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 influence of education on pain during and following acute exercise in people with knee osteoarthritis: A randomised controlled trial

BACKGROUND

Explicit education about exercise-induced hypoalgesia (EIH) reduces experimental pain after a single exercise session in pain-free individuals. However, the effect in people with chronic pain is unclear. This study aimed to determine the effect of EIH education on pain during and following exercise in people with knee osteoarthritis (OA).

METHODS

All procedures were administered online. Participants were randomised to receive 15-min of explicit EIH education or 15-min of general education about knee OA. Participants then completed a questionnaire on their beliefs about exercise and pain, followed by a bout of home-based lower limb resistance exercise. Pain intensity (0-10) was assessed before, during and immediately after exercise.

RESULTS

40 participants completed the study (67.3 ± 10.8 years old, 73 % female). Participants only somewhat agreed pain could be reduced following a single session of exercise and that the education changed what they thought about exercise and pain, but these beliefs were not significantly different between groups (p = 0.053 and p = 0.104, respectively). Pain was similar between groups (adjusted mean difference [95 % CI]) during exercise (0.51 [-0.72 to 1.74], p = 0.410) and following exercise (-0.75 [-1.62 to 1.11], p = 0.087. Compared to baseline, pain (mean difference [95 % CI]) was lower during exercise (-1.01 [-1.66 to -0.36], p = 0.003) and following exercise (-0.96 [-1.5 to -0.42], p < 0.001).

CONCLUSION

A single exercise session reduces pain in people with knee OA, but this was not influenced by pre-exercise education about EIH. Further research is needed to understand if and how EIH can be modulated in people with knee OA.

Prolonged loneliness and risk of incident cognitive decline and dementia: A two-cohort study

BACKGROUND

Loneliness is prevalent currently and could result in increased dementia risks, whereas the associations of prolonged loneliness and its changes with cognitive decline and dementia remain less investigated.

METHODS

Data were from the English Longitudinal Study of Ageing (ELSA) and Health and Retirement Study (HRS). Loneliness was assessed using the Revised UCLA Loneliness Scale. Health risk factors for dementia included unhealthy lifestyles, depressive symptoms, chronic diseases, and functional limitations. Cognitive function was assessed using validated tests in both cohorts, with cognitive decline defined as cognitive z-scores < -1.5. Dementia was identified through self- or proxy-reported physician diagnoses. The Cox proportional hazard regression and Aalen's additive hazard regression were performed to calculate the relative and absolute risk for cognitive decline and dementia, respectively. Covariates including socio-demographic characteristics, social networks, and polygenic scores were adjusted.

RESULTS

Of 6721 ELSA and 10,195 HRS participants aged ≥50y, 2129 (13.7 %) and 612 (3.6 %) developed incident cognitive decline and dementia in about 10 years, respectively. Participants with severe (versus no) cumulative loneliness had 42 % and 98 % higher cognitive decline and dementia risks after pooling, corresponding to 791.6 (477.4-1105.8) and 372.8 (223.6-522.0) excess incidence densities (/105 person-years). Additionally, those who recovered from frequent loneliness (versus persistent frequent) were 9 %-31 % less likely to develop unhealthy lifestyles, depressive symptoms, chronic diseases, and functional limitations, and were at 33 % lower risks of dementia, corresponding to -248.6 (-446.0 ~ -51.2) excess incidence density.

CONCLUSIONS

Prolonged loneliness could increase the risks of incident cognitive decline and ADRD, while alleviating loneliness may help.

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.

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.

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.

Arrestin domain containing 3 promotes alcohol-induced liver steatosis by reducing stearoyl-CoA desaturase-1 ubiquitinated degradation

BACKGROUND AND AIMS

Alcoholic liver disease (ALD) is a major cause of chronic liver disease worldwide with no approved therapy. The development of ALD is strongly associated with hepatic lipid accumulation. Arrestin domain containing 3 (ARRDC3), a member of the α-arrestin family, is involved in obesity, inflammation, and cancer. However, its role in ALD remains largely unexplored.

METHODS

Both the NIAAA and traditional Lieber-De Carli mouse models of ALD were employed. ARRDC3 expression was evaluated in liver specimens from ALD patients, mouse hepatic tissues, and hepatocytes. Hepatocyte-targeted Arrdc3 knockdown was achieved through intrahepatic delivery of adeno-associated virus 8 (AAV8) carrying shRNA under a hepatocyte-specific promoter. Mass spectrometry analysis, immunofluorescence, co-immunoprecipitation (co-IP) assays, and molecular docking were used to identify the interaction between ARRDC3 and stearoyl-CoA desaturase 1 (SCD1).

RESULTS

ARRDC3 levels were significantly elevated in the livers of both ALD patients and mouse models. Knockdown of Arrdc3 using AAV8 alleviated alcohol-induced liver steatosis in both the NIAAA and traditional Lieber-De Carli mouse models. We demonstrated that ARRDC3 promoted the progression of ALD by inducing lipid accumulation in hepatocytes. Mechanistically, ARRDC3 directly binds to SCD1 and inhibits its ubiquitin-proteasome degradation. Inhibition of SCD1 blocked ARRDC3-induced lipid deposition in hepatocytes. We also observed a correlation between ARRDC3 and SCD1 in liver samples from ALD patients.

CONCLUSIONS

Our findings reveal that ARRDC3 promotes hepatic steatosis in ALD by reducing the ubiquitin-dependent degradation of SCD1. ARRDC3 may serve as a potential therapeutic target for ALD.

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.

Role of the globus pallidus in motor and non-motor symptoms of Parkinson's disease

The globus pallidus plays a pivotal role in the basal ganglia circuit. Parkinson's disease is characterized by degeneration of dopamine-producing cells in the substantia nigra, which leads to dopamine deficiency in the brain that subsequently manifests as various motor and non-motor symptoms. This review aims to summarize the involvement of the globus pallidus in both motor and non-motor manifestations of Parkinson's disease. The firing activities of parvalbumin neurons in the medial globus pallidus, including both the firing rate and pattern, exhibit strong correlations with the bradykinesia and rigidity associated with Parkinson's disease. Increased beta oscillations, which are highly correlated with bradykinesia and rigidity, are regulated by the lateral globus pallidus. Furthermore, bradykinesia and rigidity are strongly linked to the loss of dopaminergic projections within the cortical-basal ganglia-thalamocortical loop. Resting tremors are attributed to the transmission of pathological signals from the basal ganglia through the motor cortex to the cerebellum-ventral intermediate nucleus circuit. The cortico-striato-pallidal loop is responsible for mediating pallidi-associated sleep disorders. Medication and deep brain stimulation are the primary therapeutic strategies addressing the globus pallidus in Parkinson's disease. Medication is the primary treatment for motor symptoms in the early stages of Parkinson's disease, while deep brain stimulation has been clinically proven to be effective in alleviating symptoms in patients with advanced Parkinson's disease, particularly for the movement disorders caused by levodopa. Deep brain stimulation targeting the globus pallidus internus can improve motor function in patients with tremor-dominant and non-tremor-dominant Parkinson's disease, while deep brain stimulation targeting the globus pallidus externus can alter the temporal pattern of neural activity throughout the basal ganglia-thalamus network. Therefore, the composition of the globus pallidus neurons, the neurotransmitters that act on them, their electrical activity, and the neural circuits they form can guide the search for new multi-target drugs to treat Parkinson's disease in clinical practice. Examining the potential intra-nuclear and neural circuit mechanisms of deep brain stimulation associated with the globus pallidus can facilitate the management of both motor and non-motor symptoms while minimizing the side effects caused by deep brain stimulation.

Small dense low-density lipoprotein as biomarker in the elderly

OBJECTIVES

Small dense low-density lipoprotein (sdLDL) is atherogenic and associated with atherosclerotic cardiovascular diseases (ASCVD). The aim of this study was to perform the prospective evaluation of sdLDL-c in new ASCVD over 18 years of follow up, and to compare the association of sdLDL-c and conventional lipids and apolipoproteins with ASCVD in the elderly.

METHODS

This prospective study included a total of 1770 subjects ≥ 64 years of age with an 18-year follow-up period. The determination of sdLDL-c was measured by a homogenous, selective enzymatic method. Levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c) and triglycerides (TG) were determined by enzymatic methods. Apolipoproteins, ApoA1 and ApoB, were analyzed by immunonephelometric methods. Low-density lipoprotein cholesterol (LDL-c) levels were calculated using the Friedewald formula.

RESULTS

According to Pearson's correlation coefficients, sdLDL-c concentration was positively correlated with LDL-c, nonHDL-c, TC and ApoB concentrations. During follow up, sdLDL-c was significantly associated with new ASCVD in men aged 64-76 years in both unadjusted and adjusted Cox regression models. The adjusted hazard ratio (95 % CI) for sdLDL-c was 1.61 (1.13-2.28). No significant associations between sdLDL-c and ASCVD were observed in men aged 77-97 years, nor in women aged 64-79 or 80-100 years.

CONCLUSIONS

Lipid and apolipoprotein concentrations of the elderly were high compared to the recommended target values. In addition, lipid and apolipoprotein baseline concentrations were not higher in the ASCVD group than in the control group. Our results indicated that sdLDL-c is as good a marker as ApoB and better than LDL-c.

Updates in Treatment of Hypoxic-Ischemic Encephalopathy

Worldwide, hypoxic-ischemic encephalopathy (HIE) remains one of the leading causes of nervous system disabilities. Therapeutic hypothermia is the current standard-of-care treatment in high-income countries, because it was shown to reduce associated mortality and morbidities. However, up to 29% of treated neonates still experience adverse neurodevelopmental outcomes, and its efficacy in low- and middle-income countries remains debated, highlighting the need for adjunct or alternative therapies. Treatments for HIE targeting neuroprotection and/or neurorestoration are under investigation. Meanwhile, attentive daily management of multiorgan failure during the first days of life continues to be essential to limit further brain injury.

Neovascular age-related macular degeneration on three nationwide survey and register data in Finland during 2000-2017

PURPOSE

To evaluate time trends in the incidence and prevalence of neovascular age-related macular degeneration (nAMD) and its treatments, associated factors, and effects on vision in Finland during 2000-2017.

METHODS

We used three nationwide health examination surveys representing the Finnish population aged 30 years or older. All three surveys were linked to the national care register covering nAMD diagnoses and intravitreal injections between 2000 and 2017. All three surveys included a health examination in which distance and near visual acuity (VA) were measured, as well as self-reported and register-based information on socio-demographic status and lifestyle, health care use, co-morbidities, and quality of life. The data included two cross-sectional time points in 2011 and 2017 and two 11 year longitudinal follow-ups during 2000-2011 and 2006-2017.

RESULTS

The incidence and prevalence of nAMD were two times higher in women than in men. The annual prevalence of nAMD increased from 0.51% to 0.70% and from 0.22% to 0.46% in treated nAMD between 2011 and 2017. Treated nAMD patients had an average of 4 intravitreal injections per treatment year. nAMD patients showed significantly poorer distance and near VA than persons without any AMD in 2011 and 2017 (p < 0.001). However, near VA was significantly better in 2017 than in 2011 among nAMD patients (p = 0.036). The duration of nAMD showed weak negative correlation with distance and near VA. After adjusting for age and sex, nAMD patients showed significantly higher univariable odds ratios for lower distance VA, low consumption of vegetables, living in central Finland, a higher number of hospitalisations per year, and older age compared with persons without any AMD.

CONCLUSION

Since nAMD is an increasing burden for public health with gender discrepancy and a detrimental impact on vision, we should better find patients who have a high risk of developing nAMD and try to optimise their preventive intervention. Once nAMD is developed, we should understand treatment and follow-up demands at the personalised level. The nationwide register data help us in those challenges.

The Prevalence of Migraine in Children Diagnosed with Familial Mediterranean Fever

PURPOSE

 Familial Mediterranean fever (FMF) is an autosomal recessive disorder characterized by recurrent episodes of fever and serositis, caused by mutations in the MEFV gene. Inflammatory pathways associated with FMF are linked to increased proinflammatory cytokines, which may be related to primary headaches, including migraine. The aim of this study was to evaluate the frequency of migraine and other primary headaches in FMF patients.

METHODS

 In this retrospective study, the medical records of FMF patients were analyzed. Demographic data, MEFV gene mutations, and headache histories were collected. The frequency of migraine was compared among patients with these mutations, and statistical analyses were conducted.

RESULTS

 The study included 148 FMF patients, comprising 56.1% females and 43.9% males, with a mean age of 11.3 ± 3.7 years. A family history of FMF was reported in 77.7% of patients, and 35.8% had a family history of migraine. Headaches were reported in 52.7% of patients: 24.3% non-specific, 15.5% tension-type, and 12.8% migraine. Of those with migraine, 8.1% had migraine with aura, and 4.7% without aura. Headaches were more frequently frontal in patients under 12 years of age and temporal in those aged ≥12 years (p = 0.011). The most common genetic mutations were M694V heterozygous and homozygous, with M694V and E148Q mutations linked to more frequent migraines, although not statistically significant.

CONCLUSION

 FMF patients should be screened for primary headaches, particularly migraine. The high frequency of migraine observed in this study suggests that clinicians should particularly consider migraine as a diagnosis in headache episodes experienced by FMF patients.

Patient Navigators Improve In-Office Eye Exam Adherence After Community Eye Screenings in a Randomized Clinical Trial: NYC-SIGHT Study

PURPOSE

To assess the effectiveness and cost of patient navigators in improving adherence to an initial in-office eye exam following community-based eye health screenings and referral to ophthalmology among underserved populations.

DESIGN

5-year prospective, cluster-randomized clinical trial.

PARTICIPANTS

Eligible individuals aged 40 years and older were recruited from affordable housing developments and senior centers in Upper Manhattan.

METHODS

Demographics, social determinants of health, clinical characteristics, and access to eye care were collected. Eye health screenings included visual acuity, intraocular pressure, and fundus photography. Those diagnosed with glaucoma, suspected glaucoma, retinal abnormalities, cataracts, or other ocular conditions were referred for in-office eye exams, with initial appointments scheduled by study staff. Navigator Intervention participants received appointment scheduling support for 10 months, Usual Care participants did not receive navigator assistance. T tests, chi-square tests and multivariate stepwise logistic regression analyzed factors associated with adherence. Cost-effectiveness analysis was conducted alongside the study.

MAIN OUTCOME MEASURES

Adherence to the initial in-office eye exam for those referred to ophthalmology.

RESULTS

Of 468 referred participants, 47% (n = 220/468) attended the initial in-office eye exam. Adherence rates: Navigator Intervention (51.8%) versus Usual Care (38.1%). Of those who attended the in-office eye exam, mean age: 70.2 ± 11.3 years; 65.5% female; 46.8% African American, 47.3% Hispanic. Participants in the Navigator Intervention group had higher odds of adhering to the initial in-office eye exam compared to those receiving Usual Care (OR = 1.529; 95% CI (1.023, 2.285)). Participants who spoke English as their primary language also had higher odds of adhering to the initial eye exam (OR = 1.815; 95% CI (1.211, 2721)). Cost per participant in the Navigator Intervention group who attended the in-office eye exam: $24.25 vs. $33.03 per Usual Care participant.

CONCLUSIONS

Patient navigators improved adherence to in-office eye exams following community-based eye health screenings and referral to ophthalmology among an underserved population. The Navigator Intervention resulted in cost savings with an incremental cost-effectiveness difference of $8.78 less per participant randomized to the Navigator Intervention group.

Inhibition of monoamine oxidases and neuroprotective effects: chalcones vs. chromones

Eighteen compounds derived from two sub-series, (HC1-HC9) and (HF1-HF9), were synthesized and evaluated for their inhibitory activities against monoamine oxidase (MAO). HC (chalcone) series showed higher inhibitory activity against MAO-B than against MAO-A, whereas the HF (chromone) series showed reversed inhibitory activity. Compound HC4 most potently inhibited MAO-B with an IC50 value of 0.040 μM, followed by HC3 (IC50 = 0.049 μM), while compound HF4 most potently inhibited MAO-A (IC50 = 0.046 μM), followed by HF2 (IC50 = 0.075 μM). The selectivity index (SI) values of HC4 and HF4 were 50.40 and 0.59, respectively. Structurally, HC4 (4-OC2H5 in B-ring) showed higher MAO-B inhibition than other derivatives, suggesting that the -OC2H5 substitution of the 4-position in the B-ring contributes to the increase of MAO-B inhibition, especially -OC2H5 (HC4) > -OCH3 (HC3) > -F (HC7) > -CH3 (HC2) > -Br (HC8) > -H (HC1) in order. In MAO-A inhibition, the substituent 4-OC2H5 in the B-ring of HF4 contributed to an increase in inhibitory activity, followed by -CH3 (HF2), -F (HF7), -Br (HF8), -OCH3 (HF3), and-H (HF1). In the enzyme kinetics and reversibility study, the Ki value of HC4 for MAO-B was 0.035 ± 0.005 μM, and that of HF4 for MAO-A was 0.035 ± 0.005 μM, and both were reversible competitive inhibitors. We confirmed that HC4 and HF4 significantly ameliorated rotenone-induced neurotoxicity, as evidenced by the reactive oxygen species and superoxide dismutase assays. This study also supports the significant effect of HC4 and HF4 on mitochondrial membrane potential in rotenone-induced toxicity. A lead molecule was used for molecular docking and dynamic simulation studies. These results show that HC4 is a potent selective MAO-B inhibitor and HF4 is a potent MAO-A inhibitor, suggesting that both compounds can be used as treatment agents for neurological disorders.

Attributable risk factors and trends in global burden of falls from 1990 to 2021: A comprehensive analysis based on Global Burden Of Disease Study 2021

BACKGROUND

Falls are a leading cause of disability-adjusted life years (DALYs) and mobility difficulties. Previous estimates have relied on restricted regional scope and lack a thorough global study. This study, for the first time, examines the evolving trends in the global burden of falls from 1990 to 2021, focusing on geographic variation in disease burden and risk factors, predicting the development of burden of falls. Our aim was to provide information for allocating medical resources, taking health policies into action, and making patient management systems operate better.

METHOD

Data on incident cases, deaths, and DALYs were collected for countries, regions, ages, and sexes worldwide from the Global Burden Disease (GBD) 2021 database. Using R (version 4.3.2), we calculated estimated annual percent changes (EAPCs) for assessing trends in age-standardized rates, visualized risk factors, and predicted the global burden of falls. Joinpoint regression (version 4.9.1.0) was used to identify significant temporal trends and change points.

RESULTS

In 2021, 548.8 million people were affected by falls. There were 215 million incidence, 43.8 million DALYs, and 800,000 deaths caused by falls. The incidence rate of falls increases with age, and sex inequalities exist. Compared with 1990, the age-standardized incidence rate (ASIR), death rate (ASDR), and DALY rate (ASDALYsR) declined despite an increase in absolute numbers. The ASDR and ASDALYsR of falls are expected to decline in the future, whereas the ASIR is expected to rise. The fall burden varied significantly according to region and its sociodemographic index (SDI). Both ASIR (R = 0.510, p < 0.001) and ASDALYsR (R = 0.2762, p < 0.001) were positively correlated with SDI. In contrast, ASDR (R=-0.536, p < 0.001) showed a consistently negative association with SDI. Low bone mineral density, occupational injuries, alcohol use, and smoking emerged as the top factors associated with fall-related DALYs and deaths.

CONCLUSIONS

The overall burden of falls declined between 1990 and 2021, but the future incidence is expected to increase. The global burden of falls remains unchanged and shows significant regional and sex-based differences. Effective prevention and strategies against risk factors are imperative for reducing the future burden.

Associations Between Ambient Air Pollution and Five Common Vision-Threatening Ocular Diseases in Middle-Aged and Older Adults: A Large Prospective Cohort Study

PURPOSE

Ambient air pollution may exacerbate ocular conditions; however, comprehensive research on the effects of various pollutants remains limited. This study aims to evaluate the association between multiple air pollutants and the incidence of five common vision-threatening ocular diseases: cataracts, glaucoma, macular degeneration, diabetic retinopathy, and retinal detachment.

DESIGN

Prospective cohort study.

METHODS

We included 114,930 participants with refractometry at baseline in this prospective cohort study based on data from the UK Biobank. Annual average concentrations of nitrogen oxides (NOx), nitrogen dioxide (NO2), and particulate matter (PM) with diameters <2.5 µm (PM2.5) and <10 µm (PM10) were assessed using land use regression models. Restricted cubic spline models and Cox proportional hazards regression were used to estimate the association between air pollution exposure and ocular disease incidence, with stratified analyses based on myopia status.

RESULTS

An interquartile range increase in PM10 and NOx was significantly associated with a higher risk of diabetic retinopathy among participants with myopia, with hazard ratios of 1.11 (95% confidence interval: 1.01-1.23) and 1.22 (95% confidence interval: 1.02-1.45), respectively. PM10 was linked to a 9% increase in retinal detachment incidence in the myopic population, and PM2.5 was linked to an 8% increase in glaucoma incidence in the nonmyopic population. High PM10 exposure was associated with a 61% higher risk of diabetic retinopathy in the myopic group. Further stratified analysis revealed that the impact of PM10 on diabetic retinopathy was more pronounced in individuals with low-to-moderate myopia than in those with high myopia. High PM10 exposure also correlated with a 67% higher risk of retinal detachment and a 44% higher risk of macular degeneration in the low-to-moderate myopic population.

CONCLUSIONS

Exposure to high levels of PM10 was associated with an increased risk of diabetic retinopathy and retinal detachment, highlighting the importance of addressing air pollutants as an intervention for vision-threatening ocular diseases.

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.

Sex-stratified osteochondral organ-on-chip model reveals sex-specific responses to inflammatory stimulation

Osteoarthritis (OA) is a musculoskeletal degenerative disease characterized by alterations in cartilage and subchondral bone leading to impaired joint function. OA disproportionally affects females more than males, yet the molecular mechanisms underlying these biological sex differences remain elusive. Current therapeutic strategies to halt the progression of OA are still lacking, in part due to the limited predictive potential of standard models which often do not account for sex disparities. Herein, an organ-on-chip microfluidic platform was developed to model the osteochondral unit, composed of adjacent bone and cartilage culture chambers, and capture sex-specific hallmarks of OA. Sex-stratified human primary chondrocytes and osteoblasts were compartmentalized within biomimetic hydrogels emulating the bone-cartilage interface, which were subjected to inflammatory triggers to mimic the onset of OA. We confirmed that interleukin-1β and Tumor Necrosis Factor-α stimulation triggered upregulation of pro-inflammatory cytokines and matrix metalloproteinases related genes in all donors, with marginal trends for increased expression in female cells. In addition, metabolic labeling coupled with confocal imaging revealed that inflammatory stimulation modulated extracellular matrix deposition by human chondrocytes in a sex-specific fashion. Not only matrix deposition but also matrix remodeling was altered upon inflammation, leading to a significant reduction in matrix stiffness in both cartilage and bone compartments. Overall, sex-stratified osteochondral unit on-chips offer novel insights into sex-specific cellular responses to inflammatory insults, demonstrating the importance of incorporating sex stratification in emergent organ-on-chip models. Thus, this platform provides a physiologically relevant 3D microenvironment to further investigate sex-specific drivers of OA, paving the way for targeted therapies.

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.

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.

Comprehensive investigation of network pharmacology, computational modeling, and pharmacokinetic assessment to evaluate the efficacy of flavonoids in rheumatoid arthritis

Rheumatoid arthritis is a chronic autoimmune disease characterized by inflammation and joint damage, imposing a significant burden on affected individuals worldwide. Flavonoids, a class of natural compounds abundant in various plant-based foods, have shown promising anti-inflammatory and immunomodulatory effects, suggesting their potential as therapeutic agents for RA. In this study, we conducted a comprehensive investigation of identified LCMS compounds utilizing network pharmacology, computational modeling, in silico approaches, and pharmacokinetic assessment to evaluate the efficacy of flavonoids in RA treatment. The study identified 5 flavonoid structures with common targets via LCMS and Integration of network pharmacology approaches enabled a comprehensive evaluation of the pharmacological profile of flavonoids in the context of RA treatment, guiding the selection of promising candidates for further experimental validation and clinical development. The top 10 targets were AKT1, PI3KR1, CDK2, EGFR, CDK6, NOS2, FLT3, ALOX5, CCNB1, and PTPRS via PPI network. The investigation emphasized several pathways, including the AGE-RAGE signaling pathway, resistance to EGFR tyrosine kinase inhibitors, the PI3K-AKT signaling network, and the Rap 1 signaling pathway. In silico studies estimated binding affinities that ranged from - 7.0 to - 10.0 kcal/mol. Schaftoside and Vitexin showed no toxicity in computational approach and found suitable for further investigations. Overall, our study underscores the potential of flavonoids as therapeutic agents for RA and highlights the utility of integrative approaches combining network pharmacology, computational modeling, in silico methods, and pharmacokinetic assessment in drug discovery and development processes.

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.

Assessing the Causal Relationships Between Lipid Species and Stroke by Using Mendelian Randomization

Circulating lipids and changes in lipid profiles have long been associated with the development of stroke but causal relationships remain unclear.In this study, we aimed to assess the causal relationships between lipid species and multiple stroke phenotypes to inform stroke prevention and treatment strategies. We conducted a two-sample Mendelian randomization analysis using data from genome-wide association studies. The primary method for causal assessment was inverse variance weighting (IVW), complemented by the MR-Egger, weighted median, and weighted mode methods. Sensitivity analyses, based on MR-Egger, MR-PRESSO, and Cochran's Q statistics, were also applied to reinforce the results. In total, potential causality was observed for 133 pairs of lipids with stroke types(P < 0.05). After multiple testing correction (PFDR < 0.05), potential causal associations remained for 10 pairs of lipids, including specific sterol esters and phosphatidylcholines, with various stroke subtypes. The findings demonstrate the significant role that genetically determined lipid profiles may play in the pathogenesis of stroke. Further research is needed to establish whether these biomarkers can be used for stroke prevention or treatment.

Diagnostic Accuracy of Pediatrician-performed Digital Retinal Imaging with 3nethra neo for ROP Screening

OBJECTIVES

To evaluate the accuracy of pediatrician-performed wide-field digital retinal imaging (WFDRI) for diagnosing Retinopathy of prematurity (ROP), as compared to binocular indirect ophthalmoscopy (BIO) as the reference standard.

METHODS

Eligible infants undergoing ROP screening were enrolled consecutively. BIO was performed by trained ophthalmologists, followed by WFDRI (using "3nethra neo" camera) by a pediatrician. An expert pediatric ophthalmologist reviewed de-identified images for quality, presence, and severity of ROP. She was masked to the findings of BIO and the pediatrician. Diagnostic accuracy for detecting any ROP, ROP requiring treatment (Type 1), and ROP requiring referral (Type 1 or 2) were calculated for WFDRI, considering BIO as the reference standard.

RESULTS

The analysis included 427 eyes. The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic accuracy, and diagnostic odds ratio of WFDRI were 0.88 (95% CI: 0.81, 0.93), 0.89 (0.85, 0.92), 7.8 (5.7, 10.9), 0.14 (0.09, 0.21), 0.89 (0.85, 0.91), and 58.3 (31, 110) respectively for detection of 'any ROP'. For detecting ROP requiring treatment (Type 1), the sensitivity, specificity, NLR, and diagnostic accuracy were 0.90 (0.75, 0.97), 1.00 (0.99, 1.00), 0.11 (0.04, 0.27), and 0.99 (0.98, 1.00) respectively. For ROP requiring referral, the sensitivity, specificity, NLR, and diagnostic accuracy of pediatrician-performed WFDRI were 0.92 (0.80, 0.98), 1.00 (0.99, 1.00), 0.08 (0.03, 0.21), and 0.99 (0.98, 1.00) respectively. No serious adverse events were noted. The pediatrician and ophthalmologist had a near-perfect (k-1.00) and strong (k-0.88) agreement for ROP requiring treatment and any ROP, respectively.

CONCLUSIONS

Pediatrician-performed WFDRI is feasible, safe, and has excellent diagnostic accuracy for identifying ROP requiring treatment.

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.

Move to improve - Prescribing physical activity and deprescribing paracetamol for people with low back pain: Findings from a hybrid type III feasibility study

OBJECTIVE

To evaluate the feasibility of implementing a culturally adapted multimedia intervention in the waiting room of a public hospital physiotherapy outpatient service to guide the implementation of a large multicentre trial investigating the effects of a multimedia intervention to promote physical activity and reduce paracetamol use in people reporting low back pain (LBP).

METHODS

A six-month (March to September 2024) hybrid type III feasibility study was conducted in an outpatient physiotherapy department of a public hospital in Sydney, Australia. The intervention included a brief video and booklet designed to engage patients and encourage informed management of LBP. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework guided the evaluation. The educational materials were available in English, Arabic and Mandarin.

RESULTS

The study revealed limited engagement, with only 11% of 688 potential people exposed to the intervention interacting with it. A total of 66 people completed the surveys (mostly English speakers), and six accepted to participate in a follow-up survey. Despite this low engagement, feedback from those who participated was positive. Satisfaction and usefulness ratings were high, with scores of 7.7-7.9 out of 10 for both video and booklet. Helpfulness was also rated positively, particularly for the video (8.6/10). Barriers to engagement included unfamiliarity with digital formats, video length, and the need for staff assistance in accessing the materials.

CONCLUSION

The findings suggest that the intervention, as currently designed, is not feasible for effective implementation in its present form. While engagement with the multimedia intervention was limited, findings allowed for a comprehensive understanding of the barriers and contextual factors impacting patient interaction. Notably, the majority of feedback was positive, with high satisfaction and usefulness ratings. The results underscore the need for alternative implementation strategies and further refinement of the approach to improve engagement with culturally diverse populations experiencing LBP and optimise outcomes in future implementations.

Zolmitriptan niosomal transdermal patches: combating migraine via epigenetic and endocannabinoid pathways and reversal of migraine hypercoagulability

Conventional zolmitriptan (ZOL) has limited oral bioavailability, many adverse effects, and poor membrane penetrability that negatively influences its accessibility to its 5-HT1B/1D receptor binding pocket, located transmemberanous. This work aimed at preparing transdermal ZOL-nanoformulation (niosomes) to surpass these limitations and to explore novel antimigraine mechanisms for ZOL via modulation of the epigenetically-altered chronification genes (RAMP-1, NPTX-2) or microRNAs and affecting the endocannabinoid CB-1/MAPK pathway. The prepared ZOL niosomes (Fsp60/6-1:1) exhibited %EE of 57.28%, PS of 472.3 nm, PDI of 0.366, and ZP of -26 mV were cast into patch with content uniformity of 93.12%, maintained endurance after 200-times folding, no interaction between its components (FT-IR), a biphasic release pattern and good stability after storage at 4 °C for 6 months. In-vivo ZOL-patch application in rats with nitroglycerin-induced migraine showed significant management of migraine pain symptoms and photophobia assessed behaviorally, decreased brain levels of the trigeminal neuronal activation marker (c-fos), the migraine pain neurotransmitter (CGRP) and the serum levels of different migraine pain markers (substance P, nitric-oxide, and TNF-α). It also significantly decreased RAMP-1, NPTX-2, miR-382-5p, and CB-1/MAPK gene expression reflecting improved efficacy and brain receptors delivery to a much greater extent than conventional ZOL has done. Additionally, this nanoformulation significantly opposed migraine-induced platelet activation and hypercoagulable status in both central and peripheral circulations as evidenced by the significant decrease in adenosine diphosphate, thrombin, factor X, CD41, and Von-Willebrand factor levels assessed peripherally and centrally. TPFsp60/6-1:1 significantly improved ZOL efficacy and accessibility to brain-receptors to a much greater extent than conventional ZOL-solution.KeywordsEndocannabinoid receptors; Epigenetically-altered genes; Hemostatic pathways; Niosomal patch; Transdermal; Zolmitriptan.

Effectiveness of technological interventions on psychosocial well-being and perception of technological interventions among people with Parkinson's disease: A systematic review

OBJECTIVES

The increasing number of technological interventions related to Parkinson's disease (PD) signifies growing research interest in the PD technological domain. It remains unknown how these interventions could affect the psychosocial health of people with PD. This systematic review aims to explore how technological interventions affect people with PD psychosocial well-being and their perception towards these interventions.

METHOD

A systematic review was conducted using Cochrane Library®, Embase®, IEEE Xplore Digital Library®, PsycInfo®, PubMed® and Web of Science® databases following PRISMA guidelines. Two individual assessors conducted quality appraisals using the Mixed Method Appraisal Tool. Both quantitative narrative and qualitative thematic synthesis were adopted to analyse the extracted data.

RESULTS

This review included 27 articles with 752 people with PD, with seven categories of technologies implemented in physical rehabilitation. Qualitative findings indicated the overarching theme of coping with technological intervention. Three themes were identified: user perception of intervention design and functional appropriateness, attitude shift and coping, and perceived benefits from technological interventions. Unsuccessful coping attempts and overcomplicated intervention designs induced negative emotions and affected the psychosocial well-being of people with PD.

CONCLUSIONS

Although most PD technological interventions focused on physical rehabilitation, people with PD reported a psychosocial gain in improved autonomy and reinforced social relationships during the intervention period. A better rewardability intervention design was considered more satisfying and could promote self-acceptance rather than stress-inducing. Interventions' technological complexity should match participants' expectations and technological literacy to facilitate the coping process with the intervention for people with PD. More research would be required to quantify the reported psychosocial gain and examine the technological literacy of people with PD when designing a more appropriate intervention regime.

Identifying individuals at risk for weight gain using machine learning in electronic medical records from the United States

AIMS

Numerous risk factors for the development of obesity have been identified, yet the aetiology is not well understood. Traditional statistical methods for analysing observational data are limited by the volume and characteristics of large datasets. Machine learning (ML) methods can analyse large datasets to extract novel insights on risk factors for obesity. This study predicted adults at risk of a ≥10% increase in index body mass index (BMI) within 12 months using ML and a large electronic medical records (EMR) database.

MATERIALS AND METHODS

ML algorithms were used with EMR from Optum's de-identified Market Clarity Data, a US database. Models included extreme gradient boosting (XGBoost), random forest, simple logistic regression (no feature selection procedure) and two penalised logistic models (Elastic Net and Least Absolute Shrinkage and Selection Operator [LASSO]). Performance metrics included the area under the curve (AUC) of the receiver operating characteristic curve (used to determine the best-performing model), average precision, Brier score, accuracy, recall, positive predictive value, Youden index, F1 score, negative predictive value and specificity.

RESULTS

The XGBoost model performed best 12 months post-index, with an AUC of 0.75. Lower baseline BMI, having any emergency room visit during the study period, no diabetes mellitus, no lipid disorders and younger age were among the top predictors for ≥10% increase in index BMI.

CONCLUSION

The current study demonstrates an ML approach applied to EMR to identify those at risk for weight gain over 12 months. Providers may use this risk stratification to prioritise prevention strategies or earlier obesity intervention.

Moderating Impact of Dispositional Mindfulness in the Relationship Between Future Expectancies and Psychological Well-Being

ObjectivesMindfulness has been studied under cultivated or dispositional divisions where the latter has strong implications for psychological well-being in meditators and non-meditators alike. In addition, future expectations, or prospections, regarding the occurrence of important events in a person's future have recently been hypothesized to be the main cause behind symptoms of major depression. There is, however, a lack of empirical research looking at possible links between dispositional mindfulness, as understood in its facet structure, and future expectations as understood via perceived risk of occurrence and vividness of mental imagery when prompted to imagine a given list of positive and negative prospective event item lists. Therefore, this research aimed at examining how dispositional mindfulness may be related to probabilistic risk assessments of positive and negative future events (Stage I); and how mental imagery vividness may be moderated by mindfulness facets (Stage II).MethodsBoth stages included healthy participants and incorporated the PROCESS macro for moderated regression analysis done with the SPSS software. Stage I included 204 voluntary college students, and Stage II was conducted online with a public sample of 110 adults.ResultsAlthough no interaction effect was found in Stage I, nonreactivity to inner experience facet of dispositional mindfulness moderated the relationship between negative imagery vividness and psychological distress in Stage II (F(1,103) = 4.00, R2 change=.018, p <.05).ConclusionsThis is a novel finding that could inform a future line of research looking into the relationship between prospection and mindfulness, holding a potential for informing research on mindfulness-based interventions.

Temporal validation of machine learning models for pre-eclampsia prediction using routinely collected maternal characteristics: A validation study

BACKGROUND

Pre-eclampsia (PE) contributes to more than one-fourth of all maternal deaths and half a million newborn deaths worldwide every year. Early screening and interventions can reduce PE incidence and related complications. We aim to 1) temporally validate three existing models (two machine learning (ML) and one logistic regression) developed in the same region and 2) compare the performances of the validated ML models with the logistic regression model in PE prediction. This work addresses a gap in the literature by undertaking a comprehensive evaluation of existing risk prediction models, which is an important step to advancing this field.

METHODS

We obtained a dataset of routinely collected antenatal data from three maternity hospitals in South-East Melbourne, Australia, extracted between July 2021 and December 2022. We temporally validated three existing models: extreme gradient boosting (XGBoost, 'model 1'), random forest ('model 2') ML models, and a logistic regression model ('model 3'). Area under the receiver-operating characteristic (ROC) curve (AUC) was evaluated discrimination performance, and calibration was assessed. The AUCs were compared using the 'bootstrapping' test.

RESULTS

The temporal evaluation dataset consisted of 12,549 singleton pregnancies, of which 431 (3.43 %, 95 % confidence interval (CI) 3.13-3.77) developed PE. The characteristics of the temporal evaluation dataset were similar to the original development dataset. The XGBoost 'model 1' and the logistic regression 'model 3' exhibited similar discrimination performance with an AUC of 0.75 (95 % CI 0.73-0.78) and 0.76 (95 % CI 0.74-0.78), respectively. The random forest 'model 2' showed a discrimination performance of AUC 0.71 (95 % CI 0.69-0.74). Model 3 showed perfect calibration performance with a slope of 1.02 (95 % CI 0.92-1.12). Models 1 and 2 showed a calibration slope of 1.15 (95 % CI 1.03-1.28) and 0.62 (95 % CI 0.54-0.70), respectively. Compared to the original development models, the temporally validated models 1 and 3 showed stable discrimination performance, whereas model 2 showed significantly lower discrimination performance. Models 1 and 3 showed better clinical net benefits between 3 % and 22 % threshold probabilities than default strategies.

CONCLUSIONS

During temporal validation of PE prediction models, logistic regression and XGBoost models exhibited stable prediction performance; however, both ML models did not outperform the logistic regression model. To facilitate insights into interpretability and deployment, the logistic regression model could be integrated into routine practice as a first-step in a two-stage screening approach to identify a higher-risk woman for further second stage screening with a more accurate test.

Efficacy of supervised exercise on sleep of women who survived breast cancer: a systematic review with meta-analysis

PURPOSE

To analyze the efficacy of supervised exercise (SE) compared with control protocols on sleep parameters of women who survived breast cancer.

METHODS

This systematic review with meta-analysis searched studies using the following electronic databases: PubMed, Scopus, Physiotherapy Evidence Database (PEDro), Cochrane Library, and EMBASE. The PEDro scale assessed the bias risk, and the study protocol was registered in the PROSPERO (no. CRD42023420894).

RESULTS

Of 3,566 identified studies, 13 randomized clinical trials involving 847 women diagnosed with breast cancer were included. Interventions consisted of SE in an outpatient setting (62%) or combined protocols with supervised and home exercises. Most interventions (85%) used multicomponent protocols with aerobic and resistance exercises. Usual care and health education were the most reported controls. SE decreased the sleep disturbance score (- 31.61 [95% confidence interval =  - 39.40 to - 23.83]) of the European Organisation for Research and Treatment of Cancer quality of life questionnaire and daytime dysfunction score (- 0.41 [95% confidence interval =  - 0.73 to - 0.09]) of the Pittsburgh Sleep Quality Index (PSQI). Also, SE presented a tendency to improve the self-reported sleep quality score of the PSQI (p = 0.06).

CONCLUSION

SE increased the subjective sleep quality and immobility time and decreased sleep disturbance and daytime dysfunction symptoms in women who survived breast cancer. Most SE protocols were multicomponent, with aerobic and resistance exercises ranging from moderate to high intensity.

IMPLICATIONS FOR CANCER SURVIVORS

Supervised exercise may improve sleep quality and reduce symptoms of sleep disorders, contributing to survival outcomes.

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.

Investigating the Interplay Between the Nrf2/Keap1/HO-1/SIRT-1 Pathway and the p75NTR/PI3K/Akt/MAPK Cascade in Neurological Disorders: Mechanistic Insights and Therapeutic Innovations

Neurological illnesses are debilitating diseases that affect brain function and balance. Due to their complicated aetiologies and progressive nature, neurodegenerative and neuropsychiatric illnesses are difficult to treat. These incurable conditions damage brain functions like mobility, cognition, and emotional regulation, but medication, gene therapy, and physical therapy can manage symptoms. Disruptions in cellular signalling pathways, especially those involving oxidative stress response, memory processing, and neurotransmitter modulation, contribute to these illnesses. This review stresses the interplay between key signalling pathways involved in neurological diseases, such as the Nrf2/Keap1/HO-1/SIRT-1 axis and the p75NTR/PI3K/Akt/MAPK cascade. To protect neurons from oxidative damage and death, the Nrf2 transcription factor promotes antioxidant enzyme production. The Keap1 protein releases Nrf2 during oxidative stress for nuclear translocation and gene activation. The review also discusses how neurotrophin signalling through the p75 neurotrophin receptor (p75NTR) determines cell destiny, whether pro-survival or apoptotic. The article highlights emerging treatment approaches targeting these signalling pathways by mapping these connections. Continued research into these molecular pathways may lead to new neurological disease treatments that restore cellular function and neuronal survival. In addition to enhanced delivery technologies, specific modulators and combination therapies should be developed to fine-tune signalling responses. Understanding these crosstalk dynamics is crucial to strengthening neurological illness treatment options and quality of life.

Occupational Exposure Patterns to Disinfectants and Cleaning Products and Its Association With Asthma Among French Healthcare Workers

BACKGROUND

Disinfectants and cleaning products (DCPs) are important asthma risk factors among healthcare workers. However, healthcare work involves heterogenous cleaning tasks and co-exposure to many chemicals. These multidimensional aspects have rarely been considered. We aimed to identify patterns of occupational exposure to DCPs and study their associations with asthma.

METHODS

CONSTANCES is a French population-based cohort of ≈220,000 adults. Current asthma and asthma symptom score were defined by questionnaire at inclusion (2012-2021). Healthcare workers completed a supplementary questionnaire on their current/last held occupation, workplace, and cleaning activities that were used in unsupervised learning algorithms to identify occupational exposure patterns. Logistic and negative binomial regression models, adjusted for potential confounders, were used to assess associations with asthma outcomes.

RESULTS

In 5512 healthcare workers, four occupational exposure clusters were identified: Cluster1 (C1, 42%, reference), mainly characterized by low exposed nurses and physicians; C2 (7%), medical laboratory staff moderately exposed to common DCPs (chlorine/bleach, alcohol); C3 (41%), nursing assistants and nurses highly exposed to a few DCPs (mainly quaternary ammonium compounds); and C4 (10%), nurses and nursing assistants highly exposed to multiple DCPs (e.g., glutaraldehyde, hydrogen peroxide, and acids). Among women (n = 3734), C2 (mean score ratio [95% CI]: 1.31 [1.02; 1.68]) and C3 (1.18 [1.03; 1.36]) were associated with higher asthma symptom score, and an association was suggested between C3 and current asthma (odds ratio 1.22 [0.99; 1.51]).

CONCLUSION

In a large population of healthcare workers, four DCP exposure patterns were identified, reflecting the heterogeneity of healthcare jobs. Two patterns, including one characterized by laboratory workers, were associated with greater asthma symptoms in women.

Injury caseload, pattern and time of presentation to emergency services in Mozambique: A pragmatic, multicentre, observational study

BACKGROUND

Rapid population growth and urbanisation raise a critical need to better understand the burden of injuries in sub-Saharan Africa. We assessed the pattern of service demand for injuries at emergency department (ED) in urban areas of Mozambique.

METHODS

This prospective, multi-centric, observational study was conducted in EDs in southern (Maputo), central (Beira) and northern (Nampula) of Mozambique. We randomly selected 7809 cases (age ≥1 years) during the seasonally distinct months of April/2016-2017 and October/2017. Data on patients' demographics, nature of injury and clinical outcomes were collected.

RESULTS

Overall, 1881/7809 (26.2 %) emergency cases comprising 518 children (58.5 % male, aged 4.6 ± 2.5 years), 324 adolescents (64.8 % male, 14.7 ± 3.0 years) and 10,39 adults (60.8 % male, 34.5 ± 13.0 years) presented with injury. The arms, legs and head were most affected in both children (518 with 795 injuries) and adults (1039 with 1496 injuries). The diversity of injuries increased with older age. Injury cases predominantly presented during daylight hours (from 0900 to 1900) with age-differentials evident. There were proportionately more injury presentations in the hotter and wetter October than in colder and drier April. The most common mechanisms of injury were falls, physical violence and road traffic injuries. Overall, 9.1 % of injury cases were admitted to hospital and 0.2 % died.

CONCLUSIONS

Injuries corresponded to around one-quarter of all emergency admissions in urban Mozambique, and were predominantly caused by falls, physical violence, and road traffic injuries. Understanding distinctive variations in the pattern and timing of these presentations according to the age, location and season will assist in future planning for more efficient injury prevention and health care services in Mozambique.

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.

Impact of eyewear insurance coverage on utilization of eyecare providers in Ontario, Canada

OBJECTIVE

To obtain prescription eyewear in Ontario, eye exams must be performed by optometrists or ophthalmologists (eye care providers [ECPs]). In 2004, government-insured routine eye exams were delisted for Ontarians aged 20-64 leaving eye exam coverage only for those aged ≤19 and 65+. We assessed whether having eyewear insurance impacts Ontarians' utilization of ECPs.

DESIGN

Cross-sectional survey.

PARTICIPANTS

Ontarians aged 12+ without diabetes responding to the Canadian Community Health Survey in 2003, 2005, and 2013/2014.

METHODS

We compared the utilization of ECPs by eyewear insurance status and eligibility for government-funded eye exams. Individuals with eyewear insurance funded by employers, government or privately were considered to have insurance.

RESULTS

ECP utilization was significantly higher in Ontarians with eyewear insurance versus those without, in all survey years and all age groups, including those eligible for government-funded eye exams (e.g., 66.4% vs 59.1% [p < 0.05] for the 65+). This higher level of utilization was particularly evident among Ontarians aged 20-64 in 2013/2014, when this group no longer had government-funded eye exams (34.9% vs 19.9% among 20-39-year-olds, 43.4% vs 32.9% among 40-64-year-olds, p < 0.05 for both). Adjusting for confounding effects, the likelihood of visiting an ECP was greater among Ontarians with eyewear insurance than those without (adjusted prevalence ratio 1.26 for Ontarians aged 12+ and 1.41 for those aged 20-64; p < 0.05 for both).

CONCLUSIONS

Lack of eyewear insurance negatively impacts the utilization of ECPs, even among Ontarians eligible for government-funded eye exams, where the cost barrier for eye exams has been removed by the Ontario government.

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.

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.