BACKGROUND:Elevated prolactin level is associated with an increased risk of coronary artery disease (CAD), probably through promoting vascular inflammation and thrombosis. This study investigated whether prolactin exacerbates atherothrombosis by regulating endothelial dysfunction and platelet activation and further explored the underlying mechanisms. METHODS:A co-culture model of human umbilical vein endothelial cells (HUVECs) and platelets was employed to simulate the vascular interface. The effects of prolactin, alone or in combination with a protein kinase C (PKC) inhibitor or aspirin (a thromboxane A2 [TXA2] pathway inhibitor) were assessed. Endothelial activation was assessed by measuring proliferation, the expression of adhesion molecules vascular cell adhesion molecule 1 (VCAM-1) and intercellular cell adhesion molecule 1 (ICAM-1), and the production of inflammatory cytokines interleukin (IL)-6 and IL-1β in HUVECs. Platelet function was analyzed by measuring CD61 expression, surface levels of P-selectin and CD40L, and the release of platelet microparticles (PMPs). RESULTS:Prolactin significantly enhanced endothelial proliferation and the expression of adhesion molecules and inflammatory cytokines. Concurrently, it enhanced platelet aggregation and increased the surface expression of activation markers (P-selectin, CD40L) and pro-thrombotic PMPs. These effects were mediated through the PKC pathway, as they were markedly reversed by PKC inhibition. Prolactin partially restored endothelial and platelet activation even in the presence of aspirin, indicating an additional role for the TXA2 pathway. CONCLUSION:Prolactin coordinately exacerbates endothelial dysfunction and platelet activation through PKC and TXA2 pathway activation. These findings identify a dual-pathway mechanism by which prolactin may promote a pro-thrombotic state, contributing to the pathogenesis of atherothrombosis in CAD.

BACKGROUND:Nonrheumatic valvular heart disease is an increasing public health concern. This study assessed the burden and quality of care for nonrheumatic valvular heart disease in Asia and at the global level from 1990 to 2021, and projected trends to 2050 using data from the GBS (Global Burden of Disease Study) 2021. METHODS:Incidence, age-standardized incidence rate, deaths, age-standardized mortality rate, disability-adjusted life years, and age-standardized disability-adjusted life years rate were analyzed. A time-series model (autoregressive integrated moving average was used for forecasting future trends. A quality-of-care index was constructed through principal component analysis, and future quality-of-care index trends were projected using a Bayesian age-period-cohort model. RESULTS:From 1990 to 2021, both incident nonrheumatic valvular heart disease cases and age-standardized incidence rate increased globally and in Asia, whereas age-standardized mortality rate and age-standardized disability-adjusted life years rate declined. Projections suggest that incident cases will continue to rise through 2050, with age-standardized incidence rate decreasing globally but remaining relatively stable in Asia. Although Asia has lower age-standardized rates than the global average, its projected age-standardized incidence rate increase is greater. Disease burden varied by age and sex, with incidence peaking at 70 to 74 years. Mortality exceeded that of men among women after age 70 to 74. Nonrheumatic aortic valve disease contributed to the greatest burden. Quality-of-care index improved markedly from 1990 to 2021 globally and in Asia, but recent gains have slowed, suggesting a plateau in care improvement. CONCLUSIONS:Nonrheumatic valvular heart disease burden is rising, especially in aging Asian populations. Despite declining mortality and improved care quality, increasing incidence and slowing quality-of-care index gains may intensify future health system pressures.

OBJECTIVE:Based on the FDA Adverse Event Reporting System (FAERS) database, data mining of adverse event (AE) signals related to anthracyclines was conducted to explore their potential medication risks, especially cardiotoxicity, in order to promote the rational and safe use of these drugs in clinical practice. METHODS:AE data for anthracyclines (represented by aclarubicin, daunorubicin, doxorubicin, and epirubicin) commonly used to treat hematologic malignancies and solid tumors were retrieved from the FAERS database from January 1, 2004, to June 30, 2025. Disproportionation analysis was primarily used to mine signals of AEs related to anthracyclines. RESULTS:A total of 324 AE reports related to aclarubicin, 298 related to daunorubicin, 822 related to doxorubicin, and 334 related to epirubicin were extracted from the FAERS database. Based on risk signal detection using the Bayesian confidence propagation neural network (BCPNN) for cardiac AEs: For aclarubicin, left ventricular dysfunction exhibited the strongest risk signal among AEs with positive risk signals, whereas cardiac failure had the largest number of reports. For daunorubicin, supraventricular arrhythmia represented the strongest risk signal among AEs with positive risk signals, and tachycardia had the highest reporting count. For doxorubicin, acute cardiomyopathy showed the strongest risk signal among AEs with positive risk signals, whereas cardiac failure possessed the greatest number of reports. For epirubicin, heart failure with midrange ejection fraction yielded the strongest risk signal among AEs with positive risk signals, and cardiac failure had the largest number of reports. CONCLUSION:This study provides a more comprehensive insight into the monitoring, supervision, and management of adverse reactions related to anthracyclines. Clinicians should further focus on the impact of various AEs related to anthracyclines and their corresponding signal strengths, especially the cardiotoxicity of anthracyclines, which is of great value for improving the clinical safety of anthracyclines.

Heart failure (HF) remains a major public health challenge in Asia, with rising prevalence and disability burden. This study analyzed data from the 2021 Global Burden of Disease study (GBD 2021) to assess HF trends across 48 Asian countries from 1990 to 2021. In 2021, there were 29.5 million HF cases in Asia, a 155% increase since 1990, with an age-standardized prevalence rate rising from 583.62 to 633.76 per 100,000. Years lived with disability (YLDs) also surged by 155%, reaching 2.86 million in 2021. China accounted for 44.34% of Asia's HF cases, with the highest YLDs. Treated HF cases were most common, but severe HF contributed most to YLDs. The middle-high socio-demographic index (SDI) region had the highest age-standardized prevalence rate, while most SDI regions saw increasing trends, except Japan and Cyprus. The findings highlight the growing HF burden in Asia, urging targeted interventions to address this escalating health crisis.

ETHNOPHARMACOLOGICAL RELEVANCE:Yuxintong capsule, a traditional Chinese patent medicine, has been widely used in the treatment of coronary heart disease (CHD). However, whether it can improve cardiopulmonary fitness (CRF) in patients with CHD remains unclear. AIM OF THE STUDY:To evaluate the efficacy and safety of Yuxintong capsule in CRF in patients with stable CHD. MATERIALS AND METHODS:A multicentre, randomized, double-blind, placebo-controlled, parallel-group trial was conducted in 13 hospitals in China from March 2021 to November 2021, and 404 patients with stable CHD were randomly assigned to receive either Yuxintong capsule and conventional Western medicine (Yuxintong group) or placebo and conventional Western medicine (placebo group) in a 1:1 ratio for 12 weeks (ChiCTR2000041293, December 23, 2020). The primary outcomes were peak oxygen uptake (VO2peak) and anaerobic threshold (AT). The secondary outcomes were metabolic equivalents (METs), duration and onset time of 1-mm ST-segment depression on electrocardiography (ECG), and 36-Item Short Form Health Survey (SF-36) scores. The main safety indicators included complete blood count, urinalysis, liver function, renal function, coagulation function, and 12-lead electrocardiogram. And adverse events were recorded throughout the trial. RESULTS:369 patients, 187 in the Yuxintong group and 182 in the placebo group, were finally included for analysis. Compared with placebo group, 12-week treatment with Yuxintong showed an improvement in AT (0.98 ± 2.88 vs. 0.12 ± 2.79 mL kg-1·min-1; LSMD, 0.80 [95 % CI: 0.28 to 1.32]; P < 0.025), and general health (13.61 ± 15.13 vs. 8.29 ± 14.14; LSMD 5.30, [95 % CI: 2.33 to 8.31]; P < 0.05) and vitality scores (12.46 ± 11.32 vs. 6.01 ± 11.41; LSMD 6.43, [95 % CI: 4.13 to 8.31]; P < 0.05) on SF-36 scale. The other outcomes did not significantly differ between the two groups. The adverse events were similar between the two groups. CONCLUSIONS:Yuxintong capsule, as an adjunctive therapy to conventional treatment, improved AT, and general health and vitality scores on SF-36 scale in patients with stable CHD. However, the improvements in VO2peak, METs, and the duration and onset time of 1-mm ST-segment depression on ECG were not statistically significant.

ObjectiveEarly-onset preeclampsia (EOPE) represents a particularly severe clinical subtype of preeclampsia (PE) and is frequently complicated by placental abruption, which can result in serious maternal and fetal morbidity or mortality. This study aimed to develop and validate an interpretable machine learning (IML) model for predicting placental abruption in patients with EOPE.MethodsA retrospective cohort of 580 EOPE patients who delivered between January 2021 and June 2025 was analyzed and randomly divided into training (70%) and validation (30%) sets. Dual-step feature selection combining LASSO regression and the Boruta algorithm identified the most relevant predictors. Six supervised algorithms, including decision tree (DT), k-nearest neighbor (KNN), logistic regression, random forest (RF), support vector machine (SVM), and extreme gradient boosting (XGBoost), were developed and compared. Model performance was evaluated using AUC, F1 score, calibration curve, and decision curve analysis (DCA). SHapley Additive exPlanations (SHAP) were employed for model interpretation.ResultsEight optimal predictors were selected: urinary protein, placental growth factor (PlGF), diastolic blood pressure (DBP), age, fibrinogen (FIB), prepregnancy BMI, disease severity, and smoking during pregnancy. The RF model achieved the best performance (training AUC = 0.968; validation AUC = 0.894), along with the highest accuracy and F1 score among all algorithms. Calibration curves showed strong consistency between predicted and observed probabilities, and DCA confirmed greater net clinical benefit across a wide range of threshold probabilities. The confusion matrix demonstrated high sensitivity and specificity, indicating stable classification performance. SHAP analysis revealed that urinary protein, PlGF, FIB, and DBP were the dominant predictors, where elevated urinary protein and DBP and reduced FIB and PlGF significantly increased abruption risk.ConclusionThe SHAP-based RF model demonstrated high predictive accuracy and interpretability, providing a transparent, data-driven framework for individualized risk assessment of placental abruption in EOPE. This interpretable approach may facilitate early risk identification and personalized management in clinical practice.

ObjectiveTo evaluate the clinical efficacy and safety of Yingxin Pill (YXP) in patients with stable angina pectoris (SAP) and heart blood stasis obstruction syndrome.MethodsSixty patients were randomly assigned to either the experimental group (YXP plus conventional Western medicine) or the control group (Shexiang Baoxin Pill [SBP] plus conventional Western medicine), with 30 patients in each group. Treatment lasted for 4 weeks. Outcomes included the Seattle Angina Questionnaire (SAQ), a Traditional Chinese Medicine (TCM) efficacy scale, blood lipid profiles, and inflammatory markers. The effective rate and incidence of adverse events were also compared.ResultsAfter treatment, both groups showed significant improvements in SAQ scores, TCM efficacy scale scores, lipid profiles, and inflammatory markers compared to baseline (P < 0.05). There were no significant differences between the two groups in these outcomes, nor in the total effective rate or incidence of adverse events (P > 0.05).ConclusionThe addition of YXP to conventional therapy can improve symptoms, reduce blood lipid and inflammation levels, and is safe for patients with SAP and heart blood stasis obstruction syndrome.Clinical Trial Registrationhttps://itmctr.ccebtcm.org.cn/, identifier ITMCTR2025000274.

IntroductionAnthracycline-induced cardiotoxicity is a major concern in cancer treatment, as it can lead to various arrhythmias, with frequent premature ventricular contractions (PVCs) being one of the most common types. Sheng Mai Yin (SMY), a widely used Chinese herbal compound in China, has shown potential in treating anthracycline-induced cardiac dysfunction and arrhythmias. However, the evidence supporting its efficacy is limited due to methodological flaws in prior studies. Therefore, high-quality trials are essential to rigorously evaluate the efficacy and safety of SMY.MethodsThis multicenter, randomized, double-blind, placebo-controlled trial will assess the efficacy and safety of SMY in treating frequent PVCs induced by anthracycline chemotherapy. A total of 212 patients with breast cancer or malignant lymphoma undergoing anthracycline-based chemotherapy, who have been diagnosed with new-onset frequent PVCs and Qi and Yin deficiency syndrome, will be enrolled. Participants will be randomly assigned to receive either SMY or a placebo for 8 weeks, alongside standard medications. The primary outcome is the reduction rate in PVC frequency. Secondary outcomes include PVC symptom scores, Traditional Chinese Medicine syndrome scores, cardiac dysfunction biomarkers, and major adverse cardiovascular events.DiscussionThe results of this trial are expected to provide robust evidence regarding the efficacy and safety of SMY in the treatment of anthracycline-induced frequent PVCs.Trial registrationhttp://itmctr.ccebtcm.org.cn. Registration number: ITMCTR2024000858.

BackgroundCardiovascular diseases (CVDs) are the leading global disease burden, with alcohol consumption closely linked to their occurrence. This study analyzes data from the Global Burden of Disease Study 2021 (GBD 2021) to assess the distribution and trends of high alcohol use-related CVD from 1990 to 2021 across global, regional, and national levels.Materials and methodsWe used the data from the GBD 2021 to conduct stratification by region, country, gender, age, SDI, and disease type in terms of the number of deaths, age-standardized mortality rate (ASMR), disability-adjusted life years (DALYs), age-standardized rate of DALYs (ASDR), years lived with disability (YLDs), age-standardized rate of YLDs, years of life lost (YLLs), and age-standardized rate of YLLs to comprehensively assess the burden of high alcohol use-related CVD from 1990 to 2021. All statistical analyses in this study were performed using R statistical software (version 4.1.2).ResultsBetween 1990 and 2021, global deaths, DALYs, YLDs, and YLLs attributable to high alcohol use-related CVD showed notable variation. By 2021, global deaths had doubled compared to 1990, while ASMR, ASDR, age-standardized YLD rate, and YLL rate all declined. Eastern Europe had the highest rates in 2021. Males consistently had higher ASMR, ASDR, YLD, and YLL rates compared to females, with the highest number of deaths occurring in the 70–74 age group, and the 65–69 age group showing the highest DALYs, YLDs, and YLLs. These rates increased with age. Stroke was the most common high alcohol use-related CVD, while ischemic heart disease (IHD) was the least common.ConclusionBetween 1990 and 2021, the overall burden of high alcohol use-related CVD declined globally, though some regions experienced an increase. This highlights the need for continued public health efforts, particularly targeting high-risk regions and populations, to mitigate the impact of alcohol on cardiovascular health.

AIMS:To assess the changing patterns of heart failure (HF) in China from 1990 to 2021, providing evidence for informed healthcare strategies. METHODS AND RESULTS:Data on prevalence, years lived with disability (YLDs), and their corresponding 95% uncertainty intervals (UI) were obtained from the Global Burden of Disease (GBD) Study 2021. The joinpoint regression model, the age-period-cohort model, and the autoregressive integrated moving average (ARIMA) model were utilized for more in-depth analysis. In 2021, 13 099 727 (95% UI, 11 320 895 to 15 376 467) individuals lived with HF and this illness accounted for 1 290 810 (95% UI, 865 894 to 1 775 731) YLDs in China. The burden of HF is more pronounced in males and the elderly, with ischaemic heart disease having become the leading cause since 2002. The age-standardized rates of prevalence and YLDs increased at average annual percentage changes of 0.23% (95% CI, 0.20 to 0.26) and 0.25% (95% CI, 0.23 to 0.27), respectively. The curve of local drift showed a downward trend with age. Both the period and cohort rate ratios have increased significantly over the last 30 years. By 2031, the age-standardized rates of prevalence will decrease to 678.69 (95% CI, 640.75 to 716.63), while the age-standardized rates of YLDs will increase to 69.19 (95% CI, 66.95 to 71.43). CONCLUSION:The burden and risk of HF in China remains a major concern. The implementation of comprehensive strategies should be taken into consideration, including strengthening the primary healthcare system, enhancing public health education, and promoting cardiac rehabilitation.

Resumo Fundamento Os RNAs longos não codificantes (lncRNAs) e os microRNAs (miRNAs) são considerados elementos-chave na fisiopatologia do fluxo lento coronário (FLC). Objetivos Este estudo teve como objetivo explorar as redes biológicas complexas envolvidas no FLC por meio do sequenciamento do transcriptoma completo, visando identificar potenciais biomarcadores diagnósticos e alvos terapêuticos. Métodos O sequenciamento do transcriptoma completo foi realizado em amostras de três pacientes com FLC e três indivíduos controle pareados. Foi considerado estatisticamente significativo o valor de p < 0,05. Resultados Foram identificados 854 lncRNAs diferencialmente expressos, sendo 425 com expressão reduzida e 429 com expressão aumentada. A análise de vias do KEGG mostrou enriquecimento significativo de lncRNAs em vias associadas a doenças cardiovasculares, distúrbios endócrinos e metabólicos, e progressão de doenças neurodegenerativas. Além disso, foram identificados 1.999 mRNAs diferencialmente expressos, dos quais 990 estavam regulados negativamente e 1.009, positivamente. A análise de função molecular revelou participação em ligação a proteínas, regulação da atividade de quinases, atividade de transferase de ubiquitina-proteína e ligação a RNA. A análise de vias KEGG indicou que os mRNAs diferencialmente expressos estavam principalmente envolvidos em autofagia, sarampo, proteólise mediada por ubiquitina, via de sinalização por receptores do tipo NOD, via de sinalização do fator de necrose tumoral (TNF), via de sinalização por receptores do tipo Toll (TLR) e via de sinalização NF-κB. Conclusões Os mRNAs diferencialmente expressos apresentaram enriquecimento significativo em vias KEGG relacionadas à autofagia, sarampo e degradação mediada por ubiquitina, além de cascatas de sinalização envolvendo receptores do tipo NOD, TNF, TLR e NF-κB. Novos estudos são necessários para validar esses achados.

Objective:To deeply analyze the epidemiological characteristics of the disease burden of hypertension and its related damages among adolescents and young adults aged 15-39 globally from 1990 to 2021, and predict the trends until 2050, providing key evidence for formulating global public health strategies. Methods:The research data were derived from the Global Burden of Disease (GBD) 2021 database. The epidemiological trends of hypertension were systematically analyzed based on dimensions such as country/region, age, gender, and Socio-demographic Index (SDI). The age-standardization method was used to eliminate the influence of age-structure differences. Multiple statistical methods, including creating global maps, regional comparative analysis, and Joinpoint regression analysis, were employed to explore the distribution and change trends of the disease burden. The Bayesian Age to Period to Cohort (BAPC) model was utilized to predict future trends. Results:From 1990 to 2021, the absolute numbers of hypertension-related deaths, Disability-Adjusted Life Years (DALYs), and Years Lived with Disability (YLDs) increased significantly globally. The age-standardized mortality rate and DALY rate decreased to some extent, while the YLDs rate increased slightly. There were significant differences in the hypertension burden across different regions, countries, SDI regions, genders, and age groups. Predictions indicate that by 2050, the age-standardized mortality rate and DALY rate will generally show a downward trend, while the age-standardized YLDs rate will continue to rise. Conclusion:The burden of hypertension among the global population aged 15-39 is severe and complex, affected by multiple factors. This study provides important reference directions for global public health efforts. In the future, it is necessary to strengthen international cooperation and develop targeted prevention and control strategies to reduce the burden of hypertension-related diseases among adolescents and young adults and promote the healthy development of youth worldwide.

Postpartum hemorrhage (PPH) is a serious complication of hypertensive disorders of pregnancy (HDP) that can severely endanger maternal life. However, clinicians lack an HDP-specific, pre-delivery tool to quantify individual PPH risk. We aimed to develop and internally validate a nomogram for predicting PPH in patients with HDP. This retrospective single-center study included 480 women with HDP admitted between January 2022 and January 2025. PPH was defined as blood loss ≥ 500 mL after vaginal delivery or ≥ 1000 mL after cesarean section within 24 h. Patients were randomly assigned to a training set (n = 336) and a validation set (n = 144) in a 7:3 ratio. Clinical and laboratory variables, including systolic blood pressure (SBP), proteinuria, activated partial thromboplastin time (APTT), fibrinogen (FIB), 25-hydroxyvitamin D [25(OH)D], hepatocyte growth factor (HGF), and endothelin (ET), were analyzed by logistic regression to identify independent predictors for inclusion in the nomogram. Model performance was evaluated by area under the receiver operating characteristic curve (AUC), sensitivity, specificity, calibration curves, and decision curve analysis (DCA). Multivariate analysis indicated that SBP, proteinuria, APTT, and ET were independent risk factors for PPH in HDP patients, whereas FIB, 25(OH)D, and HGF were independent protective factors (P <0.05). The nomogram yielded an AUC of 0.895 (95% CI: 0.859-0.931; sensitivity 75.6%, specificity 86.2%) in the training set and 0.882 (95% CI: 0.811-0.953; sensitivity 78.9%, specificity 83.0%) in the validation set, with Hosmer-Lemeshow χ2 = 2.114, p = 0.977 and χ2 = 10.093, p = 0.259, respectively, indicating excellent discrimination and calibration. DCA indicated clinical net benefit across a wide range of threshold probabilities. This nomogram demonstrated high discrimination and good calibration for predicting PPH risk in women with HDP, with possible applicability in pre-delivery risk stratification. External validation is warranted before its application in routine clinical practice.

BACKGROUND AND OBJECTIVE:Over the last two decades, bioelectrical impedance analysis (BIA) has gained popularity as a method for assessing body compartments in nutrition studies, sports medicine, and evaluating hydration levels, fat mass, and fat-free mass variations in both healthy and diseased individuals. This study aims to offer researchers an overview of the research trends in BIA. METHODS:The data was obtained from the Web of Science Core Collection database. Bibliometric analysis was conducted using a package of R software (Bibliometrix 4.0). RESULTS:A total of 9471 articles have been published over the past 20 years, with an average annual growth rate of 10.1%. The research field primarily focuses on nutrition and dietetics, followed urology and nephrology, endocrinology and metabolism, general and internal medicine, engineering, geriatrics and gerontology, sport sciences, cardiovascular system and cardiology, physiology and science and technology-other topics. The research hotspots of BIA over the past 20 years have transitioned from "water" to "fat," and subsequently to "sarcopenia." "Sarcopenia" and "phase angle" (PhA) have emerged as recent research hotspots in the field of BIA. CONCLUSION:A total of 9471 articles have been published over the past 20 years, with an average annual growth rate of 10.1%. Nutrition and dietetics have consistently been the primary research areas in the field of BIA. "Sarcopenia" and "PhA" have emerged as recent research hotspots in the field of BIA. The application of BIA in clinical practice still holds significant untapped potential.

Background and objective Cardiac rehabilitation (CR) has been demonstrated to improve outcomes in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). However, the optimal CR initiation time and duration remain to be determined. This study aimed to explore the impact of the time factors on the CR outcomes in AMI patients who received PCI by the method of meta-regression analysis. Methods We searched five databases (PubMed, Embase, Cochrane Library, Web of Science and Google scholar) up to October 31, 2023. Meta-regression analysis was utilized to explore the impact of the time factors on the effect sizes. Subgroups with more than 3 studies were used for meta-regression analysis. Results Our analysis included 16 studies and a total of 1810 patients. The meta-regression analysis revealed that the initiation time and duration of CR had no significant impact on the occurrence of arrhythmia, coronary artery restenosis and angina pectoris. The initiation time and duration of CR also had no significant impact on the changes in left ventricular ejection fraction (LVEF, starting time: estimate = 0.160, p = 0.130; intervention time: estimate = 0.017, p = 0.149), left ventricular end-diastolic volume (LVEDV, starting time: estimate = − 0.191, p = 0.732; intervention time: estimate = − 0.033, p = 0.160), left ventricular end-systolic volume (LVESV, starting time: estimate = − 0.301, p = 0.464; intervention time: estimate = 0.015, p = 0.368) and 6-minute walk test (6MWT, starting time: estimate = − 0.108, p = 0.467; intervention time: estimate = 0.019, p = 0.116). Conclusion Implementation of CR following PCI in patients with AMI is beneficial. However, in AMI patients, there is no significant difference in the improvement of CR outcomes based on different CR starting times within 1 month after PCI or different durations of the CR programs. It indicates that it is feasible for patients with AMI to commence CR within 1 month after PCI and continue long-term CR, but the time factors which impact CR are intricate and further clinical research is still needed to determine the optimal initiation time and duration of CR.

Objectives To analyze the methodology, evidence, recommendations, quality, and implementation of traditional Chinese patent medicine (CPM) guidelines. Methods We retrieved clinical application guidelines of CPM published from 2019 to 2022. Independent screening and data extraction were performed by two evaluators. The basic information about the guidelines, including evidence and recommendations, were extracted and statistically analyzed. Quality and implementation were evaluated using the Implementation Evaluation Tool and Appraisal of Guidelines for Research & Evaluation (AGREE) II. Results In total, 29 guidelines were analyzed, including 262 recommendations and 2,308 references. All the CPM guidelines followed the principle of “evidence as a core, consensus as a supplement, and experience as a reference" and the methods provided by WHO Handbook. An average of 89 references were cited in each guideline and 8 in each recommendation. Randomized controlled trials and systematic reviews constituted 89% and 0.9%, respectively, of all references. Low or very low-quality evidence characterized 74.5% and weak recommendations characterized 83.6%. Of all recommendations, 13.7% were based on expert consensus, and 9.5% of strong recommendations were based on low or very low-quality evidence. The AGREE II scores for each domain were: scope and purpose (79.63%) and editorial independence (79.27%), followed by clarity of presentation (72.59%), stakeholder involvement (69.99%), rigor of development (53.97%) and applicability (5.11%). The implementation quality of most guidelines was either high (44.8%) or moderate (55.2%). Conclusions The results for CPM guidelines were impressive in terms of methodology, quality, and implementation. However, confidence in CPM recommendations was downgraded by low quality of evidence.

Objective: The purpose of this preliminary investigation into the pathogenesis of pre-eclampsia was to screen the differential proteins in the serum of pregnant women with normal pregnancy and early-onset pre-eclampsia using isobaric tags for relative and absolute quantitation (iTRAQ), so as to identify serum biomarkers for the early diagnosis of pre-eclampsia.Methods: We examined the peripheral serum of 58 normal pregnant women and 42 pregnant women with early-onset pre-eclampsia using iTRAQ; the differentially expressed proteins were screened for bioinformatics analysis; and the expression of candidate proteins human leukocyte antigen-1 (HLA-1) and beta 2-microglobulin (beta 2M) in placental tissues was detected using western blot.Results: We identified a total of 63 differential proteins in the serum of patients from the normal control group and the pre-eclampsia group, and this included 24 up-regulated proteins and 39 down-regulated proteins. The western blot results of placental tissue showed reduced HLA-1 expression (1.12 +/- 0.23) in the placenta in the pre-eclampsia group as compared with the normal control group (1.34 +/- 0.22). Consistent with the results observed in the serum, beta 2M in the placenta in the pre-eclampsia group was significantly elevated (1.05 +/- 0.47) in comparison with the normal group (0.75 +/- 0.33) (P < 0.05).Conclusion: In this study, we found that iTRAQ technology was useful for identifying differentially expressed proteins in the peripheral serum of pregnant women with pre-eclampsia, and that HLA-1 and beta 2M, which may be involved in the occurrence of pre-eclampsia, show promise as predictive markers of pre-eclampsia.

Background and aimsCoffee contains many bioactive compounds, and its inconsistent association with subclinical atherosclerosis has been reported in observational studies. In this Mendelian randomization study, we investigated whether genetically predicted coffee consumption is associated with subclinical atherosclerosis, as well as the role of potential mediators.MethodsWe first conducted a two-sample Mendelian randomization analysis to examine the causal effect of coffee and its subtypes on subclinical atherosclerosis inferred from coronary artery calcification (CAC). Next, the significant results were validated using another independent dataset. Two-step Mendelian randomization analyses were utilized to evaluate the causal pathway from coffee to subclinical atherosclerosis through potential mediators, including blood pressure, blood lipids, body mass index, and glycated hemoglobin. Mendelian randomization analyses were performed using the multiplicative random effects inverse-variance weighted method as the main approach, followed by a series of complementary methods and sensitivity analyses.ResultsCoffee, filtered coffee, and instant coffee were associated with the risk of CAC (β = 0.79, 95% CI: 0.12 to 1.47, p = 0.022; β = 0.66, 95% CI: 0.17 to 1.15, p = 0.008; β = 0.66, 95% CI: 0.20 to 1.13, p = 0.005; respectively). While no significant causal relationship was found between decaffeinated coffee and CAC (β = −1.32, 95% CI: −2.67 to 0.04, p = 0.056). The association between coffee and CAC was validated in the replication analysis (β = 0.27, 95% CI: 0.07 to 0.48, p = 0.009). Body mass index mediated 39.98% of the effect of coffee on CAC (95% CI: 9.78 to 70.19%, p = 0.009), and 5.79% of the effect of instant coffee on CAC (95% CI: 0.54 to 11.04%, p = 0.030).ConclusionOur study suggests that coffee other than decaffeinated coffee increases the risk of subclinical atherosclerosis inferred from CAC. Body mass index mediated 39.98 and 5.79% of the causal effects of coffee and instant coffee on CAC, respectively. Coffee should be consumed with caution, especially in individuals with established cardiovascular risk factors, and decaffeinated coffee appears to be a safer choice.

Background: The association of insulin resistance (IR) with cardiovascular disease (CVD) and all-cause mortality in type 1 diabetes (T1D) remains unclear. Purpose: To investigate whether IR is associated with CVD and all-cause mortality among individuals with T1D. Data Sources: PubMed, EMBASE, and the Cochrane Library databases were searched from inception to 31 October 2023. Study Selection: Observational studies reporting the associations between IR, as calculated by estimated glucose disposal rate (eGDR), and the risk of CVD and all-cause mortality in individuals with T1D were eligible for inclusion. Data Extraction: Data from 8 selected studies were extracted, pooled by random- effects models, and results were presented as hazard ratios (95% CI). Data Synthesis: Eight studies involving 21,930 individuals were included, of which 5 studies involving 19,960 T1D individuals reported the risk of CVD. During a median follow-up of 10 years, there were 2,149 cases of incident CVD. The pooled hazard ratio for composite CVD outcome per 1-unit increase in the eGDR index was 0.83 (95% CI 0.78–0.90, I2 = 58.9%). Five studies involving 19,403 T1D individuals reported the risk of all-cause mortality. During a median follow-up of 10 years, 1,279 deaths were observed. The pooled hazard ratio for all-cause mortality per 1-unit increase in the eGDR index was 0.84 (95% CI 0.81–0.87, I2 = 0%). Limitations: The small number of available studies restricted our ability to perform meta-regression analyses or more detailed subgroup analyses. Conclusions: IR, as calculated by eGDR, may be an additional risk factor for CVD and all-cause mortality in T1D.