Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016

Cumulative blood pressure predicts risk of cardiovascular outcomes in middle-aged and older population

BACKGROUND

Cardiovascular disease (CVD) remains a major health concern globally, contributing to a considerable disease burden. However, few studies have considered long-term cumulative blood pressure (cBP) exposure in middle-aged and older population in China. The aim of this study was to investigate whether long-term cBP was associated with subsequent cardiovascular outcomes among participants without CVD at baseline in Chinese over 45 years old.

METHODS

6435 participants in China of the CHARLS (The China Health and Retirement Longitudinal Study) were included. Cumulative BP was calculated as the area under the curve using measurements from wave 1 (2011) to wave 2 (2013). Outcomes included CVD, heart disease and stroke.

RESULTS

During a median follow-up period of 5 years, 1101 CVD events, 826 heart disease, and 351 stroke were recorded. Each 1-SD increase in cumulative systolic blood pressure (cSBP), cumulative diastolic blood pressure (cDBP), and cumulative mean arterial pressure (cMAP) was associated with increased risk of CVD (HR, 1.12; 95%, 1.05-1.20, HR, 1.14; 95%, 1.07-1.22, HR, 1.14; 95%, 1.07-1.22), heart disease (HR, 1.05; 95%, 0.97-1.13, HR, 1.09; 95%, 1.01-1.17, HR, 1.08; 95%, 1.00-1.16) and stroke (HR, 1.35; 95%, 1.21-1.51, HR, 1.31; 95%, 1.17-1.46, HR, 1.36; 95%, 1.22-1.51). The relationship between cBP and CVD has only been found in people younger than 60 years of age. A significant association was observed for cumulative pulse pressure (cPP) with stroke (HR, 1.23; 95%, 1.10-1.38). None nonlinear relationships were identified (p-nonlinear > .05). For the prediction of cardiovascular outcomes, cBP load outperformed baseline BP in terms of C statistics (p < .001).

CONCLUSIONS

Long-term cSBP, cDBP and cMAP were associated with subsequent CVD and only found in people younger than 60 years of age, whereas cPP was associated with stroke only across all ages. Cumulative BP may provide a better prediction of cardiovascular outcomes compared with single BP measurement. Efforts are required to control long-term BP in assessing cardiovascular risks.

A tombus-like virus in patients with lower respiratory tract infection: an observational study based on meta-transcriptomic sequencing

The identification of a novel virus related to the family Tombusviridae, provisionally named human tombus-like virus (hTLV), is significant in the context of ongoing surveillance for respiratory pathogens. Meta-transcriptomic sequencing was utilized to detect respiratory pathogens in patients with lower respiratory tract infections (LRIs) in Jinan, China, from 2022 to 2023. The additional hTLV infections were identified through retrospective analysis of meta-transcriptome data collected in Beijing, China, from 2016 to 2019, prior to the COVID-19 outbreak. Phylogenetic analyzes indicated that hTLVs were clustered with a Jingmen tombus-like virus 2 but in a distinct clade. The hTLVs genomes consist of a single-stranded positive-sense RNA genomes of 4.7-4.8 kb in size, and contained four putative open reading frames (ORF1-4). The RNA-dependent RNA polymerase protein of hTLV shared significant sequence similarity containing three conserved motifs with 15, 24, and 15 amino acids, respectively. The hTLV genome included the canonical Gly376-Asp377-Asp378 (GDD) catalytic residues, which were a unifying feature of viruses in the family Tombusviridae. The main clinical manifestations of the 23 patients were fever, cough, expectoration and dyspnea, with varying degrees of lung infection or abnormalities in other laboratory indicators. Serological studies showed that fourfold rise in IgG titers in sera of a patient between acute and convalescent phase by ELISA. Identification of the pathogens for acute respiratory tract infections is essential for timely public health interventions and clinical management. The discovery of a novel virus, hTLV, in patients with LRIs highlights the continuous emergence of new respiratory pathogens in humans.

Pneumococcal vaccines in China

Invasive pneumococcal disease (IPD) is a serious global public health problem and the leading cause of morbidity and mortality in children and adults in China. Thus, developing and administering pneumococcal vaccines are important for disease prevention. The PPV23 and PCV13 vaccines are available in the Chinese market and are primarily produced by domestic manufacturers. The potential risk of increased IPD caused by non-vaccine serotypes should be considered. Here, we review the current status of IPD, pneumococcal vaccines, and their quality control in China. We also address the challenges and future directions for making progress in controlling IPD, emphasizing the need for further evaluation of the disease burden and monitoring the effectiveness of vaccination efforts.

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.

Association between phenotypic age and in-hospital outcomes in patients with acute myocardial infarction: A retrospective observational study

Background

Phenotypic age (PhenoAge) has emerged as a superior predictor of age-related morbidity and mortality. This study aimed to assess the associations between PhenoAge and in-hospital outcomes in patients with acute myocardial infarction (AMI).

Methods

2896 AMI patients admitted to the First Affiliated Hospital of Xi'an Jiaotong University from 2019 to 2022 were analyzed in this retrospective study. PhenoAge was calculated by using the phenotypic age calculator, an equation for chronologic age and 9 clinical biomarkers, and Phenotypic Age Accelerate (PhenoAgeAccel) was measured using the residuals of regression PhenoAge on chronological age. Clinical outcomes were defined as in-hospital major adverse cardiovascular events (MACEs), including cardiogenic shock, malignant arrhythmia, acute heart failure, and mechanical complications.

Results

Overall, patients with high PhenoAge had a higher Gensini score and a higher likelihood of receiving supportive care, as well as worse clinical outcomes. The same results were observed in patients with positive PhenoAgeAccel. Moreover, PhenoAge and PhenoAgeAccel were significantly associated with in-hospital MACEs even after adjusting for multiple traditional risk factors. The area under the curve for PhenoAge was 0.714 (P < 0.001), which significantly outperformed chronologic age (AUC: 0.601, P < 0.001) and other cardiovascular risk factors. Re-examination of the ROC curves using different combinations of variables, PhenoAge was also able to significantly improve the predictive value of several models.

Conclusions

PhenoAge is significantly associated with clinical outcomes and reliably predicts in-hospital MACEs. Compared with chronological age, PhenoAge is a better complementary biomarker for predicting the risk of in-hospital adverse cardiovascular events in patients with AMI.

Visit-to-visit glucose variability is associated with echocardiographic variables in people with type 2 diabetes: epidemiological and mendelian randomization approaches

BACKGROUND

This study aimed to examine the associations between visit-to-visit variability in fasting plasma glucose (FPG) and HbA1c with echocardiographic variables in patients with type 2 diabetes using epidemiologic and Mendelian randomization (MR) methods.

METHODS

From January 2001 to December 2020, 2,326 (1,233 men and 1,093 women) subjects with type 2 diabetes who underwent echocardiography assessment were enrolled in the diabetes care management program of a medical center in Taiwan. The echocardiographic variables included those for cardiac structural, cardiac systolic, and diastolic function. Variability in FPG and HbA1c within one-year prior echocardiographic measurements was calculated using coefficient of variation (CV). A two-stage multivariable regression analysis was used to assess the causal relationship among FPG-CV, HbA1c-CV, and echocardiographic variables using 22 SNPs for FPG and 14 SNPs for HbA1c as instrumental variables.

RESULTS

A total of 2,326 participants were included, with a mean age of 64.5 years and 53.0% were men. Epidemiologic and MR analyses show the significant associations between left atrium diameter (LAD), left ventricular systolic diameter (LVSd), left ventricular mass (LVM), left ventricular ejection fraction (LVEF), E, and E/e' ratio with FPG variability. Significant associations between HbA1c variability and echocardiographic variables including LAD, E/e', and deceleration time identified in the epidemiologic approach became non-significant in the MR analysis when controlling for covariates.

CONCLUSIONS

Our epidemiologic and MR studies demonstrated that visit-to-visit variability of FPG in patients with type 2 diabetes was independently associated with the left cardiac structure as well as systolic and diastolic function.

Associations Between Community Social Vulnerability or Socioeconomic Deprivation and Respiratory Virus Infection in Decedents in a Large, Urban Medical Examiner's Office

BACKGROUND

Current respiratory virus surveillance relies primarily on medically attended, symptomatic cases, which may distort the true patterns of respiratory virus infection. Estimating the underlying respiratory viral infection patterns, regardless of the symptomatic status, may help us to better intervene and address issues of racial and ethnic health equity. We tested decedents from the Wayne County Medical Examiner's Office (Wayne & Monroe Counties, Michigan including Detroit) regardless of the cause of death.

METHODS

Nasopharyngeal samples were collected from decedents at the Wayne County Medical Examiner's Office between October 2020 and September 2022 and tested for a panel of respiratory viruses. We identified 3430 decedents with catchment addresses, which we linked to the social vulnerability index (SVI) and area deprivation index (ADI) through US Census tract/block. We evaluated non-linear associations between each of adenovirus (AdV), SARS-CoV-2, parainfluenza virus 2 (PIV2), rhinovirus (RV), and respiratory syncytial virus (RSV) prevalence and ADI, SVI, and SVI subthemes using splines in log-binomial regression models.

RESULTS

There were few statistically significant associations observed between overall SVI or ADI and respiratory virus infection prevalence. However, RV was significantly associated with ADI, SVI, and most SVI subthemes. The SVI Minority Status and Language (MSL) subtheme was statistically significantly associated with the prevalence of AdV and RV (p < 0.05) and associations with SARS-CoV-2 and RSV approached significance (p < 0.10).

CONCLUSIONS

Our results suggest that the MSL subtheme of SVI may be the most informative community-level predictor of respiratory virus infections and could be used to prioritize health-equity-focused distribution of public health resources.

Identifying the genetic association between rheumatoid arthritis and the risk of infectious diseases

BACKGROUND

Previous evidence suggests an association between rheumatoid arthritis (RA) and infectious diseases, but the causal relationship remains unclear. This study sought to explore causal associations between RA and five common infections: pneumonia, sepsis, urinary tract infections (UTI), skin and subcutaneous tissue infections (SSTI), and bacterial intestinal infections (BII).

METHODS

To identify the causal links, we adopted a Mendelian randomization (MR) design utilizing the inverse variance weighted (IVW), weighted median (WM), and MR-Egger approaches. Univariable MR (UVMR) and multivariable MR (MVMR) analyses were performed using pooled genome-wide association studies (GWAS) data. Additionally, various sensitivity analyses were conducted to ensure the reliability of the results.

RESULTS

In the UVMR analysis, RA was potentially associated with elevated risks of pneumonia (OR = 1.034, 95% CI: 1.016-1.052, P < 0.001) and sepsis (OR = 1.079, 95% CI: 1.048-1.110, P = 3.507E-07). This association remained significant after adjusting for smoking, alcohol consumption, or type 2 diabetes mellitus (T2DM) in the MVMR analysis. However, no causal links were found between RA and UTI, SSTI, and BII. Sensitivity analyses showed no detectable heterogeneity or pleiotropy, strengthening the causal inference of results.

CONCLUSION

Our study provides strong evidence of the association between RA and increased risks of pneumonia and sepsis. Further research is required to validate these findings and elucidate the underlying mechanisms. Key Points • It remains unclear whether the increased susceptibility to infections in RA stems from a genetic predisposition or results from immunosuppressive treatments. • The MR method is employed to assess the relationship between RA and common infectious diseases. • Our MR study supports a potential causal relationship between RA and elevated risks of pneumonia and sepsis.

Global, regional, and national trends in tobacco-induced cardiovascular disease burden for 1990-2021 with projections to 2045: A comprehensive analysis based on the Global Burden of Disease Study 2021

INTRODUCTION

Tobacco use is a major risk factor for cardiovascular disease (CVD), and its global disease burden trends require further clarification. This study aims to analyze trends in global CVD burden attributable to tobacco in 1990-2021 and project mortality rates and disease burden through 2045.

METHODS

Using Global Burden of Disease Study (GBD) 2021 data, we analyzed temporal trends using age-period-cohort models, evaluated change points with Joinpoint regression, and conducted forecasting using Bayesian age-period-cohort (BAPC) models.

RESULTS

In 2021, tobacco-attributable CVD deaths reached 2.147 million globally (71.3% increase from 1990), although age-standardized mortality rates decreased to 25.36 per 100000 (83.3% reduction). Mortality rates were lowest in high SDI regions (326.71 per 100000) and highest in low-middle sociodemographic index (SDI) regions (788.05 per 100000). The proportion of deaths among those aged ≥80 years increased from 19.2% to 26.2%. Global mortality rates decreased by 1.8% annually, with a greater decline in females (-2.6%) than males (-1.6%). Projections suggest that by 2045, global CVD deaths may reach approximately 3.267 million (52.1% potential increase), although age-standardized mortality rates are expected to decrease to around 38.6 per 100000 (15.9% estimated reduction). Disability-adjusted life years (DALYs) are projected to potentially increase to 75.755 million (39.9% estimated increase), while age-standardized DALY rates could decline to approximately 1008.02 per 100000.

CONCLUSIONS

Between 1990 and 2021, global tobacco-attributable CVD mortality rates showed a declining trend, with notable regional, sex, and age disparities. Projections indicate that while age-standardized rates will continue to decrease, absolute numbers of deaths and disease burden will increase. The findings emphasize the need to strengthen tobacco control and CVD prevention in low-middle SDI regions.

Epidemiological features of hypertension in a high-altitude population in Tibet, China: a cross-sectional study

BACKGROUND

Hypertension is a significant public health challenge in high-altitude areas of Tibet, China. This study aimed to investigate the current epidemiologic status of hypertension in Tibet and to provide insights for enhancing prevention and control strategies in this population.

METHODS

A cross-sectional study was conducted across seven cities in the Tibet autonomous Region. Using multi-stage stratified cluster sampling, 8,992 residents aged 35-75 were enrolled. Hypertension prevalence, awareness, treatment, control rates, and associated risk factors were analyzed. We conducted descriptive and logistic regression analyses in this study.

RESULTS

The crude and weighted hypertension prevalence rates were 46.5% and 46.7%, respectively. Stage 2 or higher hypertension accounted for 49.8% of cases. Among hypertensive individuals, 45.2% were aware of their diagnosis, 30.8% received treatment, and only 3.0% achieved blood pressure control. Risk factors included aging, urban residence, alcohol consumption, overweight, obesity, diabetes, and central obesity (all p < 0.05). Monotherapy was used by 94.2% of treated patients, predominantly calcium channel blockers (CCBs). Among CCBs, nifedipine was the most commonly used agent (38.2%), with women more likely to use CCBs and less likely to receive beta-blockers than men (p < 0.05).

CONCLUSIONS

Hypertension in Tibet is characterized by high prevalence, multifactorial risk, and critically low rates of awareness, treatment, and control. Strengthening primary healthcare infrastructure and targeted health promotion programs are urgently needed to address this burden in high-altitude populations.

Reduced blood EPAC1 protein levels as a marker of severe coronary artery disease: the role of hypoxic foam cell-transformed smooth muscle cells

BACKGROUND

Vascular smooth muscle cells loaded with cholesterol (foam-VSMCs) play a crucial role in the progression of human atherosclerosis. Exchange Protein Directly Activated by cAMP 1 (EPAC1) is a critical protein in the regulation of vascular tone, endothelial function, and inflammation. Our objectives were to identify proteins specifically secreted by foam human coronary VSMCs (foam-hcVSMC) to evaluate their potential as circulating biomarkers for diagnosing coronary artery disease (CAD), and to ascertain the mechanisms underlying their levels in the blood of patients with CAD.

METHODS AND RESULTS

Differential proteomics identified EPAC1 as a differential foam-hcVSMC-secreted protein. Circulating EPAC1 levels were measured by ELISA in blood from 202 patients with suspected CAD who underwent coronary computed tomography angiography (CCTA). Blood EPAC1 levels were significantly lower in CAD patients compared to controls (p < 0.001). EPAC1 levels were reduced in both men and women with severe CAD (SIS > 4) compared to those with moderate CAD (SIS 1-4). ROC analysis identified 9.16 ng/ml as the optimal EPAC1 cut-off for severe CAD. At this threshold, EPAC1 predicted severe CAD (SIS > 4) with 69.6% sensitivity and 79.4% specificity, outperforming hs-CRP and hs-TnT in predicting CAD severity. Real-time PCR and Western blot analysis revealed that human foam-SMCs under hypoxic conditions exhibited a significant reduction in EPAC1 mRNA (p = 0.013) and protein (p < 0.001) levels.

CONCLUSIONS

These findings suggest that circulating EPAC1 protein levels lower than 9.16 ng/mL are predictive of severe CAD in humans. Hypoxic foam-SMCs, characteristic of advanced atherosclerotic lesions, exhibit diminished production of EPAC1, potentially contributing to the decreased circulating EPAC1 levels in patients with severe CAD.

Characterising acute and chronic care needs: insights from the Global Burden of Disease Study 2019

Chronic care manages long-term, progressive conditions, while acute care addresses short-term conditions. Chronic conditions increasingly strain health systems, which are often unprepared for these demands. This study examines the burden of conditions requiring acute versus chronic care, including sequelae. Conditions and sequelae from the Global Burden of Diseases Study 2019 were classified into acute or chronic care categories. Data were analysed by age, sex, and socio-demographic index, presenting total numbers and contributions to burden metrics such as Disability-Adjusted Life Years (DALYs), Years Lived with Disability (YLD), and Years of Life Lost (YLL). Approximately 68% of DALYs were attributed to chronic care, while 27% were due to acute care. Chronic care needs increased with age, representing 86% of YLDs and 71% of YLLs, and accounting for 93% of YLDs from sequelae. These findings highlight that chronic care needs far exceed acute care needs globally, necessitating health systems to adapt accordingly.

Determining the effects of social-environmental factors on the incidence and mortality of lung cancer in China based on remote sensing and GIS technology during 2007-2016

BACKGROUND

Lung cancer is the leading cause of cancer-related death in China. However, its relationship with social-environmental factors has not been revealed comprehensively. We are the first group to determine cold and hot spots associated with the incidence and mortality of lung cancer (IMLC) in both females and males and their spatiotemporal changes and to explore the social‒environmental burden of lung cancer in China between 2007 and 2016.

METHODS

The explanatory powers of various social-environmental factors for the IMLC were evaluated through correlation analysis and the Geodetector tool. Spatial analysis models were applied to determine the relationships between the IMLC and social-environmental factors.

RESULTS

The results are as follows: (1) The distribution of the IMLC exhibited significant spatial heterogeneity; the Global Moran's index values for incidence ranged from 0.04-0.2 and 0.09-0.33 in males and females, respectively, and the values for mortality ranged from 0.01-0.12 and 0.11-0.32 in males and females, respectively. (2) The IMLC was spatially clustered with an overall positive autocorrelation. Male population-related hot spots were observed in the central-southern region of China, and cold spots were observed in western China. Female population-related hot spots were observed primarily in northeastern China. The cold spots occurred primarily in southern and some western regions of China. (3) The effects of social-environmental factors on the IMLC showed significant spatial and temporal variability: in males, the interaction between terrain undulation and road area exhibited the highest explanatory power for the incidence and mortality, with a value of 0.22 for both; in females, the interaction between O3 and road area and the interaction between O3 and the number of medical beds exhibited the highest explanatory powers for the incidence and mortality, reaching 0.27 and 0.34, respectively. (4) The optimal model capturing the relationships between the IMLC and social-environmental factors was the GTWR model, which relies on reclassified data. The best R2 value is 0.456.

CONCLUSIONS

The influence of each social‒environmental factor on the IMLC showed significant spatiotemporal variability, providing a systematic basis for governments to implement better targeted control of lung cancer.

Identifying the causes of adolescent malnutrition in Nuwara-Eliya District, Sri Lanka

Malnutrition, a persistent illness, significantly reduces fat, muscle and bone levels, harming internal organs. The economic crisis in Sri Lanka has led to widespread malnutrition among children, including adolescents experiencing growth spurts. This study identifies factors influencing malnutrition in grade 10 pupils in the Nuwara-Eliya District, with the highest rates of malnutrition and also a multicultural area with many estate sector residents. Using a cross-sectional, quantitative approach, the data was collected from 379 respondents via a Likert scale questionnaire. Structural Equation Model (SEM) analysis was conducted using Smart PLS 4.0. Key findings indicate that environmental factors, such as access to clean water and sanitation, significantly influence adolescent malnutrition. A comprehensive strategy incorporating education, healthcare, and environmental improvements is essential for this. Ongoing observation, community engagement, and cooperative tactics are crucial for sustainable solutions. Addressing environmental issues and promoting a holistic approach to health education and infrastructure improvements are vital to combat adolescent malnutrition in vulnerable populations.

Burden of Congenital Heart Anomalies in North Africa and the Middle East, 1990 to 2021: A Systematic Analysis for the Global Burden of Disease Study 2021

BACKGROUND

Congenital heart anomalies (CHAs) remain a significant global health burden despite advances in diagnosis and management. Data on CHA burden in North Africa and the Middle East region are scarce. This study aimed to estimate CHA trends from 1990 to 2021.

METHODS AND RESULTS

Using the Global Burden of Disease Research 2021 database, we assessed CHA incidence, prevalence, mortality, and disability-adjusted life years (DALYs), stratified by age, sex, and sociodemographic index (SDI) at regional and national levels. Decomposition analysis was used to evaluate the impact of population growth on CHA incidence. In 2021, CHAs caused 35 272 deaths (95% uncertainty interval [UI], 28 067-43 670) and 3 181 543 DALYs (95% UI, 2 544 864-3 899 408) in the North Africa and the Middle East region. Incidence and prevalence increased by 13% (95% CI, 10-17) and 70% (95% CI, 67-74), respectively, whereas CHA-related deaths and DALYs declined by 63% (95% CI, 28-73). Infants <12 months of age accounted for 74.9% of deaths and DALYs, with half occurring within the first month. High-SDI countries had the lowest CHA-related DALYs, whereas middle-SDI countries showed the most substantial decline in mortality. Decomposition analysis highlighted that the actual CHA incidence is lower than expected despite population growth.

CONCLUSIONS

Although CHA incidence and prevalence increased, mortality and DALYs decreased, particularly in middle-SDI countries. The highest burden was among infants, with better outcomes in higher-SDI nations. More effective strategies are needed to reduce the preventable childhood deaths related to CHAs in the North Africa and the Middle East region.

Joint BrEast CAncer & CardiOvascular ScreeniNg: BEACON Study to Assess Opportunistic Cardiovascular Screening Using Breast Arterial Calcification on Mammography

Purpose: Breast arterial calcifications (BAC) are not routinely reported on mammography but are linked to coronary artery calcification (CAC) and cardiovascular disease (CVD) events. We sought to assess primary care provider (PCP) follow-up after BAC and CAC notification and the association between BAC on mammography and CAC on CT. Methods: Participants without known CVD undergoing mammography at a single centre were prospectively recruited over 18 months. BAC were qualitatively scored (none/mild/moderate/severe) by 2 breast radiologists. All participants had research cardiac CT for CAC within 6 months, scored using the Agatston method. Questionnaires collected baseline demographics, risk factors, and follow-up data. Results: 286 participants were included (median age 62 ± 10). Prevalence of BAC was 13% (38/286), 248 had none, 18 mild, 16 moderate, and 4 severe. For CAC: 180 had none, 70 had mild (CAC 1-99), 28 had moderate (CAC 100-399), and 8 had severe (CAC >400). For detecting CAC, BAC presence had 92% specificity (166/180), 23% sensitivity (24/106), and 67% negative predictive value (166/248). Most participants with BAC and CAC (71%, 17/24) were not on lipid-lowering therapy and 63% (15/24) did not believe they had elevated CVD risk. At follow-up (median 202 days), 46% (11/24) with BAC and CAC implemented lifestyle modifications, 92% (22/24) scheduled PCP follow-up, and 56% (10/18) underwent further CV risk assessment following their appointment. One participant with BAC and CAC had a stroke during follow-up. Conclusion: In a prospective cohort without known CVD undergoing mammography, notification of BAC and CAC status prompted high follow-up rates with PCPs and lifestyle modifications.

[Costs and Consequences of Chronic Kidney Disease in People with Diabetes in Portugal: A Modelling Study]

INTRODUCTION

Chronic kidney disease is the fastest-growing chronic disease in terms of prevalence and one of the biggest causes of global mortality according to the Global Burden of Disease Collaboration. This study aimed to project the natural disease progression of this disease in people with diabetes, and to quantify the costs and consequences in the Portuguese context. This was achieved by developing an analytical model reflecting the epidemiology of chronic kidney disease and integrating the various stages of disease progression.

METHODS

A population-based cohort Markov model was used, to follow an adult cohort of people with diabetes and chronic kidney disease as they progressed through different risk categories, in annual cycles, over a period of 50 years. The model considered the natural progression of chronic kidney disease through 18 risk categories based on the KDIGO classification system, as well as the probability of patients receiving renal replacement therapy, including dialysis and kidney transplantation, and the probability of death. Each stage is associated with an annual cost and a disability weight, so the model allowed survival, years lived with disability and lifetime costs to be estimated for the entire population with chronic kidney disease and for patients in different risk categories.

RESULTS

Over the cohort´s lifetime, the model estimated, for the total population with chronic kidney disease and diabetes, an average survival of 8.62 years, with 0.59 years lived with disability, and an average cost of €24 613. These figures correspond to a loss of more than 410 000 years lived with disability and a total lifetime cost of 17.0 billion euros. The progression of this disease was associated with lower survival, more years lived with disability and higher costs.

CONCLUSION

The results of this study characterize the natural progression of chronic kidney disease in people with diabetes mellitus type 2, as well as the associated costs and consequences in the national context. Since diabetes mellitus type 2 is a risk factor for chronic kidney disease, it is expected that the real impact will be greater than estimated in the coming decades. Analysis by risk level shows that progression of the disease is associated with worse outcomes.

Decoding community-acquired pneumonia: a systematic review and analysis of diagnostic criteria and definitions used in clinical trials

BACKGROUND

Community-acquired pneumonia (CAP) is a frequent and potentially life-threatening condition. Even though the disease is common, evidence on CAP management is often of variable quality. This may be reinforced by the lack of a systematic and homogeneous way of defining the disease in randomized controlled trials (RCTs).

OBJECTIVES

This study aims to assess the diagnostic criteria and definitions of the term 'community-acquired' used in RCTs on CAP management.

DATA SOURCES

On the basis of the protocol (PROSPERO 2019 CRD42019147411), we conducted a systematic search of Medline/PubMed and the Cochrane Register of Controlled Trials for RCTs published or registered between 2010 and 2024.

STUDY ELIGIBILITY CRITERIA

Study eligibility criteria included completed and ongoing RCTs.

PARTICIPANTS

Participants included adults hospitalized with CAP.

METHODS OF DATA SYNTHESIS

Data were collected using a tested extraction sheet, as endorsed by the Cochrane Collaboration. After cross-checking, data were synthesized in a narrative and tabular form.

RESULTS

In total, 7173 records were identified through our searches. After removing records that did not fulfil the eligibility criteria, 170 studies were included. Diagnostic criteria were provided in 69.4% of studies, and the term 'community-acquired' was defined in 55.3% of studies. The most frequently included diagnostic criteria were pulmonary infiltrates (94.1%), cough (78.8%), fever (77.1%), dyspnoea (62.7%), sputum (57.6%), auscultation/percussion abnormalities (55.9%), and chest pain/discomfort (52.5%). The different criteria were used in 87 different sets across the studies. The term 'community-acquired' was defined in 57 different ways.

CONCLUSIONS

The diagnostic criteria and definitions of CAP in RCTs exhibit significant heterogeneity. Standardizing these criteria in clinical trials is crucial to ensure comparability across studies.

AIM2 exacerbates hypoxic-ischemic brain damage in neonatal rats via promoting neuronal pyroptosis

BACKGROUND

Pyroptosis has been reported to play a pathogenic role in neonatal hypoxic-ischemic brain damage (HIBD). Absence in melanoma 2 (AIM2) is an inflammasome involved in pyroptosis.

OBJECTIVE

This study aimed to investigate the role of AIM2 in hypoxic-ischemia (HI)-induced pyroptosis and brain damage in a neonatal rat HIBD model.

METHODS

In vivo, we injected a lentivirus that overexpressed or knocked down AIM2 into the lateral ventricle of rats within 24 h after birth and prepared a 7-day Sprague Dawley (SD) rat HIBD model. In vitro, we transfected lentiviruses overexpressing or knocking down AIM2 into cultured primary neurons and established an oxygen/glucose deprivation/reoxygenation (OGD/R) model. 2,3,5-triphenyltetrazolium chloride (TTC) staining was used to determine infarct size. Hematoxylin and eosin and Nissl staining were used to evaluate morphological changes in the damaged brain. Cell Counting Kit-8 (CCK-8) and lactate dehydrogenase (LDH) assays were used to determine cell viability and toxicity. Pyroptosis was observed using transmission electron microscopy.

RESULTS

AIM2 expression significantly increased in the HI-induced cortex of neonatal rats. Lentivirus-mediated overexpression of AIM2 significantly aggravates HI-induced brain injury and OGD/R-induced neuronal injury in vivo and in vitro. The lentivirus-mediated AIM2 knockdown significantly reversed these adverse effects. In addition, AIM2 overexpression increased HI-induced pyroptosis in neonatal rats in vivo and in vitro, whereas AIM2 knockdown suppressed HI-induced pyroptosis via the AIM2/Caspase-1/GSDMD pathway.

CONCLUSION

These findings show that the upregulation of AIM2 activates pyroptosis and plays a pathogenic role in neonatal HIBD.

Clinical and Electrocardiographic Characteristics in NSTEMI Patients With Acute Total Occlusion of Culprit Left Circumflex Artery

BACKGROUND

Complete blockage of the culprit coronary artery is associated with 30% of NSTEMI (non-ST-segment elevation myocardial infarction) patients. The culprit vessel in the left circumflex artery (LCX) is more prevalent in this subset of individuals. These people's clinical features and ischemia alterations on electrocardiography (ECG) are unknown. The goals of this study were to examine clinical features and identify predicted ECG abnormalities in NSTEMI patients with complete blockage of the culprit LCX.

METHODS

This study enrolled 5215 consecutive NSTEMI patients' data. A total of 180 people were diagnosed with acute total occlusion of the culprit artery (ATOCA). Based on the culprit vessel, the patients were classified into three groups:ATOCA in the LAD (n = 46), ATOCA in the RCA (n = 38) and ATOCA in the LCX (n = 96). Furthermore, basic clinical data, ECG alterations, and the occurrence of major adverse cardiac events (MACEs) were gathered and examined.

RESULTS

In this single-center investigation, we discovered that ATOCA was more prevalent in patients with NSTEMI in the LCX group. Patients with culprit LCX were more prone to having multivessel coronary disease (p = 0.015), poorer LVEF (p = 0.040), and a lower revascularization success rate (p = 0.019) during hospitalization, although there were no significant differences in MACEs in short and long follow-up. STV5 + STV6 ≥ 2.5 mm (OR = 2.595, 95% CI: 1.297 ~ 5.192) and T-wave imbalance (defined as an upright T-wave in V1 with an amplitude larger than V6 (T1-T6 ≥ 1 mm) recorded from the P-R interval)(OR = 3.871, 95% CI: 1.820 ~ 8.231) were shown to be independent predictors of NSTEMI patients with acute complete blockage of the culprit LCX in multivariate regression analysis.

CONCLUSION

The LCX is the most prevalent culprit vessel with acute complete occlusion in NSTEMI patients, yet it has little effect on clinical outcomes. This subset of patients may be predicted by STV5 + STV6 ≥ 2.5 mm and T-wave imbalance.

Temporal trends of diarrheal diseases and associated treatment responses among children aged under five: Insight from the multiple Indicator Cluster surveys from 2006 to 2019

BACKGROUND

Despite significant progress in its health sector, Bangladesh has a high burden of diarrheal mortality and morbidity in the South Asian region. Given recent major social and economic transitions in Bangladesh, it is important to examine how patterns of diarrhea and its treatment have evolved over the past few decades. The current study aims to assess the temporal changes in the frequency of diarrhea and identify the factors that influence whether affected children receive proper treatment.

METHODS

The current study utilized data from three Bangladesh Multiple Indicator Cluster Surveys (MICS), 2006, 2012-13, and 2019, respectively. Binary logistic regressions were conducted, and the reported results included odds ratios (OR) and 95% confidence intervals (CIs). A p-value of <0.05 was considered statistically significant (α = 0.05).

RESULTS

The prevalence of diarrhea in Bangladesh declined from 7.05% in 2006 to 3.91% in 2012-13, but then increased to 8.78% in 2019. The proportion of children with diarrhea who received oral rehydration therapy (ORT) was 68.91%, 77.35%, and 70.59% respectively. Binary logistic regression indicated that older children (OR:0.54; CI:0.51-0.58), females (OR:0.92; CI:0.86-0.98), children from upper quintile families, and children from mothers having primary education (OR:0.9; CI:0.83-0.98) were less likely to suffer from diarrhea. However, the odds of receiving proper treatment with ORT were higher among older children (OR:1.45; CI:1.26-1.68), children from the rich and richest quintiles (OR:1.85; CI:1.47-2.32 and OR:1.7; CI:1.32-2.2 respectively). Also, it was the same for children from mothers with primary (OR:1.19; CI:1.01-1.41) and secondary or above education (OR:1.32; CI:1.12-1.56).

CONCLUSION

A targeted approach is needed to reduce diarrhea and promote the use of ORT. Maternal education can be an important intervention, and steps should be taken to reduce poverty. Future policies should consider strategies focusing on socioeconomic and environmental factors.

Chronic intermittent hypoxia alleviates alcohol-related liver injury via downregulation of hepatic hypoxia-inducible factor-2α

Alcohol-related liver disease (ALD) is one of the leading causes of alcohol-related morbidity and mortality worldwide. Unfortunately, limited therapeutic options are currently available, due to the complex risk factors involved as well as the lack of information on the molecular mechanisms driving its progression. Interestingly, chronic, excessive alcohol intake has been reported to exacerbate the severity of obstructive sleep apnea (OSA), a respiratory disorder typically characterized by chronic intermittent hypoxia (CIH). However, this relationship between alcohol-enhanced OSA and ALD development/progression remains to be elucidated. As an approach to investigate this relationship, in vivo Gao-binge ALD and CIH mouse models were established. Alcohol-related liver injury, hepatic steatosis, inflammation, and oxidative stress were then assessed in these models. In addition, lipopolysaccharide (LPS) and ethanol-cotreated mouse normal hepatocyte cell line AML12 served as an in vitro model to investigate the mechanisms through which CIH affects ethanol-induced liver injury. CIH intervention ameliorated alcohol-related liver injury, reduced hepatic lipid accumulation and oxidative stress, and alleviated liver inflammation. Mechanistically, in the liver of these Gao-binge mice, CIH intervention inhibited alcohol-induced upregulation and activation of hypoxia-inducible factor 2α (HIF-2α), a protein which plays a key role in hepatic lipid metabolism and liver injury. Similar to these effects observed in response to CIH intervention, treatment of Gao-binge mice with the selective inhibitor of HIF-2α, PT2385, alleviated alcohol-related liver injury and steatosis while inhibiting oxidative stress and inflammation. Additional findings from our in vitro model revealed that CIH downregulated HIF-2α by promoting calpains protein expression, thereby reducing the accumulation of lipid droplets and decreasing reactiveoxygenspecies (ROS) production in AML12 cells co-challenged with LPS and ethanol. The above results provide important, new evidence that reconceptualizes the role of alcohol-enhanced OSA in ALD progression. Moreover, these findings can serve as the foundation for the development of HIF-2α inhibitors for use in the prevention and treatment of ALD.NEW & NOTEWORTHY Chronic intermittent hypoxia (CIH) intervention mitigated hepatic lipid accumulation and reduced hepatic injury, inflammation, and oxidative stress in alcohol-related liver disease (ALD) mice. CIH alleviates ALD and is likely linked to the downregulation of hypoxia-inducible factor 2α (HIF-2α) expression mediated by calpains. This study presents a new possibility for ALD treatment and lays a theoretical foundation for the clinical treatment of ALD.

Adapting and implementing a pre-hospital trauma program for community health responders: A pilot study from rural Nepal

INTRODUCTION

Effective pre-hospital care is critical for improving trauma outcomes, yet pre-hospital systems are underdeveloped in low-and middle-income countries (LMICs) like Nepal, where trauma-related deaths are rising. Community health responders (CHRs) have the potential to reduce time to post-injury care in rural settings, where other health infrastructure may be unavailable. This pilot study assessing the feasibility and preliminary impact of CHR based program in rural Nepal.

METHODS

This quasi-experimental study adapted and implemented a trauma training intervention for CHRs in Achham, Nepal. The program adapting the trauma portion of the World Health Organization's (WHO) Basic Emergency Care (BEC) course for the Achham context through a modified Delphi process. The final implemented program included three items: initial two-day skills-based training, a pictorial guide handbook for CHR's quick reference, and a one-day refresher training at three months. Two rural municipalities of Achham district were assigned into intervention or control. All CHRs from the intervention municipality underwent the training program. Assessment includes the program's impact on CHRs' knowledge and confidence, and impact on pre-hospital trauma care metrics, which was assessed through pre-, immediately, and six-months post-course evaluations, and pre-hospital service metrics data, respectively. A repeated measures ANOVA was used to assess change in knowledge over time by study groups. Bivariate analysis was performed to explore differences in pre-hospital patient metrics of trauma care by study group.

RESULTS

The intervention group showed a significant increase in knowledge and confidence immediately post-course and sustained over six months. There was no significant difference in mean patient age (26.5 years versus. 22.1) and trauma mechanism (p = 0.14) across two groups. The most common mechanism was falls (n = 165, 77.5 %). Intervention municipalities had higher rates of pre-hospital care provision, including fracture immobilization (51.4 % versus. 17.1 %, p < .001) and cervical collar use, compared to controls.

CONCLUSION

This study adapted and implemented a contextual trauma training program for CHRs in rural Nepal. Results shows early feasibility and appropriateness in this context. The program leverages existing community networks and offers a potential approach in LMICs to bridge the existing critical gaps in rural pre-hospital trauma care that requires further investigation.

The Regional Burden of Parkinson's Disease in Kazakhstan 2014-2021: Insights From National Health Data

Background: This study explores the burden of Parkinson's disease (PD) in Kazakhstan, the largest country in Central Asia, a region where data on neurological disorders are notably sparse. Methods: Utilizing data from Kazakhstan's Unified National Electronic Health System during 2014-2021, the study investigates the epidemiology, disability-adjusted life years (DALYs), and survival outcomes in a cohort of PD patients. The authors employed Cox proportional hazards regression models and Kaplan-Meier analysis, alongside sensitivity analyses, to assess the impact of demographic factors, hypertension, and the Charlson Comorbidity Index (CCI) on survival. Results: The study cohort included 10,125 patients, revealing a tenfold increase in PD prevalence during the study period. Mortality rates varied significantly, with the highest rates observed in the eldest age group (137.05 per 1000 person-years). PD contributed to a loss of 156.12 DALYs per 100,000 population, primarily driven by years of life lost. The analysis identified an increased risk of all-cause mortality among males (adjusted hazard ratio (aHR) 1.6; 1.5-1.8), older individuals (aHR 1.05; 1.04-1.06), those with higher CCIs, and individuals of Kazakh ethnicity. Interestingly, patients with comorbid hypertension had a higher probability of survival (aHR 0.67; 0.60-0.73). Conclusion: This study is the first of its kind in Central Asia to examine the burden of PD using a large-scale outpatient registry. The findings underscore the need for targeted interventions to address the growing burden of PD, particularly among males and ethnic Kazakhs. Additionally, further research is needed to explore the inverse association between hypertension and survival in the PD cohort.

Targeted Anti-Inflammatory Nanozymes with Pro-Angiogenic Activity for Myocardial Infarction Therapy

Myocardial infarction (MI) poses a significant threat to human health. Current treatments emphasize early revascularization to restore blood supply to the myocardium, often overlooking the extensive oxidative damage and autophagy dysfunction resulting from reactive oxygen species (ROS) release after MI. Therefore, timely and effective interventions to clear ROS in the early stages of MI are crucial for inhibiting the MI pathological progression and restoring cardiac function. This study constructed a ROS-responsive biomimetic nanoparticle (PNP@Nb2C-MSN) by integrating niobium carbide MXenes (Nb2C) onto mesoporous silica nanoparticle (MSN) coated with platelet membrane. During the MI acute phase, these nanoparticles are targeted and delivered to the infarcted heart via intravenous injection. The MSN mesoporous structure enhances the ROS scavenging capacity of Nb2C, eliminating excess ROS in the infarct region and inhibiting the oxidative stress progression. Silicon ions released from MSN further promote angiogenesis within the infarct region. PNP@Nb2C-MSN reduces inflammation by downregulating the NF-κB pathway and enhances autophagy by activating the AMPK pathway, thereby blocking pathological microenvironmental progression after MI and improving cardiac function. In vitro and in vivo results highlight the therapeutic potential of PNP@Nb2C-MSN in MI, offering a promising MI treatment strategy.

Global burden of female infertility attributable to sexually transmitted infections and maternal sepsis: 1990-2021 and projections to 2050

Infectious diseases, such as sexually transmitted infections (STIs) and maternal sepsis, are major contributors to female infertility, creating a substantial burden on women of reproductive age. Based on Global Burden of Disease (GBD) 2021, this study analyzed the global trends and regional disparities in infection-related infertility for women aged 15-49 and projected future burdens. Our result showed that from 1990 to 2021, global age-standardized prevalence rate (ASPR) rose from 839.52 to 982.37 per 100,000 with estimated annual percentage change (EAPC) (0.26 [0.19 to 0.33]), and years lived with disability (YLDs) increasing from 62.81 to 106.69 thousand (EAPC 0.23 [0.16 to 0.31]), and was predicted to continue rising from 2022 to 2050. The disease burden showed significant regional disparities, low socio-demographic index (SDI) regions had the highest ASPR (1247.25 per 100,000 [1085.17 to 1443.57]) but also the fastest decline (EAPC -1.17 [-1.34 to -0.99]), and Western Sub-Saharan Africa (ASPR 1,925.52 [1655.35 to 2241.71] per 100,000) are the regions with highest burden. The disease burden increased with age, peaking at 40-44 years, and was inversely associated with SDI. These findings provide essential insights for policymakers to develop targeted strategies to prevent and control infection-related infertility, particularly in low-SDI regions.

L-arginine from elder human mesenchymal stem cells induces angiogenesis and enhances therapeutic effects on ischemic heart diseases

BACKGROUND

Mesenchymal stem cell (MSC)-based therapy may be a future treatment for myocardial infarction (MI). However, few studies have assessed the therapeutic efficacy of adipose tissue-derived MSCs (ADSCs) obtained from elderly patients in comparison to that of bone marrow-derived MSCs (BMSCs) from the same elderly patients. The metabolomics results revealed a significantly higher L-arginine excretion from aged ADSCs vs BMSCs in hypoxic conditions. This was hypothesized as the possible mechanism that ADSCs showed an improved angiogenic capacity and enhanced the therapeutic effect on ischemic heart diseases.

AIM

To investigate the role of L-arginine in enhancing angiogenesis and cardiac protection by comparing ADSCs and BMSCs in hypoxic conditions for MI therapy.

METHODS

Metabolomic profiling of supernatants from ADSCs and BMSCs under hypoxic conditions were performed. Then, arginine succinate lyase (ASL) overexpression and short hairpin RNA plasmid were prepared and transfected into BMSCs. Subsequently, in vitro wound healing and Matrigel tube formation assays were used to verify the proangiogenetic effects of ADSC positive control, BMSCs, BMSCs ASL short hairpin RNA, BMSCs ASL overexpressed, and BMSC negative control on cocultured human umbilical vein endothelial cells. All sample sizes, which were determined to meet the statistical requirements and be greater than 3, were established on the basis of previously established literature standards. The protein levels of vascular endothelial growth factor (VEGF), basic fibroblast growth factor, etc. were detected. In vivo, the five types of cells were transplanted into the infarcted area of MI rat models, and the therapeutic effects of the transplanted cells were evaluated by echocardiography on cardiac function and by Masson's staining/terminal-deoxynucleotidyl transferase mediated nick end labeling assay/immunofluorescence detection on the infarcted area.

RESULTS

Metabolomic analysis showed that L-arginine was increased. Using ASL gene transfection, we upregulated the production of L-arginine in aged patient-derived BMSCs in vitro, which in turn enhanced mitogen activated protein kinase and VEGF receptor 2 protein expression, VEGF and basic fibroblast growth factor secretion, and inductive angiogenesis to levels comparable to donor-matched ADSCs. After the cell transplantation in vivo, the modified BMSCs as well as ADSCs exhibited decreased apoptotic cells, enhanced vessel formation, reduced scar size, and improved cardiac function in the MI rat model. The therapeutic efficacy decreased by inhibiting L-arginine synthesis.

CONCLUSION

L-arginine is important for inducing therapeutic angiogenesis for ADSCs and BMSCs in hypoxic conditions. ADSCs have higher L-arginine secretion, which leads to better angiogenesis induction and cardiac protection. ADSC transplantation is a promising autologous cell therapy strategy in the context of the present aging society.

Classification rule for ten year MACE Risk in primary care tarragona older adults with type2 diabetes: a CHAID decision-tree analysis

BACKGROUND

Cardiovascular disease is the leading cause of mortality among individuals with Type 2 Diabetes Mellitus (T2DM). This study developed a simple tool to predict the 10-year risk of major adverse cardiovascular events (MACE) in T2DM patients over 60 years within primary care.

METHODS

A retrospective cohort study was conducted on patients with T2DM who were over 60 years old in Tarragona, spanning from 01/01/2009-31/12/2018. Primary outcome was MACE, which included acute myocardial infarction (AMI), stroke, and cardiovascular death, all of which were identified using ICD-9 diagnostic codes. Other variables were age, sex, comorbidities, risk factors, as well as clinical and laboratory parameters. A Chi-Square Automatic Interaction Detector (CHAID) decision tree classification was utilized to assess the 10-year risk of developing a new MACE.

RESULTS

Five thousand five hundred fifty-four patients with T2DM were identified. Among the 4,666 with T2DM and without previous MACE, 779 patients went on to develop a new MACE. The CHAID model categorizes individuals into three risk groups based on the primary predictor variable, which is age. For patients under the age of 71 with hypertension, having HDL-c levels less than 39 mg/dL increases the risk of developing a new MACE to 19.9%. Among individuals aged 71 to 75 years, having fasting glucose levels greater than 177 mg/dL elevates the risk to 27.2%.

CONCLUSION

Classification trees based on CHAID allow for the development of decision rules and simplify the stratification of cardiovascular risk in patients with T2DM, making it a valuable tool for risk assessment within a primary care setting.

Adriamycin-induced nephropathy models: elucidating CKD pathophysiology and advancing therapeutic strategies

The Adriamycin-induced nephropathy (AN) model plays a crucial role in advancing our understanding of and research on chronic kidney disease (CKD). This review outlines methodologies for generating AN models in mice and rats, discusses their pathophysiologic and molecular characteristics, highlights their advantages and limitations, describes therapeutic interventions that have been evaluated in these models, and presents future research perspectives. The AN model replicates key features observed in human CKD, such as proteinuria, podocyte injury, glomerulosclerosis, and tubulointerstitial fibrosis. Notably, genetic factors significantly influence the onset and severity of AN, with mutations in the Prkdc gene linked to nephrotoxicity and systemic toxicity. To evaluate therapeutic interventions for CKD, agents such as ACE inhibitors, corticosteroids, and SGLT2 inhibitors have been tested in the AN model, demonstrating promising renoprotective effects. However, the systemic toxicity of Adriamycin and variability across models pose limitations, highlighting the need for caution when translating findings to human CKD. Future advancements in genetic engineering and the application of CRISPR-Cas9 technology are expected to improve the fidelity of AN models to human disease. Additionally, discovery of biomarkers by using the AN model enables us to improve early diagnosis. These efforts are anticipated to deepen our understanding of CKD pathophysiology and contribute to developing more effective diagnostic tools and targeted therapies.

Elevated waist-to-hip ratio, as an abdominal obesity index, predicts the risk of diabetic kidney injury

BACKGROUND

Diabetic nephropathy (DN) is associated with a high incidence of type 2 diabetic mellitus (T2DM) in Asia. Central obesity is an important risk factor for DN, represented by a series of indices, including waist circumference, waist-to-hip ratio (WHR), hip circumference, and visceral to subcutaneous fat area ratio (VSR). However, limited research has focused on the association between these indices and DN.

AIM

To elucidate the relationship between central fat distribution, as measured by WHR and VSR, and the DN progression.

METHODS

Between August 2018 and April 2023, a total of 991 individuals were retrospectively recruited from the Rui'an People's Hospital for this cross-sectional analysis. The 753 individuals with T2DM were divided into three groups according to the urinary albumin/creatinine ratio (ACR): normal albuminuria (n = 513, ACR < 30 mg/g), microalbuminuria (n = 166, 30 ≤ ACR < 300 mg/g), and clinical proteinuria (n = 45, ACR ≥ 300 mg/g).

RESULTS

Our results indicated that WHR and VSR were closely correlated with sex, ageing, body mass index, hypertension, T2DM causes, and experience of drinking and smoking, and potential relationships between these factors and DN progression were observed. WHR, but not VSR, gradually increased with the severity of early-stage renal injury. Abnormal serum lipid levels in T2DM patients with early-stage renal injury were strongly correlated with WHR. Logistic regression analysis revealed that WHR may be an independent risk factor for early-stage renal injury.

CONCLUSION

In patients with T2DM, WHR level, rather than VSR level, is closely associated with early-stage renal injury. An abnormal serum lipid spectrum was common in all stages of renal injury and was strongly related to high WHR. Thus, WHR measurement might be a valuable tool for the early prevention of renal injury, which could guide clinical monitoring and prevent diabetic complications.

Clinical evaluation of the installation conditions and accuracy of wearable neonatal jaundice meter

Neonatal jaundice is a physiological phenomenon that occurs in newborns. However, because excess bilirubin can cause cytotoxicity, abnormal hyperbilirubinemia can lead to bilirubin encephalopathy. In the evaluation of neonatal jaundice, serum bilirubin concentrations are indirectly assessed via a transcutaneous bilirubinometer. However, commercially available transcutaneous bilirubinometers are expensive, especially in developing countries. Therefore, many newborns still suffer from bilirubin encephalopathy worldwide. We previously developed a prototype wearable jaundice meter. In this study, we aimed to investigate further improvements in this device and evaluate its measurement accuracy at different measurement sites and at different pressures. The bilirubin values of forty-eight newborns were measured at different sites (middle of the forehead and upper eyebrows) and with different pressures (1 and 2 newtons). The transcutaneous bilirubin values measured by the wearable bilirubin meter were strongly correlated with the transcutaneous bilirubin values measured by a commercially available bilirubin meter (r > 0.9) and the actual serum bilirubin values (> 0.84), even under different conditions. This wearable jaundice meter is much cheaper and smaller than commercially available jaundice meters and is a novel medical device that could be useful for evaluating neonatal jaundice.

Potential impact of the time trend of fried food consumption on the cardiovascular disease burden in China

Background: Cardiovascular disease (CVD) is a leading cause of death in China. Fried foods are a risk factor for increasing CVD and their consumption in China is rapidly rising. Evaluation of the impact of fried foods on the CVD burden has important implications for future public health and policy making. This study aimed to evaluate the impact of fried foods on the CVD burden. Methods: We estimated the temporal trends of fried food consumption from 1997 to 2011 using data from the China Health and Nutrition Survey. We estimated CVD events attributed to fried food consumption using comparative risk assessment methods. We also projected fried food consumption and the related CVD burden from 2011 to 2031. Results: Fried food consumption continued to increase from 1997 to 2011, reaching 110.2 g per week in 2011. It is estimated that high consumption of fried foods is responsible for 3.4%, 2.3%, and 14.3% of the CVD, CHD, and stroke burden, accounting for 0.112 million CVD cases, 0.036 million CHD cases, and 0.243 million stroke cases, respectively. Notably, fried food consumption is projected to increase to 127.6 g per week by 2031. High consumption levels are projected to cause 0.239 million CVD cases, 0.078 million CHD cases, and 0.529 million stroke cases by 2031. Conclusions: The consumption of fried foods has continued to increase over time, which has an important impact on the burden of CVD in China. Dietary guidelines should continue to emphasize on decreasing the consumption of fried foods to reduce the CVD burden in China.

Incremental diagnostic value of coronary computed tomography angiography derived fractional flow reserve to detect ischemia

Over the past decade, coronary computed tomographic angiography (CCTA) has been the most robust non-invasive method for evaluating significant coronary stenosis. Thanks to new technologies, it is now possible to determine the fractional flow reserve (FFR) non-invasively using computed tomographic (CT) images. The aim of this work was to evaluate the incremental diagnostic value of CT-derived FFR for ischemia detection. In this retrospective monocentric study, we investigated 421 patients who underwent CCTA and subsequent ischemia testing between 04/2009 and 06/2020. Endpoint was ischemia on a coronary vessel level assessed by CMR (n = 20), SPECT (n = 225), invasive angiography (stenosis ≥ 90%; n = 80) or invasive FFR (positive if ≤ 0.8; n = 96). CT-FFR was derived from CCTA images by a machine learning (ML) based software prototype. Patients averaged 66.5 [58.2-73.6] years of age and 72.7% (n = 306) were male. Overall, 52.5% (n = 221) had hypertension and 67.9% (n = 286) had hypercholesteremia. Logistic regression analysis on a per vessel base showed that the diagnostic model with CT-FFR plus CCTA had significantly better-fit criteria than the diagnostic model with CCTA alone (log-likelihood χ2 230.21 vs. 192.17; p for difference < 0.001). In particular, the area under curve (AUC) by receiver operating characteristics curve (ROC) analysis for CT-FFR plus CCTA (0.87) demonstrated greater discrimination of hemodynamic ischemia compared to CCTA alone (0.83; p for difference < 0.0001). Combined CCTA and CT-FFR have improved diagnostic accuracy compared to CCTA alone in detecting ischemia on the coronary vessel level and thus could reduce the use of invasive coronary angiography in the future.

Optimizing nursing services for orthopaedic trauma patients using SERVQUAL and Kano models

Nursing managers increasingly focus on improving the quality of patient-centred nursing services.The combination of SERVQUAL model and Kano model can be used for the study on the improvement of nursing quality. Through a literature review and expert discussion, an evaluation questionnaire and a Kano model questionnaire were developed to assess the nursing service quality for orthopaedic trauma inpatients. The SERVQUAL model was used to identify low-level nursing service elements, and the Kano model, factor selection line and sensitivity analysis were used to determine the rectification order. Three hundred people completed two rounds of the survey. The total score for nursing service quality was -0.55. The 26 items assessing nursing service quality included 21 low-level items. There were 10 items that needed improvement. The main reason for low nursing service quality is inadequate attention to patient safety and comfort requirements. Constructing a training system for orthopaedic nurses and optimising the nursing service process are the primary strategies for optimizing the nursing service quality for orthopaedic trauma inpatients. It lays a good foundation for improving patients' experience and health outcomes.

Robot assisted stereotactic surgery improves hematoma evacuation in intracerebral hemorrhage compared to frame based method

Intracerebral hemorrhage (ICH) requires prompt hematoma evacuation to mitigate poor outcomes. This study compares robot-assisted stereotactic surgery with traditional frame-based methods for ICH evacuation. A retrospective analysis of 131 patients (45 robot-assisted, 86 frame-based) undergoing surgery within 72 h of supratentorial basal ganglia hemorrhage was conducted. Propensity score matching balanced baseline characteristics between 40 patients per group. Results showed robot-assisted surgery achieved a significantly higher median hematoma evacuation rate (78.7% vs. 66.2%) and shorter median hospital stay (12 vs. 15 days) compared to frame-based surgery, with no significant differences in residual hematoma volume, surgical time, postoperative complications, or short-term functional outcomes. While robot-assisted techniques enhance evacuation efficiency and reduce hospitalization without increasing risks, their long-term neurological benefits require further investigation. These findings highlight the potential of robotic assistance as a safe and effective minimally invasive approach for ICH management.

Determinants of diarrheal diseases among patients attending public health centers in Addis Ababa and Hossana, Ethiopia: a matched case-control study

BACKGROUND

The incidence of diarrheal diseases varies widely between and within countries due to different socioeconomic, environmental and behavioural factors. The aim of this study was to assess the determinants of diarrheal diseases among patients attending public health facilities in Addis Ababa and Hossana, Ethiopia.

METHODS

An age-matched case-control study was conducted in health facilities to recruit study participants and collect data from December 2021 to September 2022. Socio-demographic data and other risk factors were collected from study participants using a structured questionnaire. Conditional logistic regression was used to identify the independent predictor variables. The strength of the associations was measured using the adjusted odds ratio with the corresponding 95%CI. Statistical significance is indicated whenever the p value is less than 0.05.

RESULTS

Being partially vaccinated (AOR: 2.70; 95% CI 1.2, 5.9), use of tap water for drinking (AOR: 2.20; 95% CI 1.1, 4.4) and use of protected well/spring water for drinking (AOR: 13.90; 95% CI 3.7, 51.5), overcrowded sleeping places (AOR: 1.50; 95% CI 1.2, 1.8), contact with animal feces/food (AOR: 15.10; 95% CI 4.2, 53.6), the cleaning frequency of water-fetching materials (i.e., cleaned sometimes (AOR: 2.40; 95% CI 1.2, 4.5) and rarely (AOR: 3.03; 95% CI 1.2, 7.4)), and using an open latrine (AOR: 5.61; 95% CI 1.5, 21.0) were significantly associated with an increased likelihood of diarrhea. A higher BMI (AOR: 0.75; 95% CI 0.7, 0.8) was significantly associated with not having diarrhea.

CONCLUSIONS

The incidence of diarrheal diseases was influenced by several factors, including children's immunization status and unhygienic living conditions. Therefore, timely immunization, access to safe drinking water, proper hygiene practices and improved sanitation facilities are essential for the control of diarrheal diseases and safeguarding public health.

From Skeletal Muscle to Myocardium: Molecular Mechanisms of Exercise-Induced Irisin Regulation of Cardiac Fibrosis

This study systematically elucidates the regulatory mechanisms and potential therapeutic value of the exercise-induced hormone Irisin in the pathological progression of cardiac fibrosis. Through comprehensive analysis and multidimensional data integration, we constructed a complete regulatory network of Irisin within the cardiovascular system, spanning its secretion, signal transduction, and precise regulatory control. Our findings demonstrate that exercise intervention significantly elevates circulating Irisin levels via the skeletal muscle-peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α)-fibronectin type III domain-containing protein 5 (FNDC5) signaling axis. Irisin establishes a multidimensional molecular barrier against cardiac fibrosis by targeting Sirtuin 1 (Sirt1) activation, inhibiting the transforming growth factor-beta (TGF-β)/Smad3 signaling pathway, and modulating the transcriptional activity of the mitochondrial biogenesis core factors PGC-1α and nuclear respiratory factor 1 (NRF-1). Moreover, the dual regulatory mechanism of the exercise-skeletal muscle-heart axis not only effectively suppresses the aberrant activation of cardiac fibroblasts but also significantly reduces collagen deposition, oxidative stress, and inflammatory infiltration by restoring mitochondrial dynamics balance. Taken together, this study reveals a novel exercise-mediated cardioprotective mechanism at the molecular interaction network level, thereby providing a theoretical basis for the development of non-pharmacological bio-intervention strategies targeting the Irisin signaling pathway and laying a translational foundation for precise exercise prescriptions in cardiovascular diseases.

Mapping the Global distribution, risk factors, and temporal trends of COPD incidence and mortality (1990-2021): ecological analysis

BACKGROUND

Chronic Obstructive Pulmonary Disease (COPD) remains a significant global public health challenge, contributing to substantial morbidity and mortality worldwide. This study aims to analyze global trends in COPD from 1990 to 2021, with a focus on age, sex, and regional variations. By assessing the global burden of COPD and its association with key risk factors, this research provides critical insights into progress toward health-related Sustainable Development Goals (SDGs) and underscores the urgent need to prioritize COPD in public health agendas.

METHODS

Utilizing data from the Global Burden of Disease (GBD) study, this research conducted a comprehensive ecological analysis of COPD epidemiology from 1990 to 2021. Key measures included incidence, mortality, and age-standardized rates, alongside an examination of risk factors such as smoking and ambient particulate matter pollution, quantified using country-level summary exposure values (SEV). Statistical analyses, including descriptive analysis, annual rate of change (ARC), and correlation analysis, were applied to assess the burden of COPD and investigate its ecological associations with major risk factors.

RESULTS

In 2021, COPD accounted for 16.90 million new cases and 3.70 million deaths globally. The age-standardized incidence rate was 197.37 (95% UI: 181.6-213.42) per 100,000 person-years, while the age-standardized mortality rate was 45.22 (95% UI: 40.61-49.70) per 100,000 person-years. Although global COPD incidence rates declined by 2% from 1990 to 2021, the pace and extent of this decline varied, with some age groups, sexes, and regions experiencing slower reductions or even increases. Higher COPD burden was observed in areas with elevated smoking prevalence, air pollution and greater socioeconomic development.

CONCLUSIONS

This study highlights the ongoing global burden of COPD and its varying trends from 1990 to 2021 across age groups, sexes, and regions. While incidence and mortality rates have slightly declined, disparities persist, particularly among older adults, men, and regions with higher smoking prevalence and air pollution. These findings emphasize the urgent need to integrate COPD into public health priorities, focusing on targeted interventions to reduce key risk factors. Sustained efforts are essential to achieving health-related Sustainable Development Goals (SDGs) and improving global COPD outcomes.

Prioritizing gaps in stroke care: A two-round Delphi process

BACKGROUND

Despite international recognition of stroke as a significant health priority, discrepancies persist between the target values for stroke quality measures and the actual values that are achieved in clinical practice, referred to as gaps. This study aimed to reach consensus among international experts on prioritizing gaps in stroke care.

METHODS

A two-round Delphi process was conducted, surveying an international expert panel in the field of stroke care and cerebrovascular medicine, including patient representatives, healthcare professionals, researchers, policymakers, and medical directors. Experts scored the importance and required effort to close 13 gaps throughout the stroke care continuum and proposed potential solutions. Data were analyzed using descriptive statistics and qualitative analysis methods.

RESULTS

In the first and second Delphi rounds, 35 and 30 experts participated, respectively. Expert consensus was reached on the high importance of closing 11 out of 13 gaps. Two out of 13 gaps were considered moderately important to close, with expert consensus for one of these two gaps. Expert consensus indicated that only one gap, related to the prevention of complications after stroke, requires moderate effort to close, whereas the others were considered to require high effort to close. Key focus areas for potential solutions included: "Care infrastructure," "Geographic disparities," "Interdisciplinary collaboration," and "Advocacy and funding."

CONCLUSIONS

While closing gaps in stroke care primarily requires high effort and substantial resources, targeted interventions in the identified key focus areas may provide feasible and clinically meaningful improvements.

Air Pollution and Endurance Exercise: A Systematic Review of the Potential Effects on Cardiopulmonary Health

This systematic review aimed to analyze the implications of endurance exercise in environments with certain levels of air pollution. This study was developed on the basis of the consensus of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The present review is supported by articles containing the main databases PubMed, Elsevier, and Web of Science (WoS), including scientific articles published in the last 20 years. This study highlights that exposure to air pollution during endurance activities, such as cycling and outdoor running, significantly affects cardiopulmonary health. In conclusion, while physical exercise in environments with high air pollution presents significant risks to cardiopulmonary health, implementing preventive measures and adopting public policies are crucial to minimizing these impacts and promoting safe exercise practices. Likewise, on the basis of these results, it is possible to motivate the creation of safe and natural spaces for sports practice.

Causal effects of Annexin A1 and Annexin A2 on ischemic stroke and its subtypes: A two-sample Mendelian randomization study

BACKGROUND

Preclinical studies have suggested that Annexin A1 and Annexin A2 act as anti-inflammatory agents, slowing the progression of atherosclerosis and further potentially reducing the risk of ischemic stroke. Since the causality of Annexins and ischemic stroke remains uncertain, this study aimed to investigate the causal effects of both using a two-sample Mendelian randomization (MR) method.

METHODS

The genetic instruments associated with Annexin A1 and Annexin A2 originated from a European-descent genome-wide association study (GWAS) of 50,000 participants from the INTERVAL study. Summary statistics for ischemic stroke and ischemic stroke subtypes were derived from the MEGASTROKE consortium's GWAS dataset, involving 40,585 cases and 406,111 controls of European ancestry. The inverse-variance weighted method was utilized in the main analysis, followed by a series of sensitivity analyses for robustness validation.

RESULTS

In the primary analysis, genetically predicted high Annexin A1 levels were associated with decreased risks of ischemic stroke (OR = 0.96; 95 % CI = 0.93-0.99; p = 0.023) and large artery stroke (OR = 0.88; 95 % CI = 0.81-0.96; p = 0.004). Similarly, genetically predicted high Annexin A2 levels also had significant associations with decreased risks of ischemic stroke (OR = 0.97; 95 % CI = 0.95-1.00; p = 0.019) and large artery stroke (OR = 0.90; 95 % CI = 0.85-0.96; p = 0.001).

CONCLUSION

In this two-sample MR study, we found that Annexins had causal protective effects against ischemic stroke, especially large artery stroke. Further basic mechanistic studies should be conducted to investigate the biological roles of these genes.

Evaluating modifiable hypertension risk in Nigerian adults-The Nigerian diet risk score

AIMS

Our study aimed to derive and validate a diet risk score for clinical use in Nigeria to screen for hypertension risk and evaluate its association against a panel of cardiovascular biomarkers.

METHODS

The Nigerian dietary screening tool was used to collect dietary intake data from 151 participants visiting the River State University Teaching Hospital, Port Harcourt, Nigeria, for routine medical care. Blood samples were collected from a subsample (n = 94) for biomarker assessment. Multiple logistic regression was used to derive the Nigerian diet risk score for hypertension. Internal validation of the Nigerian diet risk score for hypertension was performed using measures of discrimination and calibration. Mediation analysis was used to evaluate the biomarker-mediated effects of the diet risk score for hypertension on hypertension. All statistical analyses were performed in R.

RESULTS

Each one-point increment in Nigerian diet risk score (on a scale of 0 to 30) was associated with a twofold increase in odds of hypertension (odds ratio: 2.04, 95% confidence interval [CI]: 1.16, 3.58, p = 0.01), with the highest score associated with >18-fold increased odds of hypertension, compared to lowest Nigerian diet risk score for hypertension. The score demonstrated good discrimination (area under the curve: 0.92, 95% CI: 0.80, 1.00) with a high sensitivity (0.85) and specificity (0.94). Additionally, mediation analysis suggested that the association between Nigerian diet risk score for hypertension and blood pressure is partly explained by shared biological pathways that mediate cholesterol, triglycerides, LDL-C, CRP and homocysteine levels.

CONCLUSION

The resulting Nigerian diet risk score for hypertension is a valuable tool for clinicians to identify individuals at risk of hypertension, and will advance community efforts in the prevention and management of hypertension in Nigeria.

Peroxiredoxin 6 Protects Pulmonary Epithelial Cells From Cigarette-related Ferroptosis in Chronic Obstructive Pulmonary Disease

Peroxiredoxin 6 (PRDX6) has a protective effect on pulmonary epithelial cells against cigarette smoke (CS)-induced ferroptosis. This study investigates the role of PRDX6 in the development of chronic obstructive pulmonary disease (COPD) and its possibility as a target. We observed that PRDX6 was downregulated in lung tissues of COPD patients and in CS-stimulated cells. The degradation of PRDX6 could be through the lysosomal pathway. PRDX6 deficiency exacerbated pulmonary inflammation and mucus hypersecretion in vivo. Overexpression of PRDX6 in Beas-2B cells ameliorated CS-induced cell death and inflammation, suggesting its protective role against CS-induced damage. Furthermore, PRDX6 deficiency promoted ferroptosis by adding the content of iron and reactive oxygen species, while iron chelation with deferoxamine mitigated CS-induced ferroptosis, cell death, and inflammatory infiltration both in vitro and in vivo. The critical role of PRDX6 in regulating ferroptosis suggests that targeting PRDX6 or iron metabolism may represent a promising strategy for COPD treatment.

Identifying risk factors for vomiting during diarrhea: A secondary analysis of a randomized trial of zinc supplementation

OBJECTIVES

Supplemental zinc during acute diarrhea reduces illness duration but also increases vomiting. In a recent trial, we found that children receiving lower daily doses of zinc (5 mg or 10 mg vs. 20 mg) had lower rates of vomiting with comparable stool output and duration of diarrhea. We performed a secondary analysis to identify sociodemographic and clinical factors associated with vomiting in children with acute diarrhea.

METHODS

We performed a secondary data analysis of 4500 children aged 6-59 months with an acute episode of diarrhea (<72 h before enrollment) in a randomized, double-blind controlled trial in India and Tanzania. To identify clinically important risk factors for overall, regimen-related, and regimen-unrelated vomiting, we created log-binomial models with relative risks (RRs) and 95% confidence intervals (CIs).

RESULTS

The trial enrolled 4500 children, of whom 1203 (26.7%) had any vomiting. After adjusting for multiple demographic and clinical characteristics, the presence of dehydration (RR: 1.45, 95% CI: 1.10-1.92), being underweight (RR: 1.22, 95% CI: 1.05-1.41), receipt of the rotavirus vaccine (RR: 1.89, 95% CI: 1.69-2.12), and household wealth above the median (RR: 1.17, 95% CI: 1.07-1.29) were factors associated with an increased risk of vomiting. Rotavirus vaccine receipt was nearly 100% concordant with the study site of Tanzania. Older age and lower zinc dosing were associated with a lower risk of vomiting.

CONCLUSIONS

Young, underweight, or dehydrated children are more likely to have concurrent vomiting with zinc supplementation. Identification of these factors may allow providers to better monitor such children, thus reducing the chances of recurrent dehydration or inadequate dietary intake.

The impact of tamoxifen on apolipoproteins and lipoprotein(a) levels: an updated meta-analysis of randomized controlled trials

OBJECTIVE

The existing evidence regarding the impact of tamoxifen on lipoprotein(a) and apolipoproteins remains inconsistent. Therefore, this updated meta-analysis of randomized controlled trials (RCTs) aims to enhance the quality of evidence concerning the effects of tamoxifen on these lipid parameters.

METHODS

Eligible RCTs published up to October 2024 were meticulously selected through a comprehensive search. A meta-analysis was then performed using a random-effects model, and results were presented as the weighted mean difference (WMD) with a 95% confidence interval (CI).

RESULTS

Findings from the random-effects model revealed an increase in ApoA-I (WMD: 15.22 mg/dL, 95% CI: 6.43-24.01, P = 0.001), alongside decreases in ApoB (WMD: -9.33 mg/dL, 95% CI: -15.46 to -3.19, P = 0.003) and lipoprotein(a) (WMD: -3.35 mg/dL, 95% CI: -5.78 to -0.91, P = 0.007) levels following tamoxifen treatment in women. Subgroup analyses indicated a more significant reduction in lipoprotein(a) levels in RCTs with a duration of ≤24 weeks (WMD: -3.65 mg/dL) and in studies using tamoxifen doses of ≥20 mg/day (WMD: -4.53 mg/dL).

CONCLUSION

This meta-analysis provides evidence that tamoxifen leads to a decrease in lipoprotein(a) levels, along with reductions in ApoB and increases in ApoA-I among women.

Clinical Validation of an AI System for Pneumoconiosis Detection Using Chest X-rays

OBJECTIVE

The aims of the study were to develop and evaluate "eTóraxLaboral," an intelligent platform for detecting signs of pneumoconiosis in chest radiographs and to assess its predictive capacity.

METHODS

A retrospective analysis of 2300 randomly selected chest radiographs was performed. Sensitivity, specificity, false positive/negative rates, predictive values, likelihood ratios, efficiency, error rate, and area under the receiver operating characteristic curve were evaluated. A Fagan nomogram and ROC curve analysis were included.

RESULTS

"eTóraxLaboral" demonstrated high sensitivity to signs of pneumoconiosis (LR+ 23, LR- 0.2). A slight tendency toward a higher number of false positives was observed, possibly due to the superposition of anatomical elements and increased lung markings. False negatives were less common, often misinterpreting pneumoconiotic opacities as consolidation-type findings.

CONCLUSIONS

"eTóraxLaboral" facilitates early pneumoconiosis detection, providing crucial diagnostic support for healthcare workers in Chile and other developed or developing nations.

Clinical practice patterns among older multimorbid adults presenting with suspected ischemic symptoms: A multi-center survey

Background

When patients with suspected or known coronary artery disease (CAD) present with new or worsening ischemic symptoms, initial referral to imaging or optimization of guideline directed medical therapy (GDMT) with deferral of testing are both acceptable management approaches.

Methods

In this 12-center study, a 19-item survey exploring preferred management strategy for symptomatic older adults (≥75 years) with or without known CAD, and major patient and clinical factors driving this decision making was administered to clinicians.

Results

There were 96 respondents (70.8 % cardiologists, 20.9 % primary care physicians/geriatricians). Among patients without known CAD, 59 (61.4 %) respondents favored early referral to testing, 6 (6.3 %) opted for initial GDMT and 23 (24.0 %) preferred both. For patients with known CAD, 27 (28.1 %) prioritized initial GDMT optimization, 37 (38.6 %) would refer for early testing and 19.8 % both. Key factors influencing initial preference for GDMT optimization were unoptimized anti-anginal medications, patient preference, increased complication risk, frailty, cognitive impairment and comorbidities. Key factors influencing preference for initial imaging were increasing symptom severity, already optimized GDMT, and electrocardiogram changes. When imaging revealed ischemia, clinicians reported weighing symptom severity, ischemic burden, current medications, comorbidities, frailty, and procedural risks before referring for invasive cardiac angiography.

Conclusion

Both initial GDMT optimization and referral for imaging are frequently used approaches for the symptomatic older patient with suspected or known CAD. The survey highlighted the importance of patient characteristics such as frailty, cognitive impairment, multimorbidity and the gap in clinical guidance on how to optimally manage symptomatic older adults with CAD.

Clinical efficacy of Angong Jiangya pill for grade 2 hypertension with liver-fire hyperactivity syndrome: a randomized, double-blind, placebo-controlled, multicenter trial

OBJECTIVE

To investigate the efficacy and safety of Angong Jiangya pill (AGJY, ) in the treatment of grade 2 hypertension with liver-fire hyperactivity syndrome.

METHODS

This multicenter, randomized, double-blind, placebo-controlled trial was conducted in eight medical institutions. Eligible patients with grade 2 hypertension were randomly allocated to receive AGJY or a placebo for 12 weeks. The primary outcome was the change in blood pressure (BP). The secondary outcomes were BP compliance rate, Traditional Chinese Medicine (TCM) symptoms, and Duchenne Hypertension Quality of Life Scale score.

RESULTS

Data were analyzed for 117 participants in the AGJY group and 118 participants in the placebo group. After 12 weeks of treatment, AGJY compared with placebo resulted in a higher and significant reduction in systolic/diastolic BP (－15.58 ± 10.16/－9.72 ± 7.41 vs －8.13 ± 8.28/－4.86 ± 5.68 mm Hg, P < 0.0001, < 0.0001, respectively). BP compliance rate (31.86% vs 19.13%, P= 0.027) was significantly higher in the AGJY group than in the placebo group. The AGJY group showed a significant reduction in TCM symptom score compared with the placebo group (10.82 ± 2.03 vs 7.83 ± 1.24, P< 0.0001). Single TCM syndrome clinical control rates of the primary symptoms (dizziness, headache, and irritability) were superior in the AGJY group (71.95%, 94.62%, 72.53%, respectively) compared with the placebo group (48.39%, 68.00%, 30.52%, respectively). Scores on the Duchenne Hypertension Quality of Life Scale showed a significant increase in the AGJY group compared with the placebo group (30.65 ± 21.06 vs 9.96 ± 10.72, P= 0.000). No serious adverse events occurred.

CONCLUSION

AGJY demonstrated efficacy in lowering BP, increasing the rate of BP compliance, and improving TCM symptoms and quality of life in patients with grade 2 hypertension liver-fire hyperactivity syndrome. However, further in-depth studies are required to determine the mechanism of TCM in treating hypertension.

Diagnostic potential of pericoronary adipose tissue mean attenuation for coronary atherosclerotic heart disease: a comparative analysis with the fat attenuation index

Background

The fat attenuation index (FAI), a threshold-based method for assessing pericoronary adipose tissue (PCAT) density, provides strong evidence for patient-specific coronary inflammation assessment. However, the reliance on fat thresholds may result in the omission of some critical information. Thus, this study aimed to explore the diagnostic potential of a novel method, pericoronary adipose tissue mean attenuation (PCATMA), which is not constrained by fat threshold limitations, by investigating the relationships among PCATMA, the FAI, and coronary artery plaque types.

Methods

This single-center observational study enrolled patients undergoing coronary computed tomography angiography (CCTA) between May 2021 and October 2022. In total, 75 patients with plaque and 63 patients without plaque were enrolled in the study. PCAT density was measured at various distances (0.50, 0.75, 1.00, 1.25, 1.50, 1.75, and 2.00 mm) from the vascular wall in the non-plaque group to investigate the effect of varying distances from the coronary artery on PCAT density. A Bland-Altman analysis and intraclass correlation coefficients were used to assess the feasibility and reproducibility of the PCATMA measurements. PCATMA and the FAI were measured in all patients to compare the differences between PCATMA and the FAI in the assessment of coronary atherosclerotic lesions.

Results

As the distance from the lumen increased, the PCAT density gradually decreased, plateauing after a distance of 0.75 mm (P=0.907). There were no differences between PCATMA and the FAI of each vessel in the non-plaque group (P>0.05), but the proximal right coronary artery (RCA) had a higher FAI compared to the mid-RCA (P=0.03). Compared with the non-plaque group, significant differences in PCATMA were observed in coronary artery segments with non-calcified plaque (NCP) (P<0.001) and mixed plaque (MP) (P=0.047); however, no such significant differences were found for the FAI (all P>0.05). Nor were any significant differences found between PCATMA and the FAI in terms of the different types of plaque (all P>0.05).

Conclusions

The novel PCATMA measurement method based on non-fat threshold limitations has good feasibility and repeatability. PCATMA may be more sensitive than the FAI in assessing changes in PCAT density resulting from early coronary artery inflammation, but it is not associated with plaque type.

Determining the Acceptability of Targeted Apps for High-Risk Alcohol Consumption in Nurses: A Qualitative Study

AIM

To determine the acceptability of targeted apps and provide recommendations for the implementation of and app addressing high risk alcohol use to nurses.

DESIGN

A qualitative descriptive study design, using the Behavioural Change Wheel implementation framework.

METHODS

Semi-structured interviews with 42 Australian nurses were subject to structural coding using the Capability, Opportunity, and Motivation (COM-B) model linked to the Behaviour Change Wheel. Qualitative data has been reported using the COREQ framework.

RESULTS

Most participants agreed that targeted apps would appeal to nurses, provided specific design considerations were included. These considerations related to privacy and confidentiality, strategies to target the app to nurses across wide age and experience ranges and identified the need for a considered campaign to both launch the app and position it with existing interventions for high-risk alcohol use.

CONCLUSIONS

Our findings indicate that a targeted app to reduce high-risk alcohol consumption could be acceptable to nurses, however the needs to include specific components suitable for nurses. We recommend further research into specific components of a targeted app, leading to a co-design process where nurses can determine app components and function.Summary of relevanceHigh-risk alcohol consumption has been shown to be an issue amongst nurses.Targeted apps have been shown to have an effect in addressing high-risk alcohol consumption among specific groups.However, consideration for privacy of data provided to the app must be considered, especially given the link between disciplinary action, loss of role identity, and nurse suicide.This paper indicates that nurses would accept a targeted app, subject to specific design considerations, particularly related to confidentiality.