Mimickers of Hypoxic Ischemic Encephalopathy

Although neonatal encephalopathy is most often caused by hypoxic-ischemic injury, there are many other causes. A careful history and clinical examination allow clinicians to identify neonates with these mimickers, so prompt intervention and support ensue to allow the best developmental outcome.

Neonatal Neurocritical Care in Low-Resource Settings: Challenges and Innovations in Hypoxic-Ischemic Encephalopathy

Many neonatal neuroprotective strategies have been developed to reduce the impact of hypoxic-ischemic encephalopathy on mortality and long-term neurodevelopmental outcomes. The most effective strategy to date is therapeutic hypothermia, which has been shown to improve survival rates and neurologic outcomes. However, a recent International Liaison Committee on Resuscitation statement recommends using therapeutic hypothermia only in specialized neonatal neurocritical care facilities, which are not universally accessible. Low-resource settings are particularly disadvantaged due to a lack of trained professionals, financial constraints, equipment scarcity, and inadequate infrastructure. While adjunctive neuroprotective therapies and telehealth tools may help to bridge this gap, more evidence is needed to establish effectiveness of these therapies.

Improving Care for People with Chronic Respiratory Diseases: Taking a Policy Lens

Chronic respiratory diseases (CRDs) affect almost 470 million people worldwide, and this number is growing. CRDs take a significant toll on the capacity of health systems and economies, and their effect on people's lives can be devastating. Despite high rates of prevalence and mortality, CRDs are underprioritised by policymakers and governments. Tackling these conditions will require a holistic, multisectoral approach, including government-led strategies for prevention, diagnosis, management and investment in research. In this article, we provide a clear rationale for prioritising CRDs to advance population health. Proactive steps in countries of all income levels must be taken promptly to limit the growing prevalence and impact of CRDs both now and in the future.

Associations between folate intake, serum folate, and stroke risk: The mediating role of dietary inflammatory index from NHANES 2007-2018

BACKGROUND

This study investigates the relationships between folate intake, RBC folate, serum folate levels, and stroke risk, with an emphasis on the mediating roles of the dietary inflammatory index (DII) and systemic immune-inflammation index (SII).

METHODS

A cross-sectional analysis was conducted using 24,106 participants from NHANES (2007-2018). Associations were assessed with weighted multivariate logistic regression, adjusting for key confounders. Propensity score matching (PSM) was applied, yielding 1,838 matched participants, respectively. Nonlinear relationships were analyzed with restricted cubic splines, and mediation analysis was performed for DII and SII.

RESULTS

Post-PSM, folate intake in Q2 (252-350 μg/day), Q3 (350-484 μg/day), and Q4 (> 484 μg/day) was significantly inversely associated with stroke risk (trend P < 0.05), with adjusted ORs of 0.62 (95 % CI: 0.45-0.85), 0.65 (95 % CI: 0.46-0.90), and 0.60 (95 % CI: 0.42-0.86), respectively. Serum folate levels in Q3 (37.0 - 54.8 nmol/L) were also protective (OR: 0.47, 95 % CI: 0.32-0.68, trend P < 0.05). Serum folate levels exhibited a biphasic effect, with the lowest stroke risk at 41.9 nmol/L before PSM and 43.3 nmol/L after PSM. Mediation analysis showed DII mediated 45.2 % of the relationship between folate intake and stroke risk (P = 0.018), while SII's mediation effect was minimal (0.412 %, P = 0.016). No significant interactions were observed between folate intake, serum folate and stratified variables (P > 0.05) after PSM.

CONCLUSION

Higher folate intake lowers stroke risk, with DII playing a significant mediating role, while serum folate presents a biphasic risk pattern. Personalized dietary strategies addressing folate intake and inflammation may be crucial for stroke prevention.

Fetuin-A levels in diabetic retinopathy: a systematic review and meta-analysis

Background

Diabetic retinopathy (DR) is one of the main microvascular complications of diabetes and one of the most common causes of vision loss worldwide. Fetuin-A is a glycoprotein correlated with insulin resistance and has been measured in DR patients. Herein, we aimed to investigate these studies through a systematic review and meta-analysis.

Methods

Four online databases, including PubMed, Embase, Scopus, and the Web of Science were searched comprehensively in order to retrieve relevant studies that compared blood fetuin-A levels in patients with DR vs. non-DR, DR vs. non-diabetic controls, non-DR vs. non-diabetic controls, and proliferative vs. non- proliferative DR. Random-effect meta-analysis was performed for the calculation of the standardized mean difference (SMD) and 95% confidence interval (CI).

Results

From the 186 found results through database search, after eligibility assessment, seven studies were included. A total of 1104 cases with a mean age of 57.24 ± 9.62 years were investigated. Meta-analysis showed that fetuin-A levels were significantly higher in patients with DR compared to both non-DR diabetic patients (SMD 0.41, 95% CI 0.10 to 0.72, P = 0.009), and non-diabetic healthy controls (SMD 0.77, 95% CI 0.47 to 1.07, P < 0.0001). Additionally, patients with proliferative DR had higher fetuin-A levels than those with non-proliferative DR (SMD 0.35, 95% CI 0.11 to 0.59, P = 0.004). However, no significant difference was found between diabetic patients without DR and healthy controls.

Conclusion

Based on our findings, fetuin-A was higher in patients with DR and could be potentially used for measurement in clinical settings if confirmed in future large-scale studies. Moreover, the fact that higher fetuin-A levels were associated with proliferative DR could have clinical implications.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-024-01533-0.

Global variations and socioeconomic inequalities in lifetime risk of lip, oral cavity, and pharyngeal cancer: a population-based systematic analysis of GLOBOCAN 2022

BACKGROUND

In 2021, the World Health Organization (WHO) identified poor oral health as a major health expenditure burden. While lip, oral cavity, and pharyngeal cancers (LOCP) are an important group of diseases threatening oral health, there have been limited studies assessing global variations in lifetime risks (LR) according to socioeconomic inequalities.

MATERIALS AND METHODS

We obtained national incidence and mortality estimates of LOCP in 185 countries from the GLOBOCAN database of the International Agency for Research on Cancer (IARC), corresponding all-cause mortality, population data, and the Human Development Index (HDI, with higher values indicating superior socioeconomic level) through the United Nations, alongside oral health-related data through WHO and INDEXBOX. LR were calculated using the adjusted multiple primary method.

RESULTS

In 2022, the global LR of developing and dying from LOCP were 0.92% (95% CI: 0.92%-0.92%) and 0.48% (95% CI: 0.48%-0.48%), respectively, with the highest burden associated with cancers of the lip and oral cavity. The LR of being diagnosed with LOCP or dying from the disease were 2.24 (95% CI: 2.22-2.25) and 2.30 (95% CI: 2.27-2.33) times higher among males relative to females. The highest LR for lip and oral cavity, salivary gland, oropharynx, and hypopharynx cancers were largely concentrated in Australia/New Zealand, Europe, and North America; whereas nasopharynx cancer was more frequent in parts of Asia and Africa. The LR of developing and dying from LOCP were positively associated with HDI, dental healthcare expenditure, areca nut consumption, the availability of refined sugar, and early screening for oral diseases, and negatively associated with the prevalence of severe periodontal disease. Although the LR of LOCP decreased with age, the rate of decline was relatively slow until the age of 50, and even at age 70, there remained non-negligible risks.

CONCLUSION

Global variations in the LR of developing and dying from LOCP by subsite, sex and age reveal significant disparities by world region, socioeconomic levels and oral healthcare factors.

Global, regional, and national burden of brain and central nervous system cancer: a systematic analysis of incidence, deaths, and DALYS with predictions to 2040

BACKGROUND

Brain and central nervous system (CNS) cancers present significant health challenges globally, characterized by increasing incidence and mortality rates. This study utilizes data from the Global Burden of Disease (GBD) 2021 to analyze trends and project future burdens.

METHODS

We calculated age-standardized rates (ASRs) of incidence, mortality, and disability-adjusted life years (DALYs) for brain and CNS cancers from 1990 to 2021. Trends were analyzed using estimated annual percentage change, and future projections were made with an Autoregressive Integrated Moving Average (ARIMA) model. Correlations between the socio-demographic index (SDI) and ASR were also examined.

RESULTS

The study revealed a 106% increase in incidence number and a 63.67% rise in death number over the study period. The ARIMA model predicts declines in incidence, mortality, and DALYs by 2040. Higher incidence rates were observed in high SDI regions, while greater mortality occurred in low SDI areas, indicating significant disparities.

CONCLUSION

These findings underscore the need for targeted interventions and sustained healthcare investments to manage the global burden of brain and CNS cancers effectively. The projected declines suggest potential effectiveness of current public health strategies but highlight the importance of addressing socio-demographic disparities.

The acute effect of two exercise modalities on neurocognitive responses in postmenopausal women: A randomized controlled trial

Menopause-related cognitive decline, often worsened by vasomotor symptoms (VMS), might be mitigated by high cardiorespiratory fitness (CRF). Although acute exercise supports neurocognitive function, its effects vary by exercise and individual characteristics. In this study, we investigated the acute effects of isometric resistance exercise (IRE) and high-intensity interval exercise (HIIE) on prefrontal cortex oxygenation and cognitive performance in postmenopausal women and examined the influence of VMS and CRF on these outcomes. A cross-over randomized controlled trial was conducted among 29 women aged 55 ± 3 years. The HIIE session included two sets of 12 × 15 s at 100% maximal aerobic power, and the IRE session included 4 × 2 min at 30% maximal voluntary force. Cognitive functions were evaluated before and after sessions using the MEM-III story recall test (episodic memory), Stroop task (inhibitory control) and n-back task (working memory). Prefrontal cortex oxygenation was assessed by measuring oxyhaemoglobin (ΔHbO2), deoxygenated haemoglobin (ΔHHb) and total haemoglobin (ΔtHb) concentrations before, during and after each session. No effect of exercise was noted on cognitive performance. However, prefrontal cortex oxygenation increased during HIIE (ΔHbO2: d = 0.99, p < 0.0001; ΔHHb: d = 0.68, p = 0.018; ΔtHb: d = 0.96, p = 0.001), during IRE (ΔHbO2: d = 1.2, p = 0.003) and post-HIIE (ΔHbO2 and ΔtHb: d > 1; p < 0.0001) versus control. CRF positively modulated cognitive and cerebrovascular responses to IRE, whereas VMS showed no influence. IRE and HIIE did not improve cognitive performance in postmenopausal women, but increased prefrontal cortex oxygenation, with sustained effects after HIIE. CRF positively modulated responses, whereas VMS did not, underscoring the importance of maintaining high CRF to support brain health in this population.

Global insight of early-onset genitourinary cancers in adolescents and adults from 1990 to 2021: temporal trends and health inequalities analyses

BACKGROUND

Prostate, bladder, and kidney cancers represent the three most prevalent genitourinary malignancies, posing substantial global health burdens. Given the limited epidemiological research on early-onset genitourinary cancers (EOGCs), this study aims to investigate the temporal trends and health disparities in EOGCs from 1990 to 2021.

METHODS

Based on the Global Burden of Disease Study 2021 (GBD), we extracted data on the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of the three major genitourinary cancers (prostate, bladder, kidney cancer) among individuals aged 15 to 49. We described the distribution of EOGCs at the global, regional and national levels, and analyzed the overall and local time trends through the estimated annual percentage change (EAPC) and joinpoint regression. Spearman's test and health inequality analysis were used to examine the relationship between the disease burden of EOGCs and the Socio-demographic Index (SDI).

RESULTS

In 2021, the incident cases of early-onset kidney cancer (EOKC), early-onset bladder cancer (EOBC), and early-onset prostate cancer (EOPC) were 52,631, 31,054, and 17,865, respectively, with 10,978, 6,328, and 2,861 death cases. The most significant attributable risk factors for EOGC-related deaths and DALYs were smoking and high body mass index. Of particular note, male EOKC consistently demonstrated the highest age-standardized incidence rate (ASIR) and mortality rate (ASMR), with both metrics exhibiting sustained increases from 1990 to 2021, corresponding to EAPCs of 1.33% and 0.3%, respectively. The disease burdens of EOGCs were distributed differently across various regions and countries, and their local trends also varied during the period from 1990 to 2021 globally. The incidence burden of EOGCs was disproportionately concentrated in high-SDI countries, with the concentration indices of EOPC, EOBC and EOKC in 2021 being 0.26, 0.17 and 0.27 respectively. Notably, in regions or countries with a higher SDI, the incidence risk of EOGCs was relatively high, but the mortality risk decreased significantly.

CONCLUSIONS

EOGCs are a major global public health challenge. There is an urgent need for personalized healthcare strategies to alleviate the burden of genitourinary cancers, particularly kidney cancer and prostate cancer, among adolescents and adults.

The role of mitochondrial dysfunction in the pathogenesis of Alzheimer's disease and future strategies for targeted therapy

Alzheimer's disease (AD) is a neurodegenerative disorder characterized by progressive cognitive decline, behavioral impairments, and psychiatric comorbidities. The pathogenesis of AD remains incompletely elucidated, despite advances in dominant hypotheses such as the β-amyloid (Aβ) cascade, tauopathy, cholinergic deficiency, and neuroinflammation mechanisms. However, these hypotheses inadequately explain the multifactorial nature of AD, which exposes limitations in our understanding of its mechanisms. Mitochondrial dysfunction is known to play a pivotal role in AD, and since patients exhibit intracellular mitochondrial dysfunction and structural changes in the brain at an early stage, correcting the imbalance of mitochondrial homeostasis and the cytopathological changes caused by it may be a potential target for early treatment of AD. Mitochondrial structural abnormalities accelerate AD pathogenesis. For instance, structural and functional alterations in the mitochondria-associated endoplasmic reticulum membrane (MAM) can disrupt intracellular Ca2⁺ homeostasis and cholesterol metabolism, consequently promoting Aβ accumulation. In addition, the overaccumulation of Aβ and hyperphosphorylated tau proteins can further damage neurons by disrupting mitochondrial integrity and mitophagy, thereby amplifying pathological aggregation and exacerbating neurodegeneration in AD. Furthermore, Aβ deposition and abnormal tau proteins can disrupt mitochondrial dynamics through dysregulation of fission/fusion proteins, leading to excessive mitochondrial fragmentation and subsequent dysfunction. Additionally, hyperphosphorylated tau proteins can impair mitochondrial transport, resulting in axonal dysfunction in AD. This article reviews the biological significance of mitochondrial structural morphology, dynamics, and mitochondrial DNA (mtDNA) instability in AD pathology, emphasizing mitophagy abnormalities as a critical contributor to AD progression. Additionally, mitochondrial biogenesis and proteostasis are critical for maintaining mitochondrial function and integrity. Impairments in these processes have been implicated in the progression of AD, further highlighting the multifaceted role of mitochondrial dysfunction in neurodegeneration. It further discusses the therapeutic potential of mitochondria-targeted strategies for AD drug development.

Factors influencing the adoption of telemedicine services among middle-aged and older patients with chronic conditions in rural China: a multicentre cross-sectional study

BACKGROUND

In recent years, telemedicine services have significantly improved healthcare quality and access for residents. However, challenges remain, including limited awareness and reluctance to adopt such services, especially among middle-aged and older patients with chronic conditions in remote areas.

OBJECTIVE

This study aimed to investigate the key factors influencing the adoption of telemedicine services among middle-aged and older patients with chronic conditions in rural China.

METHODS

A multicentre cross-sectional study was conducted between November 2023 and February 2024 at five hospitals in western China, targeting middle-aged and older patients (aged ≥ 45 years) with chronic conditions in rural areas. Participants completed the survey in person via QuestionnaireStar, with assistance provided as needed. The questionnaire was structured based on the Health Information Technology Adoption Model (HITAM) and included constructs such as Social Influence (SI), Perceived Usefulness (PU), Perceived Ease of Use (PEU), Perceived Reliability (PR), Perceived Health Threat (PHT), Self-efficacy (SE), Attitude Toward Using (ATU), Adoption Intention (AI) and Usage Behavior (UB). Data analysis was performed using structural equation modeling (SEM) to examine the relationships between these variables and to assess their impact on patients' intention to adopt telemedicine services. Additionally, to further explore the factors influencing telemedicine services adoption, a generalized linear model (GLM) analysis was performed, incorporating variables such as age, gender, education level, monthly income, and health status.

RESULTS

A total of 880 middle-aged and older patients with chronic conditions in rural areas were included in this study, with an average adoption intention score for telemedicine services of 3.94 (standard deviation 1.02). SEM analysis revealed that SI, SE, PR, and PHT were peripheral variables, while PEU, PU and ATU acted as core mediating variables that positively influenced patients' intention to adopt telemedicine services, which in turn impacted their subsequent usage behavior. SI (z = 4.767, P<0.001), PU (z = 2.894, P = 0.004), and ATU (z = 4.545, P<0.001) showed significant direct positive effects on patients' intention to adopt telemedicine services. GLM analysis revealed that education level (β = 0.032, P < 0.001), monthly income (β = 0.009, P = 0.049), required care (β = 0.034, P = 0.007), and cancer diagnosis (β = - 0.147, P < 0.001) were significant predictors of telemedicine adoption intention.

CONCLUSIONS

This study identified key determinants influencing telemedicine services adoption among rural middle-aged and older patients with chronic conditions. The findings offer valuable insights for telemedicine services providers to enhance service design and implementation strategies, thereby promoting greater adoption and sustained use among this target population.

Integrating Metabolomics and Gut Microbiota to Identify Key Biomarkers and Regulatory Pathways Underlying Metabolic Heterogeneity in Childhood Obesity

BACKGROUND/OBJECTIVES

Individuals with childhood obesity exhibit significant metabolic heterogeneity, necessitating precise biomarkers for risk stratification and assessment. This multi-omics investigation characterizes metabolic and microbial signatures underlying divergent metabolic phenotypes in the context of pediatric obesity.

METHODS

We analyzed 285 Chinese children (5-7 years) stratified into five groups: wasting (WAS, n = 55), metabolically healthy/unhealthy and normal weight (MHWH, n = 54; MUWH, n = 67), and metabolically healthy/unhealthy obesity (MHO, n = 36; MUO, n = 73). Untargeted metabolomics (Orbitrap ID-X Tribrid™) and 16S rRNA sequencing were integrated with multivariate analyses (OPLS-DA with VIP > 1, FDR < 0.05; Maaslin 2 with TSS normalization and BH correction, FDR < 0.10).

RESULTS

Analysis identified 225 differential metabolites and 12 bacterial genera. The proportion of steroids and their derivatives among differential metabolites in the MUO/MHO group was significantly lower than that in the OVOB/NOR and OVOB/WAS groups (2.12% vs. 7.9-14.1%). MUO displayed elevated C17 sphinganine and LysoPC (O-18:0) levels but reduced PI (16:0/14:1) levels. In contrast, OVOB showed upregulated glycerol phospholipids (LPCs and PSs) and downregulated PE species (e.g., PE(16:0/16:0)) as well as gut microbiota dysbiosis characterized by a higher Firmicutes/Bacteroidetes (F/B) ratio (2.07 vs. 1.24 in controls, p = 0.009) and reduced α diversity (Ace index, Chao1 index, and Shannon index values were lower in the OVOB group, Shannon index: 2.96 vs. 3.45, p = 0.03). SCFA-producing genera were negatively correlated with the OVOB group, while positively associated with PE(16:0/16:0). Internal validation showed differential metabolites had potential predictive efficacy for MUO/MHO (AUC = 0.967) and OVOB/NOR (AUC = 0.888).

CONCLUSIONS

We identified distinct lipid disruptions characterizing obesity subtypes, including steroid/terpene deficits and sphingolipid/ether lipid dysregulation in the MUO/MHO groups as well as phospholipid imbalance (↑LPC/PS↓PE) in the OVOB/NOR groups. The gut microbiota exhibited a profile characterized by low diversity, an increased F/B ratio, and a reduced abundance of SCFA-producing genera. These findings suggest potential biomarkers for childhood obesity stratification, though further validation is warranted.

Hypertension and diabetes on cognitive impairment: a case-control study in China

BACKGROUND

Cognitive impairment, hypertension and diabetes are prevalent chronic conditions in populations of older ages. Previous studies have shown that hypertension and diabetes are risk factors for the development of cognitive impairment. However, the impact of hypertension combined with diabetes (HD) and their cumulative effects on cognitive impairment remain unclear. We aimed to investigate whether HD influences development of cognitive impairment and whether the effect is cumulative.

METHODS

A case-control study was conducted. From 40,103 subjects aged 60 years or older, enrolled from 28 representative communities of 9 provinces of China between January 2015 and December 2021 into the Prevention and Intervention on Neurodegenerative Disease for Elderly in China program using multi-stage stratified random sampling, individuals not meeting our propensity score matching criteria were excluded, and 13,252 individuals were finally selected for the study. Exposure factors included hypertension, diabetes and their comorbidity. Odds ratios (ORs) of exposure factors on cognitive impairment were measured using multiple logistic regression.

RESULTS

We found significant impacts of hypertension, diabetes and their comorbidity on cognitive impairment occurrence. The OR values for dementia were 1.18 for individuals with hypertension only, 1.26 for those with diabetes only, and 1.53 for those with HD. Compared to participants without hypertension and diabetes, the OR values for mild cognitive impairment (MCI) were 1.11 for individuals with hypertension only, 1.32 for those with diabetes only, and 1.27 for those with HD. For subjects with HD longer than 5 years, the comorbidity significantly impacted on MCI and dementia, and the degree of impact increased with the duration of comorbidity. For hypertension, the influence of hypertension on dementia were most influential in middle-aged (45-64 years old) people. By contrast, the influence of diabetes on people younger than 45-year-old was most significant, with the middle-age group being the second most impacted subjects.

CONCLUSIONS

The elderly with HD have a heightened risk of developing cognitive impairment, particularly dementia, compared to those with either hypertension or diabetes alone. The study revealed a significant cumulative impact of HD on cognitive impairment.

Sex and gender differences in access, quality of care, and effectiveness of treatment in dementia: a scoping review of studies up to 2024

BACKGROUND

Dementia represents one of the greatest global health challenges. Women have a greater lifetime risk of developing dementia compared to men. Both pharmacological and non-pharmacological interventions aimed at slowing cognitive decline show promising results. However, most studies do not examine whether there are sex and gender differences in access to treatment, quality of care or treatment effectiveness.

OBJECTIVES

To summarise evidence on sex and gender differences in access to treatment, management, and treatment effectiveness for people with dementia.

METHODS

This scoping review followed PRISMA guidelines and was conducted in PubMed/MEDLINE, EMBASE, Google Scholar, and ClinicalTrials.Gov databases in November 2023 and updated in January 2024. Systematic reviews and observational studies were included to explore sex and gender differences in access or management of dementia. Systematic reviews and clinical trials were included to investigate sex and gender differences in treatment effectiveness.

RESULTS

We included 16 studies in our review. Sex and gender differences were observed in the prescription and receipt of anti-dementia medications, as well as access to primary care, with variations by settings. Mixed results were found concerning polypharmacy and inappropriate medications, with women being prescribed antipsychotic and other psychotropic medications for longer periods compared to men. Studies of the impact of exercise on cognitive decline yielded mixed results, though limited disaggregated data by sex indicated a more pronounced impact in women than in men. Cognitive stimulation therapy interventions showed greater cognitive improvements for women. Clinical trials assessing the effectiveness of disease-modifying therapies (DMTs) suggest that women may be less responsive to DMTs than men.

CONCLUSIONS

There are important differences between men and women living with dementia in access to diagnosis, treatments, quality of care and effectiveness of treatments. Such differences can significantly impact health outcomes. Sex and gender inequalities should be considered when planning and implementing healthcare, social care, and associated strategies in dementia. To provide conclusive evidence, it is essential for clinical trials to have sufficient statistical power and report outcomes disaggregated by sex.

A cross-sectional study examining the relationship between the advanced lung cancer inflammation index and prostate cancer

BACKGROUND

Prostate cancer (PCa), a significant health concern among middle-aged and elderly men globally, has increasingly been associated with metabolic and inflammatory processes. The advanced lung cancer inflammation index (ALI), a novel marker reflecting nutritional and inflammatory status, has not yet been thoroughly investigated in the context of PCa. This study investigated the potential link between ALI and PCa.

METHODS

We first conducted a cross-sectional study utilizing data from the National Health and Nutrition Examination Survey (NHANES). The relationship between ALI and PCa was examined by NHANES-provided survey weights. Smoothed curve fitting and threshold effect analyses were conducted to evaluate possible nonlinear associations. Then we analyzed the correlation between the prognosis of PCa patients and ALI.

RESULTS

Out of 15,042 adult participants, 683 (4.54%) were diagnosed with PCa. The risk of PCa decreased across increasing quartiles of ALI. Multivariate logistic regression analysis revealed that compared to participants in the lowest ALI quartile (Q1: 2.89-41.94), those in higher quartiles (Q2: 41.94-59.08, Q3: 59.08-80.88, and Q4: ≥80.88) had progressively lower odds of developing PCa in both unadjusted and adjusted models. Smoothed curve fitting indicated a U-shaped relationship between ALI and PCa. Longitudinal follow-up data indicated that lower ALI values were positively correlated with a poor survival in cancer patients.

CONCLUSION

Our study revealed a non-linear relationship between ALI and the risk of PCa development. Specifically, there was a negative correlation between ALI and PCa risk when the ALI value was < 100. Furthermore, we found that lower ALI levels are strongly associated with a poor survival in cancer patients. Additional large-scale prospective studies are needed to confirm these findings and investigate the underlying mechanisms.

Imo-induced changes in gut hormones and glucose metabolism: A key to improving insulin sensitivity in type 2 diabetes

Isomalto-oligosaccharides (IMO) are prebiotic oligosaccharides that have shown promise in improving insulin sensitivity and glucose metabolism, making them potential therapeutic agents for Type 2 Diabetes (T2D). IMO selectively stimulates beneficial gut microbiota, particularly Bifidobacterium and Lactobacillus, leading to the production of short-chain fatty acids (SCFAs) like acetate, propionate, and butyrate. These SCFAs play a pivotal role in enhancing the release of gut hormones such as GLP-1 (Glucagon-like peptide-1) and PYY (Peptide YY), which improve insulin secretion and promote satiety, thus improving glucose homeostasis. Clinical studies have reported that IMO supplementation can lower HbA1c by 0.5% and reduce postprandial glucose spikes, demonstrating its efficacy in glycemic control. Additionally, IMO promotes insulin sensitivity by reducing inflammation and enhancing adiponectin levels. Although the current findings are promising, further research is needed to determine optimal dosing, long-term safety, and the role of individual gut microbiomes in tailoring IMO interventions. Future studies focusing on personalized nutrition strategies and the synergistic effects of IMO with other lifestyle interventions could enhance its applicability as a key component in T2D management.

Enhancement of endometrial receptivity by Bushen Zhuyun Decoction via cryptotanshinone-mediated TRIM28 induction and HIF-1α suppression

ETHNOPHARMACOLOGICAL RELEVANCE

Bushen Zhuyun Decoction (BSZYD), a traditional Chinese remedy, has demonstrated clinical efficacy in the treatment of luteal phase deficiency (LPD), though its mechanistic pathways remain largely undefined.

AIM OF THE STUDY

This study aims to elucidate the mechanism by which BSZYD enhances endometrial receptivity.

MATERIALS AND METHODS

In an LPD rat model induced by RU-486 and treated with BSZYD, molecular markers of endometrial receptivity were evaluated using scanning electron microscopy (SEM). Furthermore, these markers were analyzed in the RL95-2 human adenocarcinoma cell line following knockdown of Tripartite motif containing 28 (TRIM28). Network pharmacology and UPLC-MS/MS were utilized to identify bioactive components that modulate Hypoxia-inducible factor-1 (HIF-1) signaling, followed by validation through molecular docking. The interaction between HIF-1α and TRIM28 was assessed using co-immunoprecipitation (Co-IP) and confocal microscopy. The effect of cryptotanshinone on TRIM28 expression was also examined in RL95-2 cells.

RESULTS

BSZYD significantly increased the number of embryo implantation sites and reduced endometrial reactive oxygen species (ROS) levels in LPD rats. TRIM28 was found to be crucial for BSZYD's enhancement of endometrial receptivity. Cryptotanshinone, a key component of BSZYD, downregulated HIF-1α expression in RL95-2 cells. The interaction between HIF-1α and TRIM28 was confirmed both in vivo and in vitro. In vitro, cryptotanshinone mitigated H2O2-induced oxidative stress. Furthermore, HIF-1α agonist administration attenuated BSZYD's ability to induce TRIM28 expression.

CONCLUSIONS

BSZYD and its bioactive constituent, cryptotanshinone, promote endometrial receptivity by inhibiting HIF-1α and upregulating TRIM28. These findings offer novel molecular targets and pharmacological insights for the prevention and treatment of LPD.

Systematic analysis of the global, regional, and national burden of subarachnoid hemorrhage from 1990 to 2021

Subarachnoid hemorrhage (SAH) is characterized by high rates of morbidity, mortality, and disability, which imposes a heavy disease burden on society and families. Incidence, mortality, disability-adjusted life years (DALYs) and their corresponding age-standardized rates (ASRs) and estimated annual percentage changes (EAPCs) of subarachnoid hemorrhage were analyzed by using GBD 2021 data in our study. Data were further stratified by age, sex, and region. Globally, in 2021, there were 697486 (95% UI, 614334795785) new cases of subarachnoid hemorrhage, 352,810 (309015401474) deaths, and 10.64 million (9.39 to 12.12) DALYs. The burden of subarachnoid hemorrhage showed substantial decline from 1990 to 2021. However, the decline in the age-standardized incidence rate was significantly smaller than the declines in the age-standardized mortality rate and age-standardized DALY rate, with the most pronounced downward trend in East Asia but an increase in sub-Saharan Africa, indicating that our prevention strategies require further refinement.

The Association Between the Weight-Adjusted Waist Index and Dementia Risk in Older Adults: A Prospective Cohort Study

Background/Objectives: The weight-adjusted waist index (WWI), a novel measure of abdominal obesity independent of overall weight, has shown promise in assessing health risks. However, its relationship with dementia remains unclear. This study investigates the association between the WWI and dementia risk in British older adults. Methods: Employing data from the United Kingdom Biobank, we conducted a prospective cohort study focusing on 155,683 elderly participants. Multivariable logistic regression models were employed to investigate the linear association between the WWI and all-cause dementia. Restricted cubic spline analysis was used to evaluate non-linear relationships, while subgroup analyses and interaction tests were performed to examine the stability of findings across different populations. Results: Among participants (mean age: 63.2 years; 52.2% male), 3211 dementia cases were identified during 13.1 years of follow-up (2.06% prevalence). The analysis revealed a significant inverse relationship between the WWI and dementia risk. In fully adjusted models, higher WWI was associated with a reduced risk of dementia (β = -0.274, p < 0.001). When the WWI was categorized into quartiles, participants in the highest quartile exhibited a 47% lower risk of dementia compared to those in the lowest quartile. This inverse association was particularly pronounced among non-current smokers (p < 0.05 for interaction). Restricted cubic spline analysis confirmed a non-linear relationship, with the protective effect of the WWI becoming more evident at higher values. Conclusions: The WWI is inversely associated with dementia risk in British older adults. These findings reveal that the WWI may serve as a potential predictor for dementia risk, highlighting its potential in risk stratification and prevention strategies.

Application of machine learning algorithms to model predictors of informed contraceptive choice among reproductive age women in six high fertility rate sub Sahara Africa countries

INTRODUCTION

Informed contraceptive choice is declared when a woman selects a methods of contraceptive after receiving comprehensive information on available alternatives, side effects, and management if adverse effect happens. Access to contraceptive information is a fundamental right, crucial for reducing fertility and unintended pregnancies and related complications. Despite efforts to reduce fertility, Sub-Saharan Africa region is still accounts for over half of the global births due to low contraceptive use, high discontinuation rate, and unmet needs, often linked to uninformed contraceptive choice. While studies on informed contraceptive choice are available using classical regression analysis, the diverse nature of factors have not been systematically analyzed using machine learning algorithms. Hence, this study aimed to apply machine learning algorithms to model predictors of informed contraceptive choices among reproductive age women in six high fertility rate Sub Sahara Africa countries.

METHODS

This study used 11,706 weighted women aggregated from 6 high fertility rate countries in Sub Saharan Africa including Mali, Angola, Burundi, Nigeria, Gambia, and Burkina Faso, collected using stratified sampling techniques. Data cleaning, weighting, and descriptive statistical analyses were conducted using STATA version 17 and Excel 2019, while machine learning analysis was performed using Python 3.12. Furthermore, Random Forest, eXtreme Gradient Boosting (XGBoost), Light Gradient Boosting Machine (LGBM), Naïve Bayes, Decision Tree, Logistic Regression, and Adaptive Boosting (AdaBoost) were employed to predict informed contraceptive choice and to identify its predictors. Shapley Additive Explanations (SHAP) was used to assess the link between predictors and informed contraceptive choice. Accuracy and area under the curve (AUC), along with precision, recall, and F1 score, were used to evaluate the performance of the predictive models.

RESULTS

About 58% women receive informed choice of contraceptive methods, ranges 29% in Burundi to 77% in Burkina Faso. Moreover, the highest spatial clustering of informed choice of contraceptive methods cases was observed in Burkina Faso while the lowest is clustering was found in Angola. LGBM model achieved an accuracy of 73%, area under the curve (AUC) of 0.80, precision of 71, and recall of 77. The SHAP analysis revealed that health facility visits within 12 months, religion, source of contraceptive, exposure to family planning message, mobile ownership, education, wealth index, under five children, residence, and total life time partner were the top ten predictors of informed contraceptive choice.

CONCLUSION

Nearly six out of ten women received informed contraceptive choice, the magnitude is highest in Burkina Faso and lowest in Mali. Moreover, the highest spatial clustering of informed choice of contraceptive was observed in Burkina Faso while the lowest clustering was found in Angola. The LGBM classifier outperformed among machine learning algorithms and achieved 73% accuracy and an AUC of 0.80. Key factors influencing informed contraceptive choice were health facility visits, religion, contraceptive source, family planning messages, mobile ownership, education, wealth, residence, and lifetime partners. To enhance informed contraceptive choice, governments and policymakers should strengthen family planning education, expand healthcare services, and ensure equitable access to contraceptive information. Digital health solutions, especially mobile-based platforms, can also bridge information gaps. Integrating counseling into routine healthcare, training providers, and expanding mass media campaigns can enhance awareness. Engaging communities can help overcome social and religious barriers. Continuous monitoring and data-driven policy adjustments are essential for responsive interventions that address the evolving reproductive health needs in sub-Saharan Africa. Finally, we recommend that future research validate these findings using external data sources.

Adherence to the Planetary Health Diet and Its Association with Diet Quality and Environmental Outcomes in Croatian University Students: A Cross-Sectional Study

BACKGROUND/OBJECTIVES

University students are at a critical life stage in terms of establishing lifelong dietary habits, yet little is known about the sustainability of their diets, especially in Croatia. This study aimed to assess the sustainability and environmental impacts of university students' dietary patterns at the University of Rijeka using the Planetary Health Diet Index (PHDI) and to explore the associations with demographic, lifestyle, nutritional, and environmental variables.

METHODS

A cross-sectional study was conducted from October 2023 to March 2024 among 224 students (54% male, mean age 22.7 ± 2.2 years). Data collection included sociodemographic information, physical activity, and dietary intake (semi-quantitative FFQ). Diet quality was assessed using the PHDI, Mediterranean Diet Score (MDS), and Dietary Inflammatory Index. Environmental impact indicators (carbon, water, and ecological footprints) were calculated using energy-adjusted intake data and standardized life cycle assessment data.

RESULTS

Students exhibited moderate adherence to the Planetary Health Diet (mean PHDI: 55.5). Higher PHDI scores were significantly associated with vigorous physical activity, higher MDS, and anti-inflammatory dietary patterns (all p < 0.001). Despite male students showing slightly higher PHDI scores, their diets had significantly greater environmental impacts. A one-point increase in the PHDI correlated with smaller environmental footprints (carbon: β = -7.94; water: β = -13.88; ecological: β = -3.15; all p < 0.001), with a significant decrease observed particularly in the lowest- and highest-adherence groups, while no consistent or significant effects were found in the intermediate groups. The nutrient and food group analysis supported the health-promoting profile of diets aligned with the PHDI.

CONCLUSIONS

This study highlights the moderate sustainability of students' diets, with significant associations between diet quality and environmental impacts. University settings present key opportunities for the promotion of sustainable, health-oriented eating behaviors among young adults.

Midlife dementia risk scores in a multi-ethnic population in the Netherlands: the HELIUS study

BACKGROUND

Migrant populations in the Netherlands may face greater dementia risk factor burden than Dutch natives.

OBJECTIVES

To study whether midlife dementia risk scores differ by ethnicity.

METHODS

We calculated three validated dementia risk scores in participants aged 40-70 years of Dutch (n = 2978), South-Asian Surinamese (n = 2084), African Surinamese (n = 3135), Ghanaian (n = 1699), Turkish (n = 2000), and Moroccan (n = 2025) background, from the HELIUS study (Amsterdam, the Netherlands): Cardiovascular Risk Factors, Aging and Incidence of Dementia (CAIDE), LIfestyle for BRAin Health (LIBRA), and Australian National University-Alzheimer's Disease Risk Index (ANU-ADRI). We cross-sectionally compared scores between ethnicities using linear regression.

RESULTS

Ethnic minority groups had higher risk scores than those with a Dutch background (CAIDE: +0.66-1.35; LIBRA: +0.66-1.43; ANU-ADRI: +2.75-7.25). CAIDE estimated an absolute 20-year incident dementia risk of 2.6% for Dutch, 3.4% for South-Asian Surinamese, 3.6% for Turkish, 3.7% for Moroccan, 3.7% for African Surinamese and 4.5% for Ghanaian populations. Differences were greater when removing age from scores (CAIDE +0.89-2.22; ANU-ADRI +3.03-8.20), implying that this higher risk score is independent of age.

CONCLUSION

Migrant populations had higher dementia risk scores than Dutch natives. Validation of these scores in migrant populations is warranted. If replicated, ethnicity should be considered when estimating dementia risk and developing preventive strategies for high-risk populations.

Pea and Lentil Flours Increase Postprandial Glycemic Response in Adults with Type 2 Diabetes and Metabolic Syndrome

Pea and lentil flours are added to baked foods, pastas, and snacks to improve nutritional quality and functionality compared to products made solely with refined wheat flour. However, the effect of whole pulses versus their serving size equivalent of flour on blood glucose has not been investigated in persons with altered glycemic response. Health claims for whole pulses are based on a ½ cup amount whereas commercial pulse flour servings are typically a smaller size. The glycemic responses of four treatment meals containing 50 g available carbohydrate as ½ cup whole pulse or the dry weight equivalent of pulse flour were compared with a control beverage (Glucola®). Eleven adults with type 2 diabetes mellitus (T2DM) and eight adults with metabolic syndrome (MetS) completed the study. Venous blood samples were collected at fasting and at 30 min intervals postprandial for three hours. Changes in net difference in plasma glucose over time from baseline and incremental area under the curve (iAUC) segments were analyzed. All four pulse meals attenuated the iAUC compared to the control from 0 to 120 min for T2DM participants and 0-180 min for MetS participants. Whole pulses produced a lower glycemic response than pulse flours in the early postprandial period for persons with T2DM and during the overall test period for those with MetS.

Lower water-soluble vitamins and higher homocysteine are associated with neurodegenerative diseases

Evidence of the effects of water-soluble vitamins (e.g., B vitamins, vitamin C, and total folate) on cognitive function in patients with neurodegenerative diseases is mixed. Furthermore, the relationships among homocysteine (Hcy) metabolism, water-soluble vitamins, and cognitive impairment remain unclear. Therefore, we aimed to investigate the role of the levels of water-soluble vitamins [e.g., vitamins B1, B2, B3, B5, B6, 5-methyltetrahydrofolate (5mTHF), B12, and C and total folate] and Hcy in dementia progression in patients with neurodegenerative diseases. In this retrospective cohort study, we enrolled 280 healthy controls and 646 patients with a neurodegenerative disease. Patients were classified into a Parkinson's disease (PD) group (n = 312), Alzheimer's disease (AD) group (n = 219), or other dementia group (n = 115) according to pathological features. The other dementia group comprised 25 patients with frontotemporal dementia, 38 with Lewy body dementia, 34 with vascular dementia, and 18 with semantic dementia. Serum vitamins (i.e., B1, B2, B3, B5, VB6, 5mTHF, and C) were measured via liquid chromatography-mass spectrometry/mass spectrometry. Total Hcy, vitamin B12 and total folate levels were measured using commercial electrochemiluminescence immunoassays. The serum levels of vitamins B1, B2, B5, B6, 5mTHF, and C were lower in all patient groups than in the control group. The logistic regression results revealed that lower levels of serum vitamins B2, B6, 5mTHF, and B12 were associated with a higher risk of dementia in PD patients, and higher Hcy levels and lower serum vitamin B6 and 5mTHF levels were associated with a higher risk of AD-related cognitive impairment. In addition, the level of vitamins was positively correlated with neuropsychological assessment scores and negatively correlated with Hcy level and stage of dementia. The levels of several water-soluble vitamins are lower in dementia patients. Moreover, lower levels of water-soluble vitamins and higher levels of Hcy increased odds ratios for having neurodegenerative diseases or cognitive impairment. These findings suggest that estimating water-soluble vitamin levels in older adults may be valuable given that they may help improve cognitive function.

Global, regional, and national burden of opioid use disorder from 1990 to 2021: a statistical analysis of incidence, mortality, and disability-adjusted life years

BACKGROUND

Opioid use disorder (OUD) present significant health challenges globally, especially among adolescents and young adults. This study leverages the Global Burden of Disease (GBD) Study 2021 to assess the burden of OUD from 1990 to 2021.

METHODS

The incidence, mortality, and disability-adjusted life years (DALYs) of OUD from 1990 to 2021 were extracted from the GBD Study 2021 website. The slope index of inequality (SII) and concentration index of inequality (CII) were used to quantify the inequality of OUD burden across countries. We employed frontier analysis to quantify the gap between a country's or territory's current burden and its potential minimum burden.

RESULTS

Globally, in 2021, the number of new cases, deaths, and the DALYs of OUD were 1942.52 thousand [95% uncertainty interval (UI): 1643.34, 2328.36], 99.55 thousand (95% UI: 92.94, 108.04), and 11,218.51 thousand (95% UI: 9188.65, 13,159.55), respectively. The age-standardized rates (ASRs) of incidence, mortality, and DALYs of OUD were 24.54 per 100,000 population (95% UI: 20.74, 29.48), 1.19 per 100,000 population (95% UI: 1.12, 1.29), and 137.15 per 100,000 population (95% UI: 112.29, 161.39), respectively. At the regional level, high-income North America had the most severe burden of OUD. The peak OUD incidence occurred in both males and females aged 20-24 years, and the peak OUD-related mortality occurred in males aged 30-44 years and females aged 30-59 years. Countries with higher SDIs have a heavier burden of OUD, and this trend continues to intensify. Countries with higher SDIs often have greater potential to reduce the burden of OUD.

CONCLUSIONQ

OUD remains an important contributor to the burden of disease and is concentrated mainly among young people, emphasizing the urgency of addressing this public health challenge.

The relative validity of the updated Menzies Remote Short-Item Dietary Assessment Tool (MRSDAT) for use with remote Aboriginal and Torres Strait Islander children and adults

BACKGROUND

This study aimed to determine the relative validity of dietary quality index scores estimated using the updated version of the Menzies Remote Short-item Dietary Assessment Tool (MRSDAT), a food frequency questionnaire developed for use with remote Indigenous communities in Australia.

METHODS

This validation study compares scores derived from the updated MRSDAT with those derived from 24-h recalls. Participants from nine remote communities across three discrete regions of Australia (Central Australia, North Northern Territory and Cape York) participated in June-September 2021, or May-July 2022. Participants were Indigenous children aged six months to five years, pregnant and/or breastfeeding Indigenous women, and overweight adult Indigenous males and females. The agreement between methods was explored using Lin's concordance correlation coefficient (CCC), Bland-Altman plots, weighted Cohen's kappa, paired samples t-tests and Wilcoxon signed-rank tests. Primary comparisons were completed for the whole sample, and primary and secondary comparisons for only participants with ≥ 2 × 24 h recalls.

RESULTS

Ninety-nine participants were recruited. The MRSDAT estimated dietary quality index scores 0.31/100 points higher than 24-h recall estimates for participants with ≥ 2 × 24-h recalls, and 0.18/100 points higher for all participants, with consistent results for adults and children (CCC = Rc 0.58, 95% CI 0.39, 0.72).

CONCLUSIONS

Updates to the MRSDAT have resulted in dietary quality index scores highly comparable to those derived from 24-h recalls. The MRSDAT has the practical advantages of speed and convenience for research purposes, and the built-in instant dietary feedback feature has application to service delivery settings given the robust results demonstrated in this validation study.

Association of triglyceride glucose and obesity indices with chronic obstructive pulmonary disease in US adults: data from 2013 to 2018 NHANES

BACKGROUND

The impact of insulin resistance (IR) on chronic obstructive pulmonary disease (COPD) has caught increasing attention, and the triglyceride-glucose (TyG) index and related indices are deemed reliable indicators for evaluating IR. Nevertheless, the potential associations of TyG and obesity-related indexes with COPD are currently understudied. Hence, this paper was to inspect the links of TyG and obesity-related indices with COPD.

METHODS

This was a cross-sectional study based on data from the NHANES 2013-2018. Weighted logistic regression (WLR), restricted cubic sample (RCS), and receiver operating characteristic (ROC) curves were leveraged to examine the links of the TyG index and obesity indices with COPD. The stability of the correlations was also assessed via subgroup analyses.

RESULTS

Data from 6383 participants were finally included, including 583 patients with COPD. WLR discovered positive associations of TyG, TyG-body mass index (TyG-BMI), TyG-waist circumference (TyG-WC), and TyG-waist height ratio (TyG-WHtR) with COPD regardless of covariate adjustment (p-value < 0.05, p for trend test < 0.05). After adjusting for all confounders, RCS analysis signaled notable linear links of TyG and obesity-related indices with COPD (p-value < 0.05, p for nonlinear > 0.05). TyG-WHtR showed the highest association with COPD among the indices tested, albeit with limited discriminative ability (AUC = 0.643, 95% CI: 0.619 ~ 0.665). Subgroup analyses further validated the stability and reliability of the results.

CONCLUSION

TyG and its combination with obesity-related indicators are associated with COPD. Among these, TyG-WHtR showed the strongest association with COPD, although causal relationships cannot be inferred and its discriminative ability remained modest. Further prospective studies are warranted to validate these findings.

CLINICAL TRIAL NUMBER

Not applicable.

Perception and experiences of having children and contraceptive use among women in low-income groups: a qualitative study

BACKGROUND

Low-income level has great importance on women's reproductive health issues such as childbearing and contraceptive use.

AIM

This study aims to examine in depth the perceptions and experiences of women of low socioeconomic status regarding having children and contraceptive methods.

METHODS

A phenomenological design was adopted as a qualitative research method. It was conducted with 20 women living in a city in the Eastern Anatolia Region of Türkiye, with low socioeconomic status, married, and having at least one child, between March 15, 2023, and October 18, 2023. The data obtained were analyzed using the thematic content analysis method with the assistance of the Nvivo 12 Pro software package. COREQ guidelines were followed when reporting the data.

RESULTS

Analysis revealed three main themes: "Experiences regarding having children," "Perceptions regarding having children," and "Perceptions and experiences of contraceptive methods." Most participants described having children as a sacred and meaningful experience yet emphasized the challenging aspects of this experience due to caregiving responsibilities and economic hardships. While the ideal number of children was generally stated as two, the actual number of children often exceeded this ideal; moreover, some women perceived the number of children as a matter of "destiny." Regarding contraceptive methods, lack of knowledge, the necessity of spousal approval, and concerns about side effects of certain methods were identified as key factors influencing participants' contraceptive choices.

CONCLUSION

The study revealed that complex emotional, relational, and social dynamics shape women's decisions regarding childbearing. Additionally, knowledge gaps play a significant role in shaping their perceptions and use of contraceptive methods.

Neutrophil-to-Lymphocyte Ratio in the Alzheimer's Disease Continuum

Alzheimer's disease (AD) is a neurodegenerative disorder defined clinically by progressive cognitive decline and memory impairment and pathologically by the accumulation of amyloid-beta plaques, tau neurofibrillary tangles, neuroinflammation, and immune system dysregulation. Peripheral biomarkers are gaining attention as valuable tools for elucidating neuroinflammatory mechanisms in the AD continuum, with potential implications for diagnosis and prognosis. Among these, the neutrophil-to-lymphocyte ratio (NLR) has emerged as a promising systemic inflammatory marker. NLR, a readily available and cost-effective parameter derived from routine blood tests, reflects the balance between innate and adaptive immune responses. Elevated NLR has been associated with AD and mild cognitive impairment (MCI), showing correlations with disease severity, amyloid burden, and neuroinflammation. Increased neutrophil counts may contribute to neurodegeneration through oxidative stress and pro-inflammatory cytokine release, while decreased lymphocyte levels suggest impaired adaptive immunity. However, despite growing evidence, the clinical utility of NLR in AD remains debated due to heterogeneity in study populations and confounding factors, such as comorbidities and medication effects. This review provides a comprehensive analysis of the association between NLR and AD throughout the disease continuum. Future research should prioritize longitudinal studies and integrative approaches that combine NLR with other inflammatory and neurodegenerative markers to enhance early diagnosis and personalized therapeutic strategies.

Tracheal, bronchus, and lung cancer among older adults: thirty-year global burden trends, precision medicine breakthroughs, and lingering barriers

BACKGROUND

Tracheal, bronchial, and lung (TBL) cancer presents significant health challenges for individuals aged 70 and older. However, comprehensive insights into the epidemiological patterns of and risk factors for TBL cancer in this population remain limited. This study aimed to analyze the global, regional, and national burdens and trends of TBL cancer patients aged ≥ 70 years from 1990-2021.

METHODS

The incidence, mortality, and disability-adjusted life years (DALYs) for TBL cancer patients aged ≥ 70 years from 1990-2021 were obtained from the 2021 Global Burden of Disease study. Global trends were stratified age, sex, and sociodemographic index (SDI). Decomposition analysis identified the primary drivers of burden changes, and a global risk attribution analysis was conducted. The Bayesian Age‒Period‒Cohort (BAPC) model forecasted trends over the next 14 years. The analyses were performed with Joinpoint software and the R software.

RESULTS

From 1990-2021, the ASIRs, ASMRs, and ASDRs of TBL cancer among patients ≥ 70 years increase significantly, mainly due to aging and population growth. In the precision medicine era (2015-2021), these indicators for both sexes and males have declined, but the burden among females has increased. The burden varies across regions, with the incidence of TBL cancer increasing more severely in middle-SDI regions, East Asia, and western sub-Saharan Africa, whereas high-SDI regions have shown a decline after peaking. Although the DALY proportion of smoking decreased, it was still the main cause of TBL cancer. However, the burden of environmental particulate pollution has increased. The BAPC model predicted that in the future, the ASIR, ASMR, and ASDR for males and both sexes would decrease, whereas these indicators would either remain stable or increase among females.

CONCLUSIONS

The burden of TBL cancer is increasing significantly among patients aged ≥ 70 years. Despite new hopes and approaches from precision medicine, environmental and behavioral factors still critically influence the TBL cancer burden. Future strategies could enhance subgroup-specific management and promote effective control of known risk factors.

Dietary Omega-3 PUFAs in Metabolic Disease Research: A Decade of Omics-Enabled Insights (2014-2024)

Background/Objectives: The rising global prevalence of metabolic diseases (e.g., obesity, type 2 diabetes mellitus) underscores the need for effective interventions. Omega-3 polyunsaturated fatty acids (PUFAs) exhibit therapeutic potential, yet their molecular mechanisms remain unclear. This systematic review synthesizes a decade (2014-2024) of omics research to elucidate Omega-3 PUFA mechanisms in metabolic diseases and identify future directions. Methods: A PRISMA-guided search of the Web of Science identified studies on Omega-3 PUFAs, metabolic diseases, and omics. After excluding reviews, non-English articles, and irrelevant studies, 72 articles were analyzed (16 multi-omics, 17 lipidomics, 10 transcriptomics/metabolomics/microbiomics each, and 6 proteomics). Results: Omics studies demonstrated that Omega-3 PUFAs, particularly EPA and DHA, improve metabolic health through interconnected mechanisms. They regulate epigenetic processes, including DNA methylation and miRNA expression, influencing genes linked to inflammation and insulin sensitivity. Omega-3 PUFAs reduce oxidative stress by mitigating protein carbonylation and enhancing antioxidant defenses. Gut microbiota modulation is evident through increased beneficial taxa (e.g., Bacteroidetes, Akkermansia) and reduced pro-inflammatory species, correlating with improved metabolic parameters. Mitochondrial function is enhanced via upregulated fatty acid oxidation and TCA cycle activity, while anti-inflammatory effects arise from NF-κB pathway suppression and macrophage polarization toward an M2 phenotype. Challenges include interindividual variability in responses and a limited understanding of dynamic metabolic interactions. Conclusions: Omega-3 PUFAs target multiple pathways to improve metabolic health. Future research should prioritize chemoproteomics for direct target identification, multi-omics integration, and personalized strategies combining Omega-3 with therapies like calorie restriction.

Barriers and facilitators to accessing Non-Communicable Disease services among children, adolescents and young people with Type 1 Diabetes in Mozambique: a quantitative content analysis using the COM-B framework

BACKGROUND

Non-communicable diseases (NCDs), and diabetes in particular, are on the rise even in sub-Saharan African countries. Despite this, access to care is still poor. This study aimed to assess barriers/facilitators to access NCDs services for children, adolescents and young people with Type 1 Diabetes (T1DM) in Mozambique.

METHODS

A qualitative cross-sectional study using focus groups (FG) and key-informant interviews was conducted between September and October 2023, involving patients (16-30 years), caregivers of child and adolescent patients and health care staff of 5 health facilities. A deductive approach was adopted using the Capability-Opportunity-Motivation-Behaviour (COM-B) framework to classify themes referring to barriers/facilitators to access. Two researchers carried out quantitative content analysis independently, assessing the inter-rater agreement through Cohen's K.

RESULTS

Four FGs were conducted with 26 patients (61.5% female, 16-24 years), three with 18 caregivers (83.3% female) and 16 interviews with healthcare workers. A total of 455 themes were identified, with a predominance of barriers (67.3%) compared to facilitators (32.7%) in accessing T1DM services. The area ''Capability'' was labelled significantly more often as a barrier (89.5%) than ''Motivation'' and ''Opportunities'' (60.2% and 62.6%, p < 0.001). The most frequent barriers were related to the psychological ability to accept and manage the disease in the absence of professional psychological support, inadequate interactions with healthcare personnel, long waits in the outpatient clinic and stigma towards diabetes in the community. Social support from family and friends appears to be an important facilitator. Social opportunities emerge more often as facilitators (76/105, 72.4%) than physical opportunities, which were 79.0% (n = 139/176) of the barriers in the 'Opportunities' area (p < 0.001).

CONCLUSIONS

The study highlights the difficulties of patients suffering from T1DM, in particular due to the lack of psychological support and inadequacies of the health services. It also points out the need to improve the training of healthcare personnel and to strengthen the health literacy of patients to improve recognition and management of the disease, respectively. Increased awareness by the community, supported by structured interventions, could also contribute to reducing stigma towards patients and improving the quality of care.

Absorption and metabolic transformation mechanisms of the interaction between salvianolic acids and tanshinones in DKD rats

ETHNOPHARMACOLOGICAL RELEVANCE

Salviae Miltiorrhizae Radix Et Rhizoma (SM) (The plant name has been checked with http://www.theplantlist.org) mainly contains water-soluble salvianolic acids and fat-soluble tanshinone components, which are often used to treat diabetic kidney disease (DKD) in clinical settings.

AIM OF THE STUDY

To investigate the absorption and metabolism regulation of salvianolic acid B and tanshinone IIA combination (Comb1) along with fraction of salvianolic acids and tanshinones combination (Comb2) in DKD rats.

METHODS

Plasma concentrations of 11 salvianolic acids and tanshinone compounds of Comb2 were determined using ultra-performance liquid chromatography in rats with DKD. The Caco-2 cell monolayer model was used to study the transmembrane transport of salvianolic acids and tanshinones and compatibility of the two compounds. Finally, we assessed the effects of cytochrome P450 (CYP450) enzyme on the metabolism of salvianolic acids and tanshinones as well as the compatibility of their components in normal and DKD rats using in vitro incubation of liver microsomes.

RESULTS

The results showed that danshensu, protocatechualdehyde, dihydrotanshinone I, cryptotanshinone, tanshinone I, and tanshinone IIA were well-absorbed in vivo. Salvianolic acid B and salvianolic acids promoted the absorption of tanshinone IIA, whereas tanshinones promoted the absorption of danshensu and inhibited the absorption of protocatechualdehyde. In vitro incubation of liver microsomes showed that salvianolic acids may not undergo phase I metabolism. The pathological status of DKD affected the metabolic rates of tanshinones not the content of total CYP450 enzymes.

CONCLUSION

The molecular compatibility of salvianolic acid B and tanshinone IIA as well as of salvianolic acids and tanshinones act synergistically to improve DKD by affecting drug absorption and metabolism. This study provides an experimental basis for research and development of new drugs related to salvianolic acids and tanshinones.

Epidemiological Evidence on the Associations of Metal Exposure with Alzheimer's Disease and Related Dementias Among Elderly Women

Background: Emerging evidence suggests a potential link between heavy metals and Alzheimer's disease and related dementias (AD/ADRD). This study compiled epidemiological evidence from research published over the past 11 years on the impact of metals on AD/ADRD in women. Women have unique risk factors for late onset of AD/ADRD, in addition to genetic factors, apolipoprotein E allele (APOE4), and longer life expectancy. Furthermore, women are twice likely as men to experience depression, which increases their risk of developing AD/ADRD. Our narrative review underscored the necessity of a sex-specific approach to address women's vulnerability to AD/ADRD. Methods: Electronic databases, including PubMed, Google Scholar, NIOSH Toxline, and Scopus, were thoroughly searched to identify primary epidemiological studies on older women exposed to metals and published between 2014 to 2024. Results: We identified 34 epidemiological studies that met the inclusion criteria. The findings revealed a complex interplay between environmental metals such as lead (Pb), cadmium (Cd), arsenic (As), manganese (Mn), selenium (Se), iron (Fe), zinc (Zn), copper (Cu), magnesium (Mg), and calcium (Ca) and the risk of AD/ADRD in women. Significant adverse effects were reported for Cu, Cd, As, Pb, and Mn while significant protective effects were found between Se, Fe, and Zn in blood and AD/ADRD among older women. However, some studies also reported no correlations. Conclusions: Overall, our review identified contrasting results regarding the effects of metals on AD/ADRD in women. Future studies should collect additional evidence to understanding the effects of heavy metals on AD/ADRD in women for developing preventive measures.

Photodynamic therapeutic activity of novel porphyrins against lung squamous cell carcinoma

Porphyrins, as drug-food homologous bioactive substances, hold significant potential in nanomedicine research and photodynamic therapy (PDT). In this study, we synthesized two novel porphyrin compounds, PTA and PTBA, based on the porphyrin compound TCPP. Using these compounds, we prepared metal-porphyrin nanoparticles and evaluated their properties. Results from multiple assays demonstrated that both PTA and PTBA exhibited significantly enhanced photodynamic therapeutic activation under laser irradiation compared to TCPP. This included improved reactive oxygen species (ROS) and singlet oxygen release, as well as superior antitumor activity. When prepared as metal-porphyrin nanoparticles, all three compounds-PCN224 (TCPP with Zr⁴⁺), PMOF01 (PTA with Zr⁴⁺), and PMOF02 (PTBA with Zr⁴⁺)-showed significantly upregulated photodynamic therapeutic effects. These nanoparticles induced the accumulation of ROS and singlet oxygen in lung squamous cell carcinoma (LSCC) cells and demonstrated both in vitro and in vivo antitumor activity under laser irradiation. Notably, PMOF01 and PMOF02 exhibited much stronger antitumor effects compared to PCN224 in LSCC cells. Our findings highlight the photodynamic therapeutic potential of these novel porphyrin compounds and their nanoparticles. These results not only expand our understanding of porphyrins' antitumor capabilities but also provide new options for PDT applications.

Burden of smoking-related stroke in Saudi Arabia: trends from 1990 to 2021

BACKGROUND

Stroke ranks among the top causes of death and disability globally, with smoking being a significant risk factor for its development. This study aims to assess the impact of smoking-related strokes in Saudi Arabia from 1990 to 2021.

METHODS

The data was extracted from the Global Burden of Disease (GBD) 2021 database. We assessed the burden of smoking-related stroke by estimating the age-standardized rate (ASR) of years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life years (DALYs) and deaths related to this disease.

RESULTS

From 1990 to 2021, there was a respective 22.37% and 24.15% absolute decrease in the ASR of DALYs and ASR of YLLs, with average annual percentage changes (AAPCs) of -0.85 (-0.88, -0.83) and -0.92 (-0.94, -0.89) attributable to smoking-related stroke in Saudi Arabia. The ASR of death fell absolutely by 28.48%, with AAPC of -1.08 (-1.11, -1.05) between 1990 and 2021. In contrast, the ASR of YLDs absolutely increased by 5.17% during the same period, with an APCC of 0.15 (0.14, 0.17). Further, the decline in AAPCs of ASR of DALYs (-1.99), ASR of YLLs (-1.79), and ASR of deaths (-1.90) was primarily influenced by the reduction in the female population, p < 0.001, except ASR of YLDs, where the increase in the AAPC was attributed to a rise in the male population, p < 0.001. In 2021, YLLs contributed 93% (157.81/179.02) of total DALYs from smoking-related strokes in Saudi Arabia. Death rates rose in all age groups in 2021, with the most significant increases seen in the younger and middle-aged groups (30-59 years).

CONCLUSION

While the rates of deaths, DALYs, and YLLs attributable to smoking-related stroke decreased in Saudi Arabia between 1990 and 2021, YLDs significantly increased, mainly in males during the same period. This emphasizes the need for targeted intervention focused mainly on the younger and middle-aged males.

The Role of Inflammation in Neurodegenerative Diseases: Parkinson's Disease, Alzheimer's Disease, and Multiple Sclerosis

Neurodegenerative diseases are a group of conditions that have in common the progressive damage and degeneration of neurons in the central nervous system. This group includes Parkinson's disease, Alzheimer's disease, and multiple sclerosis, among others. In recent years, increasing evidence has pointed to the important role of inflammation in the pathogenesis of these conditions. The occurrence of inflammation in the brain, which is often triggered by pro-inflammatory activation of microglia or astrocytes, can consequently lead to a chronic inflammatory response that contributes to the development of neurodegenerative processes. Inflammatory processes themselves, both within the nervous system and throughout the human body, appear to be central to the initiation and progression of neuronal damage. Understanding the role of inflammation in these diseases may open up new perspectives and opportunities in the future in the development of effective therapies to improve patients' quality of life as the vast majority of cases of patients affected by neurodegenerative diseases continue to be treated symptomatically since causal treatments are lacking. In this review, we provide information on the impact of inflammation on the pathogenesis, course, and potential therapeutic options for selected neurodegenerative diseases. In addition, this article provides a general description of neuroinflammation and the involvement and role of specific cells in the central nervous system.

Chaperonin containing TCP1 subunit 5 as a novel pan-cancer prognostic biomarker for tumor stemness and immunotherapy response: insights from multi-omics data, integrated machine learning, and experimental validation

BACKGROUND

Chaperonin containing TCP1 subunit 5 (CCT5), a vital component of the molecular chaperonin complex, has been implicated in tumorigenesis, cancer stemness maintenance, and therapeutic resistance. Nevertheless, its comprehensive roles in pan-cancer progression, underlying biological functions, and potential as a predictor of immunotherapy response remains poorly understood.

METHODS

We performed a comprehensive multi-omics pan-cancer analysis of CCT5 across 33 cancer types, integrating bulk RNA-seq, single-cell RNA-seq (scRNA-seq), and spatial transcriptomics data. CCT5 expression patterns, prognostic relevance, stemness association, and immune microenvironment relationships were evaluated. A novel CCT5-based signature (CCT5.Sig) was developed using machine learning on 23 immune checkpoint blockade (ICB) cohorts (n = 1394) spanning eight cancer types. Model performance was assessed using AUC metrics and survival analyses.

RESULTS

CCT5 was significantly overexpressed in tumor tissues and primarily localized to malignant and cycling cells. High CCT5 expression correlated with poor prognosis in multiple cancers and was enriched in oncogenic, cell cycle, and DNA damage repair pathways. CCT5 expression was positively associated with mRNAsi, mDNAsi, and CytoTRACE scores, indicating a role in stemness maintenance. Furthermore, CCT5-high tumors exhibited immune-cold phenotypes, with reduced TILs and CD8⁺ T cell activity. The CCT5.Sig model, based on genes co-expressed with CCT5, achieved superior predictive accuracy for ICB response (AUC = 0.82 in validation and 0.76 in independent testing), outperforming existing pan-cancer signatures.

CONCLUSION

This study reveals the multifaceted oncogenic roles of CCT5 and highlights its potential as a pan-cancer biomarker for prognosis and immunotherapy response. The machine learning-derived CCT5.Sig model provides a robust tool for patient stratification and may inform personalized immunotherapy strategies.

Therapeutic targeting the cGAS-STING pathway associated with protein and gene: An emerging and promising novel strategy for aging-related neurodegenerative disease

Neurodegenerative diseases (NDDs) represent a rapidly escalating global health challenge, contributing significantly to the worldwide disease burden and posing substantial threats to public health systems across nations. Among the many risk factors for neurodegeneration, aging is the major risk factor. In the context of aging, multiple factors lead to the release of endogenous DNA (especially mitochondrial DNA, mtDNA), which is an important trigger for the activation of the cGAS-STING innate immune pathway. Recent studies have identified an increasing role for activation of the cGAS-STING signaling pathway as a driver of senescence-associated secretory phenotypes (SASPs) in aging and NDDs. The cGAS-STING pathway mediates the immune sensing of DNA and is a key driver of chronic inflammation and functional decline during the aging process. Blocking cGAS-STING signaling may reduce the inflammatory response by preventing mtDNA release and enhancing mitophagy. Targeted inhibition of the cGAS-STING pathway by biological macromolecules such as natural products shows promise in therapeutic strategies for age-related NDDs. This review aims to systematically and comprehensively introduces the role of the cGAS-STING pathway in age-related NDDs in the context of aging while revealing the molecular mechanisms of the cGAS-STING pathway and its downstream signaling pathways and to develop more targeted and effective therapeutic strategies for NDDs.

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

PURPOSE

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

PARTICIPANTS

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

FINDINGS TO DATE

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

FUTURE PLANS

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

AI in Neurology: Everything, Everywhere, all at Once PART 2: Speech, Sentience, Scruples, and Service

Artificial intelligence (AI) applications are finding use in real-world neurological settings. Whereas part 1 of this 3-part review series focused on the birth of AI and its foundational principles, this part 2 review shifts gears to explore more practical aspects of neurological care. The review details how large language models, generative AI, and robotics are supporting diagnostic accuracy, patient interaction, and treatment personalization. Special attention is given to ethical and philosophical facets of AI that nonetheless impact practical aspects of care and patient safety, such as accountability for AI-driven decisions and the "black box" nature of many algorithms. We will discuss whether AI systems can develop sentience, and the implications for human-AI collaboration. By examining human-robot interactions in neurology, this part 2 review highlights the profound impact AI could have on patient care and, as covered in the ensuing part 3, on global health care delivery and data analytics, while maintaining ethical oversight and human control. ANN NEUROL 2025.

Klotho protein: a multifaceted regulator in aging and cancer dynamics

Klotho, named after the youngest of the three Fates in Greek mythology daughters of Zeus and Nyx, who together spin the thread of life, allot destiny, and determine the time of passing for both mortals and immortals, is an important regulatory factor in aging and cancer dynamics. Initially described as an aging-suppressing protein, Klotho is now recognized for its more diverse role in modulating key signaling pathways like Wnt/β-catenin, IGF-1, PI3K/AKT, and TGF-β. Essentially, its various pro-cellular health functions, such as antioxidant, anti-inflammatory, and tumor-suppressive activities, are, in fact, considered that ensures the maintenance of cellular health and reduce complications related to aging. Klotho deficiency is associated with accelerated aging, chronic kidney disease, cardiovascular disorders, neurodegeneration, and various cancers. This review thus covers the twin roles of Klotho as an antiaging and tumor-suppressor protein, on their therapeutic potential, as well as advances in delivery systems and development of biomarkers and challenges for clinical translation.. Moreover, natural strategies like exercise and dietary interventions are explored that could help overcome Klotho deficiency. Further research with Klotho may offer a paradigm shift in the treatment of aging and cancer and add yet another avenue to increase survival of the patients.

Disrupting Migraine Dynamics: A Narrative Review of the Consequences of Modern Anti-CGRP Monoclonal Antibody Therapies

This article provides an overview of a symposium held as part of the proceedings at the 10th European Academy of Neurology Congress in Helsinki, Finland, on 2 July 2024. Migraine is a common neurological disease and a leading cause of disability worldwide. Anti-calcitonin gene-related peptide (CGRP) therapies are the first to be specifically developed for migraine prevention and are recommended as a first-line option by the American Headache Society and European Headache Federation. Data on the effectiveness of anti-CGRP therapies are now available from clinical trials and real-world studies, and this article briefly reviews these data and discusses what they mean for people with migraine, and how healthcare professionals can take the conversation back to their clinics.

Associations of Accelerated Biological Aging With Dementia and the Mediation Role of Brain Structure: Findings From a Longitudinal Study

BACKGROUND AND OBJECTIVES

The association between biological aging and dementia, as well as the underlying mechanism, remains limited. The aim of this study was to investigate the relationships of biological age (BA) with incident dementia and examine the underlying neurobiological mechanisms.

METHODS

This study used data from the UK Biobank, a prospective longitudinal study. We included participants free of diagnosed dementia at baseline. BA was evaluated from clinical traits using the Klemera-Doubal method biological age (KDM-BA) and PhenoAge algorithms. Genetic risk of dementia was assessed using the apolipoprotein E (APOE) ε4 genotype and polygenic risk scores (PRSs). Cox proportional hazard regression models were used to estimate the associations of BA and the combined effect of genetic risk and BA with dementia. In addition, the potential roles of brain structures (gray matter volume [GMV], cortical mean thickness, and cortical surface area) in the associations between BA and dementia were evaluated using mediation analysis.

RESULTS

A total of 280,918 participants (mean age 56.80 years, 54.59% female) were enrolled in this study. Over a median follow-up of 13.58 years, 4,770 cases of dementia were recorded. Every SD increase in KDM-BA accelerations and PhenoAge accelerations was associated with a 14% (hazard ratio [HR] = 1.14; 95% CI 1.10-1.18) and 15% (HR = 1.15; 95% CI 1.12-1.19) higher incidence of dementia, respectively. Individuals with APOE ε4 and highest PhenoAge accelerations had the highest risk of dementia (HR = 4.20, 95% CI 3.69-4.78) compared with those with non-APOE ε4 and lowest PhenoAge accelerations, with significant interaction effect (Pinteraction < 0.001). We did not find significant modification effects of PRS on the associations between BA accelerations and dementia (Pinteraction = 0.347 for KDM-BA acceleration, Pinteraction = 0.279 for PhenoAge acceleration), as well as APOE ε4 on the association between KDM-BA accelerations and dementia (Pinteraction = 0.212). Mediation analysis showed that the identified GMV, cortical mean thickness, and cortical surface area partly mediated the association between BA accelerations and incident dementia, with proportion-mediated percentage ranging from 6.64% to 17.98%.

DISCUSSION

Advanced BA may be a potential risk factor of incident dementia. The risk is possibly mediated through the widespread reduction of brain structures.

How people with type 2 diabetes in Kuwait manage the condition: A thematic analysis and conceptual framework

BACKGROUND

Type 2 diabetes is a growing non-communicable disease burden across the Eastern Mediterranean region, particularly in Kuwait. The methods that patients adopt to manage the condition following diagnosis is poorly understood. This study aimed to explore these methods using a qualitative approach, and develop a conceptual framework characterising the phases that patients transition through.

METHODS

This was a qualitative, thematic evaluation of a grounded theory methodology investigating the methods that patients with type 2 diabetes employ to manage their condition. Qualitative coding of semi-structured interview transcripts with 22 patients, over three phases: initial, focused and theoretical, enabled categorical themes and phases to be identified. The findings were synthesised into a conceptual framework that represented the transitional journey.

RESULTS

The development of conceptual framework revealed five transitional categorical phases that characterised the journey: (1) experiencing unusual symptoms; (2) accepting the diagnosis; (3) adopting management strategies; (4) adherence and relapse; and (5) adaptation.

CONCLUSION

In Kuwait, patients with type 2 diabetes appear to transition through relatively predictable stages in learning to manage their condition. Clinical consideration of this transition could improve the quality of diabetes care provision for these patients.

Global and regional burden of congenital birth defects, 1990-2021: persistent healthcare disparities and emerging challenges from non-fatal health burden

Introduction

Approximately 3%-6% of infants were born with congenital birth defects worldwide every year, which ranked as the third leading cause of deaths among the population under 20 years of age in 2021.

Methods

By adopting the methodology from Global Burden of Disease Study 2021, we systematically analysed the burden and temporal trend of congenital birth defects at the global and regional levels. Correlations between these metrics and Healthcare Access and Quality (HAQ) Index were investigated by the Spearman correlation analyses.

Results

In 2021, there were 7.2 million cases of congenital birth defects and 0.53 million associated deaths. The highest incidence rates were observed in Central Asia, Central Sub-Saharan Africa and Western Sub-Saharan Africa, while the highest mortality rates were reported in Oceania, Western Sub-Saharan Africa and the Caribbean. Congenital heart anomalies remained the leading cause of deaths and disability-adjusted life years (DALYs). The proportion of years lived with disability (YLD) in total DALY increased significantly from 1990 to 2021, indicating a shift from fatal to non-fatal burden. The global age-standardised mortality rate markedly declined from 1990 to 2021, while the YLD rate remained relatively stable. Negative correlations were observed between the incidence, mortality, years of life lost (YLL) and DALY rates of congenital birth defects and HAQ Index of 204 countries and territories, whereas positive correlations were found for prevalence and YLD.

Conclusions

Although remarkable progress has been made in reducing the global burden of congenital birth defects, it remains a major health issue in low sociodemographic index regions lacking equitable access to healthcare facilities. The shift from fatal to non-fatal burden underscores specific medical conditions for the increasing number of adult patients with congenital birth defects to promote postoperative rehabilitation and prevent complications.

The relationship between CALLY index and stroke in hypertensive patients: insights from NHANES

Background

At present, stroke ranks as the third leading cause of mortality, and hypertension is a major risk factor for stroke. Complementary assessment of inflammation level, immunity, and nutritional status is now possible using the newly developed C-reactive protein-albumin-lymphocyte (CALLY) index biomarker. One key concern in this study is that its correlation with the risk of stroke in individuals with hypertensiveness.

Methods

In this study, we used cross-sectional analyses from the National Health and Nutrition Examination Survey (NHANES) database through 2003 to 2010. The CALLY index was calculated by albumin and lymphocytes divided by C-reactive protein (CRP). In order to further analysis, the CALLY index was log-transformed to increase data normality and lessen the impact of extreme values on the analytical findings. We investigated the odds ratios and confidence intervals of the ln CALLY index and its components in connection to stroke in people with hypertension. A weighted multivariable logistic regression model was carried out. Additionally, we used weighted restricted cubic splines (RCS) and subgroup analyses to further examine the association between the CALLY index and stroke prevalence in hypertensive individuals.

Results

This study included 8,146 hypertensive participants, of whom 616 hypertensive participants had a stroke. In unadjusted modeling, we found a 39% reduction in the incidence of stroke in the hypertensive population in the highest ln CALLY quartile group (OR 0.61, 95% CI 0.46-0.82), and the negative association remained significant after adjustment for confounders. While ALB showed a robust protective impact in hypertensive people, with greater ALB levels linked to a decreased risk of stroke (OR 0.50, 95% CI 0.37-0.68), we also discovered a positive correlation between CRP and stroke risk (OR 1.13, 95% CI 1.04-1.22). A substantial correlation between the ln CALLY index and stroke risk in hypertensive individuals was also validated by subgroup analysis. The ln CALLY index and stroke risk in this sample also showed a strong linear negative connection, according to weighted restricted cubic spline (RCS) analysis.

Conclusion

There is a significant negative association between the CALLY index and stroke risk in hypertensive patients in the U.S. adults. The CALLY index may be a potential indicator for early identification of individuals at higher risk of stroke in hypertensive patients and provide potential for clinical intervention.

Role of B lymphocyte ratio in development of type 2 diabetes mellitus: results of a 7-year follow-up study

Objective

To investigate the association between B lymphocyte ratio (BLR) and type 2 diabetes mellitus (T2DM) outcome among healthy people.

Methods

A retrospective study cohort was constructed based on healthy people who participated in annual physical examination in Shanghai Health and Medical Center from 2013 to 2020. For each patient, we collected data at the first physical examination in 2013. The Cox proportional risk regression model was used to analyze the association between BLR and the risk of T2DM. The mediating effect of traditional metabolic factors were further explored.

Results

The study included 1505 participants with a mean age of 48.77 ± 8.33 years at baseline and a follow-up duration of 7.36 ± 0.99 years. During follow-up, a total of 72 new T2DM cases were identified (7.9/1000 person-years). After adjusted for confounders, the results showed that the participants with higher level of BLR (Quartile 4) had a doubling of the risk of T2DM when compared to those with lower BLR level (Quartile 1). The association of BLR with the risk of T2DM remained robust when patients with hypertension or patients with obesity were excluded. In addition, traditional metabolic factors including HDL-C and LDL-C partially mediated the association between BLR and the risk of T2DM.

Conclusion

Elevated BLR level is significantly associated with a higher risk of T2DM development. HDL-C and LDL-C partially mediated the association between BLR and T2DM risk. Our research may have the potential to provide new therapeutic targets for the treatment of T2DM.