Background: Hypertension is a leading contributor to global chronic disease burden. China's National Essential Public Health Services (NEPHS) programme provides standardised community-based hypertension management, yet blood pressure control remains suboptimal. The spatial heterogeneity of hypertension control outcomes and its multidimensional correlates remain poorly characterised at the scale of primary healthcare institutions (PHIs). This study examined spatial clustering and region-specific correlates in Henan Province. Methods: We matched the 2023 Henan NEPHS database with 2024 inpatient medical record front-page (IMRFP) data from all secondary and tertiary hospitals via encrypted patient identifiers, covering 2,328 PHIs in 97% of counties and 6.74 million patients. The outcome was the institution-level hypertension-related hospitalisation rate (HospR). Spatial autocorrelation with inverse-variance weighting (IVW) identified clustering patterns. Multiscale geographically weighted regression (MGWR) examined spatial heterogeneity of correlates, adjusting for demographic and disease comorbidity profile (DCP). Two sensitivity analyses verified robustness. Findings: IVW Global Moran's I was 0.54 (Z=39.16, p<0.001), confirming spatial clustering. MGWR outperformed WLS: adjusted R² 0.85 vs. 0.36; residual spatial autocorrelation was eliminated. DCP was the strongest correlate (mean 0.93, 86% significant); BMI was positively associated province-wide. Management indicators showed spatial heterogeneity: the documented blood-pressure control rate was negatively associated only in Central Henan, while Eastern Henan showed the only positive patient count association and the largest positive documented blood-pressure control rate association. Region-specific correlates included economic development in Southern Henan, safe drinking water in Northern Henan, and sanitary toilet coverage in Western Henan. Interpretation: Hypertension-related hospitalisation risk shows marked spatial heterogeneity across Henan, with associations of management indicators corresponding to different primary care developmental stages. These findings support a tiered, region-specific policy framework for primary care hypertension management, tailored to local development stages and dominant correlates. As an ecological analysis, findings reflect institution-level associations and do not establish individual-level causal relationships.

Chronic obstructive pulmonary disease (COPD) is a progressive yet preventable respiratory disease, often remaining undiagnosed until significant lung function impairment has occurred. The early, asymptomatic stage, termed “pre-COPD”, offers a critical window for intervention, yet its molecular characteristics remain poorly understood. We performed integrated proteomic and metabolomic profiling of human lung tissues across the spectrum of COPD (n = 32), including non-diseased controls, individuals with pre-COPD, and patients at varying stages of established disease. Key molecules and pathways involving in the progression of COPD were revealed. The performance of candidate biomarkers for monitoring early-stage lung function decline was validated in serum samples from an independent cohort (n = 158), and a longitudinal cohort from the UK Biobank (n = 21,686). Pairwise comparisons revealed 751 proteins and 1,024 metabolites that were differentially abundant among groups. Pathways such as pyrimidine metabolism and arginine biosynthesis were revealed associated with disease progression. Notably, we identified a core protein–protein interaction network modulated by zinc and copper, two clinically used, orally available trace elements, highlighting their potential as candidate therapeutic agents for COPD. Furthermore, integrative analysis with an independent blood-based cohort and longitudinal data from the UK Biobank uncovered choline as a circulating biomarker that predicts longitudinal lung function decline. Our findings define a molecular atlas of pre-COPD, identify actionable therapeutic targets, and propose a readily measurable biomarker for early detection and risk stratification of COPD.

Background:The integration of artificial intelligence-generated content (AIGC) tools into academic research offers transformative potential for enhancing productivity and innovation. However, within the highly regulated and ethically sensitive medical context, the use of AIGC is accompanied by significant challenges. Medical postgraduates, as the future vanguard of medical science, play a crucial role in the advancement of digital health, and their intention to use AIGC tools will significantly influence the use of these emerging technologies in medical research. Despite the growing popularity of AIGC tools, there remains a paucity of in-depth understanding of the factors driving or hindering medical postgraduates' intention to use these tools in academic research. A clear comprehension of these influencing factors is essential to foster the responsible, effective, and sustainable integration of AIGC into medical research. Objective:This study aimed to systematically explore the key factors influencing medical postgraduates' intention to use AIGC tools in academic research, with the goal of informing strategies to promote their ethical use and enhance scholarly research capabilities. Methods:We used a qualitative research design based on grounded theory. Semistructured interviews were conducted with 30 medical postgraduates across diverse specialties, all of whom had prior research experience and familiarity with AIGC tools. Participants were recruited purposively to ensure diverse perspectives. Data analysis followed a systematic coding process to inductively develop a conceptual model, which was further structured and interpreted through the theoretical lens of the Unified Theory of Acceptance and Use of Technology. Results:Our analysis identified 7 core factors directly shaping usage intention: performance expectancy, effort expectancy, social influence, facilitating conditions, individual characteristics, task characteristics, and technology characteristics. Further analysis revealed that performance expectancy acted as a mediating variable in the relationships between both task characteristics and technology characteristics and usage intention. Additionally, social influence moderated the relationship between task characteristics and performance expectancy. The research findings underscore that, while AIGC tools are valued for assisting daily research tasks, medical postgraduates' intention to use them in academic research is influenced by technical deficiencies, high cognitive load, and the strict ethical risks and data governance requirements in the medical field. Conclusions:This study constructs a conceptual model aimed at elucidating the influencing factors of medical graduate students' intention to use AIGC in academic research. Recommendations derived from the findings include (1) fostering artificial intelligence literacy and critical competency among medical postgraduates; (2) optimizing AIGC tools to better address domain-specific needs, accuracy, and security concerns prevalent in health research; and (3) establishing clear academic supervision and ethical governance mechanisms to ensure responsible use. These measures are essential to harness the potential of AIGC while safeguarding the rigor and integrity of medical academic research.

To evaluate current evidence on machine learning (ML) for the diagnosis of Hirschsprung disease (HSCR) and summarize its diagnostic performance and potential clinical utility. PubMed, Web of Science, Cochrane Library, and Scopus were systematically searched (January 2016–November 2025) for studies applying ML to HSCR diagnosis. Study quality was assessed using QUADAS-2. Findings were narratively synthesized, with exploratory meta-analysis performed where feasible. Eleven studies were included, with substantial heterogeneity in design, data modalities, and outcomes. Three barium enema–based studies were eligible for meta-analysis, showing pooled sensitivity of 0.857 (95

Long-term ozone (O3) exposure is known to be associated with respiratory mortality and hospitalization, but its effects on respiratory morbidity, symptom severity, and quality of life remain undefined. This study was conducted using data from the China Pulmonary Health (CPH) study. Respiratory morbidity was measured by the COPD Assessment Test (CAT) scores, the modified Medical Research Council (mMRC) dyspnea scale, and spirometry-defined COPD. Health-related quality of life was also considered. Long-term O3 exposure was defined as the annual average of daily maximum 8-hour average (MDA8) O3 concentrations in the year prior to the survey. Logistic and linear regression models were used to explore the association between long-term O3 exposure and the health outcomes. Each 10 µg/m3 increase in O3 was associated with increased odds of CAT ≥ 10 (measured in participants with a post-bronchodilator FEV1/FVC ratio less than 0.8; OR = 1.09, 95

Objective To identify comorbidity subgroups of heart failure (HF) from electronic health record (EHR) data by computational phenotyping and evaluate their associations with mortality and healthcare utilization. Background Multimorbidity drives HF complexity, yet conventional classifications capture it poorly and EHR-based comorbidity phenotyping in Asian HF populations remains limited. Methods In this retrospective cohort using EHR data from 462 hospitals in Yichang, China (2018–2023), latent class analysis was applied to 17 ICD-10-coded comorbidity indicators among 95,593 adults with incident HF. Cox and negative binomial models assessed all-cause mortality and healthcare utilization, adjusted for age and sex. Sensitivity analyses examined stricter HF definitions, alternative class solutions, wider comorbidity ascertainment, and competing risk of death. Results Eight phenotypes emerged; most prevalent were Cardiometabolic (31.4%) and Minimal Comorbidity (28.9%; low probabilities for all conditions except COPD). Versus Cardiometabolic, Malignancy-Anemia had the highest mortality (adjusted HR 5.00, 95% CI 4.69–5.32), followed by Cardiorenal-Anemia (2.35), Severe Multimorbidity (1.99) and Minimal Comorbidity (1.93, 1.85–2.01). Malignancy-Anemia had the highest hospitalization rate (incidence rate ratio 2.85, 95% CI 2.68–3.03), yet its cumulative incidence of first hospitalization did not differ from the reference once death was treated as a competing event (subdistribution HR 1.03; P = 0.287), reflecting high early mortality. Excess mortality in Minimal Comorbidity was not attenuated by capturing index-encounter diagnoses, adjusting for baseline healthcare contact, or stratifying by COPD; phenotype ordering held across alternative HF definitions and class solutions. Conclusions Phenotypes derived entirely from routinely coded data separate HF patients into prognostically distinct groups differing up to five-fold in adjusted mortality. Low coded comorbidity does not indicate low clinical risk, with direct implications for risk tools built on administrative data. With adjustment limited to age and sex in one region, these are hypothesis-generating prognostic associations requiring external validation and prospective evaluation before clinical use.

OBJECTIVES:The rising global prevalence of electronic cigarette (e-cigarette) use poses significant public health concerns, including nicotine dependence. This systematic review and meta-analysis evaluated the efficacy and safety of pharmacological interventions for e-cigarette cessation. METHODS:We systematically searched 5 databases, including Cochrane Library, PubMed, Ovid Embase, Sinomed, and Web of Science Core Collection, up to May 1, 2024, that evaluated the efficacy and safety of pharmacological intervention compared with placebo for e-cigarette cessation. Two investigators independently screened studies, extracted data, and assessed the risk of bias. The outcomes of interest were (1) continuous abstinence rate (CAR); (2) 7-day point prevalence of e-cigarette abstinence at different weeks; and (3) adverse effects. This study was registered with PROSPERO (CRD42024577356). RESULTS:Of 1567 initially identified records, 7 studies involving 1161 participants were included. Most studies had a low risk of bias. The results indicated that varenicline (4 studies, n=463; OR=2.52, 95% CI: 1.14-5.58) was effective, while the effect of nicotine replacement therapy (NRT; 2 studies, n=538; OR=1.38, 95% CI: 0.61-3.14) was not statistically significant. One study on cytisine also suggested potential benefit. CONCLUSIONS:Varenicline has demonstrated efficacy in supporting e-cigarette cessation, whereas the current evidence for NRT and cytisine remains insufficient to draw firm conclusions. Further well-designed studies are needed to clarify the effectiveness of these 2 interventions. Although pharmacotherapies used for cigarette smoking show potential for repurposing, their utility in e-cigarette cessation should be interpreted cautiously until stronger evidence becomes available.

The escalating global prevalence of carbapenem-resistant Gram-negative bacteria has significantly constrained therapeutic options, leading to the revived use of polymyxins. However, this resurgence has been paralleled by an increase in reports of associated adverse effects. No case of drug fever induced by polymyxin B (PMB) has been reported in the literature to date. We report the first case of drug fever (≥39 °C) induced by intravenous PMB in a patient with severe pneumonia caused by carbapenem-resistant Acinetobacter baumannii, accompanied by tachypnea following concomitant nebulized PMB administration. Upon intervention by the clinical pharmacist, which involved discontinuation of PMB and adjustment of the anti-infective regimen, the patient’s fever resolved promptly and the infection was successfully controlled. This case highlights a severe and previously unreported adverse drug reaction to PMB, underscoring the necessity for vigilant monitoring and proactive antimicrobial stewardship in managing infections.

Abstract Objective To investigate the effect of different administration timings of dexmedetomidine (DEX) on the median effective dose (ED50) of sufentanil required to suppress the cardiovascular response during double-lumen tracheal intubation in elderly patients. Methods Ninety elderly patients (aged 65–85 years, BMI 18.5–30 kg/m2, ASA physical status I–III) scheduled for elective thoracic surgery were randomized into three groups: the Control group (induction initiated following a 10-min intravenous infusion of saline), the DEX1 group (DEX 0.6 μg/kg infused over 10 min before induction), and the DEX2 group (induction initiated 20 min after completion of a 10-min intravenous infusion of DEX at a dose of 0.6 μg/kg). Anesthesia induction was initiated with intravenous sufentanil starting at 0.5 μg/kg, and subsequent doses were determined using the Dixon up-and-down sequential method with a dose ratio of 1:1.1 between adjacent dose levels. Tracheal intubation was performed 5 min after sufentanil administration according to the predefined protocol, and the infusion-to-intubation interval was predefined according to group allocation. Sequential allocation continued until at least eight crossover pairs were obtained. Patient characteristics, hemodynamic variables, Surgical Pleth Index (SPI), and adverse events were recorded from study drug administration to 5 min after intubation. Results Final analysis included 87 patients (Control: n = 30, DEX1: n = 28, DEX2: n = 29). The ED50 of sufentanil was 0.675 μg/kg (95% CI: 0.634–0.732 μg/kg) in the Control group, 0.507 μg/kg (95% CI: 0.474–0.540 μg/kg) in the DEX1 group, and 0.396 μg/kg (95% CI: 0.330–0.440 μg/kg) in the DEX2 group, corresponding to relative reductions of 24.9% and 41.3%, respectively. Conclusion Premedication with dexmedetomidine reduced the ED50 of sufentanil required to suppress the cardiovascular response to double-lumen tracheal intubation in elderly patients, with earlier administration producing a greater opioid-sparing effect. Administration of DEX 30 min before anesthesia induction resulted in the lowest sufentanil requirement. Trial registration This study was registered at the China Clinical Trial Registration Center (ChiCTR2400083508, April 26, 2024).

Abstract Background Asthma is a common chronic disease responsible for a considerable disease burden in China and around the world. Despite its burden, there is substantial unmet need for asthma care, including screening, diagnosis, treatment, and management. Symptom-based screening for asthma could support identification of undiagnosed asthma patients, as well as reference to higher-level hospitals for formal diagnoses and treatment. This study focuses on identifying suspected asthma patients and encouraging them to seek formal diagnoses and treatment. This approach aligns with the novel concept of population medicine, which aims to maximize overall population health rather than focusing on individual patients within the health system. Methods We are conducting a two-arm population-based stratified clustered randomized controlled trial (cRCT) to evaluate the effectiveness of a population medicine multimorbidity intervention package. The intervention integrates community screening, chronic disease management, patient education, digital follow-up, and team-based care. The trial is being implemented in Xishui County, Guizhou Province, a mountainous low-resource county in Southwestern China, covering 26 townships and more than 300,000 permanent residents. We considered each of the 26 townships in Xishui County as a cluster and stratified them into large and small townships based on population size. Townships with an above-average population were designated as “large,” and those with a below-average population were designated as “small.” We randomized the same number of residents in each township stratum (large and small) to undergo the European Community Respiratory Health Survey (ECRHS) for identifying suspected asthma patients. Individuals identified as suspected asthma patients were considered study participants and subsequently enrolled in the intervention or control arm. All participants in the intervention arm are followed for one year, with one telephone follow-up at month three and in-person follow-ups at months six and 12, while participants in the control arm are followed only at baseline and 12 months. Primary outcomes include the number of chronic conditions controlled, whether the participant received lung function testing, and Asthma Control Test (ACT) score. In addition, we are evaluating 42 secondary outcomes covering physiological and functional indicators such as lung function, health-related quality of life, mental health, behavioral risk factors, healthcare utilization, productivity loss, knowledge of asthma and chronic obstructive pulmonary disease (COPD), and care cascade indicators for asthma and other chronic diseases. Discussion This cRCT has been featured as an important case study in the Lancet Commission on Investing in Health report to evaluate the effectiveness of the integrated intervention package on priority conditions. The trial was designed under population medicine principles, with an aim providing holistic care and enhancing the overall health status of suspected asthma patients. The results of the trial will inform the next generation of multimorbidity management and population medicine practices among global health authorities and practitioners. Trial registration ClinicalTrials.gov Identifier: NCT06457009. Registered on June 7, 2024.

Background:Chronic obstructive pulmonary disease (COPD) remains a major global health challenge, contributing significantly to morbidity and mortality. This study aims to provide a comprehensive analysis of the burden of COPD by age, sex and Sociodemographic Index (SDI), in addition to its attributable risk factors across 204 countries and territories from 1990 to 2021. Methods:This study is a systematic analysis of data from the Global Burden of Disease (GBD) 2021 from 1990 to 2021 across 204 countries and territories. The study calculates age-standardised rates (ASRs) for prevalence, deaths and disability-adjusted life-years (DALYs) by adjusting rates to a global age distribution and computed estimated annual percentage changes (EAPC) for these ASRs and the relative COPD burden, while also exploring the relationships between the SDI and age-standardised DALYs per 1000 population via linear regression. Results:In 2021, there were an estimated 213.4 million prevalent COPD cases globally, with an ASR of 2512.9 per 100 000. From 1990 to 2021, the EAPC for ASRs in prevalence was -0.044%, while the EAPC for percentage in prevalence was 1.224%. COPD caused 3.7 million deaths, with an ASR of 45.2 per 100 000, and 79.8 million DALYs, with an ASR of 940.7 per 100 000. The leading risk factor for COPD globally was particulate matter pollution, where it accounted for 41.7% of the global DALYs. Appreciable geographical and demographic variations were observed, with North America exhibiting the greatest ASRs for prevalence and South Asia showing the greatest ASRs for death rates. Conclusions:The study highlights the persistent and evolving global burden of COPD, emphasising the significant impact of environmental factors such as particulate matter pollution. It underscores the need for targeted public health interventions and resource allocation, particularly in low-income and middle-income countries, to mitigate the growing COPD challenge. To enhance COPD management, the recommendations include implementing regional plans to mitigate particulate pollution, strengthening surveillance of air quality and health outcomes, developing integrated health strategies and supporting a global framework for air quality improvement.

INTRODUCTION:Smoking is a major preventable cause of morbidity and premature death worldwide. Both bupropion and NRT help achieve smoking cessation. However, evidence on whether the combination of bupropion and NRT is more effective than bupropion alone remains uncertain. The aim of this study was to compare the efficacy and safety of bupropion combined with NRT with bupropion monotherapy. METHODS:The Cochrane Library, Embase, PubMed, and Web of Science were systematically searched for original articles published in English. Randomized controlled trials (RCTs) that compared bupropion plus NRT therapy with bupropion were included. Qualitative and quantitative analyses were conducted and the risk of bias was assessed using the Cochrane Risk of Bias 2 tool. RESULTS:Nine RCTs involving 4005 participants (53.8% female) were included in this study. The mean age across studies ranged from 27 to 55 years. The risk of bias results showed that two RCTs were rated as high, one was low, and six were unclear. Pooled analysis indicated that bupropion combined with NRT significantly improved biochemically validated 7-day point prevalence abstinence at the end of treatment [risk ratio (RR) = 1.35, 95% confidence interval (CI): 1.22-1.50, I2 = 21%]. At long-term follow-up (≥6 months), bupropion plus NRT showed a non-significant benefit over bupropion monotherapy (RR = 1.10, 95% CI: 0.90-1.34, I2 = 52%). Adverse events were generally comparable between groups, except for a higher incidence of nausea in the combination therapy group (10.9% vs. 7.3%; RR = 1.42, 95% CI 1.04-1.94, I2 = 0%). No significant subgroup differences were found based on the types of NRT (nicotine patch, gum, or lozenge) (χ2 = 0.89, p = 0.64). CONCLUSION:Combination therapy of bupropion and NRT was associated with superior short-term smoking cessation outcome compared with bupropion alone, with a comparable safety profile except for increased risk of nausea. However, the long-term benefit of combination therapy over bupropion monotherapy was attenuated and non-significant. Further high-quality RCTs with adequate long-term follow- up are needed to confirm these findings.

Buspirone, a widely used anxiolytic, has incompletely characterized adverse effects. This study aimed to comprehensively characterize buspirone's safety profile by a large-scale analysis of real-world data from the Food and Drug Administration Adverse Event Reporting System (FAERS) database, covering Q1 2006 to Q1 2025. We collected 1744 buspirone-related adverse event reports and analyzed them utilizing various signal detection techniques, including proportional reporting ratio (PRR), reporting odds ratio (ROR), multi-item gamma Poisson shrinker (MGPS), and Bayesian confidence propagation neural network (BCPNN). The most common adverse events were categorized into nervous system disorders and psychiatric disorders, with "dizziness" (n = 141), "anxiety" (n = 133), "drug interaction" (n = 86), "serotonin syndrome" (n = 83), and "tremor" (n = 71) being the most frequently reported. Notably, several safety issues linked to suicide exhibited considerable signals. In addition to the adverse events already listed on the package insert, our research identified unanticipated adverse events associated with improper buspirone use, including "drug abuse" (n = 43), "intentional overdose" (n = 30), and "drug level increased" (n = 17). These findings indicated a potential risk of abuse with buspirone exposure during therapeutic use. Moreover, the study detected a relatively rare but noteworthy signal associated with abnormal body weight, such as "obesity" (n = 19), which merits further attention. The median time to onset for adverse events was 10 days (IQR:16). In conclusion, this pharmacovigilance research underscored the safety hazards related to prolonged buspirone usage, confirmed known risks and identified novel safety signals. These findings enriched the awareness of buspirone's safety profile and provided evidence-based guidance in clinical settings.

Climate change and anthropogenic activities are intensifying the frequency and severity of sand and dust storms (SDS), leading to higher emissions of SDS-related airborne particulate matter (dust PM). However, the health risks associated with long-term exposure to size-specific dust PM and the underlying physiological mechanisms remain unclear. We used Cox proportional hazards models to estimate the all-cause and specific-cause mortality hazard ratios (HRs) associated with long-term exposure to dust PM2.5, dust PM2.5-10 and dust PM10 in a national cohort study of 46,817 participants conducted between 2012 and 2024. And mediation analyses were performed to explore the potential mediation effects of multi-dimensional health indicators. This study had a median follow-up duration of 10.87 years. And the HRs for all-cause mortality were 1.060 (95% CI: 1.033-1.087), 1.039 (95% CI: 1.029-1.050), and 1.025 (95% CI: 1.017-1.033) for each 1 μg/m3 increase in the yearly average concentration of dust PM2.5, dust PM2.5-10, and dust PM10, respectively. Increased exposure to three types of dust PM was also linked to elevated cardiovascular and respiratory mortality. Mediation analyses indicated that lung function and oxygen-carrying capacity partially mediated the associations, accounting for 5.04-26.20% of the total effect. We found that long-term dust PM exposure was significantly associated with higher all-cause and cause-specific mortality, and these effects may be mediated through lung health pathways. Targeted management to halt desertification, along with monitoring and interventions, should be strengthened to protect public health.

Introduction Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide, with China bearing a particularly high burden. Major gaps persist in early diagnosis, guideline-based treatment and long-term disease management, especially in primary care. This study aims to evaluate the efficacy and feasibility of the National Essential Public Health Services (NEPHS) COPD management approach and to generate evidence to inform the optimisation of national COPD care standards.Methods and analysis The Primary Care Integrated Management (PRIM) trial is a prospective, multicentre, cluster-randomised controlled study conducted in seven pilot regions in China, with primary healthcare institutions as the unit of randomisation. Participants are adults aged ≥35 years with spirometry-confirmed COPD, recruited either through screening or from existing patient databases. Institutions will be randomised in a 1:1 ratio to the intervention (PRIM) or usual care arms using a computer-generated allocation sequence, stratified by urban-rural location. The intervention comprises quarterly general practitioner (GP)-led follow-ups, health education and disease management according to pilot NEPHS COPD guidelines, supported by a three-tier oversight structure involving the National Center for Respiratory Medicine, leading tertiary hospitals and primary healthcare institutions. Co-primary outcomes are the annual number of acute exacerbations and health-related quality of life (European Quality of Life-5 Dimensions and 5 Levels). Secondary outcomes include smoking status, health status assessed by the COPD Assessment Test (CAT), dyspnoea score and GP knowledge. Analyses will follow the intention-to-treat principle, using multivariable regression models adjusted for clustering and prespecified baseline covariates. Cost-effectiveness analyses of the PRIM intervention in the Chinese population are also planned.Ethics and dissemination Ethics approval has been granted by China-Japan Friendship Hospital (approval number 2024-KY-163).Trial registration number NCT06573580.

BACKGROUND AND AIMS: Evidence on the dual use profile of electronic cigarettes (e-cigarettes) and cigarettes remains limited, especially for the adult population. This study aimed to assess the prevalence and associated factors of lifetime dual use among adults who smoke in China. METHODS: The nationally representative survey of the China Health Literacy Survey (CHLS) was conducted in 2018. Participants were recruited from 31 provinces in the Mainland of China (n=21,582). Dual use was defined as self-reported ever use of both cigarettes and e-cigarettes. Multivariate logistic regression models with weights (accounting for study design, non-response rate and post hoc stratification) were used to identify the associated factors of dual use, shown in adjusted odds ratios (aOR) and 95% confidence intervals (CI). RESULTS: The prevalence of lifetime dual use of cigarettes and e-cigarettes was 0.82% in China, 2.95% among those who ever smoked, and 3.01% among those who currently smoked. The dual use was consistently more prevalent in urban areas than rural areas and decreased with age. In the adjusted logistic model, dual use was associated with younger age, living in urban areas, single status, high educational level, high income, poor self-reported health status, nicotine dependence, and other smoking-related factors. Withdrawal symptoms were more prevalent among those who used both cigarettes and e-cigarettes compared with those who exclusively smoked cigarettes, including the urge to smoke, hard to concentrate, quick temper, increased appetite, weight gain, involuntary hand tremor, and sleepiness (P<0.05). CONCLUSION: Although the prevalence of lifetime dual use is low, the absolute number of affected individuals in China is substantial. Our study identified key risk factors associated with lifetime dual use, providing critical evidence to inform targeted interventions for at-risk populations and guide the development of tailored tobacco control strategies.

Sarcoidosis is a systemic granulomatous disease that often affects the lungs, lymph nodes, and skin. The pathological hallmark of sarcoidosis is the formation of epithelioid, non-necrotizing granulomas, with CD4+ T-helper (Th) type 1 (Th1), Th17, and Th17.1 cells scattering throughout the granuloma. The CXCL16-CXCR6 axis plays a crucial role in the development of inflammatory diseases. However, the precise role of CXCR6+ CD4+ T cells in sarcoidosis pathogenesis and their therapeutic potential remain unclear. In this study, we confirmed the enrichment of CXCR6+ CD4+ T cells in the lesional tissue of sarcoidosis patients and Propionibacterium acnes-induced sarcoidosis-like model mice. Flow cytometric analysis and single-cell RNA sequencing revealed that CXCR6+ CD4+ T cells exhibited a Th17/Th17.1 phenotype and displayed pro-inflammatory characteristics. By performing cell-cell communication analysis and validating the findings with flow cytometry and CXCL16-blockade experiments, we demonstrated an active crosstalk between CXCR6+ CD4+ T cells and CXCL16+ macrophages in mice. Furthermore, treating mice with an anti-CXCR6 monoclonal antibody effectively reduced the mRNA levels of pro-inflammatory genes, including Nos2, Cxcl9, Cxcl10, Il17a, Tnf, and Ifng. In addition, anti-CXCR6 treatment reduced the abundance of Th17 and Th17.1 cells, which was associated with inhibition of downstream mTORC1 signaling. Finally, anti-CXCR6 treatment suppressed granuloma formation and attenuated collagen deposition in the lungs. Taken together, our findings highlight CXCR6 as a promising therapeutic target for inhibiting granuloma formation and pulmonary fibrosis in sarcoidosis.

Pulmonary infections have become a major global health challenge due to their high incidence, and the escalating bacterial resistance has further increased the difficulty of clinical treatment. As a pivotal agent for treating infections caused by multidrug-resistant Gram-negative bacteria, polymyxins hold a critical position in the management of pulmonary infection. This retrospective cohort study aimed to compare the efficacy, safety, and cost comparison of polymyxin B sulfate (PMB) and colistimethate sodium (CMS) in the treatment of pulmonary infections, providing real-world evidence to support clinical decision-making. A total of 527 inpatients diagnosed with pulmonary infections were included. Univariate and multivariate logistic regression analyses were performed to assess treatment outcomes and identify risk factors associated with all-cause mortality and nephrotoxicity. The results showed that there were no statistically significant differences between the two groups in 28-day and 42-day all-cause mortality or clinical response rate, whereas the PMB group was associated with a significantly shorter length of hospital stay. Univariate and multivariate logistic regression analyses on the factors influencing 28-day all-cause mortality revealed that concomitant extracorporeal membrane oxygenation (ECMO) (OR = 5.312, 95% CI: 1.412-22.893, P = 0.018), hypoalbuminemia (OR = 2.641, 95% CI: 1.549-4.613, P < 0.001), intensive care unit (ICU) admission (OR = 2.579, 95% CI: 1.273-5.330, P = 0.009), central nervous system infection (OR = 8.577, 95% CI: 3.198-24.254, P < 0.001) and concomitant use of immunosuppressants (OR = 4.113, 95% CI: 2.498-6.925, P < 0.001) significantly increased the risk of death in patients. In contrast, adjuvant inhaled polymyxin E therapy and prolonged duration of polymyxin administration exhibited a protective effect. Regarding safety, the incidence of hepatotoxicity was similar between the two groups. Although the difference in nephrotoxicity incidence was not statistically significant, the CMS group showed a numerically higher trend. In addition, the incidence of hematologic toxicity was significantly higher in the CMS group than in the PMB group. Univariate and multivariate logistic regression analyses identified the factors influencing nephrotoxicity, indicating that concomitant dialysis (OR = 2.539, 95% CI: 1.461-4.442, P = 0.001), hypoalbuminemia (OR = 2.620, 95% CI: 1.542-4.596, P = 0.001) and concomitant use of diuretics (OR = 3.022, 95% CI: 1.921-4.837, P < 0.001) were independent risk factors for nephrotoxicity. Regarding economic aspects, following the implementation of the national volume-based procurement (VBP) policy, the procurement cost of PMB was significantly lower than that of CMS (P < 0.05), indicating a clear economic advantage for PMB. No significant difference was observed in total hospitalization costs between the two groups. In conclusion, in the treatment of pulmonary infections in adults, PMB and CMS show comparable overall efficacy, while PMB is associated with a significantly shorter length of hospital stay and presents advantages in safety and cost outcomes. Limited by the retrospective observational design, the above conclusions still require further validation in prospective studies.

BackgroundChronic obstructive pulmonary disease (COPD) and mental health conditions represent intersecting public health challenges, especially in resource-limited rural China. Existing care models often neglect the psychosocial needs of populations at high risk for COPD, resulting in limited effectiveness of prevention and management strategies. This study evaluates an integrated intervention designed to improve both mental and physical health outcomes among high-COPD-risk individuals with mental health symptoms, using a population medicine framework. ObjectiveThis study aims to evaluate the effect of an integrated, population medicine–based multimorbidity intervention package among high-COPD-risk individuals with mental health symptoms in Xishui County, Guizhou Province, China. MethodsWe are conducting a 12-month, 2-arm cluster randomized controlled trial across 26 townships in Xishui County, Guizhou, China. A total of 44,000 residents aged ≥35 years were screened using the Chronic Obstructive Pulmonary Disease Screening Questionnaire, identifying 10,000 individuals at high risk of COPD. Among them, 3807 individuals with Warwick-Edinburgh Mental Well-Being Scale scores below 45 were enrolled as participants. Intervention components include digital cognitive behavioral therapy–based mental health support, community screening, chronic disease management, patient education, digital follow-up, and team-based care. The primary outcomes are depressive symptoms (9-item Patient Health Questionnaire), anxiety symptoms (7-item General Anxiety Disorder), and mental well-being (Warwick-Edinburgh Mental Well-Being Scale). Secondary outcomes are control of chronic diseases, physiological and functional indicators such as lung function, health-related quality of life, mental and behavioral health, health care utilization, knowledge of COPD and asthma, productivity loss, and care cascade indicators for chronic conditions. ResultsData collection for the POPMIX-MH trial began in June 2024. Baseline, 3-month, and 6-month assessments have been completed, and the 12-month follow-up assessments are planned to be completed in March 2026. ConclusionsThis study is the first to integrate psychological support, chronic disease management, and community-based screening into a single scalable intervention package targeting multimorbidity in China. It tests the feasibility of applying population medicine principles, emphasizing integrated, preventive, and population-level care, within primary care systems in low-resource settings. By targeting both mental and physical health, it redefines chronic care beyond traditional organ-specific approaches. Trial RegistrationClinicalTrials.gov NCT06458218; https://clinicaltrials.gov/ct2/show/NCT06458218 International Registered Report Identifier (IRRID)DERR1-10.2196/85853