Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

Subnational trend and driving factors for pancreatic cancer burden in China, 1990-2021: an analysis based on the Global Burden of Disease Study 2021

BACKGROUND

The mortality of pancreatic cancer in China showed an increasing trend between 2005 and 2020, with significant discrepancies in the burden of pancreatic cancer in provinces.

METHODS

We analyzed numbers of death, incidence, disability-adjusted life years (DALY) and corresponding age-standardized rates for pancreatic cancer in China using data from the Global Burden of Disease Study 2021. We conducted trend analysis in pancreatic cancer burden over time by age group and gender. Decomposition analysis was used to assess the drivers of change in cancer-related deaths in China due to three explanatory factors: population growth, population ageing and age-specific mortality.

RESULTS

In 2021, the ASMR of pancreatic cancer in China was 5.72/100,000(95%UI: 4.59, 6.91), the age-standardized incidence (ASIR) rate was 5.64/100,000(95%UI: 4.52, 6.84) and the age-standardized DALY rate was 137.23/100,000 (95%UI:108.15, 166.74). From 1990 to 2021, the ASMR of pancreatic cancer in China generally showed an increasing trend (AAPC: 0.56, 95%UI: 0.52, 0.59). The burden of pancreatic cancer was consistently higher in Chinese men compared to women during the study period.Compared with 1990, the number of deaths from pancreatic cancer has increased in all provinces of China in 2021, with the overall number of deaths increasing by 67.49%. Population ageing was the major cause of the increase in deaths from pancreatic cancer in China, accounting for 45.89%.

CONCLUSIONS

The burden of pancreatic cancer in China is still at a high level and population ageing is the main reason for the increase in pancreatic cancer deaths.

Impact of improved air quality on lung function and blood pressure of middle-aged and older population in China

Long-term exposure to fine particulate matters (PM2.5) has been associated with respiratory and cardiovascular diseases and the burden are potentially higher in China experiencing heavy air pollution. In this study, we established the exposure-response association between long-term exposures to PM2.5 and lung function and blood pressure in Chinese middle-aged and older adults using linear mixed-effects and generalized additive mixed models based on 3 waves longitudinal health outcomes data by enrolling 19,988 participants from 121 cities across the mainland of China. We also assessed the effect of Clean Air Policy (CAP) based on a quasi-experimental difference-in-differences (DID) design. A 10 µg/m3 increase in PM2.5 concentration was associated with a 7.18 (95 % confidence interval [CI]: -8.35, -6.02) L/min decrease in PEF (peak expiratory flow) and a 0.72 (95 % [CI]: 0.53, 0.90) and a 0.30 (95 % [CI]: 0.18, 0.42) mmHg increase in systolic and diastolic blood pressure, respectively. The associations were more pronounced in males and rural areas for PEF, but similar across subgroups for blood pressure. DID results suggested that the effect of CAP on health outcomes were sensitive to magnitudes of reduction in PM2.5. A 5 µg/m3 reduction in PM2.5 or more generally led to 18.70 (95 % [CI]: 0.79, 36.61) higher PEF and -2.05 (95 % [CI]: -3.87, -0.23) lower diastolic blood pressure, respectively, compared to no reduction or increase in exposure. However, the effects were significant only in rural areas. Our analysis support CAP aiming to benefit public health and provides insights to inform future control policy for efficiently decreasing air pollution exposure burden.

Association between community environment and depression: Evidence from a population-based study in China

OBJECTIVE

Less is known about the association between community environment and depression. To bridge this gap, the aim of this research is to explore the association between community environment and depression using panel data.

METHODS

The data of the present study were sourced from 2016 and 2020 waves of China Family Panel Studies. Panel data regression models were exploited to identify the association between community environment and depression. The present study employed Karlson-Holm-Breen method to analyze the mediation roles of physical exercise and smoking on the association between community environment and depression.

RESULTS

The panel data regression results suggest that community public facility is negatively associated with CES-D score (coefficient = -0.1399, p < 0.001). Community surrounding environment is negatively correlated with CES-D score (coefficient = -0.1618, p < 0.001). Moreover, physical exercise mediates the association between community environment and CES-D score (p < 0.01). In addition, there is no evidence indicating that smoking mediates the association between community environment and CES-D score (p > 0.05).

CONCLUSION

Community public facility and surrounding environment are negatively associated with depression of the adults. In addition, physical exercise mediates the association between community environment and depression. The findings highlight the importance of optimizing community environment. It is necessary to understand depression from a multi-dimensional perspective.

Echinatin inhibits the growth and metastasis of human hepatocellular carcinoma cells through p38 and JNK signaling pathways

Hepatocellular carcinoma (HCC) ranks among the most prevalent cancers, with both a high incidence and a significant mortality rate. Clinical medications are highly toxic to patients and prone to resistance. Natural products are highly valued in the development of antitumour drugs. This study aimed to elucidate the anti-HCC ability and potential mechanism of Echinatin (Ecn), a natural existed flavonoid. Our findings revealed that Ecn suppressed the growth, migration, and invasion of HCC cells and demonstrated a superior inhibitory impact on the development of xenograft tumors. Moreover, Ecn was less toxic to mice and had a good drug safety. Mechanistically, Ecn was found to activate p38 and JNK signaling pathways. Accordingly, the suppressive effect of Ecn on HCC cells was attenuated by the introduction of p38 blocker SB203580 and JNK blocker SP600125. Collectively, our research suggests that Ecn might have anti-HCC properties through the activation of p38 and JNK signaling.

Dynamic cross-lagged effects between healthy lifestyles and multimorbidity among middle-aged and older adults in China

BACKGROUND

While healthy lifestyles mitigate the risk of multimorbidity (≥ 2 chronic diseases), their temporal dynamics in aging populations, particularly in low- and middle-income countries undergoing rapid demographic structure transition, remain understudied.

METHODS

Using longitudinal data (2014-2020) from 6,852 Chinese adults (aged ≥ 45 years) in the China Family Panel Studies, we used the subgroup analysis to investigate high risk groups in the chronic diseases status, employed alluvial diagrams to visualize diseases status transition and random intercept cross-lagged panel model to quantify the lagged effect between healthy lifestyles (sleep, physical exercise, smoking, drinking) and chronic diseases status (without diseases, single, multimorbidity).

RESULTS

Compared to male, urban and middle-aged individuals, female, rural and older adults demonstrated more severe chronic diseases status (P < 0.05). The proportion of people with multimorbidity increased over time, from 9.2% in 2014 to 29.1% in 2020. A total of 37.8% of participants experienced diseases status transition, and more than half of whom progressed to multimorbidity. Disease trajectories disproportionately progressed toward multimorbidity. The direction and size of the cross-lagged effects are dynamic. Healthier lifestyles predicted reduced disease severity from 2014 to 2018 (β1=-0.106, P1 < 0.001; β2=-0.111, P2 < 0.001), but this protective effect reversed post-2018, with multimorbidity predicting lower probability of choosing healthy lifestyles (β3=-0.160, P3 < 0.001).

CONCLUSIONS

Our study demonstrates dynamic cross-lagged effect exists between healthy lifestyles and chronic diseases status in middle-aged and older Chinese. Disease trajectories and lifestyle-disease interplay reveal critical time-sensitive windows for intervention. Early-stage lifestyle promotion could delay progression, whereas later-stage disease management requires system-level strategies addressing urban-rural healthcare disparities and self-efficacy barriers. These findings directly inform China's Healthy Aging 2030 priorities.

Trends and future burden of other musculoskeletal diseases in China (1990-2041): a comparative analysis with G20 countries using GBD data

BACKGROUND

Other musculoskeletal diseases (OMSDs), as a critical component of the global public health challenge, remain understudied in China. This study aims to systematically analyze the epidemiological characteristics and future trends of OMSDs in China from 1990 to 2021.

METHODS

Based on data from the Global Burden of Disease Study(GBD) 2021, this research focused on prevalence and years lived with disability (YLDs), which were compared with G20 countries. Joinpoint regression was used to identify trend breakpoints, age-period-cohort analysis evaluated the independent effects of age, period, and cohort, and the Autoregressive Integrated Moving Average (ARIMA) model predicted the disease burden through 2041.

RESULTS

Between 1990 and 2021, both age-standardized prevalence rates (ASPR) and YLDs rates(ASYR) of OMSDs in China showed upward trends. Two critical turning points in ASPR occurred during 2000-2005 (APC = 1.5%, 95% CI: 1.4-1.6) and 2005-2009 (APC = 0.9%, 95% CI: 0.7-1.0). Age effects indicated that relative risk (RR) first increased and then decreased with age, peaking at 60-64 years (RR = 3.62, 95% CI: 3.62-3.63). Period effects showed a rising trend, while cohort effects revealed declining prevalence and YLDs rates. Projections suggest a gradual increase in burden indicators through 2041. Compared to other G20 countries, China ranked eighth from the bottom in disease burden, approaching the level of Germany.

CONCLUSION

The burden of OMSDs in China continues to rise, particularly among women and the elderly. Although the current burden is at a mid-range level among G20 nations, population aging will exacerbate future challenges. To address this, advocating for healthy lifestyles, strengthening health education, and optimizing healthcare strategies are essential.

Association of echocardiographic pulmonary hypertension with all-cause mortality in hospitalized AECOPD patients

Background

Chronic obstructive pulmonary disease (COPD) often coexists with pulmonary hypertension (PH). However, whether pulmonary artery pressure (PAP) or even suspected PH assessed by echocardiography during acute exacerbation stage predicts mortality after discharge is unclear.

Methods

We conducted an retrospective study of hospitalized patients with acute exacerbation of COPD (AECOPD). Peak tricuspid regurgitation velocity (TRV) and additional variables were used to assess PH risk.

Results

Cox regression analysis showed that echocardiographic suspected PH was the independent risk factor for the significantly increased long-term mortality (adjusted HR 1.64; 95% CI 1.06-2.53) after discharge in AECOPD patients. Logistic regression analysis revealed a negative correlation between blood eosinophil (EOS) counts at admission and the prevalence of suspected PH (adjusted OR 0.18; 95% CI 0.04-0.89). Triple therapy (adjusted HR 0.18; 95% CI 0.05-0.61), neither LABA/ICS during stable stage was associated with a significant reduction in long-term mortality in hospitalized AECOPD patients with suspected PH.

Conclusion

Echocardiographic suspected PH was associated with adverse survival in hospitalized AECOPD patients. Low EOS counts at admission emerged as a potential biomarker for elevated estimated systolic PAP. Triple therapy during stable stage was associated with a significant reduction in long-term mortality in AECOPD patients with suspected PH.

LDL-C Reduction with Evolocumab Among Patients with ASCVD in China: Real-World Evidence from Tianjin Metropolitan Area

INTRODUCTION

Clinical trials have shown that adding evolocumab to statin therapy reduces low-density lipoprotein cholesterol (LDL-C) levels by approximately 60%. Given differences in patient characteristics and standards of care between trial and real-world settings, we conducted a cohort study to evaluate the LDL-C reduction achieved with evolocumab in clinical practice of China.

METHODS

The data source was the Tianjin Regional Healthcare Database (TRHD), which includes linked electronic health records (EHR) of public hospitals serving over 15 million residents in the Tianjin metropolitan area. The study cohort included adult patients with atherosclerotic cardiovascular disease (ASCVD) who added evolocumab to their statin therapy between 2019 and 2023. Key inclusion criteria were use of the same statin intensity before and after evolocumab initiation and available LDL-C values at baseline (within 90 days before initiation) and follow-up (15-90 days after initiation). Descriptive statistics were used to analyze LDL-C change between baseline and follow-up. To provide the context for evolocumab use and for study method assessment, we included another cohort of patients with stable statin intensity (unchanged for at least 180 days)-a cohort with minimal clinical expectation of further LDL-C change over time.

RESULTS

At baseline, the median (interquartile range [IQR]) LDL-C level was 3.44 (2.73-4.15) mmol/L in the evolocumab cohort (n = 395) and 2.20 (1.72-2.92) mmol/L in the stable statin cohort (n = 4160). At follow-up, the mean (95% confidence interval [CI]) percentage reduction in LDL-C levels was 63.0% (60.5-65.5%) in the evolocumab cohort and 2.5% (0.3-4.7%) in the stable statin cohort.

CONCLUSIONS

LDL-C reductions in patients who added evolocumab to statin therapy in real-world clinical practice in China align with reductions observed in clinical trials.

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

Objectives

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

Methods

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

Results

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

Conclusions

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

Supplementary Information

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

Fertility preservation in young breast cancer patients: A nationwide survey on knowledge, attitudes, and practices among breast surgical healthcare providers in China

PURPOSE

Fertility preservation (FP) is a critical concern for young breast cancer (YBC) patients receiving gonadotoxic treatments. Breast surgical healthcare providers (HCPs) play a pivotal role in discussing FP options and facilitating timely referrals. This study aimed to assess the knowledge, attitudes, and practices of breast surgical HCPs in China regarding FP, identify barriers to FP discussions, and examine factors influencing referral practices.

METHODS

A nationwide cross-sectional survey was conducted from March to June 2023 among board-certified breast surgeons and nurses across China using a 24-item questionnaire. Participants were recruited via WeChat through BestOnco, a professional platform for oncology HCPs. The survey assessed FP knowledge, attitudes, clinical practices, and perceived barriers. Multivariate logistic regression was performed to determine factors associated with FP referral practices.

RESULTS

A total of 355 valid responses were analyzed. The mean FP knowledge score was 6.05 ± 1.94 (range 0-10), with 49.3 % of HCPs never consulting FP guidelines. While 82.8 % expressed a favorable attitude toward FP, only 42.3 % routinely discussed FP options, and 44.7 % referred patients to reproductive specialists. Major barriers included poor prognosis concerns (87.0 %), treatment urgency (67.9 %), and financial burden (60.0 %). Multivariate analysis revealed that higher FP knowledge (OR = 1.23, p < 0.0001), longer clinical experience (OR = 2.93, p = 0.001), and hospital-based FP integration (OR = 1.83, p < 0.0001) were significant predictors of referral.

CONCLUSIONS

Notable gaps were identified in FP knowledge, discussions, and referrals among breast surgical HCPs in China. Targeted FP training programs, culturally informed shared decision-making strategies, and oncofertility navigation systems are recommended to enhance FP service delivery and improve patient outcomes.

Quality of life and associated factors among people with chronic diseases in Hubei, China: a cross-sectional study

BACKGROUND

Chronic diseases are a major threat to human health, substantially reducing quality of life (QOL). Since the COVID-19 pandemic there have been surprisingly few surveys specifically focusing on the QOL of individuals living with chronic diseases. This study addresses this gap and assesses the QOL and associated factors of those with chronic diseases in the immediate aftermath of the COVID-19 pandemic.

METHODS

We conducted a cross-sectional study in six cities of Hubei Province, China, from May to August 2021, using a multi-stage cluster sampling technique to select 1,560 study participants. A 12-Item Short Form Survey (SF-12) Scale assessed QOL. Multivariate linear regression analyses and the Shapley decomposition technique identified related factors and the extent of contribution to QOL.

RESULTS

We enjoyed a very high response rate to our invitation to participate; of these 1,507 questionnaires were considered valid (96.6%), and of these 354 patients reported a chronic disease (23.5%). The Physical Component Score (PCS) and Mental Component Score (MCS) among respondents were 59.13 ± 20.17 and 71.14 ± 13.55, respectively. The results of the regression analysis indicated that those who were 60 years or older and reported a recent acute illness in the immediate two-week period prior to survey were more likely to exhibit poorer PCS, whereas those with annual income of 30,000-100,000 Yuan, engaged in regular exercise and reported having eating regularly (regular eating to encourage relatively stable blood sugar levels as opposed to irregular meals/eating) were more likely to have higher PCS. Those reporting an acute illness in the immediate two-week period prior to survey also had lower MCS, but this was mitigated if the person had medical insurance, an annual income of 50,001-100,000 Yuan, regularly exercised, and a more nutritious diet. The Shapley decomposition results revealed that factors such as age (31.2%), income (24.8%), the presence of an illness in the immediate two-week period prior to survey (14.8%), regular meals (13.5%), regular physical exercise (10%), and alcohol consumption (5.7%) contributed to improved PCS, whereas the factors associated with improved MCS included regular meals (33.8%), length of illness/recovery of two-weeks (23%), comparatively higher annual income (16.2%), regular physical exercise (13.9%), and access to medical insurance (11.1%).

CONCLUSION

The QOL of those with chronic disease in our study sample was significantly lower than those of healthy individuals. Higher annual income, regular physical exercise, the presence of an acute illness in the immediate two-week period prior to survey, consistent meal routines, adequate medical insurance and age were influencing factors of QOL for those with chronic diseases. Countermeasures should be implemented to promote healthy lifestyles and strengthen the prevention and control of chronic diseases.

Sustained Effects of a Scaled-Up mHealth and School-Based Intervention for Salt Reduction (EduSaltS) in Schoolchildren and Their Families: 1-Year Follow-Up of a Cluster Randomized Controlled Trial

Background: While the mHealth and school-based scale-up intervention for salt reduction (EduSaltS) effectively reduced salt intake and blood pressure among adults living with participating schoolchildren, the sustainability of these effects remains uncertain. This study aimed to evaluate whether these effects persisted one year post intervention. Methods: A one-year follow-up of a cluster randomized controlled trial was conducted, involving 524 children and their 524 adult family members from 20 primary schools. At 24 months, 509 children (97.1%) and 486 adults (92.7%) completed the assessment. Mixed linear models were used to analyze the difference in changes in salt intake between the intervention and control groups at 24 months, compared to baseline and 12 months, as measured by consecutive 24 h urinary sodium excretions. Secondary outcomes included the differences in changes in blood pressure and salt-related knowledge, attitudes, and practices (KAP) scores. Results: The adjusted mean difference in changes in salt intake between groups was -0.34 g/24 h (95% CI: -0.94 to 0.26, p = 0.265) for children and -0.72 g/24 h (95% CI: -1.48 to 0.05, p = 0.065) for adults at 24 months versus baseline. The corresponding differences from 12 to 24 months were -0.09 g/24 h (95% CI: -0.69 to 0.51, p = 0.775) for children and 0.29 g/24 h (95% CI: -0.50 to 1.08, p = 0.468) for adults. The adjusted difference in changes in adult blood pressure showed a slight, nonsignificant rebound at 24 months. The intervention group maintained significantly higher KAP scores than the control group at both 12 and 24 months. Conclusions: The effects of EduSaltS on reducing salt intake and blood pressure in adults diminished slightly one year after the intervention ended. However, sustained improvements in salt-related KAP were observed in both children and adults. Ongoing support is vital to sustain long-term salt-reduction behaviors.

Ki-67-Playing a key role in breast cancer but difficult to apply precisely in the real world

The Ki-67 index, which is a proliferative index, has become more important in making treatment decisions for patients with breast cancer (BC) and plays both a predictive role and a prognostic role. However, a few factors limit its use in clinical practice, particularly the assessment of the percentage of Ki-67-positive cells and the cutoff value of Ki-67. In this study, we examined the expression of Ki-67 via immunohistochemistry and systematically evaluated the value of the Ki-67 index in patients with BC. This was a retrospective study including 280 patients diagnosed with BC. There were marked differences in overall survival (OS) between patients with BC when the Ki-67 index ranged from 46 to 68% (χ2 = 5.87, P = 0.0154; χ2 = 7.64, P = 0.0057, respectively), and the same results were also found when the staining density was added to the Ki-67 index; however, the staining density alone has limited value in assessing the value of Ki-67. There were marked differences in disease-free survival (DFS) among BC patients when the Ki-67 index ranged from 50 to 58% (χ2 = 7.31, P = 0.0069; χ2 = 7.88, P = 0.005). When 14% was used as a cutoff point to classify the molecular type of BC, the luminal A-type patients were significantly different from patients with HER2-overexpressing subtype BC in terms of OS (χ2 = 5.33, P = 0.021). There was a significant difference in the OS of patients with human epidermal growth factor receptor 2 (HER-2)-overexpressing subtype BC when the Ki-67 index fell within the range of 49-60% (χ2 = 4.86, P = 0.0275; χ2 = 5.50, P = 0.019, respectively). There were significant differences between luminal A-type BC and HER2-overexpressing subtype BC in terms of OS (χ2 = 5.53, P = 0.019), according to suggestions of the 2019 CSCO consensus. There were significant differences between the two groups of luminal B HER-2(-) BC when the Ki-67 index was 52% (χ2 = 6.61, P = 0.0101). The differentiated Ki-67 index can be used to assess the OS and DFS of patients with BC, and the staining density of Ki-67 has little value in assessing prognosis in these patients. Different molecular classification methods may influence the assessment of prognosis and the results of molecular subtype in patients with BC. To predict the prognosis of BC patients, it is more scientifically feasible to use the interval values of Ki-67 than a specific value.

Overexpression of c-Myc triggers p62 aggregation-mediated mitochondrial mitophagy in cabozantinib resistance of hepatocellular carcinoma

Resistance to tyrosine kinase inhibitors (TKIs) poses a significant challenge in the treatment of hepatocellular carcinoma (HCC). Although dysregulation of mitochondrial dynamics has been implicated in the aggressive behaviors of various tumors, the specific role and underlying mechanisms by which this dysregulation contributes to cabozantinib resistance in HCC cells remains insufficiently characterized. By investigating mitochondrial dynamics as central regulators of cabozantinib resistance, this work specifically aims to discover actionable targets for restoring drug sensitivity in treatment-refractory HCC cells. We employed transmission electron microscopy (TEM) and confocal microscopy to analyze mitochondrial morphology in HCC cells resistant to TKIs. Additionally, we utilized an oncogene hydrodynamic injection-induced primary liver cancer mouse model to assess the therapeutic efficacy of combining cabozantinib with other pharmacological agents. Our results demonstrated significant increases in mitochondrial fragmentation, p62 aggregation, and mitophagy in cabozantinib-resistant HCC cells, which correlated with overexpression of c-Myc. Notably, inhibiting mitochondrial fission, p62 aggregation, or autophagy effectively reversed the resistance of HCC cells to cabozantinib. Mechanistically, cabozantinib treatment was shown to induce c-Myc expression, which significantly enhanced mitochondrial fragmentation and p62 aggregation, thereby promoting mitophagy. This mitophagic process selectively eliminated damaged mitochondria, reducing cytochrome C-induced apoptosis in cabozantinib-resistant cells. Ultimately, combining cabozantinib with either the autophagy inhibitor chloroquine or the p62 aggregation inhibitor XRK3F2 resulted in improved anticancer efficacy. In conclusion, c-Myc overexpression facilitates p62 aggregation-mediated mitophagy, leading to cabozantinib resistance in HCC cells. Inhibition of autophagy effectively restores cabozantinib sensitivity in HCC.

Progress in the application of fludeoxyglucose positron emission tomography computed tomography in biliary tract cancer

Biliary tract cancer (BTC) is a group of heterogeneous sporadic diseases, including intrahepatic, hilar, and distal cholangiocarcinoma, as well as gallbladder cancer. BTC is characterized by high invasiveness and extremely poor prognosis, with a global increased incidence due to intrahepatic cholangiocarcinoma (ICC). The 18F-fludeoxyglucose positron emission tomography (PET) computed tomography (18F-FDG PET/CT) combines glucose metabolic information (reflecting the glycolytic activity of tumor cells) with anatomical structure to assess tumor metabolic heterogeneity, systemic metastasis, and molecular characteristics noninvasively, overcoming the limitations of traditional imaging in the detection of micrometastases and recurrent lesions. 18F-FDG PET/CT offers critical insights in clinical staging, therapeutic evaluation, and prognostic prediction of BTC. This article reviews research progress in this field over the past decade, with a particular focus on the advances made in the last 3 years, which have not been adequately summarized and recognized. The research paradigm in this field is shifting from qualitative to quantitative studies, and there have been significant breakthroughs in using 18F-FDG PET/CT metabolic information to predict gene expression in ICC. Radiomics and deep learning techniques have been applied to ICC for prognostic prediction and differential diagnosis. Additionally, PET/magnetic resonance imaging is increasingly demonstrating its value in this field.

Digital Therapeutics in China: Comprehensive Review

BACKGROUND

Digital therapeutics (DTx) are software-driven interventions that provide personalized, evidence-based treatments for various medical conditions. China's rapid technological adoption, large population, and supportive government policies position it as a potential global leader in DTx. However, challenges remain in clinical trial standardization, regulatory approval, product development, and reimbursement models. A comprehensive assessment of clinical evidence, commercialization trends, and regulatory frameworks is essential for understanding China's evolving DTx ecosystem and its global implications.

OBJECTIVE

This study systematically reviews and analyzes the DTx landscape in China, focusing on clinical trials, commercial products, regulatory frameworks, and pricing and reimbursement models. The findings provide insights for countries aiming to develop, regulate, and integrate DTx solutions into health care systems.

METHODS

This comprehensive review integrates multiple methodological approaches to examine different aspects of the DTx ecosystem in China. We conducted a systematic review and meta-analysis to evaluate clinical trials, searching PubMed, Google Scholar, IEEE, Web of Science, and ScienceDirect until July 2024. Meta-analyses used random-effects models, reporting results as standardized mean differences (SMDs) and 95% CIs. For commercial products, a scoping review using the National Medical Products Administration database was performed. Regulatory policies were systematically identified through a manual review of official government sources, while pricing and reimbursement models were analyzed through a comprehensive assessment of public and private insurance policies, government initiatives, and commercial pathways.

RESULTS

: A total of 96 clinical trials on DTx in China were identified, with cognitive disorders (n=21, 22%) and diabetes (n=20, 21%) being the most frequently studied, followed by cardiovascular diseases (n=8, 8%), sleeping disorders (n=6, 6%), and smoking cessation (n=6, 6%). Meta-analysis for diabetes DTx showed a trend toward improved hemoglobin A1c levels in digital intervention groups compared to controls (SMD -0.96, 95% CI -2.03 to 0.11) but did not reach statistical significance (I²=97%). Meta-analysis for cognitive disorder DTx showed significant improvement in global cognitive function in DTx-treated participants (SMD 0.65, 95% CI 0.37-0.94), despite notable heterogeneity (I²=71.7%). The commercial landscape analysis identified 97 active DTx solutions, primarily targeting cognitive impairment (38 companies), ophthalmic diseases (30 companies), and respiratory diseases (5 companies). The regulatory review highlighted China's reliance on general medical device policies under the National Medical Products Administration rather than DTx-specific regulations, with emerging regional innovation policies supporting industry growth. Pricing analysis revealed diverse reimbursement models, including value-based pricing, private insurance partnerships, and government-facilitated programs.

CONCLUSIONS

China has made substantial progress in DTx development but still faces challenges in clinical trial standardization, regulatory approval, and reimbursement. Key factors driving DTx adoption include targeted indications, standardized clinical trials, streamlined regulation, and diversified pricing models. China's experience provides valuable lessons for other countries with emerging digital health ecosystems as they develop DTx research, regulations, and integration strategies.

TRIAL REGISTRATION

PROSPERO CRD42024615584; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024615584.

The association of triglyceride glucose index and postoperative outcome in patients with severe spontaneous intracerebral hemorrhage: a multiple-center cohort study

The triglyceride-glucose (TyG) index, a marker of insulin resistance, reflects combined lipid and glucose dysregulation, which may exacerbate severe spontaneous intracerebral hemorrhage (SSICH) outcomes. The association of TyG index and postoperative outcome of SSICH patients hasn't been extensively studied. This study aimed to investigate whether the high TyG index was associated with increased risk of poor outcomes in SSICH patients. This study included SSICH patients from a multicenter, prospective cohort study in China from September 2019 to December 2022. TyG index was calculated on admission and the 7th day after surgery and all patients were categorized as Q1 to Q4 according to the interquartile ranges (IQRs) of TyG index. The primary outcome was the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) within 180 days after hemorrhage. This study included 761 SSICH patients receiving surgery with a median admission TyG index of 7.2 (IQR, 6.7-7.6). MACCE occurred in 131 (17.2%) patients within 180 days after SSICH. The results showed that a high TyG index is related to a high incidence of 180-day MACCE events (odds ratio, 2.36, per 1 unit; 95% CI: 1.82, 2.06; P < 0.001), and the risk of 180-day MACCE events significantly increased with the TyG index from Q1 to Q4 (P for trend < 0.001). The further analysis of TyG index on the 7th day after surgery reveal the similar results between TyG index and 180-day clinical outcomes (P < 0.001). This study revealed that high TyG index was associated with the risk of poor outcomes in SSICH patients after surgery, which may serve as an effective and stable indicator for clinical monitoring.

Effectiveness of Digital Health Interventions for Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis

BACKGROUND

Chronic obstructive pulmonary disease (COPD), marked by dyspnea, cough, and sputum production, significantly impairs patients' quality of life and functionality. Effective management strategies, particularly those empowering patients to manage their condition, are essential to reduce this burden and health care use. Digital health interventions-such as mobile apps for symptom tracking, wearable sensors for vital sign monitoring, and web-based pulmonary rehabilitation programs-can enhance self-efficacy and promote greater patient engagement. By improving self-management skills, these interventions also help alleviate pressure on health care systems.

OBJECTIVE

This systematic review and meta-analysis assesses the clinical effectiveness of smartphone apps, wearable monitors, and web-delivered platforms in four COPD management areas: (1) quality of life (measured by the COPD Assessment Test [CAT] and St George's Respiratory Questionnaire), (2) self-efficacy (assessed by the General Self-Efficacy Scale), (3) functional capacity (evaluated via the 6-minute walk test and Modified Medical Research Council Dyspnea Scale), and (4) health care use (indicated by hospital and emergency department visits).

METHODS

A systematic review was conducted using predefined search terms in PubMed, Embase, Cochrane, and Web of Science up to January 26, 2025, to identify randomized trials on digital health interventions for COPD. Two reviewers independently screened studies and extracted data. Outcomes included quality of life, self-efficacy, functional status, and health care use.

RESULTS

This review included 17 studies with 2027 participants from 11 countries. Eleven trials involved health care professionals in digital platform use, and 12 reported adherence strategies. Digital tools for COPD primarily focused on telerehabilitation (eg, video-guided exercises) and self-management systems (eg, artificial intelligence-driven exacerbation alerts). The study participants were predominantly older adults. Meta-analysis results indicated that digital health interventions significantly improved quality of life at 3 months on the CAT (mean difference [MD] -1.65, 95% CI -3.17 to -0.14; P=.03); at 6 months on the CAT (MD -2.43, 95% CI -3.93 to -0.94; P=.001) and St George's Respiratory Questionnaire (MD 3.25, 95% CI 0.69-5.81; P=.01); at 12 months on the CAT (MD -2.53, 95% CI -3.91 to -1.16; P<.001), EQ-5D (MD 0.04, 95% CI 0.01-0.07; P=.02), and EQ-5D visual analogue scale (MD 5.88, 95% CI 0.38-11.37; P=.04); the General Self-Efficacy Scale at 3 months (MD 1.65, 95% CI 0.62-2.69; P=.002) and 6 months (MD 1.94, 95% CI 0.83-3.05; P<.001); and the Modified Medical Research Council Dyspnea Scale at more than 3 months (MD -0.23, 95% CI -0.36 to -0.11; P=.003). However, no significant differences were observed in the 6-minute walk test, emergency department admissions, hospital admissions, emergency department admissions for COPD, or hospital admissions for COPD.

CONCLUSIONS

Our findings suggest that digital health interventions may benefit COPD patients, but their clinical effectiveness remains uncertain. Further robust studies are needed, particularly those involving larger numbers of older adults with COPD.

TRIAL REGISTRATION

PROSPERO CRD420251032053; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251032053.

Adjuvant Lenvatinib for High-Risk CNLC IIb/IIIa Hepatocellular Carcinoma After Curative Hepatectomy: A Prospective Exploratory Study

Objective

The risk of hepatocellular carcinoma (HCC) recurrence following surgical resection remains high, approaching 50%-70% at 5 years, with the highest risk occurring in the first year after resection. This study aimed to evaluate the efficacy and safety of lenvatinib as adjuvant therapy for HCC.

Methods

In this open-label, single-arm, prospective, multicenter Phase II clinical study, a total of 51 hCC patients with China Liver Cancer (CNLC) stage IIb/IIIa (ie tumor number ≥ 4 or vascular invasion, equivalent to BCLC B/C) who underwent R0 resection 4-6 weeks after curative surgery were enrolled. Patients received lenvatinib for up to 12 months, at a dose of 8 mg/day for body weight < 60 kg, or 12 mg/day for ≥ 60 kg. Patients were followed up every 2 months for a median of 24.1 months.

Results

The median recurrence-free survival (RFS) was 16.1 months, with a 12-month RFS rate of 60.4%, exceeding the historical rate of under 50% in similar high-risk populations. The 12-month overall survival (OS) rate was 93.6%, while median OS was not reached. Treatment-related adverse events (TRAEs) occurred in 88.0% of patients, with ≥ grade 3 TRAEs in 14.0%, including thrombocytopenia and proteinuria in 6.0% of patients each, and leukopenia, neutropenia, elevated aspartate aminotransferase, and elevated alanine aminotransferase in 2.0% of patients each. AEs leading to the interruption of lenvatinib occurred in 6.0% of patients, and dose reduction was required in 18% of patients. No deaths were observed.

Conclusion

Lenvatinib may be an effective adjuvant therapy for patients with CNLC stage IIb/IIIa HCC after R0 hepatectomy. However, the findings are limited by the single-arm design and small patient cohort, necessitating larger randomized controlled trials for validation.

Plasma fibrinogen levels towards cancer incidence: a systematic review and meta-analysis of epidemiological studies

IMPORTANCE

Understanding the association between fibrinogen levels and cancer incidence is crucial for elucidating potential diagnostic and therapeutic implications in oncology.

OBJECTIVE

This meta-analysis aimed to comprehensively evaluate the relationship between circulating fibrinogen levels and various tumour types.

REGISTRATION

This systematic review had been registered in PROSPERO (ID: CRD42024616015).

DATA SOURCES

A systematic review search was performed on PUBMED, EMBASE and Cochrane databases until June 3, 2023.

STUDY SELECTION

Studies that fulfilled our pre-established inclusion criteria were incorporated into our analysis. These criteria encompassed prospective cohort, case-control, and nested case-control designs, all featuring histopathologically confirmed primary cancers. Furthermore, we included studies that had reported odds ratios (ORs), relative ratios (RRs) or hazard ratios (HRs) along with their corresponding 95% confidence intervals (95% CIs), ensuring the reliability and comparability of the data across studies.

DATA EXTRACTION AND SYNTHESIS

Two independent authors meticulously extracted data from eligible studies, ensuring rigour and accuracy. Subsequently, we performed statistical analyses using the robust STATA version 12.0 software, guaranteeing the reliability of our findings. Moreover, we carried out in-depth subgroup analyses, categorizing studies based on tumour type, to meticulously explore and quantify the variations in the correlation between fibrinogen levels and tumour incidence. Through this approach, we have gained a nuanced understanding of the potential heterogeneity of this relationship across different cancer types.

MAIN OUTCOMES AND MEASURES

The major outcome of this study centred on elucidating the relationship between fibrinogen levels and cancer incidence, with subsequent subgroup analyses conducted to delve deeper into this relationship within specific tumour types. This approach aimed to provide a comprehensive understanding of how fibrinogen levels may varying influence different cancer types, thereby offering potential insights into the identification of novel risk factors or biomarkers for further clinical investigation.

RESULTS

Twelve studies were meticulously incorporated into the meta-analysis. Notably, significant heterogeneity was observed across these studies, necessitating careful interpretation of the results. The meta-analysis demonstrated a compelling connection between elevated fibrinogen levels and an increased risk of cancer incidence, with an hazard ratio (HR) of 1.33 (95% CI: 1.16, 1.51; p = 0.000), demonstrating a statistically significant finding. Further subgroup analyses delved into specific cancer types and identified significant associations with smoking-related cancer (HR = 1.79; 95% CI: 1.54, 2.09; p = 0.000), lung cancer (HR = 1.98; 95% CI: 1.62, 2.43; p = 0.000) and colorectal cancer (HR = 1.27; 95% CI: 1.00, 1.62; p = 0.048). These findings underline the potential significance of fibrinogen levels as a potential biomarker or risk factor for these particular cancer types.

CONCLUSIONS AND RELEVANCE

Elevated plasma fibrinogen levels have been significantly associated with an increased incidence of cancer, particularly in the cases of lung and colorectal cancers. These compelling findings underscore the potential value of fibrinogen levels as a diagnostic or prognostic biomarker in cancer management. Accordingly, further studies and clinical validation are urgently needed to fully explore the role of fibrinogen in cancer and its potential application in clinical practice.

Trends in rheumatoid arthritis burden in China and globally, 1990-2021: A longitudinal study based on the GBD database

BACKGROUND

Rheumatoid arthritis (RA) is a chronic autoimmune disease that imposes significant health and economic burdens worldwide, particularly in developing countries such as China.

METHOD

In this study, the Global Burden of Disease, The GBD database system stratified the incidence,prevalence,death and disability-adjusted life years (DALYs) of RA in China and the world from 1990 to 2021 by age, sex and period. Joinpoint Regression Program 5.1.0 was then used to calculate average annual percent change (AAPC) and 95% confidence interval (95% confidence interval). CI) to identify trends in disease burden. In addition, data collation using WPS allows for the comparison of RA burdens across different age groups, genders and time points in China and globally, and the data is rigorously screened and processed to ensure accuracy and comparability.

RESULTS

From 1990 to 2021, ASIR of RA in China increased by 0.54%, while the global ASIR rose by 0.41%.The number of RA cases in China increased cumulatively by 133%, compared to a global increase of 125.21%.Simultaneously, ASPR in China and globally increased by 17% and 14.44%, respectively.Regarding mortality, although the number of RA-related deaths increased in both China and globally, ASMR decreased by 26.23% in China and 22.86% globally.The trend in ASDR was consistent with ASMR, with declines of 0.40% in China and 1.46% globally.Furthermore, the study revealed significant gender disparities in RA both in China and globally, with women experiencing higher incidence, prevalence, mortality, and DALYs than men.The burden of RA increased significantly with age, particularly among middle-aged and older adults aged 45 and above.

CONCLUSION

Over the past 30 years, the burden of RA in China and globally has undergone significant changes.The study found that while RA related mortality and DALYs have slightly decreased in China and globally, the incidence and prevalence rates have continued to rise, particularly among women and middle-aged to elderly populations.Population aging and changes in lifestyle are key drivers of the increasing RA burden, with women showing higher susceptibility and burden due to their unique physiological characteristics and societal roles.The study highlights the need to strengthen early screening and intervention, optimize personalized treatment plans, and pay special attention to the unique needs of elderly and female populations.Additionally, promoting healthy lifestyles, improving primary healthcare services, and implementing supportive policies can effectively alleviate the health and socioeconomic burden of RA, ensuring a better quality of life for patients.

Identifying KL-6-Associated Immune Cell Signatures and Key Genes in Emphysematous COPD

Background

This study aimed to evaluate the potential of Krebs von den lungen-6 (KL-6) as a biomarker for distinguishing emphysematous chronic obstructive pulmonary disease (COPD-E) from non-emphysematous COPD (COPD-NE), and to explore the underlying mechanisms associated with KL-6 expression.

Methods

We enrolled 154 patients with COPD and 170 healthy controls to assess serum KL-6 levels. Receiver operating characteristic curve was used to determine the diagnostic sensitivity and specificity. Pearson's correlation analysis was used to evaluate the correlation. Univariate and multivariate linear regression analyses were performed to explore the factors influencing KL-6 levels in COPD. Transcriptomic sequencing was performed on peripheral blood mononuclear cells from COPD patients with varying KL-6 levels to explore underlying biological mechanisms. A Mendelian randomization analysis was employed to ascertain the association between the expression quantitative trait loci of key genes and emphysema risk.

Results

Serum KL-6 levels were significantly elevated in COPD patients, particularly in COPD-E. Pearson analyses revealed that the serum KL-6 concentration was positively correlated with eosinophil count. Transcriptomic analysis revealed 237 differentially expressed genes (DEGs) between patients with high and low levels of KL-6. Gene set enrichment analysis revealed that these DEGs were associated with immune responses. No significant difference in immune cell proportions were observed between high and low KL-6 groups, but KL-6 showed a negative correlation with T cell gamma delta. By intersecting the DEGs with those from the GSE248493 dataset, we identified seven key genes and further validated their association with the risk of emphysema using Mendelian randomization, with amidohydrolase domain containing 2 (AMDHD2) potentially reducing the risk of the disease.

Conclusion

KL-6 is a promising biomarker for distinguishing COPD-E from COPD-NE and AMDHD2 may be involved in the regulation of increased KL-6 levels in COPD-E.

Enhanced prognosis and regional cooperative rescue systems for acute myocardial infarction: insights from chest pain centers in Ningxia, China

Chest Pain Centers (CPC) demonstrated improved outcomes for patients with acute myocardial infarction (AMI) globally. However, the long-term impact of CPC establishment in economically developing areas, such as Ningxia, China, remains unclear. This study aimed to assess the long-term prognosis and efficacy of collaborative regional rescue systems centered on CPC for ST-segment elevation myocardial infarction (STEMI) patients in Ningxia. This retrospective cohort study analyzed 5344 STEMI patients from the Ningxia Myocardial Infarction Registry (2014-2019). Based on CPC establishment, patients were segregated into two groups: pre-CPC (n = 2141) and post-CPC (n = 3203). Kaplan-Meier survival analysis and Cox proportional hazards models were employed to compare the groups and evaluate long-term outcomes, including mortality and major adverse cardiovascular and cerebrovascular events (MACCEs). A total of 5344 acute STEMI patients were included, with 2141 (40.06%) in the pre-CPC group and 3203 (59.94%) in the post-CPC group. In comparison to the pre-CPC group, the post-CPC group exhibited lower all-cause mortality rates at 30 days (4.53% vs. 6.68%, p = 0.001), 1 year (6.24% vs. 9.11%, p = 0.001), and 3 years (8.55% vs. 11.86%, p < 0.001). Additionally, the post-CPC group showed decreased rates of MACCEs at 30 days (7.90% vs. 10.00%, p = 0.008) and 3 years (18.86% vs. 23.12%, p < 0.001). Kaplan-Meier survival analysis yielded similar results. After adjusting for confounding factors using COX multivariable regression, the CPC establishment was found to be a protective factor for all-cause mortality and MACCEs within 30 days (MACCEs: HR = 0.72, 95%CI 0.59-0.88, p = 0.005; all-cause mortality: HR = 0.59, 95%CI 0.46-0.77, p < 0.001), 1 year (MACCEs events: HR = 0.80, 95%CI 0.68-0.94, p = 0.006; all-cause mortality: HR = 0.59, 95%CI 0.44-0.69, p < 0.001), and 3 years (MACCEs: HR = 0.71, 95%CI 0.62-0.81, p < 0.001; all-cause mortality: HR = 0.55, 95%CI 0.46-0.67, p < 0.001). The establishment of Chest Pain Centers and implementation of regional cooperative rescue systems significantly improved the long-term prognosis of STEMI patients in Ningxia. These findings underscore the importance of developing CPC in underdeveloped regions to enhance cardiovascular emergency care and reduce mortality and morbidity associated with acute myocardial infarction.

Hypercoagulable state and gut microbiota dysbiosis as predictors of poor functional outcomes in acute ischemic stroke patients

Stroke is the second leading cause of death worldwide. Acute ischemic stroke (AIS) patients often exhibit hypercoagulable state and gut microbiota dysbiosis. However, the association between coagulation abnormalities and gut microbiota dysbiosis in AIS patients and their predictive value for poor functional outcomes in AIS has not been investigated. Our study enrolled 95 AIS patients and 81 healthy controls, using 16S rRNA sequencing to analyze gut microbiota composition. Baseline fibrinogen level was found to be an independent risk factor for poor functional outcomes at 90-day follow-up (odds ratio = 2.16, 95% confidence interval: 1.02-4.59, P = 0.044). AIS patients showed significant gut microbiota dysbiosis, with significantly increased Parabacteroides and Alistipes, and decreased Prevotella and Roseburia, associated with coagulation indices. Furthermore, compared with AIS patients with normal coagulation function, those in a hypercoagulable state exhibited a significant increase in Alistipes and a decrease in Prevotella. We identified gut microbial biomarkers consisting of 15 bacteria that predicted poor functional outcome in AIS patients at 90-day follow-up. Coagulation indices improved the predictive performance of these biomarkers. In training and validation cohorts, area under the curve (AUC) values were 0.930 and 0.890 for microbial biomarkers alone, 0.691 and 0.751 for coagulation indices alone, and 0.943 and 0.944 for coagulation indices combined with gut microbial biomarkers. Our study showed that AIS patients with hypercoagulable state had gut microbiota dysbiosis, with Alistipes and Prevotella significantly associated with coagulation indices. A classification model based on coagulation indices and gut microbial biomarkers accurately predicted poor functional outcome in AIS patients at 90-day follow-up.

IMPORTANCE

Acute ischemic stroke (AIS) patients often exhibit hypercoagulable state and gut microbiota dysbiosis. However, the relationship between hypercoagulable state and gut microbiota dysbiosis in AIS patients and their predictive value for poor functional outcomes has not been fully explored. Our study of 95 AIS patients showed that baseline fibrinogen level was an independent risk factor for poor functional outcome at 90-day follow-up in AIS patients. Hypercoagulable state in AIS patients correlates with gut microbiota dysbiosis. AIS patients with hypercoagulable state had increased Alistipes abundance and decreased Prevotella abundance. A classification model based on coagulation indices and gut microbial biomarkers accurately predicted poor functional outcome in AIS patients at 90-day follow-up.

Spatial-temporal analysis and spatial drivers of childhood obesity in China from 1985 to 2019

OBJECTIVE

We characterized the spatial-temporal trends of obesity among Chinese children and adolescents from 1985 to 2019 and examined the impact of social determinants of health (SDOH) patterns.

METHODS

Using data from the Chinese National Survey on Students' Constitution and Health (CNSSCH) conducted between 1985 and 2019, featuring seven cross-sectional surveys, we employed spatial-temporal analysis methods and collected 23 obesity-related variables to identify SDOH patterns. A general linear regression model investigated associations between SDOH patterns and obesity prevalence.

RESULTS

Obesity prevalence rose from 0.1% to 8.1%. Northern regions formed a high-obesity cluster, whereas Southern regions were low-obesity clusters. The following four SDOH patterns emerged: Western Resource-Limited Frontier, Coastal-Central Development Belt, Inland Agricultural Heartland, and Metropolitan Resource-Rich Hubs. Prevalence was 5.7%, 5.8%, 10.2%, and 11.3% for Patterns 1 through 4, respectively. Compared with Pattern 2, Patterns 3 and 4 showed higher obesity risks.

CONCLUSIONS

Childhood obesity prevalence in China increased with regional disparities from 1985 to 2019, with higher prevalence in the North and lower prevalence in the South. SDOH patterns were linked to spatial clusters, suggesting that regions characterized by advanced urbanization, abundant resources (Pattern 4), and a dietary profile heavy in carbohydrates and low in protein (Pattern 3) potentially contributed to increased obesity risk.

Trends in adult physical fitness in China: an analysis of national monitoring reports (2000-2020)

Background/Objectives

To summarize the results of China's five national monitoring reports (CFNMR) on physical fitness (PF) for adults. The Government of China has taken a systematic administrative approach to a creative environment building, and has conducted five national physical fitness monitoring, with a sixth already started in 2024.

Methods

CFNMR included indices, rates, test indicators, and questionnaire indicators collected between 2000 and September 2024. Data were collected (every 5 years), analyzed (every 3 years) and published (government announcements and reports) by the Monitoring Center of the General Administration of Sport of China. Adults' data were divided into Group A (20-39 years) and Group B (40-59 years). In this study, once the database was established using government reports as the standard, the indicators were categorized, counted, and descriptively analyzed using EXCEL.

Results

Group A: Indices fluctuated up 2.98 (2010 highest 102.98), and rates fluctuated up 2.40% (2005 highest 89.3%). Group B: Indices continued to decline 0.23 (2014 lowest 99.77), and rates fluctuated up 3.00% (2019 highest 90.6%). Test and questionnaire indicators show different structural characteristics, but obesity (7.33%) and overweight rates (5.88%) continue to increase.

Conclusion

Adult physical fitness is improving, but physical activity is decreasing. The results of the overall growth shown by the tested indicators do not, however, represent the formation of well-functioning mechanisms. Obesity is an ongoing and growing problem that requires constant attention. It should consider adding a physical literacy monitoring component, utilizing public goods attributes, to promote sustainable change and reach more adults.

Effects of self-managed lifestyle behavioral changes on cognitive impairment control in Chinese older adults: a population-based prospective study

Few studies have examined the effects of self-managed lifestyle behavioral adjustment on cognitive status. This study aimed to explore the association between self-managed behavioral changes and transitions in cognitive status. The Hubei Memory and Aging Cohort Study was a prospective cohort study conducted from 2018-2023 in rural and urban areas. Home-dwelling adults aged ≥65 years completed neuropsychological, lifestyle, clinical, and cognitive assessments. The Cox regressions and cubic splines were used to assess the risk of incident cognitive impairment, and latent class analysis was used to group participants based on behavioral patterns and assess transitions in cognitive status. Among 2477 participants with a mean of 2.02 (SD, 1.25) years of follow-up were included in the study. Participants with low and intermediate compared with high baseline behavioral risk exhibited a reduced risk of incident cognitive impairment. At follow-up, those who maintained stable healthy behaviors or positively adjusted them had a 54% (HR, 0.46 [95% CI, 0.34-0.62]) and 84% (0.16 [0.07-0.35]) lower risk of developing cognitive impairment, respectively, compared with those who maintained unhealthy behaviors. The standard and reinforced behavioral adjustment patterns exhibited a 37% (0.63 [0.22-1.79]) and 77% (0.23 [0.05-0.97]) reduction in the risk of incident cognitive impairment, respectively, compared with the basic pattern. Optimal cognitive gains were attributed to positive adjustments in social networks, physical exercise, cognitive activity, and sleep health. Older adults who maintained healthy behaviors or positively adjusted their unhealthy behaviors exhibited a reduced risk of incident cognitive impairment. Positive behavior modification brought greater cognitive improvement to all participants and more pronounced effects for those with dementia.

The burden of ischemic heart disease among women of childbearing age in China from 1990 to 2021, and projections for the next 15 years

BACKGROUND

There are no studies on the burden of ischemic heart disease (IHD) among women of childbearing age (WCBA) in China. This study aims to describe the IHD burden among WCBA in China from 1990 to 2021, predict the trends over the next 15 years, and identify the contributing factors associated with IHD-related deaths.

METHODS

The data was extracted from the Global Burden of Disease Database 2021. The Direct age-standardized method was used to estimate the age-standardized (AS) prevalence rate (ASPR), mortality rate (ASMR), incidence rate (ASIR), and disability-adjusted life years rate (ASDR) of IHD among WCBA. Joinpoint regression analysis was used to analyze the Annual Percent Change and Average Annual Percent Change from 1990 to 2021. The Autoregressive Integrated Moving Average model was used to predict the trend over the next 15 years.

RESULTS

From 1990 to 2021, the ASPR and ASIR increased by 17.44% and 25.83%, culminating in 616.50 (95% UI, 498.42-762.38) and 79.93 (95% UI, 49.43-113.88) cases per 100,000 individuals. Conversely, the ASMR and ASDR declined to 5.17 (95% UI, 4.14-6.33) and 261.24 (95% UI, 212.03-318.03) cases per 100,000 individuals. Over the next 15 years, the ASPR is projected to increase by 25.74%, culminating in 775.20 (95% UI, 637.98-912.42) cases per 100,000 individuals. The main contributor to increased IHD-related deaths among WCBA in China was high low-density lipoprotein.

CONCLUSIONS

Despite the significant decline in the ASMR and ASDR of IHD among WCBA in China over the last 30 years, the ASPR and ASIR continue to increase. Additionally, the ASPR is projected to rise over the next 15 years. These findings emphasize that effective measures and timely interventions are needed to reduce the disease burden.

Outpatient pooling policy and healthcare satisfaction among middle-aged and older adults: evidence from China

OBJECTIVE

Previous studies have shown that health insurance and financial burden affect satisfaction with healthcare. This study aims to examine the relationship between China's outpatient pooling policies and healthcare satisfaction among middle-aged and older adults. Additionally, it investigates how demographic, socioeconomic, health status, healthcare utilization, and regional healthcare resource variables influence satisfaction levels.

METHODS

Using data from the 2015 and 2018 China Health and Retirement Longitudinal Study, a mixed-effects ordered logit model was employed to assess the relationship between outpatient pooling policies and healthcare satisfaction.

RESULTS

Outpatient pooling policies for Urban Employee Basic Medical Insurance were significantly associated with higher healthcare satisfaction (AOR = 1.29, 95% CI = [1.03, 1.62]), with particularly strong effects observed in the middle (AOR = 2.55, 95% CI = [1.05, 6.18]) and eastern regions of China (AOR = 3.05, 95% CI = [1.46, 6.39]). Higher financial levels of outpatient insurance protection were also associated with greater healthcare satisfaction (AOR = 1.44, 95% CI = [1.11, 1.86]). However, no significant association was observed regarding the outpatient pooling policies for Urban and Rural Residents Basic Medical Insurance. Additionally, demographic, socioeconomic, health, and healthcare utilization variables, along with regional healthcare resources, were significantly associated with healthcare satisfaction.

CONCLUSIONS

This study highlights the role of implementing outpatient pooling policies, especially a higher level of protection under these policies, in improving healthcare satisfaction among middle-aged and elderly individuals in China.

Disparities, trends, and projections of cancer mortality burden related to high body mass index in China from 2005 to 2030

High body mass index (BMI), defined as a BMI greater than or equal to 20-25 kg/m2, is considered a rapid-increased risk factor for cancer. Based on comparative risk assessment framework, we elaborate the mortality burden of cancers attributable to high BMI in China. In 2018, we estimated that there were 85.19 thousand cancer-related deaths and 2,220.01 thousand cancer-related years of life lost (YLLs) attributable to high BMI in China. Of these, 62.14 thousand deaths and 1,698.81 thousand YLLs were from males. With higher socioeconomic levels, the burden generally increases initially and then decreases. By 2030, the projected age-standardized mortality rate attributable to high BMI in China will be 6.67 per 100,000 people, increased by 3.25% from that in 2005. In summary, the swift increase and substantial disparities in the cancer burden attributable to high BMI underscore the urgent need for evidence-based policies and interventions in China.

Effects of traditional Chinese exercises on post-stroke depression: a meta-analysis of randomized controlled trials

Post-stroke depression (PSD) is a common complication that worsens neurological recovery and increases mortality among stroke survivors, creating a significant burden on patients and families. While exercise interventions are known to alleviate depressive symptoms in mild stroke cases, the effects of traditional Chinese exercises on PSD have not been systematically reviewed. This study aimed to evaluate the clinical efficacy of traditional Chinese exercises in treating PSD. A comprehensive search of eight Chinese and English databases identified randomized controlled trials (RCTs) published up to July 2024. Data were independently screened, extracted, and analyzed using RevMan 5.3 and Stata 17, with heterogeneity assessed through sensitivity, subgroup, and meta-regression analyses. Ten RCTs involving 627 participants were included. Meta-analysis revealed that traditional Chinese exercises significantly reduced depressive symptoms and improved daily living abilities in PSD patients. Specifically, HAMD scores decreased [SMD = -1.40, 95% CI (-1.88, -0.92), p < 0.00001], treatment efficacy improved [OR = 3.74, 95% CI (1.69, 8.28), p = 0.001], FMA scores increased [MD = 6.22, 95% CI (4.12, 8.32), p < 0.00001], and BI levels rose [MD = 4.95, 95% CI (2.96, 6.93), p < 0.00001]. In conclusion, traditional Chinese exercises offer significant benefits in treating PSD, demonstrating both efficacy and safety. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024574791.

Establishment and validation of systemic inflammatory index model and risk assessment of PVT in cirrhosis after splenectomy-a retrospective study

Objective

The study aimed to create and validate a straightforward nomogram to predict portal vein thrombosis (PVT) in cirrhotic patient post-splenectomy, and investigate the predictive potential of systemic inflammation markers. One objective of the study was to develop a predictive model utilizing these markers to detect high-risk individuals early on.

Methods

A retrospective analysis was conducted on 184 cases of patients with cirrhosis who underwent splenectomy at The First Affiliated Hospital of University of South China from January 2015 to September 2023. The cohort was randomly divided into training (n = 130) and validation (n = 54) groups. Univariate and multivariate logistic regression analysis was employed to construct the prediction model. The performance of the nomogram was evaluated based on its ability to discriminate, calibrate, and demonstrate clinical utility.

Results

According to univariate and multivariate logistic regression analysis, we found six prediction indexes of PVT in patients with cirrhosis after splenectomy: postoperative neutrophil-to-lymphocyte ratio (NLR), postoperative derived NLR (dNLR), C-reactive protein to albumin ratio (CAR), portal vein diameter (DPV), platelet change value (PVB), and D-dimer (p-value < 0.05). Our clinical prediction model was created based on the aforementioned risk factors and demonstrated superior predictive power in both the primary cohort (AUC = 0.876) and validation cohort (AUC = 0.817). The calibration curve demonstrated satisfactory agreement between model predictions and actual observations, and the decision curve analysis (DCA) curve indicated high clinical net benefit.

Conclusion

Postoperative NLR, dNLR, CAR, PVB, DPV, and D-dimer were identified as the independent risk factors of PVT in cirrhotic patients post splenectomy. We had successfully established and validated a novel predictive model with good performance, based on systemic inflammatory indices in predicting PVT in cirrhosis after splenectomy.

The Effect of Nurse-Led Intervention on Limiting Health Costs of Cardiovascular Diseases in Chinese Adults

Cardiovascular diseases (CVDs), as the leading cause of mortality worldwide, impose substantial health-related costs. Lifestyle modification through education and counseling is a key strategy in CVD management. This study aimed to evaluate the impact of a nurse-led intervention on CVDs-related health costs and lifestyle habits among Chinese adults with CVDs. A quasi-experimental study was conducted among adults with CVDs assigned to either an intervention or control group. The intervention consisted of bi-monthly sessions over a six-month period, conducted in a hospital setting by trained registered nurses. Outcomes included CVD-related health costs and lifestyle behaviors (smoking, alcohol use, physical activity, and diet), measured at baseline, post-intervention, and six-month follow-up. Data were analyzed using Analysis of covariance (ANCOVA) to compare adjusted outcomes between groups, controlling for baseline values, age, gender, and BMI. The intervention group showed a higher proportion of non-smokers (from 65.2 to 74.1%) and participants with healthy diets (from 14.8 to 27.4%). At post-intervention, they had significantly fewer cigarettes smoked (9.6 ± 0.27, 95% CI: 9.07, 10.13 in intervention group vs. 11.1 ± 0.31, 95% CI: 10.49, 11.71 in control group; p = 0.024, η² = 0.020) and higher physical activity levels (264.4 ± 5.7, 95% CI: 253.23, 275.57 in intervention group vs. 229.2 ± 6.2, 95% CI: 217.05, 241.35 in control group; p = 0.032, η² = 0.018). At follow-up, they also showed significantly lower adjusted CVD-related health costs (17.2 ± 0.41, 95% CI: 16.4, 18.0 in intervention group vs. 20.7 ± 0.46, 95% CI: 19.8, 21.6 in control group; p = 0.029, η² = 0.018), sustained reductions in cigarette use (9.5 ± 0.26, 95% CI: 8.99, 10.01 in intervention group vs. 11.2 ± 0.32, 95% CI: 10.57, 11.83 in control group; p = 0.013, η² = 0.024), and increased physical activity (260.1 ± 5.4, 95% CI: 249.52, 270.68 in intervention group vs. 229.1 ± 6.4, 95% CI: 216.56, 241.64 in control group; p = 0.016, η² = 0.021). The nurse-led intervention may help promote lifestyle improvements and contribute to reductions in CVD-related health costs.

An elevated percentage of CD4⁺CD25⁺CD127low regulatory T cells in peripheral blood indicates a poorer prognosis in hepatocellular carcinoma after curative hepatectomy

BACKGROUND

Previous studies suggest the percentage of CD4⁺CD25⁺CD127low regulatory T cells (Tregs) in peripheral blood of patients with hepatocellular carcinoma (HCC) was significantly higher than that in healthy, which may be a significant predictor of HCC clinical outcome, and we examined the utility of Tregs in predicting prognosis in HCC after curative hepatectomy.

METHODS

77 diagnosed HCC patients from August 2018 to March 2023 were selected as research objects, we retrospectively analyzed whether the preoperative percentage of CD4⁺CD25⁺CD127low Tregs in peripheral blood predicts prognosis after curative hepatectomy in HCC patients. The percentage of CD4⁺CD25⁺CD127low Tregs was detected by flow cytometry.

RESULTS

The percentage of CD4⁺CD25⁺CD127low Tregs was significantly elevated in patients who developed recurrence and death (p < 0.050). X-tile software was used to calculate optimal cut-off value of Treg percentage (5.85%), and patients were divided into two groups with high and low Treg percentage. Patients with higher preoperative Treg percentage had a significantly poorer prognosis (p < 0.050). Cox regression demonstrated the percentage of CD4⁺CD25⁺CD127low Tregs was an independent indicator for poor prognosis after hepatectomy. The Recurrence-free survival (RFS) (the log-rank test, p < 0.001) and Overall survival (OS) (the log-rank test, p = 0.008) in patients with higher Treg percentage were significantly lower than that in patients with lower Treg percentage. The results were confirmed by the subgroup analysis.

CONCLUSION

The percentage of CD4⁺CD25⁺ CD127low Tregs in peripheral blood is associated with poor prognosis in HCC patients. It can be suggested as a potential prognostic indicator for HCC patients after hepatectomy and complement existing risk stratification tools. Measuring the percentage of CD4⁺CD25⁺ CD127low Tregs may contribute to the formulation of treatment strategies and the improvement of the prognosis for HCC patients.

The burden of colorectal cancer attributable to high body mass index in China: findings from 1990 to 2021 and prediction to 2035

BACKGROUND

Colorectal cancer (CRC) incidence and mortality are rising in China, with high body mass index (BMI) established as a significant risk factor. However, comprehensive evidence regarding the BMI-attributable CRC burden in the Chinese population remains limited.

OBJECTIVE

This study aims to analyze the trend of CRC burden attributable to high BMI (BMI ≥ 25 kg/m2) in China from 1990 to 2021 and to predict its development from 2022 to 2035, in order to provide a scientific foundation for the formulation of public health policies.

METHODS

We analyzed data from the Global Burden of Disease Study 2021 (GBD 2021) to assess the BMI-attributable CRC burden in China from 1990 to 2021. Temporal trends were analyzed using Joinpoint regression models. Future projections through 2035 were generated using Bayesian age-period-cohort (BAPC) modeling. The Das Gupta method was used to explore the contribution of population growth, aging, and epidemiologic factors to these burden changes.

RESULTS

From 1990 to 2021, China's BMI-attributable CRC burden increased substantially, with ASMR and ASDR rising at annual rates of 2.393% (95% CI 2.306-2.481) and 2.305% (95% CI 2.188-2.422), respectively. The mortality and disability-adjusted life years (DALYs) rate both increased with age. Males showed higher burden rates in most age groups. Projections indicate continued increases in ASMR (2.43% annually) and ASDR (2.44% annually) through 2035. Epidemiological factors were the primary drivers, contributing 99.73% to mortality changes and 44.81% to DALYs changes.

CONCLUSIONS

The BMI-attributable CRC burden in China shows a concerning upward trajectory that is predicted to continue, with epidemiologic factors playing a major role. Urgent public health interventions targeting obesity prevention, lifestyle modification, and expanded CRC screening are needed to mitigate this growing burden.

Trends in the global, national, and regional burden of breast cancer among adolescents and young adults from 1990 to 2021: Analyses of the 2021 global burden of disease study

BACKGROUND

This study was devised to evaluate the burden of breast cancer (BC) among adolescents and young adults (AYAs) between 1990 and 2021.

METHODS

BC burden among AYAs (15-39 years of age) was analyzed by examining the associated age-standardized incidence rate, age-standardized prevalence rate, age-standardized death rate, and age-standardized disability-adjusted life year (DALY) rates between 1990 and 2021 at the global, national, and regional levels, together with corresponding analyses of health inequality and decomposition analyses.

RESULTS

In 2021, the respective global age-standardized incidence rate, age-standardized prevalence rate, age-standardized death rate, and age-standardized DALYs for BC were 5.87 (5.39,6.41), 49.35 (45.46,53.86), 1.37 (1.24,1.51), and 80.8 (72.84,89.23), which respectively showed increases of 33.4 %, 35.2 %, 1.5 %, and 3.3 % compared to the rate of 1990. While women comprise the vast majority of all BC cases, a higher average annual percent change was observed for males relative to females at the global level. The average annual percent change for BC incidence, prevalence, death, and DALYs among men AYAs (2.59, 2.49, 1.06, 1.10) were all higher than the corresponding values among women (0.91, 0.96, 0.02, 0.09). Regional and national differences in disease burden were observed. BC disease burden was significantly positively correlated with socio-demographic index (SDI). Similar trends were observed in terms of female disease burden, whereas disease burden of male patients was negatively related to SDI. In decomposition analyses, the primary factors associated with changes in age-standardized DALY rates were identified as aging and population growth. Health inequality analyses revealed that the burden of BC among AYAs was particularly concentrated in lower-income countries.

CONCLUSIONS

These results highlight that the burden of BC among AYAs has grown in recent decades, while also emphasizing the need to be attentive to the rising occurrence of male BC. Lower-income regions also faced a heavier BC-related burden as compared to more affluent nations. Efforts to reduce the disease burden associated with BC may thus hinge on government-based initiatives focused on improving overall national economic strength and medical system quality.

Alteration of Ubiquitination in the Brain of ENOPH1 Knockout Mice after Early Ischemic Stroke

Enolase-phosphatase 1 (ENOPH1) is a newly identified enzyme associated with stress responses and neurodevelopmental disorders. Our previous study found that ENOPH1 mediates cerebral cell apoptosis and blood-brain barrier (BBB) dysfunction during early cerebral ischemia. Ubiquitination has been identified in neuronal damage and the neuroinflammatory response in ischemic stroke. However, whether ENOPH1 regulates ischemia-induced protein ubiquitination alteration is yet unclear. Hence, the present study explored changes in the ubiquitinomic in early ischemic brain tissues between wildtype and ENOPH1 knockout mice using a comprehensive quantitative analysis. Our results showed that 4000 ubiquitination-modified sites in 1613 proteins were quantified, with 772 ubiquitinated sites in 464 proteins significantly decreasing or increasing after ENOPH1 knockout (fold change >1.5 or <1/1.5, p < 0.05). When compared to our previous parallel proteome profiles, common differential proteins FKBP5 and Claudin-11 were observed and further validated. ENOPH1 regulates the degradation of FKBP5 and the promotion of Claudin-11 by ubiquitination mediation, leading to the activation or inhibition of nuclear-initiated steroid signaling and transendothelial migration pathways. These findings, for the first time, identified ubiquitinomic features of early ischemic brain tissues after ENOPH1 knockout, suggesting that ENOPH1 may regulate neuroinflammatory stress and barrier function by modifying FKBP5 and Claudin-11 protein ubiquitination.

Impact of COVID-19 on place of death for disease-related causes: a population-based study in Nanchang, China

Little is known about the place of death at the regional level in China. Furthermore, the impact of COVID-19 on the place of death remains unclear. We aimed to examine the place of death before and during COVID-19 in Nanchang, China, focusing on changes in home death across different causes, to determine whether these changes were disproportionately experienced among patients with different diseases. Using data from the National Death Registration System, Nanchang, China, this population-based, observational study examined all non-accidental deaths from 1 January 2014 to 31 December 2019 (pre-COVID-19), and 25 January 2020 to 31 December 2022 (during COVID-19). Modified Poisson regression models were employed to assess the association between underlying cause of death and home death, and interaction terms added to evaluate changes over periods. We used R version 4.2.2 for all analyses. The analysis included 198,383 deaths, with a median age of 78 years (IQR: 66-85); 58.2% were male and 41.8% were female. Home deaths rose from 72.7% pre-COVID-19 to 75.6% during COVID-19 (p < 0.0007). Before COVID-19, patients with renal failure (adjusted PR 0.74 [95% CI, 0.67-0.81]), liver disease (0.81 [0.76-0.86]), and hematological cancer (0.88 [0.84-0.92]) were less likely to die at home compared to those with solid cancer. During COVID-19, these disparities diminished, with a significant increase in home deaths among renal failure (1.32 [1.19-1.48]), liver disease (1.19 [1.10-1.29]), and hematological cancer (1.12 [1.05-1.20]). The majority of non-accidental deaths occurred at home, with a notable rise during COVID-19, underscoring the urgent need to strengthen community- and home-based end-of-life care services. Although home death rates for patients with renal failure, liver disease, and hematological cancer were lower before COVID-19, they increased significantly during the pandemic, highlighting disparities in end-of-life care that necessitate targeted improvements.

Efficacy of probiotics in patients with cognitive impairment: A systematic review and meta-analysis

OBJECTIVE

To conduct an in-depth exploration of the specific impacts of probiotics and prebiotic supplements on cognitive impairment, it is imperative to also investigate pertinent factors, including the optimal dosage of probiotics for enhancing cognitive function. This investigation is essential for optimizing probiotic interventions to prevent and treat cognitive decline, aimed at preventing and aiding in the treatment of cognitive decline among patients with cognitive impairment.

METHODS

A comprehensive computerized search was conducted across the Embase, PubMed, Web of Science, Cochrane Library, SinoMed, CNKI, Wanfang and WeiPu Data. Studies targeting randomized controlled trials (RCTs) were included. This search covered a timeframe extending from the inception of each database to September 2024. Following an independent process of literature screening, data extraction, and rigorous quality assessment conducted by two investigators, a meta-analysis was performed using Stata 15.0 software.

RESULTS

A total of ten studies, involving 778 patients, were included in the analysis. The meta-analysis revealed that probiotics were effective in enhancing cognitive function among patients with cognitive impairment, with a standardized mean difference (SMD) of 0.52 (95% CI: 0.07, 0.98; P < 0.001). Subgroup analysis further demonstrated that the largest effect size was observed for studies utilizing the Mini-Mental State Examination (MMSE) scale as the outcome measure (SMD = 0.88). Additionally, the greatest efficacy was associated with single-strain probiotics (SMD = 0.81), and interventions lasting ≤12 weeks exhibited the most pronounced effect (SMD = 0.61).

CONCLUSION

Probiotics have been shown to enhance cognitive function, with a probiotic intervention program featuring a single probiotic strain and a duration of ≤12 weeks demonstrating particularly robust efficacy in improving cognitive function, as assessed by the MMSE scale.

A Cross-Sectional Study of the Practice of Orthopedic Specialty Nursing in Hospitals in Jiangsu Province

Purpose

To evaluate the development status of orthopedic specialty nursing in hospitals in Jiangsu Province in China.

Patients and Methods

This cross-sectional study was conducted from August to September 2024 in the orthopedics departments of secondary and tertiary hospitals in Jiangsu Province, China. Data were collected using a self-designed questionnaire administered through the online platform Wenjuan Xing. Moreover, data on specialty nursing techniques and specialty quality indicators were collected. The Pearson's chi-square test and Mann-Whitney U-test were used to identify the differences between the different types and sizes of hospitals.

Results

Data analysis involved 229 hospitals. Nurse-led clinics (8.30%) were the least used format of orthopedic specialty nursing, and there were significant differences in different sizes of hospitals (P<0.001). The most commonly implemented specialty nursing technique was coordination and nursing of bone traction (79.23%). Concerning the measures to guarantee the quality of specialty nursing, the nursing ward round was the most common, and there were significant differences in different sizes of hospitals about "specialty nursing goals or evaluation indicators to be developed" (P<0.001). 88.21% of the hospitals regularly provided specialized nursing training to nurses, and only 29.26% of hospitals set up specialist nurse positions. Only 90.83% of hospitals regularly monitored, analyzed, and there were significant differences in the improvement of quality through "clinical research" in hospitals of different sizes (P<0.001). Specialty nursing activities conducted by nurses were mainly related to performance assessment (73.80%). The standardized prevention rate of venous thromboembolism (62.31%) was the most frequently used indicator. Concerning obstacles to implementing orthopedic specialty nursing, 82.53% of the orthopedic departments expressed dissatisfaction over a lack of nurses.

Conclusion

Hospital managers and policymakers should support the growth of orthopedic specialty nursing, hire more nurses and specialist nurses, address the obstacles of evaluation and incentive mechanisms of orthopedic nurses, and investigate additional strategies for the field's advancement.

Risk factors and prognosis of acute ischemic stroke related restless legs syndrome

BACKGROUND

Recent studies suggest that stroke may be associated with an increased prevalence of restless legs syndrome (RLS) as a comorbidity or a risk factor. We aimed to explore the association between acute ischemic stroke (AIS) and RLS, and the possible pathogenesis of acute ischemic stroke related restless legs syndrome (AIS-RLS), for guiding its diagnosis and treatment.

METHODS

In this single-center, prospective study, we identified consecutive AIS patients and segregated into AIS-RLS group and non-AIS-RLS group based on the diagnostic criteria of RLS. The differences in baseline data, clinical features, examination results, stroke etiology, stroke location, and clinical prognosis (functional disability, cognitive and mood disorders) of the two groups were analyzed. Logistic regression analysis was used to evaluate the risk factors for RLS.

RESULTS

A total of 201 AIS patients were included in our study, and 21 (10.45 %) demonstrated RLS. Compared with non-AIS-RLS group, AIS-RLS group patients had higher systolic blood pressure (SBP) at admission (P < 0.05), higher mean 24-h SBP (P < 0.01), higher mean 24-h diastolic blood pressure (DBP) (P < 0.01), higher mean daytime SBP (P < 0.01), higher mean daytime DBP (P < 0.01), higher mean nocturnal SBP (P < 0.01), higher mean nocturnal DBP (P < 0.05), smaller variation coefficient of 24-h SBP (P < 0.05). The distribution of AIS-RLS and non-AIS-RLS was not different for each subtype according to the cortical and subcortical classification of lesion sites. The NIHSS score, GAD-7 score and PHQ-9 score were higher at 7 days (P < 0.05), and the modified Rankin scale (mRS) was higher at 3 months follow-up (P < 0.05) in the AIS-RLS group. In the logistic regression, the higher SBP at admission had a statistically significant effect on AIS-RLS(OR = 1.030,P = 0.016)even after adjusting for age and gender(OR = 1.030,P = 0.014).

CONCLUSION

Stroke anatomy did not differ between AIS-RLS and non-AIS-RLS groups. AIS-RLS group patients tend to experience higher blood pressure. Moreover, AIS-RLS patients had worse clinical prognosis (functional disability and mood disorders) compared with non-AIS-RLS patients.

Changes in Clinical Trials of Dermatological Drugs in Mainland China Between 2016 and 2022: A Narrative Review

INTRODUCTION

Policy reforms in drug regulation and reimbursement have encouraged drug research and development in China. However, there is a lack of insights on industry trends for dermatology research. We aim to describe trends and features of clinical trials for dermatology drugs in China, understand recent achievements, and forecast development trends.

METHODS

Clinical trial records posted on the Registration and Information Disclosure Platform of Center for Drug Evaluation (CDE) were screened. All trials for dermatological drugs, posted on platform between 2016 and 2022 were included.

RESULTS

A total of 1172 trial records were identified, among which studies for skin infection, immune-mediated and inflammatory skin disease (IMIDs) and skin malignancy accounted for 48.9% (n = 573), 42.0% (n = 492) and 9.1% (n = 107), respectively. Most trials focused on generic drugs (n = 728, 62.1%). Multi-regional clinical trials (MRCTs) accounted for less than 6% of all trials. The number of trials on dermatology drugs increased sharply from 2016 to 2018 followed by a decline, which is mainly driven by the drop in bioequivalence evaluation (BE) studies for generic drugs indicated for skin infection. A growing trend in the number of trials for innovative drugs was observed. After removing duplicated drugs based on generic name, a total of 607 tested dermatology drugs were identified among which 51.9% were indicated for IMIDs. The number of innovative drugs exceeded generic drugs from 2020 to 2022. The geographic distribution of lead sites (the site where the principal investigator being employed) was uneven, with most of them located in east China. Of 1,068 trials sponsored by Chinese firms, most were BE (n = 692, 64.8%) and generic drugs (n = 722, 67.6%), while among 104 trials sponsored by multinational corporations (MNC), a majority were phase III (n = 53, 51.0%) trials and focused on innovative drugs (n = 94, 90.4%).

CONCLUSION

Findings demonstrated positive consequences of reforms in the healthcare industry in China. Nevertheless, long-term policies are expected to enhance the innovative capabilities of Chinese pharmaceutical companies while ensuring accessible and affordable drug supply with generics, encourage early participation in global drug R&D activities to shorten "drug lag", and promote investment in innovative drugs.

Burden of neurological disorders in China and its provinces, 1990-2021: Findings from the global burden of disease study 2021

BACKGROUND

The burden of neurological disorders in China has not been systematically analyzed. We aim to provide a comprehensive estimation of the national and subnational neurological burden across China from the Global Burden of Disease Study (GBD) 2021.

METHODS

We assessed burden estimates for 16 neurological disorders by age, sex, and province from 1990 to 2021, with prevalence, death, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs). We performed decomposition analysis to determine contributing factors for DALYs and used the socio-demographic index (SDI) to assess relations with development level.

FINDINGS

In 2021, there were 468.29 million prevalent cases of neurological disorders in China, corresponding to 78.10 million DALYs. Intracerebral hemorrhage was the leading cause of DALYs, followed by ischemic stroke, dementias, and migraine. DALYs of neurological disorders were higher in males than females, peaking at 70-74 years. From 1990 to 2021, the number and age-standardized rate of DALYs significantly decreased for idiopathic epilepsy and subarachnoid hemorrhage, primarily attributed to the reduction in YLLs, while the number of DALYs disproportionately increased for dementias, Parkinson's disease, and ischemic stroke contributed by population aging. The age-standardized DALY rates of seven neurological disorders had more than 5-fold variation between western and eastern provinces, despite reduced burdens with rising SDI.

CONCLUSIONS

Neurological disorders pose a large and growing burden on public health, primarily driven by population aging. Our findings could inform priority setting and targeted strategies to optimize neurological service delivery.

FUNDING

The funding information is presented in the acknowledgments.

The disease burden, risk factors and future predictions of Alzheimer's disease and other types of dementia in Asia from 1990 to 2021

BACKGROUND

There is a lack of analysis and prediction of the disease burden of Alzheimer's disease and other dementias (ADOD) in Asia.

OBJECTIVES

This study aims to explore the impact of ADOD on the Asian region during the period from 1990 to 2021.

DESIGN

Data on ADOD in Asia from 1990 to 2021 were collected from the Global Burden of Disease (GBD) Study 2021. We analyzed the number and age-standardized rates (ASRs) of incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) of ADOD from 1990 to 2021. Joinpoint regression analysis was performed, and the average annual percent changes (AAPCs) were calculated to evaluate the trends during this period. Subsequently, an auto - regressive integrated moving average (ARIMA) prediction model analysis was conducted to assess the trends in the next 30 years, aiming to report the epidemiology and disease burden of ADOD in Asia.

RESULTS

According to the analysis of the GBD database in 2021, the deaths, DALYs, incidence, and prevalence of ADOD increased by 297.34 %, 249.54 %, 244.73 %, and 250.44 % in Asia from 1990 to 2021. The ASRs of incidence, prevalence, death, and DALYs in both males and females, which consistently increased over the study period, showed that the ASRs of all females were consistently higher than those of males in Asia from 1990 to 2021. During the period from 1990 to 2021, Qatar and the United Arab Emirates witnessed the greatest changes in the number of DALYs, incidence, and prevalence. Afghanistan and China had the highest age-standardized mortality rate (ASMR) in 2021. It is worth noting that high fasting blood glucose is the top risk factor for the onset of ADOD. Females are more susceptible to the risk factor of high body-mass index (BMI), while males are more likely to be affected by smoking. According to the analysis of the ARIMA prediction model, the disease burden of ADOD in Asia will continue to show an upward trend in the next 30 years.

CONCLUSIONS

We should pay attention to the issue of population aging, attach importance to the intervention measures targeting the risk factors of ADOD, and formulate action plans to address the rising incidence of ADOD.

Application of sodium alginate and polyethylene glycol bilayer multifunctional hydrogel microneedles in infectious and diabetic wounds

Chronic wounds are challenging to heal due to persistent infection, prolonged inflammation, and impaired angiogenesis, which can ultimately lead to severe disabilities. Current treatment strategies are unable to provide the comprehensive conditions needed for effective chronic wound healing. Herein, we proposed a multifunctional microneedle patch for chronic wound healing, consisting of a needle-like drug-loading gel (DG) constructed with polyethylene glycol (PEG) and a backing hydrogel (BHG) layer constructed with sodium alginate. This design combines the therapeutic effects of drug delivery with the protective benefits of a hydrogel. The needle-like DG layer effectively penetrates the bacterial biofilm, releasing Erythromycin, Vaccarin, Demethylsuberosin, and Cyanidin, agents with synergistic antibacterial, anti-inflammatory, pro-angiogenic, and antioxidant effects in a temperature response-dependent manner. Together, these components address multiple barriers to chronic wound healing. The DG layer also maintains a moist wound environment for the wound. The pH-responsive properties of Cyanidin visually indicate the wound healing status. The multifunctional microneedle patch (DG@BHG) significant enhances healing in both infected and diabetic wounds, leveraging the combined effects of drug action and hydrogel support. This approach presents a novel therapeutic strategy for chronic wound healing by addressing infection, inflammation, and angiogenesis simultaneously.

Acid-responsive engineered bacteria with aberrant In-Situ anti-PD-1 expression for post-ablation immunotherapy of hepatocellular carcinoma

Local thermal ablation (TA) can not only reduce the tumor burden of hepatocellular carcinoma (HCC) but also stimulate the host anti-tumor immune response, offering a promising avenue for combination with immune checkpoint blockade (ICB). However, tumor recurrence and ICB resistance are associated with residual tumor masses caused by incomplete TA treatment. Thus, adjuvant therapy that can accurately eliminate residual HCC tumors post-TA is expected to improve prognosis. Bacteria-mediated tumor therapy has showed promising potential for tumor-targeting ability and in situ therapeutic proteins expression in the tumor. Here, we presented a kind of nonpathogenic engineered bacteria (named PD-1@EcM) for the potent tumor-targeting and acidic-controlled production of fusion protein comprising a mouse-derived anti-PD-1 single-chain variable fragment (scFv). A single injection of this engineered bacteria demonstrated a significantly tumor inhibition and extended survival in advanced murine primary and metastatic post-TA treatment HCC model. We observed that this engineered bacteria elicited an enhanced antitumour immune response resulting in an extensive priming of activated CD8+ T cells and polarization of tumor-associated macrophage from M2 phenotype to M1 phenotype. Taken together, this work provides a novel strategy to address major challenges in TA therapy and expand the current applications of bacteria-based platforms for precision therapy.

Analysis of the clinical application value of cfDNA methylation and fragmentation in early diagnosis of esophageal cancer

BACKGROUND

This study explores the clinical value of cfDNA methylation and fragmentation for the early diagnosis of esophageal cancer using liquid biopsy.

METHODS

Whole genome bisulfite sequencing and low-pass whole genome sequencing were utilized to detect cfDNA biomarkers, comparing 30 esophageal cancer patients with 10 healthy controls.

RESULTS

Significant differences in cfDNA methylation and fragmentation were observed between cancerous and non-cancerous samples (p < 0.05). A volcano plot identified 822 differentially methylated markers (817 upregulated, 5 downregulated), with SOX17, SOX1, ZNF382, ZNF667-AS1, and TFPI2 highly associated with esophageal cancer. Fragmentation markers (EDM, FSD, FSR, TFBS, CNV) showed 95 % specificity and sensitivity, with EDM demonstrating the best performance.

CONCLUSION

Our study highlights the clinical potential of cfDNA methylation and fragmentation biomarkers for the early diagnosis of esophageal cancer.

Diagnostic performance of deep learning-based coronary computed tomography angiography in detecting coronary artery stenosis

PURPOSE

To validate a fully automated, deep learning model based on coronary computed tomography angiography (CCTA) for the diagnosis of obstructive coronary artery disease (CAD) with stenosis ≥ 50%, which is commonly used as a clinical threshold for further testing and management. This model aims to improve diagnostic efficiency by automating the identification of significant coronary stenosis(≥ 50%).

METHODS

This multicenter clinical trial included patients been undergone CCTA from October 13, 2022, to February 28, 2023. CCTA data from suspected coronary artery disease (CAD) patients were retrospectively analyzed using deep learning-based software for comprehensive assessment, including coronary segmentation, lumen, and stenosis determination with comparison to the reference standard of consensus by three experts. This study utilized a multi-stage deep learning framework for coronary artery segmentation and stenosis analysis from CCTA images, consisting of several key components, including the 3D Multi-resolution Cascade Convolutional Neural Network (CNN), 3D Cascade-Locally Optimized Network, and Stenosis Analysis Network. The clinical trial registry number was NCT06172985.

RESULTS

A total of 1090 patients (mean age: 59.90 ± 11.51 years, 47.3% female) were included in this multicenter study. Artificial intelligence (AI) demonstrated excellent performance at the patient level, accurately diagnosing ≥ 50% stenosis by assessing each patient's coronary artery condition. The AI system showed high values for accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The values of the above statistics were 92.8%, 95.3%, 91.4%, 85.6%, and 97.3%, respectively. Excellent agreement was seen between expert readers and deep learning-determined maximal diameter stenosis for per-patient (kappa coefficients: 0.84, 95%CI: 0.81-0.88). Regarding diagnostic efficiency, comparing the AI with expert readers, the average reading time decreased from 5.94 min to 2.01 min (p < 0.001).

CONCLUSION

A novel AI-based assessment of CCTA can accurately and rapidly identify patients with coronary artery stenosis ≥ 50%, aiding in effective triage within the defined study population.

Air pollutions affect restaurant and foodservice industry in China

This study examines the impact of air pollution on food away from home (FAFH) consumption in 52 cities across 20 provinces of China, focusing on expenditures for online food delivery (online FAFH) and dine-in restaurants (offline FAFH). Using unique daily aggregated city-level consumption data linked with hourly air quality data, we employ both semiparametric and parametric models to uncover a positive relationship between PM2.5 levels and online FAFH, contrasted by a significantly negative relationship with offline FAFH. Our analysis reveals that shifts in consumer demand for food services on polluted days, coupled with changes in urban mobility patterns, contribute to these outcomes. We also detect temporal variations based on meal type, enhancing our understanding of how air pollution influences food consumption behavior. The findings indicate that increased PM2.5 levels lead to a net loss in restaurant revenue, a reduction in greenhouse gas emissions, and an increase in plastic waste. These findings contribute to a deeper understanding of the multifaceted impacts of air pollution on FAFH and corresponding economy and environmental implications.

Efficacy and Safety of Erzhu Jiedu Decoction Granules in Treating Mid-advanced Hepatitis B Virus-Associated Primary Liver Cancer Patients with Pi (Spleen)-Deficiency and Dampness-Heat Syndrome

OBJECTIVE

To assess the efficacy and safety of Erzhu Jiedu Decoction (EZJDD) Granules in treating mid-advanced hepatitis B virus-associated primary liver cancer (HBV-PLC) patients with Pi (Spleen)-deficiency and dampness-heat syndrome.

METHODS

From January 2021 to June 2023, a cohort of 132 patients were enrolled and randomly assigned to a control group or a EZJDD group according to the random numbers, with 66 patients in each group. The patients in the control group received conventional treatment for 3 months, followed by a 3-month follow-up. In addition to the conventional treatment, patients in the EZJDD group were administered EZJDD Granules (10.9 g/pack, 2 packs twice per day) orally for same duration. Progression-free survival (PFS) as primary outcome was evaluated by Kaplan Meier method. Karnofsky performance status (KPS) scores were used to assess the quality of life in two groups before and after treatment, and survival rates were determined as well. The efficacy of Chinese medicine syndrome was calculated with Nimodipine method. Liver function, tumor indicators and T lymphocyte subsets were measured, respectively. Safety indicators were recorded and assessed.

RESULTS

Of the 116 patients who completed the study, 57 were in the control group and 59 in the EZJDD group. The median PFS was 3.53 months (106 days) in the EZJDD group compared to 2.33 months (70 days) in the control group (P=0.005). Six-month survival rate was 52.63% (30/57) in the control group and 69.49% (41/59) in the EZJDD group (P=0.039). The median KPS score in the EZJDD group [70(63, 90)] was higher than that in the control group [70(60, 80)] (P=0.013). The total effective rate of CM syndrome was 52.63% (30/57) in the control group and 77.97% (46/59) in the EZJDD group (P=0.005). The levels of alpha fetoprotein, alpha fetoprotein-L3, alpha-L-fucosidase and protein induced by Vitamin K absence or antagonist- II in the EZJDD group increased less than the control group (P>0.05). CD8+ levels were decreased, while CD3+ and CD4+ levels, as well as CD4+/CD8+ ratio were significantly increased in the EZZJD group (P<0.05). No treatment-related adverse reactions were observed during the study.

CONCLUSION

EZJDD Granules significantly prolonged the median PFS and improved 6-month survival rate in patients with mid-advanced HBV-PLC (Registration No. ChiCTR2200056922).