Methylprednisolone as Adjunct to Thrombectomy for Acute Intracranial Internal Carotid Artery Occlusion Stroke: Post Hoc Secondary Analysis of the MARVEL Randomized Clinical Trial

Importance

Patients with acute ischemic stroke (AIS) due to intracranial internal carotid artery (ICA) occlusion often have poor functional outcomes despite undergoing endovascular thrombectomy (EVT).

Objective

To investigate the effectiveness and safety associated with intravenous methylprednisolone as adjunctive treatment to EVT for patients with AIS due to intracranial ICA occlusion.

Design, Setting, and Participants

This was a post hoc analysis of the MARVEL randomized, double-blind, placebo-controlled clinical trial conducted from February 9, 2022, to June 30, 2023, at 82 stroke centers across China with a 3-month follow-up. The primary trial enrolled 1680 patients with large vessel occlusion within 24 hours from last known well time in the intracranial ICA, the first segment of the middle cerebral artery (M1), or the second segment of the middle cerebral artery (M2), of whom 579 patients had intracranial ICA occlusion.

Intervention

Intravenous methylprednisolone, 2 mg/kg/d (maximum dose, 160 mg) for 3 days plus EVT vs placebo plus EVT.

Main Outcomes and Measures

The primary outcome was independent ambulation at 90 days, defined as a score of 0 to 3 on the modified Rankin Scale (range, 0 [no symptoms] to 6 [death]). Safety outcomes included death within 90 days, symptomatic intracranial hemorrhage (sICH) within 48 hours, and decompressive hemicraniectomy to relieve midline-shift and intracranial pressure after EVT.

Results

Among 579 patients (median age, 69.0 years [IQR, 59.0-76.0 years]; 338 men [58.4%]), there were 286 patients in the methylprednisolone group and 293 patients in the placebo group. The proportion of patients who achieved 90-day independent ambulation was significantly higher in the methylprednisolone group than in the placebo group (151 of 284 [53.2%] vs 125 of 293 [42.7%]; adjusted risk ratio [RR], 1.27 [95% CI, 1.07-1.52]; P = .007). The incidence of sICH was lower in the methylprednisolone group than in the placebo group (26 of 277 [9.4%] vs 45 of 290 [15.5%]; adjusted RR, 0.55 [95% CI, 0.35-0.87]; P = .01). The rate of decompressive hemicraniectomy was lower in the methylprednisolone group compared with the placebo group (16 of 286 [5.6%] vs 29 of 293 [9.9%]; adjusted RR, 0.54 [95% CI, 0.30-0.98]; P = .04). No significant difference was observed in mortality between groups (methylprednisolone, 92 of 284 [32.4%] vs placebo, 111 of 239 [37.9%]; adjusted RR, 0.84 [95% CI, 0.67-1.05]; P = .13).

Conclusions and Relevance

In this secondary analysis of a randomized clinical trial of intravenous methylprednisolone vs placebo for patients with intracranial ICA occlusion undergoing EVT, intravenous methylprednisolone was associated with improved ambulation. These findings suggest that the use of intravenous methylprednisolone as an adjunct to EVT may hold promise as a treatment option for patients with AIS due to intracranial ICA occlusion.

Trial registration

ChiCTR.org.cn Identifier: ChiCTR2100051729.

Interruption of mitochondrial symbiosis is associated with the development of osteoporosis

Mitochondria maintain bacterial traits because of their endosymbiotic origins, yet the host cell recognizes them as non-threatening since the organelles are compartmentalized. Nevertheless, the controlled release of mitochondrial components into the cytoplasm can initiate cell death, activate innate immunity, and provoke inflammation. This selective interruption of endosymbiosis as early as 2 billion years ago allowed mitochondria to become intracellular signaling hubs. Recent studies have found that the interruption of mitochondrial symbiosis may be closely related to the occurrence of various diseases, especially osteoporosis (OP). OP is a systemic bone disease characterized by reduced bone mass, impaired bone microstructure, elevated bone fragility, and susceptibility to fracture. The interruption of intra-mitochondrial symbiosis affects the energy metabolism of bone cells, leads to the imbalance of bone formation and bone absorption, and promotes the occurrence of osteoporosis. In this paper, we reviewed the mechanism of mitochondrial intersymbiosis interruption in OP, discussed the relationship between mitochondrial intersymbiosis interruption and bone marrow mesenchymal stem cells, osteoblasts and osteoclasts, as well as the inheritance and adaptation in the evolutionary process, and prospected the future research direction to provide new ideas for clinical treatment.

Rice bran peptides target lectin-like oxidized low-density lipoprotein receptor-1 to ameliorate atherosclerosis

Food-derived multifunctional peptides offer numerous health benefits through different biochemical pathways. However, their impact on aging-related atherosclerotic cardiovascular disease (ASCVD), especially atherosclerosis, remains underexplored despite cardiovascular disease (CVD) being the leading cause of death globally. In this study, NHANES data and Mendelian randomization were used to analyze the association between lipid metabolism disorders, systemic immune responses, dietary inflammatory index, and ASCVD. The results showed that they were all positively correlated with ASCVD. A dietary intervention was used to induce a mouse model of atherosclerosis through a high-fat diet (HFD). Our findings demonstrate that rice bran peptide could mitigate the typical pathological features of atherosclerosis. Molecular docking analysis further predicted that lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) is a key target of rice bran peptide. This prediction was validated through a two-cell model of endothelial cells and lox-1-interfered macrophages. Therefore, targeting LOX-1 with rice bran peptide inhibits the excessive uptake of oxidized LDL (ox-LDL) by macrophages, thereby hindering the mass production of foam cells, which is crucial in preventing the early onset of atherosclerosis.

The Role of Extracellular Vesicles in Aging and Age-Related Disorders

A variety of molecular and cellular changes distinguish the multifaceted biological process of aging. Recent studies in this decade have demonstrated the essential role of extracellular vesicles (EVs) in the aging process. Mitochondrial malfunction and increased oxidative stress are major contributors for the aging process. This review investigates the role of EVs in intercellular communication, tissue regeneration, and inflammation in the context of aging. We also discuss the exosome and its utility to reduce oxidative stress, which is a key part of aging, as well as the possibility of using the exosomes (EVs) as anti-aging drugs. Changes in cargo composition can influence the aging phenotype and impact the functionality of cells and tissues. Additionally, the role of EVs in oxidative stress during the aging process addresses potential treatment strategies and the development of biomarkers for age-associated disorders. The review also highlighted the role of exosomes in providing antioxidant properties, which help reduce excessive reactive oxygen species (ROS) and strengthen cellular defenses against oxidative stress. Additionally, it emphasized the role of extracellular vesicles (EVs) in age-related pathologies, such as neurodegenerative diseases, cardiovascular disorders, and immunosenescence, offering insights into targeted interventions for promoting healthy aging. This article provides a comprehensive analysis of the current body of knowledge regarding the therapeutic effects of EVs on aging, with a particular emphasis on the implications of this emerging field of research and its relationship to oxidative stress.

Global, regional, and national burden of pancreatic cancer from 1990 to 2021, its attributable risk factors, and projections to 2050: a systematic analysis of the global burden of disease study 2021

BACKGROUND

The incidence and mortality rates of pancreatic cancer are rising globally. This study examines global and regional trends in pancreatic cancer incidence, Disability Adjusted Life Years (DALYs), and mortality from 1990 to 2021, utilizing data from the most recent Global Burden of Disease (GBD) 2021 database.

METHODS

Data were sourced from the GBD database over the period from 1990 to 2021. Age-standardized rates for incidence, DALYs, and mortality were calculated per 100,000 population. We also calculated the proportion of DALYs and mortality attributable to risk factors. The Bayesian age-period-cohort model was applied to project future trends until 2050.

RESULTS

Between 1990 and 2021, the global incidence of pancreatic cancer increased significantly, with the number of cases rising from approximately 207,905 to 508,533 and the age-standardized incidence rate (ASIR) increasing from 5.47 to 5.96 per 100,000 population. The global burden of pancreatic cancer, measured in DALYs, rose from 5.21 million to 11.32 million. Mortality rates showed a similar upward trend, with the number of deaths increasing from around 211,613 to 505,752, and the age-standardized mortality rate (ASMR) rising from 5.655 to 5.948 per 100,000 population. Notable increases in ASIR and ASMR were observed in low-middle and low sociodemographic index regions with males experienced higher rates compared to females. Age-standardized DALYs rate (ASDR) and ASMR worldwide were attributable to tobacco smoking, high BMI, and high fasting plasma glucose. Furthermore, our projection model estimates that the ASIR and ASMR of pancreatic cancer will significantly decline, while the ASDR is anticipated to maintain a steady downward trend by 2050.

CONCLUSION

This study offers a comprehensive analysis of pancreatic cancer trends, providing crucial insights for public health planning and policy-making. Addressing identified risk factors and targeting high-risk populations are essential for effective strategies to reduce the global burden of pancreatic cancer.

Association of body roundness index with cardiovascular disease in patients with cardiometabolic syndrome: a cross-sectional study based on NHANES 2009-2018

Background

Cardiometabolic syndrome (CMS), marked by abdominal obesity and metabolic dysregulation, is associated with a heightened risk of cardiovascular disease (CVD). Compared to the traditional anthropometric predictors represented by body mass index (BMI) and waist circumference (WC), body roundness index (BRI) appears to provide a more accurate reflection of the abdominal fat distribution associated with metabolic diseases. Therefore, this study intends to investigate the association of BRI with the risk of CVD and its components including congestive heart failure (CHF), coronary heart disease (CHD), angina, heart attack, and stroke in patients with CMS. At the same time, we hypothesized that BRI would identify CVD better than BMI or WC.

Methods

Data from the 2009-2018 National Health and Nutrition Examination Survey (NHANES). Logistic regression models were mainly utilized to evaluate the relationship between BRI and CVD in patients with CMS, including smooth curve analysis, threshold effects analysis, subgroup analysis and multiple imputation. In addition, receiver operating characteristic (ROC) curves were used to assess the ability of BRI to predict CVD.

Results

The logistic regression model showed a positive association between the BRI and CVD. The highest quartile of BRI (Q4) showing the strongest association with CVD. The smoothed curve revealed a linear relationship between BRI and CVD, but a U-shaped association between the BRI and CHF. For CVD, stratified analyses did not show significant difference between strata. For CHF, BMI interacted with the association, with BRI being associated with decreased risk of CHF in a subgroup of normal weight subjects and increased risk of CHF in a subgroup of obese subjects. The multiple imputation further confirmed the robustness of these results. Additionally, the ROC curve indicated that BRI, BMI and WC had predictive power for CVD and CHF (AUC > 0.05). BRI has similar predictive power to WC but better than BMI.

Conclusions

An elevated BRI is associated with a heightened risk of CVD in patients with CMS. BRI has similar ability to predict CVD and CHF as WC, but superior to BMI.

Homicide Rates Across County, Race, Ethnicity, Age, and Sex in the US: A Global Burden of Disease Study

Importance

Homicide is one of the leading causes of death in the US, especially among adolescents and adults younger than 45 years. While geographic, racial and ethnic, and sex differences in homicide rates have been documented, a comprehensive assessment across all sociodemographics is needed.

Objective

To assess variation in US homicide rates from 2000 to 2019 across geographic location, race and ethnicity, sex, and age.

Design, Setting, and Participants

This cross-sectional study used deidentified death records from the National Vital Statistics System and population estimates from the National Center for Health Statistics for all individuals living in the US from January 1, 2000, to December 31, 2019. Data analysis was completed in April 2023.

Exposure

County, race and ethnicity (American Indian or Alaska Native, Asian or Pacific Islander, Black, Hispanic or Latino, and White), age (0-14, 15-24, 25-44, 45-64, and ≥65 years), and sex (female and male) as reported on death certificates.

Main Outcomes and Measures

The main outcome was homicide rates per 100 000 individuals. Validated small-area estimation models were used to estimate county-level homicide rates by race and ethnicity, age, and sex (50 unique populations). Estimates were corrected for race and ethnicity misclassification on death certificates and were age standardized.

Results

Between 2000 and 2019, there were 367 827 (95% uncertainty interval [UI], 366 683-369 046) homicides in the US, with decedents most commonly being male (77.7% [95% UI, 77.5%-77.8%]), aged 15 to 44 years (69.8% [95% UI, 69.6%-69.9%]), and Black (46.0% [95% UI, 45.5%-46.5%]). The highest homicide rates were among Black males aged 15 to 24 years (74.6 [95% UI, 72.3-77.0] per 100 000 population) and 25 to 44 years (70.0 [95% UI, 68.4-71.4] per 100 000 population) followed by American Indian and Alaska Native males aged 15 to 24 years (24.5 [95% UI, 19.2-31.0] per 100 000 population) and 25 to 44 years (33.5 [95% UI, 28.6-38.8] per 100 000 population). Homicide rates higher than 100 deaths per 100 000 population among American Indian or Alaska Native or Black males aged 15 to 44 years were observed in 143 counties; more than 25% of counties with this homicide level among Black males were in Arkansas, Louisiana, and Mississippi, and all counties with this homicide level among American Indian or Alaska Native males were in North Carolina. Despite national homicide rates remaining stable over the study period (6.1 [95% UI, 6.0-6.2] per 100 000 population for both years; incidence rate difference, 0.04 [95% UI, -0.16 to 0.07]), homicide rates increased in most counties (range, 1631 of 3051 [53.5%] to 1406 of 1488 [94.5%]) among American Indian or Alaska Native, Black, and White males and females younger than 65 years.

Conclusions and Relevance

In this cross-sectional study of US homicide rates, substantial variation was found across and within county, race and ethnicity, sex, and age groups; American Indian and Alaska Native and Black males aged 15 to 44 years had the highest rates of homicide. The findings highlight several populations and places where homicide rates were high, but awareness and violence prevention remains limited.

Evaluation of the effectiveness of the Iran-package of essential non-communicable disease (IraPEN) program in reducing cardiovascular disease risk in pilot areas

BACKGROUND

To assess the effectiveness of the IraPEN program in decreasing the risk of cardiovascular disease (CVD) and associated risk factors in selected areas of Iran.

METHODS

A secondary data analysis of longitudinal data collected between 2016 and 2017 from health centers in four pilot areas. The target population consisted of people aged 40 years and above, as well as individuals aged 30-40 years who had at least one CVD risk factor. We compared mean CVD risk and risk factor levels before and one year after the intervention and utilized Generalized Estimating Equations to analyze the trends during subsequent visits.

RESULTS

A total of 160,223 eligible individuals (93,081 female) were screened at baseline, of which 25,764 individuals (17,386 female) were followed up for at least one year. The proportion of men with a CVD risk score above 10%, according to the WHO/ISH risk charts, decreased from 7.5 to 5.3%, while the proportion of women decreased from 6.1 to 4.7%. Based on the revised WHO risk score, the mean CVD risk for those with a risk score above 10% at baseline and one year later was 0.198 and 0.177 in men and 0.119 and 0.109 in women, respectively. There was a significant decrease in all risk factors, except for waist circumference in both sexes and BMI in women. The trend analysis of risk factors over time confirmed these findings.

CONCLUSION

The program was modestly effective in reducing CVD risk in the pilot areas. However, further modifications may be needed to enhance its effectiveness.

Schistosomiasis Burden and Trend Analysis in Africa: Insights from the Global Burden of Disease Study 2021

Schistosomiasis remains a major public health concern in Africa, despite global efforts to eliminate the disease by 2030. This study estimates the burden, trends, and inequalities of schistosomiasis in Africa from 1990 to 2021, and projects future prevalence to inform the WHO's elimination strategies. Data from the Global Burden of Disease Study (GBD 2021) were used to calculate annual average percentage change (AAPC) and annual percentage change (APC), with spatial global autocorrelation analysis performed to examine temporal and spatial trends. Five modeling algorithms were constructed to predict disease burden in Africa from 2022 to 2041. The age-standardized prevalences rate (ASPR) of schistosomiasis in Africa decreased from 18,495.51 per 100,000 in 1990 to 9,461.76 per 100,000 in 2021. The total number of cases, disability-adjusted life-years (DALYs), and mortality accounted for 84.25%, 87.92% and 87.28% of the global totals, respectively. ARIMA modeling predicts that by 2030, the ASPR will reach 3.99%. Despite progress, the burden remains significant, and intensified efforts are needed, particularly in high-burden regions like West Africa, to meet the WHO's 2030 elimination targets.

In situswelling of low-friction, high load-bearing self-bending bilayer hydrogels inspired by articular cartilage

The articular cartilage is characterized by its gradient hierarchical structure, which exhibits excellent lubrication and robust load-bearing properties. However, its inherent difficulty in self-repair after damage presents numerous formidable challenges for cartilage repair. Inspired by the unique structure of articular cartilage, a biomimetic bilayer hydrogel composed of PAM (polyacrylamide) and PAM/SA (sodium alginate) is prepared using a two-stepin-situswelling method. The bilayer hydrogel demonstrates exceptional structural stability due to the interlayerin-situchemical cross-linking. Compared to monolayer hydrogels, the PAM-PAM/SA bilayer hydrogel demonstrates superior mechanical attributes, exhibiting a compressive strength of 1 MPa and a compressive modulus of 0.22 MPa. Furthermore, exploration of the tribological performance of the PAM-PAM/SA bilayer hydrogel have revealed its low-friction performance under high loads, with a coefficient of friction as low as 0.032. Finally, leveraging the differential swelling properties between the distinct layers of the PAM-PAM/SA bilayer hydrogel, a self-bending biomimetic cartilage capable of conforming to complex joint surfaces is fabricated. This highly lubricating, mechanically robust, and conformal biomimetic cartilage provides an effective means for addressing cartilage defects and joint diseases.

Interplay between platelets and coagulation: from protective haemostasis to pathological arterial thrombosis

Haemostasis refers to the physiological process aimed at repairing vessel injury and preventing bleeding. It involves four interlinked stages culminating in the formation of a platelet-fibrin haemostatic plug that is eventually dissolved once the vessel heals. In contrast, arterial thrombosis is a pathological condition resulting from atheroma exposure, triggering the formation of a platelet-rich thrombus that may obstruct blood flow, leading to the clinical manifestations of ischaemic cardiovascular disease. The following review will provide a comprehensive overview of the finely regulated endogenous antithrombotic mechanisms responsible for maintaining the haemostatic balance and preventing intravascular thrombosis. Thereafter, it will further detail the different stages and mechanisms governing the intricate interplay between the vessel, platelets, and the coagulation cascade in haemostasis, highlighting the most recent advances in platelet biology and function, to further elucidate the differential traits and players contributing to pathological arterial thrombus growth. The review will also delve into the impact of emerging cardiovascular risk factors on tilting the haemostatic balance towards a pro-thrombotic state, thereby increasing the patient's vulnerability to thrombotic events. Finally, it will underscore the importance of early screening for subclinical atherosclerosis through advanced imaging technologies capable of quantifying plaque burden and metabolic activity since they may set the stage for an increased thrombotic risk. Implementing proactive interventions to halt atherosclerosis progression or inducing its regression at early stages is crucial for preserving haemostasis and reducing the likelihood of ischaemic atherothrombotic disease.

Dynamic functional connectivity patterns predict early antidepressant treatment response in drug-naïve, first-episode adolescent MDD

Objective

Adolescents with major depressive disorder (MDD) exhibit abnormal dynamic functional connectivity (dFC) patterns, but it remains unclear whether these aberrant dFC patterns are linked to antidepressant treatment. The aim of this study is to investigate whether dFC patterns will be changed by antidepressant treatment, as well as whether baseline dFC pattern could predict treatment response in adolescent MDD patients.

Method

We included 35 drug-naïve, first-episode MDD adolescents (age 14.40 ± 1.24; 8 males and 27 females) and 24 healthy controls (HCs, age 14.21 ± 1.41; 11 males and 13 females). All MDD adolescents received 6 weeks of antidepressant treatment. Resting state and T1 MRI data were collected in MDD adolescents before and after treatment and in HCs. Independent component analysis (ICA) was used to compare the different dFC pattern between MDD adolescents and HCs at baseline, as well as which between before and after treatment in MDD adolescents. Finally, Pearson correlation and multivariate linear regression analyses were used to explore the associations between dFC pattern and changed score of BDI in MDD adolescents.

Results

The mean dFC value between right inferior frontal gyrus (IFG) and bilateral insular cortex (IC; right, r = -0.461, p-FDR = 0.012; left, r = -0.518, p-FDR = 0.007) at baseline were negatively correlated with BDI score reduction. The mean dFC value between left frontal pole (FP) and right superior parietal lobule (SPL) after treatment was positively correlated with BDI score reduction (r = 0.442, p-FDR = 0.014). And the mean dFC values between right IFG and bilateral IC (right, β = -1.563, p-FDR = 0.021; left, β = -1.868, p-FDR = 0.012) at baseline could predict antidepressant treatment response.

Conclusion

These findings demonstrate that dFC patterns between some brain areas could be a prospective factor for predicting antidepressant treatment response.

[Elevated blood pressure and hypertension : Focus of the 2024 ESC guidelines on risk reduction]

The 2024 guidelines of the European Society of Cardiology (ESC) for the management of elevated blood pressure and hypertension introduce the new category "elevated blood pressure" (120-139/70-89 mm Hg). All patients with elevated blood pressure are advised to implement lifestyle modifications. The aim is to reduce the cardiovascular risk at an early stage. In addition, a structured assessment should be carried out based on the comorbidities, such as coronary artery disease, heart failure and stroke as well as on risk factors, which can result from an antihypertensive treatment in cases of moderate to high risk and a blood pressure of 130/80 mm Hg or more despite 3 months of lifestyle modifications. For patients with hypertension (≥ 140/90 mm Hg), the guidelines now recommend initiating lifestyle modifications and antihypertensive medication concurrently. The new target systolic blood pressure is 120-129 mm Hg, with establishment of individualized treatment goals in cases of frailty or age ≥85 years. Compared to the guidelines of the European Society of Hypertension (ESH) and the German national guidelines (NVL), the ESC extends the treatment recommendations to patients with elevated blood pressure even below the threshold of 140/90 mm Hg. For resistant hypertension spironolactone is recommended, with renal denervation being an alternative option to increasing the antihypertensive medication.

Therapeutic potential of mesenchymal stem cell-derived extracellular vesicles in ischemic stroke: A meta-analysis of preclinical studies

BACKGROUND

Ischemic stroke (IS) remains a significant global health burden, necessitating the development of novel therapeutic strategies. This study aims to systematically evaluate the therapeutic effects of mesenchymal stem cell-derived exosomes (MSC-Exos) on IS outcomes in rodent models.

METHODS

A comprehensive literature search was conducted across multiple databases to identify studies investigating the effects of MSC-Exos on rodent models of IS. Following rigorous inclusion and exclusion criteria, 73 high-quality studies were selected for meta-analysis. Primary outcomes included reductions in infarct volume/ratio and improvements in functional recovery scores. Data extraction and analysis were performed using RevMan 5.3 software.

RESULTS

Pooled data indicated that MSC-Exos administration significantly reduced infarct size and improved functional recovery scores in rodent models of IS. Treatment within 24 hours and beyond 24 hours of stroke induction both demonstrated substantial reductions in infarct volume/ratio compared to controls. Furthermore, MSC-Exos-treated groups exhibited marked improvements in functional recovery, as assessed by various neurobehavioral tests. The meta-analysis showed no significant publication bias, and heterogeneity levels were acceptable.

CONCLUSIONS

MSC-Exos reveal significant therapeutic potential for IS, with evidence supporting their efficacy in reducing infarct size and enhancing functional recovery in preclinical rodent models. These findings pave the way for further research and potential clinical translation.

The alteration of gut microbiota composition in patients with epilepsy: A systematic review and meta-analysis

BACKGROUND

There is accumulating evidence suggesting a connection between epilepsy, a neurologic disease with recurrent seizures, and gut microbiota. This systematic review and meta-analysis explores the alterations of GM composition in patients with epilepsy.

METHODS

A systematic search was conducted up to June 26, 2024, across PubMed, Scopus, Web of Science, and Embase. The study outcomes were α- and β-diversity indexes, and relative abundance at different bacterial taxonomic levels, compared between epilepsy patients and healthy controls. Inverse variance-weighted meta-analysis was performed to estimate the standardized mean difference. We utilized the Newcastle-Ottawa Scale (NOS) to assess the quality of the included studies.

RESULTS

In this systematic review, we included 16 case-control studies encompassing 438 cases and 369 controls, and 12 studies were included in the meta-analyses. α-diversity was not significantly different between epilepsy and control group. Of the 11 studies measuring β-diversity, 8 studies showed that the microbiota compositions of the two groups differed significantly. Verrucomicrobia was significantly higher in the epilepsy group (SMD = 0.39 [0.05, 0.72], p = 0.022) than in the control group. At the genus level, Roseburia (SMD = -0.50 [-0.84, -0.17], p = 0.003), Blautia (SMD = -0.40 [-0.73, -0.06], p = 0.022), and Dialister (SMD = -0.40 [-0.74, -0.07], p = 0.018) were significantly less abundant in patients with epilepsy.

CONCLUSIONS

Our findings evince remarkable changes in gut microbiota composition in epilepsy. Bacterial genera that promote neuroinflammation are elevated in epilepsy. Our study revealed the interrelation between GM disruption and epileptogenesis, but the heterogeneity among the included results was high, and further investigation is encouraged.

The global magnitude and temporal trend of hypertensive heart disease burden attributable to high sodium intake from 1990 to 2021

BACKGROUND

The relationship between high sodium intake (HSI) and hypertensive heart disease (HHD) has been confirmed. However, notable regional disparities exist in implementing effective measures to control sodium intake. This study was carried out to estimate the spatiotemporal trends in the burden of HHD attributable to HSI.

METHODS

Data obtained from the Global Burden of Disease Study 2021 were analyzed, considering factors such as age, gender, year, and region. Joinpoint regression analysis was applied to investigate the temporal trends in the HHD burden resulting from HSI over the past 32 years.

RESULTS

From 1990 to 2021, the global cases of HHD increased significantly annually. The age-standardized prevalence rates showed a slow gradual increase. However, both the age-standardized death and disability-adjusted life-year (DALY) rates decreased. Specifically, HSI was responsible for 29.2% of total HHD deaths and 30.4% of total DALYs in 1990 but only 22.8% of total HHD deaths and 23.4% of total DALYs in 2021. A greater burden from HSI exposure was observed among men, older adults and people living in middle and low sociodemographic index (SDI) countries and regions. Moreover, over the 32-year period, Guam and Colombia demonstrated the highest reduction in age-standardized death and DALY rates, respectively.

CONCLUSION

Globally, the age-standardized burden of HHD due to HSI has demonstrated a decline. Although some areas have effectively managed this issue, it remains a challenge in specific areas. Hence, it is crucial to examine and implement the strategies adopted by successful nations to further mitigate this burden.

Implementation of Green Surgery Approach in Healthcare System and its Effect on Carbon Footprint Reduction in Operating Theatres

Healthcare systems, particularly operating theatres (OTs), are among the leading causes of pollution due to energy-intensive procedures, anaesthetic gases, and single-use surgical instruments. This perspective review provides actionable, evidence-based recommendations that not only minimise the environmental impact but also offer quality patient care. A wide literature search of available studies on green surgery was conducted. Searches were conducted in databases, including PubMed, Science Direct, Scopus, ProQuest, and Web of Science, from January 2013 to the present. A review of global practices highlighted the effectiveness of green surgical initiatives. Some initiatives related to the health sector report reductions in carbon emissions by reusable surgical instrument implementation in hospitals of up to 97%, energy savings of up to 50% with modifications to heating, ventilation, and air-conditioning (HVAC) systems, and waste management programmes, including the recycling and reprocessing of single-use devices, reporting waste reductions from 40% to 66%. Key strategies include shifting to renewable energy sources by promoting reusable instruments, optimising HVAC systems, and promoting comprehensive staff training for sustainability. All these factors are important for decreasing the environmental burden without compromising operational efficiency. The integration of sustainable practices in Malaysian OTs can significantly reduce carbon emissions and waste generated by hospitals while maintaining patient safety. These measures support the national goals of achieving Sustainable Development Goals (SDGs) and advancing Universal Health Coverage (UHC). Aligning with global sustainability efforts, Malaysia's health care system can reduce its carbon footprint.

Burdens of type 2 diabetes and cardiovascular disease attributable to sugar-sweetened beverages in 184 countries

The consumption of sugar-sweetened beverages (SSBs) is associated with type 2 diabetes (T2D) and cardiovascular diseases (CVD). However, an updated and comprehensive assessment of the global burden attributable to SSBs remains scarce. Here we estimated SSB-attributable T2D and CVD burdens across 184 countries in 1990 and 2020 globally, regionally and nationally, incorporating data from the Global Dietary Database, jointly stratified by age, sex, educational attainment and urbanicity. In 2020, 2.2 million (95% uncertainty interval 2.0-2.3) new T2D cases and 1.2 million (95% uncertainty interval 1.1-1.3) new CVD cases were attributable to SSBs worldwide, representing 9.8% and 3.1%, respectively, of all incident cases. Globally, proportional SSB-attributable burdens were higher among men versus women, younger versus older adults, higher- versus lower-educated adults, and adults in urban versus rural areas. By world region, the highest SSB-attributable percentage burdens were in Latin America and the Caribbean (T2D: 24.4%; CVD: 11.3%) and sub-Saharan Africa (T2D: 21.5%; CVD: 10.5%). From 1990 to 2020, the largest proportional increases in SSB-attributable incident T2D and CVD cases were in sub-Saharan Africa (+8.8% and +4.4%, respectively). Our study highlights the countries and subpopulations most affected by cardiometabolic disease associated with SSB consumption, assisting in shaping effective policies and interventions to reduce these burdens globally.

Temporal trends in the burden of musculoskeletal diseases in China from 1990 to 2021 and predictions for 2021 to 2030

BACKGROUND

Musculoskeletal (MSK) diseases represent a significant global public health challenge. Conducting comprehensive research on MSK diseases in China holds profound implications for public health.

METHODS

This study utilized data from the Global Burden of Disease 2021 (GBD 2021) to analyze the incidence rate, prevalence rate, mortality rate, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) of MSK diseases in China from 1990 to 2021. Trends were evaluated using annual percentage change (APC), average annual percentage change (AAPC), and estimated annual percentage change (EAPC). Future disease trends were predicted using the Bayesian Age-Period-Cohort (BAPC) model.

RESULTS

China had the highest number of DALYs cases globally, totaling 30.4194 million. Low back pain (LBP) represented the largest burden, while hand osteoarthritis exhibited the fastest growth. Differences in disease burden were observed across various genders and age groups. Predictions indicate that between 2021 and 2030, the age-standardized DALYs rate in China will increase annually, reaching 1779.08 per 100,000 population by 2030. Environmental (occupational) factors had the most significant impact on the age-standardized DALYs rate, whereas renal dysfunction had the least impact. The SDI showed a moderately strong positive correlation with the age-standardized DALYs rate of MSK diseases.

CONCLUSION

Over the past 20 years, the prevalence of MSK diseases in China has experienced a slight increase, while other epidemiological burden indicators have shown a downward trend. Projections indicate that the overall disease burden of MSK in China will continue to rise over the next decade, underscoring the need for early intervention strategies. Moreover, substantial differences in MSK disease burden across genders and age groups highlight the importance of developing targeted policy interventions to mitigate this burden.

Association of food insecurity with MASLD prevalence and liver-related mortality

BACKGROUND & AIMS

The global burden of metabolic dysfunction-associated steatotic liver disease (MASLD) is growing. This study explores the association of food insecurity with MASLD prevalence and liver-related mortality (LRM) across the globe.

METHODS

The study combines United Nations' country-level food security data with the MASLD data from the Global Burden of Disease study 2021. Mixed-effects linear regression models, accounting for country-level random effects, were used to assess associations of food security indicators with MASLD prevalence and LRM. The analyses were performed according to each country's socio-demographic index (SDI) status.

RESULTS

In 2021, the median MASLD prevalence and liver-related mortality (MASLD-LRM) across 204 countries was 21.77% (14.14%-48.18%) and 2.92 per 100,000 (0.42-10.79) with the highest MASLD prevalence located in North Africa & Middle East (41.70%) and the lowest prevalence in high-income countries (17.31%). After adjustments for age, gender and SDI, higher MASLD prevalence was associated with increasing rates of obesity, type 2 diabetes and low physical activity (p <0.001). When analyses were performed based on SDI status, divergent patterns of MASLD prevalence were observed. In high SDI countries (socioeconomically more developed), MASLD prevalence was significantly higher in those in the top tertile of food insecurity compared to the bottom tertile (mean, 26.73% vs. 18.87%, p = 0.0001). In contrast, in low SDI countries (socioeconomically less developed), the opposite was true (19.45% vs. 24.96%, p = 0.0008). MASLD-LRM was associated with older age, obesity, and metabolic risks (p <0.001).

CONCLUSIONS

MASLD prevalence and MASLD-LRM exhibit significant geographical variability, which is influenced by clinicodemographic factors, and food insecurity. Targeted public health strategies which consider the socio-economic realities of each region are essential for mitigating the global burden of MASLD.

IMPACT AND IMPLICATIONS

Metabolic dysfunction-associated steatotic liver disease (MASLD) burden varies by region, influenced by food insecurity and healthcare access. In high socio-demographic index (SDI) countries, higher MASLD prevalence is linked to the consumption of low-quality, ultra-processed foods. Public health policies should focus on improving food quality, reducing unhealthy food consumption, and enhancing healthcare access. Conversely, in low SDI countries, while food insecurity can lead to outright deficiencies, the observed lower MASLD prevalence may also be partly attributable to underdiagnosis. In this context, limited healthcare access may have contributed to underestimation of the prevalence of MASLD. Therefore, country-specific policies should address both the issues related to poverty, as well as improving access to diagnostic modalities and healthcare infrastructure to ensure more accurate estimates of cases of MASLD in the specific country. Promoting physical activity is crucial in both high and low SDI countries to manage metabolic conditions associated with MASLD.

Global burden, risk factors, and projections of early-onset dementia: Insights from the Global Burden of Disease Study 2021

BACKGROUND

Despite increasing global awareness of dementia, reliable estimates of the disease burden associated with Early-Onset Dementia (EOD) remain insufficiently quantified. This study aims to estimate the disease burden of EOD, analyze the burden attributable to risk factors from 1990 to 2021, and project these trends to 2050 at global, regional, and national levels, providing essential data to inform public health policy.

METHODS

By utilising data from the GBD 2021 database, this study analysed metrics such as age-standardized prevalence (ASPR), mortality (ASMR), and disability-adjusted life years (AS-DALYs) for EOD. Joinpoint Regression analysis was used to calculated average annual percent changes (AAPCs) of ASPR, ASMR, and AS-DALYs. Then, the disease burden attributable to high fasting plasma glucose (FPG), high body-mass index (BMI), and tobacco were also reported. Finally, the Bayesian age-period-cohort (BAPC) model was employed to project global ASPR, ASMR and AS-DALYs, as well as ASMR and AS-DALYs attributed to the three risk factors from 2022 to 2050.

RESULTS

In 2021, the global case numbers of prevalence, mortality and DALYs for EOD were 7.75 (95 %UI: 5.82, 10.08) million, 73,386 (14,059, 232,169), and 3.77 (1.69, 8.88) million. Despite large increases in case numbers, AAPCs of ASR (0.08 % [0.02, 0.14], 0.07 % [0.05, 0.1], and 0.08 % [0.05, 0.1]) kept stable. Females exhibited higher case numbers and ASR across all disease burden indicators than males. Region- and country-level geographical heterogeneities were evident. Furthermore, global ASMR and AS-DALYs associated with high BMI and high FPG showed a steady increase, while the growth in ASMR and AS-DALYs attributable to tobacco has declined. To 2050, global case numbers of prevalence, mortality and DALYs for EOD will continue to rise, but ASRs won't change considerably. Females are anticipated to remain at a higher risk. The disease burden associated with high BMI and high FPG are expected to persist in their upward trends, whereas that related to tobacco are projected to decline.

CONCLUSION

The increasing burden of EOD underscores the critical need for tailored public health strategies and policies, a unique challenge underrecognized before.

Clinical evaluation of a highly multiplexed CRISPR-based diagnostic assay for diagnosing lower respiratory tract infection: a prospective cohort study

OBJECTIVE

Accurate and rapid identification of causative pathogens is essential to guide the clinical management of lower respiratory tract infections (LRTIs). Here we conducted a single-centre prospective study in 284 patients suspected of lower respiratory tract infections to evaluate the utility of a nucleic acid test based on highly multiplexed polymerase chain reaction (PCR) and CRISPR-Cas12a.

METHODS

We determined the analytical and diagnostic performance of the CRISPR assay using a combination of reference standards, including conventional microbiological tests (CMTs), metagenomic Next-Generation Sequencing (mNGS), and clinical adjudication by a panel of experts on infectious diseases and microbiology.

RESULTS

The CRISPR assay showed a higher detection rate (63.0%) than conventional microbiological tests (38.4%) and was lower than metagenomic Next-Generation Sequencing (72.9%). In detecting polymicrobial infections, the positivity rate of the CRISPR assay (19.4%) was higher than conventional microbiological tests (3.5%) and lower than metagenomic Next-Generation Sequencing (28.9%). The overall diagnostic sensitivity of the CRISPR assay (67.8%) was higher than conventional microbiological tests (41.8%), and lower than metagenomic Next-Generation Sequencing (93.2%).

CONCLUSIONS

Considering the low cost, ease of operation, short turnaround time, and broad range of pathogens detected in a single test, the CRISPR assay has the potential to be implemented as a screening tool for the aetiological diagnosis of lower respiratory tract infections patients, especially in cases where atypical bacteria or coinfections are suspected.

What is normal age-related thigh muscle composition among 45- to 84-year-old adults from the UK Biobank study

A loss of skeletal muscle mass and an increase in intramuscular fat are known to occur as we enter middle and older age, but the expected changes or normative values have remained unknown. The primary reason for this is that imaging studies are difficult and expensive to conduct, and consequently, the sample sizes have remained small. The development of the UK Biobank which provides access to a large magnetic resonance imaging (MRI) data set of more than 50,000 participants provides an opportunity to finally address this question of normative values for each age group. The study's primary aim was to determine the age-related changes in thigh muscle composition (e.g., thigh fat-free muscle volume and intramuscular fat) between the ages of 45 and 84 years. The second aim was to analyse associations between thigh fat-free muscle volume and intramuscular fat with lifestyle behaviours (smoking, alcohol consumption, and physical activity), leg pain, and bone mineral density. Fifty thousand three hundred thirty-two participants were included in the study. Total fat-free thigh muscle declined between the ages of 45 and 84 years, while intramuscular fat of the thigh continued to increase. The changes were stable between these age groups. The mean volume of fat-free muscle ranged from 11.16 (SD: 1.40) to 13.26 L (SD: 1.85) in adult males and 7.60 (SD: 0.97) to 8.80 L (SD 1.29) in females between the ages of 45 and 84 years. For intramuscular fat, the change among women was from 6.94% (SD: 1.59) in the 45 to 54 years age bracket to 8.83% (SD: 1.92) in the 75 to 84 age bracket, while for men, it was 5.83% (SD: 1.30) in the 45 to 54 age bracket to 7.85% (SD 1.89) in the 75 to 84 age bracket. The total fat-free muscle volume and intramuscular fat percentage provided can be used for the purpose of reference standards or normative values for adults in the age groups provided. Fat-free muscle and intramuscular fat were found to be associated with a range of health, activity, and leg pain outcomes, and these should be investigated in a follow-up longitudinal imaging study.

Harnessing Evolution and Biomimetics to Enhance Planetary Health: Kidney Insights

Planetary health encompasses the understanding that the long-term well-being of humanity is intrinsically linked to the health of global ecological systems. Unfortunately, current practices often overlook this principle, leading to a human-oriented (anthropocentric) worldview that has resulted in heightened greenhouse gas emissions, increased heat stress, lack of access to clean water, and pollution, threatening both the environment and health and survival of Homo sapiens and countless other species. One significant consequence of these environmental changes is the exacerbation of inflammatory and oxidative stressors, which not only contributes to common lifestyle diseases but also accelerates the aging process. We advocate for a shift away from our current anthropocentric frameworks to an approach that focuses on nature's solutions that developed from natural selection over the eons. This approach, which encompasses the field of biomimicry, may provide insights that can help protect against an inflammatory phenotype to mitigate physiological and cellular senescence and provide a buffer against environmental stressors. Gaining insights from how animals have developed ingenious approaches to combat adversity through the evolutionary process of natural selection not only provides solutions for climate change but also confronts the rising burden of lifestyle diseases that accumulate with age.

Disease burden of cancers attributable to high fasting plasma glucose from 1990 to 2021 and projections until 2031 in China

BACKGROUND

High fasting plasma glucose (HFPG) has been indicated as one of the important risk factors for cancers. This study aimed to estimate the disease burden of cancers attributable to HFPG in China from 1990 to 2021 and predict the burden until 2031.

METHODS

The data of cancers attributable to HFPG were extracted from Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 project. A joinpoint regression model was conducted to estimate the temporal trends from 1990 to 2021. The effects of age, period, and cohort were estimated by an age-period-cohort (APC) model. Lastly, a Bayesian APC model was employed to predict the disease burden for the next decade.

RESULTS

From 1990-2021, cancer deaths attributable to HFPG in China increased by 232 % (95 % uncertainty interval [UI]: 156-330.77 %), and disability-adjusted life-years (DALYs) increased by 195.4 % (95 % UI: 127.38-289.7 %). In addition, the average annual percentage change (AAPC) for the age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) were 0.6364 % (95 % confidence interval [CI]: 0.4234-0.8498 %) and 0.6263 % (95 % CI: 0.3024-0.9512 %), respectively. Among all cancer types, pancreatic cancer had the largest increase in disease burden. The risks of mortality and DALYs increased with age, while showing initial rapid increase with period growth followed by relative stabilization. The cohort effect indicates that males born later had higher risks of mortality and DALYs. Finally, despite a continuous decline in both ASMR and ASDR, the numbers of deaths and DALYs were projected to continue increasing in the next decade.

CONCLUSIONS

The disease burden of cancers attributable to HFPG significantly increased from 1990 to 2021 in China, and the numbers of deaths and DALYs would continuously increase in the next decade. Therefore, it is necessary to introduce targeted policies controlling the disease burden.

Are dietary changes over eight years in the prospective NutriNet-Santé cohort consistent with the EAT-Lancet reference diet?

BACKGROUND

The transition toward sustainable dietary patterns, such as the planetary diet proposed by the EAT-Lancet Commission, is warranted to optimize health and achieve environmental sustainability.

OBJECTIVES

To examine the extent to which the evolution of dietary changes over an 8-y period in the French NutriNet-Santé cohort aligned with the EAT-Lancet diet.

METHODS

A sample of 17,187 participants of the prospective NutriNet-Santé study was used. Dietary intakes were evaluated in 2014, 2018, and 2022 using a food frequency questionnaire. The alignment of dietary patterns with the EAT-Lancet diet was assessed using the EAT-Lancet dietary index (ELD-I). Changes over time in the ELD-I score and component sub-scores were evaluated using linear mixed regression models.

RESULTS

The mean ELD-I score in 2014 (35.1 ± 0.4 points) increased by a mean of 5.5 points [95% confidence interval (CI): 5.0, 5.9] in 2018, with no further increase in 2022 (+4.2 points compared with 2014: 95% CI: 3.6, 4.9). The increase in the ELD-I observed in 2018 was mostly explained by increases in the sub-scores of these components: Beef, lamb, and pork (+3.4 points; 95% CI: 3.1, 3.6, i.e., lower consumption), Fruits (+1.6 points; 95% CI: 1.3, 1.9, i.e., greater consumption), and Nuts (+1.1 points; 95% CI: 1.0, 1.2, i.e., greater consumption). Changes of similar magnitudes were observed between 2014 and 2022, except for the Fruits component, which showed a decrease (-1.3 points; 95% CI: -1.7, -0.9). Greater changes in the ELD-I score over time were observed for females, younger adults, and adults with high education levels.

CONCLUSIONS

Results suggest that the slight shift toward more sustainable dietary patterns within the NutriNet-Santé cohort between 2014 and 2018 has stabilized in 2022. This suggests the need for strong efforts from various actors in the field of nutrition and public health that may facilitate the transition toward sustainable dietary patterns.

Global, regional, and national epidemiology of hepatoblastoma in children from 1990 to 2021: a trend analysis

BACKGROUND AND PURPOSE

Hepatoblastoma is the most common primary liver cancer in children, yet comprehensive understanding of its epidemiology is limited globally. We aimed to estimate the global trend of hepatoblastoma in children from 1990 to 2021.

METHODS

We collected data on hepatoblastoma in children aged 0 to 10 years from 1990 to 2021, derived from Global Burden of Disease (GBD) 2021. Three disease burden indicators, including incidence, mortality, and disability-adjusted life-years (DALYs), were studied. The corresponding average annual percentage changes (AAPCs) were used to explore the temporal trends of hepatoblastoma.

RESULTS

In 2021, hepatoblastoma accounted for 4048 incident cases, 2416 deaths, and 213,478 DALYs globally. Incidence, mortality, and DALYs of hepatoblastoma decreased significantly from 1990 to 2021, with AAPCs of -2.12, -2.53, and -2.53. The highest incidence of hepatoblastoma was observed among those aged < 28 days in 2021 (2.57 per 100,000 individuals). Only high-income region showed an upward trend in incidence from 1990 to 2021, with an AAPC of 0.57. The Western Pacific region had the fastest decrease in the incidence, mortality, and DALY rate of hepatoblastoma. Human development level (HDI) was positively associated with the AAPC in incidence from 1990 to 2021, while HDI was negatively associated with the incidence, mortality, and DALY rate of hepatoblastoma in 2021.

CONCLUSION

Global efforts over the past 3 decades have substantially decreased the disease burden of hepatoblastoma in children. However, increases in the incidence of hepatoblastoma in high-income region merit attention. The highest disease burden of hepatoblastoma was observed in the neonatal period. Improved understanding of hepatoblastoma epidemiology may facilitate prevention and management.

The Number of Patients Lost to Follow-Up May Exceed the Fragility Index of a Randomized Controlled Trial Without Reversing Statistical Significance: A Systematic Review and Statistical Model

PURPOSE

To (1) analyze trends in the publishing of statistical fragility index (FI)-based systematic reviews in the orthopaedic literature, including the prevalence of misleading or inaccurate statements related to the statistical fragility of randomized controlled trials (RCTs) and patients lost to follow-up (LTF), and (2) determine whether RCTs with relatively "low" FIs are truly as sensitive to patients LTF as previously portrayed in the literature.

METHODS

All FI-based studies published in the orthopaedic literature were identified using the Cochrane Database of Systematic Reviews, Web of Science Core Collection, PubMed, and MEDLINE databases. All articles involving application of the FI or reverse FI to study the statistical fragility of studies in orthopaedics were eligible for inclusion in the study. Study characteristics, median FIs and sample sizes, and misleading or inaccurate statements related to the FI and patients LTF were recorded. Misleading or inaccurate statements-defined as those basing conclusions of trial fragility on the false assumption that adding patients LTF back to a trial has the same statistical effect as existing patients in a trial experiencing the opposite outcome-were determined by 2 authors. A theoretical RCT with a sample size of 100, P = .006, and FI of 4 was used to evaluate the difference in effect on statistical significance between flipping outcome events of patients already included in the trial (FI) and adding patients LTF back to the trial to show the true sensitivity of RCTs to patients LTF.

RESULTS

Of the 39 FI-based studies, 37 (95%) directly compared the FI with the number of patients LTF. Of these 37 studies, 22 (59%) included a statement regarding the FI and patients LTF that was determined to be inaccurate or misleading. In the theoretical RCT, a reversal of significance was not observed until 7 patients LTF (nearly twice the FI) were added to the trial in the distribution of maximal significance reversal.

CONCLUSIONS

The claim that any RCT in which the number of patients LTF exceeds the FI could potentially have its significance reversed simply by maintaining study follow-ups is commonly inaccurate and prevalent in orthopaedic studies applying the FI. Patients LTF and the FI are not equivalent. The minimum number of patients LTF required to flip the significance of a typical RCT was shown to be greater than the FI, suggesting that RCTs with relatively low FIs may not be as sensitive to patients LTF as previously portrayed in the literature; however, only a holistic approach that considers the context in which the trial was conducted, potential biases, and study results can determine the merits of any particular RCT.

CLINICAL RELEVANCE

Surgeons may benefit from re-examining their interpretation of prior FI reviews that have made claims of substantial RCT fragility based on comparisons between the FI and patients LTF; it is possible the results are more robust than previously believed.

Enrichment of Fat Graft with Association of ASC and Nanofat in an Animal Model

INTRODUCTION

Fat graft (FG) absorption rate varies from 20 to 80% in two years. Recently, several bioengineering techniques were applied to improve FG retention rate. Numerous studies investigated the use of adipocyte-derived stem cells (ASC) as FG enrichment. However, ASC production is costly, complex, and time-consuming. In contrast, Nanofat, a combination of lipids, stem cells and growth factors, offers a faster, simpler, and more cost-effective alternative for FG enrichment.

OBJECTIVE

This study aims to compare the effects of ASC with those of Nanofat, as a viable option in FG enrichment.

MATERIAL AND METHODS

Animals were allocated in three groups: Control group (1 mL fat), ASC group (1 mL fat +1x106 ASC), and NnF group (1 mL of fat + 0.3mL NnF). These groups were subdivided in three subgroups (4, 8, and 12 weeks, n = 6/group). We performed ultrasound and macroscopic measurements for FG volume, histology and expression of healing and inflammation genes.

RESULTS

At week 12, ASC and NnF groups showed a higher retention of FG when compared to the Control group (51%, 46%, 12% respectively, p < 0.01). Fibrosis was similar in ASC and Nanofat groups. The Nanofat group showed a higher vascular density then the Control group (p < 0.05). Il-10 gene expression was higher, and Mmp9 was lower in the Nanofat group when compared to the ASC and Control groups.

CONCLUSION

This study indicates that enriching FG with both ASC and Nanofat led to an increased retention rate of the FG, suggesting that Nanofat might be a promising alternative for FG enrichment.

NO LEVEL ASSIGNED

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PHAT Lips and PHAT Face: Platelet Hybridized Adipose Therapy for Superficial Musculoaponeurotic System and Dermal Rejuvenation

Platelet-rich plasma has been increasingly used for facial rejuvenation in conjunction with other modalities such as microneedling or on its own. Nanofat grafting to the face has also been utilized for skin quality improvements. Our group previously described the novel combined Platelet Hybridized Adipose Transplant (PHAT) technique for hair restoration. In this series, we describe our experience with the PHAT technique for lip and facial rejuvenation to improve the quality of facial skin and superficial musculoaponeurotic system, and enhancing surgical results.

Global, regional, national burden of asthma from 1990 to 2021, with projections of incidence to 2050: a systematic analysis of the global burden of disease study 2021

Background

Asthma is the second leading cause of mortality among chronic respiratory illnesses. This study provided a comprehensive analysis of the burden of asthma.

Methods

Data on asthma were extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. We focused on the effects of age, sex, risk factors, and the socio-demographic index (SDI) on the burden of asthma and calculated the average annual percent change (AAPC) via joinpoint regression. Two-sample Mendelian randomization (MR) was adopted to estimate the causal relationships between risk factors and asthma. The Bayesian age-period-cohort (BAPC) model was used to predict incidence patterns of asthma from 2022 to 2050.

Findings

In 2021, there was an observed prevalence of asthma, with 3,340 cases per 100,000 people. Males who were below 20 years old had a greater prevalence of asthma. The incidence and prevalence correlated positively with the SDI, whereas mortality and disability-adjusted life years (DALYs) correlated negatively. The contribution of high body mass index (BMI) to asthma DALYs increased by 4.3% worldwide between 1990 and 2021. MR studies have confirmed that high BMI and smoking can increase the risk of asthma. The prediction results indicated that the global age-standardised incidence rate will remain high from 2022 to 2050.

Interpretation

The global mortality of patients with asthma is a significant concern. The analysis of the burden of asthma can help formulate public health policies, allocate resources, and prevent asthma.

Funding

This study was supported by the National Natural Science Foundation of China; Program for Young Talents of Basic Research in Universities of Heilongjiang Province; Marshal Initiative Funding; Mathematical Tianyuan Fund of the National Natural Science Foundation of China; XingLian Outstanding Talent Support Program 2024.

Influence of air quality on lung cancer in people who have never smoked

OBJECTIVE

Lung cancer is the leading cause of cancer-related death. The percentage of people who have never smoked with lung cancer has risen recently, but alternative risk factors require further study. Our goal was to determine the influence of air quality on incidence of lung cancer in people who have smoked or never smoked.

METHODS

The cancer registry from a large urban medical center was queried to include every new diagnosis of lung cancer from 2013 to 2021. Air quality and pollution data for the county were obtained from the US Environmental Protection Agency from 1980 to 2018. Patient demographics, location of residence, smoking history, and tumor stage were recorded. Bivariate comparison analyses were conducted in R (R Foundation for Statistical Computing).

RESULTS

A total of 2223 new cases of lung cancer were identified. Mean age was 69.2 years. There was a nonsmoking rate of 8.1%. A total of 37% of patients identified as a racial minority. People who have never smoked were more likely to be diagnosed at an advanced stage. When analyzing geographic distribution, incidence of lung cancer among people who have never smoked was more closely associated with highly polluted areas. People who have never smoked with lung cancer had significantly higher exposure levels of multiple pollutants.

CONCLUSIONS

Newly diagnosed lung cancer appears to be more related to poor air quality among people who have never smoked than people who have smoked. Future studies are needed to examine the associations of specific pollutants with lung cancer incidence.

Association between social determinants of health and premature atherosclerotic cardiovascular disease and sex differences in US adults: A cross-sectional study

Background

Premature atherosclerotic cardiovascular disease (ASCVD) is a major public health issue, leading to productivity losses and higher healthcare costs. This study examines the association between social determinants of health (SDoH) and premature ASCVD, with a focus on sex differences.

Method

Data on self-reported SDoH based on Healthy People 2030 criteria were obtained from U.S. National Health and Nutrition Examination Surveys (2003-2018). Weighted logistic regression models were used to examine the relationship between SDoH (including eight sub-items and the cumulative number of unfavorable SDoH) and premature ASCVD. Analyses were further stratified by sex.

Result

A total of 40,536 participants aged ≥18 years (19,548 men and 20,888 women) were included in the analysis. The overall prevalence of premature ASCVD was 1756 cases, with a weighted estimate of 7,625,240. Although women had a lower prevalence of premature ASCVD (3.2 % [n = 784] vs. 4.3 % [n = 972]), they exhibited a higher level of unfavorable SDoH compared to men. Logistic regression indicated a 21 % increase in risk for each additional unfavorable SDoH (AOR = 1.21; 95 % CI, 1.16-1.26), and the cumulative number of unfavorable SDoH were positively associated with the odds of developing premature ASCVD (P for trend <0.01). Notably, the impact of unfavorable SDoH was greater in women, revealing significant sex disparities in susceptibility to premature ASCVD.

Conclusion

This study demonstrates that unfavorable SDoH significantly increase the risk of developing premature ASCVD. Furthermore, the cumulative effect of unfavorable SDoH pose a higher risk for women.

Global Burden, Trends, and Inequalities of Gallbladder and Biliary Tract Cancer, 1990-2021: A Decomposition and Age-Period-Cohort Analysis

BACKGROUND

Gallbladder and biliary tract cancer (GBTC) increasingly aggravates the global malignancy burden. This study aimed to evaluate the updated condition of GBTC temporal burden trends and inequalities from 1990 to 2021.

METHODS

Data on GBTC were extracted from the Global Burden of Disease (GBD) 2021 study. Incidence, deaths, and disability-adjusted life years (DALYs) and their age-standardised rates (ASR) were quantified from 1990 to 2021, stratified by sex, age and sociodemographic index (SDI). The age-period-cohort (APC) model was used to elucidate the effects of age, period, and cohort. Decomposition analysis and cross-country inequality evaluation were performed to assess the contributing factors and disease imbalance, respectively. Bayesian APC analysis was used to estimate the future burden.

RESULTS

In 2021, the global incident cases of GBTC were 216 768, with 171 961 deaths and 3 732 121 DALYs lost. From 1990 to 2021, the ASR of incidence, mortality, and DALYs decreased slightly. Males showed a slight increase in ASR of incidence, while females experienced a significant decrease. High-income regions, particularly in Asia Pacific and Latin America, exhibited a higher burden, while Western Sub-Saharan Africa had the lowest. Low and low-middle SDI regions showed a gradual rise in all metrics despite lower absolute numbers. The APC analysis indicated that the global incidence of GBTC tended to rise with age, but gender differences existed. Besides, a deteriorating cohort effect was detected amongst individuals born between 1907 and 1917. Decomposition analysis revealed that population growth was the primary driver of the increased GBTC burden globally. Significant disparities in GBTC burden by SDI were observed, with a notable decline in inequality over time. Projections indicated a slow decline in the global ASR through 2040, with a more pronounced decrease in females.

CONCLUSIONS

There are significant regional and gender differences in the global burden of GBTC. Population growth remains a major contributor to the burden. Despite the overall decline, the increasing incidence in low and lower-middle SDI regions and the persistent male burden highlight the need for targeted interventions. Future efforts should focus on addressing socio-economic inequalities and reducing risk factors, particularly in vulnerable populations.

Evaluation of the toxic effects of food additives, alone or in mixture, in four human cell models

Food additives are present in more than 50% of food products. Several studies have suggested a link between the consumption of certain food additives and an increased risk of developing cancer. This study aimed to evaluate the genotoxicity of 32 additives and six mixtures identified by the NutriNet-Santé cohort as the most widely consumed. Genotoxicity screening was conducted using the γH2AX (for clastogenic compounds) and pH3 (for aneugenic compounds) biomarkers in four human cell models (colon, liver, kidney, and neurons) representing the target organs of food contaminants. The 32 compounds were categorized into five groups based on their toxicological profiles. Eight additives were cytotoxic, four promoted cell proliferation, two were genotoxic with a clastogenic mode of action, and the remaining 19 were neither cytotoxic nor genotoxic at the concentration tested. Among the six mixtures tested, three were neither cytotoxic nor genotoxic, one was cytotoxic, and two were genotoxic at the highest tested concentrations. The observed genotoxicity of the mixtures could not be attributed to the relative concentrations of the individual additives. These findings suggest the possibility of toxic synergies in mixtures and highlight the challenges of studying the combined effects of multiple substances.

Association between headache frequency and risk for fibromyalgia in patients with migraine

BACKGROUND

The present study aimed to evaluate the risk and impact of fibromyalgia in relation to headache frequency in migraine patients.

METHODS

This cross-sectional study involved migraine patients from a regional hospital and a tertiary medical center. Diagnoses of migraine and fibromyalgia were made according to the International Classification of Headache Disorders, 3rd edition, and the modified 2016 American College of Rheumatology diagnostic criteria, respectively. Clinical data, including Fibromyalgia Symptoms (FS) scale and revised Fibromyalgia Impact Questionnaire (FIQR), were collected systematically by questionnaires-based interviews. Patients were categorized based on monthly headache day (MHD) cut-offs derived from decision tree analysis based on the chi-squared automatic interaction detection algorithm.

RESULTS

The study involved 2082 migraine patients (1619 female/463 male, mean ± SD age 39.3 ± 12.0 years), including 132 with fibromyalgia (118 female/14 male, mean ± SD age 44.1 ± 12.7 years) (6.3%). Patients were divided into three groups: ≤9 MHDs (n = 924), 10-20 MHDs (n = 745) and ≥21 MHDs (n = 413). The percentage of fibromyalgia increased with headache frequency (p < 0.001). When compared with patients with ≤9 MHDs (2.8%), those with 10-20 MHDs (6.2%) (odds ratio (OR) = 1.90, 95% confidence interval (CI) = 1.11-3.23, p = 0.019) and ≥21 MHDs (14.5%) (OR = 3.68, 95% CI = 2.08-6.49, p < 0.001) were more likely to have fibromyalgia. Patients with more frequent headaches had higher FS and FIQR scores (all p < 0.001 between MHD categories).

CONCLUSIONS

There was an independent dose-response association between headache frequency and odds, severity, and impact of fibromyalgia in migraine patients. For migraine patients with a higher headache frequency, the potential risk of comorbid fibromyalgia should not be overlooked given its association with more severe clinical manifestations and greater disability.

Progress on HIV and other sexually transmitted infections elimination among youth and adults across BRICS-plus countries: Results from the Global Burden of Disease Study 2021

BACKGROUND

Global strategies aim to eradicate HIV and other sexually transmitted infections (STIs) by 2030. We aim to assess HIV and other STIs morbidity trends from 1992 to 2021 across BRICS-plus (Brazil, Russia, India, China, South Africa, Egypt, Ethiopia, Iran, Saudi Arabia, and the United Arab Emirates), which accounts for nearly half of the world population.

METHODS

HIV and other STIs morbidity estimates were derived from the Global Burden of Disease Study 2021. We derived percentage changes to evaluate the progress towards HIV 2020 milestones and annualised rate of change to determine the progress needed to achieve 2030 targets. We used age-period-cohort (APC) model to estimate period (cohort) relative risks for both disease areas.

RESULTS

Around 46 % of global incident cases attributed to HIV and other STIs were found in BRICS-plus countries, exceeding the combined totals of North American countries. The HIV new cases in BRICS-plus declined by 8.2 % between 2010 and 2020. No countries within BRICS-plus achieved a target of a 75 % decrease in HIV new cases in 2020 or 2021, but India (-41.7 %), Ethiopia (-34.4 %), China (-29.7 %), and South Africa (-11.7 %) showed reductions. Individuals aged 15-24 years (-32·9 %) had a decline for HIV new cases, while individuals aged ≥ 25 years plateaued. There were evident period risks of morbidity for HIV in Russia and Iran since 2012 and for syphilis and gonorrhea in Brazil since 2012. Younger generations had a higher risk of contracting HIV in Brazil, China, Egypt, Iran, and Russia, and other STIs in Brazil, India, Iran, and South Africa, particularly genital herpes.

CONCLUSION

BRICS-plus was still far from reaching the global 2030 targets for both disease areas. Adults aged ≥ 25 years have little progress in HIV new cases, and youth and adults in other STIs.

Admission to acute medical wards for mental health concerns among children and young people in England from 2012 to 2022: a cohort study

BACKGROUND

There are challenges in providing high quality care for children and young people who are admitted to acute medical wards for mental health concerns. Although there is concern that these admissions are increasing, national data describing these patterns are scarce. We aimed to describe trends in these admissions in England over a 10-year period, and to identify factors associated with repeat admission and length of stay.

METHODS

In this cohort study we used data on all admissions to medical wards in England among children and young people aged 5-18 years from April 1, 2012, to March 31, 2022. We classified admissions for mental health concerns using the Global Burden of Disease Study cause hierarchy. We described national trends in admissions for mental health concerns over time by sex, age, ethnicity, and index of multiple deprivation quintile. We examined associations between sociodemographic and clinical factors and odds of the admission lasting more than 1 week, as well as hazard ratios of repeat admissions, using mixed-effects models.

FINDINGS

We identified 342 511 admissions for any cause in children and young people aged 5-18 years in 2021-22 in England, of which 39 925 (11·7%) were for mental health concerns. 21 337 (53·4%) admissions for mental health concerns were due to self-harm. Between 2012-13 and 2021-22, annual admissions for mental health concerns increased from 24 198 to 39 925 (65·0% increase), whereas all-cause admissions increased from 311 067 to 342 511 (10·1% increase). Increases were particularly steep in females aged 11-15 years, rising from 9091 to 19 349 (112·8% increase), and for eating disorders, rising from 478 to 2938 (514·6% increase). In 2021-22, 3130 (7·8%) admissions for mental health concerns lasted longer than 1 week, compared with 12 044 (3·5%) all-cause admissions. Of 239 541 children and young people who were admitted for mental health concerns between 2012-13 and 2021-22, 32 107 (13·4%) had a repeat admission within 6 months. The odds of long-stay admission and hazard ratios for being readmitted were significantly higher for children and young people aged 11-15 years, those who were female, those from less deprived areas, and those with eating disorders than among other groups.

INTERPRETATION

We found large increases in the number of children and young people admitted to acute medical wards for mental health concerns over a 10-year period. Further work is needed to understand factors driving these trends and how to improve care for children and young people with mental health concerns admitted to medical wards.

FUNDING

National Institute for Health and Care Research.

16s RNA-based metagenomics reveal previously unreported gut microbiota associated with reactive arthritis and undifferentiated peripheral spondyloarthritis

OBJECTIVES

Reactive arthritis (ReA) provides a unique opportunity to comprehend how a mucosal infection leads to inflammatory arthritis at a distant site without the apparent invasion of the pathogen. Unfortunately, conventional stool cultures after ReA provide limited information, and there is a dearth of metagenomic studies in ReA. The objective of this study was to identify gut microbiota associated with the development of ReA.

METHODS

Patients with ReA or undifferentiated peripheral spondyloarthritis (UpSpA) were included if they presented within 4 weeks of the onset of the current episode of arthritis. Metagenomic DNA was extracted from the stools of these patients and of 36 age- and sex-similar controls. Sequencing and analysis were done using a standard 16S ribosomal pipeline.

RESULTS

Of 55 patients, there was no difference between the gut microbiota of postdiarrheal ReA (n = 20) and of upSpA (n = 35). Comparing the gut microbiota of patients vs healthy controls, the patients had significantly higher alpha and beta diversity measures. After stringency filters, Proteobacteria had high abundance while Firmicutes had lesser as compared with the controls. Six families were overexpressed in patients, while another five were overexpressed in controls. Sixteen genera and 18 species were significantly different between patients and controls. At the species level there was strong association of Staphylococcus aureus, Clostridium septicum Klebsiella pneumoniae, Escherichia coli, Empedobacter brevis, Roseburia hominis, Bacillus velezensis and Crassaminicella with ReA.

CONCLUSION

The microbiota of classical gut-associated ReA and upSpA is similar. Patients have higher diversities in their gut microbiota compared with healthy controls. Both known and previously unreported species associated with ReA/upSpA were identified.

Predicting Depression Severity in Major Depressive Disorder Using Electroencephalography and Heart Rate Variability: A Cross-Sectional Analytical Study

Introduction Mood disorders comprise the largest burden on mental health, with major depressive disorder (MDD) being the most prevalent among them. While the diagnosis of mood disorders is generally subjective based on history and structured interviews or questionnaires, efforts are being made to identify biological markers that could provide an objective method for diagnosis, classification, prognosis, and elucidation of the underlying mechanisms of mood disorders. Electroencephalography (EEG) and heart rate variability (HRV) are two biosignals that have been studied in this regard. This study aimed to assess the associations between the severity of MDD, EEG alpha asymmetry, and HRV indices in individuals diagnosed with MDD. The EEG and HRV findings were also compared with age- and gender-matched euthymic controls. Methods In this cross-sectional study, 45 individuals (28 males and 17 females, aged 18-50 years) with MDD (as per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) who were either drug naive or had a drug-free interval of at least six weeks (defaulters) were included in the test group. Similarly, 45 age- and gender-matched healthy individuals were included in the control group. The study parameters, namely, the severity of depression, EEG alpha asymmetry, and HRV indices, were assessed from the Hamilton Depression Rating Scale 17 (HDRS-17) score, EEG recording, and lead II ECG data, respectively, and were compared across the test and control groups. In addition, the bivariate correlation between the severity of depression and other parameters in the MDD group and linear regression modeling with the severity of depression as the dependent variable and EEG alpha asymmetry and HRV indices as predictors were performed for the test group. Results HRV indices, namely LF n.u. and LF/HF ratio, were significantly higher, and HF n.u. was significantly lower in MDD individuals compared to healthy controls. A comparison of alpha asymmetry metrics revealed significantly high alpha asymmetry in MDD individuals compared to controls in all three frontal lead pairs (Fp1-Fp2, F3-F4, and F7-F8) and the T3-T4 temporal lead pair. While weak positive correlations were observed between HDRS-17 score and age (ρ = 0.313, p = 0.036), illness duration (ρ = 0.336, p = 0.024), F7-F8 asymmetry (r = 0.364, p = 0.014), LF n.u. (r = 0.349, p = 0.019), and LF/HF ratio (ρ = 0.416, p = 0.005), a weak negative correlation was observed between HDRS-17 and HF n.u. (r = -0.347, p = 0.019) in the test group. Similarly, age, illness duration, F7-F8 asymmetry, O1-O2 asymmetry, LF n.u., HF n.u., and LF/HF ratio were identified as correlates of HDRS-17 for multiple linear regression modeling. The resulting model, with F7-F8 asymmetry and HF n.u. as predictors, was found to be statistically significant in the test group (R² = 0.224, p = 0.005). Conclusions Evidence of a possible relationship between the severity of depression and two objective physiological measures, namely HRV HF n.u. and EEG frontal alpha asymmetry (FAA), was observed in this study. The combination of HRV HF n.u. and EEG F7-F8 FAA could explain 22.4% of the variation in severity of depression, as quantified by HDRS-17, mainly in newly diagnosed drug-naive patients of MDD at presentation.

Global, regional and national burden of lung cancer attributable to occupational carcinogens, 1990-2019: A study of trends, inequalities and predictions based on GBD 2019

BACKGROUND

Lung cancer, a leading cause of cancer-related mortality, is significantly influenced by occupational carcinogens. This study aimed to assess and predict global, regional and national trends of lung cancer burden attributable to occupational carcinogens.

METHODS

Data on the lung cancer burden attributable to nine occupational carcinogens were obtained from the Global Burden of Disease Study 2019. Regions were categorized by the Socio-Demographic Index (SDI). Descriptive statistics, Joinpoint regression, and Age-Period-Cohort (APC) models were employed to analyze trends in mortality and Disability-Adjusted Life Years (DALYs). Using the Slope Index of Inequality and Concentration Index, health inequalities were quantified. The ARIMA-LSTM model was developed to predict the burden from 2020 to 2030.

RESULTS

From 1990-2019, lung cancer deaths and DALYs due to occupational carcinogens increased. Global age-standardized mortality (ASMR) and DALY (ASDR) rates declined, while middle and lower SDI regions increased. Joinpoint regression and APC analysis revealed that the local drift, period, and cohort effects exhibited increasingly unfavorable trends in lower SDI regions, while they were decreasing trends in higher SDI regions. Conversely, age effects increased similarly across all SDI regions. Health inequalities worsened over time. The ARIMA-LSTM model demonstrated global ASMR and ASDR would decrease, while low-middle and low SDI regions were expected to experience substantial increases from 2020 to 2030.

CONCLUSION

Health inequality of lung cancer burden attributable to occupational carcinogens remained a critical concern, underscoring the urgent need for targeted occupational health policies for low and low-middle SDI regions.

Tripartite motif-containing 32 regulated by miR-6236-p5 inhibited silica-induced apoptosis of alveolar macrophages

Apoptosis of alveolar macrophages (AMs) induced by silica is one of the crucial driving factors of silicosis inflammation and fibrosis. However, the mechanism of silica-induced AMs apoptosis remains unclear. In this study, transcriptome sequencing identified 11 differentially expressed (DE)-mRNAs enriched in the regulation of apoptotic signaling pathways in AMs treated with 250 μg/mL silica for 24 h, of which tripartite motif-containing 32 (Trim32) was the most significant and down-regulated. The decreased Trim32 promoted AMs apoptosis, while Trim32 overexpression inhibited the apoptosis of AMs induced by silica at 250 μg/mL for 24 h. MiR-6236-p5 was then identified by MiRNA sequencing as the most significant DE-miRNA potentially regulating Trim32 expression, and the interaction between miR-6236-p5 and Trim32 3'-UTR was confirmed by dual luciferase reporter gene assay. Treated with 100 nM miR-6236-p5 inhibitor increased the expression of Trim32 and inhibited the apoptosis of AMs induced by silica at 250 μg/mL for 24 h, while miR-6236-p5 mimic promoted the apoptosis of silica-induced AMs. In conclusion, this study identified Trim32 regulated by miR-6236-p5 played an important role in silica-induced AMs apoptosis based on RNA sequencing, which provided a novel clue for exploring the mechanism of silica-induced AMs apoptosis.

The Global Burden of Migraine: A 30-Year Trend Review and Future Projections by Age, Sex, Country, and Region

INTRODUCTION

Migraine is a prevalent neurological disorder causing significant disability worldwide. Despite extensive research on specific populations, comprehensive analyses of global trends are remains limited.

METHODS

We extracted incidence, prevalence, and disability-adjusted life years (DALYs) data for migraine from the Global Burden of Disease 2021 database. Trends were analyzed across regions, age groups, sexes, and sociodemographic index (SDI) using estimated annual percentage changes (EAPC). Predictive models (ARIMA) were used to forecast trends to 2050.

RESULTS

From 1990 to 2021, the global burden of migraine significantly increased: prevalence increased by 58.15%, from 732.56 million to 1.16 billion cases, and incidence increased by 42.06%. The DALYs also increased by 58.27%. There were differences between the sexes: female individuals had higher absolute rates of migraine incidence and prevalence, but male individuals exhibited a four- to five-fold more rapid increase than female individuals in these parameters. Adolescents (< 20 years old) have the fastest growth in prevalence and DALYs. Regionally, high SDI regions having the highest age-standardized rate (ASR) and low SDI regions having the lowest ASR in DALYs. East Asia and Latin America exhibited the most significant increases in migraine burden, whereas Southeast Asia exhibited the most pronounced decrease. Predictive analysis suggests prevalence will continue to rise until 2050, particularly among male individuals and adolescents.

CONCLUSIONS

The global burden of migraine has significantly escalated from 1990 to 2021, with female individuals bearing a greater burden but male individuals showing a faster growth rate. Adolescents also face a rapidly rising prevalence. Disparities across SDI regions, countries, age groups, and sexes emphasize the need for targeted public health strategies. Focused interventions are required to mitigate the growing impact of migraines on global health, particularly among male individuals and adolescents.

Preterm Brain Injury: Mechanisms and Challenges

Preterm fetuses and newborns have a high risk of neural injury and impaired neural maturation, leading to neurodevelopmental disability. Developing effective treatments is rather challenging, as preterm brain injury may occur at any time during pregnancy and postnatally, and many cases involve multiple pathogenic factors. This review examines research on how the preterm fetus responds to hypoxia-ischemia and how brain injury evolves after hypoxia-ischemia, offering windows of opportunity for treatment and insights into the mechanisms of injury during key phases. We highlight research showing that preterm fetuses can survive hypoxia-ischemia and continue development in utero with evolving brain injury. Early detection of fetal brain injury would provide an opportunity for treatments to reduce adverse neurodevelopmental outcomes, including cerebral palsy. However, this requires that we can detect injury using noninvasive methods. We discuss how circadian changes in fetal heart rate variability may offer utility as a biomarker for detecting injury and phases of injury.

From onset to advancement: the temporal spectrum of α-synuclein in synucleinopathies

This review provides an in-depth analysis of the complex role of alpha-synuclein (α-Syn) in the development of α-synucleinopathies, with a particular focus on its structural diversity and the resulting clinical variability. The ability of α-Syn to form different strains or polymorphs and undergo various post-translational modifications significantly contributes to the wide range of symptoms observed in disorders such as Parkinson's disease (PD), dementia with Lewy bodies (DLB), and multiple system atrophy (MSA), as well as in lesser-known non-classical α-synucleinopathies. The interaction between genetic predispositions and environmental factors further complicates α-synucleinopathic disease pathogenesis, influencing the disease-specific onset and progression. Despite their common pathological hallmark of α-Syn accumulation, the clinical presentation and progression of α-synucleinopathies differ significantly, posing challenges for diagnosis and treatment. The intricacies of α-Syn pathology highlight the critical need for a deeper understanding of its biological functions and interactions within the neuronal environment to develop targeted therapeutic strategies. The precise point at which α-Syn aggregation transitions from being a byproduct of initial disease triggers to an active and independent driver of disease progression - through the propagation and acceleration of pathogenic processes - remains unclear. By examining the role of α-Syn across various contexts, we illuminate its dual role as both a marker and a mediator of disease, offering insights that could lead to innovative approaches for managing α-synucleinopathies.

Suboptimal dietary patterns are associated with accelerated biological aging in young adulthood: A study with twins

BACKGROUND & AIMS

Suboptimal diets increase morbidity and mortality risk. Epigenetic clocks are algorithms that can assess health and lifespan, even at a young age, before clinical manifestations of diseases. We investigated the association between dietary patterns and biological aging in young adult twins.

METHODS

The data were drawn from the population-based FinnTwin12 study and consisted of twins aged 21-25 years (n = 826). Food and beverage intakes were assessed using a food frequency questionnaire. Biological aging was estimated using the epigenetic clocks GrimAge and DunedinPACE. Latent class analysis was used to identify dietary patterns. The association between dietary patterns and biological aging was assessed using linear regression modeling at the individual level, followed by within-twin pair analyses to account for genetic liabilities and shared familial confounders.

RESULTS

Six dietary patterns were identified: 1) High fast food, low fruits and vegetables (F&V), 2) Plant-based, 3) Health-conscious, 4) Western with infrequent fish, 5) Western with regular fish, and 6) Balanced average. At the individual level, GrimAge acceleration was slower in the Plant-based, Health-conscious, and Balanced-average patterns compared to the High fast food, low F&V, and faster in the Western with infrequent fish pattern compared to the Balanced average, regardless of sex, nonalcoholic energy intake, smoking, and alcohol consumption. After further adjustment for BMI and sports participation, the strengths of the associations modestly decreased; however, the difference between the Balanced-average and High fast food, low F&V patterns remained significant. The pace of aging (DunedinPACE) was slower in the Plant-based pattern compared to the High fast food, low F&V and the Western with infrequent fish patterns after adjustment for sex, nonalcoholic energy intake, smoking, and alcohol. The effect sizes were attenuated and reached a non-significant level when BMI and sports participation were added to the model. Most of the associations were replicated in the within-pair analyses among all twin pairs and among dizygotic twin pairs, but the effect sizes tended to be smaller among monozygotic twin pairs. This suggests that genetics, but not a shared environment, may partially explain the observed associations between diet and biological aging.

CONCLUSION

Diets high in fast food, processed red meat, and sugar-sweetened beverages and low in fruits and vegetables are associated with accelerated biological aging in young adulthood. The clustering effect of lifestyle factors and genetic confounders should be considered when interpreting the findings.

Global, Regional and National Burden of Maternal Obstructed Labour and Uterine Rupture, 1990-2021: Global Burden of Disease Study 2021

BACKGROUND

Maternal obstructed labour and uterine rupture (MOLUR) are among the major maternal labour complications that threaten maternal and child health.

OBJECTIVE

The objective of this study was to systematically analyse the global burden of MOLUR using the Global Burden of Disease 2021 (GBD 2021) database to inform further improvements in maternal-related public health policies.

METHODS

Incidence and disability-adjusted life-year (DALY) data on MOLUR from 1990 to 2021 were collected in the GBD 2021. The joinpoint and Bayesian age-period-cohort models were used to analyse and predict time burden trends. The slope index and concentration index were used to evaluate health inequality. Frontier analysis was used to visualise the potential for burden reduction in individual countries or territories.

RESULTS

In 2021, 13,471,093 (95% uncertainty interval [UI] 8,938,373, 19,008,282) incident cases of MOLUR were reported worldwide, which caused 1,067,270 (95% UI 896,161, 1,275,042) DALYs. Over the past three decades, there has been an overall downward trend in the age-standardised incidence rate (ASIR) and age-standardised DALY rate (ASDR) of MOLUR globally, with the ASIR decreasing from 554.0 (95% UI 355.6, 786.3) per 100,000 in 1990 to 347.0 (95% UI 228.8, 489.4) in 2021. The ASDR decreased from 65.4 (95% UI 56.0, 75.7) per 100,000 in 1990 to 27.0 (95% UI 22.7, 32.2) in 2021. By 2040, the global ASIRs and ASDRs projections for MOLUR will likely continue to decline. Socioeconomic-related inequalities are narrowing, but the burden remains concentrated in low socioeconomically developed countries. Israel and Afghanistan showed the largest differences from the frontier boundaries of ASIR and ASDR.

CONCLUSIONS

Although the global burden of MOLUR has declined in the last three decades, it remains high and is still concentrated in economically underdeveloped countries. The reduction in DALYs attributable to MOLUR globally reflects significant progress in improving maternal health and reducing complications of childbirth.

Socioeconomic inequality in the outcomes of a psychological intervention for depression for South Africans with a co-occurring chronic disease: A decomposition analysis

Task-shared psychological interventions are effective for reducing the severity of depression symptoms, but differences in treatment outcome by socioeconomic status is uncertain. This study examines socioeconomic inequalities (SEI) in depression outcomes among people with HIV and/or diabetes who participated in a cluster randomised controlled trial in the Western Cape Province of South Africa. The trial took place at 24 primary care clinics randomised to deliver a task-shared psychological intervention or treatment as usual (TAU). The trial enrolled 1119 participants meeting criteria for probable depression. Depression symptom severity was evaluated at baseline and 24-month follow-up. Using a concentration index (CI), SEIs in depression were assessed for the intervention and TAU arms. Demographic and socioeconomic variables were used to decompose the CI to identify contributors to SEI. Results indicate poorer participants at the intervention arm have significantly worse 24-month outcomes than wealthier counterparts (CI = - 0.080; SE = 0.025). Race (34.2%), unemployment (17.4%) and food insecurity (15%) were the main contributing factors. While policymakers need to invest in psychological interventions to reduce the burden caused by depression, this study suggests treatment outcomes may be different across the socioeconomic spectrum. Decomposition of these findings points to structural constraints, such as unemployment, as the key contributors towards poorer treatment outcomes. These findings suggest a need to combine psychological interventions with structural interventions that address the broader socio-economic determinants of mental health.