Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

Mediated roles of oxidative stress and kidney function to leukocyte telomere length and prognosis in chronic kidney disease

BACKGROUND

Few studies have focused on the correlation between leukocyte telomere length (LTL) and cancer-related mortality or identified potential factors that mediate the relationship between LTL and mortality among chronic kidney disease (CKD) patients. Our study aimed to explore the associations between LTL and all-cause and cause-specific mortality and to identify the underlying mediators.

METHODS

CKD patients were obtained from the National Health and Nutrition Examination Survey (NHANES) 1999-2002. Cox regression analysis and restricted cubic spline analysis were used to explore the associations between LTL and all-cause or specific-cause mortality and their nonlinear connections. Stratified analyses were executed to assess the relationships among the different subgroups. The latent mediated factors were confirmed using mediation analysis. Sensitivity analyses were used to evaluate the robustness of our findings.

RESULTS

Longer LTL associated with the lower risk of all-cause mortality, cardiovascular disease (CVD) and cancer-related mortality, and U-shaped relationships were detected. Patients younger than 65 years with greater LTL or who had hypertension had better prognoses. Age and history of hypertension were associated with LTL and overall mortality. In addition, estimated glomerular filtration rate (eGFR), albumin, and total bilirubin mediated the association, and the proportions of indirect effects were 7.81%, 3.77%, and 2.50%, respectively. Six sensitivity analyses confirmed the robustness of our findings.

CONCLUSIONS

This study revealed that LTL was a protective factor for survival among patients with CKD and emphasized the mediating roles of oxidative stress and kidney function.

Burden of female infertility in 204 countries and territories, 1990-2021: results from the Global Burden of Disease Study 2021

OBJECTIVE

To explore the global burden of female infertility from 1990 to 2021 by examining trends in prevalence and years lived with disability (YLD).

METHODS

Data from the Global Burden of Disease Study 2021 (GBD 2021) were analyzed with a focus on the prevalence and YLD of female infertility in women aged 15-49 years. Statistical models were used to estimate ASPRs and YLD across regions and countries.

RESULTS

The global prevalence of female infertility was 110.1 million in 2021, with an age-standardized rate of 2,764.6 per 100,000 population. The YLD for infertility in 2021 was 601,134, which represented a 33.1% increase since 1990. Regionally, East Asia and Eastern Europe had the highest rates of infertility, whereas Australasia had the lowest rate.

CONCLUSIONS

The study highlights a significant rise in the burden of female infertility, particularly in high-income regions. Study findings emphasize the need for targeted public health strategies and healthcare interventions to address this growing issue.

Temporal trends in gender, etiology, severity and outcomes of acute pancreatitis in a third-tier Chinese city from 2013 to 2021

BACKGROUND

To evaluate temporal trends in gender, etiology, severity, outcomes, cost and median length of stay (MLS) in patients with acute pancreatitis (AP) in a third-tier Chinese city.

METHODS

Patients with AP admitted to a university hospital between January 2013 and December 2021. Relationships between etiology, prevalence of severe acute pancreatitis (SAP) and survey years were investigated by joinpoint regression analysis.

RESULTS

A total of 5459 (male 62.3%) patients with AP were included. Between January 2013 and December 2021, we observed: (a) the prevalence of biliary diseases-related AP was stable, while the prevalence of hypertriglyceridemia (HTG)-associated AP (Ptrend = 0.04) and alcohol-associated AP (Ptrend < 0.0001) both increased; (b) there was an increase in crude prevalence of SAP from 4.97% to 12.2% between 2013 and 2021 (Ptrend < 0.0001); (c) compared to female populations, male gender had a higher prevalence of AP; (d) there was a decrease in MLS from 11 days to 8 days (Ptrend < 0.0001) and in median cost of hospitalization (MCH) for all patients (from 20,166 to 12,845 YUAN) (Ptrend < 0.0001); (e) the overall in-hospital mortality rate was 1.28% (70/5459) for patients with AP. There was no statistically significant in the time trend of mortality during the study period (Ptrend = 0.5873). At multivariate analysis, survey year was associated with prevalence of SAP after adjustment by age and biliary diseases (OR: 1.07; 95% CI: 1.03-1.12). Based on the stratification by severity of disease, the decrease of MLS and MCH was more significant in non-SAP vs. SAP patients.

CONCLUSIONS

Over the observational period, the proportion of male patients with AP, prevalence of age-adjusted rate of HTG and alcohol-associated AP and SAP increased, while MLS and MCH for all patients decreased, and the time trend of mortality of AP was stable.

Relationship prediction between clinical subtypes and prognosis of critically ill patients with cirrhosis based on unsupervised learning methods: A study from two critical care databases

BACKGROUND

Our objective was to identify distinct clinical subtypes among critically ill patients with cirrhosis and analyze the clinical features and prognosis of each subtype.

METHODS

We extracted routine clinical data within 24 h of ICU admission from the MIMIC-IV database. To determine the number of clinical subtypes, we employed the "elbow method," "cumulative distribution function (CDF) plot," and "consensus matrix." Consensus k-means, k-means, and SOM methods were used to identify different clinical subtypes of critically ill cirrhosis. We validated our findings using patients from the eICU database. The SHapley Additive exPlanations (SHAP) method was used to explore the features of each clinical subtype, and 28-day Kaplan-Meier curves were generated. Survival differences among the clinical subtypes were assessed using the log-rank test.

RESULTS

Our study included 2,586 patients from the MIMIC-IV database and 1,670 patients from the eICU database. Based on the clinical routine variables, we identified three clinical subtypes among patients in the MIMIC-IV database. Subtype A (N = 1424, 55.07 %) was labeled the "common subtype" and exhibited the lowest mortality. Subtype B (N = 703, 27.18 %) was classified as the "hyperinflammatory response subtype" and had a relatively high mortality. Subtype C (N = 459, 17.75 %) was identified as the "liver dysfunction subtype" and had the highest mortality. These findings were consistent with the results obtained from both the internal validation set (MIMIC-IV database) and the external validation set (eICU database).

CONCLUSIONS

Our study presents a novel and clinically applicable approach for subtyping critically ill cirrhosis.

Global and regional trends in the burden of surgically confirmed endometriosis from 1990 to 2021

BACKGROUND

endometriosis as a common gynecologic finding significantly affects the quality of life of many women. An accurate understanding of the epidemiological characteristics of endometriosis is essential for disease control and prevention. We aimed to use the latest data from the Global Burden of Disease (GBD) 2021 to comprehensively analyze the various epidemiological indicators of surgically confirmed endometriosis and their changing trends to better measure the disease burden and help improve health management.

METHODS

We delineated incidence, prevalence, and years lived with disability (YLDs) of surgically confirmed endometriosis at the global, regional, and national levels. The estimated annual percentage change (EAPC) was calculated to assess temporal trends in the age-standardized rate (ASR). In addition, we used joinpoint regression models to describe local trends in these indicators, assessed the correlation between disease burden and Socio-demographic index (SDI) levels, and used decomposition analysis to quantitatively analyze the driving factors leading to changes in disease burden.

RESULTS

Globally, the age-standardized rate of incidence, prevalence, and YLDs of surgically confirmed endometriosis all showed a decreasing trend from 1990 to 2021. The burden of surgically confirmed endometriosis is mainly concentrated in women aged 20-30 years and declines with increasing SDI levels. The results of the decomposition analysis indicated that population growth is the main driving factor for the upward in the number of incidence, prevalence, and YLDs cases of endometriosis worldwide.

CONCLUSIONS

The overall burden of endometriosis has decreased globally from 1990 to 2021, but there are regional disparities. Managing this condition remains a major challenge, and more refined policies and interventions are needed to effectively address the burden of endometriosis.

Global burden of non-communicable diseases attributable to kidney dysfunction with projection into 2040

BACKGROUND

Spatiotemporal disparities exist in the disease burden of non-communicable diseases (NCDs) attributable to kidney dysfunction, which has been poorly assessed. The present study aimed to evaluate the spatiotemporal trends of the global burden of NCDs attributable to kidney dysfunction and to predict future trends.

METHODS

Data on NCDs attributable to kidney dysfunction, quantified using deaths and disability-adjusted life-years (DALYs), were extracted from the Global Burden of Diseases Injuries, and Risk Factors (GBD) Study in 2019. Estimated annual percentage change (EAPC) of age-standardized rate (ASR) was calculated with linear regression to assess the changing trend. Pearson's correlation analysis was used to determine the association between ASR and sociodemographic index (SDI) for 21 GBD regions. A Bayesian age-period-cohort (BAPC) model was used to predict future trends up to 2040.

RESULTS

Between 1990 and 2019, the absolute number of deaths and DALYs from NCDs attributable to kidney dysfunction increased globally. The death cases increased from 1,571,720 (95% uncertainty interval [UI]: 1,344,420-1,805,598) in 1990 to 3,161,552 (95% UI: 2,723,363-3,623,814) in 2019 for both sexes combined. Both the ASR of death and DALYs increased in Andean Latin America, the Caribbean, Central Latin America, Southeast Asia, Oceania, and Southern Sub-Saharan Africa. In contrast, the age-standardized metrics decreased in the high-income Asia Pacific region. The relationship between SDI and ASR of death and DALYs was negatively correlated. The BAPC model indicated that there would be approximately 5,806,780 death cases and 119,013,659 DALY cases in 2040 that could be attributed to kidney dysfunction. Age-standardized death of cardiovascular diseases (CVDs) and CKD attributable to kidney dysfunction were predicted to decrease and increase from 2020 to 2040, respectively.

CONCLUSION

NCDs attributable to kidney dysfunction remain a major public health concern worldwide. Efforts are required to attenuate the death and disability burden, particularly in low and low-to-middle SDI regions.

Connection between trajectory of primary cancer monitoring indicators and mortality after cancer in South Korea

BACKGROUND

Cancer remains a leading global cause of mortality, responsible for nearly 10 million deaths in 2020. Given the country's low birth rate and aging population, the escalating cancer burden poses significant challenges to its healthcare systems. This study aimed to investigate the relationship between lifestyle risk factors and cancer case fatality, emphasizing the collective impact of these factors through a prevention index at the regional level.

METHODS

The study focused on ten cancer types, categorizing counties into three levels of cancer incidence rates using group-based trajectory modeling to identify disparities in patterns and levels among groups. Additionally, we segmented the proportions of obesity prevalence, average daily per capita smoking amount, prevalence of smoking, prevalence of high-risk alcohol consumption, prevalence of hypertension diagnosis, prevalence of diabetes diagnosis, and cancer case fatality into three groups through group-based trajectory modeling. Cox proportional hazard models were employed to evaluate the hazard ratios (HR) for cancer case fatality, adjusting for age, sex, income level, and cancer stage.

RESULTS

The study population comprised 294,070 cancer patients, with thyroid, stomach, colorectal, breast, and lung cancers being the most common. The prevention index (PI) levels, calculated from six primary prevention indicators, were categorized into High, Medium, and Low grades. Counties with higher PI levels (H) exhibited significantly lower cancer case fatality among cancer patients compared to those with lower PI levels (L). Across all cancer types, females had lower cancer case fatality compared to males, higher age was linked to higher cancer case fatality, advanced stage cases had the highest cancer case fatality, and the highest income quintile consistently showed the lowest cancer case fatality.

CONCLUSIONS

The study highlights the significant inverse relationship between primary prevention indicator levels and cancer case fatality. Higher scores on primary prevention indicators are associated with lower cancer mortality among cancer patients for various cancer types, underscoring the importance of comprehensive, community-based prevention strategies in mitigating cancer risk and improving public health outcomes in South Korea.

The Association of the Distance to the Hospital, Hospital Reputation, and Hospitalization Outcomes Among Patients with Stroke in China

Background: Both distance to the hospital and hospital reputation influence patient choice of hospital; but the combined effect of these factors and how they relate to hospitalization outcomes has yet to be determined. The purpose of this study was to assess the combined influence of distance to hospital and hospital reputation on the hospitalization outcomes in patients with stroke. Methods: This retrospective observational study utilized data from 69,107 stroke patients hospitalized in southern Chinese megacity between 2019 and 2021. A generalized linear model was used to assess the association between hospital reputation, distance to the hospital, hospitalization costs, and the length of stay. Multivariate logistic regression was used to estimate the combined effect on in-hospital mortality. Results: Compared with patients who chose hospitals without a good reputation and close to home, those who chose hospitals with a good reputation had lower hospitalization costs (-0.05; 95% CI: -0.08 to -0.02), a shorter length of stay (-0.18; 95% CI: -0.20 to -0.16), and lower in-hospital mortality (0.52; 95% CI: 0.40 to 0.67). However, patients who chose hospitals with a good reputation but farther distance experienced higher hospitalization costs (0.20; 95% CI: 0.17 to 0.23). Conclusions: A shorter distance to the hospital and a higher reputation of the hospital are associated with lower costs and better outcomes. Our study indicates that improving outcomes for patients with stroke requires equitable distribution of quality medical resources.

Impact of temperature variations on burden of lower respiratory infections under climate change (1990-2021)

OBJECTIVES

We aimed to evaluate the global burden and trends of lower respiratory infections (LRIs) attributable to non-optimal temperatures between 1990 and 2021, focusing on age, period, and cohort effects as well as health inequalities to inform targeted public health policies.

METHODS

Using the Global Burden of Disease 2021 database, we obtained the age-standardized mortality rate (ASMR) and disability-adjusted life-years rate (ASDR) for LRIs related to non-optimal temperatures. We calculated estimated annual percentage changes (EAPC) to assess LRIs burden trends and applied age-period-cohort modeling to quantify age, period, and cohort effects. Health inequalities were evaluated using the slope index of inequality and the concentration index.

RESULTS

In 2021, the highest ASDR for LRIs due to high temperatures occurred in children under 5 (347.66/100,000), whereas the highest ASMR for LRIs due to low temperatures occurred in adults aged ≥ 65 (338.49/100,000). Globally, the LRIs burden from non-optimal temperatures declined (EAPC: ASMR -2.48; ASDR -3.33). However, among the five climate zones, the LRIs burden in the boreal zone due to high temperatures increased (EAPC: ASMR 24.14; ASDR 45.14), whereas all other climate zones showed decreasing trends. In lower Sociodemographic Index (SDI) regions, the high-temperature-related LRIs burden was more pronounced. Relative inequities driven by non-optimal temperatures worsened in low-SDI regions.

CONCLUSION

From 1990 to 2021, the global burden of LRIs attributable to non-optimal temperatures declined overall; however, high-temperature-related LRIs increased in boreal zones. These health inequalities underscore the urgent need for targeted climate adaptation policies, such as providing international assistance, improving infrastructure, offering healthcare resources, and promoting vaccine coverage, particularly for vulnerable populations in low-SDI regions and boreal zones.

Development and validation of a quick screening tool for predicting neck pain patients benefiting from spinal manipulation: a machine learning study

BACKGROUND

Neck pain (NP) ranks among the leading causes of years lived with disability worldwide. While spinal manipulation is a common physical therapy intervention for NP, its variable patient responses and inherent risks necessitate careful patient selection. This study aims to develop and validate a machine learning-based prediction model to identify NP patients most likely to benefit from spinal manipulation.

METHODS

This multicenter study analyzed 623 NP patients in a retrospective cohort and 319 patients from a separate hospital for external validation, with data collected between May 2020 and November 2024. Treatment success was defined as achieving ≥ 50% reduction in Numerical Rating Scale (NRS) and ≥ 30% reduction in Neck Disability Index (NDI) after two weeks of spinal manipulation. We compared data imputation methods through density plots, and conducted δ-adjusted sensitivity analysis. Then employed both Boruta algorithm and LASSO regression to select relevant predictors from 40 initial features, and four feature subsets (Boruta-selected, LASSO-selected, intersection, and union) were evaluated to determine the optimal combination. Nine machine learning algorithms were tested using internal validation (70% training, 30% testing) and external validation. Performance metrics included Area Under the Receiver Operating Characteristic Curve (AUC), accuracy, F1-score, sensitivity, specificity, and predictive values. The SHAP framework enhanced model interpretability. Youden's Index was applied to determine the optimal predictive probability threshold for clinical decision support, and a web-based application was developed for clinical implementation.

RESULTS

The combined LASSO and Boruta algorithms identified nine optimal predictors, with the union feature set achieving superior performance. Among the algorithms tested, the Multilayer Perceptron (MLP) model demonstrated optimal performance with an AUC of 0.823 (95% CI 0.750, 0.874) in the test set, showing consistency between training (AUC = 0.829) and test performance. External validation confirmed robust performance (AUC: 0.824, accuracy: 0.765, F1 score: 0.76) with satisfactory calibration (Brier score = 0.170). SHAP analysis highlighted the significant predictive value of clinical measurements and patient characteristics. Based on Youden's Index, the optimal predictive probability threshold was 0.603, yielding a sensitivity of 0.762 and specificity of 0.802. The model was implemented as a web-based application providing real-time probability calculations and interactive SHAP force plots.

CONCLUSION

Our machine learning model demonstrates robust performance in identifying suitable candidates for spinal manipulation among neck pain patients, offering clinicians an evidence-based practical tool to optimize patient selection and potentially improve treatment outcomes.

Genetic liability to sedentary behaviour and cardiovascular disease incidence in the FinnGen and HUNT cohorts

OBJECTIVE

Energy-saving sedentary behaviour may be an evolutionarily selected trait that is no longer advantageous. We investigated the associations between genetic liability to sedentary behaviour and the incidence of the most common cardiovascular disease (CVD).

METHODS

We constructed and validated a genome-wide polygenic score for leisure screen time (PGS LST) as a measure of genetic liability to sedentary behaviour. We performed survival analyses between higher PGS LST and register-based CVDs using the FinnGen cohort (N=293 250-333 012). Replication and exploratory analyses were conducted in an independent Norwegian Trøndelag Health Study (HUNT) cohort (N=35 289).

RESULTS

In FinnGen, each SD increase in PGS LST was associated with a higher risk of incident CVD (HR: 1.05 (95% CI 1.05 to 1.06)) (168 770 cases over 17 101 133 person-years). The magnitudes of association for the three most common CVDs were 1.09 ((95% CI 1.08 to 1.09), 1.06 ((95% CI 1.05 to 1.07) and 1.05 ((95% CI 1.04 to 1.06) for hypertensive disease, ischaemic heart disease and cerebrovascular disease, respectively. Those in the top decile of PGS LST had 21%, 35%, 26% and 19% higher risk of any CVD, hypertensive disease, ischaemic heart disease and cerebrovascular disease, respectively, than those in the bottom decile. Associations were replicated in HUNT and remained independent of covariates (socioeconomic status, body mass index and smoking) except for cerebrovascular disease. Besides direct effects, reduced physical activity served as a potential mediating pathway for the observed associations.

CONCLUSIONS

We found that genetic liability to sedentary behaviour is associated with incident CVD, although effect sizes with current PGS remained small. These findings suggest that genetic liability to sedentary behaviour is an under-recognised driver of common CVDs.

The global burden of bladder, kidney, and prostate cancers attributable to smoking from 1990 to 2021 and projections for the next two decades: A cross-sectional study

INTRODUCTION

Smoking increases the risk of bladder and kidney cancers and is associated with a poorer prognosis in prostate cancer (PCa) patients, which poses a significant health and socioeconomic burden. Understanding the epidemiologic trends of urological cancers attributable to smoking is critical to developing targeted prevention strategies. This study examines global trends in the three urological cancers attributable to smoking from 1990 to 2021 and projects future trends over the next two decades.

METHODS

Data were obtained from the Global Burden of Disease (GBD) 2021. Metrics included deaths, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMR), and age-standardized DALY rates (ASDR), with uncertainty intervals (UIs). Burden comparisons were stratified by sex, age, and sociodemographic index (SDI). Temporal trends were analyzed using Joinpoint regression to calculate annual percentage change (APC) and average annual percentage change (AAPC), with 95% confidence intervals (CIs). Future trends were predicted using the autoregressive integrated moving average (ARIMA) model.

RESULTS

Compared with 1990, the number of deaths of bladder cancer, kidney cancer and PCa attributable to smoking increased by 43%, 67%, and 31%, and the number of DALYs increased by 31%, 52%, and 29% in 2021. However, the corresponding age-standardized rates showed a downward trend (AAPCASMR of bladder cancer, -1.53; AAPCASDR of bladder cancer, -1.68; AAPCASMR of kidney cancer, -0.89; AAPCASDR of kidney cancer, -1.11; AAPCASMR of PCa, -2.10; AAPCASDR of PCa, -1.97). The burden was higher among males than females, with the highest burden observed in high-SDI regions. The ASMR and ASDR were found to have a non-linear positive correlation with SDI (RASMR of bladder cancer=0.574, p<0.001; RASDR of bladder cancer=0.580, p<0.001; RASMR of kidney cancer=0.792, p<0.001; RASDR of kidney cancer=0.783, p<0.001; RASMR of PCa=0.417, p<0.001; RASDR of PCa=0.436, p<0.001), although the greatest improvements over the past three decades were observed in high-SDI regions. Joinpoint regression analysis indicated a downward trend in global deaths and DALYs burden, and the ARIMA model predicted that the burden of related diseases will continue to decline through 2041 (ASMRbladder cancer=0.44; ASDRbladder cancer=8.56; ASMRkidney cancer=0.13; ASDRkidney cancer=2.82; ASMRPCa=0.28; ASDRPCa=4.28).

CONCLUSIONS

Smoking has imposed a substantial disease burden on urological cancers over the past three decades. While overall ASDR and ASMR are declining, the disease burden remains high among men, especially those in high-SDI areas. This emphasizes the need for increased tobacco control for these populations or regions.

Global burden of low back pain from 1990 to 2021: a comprehensive analysis of risk factors and trends using the Global Burden of Disease Study 2021

BACKGROUND

This study comprehensively assesses low back pain-related risk factors and the global burden from a multi-dimensional perspective, aiming to provide scientific evidence for disease prevention.

METHODS

Data from the Global Burden of Disease (GBD) database spanning from 1990 to 2021 were incorporated into this study. We conducted an analysis of baseline data, as well as gender and age subgroup data. Additionally, we introduced the Age-Period-Cohort (APC) and decomposition analysis models to clarify the independent effects of factors such as age, period, cohort, population growth, population aging and changes in epidemiological trends on the disease burden. The Estimated Annual Percentage Change (EAPC) was used to measure the temporal trends of health indicators. To enhance practical applicability, we constructed a model that integrates frontier analysis with health inequality assessment. Furthermore, the Autoregressive Integrated Moving Average (ARIMA) model was employed to forecast trends in LBP over the next 15 years.

RESULTS

In 2021, the global age-standardized prevalence of low back pain decreased by 11.06% compared to that in 1990. However, the number of affected individuals increased from 386.7 million to 628.8 million. Concurrently, the age-standardized Disability-Adjusted Life Years (DALYs) rate declined by 11.22% relative to 1990, while total DALYs rose from 43,386,225 to 70,156,962. The results derived from multiple models indicate that higher socio-demographic index levels, advancing age, female sex and occupational ergonomics-related factors may contribute to disparities in the burden of low back pain. Furthermore, this unequal health gap appears to be widening over time.

CONCLUSIONS

Disease burden of low back pain exhibit varying manifestations across different regions and temporal dimensions. Higher levels of the Socio-Demographic Index(SDI), increasing age, female gender and adverse occupational ergonomic factors may be important risk elements for the burden of low back pain. Meanwhile, certain changes in epidemiological trends may alleviate this burden to some extent. In the absence of effective intervention measures, the gaps in health inequality engendered by the aforementioned diverse factors are likely to expand continuously. In light of this, it is crucial to actively develop systematic, comprehensive and targeted health prevention strategies.

Efficacy of early rehabilitation nursing on the prognosis of China stroke patients: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

The efficacy of early rehabilitation care on stroke patients was evaluated to determine the start time of early rehabilitation nursing.

DESIGN

Seventeen randomized controlled trials (RCTs) on the effect of early rehabilitation care on stroke patients were included.

METHODOLOGY

Four databases were comprehensively searched for RCTs concerning the efficacy of early rehabilitation care on stroke patients. Stata 15.1 was employed for statistical analysis.

DATA SOURCES

Embase, PubMed, Cochrane, and Web of Knowledge were searched to identify RCTs published from inception to December 1, 2023, with the language restricted to English.

RESULTS

Early rehabilitation care notably mitigated neurologic impairments, anxiety, depression, and cognitive disorders, and ameliorated the functional status of daily activities and upper and lower limb functions, increasing patient satisfaction and decreasing the incidence of complications in stroke patients.

CONCLUSIONS

Early rehabilitation nursing within 24 and 48 h can ameliorate the prognosis and quality of life of stroke patients.

Anti-aging protein α-Klotho is potential for reducing comorbidity risk of cardiometabolic diseases in vulnerable populations and enhancing long-term prognosis

This study investigated the impact of anti-aging protein α-Klotho on cardiometabolic diseases (CMDs) among middle-aged and elderly population. A total of 11,198 participants aged 40-79 years were included in the National Health and Nutrition Examination Survey (NHANES) spanning 2007-2016. Serum α-Klotho levels were quantified via enzyme-linked immunosorbent assays. CMDs comprised cardiovascular disease (CVD), and four metabolic disorders: type 2 diabetes (T2DM), obesity, chronic kidney disease (CKD), and non-alcoholic fatty liver disease (NAFLD). Weighted logistic regression analysis, subgroup analysis, mediation analysis, restricted cubic splines (RCS), and Cox proportional hazards regression analysis were used. α-Klotho exhibited negative associations with each single CMD except T2DM, and RCS showed U-shape and L-shape dose-response relationships of α-Klotho with risk of T2DM and CKD, respectively. Ordered logistic regression analysis revealed that higher levels of Klotho markedly reduced the cumulative number of metabolic comorbidities complicating CVD (OR 0.56 (0.35, 0.91)). Simple mediation analysis showed CKD may explain up to 20.42% of the association between Klotho and CVD. Notably, α-Klotho's association with cardiometabolic comorbidities was particularly evident among individuals who were widowed/divorced/separated, non-Hispanic Black, lower-income, or less educated, with hypertension, current smokers, lower leisure and commuting physical activity, but higher work-related physical activity. Regarding long-term effects, higher α-Klotho levels were associated with lower all-cause mortality among participants with CMDs, but not among those without CMDs. Higher α-Klotho levels were associated with lower CMD prevalence, particularly in high-risk cardiovascular populations with lower socioeconomic status and unfavorable lifestyles and reduced all-cause mortality risk among CMD patients.

HDAC inhibitors: Cardiotoxicity and paradoxical cardioprotective effect in ischemia-reperfusion myocardiocyte injury

Histone deacetylase inhibitors (HDACIs) are epigenetic drugs that regulate the acetylation status of histones and non-histone proteins, thereby leading to chromatin remodeling and transcriptional regulation of key apoptotic and cell cycle regulatory genes. There are currently five HDACIs clinically approved by the major regulatory authorities for treating hematological cancers, primarily as monotherapy. While HDACIs have been particularly effective in T-cell lymphomas, their clinical efficacies have not yet extended to solid tumors. The development of HDACIs continues, including for the treatment of a non-malignant conditions, with givinostat recently approved by the US FDA. However, the early development of HDACIs was limited by concerns about cardiotoxicity including QT interval prolongation. Yet, paradoxically, the latest research suggests some cardioprotective effect of HDACIs in ischemic heart disease or heart failure. This review presents the latest update about the cardiotoxicity of the clinically approved HDACIs. The mechanisms leading to HDACI-induced cardiotoxic adverse events and clinical strategies for their management are discussed. We will also deliberate the potential repurposing use of HDACIs and their HDAC isoform selectivity for treating ischemia-reperfusion cardiac muscle injury, cardiac hypertrophy, and fibrosis.

Perfluoroalkyl and polyfluoroalkyl substances interact with platelet glycoprotein Ibα and exacerbate thrombosis

Perfluoroalkyl and polyfluoroalkyl substances (PFAS) are highly stable man-made chemicals. They have recently garnered significant attention due to their ubiquitous presence in the environment and deleterious effects on human health including cardiovascular diseases (CVDs). Thrombosis due to platelet activation is a major aspect in CVDs. However, the direct effect and underlying mechanism of PFAS on the platelets remains elusive. Here, we observed that PFAS engagement with the extracellular domain of platelet GPIbα, transduced GPIbα-driven inward signals, resulting in intracellular calcium mobilization, activation of Akt and αⅡbβ3 integrin, culminating in platelet aggregation and procoagulant platelet formation. PFAS pretreatment enhanced GPIb-mediated platelet spreading and thrombus formation under high shear conditions. PFAS-induced platelet activation was markedly decreased in Gpibα-deficient mice. PFAS-primed platelets drove neutrophil extracellular traps formation through GPIbα-dependent pathway. Further, PFAS-exposed mice showed heightened risk of thrombus growth and ischemic stroke. Our findings provide experimental evidence for the causal links between PFAS exposure and thrombotic CVDs. Blockade of GPIbα and the downstream pathways could be an instrumental strategy against PFAS-induced platelet activation and thrombosis.

Genetic Insights Into Hemorrhagic Stroke and Vascular Malformations: Pathogenesis and Emerging Therapeutic Strategies

Brain arteriovenous malformations (AVMs), cerebral cavernous malformations (CCMs), and intracranial aneurysms are major causes of hemorrhagic stroke, yet noninvasive therapies to prevent growth or rupture are lacking. Understanding the genetic basis of these malformations is critical for uncovering underlying mechanisms, developing targeted prevention strategies, and identifying novel therapeutic targets. This review highlights the causal genes and signaling pathways in AVMs, CCMs, and intracranial aneurysms, noting both their commonalities and differences. For AVMs, somatic mutations in the RAS (rat sarcoma virus)/MAPK (mitogen-activated protein kinase) and MAPK/ERK (extracellular signal-regulated kinase) pathway are key, particularly in sporadic cases, whereas hereditary conditions like hereditary hemorrhagic telangiectasia and capillary malformation-AVM involve the TGF-β (transforming growth factor β), Ephrin receptor, and angiopoietin-VEGF (vascular endothelial growth factor) signaling pathways. In CCMs, pathways affecting endothelial junctions and vascular stability, such as the ROCK (RhoA/Rho-associated coiled-coil containing kinases) pathway, play a central role. Although the genetic drivers of intracranial aneurysms are more diverse and less clearly linked to specific pathways, there is some overlap with genes in the TGF-β and endothelial function pathways seen in AVMs and CCMs. Emerging therapies for AVMs and CCMs include MAPK/ERK inhibitors, anti-VEGF treatments, and RhoA/ROCK inhibitors, showing potential in preclinical models. Due to the genetic overlap, these advancements may also offer future therapeutic strategies for intracranial aneurysms. As personalized medicine progresses, the development of reliable biomarkers, such as the candidate biomarker VEGF for AVMs and CCMs, will be crucial for guiding treatment decisions. In conclusion, ongoing research into genetic pathways holds promise for novel therapeutic targets that could transform the management of vascular malformations and reduce the risk of hemorrhagic stroke.

AhR Activation at the Air-Blood Barrier Alters Systemic microRNA Release After Inhalation of Particulate Matter Containing Environmentally Persistent Free Radicals

Particulate matter containing environmentally persistent free radicals (EPFRs) is formed when organic pollutants are incompletely burned and adsorb to the surface of particles containing redox-active metals. Our prior studies showed that in mice, EPFR inhalation impaired vascular relaxation in a dose- and endothelium-dependent manner. We also observed that activation of the aryl hydrocarbon receptor (AhR) in the alveolar type-II (AT-II) cells that form the air-blood interface stimulates the release of systemic factors that promote endothelial dysfunction in vessels peripheral to the lung. AhR is a recognized regulator of microRNA (miRNA) biogenesis, and miRNA control diverse signaling pathways. We thus hypothesized that systemic EPFR-induced vascular endothelial dysfunction is initiated via AhR activation in AT-II cells, resulting in a systemic release of miRNA. Using a combustion reactor, we generated EPFR of two free radical concentrations-EPFRlo (1016-17 radicals/g particles) and EPFR (1018-19 radicals/g)-and exposed mice by inhalation. EFPR inhalation resulted in changes in a distinct array of miRNA in the plasma, and these miRNAs are linked to multiple systemic effects, including cardiovascular diseases and dysregulation of cellular and molecular pathways associated with cardiovascular dysfunction. We identified 17 miRNA in plasma that were altered dependent upon both AhR activation in AT-II cells and ~ 280 ug/m3 EPFR exposure. Using Ingenuity Pathway Analysis, we found that 5 of these miRNAs have roles in modulating endothelin-1 and endothelial nitric oxide signaling, known regulators of endothelial function. Furthermore, EPFR exposure reduced the expression of lung adherens and gap junction proteins in control mice but not AT-II-AhR deficient mice, and reductions in barrier function may facilitate miRNA release from the lungs. In summary, our findings support that miRNA may be systemic mediators promoting endothelial dysfunction mediated via EPFR-induced AhR activation at the air-blood interface.

Applications of Gene Editing and Nanotechnology in Stem Cell-Based Therapies for Human Diseases

Stem cell research is a dynamic and fast-advancing discipline with great promise for the treatment of diverse human disorders. The incorporation of gene editing technologies, including ZFNs, TALENs, and the CRISPR/Cas system, in conjunction with progress in nanotechnology, is fundamentally transforming stem cell therapy and research. These innovations not only provide a glimmer of optimism for patients and healthcare practitioners but also possess the capacity to radically reshape medical treatment paradigms. Gene editing and nanotechnology synergistically enhance stem cell-based therapies' precision, efficiency, and applicability, offering transformative potential for treating complex diseases and advancing regenerative medicine. Nevertheless, it is important to acknowledge that these technologies also give rise to ethical considerations and possible hazards, such as inadvertent genetic modifications and the development of genetically modified organisms, therefore creating a new age of designer infants. This review emphasizes the crucial significance of gene editing technologies and nanotechnology in the progress of stem cell treatments, particularly for degenerative pathologies and injuries. It emphasizes their capacity to restructure and comprehensively revolutionize medical treatment paradigms, providing fresh hope and optimism for patients and healthcare practitioners.

Global burden of type 2 diabetes attributable to secondhand smoke: a comprehensive analysis from the GBD 2021 study

Introduction

Secondhand smoke (SHS) exposure represents an underappreciated global health risk for type 2 diabetes mellitus (T2DM), with complex epidemiological implications.

Methods

Leveraging the comprehensive Global Burden of Disease (GBD) 2021 dataset, we systematically evaluated the worldwide burden of type 2 diabetes mellitus attributable to secondhand smoke (T2DM-SHS) across 204 countries. The analysis encompassed both death and disability-adjusted life years (DALYs) across various genders, age groups, and 204 nations over the period from 1990 to 2021. We examined trends and socioeconomic impacts by analyzing age-standardized DALYs rates and estimated annual percentage changes, stratified by socio-demographic Index (SDI) quintiles.

Results

The following changes occurred between 1990 and 2021: while age-standardized mortality rates decreased by 8.903% (95% UI: -16.824% to -1.399%), DALYs increased by 17.049% (95% UI: 9.065% to 25.557%). Age-stratified analysis revealed peak death in the 70-74 years group, with females experiencing highest DALYs in the 75-79 years group and males in the 90-94 years group. An inverted U-shaped relationship between SDI and disease burden emerged, with peak rates at moderate SDI levels.

Discussion

Despite lowest burdens in high-income countries, disease dynamics were most complex in middle-range SDI countries, indicating that economic development does not linearly correlate with health outcomes. This comprehensive analysis unveils the multifaceted global landscape of T2DM-SHS, exposing critical disparities across gender, age, and socioeconomic contexts. The findings urgently call for targeted, context-specific public health interventions, particularly in low- and middle-income countries, to mitigate the escalating T2DM-SHS burden.

Path analysis of the influence of digital health literacy on self-management behaviour among elderly patients with chronic diseases in rural China

BACKGROUND

Chronic disease self-management is very important for the progression and treatment of diseases worldwide. The management of chronic diseases among elderly individuals in rural areas is an urgent public health concern in China. The purpose of this study was to investigate the relationship between digital health literacy and chronic disease self-management behaviour in elderly Chinese patients with chronic diseases in rural areas, as well as the chain mediating effects of social support and depression. The objective was to provide a scientific basis for improving the active health behaviour of rural elderly patients with chronic diseases in China and worldwide.

METHODS

Using convenience sampling, the survey subjects were elderly patients with chronic diseases in rural areas of Anhui Province, China. A self-designed questionnaire was used to collect general survey data, digital health literacy scale scores, social support scale scores, depression scale scores, and chronic disease self-management behaviour scale scores. Common method bias tests, descriptive statistics and correlation analyses were performed via SPSS 29.0. The structural equation model was constructed and tested via AMOS 27.0. Differences for which p < 0.05 were considered statistically significant.

RESULTS

In all, 202 elderly patients with chronic diseases who resided in rural areas were enrolled. The digital health literacy score was 39.25 ± 9.00, and the chronic disease self-management behaviour score was 27.82 ± 9.56. The self-management behaviours of rural elderly patients with chronic diseases were positively correlated with digital health literacy and social support and were negatively correlated with depression (p < 0.01). After the mediating effect test, the total indirect effect value of social support and depression was 0.167, which accounted for 36.07% of the total effect. Among them, social support and depression were partial mediators of digital health literacy and chronic disease self-management behaviour, with effect values of 0.055 (95% CI: 0.012, 0.127) and 0.094 (95% CI: 0.024, 0.201), which accounted for 11.88% and 20.3% of the total effect, respectively. Social support and depression were chain mediators of digital health literacy and chronic disease self-management behaviour, with an effect value of 0.018 (95% CI: 0.004, 0.055) and an effect share of 3.89%.

CONCLUSION

The self-management level of elderly patients with chronic diseases in rural China is low. Digital health literacy not only directly affects the chronic disease self-management behaviour of elderly individuals but also indirectly predicts chronic disease self-management behaviour through the mediating effects of social support and depression.

From chronic obstructive pulmonary disease (COPD) to lung cancer: a Mendelian randomization study revealing mediation pathways through plasma metabolomics, proteomics, and immunophenotyping

BACKGROUND

Chronic obstructive pulmonary disease (COPD) and lung cancer are pathologically intertwined, with chronic inflammation fostering carcinogenic transformation through dynamic interactions in the tumor microenvironment.

METHODS

This investigation utilized a comprehensive two-sample Mendelian randomization (MR) approach on public genetic datasets to mitigate confounding and determine causality between COPD and lung cancer. We integrated 1400 plasma metabolite characteristics (N = 8299), 731 immune cell attributes (N = 3757), and 4907 plasma protein characteristics (N = 35,559), employing two-sample MR to deduce causal correlations with lung cancer. Sensitivity assessments were executed to fortify the robustness of MR outcomes. Finally, Mendelian mediation analysis was administered to delineate the pathways mediated by plasma immune cells, metabolites, and proteins in the COPD-to-lung cancer continuum. Additionally, we validated our findings using external datasets from the NHANES and TCGA databases to further confirm the reliability of the results.

RESULTS

MR analysis confirmed COPD as a causal risk factor for lung cancer (IVW P-value = 1.38 × 10-5, OR = 1.63(1.31-2.02). We recognized 96 plasma metabolites (comprising 77 distinct metabolites and 19 ratios), 30 immune cell categories, and 58 plasma proteins as having putative causal associations with lung cancer. Mediation analysis revealed 9 mediator interactions, implicating 3 immune cell types, 1 metabolite, and 5 proteins, Sensitivity analyses verified homogeneity and negated pleiotropic effects.

CONCLUSION

Our genetic inquiry endorses a causal link from COPD to lung cancer, mediated through plasma-based immunological, metabolic, and proteomic mechanisms. These biomarkers afford groundbreaking insights into the etiology of lung cancer, facilitating its prophylaxis, diagnosis, and therapeutic interventions.

Modeling the economic and health impact of substandard uterotonics in Senegal

BACKGROUND

Maternal mortality due to postpartum hemorrhage (PPH) remains a global concern especially in low- and lower-middle income countries. PPH is preventable with quality-assured uterotonics. However, substandard uterotonics pose a significant risk to PPH, and there is limited evidence available to provide quantitative estimates of their economic impact. This study aims to evaluate the impact of ensuring uterotonic quality in Senegal, highlighting the potential to lower healthcare costs, reduce maternal deaths, and contribute to achieving Sustainable Development Goals related to maternal health and Universal Healthcare Coverage.

METHODS

We utilized a decision tree model to estimate the economic and health impact of improving the quality of uterotonics in prevention of PPH in Senegal. We simulated women giving birth in various healthcare settings, receiving uterotonics of varied quality, and subsequent PPH-related outcomes. Data from the Senegal Demographic and Health Survey, Cochrane review, and E-MOTIVE trial informed the model. We compared scenarios with and without substandard uterotonics, along with scenarios altering uterotonic usage and care-seeking behavior.

RESULTS

Our findings indicate that utilizing quality-assured uterotonics in Senegal could lead to a notable 7-9% reduction in the overall economic burden of PPH, saving over 1 million USD annually in direct costs and long-term productivity losses. Improving the quality of uterotonics in Senegal would result in a 6-8% reduction in PPH cases, translating to over 5,000 fewer PPH cases annually. Using quality uterotonics instead of substandard ones also decreased deaths from PPH by 6-8% annually.

CONCLUSIONS

This study underscores the importance of ensuring uterotonic quality to showcase significant cost savings and improvements in maternal health outcomes in Senegal. The accrued cost savings from improved maternal health outcomes related to PPH prevention and treatment would greatly benefit mothers, their families, healthcare providers, and the healthcare system. This case study offers valuable insights into improving the quality of maternal care and achieving more efficient resource allocation to advance Senegal's progress towards Universal Health Coverage.

Factors Determining the Burden of a Caregiver Providing Care to a Post-Stroke Patient

Background: Physical, emotional, psychological, and social factors influence the high level of burden of a caregiver providing care for a patient at home after a stroke. The purpose of this study was to identify and evaluate factors influencing the high level of burden on the caregiver providing care for a post-stroke patient, including factors on the part of the patient and caregiver. Methods: This cross-sectional study was conducted at the Neurological Rehabilitation Department of the Hospital Beskid Treatment and Rehabilitation Complex in Jaworze, Poland, and the Neurological Rehabilitation Department of the Railway Hospital in Wilkowice-Bystra. The study participants comprised post-stroke patients and their family caregivers (during visits to hospital), 110 pairs. The measures for caregivers were such as the following: Beck Depression Inventory, the Polish adaptation of the Perceived Stress Scale, the Polish adaptation of the Mini-COPE questionnaire to measure stress coping strategies, and the WHO Quality of Life Brief Version. The measures for patients were such as the following: the modified Rankin Scale and Abbreviated Mental Test Score to assess functional capacity for simple Activities of Daily Living (ADL). All statistical calculations were performed using the R statistical package version 4.4.2. Results: A high caregiver burden was found in 30 people (27.3%). Logistic regression analysis proved that low quality of life, stress, caregiver-triggered strategies (discharge and cessation of activities), caregiver frustration, psychological burden, financial situation, longer time spent on patient care, functional status (ADL) on the part of the patient, judgment of significant degree of disability judgment, and age of the patient are determinants affecting high caregiver burden levels. Conclusions: Almost 1/3 of caregivers experienced a high burden when taking care of a person after stroke. Analyzing the Gini index, from the model's point of view, quality of life is the most important characteristics, and caregiver frustration is the least important, which influences the high level of caregiver burden.

Age-period-cohort analysis of autism spectrum disorders-related prevalence and DALYs: based on the Global Burden Of Disease Study 2021

Background

The Sustainable Development Goals (SDGs) call for systematic monitoring to optimize child development outcomes. As a developmental disorder affecting children and adults, Autism Spectrum Disorder (ASD) not only impacts individual social functioning but also places a burden on families and society. A detailed analysis of the latest global burden data on ASD can assist stakeholders in formulating support policies and interventions, thereby helping to meet the health needs of ASD.

Methods

We used data from the Global Burden of Disease Study 2021 (GBD 2021), compiled by the Institute for Health Metrics and Evaluation (IHME). Data were obtained through the Global Health Data Exchange (GHDx) and covered 204 countries and territories from 1990 to 2019. Variables included ASD-related prevalence, mortality, disability-adjusted life years (DALYs), age-standardized rates, and the sociodemographic index (SDI).

Results

Exposure to autism spectrum disorders contributed to 61823540 prevalence and 11544038 DALYs globally in 2021. Males and younger adults were high-risk populations. Higher socio-demographic index (SDI) regions were high-risk areas. The disease burden varied considerably across the GBD regions and the countries. From 1990 to 2021, the number of cases increased. The predicted results showed that the disease burden for both genders would still increase from 2022 to 2046. Countries or regions with a higher SDI have greater burden improvement potential.

Conclusion

The global burden of ASD has shown a continuous upward trend, with some differences observed across gender, age groups, and SDI regions. In terms of gender, the burden of ASD among females may be underestimated. Regarding age groups, the aging process has highlighted the urgent need to address ASD in the elderly population. High-SDI regions should place greater emphasis on improving diagnostic methods and implementing precise interventions, while middle- and low-SDI regions should focus on raising public awareness and enhancing screening capabilities.

Exploring Therapeutic Potential of Bi-Qi Capsules in Treatment of Gout by Discovering Crucial Drug Targets

Objectives: This research aims to explore the therapeutic potential of Bi-Qi capsules in the treatment of gout by identifying crucial drug targets through a multidimensional data analysis strategy. Methods: Bi-Qi capsule drug targets and differentially expressed genes (DEGs) of gout were derived from public databases, such as Swiss Target Prediction, STITCH, and the GEO database. Subsequently, the overlapped targets were analyzed to elucidate the potential therapeutic mechanism and to identify candidate targets of Bi-Qi capsules against gout. Next, Mendelian randomization (MR) analysis was employed to screen and explore the causal relationship between candidate targets and gout. Finally, single-cell RNA sequencing (scRNA-seq), gene set enrichment analysis (GSEA), transcription factor and ceRNA regulatory networks, and molecular docking were performed to validate the role of the crucial targets of Bi-Qi capsules in the treatment of gout. Results: A total of 46 candidate targets were identified, in which KCNA5, PTGS2, and TNF exhibited significant causal relationships with gout (p < 0.05) and were regarded as the crucial targets. Through scRNA-seq and gene labeling, crucial targets were found to be expressed in eighteen cell clusters and eight cell types, which are closely associated with carbohydrate metabolism, nerve conduction, and the innate immunity process. Bi-Qi capsule active compounds such as tanshinone IIA, strychnine, tanshinaldehyde, cryptotanshinone, tumulosic acid, and glycyrrhetic acid exhibit a better binding ability to crucial targets. Conclusions: The results not only elucidate the anti-gout mechanism of Bi-Qi capsules but also provide an insight into multi-target natural medication for metabolic disease treatment, which contributes to guiding the clinical application of Bi-Qi capsules in the future.

PM2.5 exposure modifies the association of physical activity with depressive symptoms and glaucoma in middle aged and elderly Chinese

It remains unclear that trade-off between the benefits of regular physical activity (PA) and the potentially harmful effects of exposure to PM2.5 (particulate matter with aerodynamic diameter < 2.5 μm) in highly polluted regions. Therefore, we aimed to investigate the modification of PM2.5 on the associations of PA volume and intensity with depressive symptoms and glaucoma in individuals with or without depressive symptoms. Data of this study was obtained from the China Health and Retirement Longitudinal Survey (CHARLS) implemented during 2011 to 2020. PA volume and intensity were measured by a standardized questionnaire; a machine learning prediction model was applied to ascertain the PM2.5 concentrations. Cox proportional hazards regression models were employed to explore associations. A total of 20,930 participants were finally included, with 11,214 analyzed for PA and depressive symptom risk and 16,965 analyzed for PA and glaucoma risk. PA volume or intensity was independent protective factor for incident depressive symptoms, while PM2.5 was independent risk factor for depressive symptoms and glaucoma in participants with or without depressive symptoms. Among participants with low PM2.5 exposure (< 35 micrograms per cubic meter [µg/m3]), PA volume or intensity showed an inverse association with the risk of incident depressive symptoms, but insignificant associations between PA volume or intensity and glaucoma risk were observed in either participants with or without depressive symptoms. Among participants with high PM2.5 exposure (≥ 35 µg/m3), higher PA volume or intensity increased the risks of depressive symptoms and glaucoma. Higher PA level was associated with a reduced risk of depressive symptoms only among participants with low PM2.5 exposure, and higher PA did not decrease the risk of glaucoma regardless of PM2.5 level. Our findings recommend regular PA to prevent depressive symptoms in less polluted regions and reinforce the importance of air quality improvement.

Prevalence and network structure of depression and its association with quality of life among older stroke survivors: findings from a national survey in China

Background

Post-stroke depression (PSD) is a common neuropsychiatric problem associated with a high disease burden and reduced quality of life (QoL). To date, few studies have examined the network structure of depressive symptoms and their relationships with QoL in stroke survivors.

Aims

This study aimed to explore the network structure of depressive symptoms in PSD and investigate the interrelationships between specific depressive symptoms and QoL among older stroke survivors.

Methods

This study was based on the 2017-2018 collection of data from a large national survey in China. Depressive symptoms were assessed using the 10-item Centre for Epidemiological Studies Depression Scale (CESD), while QoL was measured with the World Health Organization Quality of Life-brief version. Network analysis was employed to explore the structure of PSD, using expected influence (EI) to identify the most central symptoms and the flow function to investigate the association between depressive symptoms and QoL.

Results

A total of 1123 stroke survivors were included, with an overall prevalence of depression of 34.3% (n=385; 95% confidence interval 31.5% to 37.2%). A higher risk of PSD was significantly associated with limited activities of daily living (odds ratio (OR)=1.340; p=0.048), presence of heart diseases (OR=1.589; p=0.002) and more severe anxiety symptoms (OR=1.472; p<0.001). In the network model of depression, the most central symptoms were CESD3 ('feeling blue/depressed', EI: 1.180), CESD6 ('feeling nervous/fearful', EI: 0.864) and CESD8 ('loneliness', EI: 0.843). In addition, CESD5 ('hopelessness', EI: -0.195), CESD10 ('sleep disturbances', EI: -0.169) and CESD4 ('everything was an effort', EI: -0.150) had strong negative associations with QoL.

Conclusion

This study found that PSD was common among older Chinese stroke survivors. Given its negative impact on QoL, appropriate interventions targeting central symptoms and those associated with QoL should be developed and implemented for stroke survivors with PSD.

Disrupted Hierarchical Functional Brain Organization in Affective and Psychotic Disorders: Insights from Functional Brain Gradients

Patients with psychosis and depression show widespread alterations in brain resting-state functional connectivity (rs-FC), affecting both sensory and higher-order brain regions. In this study, we investigate disruptions in the hierarchical organization of brain functional networks in patients with psychotic and affective disorders. We derived functional brain gradients, low dimensional representations of rs-FC that capture cortical hierarchy, in a large patient sample including clinical high-risk for psychosis (CHR-P) patients, recent-onset psychosis (ROP) patients, recent-onset depression (ROD) patients, and healthy controls (HC). We examined regional alterations, network-level alterations and functional differentiation and their relationship to clinical symptoms. In addition, we linked case-control differences to receptor expression maps to explore underlying neurobiological mechanisms. All patient groups exhibited alterations in the visual-to-sensorimotor gradient, while only ROP patients showed alterations in the association-to-sensory gradient. CHR-P and ROP patients exhibited lower values in the ventral attention network. Additionally, patients combined showed higher values in the somatomotor network, a reduced gradient range and altered between-network dispersion. ROD showed reduced within-network dispersion in the attentional networks and a reduced range. Correlational analysis revealed weak associations of gradient measures with functioning, visual dysfunctions and cognition. Furthermore case-control differences showed associations to receptor expression maps, suggesting the involvement of neurotransmitter systems in these disruptions. Our findings reveal transdiagnostic and disease-specific alterations of hierarchical brain organization. These alterations indicate deficits in functional integration across psychiatric diseases, highlighting the role of attentional and sensory networks in disease processes.

Joint modeling of multistate survival processes with informative examination scheme: application to progressions in diabetes

BACKGROUND

Multistate survival models (MSMs) are widely used in the medical field of clinical studies. For example, in type 2 diabetes mellitus (T2D), these models can be applied to describe progression in T2D by predefining several T2D states based on available biometric measurements such as hemoglobin A1 C (HbA1c). In most cases, MSMs come with an assumption that the examination process is independent of disease progression. However, in practice, complete independence between disease progression and examination processes is unrealistic, as the frequency at which a patient accesses healthcare may vary based on treatment and/or control of the health condition.

METHODS

We built a joint model of a 4-state transition process of T2D with informative examination scheme (i.e., the patterns of examination times are not random). Risk factors including age, sex, race, and socioeconomic disadvantage were included in a log-linear model examining T2D transition intensities and healthcare visit frequencies. Parameters of the joint model are estimated under the framework of likelihood function by the expectation-maximization (EM) algorithm.

RESULTS

The joint model demonstrated that people living in neighborhoods with greater socioeconomic disadvantage had a lower healthcare visit frequency under all 4 defined T2D statuses. Evaluation of race/ethnicity revealed that comparing to non-Hispanic White patients, Black patients had higher risk for progressing from Normal to Prediabetes, T2D, and Uncontrolled T2D states.

CONCLUSIONS

Our joint model offers a framework for analyzing multistate survival processes while accounting for the dependence between disease progression and examination frequency. Unlike traditional MSMs that estimate only transition intensities, our model captures variations in healthcare visit frequencies across different disease states, providing a more comprehensive understanding of disease dynamics and healthcare access patterns.

Cardiovascular disease in adolescents and young adults in Mexico: Secondary analysis of the 2021 global burden of disease study

BACKGROUND AND AIMS

To analyse the burden of young-onset cardiovascular disease (CVD) in Mexico for the years 1990 and 2021, as well as trends from 1990 to 2021, and to evaluate its association with the sociodemographic index (SDI) and the Healthcare Access and Quality Index (HAQI).

METHODS

A secondary analysis of data from the Global Burden of Disease (GBD) study was conducted, stratified by sex, age groups, states, and CVD subcauses. Metrics included mortality, years of life lost (YLL), years lived with disability (YLD), and disability-adjusted life years (DALY).

RESULTS

There was an increase in age-standardized young-onset CVD DALY rates in men and a decrease in women. The leading causes of young-onset CVD deaths were ischemic heart disease, and stroke. Males showed a higher burden for all CVD causes, except for rheumatic heart disease and pulmonary arterial hypertension. The burden of premature mortality was higher in men, while disability was more pronounced in women. Complex associations were observed between SDI, HAQI, and CVD burden, highlighting a heterogeneous situation among Mexican states.

CONCLUSIONS

Recognizing the unique cardiovascular profiles of young men and women and effectively engaging them in healthcare systems may lead to targeted interventions that reduce risk factors, improve health outcomes, and further decrease the burden of young-onset CVD in Mexico.

Relationship between life's essential 8, vitamin D, and cardiometabolic outcomes

AIMS

To assess the association between cardiovascular health (CVH) and cardiometabolic outcomes and the impact of vitamin D on the relationship. Additionally, we seek to analyze the predictive ability of CVH metrics for cardiometabolic outcomes.

METHODS

This cross-sectional study included 21,913 adult participants of the National Health and Nutrition Examination Survey (2007-2018). Logistic regression models and restricted cubic spline curves were employed to evaluate the association between CVH and cardiometabolic outcomes and analyze the influence of vitamin D on the relationship. Receiver operating characteristic curves were used to assess the predictive ability of CVH metrics for cardiometabolic outcomes.

RESULTS

The study included 21,913 participants, among whom 6193 (28.3%) were classified as having low CVH, 14,080 (64.3%) as having moderate CVH, and 1640 (7.5%) as having high CVH. CVH scores were significantly negatively correlated with cardiometabolic outcomes. Among the CVH metrics, blood glucose and blood pressure had higher predictive values for cardiovascular disease, chronic kidney disease, hypertension, and diabetes. Additionally, there was a significant interaction between CVH and vitamin D.

CONCLUSION

These findings underscore that higher CVH scores, assessed by Life's Essential 8, are associated with lower risks of cardiometabolic outcomes. Improving CVH contributes to reducing the burden of disease and promoting human health.

Disease Burden, Temporal Trends, and Cross-Country Inequality Associated with Sociodemographic Indicators in Alzheimer's Disease and Other Dementias

INTRODUCTION

The purpose of this article is to describe the global burden and temporal trends of Alzheimer's disease and other dementias from 1990 to 2021 and explore cross-country inequality associated with sociodemographic development-related factors.

METHODS

The disability-adjusted life years of Alzheimer's disease and other dementias and sociodemographic index were extracted from the Global Burden of Disease 2021 study, and other sociodemographic development-related factors, including government expenditure on education (% of GDP), net national income per capita, health expenditure per capita, and fertility rate, were sourced from World Bank Data. Disability-adjusted life years of Alzheimer's disease and other dementias across 204 countries/territories and global age-sex distribution in 2021 were illustrated. The Joinpoint regression model was used to analyze the temporal trends of disease burden, and the slope index of inequality and concentration index were calculated to quantify cross-country inequalities. Analyses were conducted in 2024.

RESULTS

Significant disparities were observed in the numbers, rates, and age-standardized rates of disability-adjusted life years across 204 countries/territories. Females demonstrated higher disability-adjusted life year numbers (rates) for all age groups. Age-standardized disability-adjusted life year rate increased worldwide and was high in high-middle and middle sociodemographic index regions but increased faster in low (average annual percentage change=0.227%) and low-middle (average annual percentage change=0.244%) sociodemographic index regions. Cross-country inequality analyses indicated that disability-adjusted life years of Alzheimer's disease and other dementias were skewed and higher in countries with higher sociodemographic development, and the inequality increased with time except for education expenditure-related inequality.

CONCLUSIONS

The burden of Alzheimer's disease and other dementias has risen globally over the past 3 decades, accompanied by increasing cross-country inequalities, which disproportionately affects countries with high sociodemographic development. Boosting expenditure on education may narrow this inequality.

Exploring the Impact of Cognitive Dysfunction During Recurrent Depression in a Sample of Mid-to-Older Age British South Asians: A Qualitative Study

INTRODUCTION

Depression is a major public health issue, increasing the risk of comorbidities. Some people with depression experience cognitive dysfunction, which can persist even after symptomatic recovery. British South Asians are at greater risk of developing depression and are less likely to seek treatment. It is important to understand their experience of subjective cognitive dysfunction in depression and how best to support them.

AIMS

This study explored subjective experience of cognitive dysfunction during recurrent depression, in a sample of 12 British South Asians aged between 45 and 60 years.

METHODS

We conducted semi-structured interviews to explore cognitive dysfunction during recurrent depression. We analysed the data using thematic analysis.

RESULTS

Difficulties in attention and concentration resulted in lower quality of social relationships, including not feeling present and social isolation. Learning new information was difficult, thus impacting productivity. Participants found it difficult to engage in enjoyable activities that promoted brain health. The emotional, physical and spiritual impact negatively impacted on quality of life.

DISCUSSION

Cognitive strategies used in therapies could improve brain health and functional recovery in people living with depression.

IMPLICATIONS

Mental health nurses play a pivotal role in providing culturally appropriate information and strategies for managing cognitive dysfunction in recurrent depression.

Global Burden of Traumatic Brain Injury in 204 Countries and Territories From 1990 to 2021

INTRODUCTION

This study aimed to evaluate the burden and underlying causes of traumatic brain injury (TBI) in 204 countries and territories from 1990 to 2021.

METHODS

Utilizing data from the Global Burden of Disease 2021 study, which derived estimates of TBI burden from hospital and emergency department records, national surveys, and claims data, the incidence, prevalence, and years lived with disability (YLDs) associated with TBI were analyzed. A comparative analysis of TBI burden by location, age, sex, and sociodemographic index was performed, along with an underlying assessment of 15 major causes contributing to age-standardized incidence rates. Analyses were conducted in 2024.

RESULTS

In 2021, there were 20.84 million (95% uncertainty interval [UI]=18.13, 23.84) incident cases and 37.93 million (95% UI=36.33, 39.77) prevalent cases of TBI globally, resulting in 5.48 million (95% UI=3.87, 7.33) YLDs. While the absolute number increased from 1990 to 2021, age-standardized rates of TBI incidence, prevalence, and YLDs showed a significant decline. These rates generally increased with age and were higher in males than females. The highest age-standardized prevalence and YLD rates were observed in Eastern and Central Europe. Globally, falls were the leading cause of TBI in 2021, followed by road injuries, interpersonal violence, and exposure to mechanical forces.

CONCLUSIONS

Despite declines in age-standardized rates, the total number of TBI cases and associated disabilities has risen since 1990, indicating a persistent global burden. Targeted interventions are urgently needed in high-burden regions like Eastern and Central Europe, with focus on leading causes and vulnerable populations.

Translating in-person care to telehealth: a secondary analysis of GP consultations on musculoskeletal conditions

BACKGROUND

The COVID-19 pandemic led to a rapid transition to telehealth, particularly in general practice where continuous care for chronic conditions, such as musculoskeletal (MSK), is provided.

AIM

To determine the appropriateness of telehealth for MSK conditions by identifying whether in-person tasks can be supported remotely via telehealth.

DESIGN & SETTING

This study is a secondary analysis of the Harnessing Resources from the Internet (HaRI) dataset. This dataset comprises of 281 videos of recorded GP consultations. The dataset includes 10 GPs, across eight separate clinics, and was collected during 2017 in the UK.

METHOD

Content analysis was conducted to identify the clinical tasks, physical examinations, and physical artefacts used during the consultations. A scoring method applying two key metrics was developed to assess the translatability of clinical tasks to telehealth.

RESULTS

Across the 31 MSK consultations analysed, 12 clinical tasks, five physical examinations, and 12 physical artefacts were observed. Of clinical tasks, 17% (n = 2/12) were deemed to be 'easily translatable over telehealth' and 50% (n = 6/12) were deemed 'relatively easy to be translated over telehealth'. Only 17% (n = 2/12) of tasks were rated 'moderately translatable over telehealth', and 17% (n = 2/12) were deemed 'potentially translatable over telehealth'. No clinical tasks in this study were categorised as untranslatable to telehealth. The average telehealth translatability score was 7.1/10.

CONCLUSION

Most clinical tasks observed during in-person GP consultations with patients with MSK conditions are translatable to telehealth. Further research is necessary to investigate the long-term efficacy and safety of telehealth utilisation for MSK conditions in primary care.

Association between uric acid to high-density lipoprotein cholesterol ratio and chronic kidney disease among Chinese middle-aged and older adults with abnormal glucose metabolism: a nationwide cohort study

BACKGROUND

Previous research has demonstrated a correlation between uric acid to high-density lipoprotein cholesterol ratio (UHR) and chronic kidney disease (CKD), yet the evidence remains unclear in individuals with abnormal glucose metabolism. The objective of this research was to investigate the correlation between UHR and the occurrence of CKD, as well as the rapid kidney function decline among individuals aged over 45 years with abnormal glucose metabolism, using data from the China Health and Retirement Longitudinal Study (CHARLS).

METHODS

This study employed K-means clustering to categorize individuals based on UHR control levels into four classes. Subsequently, multivariate logistic regression analyses were utilized to explore the relationships between UHR and the occurrence of CKD as well as rapid kidney function decline. To examine the potential nonlinear relationship, restricted cubic spline (RCS) analyses were employed. Subgroup analyses and various sensitivity analyses were applied to validate the reliability of the results.

RESULTS

This study encompassed 3902 participants, all of whom had prediabetes or diabetes. In the fully adjusted logistic regression model assessing the risk of CKD development, the odds ratios (ORs) for Class 2, Class 3, and Class 4, versus Class 1, were 1.08 (0.71 to 1.67), 1.71 (1.06 to 2.77), and 2.13 (1.02 to 4.35), respectively. For every 1 standard deviation (SD) increase in cumulative UHR exposure, there was a 32% elevation in the risk of CKD incidence (OR: 1.32, 95% CI 1.12 to 1.56). RCS curves suggested a linear association between cumulative UHR (CumUHR) and CKD occurrence, but a nonlinear association with rapid renal function progression. Subgroup analysis indicated an interaction between age and UHR on the development of CKD. The application of multiple sensitivity analyses yielded consistent outcomes, suggesting the robustness of the findings.

CONCLUSION

In individuals with abnormal glucose metabolism, suboptimal control of UHR signifies an elevated risk of rapid kidney function decline and the incidence of CKD in the future. Therefore, close monitoring of long-term variations in UHR can facilitate early identification of the risk for CKD development.

Dosing practices, pharmacokinetics, and effectiveness of allopurinol in gout patients receiving dialysis: a scoping review

Urate and oxypurinol, allopurinol's active metabolite, are predominantly eliminated by the kidneys. Therefore, optimising allopurinol dosing in patients on dialysis is challenging. This review explores allopurinol dosing practices, oxypurinol pharmacokinetics, and effectiveness in gout patients receiving haemodialysis or peritoneal dialysis (PD). Five databases and grey literature were searched. Studies on gout patients on allopurinol, receiving dialysis, and reporting dosing, pharmacokinetics, or effectiveness (reduction in urate and/or gout flares) were included. Abstract, full text screening and data extraction were done by two authors. Studies were grouped by dialysis modality. Eighteen studies were identified including 390 patients, most (n = 274, 70%) on haemodialysis with allopurinol administered after dialysis. The peritoneal dialytic clearance of oxypurinol (3.14 mL/min, n = 5) and urate (2.7-4 mL/min, n = 25) was similar. The haemodialytic clearance was 78-137 mL/min for oxypurinol (n = 21) and 80-165 mL/min for urate (n = 19). Allopurinol doses were higher in haemodialysis (100-600 mg/day) than PD (110-125 mg/day). Haemodialysis sessions decreased oxypurinol and urate concentrations by 39-57% (n = 30) and 56-71% (n = 6), respectively. Over time (1-230 days), urate concentrations in haemodialysis (n = 85) reduced by 14-41%. Target serum urate (< 0.36 mmol/L) was achieved in 61% (20/33) and 47% (13/28) of haemodialysis and PD patients, respectively. Gout flares decreased from 2 to 0.1 attacks/year in patients receiving dialysis (n = 79). Oxypurinol and urate clearance by haemodialysis was higher than PD, necessitating higher doses of allopurinol. POST dialysis allopurinol doses titrated to target urate are suggested. Future studies considering the impact of dialysis modality on allopurinol dose requirements are needed.

Comparison of the efficacy and safety of GLP-1 receptor agonists on cardiovascular events and risk factors: A review and network meta-analysis

OBJECTIVE

This study aims to systematically evaluate and perform a systematic review and network meta-analysis comparing the comprehensive cardiovascular protective effects of various glucagon-like peptide-1 receptor agonists (GLP-1RAs), focusing on cardiovascular events and risk factors.

METHODS

We searched PubMed, Embase, Cochrane Library and Web of Science from inception to December 15, 2024. Included studies were published randomized controlled trials (RCTs) comparing GLP-1RAs to placebo or other GLP-1RAs. Missing data were standardized, and network meta-analysis was performed using Stata 17.0. Study heterogeneity, publication bias and evidence quality were assessed using the Cochrane Risk of Bias tool and Confidence in Network Meta-Analysis (CINeMA).

RESULTS

As of December 15, 2024, a total of 18 313 articles were retrieved. Based on the inclusion and exclusion criteria, 156 high-quality studies were included, incorporating 144 782 patients and 14 different GLP-1RAs. The network meta-analysis demonstrated low heterogeneity, ensuring the reliability of the results. Comprehensive analysis revealed the following: Efpeglenatide was the most effective in reducing major adverse cardiovascular events. Oral semaglutide shows more significant advantages in reducing all-cause mortality and cardiovascular mortality. Orforglipron excelled in glycaemic control and weight reduction. SC-Semaglutide showed the greatest efficacy in lowering both systolic blood pressure and diastolic blood pressure, Liraglutide showed the greatest efficacy in lowering total cholesterol, Noiiglutide in triglycerides and Taspoglutide in low-density lipoprotein cholesterol, but no GLP-1RAs in high-density lipoprotein cholesterol. GLP-1RAs did not significantly increase the incidence of adverse events, but Orforglipron and Taspoglutide significantly increased the incidence of gastrointestinal adverse events compared with placebo.

CONCLUSION

This study compared the cardiovascular benefits of different GLP-1RAs, including reductions in cardiovascular events and improvements in multiple cardiovascular risk factors. However, due to limitations in the quantity and quality of the included studies, the conclusions should be interpreted with caution. Future large-scale, high-quality clinical trials are needed to validate these findings and further optimize comprehensive cardiovascular management strategies for patients.

Long-Chain Polysaturated Fatty Acid in Atrial Fibrillation-Associated Stroke: Lipidomic-GWAS Study

This study aimed to explore the relationship between lipidomic domains, particularly free fatty acids (FFAs), and the presence of atrial fibrillation (AF) in patients with acute stroke, and to identify mechanisms of AF-associated stroke through genetic studies.A total of 483 stroke patients without AF (n = 391) and with AF (n = 92) were selected from a prospectively collected stroke registry. Lipidomic profiling was conducted, and the lipid components associated with AF were explored using fold-change analyses and clustering. Genotyping was conducted through trait comparison. Colocalization was also performed.Among the lipidomic domains, the free fatty acid (FFA) class was positively associated with AF. Long-chain fatty acids with 14 to 24 carbons and unsaturated FFAs distinguished AF. Clustering analysis based on FFAs revealed differences in AF proportion across groups. Genome-wide association study (GWAS) identified two loci associated with clustered groups of FFA metabolites: near MIR548F3 associated with FFA 20:1, FFA 20:2, FFA 22:5, and FFA 22:6; and near RPL37A associated with FFA 22:5 and FFA 22:6. These loci were associated with increased fibrinogen levels. In the GWAS for the FFA metabolite, quantitative trial locus analysis, loci near rs28456 and rs3770088, and FFA 20:4-QTLs were co-localized with the eQTLs of FADS2, a gene involved in the peroxisome proliferator-activated receptor gamma-related signaling pathway, in the whole blood, left ventricle, and atrial appendage tissue.Elevated FFA levels, especially those of long-chain unsaturated FFAs, are strongly associated with AF-associated stroke. This relationship is regulated by the peroxisome proliferator-activated receptor (PPAR) gamma-related signaling pathway.

Extracorporeal Counterpulsation Therapy Enhances Neurological Outcomes in Patients Experiencing Acute Ischemic Stroke

OBJECTIVE

The aim of this study was to assess the effects of extracorporeal counterpulsation therapy (ECP) on the short-term outcomes of patients with acute ischemic stroke in the mid-stroke phase.

METHODS

A total of 171 patients with acute ischemic stroke from the Department of Neurology at our hospital were selected and randomly assigned to 2 groups: 84 patients in the ECP group and 87 patients in the control group. Both groups received standard medication and rehabilitation. In addition, extracorporeal counterpulsation was incorporated into the treatment for the ECP group. At the conclusion of the treatment and after 90 days, both groups were evaluated based on the NIHSS and MRS scores.

RESULTS

No statistically significant differences were detected between the NIHSS and MRS scores of the 2 groups before and following treatment (P>0.05). However, on the 90th day, the NIHSS and MRS scores of the ECP group were significantly lower than those of the comparison group (P<0.05). The difference in the proportion of patients with NIHSS scores ≤1 between the 2 groups was 20.8%, whereas the absolute difference in MRS scores was 14.1%.

CONCLUSION

Extracorporeal counter therapy effectively enhances neurological function in patients with ischemic stroke, thereby improving their ability to perform activities of daily living and overall prognosis.

Using the THINC-integrated tool to compare the characteristics of cognitive dysfunction in patients with unipolar and bipolar depression

BACKGROUND

Major depressive disorder (MDD) and bipolar depression (BD-D) are both intricate, enduring, and profound psychiatric conditions characterized primarily by depressive episodes and cognitive dysfunction. However, distinguishing the characteristics and influencing factors of cognitive impairment in unipolar and BD-D is crucial for identification and intervention.

AIM

To compare neurocognitive characteristics and investigate associations between cognitive function and clinical features in unipolar and BD-D.

METHODS

The THINC-integrated tool (THINC-it) as a cognitive assessment tool was applied to 295 individuals: 75 patients with depressive disorders (MDD), 120 individuals with BD-D, and 100 healthy controls. The Hamilton Depression Scale-17 (HAMD), Hamilton Anxiety Scale-14 (HAMA), and Pittsburgh Sleep Quality Index (PSQI) were employed to assess depression, anxiety, and sleep. Neurocognitive function characteristics and the relationships between cognitive impairment and general clinical attributes were analyzed.

RESULTS

There were no statistically significant differences in the overall THINC-it with each objective subscale. However, the subjective subscale (Perceived Deficits Questionnaire for Depression-5-item) showed significant differences between MDD and BD-D (P < 0.001). Linear regression analyses were explored to determine associations. Age, years of education, age at onset, and HAMD were significantly co-associated with the overall THINC-it and each subscale in both MDD and BD-D (P < 0.05). Furthermore, years of education showed a positive correlation with objective cognitive impairment (e.g., Codebreaker, Trails) (P < 0.05). There was a notable difference in that the number of depressive episodes, disease duration, hospitalizations, HAMA, and PSQI were significantly associated with the overall THINC-it with each subscale between MDD and BD-D (P < 0.05).

CONCLUSION

Although both unipolar and BD-D showed similar objective cognitive impairments, there was a significant difference in subjective cognitive impairment. Our findings suggest that factors like age, years of education, age at onset, and depression severity might not be significantly difference in the influence of cognitive impairment. Furthermore, we found that education was a protective factor for cognitive impairment in both unipolar and BD-D. Our analysis revealed that distinct factors including disease duration, number of depressive episodes, hospitalizations, anxiety levels, and sleep quality influenced cognitive impairment between unipolar and BD-D. Therefore, it was important to investigate the specific characteristics of cognitive impairment and influencing factors to identify differentiating unipolar and BD-D.

Advancing local manufacturing capacities for vaccines within Africa - Opportunities, priorities and challenges

Our viewpoint focuses on the paradox that Africa represents 25 % of total global vaccine usage, yet 99 % of these vaccines are manufactured overseas. In view of the iniquitous supply and distribution of COVID-19 vaccines to Africa during the pandemic, we emphasize the need for scaling up local vaccine manufacturing capacities across Africa. We review current vaccine manufacturing capacities within Africa, highlight priority vaccines needs, and describe opportunities and challenges of advancing local manufacturing capacities within Africa. Of 11 manufacturers in Africa, ten have operational formulation/fill/finish capacities. However, capacities to produce active vaccine components locally are very limited and leveraging of vaccine technology platforms such as live-attenuated virus, inactivated virus, and mRNA remain scanty. South Africa and Senegal are the only countries with end-to-end manufacturing capacities. Based on market demand, manufacturing complexity, target population, disease burden and vaccination regimen, the top 5 priority vaccines identified for local manufacturing in Africa were measles-rubella, yellow fever, cholera, rotavirus, and meningococcal vaccines. Enablers identified for Africa's vaccine manufacturing initiatives include: a preferential procurement of African-made vaccines for sustainable and reliable volumes through GAVI and UNICEF; deal preparation to target investments avoiding overproduction; technology transfers; regulatory systems strengthening; R&D capacities and infrastructure. Thus, African vaccine manufacturers and all stakeholders should focus taking forward the portfolio of activities required for continental vaccine manufacturing, including regulatory strengthening capacities, training and workforce development, rather than only focus on efforts that benefit a particular manufacturer or country. Optimism for advancing vaccine manufacturing in Africa comes from the announcement in December 2023 by GAVI for the establishment of the African Vaccine Manufacturing Accelerator, a financing mechanism of USD 1 billion aimed at creating a sustainable vaccine manufacturing industry in Africa. However, many challenges need to be overcome including that of having secure funding for sustaining what is developed.

Organelle-tuning condition robustly fabricates energetic mitochondria for cartilage regeneration

Mitochondria are vital organelles whose impairment leads to numerous metabolic disorders. Mitochondrial transplantation serves as a promising clinical therapy. However, its widespread application is hindered by the limited availability of healthy mitochondria, with the dose required reaching up to 109 mitochondria per injection/patient. This necessitates sustainable and tractable approaches for producing high-quality human mitochondria. In this study, we demonstrated a highly efficient mitochondria-producing strategy by manipulating mitobiogenesis and tuning organelle balance in human mesenchymal stem cells (MSCs). Utilizing an optimized culture medium (mito-condition) developed from our established formula, we achieved an 854-fold increase in mitochondria production compared to normal MSC culture within 15 days. These mitochondria were not only significantly expanded but also exhibited superior function both before and after isolation, with ATP production levels reaching 5.71 times that of normal mitochondria. Mechanistically, we revealed activation of the AMPK pathway and the establishment of a novel cellular state ideal for mitochondrial fabrication, characterized by enhanced proliferation and mitobiogenesis while suppressing other energy-consuming activities. Furthermore, the in vivo function of these mitochondria was validated in the mitotherapy in a mouse osteoarthritis model, resulting in significant cartilage regeneration over a 12-week period. Overall, this study presented a new strategy for the off-the-shelf fabrication of human mitochondria and provided insights into the molecular mechanisms governing organelle synthesis.

Digital Multidomain Lifestyle Intervention for Community-Dwelling Older Adults: A Mixed Methods Evaluation

Objectives

As life expectancy rises at a faster rate than healthy life expectancy, there is a global need for scalable and cost-effective interventions that enhance the health-related quality of life of older adults. This study aimed to examine the user experience and usability of a 12-week digital multidomain lifestyle intervention in community-dwelling older adults aged 65 years and above.

Methods

The intervention was developed involving older adults and delivered through a mobile application (app) focusing on physical activity, nutrition, sleep and mindfulness/relaxation. We used a mixed methods sequential explanatory approach to evaluate the user experience and usability of the intervention. We delivered online questionnaires before and after the intervention, collected app usage data and conducted semi-structured interviews.

Results

One hundred eight older adults participated in the study. Fifty-six percent of participants completed the 12-week intervention. Users who completed the intervention experienced it as highly satisfactory and rated the usability as high. User engagement was particularly high for the physical activity content.

Conclusion

Although participant retention can be a challenge, a digital multidomain lifestyle intervention developed involving community-dwelling older adults can lead to positive user experience and high usability.

Prediction of dementia using CT imaging in stroke (PRODUCTS)

INTRODUCTION

A better understanding of who will develop dementia can inform patient care. Although MRI offers prognostic insights, access is limited globally, whereas CT-imaging is readily available in acute stroke. We explored the prognostic utility of acute CT-imaging for predicting dementia.

PATIENTS AND METHODS

We included stroke or transient ischaemic attack (TIA) survivors from participating stroke centres in Scotland. Acute CT-scans were rated using ordinal scales for neurodegenerative and cerebrovascular changes (old infarcts, white matter lesions (WMLs), medial temporal lobe atrophy (MTA), and global atrophy (GA)) and combined together to a 'brain-frailty' score. Dementia status was established at 18-months following stroke or TIA.

RESULTS

Among 195 participants, 33% had dementia after 3 years of follow-up. High brain-frailty score (⩾2/4) correlated with higher risk of dementia (HR (95% CI) 6.02 (1.89-19.21)). As individual predictor, severe MTA was most strongly associated with dementia (adjusted HR (95% CI) 2.09 (1.07-4.08)). Other predictors associated with dementia included older age, higher prestroke morbidity (mRS), WMLs, and GA. Integrated in a prediction model with clinical parameters, prestroke mRS, cardiovascular disease, GA, MTA and Abbreviated-Mental-Test were the strongest predictors of dementia (c-statistic: 0.77).

DISCUSSION AND CONCLUSION

Increased brain-frailty, and its individual components (WMLs, MTA, and GA) are associated with a higher risk of dementia in participants with stroke. Combining clinical and brain-frailty parameters created a moderate dementia prediction model but added little value over clinical parameters in combination with cognitive testing. CT-based brain-frailty may provide better prognostic insights when cognitive testing isn't feasible and for identifying highest-risk individuals for dementia prevention trials to increase trial efficiency.

Mortality Projections, Regional Disparities in the Burden of Neonatal Disorders, and the Status of Achieving SDG Targets by 2030 in South Asia: Insights from the Global Burden of Disease Study 2021

BACKGROUND

Neonatal disorders represent a significant public health challenge, particularly in low- and middle-income countries, where they account for 79% of global neonatal mortality. South Asia, comprising countries such as India, Pakistan, Bangladesh, Nepal, and Bhutan, bears a disproportionately high burden, contributing to 38% of the world's neonatal deaths. Despite notable progress, South Asia remains off track in meeting the Sustainable development goals (SDG). This study aims to assess the current burden, trends in neonatal disorders, and forecast mortality rates across South Asian countries, providing insights to guide investment priorities and improve neonatal outcomes.

METHODS

Data for this study were sourced from the Global burden of disease (GBD) 2021 study, which utilizes a Bayesian meta-regression model to estimate mortality, prevalence, and disability-adjusted life years (DALYs). Spatial maps depicting the age-standardized prevalence rate and age-standardized mortality rate for neonatal disorders in South Asia were generated using QGIS software. Mortality forecasts for the period 2022-2031, attributed to various neonatal disorders, were produced employing the Auto-Regressive Integrated Moving Average model in R software. Additionally, an analysis of overall neonatal mortality trends from 1980 to 2021 was conducted, supplemented by a heat map that compares DALYs attributable to various neonatal disorders across South Asian countries in 2021.

RESULTS

Between 1980 and 2021, South Asia experienced a substantial decline in neonatal mortality rates, with India and Bangladesh leading the progress. Mortality decreased by 40%, while DALYs fell by 35%, despite a 15% increase in the prevalence. The prevalence of neonatal encephalopathy due to birth asphyxia and trauma surged by 355%, yet its mortality dropped by 31%. Pakistan recorded the highest neonatal mortality and disease burden, particularly for hemolytic disease and other neonatal jaundice and neonatal encephalopathy due to birth asphyxia and trauma. In India and Bangladesh, neonatal preterm birth and neonatal sepsis and other neonatal infections contributed most to mortality. Neonatal encephalopathy due to birth asphyxia and trauma accounted for the highest DALYs. Forecasts predict continued reductions in neonatal mortality across South Asia, except in Pakistan, where persistently high rates are expected till 2031.

CONCLUSION

For South Asian countries to meet the SDG target for neonatal mortality by 2030, intensified and continuous efforts are required. These efforts should focus on identifying high-risk pregnancies and improving the quality of care during childbirth to address the root causes and reduce preventable neonatal deaths.

Temporomandibular disorders and mental health: shared etiologies and treatment approaches

The biopsychosocial model suggests that temporomandibular disorders (TMDs) often coexist with mental health disorders, particularly depression and anxiety, affecting a significant portion of the global population. The interplay between TMDs and mental health disorders contributes to a complex comorbidity, perpetuating a cycle of mutual influence and reinforcement. This review investigates the neurobiological mechanisms and epidemiological evidence supporting the shared etiology of TMDs and mental health disorders, exploring potential shared vulnerabilities and bidirectional causal relationships. Shared vulnerabilities between TMDs and mental health disorders may stem from genetic and epigenetic predispositions, psychosocial factors, and behavioral aspects. Inflammatory cytokines, neurotransmitters, neurotrophins, and neuropeptides play pivotal roles in both peripheral and central sensitization as well as neuroinflammation. Brain imaging studies suggest that TMDs and mental health disorders exhibit overlapping brain regions indicative of reward processing deficits and anomalies within the triple network model. Future research efforts are crucial for developing a comprehensive understanding of the underlying mechanisms and confirming the reciprocal causal effects between TMDs and mental health disorders. This review provides valuable insights for oral healthcare professionals, stressing the importance of optimizing treatment strategies for individuals dealing with concurrent TMDs and mental health issues through a personalized, holistic, and multidisciplinary approach.