Prolonged loneliness and risk of incident cognitive decline and dementia: A two-cohort study

BACKGROUND

Loneliness is prevalent currently and could result in increased dementia risks, whereas the associations of prolonged loneliness and its changes with cognitive decline and dementia remain less investigated.

METHODS

Data were from the English Longitudinal Study of Ageing (ELSA) and Health and Retirement Study (HRS). Loneliness was assessed using the Revised UCLA Loneliness Scale. Health risk factors for dementia included unhealthy lifestyles, depressive symptoms, chronic diseases, and functional limitations. Cognitive function was assessed using validated tests in both cohorts, with cognitive decline defined as cognitive z-scores < -1.5. Dementia was identified through self- or proxy-reported physician diagnoses. The Cox proportional hazard regression and Aalen's additive hazard regression were performed to calculate the relative and absolute risk for cognitive decline and dementia, respectively. Covariates including socio-demographic characteristics, social networks, and polygenic scores were adjusted.

RESULTS

Of 6721 ELSA and 10,195 HRS participants aged ≥50y, 2129 (13.7 %) and 612 (3.6 %) developed incident cognitive decline and dementia in about 10 years, respectively. Participants with severe (versus no) cumulative loneliness had 42 % and 98 % higher cognitive decline and dementia risks after pooling, corresponding to 791.6 (477.4-1105.8) and 372.8 (223.6-522.0) excess incidence densities (/105 person-years). Additionally, those who recovered from frequent loneliness (versus persistent frequent) were 9 %-31 % less likely to develop unhealthy lifestyles, depressive symptoms, chronic diseases, and functional limitations, and were at 33 % lower risks of dementia, corresponding to -248.6 (-446.0 ~ -51.2) excess incidence density.

CONCLUSIONS

Prolonged loneliness could increase the risks of incident cognitive decline and ADRD, while alleviating loneliness may help.

Attributable risk factors and trends in global burden of falls from 1990 to 2021: A comprehensive analysis based on Global Burden Of Disease Study 2021

BACKGROUND

Falls are a leading cause of disability-adjusted life years (DALYs) and mobility difficulties. Previous estimates have relied on restricted regional scope and lack a thorough global study. This study, for the first time, examines the evolving trends in the global burden of falls from 1990 to 2021, focusing on geographic variation in disease burden and risk factors, predicting the development of burden of falls. Our aim was to provide information for allocating medical resources, taking health policies into action, and making patient management systems operate better.

METHOD

Data on incident cases, deaths, and DALYs were collected for countries, regions, ages, and sexes worldwide from the Global Burden Disease (GBD) 2021 database. Using R (version 4.3.2), we calculated estimated annual percent changes (EAPCs) for assessing trends in age-standardized rates, visualized risk factors, and predicted the global burden of falls. Joinpoint regression (version 4.9.1.0) was used to identify significant temporal trends and change points.

RESULTS

In 2021, 548.8 million people were affected by falls. There were 215 million incidence, 43.8 million DALYs, and 800,000 deaths caused by falls. The incidence rate of falls increases with age, and sex inequalities exist. Compared with 1990, the age-standardized incidence rate (ASIR), death rate (ASDR), and DALY rate (ASDALYsR) declined despite an increase in absolute numbers. The ASDR and ASDALYsR of falls are expected to decline in the future, whereas the ASIR is expected to rise. The fall burden varied significantly according to region and its sociodemographic index (SDI). Both ASIR (R = 0.510, p < 0.001) and ASDALYsR (R = 0.2762, p < 0.001) were positively correlated with SDI. In contrast, ASDR (R=-0.536, p < 0.001) showed a consistently negative association with SDI. Low bone mineral density, occupational injuries, alcohol use, and smoking emerged as the top factors associated with fall-related DALYs and deaths.

CONCLUSIONS

The overall burden of falls declined between 1990 and 2021, but the future incidence is expected to increase. The global burden of falls remains unchanged and shows significant regional and sex-based differences. Effective prevention and strategies against risk factors are imperative for reducing the future burden.

The impact and projection of the COVID-19 pandemic on the burden of stroke at global, regional, and national levels: A comprehensive analysis for the Global Burden of Disease Study 2021

BACKGROUND

We aim to estimate impact and projection of the COVID-19 pandemic on the burden of stroke at global, regional, and national levels METHODS: Utilizing standardized GBD methodologies, we conducted a comprehensive analysis of the prevalence, incidence, mortality, and disability-adjusted life years (DALYs) associated with stroke across 204 countries and regions spanning the periods from 1990 to 2019, 2019 to 2021, and 1990 to 2021. Our study provides detailed estimates accompanied by corresponding 95% uncertainty intervals (UIs), stratified by age and sex. To elucidate the temporal trends in stroke burden, we calculated the Estimated Annual Percentage Change (EAPC). Additionally, we explored the relationship between stroke burden and sociodemographic index (SDI) levels. The DALYs attributable to various risk factors for stroke were also analyzed. The burden of stroke in the next 20 years was also predicted.

RESULTS

From 2019 to 2021, the age-standardized prevalence rates (ASPR), incidence rates (ASIR), mortality rates (ASMR), and DALYs rates for stroke remained stable, diverging from the declining trends observed from 1990 to 2019 and from 1990 to 2021 at global, regional, and national levels, as indicated by both percent change analysis and EAPC analysis. This pattern was similarly reflected in the global burden of intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), and ischemic stroke (IS). The changes in the burden of stroke, ICH, and IS from 2019 to 2021 were consistent between males and females. Importantly, the impact of COVID-19 on stroke burden remains substantial, irrespective of variations in the SDI. The IS burden increased in the next 20 years, and more attention should be paid on the stroke burden in young people.

CONCLUSIONS

Throughout the COVID-19 pandemic, the burden of stroke exhibited a stable trajectory, in contrast to the declining trend observed from 1990 to 2019 and from 1990 to 2021. The increased burden was observed in IS and young people in the next 20 years. These observations highlight the disparities in stroke burden that exist across different levels of socioeconomic development. The longitudinal epidemiological data presented in this study provide valuable insights into the significant shifts brought about by the COVID-19 pandemic, offering crucial information for researchers, policymakers, healthcare professionals, and other stakeholders.

Updates in Treatment of Hypoxic-Ischemic Encephalopathy

Worldwide, hypoxic-ischemic encephalopathy (HIE) remains one of the leading causes of nervous system disabilities. Therapeutic hypothermia is the current standard-of-care treatment in high-income countries, because it was shown to reduce associated mortality and morbidities. However, up to 29% of treated neonates still experience adverse neurodevelopmental outcomes, and its efficacy in low- and middle-income countries remains debated, highlighting the need for adjunct or alternative therapies. Treatments for HIE targeting neuroprotection and/or neurorestoration are under investigation. Meanwhile, attentive daily management of multiorgan failure during the first days of life continues to be essential to limit further brain injury.

The Indirect Impact of COVID-19 Pandemic on Mortality, Complications, and Healthcare Utilization Among Patients With Chronic Respiratory Diseases in Hong Kong: An Interrupted Time Series Analysis

PURPOSE

This study aimed to investigate COVID-19's indirect influence on chronic respiratory disease (CRD) patients for two years since the COVID-19 pandemic began.

METHODS

Using population-based data in Hong Kong, we included CRD patients diagnosed from January 2011 to December 2021. Interrupted Time Series Analysis were applied to assess mortality, complications, and healthcare utilization rates during the "pre-COVID-19 pandemic" (January 2012-January 2020), "initial COVID-19 pandemic" (February 2020-February 2021), and "post-initial COVID-19 pandemic" (March 2021-December 2021) periods.

RESULTS

Among 587,049 patients with CRD, all-cause mortality had an increasing trend during the post-initial COVID-19 pandemic period (incidence rate ratio (95% CI): 1.019 (1.005, 1.034); p = 0.007), compared with pre-COVID-19 pandemic period. Nonrespiratory mortality had an increasing trend in the initial COVID-19 pandemic period (1.020 (1.006, 1.033); p = 0.004) and was higher than the pre-pandemic level in the post-initial COVID-19 pandemic. We observed abrupt declines in the incidence rates of asthma exacerbation, acute exacerbation of chronic obstructive pulmonary disease, pneumonia, and acute respiratory failure in the first month of initial COVID-19 pandemic period, remaining below pre-COVID-19 pandemic levels throughout the initial pandemic period.

CONCLUSION

The disruption of usual healthcare impacts mortality rates among patients with CRD without COVID-19, particularly nonrespiratory mortality. Contingency plans on continuing follow-up and monitoring of CRD patients are needed, for example, teleconsultations, shared primary care, and tele-reminders on red-flag symptoms for patients with CRD, when healthcare services may be disrupted during public health crises.

Type 2 gene expression signature in severe asthma associates with more advanced airway remodeling

BACKGROUND

Asthma is a heterogeneous disease with various inflammatory subtypes, including the type-2 (T2) endotype associated with airway eosinophilia. Severe asthma is linked to reduced ventilatory function due to airway structural changes. This study compared the extent of airway remodeling in different immunological endotypes of asthma.

METHODS

Severe asthma patients (n = 30) were stratified based on bronchial expression of T2 (e.g., CST1) and T3 (e.g., IL17A) immunity genes as T2-high, T3-high, or low-inflammatory. We analyzed airway wall thickness using endobronchial ultrasound (EBUS), bronchial biopsy morphometry, and mRNA expression of remodeling genes. Bronchial epithelial cell cultures were used to assess cytokine responses.

RESULTS

T2-high asthma patients showed lower predicted FEV1 (59 vs. 74 % in low-inflammatory variant, p = 0.049) and increased submucosa layer (L2) in EBUS (0.203 vs. 0.189 mm, p = 0.018). T2-high asthma patients also had increased airway smooth muscle (ASM) mass (∼2-fold, p = 0.018) and marginally thicker reticular basement membrane. T3-high asthma showed only a trend toward thicker L2 (p = 0.055). Only patients with an eosinophilic signature in endobronchial biopsy demonstrated increased expression of remodeling genes, including TGFB1. A profibrotic profile was also induced in bronchial epithelium stimulated in vitro with IL-13.

CONCLUSION

These data suggest that T2-signature in severe asthma is associated with increased ASM mass and more pronounced airway obstruction. Overexpression of remodeling genes primarily occurred in patients with signs of eosinophilic infiltration in the bronchial mucosa, suggesting that remodeling may progress with uncontrolled airway inflammation.

Current research on mitochondria‑associated membranes in cardiovascular diseases (Review)

The present study aimed to explore the role of mitochondria‑associated membranes (MAMs) as a key interface between mitochondria and the endoplasmic reticulum (ER) and to evaluate their importance in maintaining the physiological functions of these two organelles. MAMs not only act as a structural bridge between mitochondria and the ER but also widely participate in the regulation of mitochondrial biosynthesis and function, Ca2+ signal transduction, lipid metabolism, oxidative stress response and autophagy. In addition, the specific protein composition of MAMs is increasingly being recognized as having a profound impact on their function, and these proteins play a central role in regulating intercellular communication. Recently, the scientific community has accumulated a large amount of evidence supporting MAMs as potential targets for cardiovascular disease treatment. The present review focuses on the fine structure and multifunctional properties of MAMs and their mechanisms in the occurrence and development of cardiovascular diseases. The goal is to explore the mechanism of MAMs, therapeutic intervention points directly related to cardiovascular diseases, and feasibility of incorporating MAMs into the diagnostic strategy and treatment plan of cardiovascular diseases to provide novel insights and theoretical support for clinical practice in this field. MAMs have great potential as therapeutic targets for various cardiovascular diseases. This finding not only deepens the understanding of the interaction between organelles but also opens up a promising research path for the development of new therapeutic strategies for cardiovascular diseases.

Plant proteins and peptides as key contributors to good health: A focus on pulses

The growing interest of the public in healthy food products with adequate nutritional quality has triggered a search for novel sources of protein. This review discusses scientific evidence on the available sources, processing, and biological properties of plant-based protein and bioactive peptides, with a particular emphasis on pulses, as these are some of the most important sources of protein and peptides displaying a wide range of health benefits. Processing plant-based proteins and derived peptides require standardized methods ensuring the improvement of their nutritional quality to counteract limiting factors affecting their evenness to other protein sources. If protein and bioactive peptides can be produced as functional ingredients, the industry releases patents, making them highly marketable to develop functional food products. Current research supports that plant-based food products constitute a nutritious part of a healthy diet by preventing chronic non-communicable diseases, but more studies, particularly clinical trials, are needed to demonstrate these effects fully.

Low-intensity pulsed ultrasound relieved the diabetic peripheral neuropathy in mice via anti-oxidative stress mechanism

Diabetic peripheral neuropathy (DPN), as one of the most prevalent complications of diabetes, leads to significant pain and financial burden to patients. Currently, there was no effective treatment for DPN since the glucose control was just a prevention and the drug therapy only relieved the DPN pain. As a non-invasive physical therapy, low-intensity pulsed ultrasound (LIPUS) is utilized in the musculoskeletal and nerve injuries therapy. Studies revealed that LIPUS could regenerate nerves by the mechanical stimulation via oxidative stress pathway, which was thought as the important factor for DPN, and might have potential in the DPN therapy. This study aimed to identify a new therapeutic strategy for DPN using LIPUS. We analyzed the therapy effect and explored the therapeutic mechanism of LIPUS on DPN in mice. This study involved animal experiments and C57BL/6J mice were randomly assigned to DPN model and Sham groups. The DPN model group was fed a high-fat chow diet and injected with streptozotocin (STZ) for 3 consecutive days (40 mg/kg/d), whereas the Sham group was fed a normal diet and injected with an equal volume of sodium citrate buffer. After the DPN model confirmed with the 84-day modeling process, the DPN mice were randomly allocated into the DPN group and the LIPUS group. The LIPUS group underwent ultrasound treatments with a center frequency of 1 MHz, a duty cycle of 20 %, and a spatial average temporal average intensity (ISATA) of 200 mW/cm2 for 20 min/d, 5 d/w. After the 56-day treatment, all mice were euthanized. LIPUS therapeutic effects were evaluated through measurements of fasting blood glucose (FBG), behavioral tests, oxidative stress tests, morphological analysis, immunofluorescence, and western blot analysis. The results indicated that DPN mice had significantly higher FBG levels (28.77 ± 2.95 mmol/L) compared with sham mice (10.31 ± 1.49 mmol/L). Additionally, DPN mice had significantly lower mechanical threshold (4.13 ± 0.92 g) and higher thermal latency (16.20 ± 2.39 s) compared with the sham mice (7.31 ± 0.83 g, 11.67 ± 1.21 s). After receiving LIPUS treatment, the glucose tolerance tests (GTT) suggested that LIPUS treatment improved glucose tolerance, which was shown by a decrease in the area under the curve (AUC) for glucose in the LIPUS group (AUC = 2452 ± 459.33 min*mmol/L) compared with the DPN group (AUC = 3271 ± 420.90 min*mmol/L). Behavioral tests showed that LIPUS treatment significantly alleviated DPN-induced abnormalities by improving the mechanical threshold from 2.79 ± 0.79 g in the DPN group to 5.50 ± 1.00 g in the LIPUS group, and significantly decreasing thermal latency from 12.38 ± 1.88 s in the DPN group to 9.49 ± 2.31 s in the LIPUS group. Morphological observations revealed that DPN mice had a thinning and irregularly shaped myelin sheath, with 61.04 ± 5.60 % of abnormal nerve fibers in the sciatic nerve in LIPUS group, compared with 49.76 ± 4.88 % of abnormal nerve fibers in the LIPUS-treated group. Additionally, LIPUS treatment increased the mean fluorescence intensity of the associated nerve regeneration protein (i.e., Nf200) from 27.81 ± 0.32 arbitrary units in the DPN group to 37.62 ± 0.36 arbitrary units in the LIPUS group. Western blot and immunofluorescence analysis showed that LIPUS treatment significantly reduced Keap1 expression to 0.04 ± 0.06 relative units, compared with 0.17 ± 0.30 in the DPN group. Furthermore, immunofluorescence analysis revealed that LIPUS treatment promoted the production of its downstream antioxidant protein, heme oxygenase-1 (HO-1), with an increase in the fluorescence intensity from 27.81 ± 0.32 arbitrary units in the DPN group to 37.62 ± 0.36 arbitrary units in the LIPUS-treated group. The fluorescence intensity of Nrf2 was significantly higher in the LIPUS group, increasing from 4.90 ± 0.25 arbitrary units in the DPN group to 15.18 ± 2.13 arbitrary units in the LIPUS-treated group. Additionally, the malondialdehyde (MDA) levels, an indicator of oxidative stress, were significantly reduced in the serum, from 5.40 ± 0.48 nmol/ml in the DPN group to 4.64 ± 0.16 nmol/ml in the LIPUS-treated group, and in the sciatic nerve, from 16.17 ± 5.88 nmol/mg protein to 4.67 ± 2.10 nmol/mg protein, suggesting the oxidative stress was inhibited by LIPUS. This study demonstrated for the first time that LIPUS could relive DPN through anti-oxidative stress process. This study suggests that LIPUS might be a new therapy strategy for DPN.

Prevalence of macro-vascular complications among type 2 diabetic adults aged 50 and over: results from Ardakan cohort study on aging (ACSA)

Objective

Type 2 diabetes mellitus (T2DM) is a common condition that can lead to adverse macrovascular complications. This study aims to determine the prevalence of macrovascular complications in adults aged ≥ 50 with T2DM in Ardakan city, using data from the Ardakan Cohort Study on Aging (ACSA).

Methods

A cross-sectional investigation involved 5933 participants from the ACSA; of those assessed, 2340 had T2DM. Macrovascular complications, specifically coronary artery disease (CAD), cerebrovascular disease (CVD), and peripheral artery disease(PAD) were identified through medical records and physician assessment. Logistic regression was used to identify risk factors for these complications.

Results

The prevalence of CAD and CVD were 16.9% (95% CI:16.0-19.0) and 4% (95% CI:3.3-5.0), respectively. risk factors for CAD included age over 60 (OR = 1.47, 95% CI: 1.08-2.01, p = 0.01), male gender (OR = 1.87, 95% CI: 1.33-2.62, p < 0.001), former smoking (OR = 1.96, 95% CI: 1.30-2.95, p = 0.001), hypertension (OR = 3.16, 95% CI: 2.23-4.46, p < 0.001), and over ten years of diabetes duration(OR = 2.04, 95% CI: 1.39-2.99, p < 0.001) and For CVD, significant risk factors included male gender (OR = 2.61, 95% CI: 1.52-4.51, p = 0.001) and hypertension (OR = 2.36, 95% CI: 1.27-4.39, p = 0.006).

Conclusion

This study highlights the high prevalence of macrovascular complications in adults over 50 with T2DM in Ardakan. It emphasizes the importance of managing key risk factors such as hypertension and quitting smoking, especially in older adults and males.

X-chromosome-wide association study for Alzheimer's disease

Due to methodological reasons, the X-chromosome has not been featured in the major genome-wide association studies on Alzheimer's Disease (AD). To address this and better characterize the genetic landscape of AD, we performed an in-depth X-Chromosome-Wide Association Study (XWAS) in 115,841 AD cases or AD proxy cases, including 52,214 clinically-diagnosed AD cases, and 613,671 controls. We considered three approaches to account for the different X-chromosome inactivation (XCI) states in females, i.e. random XCI, skewed XCI, and escape XCI. We did not detect any genome-wide significant signals (P ≤ 5 × 10-8) but identified seven X-chromosome-wide significant loci (P ≤ 1.6 × 10-6). The index variants were common for the Xp22.32, FRMPD4, DMD and Xq25 loci, and rare for the WNK3, PJA1, and DACH2 loci. Overall, this well-powered XWAS found no genetic risk factors for AD on the non-pseudoautosomal region of the X-chromosome, but it identified suggestive signals warranting further investigations.

Effective interventions to reduce sick leave in workers with mental illnesses: A systematic review of randomized controlled trials

OBJECTIVE

Effective interventions to reduce sick leave in people with mental illnesses remain unknown. This systematic review of randomized controlled trials (RCTs) assessed the impact of various interventions on reducing sick leave among individuals with mental illnesses.

METHODS

We conducted searches in PubMed, Cochrane Library, and PsycInfo until February 2024 and included RCTs with parallel designs. Two reviewers assessed the quality of trials using the Cochrane risk of bias tool (ROB-2).

RESULTS

Out of 5109 publications, 75 RCTs were included. Ten RCTs with no serious risk of bias demonstrated that certain interventions could reduce sick leave. Interventions based on cognitive behavioral therapy and problem-solving therapy reduced sick leave within a year, but the effect was not long-lasting. Enhanced care approaches, where physicians and care managers encouraged patients to start and maintain pharmacotherapy or psychotherapy, also decreased absenteeism. Online cognitive behavioral therapy yielded a modest decrease in absenteeism. An intervention involving both employees and supervisors to modify the workplace and address stress reduced long-term sick leave. Involving employees in stressor management initiatives decreased sick leave, and a combination of work-focused and online cognitive behavioral therapy reduced short-term sick leave but did not affect long-term (≥15 days) rates. Group therapy led by a clinical psychologist for stress management also showed benefits in the short term (3 months).

CONCLUSION

Multifaceted approaches that combine individual therapy and workplace adjustments are more effective in managing sick leave for individuals with mental illnesses than either approach alone.

Factors Associated With Dementia Worry Among Middle-Aged or Older Adults Living in a Japanese Community: A Cross-Sectional Study

Recently, dementia worry has been highlighted internationally; thus, Japan is making efforts to promote public understanding of dementia. This study clarified the factors associated with dementia worry among middle-aged or older adults living in a Japanese community. The participants completed questionnaires, including the Dementia Worry Assessment Scale and questions concerning personal attributes. We conducted a multiple regression analysis using the forced entry method, with the scale as the dependent variable and others as independent variables. A total of 299 completed questionnaires were analysed. The participants' mean age was 64.8 (±11.6) years. Univariate analysis and correlation coefficients showed that variables such as sex, bothering stress in the last year, depression severity, and number of bothering symptoms in the last year were associated with dementia worry. Multiple regression analysis reported the association between four factors-knowledge of dementia, number of bothering symptoms in the last year, depression severity and diagnosis of dementia in either or both parents-and the Dementia Worry Assessment Scale score. Specifically, more knowledge of dementia and more bothering symptoms resulted in a higher score. Moderate or severe depression and parents' diagnosis of dementia presented a higher score than those without. Nurses in the community are required to identify residents with these four factors and provide support to alleviate dementia worry. When residents experience severe dementia worry from greater knowledge of dementia, continuous education that is tailored to the individual knowledge bias should be provided by nurses.

Reducing premature mortality from cardiovascular diseases in low and middle income countries: The role of Polypill in public health policy

Premature deaths account for about half of all fatalities in developing countries. In low- and middle-income countries, cardiovascular diseases have consistently been the primary cause of premature mortality for men and women during the past three decades. Current evidence indicates that fixed-dose combination therapy, the so-called Polypill, effectively reduces the burden of cardiovascular diseases, with greater benefits observed in combinations that include aspirin. Polypill demonstrates high adherence and an acceptable safety profile, with adverse drug events being comparable between the groups receiving treatment and those in the control group. Therefore, this paper advocates for the broader implementation of Polypill in low and middle-income countries, emphasizing its efficacy in the primary and secondary prevention of cardiovascular diseases. The strategy could also benefit high-risk groups with special conditions, such as non-alcoholic fatty liver disease and chronic kidney disease. The cost-effectiveness of Polypill and its potential to address health inequities in low and middle-income countries underscore its value as a public health strategy. Policymakers are encouraged to consider Polypill as a viable option to enhance cardiovascular health outcomes and reduce premature deaths in low-resource settings.

Global, regional, and national burdens of hip fractures in elderly individuals from 1990 to 2021 and predictions up to 2050: A systematic analysis of the Global Burden of Disease Study 2021

PURPOSE

We aimed to analyse the global, regional, and national burdens of hip fractures in older adults from 1990 to 2021, with projections to 2050, on the basis of data from the GBD 2021 study.

METHODS

We employed a joinpoint model to analyse trends in the burden of hip fractures from 1990‒2021. The estimated annual percentage change (EAPC) was used to quantify temporal trends over this period. We evaluated the relationship between the social development index and the burden of hip fracture in elderly people and conducted a health inequality analysis. Additionally, we applied Long-short Term Memory (LSTM) networks to forecast burden trends of hip fractures up to 2050.

RESULTS

The global age-standardized incidence rate (ASIR) for hip fractures in older adults rose from 781.56 per 100,000 in 1990 to 948.81 in 2021. The 2021 age-standardized prevalence rate (ASPR) was 1,894.07, and the age-standardized YLD rate (ASDR) was 173.52. From 1990 to 2021, the incidence and prevalence increased by 168.71 % and 173.07 %, respectively, while the burden of DALYs decreased. Future trends were projected via the LSTM. The burden and risk factors for hip fractures varied significantly by sex, country, and region. Population and aging are primary contributors to the rising incidence of elderly hip fractures, with falls being the leading direct cause.

CONCLUSION

From 1990 to 2021, the global burden of hip fractures in the elderly population, especially among older women, steadily increased. Population ageing highlights the urgent need for targeted public health interventions and resource allocation, including early diagnosis, effective prevention strategies, and region-specific management approaches.

Vision transformer-based stratification of pre/diabetic and pre/hypertensive patients from retinal photographs for 3PM applications

Objective

Diabetes and hypertension pose significant health risks, especially when poorly managed. Retinal evaluation though fundus photography can provide non-invasive assessment of these diseases, yet prior studies focused on disease presence, overlooking control statuses. This study evaluated vision transformer (ViT)-based models for assessing the presence and control statuses of diabetes and hypertension from retinal images.

Methods

ViT-based models with ResNet-50 for patch projection were trained on images from the UK Biobank (n = 113,713) and Singapore Epidemiology of Eye Diseases study (n = 17,783), and externally validated on the Singapore Prospective Study Programme (n = 7,793) and the Beijing Eye Study (n = 6064). Model performance was evaluated using the area under the receiver operating characteristic curve (AUROC) for multiple tasks: detecting disease, identifying poorly controlled and well-controlled cases, distinguishing between poorly and well-controlled cases, and detecting pre-diabetes or pre-hypertension.

Results

The models demonstrated strong performance in detecting disease presence, with AUROC values of 0.820 for diabetes and 0.781 for hypertension in internal testing. External validation showed AUROCs ranging from 0.635 to 0.755 for diabetes, and 0.727 to 0.832 for hypertension. For identifying poorly controlled cases, the performance remained high with AUROCs of 0.871 (internal) and 0.655-0.851 (external) for diabetes, and 0.853 (internal) and 0.792-0.915 (external) for hypertension. Detection of well-controlled cases also yielded promising results for diabetes (0.802 [internal]; 0.675-0.838 [external]), and hypertension (0.740 [internal] and 0.675-0.807 [external]). In distinguishing between poorly and well-controlled disease, AUROCs were more modest with 0.630 (internal) and 0.512-0.547 (external) for diabetes, and 0.651 (internal) and 0.639-0.683 (external) for hypertension. For pre-disease detection, the models achieved AUROCs of 0.746 (internal) and 0.523-0.590 (external) for pre-diabetes, and 0.669 (internal) and 0.645-0.679 (external) for pre-hypertension.

Conclusion

ViT-based models show promise in classifying the presence and control statuses of diabetes and hypertension from retinal images. These findings support the potential of retinal imaging as a tool in primary care for opportunistic detection of diabetes and hypertension, risk stratification, and individualised treatment planning. Further validation in diverse clinical settings is warranted to confirm practical utility.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-025-00412-9.

Large-Scale Proteomics Improve Risk Prediction for Type 2 Diabetes

OBJECTIVE

This study evaluated the incremental predictive value of proteomic biomarkers in assessing 10-year type 2 diabetes risk when added to the clinical Cambridge Diabetes Risk Score (CDRS).

RESEARCH DESIGN AND METHODS

Data from 21,898 UK Biobank participants were used for model derivation and internal validation, and 4,454 Epidemiologische Studie zu Chancen der Verhütung, Früherkennung und optimierten Therapie chronischer Erkrankungen in der älteren Bevölkerung (ESTHER) cohort (Germany) participants were used for external validation. Proteomic profiling included the Olink Explore (2,085 proteins) and Olink Target 96 Inflammation panel (73 proteins).

RESULTS

Adding 15 proteins from Olink Explore or 6 proteins from the Olink Inflammation panel improved the C-index of the CDRS by 0.029 or 0.016 in internal validation with net reclassification of 23.0% and 29.0%, respectively. External validation was only conducted for the six-protein-extended model, and the C-index improved by 0.014.

CONCLUSIONS

The Olink Explore-based 15-protein model enhanced the CDRS model performance most, and this promising prediction model should be externally validated. Our successful external validation of the Olink Inflammation panel-based six-protein model shows that this is a promising endeavor.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Investigating the Interplay Between the Nrf2/Keap1/HO-1/SIRT-1 Pathway and the p75NTR/PI3K/Akt/MAPK Cascade in Neurological Disorders: Mechanistic Insights and Therapeutic Innovations

Neurological illnesses are debilitating diseases that affect brain function and balance. Due to their complicated aetiologies and progressive nature, neurodegenerative and neuropsychiatric illnesses are difficult to treat. These incurable conditions damage brain functions like mobility, cognition, and emotional regulation, but medication, gene therapy, and physical therapy can manage symptoms. Disruptions in cellular signalling pathways, especially those involving oxidative stress response, memory processing, and neurotransmitter modulation, contribute to these illnesses. This review stresses the interplay between key signalling pathways involved in neurological diseases, such as the Nrf2/Keap1/HO-1/SIRT-1 axis and the p75NTR/PI3K/Akt/MAPK cascade. To protect neurons from oxidative damage and death, the Nrf2 transcription factor promotes antioxidant enzyme production. The Keap1 protein releases Nrf2 during oxidative stress for nuclear translocation and gene activation. The review also discusses how neurotrophin signalling through the p75 neurotrophin receptor (p75NTR) determines cell destiny, whether pro-survival or apoptotic. The article highlights emerging treatment approaches targeting these signalling pathways by mapping these connections. Continued research into these molecular pathways may lead to new neurological disease treatments that restore cellular function and neuronal survival. In addition to enhanced delivery technologies, specific modulators and combination therapies should be developed to fine-tune signalling responses. Understanding these crosstalk dynamics is crucial to strengthening neurological illness treatment options and quality of life.

Implantable systems for neurological chronotherapy

Implantable systems for neurological chronotherapy are poised to revolutionize the treatment of central nervous system diseases and disorders. These devices enable precise, time-controlled drug delivery aligned with the body's circadian rhythms, optimizing therapeutic outcomes. By bypassing the blood-brain barrier, they achieve high local drug concentrations while minimizing systemic side effects, offering significant advantages for conditions where traditional therapies often fall short. Platforms like SynchroMed II and CraniUS showcase this innovation, providing programmable delivery for conditions such as epilepsy and glioblastoma, with customizable profiles ranging from continuous infusion to timed bolus administration. Preclinical and clinical studies underscore the efficacy of aligning drug delivery with circadian rhythms, enhancing outcomes in chrono-chemotherapy and anti-epileptic treatments. Despite their promise, challenges remain, including the invasiveness of implantation within the brain, device longevity, synchronization complexities, and cost(s). Accordingly, this review explores the current state of implantable neurological systems that may be leveraged for chronotherapy, their applications, limitations, and potential to transform neurological disease/disorder management.

Effects of Primary Healthcare Quality and Effectiveness on Hospitalization Indicators in Brazil

Advances in primary healthcare coverage for the improvement in health outcomes at the population level comprise a major goal of public policies of health, particularly considering increases in hospitalization costs linked to chronic diseases in recent decades. Previous evidence shows the positive effects of access to primary healthcare on hospitalization indicators in high-income countries; however, there is a lack of literature on the subject in Latin American countries. Thus, the present study proposes a quantitative investigation on connections between primary healthcare quality and effectiveness in relation to hospitalization indicators, in addition to the identification of its effects on inequalities in hospitalizations in Brazil. The study was based on an empirical analysis of data from five cross-sectional surveys representative at the population level conducted by the Brazilian Institute for Geography and Statistics (IBGE) in 1998, 2003, 2008, 2013, and 2019. Information on the demographic, socioeconomic, and health characteristics of individuals compatible across surveys were included in the analyses, in addition to data on household and survey characteristics. The statistical analyses were based on the estimation of logistic regression models for the exploration of effects of primary healthcare quality and effectiveness on hospitalizations, inpatient days, and perception of quality of hospital care. Furthermore, the estimation of concentration indexes and their disaggregation allowed to verify trends and determinants of inequalities in hospitalization indicators in Brazil throughout the period. The results indicate that primary healthcare effectiveness is associated with the lower occurrence and frequency of hospitalizations, and a lower length of stay in hospitals. Primary healthcare quality was associated with the perception of higher quality of hospital care. Trends in hospitalization indicators showed reduction in inequalities towards low-income individuals from 1998 to 2013, and primary healthcare quality presented minor influence on inequalities in hospitalizations, inpatient days, and perception of quality of hospital care.

A nomograph model for predicting the risk of diabetes nephropathy

OBJECTIVE

Using machine learning to construct a prediction model for the risk of diabetes kidney disease (DKD) in the American diabetes population and evaluate its effect.

METHODS

First, a dataset of five cycles from 2009 to 2018 was obtained from the National Health and Nutrition Examination Survey (NHANES) database, weighted and then standardized (with the study population in the United States), and the data were processed and randomly grouped using R software. Next, variable selection for DKD patients was conducted using Lasso regression, two-way stepwise iterative regression, and random forest methods. A nomogram model was constructed for the risk prediction of DKD. Finally, the predictive performance, predictive value, calibration, and clinical effectiveness of the model were evaluated through the receipt of ROC curves, Brier score values, calibration curves (CC), and decision curves (DCA). In addition, we will visualize it.

RESULTS

A total of 4371 participants were selected and included in this study. Patients were randomly divided into a training set (n = 3066 people) and a validation set (n = 1305 people) in a 7:3 ratio. Using machine learning algorithms and drawing Venn diagrams, five variables significantly correlated with DKD risk were identified, namely Age, Hba1c, ALB, Scr, and TP. The area under the ROC curve (AUC) of the training set evaluation index for this model is 0.735, the net benefit rate of DCA is 2%-90%, and the Brier score is 0.172. The area under the ROC curve of the validation set (AUC) is 0.717, and the DCA curve shows a good net benefit rate. The Brier score is 0.177, and the calibration curve results of the validation set and training set are almost consistent.

CONCLUSION

The DKD risk nomogram model constructed in this study has good predictive performance, which helps to evaluate the risk of DKD as early as possible in clinical practice and formulate relevant intervention and treatment measures. The visual result can be used by doctors or individuals to estimate the probability of DKD risk, as a reference to help make better treatment decisions.

Burden of cardiometabolic disease attributable to sugar sweetened beverages consumption in North Africa and the Middle East from 1990 to 2021

Objectives

The consumption of sugar-sweetened beverages (SSBs) is recognized as a significant risk factor for chronic non-communicable diseases (NCDs). Accurate estimates of the burden of SSBs are crucial for preventing, controlling, and treating associated diseases to achieve the Third United Nations Sustainable Development Goal of reducing premature mortality from NCDs by one-third by 2030. In this study, we aim to systematically assess the regional patterns and trends in the burden of SSBs in the North Africa and the Middle East (NAME) region. By analyzing regional differences, the study identifies specific areas where SSBs consumption has a more significant impact on public health.

Methods

The study data were retrieved from the Global Burden of Disease (GBD) study 2021. This study analyzed the impact of SSBs on mortality, years lived with disability, years of life lost, and disability-adjusted life years (DALYs) in 21 countries in the NAME region from 1990 to 2021. Our analysis considered various factors, including sex, age, region, and socio-demographic index.

Results

In 2021, DALYs attributable to SSBs there were 315,312 (95% uncertainty interval, 140,854 to 503,347) in absolute terms reflecting 518.3% (424.9 to 642.2) increase over three decades. From 1990 to 2021, the age-standardized rate of DALYs attributable to SSBs increased by 118.5%, from 27.9 (11.4 to 43.9) to 61.0 (27.6 to 97.0) per 100,000 population. Qatar (246.7 [113.1 to 404.5]), Saudi Arabia (201.2 [87.1 to 314.2]), and Bahrain (180.1 [78.4 to 295.8]) had the highest age-standardized rate of DALYs. The highest attributable DALYs and mortality from SSBs consumption were due to diabetes mellitus in all countries in 1990 and 2021. In 2021, Qatar (224.7 [104.9 to 365.5]), Bahrain (167.0 [74.8 to 274.8]), and Saudi Arabia (153.1 [75.3 to 230.4]) had the three highest age-standardized rates of DALYs from diabetes mellitus attributed to SSBs.

Conclusions

NAME witnessed a substantial increase in the burden attributable to SSBs. Alarmingly, exposure to SSBs has principally contributed to the increased burden of diabetes mellitus and chronic kidney disease. Among the region's countries, exposure and attributable burden trends vary considerably. It is imperative that governments and health authorities within the NAME region work together to combat SSBs' detrimental effects. Local, socioeconomic, and educational factors need to be considered when developing prevention and treatment strategies at the individual, community, and national levels.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-025-01578-9.

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

BACKGROUND

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Genome-wide association study -Driven drug repositioning for the treatment of insomnia

Insomnia is a prevalent sleep disorder characterized by difficulty initiating or maintaining sleep, leading to severe health complications, increased mortality, and substantial socioeconomic burdens. Despite therapeutic advancements, effective pharmacological interventions remain limited, necessitating alternative approaches for drug discovery. This study aimed to identify potential therapeutic targets for insomnia by integrating gene network analysis, genomic data, and bioinformatics-driven drug repurposing strategies, aligning with the United Nations' Sustainable Development Goal (SDG) 3: Good Health and Well-being. Insomnia-associated Single Nucleotide Polymorphisms (SNPs) were retrieved from the GWAS catalog, yielding 3,952 loci. Insomnia risk genes were identified by linking these loci to proximal SNPs (r2 ≥ 0.8) in Asian populations using HaploReg v4.2, resulting in 1,765 candidate genes. A bioinformatics pipeline incorporating ten functional annotations and drug-gene interaction was employed to prioritize gene targets and identify novel repurposed drugs with potential biological relevance to insomnia. Drug-Gene Interaction Database (DGIdb) analysis identified seven druggable targets among 27 biologically significant insomnia risk genes, corresponding to 12 existing drugs. Notably, NRXN1 emerged as a highly promising target due to its strong functional annotation score and its known interaction with Duloxetine hydrochloride and nicotine polacrilex. This study underscores the potential of bioinformatics-driven gene network analysis in identifying drug repurposing candidates for insomnia. Further experimental validation is warranted to elucidate the therapeutic mechanisms of NRXN1 modulation in insomnia treatment.

Cognitive markers of resilience to dementia in mild Neurocognitive Impairment: a meta- analysis

BACKGROUND

Numerous risk factors for dementia have been identified, but the concern of how cognitive functions in the mild Neurocognitive Impairment (mild NCI) stage predict dementia occurrence and incidence is still a matter of debate. The present paper aims to fill this gap by conducting an updated meta-analysis of studies examining the probability over time of developing dementia in relation to measures of global cognitive functioning, long-term verbal memory, complex attention, visuoconstructional ability, and language in the mild NCI stage.

METHODS

We conducted a systematic literature search up to March 2024 in PubMed, PsycINFO (PROQUEST), and Scopus databases. We used random-effects models to pool the ratio measure (odds, hazard, or risk ratios) for the association between cognitive domains and the risk of developing dementia in people with mild NCI.

RESULTS

The systematic search in electronic databases identified 44 relevant studies. Results showed that better performance in long-term verbal memory, visuoconstructional, and language abilities in individuals with mild NCI were associated with a lower risk of progression to dementia.

DISCUSSION

These findings might suggest that interventions aimed at preserving or enhancing these cognitive domains could be beneficial in delaying or preventing dementia onset, offering a potential therapeutic target for clinicians working with at-risk populations.

N-acetyl-L-cysteine mitigates diabetes-induced impairments in sciatic nerve

Diabetic neuropathy is a consequence of long-term hyperglycemia. The emergence of neuronal condition is a result of hyperglycemia-induced oxidative stress. In the present study, streptozotocin-induced diabetes exhibited notable decrease in the levels of phospholipids, glycolipids, gangliosides, and triglycerides in the sciatic nerve. The alterations in lipids resulted in increase in cholesterol to phospholipid ratio in sciatic nerve of diabetic animals. This ratio is crucial and determines the rheological properties of membranes and resulted in substantial reduction in the activity of membrane-bound enzymes; Ca2 + ATPase and acetylcholinesterase. Histological examination of the cross-section of the sciatic nerve in diabetic mice revealed axonal atrophy and disarrayed myelin sheath. The potential therapeutic impact of N-acetyl Cysteine (NAC), a powerful antioxidant, on a rat model of diabetic neuropathy was evaluated. NAC was administered to rats in drinking water for a period of 8 weeks. The results indicate that administration of NAC restored lipid composition; ratio of cholesterol to phospholipids, the activity of membrane linked enzymes, and improved the structural defects in sciatic nerve. NAC plays protective role against diabetes-induced alterations in lipid composition in sciatic nerve membranes leading to improvement in structure and function of membranes. Overall, the findings suggest NAC as a potential therapeutic strategy in preventing diabetic neuropathy and other diabetic complications.

The role of branched chain aminotransferase in the interrelated pathways of type 2 diabetes mellitus and Alzheimer's disease

Objectives

This review assessed the role of Branched-Chain Amino Acid Transaminase (BCAT) enzymes in human metabolism, and their involvement in the catabolism of branched-chain amino acids (BCAAs) and exploring the association between Type 2 Diabetes Mellitus (T2DM) and Alzheimer's disease (AD) through insulin resistance.

Methods

The analysis involves a comprehensive literature review of recent research findings related to BCAT enzymes, BCAA metabolism, T2DM, and AD. Relevant studies and articles were identified through systematic searches in databases such as PubMed, ScienceDirect, and other scholarly resources. Inclusion criteria encompassed research articles, reviews, and studies published in peer-reviewed journals, with a focus on human metabolism, BCAT enzymes, and the interplay between BCAA metabolism, T2DM, and AD.

Results

The association between T2DM and AD suggests a potential metabolic link, particularly through dysregulated BCAA metabolism leading to insulin resistance. The impact of impaired insulin signaling is implicated in brain function and the accumulation of amyloid plaques facilitated by BCAT.

Conclusion

The identified link between BCAT, BCAA metabolism, T2DM, and AD suggests that disruptions in BCAT levels could serve as valuable indicators for early detection of insulin resistance and cognitive impairment as observed in Type 3 Diabetes which may present a promising therapeutic target.

Global burden and national health inequity of ischemic heart disease attributed to kidney dysfunction from 1990 to 2021: Findings from the global burden of disease study 2021

BACKGROUND AND AIMS

To estimate the global disease burden and cross-national inequalities in the distribution of ischemic heart disease attributable to kidney dysfunction (KI-IHD) from 1990 to 2021.

METHODS

The estimates for age-standardized death rates (ASDR) and age-standardized disability-adjusted life-years rates (ASDAR) of KI-IHD were obtained from the Global Burden of Disease Study (GBD) 2021. Data for gross domestic product (GDP) and GDP growth rates were extracted from World Bank database. The average annual percent change (AAPC) was calculated to analyze temporal trends of ASDR and ASDAR by Joinpoint regression model. Slope index of inequality and concentration index were generated to quantify the cross-national socioeconomic inequality of KI-IHD burden.

RESULTS

From 1990 to 2021, the ASDR and ASDAR of KI-IHD has shown downward trend globally; with AAPC values of -1.384 % and -1.204 %. The ASDR and ASDAR of KI-IHD was higher in males than females, with increasing age, the burden gradually increased. The concentration index showed 0.02 (95%CI: 0.02, 0.06) in 1990 and -0.11 (95%CI: 0.15, -0.07) in 2021. The slope index of inequality showed that an excess of 170 ASDR per 100,000 existed between countries with the lowest and the highest SDI in 1990, however, in 2021, the results are reversed, a reduction of 159 per 100,000. GDP growth rate and GDP per capita might be associated with the health inequality of KI-IHD.

CONCLUSION

The burden of KI-IHD has decreased in almost 70 % of countries over the past three decades. Disproportional distribution of health inequalities was concentrated in poor countries.

Curvilinear incidence models for parity in the entire fertility range for cancers of the breast, ovary, and endometrium: A follow-up of the Norwegian 1960 Census

The protective effect of parity has been demonstrated for cancer of the breast, ovary, and endometrium but no studies have estimated the effect of each subsequent birth in women with 10 or more children or grand-grand parity women, nor compared the linear relationship of the three cancers sites. Here, we aim to explore these relationships based on the Norwegian 1960 Census. The question of parity in present marriage was answered by 385,816 women born 1870-1915, a period with high fertility. Age at marriage has been validated as a proxy for age at first birth AFB. With high parity age at first birth will logically be restricted to early births giving structural zeros. Follow-up was based on linkages to national registers until the first of any of the three diagnoses, death, or age 90 before 31.12.2005. Included were 16,905 breast cancers, 3827 ovarian cancers, and 3834 endometrial cancers. Age- and period-specific incidence rates based on person-years, PY, were used in logit regression models. The percentage decrease for each additional child over the total parity range was for breast cancer 10.5% (95% CI; 9.6-11.4), ovarian cancer 13.2% (11.2-15.3), and endometrial cancer 10.9% (8.9-12.8), in a model without higher order terms. Adjustment for structural zeros reduced the effect of age at first birth to less than one additional child. To the best of our knowledge this is the first analysis of the curvilinear relationships for cancers of the breast, ovary, and endometrium throughout the extended fertility range.

The rabies virus matrix protein (RABV M) interacts with host histone deacetylase 6 (HDAC6) to activate the MEK/ ERK signaling pathway and enhance viral replication

Rabies virus (RABV) is the causative agent of rabies, posing a severe threat to human and animal health. The matrix (M) protein of RABV plays crucial roles during viral infection. In this study, we identified RABV M protein interacted with host histone deacetylase 6 (HDAC6) through a combination of immunoprecipitation and mass spectrometry analysis. Specifically, the catalytic domains of HDAC6 (amino acids 435-835) was shown to be critical for the interaction between HDAC6 and the RABV M protein. Overexpression of HDAC6 significantly enhanced RABV replication, whereas inhibition of HDAC6 expression or its deacetylase activity had the opposite effect，indicating that HDAC6 is a positive regulator of RABV replication. We further determined that RABV infection actives the MEK/ERK pathway, and inhibition of this pathway with U0126 significantly reduced viral titers. Moreover, HDAC6 positively regulated MEK/ERK pathway activation in a manner independent of its deacetylase activity but dependent on the presence of HDAC6 during virus infection. Finally, we demonstrated that co-expression of RABV M enhanced the role of HDAC6 in facilitating MEK/ERK pathway activation. Collectively, our findings demonstrate that RABV exploits the HDAC6-M interaction to hijack the MEK/ERK signaling axis, which is essential for viral replication. Notably, HDAC6 facilitates MEK/ERK activation in a deacetylase activity-independent manner, revealing a novel mechanism by which viruses manipulate host machinery. These results highlight HDAC6 as a potential therapeutic target for combating rabies.

Multimodal fusion architectures for Alzheimer's disease diagnosis: An experimental study

OBJECTIVE

In the attempt of early diagnosis of Alzheimer's Disease, varying forms of medical records of multiple modalities are gathered to seize the interaction of multiple factors. However, the heterogeneity of multimodal data brings a challenge. Hence, the role of artificial intelligence comes into play to provide the medical practitioner assistance in making diagnosis and prognosis. In order to be adopted as a clinical decision support system, interpretable or explainable model is important for healthcare professionals to trust the results. This study assessed various popular machine learning models under two multimodal fusion architectures to find the best combination in terms of both predictive performance and interpretability.

METHODS

Two architectures, early and late, also known as feature- and decision-level fusion were chosen for multinomial classification task. On top of the commonly used simple concatenation, this study employed weighted and hybrid weighted concatenation to fuse features within and across modalities under the two fusion structures. To test the efficacy of each model pipeline, the assessment was done according to their distinct foundations on which the models were built and each of their advantages was recognized. Classification metrics were unified and visualized into a pentagon to compare the overall performance of each pipeline. In addition, interpretability analysis was provided to quantify the importance of each modality and feature recognized by each model.

RESULTS

The potential characteristics of each type of pipelines in terms of prediction accuracy and ability to capture the relevant markers of each cognitive state were uncovered. In this particular healthcare application, the tree-based and linear models were the top 2 choices. Coupled with early and late fusion structure with weighted concatenation, reaching the balanced accuracy of 0.920 and 0.912, consecutively. The top 5 most important features revealed belong to Cognitive Test Scores and Neuropsychological Battery of Test modalities.

CONCLUSION

This work contributes as medical applications of artificial intelligence evaluation to aid practitioners in understanding the capability of different fusion architectures with different classifiers in getting to know the use of machine learning in clinical setting. With accurate classification, early detection of Mild Cognitive Impairment and Alzheimer's Disease can be achieved.

The burden of informal family caregiving in Europe, 2000-2050: a microsimulation modelling study

Background

The demand for informal care in Europe is increasing, with family members often providing essential support. However, the future burden of informal family caregiving remains unclear. This study estimates and projects trends in the burden of family caregiving across 31 European countries from 2000 to 2050.

Methods

We developed a demographic microsimulation model to estimate and project family care burden. The model produces virtual populations with realistic kinship networks and health trajectories over time. From these kinship structures, we defined a novel metric - Years Lived Caregiving for older relatives (YLCs). It accounts for care recipients' disability severity, care dynamics within kinship networks, and national institutional care capacity. Model inputs included demographic data from UN World Population Prospects, marital statistics from Eurostat, disease prevalence from the Global Burden of Disease study, and microdata from the SHARE survey.

Findings

From 2000 to 2050, in Europe the overall burden for informal care is projected to increase by +49.7% (95% UI 45-53.6), from 7.98 (7.65-8.28) to 11.9 (11.4-12.5) million YLC. Musculoskeletal disorders are the largest cause of care burden, contributing to 2.3 (2.18-2.42) million YLC in 2050. Burden of informal care is disproportionally higher for women, although the gender gap is in a descending trend.

Interpretation

Projections indicate a substantial rise in the informal family care burden across Europe by 2050, with only limited offsetting from institutional care. These findings underscore the need for comprehensive strategies to support both caregivers and care recipients, ensuring sustainable healthcare systems across Europe.

Funding

Italian government and the European Union, National Plan for NRRP Complementary Investments (PNC).

Italian adolescents' body image and sociocultural influences: An investigation using the Sociocultural Attitudes Towards Appearance Questionnaire-4-Revised

Body dissatisfaction and eating disorders (EDs) are highly prevalent among adolescents, imposing a significant burden on this group. Therefore, a deeper investigation into the risk factors of these issues is urgently needed. In this regard, adopting a sociocultural framework can offer valuable insights; however, research on the assessment of appearance-related sociocultural pressures among adolescents remains limited. This study aimed to validate the Sociocultural Attitude Towards Appearance Questionnaire-4-Revised (SATAQ-4R) among Italian adolescents aged 13-17 years. A total of 692 girls (Mage = 15.5 years ± 1.16) and 450 boys (Mage = 15.2 years ± 1.21) completed the Female and Male versions of the SATAQ-4R along with other self-report tools assessing ED symptoms, body dissatisfaction, self-esteem, peer and family appearance pressure, drive for muscularity, and frequency of Instagram appearance comparisons. To investigate the SATAQ-4R factor structure, several models were tested. Measurement invariance across early and middle adolescent groups, reliability, and validity were addressed. The original 7-factor model yielded the best fit to the data for both boys and girls. This model was also invariant across age groups. Both the SATAQ-4R-Male and Female exhibited excellent psychometric properties in terms of construct and criterion validity, as well as internal consistency (McDonald's omega values ranging from .79 to .93 for the SARAQ-4R-Male and from .82 to .93 for the SATAQ-4R-Female). Therefore, the SATAQ-4R can be considered a valid and reliable tool for measuring societal influences on body image among Italian adolescents. Research and practical implications are discussed.

DCLK1 in gastrointestinal cancer: A driver of tumor progression and a promising therapeutic target

Cancers of the gastrointestinal (GI) tract, including colorectal, pancreatic, and hepatocellular carcinomas, represent a significant global health burden due to their high incidence and mortality rates. Doublecortin-like kinase 1 (DCLK1), initially identified for its role in neurogenesis, has emerged as a crucial player in GI cancer progression. This review comprehensively examines the multifaceted roles of DCLK1 in GI cancers, focusing on its structural isoforms, functions in normal and inflammatory states, and contributions to cancer progression and metastasis. DCLK1 is overexpressed in various GI cancers and is associated with poor prognosis, enhanced tumorigenic potential, and increased metastatic capacity. The review discusses the molecular mechanisms through which DCLK1 influences cancer stem cell maintenance, epithelial-mesenchymal transition (EMT), and cell survival pathways, as well as its interactions with key signaling pathways such as Notch, WNT/β-catenin, and NF-κB. The potential of DCLK1 as a therapeutic target is also explored, highlighting preclinical and early clinical efforts to inhibit its function using small molecule inhibitors or monoclonal antibodies. Despite significant advancements, further research is needed to fully elucidate DCLK1's role in GI cancers and to develop effective therapeutic strategies targeting this protein.

Age- and sex-specific analysis of the impact of bipolar disorder in Iran and its provinces: Prevalence, incidence, and disability-adjusted life years: Global burden of disease 2021

OBJECTIVES

This study sought to deliver a prevalence, incidence, and Disability-Adjusted Life Years (DALYs) of bipolar disorder in Iran, covering both national and subnational scales. The results were broken down by age group and sex, alongside an analysis of trends in bipolar disorder from 1990 to 2021. The estimates gathered were further compared to global averages to offer deeper insights into the prevalence and impact of bipolar disorder in Iran.

METHODS

This study analyzed data from the Global Burden of Disease 2021 framework to assess various health metrics. Key indicators such as prevalence, incidence, and Disability-Adjusted Life Years (DALYs) were examined using all-age count estimates and age-standardized rates per 100,000 individuals. The analysis spanned the years 1990 to 2021, with results categorized by sex, age group, and geographic location. Furthermore, percentage changes over this period were calculated. To enhance the reliability of the findings, all reported estimates included a 95 % uncertainty interval.

RESULTS

In 1990, the age-standardized prevalence rate of bipolar disorder in Iran was 770.09 per 100,000 individuals [95 % UI: 657 to 902], and by 2021, it slightly increased to 780 per 100,000 [95 % UI: 667 to 915]. The percentage change over the period from 1990 to 2021 was 0.01 %. In 2021, the total number of bipolar disorder cases in Iran was reported at 724,891, with a 95 % uncertainty interval ranging from 614,626 to 848,263. Among these cases, 376,813 were observed in females and 348,077 in males. Notably, individuals aged 10 to 24 accounted for 127,388 of the overall cases, making this age group the most affected. The age-standardized incidence rate (per 100,000) of bipolar disorder was estimated to be 52 [95 % UI: 44 to 61] in 1990 and 53 [95 % UI: 45 to 62] in 2021, reflecting a minimal change of 0.01 % over this period. Similarly, the age-standardized disability-adjusted life years (DALYs) rate (per 100,000) for bipolar disorder was recorded at 164 [95 % UI: 107 to 240] in 1990 and 166 [95 % UI: 109 to 241] in 2021, with an equivalent negligible change of 0.01 % from 1990 to 2021.

DISCUSSION

In Iran, the burden of bipolar disorder has been found to exceed global averages, and due to demographic changes, young population, regional stressors this burden has grown significantly over the past three decades. Therefore, it remains crucial to focus increasing access to mental health care by increasing mental health care infrastructure in the country, especially in densely populated areas.

Are We Stepping Back? Findings From an Italian Study on Post-Pandemic Changes in Nursing Education

AIM

To describe (a) recommended changes implemented and their perceived effectiveness at the country level, (b) changes discontinued in the post-pandemic era with reasons, and (c) research priorities in nursing education for the next five years.

BACKGROUND/INTRODUCTION

The COVID-19 pandemic has pushed several nursing education transformations. However, no studies have documented changes still prevalent in the post-pandemic era.

DESIGN

A national cross-sectional study following the STROBE guidelines.

METHODS

All Italian nursing programs (n = 241) were targeted. Eight major and 21 subrecommendations indicating changes expected were included in the online survey to measure their implementation, their perceived effectiveness and status at the time of the survey, discontinuation reasons, and the research priorities. Descriptive and content analyses were used.

RESULTS

113 (45.5%) nursing programs participated reflecting the education received by >70% of Italian nursing students. All recommended changes have been implemented from 60.2% to 100% nursing programs, resulting in a perceived effectiveness from 4.29 (confidence interval [CI] 95%, 4.07-4.51) to 6.37 (CI 95%, 6.19-6.56) out of 7. A few recommendations were still applied at the time of the survey, while several were discontinued (from 4.8% to 61.9%) because, in order, of concern regarding their effectiveness, university/law dispositions, traditional methods reimplemented, technical/logistic difficulties and students' requests. Digital solutions' impact on nursing education was identified as a research priority.

CONCLUSION

After the multifaced changes triggered by the pandemic, the pace of transformation of nursing education seems to have been decelerated.

IMPLICATIONS FOR NURSING

The potential regressive pattern that has emerged, wherein the previous model of nursing education is repristinated, calls for immediate action, which is also in line with the research priorities.

Efficacy of digital therapeutic applications for cognitive training among older adults with mild cognitive impairment or dementia: A systematic review and network meta-analysis of randomized controlled trials

Various digital therapeutics (DTx), which utilize computerized cognitive training (CCT) to improve cognitive functioning, have been tested and released. However, the efficacy of these DTx approaches may be diverse. This study aims to meta-synthesize the associations between mobile applications and cognitive functioning outcomes in older adults with mild cognitive impairment (MCI) or dementia from randomized controlled trials (RCTs). We searched PubMed, EMBASE, Scopus, and Cochrane Library from the inception through the end of June 2024. We selected RCTs using mobile application interventions in older adults with MCI or dementia. Interventions and comparisons included: CCT, intensive CCT (CCT2x), computerized cognitive engagement, progressive resistance training (PRT), CCT plus medication, CCT plus PRT, and medications only. Outcomes of interest included cognitive functioning and other measures of functioning (e.g., activities of daily living [ADLs]). Network meta-analysis was conducted to estimate pooled standardized mean differences (SMDs) with corresponding 95 % confidence intervals (CIs). Of 1,189 studies extracted, 10 RCTs were included in our analysis. CCT2x demonstrated statistically significant improvements in global cognitive function (SMD, 1.21 [95 % CI, 0.69-1.73]), episodic memory (SMD, 0.87 [0.47-1.27]), and working memory (SMD, 0.93 [0.44-1.42]) when compared with controls. For ADLs, CCT significantly reduced functional impairment (SMD, -0.80 [-1.40 to -0.21]). In depressive symptoms, CCT2x was the most effective in reducing symptoms (SMD, -0.77 [-1.08 to -0.45]). Overall, the DTx may be effective in improving cognitive and other functioning outcomes in older adults with MCI or dementia.

Prospective Investigation Unravels Plasma Proteomic Links to Dementia

Investigating plasma proteomic signatures of dementia offers insights into its pathology, aids biomarker discovery, supports disease monitoring, and informs drug development. Here, we analyzed data from 48,367 UK Biobank participants with proteomic profiling. Using Cox and generalized linear models, we examined the longitudinal associations between proteomic signatures and dementia-related phenotypes. Mendelian randomization analysis was employed to identify causal associations, and machine learning algorithms were applied to develop protein-based models for dementia prediction. We identified 74 proteins significantly associated with the risk of various types of dementia and cognitive functions after Bonferroni correction. Among these, strong associations were observed for growth/differentiation factor 15 (GDF15), glial fibrillary acidic protein (GFAP), and neurofilament light polypeptide (NEFL), across all types of dementia. Additionally, 15 proteins demonstrated significant associations with neuroimaging-defined dementia endophenotypes. Two-sample Mendelian randomization analyses further substantiated causal relationships between dementia-associated proteins and Alzheimer's disease, particularly involving GDF15, proto-oncogene tyrosine-protein kinase receptor Ret (RET), and GFAP. Moreover, we identified three protein modules associated with dementia, primarily linked to immune system processes, angiogenesis, and energy metabolism, providing insights into potential biological pathways underlying the disease. Furthermore, we proposed a ten-protein panel capable of forecasting dementia over a median follow-up period of 8.6 years, achieving an area under the curve (AUC) of 0.857 (95% confidence interval (CI), 0.837-0.876). Our results revealed dementia-associated plasma proteomic signatures, and their causal relationships, notably GDF15-RET signaling with Alzheimer's disease, and proposed a promising protein panel for high-risk dementia screening.

Milk-derived exosomes as functional nanocarriers in wound healing: Mechanisms, applications, and future directions

Wound healing presents a significant challenge in healthcare, imposing substantial physiological and economic burdens. While traditional treatments and stem cell therapies have shown benefits, milk-derived exosomes (MDEs) offer distinct advantages as a cell-free therapeutic approach. MDEs, isolated from mammalian milk, are characterized by their biocompatibility, ease of acquisition, and high yield, making them a promising tool for enhancing wound repair. This review provides a comprehensive analysis of the composition, sources, and extraction methods of MDEs, with a focus on their therapeutic role in both acute and diabetic chronic wounds. MDEs facilitate wound healing through the delivery of bioactive molecules, modulating key processes such as inflammation, angiogenesis, and collagen synthesis. Their ability to regulate complex wound-healing pathways underscores their potential for widespread clinical application. This review highlights the importance of MDEs in advancing wound management and proposes strategies to optimize their use in regenerative medicine.

Yoga in Obesity Management: Reducing cardiovascular risk and enhancing well-being- A review of the current literature

BACKGROUND

Obesity, a global epidemic, significantly increases cardiovascular disease (CVD) risk. Conventional treatments often lack long-term efficacy, emphasizing the need for integrative, sustainable approaches.

OBJECTIVE

This review assesses the role of yoga as a complementary intervention in obesity management and its effectiveness in reducing cardiovascular risk.

METHODS

We systematically reviewed literature up to March 2024 from Medline/PubMed, Scopus, Embase and the Cochrane Central Library. The focus was on randomized controlled trials (RCTs), observational studies, systematic reviews and meta-analyses evaluating the impact of yoga on obesity-related outcomes and cardiovascular risk factors. Studies were reviewed for quality, outcomes, and both physiological and psychological effects of yoga on obese individuals.

RESULTS

Yoga interventions consistently yielded positive results in reducing body mass index (BMI), waist circumference, and body fat. These physical changes correlate with significant improvements in cardiovascular markers, including blood-pressure, cholesterol levels, endothelial and autonomic functions. Yoga also enhances stress management and psychological well-being, addressing both mental and physical facets of obesity. The benefits extend beyond mere weight reduction, affecting systemic inflammation and metabolic health, crucial for mitigating CVD risks.

CONCLUSION

Yoga represents a promising, non-pharmacological approach to obesity management and CVD risk reduction. Its holistic impact on physical and psychological health makes it a viable adjunct therapy in comprehensive obesity management, fostering sustainable lifestyle changes and long-term health benefits.

IMPLICATIONS

Incorporating yoga into standard obesity management protocols could enhance therapeutic outcomes. Future research should standardize yoga interventions to better integrate them into modern healthcare and explore their long-term cardiovascular effects.

Assessment of immune function in individuals without and with obesity and normoglycemia, glucose intolerance, or type 2 diabetes: primary findings of the NutrIMM study, a single-arm controlled feeding trial

BACKGROUND

Obesity and type 2 diabetes (T2D) are associated with immune dysfunction, increasing infection susceptibility and impairing immune responses. However, the independent effects of obesity and hyperglycemia on immune dysregulation remain unclear, particularly under controlled dietary conditions.

OBJECTIVES

The Nutrition and Immunity study investigated the effects of obesity and hyperglycemia on immune cell function, phenotype, and systemic inflammation in individuals with obesity with or without T2D, compared with lean individuals with normoglycemia.

METHODS

This single-arm controlled feeding trial included 112 participants across 4 groups: lean-normoglycemic (Lean-NG), obese-normoglycemic (OB-NG), obese-glucose intolerant (OB-GI), and obese-T2D. Participants followed a standardized isocaloric North American diet for 4 wk. Blood samples were collected at baseline and week 4. One-way and repeated measures analysis of variance assessed group differences and/or dietary effects. Linear regression analyses examined associations between glucose control and immune function.

RESULTS

C-reactive protein levels were higher in the OB-NG group [mean difference (MD): 4.1 mg/L; 95% confidence interval (CI): 1.7, 6.6], OB-GI group (MD: 3.1 mg/L; 95% CI: 0.82, 5.4), and OB-T2D (MD: 2.7 mg/L; 95% CI: 0.3, 5.1) compared with Lean-NG, whereas interleukin (IL)-2 secretion was lower in OB-T2D group (MD: -2086.4 pg/mL; 95% CI: -4375.9, -37.4). OB-T2D also exhibited higher neutrophils (MD: 0.7%; 95% CI: 0.01, 0.12), Systemic Immune-Inflammation Index (MD: 155.3; 95% CI: 0.90, 309.7), and system inflammation response index (MD: 0.58, 95% CI: 0.20, 0.97) compared with Lean-NG, and a lower proportion of naïve CD8+ T cells than OB-NG (MD: -13.7%; 95% CI: -27.3, -0.14). Regression analysis showed an association between hyperglycemia and reduced immune function, particularly for IL-2 (β = -0.296, P = 0.037) and interferon-gamma secretion (β = -0.325, P = 0.017).

CONCLUSIONS

Immune function is compromised in obesity and worsens in T2D, suggesting both obesity and poor glucose control drive immune dysfunction. Addressing metabolic health may help mitigate immune dysfunction and inflammation in obesity-related conditions.

TRIAL REGISTRATION NUMBER

This trial was registered at clinicaltrials.gov as NCT04291391 (https://www.

CLINICALTRIALS

gov/study/NCT04291391?term=NCT04291391&rank=1).

Anti-Amyloid Therapies for Alzheimer's Disease and Amyloid-Related Imaging Abnormalities: Implications for the Emergency Medicine Clinician

Alzheimer's disease is the neurodegenerative disorder responsible for approximately 60% to 70% of all cases of dementia and is expected to affect 152 million by 2050. Recently, anti-amyloid therapies have been developed and approved by the Food and Drug Administration as disease-modifying treatments given as infusions every 2 to 5 weeks for Alzheimer's disease. Although this is an important milestone in mitigating Alzheimer's disease progression, it is critical for emergency medicine clinicians to understand what anti-amyloid therapies are and how they work to recognize, treat, and mitigate their adverse effects. Anti-amyloid therapies may be underrecognized contributors to emergency department visits because they carry the risk of adverse effects, namely amyloid-related imaging abnormalities. Amyloid-related imaging abnormalities are observed as abnormalities on magnetic resonance imaging as computed tomography is not sensitive enough to detect the microvasculature abnormalities causing vasogenic edema (amyloid-related imaging abnormalities-E) microhemorrhages and hemosiderin deposits (amyloid-related imaging abnormalities-H). Patients presenting with amyloid-related imaging abnormalities may have nonspecific neurologic symptoms, including headache, lethargy, confusion, and seizures. Anti-amyloid therapies may increase risk of hemorrhagic conversion of ischemic stroke patients receiving thrombolytics and complicate the initiation of anticoagulation. Given the novelty of anti-amyloid therapies and limited real-world data pertaining to amyloid-related imaging abnormalities, it is important for emergency medicine clinicians to be aware of these agents.

Unlocking the Neuroprotective Potential of Silymarin: A Promising Ally in Safeguarding the Brain from Alzheimer's Disease and Other Neurological Disorders

Medicinal plants and their phytochemicals have been extensively employed worldwide for centuries to address a diverse range of ailments, boasting a history that spans several decades. These plants are considered the source of numerous medicinal compounds. For instance, silymarin is a polyphenolic flavonoid extract obtained from the milk thistle plant or Silybum marianum which has been shown to have significant neuroprotective effects and great therapeutic benefits. Neurodegenerative diseases (NDs) are a class of neurological diseases that have become more prevalent in recent years, and although treatment is available, there is no complete cure developed yet. Silymarin utilizes a range of molecular mechanisms, including modulation of MAPK, AMPK, NF-κB, mTOR, and PI3K/Akt pathways, along with various receptors, enzymes, and growth factors. These mechanisms collectively contribute to its protective effects against NDs such as Alzheimer's disease, Parkinson's disease, and depression. Despite its safety and efficacy, silymarin faces challenges related to bioavailability and aqueous solubility, hindering its development as a clinical drug. This review highlights the molecular mechanisms underlying silymarin's neuroprotective effects, suggesting its potential as a promising therapeutic strategy for NDs.

Trends in the incidence and burden of otitis media in children: a global analysis from 1990 to 2021

BACKGROUND

Otitis media (OM) is a prevalent and serious condition in childhood, but comprehensive global studies assessing its burden are lacking.

METHODS

Using data from the 2021 Global Burden of Disease (GBD) study, we analyzed OM incidence cases and disability-adjusted life years (DALYs) in children aged 0-14 from 1990 to 2021. Trends were analyzed across regions, age groups, sexes, and socio-demographic index (SDI) using estimated annual percentage changes (EAPC). Predictive models were used to forecast trends to 2050.

RESULTS

The global number of OM incidence cases in children increased from 256 million in 1990 to 297 million in 2021, a 15.97% rise. The age-standardized incidence rate (ASIR) showed a slight increase (EAPC: 0.12). Despite some variations across age, sex, and regions, the age-standardized DALY rate (ASDR) declined. ASIR and ASDR were highest in children aged < 1 year and gradually decreased with age. The largest burden was observed in low- and middle-low-SDI regions, although these regions showed the greatest declines in EAPC. Correlation analysis indicated that ASDR decreases as the SDI increases. By 2050, the number of global OM incidence cases in children is projected to reach 334 million, with most of the increase concentrated in low-SDI regions, while ASIR is expected to remain stable.

CONCLUSION

Although progress has been made in controlling OM in children over the past 30 years, the ASIR remains high. The sustained high burden and incidence of OM in low-SDI regions, and among young children, pose a significant challenge to children's health.

The changes in global burden of autoimmune diseases two years after the COVID-19 pandemic: a trend analysis based on the Global Burden of Disease Study 2021

Background

Data on the epidemiological changes in the global burden of autoimmune diseases (ADs) after the Coronavirus disease 2019 (COVID-19) pandemic is lacking. This study investigated the impact of the COVID-19 pandemic on the global burden of ADs, including psoriasis (PsO), inflammatory bowel disease (IBD), type 1 diabetes (T1DM), rheumatoid arthritis (RA), and multiple sclerosis (MS).

Methods

Age-standardized rates (ASR), including incidence (ASIR), prevalence (ASPR), disability-adjusted life years (DALYs), and death (ASDR), were extracted from the Global Burden of Disease Study 2021 from 1990 to 2021. The changes in number and ASR of ADs burden were assessed by absolute and relative increases comparing 2021 to 2019. Joinpoint regression analysis was used to determine whether the year 2019 marked the substantial changes in trends of ASR across global, 21 geographical regions, and 204 countries. The correlations between COVID-19 incidence, vaccination and the relative increased ASIR/ASPR of ADs were also evaluated.

Results

Joinpoint regression analysis identified 2019 as a pivotal year, marking a global increase in the burden of PsO. The global ASR of PsO in 2021 showed an increased incidence, prevalence, and DALYs of 0.78, 5, and 0.33 DALYs per 100,000, respectively, compared to 2019 (194.1 × 103 cases, 1651.3 × 103 cases, and 131.4 × 103 DALYs, respectively). Notable absolute increases in PsO incidence rates in 2021 were observed in regions with a high socio-demographic index, particularly among individuals aged 50 to 54 and among males. Furthermore, 2019 marked a joinpoint with increased ASIR or ASPR of ADs in various regions, notably PsO in High-income North America, Southern Latin America, and South Asia, as well as IBD in Southern and Eastern Sub-Saharan Africa, Central Europe, and East Asia. Regional data from the USA, England, and Japan indicated a positive correlation between COVID-19 incidence and relative increases in the burden of PsO in 2020 (Spearman R 0.35, 0.24, and 0.36, respectively, for incidence; R 0.35, 0.2, and 0.36, respectively, for prevalence; all p < 0.05). Additionally, 2021 state-level vaccination rates in the USA were negatively correlated with the relative increases in the ASIR of PsO and RA (R: 0.27 and -0.54, respectively; p < 0.001 for all), as well as the ASPR of PsO, RA, and MS (R: 0.45, -0.49, and -0.41, respectively; p < 0.01 for all) in 2021.

Conclusions

The year 2019 marked a pivotal point for increased global burden of PsO and regional burdens of other ADs. These observations have important implications for subsequent healthcare planning and resource allocation.

Global Burden of Chronic Liver Disease and Temporal Trends: A Population-Based Analysis From 1990 to 2021 With Projections to 2050

BACKGROUND AND AIMS

Globally, the aetiology and epidemiology of chronic liver disease (CLD) are undergoing significant changes. We aimed to investigate the updated global burden of CLD, evaluate the cross-country inequalities, and provide 2050 predictions.

METHODS

Using the Global Burden of Disease Study (GBD) 2021 data resources, we analysed and forecasted CLD prevalence, incidence, and related death from 1990-2021 to 2050, respectively. We calculated average annual percent change (AAPC) by joinpoint regression model and quantified inequalities according to World Health Organisation-recommended health equity standards.

RESULTS

In 2021, the number of prevalent, incident CLD and related deaths globally were 1.7 billion (95% uncertainty interval (UI): 1.6-1.8), 58.4 million (95% UI: 54.2-62.8) and 1.4 million (95% UI: 1.3-1.5), respectively. During 1990-2021, the age-standardised incidence rate (ASIR) increased, especially in those aged 15-49 (AAPC: 0.49%; 95% confidence interval [CI]: 0.45%-0.53%), in Europe (AAPC: 0.41%; 95% CI: 0.41%-0.42%) and the Americas (AAPC: 0.41%; 95% CI: 0.39%-0.42%), whereas the age-standardised death rate (ASDR) decreased globally (AAPC: -1.26%; 95% CI: -1.35% [-1.17%]) and across subgroups. During 1990-2021, the ASIR of metabolic dysfunction-associated steatotic liver disease (MASLD) increased the most in those aged 15-49 (AAPC: 0.72%; 95% CI: 0.67%-0.77%) and in the Western Pacific region (AAPC: 0.73%; 95% CI: 0.59%-0.86%). Socio-demographic index (SDI)-related inequalities decreased for the age-standardised prevalence rate (ASPR) and ASIR of CLD but increased for ASDR, placing a disproportionately heavier burden on low-SDI countries. From 2022 to 2050, the ASIR of CLD is projected to increase (AAPC: 0.20%; 95% CI: 0.19%-0.20%), but the ASDR is projected to decline (AAPC: -1.91%; 95% CI: -1.96% [-1.85%]).

CONCLUSIONS

This study's findings highlight targeted interventions for CLD disparities, focusing on MASLD management, the younger population (15-49 years), and socio-demographic inequalities.

Radiomic and proteomic signatures of body mass index on brain ageing and Alzheimer's-like patterns of brain atrophy

BACKGROUND

The impact of high body mass index (BMI) states and associated proteomic factors on brain ageing and Alzheimer's disease (AD) remains unclear.

METHODS

We sought to evaluate machine learning (ML)-based neuroimaging markers of brain age and AD-like brain atrophy in participants with obesity or overweight without diagnosed cognitive impairment (WODCI), in a harmonised study of 46,288 participants in 15 studies (the Imaging-Based Coordinate System for Aging and Neurodegenerative Diseases (iSTAGING) consortium). We also assessed the association between cognition, serum proteins, and brain ageing indices. Data were acquired between 1999 and 2020 and analysed from November 2024 onwards.

FINDINGS

The study comprised 46,288 participants, including 24,897 females and 21,391 males, with a mean age of 64.33 years (SD = 8.13) and a mean BMI of 26.81 kg/m2 (SD = 4.49). The results demonstrate that the impact of obesity on brain ageing, and AD-like brain atrophy is weaker with increasing age and is significantly pronounced in males compared to females. Additionally, in males, obesity was significantly associated with approximately 2 additional years of brain ageing compared to normal weight and 1 additional year compared to the overweight group. Males with overweight also showed higher brain ageing values (8 additional months) than males with normal weight. Regarding AD-like brain atrophy, males with obesity displayed higher AD-like brain atrophy than males with normal weight, but females with normal weight showed higher AD-like brain atrophy than females with overweight. Sex differences within the same BMI categories were observed, with males exhibiting increased brain ageing compared to females, in obesity (1 additional year) and overweight groups (3 additional months). Higher AD-like brain atrophy was observed in males with overweight than in females with overweight. Females with normal weight displayed increased brain ageing (8 additional months) and AD-like brain atrophy relative to males with normal weight. In both retrospective and cross-sectional proteomics studies, five and eight proteins out of 1463 proteins were significantly (positively or negatively) associated with brain ageing and 1-SD BMI change (SD = 4.2 kg/m2), respectively.

INTERPRETATION

The findings demonstrate that higher BMI states are associated with accelerated brain ageing and AD-like atrophy, particularly in males, while females with normal weight demonstrated higher brain ageing and AD-like atrophy than males with normal weight. Moreover, the impact of obesity on brain ageing and AD-like brain atrophy becomes weaker with increasing age. Further research is needed to investigate sex-specific mechanisms by which weight gain influences brain ageing.

FUNDING

National Institute on Aging's Intramural Research Program, National Institute on Aging, Intramural Research Program.

Identification of novel small molecule chaperone activators for neurodegenerative disease treatment

A pathological hallmark of neurodegenerative disease is the accumulation of aberrant protein aggregates which contribute to the cytotoxicity and are therefore a target for therapy development. One key mechanism to manage cellular protein homeostasis is heat shock proteins (HSPs), protein chaperones which are known to target aberrant protein accumulation. Activation of HSPs target aberrant TDP-43, tau and amyloid to rescue neurodegenerative disease. As an attempt to target HSP activation for neurodegeneration therapy, we here develop a drug screening assay to identify compounds that will activate the master regulator of HSPs, the transcription factor heat shock factor 1 (HSF1). As HSF1 is bound by HSP90 which prevents its activation, we developed a NanoBRET assay, which allows us to monitor and quantify the HSF1-HSP90 interaction in living cells to screen for compounds disrupting this interaction and thereby releasing HSF1 for activation. After the optimisation and validation of the assay, a two thousand compound library was screened which produced 10 hits including two known HSP90 inhibitors. Follow-up functional study showed that one of the hits oxyphenbutazone (OPB) significantly reduces the accumulation of insoluble TDP-43 in a cell model, eliciting no signs of stress or toxicity. Overall, this study demonstrates a viable strategy for new drug discovery in targeting aberrant proteins and identifies potential candidates for translation into neurodegenerative disease treatment.

Design, rationale, and characterization of the mobile health based occupational cardiovascular risk intervention study (mHealth-OPEN study)

BACKGROUND

The substantial workforce and suboptimal cardiovascular health highlights the urgent need for workplace interventions. This ongoing cluster-randomized trial aims to evaluate the effectiveness, feasibility, and acceptability of a mobile health (mHealth) based comprehensive intervention program to improve cardiovascular health among employees.

METHODS AND RESULTS

We conducted a 1-year, 2-arm, parallel-group, cluster-randomized controlled multicenter trial involving 10,000 participants (aged 18-65, including 1,600 participants with high cardiovascular risk) across 20 workplaces. Workplaces were randomly assigned in a 1:1 ratio to either the intervention or control group. We established a mHealth based multifaceted cardiovascular risk management system that enables intelligent management. The intervention groups received a mHealth-based management with primary prevention inventions for all participants and additional cardiovascular risk interventions for participants with high cardiovascular risk via the system. The control groups received usual care. Primary outcomes included percentage changes in hypertension, diabetes, and dyslipidemia control rates among participants with high cardiovascular risk, and percentage changes in the rate of regular physical activity among all the participants, from baseline to 12-month follow-up. Secondary outcomes included changes in blood pressure, glucose, lipid, treatment adherence, behavioral factors, questionnaire scores, and incidence of major cardiovascular events. By now, baseline recruitment has been completed, with comparable characteristics between management and control groups.

CONCLUSIONS

This rigorous designed mHealth-based workplace intervention demonstrates potential for nationwide implementation, offering cardiovascular benefits for employees.

CLINICAL TRIAL REGISTRATION

www.chictr.org.cn. Identifier: ChiCTR2200066196.