Pathogens and drug resistance or virulence genes from animals and surrounding environment in Shenzhen, 2023 using targeted next-generation sequencing

Identifying the pathogen spectrum of animals and surrounding environment is essential for the prevention and control of zoonotic diseases. From February 1 to June 30, 2023, we randomly collected respiratory and intestinal samples from animals and swab samples from surrounding environment in 33 units in Shenzhen, and carried out pathogen/gene screening using pathogen targeted next-generation sequencing technology. A total of 2000 samples were collected and mixed to obtain 415 samples for detection. The detection rate of respiratory pathogens (76.9 %, χ2 = 15.892, P < 0.001), drug resistance genes (59.0 %, χ2 = 52.888, P < 0.001), the co-detection proportion of intestinal pathogens (87.0 %, χ2 = 9.605, P = 0.002) in livestock and poultry, and drug resistance genes in surrounding environment (30.5 %, χ2 = 14.932, P < 0.001) were higher than dogs and cats, and wild animals. Escherichia coli (37.3 %, 30.5 %) and β-lactamase-resistance NDM genes (31.3 %, 27.1 %) were the main respiratory pathogens in livestock and poultry, and surrounding environment. The detection rate of Pasteurella multocide was 25.0 % in dogs and cats. The detection rates of intestinal pathogens Campylobacter coli and Clostridium perfringens in livestock and pourtry were 23.9 % and 17.9 %, and Clostridium perfringens in dogs and cats and wild animal was 18.2 % and 15.7 %. The total detection rate of intestinal pathogens of wild animals in wildlife parks (44.0 %) and indoor pet parks (38.9 %) was higher than that in animal nature reserves (χ2 = 15.686, P = 0.001). The respiratory/intestinal pathogens in animals and surrounding environment was common in Shenzhen. The drug resistance genes in livestock and poultry, and intestinal pathogens of wild animals in indoor pet parks needed more attention.

ASK1 inhibition by selonsertib attenuates elastase-induced emphysema in mice

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, with its most severe form being pulmonary emphysema, for which no effective treatment currently exists. Apoptosis signal-regulating kinase 1 (ASK1) has been implicated in lung inflammation and injury. Here, we investigated the experimental treatment of elastase-induced emphysema in mice with selonsertib, an ASK1 inhibitor. Animals received intratracheal elastase and were subsequently treated with intranasal selonsertib at different doses. On day 21, bronchoalveolar lavage fluid and lung tissues were collected for histological and biochemical analyses. Results showed that elastase-instilled mice developed pulmonary emphysema, whereas treatment with selonsertib at a dose of 2 mg/kg significantly reduced mean alveolar diameter. Moreover, higher doses of selonsertib were effective in reducing inflammatory cytokines (CX3CL1, IL-6, CCL2, and IL-1β), reactive oxygen species, and apoptosis. These findings suggest that ASK1 plays a critical role in the development of elastase-induced emphysema in mice and could be a target for COPD treatment.

Acute and chronic excitotoxicity in ischemic stroke and late-onset Alzheimer's disease

Stroke and Alzheimer's disease are common neurological disorders and often occur in the same individuals. The comorbidity of the two neurological disorders represents a grave health threat to older populations. This review presents a brief background of the development of novel concepts and their clinical potentials. The activity of glutamatergic N-methyl-D-aspartate receptors and N-methyl-D-aspartate receptor-mediated Ca 2+ influx is critical for neuronal function. An ischemic insult induces prompt and excessive glutamate release and drastic increases of intracellular Ca 2+ mainly via N-methyl-D-aspartate receptors, particularly of those at the extrasynaptic site. This Ca 2+ -evoked neuronal cell death in the ischemic core is dominated by necrosis within a few hours and days known as acute excitotoxicity. Furthermore, mild but sustained Ca 2+ increases under neurodegenerative conditions such as in the distant penumbra of the ischemic brain and early stages of Alzheimer's disease are not immediately toxic, but gradually set off deteriorating Ca 2+ -dependent signals and neuronal cell loss mostly because of activation of programmed cell death pathways. Based on the Ca 2+ hypothesis of Alzheimer's disease and recent advances, this Ca 2+ -activated "silent" degenerative excitotoxicity evolves from years to decades and is recognized as a unique slow and chronic neuropathogenesis. The N-methyl-D-aspartate receptor subunit GluN3A, primarily at the extrasynaptic site, serves as a gatekeeper for the N-methyl-D-aspartate receptor activity and is neuroprotective against both acute and chronic excitotoxicity. Ischemic stroke and Alzheimer's disease, therefore, share an N-methyl-D-aspartate receptor- and Ca 2+ -mediated mechanism, although with much different time courses. It is thus proposed that early interventions to control Ca 2+ homeostasis at the preclinical stage are pivotal for individuals who are susceptible to sporadic late-onset Alzheimer's disease and Alzheimer's disease-related dementia. This early treatment simultaneously serves as a preconditioning therapy against ischemic stroke that often attacks the same individuals during abnormal aging.

Rhein alleviates diabetic cardiomyopathy by inhibiting mitochondrial dynamics disorder, apoptosis and hypertrophy in cardiomyocytes

BACKGROUND

Diabetic cardiomyopathy (DCM) is a significant cardiovascular complication in diabetic patients, and treatment regimens are limited. Rhein, a compound extracted from the herb rhubarb, was investigated in this study for its efficacy on DCM and the potential mechanism.

METHODS

Streptozotocin-induced DCM mice, high-glucose (HG)-treated neonatal rat cardiomyocytes (NRCMs), and H9c2 cells with ClpP knockdown were used for the study. We performed phenotypic and molecular mechanistic studies using immunoblotting, quantitative polymerase chain reaction, transmission electron microscopy, cardiac echocardiography, and histopathological analysis.

RESULTS

Rhein improved the cardiac function and myocardial fibrosis, and decreased the cross-sectional area of cardiomyocytes in the DCM mice. It also improved mitochondrial dynamic disorder as evidenced by a decreased ratio of mitochondrial fission-related proteins p-Drp1S616/ Drp1 and increased expression of mitochondrial fusion proteins (Opa1, Mfn1 and Mfn2). Rhein mitigated apoptosis as indicated by decreased apoptosis-related proteins (caspase 9, cleaved-caspase 3 and Bax) and increased anti-apoptosis protein Bcl2 in the heart tissue of DCM mice. Upregulations of cardiac hypertrophy associated genes (ANP, BNP and β-MHC) were significantly inhibited by Rhein treatment. In addition, the level of ClpP, a mitochondrial protease, was increased in DCM, but was normalized by Rhein treatment. However, ClpP knockdown exacerbated cardiomyocyte injury in the presence or absence of HG in H9c2 cells, indicating that a normal level of ClpP is essential for cardiomyocytes to survive.

CONCLUSIONS

Our results suggest that Rhein protects DCM by ameliorating mitochondrial dynamics disorder, inhibiting cardiomyocyte apoptosis, and myocardial hypertrophy. These protective effects of Rhein may be mediated by preventing ClpP upregulation.

Enlarged perivascular spaces and clinical outcome of acute ischemic stroke patients receiving intravenous thrombolysis

BACKGROUND

Enlarged perivascular spaces (EPVS) is one of the main imaging features of cerebral small vessel disease (CSVD). Previous studies have shown that hypertension and advanced age were important risk factors for the occurrence and development of EPVS. We aim to explore the correlation between the severity of EPVS at centrum semiovale and basal ganglia and the early and long-term outcome of acute ischemic stroke (AIS) patients receiving intravenous thrombolysis.

METHODS

AIS who received intravenous thrombolysis at the First Affiliated Hospital of Kunming Medical University were retrospectively collected. Demographic data, stroke risk factors, laboratory test results and head imaging data were collected. The number of EPVS in centrum semiovale and basal ganglia of patients in cranial magnetic resonance imaging (MRI) was counted by visual quantification method. Logistic regression analysis was used to evaluate the independent risk factors affecting the prognosis.

RESULTS

A total of 196 subjects were included in this study. The proportion of patients with poor clinical outcome at 90 days was higher in patients with moderate-to-severe centrum semiovale EPVS than in those with no-to-mild EPVS (42.9 % vs 18.7 %, P=0.031). Similarly, patients with moderate-to-severe EPVS in the basal ganglia region had a significantly poor clinical outcome at 90 days (51.7 % vs 18.3 %, P=0.001). Moderate to severe basal ganglia EPVS (OR=2.661, 95 %CI: 1.070-6.618, P=0.035), hyperlipidemia (OR=3.011, 95 %CI: 1.147-7.902, P=0.025) and a higher baseline NIHSS score before thrombolysis (OR=1.194, 95 %CI: 1.071-1.331, P=0.001) were independent risk factors for poor clinical outcome at 90 days. Early neurological improvement (OR=0.220, 95 %CI 0.093-0.520, P=0.001) was associated with a reduced risk of poor clinical outcomes at 90 days.

CONCLUSIONS

Moderate-to-severe EPVS in basal ganglia were an independent risk factor for poor clinical outcome at 90 days in AIS patients with intravenous thrombolysis. Therefore, the severity of EPVS in the basal ganglia region can serve as an imaging marker to predict the 90-day clinical outcome of AIS patients treated with intravenous thrombolysis.

Impact of virtual reality-based rehabilitation on poststroke depression: A systematic review and meta-analysis

BACKGROUND

Depression is the most common neuropsychiatric sequela of stroke, negatively affecting functional recovery and quality of life. Although virtual reality-based rehabilitation (VRBR) is an effective intervention in stroke rehabilitation, its efficacy in treating poststroke depression (PSD) remains unclear.

OBJECTIVES

To evaluate the treatment effect of VRBR on PSD.

DATA SOURCES AND METHODS

Six medical databases were systematically searched from inception to May 31, 2024, with an update on October 5, 2024. Potentially eligible studies were screened against the inclusion and exclusion criteria. Review Manager 5.4 and Stata 14.0 were used to conduct statistical analysis.

RESULTS

Twelve studies published between 2015 and 2024 were included. The pooled results revealed that VRBR significantly reduced depression scores among poststroke patients [SMD = -0.56, 95 % CI (-0.90,-0.23), P = 0.001]. Subgroup analyses suggested numerically greater improvements in patients with a mean age < 60 years and those receiving ≥20 intervention sessions, though between-subgroup differences were not statistically significant.

CONCLUSION

VRBR may be a promising therapy for PSD. However, methodologically rigorous studies are needed to further confirm its efficacy and safety.

TRIAL REGISTRATION

PROSPERO, CRD42024550019.

Work-related musculoskeletal pain among orthopaedic surgeons: A systematic literature search and narrative synthesis

Background

Performing surgery is associated with physical demands and musculoskeletal hazards. Orthopaedic surgery is a particularly physically demanding surgical discipline. We aimed to systematically examine the literature characterizing the prevalence and nature of work-related musculoskeletal (MSK) pain among orthopaedic surgeons.

Methods

Systematic search and narrative synthesis methodology of studies on MSK pain among orthopaedic surgeons was conducted in MEDLINE, Embase, and CINAHL. Data extraction of study characteristics was performed and further analyzed for prevalence, pain outcome measures, and anatomical location of MSK pain. This review is registered in PROSPERO CRD420250650511.

Results

25 studies met our inclusion criteria. 14 studies were published since 2019, with no articles before 1995. 11 papers studied surgeons in the USA and the remaining from other countries. The range of overall MSK pain prevalence was 51.7-97.0 %. 11 studies reported on pain in 1-2 anatomical regions, while 9 studies reported on >3 regions. MSK pain was most frequently reported in the lower back (prevalence of 17.1-77.0 %); neck (10.4-74.4 %); and shoulder (12.8-66.7 %). 13 studies determined MSK pain via author-made or unspecified instruments while 12 papers used validated tools for surveying MSK pain. 17 studies specified a time period in which MSK pain reports were captured.

Conclusion

Orthopaedic surgeons report a high frequency of MSK pain, in the lower back, neck and shoulder regions. There was considerable heterogeneity of research methods and outcome measures utilized. Further research is needed to better understand the role of preventive measures and the potential influence of MSK pain on surgeon occupational function, and the orthopaedic surgeon workforce.

Malignancy risk stratification for pulmonary nodules: comparing a deep learning approach to multiparametric statistical models in different disease groups

OBJECTIVES

Incidentally detected pulmonary nodules present a challenge in clinical routine with demand for reliable support systems for risk classification. We aimed to evaluate the performance of the lung-cancer-prediction-convolutional-neural-network (LCP-CNN), a deep learning-based approach, in comparison to multiparametric statistical methods (Brock model and Lung-RADS®) for risk classification of nodules in cohorts with different risk profiles and underlying pulmonary diseases.

MATERIALS AND METHODS

Retrospective analysis was conducted on non-contrast and contrast-enhanced CT scans containing pulmonary nodules measuring 5-30 mm. Ground truth was defined by histology or follow-up stability. The final analysis was performed on 297 patients with 422 eligible nodules, of which 105 nodules were malignant. Classification performance of the LCP-CNN, Brock model, and Lung-RADS® was evaluated in terms of diagnostic accuracy measurements including ROC-analysis for different subcohorts (total, screening, emphysema, and interstitial lung disease).

RESULTS

LCP-CNN demonstrated superior performance compared to the Brock model in total and screening cohorts (AUC 0.92 (95% CI: 0.89-0.94) and 0.93 (95% CI: 0.89-0.96)). Superior sensitivity of LCP-CNN was demonstrated compared to the Brock model and Lung-RADS® in total, screening, and emphysema cohorts for a risk threshold of 5%. Superior sensitivity of LCP-CNN was also shown across all disease groups compared to the Brock model at a threshold of 65%, compared to Lung-RADS® sensitivity was better or equal. No significant differences in the performance of LCP-CNN were found between subcohorts.

CONCLUSION

This study offers further evidence of the potential to integrate deep learning-based decision support systems into pulmonary nodule classification workflows, irrespective of the individual patient risk profile and underlying pulmonary disease.

KEY POINTS

Question Is a deep-learning approach (LCP-CNN) superior to multiparametric models (Brock model, Lung-RADS®) in classifying pulmonary nodule risk across varied patient profiles? Findings LCP-CNN shows superior performance in risk classification of pulmonary nodules compared to multiparametric models with no significant impact on risk profiles and structural pulmonary diseases. Clinical relevance LCP-CNN offers efficiency and accuracy, addressing limitations of traditional models, such as variations in manual measurements or lack of patient data, while producing robust results. Such approaches may therefore impact clinical work by complementing or even replacing current approaches.

Association between physical activity and sedentary behavior with cardiometabolic multimorbidity in the elderly hypertensive population: an observational and Mendelian randomization study

BACKGROUND

The causal relationships between physical activity (PA), sedentary behavior (SB), and the risk of cardiometabolic disease (CMD) in hypertensive populations remain unclear. We conducted a Mendelian randomization (MR) analysis to investigate these associations.

METHODS

We conducted an observational analysis using a sample of 18,963 hypertensive population. For the two-sample Mendelian Randomization (MR) analysis, we used genome-wide association study (GWAS) summary data from population-wide cohorts obtained from the MRC Integrative Epidemiology Unit (MRC-IEU). The observational study was conducted from July 2023 to September 2023. Genetic tools were selected from GWAS at genome-wide significance (P < 5 × 10-8). The summary statistics for CMD include type 2 diabetes (T2D), stroke, and coronary heart disease (CHD). Logistic regression models were employed to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between PA and SB with CMD (T2D, stroke, and CHD) in the hypertensive population.

RESULTS

A total of 17,234 elderly hypertensive population were included, with an average age of 73.0 years. Among them, 9888 (57.4 %) were women, and 9406 (54.5 %) had CMD. Compared to low physical activity (LPA), moderate physical activity (MPA) was associated with a decreased risk of T2D [OR (95 % CI): 0.749 (0.682, 0.823)] and stroke [OR (95 % CI): 0.525 (0.480, 0.575)]. Vigorous physical activity (VPA) was linked to a reduced risk of T2D, stroke, and CHD. In contrast, prolonged SB was associated with an increased risk of T2D, stroke, and CHD. The MR analyses found that genetically predicted MPA was significantly associated with a reduced risk of T2D in the general population, consistent with the observational study results in hypertensive individuals. Similarly, VPA and SB were causally associated with T2D, stroke, and CHD, supporting the inverse relationships observed in the observational study.

CONCLUSIONS

This study suggests that a sedentary lifestyle and moderate to vigorous physical activity may play a significant role in the development of CMD in hypertensive populations.

Effects of Fermented Kimchi Consumption on Anthropometric and Blood Cardiometabolic Indicators: A Systematic Review and Meta-Analysis of Intervention Studies and Prospective Cohort Studies

CONTEXT

Increasing global kimchi consumption has prompted interest in its health impact. However, comprehensive reviews of the influence of kimchi on cardiometabolic risk factors, especially meta-analyses, remain limited.

OBJECTIVE

This review assessed the impact of fermented kimchi consumption on cardiometabolic risk factors by systematically reviewing human intervention and prospective cohort studies, and conducting a meta-analysis of intervention studies.

DATA SOURCES

A literature search of PubMed, EMBASE, Scopus, Web of Science, RISS, KISS, and ScienceON databases was conducted through April 30, 2024. The inclusion criteria encompassed studies that examined the effects of fermented kimchi, without any added ingredients or lactic acid bacteria, on health outcomes, including anthropometric measures, blood pressure, cardiometabolic and glycemic indicators, inflammatory cytokines, and the incidence of related chronic diseases.

DATA EXTRACTION

Data extraction and quality evaluation were conducted independently by 3 researchers.

DATA ANALYSIS

Pooled effect sizes were calculated as weighted mean differences (WMDs) with 95% CIs employing random-effects models.

RESULTS

Five intervention studies (205 participants) and 4 prospective cohort studies (42 455 participants) were selected. A meta-analysis of the intervention studies revealed a significant reduction in fasting blood glucose (WMD: -1.93 mg/dL; 95% CI: -3.82, -0.03; I2 = 17.4%) following the consumption of fermented kimchi. After excluding studies that contributed to increased heterogeneity, significant inverse associations were observed between fermented kimchi consumption and triglycerides (WMD: -28.9 mg/dL; 95% CI: -53.2, -4.5; I2 = 0.0%), systolic blood pressure (WMD: -3.48 mmHg; 95% CI: -5.95, -1.01, I2 = 0.0%), and diastolic blood pressure (WMD: -2.68 mmHg; 95% CI: -4.75, -0.62; I2 = 0.0%). Prospective cohort studies linked higher kimchi intake with a lower incidence of cancer and metabolic syndrome and an increased likelihood of achieving normal body weight.

CONCLUSION

This review supports beneficial effects of fermented kimchi on cardiometabolic health. However, due to the limited number of studies, these findings should be interpreted cautiously, highlighting the need for further research in diverse populations.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration No. CRD42024532020.

Indole lactic acid derived from Akkermansia muciniphila activates the aryl hydrocarbon receptor to inhibit ferroptosis in ischemic stroke

Ischemic stroke concurrent with gut microbiome dysbiosis induces intestinal damage, which exacerbates cerebral infarction. Probiotic or prebiotic interventions that reverse gut microbiome dysbiosis can promote recovery after ischemic stroke. Akkermansia muciniphila (AKK) safeguards intestinal health and is a promising probiotic; however, its role in ischemic stroke remains unclear. In this study, we found that live AKK, but not pasteurized AKK, mitigated ischemic-stroke-induced neurological injury, reduced cerebral infarction, and enhanced both blood-brain and intestinal barrier integrity. Moreover, the AKK supernatant reduced intestinal and cerebral injury, demonstrating efficacy comparable to that of live AKK. Metabolomic analysis revealed that the AKK supernatant was significantly enriched in indole lactic acid (ILA), a tryptophan metabolite. ILA levels were elevated in the serum and brains of pseudo-germ-free stroke rats administered AKK. Exogenous gavage with ILA mitigated ischemic-stroke-induced brain and intestinal damage. Mechanistically, ILA activated the aryl hydrocarbon receptor (AhR) and the nuclear transcription factor Nrf2, leading to the upregulation of SLC7A11 and GPX4 protein expression. This attenuated lipid peroxidation and intracellular iron accumulation triggered by ischemic stroke. Notably, intervention with the AhR inhibitor CH223191 abrogated the protective effects of ILA in ischemic stroke rats. These findings suggest that the therapeutic efficacy of AKK in ischemic stroke is at least partially attributable to ILA-mediated ferroptosis inhibition via AhR activation. AKK was selectively enriched by Puerariae lobatae Radix-resistant starch (PRS), promoting ILA generation more effectively than inulin and β-glucan. AKK and PRS synergistically alleviated ischemic-stroke-induced impairments, outperforming monomicrobial or prebiotic treatment alone. These findings reveal the unique mechanisms of AKK in ischemic stroke and provide a viable strategy for the clinical treatment of ischemic stroke through a novel synbiotic combination.

Modeling Disability-Adjusted Life-Years for Policy and Decision Analysis

This study outlines methods for modeling disability-adjusted life-years (DALYs) in common decision-modeling frameworks. Recognizing the wide spectrum of experience and programming comfort level among practitioners, we outline 2 approaches for modeling DALYs in its constituent parts: years of life lost to disease (YLL) and years of life lived with disability (YLD). Our beginner approach draws on the Markov trace, while the intermediate approach facilitates more efficient estimation by incorporating non-Markovian tracking elements into the transition probability matrix. Drawing on an existing disease progression discrete time Markov cohort model, we demonstrate the equivalence of DALY estimates and cost-effectiveness analysis results across our methods and show that other commonly used "shortcuts" for estimating DALYs will not, in general, yield accurate estimates of DALY levels nor incremental cost-effectiveness ratios in a modeled population.HighlightsThis study introduces 2 DALY estimation methods-beginner and intermediate approaches-that produce similar results, expanding the toolkit available to decision modelers.These methods can be adapted to estimate other outcomes (e.g., QALYs, life-years) and applied to other common decision-modeling frameworks, including microsimulation models with patient-level attributes and discrete event simulations that estimate YLDs and YLLs based on time to death and disease duration.Our findings further reveal that commonly used shortcut methods for DALY calculations may lead to differing results, particularly for DALY levels and incremental cost-effectiveness ratios.

Predictors of Anaemia Among Young Children Receiving Daily Micronutrient Powders (MNPs) for 24 Weeks in Bangladesh: A Secondary Analysis of the Zinc in Powders Trial

In Bangladesh, anaemia is estimated to affect 52% of children 6-59 months, with the youngest children (6-23 months) experiencing the highest levels of anaemia (71%). Micronutrient powders (MNPs) are designed to increase micronutrient intake in young children; however, in some settings, the prevalence of anaemia may remain elevated despite the high coverage of MNPs. In a secondary analysis of the Zinc in Powders trial (ZiPT), we identified risk factors that were associated with anaemia among Bangladeshi children 9-11 months of age who received standard 15-component MNPs, including 10 mg of iron, daily for 24 weeks. At enrolment, socio-demographic characteristics were collected. Morbidity symptoms were assessed on a semi-weekly basis. Haemoglobin (measured via single-drop capillary blood using Hemocue 301+) and child anthropometry were assessed at enrolment and endline (24 weeks). Risk factors for anaemia at endline (24 weeks) were identified using minimally adjusted (age and sex) logistic regression models. Multivariate models were subsequently constructed, controlling for age, sex and significant risk factors. Of the 481 children randomized to the MNP arm, 442 completed the trial and had haemoglobin data available at endline. Anaemia (haemoglobin < 10.5 g/dL) prevalence declined from 54.1% at baseline to 32.6% at endline. In minimally adjusted models, season of enrolment, underweight at enrolment, asset score, hygiene score and frequent morbidity symptoms were associated with the odds of anaemia at endline. However, some factors lost statistical significance in multivariate models. MNPs are an important tool for anaemia prevention; however, they should be part of an integrated approach for anaemia control.

A glycopeptide-based pH-responsive hydrogel promotes diabetic wound healing via antimicrobial and remodeling microenvironment

Treating bacterium-infected diabetic wounds remains a major medical challenge. Antimicrobial activity, remodeling of oxidative stress-heavy and angiogenesis-impaired microenvironments are critical factors for effective wound healing. Hydrogels can function as drug delivery systems that encompass all these capabilities to enhance wound healing. In this study, we developed a glycopeptide-based hydrogel (DA/bF@OD-PL) composed of oxidized dextran (OD), polylysine (PL), dopamine (DA), and basic fibroblast growth factor (bF). This hydrogel exhibits excellent structural integrity, injectability, adhesion properties, swelling capacity, and degradability. Notably, the hydrogel is responsive to acidic conditions due to the presence of Schiff base bonds, enabling it to respond to the acidic environment characteristic of bacterium-infected wounds and release its encapsulated drugs accordingly. Among these components, PL has a strong antibacterial effect and can easily kill S. aureus and E. coli. DA effectively scavenges multiple reactive oxygen species (ROS) and induces macrophage polarization to M2 macrophages to alleviate oxidative stress. bF upregulates the expression of CD31 and vascular endothelial growth factor (VEGF) to promote angiogenesis. Finally, we validated the ability of this hydrogel to promote rapid wound healing in an S. aureus-infected diabetic mouse wound model.

Phytochemical and biological studies on rare and endangered plants endemic to China. Part XLIV. Integrated NMR/EI-MS/LC-PDA-ESIMS approach for dereplication and targeted isolation of fortunefuroic acids from Keteleeria fortunei across diverse geographical origins

Secondary metabolites in plants of the same species, though originating from distinct geographical regions, frequently display both similarities and notable variations. A prior study on the vulnerable Chinese endemic conifer Keteleeria fortunei, collected from Yunnan province (KFYN), led to the isolation of fortunefuroic acids (FFAs) A-I. These compounds represent a unique class of triterpenoids characterized by a rare furoic acid moiety within the lateral chain. The distinct 23,27-epoxy-23,25(27)-dien-26-oic acid unit present in FFAs can be readily identified by characteristic proton NMR signals (δH-24: ca 6.36 ppm; δH-27: ca 7.97 ppm), a prominent ion fragment at m/z 125 in the EI-MS, and typical UV absorption peak around λmax 245 nm. In this study, an integrated approach was employed to dereplicate and isolate FFA-type compounds from K. fortunei collected from Fujian Province (KFFJ). This approach combined NMR, EI-MS, and LC-PDA-ESIMS data to detect and analyze compounds with molecular weights in the range of 464-468 Da, a distinguishing feature of FFA-type compounds. Consequently, six previously undescribed FFAs K-P (1-6) were obtained, alongside the re-isolation of FFAs A-D and H. Compound 1 exhibits a rare 17,14-friedo-cyclaorane type skeleton, while compound 2 is characterized as a 3,4-seco-cyclaorane-3,26-dioic acid. Compounds 3-6 are identified as derivatives of 9βH-lanost-26-oic FFAs. Additionally, a previously unreported lanost-26-oic acid derivative (7) was also identified, exhibiting an inhibitory effect on ATP-citrate lyase. Their chemical structures and absolute configurations were determined through spectroscopic analysis, GIAO NMR calculations combined with DP4+ probability analyses, and electronic circular dichroism calculations. The isolated FFAs have the potential to serve as chemotaxonomic markers for the genus Keteleeria within the Pinaceae family. This study marks the first application of integrated NMR/EI-MS/LC-PDA-ESIMS methods for both dereplication and the discovery of new natural products. Notably, the KFFJ samples were collected from a location approximately 1500 km away from that of KFYN. Understanding the impact of geographical origins on specialized metabolites may provide valuable insights into the sustainable utilization and conservation of endangered plant species.

Insomnia and its risk factors in patients with type 2 diabetes: A cross-sectional study

AIMS

Insomnia is notably prevalent among individuals with type 2 diabetes and adversely affects both glycemic control and overall quality-of-life. The objective of this study was to evaluate the possible risk factors for insomnia in patients diagnosed with type 2 diabetes and co-morbid insomnia.

METHODS

This is a baseline study analyzing cross-sectional data at baseline timepoint collected in a randomized controlled trial study. A total of 227 participants with type 2 diabetes and insomnia were recruited. The diagnosis of insomnia was based on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and the total score of Insomnia Severity Index. Multiple linear regression model was used to analyze the possible biomedical and mental health risk factors for insomnia severity, total sleep time, sleep efficiency and sleep onset latency.

RESULTS

Factors significantly associated with insomnia severity included fasting blood glucose and depression. Blood magnesium level was related to total sleep time. Sleep efficiency was associated with blood phosphorus. Factors related to sleep onset latency were depression and fatigue.

CONCLUSION

Factors related to high insomnia severity and poor sleep quality in type 2 diabetes patients with insomnia included fasting blood glucose, blood magnesium, blood phosphorus, depression and fatigue.

Changes Over 10 Years in Peripheral Nerve Function in People With Well-Controlled Type 2 Diabetes and Those With Normal Glucose Tolerance

BACKGROUND AND OBJECTIVES

There is a lack of knowledge on the changes in peripheral nerve function in people with well-controlled, recently diagnosed type 2 diabetes compared with those with normal glucose tolerance (NGT). In this study, we aimed to investigate the natural course of the function of lower extremity small and large nerve fibers in people with NGT and its decline in those with well-controlled type 2 diabetes.

METHODS

This prospective observational study assessed changes in nerve function in participants of the German Diabetes Study with recently diagnosed (≤1 year) type 2 diabetes and age-matched and sex-matched individuals with NGT after 5 years and in a larger group of participants with type 2 diabetes after 5 and 10 years. Reference tests of lower extremity peripheral nerve function included peroneal motor nerve conduction velocity (MNCV) and sural sensory nerve conduction velocity (SNCV), sural sensory nerve action potential (SNAP), malleolar vibration perception threshold (VPT), and thermal detection thresholds (TDTs). Data were analyzed using multiple linear or logistic regression analyses.

RESULTS

At baseline, all 5 nerve function measures showed impairment in the 52 individuals in the diabetes group (33% female, median age 51.7 years) compared with the 52 individuals in the matched NGT group (33% female, median age 51.4 years). After 5 years, 2 nerve indices declined in the diabetes group (peroneal MNCV and VPT) and 3 in the NGT group (peroneal MNCV, VPT, and TDT for cold), with similar 5-year declines observed in both groups after adjustment for baseline values and pairwise matching. In addition, the Neuropathy Disability Score increased in the NGT group but not in the diabetes group. Comparable patterns of decline after 5 and 10 years were found in the larger diabetes cohort of 141 individuals (39% female, median baseline age 53.6 years). The observed 10-year prevalence of abnormal NCVs closely matched estimates based on natural aging-related decline (14.2% vs 12.8% for peroneal MNCV and 30.2% vs 31.0% for sural SNCV).

DISCUSSION

These findings suggest that nerve function deterioration in well-controlled type 2 diabetes is primarily influenced by nerve function status at diagnosis and physiologic aging, rather than diabetes-related progression.

Association of Prenatal Exposure to Triptans, Alone or Combined With Other Migraine Medications, and Neurodevelopmental Outcomes in Offspring

BACKGROUND AND OBJECTIVES

The long-term reproductive safety of migraine medications remains uncertain. This study sought to examine the effect of different intensities and durations of prenatal exposure to triptans, alone and combined with other preventive migraine medications, on neurodevelopmental disorders (NDDs) in children.

METHODS

This nationwide health registry study in Norway included pregnancies of women with migraine before pregnancy and followed up their children up to 14 years of age. Single and multiple group-based trajectory models and group-based multitrajectory models were applied to cluster triptan exposure alone and combined with preventive antimigraine medications. Child outcomes, based on specialist outpatient and inpatient diagnoses, included autism spectrum and behavioral disorders, learning and intellectual disabilities, speech/language and developmental coordination disorders, and attention-deficit hyperactivity disorders (ADHDs). We fit adjusted and weighted pooled logistic regression models and standardized risk curves using propensity score-based overlap weighting.

RESULTS

We included 26,210 pregnancies of women with migraine; 4,929 and 21,281 were, respectively, nonmedicated and medicated with triptans in the year of prepregnancy. In the latter group, we identified 4 group-based trajectories of triptans alone and combined with preventive medications: discontinuers before (low use) (41.5%, 47.0%), early discontinuers (short-term low use) (31.3%, 28.8%), late discontinuers (moderate use) (21.3%, 9.1%), and late discontinuers (high use) (5.9%, 15.2%). Overall, 1,140 children (4.3%) had a NDD (mean follow-up time: 8 years). Children born to women with any triptan trajectory had a slightly higher risk of NDD compared with children of nonmedicated women (magnitude range of the weighted hazard ratio [wHR]: 1.05-1.16). These risks decreased to the null when discontinuers before (low use) acted as a comparator (magnitude of wHR: 0.94-1.01) or when analyzing speech/language disorders or ADHD (magnitude of wHR: 0.82-1.14). There was a slightly elevated risk of autism disorders with both triptan late discontinuation trajectories (wHR 1.24, 95% CI [0.78-1.97]; wHR 1.30, 95% CI [0.66-2.56]), but the 95% CI crossed the null and the weighted risk difference remained low.

DISCUSSION

Our findings indicate that prenatal exposure to triptans, alone or combined with other migraine medications, does not substantially increase the risk of a broad range of neurodevelopmental outcomes in children up to adolescence.

Mogroside V prevents ethanol-induced hangover and liver damage by reducing oxidative stress, steatosis and inflammation

Excessive alcohol consumption is a leading cause of alcohol-associated liver disease (ALD). Previous studies presented Mogroside V (MV) have protective effects on against nonalcoholic fatty liver disease. however, the effects of MV on ethanol-induced hangover and liver damage remains to be elucidated. Herein, we investigated the potential effects of MV in relieving hangover and mitigating liver injury induced by ethanol. MV significantly reduced blood ethanol, liver histological alterations and serum ALT, AST、TG levels in ethanol-treated mice. Moreover, MV accelerates alcohol metabolism by inhibiting the upregulation of CYP2E1 induced by ethanol, while enhancing the activity of ADH and ALDH, as well as upregulating the expression of ADH1 and ALDH2. MV mitigates oxidative stress by decreased hepatic malondialdehyde (MDA) levels, restored glutathione (GSH)、superoxide dismutase (SOD) and catalase (CAT) content in ethanol-induced mice. Mechanistically, MV activated the p-AMPK/SREBP-1/FASN pathway to decreased hepatic lipid accumulation and alleviated steatosis. Additionally, MV promoted nuclear translocation of Nrf-2 to attenuates oxidative stress and suppressed TLR4/MyD88/NF-κB signaling pathway to reduce Inflammatory responses triggered by ethanol in mice. In summary, this study highlights mogroside V's hangover relieving effect and its protective effects against ethanol-related liver damage through its lipid metabolism regulation, antioxidative action and anti-inflammatory properties. These results suggest that mogroside V could be developed as a potential therapeutic agent against ethanol-induced liver damage.

Prevalence and risk factors of depressive and anxiety symptoms and functional constipation among university students in Eastern China

BACKGROUND

Depression and anxiety are prevalent among university students worldwide, often coexisting with functional constipation (FC). Family relationships have been identified as crucial factors affecting mental health, yet the gender-specific associations between these conditions remain underexplored.

AIM

To assess prevalence of depressive symptoms, anxiety symptoms, and FC among Chinese university students and explore their associations.

METHODS

Using a cross-sectional survey design, data were collected from 12721 students at two universities in Jiangsu Province and Shandong Province. Depressive symptoms were assessed using the Patient Health Questionnaire-9, anxiety symptoms using the Generalized Anxiety Disorder-7 scale, and FC using the ROME IV. Gender-stratified analyses and population attributable risk proportions were calculated to evaluate risk factor patterns and population impact.

RESULTS

The prevalence of self-reported depressive, anxiety, and comorbid depressive and anxiety symptoms was 16.3%, 24.9%, and 13.3%, respectively, whereas that of FC was 22%. Students with depressive symptoms were 1.811 times more likely to have FC than those without. Female gender, parental relationships, and lower household income were significant risk factors for both mental health conditions. For depressive symptoms, females experienced stronger effects from both parental conflict [odds ratio (OR) = 8.006 vs OR = 7.661 in males] and FC (OR = 1.954 vs OR = 1.628 in males). For anxiety symptoms, conflicted parental relationships had stronger effects in males (OR = 5.946) than females (OR = 4.262). Overall, poor parental relationships contributed to 38.6% of depressive and 33.5% of anxiety symptoms.

CONCLUSION

Family relationships significantly impact student mental health, with gender-specific patterns. Targeted interventions addressing family dynamics could reduce mental health burden in university settings.

Psychiatric symptoms in stroke patients: Clinical features of depression and anxiety

BACKGROUND

Post-stroke psychiatric complications, particularly depression and anxiety, significantly impact rehabilitation outcomes and quality of life. Despite their prevalence and clinical significance, these conditions often remain underrecognized in routine stroke care. Understanding their clinical features and temporal patterns is crucial for improving patient outcomes.

AIM

To investigate the prevalence, temporal evolution, and clinical correlates of depression and anxiety post-stroke and their impact on functional recovery.

METHODS

In this prospective observational study, 127 patients first-ever ischemic stroke were enrolled between June 2022 and June 2024. Depression and anxiety were assessed using the Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale at baseline and follow-up intervals (2 weeks, 1 month, 3 months, and 6 months). Stroke severity was evaluated using the National Institutes of Health Stroke Scale, and functional outcomes were measured using the modified Rankin Scale.

RESULTS

Among 120 patients who completed follow-up (94.5% completion rate), 37.5% had depression (mild: 18.3%, moderate: 12.5%, severe: 6.7%) and 41.7% had anxiety at baseline. Depression prevalence showed a biphasic pattern, peaking at 2 weeks (37.5%), declining at 3 months (28.3%), and slightly increasing at 6 months (30.8%). Stroke severity significantly correlated with both depression (odds ratio = 1.18, 95%CI: 1.06-1.31, P = 0.003) and anxiety (odds ratio = 1.15, 95%CI: 1.04-1.27, P = 0.008). Left hemisphere lesions had a stronger association with psychiatric symptoms than right hemisphere lesions (P = 0.035). Patients with psychiatric complications demonstrated poorer functional outcomes at 6 months (median modified Rankin Scale 3 vs 2, P = 0.015) and longer hospital stays (mean difference: 3.2 days, P = 0.002).

CONCLUSION

Identifying the clinical and neuroanatomical correlates of depression and anxiety will enable effective risk stratification and patient management. Integrating routine psychiatric screening and early intervention is essential in stroke care.

Sleep deficiency exacerbates periodontal inflammation via trigeminal TRPV1 neurons

Periodontitis, a prevalent chronic inflammatory disease, profoundly impacts both quality of life and overall health. Clinical studies have suggested a correlation between periodontitis and sleep deficiency, but the underlying mechanisms involved remain elusive. Here, we observed an elevated risk of periodontitis in individuals with sleep deficiency, as demonstrated in both clinical subjects and mouse models. Retrograde tracing from the periodontium revealed a neural connection from trigeminal TRPV1 neurons, which may mediate the aggravating effects of sleep deficiency on periodontitis. The ablation of TRPV1 neurons effectively mitigated the aggravating effects of sleep deficiency on periodontitis. Under periodontitis, sleep restriction increased the secretion of substance P from trigeminal neurons in the periodontium, enhancing vasodilation and vascular permeability, which in turn promoted the infiltration of proinflammatory immune cells. Blocking substance P signaling via a Neurokinin-1 receptor antagonist or knocking down Tacr1 in vascular endothelial cells alleviated these detrimental effects. Our findings unveil a critical neuron-vessel-immune axis that exacerbates periodontitis during sleep deficiency and suggest potential therapeutic strategies targeting this axis for managing periodontitis in individuals suffering from sleep deficiency.

The role of oxidative stress in the association between metabolic score for insulin resistance and stroke: evidence from two large population-based studies

OBJECTIVE

This study endeavors to unveil the association between the Metabolic Score for Insulin Resistance (METS-IR) and stroke among adults utilizing data of the National Health and Nutrition Examination Survey (NHANES) and the China Health and Retirement Longitudinal Study (CHARLS), and whether oxidative stress (OS) mediates their association.

METHODS

Our study cohort comprised 101,316 individuals from NHANES and 17,708 individuals from CHARLS. The intricate relationships among the METS-IR, stroke, and OS biomarkers were evaluated via logistic regression, restricted cubic splines (RCS), as well as mediation analysis.

RESULTS

The final analysis included 22,542 American and 9521 Chinese participants, among whom 844 and 887 were diagnosed with stroke, respectively. Regression analysis indicated a positive association of METS-IR with stroke [NHANES: OR = 1.01, 95 % CI (1.01, 1.02), p < 0.001; CHARLS: OR = 1.02, 95 % CI (1.02, 1.03), p < 0.001], with higher METS-IR quartiles being associated with elevated stroke incidence [NHANES: OR = 1.39, 95 % CI (1.11, 1.73), p = 0.004; CHARLS: OR = 1.74, 95 % CI (1.39, 2.17), p < 0.001]. Participants with elevated METS-IR and serum uric acid (SUA) exhibited the greatest probability of stroke. Mediation analysis proved that OS partially mediated this association [Mediation effect: NHANES β = -8.45e-5, 95 % CI (-1.41e-4, -4.01e-5), p < 0.001; CHARLS β = -4.02e-5, 95 % CI (-8.14e-5, -7.76e-6), p = 0.012].

CONCLUSION

The METS-IR was positively associated with stroke in NHANES and CHARLS cohorts, and OS partially mediated this association.

ALX/FPR2 Contributes to Serum Amyloid A-Induced Lung Neutrophil Recruitment Following Acute Ozone Exposure

Ozone (O3) is a toxic air pollutant that causes pulmonary inflammation, neutrophil recruitment, and lung injury. Part of the inflammatory response to O3 includes altered expression of formyl peptide receptor 2 (ALX/FPR2), a G protein-coupled receptor expressed primarily in immune cells. ALX/FPR2 is considered either anti-inflammatory/proresolving or proinflammatory depending on its ligands, which include lipoxin A4 or serum amyloid A (SAA). While the anti-inflammatory/proresolving lipoxin A4 ligand has been well studied, there remains a significant knowledge gap in the interaction between proinflammatory SAA and ALX/FPR2. To date, SAA has been shown to increase neutrophil recruitment through ALX/FPR2 and is increased systemically after O3 exposure. However, it is unclear if pulmonary SAA signals through ALX/FPR2 during the O3-induced inflammatory response. We hypothesized that ALX/FPR2-SAA signaling is required to initiate neutrophil recruitment to the lungs following O3 exposure. To test this hypothesis, ALX/FPR2 wild type (FPR2+/+) or knockout (FPR2-/-) mice were exposed to filtered air (FA) or 1 ppm O3 for 3 h. Pulmonary inflammation was assessed 6, 24, and 48 h following O3 exposure. FPR2-/- mice exhibited impaired neutrophil recruitment at 6 and 24 h after O3 exposure. In addition, FPR2-/- mouse pulmonary SAA expression was significantly increased after O3 exposure compared to FPR2+/+ mice. FPR2+/+ mice dosed with SAA via oropharyngeal aspiration had increased pulmonary neutrophils, while neutrophils were not increased in FPR2-/- mice. Taken together, these data indicate that ALX/FPR2 may contribute to SAA-induced pulmonary neutrophilia following O3 exposure.

Acid reflux medication use among adults with depressive symptoms

Emotional stress, including depression, may contribute to increased gastroesophageal reflux disease symptoms. In this paper, we aim to evaluate the associations between depressive symptoms, depressive symptom severity, and symptom clusters with acid reflux medication use, considering the potential interaction effect of sex. Data from the 2007-2018 National Health and Nutrition Examination Survey were used. Participants aged 18 years or older were included if they responded to the depressive symptoms and prescription medication questionnaires. This study included 31,444 participants, of whom 2871 had depressive symptoms. Participants with depressive symptoms had significantly higher odds of using antacids (aOR = 1.735; p < 0.001), histamine-2 receptor antagonists (H2RAs) (aOR = 1.653; p < 0.001), and proton pump inhibitors (PPIs) (aOR = 1.723; p < 0.001). A positive association was also found between depressive symptom severity and the use of antacids (aOR = 1.054; p < 0.001), H2RAs (aOR = 1.048; p < 0.001), and PPIs (aOR = 1.053; p < 0.001). Moreover, increases in cognitive-affective and somatic scores were associated with higher odds of using antacids (aOR = 1.080 for cognitive, 1.102 for somatic; p < 0.001), H2RAs (aOR = 1.078 for cognitive, 1.083 for somatic; p < 0.001), and PPIs (aOR = 1.075 for cognitive, 1.105 for somatic; p < 0.001). No significant sex interaction effects were observed. Adjusted models demonstrated no significant associations between depressive symptoms and the duration of medication use. This study provides evidence of an association between depressive symptoms and acid reflux medication use, highlighting the need to screen for related symptoms in patients with depressive symptoms.

The prognostic role of Fibrosis-4 score in heart failure with reduced ejection fraction

BACKGROUND

Heart failure with reduced ejection fraction (HFrEF) and metabolic dysfunction-associated steatotic liver disease (MASLD) are both associated with liver fibrosis. HFrEF patients may develop liver fibrosis due to hepatic congestion, MASLD, or a combination of both. The Fibrosis-4 (FIB-4) score calculated using age, aspartate aminotransferase, alanine aminotransferase, and platelet count, serves as a screening tool for advanced liver fibrosis. This study examines the association between the FIB-4 score and all-cause mortality, cardiovascular mortality, and major adverse liver outcomes (MALO) in patients with HFrEF.

METHOD AND RESULTS

This study included 4523 HFrEF patients from the Danish Heart Failure Registry. Based on FIB-4 score, 25.5 % were low-risk, 45.7 % were indeterminate-risk, and 28.8 % were high-risk for advanced liver fibrosis. After five years, the cumulative incidence of all-cause mortality was 43 % for the high-risk group, 36 % for the indeterminate-risk group, and 23 % for the low-risk group. The indeterminate-risk and high-risk group had an increased hazard ratio (HR) for all-cause mortality (HR 1.33, 95 % confidence interval [CI] 1.16-1.52; HR 1.51, 95 % CI 1.31-1.74) compared to the low-risk group. Similarly, HRs were elevated for cardiovascular mortality (HR 1.61, 95 % CI 1.27-2.05; HR 2.14, 95 % CI 1.67-2.74) and MALO (HR 1.77, 95 % CI 1.01-3.31; HR 2.54, 95 % CI 1.43-4.52).

CONCLUSION

A high FIB-4 score in patients with HFrEF is associated with increased mortality and MALO.

Beyond glycemic control: Roles for sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists in diabetic kidney disease

The global prevalence of diabetes has surged in recent years, with diabetic kidney disease (DKD) emerging as a major complication. Traditional therapies have had limited success in slowing progression to end-stage kidney disease. However, novel therapies, particularly sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists, which were initially developed for hyperglycemia management, have transformed the treatment of obesity, heart failure, cardiovascular disease, and more recently, DKD. SGLT2 inhibitors have consistently and significantly reduced cardiovascular events, albuminuria, and glomerular filtration rate, highlighting their efficacy across diverse clinical presentations for patients with kidney impairment. Although fewer studies have specifically investigated GLP-1 receptor agonists in patients with kidney disease, existing evidence underscores their potential to slow renal disease progression, reduce albuminuria, and improve clinically relevant outcomes. However, further research is needed to better identify patients most likely to benefit from treatment. Together, these therapies represent valuable advancements for DKD, offering significant reductions in morbidity and mortality and shifting the management of the disease by becoming essential pillars for the treatment of these patients.

Mediation role of gut microbiota in the association between ambient fine particulate matter components and cardiovascular disease: Evidence from a China cohort

BACKGROUND

Pairwise associations among fine particulate matter (PM2.5), gut microbiota, and cardiovascular disease (CVD) have been established. However, the mediating role of gut microbiota in the relationship between PM2.5 and its components and CVD remains unclear.

METHODS

We included 1459 participants from the China Multi-Ethnic Cohort between May 2018 and September 2019. CVD was identified using ICD-10 codes based on hospital surveillance system. PM2.5 and its components were sourced from the ChinaHighAirPollutants dataset. Gut microbiota was obtained from 16S rRNA sequencing of stool samples, and five α-indexes along with 1088 gut compositions were used as mediators. Cox proportional hazards and multiple linear regression were used to explore the associations among PM2.5 and its components, gut microbiota, and CVD. Causal mediation analysis was conducted to evaluate the potential mediating role of gut microbiota between PM2.5 and its components and CVD.

RESULTS

Among all the participants, 204 (14.0 %) had developed CVD during a 5501 person-year follow-up (median, 3.8 years). The ACE, Chao1, and Obs indexes positively mediated the associations of PM2.5 and its components with both CVD and stroke, with mediation proportions ranging from 7.9 % to 8.9 % for CVD and 10.0 %-12.1 % for stroke. The ACE index had the highest mediation proportion (12.1 %) in the relationship between sulfate and stroke. The genus Pasteurella also demonstrated a mediating role, accounting for 2.6 %-3.2 % for CVD, and 2.5 %-3.6 % for stroke, exhibiting the highest mediation proportion (3.6 %) on the association between black carbon or nitrate and stroke.

CONCLUSION

Three α-indexes (ACE, Chao1, and Obs) and the Pasteurella positively mediated the association between PM2.5 and its components and CVD risk. Enhancing the richness of gut microbiota could potentially reduce the risk of CVD induced by PM2.5 and its components.

Working life patterns after sickness absence due to depression: A 15-year register-based prospective cohort study

AIM

To identify working life patterns after sickness absence (SA) due to depression and sociodemographic, work, and health-related factors associated with them.

METHODS

The study cohort included 9139 Swedish residents, aged 25-40, with a new SA spell due to depression in 2005. We followed the cohort for 15 years analyzing their yearly dominant labor market outcomes. Sequence analysis was used to identify distinct labor market sequences and cluster analysis - to group similar sequences into working life typologies. For the sociodemographic, work, and health-related factor analysis, we used multinomial logistic regression.

RESULTS

We identified 4373 sequences and seven typologies: 1) "Predominant Economic Activity (EA)" (70.7 %), 2) "Predominant EA with Intermittent SA/Disability Pension (DP)" (14.4 %), 3) "Predominant Long-Term SA/DP" (8.0 %), 4) "Long-Term SA/DP Followed by No EA" (2.2 %), 5) "SA/DP with Some EA" (1.6 %), 6) "Emigration" (1.7 %), and 7) "Death" (1.4 %). Factors associated with the predominant long-term SA/DP typology included birth outside Sweden (OR = 1.61, 95 % CI: 1.29-2.01), lower educational attainment (OR = 3.20, 95 % CI: 2.42-4.22), prolonged index SA spell due to depression (OR = 4.81, 95 % CI: 3.71-6.25), prior long-term SA (OR = 3.60, 95 % CI: 2.87-4.50) and unemployment (OR = 2.00, 95 % CI: 1.61-2.48). Living with children (OR = 0.68, 95 % CI: 0.56-0.82) was associated with lower odds of belonging to this typology.

CONCLUSIONS

Most individuals after SA due to depression maintained their engagement in the labor market suggesting that Sweden's welfare system is supportive of their workforce participation. However, some individuals belonged to long-term SA, DP, and lack of EA typologies indicating a potential path to labor market marginalization.

Calycosin treats acute myocardial infarction via NLRP3 inflammasome: Bioinformatics, network pharmacology and experimental validation

BACKGROUND

Calycosin (CA) is a flavonoid natural product that may effectively treats acute myocardial infarction (AMI), but its mechanism is unclear.

METHODS

Targets related to AMI and CA were identified using the GEO database, SwissTargetPrediction, PharmMapper and literature searches. Protein-protein interactions analysis and Cytoscape were used to screen the core targets of CA for AMI treatment. Enrichment analysis identified biological pathways linked to AMI and potential mechanisms of CA. Immune infiltration analysis was used to explore the role of immune cells in AMI and the correlation between core targets and immune cells. And further validated in AMI rats with ligated left anterior descending.

RESULTS

Bioinformatics identified relevant targets and biological mechanisms of AMI, and network pharmacology revealed 31 potential targets affected by CA, with NLRP3, IL-18, IL-1β, MMP9, and TLR4 as core targets. Enrichment analysis demonstrated the biological roles of these potential targets and NLRP3, IL1β and IL18 were selected for further analysis. Immune infiltration analysis showed that both NLRP3 and IL-1β were closely associated with monocytes, mast cells activated and neutrophils, and IL-18 was closely associated with monocytes. CA exerted cardioprotective effects in AMI rats by inhibiting NLRP3 inflammasome activation and reducing IL-18 and IL-1β levels, improving cardiac function and attenuating myocardial injury and fibrosis.

CONCLUSION

CA effectively protects cardiac function and mitigates myocardial injury in post-AMI rats, probably through NLRP3 inflammasome inhibition.

Mediating effects of gastroesophageal reflux disease and smoking behavior on the relationship between depression and chronic obstructive pulmonary disease: Trans-ethnic Mendelian randomization study

BACKGROUND

This study seeks to elucidate the association between depression and the risk of chronic obstructive pulmonary disease (COPD) by Mendelian randomization (MR) analysis, motivated by prior observational studies indicating a potential link between these conditions.

METHODS

Data from individuals of European (EUR) and East Asian (EAS) ancestries diagnosed with major depressive disorder (MDD) were selected for analysis. The primary method utilized was inverse variance weighted (IVW) method, supplemented by a series of sensitivity analyses and false discovery rate (FDR) corrections. Subsequently, multivariable and mediation MR analyses were conducted to assess the impact of potential confounders and their mediating effects.

RESULTS

IVW revealed a significant causal relationship between MDD and COPD within EUR ancestry (OR 1.425, 95 % CI 1.243-1.633, P = 3.56 × 10-7, PFDR = 2.14 × 10-6). Additionally, replication datasets provided consistent evidence for these causal associations. Multivariable and mediation MR analyses identified gastroesophageal reflux disease (GORD) as a complete mediator (mediation effect: 98.97 %, P = 1.38 × 10-15), while smoking initiation (SI) (26.30 %, 5.54 × 10-9), age of smoking initiation (ASI) (18.73 %, 0.019), and cigarettes per day (CPD) (18.72 %, 0.004) were identified as partial mediators of this causal relationship. No causal association was detected in EAS ancestry, nor was reverse analysis.

CONCLUSIONS

This study established a causal relationship between MDD and COPD risk in EUR ancestry, identifying GORD and smoking as pivotal mediators. Future research involving larger cohorts is essential to validate the generalizability of these findings across other ancestries.

Prevalence and correlates of generalized anxiety disorder and subthreshold anxiety symptoms in south China: A network perspective

AIMS

To investigate the prevalence of generalized anxiety disorder (GAD) and subthreshold anxiety symptoms (SAS) in Guangdong province of China, and to identify the central anxiety symptoms, while further exploring their associations with sociodemographic characteristics, lifestyle factors, and somatic diseases.

METHODS

This survey was conducted in 21 administrative regions of Guangdong province with multistage-stratified cluster random sampling method. Multivariate logistic regression analyses were performed to estimate the adjusted odds ratios (ORs) and their 95 % confidence intervals (CIs). Network analyses were conducted to explore the centrality of anxiety symptoms.

RESULTS

A total of 16,377 individuals were included in this study. The weight 12-month prevalence rates for GAD and SAS were 3.5 % and 10.0 %, respectively. Multivariable logistic regression analysis identified several factors significantly associated with increased risks of GAD and SAS, including younger age, female, no spouse, current alcohol consumption, never exercising, comorbidities, sleep duration of less than 7 h. Notably, the factors related to GAD and SAS largely overlapped, with urban residency and napping correlating specifically with SAS, and mental health literacy correlating specifically with GAD. Network analysis identified "Trouble relaxing" (GAD4) as the most central symptom of anxiety.

CONCLUSIONS

GAD and SAS were prevalent among residents in south China. More attention and assistance should be prioritized to individuals with younger age, female, no spouse, current alcohol consumption, sleep less than 7 h, and comorbid with somatic diseases. Taking regular exercise and improving mental health literacy may be beneficial in preventing and controlling anxiety.

Lipid metabolism of Acetobacter pasteurianus and its main components with hypoglycemic effects

BACKGROUND

Probiotic Acetobacter pasteurianus is used to treat diabetes, but its specific hypoglycemic substances and mechanisms remain unclear.

AIM

To investigate the components for lipid metabolism of A. pasteurianus and its hypoglycemic effects, providing a basis for its broader application.

METHODS

The lipid metabolism of A. pasteurianus under different growth conditions was analyzed using lipidomics. Neutral lipid staining in A. pasteurianus cells and the formation of lipid droplet-like structures were observed using a confocal laser scanning microscope. The neutral lipid components were also analyzed using thin layer chromatography. A diabetic mouse model was established to evaluate the hypoglycemic effects of the main lipid components of A. pasteurianus and their role in repairing tissues such as the pancreas.

RESULTS

After comparing the effects of three culture media, namely, brain heart infusion (BHI) medium with 2% glucose, chromium-rich and zinc-rich medium, and mineral salt medium, A. pasteurianus grew well in BHI containing 2% glucose and produced the most lipids. A total of 583 lipid metabolic products was identified, with higher levels of coenzyme Q9 (CoQ9), oleic acid (OA), and wax ester, but no triacylglycerol was observed. It was found that the components that affected lipid metabolism in A. pasteurianus were mainly CoQ9 and OA. They exhibited hypoglycemic effects comparable to metformin in diabetic mice, repaired damaged pancreatic tissues, and did not cause damage to the liver and spleen.

CONCLUSION

Under high-nutrient growth conditions, A. pasteurianus contains abundant lipid components, such as CoQ9 and OA, with good hypoglycemic effects.

Prospective association between depressive symptoms and incident hypertension: Results from the Hispanic community health study/study of Latinos

OBJECTIVE

Previous research on depressive symptoms with incident hypertension has yielded mixed results, and this relationship has not been studied in a diverse group of Hispanic/Latino adults.

METHODS

We studied 5927 Hispanic/Latino adults aged 18-74 years from four U.S. cities who attended baseline (2008-2011) and follow-up (2014-2017) examinations of the Hispanic Community Health Study/Study of Latinos. Baseline depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale-10; clinically relevant depressive symptoms were defined as ≥10 points. Blood pressure (BP) was measured using a standardized protocol at both examinations. Hypertension was defined as measured systolic BP ≥130 mmHg, or diastolic BP ≥80 mmHg, or self-reported antihypertension medication use. Analyses accounted for the complex survey design.

RESULTS

Among 5927 persons without hypertension at baseline, the six-year age-adjusted incidence rates of hypertension were 40 and 31 per 1000 person-years among those with and without elevated depressive symptoms, respectively. Persons with elevated depressive symptoms had a 25 % (p = .003) higher 6-year incidence of hypertension than those with fewer symptoms, after adjusting for sociodemographic and clinical covariates. There was an interaction between depressive symptoms and age (pinteraction < 0.05). Among adults aged 18-34 years without hypertension at baseline (n = 1748), those with elevated depressive symptoms had 80 % higher 6-year incidence of hypertension than those with fewer symptoms (p = .001).

CONCLUSIONS

These findings suggest that depressive symptoms are a risk factor for hypertension in young Hispanic/Latino adults. Early screening and treatment of depressive symptoms may aid in the prevention of hypertension.

Prenatal exposure to ozone and bone mineral density in early childhood: Susceptible window identification

BACKGROUND

The effect of prenatal ozone exposure on early childhood bone mineral density (BMD) remains to be explored.

METHODS

This study was based on the pediatric subcohort of the Fujian Birth Cohort Study. The mean ozone exposure concentration was calculated for the entire pregnancy, as well as for each trimester (first, second, and third) and for every gestational week. BMD was assessed using quantitative ultrasonography (QUS). Low BMD was defined as a z-score of less than -1. Linear and logistic regression models were used to assess the effect of maternal ozone exposure. Distributed lag models (DLMs) were applied to identify the sensitive windows of ozone exposure.

RESULTS

1345 mother-offspring pairs were included in this study. We found that for every interquartile range (IQR) increase in ozone levels of different exposure durations (entire pregnancy, first, second, and third trimester), BMD z-scores decreased by 0.12 (95 % CI: 0.18, -0.07), 0.07 (95 % CI: 0.11, -0.02), 0.08 (95 % CI: 0.14, -0.02), and 0.07 (95 % CI: 0.13, -0.01), respectively. For low BMD, an IQR increase in ozone levels was associated with 1.47 times higher odds of low BMD (95 % CI: 1.09, 1.98) in the second trimester. The most pronounced negative association with BMD z-scores was observed between the 9th and 16th gestational weeks. For low BMD, the highest OR was observed between the 15th and 17th gestational weeks.

CONCLUSIONS

Prenatal exposure to ozone was inversely associated with BMD in early childhood, with early to mid-pregnancy identified as the susceptible window.

Development of an explainable machine learning model for predicting depression in adolescent girls with non-suicidal self-injury: A cross-sectional multicenter study

Non-suicidal self-injury (NSSI) in adolescent girls is a critical predictor of subsequent depression and suicide risk, yet current tools lack both accuracy and clinical interpretability. We developed the first explainable machine learning model integrating multicenter psychosocial data to predict depression among Chinese adolescent girls with NSSI, addressing the critical need for culturally tailored risk stratification tools. In this cross - sectional observational study, our model was developed using data from 14 hospitals. We used five categories of data as predictors, including individual, family, school, psychosocial, and behavioral and lifestyle factors. We compared seven machine learning models and selected the best one to develop final model and the Shapley Additive exPlanations (SHAP) method were used to explain model prediction. The Random Forest (RF) model was compared against six other machine learning algorithms. We assessed the discrimination using the area under receiver operating characteristic (AUROC) with 95 % CIs. Using the development dataset (n = 1163) and predictive model building process, a simplified model containing only the top 20 features had similar predictive performance to the full model, the RF model outperformed six algorithms (AUROC = 0.964 [0.945-0.975]), demonstrating superior discriminative power and robustness. The top ten risk predictors were Borderline personality, Rumination, Perceived stress, Hopelessness, Self-esteem, Sleep quality, Loneliness, Resilience, Parental care, and Problem-focused coping. We developed a three-tiered, color-coded web-based clinical tool to operationalize predictions, enabling real-time risk stratification and personalized interventions. Our study bridges machine learning and clinical interpretability to advance precision mental health interventions for vulnerable adolescent populations.

Associations between major depressive disorders and Parkinson's Disease and impact of their comorbidity sequence

BACKGROUND

The comorbidity of major depressive disorder (MDD) and Parkinson's disease (PD) were prevalent and has a profound impact on patients. However, whether this comorbidity results from specific pathological processes or a mutual cause-and-effect relationship was largely controversial. Additionally, although MDD can appear before or after PD, the health impact of the comorbidity sequence is poorly understood.

METHODS

We used mendelian randomization (MR) and UK biobank (UKB) cohort to explore the associations between MDD and PD. MR was also utilized to investigate potential confounders. By classifying UKB patients into MDD first and PD first groups, we evaluated the health impact of the comorbidity sequence using Cox regression.

RESULTS

Bidirectional MR and cohort study showed conflicting results. MR did not find associations between MDD followed by PD (odds ratio [OR] = 1.28, 95 % confidence interval [CI] = 0.85-1.94) or PD followed by MDD (OR = 0.99, 95 % CI = 0.97-1.01). However, the cohort study found a significant effect of MDD on PD (hazard ratio [HR] = 1.75, 95 % CI = 1.55-1.97) and PD on MDD (HR = 4.35, 95 % CI = 3.65-5.19). By performing MR on 4709 proteins, we identified ESD, LEAP2, NDRG3, NRXN3, and PLXNB2 as potential common causes of MDD and PD. Additionally, PD first group had higher risks of all-cause mortality (HR = 1.65, 95 % CI = 1.03-1.90), dementia (HR = 1.88, 95 % CI = 1.16-3.04), and aspiration pneumonia (HR = 1.89, 95 % CI = 1.09-3.27).

CONCLUSIONS

Our study suggested the comorbidity of MDD and PD is likely the result of certain pathological processes. Additionally, patients with PD first had higher risks of several adverse outcomes.

Association between cardiovascular comorbidities and psychological anxiety & depression in the elderly

BACKGROUND

Limited research examining the relationship between cardiovascular comorbidities and psychological anxiety & depression in the elderly, and the conclusions are inconsistent. This study aimed to investigate the intricate relationships between them among the pariticipants aged 60 years and above.

METHODS

Utilizing multivariate logistic regression and stratified analysis to analyze the association between cardiovascular comorbidities and psychological anxiety & depression. Trend analysis was performed to evaluate the risk of developing depression and anxiety as the number of diseases increased. Interaction analysis was utilized to explore potential factors underlying the comorbidity of cardiovascular diseases and depression.

RESULTS

Among 11,960 elder participants (mean age 82 years, 46.5 % male), the prevalences of psychological anxiety, depression, and ≥2 types of cardiovascular diseases are 11.7 %, 25.8 %, and 24.7 %, respectively. Compared to subjects without cardiovascular diseases, those with 2, 3, and 4 types of cardiovascular diseases respectively have increased risk of depression, with corresponding ORs (95 % CI) being 1.23 (1.08-1.40), 1.50 (1.24-1.81), and 1.91 (1.42-2.56), respectively. Trend analysis shows that for each additional cardiovascular comorbidity, the risk of depression increases by 15 % (OR 1.15, 95%CI 1.10-1.20). The interaction effect showed that social activities were both additive and multiplicative factors affecting cardiovascular comorbidity and depression. The association between the risk of anxiety and the complexity of cardiovascular comorbidities is not strong (P > 0.05).

CONCLUSION

As the complexity of cardiovascular comorbidity increases, the risk of depression skyrockets among older adults, social activities may serve as a remedy.

Evaluation of behavioural and neurochemical effects of psilocybin in mice subjected to chronic unpredictable mild stress

Depression and anxiety are disabling and high incidence mental disorders characterized by phenotypic heterogeneity. Currently available treatments show severe limitations. Thus, there is an urgent need for effective treatments in this population. In the search for novel rapid-acting antidepressants, the psychedelic psilocybin has emerged as a promising therapy in several clinical trials. However, its antidepressant mechanism of action is still not well understood. The aim of the present study was to evaluate the therapeutic potential of psilocybin in ameliorating the adverse behavioural and neurochemical consequences of chronic stress. To this end, a chronic unpredictable mild stress (CUMS) animal model was used, and psilocybin treatment was administered (two doses of 1 mg/kg, i.p., administered 7 days apart). Psilocybin reversed impairments in anhedonia and behavioural despair dimensions of depressive phenotype but not in apathy-related behaviour. Psilocybin administration was also able to exert an anxiolytic-like effect on treated animals. Physiological alterations caused by stress, indicative of a hyperactive hypothalamic-pituitary-adrenal axis (HPA), were not reversed by psilocybin. When neuroplasticity-related proteins were assessed in cerebral cortex, brain-derived neurotrophic factor (BDNF) was found to be decreased in stressed animals, and treatment did not reverse such impairment. Psilocybin administration increased the expression and function of serotonin-2A-receptor (5HT2AR) in brain cortex of control and CUMS groups. Furthermore, psilocybin treatment caused a selective increase in the expression of glucocorticoid-receptor (GR) in brain cortex of CUMS mice. In conclusion, psilocybin was able to rescue impairments in the depressive phenotype, and to induce anxiolytic-like effects. Furthermore, an enhancement in sensitivity to psilocybin-induced HTR was observed following a booster dose. Altogether, this work provides new knowledge on the putative benefit/risk actions of psilocybin and contributes to the understanding of the therapeutic mechanism of action of psychedelics.

Association of atherogenic index of plasma and its modified indices with stroke risk in individuals with cardiovascular-kidney-metabolic syndrome stages 0-3: a longitudinal analysis based on CHARLS

BACKGROUND

The association between the atherogenic index of plasma (AIP), its modified indices (such as AIP-waist circumference [AIP-WC], AIP-waist-to-height ratio [AIP-WHtR], AIP-body mass index[AIP-BMI]), and incident stroke in individuals with cardiovascular-kidney-metabolic (CKM) stages 0-3 remains understudied. This study investigated these associations and their utility for risk stratification.

METHODS

Data from 3697 China Health and Retirement Longitudinal Study (CHARLS) participants (≥ 45 years, CKM stages 0-3) were analyzed. Baseline, cumulative, and changes in AIP and its modified indices (AIP-WC, AIP-WHtR, AIP-BMI) were calculated. Logistic regression, Delong's test, integrated discrimination improvement (IDI), weighted quantile sum (WQS) regression, and mediation analysis were used to assess associations, predictive performance, component contributions, and mediation effects.

RESULTS

Stroke occurred in 4.8% of participants. Under the fully adjusted Model 3: The third level of AIP, AIP-WHtR, AIP-WC, and AIP-BMI showed increased risks (ORs 1.58 [95% CI 1.05-2.38], 1.99 [95% CI 1.31-3.02], 1.99 [95% CI 1.31-3.02], and 1.92 [95% CI 1.26-2.92], respectively); The third level of cumulative AIP, AIP-WHtR, AIP-WC, and AIP-BMI showed elevated risks (ORs 1.79 [95% CI 1.19-2.69], 2.07 [95% CI 1.37-3.13], 2.01 [95% CI 1.33-3.04], and 1.92 [95% CI 1.27-2.89], respectively); The third category of AIP, AIP-WHtR, AIP-WC, and AIP-BMI changes showed risk increases of 2.28 (95% CI 1.46-3.55), 2.39 (95% CI 1.50-3.79), 2.56 (95% CI 1.61-4.07), and 2.22 (95% CI 1.38-3.56). Modified AIP indices (especially AIP-WHtR) demonstrated superior predictive ability than AIP alone. The association was amplified in advanced CKM (stages 2-3) but not significant in early CKM (stages 0-1). Triglycerides (TG) primarily drove the AIP-WHtR-stroke risk, which was partially mediated by estimated pulse wave velocity (ePWV) (6.48%).

CONCLUSIONS

AIP and its modified indices, especially AIP-WHtR, are significantly associated with incident stroke in CKM stages 0-3. Dynamically monitoring changes in these indices is crucial for stroke risk assessment and stratification, particularly in advanced CKM. TG primarily drives this risk, while ePWV partially mediates the AIP-WHtR-stroke link.

Association of the Appendicular Skeletal Muscle Mass-to-Visceral Fat Area Ratio with Cause-Specific Mortality in Diabetes

The relationship between muscle mass and visceral fat with mortality risk in diabetes has been extensively studied. This study investigates the association between the appendicular skeletal muscle mass-to-visceral fat area ratio (SVR) and cardiovascular and cancer-related mortality in diabetic patients in the United States. A nationwide cohort study was conducted using NHANES data (2011-2018), including 1439 diabetic patients with dual-energy X-ray absorptiometry (DXA) measurements. Weighted Cox proportional hazards models and restricted cubic splines (RCS) were employed to evaluate the association between SVR and cause-specific mortality rates. Weighted receiver operating characteristic (ROC) curves were used to assess the diagnostic performance of SVR and other conventional indicators in predicting mortality. After adjusting for multiple confounding factors, SVR showed a linear negative association with cardiovascular and cancer-related mortality in diabetes. Each 0.01-unit increase in SVR was associated with a 3% reduction in the risk of cardiovascular death and a 2% reduction in cancer-related death. However, SVR demonstrated weak diagnostic performance for both cardiovascular and cancer mortality, with weighted AUCs of 0.520 and 0.527, respectively, compared to other metrics including BMI, WC, ASM, and VFA. Although SVR was significantly associated with cardiovascular and cancer mortality, its predictive performance was not superior to that of simpler or more established indicators, suggesting that it has limited clinical utility for predicting mortality in diabetic patients.

Comparative association between NAFLD and MAFLD with cardiovascular events and mortality: Evidence from observational studies

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated fatty liver disease (MAFLD) are increasingly recognized as multisystemic conditions with significant extrahepatic manifestations. Although both diseases have been linked to cardiovascular events and mortality, the strength of these associations remains controversial. This review aims to compare the risks of cardiovascular disease (CVD) events in individuals with NAFLD and MAFLD.

METHODS

The PubMed, Embase, and Cochrane Library databases were searched to identify studies investigating the risk of CVD, CVD death, and all-cause death associated with NAFLD and MAFLD through April 28th, 2024. Data extraction and study quality assessment were performed using the Newcastle-Ottawa Scale. Statistical analysis utilized random-effects models. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology.

RESULTS

Eleven cohort studies with 11,995,994 patients were included. Both NAFLD and MAFLD were associated with an increased risk of cardiovascular events (NAFLD group vs. non-NAFLD group: HR = 1.30, 95% confidence interval (CI): 1.13-1.49, I2 = 91%; MAFLD group vs. non-MAFLD group: HR = 1.54, 95% CI: 1.32-1.81, I2 = 92%) and all-cause death (NAFLD group vs. non-NAFLD group: HR = 1.18, 95% CI: 1.04-1.33, I2 = 55%; MAFLD group vs. non-MAFLD group: HR = 1.30, 95% CI: 1.20-1.40, I2 = 0%). The MAFLD-only group had a stronger association with cardiovascular death than the NAFLD-only group (MAFLD-only group vs neither MAFLD nor NAFLD group: HR = 1.46, 95% CI: 1.40-1.51, I2 = 0%; NAFLD-only group vs neither MAFLD nor NAFLD group: HR = 1.10, 95% CI: 0.95-1.28, I2 = 0%, P for interaction < 0.01). The GRADE assessment revealed low certainty for cardiovascular disease (CVD) (NAFLD only group vs. neither NAFLD nor MAFLD group), cardiovascular death (NAFLD only group vs. neither NAFLD nor MAFLD group), and all-cause death (MAFLD group vs non-MAFLD group), and very low certainty for other results.

CONCLUSION

MAFLD and NAFLD are both associated with cardiovascular events and all-cause mortality. However, the odds of cardiovascular death seems to be greater in patients with MAFLD than in those with NAFLD, suggesting that the use of MAFLD criteria may identify more at-risk individuals.

PROSPERO REGISTRATION

CD42022361164.

Time to inclusion of selected medicines for priority diseases in National Essential Medicines Lists compared with the WHO Model List

INTRODUCTION

The WHO maintains a Model List of Essential Medicines, which guides countries in developing their National Essential Medicines List (NEML) to improve access to medicines. We aimed to assess the time it took for countries to adjust their NEMLs when medicines were added or deleted from the WHO Model List and if this differed between priority diseases.

METHODS

We extracted medicines added or deleted from the WHO Model List (2007-2021) for selected priority diseases: diabetes, hepatitis C, HIV, oncology and tuberculosis. These medicines were compared with NEMLs from 20 countries; reimbursement lists (RLs) were used in the absence of an NEML. The time to inclusion in NEMLs/RLs and the percentage of included medicines in the most recent NEML/RL were assessed.

RESULTS

90 medicines were added, and 15 medicines were deleted from the WHO Model List. Low-income and middle-income countries (LMICs) mostly included medicines in NEMLs after their addition to the WHO Model List (median: 1 year), and high-income countries prior to addition (median: -9 years). Medicines for HIV (62%) and tuberculosis (59%) were most frequently included in the most recent NEML/RL. High-income countries included the most medicines for diabetes (86%) and oncology (67%).

CONCLUSIONS

The WHO Model List may be a guiding tool for selecting medicines in LMICs, although it is applied differently between the priority diseases included in the present study. More medicines could be included in NEMLs for non-communicable diseases, which impose a large health burden on LMICs, as a first step to ensure their sustainable access.

Vascular effects of perivascular adipose tissue-derived chemerin in obesity-associated cardiovascular disease

Perivascular adipose tissue (PVAT) is a unique and metabolically active adipose tissue that is adjacent to most systemic blood vessels. Healthy PVAT exerts anticontractile and anti-inflammatory effects, contributing to vascular protection. However, during obesity, PVAT becomes proinflammatory and profibrotic, exacerbating vascular dysfunction. Chemerin, a multifunctional adipokine, has emerged as a key regulator of vascular tone, inflammation, and remodeling. Although liver-derived chemerin dominates the circulating chemerin pool, PVAT-derived chemerin plays a more localized and functionally important role in vascular pathophysiology because of its proximity to the vessel wall. This review highlights the role of PVAT-derived chemerin in vascular health, the mechanistic involvement of PVAT-derived chemerin in certain aspects of obesity-associated cardiovascular diseases, and the therapeutic potential of targeting PVAT-derived chemerin.

In silico estimation of thrombogenic risk after left atrial appendage excision: Towards digital twins in atrial fibrillation

BACKGROUND & AIM

The left atrial appendage (LAA) is a highly variable, pouch-like structure in the left atrium prone to thrombus formation, especially in atrial fibrillation (AF) patients. In silico cardiac models can help characterize the LAA's complex morphology and hemodynamics, aiding in identifying pro-thrombotic areas. This study assessed atrial hemodynamics and thrombus formation risk after LAA excision and compared with optimal synthetic excisions and occluder placements in high thrombogenic-risk cases.

METHODS

We included 33 patients from the MARK-AF study who had persistent AF and underwent excision of the LAA. We quantified the morphological characteristics of the post-excision LAA remnant. With patient-specific atrial geometries and boundary conditions, in silico blood flow simulations were performed. For each patient, we quantified multiple in silico indices to characterize blood flow patterns and identify thrombogenic regions. We performed an in silico comparison of different LAA treatment approaches.

RESULTS

In our cohort, 25/33 (76 %) of patients had a post-excision, protruding LAA remnant (LAA depth >10 mm). In silico simulations indicated that patients with a protruding remnant more frequently showed unfavorable values for in silico indices associated with high thrombogenic risk at the excision site. However, a prominent LAA remnant was not the only factor associated with a high thrombogenic risk. An optimal excision or optimal occluder device placement reduced thrombus formation risk.

CONCLUSION

The combination of LAA remnant morphology and hemodynamics contributed to thrombus formation risk. Advanced in silico simulations uniquely enabled the comparison of different therapies, until now only centered on device occluders, contributing to digital twins in AF.

Does home-based screening improve hypertension diagnosis, treatment and control? A regression discontinuity analysis in urban India

As part of India's efforts to expand primary healthcare services, several state governments are implementing or considering home-based hypertension screening programmes to improve population-wide diagnosis and blood pressure (BP) control rates. However, there is limited evidence on the effectiveness of home-based screening programmes in India. Using six waves of population-representative cohort data (N=15574), we estimate the causal effect of a home-based hypertension screening intervention on diagnosis, treatment, and BP using a novel application of the Regression Discontinuity Design. We find that measuring individuals' BP in their homes and providing health information and a referral to those with elevated BP did not meaningfully improve hypertension diagnosis (0.12 percentage points (pp), 95% CI -1.39 to 1.75), treatment (-0.16 pp, 95% CI -2.18 to 1.03), or change in BP (systolic: -0.96mm Hg, 95% CI -5.63 to 1.14; diastolic: 0.21, 95% CI -1.65 to 1.65). Our heterogeneity analyses suggest that home-based screening may reduce systolic BP for women with secondary education and women living in Chennai. However, we find null effects for diagnosis and treatment among these subpopulations and in all outcome variables across the other subpopulations and alternative specifications. Our findings suggest that a lack of knowledge of one's hypertension status might not be the primary reason for low diagnosis and treatment rates in India, where other structural and behavioural barriers may be more relevant. Adapting screening efforts to address these additional barriers will be essential for India's efforts to achieve universal health coverage.

Portable ultra-low-field MRI in acute stroke care: A pilot study

INTRODUCTION

Neuroimaging is a prerequisite for treatment of stroke patients, but it is not available all over the globe. Portable ultra-low field (pULF) MRI has the potential to improve access to neuroimaging and thus stroke care worldwide. In a pilot study, we were the first to utilise pULF-MRI in a European tertiary stroke centre and to evaluate its diagnostic value compared to high-field (HF) MRI.

PATIENTS AND METHODS

Consecutive patients admitted for suspected ischaemic stroke underwent pULF-MRI using the 0.064 Tesla Swoop® portable MR imaging system in addition to standard imaging. HF-MRI and pULF-MRI scans were blindly assessed to compare the diagnostic accuracy and imaging-based therapeutic decisions based on pULF-MRI to HF-MRI.

RESULTS

Seventeen patients underwent pULF-MRI, 12 of whom had ischaemic lesions on HF-MRI. Ischaemic lesions were detected on pULF-MRI in 8/12 cases. The four infarcts not identified on pULF-MRI were all smaller than 6 mm in diameter. In all cases, a virtual treatment decision based on pULF-MRI by a blinded team matched the actual clinical decisions.

CONCLUSION

This single-centre study demonstrates that pULF-MRI is a promising tool in acute stroke care, providing reliable imaging for treatment decision and follow-up monitoring. pULF-MRI may support acute stroke care if HF-MRI is unavailable and may be particularly helpful in resource-limited settings. Limitations of pULF-MRI include long acquisition times and the lack of vessel imaging and haemorrhage-sensitive sequences.

Physiological microbial exposure normalizes memory T cell surveillance of the brain and modifies host seizure outcomes

Recent studies have highlighted the presence of memory T cells in human brains, some of which are specific for peripheral infections. To address their potential origins, we used two models of polymicrobial exposure to 'normalize' the immune systems of specific pathogen-free mice and queried the impact on brain T cell biology. Here, we show that cohousing and sequential infection induce marked enhancement of memory T cells in the brain tissue of mice. These resident and circulating memory T cells localized to diverse brain regions where dynamic interactions with myeloid cells occurred. Following an induced seizure, brain-localized memory T cells were functionally altered in microbe-experienced mice. Microbial exposure also induced T cell-dependent changes in seizure duration. These data not only suggest a potential origin for memory T cells in human brains but also reveal the ability of these cells to modulate brain biology, prompting the future utilization of microbe-experienced mice in studies of neurological health and disease.

Dietary consumption trajectory profiles over time of French adults from the NutriNet-Santé cohort (2014-2022): multicriteria analysis of sustainability

BACKGROUND

Dietary patterns significantly impact climate change and morbidity, making transitions to sustainable diets urgent. Few studies explore repeated dietary measures collected over several years or variations across distinct consumer profiles characterized by sociodemographic and dietary patterns.

OBJECTIVE

Our study aims to identify dietary trajectory profiles in French adults (2014-2022), assessing environmental, nutritional, and health outcomes.

METHODS

Consumption data from 17,187 NutriNet-Santé cohort participants (52% women, average age 48y, SD = 16) were collected via food frequency questionnaires in 2014 (weighted to the French Census), 2018, and 2022. Dietary trajectory profiles were modeled using Group-based multi-trajectory modeling based on principal component analysis of energy-adjusted consumption data. Associations with environmental (greenhouse gas (GHG) emissions) and nutritional (adherence to French dietary guidelines, diet quality index) dimensions were assessed via multivariable mixed models. Health impacts were evaluated as Disability-Adjusted Life Years (DALYs)avoided, using the Comparative Risk Assessment approach.

RESULTS

Six dietary trajectory profiles (P) with distinct starting diets and evolutions were identified. P0 had average intakes, while P1 and P5 were meat-focused, with P5 showing the highest animal consumption. P3 and P4 leaned plant-based, with P4 maintaining high fish and plant intakes, and P3 increasing ruminant meat. P2 initially high in salty or sweet fatty foods, shifted significantly toward plant-based diets. Over time, GHG emissions decreased (- 5% to - 14%), diet quality (PNNS-GS2 score) improved (+ 12% to + 174%), and health risks declined in four profiles due to reduced red meat and higher whole grains/fruits but increased for P4 and P5 due to processed meat.

CONCLUSION

These profiles reflect diverse population segments with distinct dietary profiles and degrees of sustainability improvements. However, significant advancements remain limited, highlighting the need for further research on economic, psychological, and cultural factors to guide sustainable changes.

TRIAL REGISTRATION

Trial registration number: NCT03335644. URL of registration: https://clinicaltrials.gov/study/NCT03335644?id=NCT03335644&rank=1.

Causal relationships between metabolic syndrome, plasma metabolites, and female reproductive diseases: insights from a two-step mendelian randomization approach

BACKGROUND

Female reproductive diseases-including endometriosis (EMs), uterine fibroids (UFs), polycystic ovary syndrome (PCOS), gestational diabetes mellitus (GDM), eclampsia, ectopic pregnancy (EP), infertility, miscarriage, and ovarian aging-pose significant global health challenges. Metabolic syndrome (MetS) is characterized by a series of metabolic irregularities and has been linked to distinct plasma metabolomic profiles. Investigating the etiological connections among MetS, plasma metabolites, and female reproductive diseases is essential for devising effective prevention and treatment strategies.

OBJECTIVE

This study sought to evaluate the causal relationships among MetS, plasma metabolites, and female reproductive diseases using a two-step Mendelian randomization (MR) methodology.

METHODS

Initially, MR investigations were conducted to determine the causative impact of MetS on nine female reproductive diseases utilizing genome-wide association study (GWAS) data procured from European-descent populations. Statistically significant associations were identified for five diseases: UF, PCOS, GDM, eclampsia, and miscarriage. One hypothesis is that plasma metabolites may contribute to these associations. Subsequently, comprehensive MR analyses were performed using GWAS data on 233 plasma metabolites to examine causal relationships between these MetS-associated reproductive conditions and eight distinct classes of plasma metabolites. Sensitivity analyses, replication studies, and colocalization assessments were performed to validate the reliability of the outcomes.

RESULTS

MetS was identified as a causal factor for increased risks of UF, PCOS, GDM, eclampsia, and miscarriage. Further MR analyses revealed that specific plasma metabolites might causally affect the risk of female reproductive diseases: Eclampsia: Protective associations were observed with lipid molecules in large and very large high-density lipoprotein (HDL) particles, including cholesterol esters and total cholesterol. Conversely, triglycerides in large HDL particles and indicators related to small HDL particles were linked to increased risk. PCOS: Risk factors included elevated levels of triglycerides in HDL particles, various very low-density lipoprotein metabolites, acetone, 3-hydroxybutyrate, and conjugated linoleic acid. GDM: Increased glucose levels were associated with increased GDM risk.

CONCLUSIONS

This investigation established that MetS causally elevates the risk of certain female reproductive diseases and identified plasma metabolites that influence these conditions. These findings enhance the understanding of the etiological pathways involved in MetS and reproductive disorders, highlighting plasma metabolites as potential biomarkers or therapeutic targets.