MXene-Based Photothermal-Responsive Injectable Hydrogel Microsphere Modulates Physicochemical Microenvironment to Alleviate Osteoarthritis

Osteoarthritis (OA) is a physical lubrication microenvironment-inadequate disease accompanied by a sustained chronic chemical inflammation microenvironment and the progression of articular cartilage destruction. Despite the promising OA treatment outcomes observed in the enhancement of lubrication inspired by ball bearings to reduce friction and support loads, the therapeutic effect of near-infrared (NIR) irradiation-based photothermal-responsive controlled release "smart hydrogel microspheres" on OA remains unclear. Here, we prepared MXene/NIPIAM-based photothermal-responsive injectable hydrogel microspheres encapsulating diclofenac sodium using a microfluidic system. Consequently, NIR irradiation-based photothermal-responsive controlled release "smart hydrogel microspheres" demonstrate beneficial therapeutic effects in the treatment of OA by modulating the physical lubrication and chemical chronic inflammation microenvironment, laying the foundation for the application of smart hydrogel microsphere delivery systems loaded with bioactive factors (including agents, cells, and factors) to regulate multiple pathological microenvironments in regenerative medicine.

Clinical Application Guideline of Combination With Traditional Chinese Medicine and Western Medicine in the Prevention and Treatment of Chronic Obstructive Pulmonary Disease (2024)

AIM

Chronic Obstructive Pulmonary Disease (COPD) is a common chronic airway disease that can lead to decreased lung function in patients. It places a heavy economic burden on patients and society. Traditional Chinese medicine (TCM) and Western medicine have played important roles in managing COPD. We aimed to develop an evidence-based guideline for treating COPD with Chinese and Western Medicine.

METHODS

We formed a guideline panel of multidisciplinary experts. The clinical questions were identified based on two rounds of issue solicitation and expert demonstration. We searched the literature for direct evidence on the management of COPD and assessed its certainty-generated evidence using the grading of recommendations, assessment, development, and evaluation (GRADE) approach. The recommendations and their strengths were formulated using the Delphi method.

RESULTS

Our guideline covers aspects of the diagnosis and treatment of COPD such as principles and commonly used medications for both traditional Chinese medicine and Western medicine, complications, and the high-risk populations. 9 clinical questions and 35 recommendations were identified, which covered the combinations of YuPingFeng granule, Buzhong Yiqi decoction, Gushen Dingchuan Pill, Bufei Huoxue Capsules, Runfei cream, Bailing Capsule, Tanyin Pills, etc., and nonpharmacological therapy of TCM such as combined acupoint application, electroacupuncture, and Chinese exercise techniques (Tai Chi, Baduanjin), etc. Recommendations were either high or low or in the form of ungraded consensus-based statements.

CONCLUSIONS

This is a comprehensive and systematic evidence-based guideline and we hope it can systematically and effectively guide clinicians in managing COPD and improve overall medical care.

Windows of susceptibility to air pollution during and surrounding pregnancy in relation to longitudinal maternal measures of adiposity and lipid profiles

Pregnancy is a critical window for long-term metabolic programming of fetal effects stemming from airborne particulate matter ≤2.5 μm (PM2.5) exposure. Yet, little is known about long-term metabolic effects of PM2.5 exposure during and surrounding pregnancy in mothers. We assessed potential critical windows of PM2.5 exposure during and surrounding pregnancy with maternal adiposity and lipid measures later in life. We included 517 pregnant women from the PROGRESS cohort with adiposity [body mass index (BMI), waist circumference (WC), % body fat] and lipids [total cholesterol, high-density-lipoprotein (HDL), low-density-lipoprotein (LDL)] measured repeatedly at 4, 6 and 8 years post-delivery. Monthly average PM2.5 exposure was estimated at each participant's address using a validated spatiotemporal model. We employed distributed lag interaction models (DLIMs) adjusting for socio-demographics and clinical covariates. We found that a 1 μg/m3 increase in PM2.5 exposure throughout mid-/late-pregnancy was associated with higher WC at 6-years post-delivery, peaking at 6 months of gestation: 0.04 cm (95%CI: 0.01, 0.06). We also identified critical windows of PM2.5 exposure during and surrounding pregnancy associated with higher LDL and lower HDL both measured at 4 years post-delivery with peaks at pre-conception for LDL [0.17 mg/dL (95%CI: 0.00, 0.34)] and at the 11th month after conception for HDL [-0.07 mg/dL (95%CI: -0.11, -0.02)]. Stratified analyses by fetal sex indicated stronger associations with adiposity measures in mothers carrying a male, while with lipids in mothers carrying a female fetus. Stratified analyses also indicated potential stronger deleterious lagged effects in women with folic acid intake lower than 600mcg/day during pregnancy.

HMGB1: A New Target for Ischemic Stroke and Hemorrhagic Transformation

Stroke in China is distinguished by its high rates of morbidity, recurrence, disability, and mortality. The ultra-early administration of rtPA is essential for restoring perfusion in acute ischemic stroke, though it concurrently elevates the risk of hemorrhagic transformation. High-mobility group box 1 (HMGB1) emerges as a pivotal player in neuroinflammation after brain ischemia and ischemia-reperfusion. Released passively by necrotic cells and actively secreted, including direct secretion of HMGB1 into the extracellular space and packaging of HMGB1 into intracellular vesicles by immune cells, glial cells, platelets, and endothelial cells, HMGB1 represents a prototypical damage-associated molecular pattern (DAMP). It is intricately involved in the pathogenesis of atherosclerosis, thromboembolism, and detrimental inflammation during the early phases of ischemic stroke. Moreover, HMGB1 significantly contributes to neurovascular remodeling and functional recovery in later stages. Significantly, HMGB1 mediates hemorrhagic transformation by facilitating neuroinflammation, directly compromising the integrity of the blood-brain barrier, and enhancing MMP9 secretion through its interaction with rtPA. As a systemic inflammatory factor, HMGB1 is also implicated in post-stroke depression and an elevated risk of stroke-associated pneumonia. The role of HMGB1 extends to influencing the pathogenesis of ischemia by polarizing various subtypes of immune and glial cells. This includes mediating excitotoxicity due to excitatory amino acids, autophagy, MMP9 release, NET formation, and autocrine trophic pathways. Given its multifaceted role, HMGB1 is recognized as a crucial therapeutic target and prognostic marker for ischemic stroke and hemorrhagic transformation. In this review, we summarize the structure and redox properties, secretion and pathways, regulation of immune cell activity, the role of pathophysiological mechanisms in stroke, and hemorrhage transformation for HMGB1, which will pave the way for developing new neuroprotective drugs, reduction of post-stroke neuroinflammation, and expansion of thrombolysis time window.

Effect of oxygen on antimicrobial resistance genes from a one health perspective

Bacteria must face and adapt to a variety of physicochemical conditions in the environment and during infection. A key condition is the concentration of dissolved oxygen, proportional to the partial pressure of oxygen (PO2), which is extremely variable among environmental biogeographical areas and also compartments of the human and animal body. Here, we sought to understand if the phenotype of resistance determinants commonly found in Enterobacterales can be influenced by oxygen pressure. To do so, we have compared the MIC in aerobic and anaerobic conditions of isogenic Escherichia coli strains containing 136 different resistance genes against 8 antibiotic families. Our results show a complex landscape of changes in the performance of resistance genes in anaerobiosis. Certain changes are especially relevant for their intensity and the importance of the antibiotic family, like the large decreases in resistance observed against ertapenem and fosfomycin among blaVIM β-lactamases and certain fos genes, respectively; however, the blaOXA-48 β-lactamase from the clinically relevant pOXA-48 plasmid conferred 4-fold higher ertapenem resistance in anaerobiosis. Strong changes in resistance patterns in anaerobiosis were also conserved in Klebsiella pneumoniae. Our results suggest that anaerobiosis is a relevant aspect that can affect the action and selective power of antibiotics for specific AMRs in different environments.

Finding purpose: Integrated latent profile and machine learning analyses identify purpose in life as an important predictor of high-functioning recovery after alcohol treatment

BACKGROUND

Recent investigations of recovery from alcohol use disorder (AUD) have distinguished subgroups of high and low functioning recovery in data from randomized controlled trials of behavioral treatments for AUD. Analyses considered various indicators of alcohol use, life satisfaction, and psychosocial functioning, and identified four recovery profiles from AUD three years following treatment.

OBJECTIVES

The present study integrates these profiles into a two-part machine learning framework, using recursive partitioning and random forests to distinguish a) clinical cut-points across 28 end-of-treatment biopsychosocial measurements that are predictive of high or low functioning recovery three years after treatment; and b) a rank-ordered list of the most salient variables for predicting individual membership in the high-functioning recovery sub-groups.

METHODS

This secondary data analysis includes individuals (n = 809; 29.7% female) in the outpatient arm of Project MATCH who completed the end-of-treatment assessment and three-year follow-up batteries.

RESULTS

Recursive partitioning found individuals with low depressive symptoms and less than 25% drinking days were more likely to be in a high functioning recovery profile (68%), whereas those with at least mild depressive symptoms and low purpose in life were more likely to be in a low functioning recovery profile (70%). Random forests identified purpose in life, social functioning, and depressive symptoms as the best predictors of recovery profiles.

CONCLUSIONS

Recovery profiles are best predicted by variables often considered of secondary interest. We demonstrate the utility of two machine learning approaches, highlighting how random forests can overcome recursive partitioning limitations.

Understanding the dynamics of malnutrition dichotomy in India: Trends and insights from the National Family Health Surveys

Purpose

India is confronted with a multifaceted malnutrition landscape, characterized by the coexistence of stunting, underweight, and escalating overweight and obesity rates. Current programs predominantly target undernutrition, overlooking the surging prevalence of overweight and obesity. These trends carry substantial economic ramifications, with obesity-related costs expected to rise significantly. Addressing these challenges requires enhanced policy execution and strategic collaboration. This article seeks to help overcome policy inertia in addressing the other end of the malnutrition spectrum-overnutrition.

Methods

The National Family Health Survey (NFHS), a large-scale survey conducted by the Ministry of Health and Family Welfare, Government of India, provides high-quality data on population dynamics and health indicators. Data for relevant health indicators were extracted from NFHS-3 to NFHS-5 to identify trends and shifting paradigms in malnutrition profiles. Data from the latest NFHS (NFHS-5) were briefly analyzed to highlight the malnutrition dichotomy and perform linear regression analysis.

Results

The data revealed a declining trend in stunting and underweight prevalence alongside a rise in overweight prevalence. Linear regression analyses on NFHS-5 data showed a positive association between literacy and obesity in both men and women. The findings also indicated that children fed with minimum dietary diversity were more likely to be overweight, and revealed a significant association between elevated random blood glucose levels and obesity in women.

Conclusions

By implementing the necessary interventions and strategies, India can establish a holistic approach to addressing both undernutrition and overnutrition effectively, thus contributing to Sustainable Development Goal-2 and paving the way for a healthier and more productive future for India's population.

Efficacy of intra-articular injections for the treatment of osteoarthritis: A narrative review

Osteoarthritis (OA) is a prevalent degenerative joint disease characterized by progressive cartilage loss, inflammation, and joint dysfunction. With profound effects on joint function and quality of life, OA imposes a substantial socio-economic burden. As of now, OA remains incurable, lacking approved medications, regenerative therapies, or procedures that can halt the progressive destruction of the joint. Intraarticular (IA) injections have emerged as a cornerstone in the management of knee OA, offering localized minimally invasive therapeutic options. Traditional IA therapies, including corticosteroids and hyaluronic acid (HA), primarily aim to reduce pain but lack regenerative capacity. Biologic IA therapies for knee OA including autologous blood-derived products like platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC) and mesenchymal stromal cells (MSCs) have become more commonly used. Finally, newer IA therapies such as fibroblast growth factor 18 and gene therapy are being investigated. In this review, we highlight the current evidence around IA injections for the treatment of knee OA.

Ceria nanoparticles alleviate myocardial ischemia-reperfusion injury by inhibiting cardiomyocyte apoptosis via alleviating ROS mediated excessive mitochondrial fission

Reperfusion through thrombolytic therapy or primary percutaneous coronary intervention is commonly used to deal with acute myocardial infarction. However, the reperfusion procedure is accompanied by myocardial ischemia-reperfusion injury (MIRI). Currently, there is no therapeutics that can effectively deal with MIRI in clinical practice. Herein, the potential of ceria nanoparticles (CNPs) coated by different ligands in the treatment of rat MIRI is evaluated. The results demonstrate that CNPs can effectively modulate the oxidative stress in the heart tissue through the elimination of reactive oxygen species (ROS) and stimulation of endogenous antioxidant system. The inhibition of oxidative stress results in the reduction of p-Drp1 (Ser 616) which is critical in driving the fission and fragmentation of mitochondria. The improved mitochondrial dynamics saves the cardiomyocytes from apoptosis and reduces the acute injury of left ventricular wall during the MIRI. The ejection function of the left ventricle for both the short-term and long-term MIRI rats is well preserved. We therefore believe based on these results that the administration of CNPs is beneficial in the attenuation of MIRI during the acute stage. These findings provide useful information for the future fabrication of inorganic antioxidant nanomedicine for the treatment of MIRI.

Lipidomics and cardiovascular disease

Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide, necessitating innovative approaches for early detection and personalized interventions. Lipidomics, leveraging advanced mass spectrometry techniques, has become instrumental in deciphering lipid-mediated mechanisms in CVDs. This review explores the application of lipidomics in identifying biomarkers for myocardial infarction, heart failure, stroke, and calcific aortic valve stenosis (CAVS). This review examines the technological advancements in shotgun lipidomics and LC/MS, which provide unparalleled insights into lipid composition and function. Key lipid biomarkers, including ceramides and lysophospholipids, have been linked to disease progression and therapeutic outcomes. Integrating lipidomics with genomic and proteomic data reveals the molecular underpinnings of CVDs, enhancing risk prediction and intervention strategies. This review positions lipidomics as a transformative tool in reshaping cardiovascular research and clinical practice.

Sleep Quality, Depression, and the Risk of Anaemia in Adolescents Aged 10-19 Years During One Year of the COVID-19 Pandemic in Indonesia

Sleep quality and depression are known to be associated with anaemia in adults, but studies are limited among children and adolescents. The present study aimed to assess the association between sleep quality, depression, and haemoglobin concentration in Indonesian adolescents aged 10-19 years. Data of 452 adolescent boys and girls, aged 10-19 years old, were collected across all subdistricts in Gunungkidul district, Yogyakarta province, Indonesia, in 2021 (baseline) and 2022 (follow-up). Sleep quality and depression were assesed using The Pittsburgh Sleep Quality Index (PSQI) and The Kessler-10 Psychological Distress Scale (K10), respectively. Haemoglobin concentration was measured, with corrections applied for altitude and smoking. Anaemia status was defined as haemoglobin < 11.5 g/dL for adolescents aged 10-11 years old, < 12 g/dL for those aged 12-14 years old and for girls aged 15 years and older, and < 13 g/dL for boys aged 15 years old and older. Latent Class Analysis (LCA) was employed to identify distinct subgroups of adolescents based on shared patterns of sleep quality and depression. Multiple linear regression was applied to identify associations between class membership and haemoglobin concentration at baseline and follow-up, with adjustments for baseline haemoglobin concentration, sex, age, pubertal status, alcohol consumption, smoking status, and household income. The overall prevalence of anaemia was 21% at baseline and 29% at follow-up, with girls being more affected than boys. LCA yielded 5 classes of sleep quality and depression. We did not find an association between class membership and haemoglobin concentration at baseline. However, in comparison to class A and after adjustments, membership of class B (moderate-to-good sleep quality and low risk of depression, with some tiredness) predicted a reduction of 0.43 g/dL (95% CI: -0.79; -0.07), whereas membership of class C (moderate sleep quality and moderate risk of depression) predicted a reduction of 0.49 g/dL (95% CI: -0.94; -0.04) in haemoglobin concentration at 1 year follow-up. Our study found that poor sleep quality and depression symptoms are associated with lower haemoglobin concentrations over time. Mental health and sleep quality should therefore be considered in intervention programs that address anaemia.

Global evaluation of the impact of food fortification with folic acid on rates of schizophrenia

BACKGROUND

Low folate status is one of the multiple factors thought to contribute to the development of schizophrenia. As of 2023, over 70 countries have implemented mandatory fortification of foods with folic acid, a public health measure aimed at reducing neural tube defects; however, the impact of such policy on schizophrenia has not been comprehensively investigated.

METHOD

We assessed the impact of mandatory folic acid fortification on changes in the schizophrenia rates in 194 jurisdictions between 1990 and 2019 using publicly available data. We used weighted regression models adjusted for sociodemographic and sociopolitical factors, experience of natural disasters, and baseline schizophrenia rate.

RESULTS

Age-adjusted prevalence and incidence of schizophrenia increased marginally between 1990 and 2019. In all geographic regions, schizophrenia prevalence and incidence per 100,000 positively correlated with countries' sociodemographic index and were lower with fortification. Schizophrenia burdens were higher among males compared to females. Lower prevalence and incidence of schizophrenia were associated with having mandatory fortification with modest magnitudes. Duration of fortification or the fortification dose did not appear to have a strong impact. However, in the 15-39 year age-group, both mandatory fortification (β = -13·14 (-22·60, -3·68)) and duration of fortification (β = -0·82 (-1·40, -0·23)) were significantly associated with lower schizophrenia with larger magnitude in both sexes. The highest dose tertile was reported to have the lowest incidence and the smallest increase in prevalence in this age-group.

CONCLUSION

Folic acid fortification may be a beneficial intervention in lowering schizophrenia among adolescents and young adults.

The impact and projection of the COVID-19 pandemic on the burden of stroke at global, regional, and national levels: A comprehensive analysis for the Global Burden of Disease Study 2021

BACKGROUND

We aim to estimate impact and projection of the COVID-19 pandemic on the burden of stroke at global, regional, and national levels METHODS: Utilizing standardized GBD methodologies, we conducted a comprehensive analysis of the prevalence, incidence, mortality, and disability-adjusted life years (DALYs) associated with stroke across 204 countries and regions spanning the periods from 1990 to 2019, 2019 to 2021, and 1990 to 2021. Our study provides detailed estimates accompanied by corresponding 95% uncertainty intervals (UIs), stratified by age and sex. To elucidate the temporal trends in stroke burden, we calculated the Estimated Annual Percentage Change (EAPC). Additionally, we explored the relationship between stroke burden and sociodemographic index (SDI) levels. The DALYs attributable to various risk factors for stroke were also analyzed. The burden of stroke in the next 20 years was also predicted.

RESULTS

From 2019 to 2021, the age-standardized prevalence rates (ASPR), incidence rates (ASIR), mortality rates (ASMR), and DALYs rates for stroke remained stable, diverging from the declining trends observed from 1990 to 2019 and from 1990 to 2021 at global, regional, and national levels, as indicated by both percent change analysis and EAPC analysis. This pattern was similarly reflected in the global burden of intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), and ischemic stroke (IS). The changes in the burden of stroke, ICH, and IS from 2019 to 2021 were consistent between males and females. Importantly, the impact of COVID-19 on stroke burden remains substantial, irrespective of variations in the SDI. The IS burden increased in the next 20 years, and more attention should be paid on the stroke burden in young people.

CONCLUSIONS

Throughout the COVID-19 pandemic, the burden of stroke exhibited a stable trajectory, in contrast to the declining trend observed from 1990 to 2019 and from 1990 to 2021. The increased burden was observed in IS and young people in the next 20 years. These observations highlight the disparities in stroke burden that exist across different levels of socioeconomic development. The longitudinal epidemiological data presented in this study provide valuable insights into the significant shifts brought about by the COVID-19 pandemic, offering crucial information for researchers, policymakers, healthcare professionals, and other stakeholders.

Artificial intelligence based predictive tools for identifying type 2 diabetes patients at high risk of treatment Non-adherence: A systematic review

AIMS

Several Artificial Intelligence (AI) based predictive tools have been developed to predict non-adherence among patients with type 2 diabetes (T2D). Hence, this study aimed to describe and evaluate the methodological quality of AI based predictive tools for identifying T2D patients at high risk of treatment non-adherence.

METHODS

A systematic search was conducted across multiple databases including, EMBASE, Cochrane Library, MedLine, and Google Scholar search. The Prediction model Risk Of Bias ASsessment Tool (PROBAST) was used to assess the quality of studies. The performances of tools were assessed by Area Under the Curve (AUC), precision, recall, C-index, accuracy, sensitivity, specificity or F1 score.

RESULTS

Most studies measured predictive ability using AUC (75 %), and some only reported precision (25 %), recall (12.5 %), C-index (12.5 %), accuracy (37.5), sensitivity (12.5 %), specificity (12.5 %) or F1 score (25 %). All tools had moderate to high predictive ability (AUC > 0.70). However, only one study conducted external validation. Demographic characteristics, HbA1c, glucose monitoring data, and treatment details were typical factors used in developing tools.

CONCLUSIONS

The existing AI based tools holds significant promise for improving diabetes care. However, future studies should focus on refining the existing tools, validating in other settings, and evaluating the cost-effectiveness of AI-supported interventions.

The association between long-term exposure to PM2.5 constituents and ischemic stroke in the New York City metropolitan area

Numerous studies linked fine particulate matter (PM2.5) to ischemic stroke. However, only a few investigated the differential associations with specific PM2.5 components and sources. We utilized electronic health records (EHR) from the Mount Sinai Health System in the New York City metropolitan area during 2011-2019 and assessed the associations of PM2.5 components and sources with ischemic stroke. We used mixed-effect Poisson survival regressions to assess the single-exposure associations with the chemical components. We used multivariable regression to assess the simultaneous associations with source-apportioned PM2.5 exposures estimated using non-negative matrix factorization. Then, we assessed the sensitivity of our results to different specifications of EHR data continuity: (1) using a less strict definition of censorship year, (2) adjusting the model for EHR data continuity index, a validated algorithm measuring EHR-data continuity based on indicators of primary care service utilization. We observed higher risks for ischemic stroke (Risk ratio [95 % confidence intervals] per interquartile range increase) associated with higher exposure to nickel (1.080 [1.045; 1.116]), vanadium (1.070 [1.033; 1.109]), zinc (1.076 [1.031; 1.122]), and nitrate (1.084 [1.039; 1.132]). In the multivariate models we found higher risk for ischemic stroke associated with exposure to oil combustion sourced PM2.5 (1.061 [1.012; 1.113]). The results remained consistent under different model specifications accounting for EHR data continuity. In conclusion, we found an increased risk of ischemic stroke associated with specific PM2.5 components and sources. These findings were robust to different specifications of EHR-data continuity. Our findings can inform policy and interventions aimed at reducing cardiovascular disease burden.

Association of cardiovascular-kidney-metabolic syndrome with all-cause and cardiovascular mortality: A prospective cohort study

Background

Given evidence on the cardiovascular disease (CVD) risk conferred by comorbidity risk factors, the American Heart Association (AHA) recently introduced a novel staging construct, named cardiovascular-kidney-metabolic (CKM) syndrome. This study examined the association of CKM syndrome stages with all-cause and cardiovascular mortality among US adults.

Methods

Data were from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 at baseline linked to the 2019 National Death Index records. For each participant, the CKM syndrome was classified into five stages: stage 0 (no CKM risk factors), 1 (excess or dysfunctional adiposity), 2 (metabolic risk factors and chronic kidney disease), 3 (subclinical CVD), or 4 (clinical CVD). The main outcomes were all-cause and cardiovascular mortality.

Results

Among 34,809 participants (mean age: 46.7 years; male: 49.2 %), the prevalence of CKM stages 0 to 4 was 13.2 %, 20.8 %, 53.1 %, 5.0 %, and 7.8 %, respectively. During a median follow-up of 8.3 years, compared to participants with CKM stage 0, those with higher stages had increased risks of all-cause mortality (stage 2: HR 1.43, 95 % 1.13-1.80; stage 3, HR 2.75, 95 % CI 2.12-3.57; stage 4, HR 3.02, 95 % CI 2.35-3.89). The corresponding hazard ratios (95 % confidence interval) of cardiovascular mortality risks were 2.96 (1.39-6.30), 7.60 (3.50-16.5), and 10.5 (5.01-22.2). The population-attributable fractions for advanced (stages 3 or 4) vs. CKM syndrome stages (stages 0, 1, or 2) were 25.3 % for all-cause mortality and 45.3 % for cardiovascular mortality.

Conclusion

Higher CKM syndrome stages were associated with increased risks of all-cause and cardiovascular mortality. These findings emphasize that primordial and primary prevention efforts on promoting CKM health should be strengthened to reduce mortality risk.

Association between particulate matter exposure and acute ischemic stroke admissions in less-polluted areas: a time-series study using a distributed lag nonlinear model

Purpose

China has experienced a heavy public health burden due to the increasing incidence of ischemic stroke (IS). Few studies have evaluated the relationship between particulate matter (PM) exposure and acute ischemic stroke (AIS) in relatively less-polluted areas, and the results have been inconsistent. As a result, this study aimed to investigate and evaluate the association between PM exposure and hospitalizations for AIS in an area with less air pollution.

Methods

Through collecting daily AIS hospitalizations, air pollution data and meteorological data from July 1, 2017 to June 30, 2020 in Nanning, this paper explored the association between short-term exposure to PM (PM2.5, PM10 and PMc) and daily hospital admissions for AIS using a distributed lag non-linear model based on time-series. To further identify the susceptible populations, stratified analyses were performed by age and gender.

Results

During the study period, a total of 2382 patients were admitted to hospital with AIS, with the ratio of male to female reached 2.03: 1. No statistical association was found between PM exposure and AIS admissions in the total population. Subgroup analysis showed that PM2.5, PM10 and PMc exposures were significantly associated with AIS admissions in male at lag29-lag30, lag27-lag30 and lag25-lag27, respectively. In addition, PMc exposure was also relevant to admissions for AIS with aged < 65 years at lag18-lag23.

Conclusions

Short-term exposure to ambient PM was not associated with hospital admissions for AIS in the general population, but males and young adults (aged < 65 years) were more susceptible to PM exposure. Even in areas with relatively low air pollution, appropriate measures should be adopted to intervene in the adverse effects of air pollution on vulnerable populations.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40201-024-00926-w.

Effect of metabolic disorders on reactive gliosis and glial scarring at the early subacute phase of stroke in a mouse model of diabetes and obesity

It is well recognized that type II Diabetes (T2D) and overweight/obesity are established risk factors for stroke, worsening also their consequences. However, the underlying mechanisms by which these disorders aggravate outcomes are not yet clear limiting the therapeutic opportunities. To fill this gap, we characterized, for the first time, the effects of T2D and obesity on the brain repair mechanisms occurring 7 days after stroke, notably glial scarring. In the present study, by performing a 30-minute middle cerebral artery occlusion (MCAO) on db/db (obese diabetics mice) and db/+ (controls) mice, we demonstrated that obese and diabetic mice displayed larger lesions (i.e. increased infarct volume, ischemic core, apoptotic cell number) and worsened neurological outcomes compared to their control littermates. We then investigated the formation of the glial scar in control and db/db mice 7 days post-stroke. Our observations argue in favor of a stronger and more persistent activation of astrocytes and microglia in db/db mice. Furthermore, an increased deposition of extracellular matrix (ECM) was observed in db/db vs control mice (i.e. chondroitin sulfate proteoglycan and collagen type IV). Consequently, we demonstrated for the first time that the db/db status is associated with increased astrocytic and microglial activation 7 days after stroke and resulted in higher deposition of ECM within the damaged area. Interestingly, the injury-induced neurogenesis appeared stronger in db/db as shown by the labeling of migrating neuroblast. This increase appeared correlated to the larger size of lesion. It nevertheless raises the question of the functional integration of the new neurons in db/db mice given the observed dense ECM, known to be repulsive for neuronal migration. Carefully limiting glial scar formation after stroke represents a promising area of research for reducing neuronal loss and limiting disability in diabetic/obese patients.

Enhancing m6A modification in the motor cortex facilitates corticospinal tract remodeling after spinal cord injury

JOURNAL/nrgr/04.03/01300535-202506000-00026/figure1/v/2024-08-05T133530Z/r/image-tiff Spinal cord injury typically causes corticospinal tract disruption. Although the disrupted corticospinal tract can self-regenerate to a certain degree, the underlying mechanism of this process is still unclear. N6-methyladenosine (m6A) modifications are the most common form of epigenetic regulation at the RNA level and play an essential role in biological processes. However, whether m6A modifications participate in corticospinal tract regeneration after spinal cord injury remains unknown. We found that expression of methyltransferase 14 protein (METTL14) in the locomotor cortex was high after spinal cord injury and accompanied by elevated m6A levels. Knockdown of Mettl14 in the locomotor cortex was not favorable for corticospinal tract regeneration and neurological recovery after spinal cord injury. Through bioinformatics analysis and methylated RNA immunoprecipitation-quantitative polymerase chain reaction, we found that METTL14 regulated Trib2 expression in an m6A-regulated manner, thereby activating the mitogen-activated protein kinase pathway and promoting corticospinal tract regeneration. Finally, we administered syringin, a stabilizer of METTL14, using molecular docking. Results confirmed that syringin can promote corticospinal tract regeneration and facilitate neurological recovery by stabilizing METTL14. Findings from this study reveal that m6A modification is involved in the regulation of corticospinal tract regeneration after spinal cord injury.

Exploring the therapeutic potential of beetroot juice in patients with peripheral artery disease: A Narrative review

Peripheral artery disease (PAD) is a circulatory disorder caused by atherosclerosis, leading to the narrowing or blockage of peripheral arteries, often affecting the arteries in the lower limbs. This condition can result in intermittent claudication and severe limb ischemia, significantly reducing patients' quality of life. In recent years, increasing evidence suggests that dietary interventions play a crucial role in the prevention and management of PAD, offering a safe and non-invasive treatment option. Beetroot, a natural root vegetable, demonstrates significant health benefits through its various bioactive compounds. It is rich in nitrate and betaine, which are metabolized in the body via the nitrate-nitrite- nitric oxide (NO) pathway, increasing the bioavailability of NO. NO is an important vasodilator that can improve blood flow and lower blood pressure. Additionally, the active compounds in beetroot may further enhance its health effects by altering the activity of the oral microbiome. This review explores the potential therapeutic effects of beetroot juice (BRJ) in the management of PAD. The findings indicate that BRJ can improve exercise performance, lower blood pressure, improve endothelial function, enhance skeletal muscle microvascular function and central autonomic nervous system function. Based on these findings, beetroot and its rich bioactive compounds hold promise as a novel supportive therapy for improving PAD.

A network analysis of alcohol-related harms: An exploratory study in United Kingdom adolescents

BACKGROUND

This study applied a network analysis approach to the study of individual self-reported alcohol-related harms (ARHs) across four waves of data.

METHODS

Data were from a large clustered randomised control trial (N = 12,738) involving 105 schools. Data were collected at 4 time points over 4 academic years (mean age 12.5 [Time 0], 13.5 [T1], 14.5 [T2], and 15.3 years [Time 3]). Data were gathered on the experience of 16 separate ARHs experienced during the previous six months, and these were dichotomised (yes/no). We estimated cross-lagged panel networks for the 16 ARHs, capturing both the auto-regressive relationships (a harm predicting itself at follow up) and the cross-lagged relationships (a harm predicting another harm at follow-up) across the study (T0 → T1; T1 → T2; T2 →T3).

RESULTS

Exposure to all ARHs increased with age. However, the most serious ARHs (e.g., getting in trouble with the police because of your drinking) remained relatively rare, even at age 15. Actively planning to get drunk, coupled with an inability to control levels of intoxication (drinking more than planned) appeared central to each network, facilitating the emergence of all other ARHs. While the prevalence of ARHs increased with age, network complexity declined, and networks becoming more stable.

CONCLUSIONS

Interventions aimed at improving the capacity to self-regulate alcohol consumption, and actively challenging the planning of drunken episodes, may be pivotal in reducing the emergence of both acute and chronic ARHs in adolescence.

Global, regional, and national burdens of hip fractures in elderly individuals from 1990 to 2021 and predictions up to 2050: A systematic analysis of the Global Burden of Disease Study 2021

PURPOSE

We aimed to analyse the global, regional, and national burdens of hip fractures in older adults from 1990 to 2021, with projections to 2050, on the basis of data from the GBD 2021 study.

METHODS

We employed a joinpoint model to analyse trends in the burden of hip fractures from 1990‒2021. The estimated annual percentage change (EAPC) was used to quantify temporal trends over this period. We evaluated the relationship between the social development index and the burden of hip fracture in elderly people and conducted a health inequality analysis. Additionally, we applied Long-short Term Memory (LSTM) networks to forecast burden trends of hip fractures up to 2050.

RESULTS

The global age-standardized incidence rate (ASIR) for hip fractures in older adults rose from 781.56 per 100,000 in 1990 to 948.81 in 2021. The 2021 age-standardized prevalence rate (ASPR) was 1,894.07, and the age-standardized YLD rate (ASDR) was 173.52. From 1990 to 2021, the incidence and prevalence increased by 168.71 % and 173.07 %, respectively, while the burden of DALYs decreased. Future trends were projected via the LSTM. The burden and risk factors for hip fractures varied significantly by sex, country, and region. Population and aging are primary contributors to the rising incidence of elderly hip fractures, with falls being the leading direct cause.

CONCLUSION

From 1990 to 2021, the global burden of hip fractures in the elderly population, especially among older women, steadily increased. Population ageing highlights the urgent need for targeted public health interventions and resource allocation, including early diagnosis, effective prevention strategies, and region-specific management approaches.

Reducing premature mortality from cardiovascular diseases in low and middle income countries: The role of Polypill in public health policy

Premature deaths account for about half of all fatalities in developing countries. In low- and middle-income countries, cardiovascular diseases have consistently been the primary cause of premature mortality for men and women during the past three decades. Current evidence indicates that fixed-dose combination therapy, the so-called Polypill, effectively reduces the burden of cardiovascular diseases, with greater benefits observed in combinations that include aspirin. Polypill demonstrates high adherence and an acceptable safety profile, with adverse drug events being comparable between the groups receiving treatment and those in the control group. Therefore, this paper advocates for the broader implementation of Polypill in low and middle-income countries, emphasizing its efficacy in the primary and secondary prevention of cardiovascular diseases. The strategy could also benefit high-risk groups with special conditions, such as non-alcoholic fatty liver disease and chronic kidney disease. The cost-effectiveness of Polypill and its potential to address health inequities in low and middle-income countries underscore its value as a public health strategy. Policymakers are encouraged to consider Polypill as a viable option to enhance cardiovascular health outcomes and reduce premature deaths in low-resource settings.

Current research on mitochondria‑associated membranes in cardiovascular diseases (Review)

The present study aimed to explore the role of mitochondria‑associated membranes (MAMs) as a key interface between mitochondria and the endoplasmic reticulum (ER) and to evaluate their importance in maintaining the physiological functions of these two organelles. MAMs not only act as a structural bridge between mitochondria and the ER but also widely participate in the regulation of mitochondrial biosynthesis and function, Ca2+ signal transduction, lipid metabolism, oxidative stress response and autophagy. In addition, the specific protein composition of MAMs is increasingly being recognized as having a profound impact on their function, and these proteins play a central role in regulating intercellular communication. Recently, the scientific community has accumulated a large amount of evidence supporting MAMs as potential targets for cardiovascular disease treatment. The present review focuses on the fine structure and multifunctional properties of MAMs and their mechanisms in the occurrence and development of cardiovascular diseases. The goal is to explore the mechanism of MAMs, therapeutic intervention points directly related to cardiovascular diseases, and feasibility of incorporating MAMs into the diagnostic strategy and treatment plan of cardiovascular diseases to provide novel insights and theoretical support for clinical practice in this field. MAMs have great potential as therapeutic targets for various cardiovascular diseases. This finding not only deepens the understanding of the interaction between organelles but also opens up a promising research path for the development of new therapeutic strategies for cardiovascular diseases.

Prevalence of macro-vascular complications among type 2 diabetic adults aged 50 and over: results from Ardakan cohort study on aging (ACSA)

Objective

Type 2 diabetes mellitus (T2DM) is a common condition that can lead to adverse macrovascular complications. This study aims to determine the prevalence of macrovascular complications in adults aged ≥ 50 with T2DM in Ardakan city, using data from the Ardakan Cohort Study on Aging (ACSA).

Methods

A cross-sectional investigation involved 5933 participants from the ACSA; of those assessed, 2340 had T2DM. Macrovascular complications, specifically coronary artery disease (CAD), cerebrovascular disease (CVD), and peripheral artery disease(PAD) were identified through medical records and physician assessment. Logistic regression was used to identify risk factors for these complications.

Results

The prevalence of CAD and CVD were 16.9% (95% CI:16.0-19.0) and 4% (95% CI:3.3-5.0), respectively. risk factors for CAD included age over 60 (OR = 1.47, 95% CI: 1.08-2.01, p = 0.01), male gender (OR = 1.87, 95% CI: 1.33-2.62, p < 0.001), former smoking (OR = 1.96, 95% CI: 1.30-2.95, p = 0.001), hypertension (OR = 3.16, 95% CI: 2.23-4.46, p < 0.001), and over ten years of diabetes duration(OR = 2.04, 95% CI: 1.39-2.99, p < 0.001) and For CVD, significant risk factors included male gender (OR = 2.61, 95% CI: 1.52-4.51, p = 0.001) and hypertension (OR = 2.36, 95% CI: 1.27-4.39, p = 0.006).

Conclusion

This study highlights the high prevalence of macrovascular complications in adults over 50 with T2DM in Ardakan. It emphasizes the importance of managing key risk factors such as hypertension and quitting smoking, especially in older adults and males.

Activation of GPER1 alleviates white matter injury by promoting microglia M2 polarization through EGFR/Stat3 pathway in intracerebral hemorrhage mice

BACKGROUND

White matter injury (WMI) is a major pathophysiological process after intracerebral hemorrhage (ICH). G protein-coupled estrogen receptor 1 (GPER1) has been validated to exert a crucial role in regulating neuroinflammation and microglia polarization. Our previous report reveals activation of GPER1 improves the neurological deficits after ICH via inhibition of A1 astrocytes. However, the role of GPER1 on the protection of WMI and modulation of microglia polarization after ICH remains unclear.

METHODS

In present study, ICH mice model was induced by autologous whole blood injection and in vitro ICH model was established via treatment BV2 cells with FeSO4. Mice were treated with GPER1 agonist G1, antagonist G15 and BV2 cells were treated with G1, G15 or EGFR inhibitor AG1478. Besides, BV2 conditional medium was used to intervene MO3.13 oligodendrocytes. Immunostaining, immunoblots, transmission electron microscope and PI staining were used to determine the WMI, microglia polarization and potential molecular mechanism after ICH, respectively.

RESULTS

Our data showed treatment with G1 ameliorated the WMI on the day 3 after ICH. Besides, activation of GPER1 reduced the release of IL-1β, TNF-α and increased the produce of IL-4, IL-10 as well as shifting microglia from proinflammatory M1 to anti-inflammatory M2 phenotype in vivo and in vitro. Meanwhile, MO3.13 cells treated with BV2 conditional medium validated GPER1 alleviated oligodendrocytes death via mitigating neuroinflammation and modulating microglia polarization. Mechanistic study demonstrated EGFR/Stat3 signaling pathway was involved in the protection of WMI and modulation microglia polarization after ICH.

CONCLUSION

Collectively, our findings demonstrated activation of GPER1 alleviated WMI via modulating microglia M2 polarization after ICH through EGFR/Stat3 signaling pathway.

The annual economic burden of patent foramen ovale-associated stroke in the United States

BACKGROUND

Stroke is the second leading cause of death worldwide and the third leading cause of death and disability combined. Among ischemic strokes, 25 % to 40 % are classified as cryptogenic, with patent foramen ovale (PFO) identified as a potential underlying cause. PFO is found in 25 % of the general population. Despite the significant occurrence of PFO-associated strokes, the associated costs remain largely unexplored.

AIM

This study aimed to evaluate the annual economic burden of PFO-associated stroke in the US.

METHODS

A cost-of-illness study was performed, encompassing the direct and indirect costs of PFO-associated stroke on both society and the healthcare system. The model adopted a top-down approach and a one-year, US societal perspective. A payer perspective and bottom-up costing approach were included as scenario analyses. Data was obtained by a targeted literature review.

RESULTS

The societal model, assuming 32.5 % cryptogenic strokes, incurs an annual cost of over $1.3 billion in the US, with over $1.0 billion coming from new strokes and over $300 million from recurrent strokes. The majority of the costs are indirect-50 % from productivity losses due to premature death and 27 % from other productivity losses. Direct costs constitute 23 % of the total. From the payer perspective, the annual costs for PFO-associated strokes in the US were estimated at $302 million, with hospitalization costs comprising 44 %, followed by prescriptions and outpatient care at 19 % and 16 %, respectively.

CONCLUSION

The economic burden of PFO-associated strokes in the US is substantial, exceeding $1.3 billion per year. Different types of medical management or surgical treatments for PFO-associated stroke could lead to gains in both costs and health outcomes.

Low-intensity pulsed ultrasound relieved the diabetic peripheral neuropathy in mice via anti-oxidative stress mechanism

Diabetic peripheral neuropathy (DPN), as one of the most prevalent complications of diabetes, leads to significant pain and financial burden to patients. Currently, there was no effective treatment for DPN since the glucose control was just a prevention and the drug therapy only relieved the DPN pain. As a non-invasive physical therapy, low-intensity pulsed ultrasound (LIPUS) is utilized in the musculoskeletal and nerve injuries therapy. Studies revealed that LIPUS could regenerate nerves by the mechanical stimulation via oxidative stress pathway, which was thought as the important factor for DPN, and might have potential in the DPN therapy. This study aimed to identify a new therapeutic strategy for DPN using LIPUS. We analyzed the therapy effect and explored the therapeutic mechanism of LIPUS on DPN in mice. This study involved animal experiments and C57BL/6J mice were randomly assigned to DPN model and Sham groups. The DPN model group was fed a high-fat chow diet and injected with streptozotocin (STZ) for 3 consecutive days (40 mg/kg/d), whereas the Sham group was fed a normal diet and injected with an equal volume of sodium citrate buffer. After the DPN model confirmed with the 84-day modeling process, the DPN mice were randomly allocated into the DPN group and the LIPUS group. The LIPUS group underwent ultrasound treatments with a center frequency of 1 MHz, a duty cycle of 20 %, and a spatial average temporal average intensity (ISATA) of 200 mW/cm2 for 20 min/d, 5 d/w. After the 56-day treatment, all mice were euthanized. LIPUS therapeutic effects were evaluated through measurements of fasting blood glucose (FBG), behavioral tests, oxidative stress tests, morphological analysis, immunofluorescence, and western blot analysis. The results indicated that DPN mice had significantly higher FBG levels (28.77 ± 2.95 mmol/L) compared with sham mice (10.31 ± 1.49 mmol/L). Additionally, DPN mice had significantly lower mechanical threshold (4.13 ± 0.92 g) and higher thermal latency (16.20 ± 2.39 s) compared with the sham mice (7.31 ± 0.83 g, 11.67 ± 1.21 s). After receiving LIPUS treatment, the glucose tolerance tests (GTT) suggested that LIPUS treatment improved glucose tolerance, which was shown by a decrease in the area under the curve (AUC) for glucose in the LIPUS group (AUC = 2452 ± 459.33 min*mmol/L) compared with the DPN group (AUC = 3271 ± 420.90 min*mmol/L). Behavioral tests showed that LIPUS treatment significantly alleviated DPN-induced abnormalities by improving the mechanical threshold from 2.79 ± 0.79 g in the DPN group to 5.50 ± 1.00 g in the LIPUS group, and significantly decreasing thermal latency from 12.38 ± 1.88 s in the DPN group to 9.49 ± 2.31 s in the LIPUS group. Morphological observations revealed that DPN mice had a thinning and irregularly shaped myelin sheath, with 61.04 ± 5.60 % of abnormal nerve fibers in the sciatic nerve in LIPUS group, compared with 49.76 ± 4.88 % of abnormal nerve fibers in the LIPUS-treated group. Additionally, LIPUS treatment increased the mean fluorescence intensity of the associated nerve regeneration protein (i.e., Nf200) from 27.81 ± 0.32 arbitrary units in the DPN group to 37.62 ± 0.36 arbitrary units in the LIPUS group. Western blot and immunofluorescence analysis showed that LIPUS treatment significantly reduced Keap1 expression to 0.04 ± 0.06 relative units, compared with 0.17 ± 0.30 in the DPN group. Furthermore, immunofluorescence analysis revealed that LIPUS treatment promoted the production of its downstream antioxidant protein, heme oxygenase-1 (HO-1), with an increase in the fluorescence intensity from 27.81 ± 0.32 arbitrary units in the DPN group to 37.62 ± 0.36 arbitrary units in the LIPUS-treated group. The fluorescence intensity of Nrf2 was significantly higher in the LIPUS group, increasing from 4.90 ± 0.25 arbitrary units in the DPN group to 15.18 ± 2.13 arbitrary units in the LIPUS-treated group. Additionally, the malondialdehyde (MDA) levels, an indicator of oxidative stress, were significantly reduced in the serum, from 5.40 ± 0.48 nmol/ml in the DPN group to 4.64 ± 0.16 nmol/ml in the LIPUS-treated group, and in the sciatic nerve, from 16.17 ± 5.88 nmol/mg protein to 4.67 ± 2.10 nmol/mg protein, suggesting the oxidative stress was inhibited by LIPUS. This study demonstrated for the first time that LIPUS could relive DPN through anti-oxidative stress process. This study suggests that LIPUS might be a new therapy strategy for DPN.

Oral Cancer Knowledge and Screening Practices Among Dental Professionals in Yemen: a Web-Based Survey

BACKGROUND

Good knowledge and screening practices of dental professionals for oral cancer (OC) will inevitably improve its prognosis. The present study sought to evaluate OC knowledge and practices among dental professionals in Yemen.

METHODS

This study was conducted among Yemeni dentists. The used tool was a prevalidated online questionnaire composed of items on the knowledge, practices, and barriers of OC screening and early detection. The data were managed and analysed using SPSS Version 28.0.

RESULTS

A total of 506 dental professionals completed the questionnaire. The participants showed moderate levels of knowledge on risk factors and clinical signs of OC. While the majority reported tobacco (89.9%) as a potential risk factor, only 76.7% and 57.5% of the subjects reported a potential role for alcohol consumption and old age. Regarding clinical signs, the majority reported that OC can present as nonhealing ulcer (90.3%) or white/red patch (87.2%), yet only 73.7% reported that it can present as swelling/lump, and around 32% reported that teeth attrition is one of its clinical signs. Concerning practices, most of the participants reported asking their patients about their tobacco habits (84%), routinely examine patients' oral mucosa (81.4%), and refer suspicious lesions to specialists (91.3%). Only 44.9% reported feeling confident regarding their knowledge and training on OC. Specialists and those who attended educational courses on OC were more knowledgeable, more confident, and showed better practices than their counterparts. Inadequate knowledge/training, lack of time, and lack of financial compensation were the most reported barriers to OC screening and early detection.

CONCLUSION

The present study indicates marked gaps in the knowledge and screening practices of OC among Yemeni dentists. Therefore, conducting periodic continuing courses along with interventional trainings are urgently recommended to address these gaps.

Chronic meningitis: diagnostic and therapeutic challenges

PURPOSE OF REVIEW

We review recent advances in diagnosis and treatment of chronic meningitis, focusing on tuberculous meningitis (TBM), cryptococcal meningitis (CM), syphilitic meningitis, neuroborreliosis, and recurrent chronic meningitis. Noninfectious causes and unique challenges faced in resource-limited settings are also considered.

RECENT FINDINGS

Novel biomarkers are being identified that may be useful for the diagnosis of TBM [i.e. monokine induced by interferon-γ (MIG), plasminogen binding proteins] and syphilitic meningitis (i.e. CXCL13, neurofilament light protein, etc.) but require more validation. Much progress has been made regarding diagnosis and treatment of CM, with a new semiquantitative lateral flow assay showing high diagnostic and prognostic utility and clinical trials demonstrating that regimens of oral lipid nanocrystal formulation and a single dose of liposomal formulation of amphotericin B maintain clinical efficacy with improved side effect profiles. An ongoing clinical trial of ceftriaxone for treatment of syphilitic meningitis and early stage studies of linezolid for TBM treatment may also lead to changes in recommended treatment regimens for these conditions in the near future.

SUMMARY

Diagnosis and management of chronic meningitis remains a significant challenge, and further research is needed to improve our diagnostic and therapeutic armamentariums. However, emergence of potential new biomarkers for diagnosis and disease course is cause for optimism.

Effects of Bisphenols on the Assisted Reproductive Technology Outcomes Considering the Patient Clinical Parameters

Context

Bisphenol A (BPA) and its analogues disrupt endocrine functions, adversely impacting oocyte meiosis, maturation, and granulosa cell (GC) steroidogenesis.

Objective

To identify clinical factors, particularly adiposity and age, influencing ovarian cell sensitivity to bisphenol (BP) exposure.

Methods

This study analyzed a cohort of 368 women undergoing assisted reproductive technology (ART) from 2019 to 2023. Four BPs (BPA, BPS, BPF, and BPAF) were quantified, and ART outcomes (eg, oocyte count, embryo quality, and pregnancy rates) were assessed using regression models. GCs from 156 patients were cultured and exposed to BPS for 48 hours to evaluate progesterone and estradiol secretion based on clinical parameters.

Results

BPS and BPA were the most prevalent BPs in follicular fluid. BP exposure was associated with reduced fertilization rates (P = .05). Obesity tended to lower live birth rates (P = .08) but did not affect embryo development or implantation. Age significantly impacted embryo quantity (P < .001) and quality (P = .03). GC progesterone secretion was correlated with donor age after exposure to 1 µM and 10 µM BPS (P = .03 for both). GCs from younger women appeared more sensitive to BPS.

Conclusion

Although obesity did not affect embryonic development, its association with reduced live birth rates suggests a suboptimal environment for implantation and/or fetal development. Age was linked to lower antral follicle count, pregnancy rates, and live birth rates. Younger women's GCs may exhibit heightened sensitivity to BPS exposure, warranting further investigation.

Implantable systems for neurological chronotherapy

Implantable systems for neurological chronotherapy are poised to revolutionize the treatment of central nervous system diseases and disorders. These devices enable precise, time-controlled drug delivery aligned with the body's circadian rhythms, optimizing therapeutic outcomes. By bypassing the blood-brain barrier, they achieve high local drug concentrations while minimizing systemic side effects, offering significant advantages for conditions where traditional therapies often fall short. Platforms like SynchroMed II and CraniUS showcase this innovation, providing programmable delivery for conditions such as epilepsy and glioblastoma, with customizable profiles ranging from continuous infusion to timed bolus administration. Preclinical and clinical studies underscore the efficacy of aligning drug delivery with circadian rhythms, enhancing outcomes in chrono-chemotherapy and anti-epileptic treatments. Despite their promise, challenges remain, including the invasiveness of implantation within the brain, device longevity, synchronization complexities, and cost(s). Accordingly, this review explores the current state of implantable neurological systems that may be leveraged for chronotherapy, their applications, limitations, and potential to transform neurological disease/disorder management.

Prevalence and Associated Risk Factors of Hypertension Among Tribal Population Aged 15-49 in India: Evidence from National Family Health Survey, 2019-2021

BACKGROUND

Approximately 10% of non-communicable diseases (NCDs) can be attributed to hypertension. The prevalence of hypertension is steadily increasing among urban, rural, and tribal populations alike. There has been a growing incidence of hypertension within underprivileged groups; however, there is a scarcity of research focusing on the risks of hypertension within Indian tribes. The current study aimed to estimate the pooled prevalence of hypertension among tribes and the risk factors of hypertension.

METHODS

This study uses data from the fifth phase of the National Family Health Survey (NFHS-5) in India, covering 2,843,917 individuals in 636,699 households. A total of 69,176 individuals belonging to tribal communities aged between 15 and 49, encompassing both males and females, have been incorporated into our study. The study utilized bivariate and multivariable binary logistic regression analyses, which were conducted using the R statistical software.

RESULTS

Among 69,176 tribal populations between 15 and 49 years, the overall prevalence of hypertension was 12.54% (8676/69176; 95% CI, 12.29%, 12.79%). The prevalence of hypertension among males was 16.4% and 12.07% among females. Age, gender, education, marital status, smoking, and alcohol consumption were found to be the significant predictors of hypertension among tribes.

CONCLUSION

The rising prevalence and potential dangers of hypertension within Indian tribes highlight their epidemiological transition burdened by significant cardiometabolic health concerns, necessitating prompt and ongoing monitoring and surveillance.

Association between cardiometabolic index and the incidence of stroke: a prospective nationwide cohort study in China

Objectives

Cardiometabolic index (CMI), based on triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C) ratio and waist-to-height ratio (WHtR), has been recognized as a novel and practical marker for the assessment of cardiometabolic risk. However, the relationship between CMI and the incidence of stroke remains to be elucidated. This investigation aimed to explore the association between CMI and stroke incidence.

Methods

The investigation included 6,633 individuals aged over 45 years from the China Health and Retirement Longitudinal Study. Logistic regressions and restricted cubic spline regression were uitilized to determine the relationship between CMI and the incidence of stroke. Weighted quantile sum regression was used to offer a comprehensive explanation of the CMI by calculating the weights of triglyceride-glucose (TG), high-density lipoprotein cholesterol (HDL-C), weight, and height.

Results

During the 9-year follow-up, 827 (12%) incident stroke participants were identified. With CMI as a continuous variable, the OR (95% CI) for the risk of incident stroke was 1.09 (1.01-1.19) (p = 0.047) after adjusting for potential confounders, indicating a significant link between increased CMI and an elevated incidence of stroke. Additionally, when CMI was categorized into quartiles, compared to the first quartile, the incident stroke was significantly higher in the fourth quartile (OR 1.57, 95%CI 1.22-2.04, p <0.001). The association between CMI and stroke incidence was nonlinear (p overall=0.002, p non-linear = 0.006). TG emerged as the primary contributor when the weights were assigned to the constituent elements of the CMI (weight = 0.645).

Conclusions

The CMI was independently associated with stroke incidence in middle-aged and elderly Chinese populations. Long-term CMI monitoring is of great importance for early identification and prevention of stroke, with significant implications for clinical practice.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-024-01530-3.

Microcystin-LR and its health impacts: Chemistry, transmission routes, mechanisms of toxicity and target organs

Microcystin-LR, a hepatotoxin produced by cyanobacteria, poses significant health risks to humans and other animals through various routes of exposure. This review comprehensively explores the chemistry, transmission pathways, mechanisms of toxicity, and target organs affected by MC-LR to provide a detailed understanding of its health impacts on animals and humans. MC-LR exposure occurs through different transmission routes, including ingesting contaminated water and food, algal dietary supplements, direct body contact with harmful algal blooms, and inhalation of aerosolized toxins. In this review, we explored that the toxic effects of MC-LR are mediated through multiple complex mechanisms. A key mechanism of its toxicity is the inhibition of protein phosphatases PP1 and PP2A which results in abnormal cellular signalling pathways. Additionally, MC-LR induces oxidative stress and disrupts cellular homeostasis. The findings suggest that MC-LR modulates the activity of various antioxidant enzymes and also activates apoptosis pathways by different mechanisms. It also induces cytoskeletal disruption, ultimately compromising cellular integrity and function. MC-LR also induces activation of oncogenes such as Gankyrin, PI3K/AKT, HIF-1α, RAC1/JNK and NEK2 pathway and upregulates the inflammatory molecules such as NF-κβ, and TNF-α, hence leading to carcinogenesis. MC-LR has toxicological effects on multiple organs. The liver is the primary target, where MC-LR accumulates and causes hepatotoxicity, but other organs are affected as well. MC-LR shows neurotoxicity, nephrotoxicity, cardiotoxicity and reproductive toxicity.

Employing bibliometrics and natural language processing (NLP) to analyse real-world applications of adverse drug reaction

Introduction

Adverse Drug Reactions (ADRs) pose significant health and economic burdens, yet underreporting and inconsistent standards persist. Digital health innovations, particularly mobile and web-based ADR reporting applications, offer potential to enhance pharmacovigilance by improving data accuracy and patient-reported outcomes.

Objectives

The study provides a comprehensive mapping of ADR mobile and web application literature, analysing publication trends, key contributors, and core themes through bibliometric and NLP-based content analysis.

Methods

A systematic two-stage approach was applied to 289 Web of Science articles on ADR reporting applications. Bibliometric analysis explored publication trends, co-authorship networks, and keyword occurrences, while NLP-based topic modelling identified prevalent themes, ensuring thematic coherence and interpretability.

Results

Bibliometric analysis showed a rise in ADR application-related publications, primarily from the United Kingdom, United States of America, and Switzerland. Content analysis identified ten key themes, including pharmacovigilance, chemotherapy adherence, and psychiatry research. A distinct focus on digital tools in ADR reporting and management was evident, with keywords such as "mobile," "application," and "patient" becoming increasingly prominent in recent years. Co-authorship and collaboration networks, however, showed limited cross-national research partnerships.

Discussion

The study highlights the transformative role of digital solutions in pharmacovigilance, demonstrating the potential of ADR applications to enhance reporting accuracy and improve patient safety. However, adoption remains early-stage and fragmented by regional affiliations. Future research should focus on patient-centric app development, effectiveness assessment, and fostering global collaboration. Strengthening digital literacy and robust investment in ADR reporting applications is crucial for optimizing their impact in healthcare.

Roles of Adam8 in Neuroinflammation in experimental ischemic Stroke: Insights from single-cell and ribosome-bound mRNA sequencing

Stroke remains a leading cause of global mortality, with neuroinflammation significantly exacerbating clinical outcomes. Microglia serve as key mediators of post-stroke neuroinflammation, though the mechanisms driving their migration to injury sites remain poorly understood. In this study, using publicly available single-cell sequencing data (GSE234052), we identified a migration-associated microglial subtype in a murine model of distal middle cerebral artery occlusion (dMCAO). Additionally, ribosome-bound mRNA sequencing data (GSE225110) from microglia isolated from peri-infarct cortical tissue uncovered dMCAO-induced alterations in microglial mRNA translation. By integrating these datasets, we identified A Disintegrin And Metalloproteinase 8 (Adam8) as a key gene upregulated at both the transcriptional and translational levels post-dMCAO. Protein analysis revealed that both the precursor and active forms of Adam8 were predominantly expressed in microglia and significantly upregulated in peri-infarct regions following dMCAO. Notably, Adam8 inhibition with BK-1361 significantly reduced Adam8 cleavage, M1 microglial migration, inflammation, infarct size, and improved neurological outcomes. Bioinformatics analysis further identified Myo1e as a potential interacting partner of Adam8, a finding validated through immunofluorescence co-localization. These findings highlight Adam8 as a promising therapeutic target for mitigating post-stroke neuroinflammation and offer new insights into the mechanisms of microglial migration.

CKN reduces TLR4-mediated inflammation and cerebral I/R injury by activating the LXRα/ABCA1 pathway in microglia

AIMS

CKN is a self-developed LXRα agonist capable of up-regulating the expression of ABCA1, diminishing intracellular lipid deposition, and attenuating the inflammatory response. Nevertheless, the protective effect and mechanism of ischemic stroke remain indistinct. The aim of this study is to investigate the therapeutic effects and the underlying mechanisms of CKN in ischemic stroke.

MATERIALS AND METHODS

In this study, the tMCAO model was utilized to induce cerebral artery occlusion in mice, and cholesterol-induced BV2 and primary microglia models were adopted. Neuronal damage and the effect of CKN on ABCA1 expression, lipid deposition, and TLR4 signaling in penumbra microglia were assessed.

KEY FINDINGS

The results demonstrated that: (1) CKN treatment markedly ameliorated the neurological deficit score of the tMCAO model, contracted the infarct size, and mitigated the damage of the cerebral cortex. (2) CKN has the capacity to up-regulate the expression of ABCA1 in microglia within the ischemic penumbra by activating the LXRα/ABCA1 signaling pathway, and minimize lipid deposition and inflammatory responses. (3) The activation of the LXRα/ABCA1 signaling pathway is profoundly implicated in the inflammatory response triggered by CKN inhibition of the TLR4 signaling pathway in microglia.

SIGNIFICANCE

The present study demonstrated for the first time that the activation of the LXRα/ABCA1 signaling possessed the ability to attenuate reperfusion injury in ischemic stroke by means of reducing lipid droplet formation and TLR4-mediated inflammatory signaling within microglia in the ischemic penumbra.

A 5000-year overview of the history of pain through ancient civilizations to modern pain theories

Pain and its management have been a predominant issue since the dawn of humanity. Pain has been the subject of much controversy and has constantly evolved across societies. The objective of this review is to trace the historical evolution of the concept of pain through the ages and to attempt to understand how modern theories of pain represent a legacy of ancestral knowledge passed down from culture to culture. We conducted a comprehensive review of primary and secondary sources across 6 major historical periods, including Pre-history, Antiquity, the Middle Ages, the Renaissance, the Modern, and Contemporary eras, using academic databases, specialized libraries, and historical archives. Results shows that during ancient civilizations, the understanding of pain oscillated between religious beliefs and medical advances. Antiquity societies made significant contributions to the understanding of pain mechanisms and management. Contrary to popular belief, significant advances were made during the Middle Ages despite the important impact of religion on the era's conceptualization of pain. During the Renaissance, the influence of religion waned, and secular medicine made significant progress. The development of pain theories peaked in the 19th century with technological advances. Long considered an expression of internal suffering, pain has fascinated humanity throughout history. The way pain has been perceived, understood, and treated has changed greatly over the centuries. This historical scientific review allows us to keep in mind that the vision we have of pain in Western society is predominantly based on the concrete heritage of ancient civilizations.

Cardiovascular risk in newly diagnosed patients with type 2 diabetes mellitus: a nationwide, facility-based, cross-sectional study in Bangladesh

Aims

Evidence on cardiovascular (CV) risk stratification in Bangladeshi patients with type 2 diabetes mellitus (T2DM) who are asymptomatic for cardiovascular disease (CVD) is limited. This study aimed to assess the 10-year CV risk in newly diagnosed patients with T2DM.

Methods

In 2023, a cross-sectional study was carried out at endocrinology clinics in tertiary hospitals throughout Bangladesh, involving newly diagnosed patients with T2DM aged 25 to 84 who had no prior history of CVD and were asymptomatic for the condition. CV risk was assessed and classified using QRISK3.

Results

1617 newly diagnosed patients with T2DM (age 44.92 ± 11.84 years, male 49.5 %) were analyzed. Their median QRISK3 score was 11.0 %, with 46.5 % at low, 25.7 % at moderate, and 27.8 % at high 10-year CV risk, respectively. The QRISK3 score increased with age for both men and women, with men consistently scoring higher than women in every age group. Among the age groups 25-39, 40-64, and 65-84, the percentages of patients with high 10-year CV risk were 3.3 %, 34.0 %, and 94.5 %, respectively. The median relative risk (RR) of CVD was 4.3. RR decreased with age for both sexes, and men had a lower RR than women across all age groups. A sleep duration of 6-9 h was associated with a lower 10-year CV risk.

Conclusions

Many newly diagnosed Bangladeshi patients with T2DM have substantial CV risk. QRISK3 can assist clinicians in predicting 10-year CV risk and choosing appropriate treatments to prevent CVD.

Evaluation of the impacts of neuromuscular electrical stimulation based on cortico-muscular-cortical functional network

BACKGROUND AND OBJECTIVE

Neuromuscular electrical stimulation (NMES) has been extensively applied for recovery of motor functions. However, its impact on the cortical network changes related to muscle activity remains unclear, which is crucial for understanding the changes in the collaborative working patterns within the sensory-motor control system post-stroke.

METHODS

In this research, we have integrated cortico-muscular interactions, intercortical interactions, and intramuscular interactions to propose a novel closed-loop network structure, namely the cortico-muscular-cortical functional network (CMCFN). The framework is endowed with the capability to distinguish the directionality of causal interactions and local frequency band characteristics through transfer spectral entropy (TSE). Subsequently, the CMCFN is applied to stroke patients to elucidate the potential influence of NMES on cortical physiological function changes during motor induction.

RESULTS

The results indicate that short-term modulation by NMES significantly enhanced the cortico-muscular interactions of the contralateral cerebral hemisphere and the affected upper limb (p < 0.001), while coexistence of facilitatory and inhibitory effects is observed in the intermuscular coupling across different electromyography (EMG) signals. Furthermore, following NMES treatment, the connectivity of the brain functional network is significantly strengthened, particularly in the γ frequency band (30-45 Hz), with marked improvements in the clustering coefficient and shortest path length (p < 0.001).

CONCLUSIONS

As a new framework, CMCFN offers a novel perspective for studying motor cortical networks related to muscle activity.

Astrocyte heterogeneity in ischemic stroke: Molecular mechanisms and therapeutic targets

Ischemic stroke is one of the major causes of death and disability in adults, bringing a significant economic burden to the society and families. Despite significant advancements in stroke treatment, focusing solely on neurons is insufficient for improving disease progression and prognosis. Astrocytes are the most ubiquitous cells in the brain, and they undergo morphological and functional changes after brain insults, which has been known as astrocyte reactivity. Transcriptomics have shown that reactive astrocytes (RA) are heterogeneous, and they can be roughly classified into neurotoxic and neuroprotective types, thereby affecting the development of central nervous system (CNS) diseases. However, the relationship between stroke and reactive astrocyte heterogeneity has not been fully elucidated, and regulating the heterogeneity of astrocytes to play a neuroprotective role may provide a new perspective for the treatment of stroke. Here we systematically review current advancements in astrocyte heterogeneity following ischemic stroke, elucidate the molecular mechanisms underlying their activation, and further summarize promising therapeutic agents and molecular targets capable of modulating astrocyte heterogeneity.

A nomograph model for predicting the risk of diabetes nephropathy

OBJECTIVE

Using machine learning to construct a prediction model for the risk of diabetes kidney disease (DKD) in the American diabetes population and evaluate its effect.

METHODS

First, a dataset of five cycles from 2009 to 2018 was obtained from the National Health and Nutrition Examination Survey (NHANES) database, weighted and then standardized (with the study population in the United States), and the data were processed and randomly grouped using R software. Next, variable selection for DKD patients was conducted using Lasso regression, two-way stepwise iterative regression, and random forest methods. A nomogram model was constructed for the risk prediction of DKD. Finally, the predictive performance, predictive value, calibration, and clinical effectiveness of the model were evaluated through the receipt of ROC curves, Brier score values, calibration curves (CC), and decision curves (DCA). In addition, we will visualize it.

RESULTS

A total of 4371 participants were selected and included in this study. Patients were randomly divided into a training set (n = 3066 people) and a validation set (n = 1305 people) in a 7:3 ratio. Using machine learning algorithms and drawing Venn diagrams, five variables significantly correlated with DKD risk were identified, namely Age, Hba1c, ALB, Scr, and TP. The area under the ROC curve (AUC) of the training set evaluation index for this model is 0.735, the net benefit rate of DCA is 2%-90%, and the Brier score is 0.172. The area under the ROC curve of the validation set (AUC) is 0.717, and the DCA curve shows a good net benefit rate. The Brier score is 0.177, and the calibration curve results of the validation set and training set are almost consistent.

CONCLUSION

The DKD risk nomogram model constructed in this study has good predictive performance, which helps to evaluate the risk of DKD as early as possible in clinical practice and formulate relevant intervention and treatment measures. The visual result can be used by doctors or individuals to estimate the probability of DKD risk, as a reference to help make better treatment decisions.

Effects of cerebellar repetitive transcranial magnetic stimulation on stroke rehabilitation: A systematic review and meta-analysis

BACKGROUND

Cerebellum has been a emerging target for non-invasive brain stimulation (NIBS) on post-stroke patients in recent years. While research is emerging on the impact of cerebellar repetitive transcranial magnetic stimulation (rTMS) on post-stroke patients, and its integrated effect remain unclear.

OBJECTIVES

The objective of this review is to evaluate the efficacy of cerebellar rTMS on stroke rehabilitation.

METHODS

We searched PubMed, EMBASE, and Web of Science databases from inception to 31 March 2024 for randomized controlled trials (RCTs) and case studies reporting effects of cerebellar rTMS on patients with stroke.

RESULTS

This review included 18 studies (n = 638 participants), consisting of 14 RCTs and 4 case reports. A total of 6 studies focused on post-stroke dysphagia, while 12 studies investigated post-stroke motor dysfunction. Comparative analysis between treatment and control groups revealed statistically significant improvements in swallowing function, as measured by the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS) (P = 0.02), the Penetration Aspiration Scale (PAS) (P < 0.001), and the Standardised Swallowing Assessment (SSA) (P < 0.001). Moreover, cerebellar rTMS treatment showed significant enhancements in balance abilities and activity of daily living among stroke patients, as indicated by significant increases in the Berg Balance Scale (BBS) (P = 0.003) and the Barthel Index (BI) (P = 0.04) compared to the control group.

CONCLUSIONS

Existing evidence suggests that cerebellar rTMS holds promise in mitigating post-stroke swallowing dysfunction and motor dysfunction. Stimulation by cerebellar rTMS appears to be an efficacious technique for enhancing stroke rehabilitation.

Burden of cardiometabolic disease attributable to sugar sweetened beverages consumption in North Africa and the Middle East from 1990 to 2021

Objectives

The consumption of sugar-sweetened beverages (SSBs) is recognized as a significant risk factor for chronic non-communicable diseases (NCDs). Accurate estimates of the burden of SSBs are crucial for preventing, controlling, and treating associated diseases to achieve the Third United Nations Sustainable Development Goal of reducing premature mortality from NCDs by one-third by 2030. In this study, we aim to systematically assess the regional patterns and trends in the burden of SSBs in the North Africa and the Middle East (NAME) region. By analyzing regional differences, the study identifies specific areas where SSBs consumption has a more significant impact on public health.

Methods

The study data were retrieved from the Global Burden of Disease (GBD) study 2021. This study analyzed the impact of SSBs on mortality, years lived with disability, years of life lost, and disability-adjusted life years (DALYs) in 21 countries in the NAME region from 1990 to 2021. Our analysis considered various factors, including sex, age, region, and socio-demographic index.

Results

In 2021, DALYs attributable to SSBs there were 315,312 (95% uncertainty interval, 140,854 to 503,347) in absolute terms reflecting 518.3% (424.9 to 642.2) increase over three decades. From 1990 to 2021, the age-standardized rate of DALYs attributable to SSBs increased by 118.5%, from 27.9 (11.4 to 43.9) to 61.0 (27.6 to 97.0) per 100,000 population. Qatar (246.7 [113.1 to 404.5]), Saudi Arabia (201.2 [87.1 to 314.2]), and Bahrain (180.1 [78.4 to 295.8]) had the highest age-standardized rate of DALYs. The highest attributable DALYs and mortality from SSBs consumption were due to diabetes mellitus in all countries in 1990 and 2021. In 2021, Qatar (224.7 [104.9 to 365.5]), Bahrain (167.0 [74.8 to 274.8]), and Saudi Arabia (153.1 [75.3 to 230.4]) had the three highest age-standardized rates of DALYs from diabetes mellitus attributed to SSBs.

Conclusions

NAME witnessed a substantial increase in the burden attributable to SSBs. Alarmingly, exposure to SSBs has principally contributed to the increased burden of diabetes mellitus and chronic kidney disease. Among the region's countries, exposure and attributable burden trends vary considerably. It is imperative that governments and health authorities within the NAME region work together to combat SSBs' detrimental effects. Local, socioeconomic, and educational factors need to be considered when developing prevention and treatment strategies at the individual, community, and national levels.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-025-01578-9.

The Effect of Nursing-Based Enhanced Recovery After Surgery on Quality of Life in Lung Cancer Patients Receiving Surgery: A Systematic Review and Meta-Analysis

Enhanced recovery after surgery (ERAS) is an evidence-based, multidisciplinary protocol aimed at reducing surgical stress and expediting postoperative recovery. This meta-analysis will provide a comprehensive examination of the implications of ERAS care for the quality of life (QOL) of postoperative Lung cancer (LC) patients. The literature databases were searched to identify randomized controlled trials that implemented an ERAS program for adult patients with LC who underwent surgical treatment and reported QOL results. Thirty-one studies were included in the analysis. ERAS/FTS significantly improved the overall QOL of postoperative LC patients according to the Short Form-36 (SF-36) score (mean difference (MD): 8.58; 95% confidence interval (CI): 6.17, 11.00; p < 0.001). For physical functioning, the ERAS/FTS significantly improved the SF-36 score (MD: 10.45; 95% CI: 7.41, 13.50; p < 0.001). In the role-physical dimension, the ERAS/FTS nurse strategy had a significant advantage in improving the role-physical score on the SF-36 scale (MD: 10.06; 95% CI: 7.00, 13.13; p < 0.001). The ERAS has a highly positive impact on QOL in postoperative LC patients, especially in the physical functioning and role-physical dimensions.

The fraction of cancer attributable to modifiable risk factors in Turkey in 2018

Cancer is the second leading cause of death in Turkey, with nearly one in six deaths attributed to the disease. In 2018, Turkey recorded 211,273 new cancer cases. Many cancers are linked to modifiable lifestyle risk factors, such as tobacco use, alcohol consumption, obesity, and inadequate diet and physical activity. Modifying these risk factors could potentially prevent 30%-50% of cancer cases and deaths. This study aims to estimate the population attributable fraction (PAF) of cancer cases and deaths due to various modifiable risk factors in Turkey. Modifiable cancer risk factors were identified as smoking, infections, obesity, physical inactivity, alcohol consumption, inadequate intake of fruits, vegetables, fiber, and calcium. Data on exposure prevalence and cancer incidence were sourced from national surveys and reports. Relative risks (RRs) were obtained from global studies. PAFs were calculated using Levin's equation, accounting for overlaps between risk factors. In 2018, 32% of the cancer cases were attributable to lifestyle risk factors. Smoking was the most significant factor, accounting for 28.4% of cases in men, while high BMI was the leading factor in women, contributing to 11.5% of cases. Lifestyle risk factors were responsible for 41.6% of cancer deaths, with smoking being the leading cause. Lifestyle risk factors contribute significantly to cancer incidence and mortality in Turkey. Prioritizing interventions to reduce tobacco use and obesity could substantially lower the cancer burden. These results are crucial for developing effective cancer prevention strategies and informing public health policies.

Validation of the Pangao PG-800B18 upper-arm blood pressure monitor according to the ISO 81060-2:2018+Amd 1:2020 protocol in the general population

OBJECTIVE

The study aimed to validate the Pangao PG-800B18 oscillometric upper-arm blood pressure monitor in the general population in accordance with the International Organization for Standardization (ISO) 81060-2:2018 and amendment (Amd) 1:2020 protocol.

METHODS

Participants were recruited, and the same left-arm sequential method was used for blood pressure measurement in accordance with the protocol. Data validation and analysis were performed according to the protocol, and the Bland-Altman scatter plot was used to show the difference between the test device and reference results.

RESULTS

A total of 86 participants were included in the validation analysis. For the validation criterion 1 of the protocol, the mean ± SD of the differences between the test device and reference readings was -1.21 ± 6.71 mmHg and -0.73 ± 5.83 mmHg for systolic (SBP) and diastolic blood pressure (DBP), respectively. Furthermore, the SD of the differences between the test device and reference readings per participant was 5.81 and 5.02 mmHg for SBP and DBP, fulfilling the criterion 2 with SD values of ≤6.95 for SBP and ≤5.89 for DBP.

CONCLUSION

The Pangao PG-800B18 upper-arm blood pressure monitor fulfilled the requirements of the ISO validation standard and can be recommended for clinical use and self-measurement in the general population.

Neural correlates of psychotherapy in mental disorders: A meta-analysis of longitudinal resting-state fMRI studies

BACKGROUND

Psychotherapy is a crucial approach in the treatment of mental disorders. However, how psychotherapy modulate spontaneous brain activity and finally take therapeutic effects remain unknown. Among countless number of analytic methods of resting-state functional magnetic resonance imaging (rs-fMRI), Regional Homogeneity (ReHo), Degree Centrality (DC), and Amplitude of Low Frequency Fluctuation (ALFF), are commonly used voxel-wise whole-brain (VWWB) metrics, and these studies could be used for coordinate-based meta-analysis. In order to reveal the underlying neural mechanisms of psychotherapy in patients with mental disorders, serving for future precise targeting intervention, we conducted a systematic review and meta-analysis based on rs-fMRI studies at VWWB level.

MATERIAL AND METHODS

A systematic literature search was conducted in PubMed, PsycINFO, and Web of Science following PRISMA criteria (registration number CRD42023432388) to investigate the differences between pre- and post-psychotherapy. To investigate whether changes in spontaneous brain activity differ across different metrics, distinct psychotherapy approaches or specific patient populations, subgroup analyses were performed.

RESULTS

Nine studies involving a total of 192 patients were included. We observed a significant decrease in spontaneous activity within the left insular after treatment with psychotherapy. Moreover, the subgroup analysis revealed significantly decreased ReHo in the right inferior frontal gyrus.

CONCLUSIONS

The current study indicates that the clinical efficacy of psychotherapy may be modulated by insular and right inferior frontal gyrus through neurological perspective. This contributes to our understanding of the neurobiological mechanisms of psychotherapy and provides valuable insights into improving precise targeting interventions for individuals with mental disorders.

Bibliometric analysis of suicide risk assessment in children and adolescents: Trends and future directions

Suicide risk among children and adolescents continues to rise, yet critical trends and research gaps in suicide risk assessment remain unexamined. This study aimed to analyze global research trends on suicide risk assessment in children and adolescents using Scopus-indexed literature from 1984 to 2024. VOSviewer was used to visualize keyword co-occurrence and thematic trends. Bibliometric data were extracted from abstracts, including publication volume, citation counts, and author productivity. The search strategy identified 1195 articles, with 259 meeting the inclusion criteria. Publications grew annually by 7.78 %, with contributions from 1243 unique authors and an average document age of 9.22 years. The United States was the leading contributor, followed by China, Spain, and the United Kingdom. The Journal of Affective Disorders is the one with the highest number of publications on network analysis in suicide risk assessment, followed by the Journal of Archives of Suicide Research and Psychiatry Research. Most documents were articles (236), with few reviews (15). Key research areas included suicidal ideation, psychometric evaluations, and stress markers. However, critical gaps persist, particularly in developing culturally sensitive assessment tools, integrating biological and psychosocial risk factors, and expanding research in low- and middle-income countries. Most assessment tools are developed in Western settings, limiting cross-cultural applicability. Given the role of sociocultural factors in suicidal behaviors, future research should prioritize culturally adapted assessment methods and validate self-report tools in diverse populations. Addressing these gaps is essential for improving global suicide prevention strategies.