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

Introduction

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

Methods

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

Results

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

Conclusions

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

Identification of serum metabolic markers in non-obese hypertensive patients using non-targeted metabolomics

The future of hypertension management lies in distinguishing disease subtypes for precise control. The underlying drivers and pathology of non-obese hypertension (J-HTN) remain unclear. There is a lack of biomarkers for the early identification of J-HTN. The aim of this study was to identify circulating metabolomic profiles that facilitate the early detection of J-HTN patients, thereby providing valuable insights for more targeted and precision-based therapies. A non-targeted metabolomics approach was used to quantify serum metabolites in 120 patients with newly diagnosed hypertension, and to determine the metabolomic characteristics of J-HTN and two types of obese hypertension (fat-dominant and muscle-dominant). 4 metabolites unique to J-HTN were identified, with lysophosphatidylcholine 22:6 (LysoPC(22:6/0:0)) standing out as the marker showing the most pronounced difference. Using the serum metabolome alone, we were able to distinguish J-HTN from other hypertensive patients. In a secondary validation with an independent cohort of 60 medically treated J-HTN patients, 3 metabolites, including LysoPC(22:6/0:0), remained significantly altered. The serum metabolic profiles identified in this study enable the early detection of J-HTN, with LysoPC(22:6/0:0) emerging as a highly promising biomarker. This metabolite may also correlate with the clinical efficacy of J-HTN treatments.

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

Background

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

Methods

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

Results

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

Conclusion

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

BACE1 Inhibition Protects Against Type 2 Diabetes Mellitus by Restoring Insulin Receptor in Mice

β-secretase 1 (BACE1), known for its role in amyloid-β production associated with Alzheimer's disease (AD), has also been suggested to be elevated in patients with Type 2 diabetes mellitus (T2DM). Notably, BACE1 could cleave the insulin receptor (InsR), leading to reduced InsR levels, which may impair insulin signaling and contribute to insulin resistance. Presently, we observed decreased InsR levels and impaired glucose disposal in the livers of mice with systemic overexpression of BACE1 (HUBC mice). This suggests that elevated BACE1 could contribute to insulin resistance by shedding membrane InsR. Additionally, mice fed a high-fat diet (HFD), a well-established model of T2DM, displayed increased BACE1 levels and decreased InsR. To further investigate whether inhibiting BACE1 could enhance insulin sensitivity and alleviate symptoms of diabetes, we treated HFD mice with the BACE1 inhibitor Elenbecestat. Remarkably, the administration of Elenbecestat restored InsR levels and improved their downstream signaling pathways, leading to increased insulin sensitivity and enhanced glucose tolerance. In summary, our findings suggest that inhibiting BACE1 can restore InsR expression and improve insulin-signaling sensitivity, ultimately resulting in enhanced diabetic phenotypes.

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

Objective

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

Methods

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

Results

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

Conclusion

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

Global burden and prevalence of otitis media-induced hearing loss in children: 32-year study

BACKGROUND

Hearing loss in children has become a pressing public health issue, with otitis media (OM) being a leading cause. This study aims to comprehensively assess the prevalence and burden of OM-induced hearing loss in children.

METHODS

Data from the Global Burden of Disease (GBD) database were used. We evaluated the Age-standardized Prevalence Rates (ASPR), Age-standardized Years Lived with Disability rates (ASYR), and Estimated Annual Percentage Changes (EAPC) over the past 32 years. The analysis included stratification, correlation analysis, and projections.

RESULTS

From 1990 to 2021, the global prevalence of OM-induced hearing loss in children under 15 years increased from 31.18 million cases to 34.71 million cases, representing an 11.32% increase. The ASPR slightly decreased from 1793.38 to 1725.39 per 100,000 children, with an EAPC of -0.13. Boys had a higher prevalence and burden compared to girls, and the highest ASPR and ASYR were observed in children aged 5-9 years. Regions with higher Socio-Demographic Index (SDI) showed significant reductions in both prevalence and burden, while low-middle SDI regions bore a heavier burden, with ASPR 1.81 times higher and cases number 6.08 times higher than high SDI regions. Additionally, East Asia showed the largest decrease, while South Asia had the highest ASPR.

CONCLUSION

Although the global burden of OM-induced hearing loss has improved, South Asia and low-middle SDI regions continue to face a significant burden, with insufficient healthcare resources likely being a major issue. Additionally, continuing to advance pneumococcal vaccination and other preventive measures is equally crucial for alleviating this burden.

PREVENT Risk Score vs the Pooled Cohort Equations in MESA

BACKGROUND

In 2023, the American Heart Association developed the PREVENT (Predicting Risk of CVD Events) equations to estimate risk of atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF).

OBJECTIVES

Assess the comparative performance of PREVENT-ASCVD vs current guideline-recommended Pooled Cohort Equations (PCE). Evaluate the performance of the PREVENT-HF risk algorithm.

METHODS

In 6,098 individuals from the MESA (Multi-Ethnic Study of Atherosclerosis) cohort, we calculated baseline PCE, and PREVENT predicted 10-year ASCVD event percentages, observed event percentages at 10 years, discordance between observed and expected percentages, discrimination using Harrell's C index, and calibration using mean absolute error.

RESULTS

Observed ASCVD event rate (6.0%) was closer to the predicted PREVENT event rate (5.7%) than the PCE (10.8%). PREVENT was more accurate in women than men (3.3% vs -11.6% discordance between observed and PREVENT predicted ASCVD), nonsmokers compared to smokers (2.4% vs -37.0% discordance), chronic kidney disease stages 3/4 (discordance 3.2%), and those with high social deprivation scores (discordance -5.0%). Forty-two percent of this cohort would be re-classified to a lower ASCVD risk category using the PREVENT equation vs the PCE. PREVENT-HF overestimates HF events by 2.1%, a relative risk overestimation of 62.6%.

CONCLUSIONS

PREVENT-ASCVD equations demonstrated a more accurate ASCVD risk-prediction stratification than the PCE. PREVENT performs best in women, nonsmokers, those with a greater degree of renal dysfunction, social deprivation, and Black individuals. PREVENT-HF overestimates risk of incident HF in a Multi-Ethnic Study of Atherosclerosis.

Continuous glucose monitoring combined with artificial intelligence: redefining the pathway for prediabetes management

Prediabetes represents an early stage of glucose metabolism disorder with significant public health implications. Although traditional lifestyle interventions have demonstrated some efficacy in preventing the progression to type 2 diabetes, their limitations-such as lack of personalization, restricted real-time monitoring, and delayed intervention-are increasingly apparent. This article systematically explores the potential applications of continuous glucose monitoring (CGM) technology combined with artificial intelligence (AI) in the management of prediabetes. CGM provides real-time and dynamic glucose monitoring, addressing the shortcomings of conventional methods, while AI enhances the clinical utility of CGM data through deep learning and advanced data analysis. This review examines the advantages of integrating CGM and AI from three perspectives: precise diagnosis, personalized intervention, and decision support. Additionally, it highlights the unique roles of this integration in remote monitoring, shared decision-making, and patient empowerment. The article further discusses challenges related to data management, algorithm optimization, ethical considerations, and future directions for this technological integration. It proposes fostering multidisciplinary collaboration to promote the application of these innovations in diabetes management, aiming to deliver a more precise and efficient health management model for individuals with prediabetes.

Morinda officinalis oligosaccharides attenuate mitochondria-associated ferroptosis via the NOX4/mitoGPX4 pathway in myocardial ischemia‒reperfusion injury

Aim

To explore the benefits of Morinda officinalis oligosaccharides (MOO) on ischemia-reperfusion (I/R) injury and the possible mechanisms involved.

Methods

Myocardial I/R injury were induced by left anterior descending branch ligation. MOO pretreatment was given orally 2 weeks prior to ischemic treatment. Echocardiograms, biochemical parameters, and histological and immunohistochemical analyses were used to determine the benefits of MOO on myocardial I/R injury. Oxidative stress and ferroptosis were examined by biochemical parameters, Western blot, immunohistochemistry, and Tunel staining.

Results

MOO improved cardiac function and reduced myocardial oxidative stress and ferroptosis, which was associated with the inhibition of NADPH Oxidase 4 (NOX4) expression. Whereas, the upregulation of NOX4 abolished the benefits of MOO. Furthermore, MOO enhanced mitochondrial superoxide dismutase 2 (SOD2) activity and stimulated the mitochondrial translocation of glutathione peroxidase 4 (mitoGPX4) by inhibiting NOX4. Mitochondria-specific GPX4 overexpression attenuated mitochondrial oxidative stress and suppressed mitochondria-associated ferroptosis in cardiomyocytes that suffered from hypoxia-reoxygenation (H/R) injury, even after NOX4 overexpression.

Conclusion

These results indicate the beneficial effects of MOO on myocardial I/R injury by suppressing oxidative stress and mitochondria-associated ferroptosis through NOX4/mitoGPX4 pathway.

Association between accelerometer-measured physical activity and mortality in cancer survivors: A prospective cohort study from UK Biobank

OBJECTIVES

Postdiagnosis physical activity is an important component of healthy lifestyle in cancer survivors. In this study, we aimed to explore the association between intensity and duration of physical activity measured by wearable accelerometers and mortality among pan-cancer survivors.

METHODS

A prospective cohort study involving cancer survivors (n = 11,708) from UK Biobank was performed. All participants had thorough physical activity data that was measured by wrist-worn accelerometers. Restricted cubic splines and multivariate Cox proportional hazards models were employed to assess the dose-response associations between physical activity time at varying intensities and both all-cause and cancer-specific mortality.

RESULTS

During a median follow-up of 8.9 years, a total of 983 deaths occurred, including 656 cancer-related deaths. Multivariate models identified significant dose-response associations between moderate to vigorous-intensity physical activity (MVPA) time and mortality. Hazard ratios (HRs) for all-cause mortality were 0.64 (95% CI, 0.54-0.76), 0.61 (95% CI, 0.51-0.74) and 0.52 (95% CI, 0.42-0.66) in participants with MVPA time of 272-407, 407-579 and ≥579 min per week, respectively. HRs for cancer-specific mortality were 0.71 (95% CI, 0.58-0.88), 0.69 (95%CI, 0.55-0.87) and 0.61 (95%CI, 0.47-0.81) for the aforementioned groups. Similar patterns were observed for moderate-intensity physical activity but not for light-intensity physical activity. Survival benefits of active physical activity were pronounced in cancers from multiple organs.

CONCLUSIONS

Active physical activity substantially reduced all-cause mortality in pan-cancer survivors and cancer-specific mortality in cancer survivors of specific sites. However, the benefits were significant only when intensity of physical activity reached moderate to vigorous level.

Assessing the evolution of infectious disease preparedness among a province with poor economy in China in the wake of COVID-19

Introduction

To identify the factors influencing changes in knowledge and experience of infectious disease prevention and control among physicians in Guangxis grassroots hospitals before and after the COVID-19 pandemic, thereby offering insights to enhance emergency response capabilities, disease prevention and control proficiency, and the overall effectiveness of grassroots medical institutions during epidemics.

Methods

Utilizing random sampling, we conducted questionnaire surveys among primary care physicians from Guangxis primary medical institutions in June 2019 and October 2022, and analyzed the data with SPSS software.

Results

Post-COVID-19, there was a significant increase in the scores for theoretical knowledge (77.10 ± 14.83 vs. 63.10 ± 15.11, p < 0.001) and understanding of infectious disease regulations (54.78 ± 15.94 vs. 50.85 ± 12.52, p = 0.001) among grassroots hospital physicians compared to pre-COVID-19 levels, albeit with room for further improvement. The participation rate in emergency treatment of infectious diseases rose to 63.51% after COVID-19, from 58.33% of physicians lacking infectious disease training before the pandemic, which decreased to 35.60% post-pandemic. Currently, "community family medical observation" is the most sought-after training content among Guangxis grassroots physicians (31.25%).

Discussion

The capacity for infectious disease prevention and control among Guangxis grassroots hospital physicians has significantly improved following COVID-19. The high engagement in related training and emergency response efforts reflects a strong sense of professional identity and commitment. Ongoing, needs-based infectious disease training is recommended to ensure that grassroots medical staff can optimally contribute to the management of infectious disease emergencies.

Burden of Neurological Disorders in Children and Adolescents (&lt;20 Years Old) in North Africa and the Middle East from 1990 to 2021

BACKGROUND

Neurological disorders impose a significant health burden globally, particularly in regions like North Africa and the Middle East (NAME) with unique healthcare and societal challenges. Despite progress in addressing neurological conditions, understanding the burden in pediatric and adolescent populations remains limited. This study analyzes the trends and burden of neurological conditions in individuals under 20 years old across the NAME super region from 1990 to 2021 using Global Burden of Disease (GBD) data.

METHODS

GBD 2021 data were analyzed to assess prevalence, incidence, years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life years (DALYs), and mortality rates. The data were stratified by age, sex, and sociodemographic index (SDI). Population attributable fraction was used to estimate the burden attributable to risk factors, and uncertainty intervals (UIs) were calculated using 500 posterior draws, reporting 95% UIs based on the 2.5th and 97.5th percentiles. All visualizations and analyses were conducted using Python (version 3.12.4).

RESULTS

Neurological condition prevalence in 2021 was 21,797.5 per 100,000, with tension-type headaches and migraines accounting for the majority of cases. Idiopathic epilepsy remained a leading cause of mortality, although it had a decrease of -50.9% in YLLs compared to 1990. Migraine affected about 9,161.9 per 100,000, increasing by 9.9% from 1990. It also accounted for the highest YLD rate (350.9). Despite decreases in YLLs and deaths, YLDs showed minimal change. Similarly, DALYs did not show significant change from 1990 (17.9%; 95% UI: -12.17 to 36.05). Higher SDI was associated with reduced DALYs but increased prevalence and YLDs.

CONCLUSION

The burden of neurological disorders in pediatric and adolescent populations in NAME highlights regional disparities and the need for targeted healthcare strategies. Enhanced screening, early diagnosis, and management are essential to reducing the burden of these disorders.

Interplay of anxiety, depression, vascular function, and biomarkers in post-myocardial infarction patients

Background and aims

Coronary artery disease (CAD) is a leading cause of mortality. Depression and anxiety are common in CAD patients and negatively affect quality of life, physical functioning, and adherence to cardiac rehabilitation (CR) programs. This study aimed to identify possible associations with clinically relevant parameters, vascular function and blood biomarkers.

Methods

Participants were consecutively recruited during cardiac rehabilitation intake visits at the University Medical Centre Ljubljana within 4 months of myocardial infarction (MI). Hospital Anxiety and Depression Scale (HADS) scores were analyzed in relation to endothelial function (assessed with flow-mediated dilation), arterial stiffness, and blood biomarkers (fibrinogen, endocan, and brain-derived neurotrophic factor [BDNF]) in post-MI patients. All vascular and biomarker assessments were performed within 5 days of questionnaire completion and prior to the start of rehabilitation.

Results

There were 105 patients included in the study. The median age was 56 years (49-62), and 80.0% of participants were male. Clinically relevant anxiety and depression were present in 29.5% and 21.9% of participants, respectively. Anxiety was significantly associated with younger age, higher body mass index, and increased arterial stiffness, with total HADS scores negatively correlated with age. Endothelial function showed no significant associations with HADS scores. Vital signs showed no significant differences, except for slightly higher systolic blood pressure in those with clinically relevant depression. Fibrinogen levels were significantly higher in participants with anxiety and depression, while endocan and BDNF levels were lower in those with anxiety.

Conclusion

Depression and especially anxiety are significantly associated with endothelial function and relevant biomarkers in post-MI patients. However, as HADS is a screening tool and not a diagnostic instrument, and given the study's observational design, findings reflect associations rather than causality. Routine screening and targeted mental health support within CR programs might improve participation, enhance cardiovascular recovery, and optimize long-term outcomes. These findings underscore the clinical importance of psychological assessment in the early post-MI period and support the integration of mental health evaluation into cardiovascular care.

Organizational Determinants, Outcomes Related to Participation and Adherence to Cancer Public Health Screening: A Systematic Review

Cancer remains one of the leading causes of morbidity and mortality worldwide, posing a significant burden on individuals, health systems, and societies [...].

Global Burden of Anaemia Among Women of Childbearing Age: Temporal Trends, Inequalities and Projections Using the Global Burden of Disease 2021

OBJECTIVE

To analyse temporal trends, inequalities and projections in anaemia burden among women of childbearing age (WCBA).

DESIGN

Population-based study.

SETTING

Data from the Global burden of Disease (GBD) Study.

POPULATION

WCBA (ages 15-49) diagnosed with anaemia.

METHODS

According to the GBD study, original data sources, including population-based surveys, scientific studies and government reports, were synthesised to estimate WCBA anaemia prevalence and years lived with disability (YLD). We extracted annual estimates with 95% uncertainty intervals (UIs) from 1990 to 2021 and assessed relative prevalence risks by age, period and cohort. Inequality was evaluated via sociodemographic index (SDI). The Bayesian age-period-cohort model was used to predict progress toward the 2030 prevalence halving target.

MAIN OUTCOMES MEASURES

The burden of WCBA anaemia.

RESULTS

Despite population growth increasing total case numbers, the global age-standardised prevalence rate of WCBA anaemia declined from 35.64% (95% UI: 34.16 to 37.37) in 1990 to 33.77% (32.10-35.55) in 2021. Socioeconomic disparities persisted, with a stable concentration index around -0.21 over time, indicating sustained inequality disadvantaging lower-SDI countries, especially in Western and Central Sub-Saharan Africa and South Asia. Despite reductions in period/cohort prevalence risks, projections indicated insufficient progress toward the 2030 target.

CONCLUSION

The persistent global burden, inequalities and insufficient progress in addressing WCBA anaemia continue to call for improving anaemia management, contextually tailored, multisectoral nutritional and non-nutritional interventions to achieve the 2030 target.

Global, regional, and national burden of mental disorders among women of reproductive age, 1990-2021: a systematic analysis of the global burden of disease study 2021

BACKGROUND

Women of reproductive age (WRA), a key reproductive group, face mental health issues that impact both their own well-being and that of the next generation. However, research on the burden and trends of mental disorders among WRA remains limited. This study aimed to assess these on a global scale.

METHODS

The data from the Global Burden of Disease Study 2021 were utilized to analyze the age-standardized prevalence, age-standardized disability-adjusted life years (DALYs), and annual average percentage change (AAPC) of mental disorders among WRA from 1990 to 2021, examining variations by region, country, Socio-Demographic Index (SDI), and age group, along with DALYs attributable to risk factors.

RESULTS

In 2021, there were 343.22 million cases of mental disorders among WRA, with the highest DALYs among all diseases. From 1990 to 2021, the global burden increased, particularly for anxiety and major depressive disorders during the COVID-19 pandemic. Significant variations were observed across regions and countries. The different age groups showed different distributions of subtypes. High SDI regions showed the highest burdens, and the AAPC and SDI exhibit different correlation patterns before and during the pandemic. The burden of bullying victimization rose both before and during the pandemic, while intimate partner violence significantly increased during the pandemic.

CONCLUSIONS

The burden of mental disorders among WRA remained high from 1990 to 2021, exacerbated by the COVID-19 pandemic. Variations exist across regions, countries, age groups, and SDI, indicating a need for the development and adjustment of targeted interventions for WRA.

Global, regional, and national burden and trends of tension-type headache among adolescents and young adults (15-39 years) from 1990 to 2021: findings from the Global Burden of Disease study 2021

The prevalence of tension-type headache (TTH) is extremely high worldwide, but comprehensive global epidemiological studies targeting the specific age group of 15-39 years remain relatively limited. This study utilized data from the Global Burden of Disease 2021 (GBD 2021) study to analyze the incidence, prevalence, and disability-adjusted life years (DALYs) associated with TTH, and identified temporal trends using the estimated annual percentage change (EAPC). The study also investigated the association between the burden of TTH and the Socio-demographic Index (SDI). From 1990 to 2021, the global burden of TTH increased, with a 38% rise in prevalence cases and incidence cases. Across SDI regions, middle SDI region experienced the most significant growth in TTH cases, while high SDI regions showed a decline. Globally, the 35-39 age group faces a more severe disease burden, with prevalence cases at 188.27 (95% UI: 123.88-252.96) million, incidence cases at 61.82 (95% UI: 39.02-87.97) million, and DALYs cases at 461.94 (95% UI: 118.38-1494.8) thousand. From 1990 to 2021, the global epidemiological burden of TTH has shown a sustained increase. The most pronounced rise occurred in middle SDI regions, highlighting the urgent need for targeted public health strategies to enhance the quality of life among AYAs affected by TTH.

Genomic and clinical insights into ovarian cancer: subtype-specific alterations and predictors of metastasis and relapse

Ovarian cancer exhibits marked molecular heterogeneity and variable clinical outcomes. Understanding genomic alterations associated with metastasis and relapses may guide personalized management, particularly in high-grade serous carcinoma (HGSC). We performed targeted sequencing of 1021 cancer-related genes in tumor-normal pairs from 99 treatment-naïve ovarian cancer patients. Associations between copy number variations (CNVs), metastatic patterns, tumor mutation burden (TMB), and relapses were assessed. Analyses of relapse predictors were restricted to HGSC patients. Statistical significance was determined with Bonferroni correction for multiple comparisons. TP53 mutations were frequent in HGSC (96.6%), whereas PIK3CA, ARID1A, and ATRX mutations were enriched in non-HGSC tumors. FLT3, CDH23, and EPAS1 mutations were associated with metastasis. TMB-high tumors (≥ 9 mutations/Mb) showed distinct profiles, including SMARCA4 and FUBP1 mutations and CNV gains in CEBPA. Among HGSC patients, TBX3 mutations were exclusively observed in those relapsing within six months (p = 0.028), while ARID1B, MAP2K1, and FLT4 were enriched in relapse groups. After neoadjuvant chemotherapy and FIGO stage IV were also associated with relapses. This study reveals subtype-specific and metastasis-related genomic alterations in ovarian cancer and identifies potential relapse-associated mutations in HGSC. While exploring, these findings support further investigation into individualized risk stratification and biomarker-driven therapeutic strategies.

Exploring oral health related awareness, perceptions, practices and experiences among type 2 diabetes mellitus patients: a mixed method design

BACKGROUND/OBJECTIVE

The World Health Organization has classified diabetes mellitus as a pandemic disease, which is causing it to become a major worldwide health concern. It can have significant long-term repercussions, especially on dental health, if treatment is not received. The study aimed to explore patients with type 2 diabetes, awareness to, perceptions to and practices regarding oral health, in addition to their experiences.

MATERIALS AND METHODS

Convergent triangulation was applied from May to November 2022. 376 patients with type 2 diabetes mellitus participated in the quantitative part and 13 patients involved in the qualitative study. The quantitative study was applied in five randomly selected primary health centers representing the five Gaza governorates using self-developed semi-structured questionnaire. The qualitative study was applied in two central primary health centers. Descriptive analysis was applied using the SPSS software and thematic analysis was approached for the qualitative study.

RESULTS

64.4% of patients see themselves susceptible to oral health problems, and 67.8% perceived severity of oral complications of diabetes mellitus. Moreover, 73.2% perceived benefits from oral health practices and 56.2% perceived barriers to oral health practices. Patients' awareness regarding oral health complications from DM and oral health practices are inadequate (57.6%), as well as oral health habits (42.5%). Main themes elucidated from the qualitative study are dental care service quality, patient-dentist interaction, oral hygiene and self-care, and the patient's experiences with oral health problems.

CONCLUSIONS

The results point to important gaps in patients' knowledge and attitudes about dental health in relation to diabetes mellitus. Even though most people are aware of their vulnerability to oral health problems and the seriousness of any potential consequences, a sizable portion continue to believe that there are obstacles in the way of good oral hygiene habits. Poor oral hygiene practices and a lack of knowledge about oral health issues point to the need for more focused interventions and improved educational programs. The significance of high-quality dental care services, productive patient-dentist relationships, and encouraging self-care behaviors are all emphasized by the qualitative findings. In order to improve patient outcomes and encourage better dental hygiene habits among diabetics, these issues must be addressed. This will ultimately reduce oral health complications and increase general well-being.

Pediatric migraine care: bridging gaps, overcoming barriers, and advancing solutions

Pediatric migraine is an increasingly recognized public health concern, with a rising prevalence among children and adolescents. Despite advances in our understanding of migraine mechanisms and treatment, major gaps and barriers persist in diagnosis, management, and awareness. This review highlights the current gaps in pediatric migraine care, including underdiagnosis, comorbidities, disparities in access to treatment, and proposes actionable strategies to improve outcomes. A structured narrative review focused on pediatric migraine prevalence, diagnosis, treatment, and comorbidities. Emphasis was placed on interdisciplinary collaboration, emerging mechanism-based therapies, and holistic approaches to managing pediatric migraine. Pediatric migraine are frequently underdiagnosed and undertreated, partly due to a lack of physician awareness, inadequate training, and outdated guidelines. Emerging mechanism-based therapies, such as CGRP-targeted treatments, hold promise but are not yet widely adopted in pediatric care and are unlikely to be accessible to all but a few patients. Holistic approaches, including lifestyle modifications and behavioral therapy, can complement traditional treatments but remain underutilized.

CONCLUSION

Addressing the current gaps and barriers in pediatric migraine care requires updated clinical guidelines, increased healthcare provider training, increased awareness of comorbidities, affordability of approved medications, and encouragement of holistic treatment options. By fostering interdisciplinary collaboration and expanding access to care, better outcomes can be achieved for children suffering from migraine.

WHAT IS KNOWN

• Pediatric migraine is a prevalent but often underdiagnosed condition, with significant impact on quality of life. • Traditional treatment approaches are frequently inadequate, and physician awareness and training remain suboptimal.

WHAT IS NEW

• This review identifies critical gaps in pediatric migraine care, including limited access to emerging therapies and insufficient integration of holistic approaches. • It proposes actionable strategies such as interdisciplinary collaboration, updated guidelines, and enhanced provider education to improve care outcomes.

Cumulative blood pressure load as a predictor of arterial stiffness progression and incident diabetic kidney disease: a multicenter longitudinal study

BACKGROUND

Elevated blood pressure (BP) is a key contributor to the progression of arterial stiffness and the incidence of diabetic kidney disease (DKD). Cumulative BP load enables the evaluation of long-term BP exposure, but the BP targets used to calculate it vary across studies. This study aimed to compare the predictive performance of cumulative BP load calculated using different clinically recommended BP targets.

METHODS

This multicenter longitudinal study included participants with type 2 diabetes from 10 diabetes centers. Cumulative BP load was calculated using various clinically recommended BP targets (SBP < 140 mmHg, < 130 mmHg, and < 120 mmHg). The primary outcomes were the progression of arterial stiffness, assessed by brachial-ankle pulse wave velocity (ba-PWV) changes, and the incidence of DKD, defined as an estimated glomerular filtration rate < 60 mL/min/1.73m2 or urine albumin-to-creatinine ratio ≥ 3.39 mg/mmol. The predictive ability of cumulative BP load calculated under different clinically recommended targets was compared using adjusted R squared (adjusted R2) for continuous outcomes and net reclassification improvement (NRI) for binary outcomes.

RESULTS

Among the 18,168 participants included (mean age 54.5 years; 57.5% male), 13,388 met all eligibility criteria for the analysis of arterial stiffness progression, and 11,145 for the analysis of DKD incidence. Over a mean follow-up of 3.5 years, the median ba-PWV increase was 0.19 m/s per year and 2,855 (25.6%) developed DKD. When cumulative BP load was added to a model containing traditional risk factors, the adjusted R2 values for predicting the absolute annual change in ba-PWV were 0.193 (95% CI 0.180-0.200), 0.184 (0.169-0.191), and 0.172 (0.158-0.180) with BP targets of SBP < 120, < 130, and < 140 mmHg, respectively. For the incidence of DKD, the NRIs were 15.8% (11.5-20.0%), 12.5% (8.3-16.7%), and 6.4% (2.3-10.6%) with BP targets of SBP < 120, < 130, and < 140 mmHg, respectively.

CONCLUSION

Cumulative BP load is an effective indicator for predicting the progression of arterial stiffness and incidence of DKD, with the best predictive performance observed when the target SBP is set at < 120 mmHg.

Epidemiological and sociodemographic transitions in the global burden and risk factors for Alzheimer's disease and other dementias: a secondary analysis of GBD 2021

BACKGROUND

The study aimed to analyze the long-term trends in the global burden of Alzheimer's disease and other dementias(ADOD) in different regions, and assess the association between socio-demographic index(SDI) and disease burden.

METHODS

We extracted data on the incidence, mortality, disability-adjusted life-years(DALYs), and age-standardized rates related to ADOD, as disease burden measures from 1990 to 2021. The joinpoint regression, quantile regression and restricted cubic splines were adopted to estimate the temporal trends and relationships with SDI. Risk factors for deaths and DALYs were also analyzed.

RESULTS

Globally, 9.84 million cases of ADOD occurred in 2021, with 1.95 million ADOD-related deaths, causing 36.33 million DALYs. ADOD incidence, mortality and DALYs all increased from 1990 to 2021. Regional and sex variations persisted, with the fastest increase in age-standardized death rate in low-middle SDI quintiles, experienced the highest estimated annual percentage changes (0.41[0.31,0.52]). The incidence of ADOD increased more rapidly as SDI increased in areas that have historically shown lower incidence compared to other areas. In regions with higher mortality or DALYs burden, these indicators decreased relatively faster as SDI increased. High fasting plasma glucose was the main risk factor, particularly in high SDI region, with an increasing trend in attributable burden. The burden attributable to high BMI was increasing, whereas the burden associated with smoking steadily decreased.

CONCLUSION

ADOD poses a significant and escalating challenge to healthcare sustainability, with persistent regional and gender disparities. By learning from successful ADOD management in certain nations, we can proactively reduce health burdens and bridge disparities between countries at various developmental levels.

Burden and projections of malignant neoplasm of bone and articular cartilage in China: an analysis for the global burden of disease study 2021

BACKGROUND

Malignant neoplasm of bone and articular cartilage (MNBAC) represents one of the most prevalent malignant tumours among adolescents. Assessing its disease burden trends is critical for formulating prevention strategies. This study aims to evaluate the temporal trends of MNBAC burden in China, project future trajectories over the next 15 years, and compare these patterns with global benchmarks.

METHODS

Data on incidence, prevalence, deaths, and disability-adjusted life years (DALYs) were extracted from the Global Burden of Disease (GBD) database 2021. Joinpoint regression analysed temporal trends, while decomposition analysis was used to investigate the impact of aging, population growth, and epidemiological factors on the deaths and DALYs rates of MNBAC. Additionally, we conducted BPAC model to project future trends to 2036. Spearman correlation assessed associations between the burden of MNBAC and the socio-demographic Index (SDI).

RESULTS

In 2021, China's age-standardised incidence rate (ASIR), age-standardised prevalence rate (ASPR), age-standardised mortality rate (ASMR) and age-standardised DALYs rate (ASDR) for MNBAC were 1.42, 9.16, 0.93, and 29.52 per 100,000 population, respectively. Compared to 1990, these metrics increased by 118.46%, 125.62%, 60.34%, and 46.43%. Age-specific analyses revealed a bimodal burden pattern globally, peaking in adolescent and elderly populations. Joinpoint regression identified fluctuating trends in China (initial declining, subsequent rise, and then in decline), contrasting with global pattern. Decomposition analysis indicated that the increasing MNBAC burden in China was primarily driven by population aging and epidemiological changes, whereas globally, population growth played a more significant role. Projections indicated modest declines in MNBAC burden for China and globally by 2036. Spearman correlation analysis showed that the ASIR and ASPR of MNBAC in China and globally were significantly positively correlated with SDI (P < 0.05), and the ASMR and ASDR of MNBAC were also positively correlated with SDI, but not significantly.

CONCLUSIONS

This analysis underscores the substantial burden of MNBAC in China, surpassing global trends. While projections suggest gradual declines, the persistent high disability burden in youth and elderly populations necessitates strengthened screening protocols and prevention strategies. These findings provide critical epidemiological evidence for optimizing MNBAC management policies.

The bile acid-gut microbiota axis: A central hub for physiological regulation and a novel therapeutic target for metabolic diseases

Bile acids are a family of signaling molecules synthesized in the liver and metabolized by gut bacteria. As metabolites of the intestinal microbiota, bile acids bind to various receptors, and affect the metabolism and immune function of the host, including glucose and lipid metabolism, energy homeostasis, and inflammatory response. Conversely, bile acids also shape the composition of the gut microbiota. Given their critical role in physiological regulation, disrupted bile acid signaling is closely linked to metabolic diseases. Consequently, therapeutic strategies targeting bile acids are increasingly being explored. The size, composition, and function of the bile acid pool can be modulated through direct treatments (e.g., bile acid replacement therapy, administration of bile acid receptor agonists/antagonists) or indirect treatments (e.g., gut microbiota modulation, probiotic supplementation), providing new ideas for preventing and treating metabolic diseases.

Prevalence of sexual violence against children and age at first exposure: a global analysis by location, age, and sex (1990-2023)

BACKGROUND

Measuring sexual violence against children (SVAC) is vital to prevention and advocacy efforts, yet existing prevalence studies present estimates for few countries. Here we estimate the prevalence of SVAC for 204 countries by age and sex, from 1990 to 2023, and also report the age at which young survivors of lifetime sexual violence first experienced sexual violence.

METHODS

We reviewed publicly available repositories for data on the prevalence of SVAC. To harmonise heterogeneity in the identified input data, we adjusted for alternative case definitions of SVAC and differential disclosure by survey mode. We then used a spatiotemporal Gaussian process regression to estimate a full time series of exposure to SVAC for each age-sex-country combination. We accounted for uncertainty in the underlying data and modelling processes. We also analysed the age at which adolescent and young adult survivors of lifetime sexual violence first experienced this type of violence by sex, data source, and world region.

FINDINGS

We estimate that the global age-standardised prevalence of SVAC was 18·9% (95% uncertainty interval [UI] 16·0-25·2) for females and 14·8% (9·5-23·5) for males in 2023. At the super-region level, these estimates ranged from 12·2% (9·0-17·2) in southeast Asia, east Asia, and Oceania to 26·8% (21·9-32·7) in south Asia for females and from 12·3% (5·2-24·6) in central Europe, eastern Europe, and central Asia to 18·6% (9·7-32·3) in sub-Saharan Africa for males. At the country level, age-standardised estimates ranged from 6·9% (4·8-9·6) in Montenegro to 42·6% (34·4-52·1) in Solomon Islands among females and from 4·2% (1·7-9·2) in Mongolia to 28·3% (13·2-49·8) in Côte d'Ivoire among males. Globally, these estimates remained relatively stable since 1990, with slight variations at the country and regional levels. We also find that the first experience of sexual violence among adolescents and young people occurred before the age of 18 years for 67·3% of female and 71·9% of male survivors.

INTERPRETATION

The prevalence of SVAC is extremely high for both females and males across the globe. Given data sparsity and ongoing measurement challenges, findings probably underestimate the true pervasiveness of SVAC. An overwhelmingly high proportion of survivors first experienced sexual violence during childhood, revealing a narrow yet sensitive window that should be targeted in future prevention efforts. It is a moral imperative to protect children from violence and mitigate its compounding impacts on health across the lifecourse.

FUNDING

The Gates Foundation.

Trends and cross-country inequalities of alcohol use disorders: findings from the global burden of disease study 2021

BACKGROUND

Alcohol use disorder (AUD) imposes a significant burden on individuals and society. With globalization, transnational alcohol corporations influence policy enforcement and consumer behavior, hindering cost-effective and evidence-based interventions such as reducing alcohol availability and restricting alcohol advertising, as recommended in the World Health Organization (WHO) Best Buys for the prevention and control of noncommunicable diseases (NCDs).This study utilizes the Global Burden of Disease Study 2021 dataset to examine global and regional disparities, offering key insights into the global trends of AUD and addressing critical research gaps.

RESULTS

The global age-standardised prevalence of alcohol use disorders among individuals aged 15 years and older decreased from 1,698 per 100,000 in 1990 to 1,335 per 100,000 in 2021, with an average annual percent change of -0.78%. Similarly, the average annual percent change for mortality and disability-adjusted life years were - 0.82% and - 0.83%, respectively. Importantly, the age-standardised decline in alcohol use disorders was more pronounced in females compared to males (prevalence: -0.82% versus - 0.75%; mortality: -1.22% versus - 0.73%; disability-adjusted life years: -0.95% versus - 0.79%). The age-standardised prevalence of alcohol use disorders may remain higher among males until the year 2040. For the older adult groups aged 55 to 74, there was no statistically significant decline in alcohol use disorders mortality rates (Ps ≥ 0.17). Furthermore, countries characterized by a high sociodemographic index did not exhibit a significant reduction in mortality (average annual percent change: 0.02%). Between 1990 and 2021, high levels of alcohol consumption and experiences of childhood sexual abuse were identified as major risk factors for alcohol use disorders.

CONCLUSION

Understanding the trends of AUD in the context of globalization is crucial. Given that certain populations continue to experience persistent alcohol-related issues, protecting these groups from the influence of transnational alcohol corporations through effective policy measures such as strengthening regulations on alcohol advertising targeting older adults, and establishing independent regulatory agencies may be a key strategy for reducing the global health burden of AUD.

Pterostilbene as a Multifaceted Anticancer Agent: Molecular Mechanisms, Therapeutic Potential and Future Directions

Pterostilbene (PT), a natural dimethoxy analogue of resveratrol, exhibits enhanced bioavailability and lipophilicity, making it a more effective therapeutic candidate than resveratrol. These pharmacokinetic advantages improve its cellular uptake and metabolic stability, positioning PT as a promising compound in cancer treatment. PT has shown significant anticancer activity in several malignancies, including melanoma, breast, colorectal, and ovarian cancers. Its mechanisms of action include induction of apoptosis through caspase activation, cell cycle arrest, and inhibition of angiogenesis and metastasis via downregulation of matrix metalloproteinase-9 and vascular endothelial growth factor. PT also modulates epigenetic processes such as DNA methylation and histone modifications, and targets cancer stem cells by reducing the expression of stemness markers like CD44 and c-Myc. Additionally, PT enhances the efficacy of standard chemotherapeutic agents such as cisplatin, doxorubicin, and 5-fluorouracil, with preclinical studies showing synergistic effects and reversal of drug resistance. A Phase II clinical trial (NCT03671811) in endometrial cancer patients has confirmed the safety of PT and revealed its ability to modulate immune-related gene expression and suppress mechanistic target of rapamycin (mTOR) signaling. Despite promising results, several challenges remain particularly low water solubility, limited systemic bioavailability, lack of large-scale human studies, and undefined therapeutic protocols. Future research should focus on advanced formulation strategies, rigorous clinical trials across cancer types, and identification of patient-specific therapeutic responses to support PT's integration into oncology practice.

Validation of REFRESH: A Dietary Screener for Rapid Evaluation FoR Environmentally Sustainable and Healthy Diets

BACKGROUND

The urgency of promoting sustainable diets, coupled with limited knowledge of dietary sustainability among health professionals, highlights the need for simple tools to assist in advocating for such diets in clinical settings.

OBJECTIVES

We aimed to design a dietary screener to assess dietary healthiness and environmental sustainability, and validate it.

METHODS

Rapid Evaluation FoR Environmentally Sustainable and Healthy diets (REFRESH) is a dichotomous tool targeting 10 key food groups for healthy diets with low environmental impacts. Each food group is scored as either 0 or 1 point, resulting in a total score ranging from 0 to 10-where 0 indicates the lowest and 10 the highest adherence to an environmentally sustainable and healthy diet. Internal consistency was assessed using the Kuder Richardson-20 (KR-20) coefficient. REFRESH's relative validity was compared against food diaries, evaluating item agreement, and using Bland-Altman analysis for the total REFRESH score. Cross-classification was tested in low, medium, and high adherence to sustainable healthy diets, along with weighted kappa index. Construct validity was evaluated through Pearson correlation between REFRESH-derived scores and health-promoting and detrimental food groups and nutrients, and environmental impact indicators, as derived from food diaries.

RESULTS

REFRESH had a KR-20 coefficient of 0.70, indicating good internal consistency. It showed high agreement with food diaries (60%-88% item agreement), and Bland-Altman analysis indicated that REFRESH scores were 1.1 points higher on average than food diaries. Cross-classification showed 59% agreement between methods, with only 1% of participants misclassified in the opposite category. REFRESH-derived scores positively correlated with health-promoting food groups and nutrients, and negatively with detrimental ones. Higher scores were linked to reduced environmental impacts.

CONCLUSIONS

REFRESH has demonstrated good validity for assessing dietary healthiness and environmental sustainability, helping identify individuals with suboptimal diets. REFRESH can be downloaded from https://osf.io/avby9/.

The trends of mortality, aetiologies and risk factors of lower respiratory infections in Saudi Arabia from 1990 to 2021: results from the global burden of disease study 2021

BACKGROUND

Lower respiratory tract infections (LRIs) are the fourth leading cause of death globally, affecting all age groups and leading to over 2 million deaths annually. Saudi Arabia faces a significant burden from LRIs, affecting more than 15% of the population each year. This study aims to provide an overview of LRI mortality, etiologies, and risk factors in Saudi Arabia from 1990 to 2021.

METHOD

Data on LRI mortality in Saudi Arabia from 1990 to 2021 were extracted from the 2021 edition of the Global Burden of Disease (GBD) Result Tool. The analysis encompassed mortality rates across all age groups, with particular emphasis on children under five and adults over 70. Four primary etiologies influenza, respiratory syncytial virus (RSV), Streptococcus pneumoniae, and Haemophilus influenzae type b (Hib) were examined, alongside 14 associated risk factors.

RESULTS

The total LRI deaths in Saudi Arabia decreased by 6% from 1990 to 2021, with a significant reduction observed among children under five years old (96%). In contrast, LRI mortality among adults over 70 increased by 16% during the same period. The age-standardized mortality rate decreased by 47%, with significant reductions in deaths associated with pneumococcus and RSV. However, risk factors, such as smoking and ambient particulate matter pollution, showed minimal declines or even increased mortality rates in older adults.

CONCLUSION

Over the past three decades, Saudi Arabia has made significant progress in reducing LRI mortality, particularly among children under five. However, the increasing mortality rates among the elderly highlight the need for targeted interventions to address their unique vulnerabilities. Continued investment in public health infrastructure, vaccination coverage, and environmental health initiatives is essential for further reducing the burden of LRIs in Saudi Arabia.

Global Burden of Pancreatic Cancer Among Individuals Aged 15-59 Years in 204 Countries and Territories, 1990-2021: A Systematic Analysis for the GBD 2021 and Projections to 2045

BACKGROUND

Pancreatic cancer (PC), the third leading cause of cancer-related mortality globally, exhibits a persistently low five-year survival rate (13%). While the global burden of PC among individuals aged 15-59 years has declined, trends in China remain understudied. This study evaluates global and national trends in PC incidence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2021 and projects trajectories to 2045.

METHODS

Using data from the Global Burden of Disease (GBD) 2021 study, we calculated age-standardized rates (ASRs) for 204 countries/territories. Joinpoint (version: 5.3.0.0) regression identified temporal trends via average annual percentage changes (AAPCs), and Bayesian age-period-cohort (BAPC) modeling forecasted future burdens.

RESULTS

Globally, PC burden declined among 15-59-year-olds (AAPC for incidence: -0.8%, 95% UI: -1.2 to -0.4). However, China experienced a significant reversal after 2009, with incidence rising by 1.5% annually (95% UI: 0.9-2.1), disproportionately affecting males. Smoking (contributing to 22.2% of DALYs in China) and high fasting plasma glucose (15%) emerged as key modifiable risk factors, while elevated BMI exacerbated burdens in high SDI regions (3.1% of DALYs). Projections indicate a continued surge in China's PC burden by 2045, particularly among males (incidence projected to increase by 50% from 2010 to 2045).

CONCLUSIONS

High SDI regions exhibit concentrated PC burdens linked to lifestyle factors, whereas China's rising trends align with healthcare expansion and metabolic disease proliferation. Targeted interventions-smoking cessation, glycemic control, and weight management-are imperative to mitigate growing burdens in younger populations. This study highlights the urgent need for region-specific strategies to address evolving epidemiological challenges in PC prevention and control.

Decoding the Liver-Heart Axis in Cardiometabolic Diseases

The liver and heart are closely interconnected organs, and their bidirectional interaction plays a central role in cardiometabolic disease. In this review, we summarize current evidence linking liver dysfunction-particularly metabolic dysfunction-associated steatotic liver disease, alcohol-associated liver disease, and cirrhosis-with an increased risk of heart failure and other cardiovascular diseases. We discuss how these liver conditions contribute to cardiac remodeling, systemic inflammation, and hemodynamic stress and how cardiac dysfunction in turn impairs liver perfusion and promotes hepatic injury. Particular attention is given to the molecular mediators of liver-heart communication, including hepatokines and cardiokines, as well as the emerging role of advanced research methodologies, including omics integration, proximity labeling, and organ-on-chip platforms, that are redefining our understanding of interorgan cross talk. By integrating mechanistic insights with translational tools, this review aims to support the development of multiorgan therapeutic strategies for cardiometabolic disease.

Insights Into Heart-Tumor Interactions in Heart Failure

Heart failure (HF) often coexists with cancer. Beyond the known cardiotoxicity of some cancer treatments, HF itself has been associated with increased cancer incidence. The 2 conditions share common risk factors, mechanisms, and interactions that can worsen patient outcomes. The bidirectional relationship between HF and cancer presents a complex interplay of factors that are not fully understood. Recent preclinical evidence suggests that HF may promote tumor growth via the release of protumorigenic factors from the injured heart, revealing HF as a potentially protumorigenic condition. Our review discusses the biological crosstalk between HF and cancer, emphasizing the impact of HF on tumor growth, with inflammation, and modulating the immune system as central mechanisms. We further explore the clinical implications of this connection and propose future research directions. Understanding the mechanistic overlap and interactions between HF and cancer could lead to new biomarkers and therapies, addressing the growing prevalence of both conditions and enhancing approaches to diagnosis, prevention, and treatment.

Incidence trends in paediatric psoriasis 1990-2021: findings from the Global Burden of Disease Study 2021

BACKGROUND

Paediatric psoriasis is a chronic inflammatory skin disease that poses unique challenges in diagnosis and management. While studies from high-income countries have reported increasing trends in incidence, data regarding the incidence of paediatric psoriasis worldwide remain scarce.

OBJECTIVE

To provide a comprehensive description of the incidence of paediatric psoriasis at the global, regional and national levels.

METHODS

We used data from the Global Burden of Disease Study 2021 to analyse trends in the incidence of paediatric psoriasis between 1990 and 2021. Incidence rates were stratified by age, sex and sociodemographic index (SDI). The estimated annual percentage change (EAPC) was used to quantify the temporal trends.

RESULTS

In 2021, there were 664 100 cases of paediatric psoriasis globally, with an incidence rate of 33.0 per 100 000 children. Over the study period, the global incidence increased by 0.21% (95% confidence interval 0.18-0.25%) per year, with more pronounced increases observed in regions categorized as low SDI and middle SDI. The highest incidence rates were recorded in regions categorized as high SDI, such as High-income North America (70.5 per 100 000) and Western Europe (67.5 per 100 000). Notably, the largest increases in incidence occurred in regions such as sub-Saharan Africa. At the national level, 189 countries/territories experienced significant increases in the incidence of paediatric psoriasis, while only 5 countries saw a decline. Incidence was higher in girls across all age groups, and the most pronounced increase was seen in children aged less than 5 years.

CONCLUSIONS

The incidence of paediatric psoriasis has increased significantly in recent years, particularly in regions categorized as low SDI and middle SDI, underscoring the need for improved diagnosis, early intervention and targeted public health strategies.

Brain basis for physical activity levels mediate beta Inhibition to improve cognitive function in elderly based on multimodality monitoring

The ameliorative effect of regular physical activity (PA) on cognitive function (CF) in older adults has been demonstrated. However, there are differences in the effects of different levels of PA on CF over time. To provide a more efficient exercise prescription for older adults, we compared differences in CF with neural mechanisms in individuals with different weekly activity levels. In this study, 68 older adults (n = 68, M = 47, F = 21, Age = 62.43 ± 4.36) were categorized according to the International Physical Activity Questionnaire (IPAQ) into high volume PA group (HG) (MET-min/week = 1516.64 ± 138.68), moderate volume PA group (MG) (MET-min/week = 1248.02 ± 119.86), and control group (MET-min/week = 1248.02 ± 119.86). 1516.64 ± 138.68), moderate volume PA group (MG) (MET-min/week = 1248.02 ± 119.86), and control group (MET-min/week = 846.78 ± 97.53). Differences in Stop Signal, Stroop, and 2-Back were compared among the three groups. Electroencephalogram (EEG), event-related potential (ERP), and magnetic resonance imaging (MRI) features were also observed. The results showed that for CF, 2-Back with Stroop was significantly higher in MG versus HG than in CG (F = 121.45, P < 0.01; F = 88.74, P < 0.01), and the opposite was true for response (F = 236.83, P < 0.01; F = 187.64, P < 0.01). Stroop was higher in HG than in MG (F = 38.78, P = 0.037) and Stop Signal was higher than in CG (F = 52.03, P < 0.01). In terms of EEG, the alpha band share of HG was higher than CG at rest (F = 41.34, P = 0.040) and the opposite in work (F = 25.67, P = 0.046). Although the remaining results were not statistically significant, PA levels were inversely proportional to resting midrange-band β (CG = 8.98 ± 1.02, MG = 8.07 ± 0.76, HG = 8.13 ± 0.88), and positively proportional to midrange and high-band β in WORK (midrange β: CG = 12.41 ± 2.29, MG = 12.98 ± 3.04, HG = 13.21 ± 2.85; high β: CG = 6.76 ± 2.23, MG = 7.35 ± 1.96, HG = 7.91 ± 2.3). In ERP, the latencies of N200, P300, and N450 were significantly shorter than those of CG in HG (F = 44.63, P = 0.041; F = 29.69, P = 0.045; F = 76.48, P < 0.01), and only N450 was shorter than that of CG in MG (F = 59.62, P < 0.01). On MRI, HG had Middle Frontal Gyrus (MFG) (HG > CG, voxel = 188, t = 3.72), Right Superior Frontal Gyrus (RSFG) (HG > CG, voxel = 238, t = 4.07), Left Cingulate (HG > CG, voxel = 343, t = 4.36), and Left Supplementary Motor Area (LSMA) (HG > CG, voxel = 343, t = 4.36) were activated more than CG. MFG (MG > CG, voxel = 172, t = 3.56), LSMA (MG > CG, voxel = 331, t = 4.28), and PHG (MG > CG, voxel = 204, t = 3.35) were activated more than CG. It was concluded that PA significantly enhanced CF in older adults, and that high volume PA was more effective than moderate volume. Specifically, VPA was found to be significantly more effective than MPA and LPA in enhancing individuals' inhibition function, cognitive flexibility, working memory, and reaction speed. This may be attributed to the increase in ERP amplitude with shorter latency and greater gray matter density in frontal and temporal lobe regions.

Global, Regional and National Burden of Stomach Cancer and Its Prediction in 25 Years: A Cross-Sectional Study of the Global Burden of Disease Study 2021

Aims/Background Given the tremendous threat of stomach cancer (SC) to global public health, detailed information and dynamic updates on the SC health burden are needed to mitigate the repercussions. In this article, we present a systematic analysis of the global burden and trends of SC using data from the Global Burden of Disease (GBD) Study 2021, aiming to provide insights for forming effective global management and prevention strategies. Methods Stomach cancer incidence, prevalence, mortality, disability-adjusted life years (DALYs) and the corresponding age-standardized rates (ASRs) were estimated. Then, trends of the disease burden were analyzed using the estimated annual percentage changes (EAPC). Lastly, we made a unique attempt to use two powerful and versatile techniques, autoregressive integrated moving average (ARIMA) and exponential smoothing (ES) models, to provide more comprehensive and accurate forecasts for future trends in the disease burden. Results Despite the steady decreasing trend in age-standardized rates, the total numbers of incidence, prevalence, and deaths all increased from 1990 to 2021. Subgroup analysis demonstrated great disparities in different age and gender groups, sociodemographic index (SDI) quintiles, GBD regions and countries. Both the ARIMA and ES models demonstrated a persistent rise in SC cases and a concurrent decline in ASRs, with the trend being more pronounced in males. Conclusion Since SC is already a significant health issue globally, it is expected that the estimated disease burden will continue to rise in the future. Therefore, global coordinated efforts are needed to implement effective screening projects, consolidate preventive measures and formulate targeted treatments to alleviate the SC burden.

Factors affecting the severity of respiratory infections: a hospital-based cross-sectional study

BACKGROUND

Acute respiratory infections (ARIs) are a leading cause of global morbidity and mortality, with disease severity influenced by factors such as advanced age, underlying comorbidities, and pathogen type. This report analyzed the association between several clinical variables and disease severity.

METHODS

A hospital-based cross-sectional study was conducted from September 2023 to April 2024, with data collected from eight districts in Chongqing, China. The study included 1,638 patients with ARIs, including both severe and mild cases. Severe cases were identified using the qSOFA and APACHE II scores, while demographic and clinical data were obtained via questionnaires and hospital records. Pathogen detection was performed using real-time quantitative PCR. Data analysis was carried out using Stata 17.0, with multiple logistic regression models assessing the associations between clinical factors and disease severity.

RESULTS

Influenza A was the most prevalent pathogen, detected in 65.1% of severe cases and 32.9% of mild cases (P < 0.001). 42.0% (165/393) of severe cases had viral and bacterial co-infections, compared to 26.8% (334/1,245) of mild cases (P < 0.001). The most common pathogens in co-infections included influenza A and Streptococcus pneumoniae. Severe cases were more common in rural areas (28.8% vs. 18.1%, P < 0.001) and among older adults (≥ 60 years) (28.2% vs. 13.5%, P < 0.001). Clinical symptoms such as fever (61.8% vs. 40.9%, P < 0.001), cough (68.7% vs. 53.2%, P < 0.001), and dyspnea (34.8% vs. 15.1%, P < 0.001) were significantly more prevalent in severe cases. Logistic regression analysis showed that influenza A (OR: 4.52, 95% CI: 3.51-5.85), Streptococcus pneumoniae (OR: 1.54, 95% CI: 1.28-2.15), and pre-existing cardiovascular diseases (OR: 1.96, 95% CI: 1.28-2.99) were significantly associated with the development of severe outcomes.

CONCLUSIONS

This study underscores the complex interplay of factors influencing ARI severity, including pathogen type, co-infections, age, and underlying medical conditions. Early identification of high-risk patients, particularly those with bacterial co-infections and cardiovascular comorbidities, is essential for improving clinical outcomes in ARI patients. Targeted treatment and preventative strategies are needed to mitigate severe disease in vulnerable populations.

CLINICAL TRIAL NUMBER

Not applicable.

The immune system in cardiovascular diseases: from basic mechanisms to therapeutic implications

Immune system plays a crucial role in the physiological and pathological regulation of the cardiovascular system. The exploration history and milestones of immune system in cardiovascular diseases (CVDs) have evolved from the initial discovery of chronic inflammation in atherosclerosis to large-scale clinical studies confirming the importance of anti-inflammatory therapy in treating CVDs. This progress has been facilitated by advancements in various technological approaches, including multi-omics analysis (single-cell sequencing, spatial transcriptome et al.) and significant improvements in immunotherapy techniques such as chimeric antigen receptor (CAR)-T cell therapy. Both innate and adaptive immunity holds a pivotal role in CVDs, involving Toll-like receptor (TLR) signaling pathway, nucleotide-binding oligomerization domain-containing proteins 1 and 2 (NOD1/2) signaling pathway, inflammasome signaling pathway, RNA and DNA sensing signaling pathway, as well as antibody-mediated and complement-dependent systems. Meanwhile, immune responses are simultaneously regulated by multi-level regulations in CVDs, including epigenetics (DNA, RNA, protein) and other key signaling pathways in CVDs, interactions among immune cells, and interactions between immune and cardiac or vascular cells. Remarkably, based on the progress in basic research on immune responses in the cardiovascular system, significant advancements have also been made in pre-clinical and clinical studies of immunotherapy. This review provides an overview of the role of immune system in the cardiovascular system, providing in-depth insights into the physiological and pathological regulation of immune responses in various CVDs, highlighting the impact of multi-level regulation of immune responses in CVDs. Finally, we also discuss pre-clinical and clinical strategies targeting the immune system and translational implications in CVDs.

Global incidence trends and projections of Alzheimer disease and other dementias: an age-period-cohort analysis 2021

Background

Alzheimer disease (AD) is a growing global health issue, with incidence varying by gender, age, and region. Understanding these trends is essential for developing effective prevention strategies as the population ages. Unlike previous Global Burden of Disease (GBD) studies that primarily focussed on prevalence and mortality, we offer a novel perspective by examining historical incidence trends and projecting future patterns of AD and other dementias using advanced analytical approaches.

Methods

We used data from 204 countries and 21 global regions from the GBD 2021 database. We applied the age-period-cohort (APC) model to analyse historical incidence trends, and the Bayesian APC (BAPC) model to forecast future incidence from 2022-36. These models help reveal changes related to age, period, and birth cohort and enable forecasting of future trends - analytical perspectives not provided in the original GBD data sets or their supplementary documents.

Results

Between 1992-2021, global AD cases increased from 4.078 million to 9.837 million, while the global age-standardised incidence rate (ASIR) remained relatively stable, rising slightly from 117.7 to 119.8 per 100 000. ASIR increased significantly in high-middle and middle-sociodemographic index regions, but declined in the low-sociodemographic index regions. Women consistently exhibited higher incidence rates than men across all regions. Projections indicate that 2036 global AD cases will reach 19.117 million, with an ASIR of 418.92 per 100 000.

Conclusions

While global ASIR has remained stable, the number of AD cases continues to rise due to population ageing, particularly in middle- and high-income regions. Low-income regions face additional challenges due to limited health care resources. Gender disparities and unequal access to health care contribute to the variations in disease burden. These findings emphasise the need to prioritise early diagnosis and implement targeted interventions to reduce future disease burdens and address global health care inequalities.

From Hemostasis to Angiogenesis: A Self-Healing Hydrogel Loaded with Copper Sulfide-Based Nanoenzyme for Whole-Process Management of Diabetic Wounds

Diabetic wounds pose considerable healing challenges due to factors such as impaired angiogenesis, persistent inflammation, elevated levels of reactive oxygen species, and bacterial infections. In this study, we synthesized copper sulfide nanoparticles (NPs) using sericin as a biotemplate and functionalized them with tannic acid-Fe (TA-Fe) metal-phenolic network coatings to create CuS-based nanoenzymes (CuS-Se@TA-Fe NPs). These NPs were integrated into a composite hydrogel formed from polyvinyl alcohol, carboxymethyl chitosan, and borax. The hydrogen bonding between polyvinyl alcohol and carboxymethyl chitosan, combined with the borate ester bonds from borax and the electrostatic interactions with CuS-Se@TA-Fe NPs, resulted in a hydrogel with remarkable adhesion, self-healing capabilities, and shape retention (PCCuT hydrogel). Additionally, the PCCuT hydrogel demonstrated superoxide dismutase and catalase mimetic activities to eliminate excess free radicals, along with excellent photothermal conversion and antimicrobial properties due to the photothermal effect. Both in vitro and in vivo investigations indicated that the PCCuT hydrogel could enhance angiogenesis and promote the transformation of macrophages into the M2 anti-inflammatory phenotype. Notably, in a rat model of diabetic wound infection, the hydrogel exhibited substantial wound-healing benefits. In summary, the PCCuT hydrogel holds promise for advancing the treatment of diabetic wounds complicated by infection.

Prevalence of liver fibrosis index-4 (FIB-4) positive results in patients with diabetes

INTRODUCTION

One of the most important emerging complications associated with diabetes is the Metabolic dysfunction-Associated Fatty Liver Disease (MAFLD). The liver fibrosis index-4 (FIB-4) is proposed, as a first approach, to screening for cirrhosis in these patients.

PATIENTS AND METHODS

All unique patients attended by diabetes in the EDN department of our hospital from 1 January 2022 to 31 December 2022 were included. The FIB-4 value for each patient was obtained retrospectively from the laboratory programme of our hospital.

RESULTS

1259 unique patients with type 2 diabetes were attended, and the prevalence of advanced FIB-4 in these patients was 4.77% [95%CI: 3.66-6.09%]. 580 unique patients with type 1 diabetes were attended, and the prevalence of advanced FIB-4 in these patients was 1.72% [95%CI: 0.83-3.15%].

DISCUSSION

Our study confirms the importance of FIB-4 in people with diabetes to identify patients at higher risk of advanced liver fibrosis. We must highlight that 10.9% of patients with type 2 diabetes and 9.5% of patients with type 1 diabetes had an indeterminate FIB-4 result.

Single-Inhaler Triple Therapy in Primary Care Across Europe: Expert Panel Consensus on the Consequences of Payer-Driven Access Rules and Call to Action

Background

Chronic obstructive pulmonary disease (COPD) is a prevalent condition characterized by persistent airflow obstruction and respiratory symptoms. Single-Inhaler Triple Therapy (SITT) has been shown to improve patient adherence, reduce exacerbations, and lower healthcare resource utilization in patients who are not controlled despite being on dual therapy or Multiple-Inhaler Triple Therapy (MITT). Despite evidence supporting SITT, payer-driven access rules across Europe sometimes limit its use in primary care, creating barriers to optimal COPD management.

Purpose

Through expert consensus, the study seeks to generate a shared understanding of the unintended consequences of payer-driven access criteria for SITT in managing moderate-to-severe COPD in primary care.

Methods

A targeted literature review (TLR) was conducted to assess SITT initiation in primary care across Europe and examine the impact of access criteria. Semi-structured interviews were held with 14 experts from nine European countries, including clinicians, health economists, and patient advocacy representatives. A consensus generation workshop was conducted, where experts evaluated the findings and developed position statements to highlight the challenges posed by payer-driven access criteria.

Results

The TLR identified variability in access to SITT in Europe, with several countries restricting its initiation to specialists, thus limiting primary care physicians' (PCPs) ability to prescribe SITT. The expert panel generated seven consensus points stating that enabling PCPs to step up or switch eligible patients to SITT has the potential to support care continuity, enhance clinical autonomy for PCPs, reduce reliance on potentially less effective treatment options, improve patient and healthcare system outcomes, avoid unnecessary referrals to specialists, enable prompt initiation of guideline-directed medical therapy for COPD in primary care and reduce access inequalities.

Conclusion

Restrictions for SITT initiation in primary care may need to be revisited to mitigate their unintended health and cost consequences and improve equitable access to treatment. This should take into consideration each country's unique healthcare system.

A Unique Comparison of Tooth Extraction Before and After Emicizumab Prophylaxis in a Patient With Haemophilia A and Inhibitors

Haemophilia A is an inherited X-linked bleeding disorder caused by Factor VIII deficiency; approximately 30% of the patients with haemophilia A develop inhibitors against Factor VIII. Emicizumab has been licenced for the prevention of bleeding in patients with haemophilia A with inhibitors and has demonstrated an 87% reduction in the annualised bleeding rate compared with on-demand therapy in patients with haemophilia A with inhibitors. Emicizumab is approved not only for patients with inhibitors but also for those without inhibitors. However, no reports exist on intraindividual comparisons of perioperative management of tooth extraction before and after emicizumab prophylaxis. This case report describes the perioperative management of similar tooth extractions in the same patient with haemophilia A with inhibitors before and after the initiation of emicizumab. This report provides a unique opportunity for intraindividual comparison of the usage of bypassing agents, postextraction bleeding, and medical costs with and without emicizumab. Furthermore, our report also supports the hypothesis that emicizumab is superior in preventing postoperative bleeding complications.

Global Epidemiology of Early-Onset Digestive System Malignancy: A Systematic Analysis for the Global Burden of Disease Study 2021

BACKGROUND AND AIM

The researches on the global burden of digestive system malignancy in young populations were limited. This study aimed to comprehensively investigate the burden of early-onset digestive system malignancy (often defined as cancers diagnosed below the age of 50) based on the Global Burden of Disease 2021.

METHODS

Data of incidence, prevalence, deaths, disability-adjusted life years (DALYs), and risk factors for the five major early-onset digestive system malignancies, including early-onset esophageal cancer (EOEC), early-onset gastric cancer (EOGC), early-onset liver cancer (EOLC), early-onset pancreatic cancer (EOPC), and early-onset colorectal cancer (EOCRC), were extracted from GBD 2021. The average annual percent change (AAPC) was calculated using joinpoint regression analysis. The Bayesian age-period-cohort (BAPC) model was utilized to predict the burden up to 2030.

RESULTS

From 1990 to 2021, the age-standardized incidence rate (ASIR) of early-onset digestive system malignancies, except for EOCRC (AAPC, 0.37), showed a decreasing pattern. Meanwhile, the age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) of early-onset digestive system malignancy presented a downward trend. Notably, high-middle sociodemographic index (SDI) countries experienced higher disease burdens. Dietary risk factors, tobacco, alcohol consumption, and metabolic factors were the main risk factors. The ASIR of EOEC and EOCRC was projected to increase in 2030, whereas the trend for EOGC, EOLC, and EOPC was projected to decrease.

CONCLUSIONS

Early-onset digestive system malignancy presented notable heterogeneity across gender, geography, and cancer types. This emphasizes the urgency of addressing the public health challenge of early-onset digestive system malignancy.

Current Knowledge of the Impact of Vitamin D in Coronary Artery Disease

Coronary artery disease and vitamin D deficiency are both widespread conditions with a high incidence worldwide. Coronary artery disease is a complex illness with variable manifestation and pathogenesis. It often involves the development of atherosclerosis, and it frequently has serious or even fatal consequences for the patient. Vitamin D receptor expression is found in many tissues throughout the body, which results in a broad effect of the vitamin. Studies have found correlations between vitamin D deficiency and the development of coronary artery disease as well as other cardiovascular diseases, such as hypertension. This review will discuss randomized controlled trials conducted from 2020 forward, aiming to elucidate whether vitamin D supplements have the potential to be used as an add-on treatment for coronary artery disease. The randomized controlled trials all used vitamin D as intervention and tested a population suffering from coronary artery disease or the risk of developing it. Even though animal studies found evidence that vitamin D can regulate inflammation, lipid profile, foam cell formation, vessel reactivity, and blood pressure, which are all mediators in the development of atherosclerosis, the results from the randomized controlled trials were ambiguous. The general older population did not seem to benefit from the treatment, but different subgroups such as patients with type 2 diabetes and patients with more developed coronary artery disease exhibited some positive effects from the treatment. Furthermore, vitamin D showed cardioprotective effects following coronary artery bypass surgery, which make it a possible add-on treatment before invasive coronary intervention. The question in focus still needs further research and a more focused approach on subgroups that may benefit from treatment.

Global burden of low back pain from 1990 to 2021: a comprehensive analysis of risk factors and trends using the Global Burden of Disease Study 2021

BACKGROUND

This study comprehensively assesses low back pain-related risk factors and the global burden from a multi-dimensional perspective, aiming to provide scientific evidence for disease prevention.

METHODS

Data from the Global Burden of Disease (GBD) database spanning from 1990 to 2021 were incorporated into this study. We conducted an analysis of baseline data, as well as gender and age subgroup data. Additionally, we introduced the Age-Period-Cohort (APC) and decomposition analysis models to clarify the independent effects of factors such as age, period, cohort, population growth, population aging and changes in epidemiological trends on the disease burden. The Estimated Annual Percentage Change (EAPC) was used to measure the temporal trends of health indicators. To enhance practical applicability, we constructed a model that integrates frontier analysis with health inequality assessment. Furthermore, the Autoregressive Integrated Moving Average (ARIMA) model was employed to forecast trends in LBP over the next 15 years.

RESULTS

In 2021, the global age-standardized prevalence of low back pain decreased by 11.06% compared to that in 1990. However, the number of affected individuals increased from 386.7 million to 628.8 million. Concurrently, the age-standardized Disability-Adjusted Life Years (DALYs) rate declined by 11.22% relative to 1990, while total DALYs rose from 43,386,225 to 70,156,962. The results derived from multiple models indicate that higher socio-demographic index levels, advancing age, female sex and occupational ergonomics-related factors may contribute to disparities in the burden of low back pain. Furthermore, this unequal health gap appears to be widening over time.

CONCLUSIONS

Disease burden of low back pain exhibit varying manifestations across different regions and temporal dimensions. Higher levels of the Socio-Demographic Index(SDI), increasing age, female gender and adverse occupational ergonomic factors may be important risk elements for the burden of low back pain. Meanwhile, certain changes in epidemiological trends may alleviate this burden to some extent. In the absence of effective intervention measures, the gaps in health inequality engendered by the aforementioned diverse factors are likely to expand continuously. In light of this, it is crucial to actively develop systematic, comprehensive and targeted health prevention strategies.

Palliative care burden and specialist service utilisation for individuals with cardiovascular disease in Australia: a national population-based observational study

BACKGROUND

Cardiovascular disease (CVD) is a major cause of death globally. In advanced stages, patients with CVD often require palliative care due to reduced health-related quality of life from physical, psychological and spiritual symptoms, along with physical disability.

OBJECTIVES

To investigate (1) the symptom and function burden of patients with CVD on their first admission to specialist palliative care services and (2) how these care burdens, and other clinical characteristics, affected patients' utilisation of community-based versus inpatient services.

DESIGN

A national population-based observational study using point-of-care outcomes sourced from the Australian palliative care outcomes and collaboration (PCOC).

SETTINGS

Community-based and inpatient Specialist palliative care services across Australia registered in the PCOC.

PARTICIPANTS

Patients who required specialist palliative care principally for CVD, and whose death occurred between 1 January 2013 and 31 December 2022.

METHODS

Five validated clinical instruments were used to collect point-of-care outcomes on each individual's function (Resource Utilisation Groups - Activities of Daily Living (RUG) & Australia-modified Karnofsky Performance Status (AKPS)), symptom distress (Symptoms Assessment Scale & Palliative Care Problem Severity Score) and other clinical characteristics (Palliative Care Phases). Multivariable logistic regression was applied to evaluate how patients' functional and symptom burden influenced their use of inpatient versus community-based palliative care services.

RESULTS

Our analysis included 17 002 patients with CVD, with 7539 (44.3%) receiving community palliative care services and 9463 (55.7%) accessing inpatient palliative care services. On admission to palliative care services, patients often exhibit significant physical functional impairments and substantial symptom burdens, particularly related to fatigue and breathing difficulties. In comparison, patients accessing inpatient services tended to have greater functional impairment (p<0.001) but commonly reported lower symptom burdens (p<0.001). Our analysis indicated that greater functional impairment (ORs ranged from 2.53 to 6.02, p<0.001 for RUG; ORs ranged from 1.72 to 5.02, p<0.008 for AKPS), poorer overall health condition (OR ranged from 1.28 to 17.60, p<0.001) and referrals by a community service (OR=0.16, 95% CI: 0.14 to 0.18, p<0.001) were a negative predictor of inpatient services use. Surprisingly, higher levels of symptom distress and challenges in symptom management were associated with a decreased likelihood of using inpatient services compared with community-based services.

CONCLUSION

Patients with CVD frequently require support to manage decreased functional abilities, as well as symptoms like fatigue and breathing difficulties. With greater investment in community-based supportive services and a skilled palliative care workforce, more individuals with advanced CVD could potentially receive palliative care in community settings.

Association of Ambient Air Pollution With Invasive Pulmonary Hemodynamics and Long-Term Outcomes in Patients With Pulmonary Arterial Hypertension

BACKGROUND

Although the impact of ambient air pollution on mortality in cardiovascular and pulmonary diseases is well documented, its specific link to pulmonary arterial hypertension remains unclear. This study investigated the association between ambient particulate matter (PM) exposure and all-cause death or lung transplantation, as well as pulmonary hemodynamics in patients with pulmonary arterial hypertension.

METHODS

This retrospective cohort study included 1327 participants with pulmonary arterial hypertension who underwent right heart catheterization (RHC). Ambient PM2.5 and PM10 levels were estimated using the China High Air Pollutants data set, with a 3-year average exposure before diagnosis as the primary exposure metric. All-cause death or lung transplantation was the primary end point. Cox proportional hazard models assessed the association between PM exposure and primary outcomes, and generalized linear models evaluated pulmonary hemodynamics. Mediation analysis explored potential mediating factors.

RESULTS

The median age of the participants was 33.0 years, with 73.2% being women. Median PM2.5 and PM10 levels were 58.0 [43.6-76.1] and 103.0 [80.4-129.3] μg/m3, respectively. Over a median follow-up of 3.1 years, 149 patients died or underwent lung transplantation. Each 10 μg/m3 increase in PM2.5 and PM10 was associated with a 14.5% and 7.9% increased risk of primary outcomes, respectively. PM exposure was linked to worsened pulmonary hemodynamics, such as pulmonary vascular resistance and cardiac index. Mediation analysis suggested lipid metabolism, uric acid, and lymphocytes may partially mediate these effects.

CONCLUSIONS

Long-term PM2.5 and PM10 exposure is not only associated with increased risk of death or lung transplantation in patients with pulmonary arterial hypertension but also affects disease severity and pulmonary hemodynamics.

Combined effect of heatwaves and residential greenness on the risk of stroke among Chinese adults: A national cohort study

Heatwaves have been associated with an increased risk of stroke, while residential greenness may offer protective benefits. This prospective cohort study examined 22,702 participants aged 35 years or older, with no prior history of cardiovascular disease (CVD), from the China Hypertension Survey (CHS) conducted between 2012 and 2015. Participants were followed up between 2018 and 2019. Heatwaves were defined as daily maximum temperatures exceeding the 92.5th percentile of the warm season for at least three consecutive days. Residential greenness was quantified using the Normalized Difference Vegetation Index (NDVI) within buffers of 300, 500, and 1000 m from participants' residences. Multivariable Cox proportional hazards models evaluated the independent and combined effects of heatwaves and greenness on stroke risk, while restricted cubic spline analyses explored nonlinear relationships. Interaction effects were assessed using both multiplicative and additive Cox regression models. During follow-up, 597 stroke events occurred. Each additional 3-day increase in heatwave days was associated with an increased stroke risk (HR: 1.19, 95 % CI: 1.08-1.31). Interaction analyses demonstrated a synergistic effect between heatwaves and lower residential greenness (NDVI300 m, NDVI500 m and NDVI1000 m) on stroke risk, with significant additive(RERI > 0, P < 0.05) and multiplicative interactions (HR > 1, P < 0.05). The strongest protective effects of greenness were observed within a 500 m buffer zone, particularly for individuals under 60 years, rural residents, and those with higher educational attainment. This study highlights the potential benefits of enhancing greenness for cardiovascular health and provides valuable insights for environmental governance and public health policy in China.

Cost-effectiveness of clopidogrel in patients with acute coronary syndrome undergoing percutaneous coronary intervention: a systematic review protocol

OBJECTIVE

This systematic review will assess the cost-effectiveness of clopidogrel in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).

INTRODUCTION

Antiplatelet drugs, including clopidogrel, ticagrelor, prasugrel, and aspirin, are crucial in managing ACS, preventing ischemia, and ultimately, death in PCI patients. Clopidogrel is the main treatment for those who have undergone PCI, used either alone or with aspirin. The incidence of ACS is rising globally, and is a major cause of premature death for millions. ACS management involves continuous medical therapy and costly procedures such as PCI, significantly straining health care resources.

INCLUSION CRITERIA

Studies will be eligible for inclusion if they report on the cost-effectiveness of clopidogrel in patients with ACS compared with other antiplatelet drugs.

METHODS

This systematic review will adhere to the JBI methodology guidelines for systematic reviews of economic evaluation evidence. A preliminary search was conducted of MEDLINE (PubMed) using MeSH terms. Two independent reviewers will screen records at the title/abstract level, followed by full-text screening. Two reviewers will then assess methodological quality and extract data as per JBI guidelines. The JBI Dominance Ranking Matrix for economic evaluations will be used to summarize and compare the included studies. The cost-effectiveness measures will be incremental cost, incremental cost per quality-adjusted life year gained, or incremental cost per disability-adjusted life year averted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach will be used to appraise the certainty of economic evidence, such as using resources and expenditure, for incorporating the results into the decision-making process.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42024504614.

Trends in the global, regional, and national burden of cardiovascular diseases attributed to high systolic blood pressure from 1990 to 2021 and projections to 2045: a systematic analysis based on GBD 2021 data

BACKGROUND

Cardiovascular disease (CVD) remains the leading cause of death and disability worldwide, and high systolic blood pressure (HSBP) is considered among its most critical modifiable risk factors. This study analyzed the temporal trends of the global burden of CVD attributed to HSBP from 1990 to 2021, examined its relationships with age, period, and birth cohort, and projected future trends to 2045.

METHODS

The study employed a joinpoint regression model to evaluate the temporal trends of CVD burden attributed to HSBP from 1990 to 2021 and used an Age-Period-Cohort (APC) model to analyze the effects of age, period, and cohort. Additionally, a Bayesian Age-Period-Cohort (BAPC) model was applied to project the disease burden trends up to 2045.

RESULTS

From 1990 to 2021, the absolute number of deaths and DALYs (disability-adjusted life years) of CVD attributed to HSBP increased significantly. However, the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) showed a consistent declining trend. The study highlights significant regional differences, with the disease burden increasing most markedly in regions with a middle Socio-Demographic Index (SDI) and decreasing most significantly in high SDI regions. Additionally, the study revealed gender differences, with the decline in ASMR and ASDR was more pronounced in females, while males exhibited a higher overall disease burden than females. Projections from the BAPC model indicate that from 2022 to 2045, the absolute number of deaths and DALYs will continue to rise, while ASMR and ASDR will decline further.

CONCLUSIONS

This study conducted a comprehensive analysis of CVD attributed to HSBP globally, highlighting significant sex, age, and regional differences in disease burden as well as their temporal trends. The findings underscore the importance of targeted prevention strategies, particularly for high-risk populations. This study provides valuable insights for policymakers to formulate effective interventions to reduce the global disease burden.