep health in adults, but its impact on children and adolescents remains unclear. This cross-sectional study analyzed 64,203 children and adolescents (6-18 years) from four cities in Guangdong, China, to assess the impact of PM2.5 and its major constituents on sleep disorders. Sleep disorders were assessed using the Sleep Disturbance Scale for Children. Generalized linear mixed models and weighted quantile sum regression were applied to assess the joint effects of PM2.5 constituents. The results indicated a positive association between PM2.5 and sleep disorders. For example, the odds of sleep disorder increased with per interquartile range (IQR) increase in PM2.5 concentrations [odds ratio (OR): 1.15, 95 % confidence interval (CI):1.06, 1.26). Black carbon (BC) and organic matter (OM) increase the odds by 16 % (95 % CI: 9, 24 %) and 23 % (95 % CI: 9, 39 %), respectively. Notably, combustion-related BC (44.3 %) and OM (24.3 %) contributed the key contributors to the mixture risk. Children and adolescents with limited outdoor activity (< 2 hours/day) were more vulnerable to PM2.5 exposure (P for interaction = 0.028). These findings highlight that stricter air pollution regulations and targeted measures to reduce children's exposure to combustion-derived pollutants are essential for protecting sleep health and overall well-being.

The impact of different types of extreme temperature events on mental disorders: A case-crossover study in Anhui Province, China

BACKGROUND

Extreme temperatures are expected to be more frequent, intense, and complex in the context of climate change. However, epidemiologic evidence about associations between extreme temperature and mental disorders is limited.

METHODS

We conducted a case-crossover study in Anhui Province, China, focusing on outpatients diagnosed with mental and behavioral disorders (ICD-10 codes: F00-F99), further classified into schizophrenia (F20-F21), depression (F32-F33), and anxiety (F40-F41). Defining the day of each outpatient visit to the Anhui Mental Health Center as the case day, a total of 762,895 case days and 3,362,574 control days were included in the study, covering the period from 2019 to 2021. Each subject was geocoded based on their home address and matched with environmental exposures, including meteorological data and air pollutant data sourced from the CN05.1 and the TAP dataset, respectively. Extreme temperature events were categorized into heat and cold extremes, further divided into daytime, nighttime, and compound extremes.

RESULTS

Among the outpatient visits for mental disorders included in this study, the proportions were schizophrenia (28.9 %), depression (23.9 %), and anxiety (18.5 %). Exposure to extreme heat and cold was associated with increased risks of outpatient visits for mental disorders, with odds ratios (ORs) of 2.23 (95 %CI: 2.16-2.30) and 1.95 (95 %CI: 1.89-2.01), respectively. Compound heat extremes posed the highest risk of mental disorders (OR = 1.17, 95 %CI: 1.13-1.22), followed by nighttime (OR = 1.11, 95 %CI: 1.08-1.14) and daytime heat (OR = 1.05, 95 %CI: 1.04-1.07). Notably, the risk of mental disorders significantly elevated with the increased intensity and duration of extreme heat events. Besides, extreme heat was strongly associated with higher risks of depression, schizophrenia and anxiety, while extreme cold was notably linked to schizophrenia.

CONCLUSION

These findings indicate a significant correlation between extreme temperature exposure and elevated mental disorder risks, emphasizing the urgent need to address increased mental health risks posed by extreme temperatures in the changing climate.

Distinct neurotoxic mechanisms of thallium and lead: Calcium-mediated apoptosis and iron-induced ferroptosis in zebrafish at environmental concentrations

Environmental neurotoxicants, such as thallium (Tl) and lead (Pb), pose significant risks to human health, yet their toxicological mechanisms remain poorly understood. This study investigates the distinct mechanisms of Tl+- and Pb2+-induced neurotoxicity at environmentally relevant concentrations using zebrafish embryos as a model. Transcriptomic analyses revealed minimal overlap in gene expression changes between the two metals, underscoring their unique toxicological pathways. Further study demonstrated that Tl+ disrupted calcium homeostasis, activating the calcium signaling pathway and triggering apoptosis via MAPK signaling. In contrast, Pb2+ exposure triggered ferroptosis, characterized by iron overload and lipid peroxidation, with significant involvement of oxidative stress and disruption of iron metabolism. Cellular assays validated these findings, confirming the critical roles of calcium and iron dysregulation in neuronal damage. These results emphasize the complexity of metal-induced neurotoxicity and the importance of studying pollutants at realistic exposure levels. Understanding the divergent pathways of Tl+- and Pb2+-induced neurotoxicity provides critical insights for mitigating their environmental and public health impacts, highlighting the need for targeted regulatory strategies to address heavy metal pollution effectively.

Exploring the double-edged role of cellular senescence in chronic liver disease for new treatment approaches

Cellular senescence is a fundamental yet complex defense mechanism that restricts excessive proliferation, maintains cellular homeostasis under various stress conditions-such as oncogenic activation and inflammation-and serves as a dynamic stress response program involved in development, aging, and immunity. Its reversibility depends on essential maintenance components. Cellular senescence is a "double-edged sword": on one hand, it limits the malignant proliferation of damaged cells, thereby preventing tumor development. However, by retaining secretory functions, senescent cells can also induce persistent changes in the microenvironment and disrupt homeostasis, leading to tissue inflammation, fibrosis, and carcinogenesis. Senescence plays a critical role in the pathogenesis of various chronic liver diseases, including chronic viral hepatitis, liver fibrosis, and hepatocellular carcinoma. It exerts a dual influence by facilitating immune evasion and inflammation in chronic viral hepatitis, modulating hepatic stellate cell activity in fibrosis, and reshaping the tumor microenvironment to accelerate hepatocarcinogenesis. This article reviews the characteristics of cellular senescence and its role in the pathogenesis of these chronic liver diseases while exploring potential treatment and prevention strategies. The aim is to provide a comprehensive reference for future clinical and research investigations into chronic liver disease.

Systemic inflammation mediates the association between dietary inflammation index and incident anxiety and depression in UK Biobank

BACKGROUND

Evidence on whether systemic inflammation mediates the association between diet and depression and anxiety is lacking.

METHODS

We analyzed 55,799 participants from the UK Biobank, assessing dietary inflammatory index (DII) based on 3 days' 24-hour dietary recall. Systemic inflammation was represented by systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI). Incident depression and anxiety were ascertained through linkage to hospital records, and Cox proportional hazard regression models evaluated the associations, with mediation analysis performed for systemic inflammation.

RESULTS

DII ranged from -6.87 to 4.88 with a median of -0.67. After a median follow-up time of 9.12 years, 1409 were diagnosed with depression and 1806 with anxiety. Higher DII level is associated with the incident risk of depression (HRQ4vsQ1 = 1.20, 1.09-1.32, P < 0.001) and anxiety (HRQ4vsQ1 = 1.10, 1.00-1.21, P < 0.001). SIRI and SII respectively mediate 4.12 % (95 % CI = 1.30 %-23.3 %, P < 0.001) and 4.43 % (95 % CI = 1.89 %-43.75 %, P < 0.001) of the association between DII and depression incidence. As for anxiety, SIRI mediated 8.27 % (95 % CI = 1.44 %-15.31 %, P < 0.001) and SII mediated 4.19 % (95 % CI = 1.58 %-11.47 %, P < 0.001), respectively.

LIMITATIONS

The potential coexistence of anxiety and depression with other psychiatric disorders and limitations in data on changes in DII and inflammation markers over time may bias the findings. The study's generalization is constrained by the demographic of participants.

CONCLUSION

Our findings suggest that DII is positively associated with depression and anxiety, which may be mediated by SII/SIRI.

Subchronic ozone exposure leads to multi-organ injuries with differential reversibility in male C57BL/6 J mice

Ozone, a prevalent environmental pollutant, poses significant risks to human health. This study systematically evaluates the impact of subchronic ozone exposure on multiple organs using three-month-old male C57BL/6 J mice exposed to 0.5 or 2.0 ppm ozone for 12 weeks, followed by 4-week recovery period. Subchronic ozone exposure caused systemic damage, including weight loss, inflammation, oxidative stress, and dyslipidemia, with varying degrees of reversibility. Comprehensive histopathological and functional analyses revealed dose-dependent injuries, organ-specific response patterns, and varying recovery capacities within a 4-week cessation of exposure. The lung demonstrated the highest susceptibility with dose-dependent damage and high reversibility. In contrast, the liver, kidneys, and brain, exhibited milder yet largely irreversible damage, particularly at 2.0 ppm. Transcriptomic analyses identified high reversibility in lung inflammation pathways, persistent metabolic dysregulation in the liver and kidneys, neurodegeneration-related perturbations in the brain with minimal recovery capacity. Furthermore, common molecular drivers, such as oxidative stress and inflammation, were identified across all organs, revealing both unique and shared mechanisms of injury and recovery. These findings underscore the systemic nature of ozone toxicity and the need for targeted interventions. Persistent dyslipidemia and metabolic dysregulation in the liver and kidneys emphasize the necessity for ongoing monitoring and potential interventions for individuals exposed to elevated ozone levels.

Exploring the association between air pollution and urogenital congenital anomalies: a global ecological analysis

The relationship between air pollution and urogenital congenital anomalies (UCAs) remains poorly understood. This study performed an ecological analysis of air pollution emissions and the burden of UCAs, aiming to offer new global insights for air pollution control. Data were obtained from the Global Burden of Disease Study (2021) and Emission Database for Global Atmospheric Research. Joinpoint regression assessed temporal trends in burden of UCAs, mixed-effects, nonlinear lag and time-varying effect models were used to investigate potential associations between air pollution emissions and burden. The burden indicators were incidence, deaths and disability-adjusted life years. From 1990 to 2021, the global incidence of UCAs generally declined, with a significant increase observed since 2016. Our analysis identified a positive correlation between burden of UCAs and several air pollutants. Sulfur dioxide(SO2), ammonia and nitrogen oxides(NOX) are significantly associated with the incidence of UCAs, while SO2, NOX, and non-methane volatile organic compounds are significantly associated with the mortality and disability-adjusted life years rate of UCAs. Sex-specific subgroup analysis indicated differing responses to these pollutants. However, the effect of sulfur dioxide on burden was consistent across sex. Notably, we also found that some pollutants have hysteresis effects that contradict the immediate effects. Additionally, the relationship between air pollution and burden displayed distinct variations over years. This study enhances our understanding of the health impacts on UCAs associated with air pollution, suggested that pregnant women should stay away from ammonia and SO2. It also emphasizes that strengthening air pollution control should be a key monitoring policy.

Hospital-Diagnosed Traumatic Head Injury and Associated Risk of Developing ALS: A Nationwide Population-Based Case-Control Study

BACKGROUND AND OBJECTIVES

Previous studies have suggested that traumatic head injury (THI) may be a risk factor of amyotrophic lateral sclerosis (ALS) development, yet the association remains unclear. We aimed to determine whether hospital-diagnosed THI is an important ALS risk factor, and we investigated the magnitude and duration of associated ALS risk.

METHODS

In this population-based case-control study, we used individual-level data linkage across nationwide health registers from 1980 to 2021 to identify patients with hospital-diagnosed ALS. Each patient was matched 1:10 with individuals from the general population by age, sex, and diagnostic index date. We used conditional logistic regression to examine the relative risk of ALS associated with having previous hospital-diagnosed THI. To avoid the effect of reverse causation, we investigated ALS risk within several time windows and repeated all analyses after restricting THI exposures to more than 3 years before the date of ALS diagnosis.

RESULTS

THI was observed in 4.7% of 5,943 ALS cases vs 3.7% of 59,426 controls, with a matched odds ratio (OR) of 1.3 (95% CI 1.1-1.4). However, the risk of ALS declined considerably with increasing time since head injury, with a high OR of 4.5 (95% CI 2.8-7.3) observed within the 6 months before ALS diagnosis. If head injury was suffered 6-12 months before ALS diagnosis, the OR was 2.4 (95% CI 1.4-4.0). Restricting the analysis to THI suffered more than 3 years before ALS diagnosis, we found no association with an OR of 1.1 (95% CI 1.0-1.3).

DISCUSSION

Although a strong association of ALS with THI experienced ≤1 year before ALS diagnosis was evident, our results suggest that this is due to reverse causation. When restricting the analysis to a period deemed relevant for causative events leading to ALS development, no association was observed. Consequently, we do not consider THI an important ALS risk factor. This study was limited by the inability to consider minor THIs not receiving hospital attendance. Future research should explore alternative models to unfold this possible ALS risk factor.

Impact of sodium butyrate on stroke-related intestinal injury in diabetic mice: Interference with Caspase-1/GSDMD pyroptosis pathway and preservation of intestinal barrier

Diabetic stroke-associated acute intestinal injury is characterized by high mortality, disability, and poor prognosis due to the lack of effective therapies. Our prior research demonstrated that administration of 300 mg/kg sodium butyrate (NaB) can improve neurological outcomes post-diabetic stroke. Nonetheless, whether the effect of NaB is related to intestinal regulation, along with its underlying mechanisms, remains uncertain. This study aims to investigate the effects and mechanistic pathways of NaB on diabetic stroke-associated acute intestinal injury. A middle cerebral artery occlusion/reperfusion model was established in mice with streptozotocin-induced diabetes. The results demonstrated that NaB alleviated colonic injury 24 h after reperfusion in diabetic stroke. Pyroptosis-related protein levels in colonic tissues were significantly elevated following diabetic stroke but were markedly reduced with NaB treatment. NaB also improved gut barrier integrity and reduced inflammation, promoting epithelial barrier self-repair. In the NaB combined with lipopolysaccharide group, lipopolysaccharide administration induced a significant inflammatory response in the colonic tissue. Conversely, treatment with NaB and VX-765 (an inhibitor for Caspase-1) led to a notable alleviation in intestinal inflammation. These findings suggest that NaB mitigates colonic injury and enhances barrier function following diabetic stroke, potentially through the Caspase-1/Gasdermin D pyroptosis pathway. This study may provide a novel strategy and direction for intestinal rehabilitation in diabetic stroke patients.

Combined exposure of sleep deprivation and environmental particulate matter drives aging in multiple systems

Sleep disturbance accelerates aging, with accompanying exposure to air pollution. However, most studies ignore the combined exposure. This study aimed to investigate the combined effects of sleep deprivation and PM2.5 exposure on multi-system aging and to explore the damage mechanisms. The sleep deprivation instrument and the Shanghai Meteorological and Environmental Animal Exposure System (Shanghai-METAS) were used to construct a combined exposure model for one month. Our study used multiple behavioral, imaging, and molecular biological examinations to describe the aging characteristics in the cardiovascular system, metabolism, and central nervous system. Besides, the mechanisms in Sirt1, Wnt10β pathways were explored and correlation of damage among tissues was clarified. Based on sleep disruption, PM2.5 exposure was able to induce elevated serum T-CHO levels, impaired conditioned learning ability, abnormal brain tissue metabolic levels, and aberrant expression of multiple molecular markers related to cellular senescence, whereas PM2.5 exposure alone did not induce changes in the above indices. In addition, the Sirt1, Wnt10β pathway mediated cardiac and hepatic aging induced by combined exposure. Moreover, there was a significant correlation between heart and liver aging damage, which suggesting heart-liver axis may be involved in the aging process. Sleep deprivation and PM2.5 exposure trigger senescence in multiple tissues. In particular, on the basis of sleep deprivation, PM2.5 accelerates of the aging process in several tissues and organs. The problem of air pollution on top of sleep disturbance should be taken seriously, as it has a greater potential to accelerate aging than air pollution.

Tedizolid for osteoarticular infections: Evaluation of the published evidence

INTRODUCTION

Tedizolid phosphate, an oxazolidinone antibiotic, has been approved for the treatment of acute bacterial skin and skin structure infections (ABSSSIs). However, its off-label use has been reported in various infections, including osteoarticular infections.

METHODS

A systematic review of data from PubMed, Scopus, and Web of Science was conducted to evaluate the antimicrobial activity, safety, and effectiveness of tedizolid in patients with bone and joint infections, including prosthetic joint infections, osteomyelitis, and septic arthritis. The review encompassed clinical trials, prospective and retrospective studies, and case reports.

RESULTS

A total of 6 in vitro antimicrobial and 15 clinical studies were included in the review. Tedizolid demonstrated high antimicrobial activity across all in vitro studies. In 106 patients from the included clinical studies, tedizolid showed high effectiveness, with therapy success ranging from 76.5 % to 100 % in 4 cohort studies. Additionally, favorable outcomes were reported in 7 of 9 case reports. Tedizolid exhibited a favorable safety profile, with 11 of 15 clinical studies reporting no adverse events in 37 patients. Adverse events leading to therapy discontinuation were observed in 9 out of 124 patients included in the remaining studies.

CONCLUSION

The current appraisal suggests that tedizolid is a promising antibiotic for the treatment of bone and joint infections. Nonetheless, its use should be reserved for multi-drug resistant infections when other approved therapeutic options are limited. Further clinical studies are warranted to substantiate the effectiveness and safety of tedizolid in this patient population.

Synthesis and antimicrobial evaluation of novel quaternary quinolone derivatives with low toxicity and anti-biofilm activity

To overcome the increasing global drug resistance, the development of novel antimicrobial drugs is a top priority in the fight against multidrug resistant (MDR) and persistent bacteria. In this work, we report the synthesis of novel single quaternary quinolone antibacterial agents. The majority of the tested compounds exhibited significant antimicrobial efficacy against Gram-negative pathogens (E. coli and S. maltophilia). Notably, the selected compound (4e) was highly inhibitory with a MIC value of 0.25 μg/mL against E. coli. Additionally, compound 4e demonstrated excellent stability in complex biological fluids with low hemolytic activity (HC50 > 1280 μg/mL) and a significantly lower propensity to induce bacterial resistance. Encouragingly, 4e showed not only rapid bactericidal activity and inhibition of bacterial biofilms, but also low toxicity to erythrocytes and RAW 264.7 cells compared to the clinical drug ciprofloxacin. Mechanism studies have found that compound 4e has a relatively weak destructive effect on the cell membrane of E. coli. However, it can effectively inhibit the activity of glutathione (GSH), promote the massive accumulation of intracellular reactive oxygen species (ROS), and then disrupt the antioxidant defense system of bacteria, achieving a bactericidal effect. In addition, compound 4e has a certain binding effect with bacterial DNA.

Novel sodium-hydrogen exchanger 1 inhibitors with diphenyl ketone scaffold: Design, Synthesis, mechanism and evaluation in mice model of heart failure

Sodium-hydrogen exchanger 1 (NHE1) is a potential target for drug discovery of heart failure (HF). Cardioprotection effect of empagliflozin (EMPA) was reported to be related to binding with NHE1 protein. Herein, a series of NHE1 inhibitors bearing benzhydryl and diphenyl ketone skeleton were rationally designed and efficiently synthesized. Cell viability assay and pH recovery experiment based on H9c2 cells were conducted and compound 7g was found to have equal NHE1 inhibitory activity to cariporide (0.64 μM) with the IC50 values of 0.78 μM. In vitro, 7g at 1 μM effectively rescued glucose deprivation (GD)-induced cellular damage by decreased overload of Ca2+ concentration and reactive oxygen species (ROS), improved mitochondrial dysfunction and autophagy. In vivo, compared with the clinically approved drug empagliflozin (30 mg/kg), 7g alleviated left ventricular systolic dysfunction in a heart failure model induced by isoproterenol (ISO) at lower concentration (10 mg/kg). In summary, this study supplies a promising lead compound with novel scaffold for NHE1 inhibitor and also provide a feasible strategy for HF drug discovery.

Interictal suppression in patients with mesial temporal lobe epilepsy: A simultaneous PET/fMRI study

Previous stereotactic-electroencephalography (SEEG) results have suggested that seizure-onset zones (SOZs) could be suppressed by strengthened inward connectivity from the rest of the brain during interictal periods, which might explain why people with epilepsy did not have seizures continuously. However, the limited coverage of SEEG contacts and allocation bias hindered a more comprehensive survey of interictal suppression at the whole-brain level. Previous studies also lacked a direct comparison between patients and healthy controls due to the invasive nature of SEEG. In the present study, we introduced metabolic connectivity mapping (MCM), a simultaneous FDG-PET/fMRI-based measure of effective connectivity, to evaluate the inward and outward connectivity of the SOZs in patients with mesial temporal lobe epilepsy (MTLE). Specifically, simultaneous FDG-PET/fMRI data was acquired from 23 patients with left MTLE, 24 patients with right MTLE, and 25 healthy controls. At the whole-brain level, there was significant increase of inward MCM connectivity to the SOZs, which mostly came from mesial-temporo-limbic, anterior and posterior midline regions of the default mode network (DMN) and subcortical nuclei. There was also significant decrease of outward MCM connectivity from the SOZs, which mainly projected to the regions within DMN. The increased net inward MCM to the SOZs, calculated by subtracting outward MCM from the inward MCM, was positively correlated with seizure frequency. Within DMN, MTLE patients showed decreased MCM from the SOZs to posterior cingulate cortex and right ventromedial prefrontal cortex and increased effective connectivity from posterior cingulate cortex to the SOZs. Based on the MCM patterns within DMN, we were able to classify the epileptic side of MTLE with an accuracy of 91.67 % (79.17 % for MRI-negative patients). Overall, our results provide whole-brain evidences for the interictal suppression hypothesis. We also found that the regions within DMN play a critical role in the suppression of SOZs. The pattern of such suppressive network might also serve as potential features for the localization of SOZs. Our neuroimaging results does not only provide a comprehensive understanding of interictal suppression at the whole-brain level, but also shed lights on a non-invasive and time-efficient way for SOZs localization.