Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

Burdens and trends of age-related macular degeneration at global, regional, and national levels,1990-2021: findings from the 2021 global burden of disease study

OBJECTIVES

To assess global, regional, and national burdens and trends of age-related macular degeneration (AMD) from 1990 to 2021.

METHODS

Data from the Global Burden of disease Study 2021(GBD 2021) were used. The primary measurement were prevalent cases, years lived with disability (YLDs), age-standardised prevalence rate (ASPR) and age-standardised YLDs rate (ASYR), categorized by age and sociodemographic index (SDI). Trend analysis was measured by calculating average annual percentage change (AAPC) of ASPR and ASYR.

RESULTS

Globally, the prevalent AMD cases increased to 8,057,520.459 (95% uncertainty interval [UI], 6,705,283.83 to 9,823,237.34) in 2021, with associated YLDs rising to 577,984.5004 (95% UI, 401,188.20 to 797,657.63). AMD burdens varied across regions and countries, as well as level of SDI development. China, India, and the United States of America (USA) were the top three countries with AMD cases. Caribbean regions have significant lower ASPR and ASYR of AMD. The AMD burden peaked between ages 65-69. Females had a significantly higher burden of AMD compared to males. From 1990 to 2021, the global ASPR and ASYR showed downward trend (AAPC = -0.15, 95% confidence interval [CI], -0.19 to -0.12, P < 0.001; AAPC = -0.69, 95% CI, -0.71 to -0.67, P < 0.001) respectively. The USA is the only developed country showed decreasing AAPCs of ASPR and ASYR from 1990 to 2021 but increasing AAPCs of ASPR and ASYR from 2012 to 2021.

CONCLUSIONS

AMD burdens increased over 30 years, varying by age, sex, and SDI, guiding global strategies and public health interventions.

Global trends in staphylococcus aureus-related lower respiratory infections from 1990 to 2021: findings from the 2021 global burden of disease report

BACKGROUND

Lower respiratory infections (LRIs) represent a significant global health issue, especially affecting low- and middle-income countries. In this study, we explored the mortality and disability-adjusted life years (DALYs) associated with Staphylococcus aureus-related LRIs from 1990 to 2021, highlighting trends by age, sex, and Socio-Demographic Index (SDI).

METHODS

Data were derived from the 2021 Global Burden of Disease (GBD) database. Temporal trends in age-standardized mortality rates (ASMR) and disability-adjusted life years (DALYs) rates (ASDR) for S. aureus-related LRIs were analyzed based on the average annual percent change (AAPC), in terms of sex, 20-age groups, 21 regions, 204 countries, and 5 SDI quintiles.

RESULTS

In 2021, S. aureus-related LRIs contributed to 423,837 deaths (95% UI: 382,183-458,926), a 67.56% increase since 1990. In comparison, the global ASMR was 5.43 per 100,000 (95% UI: 4.89-5.90), and the ASDR was 156.80 per 100,000 (95% UI: 139.44-176.08), both exhibiting a declining trend compared to 1990. Rates were higher in low SDI regions, with Central Sub-Saharan Africa reporting the highest ASMR, while Eastern Europe had the lowest. Among the 204 countries analyzed, Zimbabwe recorded high ASMR and ASDR, at 24.84 (95% UI: 19.44-30.16) and 754.34 (95% UI: 591.05-923.06), respectively.

CONCLUSIONS

Although the global ASMR and ASDR decreased in 2021, the number of deaths from S. aureus-related LRIs significantly increased driven by the growing population and proportion of aged individuals. Additionally, the emergence of multidrug-resistant strains has made treatment more complex, particularly in low SDI regions, highlighting the urgent need for more targeted strategies, therapies, and vaccines.

Differential aging trends among candidates for liver transplant with and without HCC

HCC has become a leading indication for liver transplant (LT), with HCC registrants increasing more than 6-fold in the past 2 decades, accompanied by a significant rise in older candidates. Given this trend and the influence of hepatitis C (HCV) treatments, updated data on aging and changing etiologies in older patients with HCC are needed. This study examines age trends, clinical characteristics, and transplant outcomes by comparing older (70+), younger patients with HCC, and patients without HCC. All adult candidates for LT (18+) in the UNOS/OPTN registry (2012-2022) were analyzed and categorized by HCC status and age (<70 or 70+). Regression coefficients compared HCC and non-HCC registrants and recipients by age group. The aging trend among LT registrants was more pronounced in patients with HCC. From 2012 to 2022, the mean age of HCC registrants rose from 58.7 to 62.9, with those aged 70+ increasing from 4.2% to 15.0%. Non-HCC registrants saw minimal change, with a stable mean age of 53 years and a modest rise in those 70+ from 2.1% to 4.7%. HCV prevalence among patients with HCC decreased from 37.5% to 27.4%, while patients without HCC dropped from 14.8% to 5%. Posttransplant outcomes for older HCC recipients remained favorable, with 1-year and 5-year survival rates of 91% and 71%, respectively, comparable to older patients without HCC (87% and 69%). Among over 132,000 LT registrants from 2012 to 2022, the age of HCC candidates increased, with a growing proportion aged 70 and older, while the age and proportion of older adults among non-HCC registrants remained stable. This demographic shift underscores the importance of enhanced frailty assessments to improve outcomes for older patients with HCC.

A 5000-year overview of the history of pain through ancient civilizations to modern pain theories

Pain and its management have been a predominant issue since the dawn of humanity. Pain has been the subject of much controversy and has constantly evolved across societies. The objective of this review is to trace the historical evolution of the concept of pain through the ages and to attempt to understand how modern theories of pain represent a legacy of ancestral knowledge passed down from culture to culture. We conducted a comprehensive review of primary and secondary sources across 6 major historical periods, including Pre-history, Antiquity, the Middle Ages, the Renaissance, the Modern, and Contemporary eras, using academic databases, specialized libraries, and historical archives. Results shows that during ancient civilizations, the understanding of pain oscillated between religious beliefs and medical advances. Antiquity societies made significant contributions to the understanding of pain mechanisms and management. Contrary to popular belief, significant advances were made during the Middle Ages despite the important impact of religion on the era's conceptualization of pain. During the Renaissance, the influence of religion waned, and secular medicine made significant progress. The development of pain theories peaked in the 19th century with technological advances. Long considered an expression of internal suffering, pain has fascinated humanity throughout history. The way pain has been perceived, understood, and treated has changed greatly over the centuries. This historical scientific review allows us to keep in mind that the vision we have of pain in Western society is predominantly based on the concrete heritage of ancient civilizations.

Association between cardiometabolic index and the incidence of stroke: a prospective nationwide cohort study in China

Objectives

Cardiometabolic index (CMI), based on triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C) ratio and waist-to-height ratio (WHtR), has been recognized as a novel and practical marker for the assessment of cardiometabolic risk. However, the relationship between CMI and the incidence of stroke remains to be elucidated. This investigation aimed to explore the association between CMI and stroke incidence.

Methods

The investigation included 6,633 individuals aged over 45 years from the China Health and Retirement Longitudinal Study. Logistic regressions and restricted cubic spline regression were uitilized to determine the relationship between CMI and the incidence of stroke. Weighted quantile sum regression was used to offer a comprehensive explanation of the CMI by calculating the weights of triglyceride-glucose (TG), high-density lipoprotein cholesterol (HDL-C), weight, and height.

Results

During the 9-year follow-up, 827 (12%) incident stroke participants were identified. With CMI as a continuous variable, the OR (95% CI) for the risk of incident stroke was 1.09 (1.01-1.19) (p = 0.047) after adjusting for potential confounders, indicating a significant link between increased CMI and an elevated incidence of stroke. Additionally, when CMI was categorized into quartiles, compared to the first quartile, the incident stroke was significantly higher in the fourth quartile (OR 1.57, 95%CI 1.22-2.04, p <0.001). The association between CMI and stroke incidence was nonlinear (p overall=0.002, p non-linear = 0.006). TG emerged as the primary contributor when the weights were assigned to the constituent elements of the CMI (weight = 0.645).

Conclusions

The CMI was independently associated with stroke incidence in middle-aged and elderly Chinese populations. Long-term CMI monitoring is of great importance for early identification and prevention of stroke, with significant implications for clinical practice.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-024-01530-3.

Sun Exposure and Anorexia Nervosa: A Potential Environmental-Biological Interaction?

OBJECTIVE

Despite first being described in 1888, anorexia nervosa continues to be the deadliest of all psychiatric illnesses. Although efforts have been made to elucidate the aetiological factors involved in the illness, little progress has been made in uncovering what contributes to the development and maintenance of anorexia nervosa. A particular shortcoming of the current literature has been the investigation of interactions between environmental and biological factors. One such interaction which has yet to receive attention in anorexia nervosa is that of sun exposure. Exposure to the sun-including levels of ultraviolet radiation (UVR) and vitamin D-in the pathogenesis of other mental illnesses has long been investigated (with lower levels of vitamin D reportedly involved in the pathogenesis of conditions such as schizophrenia, for example) but is yet to be explored in anorexia nervosa.

CONCLUSIONS

The current paper proposes a novel hypothesis for the potential contribution of reduced sun exposure in the aetiology of anorexia nervosa for future investigation, and possible mechanisms for how this relationship may operate.

Neural correlates of psychotherapy in mental disorders: A meta-analysis of longitudinal resting-state fMRI studies

BACKGROUND

Psychotherapy is a crucial approach in the treatment of mental disorders. However, how psychotherapy modulate spontaneous brain activity and finally take therapeutic effects remain unknown. Among countless number of analytic methods of resting-state functional magnetic resonance imaging (rs-fMRI), Regional Homogeneity (ReHo), Degree Centrality (DC), and Amplitude of Low Frequency Fluctuation (ALFF), are commonly used voxel-wise whole-brain (VWWB) metrics, and these studies could be used for coordinate-based meta-analysis. In order to reveal the underlying neural mechanisms of psychotherapy in patients with mental disorders, serving for future precise targeting intervention, we conducted a systematic review and meta-analysis based on rs-fMRI studies at VWWB level.

MATERIAL AND METHODS

A systematic literature search was conducted in PubMed, PsycINFO, and Web of Science following PRISMA criteria (registration number CRD42023432388) to investigate the differences between pre- and post-psychotherapy. To investigate whether changes in spontaneous brain activity differ across different metrics, distinct psychotherapy approaches or specific patient populations, subgroup analyses were performed.

RESULTS

Nine studies involving a total of 192 patients were included. We observed a significant decrease in spontaneous activity within the left insular after treatment with psychotherapy. Moreover, the subgroup analysis revealed significantly decreased ReHo in the right inferior frontal gyrus.

CONCLUSIONS

The current study indicates that the clinical efficacy of psychotherapy may be modulated by insular and right inferior frontal gyrus through neurological perspective. This contributes to our understanding of the neurobiological mechanisms of psychotherapy and provides valuable insights into improving precise targeting interventions for individuals with mental disorders.

Point-of-care testing reduces antibiotic prescribing in acute exacerbations of chronic obstructive pulmonary disease: A systematic review and meta-analysis

BACKGROUND

Challenges in identifying the causes of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have led to overuse of antibiotics. The advantages of point-of-care testing (POCT) may help to identify pathogens and use antibiotics more appropriately.

METHODS

We conducted a systematic review to evaluate the effect of POCT to guide antibiotic prescriptions for AECOPD. Adhering to a protocol (CRD42024555847), we searched eligible studies. The outcomes included antibiotic-related and clinical outcomes. We evaluated the risk of bias and performed meta-analyses with subgroup based on the type and testing timing of POCT.

RESULTS

A total of 18 studies evaluating 4346 AECOPD patients were included. Overall, POCT significantly reduced the number of AECOPD patients given antibiotic prescriptions by 16% (P < 0.001). Additionally, antibiotic treatment was reduced by 1.19 days (P = 0.04). There was no detrimental impact on clinical outcomes, such as the length of hospital stay (P = 0.19). Our results proved robust to sensitivity analyses.

CONCLUSION

We offered reasonable evidence for using POCT to reduce antibiotic exposure for AECOPD without adversely affecting clinical outcomes. As diagnostic techniques become increasingly important in combating antimicrobial resistance, the use of POCT should be encouraged.

Piperazine ferulate impact on diabetes-induced testicular dysfunction: unveiling genetic insights, MAPK/ERK/JNK pathways, and TGF-β signaling

Diabetic testicular dysfunction (DTD) poses a significant threat to male reproductive health. This study delves into the potential of piperazine ferulate (PF), a natural phenolic compound, in alleviating DTD and sheds light on its underlying mechanisms in rats. Animals were divided into the control, PF, diabetic, and diabetic plus PF groups. Diabetes was induced in rats with a single intraperitoneal (i.p.) injection of streptozotocin (STZ) at 50 mg/kg. PF was administered at 50 mg/kg/day via i.p. injection for four weeks. Significant changes in sexual behavior were observed in diabetic rats, which additionally revealed lower serum levels of testosterone, FSH, and LH. The abnormalities in sperm count, viability, motility, and morphology occurred along with the demonstrated suppression of genes and protein expression related to spermatogenesis. Atrophy of the seminiferous tubules and extensive degeneration and necrosis of the germ and Leydig cells were highlighted by histopathological examination. The testicular function of diabetic rats was significantly improved after PF administration, evidenced by normalized testicular histology, increased testosterone levels, and enhanced sperm quality. In addition to reducing inflammatory cytokines, COX2, and NF-κB expression, pf administration elevated the antioxidant levels and Nrf2/HO-1 expression. Furthermore, key signaling pathways involved in testicular degeneration are regulated by PF. It promoted cell survival and tissue repair by activating the protective TGF-β signaling pathway and attenuating the MAPK/ERK/JNK signaling cascade, which in turn reduced inflammation and apoptosis. PF suppressed the expression of INSL3, SPHK1, CD62E, ANGPTL2, and miR-148a-5p, while increasing the expression of testicular genes like HSD17B1, DAZL, and S1P, addressing DTD. This study highlights the potential of PF to restore testicular function and fertility in diabetic males by modulating genetic and signaling pathways.

Comprehensive analysis of stroke epidemiology in Vietnam: Insights from GBD 1990-2019 and RES-Q 2017-2023

Background

Stroke is a significant health burden in Vietnam, with substantial impacts on mortality, morbidity, and healthcare resources. An up-to-date report on stroke epidemiology and associated risk factors in Vietnam was missing.

Method

We analyzed the data published in the Global Burden of Disease (GBD) 2019, in combination with the first-time analysis of the Registry of Stroke Care Quality Improvement (RES-Q) initiative in Vietnam from 2017 to 2023.

Findings

Comparative analysis globally revealed that Vietnam had one of the highest stroke incidence and prevalence rates in Southeast Asia and ranked 4th in stroke mortality among 11 neighbouring countries. In the RES-Q dataset, 95,696 patients (77 %) were ischemic stroke, 23,203 (18 %) were intracerebral haemorrhage, and 2816 (2 %) were subarachnoid haemorrhage. In GBD 2019, stroke was the leading cause of death among cardiovascular diseases in Vietnam, accounting for 135,999 fatalities. The incidence of stroke was 222 (95 % UIs 206-242) per 100,000 population, with a prevalence of 1541 (1430-1679) per 100,000. Results align with the report from the RES-Q dataset in two megacities of Vietnam: Hanoi (incidence rate of 168.9, prevalence rate of 1182.2) and Ho Chi Minh City (incidence rate of 207.1, prevalence rate of 1221.8). Key risk factors for stroke mortality are high systolic blood pressure (79,000 deaths), unhealthy dietary (43,000 deaths), high fasting plasma glucose (35,000 deaths), and air pollution (33,000 deaths). Incidence is lower in rural Vietnam, but availability and quality of care are higher in megacities.

Interpretation

The results promote a further understanding of stroke and risk factors for the Vietnamese population and suggest prevention and treatment strategies for the Vietnamese government, including facility and capacity improvement and applications of advanced technologies.

Feasibility of human ethomic biomarkers for the diagnosis and monitoring of hip osteoarthritis

Radiographic imaging is typically used to diagnose osteoarthritis (OA). However, patients would typically be sent for imaging after they present to a physician because of joint pain. By this time, the condition is likely irreversible. This study aims to determine if human ethomics (i.e. behavior) defined by whole-body kinematics during walking, can be used as a diagnostic biomarker of hip OA. Three-dimensional motion capture was performed on 106 participants with unilateral hip OA and 80 asymptomatic participants (N = 80) during walking. Sixteen sagittal plane joint angle variables were extracted and used as inputs into the prediction model. The categorical outcome was the radiographic severity of hip OA using the Kallgren-Lawrence (KL) scale (0 [no OA], 2, 3, 4[worse]). Functional data boosting was used for statistical modelling with bootstrap resampling. Our ethomics approach to hip OA diagnosis had positive likelihood ratio (LR+) values ranging from 4.79 (95 %CI 3.20, 7.42) to detect the presence of KL3, to 43.95 (95 % CI 14.9, 76.08) to detect the presence of any OA. The present approach had negative likelihood ratio (LR-) values ranging from 0.56 (95 %CI 0.33, 0.79) of 0.07 (95 %CI 0.04, 0.11) to detect the absence of KL4, to 0.07 (95 %CI 0.04, 0.11) to detect the absence of any OA. Human ethomics represents an ideal candidate for OA biomarkers that could overcome many of the logistical challenges of traditional imaging and biochemical biomarkers.

A mechanistic modeling approach to assessing the sensitivity of outcomes of water, sanitation, and hygiene interventions to local contexts and intervention factors

Diarrheal disease is a leading cause of morbidity and mortality in young children. Water, sanitation, and hygiene (WASH) improvements have historically been responsible for major public health gains, but many individual interventions have failed to consistently reduce diarrheal disease burden. Analytical tools that can estimate the potential impacts of individual WASH improvements in specific contexts would support program managers and policymakers to set targets that would yield health gains. We developed a disease transmission model to simulate an intervention trial with a single intervention. We accounted for contextual factors, including preexisting WASH conditions and baseline disease prevalence, as well as intervention WASH factors, including community coverage, compliance, efficacy, and the intervenable fraction of transmission. We illustrated the sensitivity of intervention effectiveness to the contextual and intervention factors in each of two plausible disease transmission scenarios with the same disease transmission potential and intervention effectiveness but differing baseline disease burden and contextual/intervention factors. Whether disease elimination could be achieved through a single factor depended on the values of the other factors, so that changes that could achieve disease elimination in one scenario could be ineffective in the other scenario. Community coverage interacted strongly with both the contextual and the intervention factors. For example, the positive impact of increasing intervention community coverage increased non-linearly with increasing intervention compliance. With lower baseline disease prevalence in Scenario 1 (among other differences), our models predicted substantial reductions could be achieved with relatively low coverage. In contrast, in Scenario 2, where baseline disease prevalence was higher, high coverage and compliance were necessary to achieve strong intervention effectiveness. When developing interventions, it is important to account for both contextual conditions and the intervention parameters. Our mechanistic modeling approach can provide guidance for developing locally specific policy recommendations.

A Systematic Review of the Effect of Gene-Lifestyle Interactions on Metabolic-Disease-Related Traits in South Asian Populations

CONTEXT

Recent data from the South Asian subregion have raised concern about the dramatic increase in the prevalence of metabolic diseases, which are influenced by genetic and lifestyle factors.

OBJECTIVE

The aim of this systematic review was to summarize the contemporary evidence for the effect of gene-lifestyle interactions on metabolic outcomes in this population.

DATA SOURCES

PubMed, Web of Science, and SCOPUS databases were searched up until March 2023 for observational and intervention studies investigating the interaction between genetic variants and lifestyle factors such as diet and physical activity on obesity and type 2 diabetes traits.

DATA EXTRACTION

Of the 14 783 publications extracted, 15 were deemed eligible for inclusion in this study. Data extraction was carried out independently by 3 investigators. The quality of the included studies was assessed using the Appraisal Tool for Cross-Sectional Studies (AXIS), the Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I), and the methodological quality score for nutrigenetics studies.

DATA ANALYSIS

Using a narrative synthesis approach, the findings were presented in textual and tabular format. Together, studies from India (n = 8), Pakistan (n = 3), Sri Lanka (n = 1), and the South Asian diaspora in Singapore and Canada (n = 3) reported 543 gene-lifestyle interactions, of which 132 (∼24%) were statistically significant. These results were related to the effects of the interaction of genetic factors with physical inactivity, poor sleep habits, smoking, and dietary intake of carbohydrates, protein, and fat on the risk of metabolic disease in this population.

CONCLUSIONS

The findings of this systematic review provide evidence of gene-lifestyle interactions impacting metabolic traits within the South Asian population. However, the lack of replication and correction for multiple testing and the small sample size of the included studies may limit the conclusiveness of the evidence. Note, this paper is part of the Nutrition Reviews Special Collection on Precision Nutrition.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration No. CRD42023402408.

Stair climb muscle power is associated with gait speed, sit-to-stand performance, patient-reported outcomes and objective measures of mechanical muscle function in individuals with knee osteoarthritis - secondary analysis from an RCT

BACKGROUND

Mechanically measured leg extensor muscle power (LEP) predicts functional performance, patient-reported outcomes (PROMs) and mechanical muscle function in patients with knee osteoarthritis (OA). The stair climb test (SCT) have been used to assess LEP in clinical populations, but the relationship between SCT derived LEP and functional- and self-reported outcome measures in patients with knee-OA remains unknown.

OBJECTIVES

To investigate the relationship between LEP derived from SCT, and patient-reported outcomes (PROMs), functional performance, knee extensor muscle strength (MVIC), rate of force development (RFD) and Nottingham LEP in individuals with knee-OA.

DESIGN

Cross-sectional study.

METHOD

SCT power was obtained in 96 knee-OA patients (age 56.9 ± 7.7 yr. males n = 47, females n = 49). The dependent variable was SCT power, while independent variables included 4 × 10 m fast-paced walk (4x10m-FWT), sit-to-stand (STS), STS power, KOOS, Oxford Knee Score (OKS), LEP, MVIC, and RFD.

RESULTS

There were strong correlations (r = 0.72-0.80, p < 0.01) between SCT power and 4x10m-FWT and STS. There were weak-to-moderate correlations (r = 0.22-0.42, p < 0.05) between SCT power versus OKS and all KOOS subscales. Moderate correlations were observed between SCT power and Nottingham LEP, MVIC, and RFD (r = 0.53-0.64, p < 0.01).

CONCLUSIONS

SCT power correlates positively with functional performance, PROMs and mechanical lower limb muscle function in male and female individuals with knee-OA.

The Fremantle Back Awareness Questionnaire: Cross-cultural adaptation, validity and reliability of the Polish version

BACKGROUND

Body image disturbance is observed in individuals with chronic low back pain (CLBP) and is a potential treatment target. The Fremantle Back Awareness Questionnaire (FreBAQ) is designed to identify disrupted body image specific to the low back. This study aimed to develop and assess the measurement properties of a Polish language version of this questionnaire (FreBAQ-PL).

METHODS

Following the translation process, cognitive interviews were carried out as a qualitative assessment of content validity. Subsequently a quantitative assessment of content validity was undertaken among in a study sample with CLBP and experts. Measurement properties were assessed in 114 participants with CLBP and 53 pain-free participants. The CLBP sample repeated the FreBAQ-PL assessment within 14-days. The measurement properties assessed in this study were content validity, internal consistency, frequency of responses, known-groups validity, convergent validity and test-retest reliability.

RESULTS

Content validity was supported, affirming relevance and comprehensiveness. Known-groups validity was confirmed by significant differences in FreBAQ-PL scores between participants with CLBP and pain-free participants (p < 0.05). Convergent validity was established through moderate associations between FreBAQ-PL scores and pain variables (intensity and duration) (ρ's = 0.24-0.27, p's < 0.01), disability (ρ = 0.34, p < 0.01), kinesiophobia (ρ = 0.37, p < 0.01), depression (ρ = 0.30, p < 0.01) and anxiety (ρ = 0.24, p < 0.01). The scale was internally consistent (Cronbach's alpha 0.81). Test-retest reliability was good (ICC 0.90).

CONCLUSIONS

The FreBAQ-PL is a reliable, internally consistent, and valid measure that can be used in clinical and research settings to assess the presence of body image disturbance in Polish-speaking individuals with CLBP.

Rural-urban migration dynamics and double burden of malnutrition among women across 29 low and middle income countries

The double burden of malnutrition (DBM) is a significant public health issue in low- and middle-income countries (LMICs), resulting from complex socioeconomic, demographic and nutrition transitions. This study examined the association between internal migration and DBM among women across LMICs, focusing on direction, recency, and age at migration. Using the latest Demographic and Health Survey (2010-2023), data on body mass index, migration status, and covariates were extracted from 232,449 women aged 15-49 years in 29 countries. Migration status was categorised as urban non-migrants, rural non-migrants, urban-to-rural, or rural-to-urban based on prior and current residences. Recency and age at migration were categorised as recent/non-recent (within the last five years or earlier) and childhood/adulthood (before or after age 19). Multinomial multivariable logistic regressions were used to estimate odds ratio for each migrant groups relative to urban and rural non-migrants, respectively. Further analyses examined the association between DBM and recency, and age at migration, among migrants. Overall, 32.1 % of women were overweight/obese while 9.7 % were underweight. Urban-to-rural migrants accounted for 9.5 % of the sample, and rural-to-urban migrants constituted 7.0 %. Rural-to-urban migrants had 21.0 % higher odds of being overweight/obese (95 % CI: 1.15-1.29) compared to rural non-migrants. Urban-to-rural migrants showed 9.0 % lower odds of being underweight (95 % CI: 0.85-0.99) compared to urban non-migrants. Among migrants, recency of migration and age at migration were found to be significantly associated with DBM. This study emphasises the need for targeted public health strategies to enhance immediate and distal determinants of DBM in urban and rural settings in LMICs.

Understanding the Causes of Delayed Decision-Making by Family Members of Stroke Patients Eligible for Thrombolytic Therapy

ABSTRACT

BACKGROUND: Thrombolytic therapy is an effective intervention for acute ischemic stroke. However, the timely administration of this treatment can be hindered by delayed decision-making on the part of family members. Little is known about the reasons for their delay in making decisions. METHODS: This qualitative interview study used face-to-face, individual, semistructured interviews with 16 participants from 2 tertiary hospital neurology wards in Guangdong, China. The interviews were analyzed using inductive content analysis, and descriptive statistics were used to summarize participants' characteristics. RESULTS: Three main themes emerged: a large family communication network, struggling with bleeding risk, and seeking distance treatment advice. CONCLUSION: In China, family members make decisions on behalf of patients and are affected by various factors in the decision-making process, resulting in delayed decision-making. They may experience psychological conflicts when deciding whether to permit thrombolysis, and they tend to seek information from external sources without understanding thrombolysis. Healthcare professionals caring for stroke patients eligible for thrombolytic therapy should provide decision-making support programs tailored to the specific needs of these family members to reduce delayed decision-making.

Pulmonary hypertension aetiologies in different parts of the world

Pulmonary hypertension is a serious condition characterised by elevated blood pressure in the pulmonary arteries, caused by various aetiologies and via different pathological processes. Over the past seventy years, our understanding and management of this disorder have greatly improved, resulting in increased diagnosis and effective clinical management. Current epidemiological estimates are challenged by the increased awareness of this condition and the changing definitions and classification systems. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has also shown temporal changes in the epidemiology of pulmonary hypertension over the last thirty years, contributing to regional variations in prevalence and incidence. This review explores the complexities of global and regional variations in different types of pulmonary hypertension reported through many registries, databases and regional studies. Although these tools can help estimate prevalence and incidences, they may also underestimate the actual number of cases due to the continuously changing understanding of the condition and increase awareness globally. Therefore, continued research, international collaboration, and standardised data collection are essential for achieving a more accurate global view of pulmonary hypertension and developing effective management strategies for this serious condition that significantly impacts general health.

Genomics of Suicidal Behaviors: What Can We Learn from Polygenic Scores?

Substantial evidence supports the role of genetic factors in suicide behaviors (SBs). The most recent and powered genome-wide association studies identified significant loci for suicide, suicide attempts, and suicide ideation. Nonetheless, more research is needed to fully understand its impact. A novel approach considering the genetic complexity of SBs is polygenic scores that, in conjunction with individual and environmental factors, may have promising results to inform suicide risk stratification. Communicating this information to patients and the open population may have ethical implications that need to be considered to avoid iatrogenic effects.

Twenty-four-hour Skin Temperature Rhythms in Young People With Emerging Mood Disorders: Relationships With Illness Subtypes and Clinical Stage

While circadian disruptions are common in some sub-groups of youth with mood disorders, skin temperature rhythms in these cohorts are understudied. We examined 24-h wrist skin temperature rhythms in youth with emerging mood disorders, exploring associations with clinical stage and proposed illness subtypes. Youth (n = 306, 23.42 ± 4.91 years, 65% females) accessing mental health care and 48 healthy controls (23.44 ± 3.38 years, 60% females) were examined. Skin temperature parameters including rhythm-adjusted mean temperature, inter-daily stability (day-to-day consistency), intra-daily variability (rhythm fragmentation), and peak temperature time were derived from a wearable sensor. Based on our illness trajectory-pathophysiology model, participants were classified by mood disorder subtypes ("hyperarousal-anxious" [n = 209], "neurodevelopmental-psychosis" [n = 40], or "circadian-bipolar spectrum" [n = 43]), as well as by clinical stage (subthreshold disorders classed as 1a or 1b [n = 47, 173, respectively], and full-threshold disorders as 2+ [n = 76]). Compared to controls, youth with mood disorders had delayed, less stable, and more variable skin temperature rhythms, indicated by lower rhythm-adjusted mean skin temperature (29.94 ± 0.10 °C vs 31.04 ± 0.25 °C, p < 0.001), delayed peak timing (0533 ± 0014 vs 0332 ± 0036, p = 0.002), reduced inter-daily stability (p = 0.009), and increased intra-daily variability (p = 0.020). Peak skin temperature also occurred later relative to sleep midpoint (0.31 ± 0.14 vs -0.48 ± 0.35 radians, p = 0.037). The "circadian-bipolar spectrum" subtype exhibited lower relative amplitude (0.07 ± 0.005 vs 0.08 ± 0.002 [hyperarousal-anxious] and 0.09 ± 0.005 [neurodevelopmental-psychosis], p = 0.039), with no delay in sleep midpoint. Clinical stages were not associated with differences in skin temperature parameters. These findings highlight the potential of use of 24-h skin temperature rhythms as a non-invasive biomarker of circadian disturbances in youth with emerging mood disorders. The observed disruptions in temperature patterns and rhythmicity support the notion that disrupted circadian rhythms may mediate the onset or illness course of some subgroups of youth with emerging major mood disorders.

Cross-tissue transcriptome-wide association study reveals novel psoriasis susceptibility genes

Background

Psoriasis is a chronic, immune-mediated inflammatory skin disorder with a strong genetic component. Although numerous GWAS have identified risk loci, many associated variants lie in non-coding regions, complicating functional interpretation.

Objective

This study aimed to identify novel psoriasis susceptibility genes by integrating large-scale GWAS and eQTL data using a cross-tissue TWAS approach.

Methods

We integrated psoriasis GWAS summary statistics from the FinnGen database with GTEx V8 eQTL data. A cross-tissue TWAS was performed using UTMOST, followed by validation with single-tissue TWAS via FUSION. Conditional and joint analyses were conducted to delineate independent genetic signals, and gene-based analysis was performed using MAGMA. Causal relationships were evaluated using Mendelian randomization (MR) and Bayesian colocalization analyses. Key SNPs were functionally characterized using CADD, GERP++, and RegulomeDB for pathogenicity prediction and regulatory potential assessment. Finally, functional network analysis was conducted using GeneMANIA.

Results

The cross-tissue TWAS identified 259 genes significantly associated with psoriasis (p < 0.05), with 12 remaining significant after FDR correction. Single-tissue TWAS validation revealed 655 significant genes, with an overlap of three protein-coding candidates: POLI, NFKB1, and ZFYVE28. Cross-validation with MAGMA refined the candidate set to NFKB1 and ZFYVE28. MR and colocalization analyses supported a causal relationship for NFKB1 in Skeletal Muscle, Transverse Colon, and Cultured Fibroblasts, and for ZFYVE28 in Subcutaneous Adipose Tissue and Esophageal Mucosa tissues. Functional annotation identified key SNPs including rs4235405, rs3774960, and rs1598856 for NFKB1, and rs1203786 for ZFYVE28, with varying degrees of pathogenicity and regulatory potential. GeneMANIA network analysis further implicated NFKB1 in NF-κB signaling and ZFYVE28 in vesicle-mediated transport.

Conclusion

Our integrative multi-omics approach identifies NFKB1 and ZFYVE28 as novel psoriasis susceptibility genes, providing potential biomarkers and therapeutic targets for this complex disease.

Cardiovascular disease mortality in Brazilian municipalities: estimates from the lobal urden of isease study, 2000-2018

Background

Age-standardized mortality rates (ASMR) for cardiovascular diseases (CVD) have decreased in Brazil in the last decades due to better control of risk factors and access to healthcare. However, how this reduction is distributed across the country's municipalities is unknown. We aimed to evaluate changes in CVD mortality rates across Brazilian municipalities from 2000 to 2018 using estimates from the Global Burden of Disease (GBD) study.

Methods

In this ecological study, ASMR for CVD were estimated using GBD methodology for 5564 Brazilian municipalities from 5 regions in the triennials: 2000-2002, 2009-2011, 2016-2018. A visuospatial analysis was applied to create clusters in ASMR with Moran Local analysis. Municipalities were stratified by population size in <30,000, 30,000-300,000, and >300,000 inhabitants per region. The % changes in ASMR from 2000-2002 to 2016-2018 were calculated.

Findings

In 2000-2002, ASMR for CVD were higher in more developed regions and in larger municipalities of all regions, except for the South. In 2016-2018, CVD ASMR increased in the least developed Northern regions. The % reduction in CVD ASMR was lower in small vs large municipalities within all 5 regions, varying from -3% in small Northern municipalities to -43% in large Southern municipalities.

Interpretation

The reduction in CVD mortality in Brazil was lower in municipalities from the most vulnerable regions and smaller populations. Public policies tailored to these smaller municipalities, particularly on the least developed regions, must be considered a priority.

Funding

Brazilian Ministry of Health [grant 148/2018] and Pan American Health Organization [Letter of Agreement SCON2021-00288].

The aetiologies, mortality, and disability of non-traumatic coma in African children: a systematic review and meta-analysis

BACKGROUND

Non-traumatic coma in African children is a common life-threatening presentation often leading to hospital attendance. We aimed to estimate the distribution of non-traumatic coma causes and outcomes, including disease-specific outcomes, for which evidence is scarce.

METHODS

We systematically reviewed MEDLINE, Embase, and Scopus databases from inception to Feb 6, 2024. We included studies recruiting children (aged 1 month to 16 years) with non-traumatic coma (Blantyre Coma Scale score ≤2, ie deep coma or comparable alternative) from any African country. Disease-specific studies were included if outcomes were reported. Primary data were requested where required. We used a DerSimonian-Laird random effects model to calculate pooled estimates for prevalence of causes, mortality, and morbidity (in-hospital and post-discharge), including analysis of mortality by temporality. This study was registered with PROSPERO (CRD4202014193).

FINDINGS

We screened 16 666 articles. 138 studies were eligible for analysis, reporting causes, outcome data, or both from 35 027 children with non-traumatic coma in 30 African countries. 114 (89%) of 128 studies were determined to be high quality. Among the causes, cerebral malaria had highest pooled prevalence at 58% (95% CI 48-69), encephalopathy of unknown cause was associated with 23% (9-36) of cases, and acute bacterial meningitis was the cause of 10% (8-12) of cases, with all other causes representing lower proportions of cases. Pooled overall case-fatality rates were 17% (16-19) for cerebral malaria, 37% (20-55) for unknown encephalopathy, and 45% (34-55) for acute bacterial meningitis. By meta-regression, there was no significant difference in cerebral malaria (p=0·98), acute bacterial meningitis (p=0·99), or all-cause coma (p=0·081) mortality by year of study. There was no substantial difference in deaths associated with cerebral malaria in-hospital compared with post-discharge (17% [16-19] vs (18% [16-20]). Mortality was higher post-discharge than in-hospital in most non-malarial comas, including acute bacterial meningitis (39% [26-52]) vs 53% [38-69]). Disability associated with cerebral malaria was 11% (9-12). Pooled disability outcomes associated with other non-malarial diseases were largely absent.

INTERPRETATION

The prevalence and outcomes of cerebral malaria and meningitis associated with non-traumatic coma were strikingly static across five decades. Enhanced molecular and radiological diagnostics, investment, policy making, community awareness, and health service provision are all required to facilitate earlier referral to specialist centres, to drive a step-change in diagnostic yield and treatment options to improve these outcomes.

FUNDING

Wellcome Trust.

TRANSLATIONS

For the Chichewa, French and Portuguese translations of the abstract see Supplementary Materials section.

Changes in neighbourhood walkability and incident CVD: A population-based cohort study of three million adults covering 24 years

BACKGROUND

To investigate the relationship between changes in residential neighbourhood walkability and cardiovascular disease (CVD) incidence in adults.

METHODS

Using data from Statistics Netherlands we included all Dutch residents aged 40 or older at baseline (2009), without a history of CVD, and who did not move house after baseline (n = 3,019,069). A nationwide, objectively measured walkability index was calculated for Euclidean buffers of 500m around residential addresses for the years 1996, 2000, 2003, 2006 and 2008. To identify changes in neighbourhood walkability, latent class trajectory modelling was applied. Incident CVD between 2009 and 2019 was assessed using the Dutch Hospital Discharge Register and the National Cause of Death Register. Cox proportional hazards modelling was used to analyse associations between walkability trajectories and subsequent CVD incidence, adjusted for individual- and area-level sociodemographic characteristics.

FINDINGS

We observed a stable but relatively low walkability trajectory (Stable low, 91.1 %), a stable but relatively higher walkability trajectory (Stable high, 0.6 %), a relatively higher initial neighbourhood walkability which decreased over time (Decreasing, 1.7 %), and relatively lower neighbourhood walkability which increased over time (Increasing, 6.5 %). Compared to stable high walkability, individuals exposed to stable low, and increasing walkability, had a 5.1 % (HR: 1.051; CI: 1.011 to 1.093) and 4.9 % (HR: 1.049; CI: 1.008 to 1.092) higher risk of any CVD. Similar associations were observed for coronary heart disease and stroke, though not statistically significant. No significant associations were found for heart failure, and CVD mortality.

CONCLUSION

Adults exposed to low walkability over time had a higher risk of CVD compared to those in stable high walkability neighborhoods. Additionally, an increasing walkability trend was associated with higher CVD risk, likely due to the overall lower cumulative walkability during the exposure period. These findings highlight the importance of longitudinal research in this field, and of long-term urban planning for cardiovascular health.

A Phase III Randomized, Double-Blind, Active-Controlled, Multicenter Study on the Efficacy and Safety of Ezetimibe/Atorvastatin/Amlodipine Combination in Patients With Comorbid Primary Hypercholesterolemia and Essential Hypertension

PURPOSE

This study aimed to evaluate the efficacy and safety of triple combination of ezetimibe (Eze)/atorvastatin (Ato) 10/40 mg + amlodipine (Aml) 10 mg therapy for lowering the low-density lipoprotein cholesterol (LDL-C) and blood pressure compared with either Eze/Ato 10/40 mg or Aml 10 mg therapies in patients with comorbid primary hypercholesterolemia and essential hypertension.

METHODS

This was a randomized, multicenter, double-blind, active-controlled, Phase III clinical trial. Participants underwent a wash-out period (2 weeks for nonfibrate medications, 6 weeks for fibrates) followed by 4 weeks of therapeutic lifestyle changes. Subsequently, 109 participants were randomly assigned to 3 groups: (1) Eze/Ato 10/40 mg + Aml 10 mg, (2) Eze/Ato 10/40 mg, and (3) Aml 10 mg. The coprimary end points were percentage change in LDL-C and change in mean sitting systolic blood pressure (SBP) compared with baseline at week 8.

FINDINGS

A total of 109 participants were enrolled in the study, and there were no statistically significant differences in the baseline characteristics of participants across the 3 groups. After 8 weeks of treatment, the least-square (LS) mean (SE) of percent change from baseline in LDL-C was -57.95% (3.52%) for the Eze/Ato 10/40 mg + Aml 10 mg group and 8.93% (3.54%) for the Aml 10 mg group. The LS mean difference (SE) between these 2 groups was statistically significant at -66.88 (4.95) (95% CI, -76.77% to -56.99%) (P < 0.0001). Furthermore, at week 8, the LS mean (SE) change in mean sitting SBP between the Eze/Ato 10/40 mg + Aml 10 mg group and the Eze/Ato 10/40 mg group was -19.24 (2.42) mm Hg and -4.43 (2.56) mm Hg, respectively. The LS mean difference (SE) between the 2 groups was statistically significant -14.81 (3.53) (95% CI, -21.87 to -7.74) mm Hg (P < 0.0001). No serious adverse drug reactions occurred in any of the study groups.

IMPLICATIONS

Triple combination therapy with Eze/Ato + Aml has effectively reduced the LDL-C and SBP independently, compared with either Eze/Ato or Aml therapies over 8 weeks of treatment period. In terms of safety, there were no significant differences among the 3 treatment groups. This research lays the groundwork for the development of a triple fixed-dose combination in the future, which could improve patient convenience and adherence by reducing pill burden. Clinical Research Information Service (CRIS), Republic of Korea: KCT0006283.

Increased cerebral hemodynamics during the interictal period of migraine and the association with migraine features

AIM

To detect cerebral hemodynamic changes in migraine's interictal period using 4D flow magnetic resonance imaging (MRI) and explore the relationships between altered hemodynamics and migraine features.

MATERIALS AND METHODS

Twenty-five patients (29 ± 4 years, 22 female) with migraine in the interictal period and twenty-five healthy controls (28 ± 4 years, 20 female) were consecutively enrolled. Migraine features including frequency, duration of migraine history, pain side and degree were collected in migraineurs. 4D flow MRI scan was performed for all subjects. Cross-sectional area, peak systolic through-plane velocity (PSV), average through-plane velocity (Vavg), average blood flow rate (Flowavg), and average wall shear stress (WSSavg) in the bilateral middle cerebral artery (MCA) and the posterior cerebral artery (PCA) were measured. Pulsatility index (PI) was calculated from the maximum, minimum and average blood flow velocity. The hemodynamic differences of MCA and PCA in migraineurs and controls were investigated. The relationships between hemodynamic changes and migraine features were further explored.

RESULTS

Increased PSV, Vavg and Flowavg in the MCA, as well as elevated Vavg, Flowavg and WSSavg in the PCA, were found among migraine patients. Flowavg of PCA was significantly correlated with the duration of migraine history (r = 0.46, P = 0.02).

CONCLUSION

Cerebral hemodynamics is significantly elevated in migraineurs during the interictal period of migraine. Notably, the Flowavg in the PCA is associated with the duration of migraine history.

Assessment and Correlates of Different Phenotypical Characteristics of Psychological Flexibility in Adapting to Chronic Pain: A Feasibility Study

OBJECTIVES

This study examined the feasibility of a research protocol for assessing psychological flexibility in patients with chronic pain to gain insight into the uniqueness of different phenotypes of psychological flexibility and to tentatively test whether psychological flexibility is associated with effective adaptation to chronic pain.

METHODS

In a cross-sectional study, in twenty patients with chronic pain, different phenotypes of psychological flexibility and a variety of positive and negative health indicators were assessed. Correlations were explored to determine the unicity of the different phenotypes of psychological flexibility and to test their associations with chronic pain.

RESULTS

All phenotypes of psychological flexibility could be assessed reliably in this patient group. Preliminary findings suggest that all phenotypes assess unique flexibility aspects (79% of the intercorrelations were less than moderate; > -0.30, < 0.30). Higher levels of different psychological flexibility phenotypes were generally associated with higher positive health indicators and lower negative health indicators (70% of the moderate correlations; ≤ -0.30 or ≥ 0.30 were in the expected direction).

CONCLUSIONS

Results confirm that the protocol is feasible for large-scale research in patients with chronic pain and that it is useful to further investigate the different phenotypes of psychological flexibility in relation to optimal adaptation to chronic pain in a longitudinal study.

PRACTICE IMPLICATIONS

Psychological flexibility is a potentially important future target in the treatment (e.g., biofeedback, cognitive behavioral therapy, mindfulness) of patients with chronic pain.

Why a responsibility sensitive healthcare system is not disrespectful

The prevalence of non-communicable diseases, the related increased medical costs, and the recent public health emergency bring out more forcefully pre-existing dilemmas of distributive justice in the healthcare context. Under this reality, would it be justified to hold people responsible for their taken lifestyle decisions, or would it constitute an instance of unjustified disrespectful treatment? From a respect-based standpoint, one could argue that a responsibility-sensitive healthcare system morally disrespects the imprudent ones engaging in disadvantageous differential treatment to their detriment. In contrast, however, we might also have luck egalitarian reasons that explain why this differential treatment is not unjust. Luck egalitarianism is a responsibility-sensitive theory of distributive justice, which argues that it is bad if some people are worse off than others through no voluntary fault of their own. In this paper, I clarify the concerns about disrespect raised against the luck egalitarian viewpoint and offer possible respect-based reasons for why this might not be the case grounded in deontological concepts. First, I employ a revised Double-effect case to support responsibility-sensitive rationing. In the last part of the paper, these are further supported through the Kantian Formula of Humanity supplemented by the concept of duties.

Manual therapy and neck-specific exercise are equally effective for treating non-specific neck pain but only when exercise adherence is maximised: A randomised controlled trial

OBJECTIVE

To assess the effectiveness of manual therapy versus a progressive, tailored neck-specific exercise program with high adherence for treating non-specific chronic neck pain (NSNP) and to examine the relationship between exercise adherence and treatment outcome.

DESIGN

Single-blind, parallel, randomized clinical trial with two treatment arms, adhering to CONSORT guidelines.

METHODS

65 NSNP participants were randomly allocated to manual therapy or exercise. They received four treatment sessions of either manual therapy or neck-specific exercise, once a week for four weeks. Outcomes measured at baseline, two weeks, four weeks, and 12 weeks post-treatment included pain intensity, disability, patient-perceived improvement, quality of life, kinesiophobia and the craniocervical flexion test (CCFT) performance. In addition to evaluating each individual outcome, patients were categorized into either responders or non-responders according to pain intensity, disability and patient-perceived improvement. Exercise adherence was recorded.

RESULTS

There were no differences between groups in individual outcomes. Treatment outcome in the exercise group was associated with exercise adherence. Patients receiving manual therapy were more likely to be classified as responders than those receiving exercise at all measured time points (odds ratio, 2 weeks: 0.14; 95 % CI: 0.02-0.79; treatment completion: 0.31; 95 % CI: 0.12-0.82; 12 weeks after treatment completion: 0.19; 95 % CI: 0.05-0.65), however these differences were no longer present when only patients whose exercise adherence was ≥95 % were analysed. Exercise was more effective than manual therapy in improving CCFT performance but only if patients with ≥95 % adherence were considered.

CONCLUSION

A four-week intervention of manual therapy was more effective than exercise, however when exercise adherence was ≥95 %, the interventions were equally effective. Manual therapy may only be superior to specific-exercise when high exercise adherence cannot be assured.

Recent advances in nanocrystals for arthritis drug delivery

INTRODUCTION

More than 500 million people worldwide suffer from arthritis, experiencing daily pain and inflammation. Current treatments for osteoarthritis (OA) and rheumatoid arthritis (RA) are palliative, offering only symptom relief. No disease-modifying OA drugs (DMOADs) capable of restoring joint functionality and regenerating the cartilage matrix have yet been approved by the FDA or EMA.

AREAS COVERED

This review highlights recent advances in nanocrystals (NCs) for arthritis drug delivery, including conventional nanosuspensions and novel transdermal microneedles. Special attention is given to intra-articular DMOADs formulated as NC-in-microparticles, designed to extend drug release over months. Papers and reviews with the mentioned contents and published over the last 5 years were included in the review process.

EXPERT OPINION

New DMOADs and disease-modifying antirheumatic drugs (DMARDs) are often poorly water-soluble, limiting their clinical progress. The versatility of NCs and nanosuspensions offers a potential advantage over other types of nanoparticles, as they can be adapted to various delivery systems, administration routes, and types of arthritis. Due to the avascular nature of cartilage, exploring the intra-articular route for OA management is essential. Implementing cartilage-targeted strategies or using stimuli-responsive hydrogels can further enhance their therapeutic potential.

Changing Trends in the Cysticercosis-Related Disease Burden from 1990 to 2021 and its Predicted Level in 2022-2050 Years

BACKGROUND

A major worldwide health concern is cysticercosis, a zoonotic parasitic illness brought on by human parasites. This study aims to examine the current worldwide cysticercosis burden in order to serve as a resource for developing successful global control initiatives.

METHODS

Five layers of data about cysticercosis were analyzed: gender, age, year, and the regional and national social and economic development index (SDI). The various groups were compared using age-standardized rates, and patterns in the burden of disease were examined and evaluated. Furthermore, from 2022 to 2050, disease patterns were predicted using the ARIMA and ES models.

RESULTS

It was discovered that compared with 1990, the number of deaths decreased by 362 in 2021, the prevalence number increased by 1,318,963, the DALYs decreased by 151,192, and the age-standardized Mortality rate (ASMR) decreased by 0.02 per 100,000 people (EAPC - 2.39, 95% CI - 2.46 to - 2.32), the age-standardized DALY rate (ASDR) decreased by 9.14 per 100,000 people (EAPC - 1.84, 95% CI - 1.93 to - 1.75), and the age-standardized prevalence rate (ASPR) decreased by 17.18 per 100,000 people (EAPC - 1.2, 95% CI - 1.3 to - 1.1).

CONCLUSIONS

To sum up, although the prevalence of cysticercosis has dramatically declined globally over the last 30 years, it is still high in many low-SDI nations and regions. Therefore, in order to further optimize prevention and control methods and lower the burden of disease in high-burden regions and countries, it is imperative that international cooperation be strengthened.

Comparative analysis of the clinical characteristics of severe Mycoplasma pneumoniae pneumonia and severe bacterial pneumonia in children

PURPOSE

The aim of this study was to analyze the clinical characteristics of severe Mycoplasma pneumoniae pneumonia and severe bacterial pneumonia in children to provide a basis for clinical recognition and diagnosis.

METHODS

This was a retrospective analysis of 130 cases of severe Mycoplasma pneumoniae pneumonia (SMPP), 81 cases of severe Streptococcus pneumoniae pneumonia (SPP) and 105 cases of severe Haemophilus influenzae pneumonia (SHIP) in children. Demographic, clinical, laboratory, and imaging data were compared between groups. One-way analysis of variance or Kruskal-Wallis test was used for continuous variables, chi-square test was used for categorical variables, and rank-sum test was used for ranked data. The level of statistical significance was set at P < 0.05.

RESULTS

All groups showed male predominance (P < 0.05). The SMPP group had older patients, longer hospital stays, prolonged fever, and higher interleukin-6, lactate dehydrogenase, and D-dimer levels (P < 0.05). Imaging revealed a higher proportion of unilateral solid lung lesions in SMPP, with increased tracheal stenosis, emphysema, pleural effusion, and pulmonary embolism (P < 0.05). Fiberoptic bronchoscopy detected more sputum plugs in SMPP (P < 0.05). Conversely, SPP and SHIP groups had younger patients, more wet rales/wheezing, higher white blood cell counts and neutrophil ratios, and bilateral patchy lung shadows (P < 0.05).

CONCLUSION

Differences in age of onset, laboratory tests, like IL-6, and imaging manifestations between SMPP and severe bacterial pneumonia can help us to recognize them early and thus target treatment more appropriately.

Diet in Knee Osteoarthritis-Myths and Facts

Knee osteoarthritis (OA) is a common degenerative joint disease affecting global health. Its increasing prevalence, particularly among aging populations, remains a leading cause of disability. Besides conventional pharmacological and surgical treatments, dietary interventions are promising strategies to alleviate OA symptoms and progression. Unfortunately, scientific evidence does not support many commonly used, misleading ideas about nutrition in knee OA. Recent data highlight the detrimental effects of high-carbohydrate and high-fat diets, particularly those rich in refined sugars and saturated fats, which exacerbate systemic inflammation and contribute to cartilage degradation. Conversely, diets rich in omega-3 fatty acids, polyphenols, and dietary fiber have shown anti-inflammatory and chondroprotective properties. A Mediterranean diet rich in these nutrients effectively prevents the development of OA and its comorbidities, including obesity and cardiovascular disease. The role of supplements, such as glucosamine, chondroitin, and vitamin D, is questioned due to the lack of evidence supporting their efficacy in treating knee OA. Despite dietary recommendations published annually, there is still a need to debunk many myths that are not confirmed by current evidence. The significant research gaps require more extensive, controlled studies to establish evidence-based dietary recommendations (particularly carbohydrates, dietary fiber, and antioxidant intake). This comprehensive review provides insight into the various indications for the impact of nutrition on knee OA, focusing on key nutrients such as carbohydrates, fats, proteins, antioxidants, and selected micronutrients, providing the clinician with ready-to-implement nutritional modifications. Such an analysis may help clinicians and patients incorporate dietary strategies into treating knee OA, emphasizing the need for personalized, sustainable approaches.

Attribution of colorectal cancer symptoms to medications for pre-existing chronic conditions: a secondary analysis of a vignette study in England

OBJECTIVE

To investigate the likelihood of attributing colorectal cancer (CRC) symptoms to medications for chronic conditions.

METHODS

The online vignette survey included 1287 participants aged ≥50 years, with quota sampling to recruit sufficient participants with type 2 diabetes. Participants self-reported chronic conditions and answered questions on symptom attribution and help-seeking, after reading vignettes describing new-onset rectal bleeding or change in bowel habit. Using multivariable logistic regression, we analyzed the association between specific conditions and attributing new-onset CRC symptoms to medications, controlling for demographics.

RESULTS

Among participants, 25% reported type 2 diabetes, 31% being overweight, 25% hypertension and 22% arthritis. Participants with diabetes, versus those without, had a higher likelihood of attributing change in bowel habit to medications [7% vs 3%; adjusted Odds Ratio (aOR) 2.55, Confidence Interval (95% CI) 1.30-5.00]. This was also the case for participants reporting being overweight (7% vs 2%; aOR 2.36, 95% CI 1.25-4.44), arthritis (8% vs 3%; aOR 2.27, 95% CI 1.19-4.35), but not for hypertension. No significant association was found regarding attribution of rectal bleeding to medications.

CONCLUSIONS

Patients with common chronic conditions have a higher likelihood of attributing change in bowel habit to medications. Tailored information is needed for these patients, encouraging them to discuss any new symptom with their doctor.

Mapping autism in Egypt: population-based insights into prevalence, risk determinants, and severity among children aged 1-12 years

BACKGROUND

The prevalence of autism spectrum disorder (ASD), a common developmental disorder, has surged in recent years. Accordingly, the identification and early management of possible risk factors can diminish ASD incidence.

AIM

To determine the prevalence and severity of idiopathic ASD in Egyptian children aged 12 months to 12 years, and to identify the epidemiological, sociodemographic, and environmental risk factors contributing to this disorder.

METHODS

This study comprised 41,640 children from the main eight geographic areas in Egypt. It was conducted through four phases: household screening, facility-based screening for high-risk children, diagnosis confirmation, and risk factor assessment.

RESULTS

The prevalence of ASD as confirmed by the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the Childhood Autism Rating Scale (CARS) was 1.1% (455 out of 41,640), with significant geographic variability. Urban areas had a significantly higher prevalence than rural areas. Children aged 3-6 years showed the highest prevalence at 1.5%. Boys were four times more affected than girls, with prevalence rates of 1.7% and 0.4%, respectively. Significant risk factors included: a history of convulsions (AOR = 4.7; 95% CI: 3.3-6.79), low birth weight (AOR = 2.08; 95% CI: 1.54-2.79), prolonged stays in neonatal intensive care unit (NICU) longer than two days (AOR = 1.91; 95% CI: 1.46-2.49) and maternal health problems during pregnancy (AOR = 1.66; 95% CI:1.36-1.95). Regarding severity, 45% of diagnosed children had moderate ASD, 39% had severe ASD, and 16% had mild ASD. Female gender and older age were significant predictors of greater ASD severity.

CONCLUSION

ASD prevalence in Egypt is comparable to other Middle Eastern countries. Policymakers should utilize these findings to design targeted public health interventions aimed at early detection, management, and prevention of ASD progression.

Nicotinamide Adenine Dinucleotide Supplementation to Alleviate Heart Failure: A Mitochondrial Dysfunction Perspective

Heart failure represents the terminal stage in the development of many cardiovascular diseases, and its pathological mechanisms are closely related to disturbances in energy metabolism and mitochondrial dysfunction in cardiomyocytes. In recent years, nicotinamide adenine dinucleotide (NAD+), a core coenzyme involved in cellular energy metabolism and redox homeostasis, has been shown to potentially ameliorate heart failure through the regulation of mitochondrial function. This review systematically investigates four core mechanisms of mitochondrial dysfunction in heart failure: imbalance of mitochondrial dynamics, excessive accumulation of reactive oxygen species (ROS) leading to oxidative stress injury, dysfunction of mitochondrial autophagy, and disturbance of Ca2+ homeostasis. These abnormalities collectively exacerbate the progression of heart failure by disrupting ATP production and inducing apoptosis and myocardial fibrosis. NAD+ has been shown to regulate mitochondrial biosynthesis and antioxidant defences through the activation of the deacetylase family (e.g., silent information regulator 2 homolog 1 (SIRT1) and SIRT3) and to increase mitochondrial autophagy to remove damaged mitochondria, thus restoring energy metabolism and redox balance in cardiomyocytes. In addition, the inhibition of NAD+-degrading enzymes (e.g., poly ADP-ribose polymerase (PARP), cluster of differentiation 38 (CD38), and selective androgen receptor modulators (SARMs)) increases the tissue intracellular NAD+ content, and supplementation with NAD+ precursors (e.g., β-nicotinamide mononucleotide (NMN), nicotinamide riboside, etc.) also significantly elevates myocardial NAD+ levels to ameliorate heart failure. This study provides a theoretical basis for understanding the central role of NAD+ in mitochondrial homeostasis and for the development of targeted therapies for heart failure.

Functional metabolomics combined with network pharmacology reveals the mechanism of alleviating rheumatoid arthritis with Yiyi Fuzi powder

ETHNOPHARMACOLOGICAL RELEVANCE

Yiyi Fuzi powder (YYFZ) is a composite formulation consisting of Fuzi and Coix lacryma-jobi seeds. The synergistic application of these exhibits notable anti-inflammatory properties, playing a crucial role in the management of rheumatoid arthritis (RA). However, the therapeutic advantages and potential mechanism of YYFZ in the treatment of RA are still unclear.

AIM OF THE STUDY

The purpose of this study is to find functional metabolites by metabolomics technology, and to investigate the mechanism of functional metabolites mediating RA inflammation on the basis of collagen-induced arthritis rat fibroblast-like synovial cells (CIA-FLS) model, and to explore the pharmacodynamic material basis of YYFZ.

MATERIALS AND METHODS

Utilizing untargeted metabolomics in conjunction with UPLC-Q-TOF/MS and GC-MS, we identified potential functional metabolites of YYFZ. In vitro experiments were conducted to determine pyroptosis-related proteins via Western blot, q-PCR and immunofluorescence, thereby exploring functional metabolic pathways. Subsequently, network pharmacology and molecular docking techniques were employed to evaluate the mode of action and mechanisms of "effective components-key targets", elucidating the active components of YYFZ.

RESULTS

Using untargeted metabolomics, 18 differential metabolites were identified, with palmitic acid (PA) showing high correlation as a potential functional metabolite. MTT experiments revealed that 300 μM PA inhibited CIA-FLS by 50%. Further analysis through in vitro experiments indicated that PA promotes inflammatory factor expression via NLRP3/Caspase-1/GSDMD-N/IL-1β mediated pyroptosis. Network pharmacology and molecular docking of 26 in vitro YYFZ components identified benzoylaconine (BAC), benzoylmesaconine (BMA) and benzoylhypacoitine (BHA) as potential active components. In vitro experiments revealed that these components reduce RA inflammation by targeting pyroptosis.

CONCLUSION

PA, a functional metabolite, can promote RA inflammatory factors by inducing pyroptosis of NLRP3/Caspase1/GSDMD-N/IL-1β. BAC, BMA and BHA derived from YYFZ have demonstrated efficacy in mitigating the inflammatory damage induced by the functional metabolite PA, suggesting their potential as therapeutic agents for RA. These findings offer valuable insights for the development of targeted therapies for RA and underscore the clinical applicability of YYFZ.

Economic burden attributable to high BMI-caused cancers: a global level analysis between 2002 and 2021

BACKGROUND

Obesity and overweight are prevailing concerns in modern society, but high BMI shows an established correlation with the risk of cancers that impacts not only medical issues but also economic performance. This study analyzes the economic loss due to high BMI-caused cancers (HBCCs).

METHODS

This study used the comprehensive Global Burden of Disease (GBD) 2021 database and estimated the economic loss of HBCCs through the Value of Statistical Life approach (VSLA), incorporating a willingness-to-pay metric. Health burdens are expressed in age-standardized DALYs and death rates, and economic burdens are shown in dollars lost (2021 PPP) calculated from total DALYs. A joinpoint regression analysis was utilized to capture the temporal trends, cancer incidence, and economic losses attributed to high BMI across various countries and income levels. We calculated the average annual percentage change (AAPC) in total economic loss to evaluate the trend over the study period.

RESULTS

There is a growing trend in both economic loss and disease burden of HBCCs on a global level. Colon and rectum cancer (CRC) show the highest economic loss ($2593.159 million, UI: 1109.04-4119.61, to $7294.52 million, UI: 3134.75-11,511.13), with pancreatic (AAPC: 10.47*, CI: 8.01-13.51) and liver cancer (AAPC: 8.08*, CI: 5.77-10.35) being the fastest growing cause. The cancer burden for all measures positively correlates with the country's income level; high-income countries are the only group to experience a decreasing trend in the health burden, but they are still increasing in economic burden. Differences in loss of certain types of cancer and gender gap are observed in different income tiers.

CONCLUSIONS

These findings indicate a significant upward trend in economic loss, highlighting the urgency for strengthened policy measures. It is crucial for policymakers to implement effective risk reduction and resilience-building strategies to mitigate future economic loss and better protect vulnerable communities.

Impact of temperature variations on burden of lower respiratory infections under climate change (1990-2021)

OBJECTIVES

We aimed to evaluate the global burden and trends of lower respiratory infections (LRIs) attributable to non-optimal temperatures between 1990 and 2021, focusing on age, period, and cohort effects as well as health inequalities to inform targeted public health policies.

METHODS

Using the Global Burden of Disease 2021 database, we obtained the age-standardized mortality rate (ASMR) and disability-adjusted life-years rate (ASDR) for LRIs related to non-optimal temperatures. We calculated estimated annual percentage changes (EAPC) to assess LRIs burden trends and applied age-period-cohort modeling to quantify age, period, and cohort effects. Health inequalities were evaluated using the slope index of inequality and the concentration index.

RESULTS

In 2021, the highest ASDR for LRIs due to high temperatures occurred in children under 5 (347.66/100,000), whereas the highest ASMR for LRIs due to low temperatures occurred in adults aged ≥ 65 (338.49/100,000). Globally, the LRIs burden from non-optimal temperatures declined (EAPC: ASMR -2.48; ASDR -3.33). However, among the five climate zones, the LRIs burden in the boreal zone due to high temperatures increased (EAPC: ASMR 24.14; ASDR 45.14), whereas all other climate zones showed decreasing trends. In lower Sociodemographic Index (SDI) regions, the high-temperature-related LRIs burden was more pronounced. Relative inequities driven by non-optimal temperatures worsened in low-SDI regions.

CONCLUSION

From 1990 to 2021, the global burden of LRIs attributable to non-optimal temperatures declined overall; however, high-temperature-related LRIs increased in boreal zones. These health inequalities underscore the urgent need for targeted climate adaptation policies, such as providing international assistance, improving infrastructure, offering healthcare resources, and promoting vaccine coverage, particularly for vulnerable populations in low-SDI regions and boreal zones.

Global time-trend analysis and projections of disease burden for neuroblastic tumors: a worldwide study from 1990 to 2021

BACKGROUND

Neuroblastoma and other peripheral nerve cell tumors (NB-PNT) are the most common extracranial solid tumors in children. This study aimed to describe the global burden of NB-PNT across different age groups and genders, including incidence, prevalence, mortality, and disability-adjusted life years (DALYs) in various countries and regions. Additionally, we analyzed changes in the disease burden over the past three decades and predicted future trends up to 2036.

METHODS

Using open data from the Global Burden of Disease (GBD) database (1990-2021), we provided a dynamic description of the disease burden of NB-PNT patients across different age and gender groups on a global scale. Joinpoint analysis was used to calculate the average annual percentage change (AAPC) to quantify trends in the burden of NB-PNT. Meanwhile, the Bayesian Age-Period-Cohort (BAPC) model was applied to predict the changes in disease burden up to 2036.

RESULTS

From 1990 to 2021, the global burden of NB-PNT increased significantly, with global prevalence rising from 41,456 to 56,326 cases. Gender and age disparities were evident, with male patients and patients aged 6-11 months exhibiting higher disease burden. Regional variations were observed, with higher disease burdens in regions with a higher sociodemographic index (SDI), although low-SDI regions showed a consistent upward trend. Overall, the prevalence of NB-PNT increased year by year (overall AAPC = 0.64% [0.56 - 0.72%]), with a slight decline in age-standardized mortality rates observed in 2019 (APC2019 - 2021 = -2.02%). Projections indicate a slight decline in both incidence and mortality rates by 2036, with a more pronounced reduction in females.

CONCLUSIONS

A higher burden of NB-PNT was evident among male patients and infants. The disease burden in low-SDI regions has increased in recent years, while a decline was observed in high-SDI regions. Over the past 30 years, the burden rose overall, although a decline in incidence was observed in 2019. Projections indicate a slight decrease in global incidence and mortality rates through 2036.

The association between circulating palmitic acid levels and risk of premature coronary artery disease in Chinese patients: a case-control study

BACKGROUND

Palmitic acid (PA) is a risk factor for atherosclerosis but its significance in premature coronary artery disease (PCAD) remains poorly understood. Herein, we investigated the impact of circulating PA levels on the risk of PCAD occurrence in Chinese patients.

METHODS

In this case control study, we included patients diagnosed with PCAD and age-matched non-CAD controls between June 2022 and December 2023. Participants' serum PA levels were quantified using ultra-performance liquid chromatography-mass spectrometry, and correlations with PCAD were determined using R (v4.2.2). The potential mediating effect of low density lipoprotein cholesterol (LDL-C) for the association between PA and PACD was also evaluated.

RESULTS

In this study of 393 adults (206 PCAD patients and 187 non-CAD controls), serum PA levels showed significant positive correlations with LDL-C and total cholesterol. Compared to controls, PCAD patients had higher proportions of males, smokers, and diabetics, along with elevated PA, LDL-C, and triglycerides, but reduced HDL-C (all P < 0.05). Elevated serum PA (per 10µmol/L increase, OR = 1.12, 95% CI = 1.05-1.20) was significantly associated with an increased risk of PCAD after adjustment for multivariable factors. Further adjustment for LDL-C levels attenuated, but remained statistically significant, the association between PA and PCAD (per 10µmol/L increase, OR = 1.10, 95% CI = 1.03-1.18). Mediation analysis showed that LDL-C mediated 16% of PA's total effect on PCAD.

CONCLUSIONS

Elevated PA circulating levels were found to be related with PCAD risks among Chinese, and increased LDL-C levels could partly mediate this effect.

Structural validity and test-retest reliability of the Patient Reported Inventory of Self-Management of Chronic Conditions (PRISM-CC) in a Swedish population of seventy-year-olds with long-term health conditions

BACKGROUND

Self-management is internationally recognized as important to maintain independence, quality of life and to minimize the risk of poor health outcomes, especially among persons with multi-morbidity. Self-management can be especially challenging for older adults, who have higher rates of multi-morbidity and experience diverse impacts of long-term health conditions on everyday life. Good measures of self-management are currently lacking. The Patient Reported Inventory of Self-Management of Chronic Conditions (PRISM-CC) is a new, generic, multidimensional measure of self-perceived ease or difficulty with self-management, that overcomes many of the limitations of existing measures.

OBJECTIVES

To test the structural validity and test-retest reliability of the Swedish version of the PRISM-CC among seventy-year-olds with long-term health conditions.

METHODS

Translation of PRISM-CC items into Swedish followed the Patient-Reported Outcome (PRO) Consortium process. Survey data (n = 516 Swedish seventy-year-olds with ≥1 long-term health condition) was used to assess structural validity of the 36-item PRISM-CC using multidimensional item response theory (IRT) models. Test-retest reliability was assessed on a subsample of 58 individuals using intra-class correlation coefficient (ICC) and Bland-Altman Plots.

RESULTS

The Swedish PRISM-CC demonstrated good internal consistency with Cronbach's alpha >0.8 for all domains, and good fit to a graded response IRT model (RMSEA 0.034, SRMSR 0.050, CFI 0.952 and TLI 0.945). All 36 items had standardized loadings >0.7. ICC showed moderate to good test-retest reliability for all seven domains. The Bland-Altman plots showed minimal bias and good test-retest agreement for all domains.

CONCLUSION

The Swedish PRISM-CC showed good structural validity and test-retest reliability in this sample of relatively healthy seventy-year-olds with long-term health condition(s). Further validation in a population with more severe health issues is needed.

Associations of exposure to heatwaves with depression and anxiety among adolescents: A cross-sectional study of the Chinese adolescent health survey

BACKGROUND

Limited research has examined the relationship between heatwaves and adolescent mental health, particularly depression and anxiety. This study aimed to explore the relationship between heatwaves and depression and anxiety.

METHODS

We conducted a cross-sectional study including 19,852 adolescents (mean age 15.16 years; 50.2 % females). Air temperature data were from the fifth generation European ReAnalysis-Land (ERA5-Land) dataset. Heat exposure was assessed using three heatwave metrics: The excess heat factor-based (HWM1), maximum temperature-based (HWM2), and minimum temperature-based (HWM3) heatwave magnitude indices. Depression and anxiety were assessed using the PHQ-9 and GAD-7 scales. Subgroup analyses evaluated interactions with sex, grade and region of school.

RESULTS

Depression and anxiety prevalence were 19.37 % and 16.27 %, respectively. Heatwaves were associated with depression (OR [95 % CI]: 1.13 [1.09-1.17]) and anxiety (OR [95 % CI]: 1.12 [1.08-1.16]) based on HWM1. Significant associations existed for depression alone (OR [95 % CI]: 1.14 [1.09-1.20]), anxiety alone (OR [95 % CI]: 1.13 [1.06-1.21]), and comorbid depression and anxiety (OR [95 % CI]: 1.13 [1.09-1.18]). Associations using HWM2 and HWM3 showed consistent directions but varied significance. We observed significant interactions between heatwaves and sex for anxiety alone, and between heatwaves and region of school for both depression alone and comorbid depression-anxiety (all P for interaction <0.05).

LIMITATIONS

The cross-sectional design constrained our capacity to draw causal inferences.

CONCLUSIONS

Heatwaves were associated with a significant of prevalence depression, anxiety, and their comorbidity, with males and rural students potentially more susceptible to these effects.

Protein-specific immune response elicited by the Shigella sonnei 1790GAHB GMMA-based candidate vaccine in adults with varying exposure to Shigella

Shigella is a leading cause of diarrheal morbidity and mortality in young children from low- and middle-income countries. Here, we aimed to verify the ability of the generalized modules for membrane antigens (GMMA)-based Shigella sonnei candidate vaccine 1790GAHB to elicit an anti-protein antibody response. Serum samples from previous clinical trials in adults (a dose-escalation study and its extension in France, a vaccine efficacy study after human challenge in the United States, and a study in Kenya) were investigated using pan-proteome microarrays consisting of 3,150 full-length or fragmented Shigella proteins. Pre-/post-vaccination comparisons identified subsets of proteins that were highly immunoreactive and largely overlapped across all trials; the T3SS lipochaperone family protein (expressed on GMMA) was the most reactive in all studies. Responses to several microarray antigens correlated well with S. sonnei LPS serum IgG antibody levels. Overall, we confirmed the ability of GMMA to elicit an anti-protein IgG/IgA response; however, no association with protection against shigellosis was identified. In the challenge study, IgG response to seven antigens (IpaC, IpaB, IpaA, IpaD, IpaH, IpgC, and MxiD; not expressed on GMMA) was associated with a decreased risk of shigellosis. These antigens were observed to also have high IgG responses at baseline in individuals naturally exposed to Shigella and could constitute targets for future vaccine development.IMPORTANCEShigella remains a major cause of diarrheal disease, especially in children aged under 5 years from low-to-middle-income countries. No vaccine against shigellosis is yet widely available despite the high public health need. An ideal vaccine would provide protection against the most prevalent species, Shigella flexneri and Shigella sonnei; therefore, it could be relevant to identify common antigens. We developed a microarray containing 3,150 full-length or fragmented proteins selected across Shigella species. Sera collected in four clinical trials conducted in three countries of varying endemicity to evaluate a S. sonnei GMMA-based candidate vaccine were tested against these proteins. We identified several Shigella proteins (IpaC, IpaB, IpaA, IpaD, IpaH, IpgC, MxiD) that induced robust antibody response following experimental challenge or natural infection. These proteins correlated with a reduced risk of shigellosis after the S. sonnei challenge. We found no apparent role for anti-GMMA proteins' IgG or IgA response in protection against shigellosis.

Community burden of acute respiratory infections in Shanghai, a longitudinal cohort study in respiratory pathogens, China, 2024-2027

PURPOSE

We are conducting a longitudinal cohort study-the Community Burden of Acute Respiratory Infections in Shanghai-to assess age-stratified incidence, healthcare utilisation and risk factors of influenza virus, respiratory syncytial virus (RSV) and SARS-CoV-2 associated acute respiratory infections (ARIs) in Shanghai, China.

PARTICIPANTS

Study participants were enrolled by family doctors in all 47 community health services centres in Pudong New Area District, Shanghai, China. All permanent residents 6 months and older living in Pudong for at least 6 months were eligible for enrolment; residents who planned to leave Pudong for more than 1 month in the first study year were excluded. During enrolment, study staff conducted baseline assessments of sociodemographics, underlying medical conditions, vaccination history and household and self-rated health status. Study participants are being followed for ARIs for 3 years. Nasopharyngeal and oropharyngeal swab specimens are being obtained from suspected ARI cases. Influenza virus, RSV, SARS-CoV-2 and other respiratory pathogens are tested for by multiplex respiratory pathogen real-time quantitative PCR assays. Illness courses and clinical recoveries of ARI cases are assessed through weekly contact with ARI cases for 28 days post ascertainment.

FINDINGS TO DATE

Between 14 October 2024 and 22 November 2024, we enrolled 5387 community residents into the cohort, including 233 children aged from 6 months to 2 years, 278 preschool children aged 3-6 years, 575 school-age children aged 7-18 years, 2150 adults aged 19-64 years and 2151 older adults aged 65+years. All finished baseline assessment and started follow-up. Surveillance of ARI symptoms, collection of specimens and laboratory testing are ongoing.

FUTURE PLANS

Findings from this study will be used to provide valuable scientific data to inform ongoing control efforts and future pandemic preparedness for respiratory diseases in China. Planned analyses include analysis of annual pathogen-specific incidence by age group and exploration of healthcare seeking behaviour and factors associated with ARIs and severe ARIs. We will also assess transmission dynamics of common respiratory pathogens in a household transmission subcohort.

The effects of Tai Chi on clinical outcomes and gait biomechanics in knee osteoarthritis patients: a pilot randomized controlled trial

Knee osteoarthritis (KOA) is a common degenerative joint disease that significantly reduces mobility and quality of life in elderly populations. Tai Chi, a low-impact mind-body exercise, has been suggested as a potential non-pharmacological intervention for managing KOA, but its biomechanical effects remain unclear. This study aimed to evaluate the effects of a 14-week Tai Chi program on clinical symptoms, lower limb biomechanics, and muscle activation patterns in elderly patients with KOA. A single-blinded randomized controlled trial was conducted, enrolling 24 participants aged 55-70 years with unilateral KOA. Participants were randomly assigned to a Tai Chi intervention group or a control group receiving health education only. Primary outcomes included joint range of motion, joint moments, and muscle activation, measured using a motion capture system and surface electromyography. Secondary outcomes, such as pain, stiffness, function (WOMAC), balance (BBS), and quality of life (SF-12), were also assessed pre- and post-intervention. The Tai Chi group demonstrated significant improvements in WOMAC pain (-1.58 ± 1.44 vs. 0.11 ± 0.78, p = 0.01), stiffness (-0.33 ± 0.78 vs. 0.56 ± 0.88, p = 0.02), and function scores (-2.58 ± 3.53 vs. 1.00 ± 2.78, p = 0.02) compared to the control group. Balance (BBS: 1.42 ± 1.88 vs. -0.89 ± 1.27, p = 0.01) and physical health (SF-12 PCS: 5.45 ± 6.76 vs. -1.05 ± 2.17, p = 0.01) were also enhanced. Biomechanically, Tai Chi reduced horizontal plane knee ROM (-3.03 ± 1.00°, p = 0.01) and maximum knee extension moments (affected side: -0.09 ± 0.04 N/kg, p = 0.04, Non-affected side: -0.11 ± 0.05 N/kg, p = 0.03). Tibialis anterior muscle activation increased significantly (5.66 ± 1.05%MVIC, p = 0.02), while other muscles showed non-significant trends. Tai Chi demonstrated significant clinical and biomechanical benefits for elderly KOA patients, suggesting its potential as a safe, accessible, and effective therapeutic intervention.

Global, regional, and national burden of osteoarthritis from 1990 to 2021 and projections to 2035: A cross-sectional study for the Global Burden of Disease Study 2021

OBJECTIVE

This study aims to report the trends and cross-national disparities in the burden of osteoarthritis (OA) by region, age, gender, and time from 1990 to 2021, and to further project changes through 2035.

METHODS

In this systematic analysis based on the Global Burden of Disease (GBD) study, population survey data on osteoarthritis from 21 countries/regions and U.S. insurance claims data were used to estimate the prevalence and incidence of OA in 204 countries and regions from 1990 to 2021. The reference case definition for OA was symptomatic and radiographically confirmed osteoarthritis. Studies using definitions other than the reference, such as self-reported OA, were adjusted through a regression model to align with the reference case. The distribution of OA severity was derived from a pooled meta-analysis using the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Final prevalence estimates were multiplied by disability weights to calculate years lived with disability (YLD). An Autoregressive Integrated Moving Average (ARIMA) model was used to forecast the prevalence and incidence of OA through 2035.

RESULTS

In 2021, approximately 607 million (95%UI 538-671) people worldwide were affected by osteoarthritis, accounting for 7.7% of the global population. Compared to 2020, the age-standardized prevalence of OA among males is projected to increase from 5,763 per 100,000-5,922 per 100,000 by 2036, while the age-standardized prevalence among females is expected to decline slightly from 8,034 per 100,000-7,925 per 100,000. In 2021, the global age-standardized YLD rate for osteoarthritis was 244.5 (95%UI 117.06-493.11), the global age-standardized prevalence rate was 6,967.29 (95%UI 6,180.7-7,686.06), and the global age-standardized incidence rate was 535 (95%UI 472.38-591.97). In 2021, the age-standardized prevalence rate exceeded 5.5% across all regions, ranging from 5,675.8 per 100,000 (95%UI 5,001.76-6,320.8) in Southeast Asia to 8,608.63 per 100,000 (95%UI 7,674.07-9,485.19) in high-income Asia Pacific regions. The knee was the most commonly affected joint. High BMI and metabolic risks are the only two GBD risk factors for osteoarthritis. From 1990 to 2021, the age-standardized prevalence, incidence, and YLD attributable to osteoarthritis have been on the rise, with substantial international variations across indicators. Countries with high socio-demographic index (SDI) bear a disproportionately high burden of OA, and inequalities in the burden of disease due to differences in SDI between countries have been increasing over time.

CONCLUSIONS

As a major public health problem, the overall global burden of OA has shown an upward trend from 1990 to 2019, including an increase in the number of cases and inequalities in distribution across the globe, which has resulted in significant health losses and economic burdens. In addition, SDI-related inequalities between countries are increasing. In this regard, national public health authorities and the World Health Organization (WHO) should work together to improve diagnosis and early treatment rates by strengthening disease awareness and education, as well as strengthening international cooperation, providing necessary medical assistance to less developed regions, and actively exploring new strategies for the prevention and treatment of OA.

Mesoporous Fe3O4 Nanoparticles Loaded with IR-820 for Antibacterial Activity via Magnetic Hyperthermia Combined with Photodynamic Therapy

The formation of bacterial biofilms presents a major challenge in infection treatments. Antimicrobial photodynamic therapy (aPDT) typically employs photosensitizers to generate reactive oxygen species (ROS) under irradiation, causing oxidative damage to both bacteria and biofilms. While prior studies have explored the integration of PDT with various other approaches, magnetic hyperthermia therapy (MHT) has not adequately addressed. To bridge this gap, a drug delivery system is designed that incorporates mesoporous Fe3O4 nanoparticles loaded with the photosensitizer IR-820, thereby combining aPDT with MHT. This system possesses magnetic-targeting capabilities, generates thermal energy when exposed to alternating magnetic fields, and facilitates the release of encapsulated IR-820. Furthermore, upon exposure to near-infrared light, IR-820 produces ROS. The synergistic effects of elevated temperature, degradation of the biofilm matrix, and enhanced ROS production effectively disrupted bacterial biofilms. This approach demonstrated promising antibacterial efficacy in both in vitro and in vivo, including in rat models of full-thickness infectious wound and subcutaneous abscesses. These results underscore the substantial potential of the system for future antibacterial applications.

Analysis and forecast of the disease burden of trachoma in China and the Global Population over 15 years of age, 1990-2021

OBJECTIVES

Trachoma is primarily transmitted through direct contact, and its complications-such as trichiasis and corneal opacity-significantly impair patients' quality of life and result in substantial productivity losses. This study explores the differences in disability-adjusted life years (DALYs) and prevalence of trachoma globally, across regions with varying Socio-demographic Index (SDI) levels, and in China, while also projecting future trends specific to China.

METHOD

This study, based on data from the Global Burden of Disease (GBD) database, utilized Joinpoint regression to analyze temporal trends in the age-standardized prevalence rate (ASPR) of trachoma in China from 1990 to 2021. The age-period-cohort (APC) model is used to estimate the net effects of age, period, and cohort on disease burden. Through decomposition analysis, the impact of aging, population growth, and epidemiological changes on trachoma disease burden is explored. In addition, the Bayesian Age-Period-Cohort (BAPC) model was used to project trends in the disability-adjusted life years (DALYs) rate and prevalence over the next 15 years, offering valuable insights for optimizing prevention and control strategies and consolidating achievements in disease elimination.

RESULTS

From 1990 to 2021, the ASPR and ASDR of trachoma exhibited a consistent downward trend in China, globally, and across regions with varying SDI levels. In 2021, the crude prevalence and crude DALYs rates of trachoma in China increased with age, reaching their peak in the 70-74-year age group. Marked disparities were observed among different SDI regions, with high-SDI areas recording the lowest prevalence and DALYs burden, while low-SDI regions experienced the highest. It is expected that from 2022 to 2036, the ASPR and ASDR of male and female populations aged 15 and above in China will both show a downward trend and continue to approach 0.

CONCLUSION

The continuous decline in the burden of trachoma disease in China from 1990 to 2021 indicates significant achievements in trachoma prevention and treatment. However, attention still needs to be paid to the elderly population aged 60 and above, and health education for the entire population should be strengthened to reduce the disease burden caused by trachoma in China.