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.

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.

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.

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 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.

Prevalence of human metapneumovirus infection among children suffering from acute respiratory illness in India: a systematic review and meta-analysis

Acute respiratory infections (ARI) are a leading cause of pediatric morbidity and mortality worldwide, with India bearing a significant burden. Human metapneumovirus (HMPV), an under-recognized respiratory pathogen, has been implicated in ARI, yet its prevalence in India remains inadequately characterized. The objective of this study was to estimate the prevalence of HMPV among children with ARI in India and assess regional, temporal, and demographic trends to guide public health interventions. This systematic review and meta-analysis was conducted following PRISMA guidelines. Data were extracted from 30 studies encompassing 12,534 children with ARI across India from 2004 to 2024. A random-effects model was used to calculate pooled prevalence, with subgroup and sensitivity analyses to explore heterogeneity. Publication bias was assessed using Egger's test and funnel plots. The pooled prevalence of HMPV was 5% (95% confidence interval: 4-6%), with significant heterogeneity (I²=95%). Subgroup analyses revealed higher prevalence in the northeast region (7%) and among children under 5 years (6%), compared to older age groups (2%). No significant differences were observed in prevalence pre- and post-COVID-19. Sensitivity analyses confirmed the robustness of findings, with minimal impact of publication bias. HMPV is a significant contributor to pediatric ARI in India, particularly among children under 5 years, highlighting its public health importance. The lack of a post-COVID-19 surge in prevalence suggests sustained circulation and widespread immunity. These findings underscore the need for enhanced diagnostic capacities, routine surveillance, and targeted interventions to mitigate the burden of HMPV-related ARI in vulnerable populations.

The Safety and Efficacy of Anticancer Therapy in Breast Cancer Patients with Liver Cirrhosis

Purpose

Special populations are not enrolled in randomized clinical trials, and their safety and efficacy of anticancer therapy are not well described. We aimed to assess the safety and efficacy of anticancer therapy in breast cancer (BC) patients with cirrhosis.

Patients and methods

We performed a retrospective case-control study (1:5) to assess the adverse events (AEs) morbidity and mortality of anticancer therapy in BC patients with cirrhosis based on a review of patients' medical records.

Results

We included 26 BC patients with cirrhosis and 130 matched BC patients without cirrhosis. Postoperative morbidity was higher in the group with cirrhosis (26.9% vs 6.9%, P = 0.007) when postoperative mortality was not significance (3.8% vs 0%, P = 0.167). Liver toxicity (73.1% vs 26.9%, P < 0.001) was more frequent in the group with cirrhosis. The incidence of disruption and mortality during chemotherapy was higher in the group with cirrhosis (46.2% vs 3.1%, P < 0.001 and 15.4% vs 0%, P = 0.001, respectively). The 2-year recurrence rate and 2-year metastasis rate were higher in the group with cirrhosis (19.0% vs 3.8%, P = 0.022 and 23.8% vs 6.9%, P = 0.028). Cirrhosis was the risk factor for liver metastasis (OR: 17.326, 95% CI: 2.164-138.707, P=0.007).

Conclusion

It is safe for BC patients with compensated cirrhosis to accept surgery. But they are vulnerable to AEs, disruptions and death during chemotherapy and have poor prognosis. Multidisciplinary cooperation before therapy and closely monitoring AEs during therapy are critical. Attention should be given to optimize the prognosis of special BC patients.

The association between overall, healthy, and unhealthy plant-based diet indexes and risk of all-cause and cause-specific mortality: a systematic review and dose-response meta-analysis of prospective cohort studies

Background: recent dietary guidelines recommend a diet that mainly includes plant-based foods and a moderate amount of animal products. Therefore, we hypothesized that plant-based diet indices (overall plant-based diet index (oPDI), healthy plant-based diet index (hPDI), and unhealthy plant-based diet index (uPDI)) might be associated with risk of all-cause and cause-specific mortality. Methods: a systematic review was conducted using PubMed, Web of Science, Scopus, and Embase databases until December 2024. Meta-analysis was performed utilizing random-effects models to calculate relative risk (RR) with the corresponding 95% confidence intervals (95% CIs). Results: from 436 initial records, 25 prospective studies met the inclusion criteria. The findings of our study indicated a modest inverse association between the adherence to oPDI and risk of all-cause mortality (RR [95% CI]: 0.89 [0.83-0.94]; n = 15 studies) as well as mortality related to cardiovascular diseases, chronic heart disease, and total cancer. Also, adherence to hPDI was found to reduce risk of all-cause (RR [95% CI]: 0.86 [0.82-0.90]; n = 21 studies), cardiovascular disease, chronic heart disease, total-cancer, and prostate cancer mortality, whereas uPDI was associated with higher risk of all-cause (RR [95% CI]: 1.20 [1.13-1.27]; n = 19 studies), cardiovascular disease, chronic heart disease, and total-cancer mortality. Our dose-response meta-analysis showed a monotonic inverse association between adherence to oPDI and hPDI and a positive linear association between adherence to uPDI and risk of all-cause mortality. Conclusion: our findings highlight the importance of evaluating the quality of plant-based foods as either healthy or unhealthy in relation to the risk of all-cause and cause-specific mortality.

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 24h 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.

Ketamine and Hydroxynorketamine as Novel Pharmacotherapies for the Treatment of Opioid Use Disorders

Opioid use disorder (OUD) has reached epidemic proportions, with many countries facing high levels of opioid use and related fatalities. Although currently prescribed medications for OUD are considered lifesaving, they inadequately address negative affect and cognitive impairment, resulting in high relapse rates to nonmedical opioid use even years after drug cessation (protracted abstinence). Evidence supports the notion that ketamine, an anesthetic and rapid-acting antidepressant drug, holds promise as a candidate for OUD treatment, including the management of acute withdrawal somatic symptoms, negative affect during protracted opioid abstinence, and prevention of retaking nonmedical opioids. In this review, we comprehensively discuss preclinical and clinical research that has evaluated ketamine and its metabolites as potential novel therapeutic strategies for treating OUD. Furthermore, we examine evidence that supports the relevance of the molecular targets of ketamine and its metabolites in relation to their potential effects and therapeutic outcomes in OUD. Overall, existing evidence demonstrates that ketamine and its metabolites can effectively modulate pathophysiological processes affected in OUD, suggesting a promising therapeutic role in the treatment of OUD and the prevention of return to opioid use during abstinence.

Burden and Predictors of Statin Use for Primary and Secondary Prevention of Cardiovascular Disease in Bangladesh: Evidence from a Nationally Representative Survey

Background

Large-scale randomized trials have established the efficacy and safety of statin therapy in preventing cardiovascular diseases (CVDs) among individuals at increased risk (i.e., primary prevention) or those with pre-existing cardiovascular disease (i.e., secondary prevention). Consequently, recent international guidelines, including those from the WHO and ACC/AHA, have expanded the eligibility criteria for statin therapy.

Objective

To assess the current burden of statin-eligible populations in Bangladesh, evaluate the current state of statin use, and identify factors associated with non-use of statins.

Methods

We analysed data from 3,140 adults aged 40 to 69 years from the nationally representative WHO-STEPS Bangladesh 2018 survey. Statin therapy eligibility for primary prevention was assessed using the WHO-2019 and the ACC/AHA-2018 guidelines separately. Individuals with a previous history of CVD were eligible for secondary prevention under both guidelines. Modified Poisson regression models identified factors associated with statin use. All analyses were conducted using appropriate survey weights.

Findings

Among the participants, 443 (14.1%) reported a previous history of CVD. Of those without CVD, 11.2% (95% CI: 9.7-12.9) and 32.3% (95% CI: 30.0-34.6) were eligible for statin use for primary prevention according to the WHO-2019 and the ACC/AHA-2018 guidelines, respectively. Among adults eligible according to WHO-2019 guideline, 6.9% (95% CI: 4.1-11.5) were using statins, while among those eligible according to ACC/AHA-2018 guideline, 3.3% (95% CI: 2.1-5.1) were using statins. For secondary prevention, 23.5% (95% CI: 16.9-31.6) of adults with prior CVD were using statins. Non-use was higher among younger adults, those without regular health visits or cholesterol measurements, and those from the Mymensingh or Rajshahi divisions.

Interpretation

In Bangladesh, approximately one in twenty eligible individuals uses statins for primary prevention of CVD, and one in five individuals for secondary prevention. Appropriate population health interventions are needed to scale up statin use to mitigate the burden of CVD.

Association of Rheumatoid Arthritis With Progression of Cognitive Impairment and Risk of Mortality in People With Dementia

BACKGROUND AND OBJECTIVES

Rheumatoid arthritis (RA) has been linked to an increased risk of dementia, yet little is known about how RA affects the progression of cognitive impairment and the risk of mortality in people with dementia. We aimed to investigate whether RA is linked to an accelerated cognitive decline and a higher risk of all-cause mortality in patients with dementia.

METHODS

We conducted a propensity score-matched register-based cohort study based on the Swedish Registry for Cognitive/Dementia Disorders-SveDem. Patients diagnosed with dementia and registered in SveDem between May 1, 2007, and October 16, 2018, were included. The main outcome for the study was cognitive decline, measured by Mini-Mental State Examination (MMSE) score changes over years. The secondary outcome was all-cause death. We used mixed-effects models to examine the association between RA and cognitive decline, and Cox proportional hazards models to investigate the risk of all-cause mortality. We also conducted subgroup analyses to explore the potential effects of sociodemographic, baseline MMSE, comorbidities, and the use of dementia medications on the association between RA and outcomes.

RESULTS

We included 1,685 dementia patients with RA (mean [SD] age, 79.9 [6.7] years; 73.4% were women) and 5,055 dementia patients with non-RA (80.1 [7.5] years; 73.1% were women). The median follow-up was 2.9 years (interquartile range, 1.5-4.6 years) for non-RA and 2.6 years (interquartile range, 1.4-4.2 years) for RA. In total, 111,266 MMSE measurements were available for analysis. Compared with non-RA patients, patients with RA presented faster cognitive decline (β = -0.24 points/y; 95% CI -0.38 to -0.10) and an increased risk of death (hazard ratio 1.15; 95% CI 1.06-1.24). In subgroup analysis, significant interactions were observed between RA and baseline MMSE scores as well as living conditions regarding cognitive decline (p for interaction <0.05).

DISCUSSION

We identified a worse cognitive function and an increased mortality risk in dementia patients with RA compared with non-RA. However, we lacked information on the duration of RA before the onset of dementia and on disease activity, which could influence our findings. Further studies are needed to validate these results in comparable populations.

GPT-4 as a Clinical Decision Support Tool in Ischemic Stroke Management: Evaluation Study

BACKGROUND

Cerebrovascular diseases are the second most common cause of death worldwide and one of the major causes of disability burden. Advancements in artificial intelligence have the potential to revolutionize health care delivery, particularly in critical decision-making scenarios such as ischemic stroke management.

OBJECTIVE

This study aims to evaluate the effectiveness of GPT-4 in providing clinical support for emergency department neurologists by comparing its recommendations with expert opinions and real-world outcomes in acute ischemic stroke management.

METHODS

A cohort of 100 patients with acute stroke symptoms was retrospectively reviewed. Data used for decision-making included patients' history, clinical evaluation, imaging study results, and other relevant details. Each case was independently presented to GPT-4, which provided scaled recommendations (1-7) regarding the appropriateness of treatment, the use of tissue plasminogen activator, and the need for endovascular thrombectomy. Additionally, GPT-4 estimated the 90-day mortality probability for each patient and elucidated its reasoning for each recommendation. The recommendations were then compared with a stroke specialist's opinion and actual treatment decisions.

RESULTS

In our cohort of 100 patients, treatment recommendations by GPT-4 showed strong agreement with expert opinion (area under the curve [AUC] 0.85, 95% CI 0.77-0.93) and real-world treatment decisions (AUC 0.80, 95% CI 0.69-0.91). GPT-4 showed near-perfect agreement with real-world decisions in recommending endovascular thrombectomy (AUC 0.94, 95% CI 0.89-0.98) and strong agreement for tissue plasminogen activator treatment (AUC 0.77, 95% CI 0.68-0.86). Notably, in some cases, GPT-4 recommended more aggressive treatment than human experts, with 11 instances where GPT-4 suggested tissue plasminogen activator use against expert opinion. For mortality prediction, GPT-4 accurately identified 10 (77%) out of 13 deaths within its top 25 high-risk predictions (AUC 0.89, 95% CI 0.8077-0.9739; hazard ratio 6.98, 95% CI 2.88-16.9; P<.001), outperforming supervised machine learning models such as PRACTICE (AUC 0.70; log-rank P=.02) and PREMISE (AUC 0.77; P=.07).

CONCLUSIONS

This study demonstrates the potential of GPT-4 as a viable clinical decision-support tool in the management of acute stroke. Its ability to provide explainable recommendations without requiring structured data input aligns well with the routine workflows of treating physicians. However, the tendency toward more aggressive treatment recommendations highlights the importance of human oversight in clinical decision-making. Future studies should focus on prospective validations and exploring the safe integration of such artificial intelligence tools into clinical practice.

Pericardial Abscess Due to Salmonella Typhi Infection

Typhoid fever is a human-specific disease caused by subspecies of Salmonella enterica (Salmonella Typhi). It spreads through ingestion of contaminated food or water and is diagnosed through blood culture or bone marrow culture. It typically presents as an intestinal infection, with a few patients developing severe disseminated infections. Here, we report a rare case of purulent pericarditis secondary to S. Typhi infection. A 67-year-old elderly male suffered from recurrent fever, diarrhea, and abdominal pain for 7 days. Initial blood and stool cultures were positive for Salmonella, and a follow-up blood culture confirmed S. Typhi. Magnetic resonance imaging showed pericardial abscess and hepatic abscess. After pericardiocentesis, the pericardial fluid culture grew S. Typhi, confirming the diagnosis of pericardial abscess secondary to S. Typhi infection. After percutaneous drainage of the pericardial abscess and administration of effective antibiotics, the patient's symptoms improved significantly. He subsequently recovered and was discharged from the hospital. During follow-up, there were no further recurrences. Disseminated infection secondary to Salmonella Typhi is extremely rare but can lead to serious life-threatening conditions. Our patient was found to have pericardial abscess caused by S. Typhi. Effective and adequate antibiotics, along with pericardial abscess drainage, can improve symptoms, assist in diagnosis, and enhance quality of life.

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.

All-in-One: A Multifunctional Composite Biomimetic Cryogel for Coagulation Disorder Hemostasis and Infected Diabetic Wound Healing

Traditional hemostatic materials are difficult to meet the needs of non-compressible bleeding and for coagulopathic patients. In addition, open wounds are susceptible to infection, and then develop into chronic wounds. However, the development of integrated dressings that do not depend on coagulation pathway and improve the microenvironment of chronic wounds remains a challenge. Inspired by the porous structure and composition of the natural extracellular matrix, adipic dihydrazide modified gelatin (GA), dodecylamine-grafted hyaluronic acid (HD), and MnO2 nanozyme (manganese dioxide)@DFO (deferoxamine)@PDA (polydopamine) (MDP) nanoparticles were combined to prepare GA/HD/MDP cryogels through amidation reaction and hydrogen bonding. These cryogels exhibited good fatigue resistance, photothermal antibacterial (about 98% killing ratios of both Escherichia coli and methicillin-resistant Staphylococcus aureus (MRSA) after 3 min near-infrared irradiation), reactive oxygen species scavenging, oxygen release, and angiogenesis properties. Furthermore, in the liver defect model of rats with coagulopathy, the cryogel displayed less bleeding and shorter hemostasis time than commercial gelatin sponge. In MRSA-infected diabetic wounds, the cryogel could decrease wound inflammation and oxidative stress, alleviate the hypoxic environment, promote collagen deposition, and induce vascular regeneration, showing a better repair effect compared with the Tegaderm™ film. These results indicated that GA/HD/MDP cryogels have great potential in non-compressible hemorrhage for coagulopathic patients and in healing infected wounds for diabetic patients.

Research progress on influencing factors and intervention measures of pre-hospital delays in acute ischemic stroke

BackgroundStroke, a leading cause of health impairment globally, sees intravenous thrombolysis as the primary treatment during the acute phase, yet delays persist due to pre-hospital and in-hospital factors. While research has reduced in-hospital delays significantly, pre-hospital delays remain a concern both domestically and internationally.ObjectiveThis article aims to provide a comprehensive review of the research progress on the influencing factors and intervention measures of pre-hospital delays in acute ischemic stroke.MethodsBy analyzing the literature, summarize the risk factors leading to treatment delay in acute ischemic stroke (AIS), and provide a review of potential improvement methods.ResultsPre-hospital delay in acute ischemic stroke (AIS) is influenced by both objective factors like age, gender, and regional economic status, as well as subjective factors such as stroke awareness. The introduction of "Stroke 120," a stroke education slogan tailored to Chinese language habits, aims to improve stroke awareness and address delayed treatment and low AIS venous thrombolysis utilization among the Chinese publicConclusionIn conclusion, collaborative efforts from the government, society, and hospitals are essential to enhance stroke education comprehensively. This will ensure widespread awareness of stroke knowledge, facilitating timely and effective treatment for AIS patients.

The association between total social exposure and incident multimorbidity: A population-based cohort study

Background

Multimorbidity, the co-occurrence of two or more chronic conditions, is associated with the social determinants of health. Using comprehensive linked population-representative data, we sought to understand the combined effect of multiple social determinants on multimorbidity incidence in Ontario, Canada.

Methods

Ontario respondents aged 20-55 in 2001-2011 cycles of the Canadian Community Health Survey were linked to administrative health data ascertain multimorbidity status until 2022. Additive total social exposure (TSE) was generated by summing 12 measures of social disadvantage captured from the survey. Weighted-additive TSE included 15 measures of social disadvantage summed across 5 equally weighted domains. Hazard ratios for the association between each TSE measure and multimorbidity were estimated using competing risk Cox-proportional hazards models. All analyses were sex-stratified.

Results

Both additive and weighted-additive TSE were associated with an increased risk of multimorbidity among females and males. A social gradient was observed for multimorbidity risk in all models. While adjusted models were attenuated, an increased risk of multimorbidity was observed among those experiencing the most social disadvantage, compared to those with the least social disadvantage in additive (HR Females = 2.16; 95%CI = 1.63, 2.86; HR Males = 1.90; 95%CI = 1.52, 2.38) and weighted-additive (HR Females = 1.94; 95%CI = 1.49, 2.53; HR Males = 1.72; 95%CI = 1.41, 2.10) models. The observed social gradient was retained.

Conclusions

These findings demonstrate the importance of considering the cumulative effects of multiple social determinants of health on multimorbidity.

Breast cancer burden among young women from 1990 to 2021: a global, regional, and national perspective

BACKGROUND

Breast cancer, the most prevalent tumor in women globally, significantly impacts young women, compromising their daily lives and overall well-being. Breast cancer represents a significant public health concern due to its extensive physical and psychological consequences.

MATERIAL AND METHODS

Data from the Global Burden of Disease (GBD) were used to assess the global, regional, and national burden of breast cancer in young women aged 20-39 from 1990 to 2021. This analysis focused on trends measured by the estimated annual percentage change (EAPC) and explored the socioeconomic impacts via the sociodemographic index (SDI).

RESULTS

During 1990-2021, the incidence and prevalence of breast cancer among young women increased globally, with annual rates of 0.82 and 0.87%, respectively. The mortality rate and disability-adjusted life years (DALYs) also rose annually by -0.12% and -0.05, respectively. A significant burden shift was observed towards regions with lower SDI, with diet high in red meat, alcohol use, and high fasting plasma glucose identified as prominent risk factors, particularly in lower SDI regions.

CONCLUSION

Our findings underscore breast cancer in young women as an escalating global health challenge, with the burden increasingly shifting towards lower socioeconomic areas. This underscores the necessity for targeted prevention and control strategies for breast cancer, focusing on reducing the identified risk factors and ensuring equitable health resource distribution.

Acupuncture modulates group neural activity in patients with post stroke sensory impairment: An fMRI study based on inter-subject correlation and inter-subject functional connectivity

Sensory impairment after stroke has become an important health problem that affects the health and quality of life of patients. Acupuncture is a widely accepted method for stroke rehabilitation. The development of fMRI provides a good platform for the study of neural activity patterns induced by acupuncture, and many studies have found that acupuncture can induce special activation of the brain in stroke patients. We introduced the inter-subject functional connectivity(ISFC) method into the study of acupuncture treatment for sensory impairment after stroke to explore the group effects of acupuncture treatment and the specific mode of action of acupuncture for sensory impairment. In this study, 24 stroke patients with limb numbness and 23 healthy controls were included, and three functional magnetic resonance scans were designed, including resting state, acupuncture task state, and acupuncture-retention state(LI11 and ST36 were used during the task fMRI). The main observation was the connection changes in 50 regions of interest, including the sensory-motor network, central executive network, thalamus, cingulate gyrus, and other brain regions. The findings showed that acupuncture could cause certain patterns of neural activity in the patients. These patterns included a significant rise in ISFC within the sensory-motor network and between the sensory-motor network and the thalamus and the central executive network. When different types of acupuncture were compared, it was found that the first effect of acupuncture was mostly large-scale activation of the sensory-motor network and the thalamus. The second effect, on the other hand, was low-intensity activation in a limited range. In general, this study explored the group mechanism of acupuncture for sensory function rehabilitation after stroke and provided some help for understanding neural activity patterns from a cross-subject dimension.

The journey of the cardiovascular polypill from its conception to the WHO List of Essential Medicines

Cardiovascular disease (CVD) has achieved pandemic proportions and is currently the leading cause of death worldwide. Barriers to optimal secondary cardiovascular prevention include lack of access to chronic treatment as well as low adherence in those who receive these treatments. The polypill represents a simple, cost-effective, scalable strategy to improve access and adherence to medication and effectively bridge the current gap in secondary prevention of CVD. Here, we review the epidemiological need for such a strategy as well as the most notable clinical evidence reported in the past decade supporting the clinical use of the polypill. Furthermore, we discuss the barriers inherent to the acceptance and use of the polypill for secondary prevention of CVD compared to the uptake of other polypills for the treatment of communicable diseases where fixed-dose combinations have become accepted as the cornerstone of treatment for other global pandemics such as HIV.

Cerebrospinal fluid multiplex PCR cycle thresholds may predict ICU admission in community-acquired meningoencephalitis

OBJECTIVE

We investigated the relationship between cerebrospinal fluid (CSF) PCR cycle threshold (Ct) values, clinical characteristics, and outcomes in suspected CAM, while assessing QIAstat-Dx® ME Panel concordance with routine diagnostic methods.

METHODS

Frozen CSF from 30 individuals with suspected CAM were analyzed using the QIAstat-Dx® ME Panel. Ct values were categorized as low (≤ 30) or high (>30). Concordance with CSF FilmArray®/culture results was assessed using the Kappa coefficient.

RESULTS

Low Ct values were associated to CSF markers of meningitis and predicted ICU admissions (log-rank P = 0.025), particularly within the first two weeks of hospitalization (85 % for low Ct values versus 50 % for high Ct values, P = 0.041). Ct values were not associated with mortality in the survival analysis (log-rank P = 0.109). Substantial agreement was observed between QIAstat-Dx® and comparators (96.7 %, Kappa 0.839).

CONCLUSIONS

CSF Ct values can assist in risk stratification for timely ICU admission in individuals with CAM.

Distribution of garbage codes in the Mortality Information System, Brazil, 2000 to 2020

The analysis of the causes of death is essential to understand the main problems that affect the health level of the population of a region or country. The garbage codes (GC) provide little useful information about causes of death. This study aims to identify the proportion of GC among the deaths registered and to analyze their temporal distribution in Brazil from 2000 to 2020. It's an ecological time-series study of the evolution of the proportion of GC in Brazil. Time series analysis was performed using segmented linear regression models (joinpoint). Between 2000 and 2020, 39.9% of deaths that occurred in Brazil were coded with GC. Between 2000 and 2007, there was a continuous and persistent reduction in the proportion of GC (APC -2.1; P < 0.001). Between 2007 and 2015, there continued to be a reduction, albeit to a lesser extent (APC = -0.7; P = 0.013). Between 2015 and 2018, there was no significant trend of the proportion of GC (APC = -2.3; P = 0.172), which persisted from 2018 (APC 3.2; P < 0.079). Although a reduction in the proportion of GC in Brazil was observed until 2018, this trend did not persist after that year. Reducing the proportion of GC allows managers to plan health policies more adequately for the population.

Effectively simplified Adriamycin-induced chronic kidney disease mouse model: Retro-orbital vein injection versus tail-vein injection

This study aimed to investigate the impact of administration routes in establishing the Adriamycin (ADR)-induced chronic kidney disease (CKD) model. Using BALB/c mice, we compared the effects of conventional tail-vein injection (TV10, 10 mg/kg) to those of retro-orbital sinus (orbital vein) injection (OV10, 10 mg/kg; OV8, 8 mg/kg). The results indicated that the OV10 group exhibited CKD pathology similar to the TV10 group, with both groups demonstrating significantly higher urinary albumin/creatinine ratio (p < 0.05), tubular injury (p < 0.05), and degree of renal fibrosis (p < 0.05) than the OV8 group. No significant differences were observed between the OV10 and TV10 groups in urinary albumin/creatinine ratio, tubular injury, and degree of renal fibrosis. These findings demonstrated that retro-orbital administration of 10 mg/kg ADR induces comparable effects to conventional tail-vein administration. This technique's technical simplicity may improve experimental efficiency, reproducibility, and animal welfare in CKD research. In conclusion, this study validates the utility of retro-orbital injection in CKD model establishment, demonstrating its potential to standardize and improve the reliability of future CKD research protocols.

KRT9 is required for GBP5 suppression of human respiratory syncytial virus

Respiratory syncytial virus (RSV) infections continue to plague infants, young children, and older individuals worldwide. Since there is no specific treatment for RSV, characterizing the interactions between RSV and host factors remains crucial for the eventual development of robust therapeutic interventions. In our previous study, guanylate binding protein 5 (GBP5) was shown to promote excessive RSV-small hydrophobic (RSV-SH) protein secretion by microvesicles and inhibited viral replication. In this study, using affinity mass spectrometry, keratin (KRT) 9 was identified to be required for GBP5 to trigger RSV-SH transport. Silencing KRT9 expression reduced the antiviral effects of GBP5 and interferon-γ. A direct interaction was detected between KRT9 and GBP5, but not RSV-SH; a GBP5 binding domain was identified on KRT9. Our results suggest that GBP5, as a bridge, interacts with KRT9 and RSV-SH, after which KRT9 triggers RSV-SH transport. The mechanism underlying the interaction between KRT9 and GBP5 explains the inability of the GBP5-C583A and GBP5-△C mutants in inhibiting RSV replication. Conversely, KRT1, KRT5, and KRT6C, which were identified as potential partners of KRT9, did not affect the GBP5 anti-RSV process. Overall, our study provides evidence for KRT9 involvement in host innate immunity for the first time.

IMPORTANCE

RSV causes severe acute lower respiratory tract infections, which have posed serious health and safety risks to children and older adults worldwide. Although some RSV interventions are available, the longer-lasting monoclonals, which are expensive, are required to be injected before RSV infection, and their protection is observed only up to one RSV infection season; vaccines are currently only available to the elderly but are not suitable for application in infants and young children. As specific drug treatments are absent, a systematic and in-depth mechanism for research is essential. In our study, KRT9 was identified to play an important role in the GBP5 anti-RSV process for the first time. This investigation improved the interaction mechanism between GBP5 and RSV, provided new evidence for the synergistic effect between keratin transport and innate immunity, and opened a new research direction with GBP5 and the keratin transport system as the main subjects.

Association between sarcopenia and cardiovascular disease according to menopausal status: findings from the China Health and Retirement Longitudinal Study (CHARLS)

BACKGROUND

Little is known about the association between sarcopenia and cardiovascular disease (CVD) according to menopausal status, and we conducted cross-sectional as well as longitudinal analyses Using nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS) to investigate the association between sarcopenia and CVD in Chinese women according to menopausal status.

METHOD

The study sample included 5365 (mean age 60.3 ± 9.3 years) female participants from CHARLS 2015 (wave 3). Additionally, 3,882 participants without cardiovascular disease (CVD) were recruited in CHARLS 2015 (Wave 3) and followed up in 2018 (Wave 4). CVD was defined as the presence of physician-diagnosed heart disease and/or stroke. Menopausal status was determined based on self-reported information from questionnaires. Sarcopenia status was assessed using the diagnostic criteria established by the Asian Working Group on Sarcopenia in 2019 (AWGS 2019). Binary logistic regression analyses were conducted to explore the association between sarcopenia and CVD in both premenopausal and postmenopausal women. Further analyses examined the interaction between sarcopenia and menopausal status to better understand its impact on CVD.

RESULTS

The prevalence of CVD in the total population is 22.5% (1209/5365). Among premenopausal women, the prevalence in no-sarcopenia, possible sarcopenia, and sarcopenia group are 11.3% (86/759), 16.2% (17/105), and 13.9% (5/36), respectively, for postmenopausal women, the prevalence are 19.2% (320/1668), 32.6% (520/1597), and 21.8% (261/1200). Both possible sarcopenia (OR = 1.58; 95% CI: 1.29-1.93) and sarcopenia (OR = 1.34; 95% CI: 1.05,1.72) are associated with CVD in the population of postmenopausal women. There was a significant positive interaction between menopause and sarcopenia on CVD, the RERI = 5.30 (95%CI: 4.63, 5.98), the SI = 2.44 (95%CI: 1.84, 3.63), and the multiplicative effect = 2.18 (95%CI: 1.70, 2.66). In the longitudinal analysis, 514 (13.2%) new cases of CVD were diagnosed. In premenopausal women, sarcopenia was significantly associated with the development of CVD (OR = 2.44, 95% CI: 1.3,4.59). In postmenopausal women, possible sarcopenia (OR = 1.45, 95% CI: 1.28, 1.65) and sarcopenia (OR = 1.42, 95% CI: 1.23, 1.65) were more likely to have new-onset CVD than the postmenopausal no-sarcopenia women.

CONCLUSIONS

Sarcopenia and cardiovascular disease (CVD) risk show significant variations in cross-sectional and longitudinal associations across different menopausal statuses, with higher risks in postmenopausal women. An interaction between menopausal status and sarcopenia on CVD risk was found.

QbD-steered HPTLC approach for concurrent estimation of six co-administered COVID-19 and cardiovascular drugs in different matrices: greenness appraisal

Many COVID-19 sufferers have a history of cardiovascular illnesses, which makes them more likely to develop severe COVID-19. Such patients were advised by experts to prioritize drug therapies based on their doctor's commendations to avoid exacerbating their basic illnesses. Therefore, developing an analytical methodology for the concurrent estimation of medications prescribed for co-treating cardiovascular and COVID-19 illnesses is becoming critical in both bioavailability hubs and QC units. Herein, an inventive, rapid, and affordable HPTLC approach was developed, and its conditions were optimized employing the full factorial design approach for the concurrent estimation of aspirin, atorvastatin, atenolol, losartan, remdesivir, and favipiravir as co-administered medications, either with salicylic acid or not. Using the desirability function, the experimental design approach could forecast the best eluent system for optimal resolution results. On HPTLC-silica plates, the above-mentioned medications were separated utilizing an eluent system of ethyl acetate, methylene chloride, methanol, and ammonia (6:4:4:1 by volume), and their spots were detected at 232 nm. The proposed methodology was evaluated following ICH prerequisites and applied successfully to the medications' dosage forms, human plasma, and buffered dissolution media with superb recovery proportions and no intrusiveness from formulations' additives or plasma matrices. Five metrics were employed to appraise the suggested technique's greenness: AGREE, eco-scale, Raynie and Driver, GAPI, and NEMI. The sensitivity, large sample capacity, and short run duration (15 min) of the proposed methodology confirm its appositeness for regular estimation of the above-mentioned medications.

Expanding access to NCD services via community retail pharmacies in LMICs: a systematic review of the literature

Background

Non-communicable diseases (NCDs) pose a significant global health challenge. In LMICs, NCDs are an incresing driver of premature deaths and have substantial economic impacts, particularly on working-age adults. The World Health Organization has identified four priority NCDs - cardiovascular diseases, diabetes, asthma/chronic obstructive pulmonary disease, and cancer - which are included in its Package of Essential Non-Communicable Disease Interventions for low-resource primary care settings. However, a shortage of healthcare professionals further compounds the problem. Pharmacists, who could play a pivotal role in NCD care, remain underutilised.

Methods

We conducted a systematic literature review to identify studies on the role of community pharmacies and pharmacists in delivering NCD services in low- and middle-income settings and assessed their risk of bias. Searches were performed in PubMed, MEDLINE via Ovid, and CINAHL from 1990 to 2022, including English, French, or Spanish publications.

Results

Out of 1,284 articles, 23 met inclusion criteria, predominantly focusing on diabetes (65%), followed by cardiovascular diseases (22%), cancer (9%), and asthma (4%). Most studies were conducted in Asia (52%), followed by South America (22%) and Africa (13%). Significant improvements were observed in glycaemic control and medication adherence for diabetes, and in blood pressure management and adherence for hypertension. Positive outcomes were also seen in health behaviours for breast cancer, asthma, and cardiovascular disease risk management. Interventions were cost-effective for managing diabetes and hypertension in elderly patients. However, accessibility challenges were noted in vaccination programmes, and concerns about bias were identified, particularly in observational studies.

Conclusions

Expanding NCD services through community pharmacies in low and middle-income countries can significantly improve health outcomes. Pharmacists can enhance education, screening, and management for NCDs, leading to better disease control and patient satisfaction. Addressing resource constraints, legal barriers, and disease focus disparities is essential. Adequate training, financial incentives, and collaboration among stakeholders are crucial for integrating pharmacists into NCD care frameworks.

Plasma Lipidomics of Preadolescent Children: A Hokkaido Study

Lipids are the most abundant biomolecules of human plasma, and their balance plays a significant role in health and disease management. Despite the importance of lipids, the studies focused on the comprehensive determination of the plasma lipidome in children are limited. In this study, we investigated the sex, age, and weight-specific changes in the plasma lipidome of nonfasting preadolescent children aged 9-12 years (n = 342) using a nontargeted liquid chromatography-mass spectrometry technique. A total of 219 lipid species were characterized in the plasma samples. Multivariate analysis revealed that boys and girls have similar lipid profiles, but relatively higher levels of capric acid-composed triacylglycerols (TGs) were observed in plasma samples of boys. Saturated fatty acids are the most abundant fatty acyls followed by mono- and polyunsaturated fatty acids in the plasma of both boys and girls. Sphingolipids such as ceramides, hexosylceramides, sphingomyelin, and a phospholipid (phosphatidylinositol) were relatively higher in the plasma of a 10-year-old group than other age groups. Plasma levels of TG and phosphatidylserine were increased within age from 9 to 12 years. Furthermore, most of the TG molecular species were increased in the plasma of overweight children compared to the normal range groups. The receiver operating characteristic analysis results show that TG (10:0/10:0/18:1) could be a specific marker for childhood obesity (area under the curve (AUC) = 0.72). Overall, this study highlights the altered plasma lipidome in preadolescent children for sex, age, and percentage of overweight. Early detection of lipid markers for obesity would be a promising target for developing therapeutic strategies.

Global burden of ischemic heart disease in older adult populations linked to non-optimal temperatures: past (1990-2021) and future (2022-2050) analysis

Background

Ischemic heart disease (IHD) is a leading cause of death and disability, particularly affecting the older adult population. Extreme temperatures, especially very low and very high temperatures, are known to exacerbate cardiovascular disease burden. With the ongoing global climate change, understanding the impact of non-optimal temperatures on IHD burden becomes increasingly important, especially in vulnerable populations such as the older adult.

Methods

This study used data from the Global Burden of Disease Study 2021 (GBD 2021) to analyze the spatiotemporal trends of low and high temperatures on IHD burden in the older adult population (aged 60 and above) from 1990 to 2021. We used age-standardized rates (ASR), annual percentage change (EAPC), and the Bayesian age-period-cohort (BAPC) model to forecast 2050. Additionally, the geographic differences in IHD burden were analyzed using World Bank regions.

Results

From 1990 to 2021, the IHD burden in the older adult population was mainly attributed to low temperatures. However, it has increased the burden of IHD due to high temperatures, especially in tropical and low-income regions. The analysis of gender difference revealed that men are usually more affected by high temperatures, though generally, women are more sensitive to low temperatures. Forecasts are that in the future, the burden of IHD due to high temperatures will continue to rise, especially in areas with limited adaptive capacity.

Conclusion

Although low temperature remains the most important contributor to IHD burden among the older adult, the burden attributable to high temperature is on the rise, which increases the need to address the extreme temperature fluctuation. That is more so in poor-income and tropical regions where the most vulnerable populations bear a higher risk for health. Thus, there is an urgent need to develop adaptive public health measures against the dual health risks from extreme temperatures. The findings emphasize that targeted interventions are necessary, with adjustments in regional differences and gender-specific risks to effectively address the growing health threats from climate change.

Only three out of ten women received adequate postnatal care in sub-Saharan Africa: evidence from 20 countries demographic and health surveys (2015-2022)

BACKGROUND

The magnitude of maternal and neonatal death and morbidity during the postnatal period remains too high. In contrast to the decline in global mortality rates, maternal and neonatal deaths continue to occur at the highest rate in sub-Saharan Africa. Appropriate care during the postpartum period is vital to prevent neonatal and maternal deaths. This study is aimed at delivering evidence on the pooled prevalence and associated factors of adequate postnatal care using the recent demographic and health surveys from 20 sub-Saharan African countries.

METHODS

Data from the recent demographic and health surveys of 20 countries in sub-Saharan Africa conducted between 2015 and 2022 were used. A total weighted sample of 90,251 women aged 15-49 years with live births in the 2 years preceding the survey was included in the study. Multilevel logistic regression was used to determine the factors associated with the outcome variable. Intra-class correlation coefficient, likelihood ratio test, median odds ratio, and deviance (-2LLR) values were used for model comparison and fitness. Finally, variables with a p-value < 0.05 were declared statistically significant.

RESULTS

The overall pooled prevalence of adequate postnatal care among women aged 15-49 years in SSA countries was 27.42% (95% CI: 27.13%, 27.71%). Factors like age [AOR = 1.10; 95% CI (1.05, 1.16)], educational status [AOR = 1.52; 95% CI (1.39, 1.67)], marital status [AOR = 0.83; 95% CI (0.79, 0.88)], working status [AOR = 0.81; 95% CI (0.78, 0.84)], media exposure [AOR = 1.05; 95% CI (1.01, 1.09)], sex of the household head [AOR = 1.13; 95% CI (1.08, 1.18)], household size [AOR = 1.07; 95% CI (1.03, 1.12)], number of ANC visits [AOR = 3.38; 95% CI (3.04, 3.75)], place of delivery [AOR = 3.77; 95% CI (3.57, 3.99)], prenatal community health workers visit [AOR = 1.45; 95% CI (1.39, 1.51)], and residence [AOR = 1.26; 95% CI (1.21, 1.32)] were significantly associated with adequate postnatal care.

CONCLUSION

Only nearly three out of ten women received adequate postnatal care in sub-Saharan African countries. Adequacy of postnatal care was determined by the age of respondents, educational status, current marital status, working status, media exposure, sex of the household head, household size, number of ANC visits, place of delivery, prenatal community health workers visit, and residence. Therefore, women's empowerment through education, employment, and decision-making involvement; strengthening ANC service utilization and health facility delivery; information dissemination through media; promoting prenatal care through community health workers home-to-home visits; and giving special attention to unmarried, young, and non-working women are strongly recommended.

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.

Examining the association between service coverage of UHC and global disease burden: A cross-country panel analysis

Over the past two decades, numerous countries have enhanced their Universal Health Coverage (UHC), as indicated by the UHC Service Coverage Index (SCI), alongside a global reduction in the disease burden measured by Disability-Adjusted Life Years (DALYs). This paper uses a cross-country panel of 190 countries from 2000 to 2019 to identify the association between UHC SCI and DALYs gain. We find that a one-unit increase in the UHC SCI was associated with a significant decrease in total DALYs. Furthermore, UHC SCI was mostly associated with lowering DALYs from communicable, maternal, neonatal, and nutritional diseases but showed little to no significant association with non-communicable diseases or injuries. These results are robust to various robustness tests. Notable reasons include governments spending more on communicable, maternal, neonatal, and nutritional diseases than on non-communicable diseases and injuries, which is also the case for external aid. Our results also suggest that moving towards UHC helps lower-income countries more than higher-income countries, as developed nation-states have already established a well-functioning health system. Addressing non-communicable diseases and injuries will be essential to improve health outcomes and achieve SDGs in future.

Clinical and Epidemiological Characteristics of Patients with Functional Stroke Mimics: A Case-Control Study from Southern Portugal

BACKGROUND

Patients with functional neurological disorder presenting as stroke mimics or functional stroke mimics (FSMs) pose significant diagnostic challenges. In the acute phase, especially when patients are present within the therapeutic window for acute reperfusion treatments, a misdiagnosis of FSM can lead to unnecessary and costly interventions. Despite its clinical importance, the literature on the risk factors for FSM is limited. This study aims to compare the clinical and epidemiological characteristics of patients with FSM to those with confirmed acute ischemic stroke (AIS).

METHODS

This case-control study involved temporal matching between consecutive series of patients with FSM and controls with AIS from a single tertiary university hospital in southern Portugal.

RESULTS

A total of 188 patients were included: 64 cases (FSM) and 188 controls (AIS). The rate of stroke code activation and use of ambulance between was comparable between the two groups. The group of patients with FSM was younger (53.2 years vs. 69.5 years, p < 0.001) and had a higher proportion of females (52.4% vs. 47.6%, p = 0.001). There was no difference in terms of clinical severity at presentation. The proportion of specific signs, such as transcortical aphasia (3.1% vs. 20.9%, p = 0.014), gait abnormalities (15.6% vs. 33.9%, p = 0.004), and cranial nerve abnormalities (31.2% vs. 43.5%, p = 0.042), was lower in the FSM group compared to the AIS group. The proportion of patients on antithrombotic therapy (90.9% vs. 9.1%, p = 0.007) and antihypertensive drugs (78.5%, vs. 21.5%, p < 0.001) prior to the event was significantly higher in the AIS group. Likewise, the prevalence of cerebrovascular risk factors such as diabetes mellitus (14.3% vs. 85.7%, p = 0.005), arterial hypertension (23.8% vs. 76.2%, p = 0.001), and smoking (43.7% vs. 56.3%, p = 0.005) was lower in the FSM group compared to the AIS group. No statistically significant differences were observed in cholesterol levels or the prevalence of dyslipidemia between the two groups. Psychiatric comorbidities, including generalized anxiety disorder (71.4% vs. 28.6%, p = 0.05) and major depressive disorder (61.9% vs. 28.1%, p = 0.01), were more prevalent in the FSM group.

CONCLUSIONS

Patients with FSM display different clinical and epidemiological profiles, with a higher likelihood of being younger, female, having prior psychiatric conditions, and lacking traditional cerebrovascular risk factors.

Regulatory mechanisms of the probiotic-targeted gut-liver axis for the alleviation of alcohol-related liver disease: a review

Alcohol abuse-triggered alcohol-related liver disease (ALD) has become as a global public health concern that substantially affects the well-being and clinical status of patients. Although modern medicine provides various treatments for ALD, their effectiveness is limited and can lead to adverse side effects. Probiotics have been employed to prevent, alleviate, and even treat ALD, with promising results. However, few comprehensive reviews are available on how they mitigate ALD by targeting the gut-liver axis. This review systematically clarifies the specific mediators of the gut-liver axis in healthy states. It also describes the alterations observed in ALD. Furthermore, this review thoroughly summarizes the underlying mechanisms through which probiotics act on the gut-liver axis to relieve ALD. It also discusses the current status and challenges faced in clinical research applications. Finally, we discuss the challenges and future prospects of using probiotics to treat ALD. This review improves our understanding of ALD and supports the development and application of probiotics that target the gut-liver axis for therapeutic use.

Elevated Plasma Matrix Metalloproteinases Are Associated With Mycobacterium tuberculosis Bloodstream Infection and Mortality in Human Immunodeficiency Virus-Associated Tuberculosis

Mortality from human immunodeficiency virus (HIV)-associated tuberculosis (TB) is high, particularly among hospitalized patients. In 433 people with HIV hospitalized with symptoms of TB, we investigated plasma matrix metalloproteinases (MMP) and matrix-derived biomarkers in relation to TB diagnosis, mortality, and Mycobacterium tuberculosis (Mtb) bloodstream infection (BSI). Compared to other diagnoses, MMP-8 was elevated in confirmed TB and in Mtb-BSI, positively correlating with extracellular matrix breakdown products. Baseline MMP-3, -7, -8, -10, and PIIINP were associated with Mtb-BSI and 12-week mortality. These findings implicate MMP dysregulation in pathophysiology of advanced HIV-TB and support MMP inhibition as a host-directed therapeutic strategy for HIV-TB.

Infectious Causes of Death: An Autopsy-Based Study of 546 Cases

Background

Diagnostic accuracy in cases of infectious diseases is crucial for appropriate patient management and public health interventions. This retrospective study aimed to evaluate the most common causes of death caused by infectious diseases and the rate of agreement between clinical diagnoses and autopsy findings in individuals diagnosed with infectious diseases in Mashhad, Iran.

Methods

Autopsy reports from March 2009 to February 2018 were analyzed for patients diagnosed with infectious diseases. Demographic data, clinical diagnoses, and autopsy results were collected and compared. Discrepancies between clinical and autopsy diagnoses were assessed, and potential predictors of diagnostic discrepancy were examined.

Results

Among 28 451 autopsied cases, 546 (1.9%) were diagnosed with infectious diseases. Pleuropulmonary infections were the most common cause of death (69.8%) as determined by autopsy, followed by bloodstream infections (14.1%) and intra-abdominal infections (10.0%). Discrepancies between clinical and autopsy diagnoses were identified in 22.4% of cases. Pleuropulmonary infections had the highest frequency of diagnostic discrepancies (29.1%), followed by central nervous system (CNS) infections (15.8%).

Conclusions

This study underscores the importance of autopsy in identifying diagnostic discrepancies and improving clinical practice in cases of infectious diseases. They also highlight the need for ongoing efforts to enhance diagnostic capabilities, particularly in challenging cases such as pleuropulmonary and CNS infections, to reduce the burden of misdiagnosis and improve patient outcomes.

Global burden and cross-country inequalities of nutritional deficiencies in adults aged 65 years and older, 1990-2021: population-based study using the GBD 2021

BACKGROUND/OBJECTIVES

Nutritional deficiencies remain significant public health issues in older populations globally. This study evaluates the burden, trends, and cross-country inequalities of four common nutritional deficiencies (protein-energy malnutrition, iodine deficiency, vitamin A deficiency, and dietary iron deficiency) in older adults from 1990 to 2021.

METHODS

Age-standardised prevalence, disability-adjusted life years (DALYs), and average annual percentage changes (AAPCs) of these deficiencies in people aged ≥ 65 years at global, regional, and national levels were estimated from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. Cross-country inequalities in disease burden were quantified using the slope index and concentration index, standard health equity methods recommended by the World Health Organization.

RESULTS

Globally, age-standardised prevalence rates of protein-energy malnutrition increased from 1407.16 per 100 000 population in 1990 to 2015.58 in 2021, with an AAPC of 1.18 (1.08-1.28), showing significant changes in 2015 and 2019, which were turning points in the joinpoint regression. Age-standardised prevalence rates of iodine, vitamin A, and dietary iron deficiencies decreased, with AAPCs of -0.49 (-0.53 to -0.44), -3.24 (-3.27 to -3.20), and - 0.14 (-0.17 to -0.12), respectively. Except for an increase in the DALY rate of vitamin A deficiency (AAPC 0.40), the DALY rates of the other three deficiencies decreased. Inequality in the burden of protein-energy malnutrition and iodine deficiency between high- and low-income countries narrowed, while inequality for vitamin A and dietary iron deficiencies remained stable. Age-standardised DALY rates for all deficiencies decreased as sociodemographic index increased.

CONCLUSIONS

The global status of nutritional deficiency among older adults has improved since 1990, but the increasing prevalence of protein-energy malnutrition requires attention. Additionally, cross-country health inequalities persist, necessitating more efficient public health measures.

Expression analysis of SOX2 and SOX9 in patients with oral squamous cell carcinoma

BACKGROUND

Lately SOX2 and SOX9, transcription factors associated with stemness-like phenotypes of cancer cells, have been linked to tumor growth, metastasis, and resistance to therapy.

METHODS

This study aimed on evaluating the expression of SOX2 and SOX9 in a large cohort of patients with OSCC including primary and recurrent tumors and corresponding lymph node metastases. Semiautomatic digital pathology scoring was used to determine protein expression and survival analysis was performed to evaluate its prognostic significance.

RESULTS

We found a significant downregulation of SOX9 from primary disease to lymph node metastases (p < 0.001). SOX9 expression and the subgroup SOX2lowSOX9high were significantly correlated with worse overall survival (p < 0.05). Additionally, SOX2lowSOX9high expression pattern was confirmed as independent prognosticator for overall survival.

CONCLUSIONS

These results indicate the relevant role of SOX2 and SOX9 in patients with OSCC and show the clinical relevance for further investigation on the molecular mechanisms underlying SOX-related gene expression.

Sarcopenia in trauma patients: A systematic review and meta-analysis

Sarcopenia is associated with poor prognosis and mortality following injury. This systematic review and meta-analysis aimed to analyze diagnostic criteria for sarcopenia, as well as to assess its prevalence and impact on health outcomes among trauma patients. We conducted a literature search on MEDLINE, EMBASE, and the Cochrane Library from inception to June 2023. A total of 27 studies were included, involving 8692 individuals (55.5 % men) with a mean age ranging from 42.2 to 80.5 years. The pooled prevalence of sarcopenia in trauma patients was 36.0 % [95 % confidence interval (CI): 29.1-43.0 %, I2 = 97.8 %], with a 39.3 % prevalence (95 % CI: 31.0-48.5 %, I2 = 96.8 %) in men and a 39.0 % prevalence (95 % CI: 31.4-46.2 %, I2 = 94.4 %) in women. Trauma patients with sarcopenia were more prone to complications [risk ratio (RR): 1.16, 95 % CI: 1.03-1.31, I2 = 45.8 %] and less able to discharge independently (RR: 0.74, 95 % CI: 0.63-0.86, I2 = 33.3 %). The risk of death in trauma patients with sarcopenia was higher than in non-sarcopenic patients [hazard ratio (HR): 1.64, 95 % CI: 1.31-2.04]. Sarcopenia is commonly present in trauma patients and has a negative impact on prognosis. Early assessment and interventions for sarcopenia should be conducted in trauma patients.

Frailty prevalence, invasive treatment frequency, and in-hospital outcome in patients hospitalized for acute coronary syndrome in Germany (2005-2022): a nationwide registry study

Background

Frailty is a significant predictor for adverse outcomes. Yet, data on prevalence and treatment of frail patients with acute coronary syndrome (ACS) remains limited. We aimed to investigate frailty prevalence, interventional treatment frequency, and in-hospital outcome for all patients hospitalized for ACS in Germany from 2005 to 2022 and validate the Hospital Frailty Risk Score (HFRS) in this population.

Methods

Data for 2005-2022 from the Statistical Federal Office included all cases with primary diagnosis of ACS treated in Germany. Patients were categorized into low, intermediate, and high frailty by HFRS. Diagnoses, procedures, and in-hospital outcomes were analyzed. Univariable and multivariable logistic regressions as well as sensitivity analyses were performed.

Findings

Between 2005 and 2022, 5,889,972 ACS patients were hospitalized in Germany. Mean age was 69 years (standard deviation (SD) ± 12.85 years) and 2,060,224 (34.98%) were female. In-hospital mortality was 6.2%. Among all, 5,001,812 (84.9%) had a low, 784,106 (13.3%) an intermediate, and 104,054 (1.8%) a high HFRS. High-frailty patients were less likely to undergo coronary intervention than low-frailty patients (47.0% vs. 70.6%, p < 0.001), had longer hospital stays (21.6 days SD 19.4 ± vs. 5.6 days SD ± 5.2, p < 0.001), and higher in-hospital mortality (adjusted odds ratio (OR) 3.34 [confidence interval (95% CI) 3.29-3.4]).

Interpretation

Nearly one-sixth of ACS-patients were frail according to HFRS. Frail patients had longer hospital stays, less often received interventional procedures, and showed substantially increased in-hospital mortality. In our aging population, frailty will play an increasing role in patient management. Frailty scores based on electronic patient records, like the HFRS, offer clinicians a tool for assessing in-hospital outcome in ACS patients, potentially enabling more individualized treatment approaches.

Funding

None.

Behavioral interventions targeting treatment adherence in chronic kidney disease: A systematic review and meta-analysis

Adherence to dialysis, medication regimens and dietary and fluid intake recommendations can improve quality of life and survival in chronic kidney disease, but non-adherence is prevalent. This review and meta-analysis investigated the effects of behavioral interventions on treatment adherence in chronic kidney disease and examined intervention characteristics (Behavior Change Techniques and delivery methods) associated with direct and indirect measures of adherence. Literature searches in five databases identified 149 eligible studies (255 study arms; 15878 patients). Random-effects meta-analyses revealed mostly small and statistically significant beneficial effects on outcomes, ranging from g = 0.27 (95% CI [0.03, 0.50]; p = 0.02) for dialysis adherence to g = 0.84 (95% CI [0.23, 1.45]; p = 0.01) for sodium. Moderator analyses revealed 16 Behavior Change Techniques and 12 delivery related moderators associated with improvements in adherence. These included intervention methods targeting behavioral regulation, health beliefs and knowledge, social support, and involving a dietitian or a nurse. The Behavior Change Techniques 'instructions on how to perform the behavior, 'information about antecedents', 'information about health consequences', 'social support (unspecified)', and 'goal setting (behavior)' were associated with beneficial changes in several adherence outcomes. These results can be used to inform the development of new interventions to improve chronic kidney disease treatment adherence.

Outcomes of intraperitoneal chemotherapy for the treatment of gastric cancer with peritoneal metastasis: A comprehensive systematic review and meta-analysis

BACKGROUND

Peritoneal metastasis is common in gastric cancer and linked to poor survival. Treatment of peritoneal metastasis with intraperitoneal chemotherapy has become an accepted practice in some centres. This systematic review and meta-analysis intends to provide a comprehensive evaluation of published evidence for the use of intraperitoneal chemotherapy is gastric cancer patients with peritoneal metastasis.

METHODS

A systematic literature search for studies reporting the use of intraperitoneal chemotherapy for the treatment gastric cancer with macroscopic peritoneal metastasis was performed up until June 2024. Studies were not eligible for inclusion if they described the use of intraperitoneal chemotherapy solely as an adjunct to gastrectomy or cytoreductive surgery. Pooled- and meta-analysis was used to summarise study outcomes.

RESULTS

Fifty-three studies reporting the outcomes of 2446 gastric cancer patients who received intraperitoneal chemotherapy for the treatment of peritoneal metastasis, were included. Three principal methods of intraperitoneal chemotherapy administration were described: catheter based (normothermic) intraperitoneal chemotherapy (n = 28); pressurised intraperitoneal aerosolised chemotherapy (n = 14), and; hyperthermic intraperitoneal chemotherapy (n = 11). The proportion of patients with complete peritoneal disease regression after receiving intraperitoneal chemotherapy was 27 % (95%CI, 14-41). Median overall survival determined was 16.4 months (95%CI, 14.4-18.4). Meta-analysis of data from eight studies comparing combined intraperitoneal and systemic chemotherapy with systemic chemotherapy alone identified a survival benefit for patients receiving intraperitoneal chemotherapy (Hazard ratio 0.57 [95%CI, 0.48-0.67],P < 0.001).

CONCLUSION

Despite variation in published treatment approaches and a lack of evidence from well-designed clinical trials, intraperitoneal chemotherapy may be considered safe and in selected circumstances efficacious.

NTHi killing activity is reduced in COPD patients and is associated with a differential microbiome

Chronic obstructive pulmonary disease (COPD) is a chronic lung disease characterized by airway obstruction and inflammation. Non-typeable Haemophilus influenzae (NTHi) lung infections are common in COPD, promoting frequent exacerbations and accelerated lung function decline. The relationship with immune responses and NTHi are poorly understood. Herein, we comprehensively characterized the respiratory microbiome and mycobiome of patients while investigating microbial dynamics and host immune changes attributable to NTHi killing activity. Mild-to-moderate COPD patients encompassing frequent and infrequent exacerbators and healthy volunteers (HV) were enrolled. Microbial composition, proteomics and NTHi killing activity was analyzed using bronchoalveolar lavage fluid (BALF). In addition, antigen-antibody titers in sera to COPD pathogens were determined using a multiplex assay. Differential abundance analysis revealed an enrichment of Actinobacteria and Bacteroidetes in the BALF of COPD and HV subjects respectively. Significant differences in the IgA titer response were observed against NTHi antigens in COPD vs. HV. Notably, there was also significantly greater killing activity against NTHi in BALF from COPD vs. HV subjects (OR = 5.64; 95% CI = 1.75-20.20; p = 0.001). Stratification of COPD patients by NTHi killing activity identified unique microbial and protein signatures wherein Firmicutes, Actinobacteria and haptoglobin were enriched in patients with killing activity. We report that differences in host immune responses and NTHi-killing activity are associated with microbiome changes in mild-to-moderate COPD. This is suggestive of a potential link between the respiratory microbiome and immune activity against NTHi in the context of COPD pathogenesis even at this disease stage.

Navigating Personal, Social, and Environmental Obstacles to Healthy Lifestyle in Jordanian Adolescents

Objective: This study aimed to investigate barriers hindering healthy eating and physical activity among Jordanian adolescents. Methods: A random sample of 1040 adolescents (596 males and 444 females) aged 11-17 from various Jordanian schools participated. A nutritionist-administered questionnaire assessed barriers. Results: The study unveiled diverse personal, social, and environmental barriers to healthy lifestyles. Notably, inadequate knowledge of nutrition and limited time for healthy food preparation due to homework emerged as key barriers to healthy eating. Conversely, insufficient exercise skills and reduced enjoyment of physical activity were the primary impediments to physical activity. Females perceived homework as a more substantial barrier than males (p=0.027). Conclusion: These barriers may contribute to increasing childhood obesity rates in Jordan. Future interventions should prioritize creating a supportive environment that respects cultural norms, emphasizing high-quality parks, nutrition and sports education, healthier food options, student motivation, and park visits. Community engagement is crucial for fostering healthier lifestyles among Jordanian youth.

Modular Engineering of Lysostaphin with Significantly Improved Stability and Bioavailability for Treating MRSA Infections

Methicillin-resistant Staphylococcus aureus (MRSA) is a refractory pneumonia-causing pathogen due to the antibiotic resistance and the characteristics of persisting inside its host cell. Lysostaphin is a typical bacteriolytic enzyme for degrading bacterial cell walls via hydrolysis of pentaglycine cross-links, showing potential to combat multidrug-resistant bacteria. However, there are still grand challenges for native lysostaphin because of its poor shelf stability and limited bioavailability. To tackle these limitations, a modular assembly strategy is proposed to actively engineer the native lysostaphin, involving nanoassembly preparation via fusing with lysine-rich polypeptide. The engineered lysine component significantly improves the membrane-penetration capability of lysostaphin, greatly increasing its intracellular antibacterial activity by 12-fold compared to wild-type lysostaphin. Notably, the half-life of the nanoassembled lysostaphin is approximately 13 times longer than that of its native counterpart, greatly outperforming other studies. Most importantly, the shelf stability of our engineered lysostaphin is significantly improved, retaining over 99.9% of antibacterial activity after 12 weeks at room temperature. This modular assembly strategy successfully enhances the overall performance of lysostaphin, offering great promise for a platform technique to refine enzymatic material for widespread clinical demands.

From Pathophysiology to Practice: Evolving Pharmacological Therapies, Clinical Complications, and Pharmacogenetic Considerations in Portal Hypertension

Background: Portal hypertension is a major complication of chronic liver diseases, leading to serious issues such as esophageal variceal bleeding. The increase in portal vein pressure is driven by both an organic component and a functional component, including tonic contraction of hepatic stellate cells. These processes result in a pathological rise in intrahepatic vascular resistance, stemming from partial impairment of hepatic microcirculation, which is further exacerbated by abnormalities in extrahepatic vessels, including increased portal blood flow. Objectives: This review aims to provide a comprehensive overview of the evolving pharmacological therapies for portal hypertension, with consideration and discussion of pathophysiological mechanisms, clinical complications, and pharmacogenetic considerations, highlighting potential directions for future research. Methods: A review of recent literature was performed to evaluate current knowledge and potential therapeutic strategies in portal hypertension. Results: For over 35 years, non-selective beta-blockers have been the cornerstone therapy for portal hypertension by reducing portal vein inflow as an extrahepatic target, effectively preventing decompensation and variceal hemorrhages. However, since not all patients exhibit an adequate response to non-selective beta-blockers (NSBBs), and some may not tolerate NSBBs, alternative or adjunctive therapies that enhance the effects of NSBBs on portal pressure are being investigated in preclinical and early clinical studies. Conclusions: A better understanding of pharmacogenetic factors and pathophysiological mechanisms could lead to more individualized and effective treatments for portal hypertension. These insights highlight potential directions for future research.