Association of ApoB/apoA1 ratio with stenosis of intracranial and extracranial arteries in patients with ischaemic stroke

Despite the well-established association between the apolipoprotein B/apolipoprotein A1 (apoB/apoA1) ratio and ischemic stroke, its specific relationship with the underlying vascular pathologies contributing to stroke remains poorly understood. This study aims to investigate the association between the apoB/apoA1 ratio and intracranial or extracranial atherosclerosis. We enrolled 408 patients with acute ischemic stroke who had never been treated with statins or fibrates. Based on the images from computed tomography angiography (CTA), the patients were categorized into four groups: intracranial atherosclerosis stenosis (ICAS, n = 136), extracranial carotid atherosclerosis stenosis (ECAS, n = 45), combined intracranial and extracranial atherosclerosis stenosis (COAS, n = 73), and non-cerebral atherosclerosis stenosis (NCAS, n = 154). Demographic characteristics, clinical factors, and serum lipid levels were collected and then compared across groups. The apoB/apoA1 ratio was significantly higher in patients with ICAS, ECAS and COAS compared to those in the NCAS group. Multivariable logistic regression analysis demonstrated that the ApoB/ApoA1 ratio was independently associated with ICAS, but not with ECAS. ROC curve analysis showed that the ApoB/ApoA1 ratio had a good diagnostic ability for ICAS, with an area under the curve (AUC) of 0.764, an optimal cut-off value of 0.8122, a sensitivity of 81.3%, and a specificity of 59.8%. An higher apoB/apoA1 ratio is associated with ICAS in ischemic stroke patients.

An Updated Systematic Review on Asthma Exacerbation Risk Prediction Models Between 2017 and 2023: Risk of Bias and Applicability

Background

Accurate risk prediction of exacerbations in asthma patients promotes personalized asthma management.

Objective

This systematic review aimed to provide an update and critically appraise the quality and usability of asthma exacerbation prediction models which were developed since 2017.

Methods

In the Embase and PubMed databases, we performed a systematic search for studies published in English between May 2017 and August 2023, and identified peer-reviewed publications regarding the development of prognostic prediction models for the risk of asthma exacerbations in adult patients with asthma. We then applied the Prediction Risk of Bias Assessment tool (PROBAST) to assess the risk of bias and applicability of the included models.

Results

Of 415 studies screened, 10 met eligibility criteria, comprising 41 prediction models. Among them, 7 (70%) studies used real-world data (RWD) and 3 (30%) were based on trial data to derive the models, 7 (70%) studies applied machine learning algorithms, and 2 (20%) studies included biomarkers like blood eosinophil count and fractional exhaled nitric oxide in the model. PROBAST indicated a generally high risk of bias (80%) in these models, which mainly originated from the sample selection ("Participant" domain, 6 studies) and statistical analysis ("Analysis" domain, 7 studies). Meanwhile, 5 (50%) studies were rated as having a high concern in applicability due to model complexity.

Conclusion

Despite the use of big health data and advanced ML, asthma risk prediction models from 2017-2023 had high risk of bias and limited practical use. Future efforts should enhance generalizability and practicality for real-world implementation.

Biliverdin alleviates cerebral ischemia-reperfusion injury by regulating the P4hb/MAPK/mTOR pathway to inhibit autophagy

BACKGROUND

Biliverdin (BV) exhibits anti-inflammatory and antioxidative effects. Autophagy activation is crucial in the pathogenesis of cerebral ischemia-reperfusion injury (CIRI). This study aimed to investigate whether BV could ameliorate CIRI by regulating autophagy.

METHODS

A middle cerebral artery occlusion-reperfusion (MCAO/R) model in Sprague-Dawley (SD) rats and an oxygen-glucose deprivation/reoxygenation (OGD/R) model in PC12 cells were employed to explore the neuroprotective effects of BV and its underlying mechanisms. In these rats, once BV was administered post-MCAO/R, its treatment efficacy and underlying mechanisms were evaluated through behavioral, morphological, and molecular analyses. Alternatively, for PC12 cells, following successful OGD/R modeling, BV, autophagy activator rapamycin, prolyl 4-hydroxylase beta (P4hb) knockdown or overexpression, and the specific inhibitors of three classic autophagy pathways were applied. Cell viability (using CCK8 assay), Calcein/PI staining, autophagosome staining (using MDC assay), reverse transcription quantitative polymerase chain reaction, and western blot were subsequently carried out to investigate the mechanisms by which BV ameliorates CIRI.

RESULTS

BV alleviated CIRI by inhibiting autophagy. Further investigation suggested that BV downregulated P4hb expression. In vitro experiments showed that P4hb knockdown reduced autophagy in post-CIRI cells, while its overexpression reversed the effects of BV. Rescue experiments indicated that MAPK pathway inhibitors counteracted the effects of P4hb overexpression on autophagy post-CIRI.

CONCLUSION

BV improves CIRI by regulating the P4hb/MAPK/mTOR signaling pathway to inhibit autophagy, offering a novel therapeutic strategy for ischemic stroke.

Global burden trends and forecasts for MAFLD in adolescents and young adults from 1990 to 2021

Metabolic-dysfunction associated fatty liver disease (MAFLD) is a widespread chronic liver condition that has been steadily increasing among adolescents and young adults in recent years, posing a major global public health concern. This study aims to conduct an in-depth analysis of the Global Burden of Disease (GBD) 2021 data on MAFLD, focusing on prevalence, incidence, and disability-adjusted life years (DALY) for individuals aged 15-39, spanning the period from 1990 to 2021. This research examines data from the GBD study covering 1990 to 2021 to assess the prevalence, incidence, and DALYs associated with of MAFLD in adolescents and young adults aged 15-39. The analysis is broken down by socioeconomic status, geographic regions, and specific countries. Advanced statistical methods, including the estimated annual percentage change (EAPC) and Bayesian age-period-cohort (BAPC) modeling, were used to deliver the most current and thorough epidemiological assessment of MAFLD in this demographic. In 2021, the estimated global cases of non-alcoholic fatty liver disease among adolescents and young adults reached approximately 423 million, representing a 75.31% increase from 1990. The age-standardized prevalence rate (ASPR) was 14,221.32 cases per 100,000 population, and the age-standardized incidence rate (ASIR) was 977.61 cases per 100,000 population in 2021. Between 1990 and 2021, the ASPR, ASIR, age-standardized DALY rate, and age-standardized mortality rate showed a continuous upward trend, with EAPC of 0.84, 0.79, 0.65, and 0.81, respectively. Regions with Middle and Low-middle Socio-Demographic Index (SDI), as well as High-middle SDI, emerged as "hotspots" for MAFLD prevalence, particularly in North Africa, the Middle East, East Asia, and South Asia. Males exhibited higher prevalence rates compared to females, and the rates continued to increase across all adolescents and young adult age groups. By 2050, the ASPR for MAFLD among this population is projected to reach 16,101 cases per 100,000, signaling an alarming trend. Over the last 30 years, the burden of metabolic-dysfunction associated fatty liver disease has significantly increased among adolescents and young adults worldwide. To counter this rising global health concern, it is crucial to develop and implement targeted and effective interventions tailored to socio-economic settings.

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.

Cancer screening and its associated factors in hypertensive individuals: new insights from the 2021 STEPs national study in Iran

BACKGROUND

Cancer continues to be a major cause of death worldwide with almost 10 million deaths from cancer each year and a significant financial burden on healthcare systems. Hypertension can increase the risk of developing certain cancers and their complications, necessitating higher screening rates in the hypertensive population. Although screening for cancer can reduce mortality rates and help with early diagnosis, the screening rates in Iran are far below the optimal level. This study aimed to identify factors associated with cancer screening participation among hypertensive individuals.

METHODS

We utilized data from the STEPs 2021 survey, a large-scale nation-wide cross-sectional study conducted in Iran to assess non-communicable disease (NCD) risk factors. The survey followed the WHO's STEPwise approach and included adults aged 18 and older from both urban and rural areas of 31 provinces of Iran. The effect of each covariate on different types of cancer screening was determined using odds ratios (ORs) which were estimated using univariate and multivariate logistic regression models.

RESULTS

We found that screening rates were significantly influenced by age, marital status, employment, wealth, and residential area. Middle-aged women were more likely to participate in breast and cervical cancer screenings, whereas prostate cancer screening was more common among men aged 70 and older. Furthermore, awareness and control of hypertension, a history of cancer, comorbid chronic diseases, and receiving lifestyle advice were all associated with increased screening participation. Lifestyle scores, BMI, education level, and insurance coverage were all linked to higher screening rates for most cancer types.

CONCLUSION

Despite these findings, cancer screening rates in Iran remain alarmingly low, particularly among high-risk groups such as hypertensive individuals. Urgent reforms and targeted strategies are required to increase screening uptake and enhance early detection efforts in populations at risk.

Targeting mTOR in myeloid cells prevents infection-associated inflammation

Infections, cancer, and trauma can cause life-threatening hyperinflammation. In the present study, using single-cell RNA sequencing of circulating immune cells, we found that the mammalian target of rapamycin (mTOR) pathway plays a critical role in myeloid cell regulation in COVID-19 patients. Previously, we developed an mTOR-inhibiting nanobiologic (mTORi-nanobiologic) that efficiently targets myeloid cells and their progenitors in the bone marrow. In vitro, we demonstrated that mTORi-nanobiologics potently inhibit infection-associated inflammation in human primary immune cells. Next, we investigated the in vivo effect of mTORi-nanobiologics in mouse models of hyperinflammation and acute respiratory distress syndrome. Using 18F-FDG uptake and flow cytometry readouts, we found mTORi-nanobiologic therapy to efficiently reduce hematopoietic organ metabolic activity and inflammation to levels comparable to those of healthy control animals. Together, we show that regulating myelopoiesis with mTORi-nanobiologics is a compelling therapeutic strategy to prevent deleterious organ inflammation in infection-related complications.

Association between estimated glucose disposal rate and future cardiovascular disease risk across glucose metabolism status: a prospective cohort study

BACKGROUND

Cardiovascular disease (CVD) remains a major global health challenge, particularly affected by glucose metabolism status. However, the relationship between estimated glucose disposal rate (eGDR) and future CVD risk across different glucose metabolism status remains unclear.

METHODS

We analyzed data from the China Health and Retirement Longitudinal Study (2011-2020) of participants aged ≥ 45 years. The eGDR was calculated using waist circumference, hypertension status, and HbA1c levels. CVD events (stroke or cardiac events) were the outcome. Participants were categorized by glucose metabolism status (normoglycemia, prediabetes, diabetes). Cox proportional hazards models and restricted cubic splines were used to assess associations and potential non-linear relationships.

RESULTS

Among 7,828 participants (52.84% male, mean age 59.01 ± 9.21 years) followed for an average of 8.29 years, 1,944 participants (24.83%) developed CVD. Higher eGDR was inversely associated with CVD risk across all glucose metabolism states. Below the inflection points (11.77, 11.15, and 11.56 mg/kg/min for normoglycemia, prediabetes, and diabetes, respectively), each 1-unit increase in eGDR reduced CVD risk by 14% (HR = 0.86, 95%CI: 0.83-0.89), 10% (HR = 0.90, 95%CI: 0.86-0.93), and 14% (HR = 0.86, 95%CI: 0.81-0.91), respectively.

CONCLUSION

The eGDR demonstrates a potentially non-linear inverse association with future CVD risk across different glucose metabolism states.

Nuances in the global impact of COVID-19 on tuberculosis control efforts: An updated review

The COVID-19 pandemic has affected public health systems in an unprecedented manner. There has been an abundance of discussion regarding the possible effects of the pandemic in disruption of health services aiming at tuberculosis (TB) infection control - including hindered screening efforts and delays in diagnosis and treatment. The pandemic has also been proposed to affect TB transmission via lifestyle modifications. Moreover, some research has suggested a more direct link between COVID-19 infection and increased TB morbidity and mortality. The authors conducted a narrative review of the relevant literature. Searches were performed in the MEDLINE, Scopus, and Web of Science databases. Reports of impaired TB case-notification were ubiquitous during the early stages of the pandemic. Subsequently, divergent patterns emerged: recovery and decreased TB incidence in countries with stringent public health measures, low local transmission of TB, and resilient health systems; or devastating results from TB underdiagnosis and delayed treatment in countries with high TB burden, limited COVID-19 control measures, and public health funding. Few studies quantified the effects of TB and COVID-19 co-infection - and the possible role of COVID-19 infection in reactivation of latent tuberculosis infection (LTBI) remains ambiguous. Despite the lapse of the COVID-19 pandemic, its effects on TB control efforts perseverate. Particularly, great care is warranted for recovery of impacted healthcare systems in low-income countries.

A description of functional needs of community-dwelling stroke survivors in Rwanda: a prospective observational cohort study

PURPOSE

Stroke survivors in low- and middle-income countries have different needs compared to those in high-income countries. Our aim was to describe the unmet functional needs of Rwandan stroke survivors at discharge and three months after stroke.

METHODS

A study using an adapted modified Needs Assessment Questionnaire (mNAQ) was conducted at six hospitals in Rwanda. Moderate or severe needs are described using descriptive statistics and logistic regression models.

RESULTS

A total of 337 participants, with a mean age of 61 years, were recruited. Most were female (59%), and 70% had an ischemic stroke, while 71% had hypertension. At discharge, 97% of participants had moderate to severe needs. Follow-up at three months was available for 78% of participants and 22% died. At three months, over 70% of participants continued to have moderate to severe needs.

CONCLUSIONS

Almost all Rwandan stroke survivors have moderate to severe needs and disability at the time of discharge, and for those that survive, over 70% continue to have moderate to severe needs at 3 months. This estimate is much higher than previously reported. Improving functioning in the community is essential for Rwandan stroke survivors.

Prevalence of genes encoding carbapenem-resistance in Klebsiella pneumoniae recovered from clinical samples in Africa: systematic review and meta-analysis

BACKGROUND

The potential of Klebsiella pneumoniae (K. pneumoniae) to acquire and spread carbapenem-resistant genes is the most concerning characteristic of the bacteria. In hospitals and other healthcare settings, multidrug-resistant K. pneumoniae can be prevalent and cause severe infections, posing significant challenges to patient management. Studying genetic variants and drug-resistant mutations in pathogenic bacteria of public health importance is essential. Therefore, this study aimed to assess the overall prevalence of carbapenemase-encoding genes in K. pneumoniae across Africa.

METHODS

All studies published between January 2010, and December 2023, were retrieved from the electronic databases PubMed, Science Direct, and Scopus, as well as through the Google Scholar search engine. This systematic review and meta-analysis adhered strictly to the PRISMA guidelines. Data analysis was performed using STATA version 17. The quality of the included studies was critically evaluated using the "Joanna Briggs Institute" criteria. To evaluate heterogeneity among the studies, inverse variance (I2) tests were utilized. Subgroup analysis was conducted when heterogeneity exists among studies. To assess publication bias, we used a funnel plot and Egger's regression test. A random effects model was used to calculate the weighted pooled prevalence of genetic variants associated with carbapenem resistance in K. pneumoniae.

RESULTS

A total of 49 potential studies were included in this systematic review and meta-analysis, encompassing 8,021 K. pneumoniae isolates. Among these isolates, 2,254 (28.1%) carbapenems-resistance-conferring genes were identified. The overall pooled prevalence of carbapenemase-encoding genes in K. pneumoniae isolated from clinical specimens across Africa was found to be 34.0% (95% CI: 26.01-41.98%). Furthermore, the pooled prevalence of the carbapenemase genes blaOXA-48 and blaNDM-1 was 16.96% (95% CI: 12.17-21.76%) and 15.08% (95% CI: 9.79-20.37%), respectively. The pooled prevalence of carbapenemase genes in K. pneumoniae isolates from clinical samples across Africa increased over time, reported as 20.4%(-0.7-41.4%) for 2010-2015, 34.5% (20.2-48.8%) for 2016-2020, and 35.2% (24.8-45.5%) for 2021-2023, with heterogeneity (I2) values of 36.5%, 96.7%, and 99.3%, respectively.

CONCLUSIONS

The emergence and spread of carbapenemase-encoding genes in K. pneumoniae pose a major threat to public health. Knowledge on the genetic mechanisms of carbapenem resistance is crucial for developing effective strategies to combat these multidrug-resistant infections and reduce their impact on healthcare systems. The carbapenemase genes blaOXA-48 and blaNDM-1 were the most prevalent and showed an increasing trend over time.

Understanding poor oral health among older adults in Türkiye: socioeconomic and healthcare access challenges

BACKGROUND

Oral health is an integral part of overall well-being, and older individuals are particularly vulnerable due to age-related changes and barriers to healthcare access. Despite Türkiye's comprehensive public health insurance system, significant disparities in oral health persist, highlighting the need for targeted research and interventions. This study assesses the oral health of people aged 65 and older in Türkiye and explores the factors linked to poor oral health, such as individual characteristics, lifestyle, socioeconomic status, social support, overall health, and access to healthcare services.

METHODS

A secondary analysis was performed using the cross-sectional 2022 Türkiye Health Survey, which gathered data from 3,144 individuals aged 65 and above. Oral health was self-reported, with poor oral health defined as participants rating their dental and gum condition as 'bad' or 'very bad.' Factors assessed included age, gender, education, social support, healthcare access, and the presence of chronic diseases.

RESULTS

Among the participants, 25.8% reported poor oral health. Key factors associated with this included being older, female, having lower levels of education, difficulty communicating in one's mother tongue, experiencing limitations in daily activities, and facing cost-related barriers to dental care. Multivariable analysis found that cost related barriers and limitations in daily activities had the strongest impact on oral health. The study also highlighted the importance of social support in maintaining better oral health.

CONCLUSIONS

Poor oral health in older adults in Türkiye is strongly influenced by cost-related barriers, limitations in daily activities, and lack of social support. Expanding public dental services, reducing out-of-pocket costs, and integrating oral health into chronic disease programs are critical steps. Providing culturally sensitive and mobile care options can also address mobility challenges and enhance oral health outcomes for the elderly.

Global and regional assessments of the burden of transport injuries and associated risk factors, 1990-2021: Insights from the 2021 Global Burden of Disease study

The burden of transport injuries continues to constitute a major global challenge. This study seeks to utilize the most recent data from the 2021 Global Burden of Disease (GBD) study to comprehensively analyze the global and regional burden of transport injuries. This study utilized the most recent data from the 2021 GBD study to comprehensively analyze the trends in ASIRs, mortality rates, and disability-adjusted life years (DALYs) for transport injuries between 1990 and 2021. Subgroup analyses were performed based on gender, age, and geographic regions. Additionally, we examined potential risk factors associated with DALYs due to transport injuries. Between 1990 and 2021, the global burden of transport injuries exhibited an overall decreasing trend. Relative to 1990, the age-standardized incidence rate (ASIR) declined by approximately 37.1%, the age-standardized death rate (ASDR) decreased by approximately 33.3%, and the age-standardized DALY rate decreased by roughly 38.0%. Regional subgroup analysis demonstrated that regions with higher Social Development Index (SDI) exhibited higher ASIRs, but lower ASDRs and age-standardized DALY rates. At the same time, the converse was observed in regions with lower SDI. The burden of transport injuries decreased across all age cohorts. Furthermore, smoking, alcohol consumption, low bone mineral density, occupational injuries, and high temperatures were recognized as the 5 major risk factors for DALYs associated with transport injuries. This GBD 2021-based study provides further insights into the global burden of transport injuries from 1990 to 2021, with a particular focus on the impact of the COVID-19 pandemic. However, due to the inherent limitation of GBD studies, which lack rigorous harmonized standards, the quality of their data is highly dependent on individual country reports. As a result, the findings may deviate to some extent from actual conditions. In conclusion, although the global burden of transport injuries has generally declined, the disparities in transport injury burden across gender, age, and geographic regions warrant attention.

Exploring the effect of dapagliflozin on coronary inflammation in type 2 diabetes patients based on the coronary artery perivascular fat attenuation index

BACKGROUND

The pericoronary fat attenuation index (FAI) is a novel biomarker that serves as an indicator of coronary artery inflammation. Dapagliflozin has become an important component of standard treatment for type 2 diabetes because of its cardioprotective and renoprotective effects. The objective of this research was to explore how dapagliflozin impacts coronary artery inflammation in T2DM patients and to establish a novel theoretical framework for the protective role of dapagliflozin in the cardiovascular system.

METHODS

This research retrospectively included 271 T2DM patients treated with coronary computed tomography angiography (CCTA) at Hebei Provincial People's Hospital from January 2021 to November 2024, with 103 patients receiving dapagliflozin therapy (dapagliflozin+) and 168 patients not receiving dapagliflozin (dapagliflozin-) (oral dapagliflozin 10 mg/day for no less than 6 months). Baseline clinical information, laboratory markers, and CCTA-related metrics were collected and analysed across both groups. The relationship between dapagliflozin treatment and the pericoronary FAI was analysed using multiple linear regression to control for confounding variables, and the correlation between the two variables was further examined across various subgroups.

RESULTS

Compared with those in the dapagliflozin- group, the patients in the dapagliflozin+ group were younger (P<0.001), and the proportion of men was higher (P<0.05). There were no between-group differences in the baseline data, such as diabetes course, BMI, and blood lipid status (P>0.05). The FAI of the LAD and RCA in the dapagliflozin+ group was lower than that in the other groups, and the average FAI of the three coronary arteries was also significantly lower, while there was no significant difference in the LCX (LAD: dapagliflozin- group: -85.50 (-90.43, -78.27)，dapagliflozin+ group：-86.94 (-92.81, -81.57)，P= 0.044；RCA：dapagliflozin- group：-86.31 (-92.12, -80.09), dapagliflozin+ group：-88.79 (-94.59, -83.31), P= 0.019; Mean: dapagliflozin- group: -84.05 (-87.73, -77.45), dapagliflozin+ group: -84.88 (-89.82, -79.67), P= 0.022; LCX: dapagliflozin- group：-77.81 (-82.57, -71.75), dapagliflozin+ group: -78.25 (-84.56, -72.15), P = 0.260). Multiple linear regression analyses revealed an independent association between dapagliflozin treatment and a decreased in FAI in the LAD and RCA (LAD: β=-2.449; RCA: β=-3.897; P values are all less than 0.05). This association was different across various subsets of T2DM patients.

CONCLUSION

Dapagliflozin treatment is associated with a significant reduction in coronary artery inflammation in T2DM patients, which may partly explain its beneficial effects on reducing cardiovascular risk.

Rapid and sensitive antimicrobial susceptibility testing of biofilm-forming bacteria using scalable paper-based organic transistors

A scalable, cost-effective paper-based organic field-effect transistor platform has been developed for rapid antimicrobial susceptibility testing (AST) of biofilm-forming pathogens. Traditional AST methods are costly, labor-intensive, and slow, with a lack of standardized biofilm models. This system directly tracks protons generated by biofilms, which serve as key indicators of bacterial metabolism under antibiotic exposure. A proton-sensitive PEDOT:PSS channel is employed, where metabolic proton activity de-dopes the transistor, reducing conductivity. The engineered paper substrate facilitates rapid, high-quality biofilm formation, improving assay reliability. The platform was validated on three clinically significant pathogens against frontline antibiotics, providing real-time, quantitative antibiotic efficacy profiles. Integrated with a microcontroller and machine learning algorithm, results are displayed on a liquid crystal display (LCD), classifying antibiotic concentration relative to the minimum inhibitory concentration with over 85% accuracy. This clinically translatable system offers a high-throughput, point-of-care solution for efficient infection management and antibiotic stewardship.

Global trends in prevalence, disability adjusted life years, and risk factors for early onset dementia from 1990 to 2021

This study aims to analyze temporal trends in the prevalence and disability-adjusted life year (DALY) burden of early-onset dementia (EOD) globally from 1990 to 2021 and assess the attributable burdens of modifiable risk factors. Data from the Global Burden of Disease Study (GBD) 2021 were used. EOD was defined as dementia in individuals aged 40-64. The analysis included case numbers, age-standardized prevalence rates (ASPRs), and DALY rates (ASDRs) with 95% confidence intervals (CIs), stratified by global, regional, and national levels, sociodemographic index (SDI), and sex. Joinpoint regression analysis evaluated the average annual percent change (AAPC). Population attributable fractions (PAFs) estimated the proportion of DALYs attributable to risk factors. The global number of EOD cases and DALYs nearly doubled from 1990 to 2021, reaching 7.758 million cases (95% CI 5.827-10.081) and 3.774 million DALYs (95% CI 1.696-8.881) in 2021. ASPR and ASDR increased slightly to 355.9 (95% CI 267.2-462.8) and 173.3 (95% CI 77.9-407.7) per 100,000 in 2021. In 2021, the highest ASPR was in high-middle SDI countries at 387.6 per 100,000 (95% CI 291.1-506.8), while the highest ASDR was in middle SDI at 182.9 per 100,000 (95% CI 82.2-431). The fastest ASDR increase was in low and low-middle SDI countries from 2010 to 2021, with AAPCs of 0.42% (95% CI 0.34-0.50) and 0.36% (95% CI 0.33-0.39), respectively. A significant negative correlation was found between SDI and ASDR. During the COVID-19 pandemic (2019-2021), ASPR and ASDR in high-SDI countries declined, while other SDI regions saw an accelerated increase. In 2021, high fasting plasma glucose (FPG) was the most significant attributable risk factor for EOD-related DALYs globally, with PAFs for high body mass index and high FPG increasing in nearly all regions since 1990, while the PAF for smoking decreased. In 2021, EOD burden was highest in high-middle and middle SDI countries, particularly rising during the COVID-19 pandemic. The growing influence of metabolic risk factors underscores the need for targeted public health policies and resource allocation to mitigate the EOD burden.

Association of atherogenic index of plasma with kidney dysfunction in diabetic individuals: findings from two national population-based studies

BACKGROUND

Extensive evidence suggests that dyslipidemia is associated with endothelial dysfunction, oxidative stress, and inflammation, all of which can contribute to kidney dysfunction. The atherogenic index of plasma (AIP) is a novel marker of lipid metabolism disorder, but its role in kidney dysfunction in diabetic individuals remains controversial. This study aims to clarify the association of AIP with kidney dysfunction in diabetic individuals.

METHODS

This cross-sectional study analyzed a representative sample of participants aged 20 years and older from the United States (n = 2,386, NHANES 2007-2018) and Korea (n = 698, KNHANES 2012). Weighted multivariate logistic regression analyses and smoothed curve fitting were conducted to investigate the relationship between logarithmically transformed AIP (lgAIP) and multiple kidney dysfunction, including albuminuria and low estimated glomerular filtration rate (eGFR) in diabetic individuals. Additionally, we conducted interaction analyses and subgroup analyses to assess whether this relationship remained consistent across different populations. We utilized receiver operating characteristic (ROC) curves to assess and compare the diagnostic performance of AIP and other lipid indices for kidney dysfunction.

RESULTS

In both databases, higher lgAIP was significantly associated with the occurrence of albuminuria in diabetic individuals (NHANES: OR = 7.69, 95%CI: 2.90-20.40; KNHANES: OR = 6.00, 95%CI: 1.05-34.36) in the fully adjusted model. However, the OR (95% CI) for the association between lgAIP and low-eGFR was 1.22 (0.33, 4.53) in the NHANES database and 2.50 (0.16, 38.62) in the KNHANES database, indicating no statistically significant association. Subgroup analysis revealed that the association between lgAIP and albuminuria in diabetic individuals was influenced by age and BMI stratification in the NHANES database, and by BMI stratification in the KNHANES database (p for interaction < 0.05). Compared to other lipid indicators, AIP appears to be more precise and discriminatory in predicting albuminuria in diabetic individuals.

CONCLUSION

Our findings highlight a strong association between lgAIP and albuminuria in diabetic individuals. Future research should explore the mechanisms that underlying this relationship.

CLINICAL TRIAL NUMBER

Not applicable.

Burden of non-communicable diseases in South Asia: a decomposition analysis

BACKGROUND

This study examines the incidence, prevalence, deaths, and disability-adjusted life years (DALYs) related to non-communicable diseases (NCDs) in South Asia, exploring the environmental, metabolic, and behavioural risk factors, and exploring changes in deaths and DALYs driven by population growth, aging, and mortality rates.

METHODS

Using data from the Global Burden of Disease (GBD) study 2021, we estimated age-standardized incidence, prevalence, deaths, and DALYs for four major NCDs: cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases from 2010 to 2021. Gender and age-specific estimations were conducted across all NCDs, with 95% uncertainty intervals and a decomposition analysis was employed to estimate change in death and DALYs attributable to NCDs.

FINDINGS

The burden of NCDs in South Asia increased by 3.00% in incidence from 2010 to 2021, while overall prevalence decreased by 1.00%, yet the age-standardized prevalence rate remains above the global rate (91,570 per 100,000 population). Incidences of cardiovascular and respiratory diseases declined by 3.00% and 13.00%, respectively, whereas diabetes and cancer rose by 21.00% and 13.00% in South Asia. Nepal faced the highest environmental impact (23.4% of DALYs), Bangladesh the greatest metabolic impact (25.62%), and India the highest from behavioural factors (23.95%). Population growth and aging were primary drivers of changes in deaths and DALYs across the region.

CONCLUSION

This finding emphasizes the need for targeted public health interventions addressing environmental, metabolic, and behavioral risks for NCDs in South Asia, alongside strategies to support healthy aging and effective disease management across diverse demographic groups.

Maternal transfer of anti-GAPDH IgG prevents neonatal infections caused by Staphylococcus aureus and group B Streptococcus

Group B Streptococcus (GBS) and Staphylococcus aureus cause 200.000 neonatal deaths every year and no vaccine has been developed yet. Here, we described that extracellular glyceraldehyde-3-phosphate dehydrogenase (GAPDH) from S. aureus is an immunomodulatory protein. Antibody mediated neutralization of S. aureus extracellular GAPDH promotes a protective inflammatory response by inhibiting an early and abnormal production of IL-10 in infected neonatal mice. As an immunomodulatory role for extracellular GAPDH was already described for GBS, we selected peptides exposed on bacterial GAPDH from both bacteria but completely absent from human GAPDH. These peptides were chemically synthesized and conjugated to a carrier protein. Maternal vaccination with these conjugated peptides induced an increased survival of mouse pups from infection with GBS or S. aureus, when compared to controls. The addition of anti-bacterial GAPDH IgG into infected human cord-blood cells caused a significant reduction in bacterial replication, suggesting a putative efficacy for humans.

Global, regional and national epidemiology of myocarditis: health inequalities, risk factors and forecasted burden based on the Global Burden of Disease Study 2021

BACKGROUND

Myocarditis is a global epidemic that causes various medical conditions associated with an increased incidence and death numbers. This study aimed to investigate the trends in myocarditis-associated incidence, mortality, and disability-adjusted life-years (DALYs) with health inequalities, risk factors, and predict the disease burden, thereby mitigating the health hazards of myocarditis.

METHODS

This was a modelling study that used data from the Global Burden of Diseases 2021, from which myocarditis was included in the analysis. Incidence, death, DALYs, age-standardised incidence rate (ASIR), age-standardised mortality rate (ASMR), age-standardised DALYs rate (ASDR), cases change, corresponding estimated annual percentage change (EAPC), Slope Inequality of Index (SII) and Concentration Index were analysed.

RESULTS

From 1990 to 2021, incidence and death cases increased by 66.88% and 45.94%, respectively. The myocarditis-associated incidence and death cases increased in all five sociodemographic index (SDI) regions. Among the five SDI regions, the High SDI region had the highest myocarditis-associated ASIR with the least ASMR and ASDR in 2021. Regionally, Central Asia had the largest increase in EAPC of ASIR, ASMR and ASDR. Among 204 countries, Japan had the highest ASIR in 2021 and Romania had the highest ASMR and ASDR. Between 1990 and 2021, the SII and Concentration Index for DALYs have shown declining trends. The extreme temperatures were major contributors to the burden of myocarditis during 1990-2021. The projections suggested that the myocarditis-related global number of new cases and death would increase over the next 15 years. There may be upward trends in people of 15+of incidence number and 40+of death and DALYs number.

CONCLUSIONS

Myocarditis is an increasing global health challenge with rising incidence and death. Management of extreme temperatures remains a major challenge. The number of incidence, death and DALYs in different age groups would continue to grow over the next 15 years. Therefore, measures should be taken to target risk factors and high-risk groups.

Inhibiting Staphylococcus aureus Virulence Factors: Advances in Traditional Chinese Medicines and Active Compounds

Staphylococcus aureus is one of the most prevalent antibiotic-resistant bacteria, characterized by high morbidity and mortality. The pathogenicity of S. aureus relies on the production of multiple virulence factors. In recent years, antivirulence strategies have shown promise in developing antiinfective drugs by targeting the inhibition of bacterial virulence factors rather than directly killing pathogens. In Asia, some traditional Chinese medicines have a long history of antiinfective application and have demonstrated therapeutic efficacy. However, their antiinfective mechanism has not been fully elucidated. Recent studies have revealed that numerous extracts of TCM, as well as pure compounds from TCM, significantly inhibited the expression of virulence factors of S. aureus, which might be one of their antiinfective mechanisms with potential for the development of novel antiinfective agents. In this review, we summarized the major virulence factors of S. aureus and recent advances in TCM-derived antivirulence agents, including TCM formulae, single herbs, and isolated bioactive compounds, which showed antivirulence capability against S. aureus. Investigating the antivirulence mechanism of TCM not only enhances our understanding of TCM's antiinfective mechanisms but also facilitates the isolation of active compounds with therapeutic potential against S. aureus infection.

Global, regional and national burden and time trends of malaria in children and young adolescents under 15 years from 1990 to 2021: a worldwide observational study

BACKGROUND

The global burden of malaria among children remains severe; however, there is a dearth of comprehensive studies comparing this burden across different countries and regions. This study aims to analyze the patterns and trends in malaria burden among children under the age of 15 at global, regional, and national levels from 1990 to 2021, and to investigate the correlation between malaria burden and the developmental status of different countries.

METHODS

This observational study utilized data from the Global Burden of Diseases Study to examine incidence and mortality rates of malaria in children under 15 between 1990 and 2021. The rates and absolute number of malaria cases and deaths showed the epidemic status of malaria. The estimated annual percentage change (EAPC) quantified the time trends of malaria burden. Nonlinear regression was conducted to explore the association between the Socio-demographic Index (SDI) and rates across countries from 1990 to 2021.

RESULTS

In 2021, there were 169,052,260 malaria cases and 469,881 deaths among children under 15 worldwide, with an incidence rate of 8402.78 per 100,000 and a mortality rate of 23.36 per 100,000. From 1990 to 2021, the global incidence rate of malaria in children under 15 showed a slight increase of 0.87% annually from 2015 to 2021, while the mortality rate decreased by 0.69% per year from 1990 to 2015 but remained stable thereafter. Additionally, there was a notable increase in the number of deaths and mortality rate from malaria in 2020 and 2021 compared to 2019. The most affected regions were in Sub-Saharan Africa, with Western, Eastern, and Central regions having the highest number of cases and deaths. Analysis by SDI indicated that low SDI regions experienced the highest burden of malaria, although all regions saw the highest incidence and mortality rates in children under 5. Despite improvements in mortality rates from 1990 to 2015, some regions such as Oceania, the Caribbean, Tropical Latin America, and North Africa and the Middle East observed increasing trends in incidence rates post-2015.

CONCLUSION

Improving socio-economic conditions is urgently needed to alleviate malaria-related morbidity and mortality among children. Our results highlight the need for targeted national policies and stronger international cooperation, especially in regions with low SDI and significant disparities. With concerted efforts, we can significantly reduce malaria's impact and move closer to a malaria-free world.

Adjunctive intra-arterial thrombolysis following successful endovascular reperfusion in acute ischemic stroke: a systematic review and meta-analysis of seven randomized controlled trials

BACKGROUND

The benefits and risks of adjunctive intra-arterial thrombolysis (IAT) after successful endovascular thrombectomy (EVT) in acute ischemic stroke due to large vessel occlusion (AIS-LVO) remain uncertain. This study aimed to evaluate the efficacy and safety of IAT in this setting.

METHODS

We systematically searched PubMed, Embase, Web of Science, CENTRAL, and ClinicalTrials.gov from inception to February 2025, and reviewed abstracts from the 2025 International Stroke Conference, to identify randomized controlled trials (RCTs) comparing IAT versus placebo or best medical management in AIS-LVO patients who achieved successful reperfusion after EVT. Outcome measures included 90-day excellent (modified Rankin Scale [mRS] 0-1) and good (mRS 0-2) functional outcomes, 90-day reduced disability (≥ 1-point mRS improvement), symptomatic intracranial hemorrhage (sICH), any ICH, and 90-day mortality. A random-effects model was employed for the meta-analysis.

RESULTS

Seven RCTs with 2131 patients (1083 assigned to IAT, and 1048 to control) were included. Compared to controls, IAT was associated with significantly higher likelihood of 90-day excellent functional outcomes (risk ratio 1.23, 95% confidence interval [CI] 1.11-1.36; I2 = 0%) and reduced disability (common odds ratio 1.20, 95% CI 1.03-1.40; I2 = 0%), but not with 90-day good functional outcomes. Risks of any ICH, sICH, and mortality were similar between groups. Subgroup analyses suggested numerically higher odds of excellent functional outcomes among patients with anterior circulation LVO or those receiving IA alteplase/tenecteplase.

CONCLUSION

Adjunctive IAT following successful EVT in AIS-LVO patients led to improved 90-day excellent functional outcomes and reduced disability without increasing sICH or mortality risks.

Effects of maternal smoking on inflammation, autophagy/mitophagy, and miRNAs in endothelial cells: Influence of newborn sex

Maternal smoking (MS) during pregnancy is linked to well-documented adverse health effects for the mother and foetus, however the role of fetal sex was largely overlooked. Primary cultures of male and female human umbilical vein endothelial cells (MHUVECs and FHUVECs, respectively) were used. IL-6, IL-8, and TNF-α levels were measured in HUVECs supernatant. The expression of genes and proteins (oestrogen receptors (ERs), Hsp90, Beclin-1, p62, LC3, LAMP-1 and Parkin), as well as the expression of miR-29a-3p, miR-29b-3p, miR-126-3p, miR-133a-3p, and miR-146a-5p were analysed in cells obtained from foetuses born to non-smoking and smoking mothers. In HUVECs from foetuses born to non-smoking mothers, Beclin-1 protein was higher in MHUVECs (1.8 fold increase), while Parkin, Hsp90 proteins, and miR-146a-5p were elevated in FHUVECs (2.2, 2.6, and 2.1 fold increase, respectively), with no other significant differences. MS amplified these sex differences, with specific effects based on foetus sex. FHUVECs obtained from foetus born to smoking mothers showed higher levels of IL-8 (1399.36 ± 123.96 pg/ml for FHUVECs vs 655.11 ± 215.94; pg/ml for MHUVECs; P < 0.001), Hsp90 gene and protein (3.3 and 2.6 fold increase), and ERβ protein and Beclin-1 gene (2.1, and 4.9 fold increase), and lower levels of miR-29b-3p, miR-133a-3p, and miR-146a-5p than MHUVECs (0.27, 0.68, and 0.1 fold change, respectively). This study shows that primary HUVECs from fetuses born to smoking mothers retain a memory of smoking effects, with sex differences in gene expression, miRNA profiles, and autophagic responses, suggesting that maternal smoking impacts endothelial cell physiology in a sex-dependent manner.

Dynamic evolution and antitumor mechanisms of CXCR6+CD8+ T cells in small cell lung cancer treated with low-dose radiotherapy and immunotherapy

BACKGROUND

Patients with small-cell lung cancer (SCLC) have the poor prognosis. Current research suggested that low-dose radiotherapy (LDRT) combined with immunotherapy can enhance the immunogenicity of tumor cells, thereby improving antigen presentation and promoting the intratumoral infiltration of CD8+ T cells, which significantly extends the survival of patients. However, the change trajectory of T cells, and the mechanisms underlying the promotion of intratumoral infiltration of CD8+ T cells, and the enhancement of their cytotoxic functions remain to be elucidated.

METHODS

To delineate the dynamic changes of T cells, we collected tumors from Kaede tumor-bearing mice that had undergone radioimmunotherapy. Using flow cytometry, we sorted intratumoral-infiltrating immune cells, which were required for single-cell RNA sequencing, at various time points (Kaede Red: derived from tumor-draining lymph node [TDLN]). The results obtained from the sequencing analysis were further validated through experiments, such as flow cytometry, immunofluorescence, and analysis of clinical cohort data.

RESULTS

Here, we observed stem-like T cells migrating from the TDLN to the tumor site and differentiating into effector phenotypes within the tumor. Dendritic cells (DCs) are the key cluster that induces the differentiation of stem-like T cell into effector phenotypes. Moreover, SCLC patients with a high infiltration of tumor-specific CXCR6+CD8+ T cells exhibited a supportive TME and longer survival time (P < 0.001).

CONCLUSIONS

This study delineates the change trajectory of CD8+ T cells, identifies the crucial role of DCs in T cell differentiation, and highlights the significance of tumor-specific CXCR6+CD8+ T cells in anti-tumor immunity. Future therapeutic strategies for SCLC could focus on enhancing the infiltration of activated DCs and CXCR6+CD8+ T cells within the tumor microenvironment to improve treatment efficacy.

Mediating role of pain sensitization in preoperative and postoperative pain in knee osteoarthritis patients

OBJECTIVE

This study aims to explore the relationship between preoperative and postoperative pain in patients with knee osteoarthritis (KOA) undergoing total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKR), and to assess the mediating roles of central and peripheral sensitization.

METHODS

This prospective cohort study enrolled a total of 105 eligible KOA patients. The Visual Analog Scale (VAS) was used to assess preoperative and postoperative pain levels. Multivariate linear regression analysis and Bootstrap mediation analysis were conducted to investigate the impact of preoperative pain intensity on postoperative pain.

RESULTS

This study revealed a significant positive correlation between preoperative VAS scores during movement and pain scores 3 days postoperatively (β = 0.4018, p = 0.0017), as well as a significant correlation with pain scores 6 months postoperatively (β = 0.735, p = 0.004). Central sensitization (β = 0.0446, p < 0.0001) and peripheral sensitization (β = 0.0333, p = 0.0015) exhibited significant mediation effects between preoperative and postoperative pain. Additionally, preoperative VAS scores (B = 1.107, p = 0.014, OR = 3.027), age (B = 0.207, p = 0.036, OR = 1.229), and duration of arthritis (B = 0.190, p = 0.013, OR = 1.210) were significant predictors of postoperative analgesic demand.

CONCLUSION

This study demonstrates that preoperative pain intensity is closely related to postoperative pain in KOA patients undergoing TKA and UKR, with central and peripheral sensitization playing significant mediating roles in this process. In particular, preoperative pain management is crucial for alleviating postoperative pain and improving patients' quality of life. Therefore, when formulating individualized pain management strategies, the central and peripheral sensitivity of patients should be comprehensively considered. Future research is necessary to develop and evaluate innovative pain control methods integrating central and peripheral mechanisms to optimize postoperative rehabilitation and long-term health outcomes.

Assessing COVID-19 Mortality in Serbia's Capital: Model-Based Analysis of Excess Deaths

Background

Concerns have been raised about discrepancies in COVID-19 mortality data, particularly between preliminary and final datasets of vital statistics in Serbia. In the original preliminary dataset, released daily during the ongoing pandemic, there was an underestimation of deaths in contrast to those reported in the subsequently released yearly dataset of vital statistics.

Objective

This study aimed to assess the accuracy of the final mortality dataset and justify its use in further analyses. In addition, we quantified the relative impact of COVID-19 on the death rate in the Serbian capital's population. In the process, we aimed to explore whether any evidence of cause-of-death misattribution existed in the final published datasets.

Methods

Data were sourced from the electronic databases of the Statistical Office of the Republic of Serbia. The dataset included yearly recorded deaths and the causes of death of all citizens currently living in the territory of Belgrade, the capital of the Republic of Serbia, from 2015 to 2021. Standardization and modeling techniques were utilized to quantify the direct impact of COVID-19 and to estimate excess deaths. To account for year-to-year trends, we used a mixed-effects hierarchical Poisson generalized linear regression model to predict mortality for 2020 and 2021. The model was fitted to the mortality data observed from 2015 to 2019 and used to generate mortality predictions for 2020 and 2021. Actual death rates were then compared to the obtained predictions and used to generate excess mortality estimates.

Results

The total number of excess deaths, calculated from model estimates, was 3175 deaths (99% CI 1715-4094) for 2020 and 8321 deaths (99% CI 6975-9197) for 2021. The ratio of estimated excess deaths to reported COVID-19 deaths was 1.07. The estimated increase in mortality during 2020 and 2021 was 12.93% (99% CI 15.74%-17.33%) and 39.32% (99% CI 35.91%-39.32%) from the expected values, respectively. Those aged 0-19 years experienced an average decrease in mortality of 22.43% and 23.71% during 2020 and 2021, respectively. For those aged up to 39 years, there was a slight increase in mortality (4.72%) during 2020. However, in 2021, even those aged 20-39 years had an estimated increase in mortality of 32.95%. For people aged 60-79 years, there was an estimated increase in mortality of 16.95% and 38.50% in 2020 and 2021, respectively. For those aged >80 years, the increase was estimated at 11.50% and 34.14% in 2020 and 2021, respectively. The model-predicted deaths matched the non-COVID-19 deaths recorded in the territory of Belgrade. This concordance between the predicted and recorded non-COVID-19 deaths provides evidence that the cause-of-death misattribution did not occur in the territory of Belgrade.

Conclusions

The finalized mortality dataset for Belgrade can be safely used in COVID-19 impact analysis. Belgrade experienced a significant increase in mortality during 2020 and 2021, with most of the excess mortality attributable to SARS-CoV-2. Concerns about increased mortality from causes other than COVID-19 in Belgrade seem misplaced as their impact appears negligible.

Joint effect of modifiable risk factors and genetic susceptibility on ischaemic stroke

PURPOSE

To investigate the effects of modifiable risk factors and genetic susceptibility on ischaemic stroke (IS).

METHODS

A total of 490365 participants from the UK Biobank, with a 17-year follow-up, were included in this study. Data on 115 modifiable exposures were collected from five domains: early life, environment, lifestyle, socioeconomic status, and physical measures. Additionaly, genetic data were collected. An exposure-wide association analysis was conducted to identify potential risk factors. Risk scores for each domain and genes were calculated. The effect of each domain score on IS and the joint effects among the five domains were analyzed using multi-variate Cox models. The population attributable fraction was estimated to quantize the impact of eliminating unfavorable factors.

RESULTS

Sixty-four of the 115 modifiable exposures were found to be significantly associated with the risk of IS (P < 4.35 × 10-4 for Bonferroni correction). Newly identified factors included maternal smoking and being either overweight or underweight at age 10, which could significantly increase the risk of IS by 4.78 % to 14.74 %, 11.01 % to 23.75 %, and 3.29 % to 12.80 %, respectively. Additionally, exposure to hard water was associated with a decreased risk of IS by 6.96 % to 11.48 % compared to exposure to soft water. The associations varied across domains, with socioeconomic factors accounting for 5.2 % of IS cases, lifestyle accounting for 2.8 %, and physical measures accounting for 2.5 %, representing the top three contributing factors. Overall, it was estimated that 10.6 % to 11.3 % of IS cases could be prevented by eliminating the identified risks.

CONCLUSIONS

Interactions between risk factors and genetic susceptibility elevated the risk of IS. Risk factors from different domains contributed variably to IS, with socioeconomic factors accounting for the largest proportion.

Linker and Head-Group Exploration of Anti-MRSA Triaromatic Pleuromutilins

Based on hit 6, a triaromatic pleuromutilin (TAP) and potent bacterial protein synthesis inhibitor, we explored the chemical space surrounding its pharmacophore by synthesizing 45 new conjugates. Herein, the adenine head was exchanged for new heterocycles, and the benzyl linker exchanged for aniline-, ether-, amide-, and hydroxybenzyl linkages, with all of them successfully engaging the pharmacophore, a result which was mirrored in a strict 3D pharmacophore model. The aniline- and amide-linked conjugates moreover demonstrated greater stability in liver microsomes, while especially conjugate 21, but also 31, 43, 45, and 55 displayed excellent potency, with MRSA activities on par with 6 or better. Docking to the ribosome suggested a shifted engagement with C2469 for 21 over 6, resulting in greater multivalency, while 43/45 likely coordinates Mg2+. Lastly, conjugate 21 displayed efficacy equal to commercial Fucidin LEO (5) in a mouse Staphylococcus aureus skin infection model, highlighting its potential as a topical antibiotic lead.

Integrated assessment of antimicrobial stewardship in carbapenem resistant Klebsiella pneumoniae prevalent hospitals in China: a multidisciplinary surveillance network-based survey

BACKGROUND

China has established an extensive multidisciplinary surveillance network encompassing antimicrobial utilisation, antimicrobial resistance, and nosocomial infections. We aimed to identify challenges and barriers in antimicrobial stewardship (AMS) development based on this national multidisciplinary surveillance network.

METHODS

This cross-sectional study was conducted in 15 hospitals across China from July 2021 to April 2023. Purposeful sampling was employed to select the hospitals based on the rising prevalence of carbapenem-resistant Klebsiella pneumoniae. The survey consisted of three parts: a testing questionnaire was used to assess the awareness of clinical physicians regarding AMS; a scoring table was developed through the Delphi method to assess the hospitals' multidisciplinary management covering antibacterial usage surveillance, resistance surveillance, fungal surveillance, infectious disease management, and infection prevention and control; an on-site investigation based on case review and field inspection. Pearson correlation tests were used to examine the relationship between resistance levels and scores for various items. Theme analysis was applied to highlight key areas of focus in hospital multidisciplinary AMS from the on-site investigation.

RESULTS

Findings revealed that physicians of respiratory, infectious disease, and critical care were the top 3 specialists in AMS awareness scores, with an average of 70 points, 65 points and 62.5 points, respectively (a full mark of 100 points). Performance in infectious disease management, antibacterial surveillance, and infection prevention and control showed a scoring rate over 70%, with relatively low scores in resistance surveillance (49.1%) and fungal surveillance (36.0%). No significant correlation was found between any single scoring item and the resistance levels of focused drug-resistance pathogens. Five key areas were identified for improving multidisciplinary AMS: organizational structure, staffing and training, drug formulary and prescription management, laboratory testing and quality control, and clinical sampling and data reporting.

CONCLUSIONS

The prevalence of focused drug-resistance pathogens could not attribute to any single factor. The following AMS activities should emphasise the establishment of sophisticated communication and collaboration mechanisms within multidisciplinary teams.

TRIAL REGISTRATION

Approval for this study was granted by the Ethics Committee of Peking University (reference number IRB00001052-22100).

Global regional, and national burden of type 2 diabetes attributable to dietary factors from 1990 to 2021

The study comprehensively assesses the global burden of type 2 diabetes (T2D) linked to dietary factors from 1990 to 2021. Data from the Global Burden of Disease Study 2021 (GBD 2021) was analyzed for T2D dietary risk factors across 204 countries, using age-standardized metrics and SDI quintiles, with joinpoint regression and other analytical methods. The results revealed a significant increase in the global burden of T2D, with a 1.92-fold rise in DALYs and a 1.28-fold rise in total mortality cases due to dietary risks. High intake of processed meat and sugar-sweetened beverages were identified as major contributors to the increasing burden, whereas the age-standardized mortality rates attributable to low vegetable intake declined over time. The study also emphasized the impact of age, period, and cohort effects on the incidence of T2D, along with the growing health disparity gaps between high and low SDI countries. The study emphasizes the importance of dietary interventions to reduce T2D burden, suggesting a decrease in processed meat and sugary drink consumption and an increase in vegetable intake. It calls for global strategies to address health disparities and improve equitable access to health resources.

Combined associations of physical activity, diet quality and their trajectories with incidence of diabetes and cardiovascular diseases in the EPIC-Norfolk Study

The combined impact of physical activity (PA), diet quality, and their change over time on cardiometabolic disease risk remains uncertain. We aimed to examine the associations between the combined trajectories of these health behaviours and the incidence of diabetes mellitus (DM) and cardiovascular diseases (CVD) among 9,276 middle-aged adults. In the EPIC-Norfolk study, longitudinal changes in PA energy expenditure (∆PAEE) and Mediterranean diet score (∆MDS) were derived from repeated measurements between 1993 and 2004. Over a median follow-up of 18 years, 968 participants developed DM and 2,540 developed CVD by 2022. In mutually adjusted Cox regression models, HR (95%CI) per 1-SD higher ∆PAEE and ∆MDS were 0.87 (0.81-0.94) and 0.92 (0.86-0.99) for incident DM, and 0.94 (0.89-0.99) and 0.93 (0.88-0.97) for incident CVD, respectively. Compared to participants with sustained low PAEE and MDS, those with sustained higher levels of both traits had a 40% (21-55%) lower incidence of DM and a 25% (11-37%) lower CVD incidence. At the population level, consistent favourable levels of activity and diet quality could reduce cumulative incidence of DM by 22% and CVD by 16%. The greatest benefit arises when an active lifestyle is combined with a high-quality diet, initiated earlier in adulthood, and maintained over time.

Structure Profiling of Broad-Specificity Immunoassays: Multitarget Recognition for Sulfonylurea Adulteration in Food

The limited understanding of the broad-specific antibody recognition mechanism significantly hinders the development of immunoassays for simultaneously detecting illegal adulterants. Herein, a recombinant antisulfonylureas (SUs) single-chain variable fragment (scFv), which retained the properties of its parental monoclonal antibody, was successfully generated. X-ray crystallography, molecular docking, functional assays, and mutation validation were used to investigate the structure-function relationships underlying antibody-SUs binding. Our study revealed three key mechanisms for broad specificity: (1) the conformational adaptability of the scFv, which enabled various SUs to access the binding pocket; (2) the role of the Trp98 residue in CDR-L3 in modulating binding affinities among multiple SUs; and (3) the design of haptens with common structures and more rigid R substituents, which emerged as a promising strategy for generating broad-specific antibodies. This study provides a comprehensive analysis of the broad-specific recognition mechanism, offering valuable insights for rational hapten design and targeted antibody evolution to advance multitarget immunoassays.

The national and subnational burden of falls and its attributable risk factors among older adults in Iran from 1990 to 2021: findings from the global burden of disease study

BACKGROUND

Falls among older adults (individuals aged 60 and above) are a substantial health issue worldwide. This study aimed to analyze the burden of falls and its attributable risk factors among older adults at the national and subnational levels in Iran over 32 years.

METHODS

Using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 data, we estimated the incidence, prevalence, death, and disability-adjusted life-years (DALYs) of falls and its attributable risk factors among older adults by sex, age groups, and socio-demographic index (SDI) in Iran and its provinces. We reported the estimates with their 95% uncertainty intervals (UIs). Rates were reported per 100,000 population.

RESULTS

In 2021 in Iran, the incidence rate of falls among older adults was 1674.0 (95% UI: 1454.9-1897.3), the prevalence rate was 11302.5 (10504.7-12095.7), the death rate was 16.9 (12.9-21.0), and the DALYs rate was 736.3 (647.6-825.4). In 2021, at the subnational level, Qazvin had the highest incidence, death, and DALYs rates for falls with values at 2329.5 (2008.8-2652.1), 24.2 (19.5-29.0), and 965.9 (856.2-1074.6), respectively, while Kohgiluyeh and Boyer-Ahmad had the highest falls prevalence rate at 16043.1 (14918.4-17149.0). In 2021, males had higher prevalence, death, and DALYs rates of falls compared to females, while females had a higher incidence rate. Among the age groups, the 90-94 age group had the highest rates of incidence, prevalence, death, and DALYs from falls. Low bone mineral density was the primary risk factor attributable to the burden of falls. There were significant positive associations between SDI and both the incidence and prevalence rates of falls. Conversely, a significant inverse association was found between SDI and the death rate.

CONCLUSIONS

From 1990 to 2021, the incidence rate of falls has increased significantly among older adults in Iran, necessitating urgent interventions. Implementing nationwide, cost-effective strategies such as exercise programs to improve strength and balance, home hazard modifications, medication reviews to reduce fall-related risks, and routine screening programs for osteoporosis and fall risk assessment can help protect and support older people, minimizing their risk of falls.

Lipidated SNAPP-Stars Target and Kill Multidrug-Resistant Bacteria within Minutes

The fast emergence of bacteria resistance has already threatened global health, and immediate action is required before the emergence of another global pandemic. Despite substantial progress in the chemical synthesis of novel antimicrobial compounds and advancements in understanding antimicrobial resistance, there has been only a handful of new antibiotics coming to the market. Structurally Nanoengineered Antimicrobial Peptide Polymers (SNAPP-stars) are a new class of antimicrobials. Here, we show that lipidation of lysine-valine 16-armed SNAPP-star, S16 (lipo-SNAPP-star) where the N-terminal arms are conjugated with different fatty acids (caproic, C6, lauric, C12, and stearic acid, C18) enhanced the antimicrobial activity toward S. aureus and MRSA. Lipidation enhanced activity by targeting the SNAPP-stars to the bacterial surface by binding to peptidoglycan, leading to greater inner membrane disruption and depolarization. Lipo-SNAPP-stars killed bacteria in under a minute, whereas vancomycin took >16 h. Lipo-SNAPP-stars were found to preferentially target and kill MRSA rather than S. aureus in a mixed bacteria model. Lipid chain length affected activity, with C6-S16 having greater activity compared to C12-S16 > C18-S16. Lauric and stearic acid enhanced SNAPP-star binding to the bacterial surface and membrane depolarization but impeded SNAPP-stars' ability to transit through the peptidoglycan layer to disrupt the inner membrane. Microbial flow cytometry showed that lipidation aided binding to bacteria via lipoteichoic acid and specifically to peptidoglycan. Further, lipid length enhanced bacterial binding with C18-S16 > C12-S16 > C6-S16 = S16, which contrasts the activity order of C6-S16 > S16 ≫ C12-S16 ≫ C18-S16. Our data demonstrate that lipidation enhances antimicrobial activity by targeting and binding an antimicrobial to peptidoglycan, but increasing lipid length reduces activity by retaining the antimicrobial in the outer layer. Lipidation of SNAPP-stars did not increase cytotoxicity, with C6-S16 having an improved therapeutic index compared to S16. Our data show how lipidation of SNAPP-stars enhances its antimicrobial activity, resulting in a highly biocompatible antimicrobial that targets and kills the "superbug" MRSA within minutes.

Association between atherogenic index of plasma and new-onset stroke in a population with cardiovascular-kidney-metabolic syndrome stages 0-3: insights from CHARLS

BACKGROUND

The associations between atherogenic index of plasma (AIP) and cardiovascular disease (CVD) have been widely reported; However, such association to the incidence of stroke in the population with Cardiovascular-Kidney-Metabolic (CKM) syndrome remains ambiguous.

METHODS

A total of 7754 participants with CKM syndrome stages 0-3 from the China Health and Retirement Longitudinal Study were enrolled in this study. The incidence of new-onset stroke events was the primary outcome of this study. We used Kaplan-Meier survival curves and Cox proportional hazards models to explore the association between baseline AIP levels and the risk of stroke in the population with CKM syndrome stages 0-3. Additionally, we utilized restricted cubic spline plots to analyze the form of this association.

RESULTS

During a median follow-up of 6.8 years, 455 participants (5.9%) with CKM syndrome experienced their first stroke events. AIP was positively associated with the risk of stroke in the population with CKM syndrome stages 0-3. Kaplan-Meier curves analysis demonstrated a significant difference in stroke incidence across the AIP groups among the entire cohort. In the fully adjusted Model 3, the results revealed a significantly elevated risk of stroke for participants in the Q2, Q3, and Q4 groups compared to those in the Q1 group, with respective HR (95% CI) value of 1.352 (1.009-1.811), 1.421 (1.064-1.897), and 1.414 (1.052-1.900). Restricted cubic spline plots revealed the association of AIP and stroke risk was nonlinear (P-overall < 0.05, P-non-linear < 0.05), with inflection points of 0.32.

CONCLUSION

This study provides evidence that baseline AIP levels were significantly positively associated with the risk of stroke in individuals with CKM syndrome stages 0-3, and AIP may serve as an effective risk marker for early identification of high-risk individuals prone to stroke within the CKM stages syndrome 0-3 population.

A Shared Threat-Anticipation Circuit Is Dynamically Engaged at Different Moments by Certain and Uncertain Threat

Temporal dynamics play a central role in models of emotion: "fear" is widely conceptualized as a phasic response to certain-and-imminent danger, whereas "anxiety" is a sustained response to uncertain-or-distal harm. Yet the underlying neurobiology remains contentious. Leveraging a translationally relevant fMRI paradigm and theory-driven modeling approach in 220 adult humans, we demonstrate that certain- and uncertain-threat anticipation recruit a shared circuit that encompasses the central extended amygdala (EAc), periaqueductal gray, midcingulate, and anterior insula. This circuit exhibits persistently elevated activation when threat is uncertain and distal and transient bursts of activation just before certain encounters with threat. Although there is agreement that the EAc plays a critical role in orchestrating responses to threat, confusion persists about the respective contributions of its major subdivisions, the bed nucleus of the stria terminalis (BST) and central nucleus of the amygdala (Ce). Here we used anatomical regions of interest to demonstrate that the BST and Ce exhibit statistically indistinguishable threat dynamics. Both regions exhibited activation dynamics that run counter to popular models, with the Ce (and BST) showing sustained responses to uncertain-and-distal threat and the BST (and Ce) showing phasic responses to certain-and-imminent threat. For many scientists, feelings are the hallmark of fear and anxiety. Here we used an independently validated multivoxel brain "signature" to covertly probe the moment-by-moment dynamics of anticipatory distress for the first time. Results mirrored the dynamics of neural activation. These observations provide fresh insights into the neurobiology of threat-elicited emotions and set the stage for more ambitious clinical and mechanistic research.

Biological sex influences severity and outcomes in Acinetobacter baumannii pneumonia

Biological sex is known to affect the incidence and outcomes of infection, varying significantly by pathogen. The bacterial pathogen Acinetobacter baumannii is recognized as a serious global healthcare threat worldwide, yet understanding of how biological sex impacts its infection course is limited. We previously documented in a murine model of acute pneumonia that female mice were more susceptible to infection, but there are no published studies looking at outcomes in humans according to biological sex. We conducted a retrospective cohort study of 220 adult patients with a positive A. baumannii culture and clinical evidence of pneumonia. Contrary to the animal data, we observed male patients to have a longer overall (32 vs 24 days, P < 0.05) and intensive care unit (ICU) length of stay (LOS) (23 vs 17 days, P < 0.001) compared to females. The primary diagnosis at admission was only a factor when it was respiratory in nature. Younger male patients had higher Pneumonia Severity Index score on admission compared to younger females. Older males required more interventions than younger males. We also observed that mortality rates were increased for patients with chronic obstructive pulmonary disease (P = 0.024) and renal disease (P < 0.001), while alcohol use or smoking within 30 days prior to admission or recent surgery all negatively impacted LOS. This study highlights the importance of sex-and-gender-based studies, identifying worse outcomes in men, the elderly, and patients with certain underlying conditions and guiding efforts to improve management of patients with A. baumannii pneumonia.

IMPORTANCE

Biological sex has been shown to influence the incidence and outcomes of infection. We had previously documented that in a mouse model of infection, the pathogen Acinetobacter baumannii caused more serious pulmonary disease in female animals. In this study, we aimed to determine if this was evident in human pneumonia data. We found that, opposite to the mice data, human males had extended hospital stays due to A. baumannii pneumonia. We also identified a number of risk factors that can impact mortality and duration of hospital stay. This information could be used to guide efforts to improve management of patients with A. baumannii pneumonia.

Chemical Innovations of Antimicrobial Polymers for Combating Antimicrobial Resistance

The global rise of antimicrobial resistance (AMR) has rendered many traditional antibiotics ineffective, leading to an urgent need for alternative therapeutic strategies. Antimicrobial polymers, with their ability to rapidly kill bacteria by disrupting or crossing membranes and/or targeting multiple microbial functions without inducing resistance, offer a promising solution. This perspective explores recent innovations in the design and synthesis of antimicrobial polymers, focusing on their chemical motifs, structural derivatives, and their applications in combating systemic and topical infections. We also highlight key challenges in translating these materials from laboratory research to clinical practice, including issues related to the high dose required, bioavailability and stability in systemic infection treatment, and ability to disperse and kill biofilms in localized infection management. By addressing these challenges, antimicrobial polymers could play a crucial role in the development of next-generation therapeutics to combat multidrug-resistant pathogens. This perspective attempts to summarize significant insights for the design and development of advanced antimicrobial polymers to overcome AMR, offering potential pathways to improve clinical outcomes in treating systemic and local infections.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Burden of Congenital Heart Anomalies in North Africa and the Middle East, 1990 to 2021: A Systematic Analysis for the Global Burden of Disease Study 2021

BACKGROUND

Congenital heart anomalies (CHAs) remain a significant global health burden despite advances in diagnosis and management. Data on CHA burden in North Africa and the Middle East region are scarce. This study aimed to estimate CHA trends from 1990 to 2021.

METHODS AND RESULTS

Using the Global Burden of Disease Research 2021 database, we assessed CHA incidence, prevalence, mortality, and disability-adjusted life years (DALYs), stratified by age, sex, and sociodemographic index (SDI) at regional and national levels. Decomposition analysis was used to evaluate the impact of population growth on CHA incidence. In 2021, CHAs caused 35 272 deaths (95% uncertainty interval [UI], 28 067-43 670) and 3 181 543 DALYs (95% UI, 2 544 864-3 899 408) in the North Africa and the Middle East region. Incidence and prevalence increased by 13% (95% CI, 10-17) and 70% (95% CI, 67-74), respectively, whereas CHA-related deaths and DALYs declined by 63% (95% CI, 28-73). Infants <12 months of age accounted for 74.9% of deaths and DALYs, with half occurring within the first month. High-SDI countries had the lowest CHA-related DALYs, whereas middle-SDI countries showed the most substantial decline in mortality. Decomposition analysis highlighted that the actual CHA incidence is lower than expected despite population growth.

CONCLUSIONS

Although CHA incidence and prevalence increased, mortality and DALYs decreased, particularly in middle-SDI countries. The highest burden was among infants, with better outcomes in higher-SDI nations. More effective strategies are needed to reduce the preventable childhood deaths related to CHAs in the North Africa and the Middle East region.

Critical reappraisal of current issues for improving the proper clinical use of the incoming beta-lactam/beta-lactamase inhibitor combinations of tomorrow

INTRODUCTION

Although different novel beta-lactam/beta-lactamase inhibitor combinations (BL/BLIc) were recently licensed, resistance occurrence have been reported up to 15% of Gram-negative pathogens. For this reason, novel BL/BLIc of tomorrow will be released for managing difficult-to-treat resistance (DTR) Gram-negative infections.

AREAS COVERED

This review provides a critical reappraisal of current issues for improving the proper clinical use of the novel BL/BLIc of tomorrow. A literature search was performed on PubMed-MEDLINE (until December 2024) for retrieving available studies on cefepime-enmetazobactam, sulbactam-durlobactam, and cefepime-taniborbactam. Four different main areas were discussed according to available evidence: 1) translating findings coming from the randomized clinical trials into the real-world clinical practice; 2) defining the optimal joint pharmacokinetic/pharmacodynamic (PK/PD) target; 3) identifying proper dosing schedules in patients with renal dysfunction; 4) attributing proper relevance to the epithelial lining fluid (ELF) penetration rate in defining optimal dosing schedule for treating pneumonia.

EXPERT OPINION

Overall, old habits die hard and issues retrieved with licensed beta-lactams emerged also with novel BL/BLIc of tomorrow, potentially affecting their efficacy when used in real-world practice. Adopting appropriate corrective measures for overcoming these issues might increase the likelihood of preserving their efficacy in the future by minimizing the propensity risk of resistance development.

Impaired cardiac branched-chain amino acid metabolism in a novel model of diabetic cardiomyopathy

BACKGROUND

Systemic insulin resistance plays an important role in the pathogenesis of type 2 diabetes and its complications. Although impaired branched-chain amino acid (BCAA) metabolism has been reported to be involved in the development of diabetes, the relationship between cardiac BCAA metabolism and the pathogenesis of diabetic cardiomyopathy (DbCM) remains unclear.

OBJECTIVES

The aim of this study was to investigate BCAA metabolism in insulin-resistant hearts by using a novel mouse model of DbCM.

METHODS

The cardiac phenotypes of adipocyte-specific 3'-phosphoinositide-dependent kinase 1 (PDK1)-deficient (A-PDK1KO) mice were assessed by histological analysis and echocardiography. The metabolic characteristics and cardiac gene expression were determined by mass spectrometry or RNA sequencing, respectively. Cardiac protein expression was evaluated by Western blot analysis.

RESULTS

A-PDK1KO mouse hearts exhibited hypertrophy with prominent insulin resistance, consistent with cardiac phenotypes and metabolic disturbances previously reported as DbCM characteristics. RNA sequencing revealed the activation of BCAA uptake in diabetic hearts. In addition, the key enzymes involved in cardiac BCAA catabolism were downregulated at the protein level in A-PDK1KO mice, leading to the accumulation of BCAAs in the heart. Mechanistically, the accumulation of the BCAA leucine caused cardiac hypertrophy via the activation of mammalian target of rapamycin complex 1 (mTORC1).

CONCLUSIONS

A-PDK1KO mice closely mimic the cardiac phenotypes and metabolic alterations observed in human DbCM and exhibit impaired BCAA metabolism in the heart. This model may contribute to a better understanding of DbCM pathophysiology and to the development of novel therapies for this disease.

Regional differences in the disease burden and attributable risk factors of female cancers

The aim was to assess the differences in the burden and risk factors of female cancers among women aged 20-94 years across regions and countries, in order to provide a reference for formulating tailored interventions. The study analyzed the incidence, deaths, and disability-adjusted life years (DALYs) using data from the Global Burden of Disease 2021 study. Age-period-cohort model evaluated the effects of the age, period, and cohort on the burden, and negative binomial regression explored the association of the socio-demographic index (SDI) with the burden. From 1990 to 2021, regional and national incidence, deaths, and DALYs of female cancers varied markedly. Overall, SDI was significantly positively associated with the incidence of female cancers, except for cervical cancer (with a negative relationship). High body-mass index as the leading risk factor of uterine cancer contributed to the higher burden, such as in the USA and higher SDI regions. Diet high in red meat, unsafe sex, and high body-mass index were the leading risk factors for breast cancer, cervical cancer, and uterine cancer, respectively; however, other socioeconomic and cultural factors should be considered, such as in the rural areas of China and lower SDI regions. A slightly increasing trend in the burden of breast cancer in the recent birth cohorts indicated the effect of generational experiences. The disease burden of female cancers has increased and varies with SDI levels and regions. The findings provide new insights into the development of targeted preventive measures for the specific region from the perspective of social and cultural context.

A Rationally Designed Sulfonium Lipoglycopeptide with Micelles Self-Assembly to Combat Multidrug Resistance via Dual Enhanced Cell Wall-Membrane Inhibition and T7SS Proteins Downregulation

Multidrug-resistant Gram-positive superbugs pose a significant menace to global public health, urgently demanding the advent of novel antibiotics. In this study, three biphenyl sulfonium lipoglycopeptides derived from vancomycin were rationally designed and synthesized to combat such resistance. Among them, the most promising derivative, BD-V-2, exhibited outstanding in vitro activity against a diverse array of refractory strains. Notably, in two highly challenging lethal sepsis models induced by MRSA and VREm (vanA), BD-V-2 achieved complete protection of the infected mice with remarkably low single-dose administrations of merely 7 and 2.5 mg/kg, respectively, vividly demonstrating its potent in vivo efficacy. Furthermore, its in vivo pharmacokinetic profile and toxicity assessment indicated favorable druggability. Interestingly, BD-V-2 was found to impart a novel self-assembly property into micelles. In addition, independent and synergistic mechanisms of action targeting the bacterial membrane, via phosphatidylglycerol (PG) interaction, and cell wall, via two more binding sites on lipid II, respectively, interpeptide bridge and pyrophosphate motif, were elucidated. Astonishingly, BD-V-2 was capable of significantly downregulating the expression of the type VII secretion system proteins, uncovering an unprecedented antivirulence mechanism for glycopeptide antibiotics. Collectively, these findings unraveled the hitherto unknown roles of the sulfonium strategy and established BD-V-2 as a highly prospective candidate for future pharmaceutical development.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

DISCUSSION

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

Infection characteristics among Serratia marcescens capsule lineages

Serratia marcescens is a healthcare-associated pathogen that can cause severe infections, including bacteremia and pneumonia. The capsule polysaccharide of S. marcescens is a bacteremia fitness determinant, and previous work defined capsule locus (KL) diversity within the species. Strains belonging to KL1 and KL2 capsule clades produce sialylated polysaccharides and represent the largest subpopulation of isolates from clinical origin. In this study, the contribution of these and other S. marcescens capsules to infection was determined in animal and cellular models. Using a murine model of primary bacteremia, clinical isolates of multiple KL types demonstrated capsule-dependent colonization of the spleen, liver, and kidney following tail vein inoculation. Similar results were observed using a bacteremic pneumonia model, in that all tested strains of clinical origin demonstrated a requirement for capsule in both the primary lung infection site and for bloodstream dissemination to secondary organs. Finally, the capsule from each KL clade was examined for the ability to resist internalization by bone marrow-derived macrophages. Only the sialylated KL1 and KL2 clade strains exhibited capsule-dependent inhibition of internalization, including KL2 capsule produced in a heterologous background. Together, these findings indicate that lineage-specific resistance to macrophage phagocytosis may enhance survival and antibacterial defenses of clinically adapted S. marcescens.

IMPORTANCE

Bacteremia occurs when the host immune system fails to contain bacterial bloodstream replication following an initial inoculation event from either an internal or external source. Capsule polysaccharides play a protective role for Serratia marcescens during bacteremia, but there is abundant genetic diversity at the capsule-encoding locus within the species. This study compares the infection characteristics of S. marcescens isolates belonging to five capsule types and defines the contributions to infection fitness for each. By characterizing the differences in capsule dependence and infection potential between S. marcescens strains, efforts to combat these life-threatening infections can be focused toward identifying strategies that target the most critical genetic lineages of this important opportunistic pathogen.