Advances in cervical cancer: current insights and future directions

In alignment with the World Health Organization's strategy to eliminate cervical cancer, substantial progress has been made in the treatment of this malignancy. Cervical cancer, largely driven by human papillomavirus (HPV) infection, is considered preventable and manageable because of its well-established etiology. Advancements in precision screening technologies, such as DNA methylation triage, HPV integration detection, liquid biopsies, and artificial intelligence-assisted diagnostics, have augmented traditional screening methods such as HPV nucleic acid testing and cytology. Therapeutic strategies aimed at eradicating HPV and reversing precancerous lesions have been refined as pivotal measures for disease prevention. The controversy surrounding surgery for early-stage cervical cancer revolves around identifying optimal candidates for minimally invasive and conservative procedures without compromising oncological outcomes. Recent clinical trials have yielded promising results for the development of systemic therapies for advanced cervical cancer. Immunotherapies, such as immune checkpoint inhibitors (ICIs), antibody-drug conjugates (ADCs), and targeted therapy have demonstrated significant effectiveness, marking a substantial advancement in cervical cancer management. Various combination therapies have been validated, and ongoing trials aim to enhance outcomes through the development of novel drugs and optimized combination regimens. The prospect of eradicating cervical cancer as the first malignancy to be eliminated is now within reach. In this review, we provide a comprehensive overview of the latest scientific insights, with a particular focus on precision managements for various stages of cervical disease, and explore future research directions in cervical cancer.

The prevalence and associated disability burden of mental disorders in children and adolescents in China: a systematic analysis of data from the Global Burden of Disease Study

Background

Understanding the disease burden of mental disorders in children and adolescents in China, especially at the sub-national level, is important for effective prevention and intervention. This study aims to assess the prevalence and related health burden of mental disorders in children and adolescents in China.

Methods

Following the same approach as the Global Burden of Disease Study 2021, we systematically analyze epidemiological and demographic information for mental disorders, and assess the prevalence, disability-adjusted life-years (DALYs), and years lived with disability (YLDs) in the children and adolescents for mental disorders and their ten subtypes across national and provinces in China from 1990 to 2021.

Findings

In 2021, the age-standardized prevalence of mental disorders in children and adolescents was 8.9% (uncertainty intervals [UI]: 8.1, 9.8) in China, accounting for 30.8 million cases (26.0, 36.3) and 2.8 million DALYs (2.0, 3.7). Among mental disorders, attention-deficit/hyperactivity disorder had the highest age-standardized prevalence, at 3.6% (3.0, 4.5). From 1990 to 2021, the age-standardized prevalence increased by 4.8%, but the number of mental disorders cases decreased by 21.9%. DALYs for mental disorders are higher in boys than in girls across all age groups. At the provincial level, the age-standardized prevalence of mental disorders in some provinces was much greater than that in other provinces (e.g., bipolar disorder in Hebei was more than two times greater than that in other provinces). Although disparities in the distribution of mental disorder burden were observed across provinces, there was a reduction in income-related inequality, where the gap in the age-standardized DALY rates between the highest and lowest income provinces decreased by 61.7% between 1990 and 2021. In 2021, among 22 health condition groups in China, mental disorders accounted for the largest proportion of health life lost.

Interpretation

Mental disorders are the leading causes of disability in children and adolescents in China, and the disease burden varies geographically. Careful planning of health services, including consideration of the local situation, is needed.

Funding

China National Natural Science Foundation (Grant No. 72104113, 72204112), Social Science Fund of Jiangsu Province (Grant No. 21GLD008), ShuangChuang Doctor Program of Jiangsu Province (Grant No. JSSCBS20210359), and the Fundamental Research Funds for the Central Universities (Grant No. 30923011101).

Delirium due to any cause is associated with higher resource utilization in patients undergoing liver transplantation: analysis of the National Inpatient Sample

OBJECTIVE

The only curative treatment for patients with end-stage liver disease (ESLD) is liver transplantation (LT). Patients with ESLD can develop delirium due to multiple etiologies. In this study, we aimed to assess the prevalence and impact of delirium on outcomes and resource utilization among hospitalized patients undergoing LT.

METHODS

We used the National Inpatient Sample Database 2016-2020 to identify adult patients undergoing LT. Patients were stratified into two groups based on the presence of delirium. The outcomes studied were in-hospital mortality, perioperative adverse events, and resource utilization. Multivariate logistic and linear regression analysis was used to identify the relationship between delirium and outcomes.

RESULTS

Of 34 405 included patients, 4930 (14.3%) patients had delirium. Patients with delirium had a higher need for renal replacement therapy (31.7% vs. 17.6%, P  < 0.001), vasopressor support (16.8% vs. 11.1%, P  < 0.001), and mechanical ventilation (34.1% vs. 15.3%, P  < 0.001). They also had higher total perioperative complications (77.3% vs. 60.4%, P  < 0.001), longer length of stay (34.8 vs. 17. 7, P  < 0.001), and total hospitalization charges ($927 200 vs. $565 486 P  < 0.001). After multivariable analysis, patients with delirium had higher odds of perioperative complications (adjusted odds ratio: 1.54, 95% confidence interval: 1.24-1.92, P  < 0.001) and resource utilization.

CONCLUSION

Our finding suggests the need for physicians to identify and reverse delirium as soon as possible.

Prevalence and influencing factors of sleep disturbance among medical students under the COVID-19 pandemic

BACKGROUND

Medical students may feel severe psychological stress during COVID-19, which might impair their ability to sleep. This research aimed to look at the risk factors for sleep disturbance and the prevalence of sleep disturbance among medical students.

METHODS

538 medical students in total were recruited for this research. Anxiety, depression, and sleep disturbance were assessed using the Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and Pittsburgh Sleep Quality Index (PSQI). To evaluate the possible risk variables, we computed descriptive statistics for each assessment item and ran univariate and logistic regression analyses.

RESULTS

Medical students had a 63.6% prevalence of sleep disturbance (n = 342). According to logistic regression, introverted students are 1.77 times more likely than extroverted students to have sleep disturbance (OR = 1.77, 95% CI 1.08-2.91). Medical students with depression had a 5.6-times higher risk of sleep disturbance than those without depression (OR = 5.60, 95% CI 3.43-9.15). Additionally, medical students with anxiety were 3.95 times more likely than those without anxiety to have sleep disturbance (OR = 3.95, 95% CI 2.04-7.64).

CONCLUSIONS

According to this research, the COVID-19 pandemic caused significant sleep disturbance among medical students. Additionally, among medical students, introversion, anxiety, and depression were risk factors for sleep disturbance.

Foresight older adults' quality of life in the aging crisis in Iran: A systematic review and meta-analysis

INTRODUCTION

To provide foresight for the older adults' quality of life (QOL) in the aging crisis in Iran, this systematic review and meta-analysis study is conducted.

METHODS

All relevant articles were searched in the English and Persian databases such as Scopus, Web of Science, PubMed, Google Scholar, SID, and Medex regardless of the time range up to December 2023.

RESULTS

Out of 348 articles found, 8 articles were included finally. In total, the QOL of 1093 older adults' people with a mean age of 71.55 ± 6.91 years were evaluated. The study showed that the overall average of the QOL of the older adults is 58.5 ± 10.1 The overall average QOL of the older adults at the Iranian community level was 57.6 ± 15.5. The overall average QOL of the older adults in nursing homes are 60.1 ± 29.7.

CONCLUSION

The Iranian older adults have an average QOL and paying attention to the older adults and their needs and designing interventions to improve their health status should be on the agenda of health policymakers.

Epidemiological study of HPV infection in 24,588 rural women in Luonan, China

Cervical cancer is a significant public health issue for women, with human papillomavirus (HPV) infection rates exhibiting regional variations throughout China. This study examined data from a cohort of 24,588 rural women who engaged in cervical cancer screening in Luonan County from 2021 to 2023, utilizing high-risk HPV (hrHPV) testing methodologies. The findings revealed an overall HPV positivity rate of 14.18 %, with hrHPV positivity rates of 13.99 % in 2021, 12.97 % in 2022, and 15.32 % in 2023. Infection rates increased with age, showing significant differences among age groups. Types 52, 16, and 58 were the most prevalent hrHPV types. Single-type infections were more common than multiple infections, with prevalent combinations such as HPV16 + HPV52, HPV52 + HPV58, and HPV51 + HPV16. The results highlight the imperative for improved screening, especially for women aged 60 to 64 residing in rural areas, and emphasize the importance of HPV vaccination and targeted screening for the prevention and eventual eradication of cervical cancer.

Global Epidemiology and health risks of Bacillus cereus Infections: Special focus on infant foods

Bacillus cereus is a common pathogen responsible for gastrointestinal and other complicated disorders, yet epidemiological data and public health measures remain scarce. To bridge these gaps, a bilingual search spaning 50 years identified 266 relevant studies on global B. cereus infection, encompassing 6,135 cases. The global mortality rate for B. cereus infection is 0.9 %. Food poisoning cases account for 94.31 % (5786/6135) of the total infections, with a mortality rate of 0.05 %. B. cereus infections were primarily reported in East Asia, Europe, and North America, with frequent studies in eastern and southern China. Rice was recognized as the highest-risk food category for B. cereus-associated food poisoning, with 43 reported incidents. Younger populations, particularly infants and toddlers (<2 years) and school-age children (6-18 years), tend to exhibit more severe symptoms. These symptoms include fulminant liver failure, rhabdomyolysis, and metabolic acidosis. The outcomes of severe cases are associated with specific toxin types, with cereulide-producing strains linked to complicated clinical disorders and outcomes. These findings highlight the need for targeted epidemiological surveillance and public health interventions to mitigate B. cereus-associated infections.

Preventing Depression Among Older Adults With Severe Illness: The Mediating Role of Life Satisfaction and the Moderating Role of Gender

PURPOSE

The occurrence of severe illness, the risk for which increases as people age, often results in depression. The current study aimed to explore how and when severe illness leads to depression among older adults.

METHOD

Data collected from a sample of 756 older adults were analyzed using moderated mediation analysis to examine the underlying mechanism between severe illness and depression.

RESULTS

Results, as verified by a robustness check, demonstrated that life satisfaction mediated the association between severe illness and depression among older men and women, and that gender moderated the direct relationship between severe illness and depression.

CONCLUSION

The formation path of depression from severe illness among older adults varies according to gender. For men, severe illness did not directly trigger depression, but indirectly triggered depression through decreased life satisfaction; for women, severe illness not only triggered depression directly, but also indirectly triggered depression through decreased life satisfaction. Results yield theoretical and practical implications for gerontological nursing. [Journal of Gerontological Nursing, 51(2), 43-52.].

Fertility desires in young men aged 18-24 living with HIV: a study across five Chinese provinces

Limited data exists concerning the fertility desires of young people living with HIV/AIDS (PLWHA) in China, making it difficult to develop appropriate reproductive health service policies and interventions for them. Extensive fieldwork was carried out from April to May 2021 in 10 selected survey sites across five provinces, targeting all young men aged between 18 and 24 years living with HIV. The association between independent variables and fertility desires was determined using Chi-square tests and Multivariate binary logistic regression models. In total, we obtained valid responses from 436 individuals, yielding a response rate of 74.9%. Nearly half of the respondents (48.6%) expressed a future desire to have children. The multivariate logistic regression models pointed to rural registered residence (AOR = 1.595, CI: 1.073, 2.371), heterosexual (AOR = 3.098, CI: 1.523, 6.301) or bisexual orientation (AOR = 2.302, CI: 1.396, 3.794), among others, as significant correlates of fertility desires. This study represents the first exploration of fertility desires among young men living with HIV in China. Evaluating these desires allows healthcare providers to anticipate patients' potential marriage and family plans, thereby facilitating timely provision of reproductive services designed to prevent HIV transmission.

Disproportionate Vulnerability to and Unique Aggregation Pattern of Non-AIDS Comorbidities Among Women With HIV in China

Background

Whether and how sex plays differential roles in aging-related multimorbidity among people with HIV (PWH) is poorly characterized.

Methods

We included 2479 PWH and 5376 people without HIV from the baseline assessment of the CHART cohort (Comparative HIV and Aging Research in Taizhou). Ten non-AIDS comorbidities were investigated. Multiple logistic regression was used to assess the correlates of multimorbidity, defined as the coexistence of ≥2 non-AIDS comorbidities. Multimorbidity patterns were identified through hierarchical cluster analysis.

Results

The prevalence of multimorbidity was higher in PWH than in people without HIV (74.6% vs 66.9%, P < .001). This difference was particularly pronounced in women in each age group from 18 through 59 years and among men in each age group from 18 through 49 years. A significant interaction between sex and HIV on multimorbidity was identified (P < .001), with the strength of the association between HIV infection and multimorbidity being stronger in women than in men. Women with HIV presented a unique aggregation pattern of multimorbidity, where neuropsychiatric disorders (depression, neurocognitive impairment) clustered with cardiometabolic diseases. In contrast, all men and women without HIV manifested a similar multimorbidity pattern, where depression and neurocognitive impairment were clustered with hematologic abnormalities but not with cardiometabolic diseases.

Conclusions

Earlier onset and higher burden of multimorbidity in PWH, as well as disproportionate vulnerability to and a unique multimorbidity pattern among women with HIV, underscore the urgent need for early and sexually oriented integrative interventions and health services targeting multimorbidity in PWH.

Five-Year (2017-2022) Evolutionary Dynamics of Human Coronavirus HKU1 in Southern France With Emergence of Viruses Harboring Spike H512R Substitution

HCoV-HKU1 diversity and evolution were scarcely studied. We performed next-generation sequencing (NGS) and analysis of HCoV-HKU1 genomes over 5 years. NGS used Illumina technology on NovaSeq 6000 following whole genome PCR amplification by an in-house set of primers designed using Gemi and PrimalScheme. Genome assembly and analyses used CLC Genomics, Mafft, BioEdit, Nextstrain, Nextclade, MEGA, and iTol bioinformatic tools. Spike molecular modeling and dynamics simulations used Molegro Molecular Viewer and Hyperchem programs. Twenty-eight PCR systems allowed obtaining 158 HCoV-HKU1 genomes including 69 and 89 of genotypes A and B, respectively. Both genotypes co-circulated during the study period but one predominated each year. A total of 1683 amino acid substitutions including 80 in ≥ 10 genomes were detected in genotype A relatively to a 2004 reference. H512R in spike, first detected in 2009 and reported as involved in antibody neutralization, was found in all genotype A, almost always with V387I and K478N, and was predicted here to significantly improve cellular TMPRSS2 protein binding. Also, 1802 amino acid substitutions including 64 in ≥ 10 genomes were detected in genotype B relatively to a 2005 reference. This study substantially expands the global set of HCoV-HKU1 genomes. Genomics with protein structural analyses contributed to our understanding of HCoV-HKU1 evolution.

Risk assessment of infection of COVID-19 contacts based on scenario simulation

We constructed a rapid infection risk assessment model for contacts of COVID-19. The improved Wells-Riley model was used to estimate the probability of infection for contacts of COVID-19 in the same place and evaluate their risk grades. We used COVID-19 outbreaks that were documented to validate the accuracy of the model. We analyzed the relationship between controllable factors and infection probability and constructed common scenarios to analyze the infection risk of contacts in different scenarios. The model showed the robustness of the fitting (mean relative error = 5.89%, mean absolute error = 2.03%, root mean squared error = 2.03%, R2 = 0.991). We found that improving ventilation from poorly ventilated to naturally ventilated and wearing masks can reduce the probability of infection by about two times. Contacts in places of light activity, loud talking or singing, and heavy exercise, oral breathing (e.g., gyms, KTV, choirs) were at higher risk of infection. The model constructed in this study can quickly and accurately assess the infection risk grades of COVID-19 contacts. Simply opening doors and windows for ventilation can significantly reduce the risk of infection in certain places. The places of light activity, loud talking or singing, and heavy exercise, oral breathing, should pay more attention to prevent and control transmission of the epidemic.

Real-World Effectiveness of 3 Types of Acellular Pertussis Vaccines Among Children Aged 3 Months-16 Years in Lu'an, China: A Matched Case-Control Study

Background

The real-world vaccine effectiveness (VE) of the diphtheria, tetanus, and acellular pertussis (DTaP), DTaP-Haemophilus influenzae type b (Hib), and DTaP-inactivated polio (IPV)/Hib vaccines has not been thoroughly evaluated in China. Additionally, there are limited data on the VE of acellular pertussis-containing vaccines (aPVs) when used interchangeably.

Methods

We conducted a matched case-control study to estimate the VE of aPVs against polymerase chain reaction-confirmed pertussis infection in Lu'an in 2024. A conditional logistic regression model was used to compare the odds ratios (ORs) of vaccination between cases and controls. VE was calculated as [(1 - adjusted OR) × 100%], and 95% confidence intervals (CIs) were computed around the estimates.

Results

A total of 1936 children aged 3 months to 16 years were included in the study. The overall VE was 77.3% (95% CI, 35.2%-92.1%). The VE for fully vaccinated children was 88.4% (95% CI, 57.3%-96.8%), while the VE for partially vaccinated children was 77.4% (95% CI, 35.5%-92.1%). The VE of DTaP, DTaP-Hib, and DTaP-IPV/Hib was 75.8% (95% CI, 29.7%-91.7%), 83.2% (95% CI, 47.8%-94.6%), and 79.8% (95% CI, 36.5%-93.6%), respectively. Compared with mixed vaccination (65.3%.), the incremental VE of DTaP, DTaP-Hib, and DTaP-IPV/Hib was 31.0% (95% CI, 1.0%-51.9%), 52.9% (95% CI, 19.1%-72.6%), and 41.1% (95% CI, -18.7% to 71.8%), respectively. We observed a decline in VE over time, decreasing from 76.5% (95% CI, 33.0%-91.7%) within the first 2 years to -5.5% (95% CI, -495.2% to 81.3%) after 6 years or more.

Conclusions

All aPVs provide significant protection against pertussis infection, although this protection wanes over time. The VE appears to decrease materially if these vaccines are administered alternately in an individual's routine immunization schedule.

Global infectious disease surveillance: bridge a 30-metre gap between the International Civil Aviation Organization and the World Anti-Doping Agency

The global aviation industry faced unprecedented challenges during the COVID-19 pandemic. As a result, the international civil aviation industry now has strong incentives to prevent and control future pandemics. It is almost unbelievable that the headquarters of the International Civil Aviation Organization (ICAO) is located right next to the headquarters of the World Anti-Doping Agency (WADA). While the vision and mission of these two organizations may seem completely different, we propose that ICAO could adopt a system similar to that of WADA to enhance its contribution to global infectious disease surveillance.

Monkeypox outbreak 2023 in Chengdu, China: an observational study

Monkeypox is a zoonotic viral disease caused by monkeypox virus infection and formerly this disease had been endemic mainly in Africa. Since May 2022, the disease has rapidly spread across the world and some imported case was confirmed sporadically in China. Under these circumstances, data of confirmed cases were collected consecutively in Chengdu, southwest China to investigate clinical and epidemiological characteristics. In this study, 28 male patients were confirmed to have monkeypox infection, with 26 identifying as MSM (men who have sex with men). Typical lesions included papules, pustular papules, vesicles, scabs and ulcerations. The most common sites of skin lesions were anogenital and perineal areas, three patients developed a widespread exanthem. Seven patients reported a history of sexual transmitted diseases, no one was hospitalized and there were no deaths. Three instances of secondary transmission were identified among close contacts, all of them were sexual partners of our participants. Furthermore, this observation provides insights of the public health for surveillance of this emerging disease and raises awareness among people at risk.

Co-infection of SARS-CoV-2 and influenza A/B among patients with COVID-19: a systematic review and meta-analysis

BACKGROUND

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) is a public health problem and may result in co-infection with other pathogens such as influenza virus. This review investigates the co-infection of SARS-CoV-2 and influenza A/B among patients with COVID-19.

METHODS

This meta- analysis included 38 primary studies investigating co-infection of SARS-CoV-2 with influenza in confirmed cases of COVID-19. The global online databases were used to identify relevant studies published between December 2019 and July 2024. Data analysis was performed using STATA Ver. 17 software, and standard errors of prevalence were calculated using the binomial distribution formula. Heterogeneity of study results was evaluated using the I-square and Q index, and publication bias was examined using the Begg's and Egger's tests, as well as funnel plot. A random effects model was used to determine prevalence rates, and a forest plot diagram was used to present results with 95% confidence intervals. In addition, sensitivity analyses were performed to check the impact of each primary study on the overall estimate.

RESULT

The analysis found that the prevalence of influenza in co-infected patients at 95% confidence interval using a random effect model was 14% (95% CI: 8-20%). Significant heterogeneity was observed in the random-effects model for influenza A, 11% (95% CI: 5-18%) and B, 4% (95% CI: 2-7%) in co-infected patients. The highest prevalence of influenza A/B (21%), influenza A (17%) and influenza B (20%) was shown in Asia and Europe respectively. Subgroup analysis by study year showed that the co-prevalence of COVID-19 and influenza A/B was similar in the pre-2021 and post-2021 time periods, at 14% (95% CI: 5-23%) for pre-2021 and 6-22% for 2021 and post-2021. Also, the overall prevalence of influenza A and B in COVID-19 patients is 11% and 4%, and there was no significant difference between the time periods before and after 2021. Meta-regression with a random-effects model showed that the variables location, year group, and total patients showed only 2.71% of very high heterogeneity (I² = 99.92%), and none of these variables had a significant effect on the co-prevalence of COVID-19 and influenza A/B (p > 0.05). Also, meta-regression results showed that these variables had no significant effect on influenza A and B prevalence (p > 0.05) and showed only a small proportion of the very high heterogeneity (I² = 99.72%), (I² = 68.78%). In our study, Egger's test indicated that there was publication bias or small study effects in this meta-analysis (p = 0.0000).

CONCLUSION

The combination of SARS-CoV-2 with influenza and other respiratory viruses requires the best treatment protocols to reduce the severity of the disease. In this approach, high vaccination coverage against seasonal influenza and SARS-CoV-2 could reduce the risk of co-infection in the recent pandemic.

Association of Childhood Trauma Subtypes and Substance Use Among Chinese College Students - Jilin Province, China, 2021

What is already known about this topic?

Childhood trauma represents a critical risk factor for substance use among young populations globally, presenting a substantial public health challenge.

What is added by this report?

This comprehensive investigation elucidates the distinct associations between specific subtypes of childhood trauma and substance use behaviors within the Chinese youth population. The findings demonstrate significantly elevated risks for smoking, e-cigarette use, and alcohol consumption, particularly among individuals who have experienced severe or multiple forms of childhood trauma.

What are the implications for public health practice?

Implementation of targeted interventions and support systems is essential for individuals with childhood trauma histories. Healthcare providers should emphasize early identification and trauma-informed care approaches. Policy frameworks promoting early intervention and sustained support mechanisms are crucial for reducing substance use behaviors and enhancing population health outcomes.

Rural-urban and age differences in association between depression and suicidal attempt: a large retrospective clinical sample study in China

OBJECTIVES

To assess the association between depression and suicide attempt (SA) by age and region.

DESIGN

Cross-sectional study.

SETTING

First Affiliated Hospital of Wannan Medical College from January 2021 to January 2022.

PARTICIPANTS

Hospitalised patients.

PRIMARY OUTCOME MEASURES

SA was the primary outcome and data on SA was obtained from the electronic medical records of hospitalised patients.

METHODS AND ANALYSIS

In this study, data on inpatients of the First Affiliated Hospital of Wannan Medical College from January 2021 to January 2022 were extracted from the medical record system using the convenience sampling method. According to the exclusion criteria, 7593 eligible research subjects were obtained. Logistic regression analysis was used to assess the association between depression and SA, combining age and region. Subgroup analyses were carried out to assess the relationship between age, region and SA in depressed patients, after excluding non-depressed patients, and to inspect the interaction of age and region. Finally, further comparisons of the disparities in suicide patterns among different age groups and regional groups were made.

RESULTS

Among 7593 patients (3630 males), 655 (8.6%) patients with SA were observed. We found that depression was significantly associated with SA by age and region (all p<0.05). Specifically, depressed juveniles and adults had a higher risk of SA compared with non-depressed adults, and ORs (95% CIs) were 2.62 (1.59 to 4.30) and 1.67 (1.30 to 2.13), respectively. Furthermore, rural individuals with depression, urban individuals without depression and urban individuals with depression had a higher risk of SA compared with rural participants without depression, and ORs (95% CIs) were 1.60 (1.22 to 2.12), 1.29 (1.04 to 1.61) and 2.53 (1.83 to 3.49), respectively. In subgroup analyses, we further found that depression was strongly associated with SA in juveniles (OR 2.84, 95% CI 1.19 to 6.76, p=0.018) and urban patients (OR 1.67, 95% CI 1.15 to 2.40, p=0.006). Notably, the predominant methods of suicide among individuals with depression were the utilisation of sleeping pills or antidepressants.

CONCLUSION

Our study found individuals with depression are at higher risk of SA, especially juveniles and urban individuals. Effective integration of mental health and urban-rural services could mitigate the risk of suicide and contribute to better outcomes.

Indoor ventilation frequency and cognitive function among Chinese old adults: the multiple mediation effect of anxiety and self-rated health

BACKGROUND

China is experiencing an increasingly serious aging population. Cognitive function is an important factor and guarantee for the quality of life of older people. Therefore, to achieve healthy aging, this study aimed to examine the sequential multiple mediating effects of indoor ventilation frequency and cognitive function on anxiety and self-rated health in the Chinese older people population.

METHODS

Using the 2018 China Longitudinal Health and Longevity Survey (CLHLS) dataset, we finally selected 10,372 Chinese seniors over the age of 65. First, we describe the basic socio-demographic information of the sample population. Second, Spearman correlation analysis was used to determine whether there was a correlation between indoor ventilation frequency, anxiety, self-rated health, and cognitive function among Chinese older people. Finally, the SPSS macro process program was used to complete the sequence multiple mediation analysis.

RESULTS

Indoor ventilation frequency, anxiety, self-rated health and cognitive function were significantly correlated (p < 0.01). Indoor ventilation frequency not only has a direct positive impact on the cognitive function of older people (effect = 0.1427; Standard error = 0.0201; 95%CI: LL = 0.1034, UL = 0.1821), but also indirectly affected cognitive function through three pathways: independent mediation of anxiety (effect = 0.0078; Standard error = 0.0021; 95%CI: LL = 0.0041, UL = 0.0121), independent mediating effect of self-rated health (effect = 0.0154; Standard error = 0.0030; 95%CI: LL = 0.0098, UL = 0.0215), and the chain mediating effect between anxiety and self-rated health (effect = 0.0046; Standard error = 0.0009; 95%CI: LL = 0.0029, UL = 0.0065).

LIMITATIONS

All projects are self-reported and some results may be biased. In the future, it may be more inspiring to explore more detailed and specific effects of indoor air quality on cognitive function in older people.

CONCLUSIONS

Studies have shown that indoor ventilation frequency can improve cognitive function by reducing anxiety and improving self-rated health in older people Chinese. Encouraging older adults to increase the frequency of indoor ventilation will benefit their mental health and cognitive function.

Pre-exposure Prophylaxis (PrEP) Awareness and Engagement Among MSM at High Risk of HIV Infection in China: A Multi-City Cross-Sectional Survey

This study aimed to explore the awareness, willingness, and engagement with pre-exposure prophylaxis (PrEP) among high-risk Chinese men who have sex with men (MSM) and to investigate the factors influencing its use. A cross-sectional survey of 1800 HIV-negative MSM was conducted in Chengdu, Suzhou, and Wuhan between June 2022 and February 2023 through in-person and online recruitment methods. Univariate and multivariate logistic regression analyses were used to identify predictors of PrEP use. Bayesian network models were constructed using the bnlearn package in R 4.1.2, and inference was conducted using Netica software. Among the 1800 participants, 1467 had ever heard of PrEP, 696 were aware of its target population, and 195 had taken PrEP in the past 6 months. PrEP use was higher among individuals reporting multiple male sex partners, illicit substance use, alcohol use, HIV testing, PEP use, and sexual partners who had used PrEP. Conversely, having a female sexual partner was a barrier to PrEP use. Bayesian network modeling unveiled factors directly and indirectly impacting PrEP use. Variables like PrEP use of sexual partners, PEP use, alcohol use, HIV testing, and WeChat-based HIV knowledge platforms exhibited direct effects. Indirect effects included having a female sexual partner, number of male sexual partners, and illicit substance use. Despite high awareness, the usage of PrEP remains low among MSM. Encouraging social agencies to leverage social media platforms to provide comprehensive HIV care services, especially to meet the PrEP needs of MSM.

Ten proposed measures to improve vaccination: Health care providers' perspectives on promoting the vaccination intake of children with special healthcare needs in China

INTRODUCTION

Children with special healthcare needs (CSHCN) often experience vaccination delays or missed vaccines in China. The coverage rate of the age-appropriate National Immunisation Programme vaccine was suboptimal. This study aimed to explore attitudes, behaviours, and suggestions regarding the improvement of routine vaccination services for CSHCN among healthcare providers.

METHODS

This study conducted local, cross-sectional interviews involving vaccination services for CSHCN. A purposive sampling strategy was used to recruit interviewees including primary care providers, paediatricians and immunisation programme administrators. The interview guide explored attitudes towards and suggestions for establishing immunisation advisory clinics and referral networks, updating immunisation guidance documents and vaccine package inserts and strengthening the education of vaccination providers.

RESULTS

21 representative healthcare providers were interviewed. 10 measures were proposed to promote routine immunisation for children with special needs: (1) using immunisation advisory clinics to provide vaccination services for CSHCN; (2) establishing a referral network and specifying which cases necessitate referral to advisory clinics; (3) using an interconnected information system to identify, document and follow-up the CSHCN; (4) supporting high-quality clinical research to update immunisation protocols; (5) providing clear and definite immunisation recommendations to parents of eligible CSHCN; (6) seeking immunisation advice from specialised professionals to enhance primary care capability; (7) creating quality improvement programmes; (8) considering immunisation status a mandatory assessment during specialist visits; (9) supporting off-label use of vaccines legally and (10) encouraging pharmaceutical companies to update vaccine package inserts.

CONCLUSION

Vaccine uptake among CSHCN in China is suboptimal, highlighting the need for a referral network and a standard immunisation protocol. The National Immunisation Programme should develop clear recommendations and an education programme for regional Centers for Disease Control and Prevention to train local providers. A quality assurance and improvement programme, along with regular feedback, is essential to ensure CSHCN receive necessary vaccinations and protection against infectious diseases.

Difference of SARS-CoV-2 infection and influence factors between people with and without HIV infection

BACKGROUND

There are mixed findings in the literature regarding the association between HIV status and the risk of COVID-19 infection. Thus, we aimed to estimate the association between characteristics of HIV infection and the risk of COVID-19 Infection in a Chinese sample.

METHODS

We conducted a cross-sectional survey of 1995 people living with HIV (PLWH) and 3503 HIV-negative adults in Ningbo, China. We compared the prevalence rates of the SARS-CoV-2 infection and the long nucleic acid conversion time (more than 2 weeks) among PLWH and HIV-negative participants, respectively. In addition, we explored the risk factors associated with SARS-CoV-2 infection and the long nucleic acid conversion time among the two groups.

RESULTS

Overall, 1485/1995 (74.4%) PLWH and 2864/3503 (81.8%) HIV-negative people were infected with SARS-CoV-2. Among the SARS-CoV-2-infected participants, 437/1485 (29.4%) PLWH and 649/2864 (22.7%) HIV-negative people had the long nucleic acid conversion time. After controlling for the potential confounders, the rate of the SARS-CoV-2 infection was lower among the PLWH than the HIV-negative group (adjusted OR = 0.836, 95% CI = 0.706-0.990). However, PLWH had a significantly higher risk of the long nucleic acid conversion time after the SARS-CoV-2 infection (adjusted OR = 1.417, 95% CI = 1.176-1.707) than the HIV negative participants. Compared with those who did not receive ART, PLWH adults who received ART significantly had the increased risk of SARS-CoV-2 infection. Furthermore, HIV-negative participants receiving COVID-19 vaccines significantly displayed the decreased likelihood of the long nucleic acid conversion time after the SARS-CoV-2 infection.

CONCLUSIONS

Our study indicates that different HIV Infection status was significantly and differently associated with the SARS-CoV-2 infection and the long nucleic acid conversion time. However, the further studies are needed to confirm the effect of ART and COVID-19 vaccines on SARS-CoV-2 infection in PLWH.

Genes related to neural tube defects and glioblastoma

There are many similarities between early embryonic development and tumorigenesis. The occurrence of neural tube defects (NTDs) and glioblastoma (GBM) are both related to the abnormal development of neuroectodermal cells. To obtain genes related to both NTDs and GBM, as well as small molecule drugs with potential clinical application value. We performed bioinformatics analysis on transcriptome sequencing data of retinoic acid (RA)-induced NTDs mice, human NTDs samples and GBM samples. RT-qPCR, Western blot, and immunohistochemistry were used to validate the expression of candidate genes. Our results indicated that two genes at mRNA and protein levels have been well verified in both NTDs mouse and GBM human samples, namely, Poli and Fgf1. Molecular docking and validating in vitro were performed for FGF1 against pazopanib by using Autodock and Biacore. Cytological experiments showed that pazopanib significantly inhibited the proliferation of GBM tumor cells and mouse neural cells, promoted apoptosis, and had no effect on GBM tumor cells migration. Overall, our results demonstrated that Fgf1 abnormally expressed at different developmental stages, it may be a potentially prenatal biomarker for NTDs and potential therapeutic target for GBM. Pazopanib may be a new drug for the treatment of GBM tumors.

Season of conception and risk of hypertensive disorder during pregnancy

BACKGROUND

Hypertensive Disorder during Pregnancy (HDP) is the most prevalent obstetric conditions in maternal health, but the etiology of most cases remains unexplained. Seasonal variations in the conception of HDP may offer insights into the potential seasonal-specific risk factors.

METHODS

Data were sourced from the China's National Maternal Near Miss Surveillance System (NMNMSS) between January 1, 2012, and December 31, 2021. HDP status was ascertained from the diagnostic records over 400 medical institutions. The conception date was estimated based on the delivery date and duration of gestation length, and the season of conception, were categorised as winter (December to February), spring (March to May), summer (June to August), and fall (September to November). Odd ratios were calculated separately using the logistic regression model.

RESULTS

Among the 14,073,565 pregnant women analysed, 3.98% met the study's criteria for HDP as defined in the present study. Maternal conception in spring was associated with a 10% increased risk of HDP (aOR, 1.10 [95% CI, 1.08-1.12]) compared with summer conceptions. Elevated risk of HDP was observed for maternal individuals conceiving in February, March, April, May, and June according to analyses conducted for specific months. The associations were slightly stronger in the subgroup of women diagnosed with gestational hypertension and preeclampsia. Significant disparities exist in this association among the diverse Köppen-Geiger climate zones.

CONCLUSION

Significant seasonal variations in the risk for HDP were observed across a range of maternal characteristics, HDP subtypes, and climatc zones. These findings imply the necessity of considering seasonally fluctuating environmental factors in the etiological investigation of HDP.

CLINICAL TRIAL NUMBER

Not applicable.

Reduced SARS-CoV-2 Infection Rates in Lab Workers Conducting Nucleic Acid Testing: Controlling for the Healthy Worker Effect

BACKGROUND

During the COVID-19 outbreak in December 2022 in China, some laboratory workers in SARS-CoV-2 nucleic acid testing (NAT) laboratories remained uninfected.

OBJECTIVES

To evaluate if the incidence of SARS-CoV-2 infection was reduced in laboratory workers who performed SARS-CoV-2 NAT, and whether this reduction resulted from the healthy worker effect.

METHODS

This retrospective cohort study included 423 laboratory workers from 14 SARS-CoV-2 NAT laboratories in Xiamen, China. The incidence of SARS-CoV-2 infection among laboratory workers was analysed based on whether and how long they were engaged in NAT. The healthy worker effect among the laboratory workers engaged in NAT was examined.

RESULTS

The incidence of SARS-CoV-2 infection was lower in workers engaged in SARS-CoV-2 NAT, with a gradual reduction observed as the cumulative time of SARS-CoV-2 NAT increased. A healthy worker effect was observed and eliminated after matching and stratification based on gender, age, education level, and vaccination. Workers who had ever participated in SARS-CoV-2 NAT had a lower cumulative probability of SARS-CoV-2 infection and a longer duration from vaccination to SARS-CoV-2 infection, and this trend was found to be more prominent with a longer cumulative time to SARS-CoV-2 NAT.

CONCLUSIONS

A reduction in SARS-CoV-2 infections was observed among laboratory workers conducting SARS-CoV-2 NAT after controlling for the healthy worker effect. This finding has broader implications for understanding the role of natural immunity and its interaction with vaccine immunity in defending against SARS-CoV-2 infection.

Different immunological characteristics of asymptomatic and symptomatic COVID-19 patients without vaccination in the acute and convalescence stages

The immune status of Coronavirus disease 2019 (COVID-19) patients in different stages of infection remains difficult to determine. In this study, we performed high-throughput single-cell mass cytometry on peripheral blood samples from 10 COVID-19 patients and four healthy donors to analyze their immune status at acute and convalescence phases. During the acute stage, the proportion of neutrophils increased significantly while natural killer (NK) cells decreased. In contrast, during the convalescence phase, the proportion of plasma cells decreased from the acute stage of disease onset and was lower than normal. The proportions of B, mast and plasma cell subsets decreased significantly with the process of disease recovery. Further analysis of the subsets of major immune cell types in COVID-19 patients with different clinical presentations in different stages showed that in the acute stages of disease progression, the T helper cell 1 (Th1), IgD+ B and neutrophil subsets increased in COVID-19 patients, especially in symptomatic patients, while the central memory CD4+T cells (CD4 TCM), mucosa-associated invariant T (MAIT) and NK cell subsets decreased significantly, especially in symptomatic patients. Then CD4 TCM and MAIT returned to normal levels at the recovery phase. Dynamic assessment displayed that the immune imbalance at the onset of COVID-19 could be corrected during recovery. Our study provides additional information on the immune status of COVID-19 patients with different clinical manifestations in different stages. These findings may provide new insights into COVID-19 immunotherapy and immune intervention.

Update on the evolving landscape of pneumococcal capsule types: new discoveries and way forward

SUMMARYStreptococcus pneumoniae (the "pneumococcus") is a significant human pathogen. The key determinant of pneumococcal fitness and virulence is its ability to produce a protective polysaccharide (PS) capsule, and anti-capsule antibodies mediate serotype-specific opsonophagocytic killing of bacteria. Notably, immunization with pneumococcal conjugate vaccines (PCVs) has effectively reduced the burden of disease caused by serotypes included in vaccines but has also spurred a relative upsurge in the prevalence of non-vaccine serotypes. Recent advancements in serotyping and bioinformatics surveillance tools coupled with high-resolution analytical techniques have enabled the discovery of numerous new capsule types, thereby providing a fresh perspective on the dynamic pneumococcal landscape. This review offers insights into the current pneumococcal seroepidemiology highlighting important serotype shifts in different global regions in the PCV era. It also comprehensively summarizes newly discovered serotypes from 2007 to 2024, alongside updates on revised chemical structures and the de-novo determinations of structures for previously known serotypes. Furthermore, we spotlight emerging evidence on non-pneumococcal Mitis-group strains that express capsular PS that are serologically and biochemically related to the pneumococcal capsule types. We further discuss the implications of these recent findings on capsule nomenclature, pneumococcal carriage detection, and future PCV design. The review maps out the current status and also outlines the course for future research and vaccine strategies, ensuring a continued effective response to the evolving pneumococcal challenge.

Forensic identification of fatal mushroom poisoning: a case report

Mushroom poisoning incidents happen infrequently, yet owing to the non-lethal nature of most toxins and the efficacy of timely treatment, fatalities from mushroom poisoning are uncommon, leading to a scarcity of pertinent clinical and pathological data. Here, we reported a case of death caused by the consumption of raw mushrooms, alongside detailed clinical data and multi-organs pathological alterations, which underscored its potential significant reference value in forensic practice. Futhermore, ibotenic acid, a type of mushroom toxin, was detected both in the patient's blood and gastric lavage fluid about 19 h after the consumption of mushrooms, and was successfully quantified at concentrations of 0.381 µg/mL and 0.202 µg/mL, respectively, indicating a relatively significant finding.

Association of Trace Elements with Polycystic Ovary Syndrome in Women-A Case-Control Study

Objectives: There are still limited or lacking data on the association of trace elements (TEs) with polycystic ovary syndrome (PCOS). This case-control study aimed to determine levels of essential TEs (manganese (Mn), copper (Cu), zinc (Zn), selenium (Se), molybdenum (Mo)) and non-essential TEs (arsenic (As), cadmium (Cd), mercury (Hg), lead (Pb)) in urine, whole blood, and serum to investigate a possible association with kidney and liver function, endocrine and metabolic parameters, and environmental and lifestyle sources of potential exposure and provide possible recommendations. Methods: In our case-control study, women with PCOS (n = 35) and healthy controls (n = 35) underwent clinical and ultrasonographic examination, filled in questionnaires targeting general, lifestyle, and environmental information, and provided fasting venous blood samples and first morning urine for biochemical, hormonal, and TE analysis. Multiple linear regression models were used to evaluate the association between TE levels and data obtained through questionnaires. Results: In women with PCOS, lower Mo levels in whole blood (p = 0.024) and serum (p = 0.011) and higher serum Cu levels (p = 0.026) were detected when compared to healthy controls. Results of this study show that amendments in Cu and Mo levels might be related to altered kidney and liver function and disrupted hormonal balance in PCOS women. Cu levels positively correlated with leukocyte count. There was a negative correlation of Mo levels with proteinuria and luteinizing hormone levels. Regarding liver function, Mo negatively correlated with urinary bilirubin levels, and there was a positive association with alanine and aspartate aminotransferase, respectively. Dietary supplement consumption and certain diet habits appeared to be important predictors of exposure to Cu (beef consumption) or Mo (cereal and boiled vegetable consumption) and modify Mo and Cu levels in women. Conclusions: Concentrations of the chemical elements Mo and Cu in biological samples of women appear to be related to PCOS and nutrition. To our knowledge, this is a novel finding for Mo. Additional research is needed to provide more insights into the causality of the PCOS relationship with Mo and Cu in humans.

Unsupervised detection of novel SARS-CoV-2 mutations and lineages in wastewater samples using long-read sequencing

The COVID-19 pandemic has underscored the importance of virus surveillance in public health and wastewater-based epidemiology (WBE) has emerged as a non-invasive, cost-effective method for monitoring SARS-CoV-2 and its variants at the community level. Unfortunately, current variant surveillance methods depend heavily on updated genomic databases with data derived from clinical samples, which can become less sensitive and representative as clinical testing and sequencing efforts decline.In this paper, we introduce HERCULES (High-throughput Epidemiological Reconstruction and Clustering for Uncovering Lineages from Environmental SARS-CoV-2), an unsupervised method that uses long-read sequencing of a single 1 Kb fragment of the Spike gene. HERCULES identifies and quantifies mutations and lineages without requiring database-guided deconvolution, enhancing the detection of novel variants.We evaluated HERCULES on Norwegian wastewater samples collected from July 2022 to October 2023 as part of a national pilot on WBE of SARS-CoV-2. Strong correlations were observed between wastewater and clinical sample data in terms of prevalence of mutations and lineages. Furthermore, we found that SARS-CoV-2 trends in wastewater samples were identified one week earlier than in clinical data.Our results demonstrate HERCULES' capability to identify new lineages before their detection in clinical samples, providing early warnings of potential outbreaks. The methodology described in this paper is easily adaptable to other pathogens, offering a versatile tool for environmental surveillance of new emerging pathogens.

Lived experiences of patients with advanced pancreatic cancer on patient-reported outcomes (PROs) management: a qualitative phenomenological study in Southwest China

OBJECTIVES

To explore the lived experiences of patients with advanced pancreatic cancer enrolled in a patient-reported outcomes (PROs) management programme and to preliminarily understand how PROs management influences various aspects of patient care and overall quality of life.

DESIGN

A qualitative phenomenological study.

SETTING

A national cancer care centre in Southwest China specialised in cancer care, with a comprehensive PROs management programme.

PARTICIPANTS

15 participants diagnosed with advanced pancreatic cancer.

RESULTS

Five key themes emerged from our interviews, including enhanced communication with healthcare providers, attributed to the structured nature of PROs; increased perceived sense of care, with patients feeling more valued and heard; PROs management facilitated better treatment decision-making, with patients feeling more involved and empowered; improved communication with family members, aiding in better understanding and support; and varied perceptions of the impact on quality of life, with some noting improvements in specific aspects like symptom management, while others were uncertain about the overall benefit.

CONCLUSIONS

PROs management plays a significant role in improving communication between patients with advanced pancreatic cancer and their healthcare providers, enhancing patients' involvement in treatment decisions, and potentially improving family dynamics. However, the impact of PROs management on the overall quality of life of patients remains complex and individualised. The findings suggest that further research with a more diverse patient population is needed to fully understand the implications of PROs management in advanced cancer care.

Nonhuman primate antigenic cartography of SARS-CoV-2

Virus neutralization profiles against primary infection sera and corresponding antigenic cartography are integral part of the COVID-19 and influenza vaccine strain selection processes. Human single variant exposure sera have previously defined the antigenic relationships among SARS-CoV-2 variants but are now largely unavailable due to widespread population immunity. Therefore, antigenic characterization of future SARS-CoV-2 variants will require an animal model, analogous to using ferrets for influenza virus. We evaluated neutralization profiles against 23 SARS-CoV-2 variants in nonhuman primates (NHPs) after single variant exposure and generated an NHP-derived antigenic map. We identified a distant antigenic region occupied by BA.2.86, JN.1, and the descendants KP.2, KP.3, and KZ.1.1.1. We also found that the monovalent XBB.1.5 mRNA vaccine induced broad immunity against the mapped antigenic space. In addition, substantial concordance was observed between our NHP-derived and two human antigenic maps, demonstrating the utility of NHPs as a surrogate for antigenic cartography in humans.

Mortality and immunological indicators of men who have sex with men living with HIV on antiretroviral therapy: a 10-year retrospective cohort study in Southern China

BACKGROUND

The proportion of people living with HIV (PLHIV) in Guangxi who are men who have sex with men (MSM) increased rapidly to nearly 10% in 2023; notably, over 95% of this particular population is currently receiving antiretroviral therapy (ART). This study aimed to describe the survival of MSM PLHIV, depict the characteristics and trends of changes in CD4+ T cell counts, CD4+/CD8+ T cell ratio, and viral load, and explore immunological indicators that may be related to mortality during different stages of treatment.

METHODS

Immunological indicators of MSM PLHIV receiving ART were extracted and categorized into baseline, mid-treatment, and last values. These were then incorporated into the Cox models in the form of repeated measurements to evaluate the associations (Adjusted-hazard ratios, aHRs) and 95% confidence intervals (95% CIs) of these immunological indicators with mortality at different stages.

RESULTS

A total of 5,642 patients who met the criteria were enrolled in the study, and 160 died, representing a mortality of 2.8%. The first, median, and last values of the CD4+ count and the CD4+/CD8+ ratio in surviving patients were significantly greater than the corresponding values in nonsurviving patients (P < 0.001). Except for the first viral load (P = 0.379), the median and last viral loads of the former were significantly lower than those of the latter (P < 0.001). In Cox model, with 2,144 cases, immunological indicators of increased mortality risk included a baseline CD4+ count below 200 cells/µL (aHR: 4.58, 95% CI: 2.28-9.19), a median (aHR: 8.46, 95% CI: 3.05-23.46), and a final (aHR: 4.43, 95% CI: 1.06-18.45) ratio below 0.7 and a median (aHR: 9.47, 95% CI: 4.02-22.35) and final (aHR: 14.46, 95% CI: 4.50-46.50) viral load 100,000 copies/mL and above.

CONCLUSIONS

Mortality among MSM PLHIV on ART in Guangxi is relatively low, and both high viral loads and low CD4+/CD8+ T cell ratios during treatment and at recent follow-up are strongly predictive of a serious prognosis and should be closely monitored.

Residential Exposure to PM2.5 Constituents and Fecundability in a Danish Preconception Cohort

BACKGROUND

Epidemiologic studies have demonstrated that ambient concentrations of particulate matter < 2.5 μm (PM2.5) are associated with reduced fecundability, the per cycle probability of conception. The specific constituents driving this association are unknown.

OBJECTIVES

We examined the association between ambient concentrations of PM2.5 constituents and fecundability in a Danish preconception cohort study.

METHODS

During 2007-2018, we enrolled female pregnancy planners in an Internet-based preconception cohort study. We included the 5905 participants who had been trying to conceive for < 3 cycles at study enrollment. Participants completed a baseline questionnaire and follow-up questionnaires every 8 weeks to update pregnancy status. We geocoded time-varying residential addresses to estimate ambient concentrations of total PM2.5 and the following PM2.5 constituents: elemental carbon (EC), primary organic aerosol (POA), secondary organic aerosols (SOA), sulfate (SO4 2-), ammonium (NH4 +), nitrate (NO3 -), and sea salt. We averaged concentrations of each pollutant across each menstrual cycle at risk. We fit proportional probabilities regression models to estimate fecundability ratios (FR) and 95% confidence intervals (CI), adjusting for potential confounders and co-pollutants.

RESULTS

Total PM2.5 concentrations were associated with reduced fecundability (the FR for an IQR increase, corresponding to 3.2 μg/m3, was 0.93 [95% CI 0.87, 0.99]). The association was strongest for POA: the FR for an IQR increase, corresponding to 1.3 μg/m3, was 0.92 (95% CI 0.84, 1.01). The corresponding FRs for the remaining PM2.5 constituents were 0.96 (95% CI 0.87, 1.05) for EC (IQR = 0.5 μg/m3), 0.98 (95% CI 0.91, 1.06) for SOA (IQR = 0.5), 0.97 (95% CI 0.92, 1.02) for SO2 4- (IQR = 0.4), 0.95 (95% CI 0.91, 1.01) for NH4 + (IQR = 0.5), 0.97 (95% CI 0.93, 1.01) for NO3 - (IQR = 1.0), and 1.00 (95% CI 0.95, 1.06) for sea salt (IQR = 0.4).

CONCLUSIONS

In this Danish preconception cohort study, PM2.5 constituents derived from biomass and transportation-related combustion may drive the association between PM2.5 concentrations and fecundability.

Factor Structure and Psychometric Properties of the Italian Version of the Childbearing Motivations Scale

The Childbearing Motivations Scale (CMS) is a multidimensional self-report measure of positive and negative motivations influencing the decision to become a parent. This study aimed to validate the Italian version of the CMS. A sample of 522 participants (27% men and 73% women) aged from 18 to 55 years was recruited. The four-factor model for the positive subscale and the five-factor model for the negative subscale of the CMS demonstrated a good fit. Reliability values ranged from 0.70 to 0.91. Both factors had evidence for convergent validity with sex, age, and relationship duration: women reported lower in some of the negative motivations to become a mother in contrast to men. Moreover, the greater the age, the lower the negative motivations for becoming a parent. Those in a longer relationship indicated lower negative motivations. No significant correlations were found for the positive motivations subscale. Significant differences were found for income levels (low vs. medium/high) regarding personal fulfillment, financial problems, and body-image concerns, as well as in cultural levels (medium vs. high) concerning economic constraints, intergenerational continuity, immaturity, and physical suffering. These findings suggest that individuals with lower economic resources scored higher across all these areas on the Negative Childbearing Motivations subscale. Our findings indicate that the CMS can be used to reliably assess the motivations for parenthood among Italian men and women.

Prediction and control for the transmission of brucellosis in inner Mongolia, China

Brucellosis, a zoonotic infectious disease caused by the Brucella genus, remains a significant global public health concern, with Inner Mongolia, China, being a notable hotspot affecting both human health and livestock. In response to this, we developed a dynamic SEIVWShIahIch model to simulate the transmission of brucellosis in Inner Mongolia. We calculated the basic reproduction number (R0 = 2.86), indicating a severe epidemic trend with cases expected to increase over the coming decades. The model was fitted to human brucellosis data, and key transmission parameters were estimated to predict future trends. We also evaluated the impact of various control measures, including vaccination, disinfection, culling, and health education. While these measures positively influence disease control, they cannot completely eliminate brucellosis, suggesting that a single control strategy is insufficient. Combining vaccination and culling proved more effective, with identified threshold values for R0 and to keep R0 < 1. Our findings indicate that a comprehensive strategy integrating vaccination, culling, disinfection, and health education is essential for effectively curbing brucellosis in Inner Mongolia, providing a strong foundation for optimizing future prevention and control strategies.

Detection of human noroviruses in sewage by next generation sequencing in Shandong Province, 2019-2021

BACKGROUND

Human noroviruses are the major cause of acute gastroenteritis and exhibit considerable genetic diversity. Next generation sequencing (NGS) analysis based on environmental surveillance has been proved to be an effective method in norovirus surveillance.

METHODS

Between January 2019 and December 2021, 36 sewage samples were collected and analyzed using real-time quantitative PCR to detect noroviruses. Partial VP1 region was amplified and subjected to NGS analysis to assess the abundance and genetic characterization of various norovirus genotypes across different samples.

RESULTS

A total of 23 norovirus genotypes were identified, including 9 genotypes of GI, 13 genotypes of GII and 1 genotype of GIX. The most frequently detected genotypes were GI.5 (86.11%), GII.2 (86.11%), GII.4 (63.89%), GII.17 (58.33%), and GII.13 (55.56%). Additionally, some rare genotypes, such as GI.7, GII.5, GII.9, and GII.16, which had not been previously reported in Shandong, were identified. No significant differences were observed in genotypic diversity or viral copy numbers in sewage samples when comparing pre- and post-COVID-19 periods. A total of 379 partial VP1 sequences were obtained, with the means sequence identity within a genotype of Shandong sequences ranging from 92.69 to 98.37% and a coefficient of variation ranging from 1.46 to 6.73%. Phylogenetic analysis indicated that local noroviruses within each genotype comprised multiple co-circulating lineages.

CONCLUSIONS

Our data demonstrate that sewage contains noroviruses with considerable high diversities. NGS based environmental surveillance greatly improves the understanding of norovirus circulation and should be encouraged.

Health risk assessment of dietary cadmium exposure based on cadmium bioavailability in food: Opportunities and challenges

Long-term exposure to Cd through contaminated food can lead to multiple adverse health effects on humans. Although previous studies have covered global food Cd concentrations and dietary Cd exposures across different populations, there are increasing concerns regarding the adequacy of current food Cd safety standards to protect populations from adverse health effects. Moreover, incorporation of Cd relative bioavailability (Cd-RBA) in foods improves the accuracy of health risk assessment. However, factors influencing food Cd-RBA have not been systematically discussed, thereby hindering its application in risk assessment. This review aims to provide an overview of Cd contents in foods, discuss concerns regarding international food Cd concentration standards, explore factors influencing food Cd bioavailability, and highlight the opportunities and challenges in refining differences between dietary Cd intakes and body burdens. Our findings suggest that current safety standards may be insufficient to protect human health, as they primarily focus on kidney damage as the protective endpoint and fail to account for global and regional variations in food consumption patterns and temporal changes in dietary habits over time. Factors such as crop cultivars and food compositions greatly influence food Cd-RBA. To improve the accuracy of Cd health risk assessment, future studies should incorporate food Cd-RBA, sociodemographic characteristics, nutritional status, and incidental Cd exposure. This review highlights new insights into food Cd safety standards and Cd bioavailability, identifies critical knowledge gaps, and offers recommendations for refining health risk assessments. This information is essential to inform future bioavailability investigations, health risk assessment, and safety standard development.

Current advances and challenges in mpox vaccine development: a global landscape

Given the surge in mpox outbreaks in 2022 and the advancements in domestic and international vaccine research, the effectiveness of smallpox vaccines in providing cross-protection against mpox remains crucial. Having learned from the COVID-19 pandemic, it is significant to continue evaluating existing vaccines to ensure their safety and efficacy. Developing new vaccines for widespread use against mpox and its emerging strains also serves as a preventive strategy in the ongoing battle against this dynamic infection. Here's an opportunity to control human-to-human transmission, give short deadlines, and avoid vaccine disparity. Public health systems must take decisive action to prevent the global spread of mpox, particularly among vulnerable groups. This action should include strengthening global surveillance, improving vaccine access, and ensuring equitable distribution, particularly in resource-poor settings, to prevent future outbreaks. This review aims to assess recent advancements and barriers in mpox vaccine development, emphasizing cross-protection and equitable vaccine distribution in resource-poor settings.

Gestational weight gain patterns as predictors of cesarean deliveries in women diagnosed with gestational diabetes mellitus

BACKGROUND

Obesity and excessive gestational weight gain (GWG) have been linked to an increased risk of cesarean section. However, existing literature primarily focuses on weight gain during individual trimesters, lacking a comprehensive assessment of GWG trajectories across all three trimesters. This study aimed to investigate the impact of pre-pregnancy BMI and changes in GWG trajectories from the first to the third trimester on cesarean section in women with confirmed gestational diabetes mellitus (GDM).

METHODS

This retrospective cohort study enrolled 947 women with GDM who delivered between January 2012 and July 2022 in northern Taiwan. GDM was diagnosed by oral glucose tolerance test (OGTT) during 24-28 weeks of gestation. Body mass index cut-offs were based on Asian-specific guidelines. The weekly GWG rate was based on baseline weight and weight at two follow-up measurements. GWG patterns were identified using group-based trajectory modeling analysis (GBTM).

RESULTS

Gestational weight gain patterns were classified into two groups during the pregnancy period: group 1 (non-rapid excessive weight gain) and group 2 (rapid excessive weight gain), comprising 70.2% and 29.8% of participants, respectively. Our study found that being pre-pregnancy underweight and experiencing rapid excessive weight gain contributed to cesarean section. Binary logistic regression analysis revealed that pre-pregnancy normal body mass index (OR = 2.06; 95% CI: 1.08-3.92) and being overweight/obese (OR = 4.04; 95%CI: 2.12-7.70) were associated with the incidence of cesarean sections. Multiparous women and women with a trajectory of rapid excessive weight gain were more likely to undergo cesarean sections.

CONCLUSIONS

Healthcare professionals should provide education on weight management from pre-pregnancy to pregnancy to reduce the incidence of cesarean sections. Particular attention should be paid to women with gestational diabetes mellitus (GDM) who exhibit rapid excessive weight gain to minimize the risk of cesarean delivery.

Biomass-Based Hydrogen Extraction and Accompanying Hazards-Review

Nowadays, there is an increased demand for energy, the access to which, however, is limited due to the decreasing of fossil sources and the need to reduce emissions, especially carbon dioxide. One possible remedy for this situation is using hydrogen as a source of green energy. Hydrogen is usually bound to other chemical elements and can be separated via energy-intensive few-step conversion processes. A few methods are involved in separating H2 from biomass, including biological and thermochemical (TC) ones. Such methods and possible hazards related to them are reviewed in this study.

Fluoride-Mediated Immune Damage Through Cytokine Network Regulation of Tregs

Long-term fluoride exposure can induce inflammatory responses in various tissues of the body, thereby affecting the inflammatory microenvironment. To explore how fluoride induces changes in immune function within this microenvironment, this study collected baseline information and biological samples from participants in areas with the drinking water type of fluorosis, and simultaneously established Wistar rat models with a 12-week and 24-week fluoride exposure, as well as a 12-week fluoride exposure followed by 12-week pure water feeding regimen. Luminex multiplex assays and enzyme-linked immunosorbent assays (ELISAs) were used to measure cytokine expression levels. Subsequently, correlation analysis, multiple linear regression, and mediation analysis were employed to explore the long-term effects induced by the complex cytokine network during fluoride exposure. The population survey results indicated that fluoride suppressed the expression of pro-inflammatory factors such as Interleukin-2 (IL-2), Interleukin-12 (IL-12), Interferon-γ (IFN-γ), Tumor necrosis factor-α (TNF-α), and anti-inflammatory factors such as Interleukin-4 (IL-4), Interleukin-13 (IL-13), and Interleukin-37 (IL-37), while promoting an increase in the proportion of regulatory T cells (Tregs) in peripheral blood. Among these, IL-2 and IFN-γ mediated the fluoride-induced peripheral Tregs expansion. Animal experiments indicate that the proportion of Tregs in peripheral blood and immune organs increases in a time-dependent manner with fluoride exposure. After reducing the fluoride concentration in the drinking water of rats, the number of Tregs remained significantly elevated. The changes in Treg numbers in the 12-week fluoride feeding group, 24-week fluoride feeding group, and 12-week fluoride feeding followed by 12-week water improvement group were related to the cytokine levels. Therefore, the impact of fluoride on the immune homeostasis has cumulative and long-term effects, and may be related to the accumulation and migration of Tregs induced by fluoride in an inflammatory environment, mediated by cytokines.

Vaccines in Dermatology-Present and Future: A Review

Dermatological vaccines have emerged as critical tools in preventing and managing a wide spectrum of skin conditions ranging from infectious diseases to malignancies. By synthesizing evidence from existing literature, this review aims to comprehensively evaluate the efficacy, safety, and immunogenicity of vaccines used in dermatology, including both approved vaccines and those currently being researched. Vaccines discussed in this paper include those targeting dermatoses and malignancies (e.g., acne vulgaris, atopic dermatitis, and melanoma); infectious diseases (e.g., human papillomavirus (HPV); varicella zoster virus (VZV); herpes zoster (HZ); warts; smallpox; mpox (monkeypox); hand, foot, and mouth disease (HFMD); candidiasis and Group B Streptococcus (GBS); and neglected tropical diseases (e.g., Buruli ulcer, leprosy, and leishmaniasis). Through this review, we aim to provide a detailed understanding of the role of vaccines in dermatology, identify knowledge gaps, and propose areas for future research.

A single immunization with intranasal Newcastle disease virus (NDV)-based XBB.1.5 variant vaccine reduces disease and transmission in animals against matched-variant challenge

The rapid development of coronavirus disease 2019 (COVID-19) vaccines has helped mitigate the initial impact of the pandemic. However, in order to reduce transmission rates and protect more vulnerable and immunocompromised individuals unable to mount an effective immune response, development of a next-generation of mucosal vaccines is necessary. Here, we developed an intranasal Newcastle disease virus (NDV)-based vaccine expressing the spike of the XBB.1.5 variant stabilized in its pre-fusion conformation (NDV-HXP-S). We demonstrated that one or two intranasal immunizations with live NDV-HXP-S expressing the XBB.1.5 spike induces systemic and mucosal antibody responses in mice and protects them from a challenge with the XBB.1.5 variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Furthermore, one or two intranasal vaccinations with NDV-HXP-S XBB.1.5 protected hamsters from variant matched infection and reduced virus emission, thereby providing complete protection to naïve animals in a direct contact transmission study. The data shown in this study supports the notion that intranasal vaccination with variant-adapted NDV-HXP-S induces protective mucosal immunity and reduces transmission rates, highlighting the robust protective efficacy of a single mucosal vaccination in mice and hamsters.

Selective phosphodiesterase 4 inhibitor roflumilast reduces inflammation and lung injury in models of betacoronavirus infection in mice

OBJECTIVE

We aimed to understand the potential therapeutic and anti-inflammatory effects of the phosphodiesterase-4 (PDE4) inhibitor roflumilast in models of pulmonary infection caused by betacoronaviruses.

METHODS

Mice were infected intranasally with murine hepatitis virus (MHV-3) or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Roflumilast was given to MHV-3-infected mice therapeutically at doses of 1 mg/kg or 10 mg/kg, or prophylactically at 10 mg/kg. In SARS-CoV-2-infected mice, roflumilast was given therapeutically at a dose of 10 mg/kg. Lung histopathology, chemokines (CXCL-1 and CCL2), cytokines (IL-1β, IL-6, TNF, IFN-γ, IL-10 and TGFβ), neutrophil immunohistochemical staining (Ly6G+ cells), macrophage immunofluorescence staining (F4/80+ cells), viral titration plaque assay, real-time PCR virus detection, and blood cell counts were examined.

RESULTS

Therapeutic treatment with roflumilast at 10 mg/kg reduced lung injury in SARS-CoV-2 or MHV-3-infected mice without compromising viral clearance. In MHV-3-infected mice, reduced lung injury was associated with decreased chemokines levels, prevention of neutrophil aggregates and reduced macrophage accumulation in the lung tissue. However, the prophylactic treatment strategy with roflumilast increased lung injury in MHV-3-infected mice.

CONCLUSION

Our findings indicate that therapeutic treatment with roflumilast reduced lung injury in MHV-3 and SARS-CoV-2 lung infections. Given the protection induced by roflumilast in inflammation, PDE4 targeting could be a promising therapeutic avenue worth exploring following severe viral infections of the lung.