Understanding physical aging in relation to biological aging, telomere length: A systematic review

BACKGROUND

Telomere length (TL) serves as a marker for biological aging, influenced by chronological aging but distinct from it. This systematic review aims to synthesize the evidence on the associations between components of physical aging and TL in the elderly population.

METHODS

A comprehensive search was conducted in online databases of PubMed, Web of Science, ProQuest, and ScienceDirect to identify the eligible papers published until 1st August 2024. The authors independently extracted data using the standardized form. The quality of the included studies was evaluated for the risks of biases.

RESULTS

A total of 1080 records were initially identified using the predefined search strategy. A total of 40 eligible records were included in this review. When assessing physical aging, the nature and type of measurements across studies vary, including subjective, objective, and a combination of both approaches. Subjective assessments of general health or physical limitations may be linked with TL, while frailty, whether measured subjectively or objectively, shows associations with TL in less than 35 percent of total studies. In contrast, composite measures of physical performance/ability are consistently associated with TL in the elderly population.

CONCLUSIONS

In conclusion, we demonstrated that the associations between physical aging and TL varies depending on the type and nature of physical aging assessments. Composite measures of physical performance/ability demonstrate a strong and consistent parameter of physical aging to link with TL. Future research should prioritize standardized, multidimensional approaches to measure physical aging to understand better its association with TL to support healthy aging strategies.

Low prealbumin level is a poor prognostic biomarker for surgically treated pancreatic cancer

The present study aimed to evaluate the clinicopathological and prognostic significance of preoperative prealbumin levels in patients with surgically treated pancreatic cancer. The present retrospective study included 95 patients with pancreatic cancer who underwent radical surgery between January 2011 and December 2021. Of the patients, 49 were male and 46 were female, with a median age of 73 years. According to the median preoperative prealbumin level of 21.1 mg/dl, the patients were divided into low (<21.1 mg/dl) and high (≥21.1 mg/dl) prealbumin groups. Univariate and multivariate analyses were performed to evaluate the prognostic significance of prealbumin levels. Notably, no clinicopathological factors were associated with low prealbumin levels. Overall (P=0.008) and recurrence-free (P=0.004) survival were significantly lower in the low prealbumin group than those in the high prealbumin group. In addition, multivariate analysis showed that low prealbumin levels were an independent risk factor for poor overall (P=0.024) and recurrence-free (P=0.013) survival. Furthermore, the liver (P=0.038) and peritoneal recurrence (P=0.012) rates were higher in the low prealbumin group than those in the high prealbumin group. In conclusion, low preoperative prealbumin levels may be a poor prognostic biomarker in patients with surgically treated pancreatic cancer.

Advances and applications of multiomics technologies in precision diagnosis and treatment for gastric cancer

Gastric cancer (GC), one of the most prevalent malignancies worldwide, is distinguished by extensive genetic and phenotypic heterogeneity, posing persistent challenges to conventional diagnostic and therapeutic strategies. The significant global burden of GC highlights an urgent need to unravel its complex underlying mechanisms, discover novel diagnostic and prognostic biomarkers, and develop more effective therapeutic interventions. In this context, this review comprehensively examines the transformative roles of cutting-edge technologies, including radiomics, pathomics, genomics, transcriptomics, epigenomics, proteomics, and metabolomics, in advancing precision diagnosis and treatment for GC. Multiomics data analysis not only deepens our understanding of GC pathogenesis and molecular subtypes but also identifies promising biomarkers, facilitating the creation of tailored therapeutic approaches. Additionally, integrating multiomics approaches holds immense potential for elucidating drug resistance mechanisms, predicting patient outcomes, and uncovering novel therapeutic targets, thereby laying a robust foundation for precision medicine in the comprehensive management of GC.

Temporal trends in prevalence for depressive disorders among women of childbearing age: Age-period-cohort analysis 2021

BACKGROUND

Depressive disorders (DD) are significant mood disorders with a notable female preference, especially affecting the well-being of women of childbearing age (WCBA). This population with DD was notably associated with severe complications during the perinatal period, leading to unfavourable maternal mortality and morbidity.

METHODS

This study extracted data from the Global Burden of Disease Study (GBD) 2021. We analysed the number of cases, calculated the age-standardized prevalence rate, and performed the age-period-cohort (APC) model to estimate prevalence trends and age, period, and cohort effects from 1992 to 2021.

RESULTS

From 1992 to 2021, the global number of WCBA with DD surged by 59.46 %, reaching 121 million cases up to 2021. India, China, and the USA had over 40 million prevalence cases, accounting for 36.17 % of global prevalence. The global net drift of DD prevalence among WCBA was -0.13 % per year (95 % CI: -0.17 % to -0.09 %). Age effects demonstrated similar patterns that the prevalence risk rose with age. All SDI regions showed unfavourable prevalence risks surging in the period of 2017-2021. The cohort risk of prevalence increased globally in younger generations after the 1987-1996 cohort.

CONCLUSION

Although the overall temporal trend (net drift) presented a downward trend in DD prevalence among WCBA over the past three decades, the prevalence cases had continued to rise with unfavourable period and cohort effects. Since COVID-19 triggered a massive increase in the prevalence of depressive disorders worldwide, there is an urgent need for stakeholders and policy makers to strengthen mental health-care systems.

Benzene exposure and risk of colorectal cancer by anatomical subsite in the Norwegian offshore petroleum workers cohort

OBJECTIVE

To investigate the association between low levels of benzene exposure (≤0.879 parts per million [ppm]-years) and risk of colorectal cancer (CRC) including its anatomical subsites.

METHODS

Among 25,347 male workers in the Norwegian Offshore Petroleum Workers (NOPW) cohort with offshore work history (1965-1998), 455 CRC cases were diagnosed 1999-2021. We compared these with a subcohort (n = 2031) drawn from the full cohort. Work histories were linked to a previously developed industry-specific benzene job-exposure matrix (JEM). Cox regression for case-cohort analyses was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for CRC, adjusted for age, body mass index, smoking, alcohol intake, red/processed meat intake, and physical activity.

RESULTS

Risks of CRC increased with increasing benzene exposure. For all CRC, the HRs (95% CI) for the most exposed [quartile 4] vs. the unexposed were 1.32 (0.96 to 1.81, [0.177-0.879 ppm-years]; p-trend = 0.085) for cumulative, 1.52 (1.11 to 2.07, [17-34 years]; p-trend = 0.032) for duration, and 1.56 (1.15 to 2.12, [0.015-0.046 ppm]; p-trend = 0.005) for average intensity of benzene exposure. For right-sided colon cancer, the association was most evident for exposure duration (HR = 2.25 (1.33 to 3.80), quartile 4 [17-34 years] vs. unexposed; p-trend = 0.007). Sensitivity analyses showed consistent associations.

CONCLUSION

This study found positive exposure-response associations between low-level benzene exposure and CRC risk in offshore petroleum workers. These findings add to emerging evidence that benzene can be associated with solid tumours including lung and bladder, which potentially has important occupational and public health implications.

Increasing Life Expectancy in Patients with Genitourinary Malignancies: Impact of Treatment Burden on Disease Management and Quality of Life

BACKGROUND AND OBJECTIVE

Treatment burden refers to the overall impact of medical treatments on a patient's well-being and daily life. Our objective is to evaluate the impact of treatment burden on quality of life (QoL) in patients with genitourinary (GU) malignancies, highlighting the importance of patient-reported outcomes (PROs) in clinical trials to inform treatment decisions and improve patient care.

METHODS

We conducted a narrative review of clinical trials focused on GU malignancy (prostate, bladder, and kidney) between January 2000 and June 2024, analyzing related PROs and findings regarding treatment burden.

KEY FINDINGS AND LIMITATIONS

Recent landmark clinical trials demonstrate significant improvements in overall survival across GU malignancies with novel therapies. However, the reporting of QoL outcomes in these trials is often inadequate, with many lacking comprehensive data or long-term impact. Current publications are increasingly evaluating treatment burden and its impact on patient well-being as a critical outcome, but most clinical trials to date have failed to assess treatment burden across key domains including financial, time and travel, and medication management.

CONCLUSIONS AND CLINICAL IMPLICATIONS

While advancements in treatment have extended longevity in patients with GU malignancies, the treatment burden associated with the receipt of novel agents and its implications for QoL remain inadequately uncharacterized.

Experimental evidence on colchicine's mode of action in human carotid artery plaques

BACKGROUND AND AIMS

Atherosclerosis, driven by inflammation, is a leading cause of cardiovascular events. Recent clinical trials have highlighted the therapeutic potential of anti-inflammatory treatments. Consequently, colchicine is being recommended for secondary prevention in current guidelines, although the drug's mechanistic actions are not fully understood.

METHODS

To this end, we conducted a multiomic investigation of colchicine's effect on human carotid plaques. Sections from endarterectomy specimens were exposed to colchicine at concentrations of 2 ng/ml and 10 ng/ml ex vivo for 24 h and compared to untreated segments of the same plaque. Gene expression changes were analyzed by bulk RNA sequencing, and plaque secretomes underwent mass spectrometry for proteomic analysis. In situ cell proliferation was assessed by histology.

RESULTS

Our data indicate, that colchicine suppresses neutrophil and platelet degranulation and activation, collagen degradation and atheromatous plaque macrophage proliferation in a dose-dependent manner in human plaques, while stimulating myofibroblast activation. Unexpectedly, interleukine (IL)-1beta release from colchicine treated plaques was not reduced. These results indicate that the inflammasome may not be the predominant target of low-dose colchicine in human carotid artery plaques.

CONCLUSION

Our study identifies multifactorial pathways through which colchicine, the first cardiovascular guideline-recommended anti-inflammatory drug, predominantly acts on human atherosclerotic lesions beyond the inflammasome. Targeting neutrophil and platelet degranulation, collagen degradation and macrophage proliferation, selectively, may provide substantial therapeutic benefit in atherosclerotic cardiovascular disease without colchicine's undesired side effects.

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

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

Investigating the Contribution of Coding Variants in Alcohol Use Disorder Using Whole-Exome Sequencing Across Ancestries

BACKGROUND

Alcohol use disorder (AUD) is a leading cause of death and disability worldwide. There has been substantial progress in identifying genetic variants that underlie AUD. However, whole-exome sequencing studies of AUD have been hampered by the lack of available samples.

METHODS

We analyzed whole-exome sequencing data of 4530 samples from the Yale-Penn cohort and 469,835 samples from the UK Biobank, which represent an unprecedented resource for exploring the contribution of coding variants in AUD. After quality control, 1750 African-ancestry (1142 cases) and 2039 European-ancestry (1420 cases) samples from the Yale-Penn and 6142 African-ancestry (130 cases), 415,617 European-ancestry (12,861‬ cases), and 4607 South Asian (130 cases) samples from the UK Biobank cohorts were included in the analyses.

RESULTS

We confirmed the well-known functional variant rs1229984 in ADH1B (p = 4.88 × 10-31) and several other variants in ADH1C. Gene-based collapsing tests that considered the high allelic heterogeneity revealed the previously unreported genes CNST (p = 1.19 × 10-6), attributable to rare variants with allele frequency < 0.001, and IFIT5 (p = 3.74 × 10-6), driven by the burden of both common and rare loss-of-function and missense variants.

CONCLUSIONS

This study extends our understanding of the genetic architecture of AUD by providing insights into the contribution of rare coding variants, separately and convergently with common variants in AUD.

Worsening heart failure: progress, pitfalls, and perspectives

For most patients with chronic heart failure (HF), the clinical course of the disease includes periods of apparent clinical stability punctuated by episodes of clinical deterioration with worsening signs and symptoms, a condition referred to as worsening heart failure (WHF). Over time, episodes of WHF may become more frequent, and patients may enter a cycle of recurrent events associated with deterioration in their quality of life and functional capacity, hospitalizations, and ultimately death. WHF is apparently an old concept but seems to have acquired new boundaries in terms of definition and clinical and prognostic value due to the fast-paced evolution of the HF treatment landscape and the emergence of new drugs in this setting. As a result, the management of WHF is being reshaped. In the present paper, a group of HF experts gathered to discuss the concept, prevention, detection, and treatment of WHF.

Multidisciplinary approach to target volume delineation in locally recurrent rectal cancer: An explorative study

Background and purpose

Interobserver variation (IOV) in locally recurrent rectal cancer (LRRC) delineations is large, possibly because of different interpretations of imaging. An explorative study was performed to investigate the benefit of additional delineations by expert radiologists.

Materials and methods

14 cases of LRRC were delineated on planning CT by 8 radiologists (RADs) to construct a median and total radiology contour, followed by 12 radiation oncologists (ROs), without (GTV-) or with (GTV+) the additional contours. IOV was calculated separately for RADs, GTV- and GTV+. The following metrics were used: the Surface Dice Similarity Coefficient (SDSC), Dice similarity coefficient (DSC), and Hausdorff Distance at the 98th percentile (HD98%). The median SDSC, DSC, and HD98% of GTV- and GTV+ were compared. Sub-analyses of IOV in different recurrence types were performed.

Results

Median SDSC significantly improved from GTV- to GTV+ overall, but a significant benefit could not be proven in individual cases. Additional radiological input consistently improved all parameters in 4/14 cases (29 %). Geographical miss occurred after radiological input in 7 %. Subgroup analyses show large IOV in mainly fibrotic and intraluminal recurrences. Little IOV is seen in solitary nodal recurrences.

Conclusion

This study highlights target volume delineation challenges in LRRC. Overall, radiological input reduced IOV amongst ROs in target volume delineation for LRRC. Large differences do however exist amongst recurrence types. A standard terminology for LRRC and close collaboration between radiologists and radiation oncologists seems necessary to reduce IOV and improve quality of care.

Dietary factors and cancer outcomes in individuals with type 2 diabetes: A systematic review and meta-analysis of prospective observational studies

INTRODUCTION

Cancer is a major health concern in persons with type 2 diabetes (T2D). Diet plays an important role in progression of diabetes and cancer. We aimed to systematically summarize the evidence on diet and cancer in individuals with T2D.

METHODS

PubMed and Web of Science were searched until August 2023 and followed up via PubMed alert until December 2024. Prospective studies investigating any dietary factor in association with cancer in individuals with T2D were eligible.

RESULTS

We identified 68 studies and conducted 20 meta-analyses. A general low-carbohydrate diet was not associated with cancer outcomes, whereas an inverse association was found for vegetable-based low-carbohydrate diet (HR per 5 points [95 % CI]: 0.90 [0.84, 0.97]; n = 2). We found indications of lower cancer incidence for higher adherence to Dietary Approaches to Stop Hypertension diet, (Alternate) Healthy Eating Index, higher intakes of n-3 fatty acids (0.73 [0.55, 0.98]; n = 2) and higher serum vitamin D (0.95 [0.93, 0.97]; n = 2), as well as a positive association for serum manganese concentrations (1.44 [1.11, 1.87]; n = 2), rated with low to very low certainty of evidence.

CONCLUSION

So far, the certainty of evidence is very limited due to the small numbers of primary studies. There is an indication of a possible association between diet and cancer risk among persons with T2D, but further well-designed prospective cohort studies are warranted.

Epidemiological Dynamics of Burden and Health Inequalities in Metabolic Dysfunction-associated Steatotic Liver Disease in Adolescents at Global, Regional, and National Levels, 1990-2021

Background

Metabolic dysfunction-associated steatotic liver disease (MASLD) has become one of the major causes of chronic liver disease among adolescents. However, epidemiological studies on MASLD in adolescents are still insufficient. In this study, we aim to investigate the global burden and the trend of MASLD in adolescents from 1990 to 2021.

Methods

The age-standardized incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of MASLD were calculated based on the Global Burden of Disease (GBD) 2021 study and stratified by sex, socio-demographic index (SDI), GBD regions, and countries. The temporal trends were examined using the average annual percentage change (AAPC) and joinpoint regression.

Results

From 1990 to 2021, the global trends of age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) of MASLD show notable increase, and the male is significantly higher than the female in adolescents. According to the incidence and prevalence, nations with low SDI confront a higher burden of MASLD. Besides, the inequality of incidence and prevalence between different SDI regions have shrunk in 2021, but the inequality of DALYs and mortality are still exacerbated. Decomposition analysis revealed that population growth and epidemiological changes were the main reasons for the increase in the incidence of MASLD.

Conclusion

From 1990 to 2021, there is a significant upward trend in the incidence of MASLD among adolescents worldwide. Of particular note are male adolescents, East Asian regions, and groups living in high SDI countries.

Tongfu Xingshen capsule alleviates stroke-associated pneumonia-induced multiple organ injuries by modulating the gut microbiota and sphingolipid metabolism

BACKGROUND

Stroke-associated pneumonia (SAP) represents a major complication and cause of death in patients suffering from intracerebral haemorrhage (ICH). It's urgent to develop more effective therapeutic strategies. Tongfu Xingshen capsule (TFXS) is a traditional Chinese medicine that has been utilised in clinical studies for the treatment of ICH and SAP, but the underlying mechanisms remain to be fully elucidated.

PURPOSE

This study aims to explore the therapeutic effects and mechanisms of TFXS on SAP using an aspiration-induced Klebsiella pneumoniae infection-complicating ICH rat model and an intratracheal injection of lipopolysaccharide (LPS)-induced acute lung injury-complicating ICH rat model.

METHODS

The chemical components of TFXS are characterised using ULPLC-Q Exactive-Orbitrap-MS. The therapeutic effects of TFXS are evaluated through neurological scoring, histopathology analysis, magnetic resonance imaging, immunofluorescence, Alcian blue-nuclear fast red staining, myeloperoxidase activity assessment, leukocyte counting, and ELISA. To investigate the underlying mechanisms, faecal microbiota transplantation, 16S rRNA sequencing, untargeted metabolomics, and Spearman correlation analyses are performed.

RESULTS

A total of 60 compounds are identified in TFXS. Pharmacological analysis reveals that TFXS significantly mitigates neurological deficits, enhances haematoma absorption, attenuates brain damage and neuroinflammation, and improves pneumonia and pulmonary injury by reducing the infiltration of leukocytes and lymphocytes, as well as suppressing the infiltration and overactivation of neutrophils. TFXS also alleviates intestinal lesions and barrier damage by increasing acidic mucins and the expression of the tight junction protein zonula occludens-1 (ZO-1). Mechanistically, TFXS ameliorates pneumonia and pulmonary injury in a gut microbiota-dependent manner. It reverses sphingolipid metabolism disorders and ceramide accumulation by modulating SAP-induced gut microbiota dysbiosis and enhancing the abundance of probiotics, including Lactobacillus, Allobaculum and Enterococcus.

CONCLUSION

TFXS exerts anti-inflammatory and protective effects on the brain, lung, and gut by alleviating gut microbiota dysbiosis and sphingolipid metabolism disorders. These findings highlight TFXS as a promising therapeutic candidate for the treatment of SAP.

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

Background

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

Methods

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

Results

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

Conclusion

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

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

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

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

OBJECTIVES

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

KEY POINTS

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

The Potential Health Economic Value of Adding Magnetomotive Ultrasound to Current Diagnostic Methods for Detecting Lymph Node Metastases in Rectal Cancer

BACKGROUND

Local resection of early rectal cancer (RC) is a desirable treatment option compared with surgery, offering reduced morbidity, mortality, health care costs and avoidance of stoma. However, local resection is restricted to cases without suspicion of lymph node metastases (LNM). Current methods to diagnose LNM and risk estimations based on histopathology cannot reliably identify patients eligible for local resection. The NanoEcho diagnostic system is based on a novel method for lymph node staging in RC. The aim of this study was to perform a health economic analysis at an early stage of clinical development to estimate the potential value of adding NanoEcho diagnostics to current diagnostic methods in RC.

METHODS

A Markov model for RC diagnosis was developed where the costs and health outcomes, including quality-adjusted life years (QALYs), for adding the NanoEcho diagnostics to current diagnostic methods were compared with current diagnostic methods alone. The diagnostic performance of the NanoEcho diagnostic system is still unknown and the base-case analysis was performed at an assumed 85% sensitivity and 85% specificity. Two testing strategies corresponding to two alternative ways of implementing the diagnostic test in clinic were evaluated: (1) examine all patients diagnosed with RC and (2) examine only patients diagnosed with clinical stages T1 and T2.

RESULTS

Adding the NanoEcho diagnostic system resulted in a gain of 0.032 life years and 0.124 QALYs per patient in the target population compared with current diagnostic methods alone. At a cost-neutral level, the estimated justifiable price of NanoEcho diagnostics was SEK 6995 in the first testing strategy and SEK 50,658 in the second testing strategy. The justifiable price of the NanoEcho diagnostics at a willingness to pay of 500,000 SEK/QALY was SEK 10,654 in the first testing strategy and SEK 65,132 in the second testing strategy.

CONCLUSION

The results indicate that adding NanoEcho diagnostics to standard of care can potentially reduce healthcare costs and increase quality of life in RC patients, assuming a sensitivity and specificity of 85%.

Global trends and burden of age-related hearing loss: 32-year study

BACKGROUND

Age-related hearing loss (ARHL) is a major cause of disability and diminished quality of life in older adults. This study uses data from the 2021 Global Burden of Disease (GBD) study to assess global ARHL.

METHODS

We evaluated ARHL prevalence, DALYs (Disability-Adjusted Life Years), ASPR (Age-Standardized Prevalence Rate), and ASDR (Age-Standardized DALYs Rate). Trend analysis was conducted using Estimated Annual Percentage Change (EAPC), with projections to 2050.

RESULT

From 1990 and 2021, global ARHL prevalence cases and DALYs increased by 109 %, reaching 1.55 billion and 44.45 million, respectively. The ASPR increased from 17,106.88 to 18,070.26, while the crude prevalence rate significantly from 13,890.66 to 19,587.14. Both ASPR and ASDR demonstrated significant age-related increases, particularly for moderate and moderately severe ARHL, with EAPC values of 1.39 and 1.49 for ASDR, respectively. Among individuals aged over 85 years, the ASPR of ARHL is expected to reach 80 %. Prevalence cases peaked in the 55-69 age group, with the highest number of cases (179.43 million) observed in the 55-59 subgroup. High-middle SDI regions and East Asia exhibited the most rapid growth. By 2050, ARHL cases are projected to reach 2.31 billion, with ASPR and ASDR expected to continue rising.

CONCLUSION

ARHL has increased globally over the past three decades, largely due to population aging. The burden is most severe in middle SDI regions, East Asia, and the 55-69 age group, primarily due to their substantial population bases. Addressing this escalating challenge requires enhanced public awareness, early screening initiatives, and targeted interventions.

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

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

Bodies bounce - deflection of bodies following first ground impact after falls from height

Forensic examination of a scene where two bodies were found after a fall from a high-rise apartment building revealed a distinct tissue imprint resembling facial contours on the asphalt between the two bodies as well as a laceration on the back of the head and an abrasion on the forehead of one body. Tissue imprints located away from the positions of the bodies can indicate manipulation of the finding scene and injuries in opposing body regions at least two distinct blunt traumas. Initial assessment ruled out intermediate contacts with the building, pointing instead to a significant horizontal deflection of the bodies after the initial impact on the ground followed by a second impact. A review of the existing literature on falls from height was conducted, which provided limited information on the possibility of a body's deflection after fall from height. Detailed investigations into the biomechanical relevance of sequences following that impact are rare. In contrast, surveillance video footage from the presented case shows the deflection of the corpses by as much as 1.5 m after initial impact, followed by a second impact. In combination with the autopsy results this provided a good explanation for the unusual forensic findings and unique biomechanical insights. It demonstrates that, depending on various factors like the impacted body region, ground structure and height of fall, a body can be significantly deflected from the initial impact region, resulting in a second impact and sometimes forensically misleading injury patterns.

Advancing minimally invasive surgery for elderly colorectal cancer patients: Bridging evidence to practice

The recent study by Min et al provides evidence supporting laparoscopic radical resection of colorectal cancer (LRRCC) as a superior surgical approach for elderly patients. Their retrospective analysis of 104 patients demonstrated that LRRCC offers higher therapeutic efficacy, reduced postoperative complications, faster recovery, and attenuated systemic inflammatory responses compared to open surgery. While the study underscores the clinical advantages of minimally invasive techniques, it also highlights critical gaps, such as single-center design and limited long-term follow-up. This editorial contextualizes these findings within the broader literature, emphasizing the role of LRRCC in enhancing postoperative quality of life for elderly patients. We further discuss the implications of inflammatory biomarker modulation, advocate for multidisciplinary care models, and call for prospective trials to validate long-term outcomes.

Solid fuel use and low birth weight: a systematic review and meta-analysis

Solid fuel use is increasingly linked to low birth weight (LBW), but conclusions were inconsistent. We aimed to summarize the association between solid fuel use and LBW. Twenty-one studies that met the inclusion criteria were identified through PubMed, Qvid Medline, and Web of Science databases. The final search occurred on March 20, 2024. Summary relative effect and 95 % confidence intervals were estimated with a random-effects model. Subgroup analyses and sensitivity analyses were performed to investigate possible sources of heterogeneity and to test the stability of the results. Nineteen studies evaluated the association between solid fuel use in pregnant woman and LBW (1.188 for solid fuels: 1.055 to 1.322). No significant heterogeneity was identified among the included studies (p=0.010, Tau2=0.02, I2=48.1 %). Subgroup analysis found positive correlations for Asia, data years prior to 2014, and rural studies (1.245 for Asia: 1.077 to 1.412; Tau2=0.03, I2=56.0 %; 1.243 for data years prior to 2014: 1.062 to 1.424; Tau2=0.04, I2=60.98 %; 1.514 for rural: 1.258 to 1.771; Tau2=0.00, I2=0.0 %). Our meta-analysis showed that solid fuel use in pregnant women had an impact on LBW. Measures and policies are also needed to promote energy conversion and to limit and reduce the use of solid fuels.

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

BACKGROUND AND OBJECTIVES

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

METHODS

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

RESULTS

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

DISCUSSION

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

Practical Guidelines for the Treatment of Gestational Trophoblastic Disease: Collaboration of the European Organisation for the Treatment of Trophoblastic Disease (EOTTD)-European Society of Gynaecologic Oncology (ESGO)-Gynecologic Cancer InterGroup (GCIG)-International Society for the Study of Trophoblastic Diseases (ISSTD)

Gestational trophoblastic diseases (GTDs) are a group of pregnancy-related premalignant and malignant diseases with generally a favorable prognosis when treated adequately. Many different treatment protocols exist worldwide. To our knowledge, this is the first set of global consensus-based guidelines for GTD. Four international organizations (European Organisation for the Treatment of Trophoblastic Diseases, European Society of Gynecologic Oncology, Gynecologic Cancer Intergroup, and International Society for the Study of Trophoblastic Diseases) delegated 53 expert GTD clinicians from 31 countries who formulated nine consensus-based definitions and the minimum criteria required to be a GTD center. Furthermore, 18 flow diagrams were developed to diagnose, treat, and follow up all forms of primary or recurrent GTD. The definitions and flow diagrams were drafted and adapted in consecutive (online) meetings until consensus was reached followed by an external review process. Here, the final guidelines are presented together with the available supporting evidence from the literature.

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

BACKGROUND

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

Verapamil inhibits TXNIP-dependent NLRP3 Inflammasome activation in an ulcerative colitis rat model: A new evolving role of the calcium channel blocker

Ulcerative colitis (UC) is a long-term inflammatory bowel disease (IBD) associated with significant morbidity. It is marked by inflammation and damage to the colon's mucosal lining. Studies have shown that NLRP3 inflammasome activation, apoptosis, and impaired autophagy are critical in its pathogenesis. Verapamil, a calcium channel blocker, has been found to inhibit NLRP3 inflammasome activation in various preclinical models. However, the potential influence of verapamil on the TXNIP in UC remains unexplored. This study investigates the effects of verapamil on an UC rat model induced chemically by acetic acid. Verapamil effectively inhibited the TXNIP-NLRP3-caspase-1 axis, reducing inflammasome activation and the release of IL-1β and IL-18. Additionally, verapamil suppressed NFκB, the priming step of NLRP3 activation. The drug enhanced autophagic activity, as indicated by increased expression of LC3-II and Beclin-1, along with reduced LC3-I and mTOR expression. Moreover, it demonstrated anti-apoptotic effects mediated by regulating Bax and cleaved caspase-3. These molecular changes contributed to mucosal healing and improved microscopic and macroscopic outcomes in the colitis model. Furthermore, verapamil improved the colon weight-to-length ratio and disease activity scores and mitigated oxidative stress. As verapamil has been safely used in clinics to treat hypertension, our findings suggest it may be a safe therapeutic option for ameliorating inflammation and apoptosis and activating autophagy in UC pathology. Since hypertension demonstrates a strong association with UC, the use of verapamil merits particular attention in hypertensive patients fighting against IBD.

Artificial Intelligence-Enabled Quantitative Assessment and Intervention for Heart Inflammation Model Organoids

Inflammation plays a crucial role in progression of cardiovascular diseases (CVDs); thus, the discovery of rapid and precise analytical tools to assess inflammation related to CVDs is highly desirable for their diagnosis and therapeutic discovery. However, a straightforward and systematic method for quantitative assessment of inflammation levels in heart organoids has yet to be developed. Herein, we describe the construction of human heart inflammatory organoids with intricate structures and diverse cell lineages and the development of an artificial intelligence (AI)-enabled method for quantitative assessment of inflammation levels in this model. Furthermore, we devised a novel therapeutic strategy to boost endogenous energy molecule production in heart inflammatory organoids to address energy metabolic disorders. This research provides a convenient method for quantitative inflammation evaluation and offers a promising tool for drug discovery.

Metal complexes with a twist: modified rhodamines as a promising theranostic approach for combating cancer

Rhodamines have been recognized for their exceptional optical properties, making them suitable for detection, imaging, and disease diagnosis. However, their use as photosensitizers in Photodynamic Therapy (PDT) has been limited by their low singlet oxygen production and limited tissue penetration. The development of rhodamine-metal complexes has overcome these limitations, offering a promising new approach for cancer treatment. These complexes in combination with structural and optical tuning of rhodamines, have been engineered to enhance tumour cell selectivity, improve reactive oxygen species (ROS) generation, and mitochondrial-targeted delivery. Notably, a variety of metal ions, including iridium(III), ruthenium(II) and platinum(II/IV) can form complexes with bright rhodamines with excellent optical responses and remarkable ROS generation. These breakthroughs have the potential to improve cancer diagnosis and therapeutic applications. Photophysical properties, photostability, and targeting agents, particularly in the near-infrared (NIR) range, will be discussed, with a focus on their applications in cancer detection, localization, and cytotoxicity.

Sprayable Reactive Oxygen Species-Responsive Hydrogel Coatings Restore Endothelial Barrier Integrity for Functional Vascular Healing

Drug-coated balloons are advancing in coronary interventional therapy for stenosis but often cause traumatic vascular injury, leading to late-stage restenosis. A critical pathological event in this process is the early disruption of the endothelial barrier integrity, which triggers inflammation and hyperplasia. However, effective therapeutic strategies to promptly restore endothelial integrity are lacking. Here, we identify the elimination of excess reactive oxygen species (ROS) as a key mechanism for reinforcing intercellular tight junctions (TJs) and restoring the endothelial barrier function. We thus propose a sprayable, ROS-responsive hydrogel coating, OA@G-NO/B-EC, for vascular balloons designed to mitigate late-stage restenosis. This hydrogel, precisely fabricated via ultrasonic spraying, comprises a reversible phenylboronic ester-bearing caffeate prodrug (B-EC) and a macromolecular nitric oxide (NO) donor (G-NO), both dynamically self-cross-linked with dopamine-modified oxidized dextran (OA) through Schiff base chemistry. The dual dynamic covalent linkages enable the hydrogel to gradually disintegrate in response to ROS accumulation at lesion sites, providing controlled, on-demand therapeutic action. Sustained release of herbal antioxidant caffeates effectively scavenges ROS, rescuing TJ integrity and attenuating inflammation. This favorable microenvironment further enhances both endogenous NO production and exogenous NO delivery, facilitating endothelial proliferation and migration. Moreover, this hydrogel's robust adhesion to the arterial wall ensures sufficient drug retention and delivery. In vitro and in vivo results, supported by RNA sequencing analysis, strongly demonstrate the hydrogel's enhanced capacity for vascular healing and restenosis prevention. This system holds broad potential for surface engineering across diverse biomedical materials and devices, advancing localized drug delivery.

Colorimetric and Fluorescent Dual-Mode Detection of Multiple Pathogenic Bacteria by Horseradish Peroxidase @ Magnetic Zeolitic Imidazole Framework Biomineralization Composites

Rapid on-site pathogen detection is of paramount importance to prevent widespread bacterial infection. In this work, we successfully developed a dual-mode pathogen detection platform based on a horseradish peroxidase (HRP) @ magnetic zeolitic imidazole framework (HMZIF). By using HRP as a biotemplate and an optimal combination of ligand and salts, the HMZIF can be readily obtained through an innovative one-pot biomineralization process without incorporation of additional magnetic nanoparticles. Compared with the conventional magnetic MOF particles, HMZIFs have a smaller particle size (9.19 nm), a larger specific surface area, outstanding bacterial enrichment capability, superparamagnetic behavior, and enhanced peroxide catalysis activity. Then, a dual-mode detection platform integrating turn-off broad-spectrum colorimetric detection and a complementary turn-on specific fluorescent assay was developed by utilizing the high peroxidase activity and porous structure of the HMZIF. The presence of bacteria triggered the competitive desorption of glucose oxidase (GOD) from the HMZIF surface, thereby inhibiting the colorimetric cascade enzymatic reaction while simultaneously releasing the fluorescent dye (FAM) through aptamer-capped micropores. Under optimal conditions, the dual-mode platform exhibited detection limits of 870 and 2300 colony-forming units (CFU)/mL for Escherichia coli and Staphylococcus epidermidis in colorimetric modality and 28 and 16 CFU/mL in fluorescent modality, respectively. In practical applications, the fluorescence signal represents a specific pathogen concentration while the colorimetric signal indicates the total bacterial count. Thus, by using these two different types of detection modes, a comprehensive assessment of liquid quality safety can be conducted. This pathogen quantification platform was validated using real contaminated sewage and juice samples and provided a general technical route for detecting other pathogenetic bacteria by replacing a specific aptamer, making it a promising tool for monitoring and preventing bacterial infections in environmental and food contexts.

The characteristics of tissue microbiota in different anatomical locations and different tissue types of the colorectum in patients with colorectal cancer

The gut microbiota is intricately associated with the onset and progression of colorectal cancer (CRC), leading to significant interest in developing prevention and treatment strategies that leverage gut microbiota. In this study, we collected 57 samples from 19 CRC patients, comprising cancerous tissue, paracancerous tissue, and normal mucosa. Utilizing metagenomic sequencing and bioinformatics analysis, we identified differences in the microbiomes and their functional characteristics across the various tissue types. The results indicated that species such as Alistipes putredinis were predominantly found in normal tissues, while Pseudomonas putida was enriched in paracancerous tissue, and Malassezia restricta was prevalent in cancerous tissues. Furthermore, the microbial functions exhibited variability among the different tissue types. Random forest analysis suggested that Moraxella osloensis may be implicated in the onset and progression of colorectal cancer. We also classified the patients into three subgroups based on the anatomical location of the colorectum: right-sided colon, left-sided colon, and rectum. The subgroup analysis revealed that the microbiota enriched in normal mucosa and paracancerous tissue varied across different anatomical sites. These findings not only elucidate the characteristics of the microbiomes in the normal mucosa, paracancerous tissue, and cancerous tissues of CRC patients, thereby providing new potential targets for clinical diagnosis and treatment, but also contribute to the existing microbiome data pertinent to CRC research.IMPORTANCEThis study provides crucial insights into the relationship between gut microbiota and colorectal cancer (CRC) by analyzing microbial communities in different tissue types and anatomical locations of CRC patients. We identified distinct microbial signatures, such as Alistipes putredinis in normal tissues and Malassezia restricta in cancerous tissues, indicating location-specific microbiomes with unique functional attributes. These findings suggest potential new biomarkers or therapeutic targets for CRC. The observed microbiota variations among right-sided colon, left-sided colon, and rectum cancers underscore the heterogeneity of CRC, pointing toward more personalized treatment strategies. By enhancing our understanding of the microbiome's role in CRC, this research paves the way for innovative diagnostic tools and targeted therapies tailored to individual patient profiles. This work is essential for advancing clinical approaches to CRC management.

Sleep deficiency exacerbates periodontal inflammation via trigeminal TRPV1 neurons

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

GP consultations for respiratory tract infections in children aged <5 years: a retrospective cohort study 2016-2023

BACKGROUND

Little is known about how GP consultation rates for children's respiratory tract infections (RTIs) have changed since the COVID-19 pandemic restrictions lifted.

AIM

To describe changes in GP consultation rates for RTIs in children aged <5 years from 2016 to 2023.

DESIGN AND SETTING

A population-based retrospective cohort study using electronic health records from primary care practices across England.

METHOD

All children aged <5 years registered with a general practice in the Clinical Practice Research Datalink Aurum database from April 2016 to March 2023 were included. Monthly GP consultation rates for RTIs from April 2021 to March 2023 were compared with the corresponding months during pre-pandemic years (April 2016 to February 2020).

RESULTS

There were 3 226 285 GP consultations for RTIs among 2 894 539 children. Pre-pandemic, mean monthly consultation rates ranged from lows in August to highs in November (from 2368 to 8682 per 100 000 children, respectively). Following the pandemic lockdowns in 2020, monthly rates in 2021/2022 peaked in June and October at 5152 and 5942 per 100 000 children, respectively, but the winter peak was less marked than pre-pandemic and mean monthly rates were 16.8% lower (95% confidence interval [CI] = - 13.4 to - 19.6). In 2022/2023, after all restrictions were lifted, rates remained around 15% below pre-pandemic years, but the winter peak for children aged 3-4 years was 8615 per 100 000 children, exceeding mean pre-pandemic winter peaks of 6011 per 100 000 children. This was an increase of 43.3% and coincided with a streptococcal group A outbreak. Across all ages there was a sharp increase (from 1486 to 2370 per 100 000 children, around 60%) in tonsillitis, Streptococcus A, and bacterial ear infections.

CONCLUSION

This study shows reductions in GP consultations for RTIs in children aged <5 years since the lifting of COVID-19 pandemic restrictions. Of concern is a sharp rise in tonsillitis, Streptococcus A, and bacterial ear infections that should be monitored.

Association between inequalities in mental health resources and burdens of mental health disorders in 146 countries and territories: An observational study

BACKGROUND

Mental health disorders impose a substantial social and economic burden. We conducted a comprehensive assessment of global mental health resource allocation and the associated burdens of mental health disorders, examining the relationship between these two factors.

METHODS

We utilized data from the WHO Global Health Observatory and GBD 2021 to encompass 146 countries. We employed spatial autocorrelation analysis and Lorenz curves to characterize the spatial distribution. Additionally, we examined the association between mental health resources and the burdens of mental disorders using a generalized linear regression model (GLM).

RESULTS

Countries and territories with higher income levels were more likely to have greater mental health resources (p < 0.05). Globally, the average mental health resource allocation index (IMRA) was 18.14, and Moran's I was 0.509 (p < 0.001). The Lorenz curve of mental health resources lay below the equality line, suggesting that these resources were more concentrated in countries and territories with higher HDI values. Between 2011 and 2021, the age-standardized incidence rate of all mental health disorders increased significantly (EAPC: 1.41 %, 95 % CI: 0.40 % to 2.53 %, p = 0.011). In multivariable GLM, a negative association was observed between the Index of IMRA and total mental health incidence.

CONCLUSION

Inequalities in mental health resources persist, and the burdens of mental disorders are increasing globally. Our findings underscore the critical need to reduce the overall burden of mental health disorders through enhanced allocation of prevention-oriented resources. Countries at different levels of human development face distinct challenges and priorities in mental health resource allocation.

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

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

Acid reflux medication use among adults with depressive symptoms

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

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Aspirin enhances the antibacterial activity of colistin against multidrug-resistant Pseudomonas aeruginosa

Multidrug-resistant (MDR) Pseudomonas aeruginosa (PSA), recently reclassified by the World Health Organization (WHO) as a high-priority antimicrobial-resistant pathogen, continues to impose a substantial global health burden due to escalating resistance and stagnant therapeutic innovation. Colistin retains critical clinical utility against MDR P. aeruginosa infections; however, its dose-limiting nephrotoxicity and neurotoxicity necessitate strategies to optimise therapeutic indices. This study investigated the molecular mechanism underlying the synergistic activity of aspirin in potentiating colistin efficacy against MDR P. aeruginosa. In vitro analyses revealed marked synergistic bactericidal activity (FIC index ≤0.5), with metabolomic profiling demonstrating suppression of key metabolic pathways integral to bacterial membrane biogenesis, including glycerophospholipid metabolism and fatty acid biosynthesis. Ultrastructural imaging confirmed irreversible disruption of membrane integrity via combined treatment. In a rat model of P. aeruginosa-induced pneumonia, colistin-aspirin co-administration demonstrated superior efficacy to monotherapy, significantly reducing pulmonary bacterial load (3 to 4-log CFU/g reduction vs colistin alone; p < 0.01), attenuating histopathological injury, and suppressing pro-inflammatory cytokine levels (IL-6, IL-8, TNF-α) by 30-47%. Critically, this synergy enabled a reduction of colistin dosing to one-sixteenth while maintaining bactericidal potency. These findings provide mechanistic insights into aspirin-mediated colistin sensitisation and evidence supporting combinatorial regimens to circumvent colistin toxicity barriers. This work establishes a rational foundation for clinical translation of repurposed aspirin-colistin therapy against MDR P. aeruginosa infections.

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

AIMS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Inequalities in residential green space and trajectory of cardiometabolic multimorbidity: Different associations by sex and socioeconomic status

Residential green space has the potential to benefit cardiometabolic health. However, little is known about its impacts on cardiometabolic multimorbidity (CMM). Furthermore, the capacity of access to green space to reduce health inequalities during the development of CMM is unclear, and longitudinal evidence is urgently needed. Hence, a large prospective study based on the UK Biobank was conducted. CMM was defined as the coexistence of at least two conditions including type 2 diabetes, ischemic heart disease, and stroke. Multi-state models were used to assess the impacts of green space on the transitions of CMM, from free of cardiometabolic disease to first cardiometabolic disease (FCMD), subsequently to CMM, and finally death. This study included 328,260 participants with a median follow-up of 12.5 years. The benefits of access to green space were observed for transitions from baseline to FCMD, from baseline to death, and from FCMD to death, with HRs of 0.975 (95 % CI: 0.959, 0.991), 0.956 (95 % CI: 0.931, 0.982) and 0.943 (95 % CI: 0.897, 0.990) per IQR increase in the percentage of green space, respectively. Although access to green space benefited early transitions related to FCMD, its protective role was not found in the progression from FCMD to CMM and finally death. Furthermore, access to green space was associated with a reduction in health inequalities influenced by sex and socioeconomic status in the earliest transition from healthy to FCMD. Future policies should prioritize green space investments to sustainably enhance cardiometabolic health and improve health inequalities.

Silibinin protects the ischemic brain in mice by exerting anti-apoptotic effects via the EGFR/ERK pathway

Apoptosis is a significant occurrence of cell death in the cerebral ischemia process, potentially revealing specific treatment points. Silibinin (SIL) has been proven to regulate a range of biological effects on inflammation, oxidative stress and apoptosis. Meanwhile, the epidermal growth factor receptor (EGFR) has been reported to impact cell apoptosis owing to its proliferative activity, which is in the opposite direction of apoptosis. This brings up the question of whether silibinin modulates apoptosis after cerebral ischemic injury and whether EGFR is involved in mediating this effect. We therefore examined the potential protective role of silibinin in ischemic brain and the underlying mechanisms. We assigned CD1 mice into groups and assessed neurological function via behavioral tests, infarct volume staining, and edema measurement. Neuronal vitality in the infarcted hemisphere was assessed using Nissl staining, while the level of apoptosis was evaluated by detecting cleaved Caspase-3, Bcl-2, and Bax. Penumbra vascular conditions were examined by immunofluorescence and two-photon imaging. Western Blot and immunohistochemistry detected EGFR/ERK level changes. An EGFR inhibitor was used to confirm the involvement of the EGFR/ERK pathway in the disease process. Our findings indicated that silibinin substantially diminished infarct volume and brain edema, reduced neuronal apoptosis following stroke, enhancing neurological function. These effects were accompanied by up-regulation of p-EGFR/EGFR, p-ERK/ERK, and Bcl-2, as well as down-regulation of Bax and cleaved-Caspase3 in ischemic brain tissue post-stroke, while inhibiting EGFR activation attenuated or reversed the anti-apoptotic effects of silibinin. We concluded that silibinin protected the brain after cerebral ischemia by exerting anti-apoptotic effects via the activation of EGFR/ERK signaling pathway.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

6-plex Crystal Digital PCR® for comprehensive surveillance of respiratory and foodborne bacterial pathogens in wastewater

Bacterial wastewater surveillance (WS) is less explored area compared to viral WS despite high burden of bacterial respiratory and gastrointestinal infections worldwide. This study established a 6-plex Crystal Digital PCR® (cdPCR) system, to comprehensively monitor an acute respiratory pathogen - Group A Streptococcus (GAS) pyogenes, foodborne disease (FBD) pathogens - Clostridium perfringens, Salmonella spp., Campylobacter jejuni, and Campylobacter coli, and an indicator bacterium, Escherichia coli in wastewater. Fifty-two grab influent samples collected weekly from a wastewater treatment plant in Yamanashi Prefecture, Japan, between June 2023 and May 2024 were centrifuged, followed by DNA extraction and cdPCR. cdPCR was performed using the naica® system (Stilla Technologies). The 6-plex cdPCR assays showed strong performance. Among the 52 samples, 100 % of samples were positive for C. perfringens, 98 % for Salmonella spp., 56 % for C. jejuni, 25 % for C. coli, and 63 % for S. pyogenes, with concentrations ranging between 4.2 ± 0.3 to 7.5 ± 0.2 log10 copies/L. The concentration of C. perfringens was significantly higher than that of other pathogens (p < 0.05), indicating its dominance. Salmonella spp. had high detection rate, implying increased Salmonella infection in the population. Seasonal variation was not observed in any of FBD pathogens, except for the detection rate of C. coli. S. pyogenes concentrations were significantly higher in spring than in other seasons, agreeing with the trend of GAS pharyngitis cases in the catchment. In conclusion, the 6-plex cdPCR system is a valuable tool for comprehensive WS, offering significant implications for public health monitoring.

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

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

The burden and trends of depressive disorders in adolescent and young adults aged 15-29 in China, 1990-2021 and its prediction to 2030: Findings from the Global Burden of Disease Study 2021

BACKGROUND

Depressive disorders (DDs) are the leading causes of disability among adolescents and young adults (AYAs) in China. This study estimated the trends of DDs burden among AYAs in China over the last 32 years, and further predicted to 2030.

METHODS

Based on the Global Burden of Disease Study 2021, age-standardized incidence, prevalence, and years lived with disability (YLDs) rates were used to describe the DDs burden among AYAs (aged 15-29 years) in China. Estimated annual percentage changes were used to describe the temporal trends from 1990 to 2021. Bayesian age-period-cohort model was used to predict the future burden to 2030.

RESULTS

In 2021, the age-standardized incidence, prevalence, and YLDs rates (per 100,000) for DDs among AYAs in China were 1884.11 (95 % confidence interval [CI]: 1383.84, 2540.68), 1951.57 (95 % CI: 1527.28, 2459.70), and 323.36 (95 % CI: 208.27, 474.88), respectively. The burden was heavier in females and individuals aged 25-29. From 1990 to 2021, all groups showed a downward trend of DDs burden. Males showed an increase in DDs burden (mainly dysthymia) in most groups in 2019-2021, while the increases in DDs burden among females were mainly in 2010-2019. The main attributable risk factor was bullying victimization. Notably, although the DDs burden was predicted to decrease from 2022 to 2030, the dysthymia burden was predicted to increase.

CONCLUSIONS

The DDs burden among AYAs is a significant public health challenge in China. It is crucial to consider the disparities among different demographic characteristics, when formulating and implementing prevention strategies.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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