Contribution of Posttuberculosis Sequelae to Life-Years Lost from Tuberculosis Disease in the United States, 2015-2019

Rationale: Individuals surviving tuberculosis (TB) disease may experience chronic sequelae that reduce survival and quality of life. These post-TB sequalae are not generally considered in estimates of the health impact of TB disease. Objectives: To estimate the TB-attributable reductions in life expectancy and quality-adjusted life expectancy for individuals developing TB disease in the United States, including post-TB sequelae. Methods: We extracted national surveillance data on individuals with diagnoses of TB from 2015 to 2019, including demographics, vital status at diagnosis, treatment duration, treatment outcome, and coprevalent conditions. Using a mathematical model, we simulated life expectancy and quality-adjusted life-years (QALYs) for the TB cohort compared with a no-TB counterfactual (with the same distributions of age, sex, race/ethnicity, and coprevalent conditions as the TB cohort but without TB-attributable mortality and disutility). We disaggregated results to report the proportions of QALYs and life-years lost from TB due to post-TB sequelae and stratified outcomes by age, sex, and race. Measurements and Main Results: Estimated life expectancy after TB diagnosis was 30.3 (95% uncertainty interval, 29.9-30.7) years for the TB cohort versus 32.3 (31.9-32.7) years without TB, a difference of 2.03 (1.84-2.21) years and 1.93 (1.69-2.18) QALYs. Life-years lost were greatest for individuals 65-74 years of age versus other age groups, for men versus women, and for American Indian or Alaska Native individuals versus persons from other races/ethnicities. Overall, 41% (35-46%) of life-years and 48% (42-54%) of QALYs lost were estimated to result from post-TB sequelae. Conclusions: In the United States, a substantial fraction of life-years and QALYs lost from TB are attributable to post-TB sequelae. Evidence is needed on approaches to prevent and repair post-TB lung damage in the context of frequent coprevalent health conditions.

Pollution by antimicrobials and antibiotic resistance genes in East Africa: Occurrence, sources, and potential environmental implications

The escalating burden of antimicrobial pollution in East Africa poses severe threats to public health, environmental integrity, and economic stability. Environmental compartments such as soil and water serve as reservoirs for these pollutants such as antimicrobials and antibiotic resistance genes, creating selective pressure that accelerates the emergence of antimicrobial resistance (AMR). These dynamic fosters the proliferation of multidrug-resistant pathogens, or "superbugs," complicating infection management and amplifying health risks in a region already challenged by inadequate healthcare and sanitation infrastructure. Furthermore, pollution by antimicrobials and antibiotic resistance genes critically disrupts ecological processes, such as nutrient cycling and organic matter degradation, diminishing soil fertility, water quality, and agricultural productivity, thereby threatening food security and overall ecological health. Current surveillance efforts, including the Global Antimicrobial Resistance and Use Surveillance System (GLASS) and the East Africa Public Health Laboratory Networking Project (EAPHLNP), have made strides in tracking AMR trends and guiding policy decisions. However, these efforts remain insufficient to address the growing crisis. This study highlights the urgent need for integrated strategies, including stringent antibiotic usage regulations, advanced wastewater treatment technologies, and comprehensive environmental surveillance. Therefore, there is a need to address the intersections of health, agriculture, and environment, to mitigate AMR and its far-reaching consequences to ensure public health safety and sustainability.

The burden and trends of road injuries in Afghanistan (1990-2021): A joinpoint analysis of data from the global burden of diseases, 2021 study

Objective

Road injuries pose a major public health challenge, particularly in low-income, conflict-affected regions like Afghanistan. Despite issues like poor infrastructure and weak traffic regulations, no national study has assessed the road injury burden. This study examines Afghanistan's road injury burden from 1990 to 2021.

Method

This epidemiological study utilized the global burden of diseases (GBD) 2021 data. Key metrics included age-standardized mortality rate (ASMR), age-standardized disability-adjusted life-years rate (ASDR), years of life lost (YLL), and years lived with disability (YLD) per 100,000 population. Trends were analyzed using joinpoint analysis to determine annual and average annual percent changes (APC and AAPC). Estimates were presented with a 95 % uncertainty Interval, and statistical significance was assessed via permutation tests (p < 0.05).

Results

Between 1990 and 2021, Afghanistan's road injury burden declined across all indicators (ASMR: -1.2 %, ASDR, YLL, YLD). Males (1.2 %) and children (AAPC: -3.1 %) saw the steepest declines, while the elderly (-0.7 %) had the slowest. Motor vehicle injuries dropped most (1.3 %), followed by pedestrian (1.0 %) and motorcyclist (0.9 %) injuries.Period-specific trends showed fluctuations: ASMR, ASDR, and YLL rose (1990-1997), then declined, except YLD, which increased post-2018 (+0.5 %). From 2017 to 2021, YLD rose across all age groups (except 0-14 years). Post-2014, motorcycle-related ASMR increased (+0.3 % APC), while from 2017 to 2021, ASDR and YLD increased across all injury types (+0.4 % to +1.3 % APC).

Conclusion

Despite progress, rising DALYs and YLDs, especially from 2017 onward, highlight a growing disability road injury burden, necessitating targeted interventions to address long-term disability and mitigate its public health impact.

Neutrophil extracellular traps in cancer: From mechanisms to treatments

Neutrophil extracellular traps (NETs) are reticular ultrastructures released by activated neutrophils. As the reaction products of neutrophils, NETs have been identified as crucial effectors in pathogen defence and autoimmune diseases. Recently, increasing evidence suggest that this process also occurs in cancer. The formation and clearance of NETs are dynamically influenced by the tumour microenvironment, while NETs reciprocally play a dual role in either promoting or inhibiting tumour progression through their DNA scaffold, proteases and other granule-derived proteins. Given the interplay between NETs and tumours, active exploration is currently underway to harness their potential as tumour biomarkers and therapeutic targets. Here, we delve into the biochemical and immunological mechanisms underlying NETs formation within the tumour microenvironment, along with recent advances elucidating their multifaceted roles in tumourigenesis, metastasis and tumour-associated co-morbidities. Furthermore, we present emerging strategies for NETs-based tumour diagnostic approaches and therapeutics, with a special focus on the challenging questions that need to be answered within this field. KEY POINTS: The formation and clearance of NETs are dynamically influenced by the tumor microenvironment. NETs are engaged in tumorigenesis, formation, metastatic spread, and cancer-associated co-morbidities. NETs-based tumor biomarkers and therapeutic strategies warrant significant attention.

A National Cross-Sectional Survey on Real-World Experiences of Calcitonin Gene-Related Peptide (CGRP) Monoclonal Antibody Use in Adults with Migraine in Finland

INTRODUCTION

Calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) were the first preventive migraine treatment group to target the underlying cause of migraine. This survey evaluated real-life experiences of adults with migraine in Finland before and after using their current subcutaneous CGRP mAb treatment.

METHODS

Adult users of a subcutaneous CGRP mAb for migraine prevention were recruited for an electronic cross-sectional survey by Finnish community pharmacies and Migraine Finland (a patient advocacy group) in 2023. The survey included questions regarding monthly migraine headache days, absenteeism, general disability, pain intensity, treatment patterns, and a validated Migraine-Specific Quality of Life (MSQoL) questionnaire.

RESULTS

The survey was completed by 383 users of subcutaneous CGRP mAb medication, of whom 78 (20.4%) were receiving galcanezumab. Users of galcanezumab, the latest CGRP mAb to be reimbursed in Finland, had more previous CGRP mAb treatment switches than users of other CGRP mAbs. Following any subcutaneous CGRP mAb use, changes were observed in the number of monthly migraine headache days (0-7 experienced by 17/379 participants [4.5%] with data before, versus 302/379 [79.7%] after using treatment; ≥ 12 experienced by 279/379 [73.6%] before, versus 34/379 [9.0%] after), monthly sick leave days (from 139/376 [37.0%] to 15/376 [4.0%] with ≥ 4 monthly sick leave days), overall ability to work or study (from 180/377 [47.7%] to 287/377 [76.1%] able to work or study full time) and average intensity of migraine pain (median [lower-upper quartile] from 8.0 [7.0-9.0] before to 6.0 [4.0-8.0] after). No differences were observed between total MSQoL scores for new (0-6 months CGRP mAb use) versus persistent (≥ 6 months use) users of any CGRP mAb.

CONCLUSIONS

Patient experiences of using subcutaneous CGRP mAbs in Finland showed improvements in several migraine-related factors, supporting the potential for CGRP mAbs to improve the quality of life of adults with migraine.

A new perspective on the antimicrobial mechanism of linezolid against Staphylococcus aureus revealed by proteomics and metabolomics analysis

Understanding bacterial responses to antimicrobials is crucial for identifying tolerance mechanisms and for developing new therapies. Using mass spectrometry-based metabolomics and proteomics, this study examines the response of Staphylococcus aureus to linezolid (LZD) treatment. Under LZD stress, significant fluctuations were observed in key metabolic pathways such as amino acid biosynthesis and the TCA cycle, alongside a general increase in ribosomal protein complexes. Additionally, LZD disrupted nucleotide metabolism, particularly affecting pyrimidine pathways. Combining LZD with the pyrimidine synthesis inhibitor leflunomide enhanced bactericidal effects both in vitro and in vivo, highlighting the importance of targeting pyrimidine biosynthesis to amplify the antimicrobial efficacy of protein inhibitors. These results underscore downstream metabolic processes as viable targets for synergistic drug combinations, suggesting a strategy to potentially improve the clinical effectiveness of LZD.

Age period cohort analysis of cancer incidence from 1990 to 2019 in Türkiye

BACKGROUND

Cancer is a major public health concern worldwide and in Türkiye, as it is one of the leading causes of disability-adjusted life years (DALYs) and mortality. This study aims to analyze long-term cancer trends in Türkiye from 1990 to 2019 using the Age-Period-Cohort (APC) model to determine the independent effects of aging, time periods, and birth cohorts on cancer incidence.

METHODS

Cancer incidence data for all cancers and the most common site-specific cancers in men and women were obtained from the Global Burden of Disease 2021 study. The analysis included 14 five-year age groups (20-94 years) and 6 five-year time periods (1990-2019). Age-standardized incidence rates (ASIR) per 100,000 persons were calculated using the world standard population. The APC analysis estimated net drift, local drifts, period rate ratios, and cohort rate ratios. The 2000-2004 period and 1945 birth cohort were set as reference points. Statistical analyses were conducted using the APC R-based Web Tool provided by the National Cancer Institute.

RESULTS

The ASIR for all cancers in men exhibited a fluctuating pattern over the study period, without a consistent annual increase or decrease; while in women, the ASIR exhibited an upward trend, increasing by 1.32 % annually, reaching its peak in 2016. Lung and stomach cancer incidence declined in males, whereas prostate, colon and rectum and bladder cancers increased. Incidence rates were higher in the periods 1990-2000 and 2010-2019 compared to the reference period (2000-2004), with similar rates in both periods. In females, breast, uterine and thyroid cancers showed substantial increases. The increase in incidence rates became particularly noticeable from the 2005-2009 period onwards. The cohort effect revealed increasing risks in recent birth cohorts, particularly for breast, uterine, thyroid, prostate and bladder cancers.

CONCLUSION

The findings highlight the dynamic nature of cancer epidemiology in Türkiye, with variations across age groups, time periods, and birth cohorts. While Türkiye's cancer incidence remains lower than in many developed countries, specific cancers, such as lung and stomach cancers, remain more prevalent. The rising burden of breast, uterine, prostate, bladder and colon and rectum cancers suggests an impact of aging, lifestyle changes, and screening programs. Continuous monitoring, preventive strategies, and early detection programs are crucial to mitigate future cancer trends.

Microplastics from cigarette filters: Comparative effects on selected terrestrial and aquatic invertebrates

Cigarette filters comprise plasticised cellulose acetate, a synthetic polymer categorized as bioplastic. They represent a significant source of microplastics (MPs), in particular microfibers, and associated chemicals, yet their impact on organisms, especially soil invertebrates, is not well-studied. This research examines the effects of MPs milled from smoked (SCF-MPs) and unsmoked cigarette filters (UCF-MPs) on terrestrial invertebrates (Porcellio scaber, Tenebrio molitor) and aquatic invertebrates (Daphnia magna, Brachionus calyciflorus). SCF-MPs and UCF-MPs were found to be 9.06 ± 4.1 μm and 12.71 ± 6.82 μm in size, respectively. Both samples contained triacetin and potentially toxic metals, while SCF-MPs also contained nicotine and a larger number of trace organic compounds. While exposure to SCF-MPs or UCF-MPs (up to 1.5 % MPs, w/w in soil) did not affect the survival of either terrestrial invertebrate, several physiological responses were observed. These included changes in immune parameters, energy-related biomarker levels, and altered glutathione S-transferase and acetylcholinesterase activities. Both types of MPs were acutely toxic to aquatic invertebrates, reducing the survival rates of B. calyciflorus (10 mg L-1 of either particle after 48h exposure) and D. magna (100 mg L-1 of SCF-MPs after 48h exposure). SCF-MPs generally caused more pronounced effects than UCF-MPs. This study highlights the need for effective environmental management to address both smoked and unsmoked cigarette filters.

An enhanced harmonic densely connected hybrid transformer network architecture for chronic wound segmentation utilising multi-colour space tensor merging

Chronic wounds and associated complications present ever growing burdens for clinics and hospitals world wide. Venous, arterial, diabetic, and pressure wounds are becoming increasingly common globally. These conditions can result in highly debilitating repercussions for those affected, with limb amputations and increased mortality risk resulting from infection becoming more common. New methods to assist clinicians in chronic wound care are therefore vital to maintain high quality care standards. This paper presents an improved HarDNet segmentation architecture which integrates a contrast-eliminating component in the initial layers of the network to enhance feature learning. We also utilise a multi-colour space tensor merging process and adjust the harmonic shape of the convolution blocks to facilitate these additional features. We train our proposed model using wound images from light skinned patients and test the model on two test sets (one set with ground truth, and one without) comprising only darker skinned cases. Subjective ratings are obtained from clinical wound experts with intraclass correlation coefficient used to determine inter-rater reliability. For the dark skin tone test set with ground truth, when comparing the baseline results (DSC=0.6389, IoU=0.5350) with the results for the proposed model (DSC=0.7610, IoU=0.6620) we demonstrate improvements in terms of Dice similarity coefficient (+0.1221) and intersection over union (+0.1270). Measures from the qualitative analysis also indicate improvements in terms of high expert ratings, with improvements of >3% demonstrated when comparing the baseline model with the proposed model. This paper presents the first study to focus on darker skin tones for chronic wound segmentation using models trained only on wound images exhibiting lighter skin. Diabetes is highly prevalent in countries where patients have darker skin tones, highlighting the need for a greater focus on such cases. Additionally, we conduct the largest qualitative study to date for chronic wound segmentation. All source code for this study is available at: https://github.com/mmu-dermatology-research/hardnet-cws.

Update in the molecular mechanism and biomarkers of diabetic retinopathy

Diabetic retinopathy (DR) is a serious complication of diabetes caused by long-term hyperglycemia that leads to microvascular and neuronal damage in the retina. The molecular mechanisms of DR involve oxidative stress, inflammatory responses, neurodegenerative changes, and vascular dysfunction triggered by hyperglycemia. Oxidative stress activates multiple metabolic pathways, such as the polyol, hexosamine, and protein kinase C (PKC) pathways, resulting in the production of, which in turn promote the formation of advanced glycation end products (AGEs). These pathways exacerbate vascular endothelial damage and the release of inflammatory factors, activating inflammatory signaling pathways such as the NF-κB pathway, leading to retinal cell damage and apoptosis. Additionally, DR involves neurodegenerative changes, including the activation of glial cells, neuronal dysfunction, and cell death. Research on the multiomics molecular markers of DR has revealed complex mechanisms at the genetic, epigenetic, and transcriptional levels. Genome-wide association studies (GWASs) have identified multiple genetic loci associated with DR that are involved in metabolic and inflammatory pathways. Noncoding RNAs, such as miRNAs, circRNAs, and lncRNAs, participate in the development of DR by regulating gene expression. Proteomic, metabolomic and lipidomic analyses have revealed specific proteins, metabolites and lipid changes associated with DR, providing potential biomarkers for the early diagnosis and treatment of this disease. This review provides a comprehensive perspective for understanding the molecular network of DR and facilitates the exploration of innovative therapeutic approaches.

Risk factors associated with morbidity and unfavorable treatment outcome in drug-resistant pulmonary tuberculosis: a case-control study

Objectives

To investigate the risk factors in patients with drug-resistant tuberculosis (DR-TB) and clinical characteristics related to unfavorable anti-TB treatment outcomes.

Methods

A total of 961 pulmonary tuberculosis (TB) patients were included at West China Hospital of Sichuan University from January 2008 to November 2023. We analyzed the differences of clinical characteristics between DR-TB and drug-sensitive tuberculosis (DS-TB), and then compared these features in DR-TB patients with different outcomes. Multivariable logistic regression models were employed to quantify risk factors associated with DR-TB and adverse treatment outcomes.

Results

Among 961 pulmonary TB patients, a history of anti-TB treatment [odds ratio (OR), 3.289; 95% confidence interval (CI), 2.359-4.604] and CT-scan cavities (OR, 1.512; 95% CI, 1.052-2.168) increased DR-TB risk. A total of 214 DR-TB patients were followed for a median of 24.5 months. Among them, 116/214 (54.2%) patients achieved favorable outcomes. Prior anti-TB treatment (OR, 1.927; 95% CI, 1.033-3.640), multidrug-resistant tuberculosis (MDR-TB) (OR, 2.558; 95% CI, 1.272-5.252), positive sputum bacteriology (OR, 2.116; 95% CI, 1.100-4.134), and pleural effusion (OR, 2.097; 95% CI, 1.093-4.082) were associated with unfavorable outcomes, while isoniazid-resistant TB patients showed better outcomes (OR, 0.401; 95% CI, 0.181-0.853). The clinical model for unfavorable outcome prediction of DR-TB achieved an area under the curve (AUC) of 0.754 (95% CI, 0.690-0.818).

Conclusions

Treatment history of anti-TB not only increases the risk of the emergence of DR-TB, but also potentially leads to treatment failure during re-treatment in DR-TB patients. Drug resistance subtypes, radiological characteristics, and the results of sputum smear or culture may affect the treatment outcome of DR-TB.

Design framework to develop sustainable innovations for addressing One Health challenges

The complexity of global health challenges requires integrated approaches that crosses traditional boundaries. One Health (OH) offers a holistic approach to address health issues at the crossroads of human, animal, and environmental domains. Antimicrobial Resistance (AMR), a prime example of a cross-sectoral issue and OH challenge, highlights the need for coordinated interventions that consider multiple stakeholders. Current approaches to improve OH challenges and AMR have limited success, often due to a lack of a structured theoretical approach that informs the design and development of solutions for long-term sustainability. Existing frameworks focus primarily on human or veterinary sectors in isolation, leaving a gap in comprehensive, integrated approaches that align with OH principles. The proposed framework addresses this gap by offering a structured approach to both implementing and evaluating interventions that consider all three sectors. This paper proposes the HEARTf of OHC (Holistic Engagement and Adaptive Responses Theoretical framework of One Health challenges), a user-centered design approach aimed at developing sustainable and innovative OHC interventions. The HEARTf of OHC integrates knowledge from social sciences, computer science, industrial design, pedagogy, and health sciences to create context specific solutions that address the specific needs of end-users in the human, animal, and environmental sectors. Additionally, this paper reviews existing frameworks addressing AMR, identifies limitations and outlines the need for a transdisciplinary approach when tackling OHC. By emphasizing the importance of the user-centered design, transdisciplinarity, and continuous evaluation, the HEARTf of OHC aims to bridge the gap between current strategies and improve the development and evaluation of innovative solutions or services. The HEARTf of OHC is a generalizable framework for the design, implementation, and evaluation of OH interventions, where we use AMR as a case study to demonstrate its application.

Shelter dogs as reservoirs of international clones of Escherichia coli carrying mcr-1.1 and blaCTX-M resistance genes in Lima, Peru

Antimicrobial resistance (AMR) poses a critical public health threat worldwide, particularly at the human-animal interface where cross-transmission of critical priority Enterobacterales, such as Escherichia coli, have become increasingly reported. Worryingly, E. coli encoding extended-spectrum β-lactamases (ESBLs) has been documented in companion animals worldwide. Conversely, the presence of mcr genes, which confer resistance to polymyxins, in bacteria from pets remains more infrequent. In this study, we sequenced and reported on the first genomic data of E. coli strains carrying mcr-1 and/or blaCTX-M genes isolated from rectal swabs of stray dogs in a shelter in the city of Lima, Peru. Antimicrobial susceptibility revealed that E. coli strains exhibited a multidrug resistance profile. In addition to mcr-1 and blaCTX-M genes, other clinically relevant resistance determinants were identified, with notably presence of blaTEM-176 and the novel blaSCO-2 variant. The association of mcr-1.1 and IncI2 plasmid was confirmed. Several virulence genes were detected, classifying strains as putative extraintestinal pathogenic E. coli. Multilocus sequence typing prediction recognized diverse sequence types (ST), including ST155, ST189, ST657, ST746, ST1140, ST3014, and ST7188. This study represents the first report of mcr-positive E. coli in dogs from Peru, emphasizing the need for continuous surveillance and genomic characterization to better understand the transmission dynamics of these critical resistance genes at the human-animal interface. Furthermore, our results provide evidence that stray, and shelter dogs could be a reservoir for the spread of WHO priority pathogens, and/or polymyxin and β-lactam resistance genes, which is a public health and One Health concern that requires appropriate management strategies.

Effect of oxygen on antimicrobial resistance genes from a one health perspective

Bacteria must face and adapt to a variety of physicochemical conditions in the environment and during infection. A key condition is the concentration of dissolved oxygen, proportional to the partial pressure of oxygen (PO2), which is extremely variable among environmental biogeographical areas and also compartments of the human and animal body. Here, we sought to understand if the phenotype of resistance determinants commonly found in Enterobacterales can be influenced by oxygen pressure. To do so, we have compared the MIC in aerobic and anaerobic conditions of isogenic Escherichia coli strains containing 136 different resistance genes against 8 antibiotic families. Our results show a complex landscape of changes in the performance of resistance genes in anaerobiosis. Certain changes are especially relevant for their intensity and the importance of the antibiotic family, like the large decreases in resistance observed against ertapenem and fosfomycin among blaVIM β-lactamases and certain fos genes, respectively; however, the blaOXA-48 β-lactamase from the clinically relevant pOXA-48 plasmid conferred 4-fold higher ertapenem resistance in anaerobiosis. Strong changes in resistance patterns in anaerobiosis were also conserved in Klebsiella pneumoniae. Our results suggest that anaerobiosis is a relevant aspect that can affect the action and selective power of antibiotics for specific AMRs in different environments.

Fitness trade-off and the discovery of a novel missense mutation in the PmrB sensor kinase of a colistin-resistant Pseudomonas aeruginosa strain developed by adaptive laboratory evolution

Pseudomonas aeruginosa is a prominent bacterial pathogen that causes several nosocomial infections and is notorious for its environmental resilience and rapid development of resistance to frontline antibiotics. A major cause of mortality and morbidity among cystic fibrosis patients, multidrug-resistant P. aeruginosa is often targeted with the antibiotic colistin as a last option. However, increasing reports of colistin resistance among P. aeruginosa is a significant concern. Though the molecular mechanisms responsible for the development of colistin resistance are well known, the evolutionary trajectory to colistin resistance is an important area of investigation. In this work, using the adaptive laboratory evolution (ALE) approach we have evolved a colistin-sensitive P. aeruginosa ancestral strain to a resistant one. During the process of laboratory evolution in 106 generations, colistin MIC was increased 32-fold. The evolved strain had lower fitness than the ancestral strain, as evidenced by a lower growth rate. Moreover, the evolved strain produced more biofilm and less pyocyanin pigment. Interestingly, the evolved strain showed collateral sensitivity to several antibiotics, including ampicillin, tetracycline, streptomycin, gentamycin, nalidixic acid, trimethoprim, rifampicin, and chloramphenicol. On analysing various TCS modules involved in the development of colistin resistance, a novel missense mutation (V136G) was detected in the PmrB sensor kinase. In silico analysis indicated that the V136G substitution would destabilize the PmrB kinase structure, making the mutation deleterious. However, the functionality of the PmrB mutant remains to be validated experimentally.

Long-term forecast for antibacterial drug consumption in Germany using ARIMA models

The increasing supply shortages of antibacterial drugs presents significant challenges to public health in Germany. This study aims to predict the future consumption of the ten most prescribed antibacterial drugs in Germany up to 2040 using ARIMA (Auto Regressive Integrated Moving Average) models, based on historical prescription data. This analysis also evaluates the plausibility of the forecasts. Our findings represent one of the first long-term national forecasts for antibacterial drug consumption. ARIMA(0,1,0), a random walk model with drift, is the best-fitting model to capture trends across all antibacterial drugs. While more complex models offer greater detail, they seem less suitable for long-term forecasting. In a short-term forecast of 5 and 10 years, predictions between significant models vary very little. Predictions indicate increasing DDD-prescriptions for amoxicillin, cefuroxime axetil, amoxicillin clavulanic acid, clindamycin, azithromycin, nitrofurantoin, and ciprofloxacin, while declines are forecasted for doxycycline, phenoxymethylpenicillin, and sulfamethoxazole-trimethoprim. The reliability of the predictions varies. Forecasts for azithromycin, phenoxymethylpenicillin, and sulfamethoxazole-trimethoprim are likely accurate, whereas uncertainties exist for doxycycline, amoxicillin clavulanic acid, nitrofurantoin, and ciprofloxacin, though general trends appear valid. Potential discrepancies may arise in the predictions for amoxicillin, cefuroxime axetil, and clindamycin. These forecasts highlight the urgent need for proactive healthcare planning to prevent future shortages, a problem underscored by recent supply disruptions in Germany. Future research should extend this analysis to the development of bacterial resistance and other frequently used drug classes.

Bioinformatics-led identification of pathophysiological hallmark genes in diabesotension via graph clustering method

Background

Diabesotension, an overlapping triad of diabetes, hypertension, and obesity, remains a diagnostic challenge due to its complex underlying molecular mechanisms. Individuals with diabesotension face twice the risk of microvascular and macrovascular complications compared to those with either condition alone. However, the complexity of diabesotension poses significant diagnostic challenges due to limited knowledge of this disease trifecta.

Methods

The protein network was constructed, and the DPClusOST algorithm was applied to determine the protein clusters with a density ranging from 0.1 to 1.0 and those relevant to the pathophysiology of diabesotension. The significance score (SScore) was computed using the p-value from Fisher's exact test to evaluate each cluster, and the clusters containing proteins associated with diabesotension were classified using receiver operating characteristic (ROC) analysis. The significant density of the cluster, as indicated by the AUC, was determined and subsequently subjected to pathway enrichment analysis using ShinyGO.

Results

At densities of 0.6 and 0.8, 14 proteins (STX3, VAMP2, STX4, SYT1, DNAJC5, HSD17B10, DLD, AIFM1, PDHA1, PDHB, DLAT, PDHX, OGDH, and STAT5A) from clusters 13 and 53 were significantly identified as potential diabesotension-related proteins. Key pathways associated with the tripartite interplay of the three pathologies were found to involve amino acid metabolism, glycolysis/gluconeogenesis, SNARE-mediated vesicle transport, insulin and salivary secretion, and the glucagon and HIF-1 signaling pathways, thus identifying novel candidates for diabesotension biomarkers and therapeutic targets.

Conclusions

This study highlights the use of graph clustering to identify potential biomarkers for the comorbid triad, which could enhance personalized future treatment strategies.

Acute gastroenteritis outbreak linked to Escherichia coli contamination in a swimming pool during a state-level school sports championship

Acute gastroenteritis (AGE) outbreaks caused by Escherichia coli are typically foodborne, and linked to contaminated food or water sources. This article describes an outbreak associated with a public aquatic facility during a state-level championship in Johor Bahru, Malaysia, in July 2024. The outbreak was linked to a malfunctioning pool filtration system and inadequate maintenance, creating an unusual environmental source of E. coli transmission. Epidemiological investigations were conducted, along with environmental assessments and laboratory analyses of clinical (rectal swabs and stool cultures) and environmental (water and surface swabs) samples. A total of 92 AGE cases were identified among 917 exposed individuals, yielding an attack rate of 10.03%. Symptoms included diarrhea, abdominal pain, nausea, vomiting, and fever. Laboratory investigations revealed E. coli contamination in five water samples, with levels exceeding permissible limits. Low residual chlorine levels (<0.2 mg/l) were observed. Leptospira species were detected in two water samples, but no confirmed leptospirosis cases were reported. Environmental assessment revealed poor pool hygiene, malfunctioning filtration systems, and incomplete renovations. This outbreak underscores the critical need for stringent hygiene standards in public swimming pools and consistent maintenance of water quality to prevent waterborne disease outbreaks in aquatic facilities.

The burden of type 2 diabetes in China from 1990 to 2021: A comparative analysis with G20 countries using the global burden of disease study 2021

OBJECTIVES

The study aims to evaluate the burden of Type 2 Diabetes (T2D) in China from 1990 to 2021, and compare to it across G20 countries.

METHODS

We utilized data from the Global Burden of Disease Study 2021 to examine the burden of T2D in China from 1990 to 2021. Prevalence, mortality, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) were calculated. Comparative analyses were conducted with other G20 countries.

RESULTS

T2D prevalence in China increased between 1990 and 2021, with rates rising from 3519.8 (3138.3-3910.1) to 6055.5 (5510.1-6614.3) per 100,000. The death rates slightly decreased from 9.3 (8.2-10.5) per 100,000 to 8.7 (7.3-10.3). The DALYs rate increased from 438.7 (358.5-531.5) to 569.8 (435.4-734.2), with increases observed in YLDs and YLLs. Males had a heavier disease burden in China. Compared to G20 countries, China ranked high in prevalence but had relatively better mortality outcomes in older age groups.

CONCLUSION

This study reveals the enormous burden and remarkable control efforts of T2D in China. Comparative analysis emphasizes the importance of tailored public health interventions to address this growing health crisis.

Optimal blood pressure target for patients with prior stroke: A systematic review and meta-analysis

In this systematic review of randomized controlled trials, we examined the optimal blood pressure (BP) target for patients with prior stroke, comparing intensive BP control (systolic BP [SBP] <130 mmHg) with standard BP control (SBP < 140 mmHg). Literature searches of PubMed/MEDLINE, the Cochrane Database, and Ichu-shi identified seven randomized controlled trials for quantitative analysis. Meta-analyses were performed using random-effects models, with most included trials assessed as having low risks of bias. The meta-analysis showed significant reductions in recurrent stroke (risk ratio [RR], 0.79; 95% confidence interval [CI], 0.65-0.96) and major cardiovascular events (RR, 0.86; 95% CI, 0.76-0.97) in the intensive BP control arm. Intensive BP control was more effective in reducing recurrent hemorrhagic stroke (RR, 0.33; 95% CI, 0.15-0.74) than ischemic stroke (RR, 0.87; 95% CI, 0.71-1.08). However, adverse events such as syncope or dizziness were significantly more frequent in the intensive BP control arm (RR, 1.30; 95% CI, 1.00-1.68). Absolute risk reductions (per 1,000 persons) for recurrent stroke (-14; 95% CI, -24 to -4) and major cardiovascular events (-17; 95% CI, -28 to -6) outweighed the absolute increase in syncope or dizziness (4; 95% CI, 0-9). We recommend a lower SBP target of <130 mmHg, with careful monitoring for hypotension-related symptoms, to prevent recurrent stroke and major cardiovascular events in patients with prior stroke.

Artificial intelligence based predictive tools for identifying type 2 diabetes patients at high risk of treatment Non-adherence: A systematic review

AIMS

Several Artificial Intelligence (AI) based predictive tools have been developed to predict non-adherence among patients with type 2 diabetes (T2D). Hence, this study aimed to describe and evaluate the methodological quality of AI based predictive tools for identifying T2D patients at high risk of treatment non-adherence.

METHODS

A systematic search was conducted across multiple databases including, EMBASE, Cochrane Library, MedLine, and Google Scholar search. The Prediction model Risk Of Bias ASsessment Tool (PROBAST) was used to assess the quality of studies. The performances of tools were assessed by Area Under the Curve (AUC), precision, recall, C-index, accuracy, sensitivity, specificity or F1 score.

RESULTS

Most studies measured predictive ability using AUC (75 %), and some only reported precision (25 %), recall (12.5 %), C-index (12.5 %), accuracy (37.5), sensitivity (12.5 %), specificity (12.5 %) or F1 score (25 %). All tools had moderate to high predictive ability (AUC > 0.70). However, only one study conducted external validation. Demographic characteristics, HbA1c, glucose monitoring data, and treatment details were typical factors used in developing tools.

CONCLUSIONS

The existing AI based tools holds significant promise for improving diabetes care. However, future studies should focus on refining the existing tools, validating in other settings, and evaluating the cost-effectiveness of AI-supported interventions.

Association of cardiovascular-kidney-metabolic syndrome with all-cause and cardiovascular mortality: A prospective cohort study

Background

Given evidence on the cardiovascular disease (CVD) risk conferred by comorbidity risk factors, the American Heart Association (AHA) recently introduced a novel staging construct, named cardiovascular-kidney-metabolic (CKM) syndrome. This study examined the association of CKM syndrome stages with all-cause and cardiovascular mortality among US adults.

Methods

Data were from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 at baseline linked to the 2019 National Death Index records. For each participant, the CKM syndrome was classified into five stages: stage 0 (no CKM risk factors), 1 (excess or dysfunctional adiposity), 2 (metabolic risk factors and chronic kidney disease), 3 (subclinical CVD), or 4 (clinical CVD). The main outcomes were all-cause and cardiovascular mortality.

Results

Among 34,809 participants (mean age: 46.7 years; male: 49.2 %), the prevalence of CKM stages 0 to 4 was 13.2 %, 20.8 %, 53.1 %, 5.0 %, and 7.8 %, respectively. During a median follow-up of 8.3 years, compared to participants with CKM stage 0, those with higher stages had increased risks of all-cause mortality (stage 2: HR 1.43, 95 % 1.13-1.80; stage 3, HR 2.75, 95 % CI 2.12-3.57; stage 4, HR 3.02, 95 % CI 2.35-3.89). The corresponding hazard ratios (95 % confidence interval) of cardiovascular mortality risks were 2.96 (1.39-6.30), 7.60 (3.50-16.5), and 10.5 (5.01-22.2). The population-attributable fractions for advanced (stages 3 or 4) vs. CKM syndrome stages (stages 0, 1, or 2) were 25.3 % for all-cause mortality and 45.3 % for cardiovascular mortality.

Conclusion

Higher CKM syndrome stages were associated with increased risks of all-cause and cardiovascular mortality. These findings emphasize that primordial and primary prevention efforts on promoting CKM health should be strengthened to reduce mortality risk.

Overproduction of secondary metabolites in Photorhabdus noenieputensis through rpoB mutations

Specific mutations of the rpoB gene, which encodes the β subunit of bacterial RNA polymerase, can enhance the production of secondary metabolites in bacteria such as actinomycetes. Entomopathogenic bacteria Photorhabdus and Xenorhabdus species produce a variety of secondary metabolites. Recently, these genera have attracted attention as a promising source for novel antibiotics. In this study, the effect of rpoB mutations on secondary metabolite production in Photorhabdus noenieputensis DSM 25462, a known producer of the antituberculosis antibiotic evybactin, was evaluated. Spontaneous rifampicin-resistant mutants, frequently carrying rpoB mutations, were generated by plating cells on agar medium containing four times the minimum inhibitory concentration (MIC) of rifampicin and evaluated their antibacterial production using Escherichia coli WO153 as a test strain. Among 190 spontaneous rifampicin-resistant mutants of P. noenieputensis, strain designated R191, which harbors the rpoB Q148K mutation (C442A), displayed higher antibacterial activity than that of the parental strain DSM 25462. The real-time quantitative RT-PCR analysis of 20 putative secondary metabolite biosynthetic gene clusters (BGCs) identified using antiSMASH revealed that seven of these BGCs were overexpressed in the strain R191. Furthermore, comparative high-pressure liquid chromatography (HPLC) analysis of the metabolite profile indicated that the strain R191 produced several compounds that were not detectable in the DSM 25462 culture. These findings suggest that the introduction of rpoB mutations into Photorhabdus strains is an effective strategy for enhancing secondary metabolite production and may lead to the discovery of novel antibiotics.

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.

Incidence, Risk and Trends of Multiple Primary Cancers in Patients With Colorectal Cancer: Evidence From the South Australian Cancer Registry

BACKGROUND

Colorectal cancer (CRC) is the fourth most diagnosed cancer in Australia. With advancements in treatment and an increase in survival rates, CRC survivors face an elevated risk of developing multiple primary cancers (MPCs), presenting a clinical challenge. Therefore, this study aimed to estimate the incidence, trend and risk of MPCs after a diagnosis of CRC in the South Australian population.

METHODS

This study analysed South Australian Cancer Registry data on individuals diagnosed with CRC as their first cancer from 1982 to 2017. The incidence of MPCs was assessed using cumulative incidence functions, and age-standardised rates were estimated. Poisson regression was used to determine the risk, and standardised incidence ratios (SIR) and absolute excess risks (AER) were estimated. Trends over time were analysed using Joinpoint regression.

RESULTS

The study included 26,729 CRC survivors. Of the cohort, 15% (3917) developed 4453 MPCs, with 96% diagnosed six or more months after index CRC. The cumulative incidence of MPCs was 22.5% (95% CI: 21.6-23.4). The median follow-up time until MPC diagnosis was 6.4 years. Common MPCs included prostate (18.9%), subsequent CRC (13.1%), lung (10.8%), haematological (10.2%) and breast (8.0%) cancers. The overall risk of MPCs was higher in CRC survivors (SIR: 1.12, 95% CI: 1.09-1.16; AER: 22.6 per 10,000) compared to the incidence in the general South Australian population. The incidence of MPCs has increased over time (annual percentage change = 1.95, 95% CI: 1.33-2.51).

CONCLUSIONS

CRC survivors are at increased risk of subsequent cancers, highlighting the need for targeted surveillance, particularly for prostate, lung, breast and blood cancers, for early detection and treatment.

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.

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.

Ferritin's role in infectious diseases: Exploring pathogenic mechanisms and clinical implications

Ferritin, an iron storage protein, is crucial for maintaining iron metabolism balance throughout the body and serves as a key biomarker for evaluating the body's iron reserves. Reduced ferritin levels typically indicate iron deficiency, whereas elevated ferritin levels indicate an acute inflammatory response in infectious diseases. Recent research has established a significant link between elevated ferritin levels and disease severity and prognosis. The concept of hyperferritinemic syndrome has underscored ferritin's role as a pathogenic mediator. During infections, ferritin not only serves as a biomarker of inflammation but also exerts pro-inflammatory functions, which is a key factor in perpetuating the vicious pathogenic cycle. This review offers a comprehensive exploration of ferritin, covering its structural characteristics, regulatory mechanisms, and how diverse pathogens modulate ferritin. Understanding its pivotal role in infectious diseases is essential for identifying novel therapeutic prospects and enhancing disease management and prevention.

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.

Oral Cancer Knowledge and Screening Practices Among Dental Professionals in Yemen: a Web-Based Survey

BACKGROUND

Good knowledge and screening practices of dental professionals for oral cancer (OC) will inevitably improve its prognosis. The present study sought to evaluate OC knowledge and practices among dental professionals in Yemen.

METHODS

This study was conducted among Yemeni dentists. The used tool was a prevalidated online questionnaire composed of items on the knowledge, practices, and barriers of OC screening and early detection. The data were managed and analysed using SPSS Version 28.0.

RESULTS

A total of 506 dental professionals completed the questionnaire. The participants showed moderate levels of knowledge on risk factors and clinical signs of OC. While the majority reported tobacco (89.9%) as a potential risk factor, only 76.7% and 57.5% of the subjects reported a potential role for alcohol consumption and old age. Regarding clinical signs, the majority reported that OC can present as nonhealing ulcer (90.3%) or white/red patch (87.2%), yet only 73.7% reported that it can present as swelling/lump, and around 32% reported that teeth attrition is one of its clinical signs. Concerning practices, most of the participants reported asking their patients about their tobacco habits (84%), routinely examine patients' oral mucosa (81.4%), and refer suspicious lesions to specialists (91.3%). Only 44.9% reported feeling confident regarding their knowledge and training on OC. Specialists and those who attended educational courses on OC were more knowledgeable, more confident, and showed better practices than their counterparts. Inadequate knowledge/training, lack of time, and lack of financial compensation were the most reported barriers to OC screening and early detection.

CONCLUSION

The present study indicates marked gaps in the knowledge and screening practices of OC among Yemeni dentists. Therefore, conducting periodic continuing courses along with interventional trainings are urgently recommended to address these gaps.

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.

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.

Brain structural correlates of an impending initial major depressive episode

Neuroimaging research has yet to elucidate whether reported gray matter volume (GMV) alterations in major depressive disorder (MDD) exist already before the onset of the first episode. Recruitment of presently healthy individuals with a subsequent transition to MDD (converters) is extremely challenging but crucial to gain insights into neurobiological vulnerability. Hence, we compared converters to patients with MDD and sustained healthy controls (HC) to distinguish pre-existing neurobiological markers from those emerging later in the course of depression. Combining two clinical cohorts (n = 1709), voxel-based morphometry was utilized to analyze GMV of n = 45 converters, n = 748 patients with MDD, and n = 916 HC in a region-of-interest approach and exploratory whole-brain. By contrasting the subgroups and considering both remission state and reported recurrence at a 2-year clinical follow-up, we stepwise disentangled effects of (1) vulnerability, (2) the acute depressive state, and (3) an initial vs. a recurrent episode. Analyses revealed higher amygdala GMV in converters relative to HC (ptfce-FWE = 0.037, d = 0.447) and patients (ptfce-FWE = 0.005, d = 0.508), remaining significant when compared to remitted patients with imminent recurrence. Lower GMV in the dorsolateral prefrontal cortex (ptfce-FWE < 0.001, d = 0.188) and insula (ptfce-FWE = 0.010, d = 0.186) emerged in patients relative to HC but not to converters, driven by patients with acute MDD. By examining one of the largest available converter samples in psychiatric neuroimaging, this study allowed a first determination of neural markers for an impending initial depressive episode. Our findings suggest a temporary vulnerability, which in combination with other common risk factors might facilitate prediction and in turn improve prevention of depression.

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.

Activation of GPER1 alleviates white matter injury by promoting microglia M2 polarization through EGFR/Stat3 pathway in intracerebral hemorrhage mice

BACKGROUND

White matter injury (WMI) is a major pathophysiological process after intracerebral hemorrhage (ICH). G protein-coupled estrogen receptor 1 (GPER1) has been validated to exert a crucial role in regulating neuroinflammation and microglia polarization. Our previous report reveals activation of GPER1 improves the neurological deficits after ICH via inhibition of A1 astrocytes. However, the role of GPER1 on the protection of WMI and modulation of microglia polarization after ICH remains unclear.

METHODS

In present study, ICH mice model was induced by autologous whole blood injection and in vitro ICH model was established via treatment BV2 cells with FeSO4. Mice were treated with GPER1 agonist G1, antagonist G15 and BV2 cells were treated with G1, G15 or EGFR inhibitor AG1478. Besides, BV2 conditional medium was used to intervene MO3.13 oligodendrocytes. Immunostaining, immunoblots, transmission electron microscope and PI staining were used to determine the WMI, microglia polarization and potential molecular mechanism after ICH, respectively.

RESULTS

Our data showed treatment with G1 ameliorated the WMI on the day 3 after ICH. Besides, activation of GPER1 reduced the release of IL-1β, TNF-α and increased the produce of IL-4, IL-10 as well as shifting microglia from proinflammatory M1 to anti-inflammatory M2 phenotype in vivo and in vitro. Meanwhile, MO3.13 cells treated with BV2 conditional medium validated GPER1 alleviated oligodendrocytes death via mitigating neuroinflammation and modulating microglia polarization. Mechanistic study demonstrated EGFR/Stat3 signaling pathway was involved in the protection of WMI and modulation microglia polarization after ICH.

CONCLUSION

Collectively, our findings demonstrated activation of GPER1 alleviated WMI via modulating microglia M2 polarization after ICH through EGFR/Stat3 signaling pathway.

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.

Selenide-Driven Reactive Oxygen Species Activation and Fe(II) Regeneration for Enhanced Nanocatalytic Antibacterial Therapeutics

Fenton-based nanocatalytic therapy has attracted widespread attention for its high efficiency and safety. Nevertheless, Fe2+ regeneration, as the rate-limiting step of Fenton reaction, hinders the ROS-induced oxidative killing. Herein, a Fe2+ auto-regeneration strategy is exemplified by 2D FeSe2 nanosheets to break the rate limitation of Fenton reaction and subsequently enhances the antibacterial oxidative damage via dual ROS generation pathways. To be specific, the Se species accelerate the Fe3+ reduction to maintain high ·OH productivity of Fe2+-mediated Fenton reaction, which is accompanied by the production of H2Se in the presence of H+. The H2Se further converts O2 into O2 ·- and synergistically breaks the oxidative threshold of bacteria, leading to irreversible bacterial death with glutathione depletion, lipid peroxidation, and membrane destruction. In summary, the FeSe2-mediated Fe2+ auto-regeneration and ROS self-production pathways largely elevate its oxidative killing capability, providing a potential ROS enhancement strategy for broad-spectrum nonantibiotic bacterial disinfection.

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.

The efficacy, mechanisms and implementation of physical activity as an adjunctive treatment in mental disorders: a meta-review of outcomes, neurobiology and key determinants

Research examining physical activity interventions for mental disorders has grown exponentially in the past decade. At this critical juncture, there is a need to synthesize the best evidence to guide researchers, clinicians and people with lived experience. This meta-review aimed to systematically identify and comprehensively evaluate the current evidence about: a) the efficacy of physical activity interventions on mental, cognitive and physical outcomes for individuals with mental disorders; b) the potential neurobiological, psychosocial and behavioral mechanisms underlying the observed effects; and c) the barriers and facilitators for individuals to successfully engage in these interventions. Our systematic search identified 13 meta-analyses of high methodological quality (i.e., A Measurement Tool to Assess Systematic Reviews, AMSTAR score ≥8) assessing outcomes of physical activity as an adjunctive treatment, which included 256 randomized clinical trials (RCTs) and 12,233 individuals. Large effect sizes were found for adjunctive physical activity interventions in improving attention in children and adolescents with attention-deficit/hyperactivity disorder (ADHD); reducing depressive symptoms in children, adolescents and adults with depressive disorders; and reducing body mass index in adults with schizophrenia. Moderate effect sizes were found for reductions of hyperactivity, impulsivity and anxiety, and improvements of executive and social functioning in children and adolescents with ADHD; reduction of anxiety symptoms in adults with anxiety disorders; improved physical and psychological quality of life and cardiovascular fitness in adults with depressive disorders; improved daily living skills, overall quality of life and cardiorespiratory fitness in adults with schizophrenia; reduction of depressive symptoms in older people with depressive disorders; and improvements in cognition and functional mobility in older people with dementia. There is, to date, no meta-analytic evidence for physical activity as a first-line treatment for people with a mental disorder. Five meta-analyses, including 89 RCTs and 4,575 individuals, investigated potential underlying mechanisms. There is a very preliminary evidence for an effect of physical activity on circulating levels of kynurenine, growth hormone, tumor necrosis factor-alpha and brain-derived neurotrophic factor in people with major depressive disorder. No meta-analytic evidence could be found for psychosocial or behavioral mechanisms. Based on 15 umbrella or systematic reviews, covering 432 studies and 48 guidelines, six implementation strategies, along with the most evidence-based behavioral change techniques to support them, were identified. Recommendations to support implementation research in this area were finally formulated.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Fighting Antibiotic Resistance: Insights Into Human Barriers and New Opportunities: Antibiotic Resistance Constantly Rises With the Development of Human Activities. We discuss Barriers and Opportunities to Get It Under Control

The public health issue of bacterial multi-resistance to antibiotics has gained awareness among the public, researchers, and the pharmaceutical sector. Nevertheless, the spread of antimicrobial resistance has been considerably aggravated by human activities, climate change, and the subsequent increased release of antibiotics, drug-resistant bacteria, and antibiotic resistance genes in the environment. The extensive use of antibiotics for medical and veterinary purposes has not only induced increasing resistance but also other health problems, including negative effects on the patient's microbiome. Preventive strategies, new treatment modalities, and increased surveillance are progressively set up. A comprehensive approach is, however, lacking for urgently tackling this adverse situation. To address this challenge, we discussed here the main causes driving antimicrobial resistance and pollution of the environment by factors favorable to the emergence of drug resistance. We next propose some key priorities for research, prevention, surveillance, and education to supervise an effective clinical and sustainable response.

Chronic meningitis: diagnostic and therapeutic challenges

PURPOSE OF REVIEW

We review recent advances in diagnosis and treatment of chronic meningitis, focusing on tuberculous meningitis (TBM), cryptococcal meningitis (CM), syphilitic meningitis, neuroborreliosis, and recurrent chronic meningitis. Noninfectious causes and unique challenges faced in resource-limited settings are also considered.

RECENT FINDINGS

Novel biomarkers are being identified that may be useful for the diagnosis of TBM [i.e. monokine induced by interferon-γ (MIG), plasminogen binding proteins] and syphilitic meningitis (i.e. CXCL13, neurofilament light protein, etc.) but require more validation. Much progress has been made regarding diagnosis and treatment of CM, with a new semiquantitative lateral flow assay showing high diagnostic and prognostic utility and clinical trials demonstrating that regimens of oral lipid nanocrystal formulation and a single dose of liposomal formulation of amphotericin B maintain clinical efficacy with improved side effect profiles. An ongoing clinical trial of ceftriaxone for treatment of syphilitic meningitis and early stage studies of linezolid for TBM treatment may also lead to changes in recommended treatment regimens for these conditions in the near future.

SUMMARY

Diagnosis and management of chronic meningitis remains a significant challenge, and further research is needed to improve our diagnostic and therapeutic armamentariums. However, emergence of potential new biomarkers for diagnosis and disease course is cause for optimism.

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.

Plant secretions and volatiles contribute to the evolution of bacterial antibiotic resistance in soil-crop system

The exponential growth of antibiotic-resistant bacteria and antibiotic-resistant genes (ARGs) in soil-crop systems in recent years has posed a great challenge to ecological security and human health. While many studies have documented the residues of ARGs in soils and crops, but little is known about who drives the proliferation of ARGs in farming systems and what their underlying mechanisms are. Herein, we explored the occurrence and proliferating behavior of ARGs in soil-crop environments in terms of root secretions and plant volatiles. This review highlighted that plant root secretions and volatile organic compounds (VOCs) served as key substances mediating the development of antibiotic resistance in the soil-crop system. Still, there is controversy here as to plant root secretions promote the ARGs proliferation or inhibit. Some studies indicated that root secretions can suppress the colonization of ARGs, mainly attributed by the production of blunted metabolic enzymes and blocking of cellular exocytosis systems. Whereas the others have evidenced that root secretions can promote ARGs proliferation, primarily by altering the structure of microbial communities to influence species interactions and thus indirectly affect the proliferation of ARGs. Also, VOCs can act as molecular signals to convey antibiotic resistance information to their neighbors, which in turn drive the up-regulation of ARGs expression. Even so, the mechanism by which VOC-driven antibiotic resistance acquisition and proliferation need to be further probed. Overall, this review contributed to the development of products and technologies to impede the ARGs proliferation in agricultural environment.