Liang Zheng

Background: Cardiovascular–Kidney–Metabolic (CKM) syndrome is a systemic condition from the interplay among metabolic risk factors, chronic kidney disease (CKD), and cardiovascular system. This study aimed to characterize bidirectional transition patterns between CKM states and identify their determinants. Methods and results: We included community-dwelling adults ≥45 years from national China Health and Retirement Longitudinal Study (CHARLS), with CKM state assessments in 2011 and 2015. Multi-state Markov models (MSM) estimated transition intensities/probabilities among non-CKM (stage 0), light CKM (stages 1,2), advanced CKM (stages 3,4), death, and factors for transitions.A total of 6,388 participants were analyzed (53.80% female; mean age 59.41±9.02 years; mean follow-up 3.86±0.51 years). Baseline: 412 (6.45%) non-CKM, 4,605 (72.09%) light CKM, 1,371 (21.46%) advanced CKM. Follow-up: 1,675 transitions (1,077 progressing, 171 regressing, 427 death). Four-year probabilities: non-CKM→light CKM (70.5%); light CKM→non-CKM (2.7%), light CKM→advanced CKM (16.7%); advanced CKM→light CKM (3.4%), advanced CKM→death (15.0%). Age, sex, urban/rural residence, activities of daily living (ADL), depressive symptoms were key determinants. Conclusion: This national cohort delineated CKM state bidirectional transitions, revealed progression-regression asymmetry and state-specific determinants, providing evidence for prevention-oriented, risk-stratified CKM management in middle-aged/older adults.

Background: Cardiac rehabilitation (CR) may benefit patients with atrial fibrillation (AF) in areas such as exercise capacity. However, evidence regarding its impact on AF recurrence, a key clinical outcome, remains inconsistent. This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the effects of CR on AF recurrence, all-cause mortality, hospitalization, and exercise capacity in patients with AF. Methods: We systematically searched the Cochrane Library, PubMed, and Embase from January 1, 1980, to April 20, 2026. Two reviewers independently screened studies, extracted data, and assessed risk of bias. A total of 1,550 patients from 11 RCTs were included in the meta-analysis based on the predefined inclusion and exclusion criteria. Results: Pooled analysis demonstrated a significant reduction in AF recurrence among patients receiving CR compared with controls (risk ratio (RR) 0.77, 95% confidence interval (CI) [0.67–0.89], p = 0.0003, I ² = 20%). However, this effect was not statistically significant in the exploratory subgroup of patients post-ablation (RR 0.86, 95% CI [0.69–1.07], p = 0.17, I ² = 0%). Exercise capacity, measured via the 6-minute walking test, significantly improved (weighted mean difference (WMD) 32.22, 95% CI [21.22–43.23], p < 0.00001, I ² = 0%). No significant differences were observed in all-cause mortality (RR 1.04, 95% CI [0.74–1.46], p = 0.81, I ² = 0%), hospitalization rates (RR 1.00, 95% CI [0.85–1.19], p = 0.97, I ² = 0%), or the composite outcome of mortality and hospitalization (RR 1.01, 95% CI [0.90–1.14], p = 0.83, I ² = 0%). Conclusions: CR is associated with a reduction in AF recurrence in the overall AF population, though this benefit was not observed in the exploratory subgroup of patients post-ablation. It significantly improves exercise capacity but does not appear to affect mortality or hospitalization rates. Further high-quality randomized trials are needed to evaluate the benefits and potential risks of CR across different types of AF.

Background: Hypertension is associated with a high rate of disability and mortality and leads to a substantial socioeconomic burden. Moxibustion is an external treatment in traditional Chinese medicine that has been used to treat mild to moderate hypertension in individuals with phlegm-dampness constitution and has demonstrated acupoint specificity. However, a standard large-scale randomized controlled trial is still needed to verify its effectiveness. This study is proposed to examine the clinical effectiveness and potential cardioprotective benefits of moxibustion performed at home as a treatment for individuals with phlegm-dampness hypertension. Objective: The objective of this trial is to evaluate the cardio-cerebral protective clinical efficacy of moxibustion for phlegm-dampness type hypertension and to explore its acupoint specific effects. Methods: This study is a multicenter, randomized controlled trial. A total of 120 patients with mild to moderate hypertension and phlegm-dampness constitution will be recruited and randomly assigned in a 1:1 ratio to the treatment group (acupoint: Zusanli, ST36) or the control group (acupoint: Xuanzhong, GB39). All patients will receive 12 weeks of treatment and a 12-week follow-up period. The primary outcome measure is the change in morning systolic blood pressure from baseline to week 12. The secondary outcome measures include blood pressure–related indicators (morning diastolic blood pressure, average systolic blood pressure, average diastolic blood pressure, nighttime systolic blood pressure, nighttime diastolic blood pressure, and blood pressure circadian rhythm) and short-term blood pressure variability coefficient, all of which will be measured by 24-hour ambulatory blood pressure monitoring. Additionally, cardiac-related indicators measured by 24-hour Holter monitoring, metabolic disorder-related indicators, liver and kidney function indicators, transformed scores of the traditional Chinese medicine phlegm-dampness constitution scale, and the Montreal Cognitive Assessment will also be evaluated. Results: This study was registered on July 5, 2024, with the Chinese Clinical Trial Registry. Data collection began in June 2023 and ended in February 2025. Currently, data from this trial are in the collection phase, and no data analysis has been performed. As of January 2025, we have collected data from 118 patients. The results of this trial are expected to be submitted for publication in May 2026. Conclusions: This multicenter, randomized, controlled clinical trial will provide evidence on the clinical effectiveness and potential cardioprotective benefits of moxibustion performed at home as a treatment for individuals with phlegm-dampness type of hypertension. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400086582; https://www.chictr.org.cn/showproj.html?proj=211688 International Registered Report Identifier (IRRID): DERR1-10.2196/79158

Background: Cardiovascular diseases (CVD) are influenced by a number of factors, including environmental and genetic components. By linking prospective cohort studies with epigenetics and CVD outcomes, it may be possible to gain insight into the complex mechanisms underlying CVD. This study aims to evaluate the impact of air pollution on CVD and investigate whether DNA methylation (DNAm) mediates the association between air pollution and CVD. Methods: In the prospective cohort study, the relationship between air pollutants and CVD incidence was analyzed using Cox regression. Dose–response was assessed by the restricted cubic spline model, and multiple pollutants’ impact was evaluated by the weighted quantile sum model. The link between genetically predicted DNAm sites related to air pollutants and CVD risk was explored through epigenetic Mendelian randomization (MR), with further evidence provided by gene colocalization analysis. Results: For every 10 μg/m ³ increase, particulate matter with diameters less than 2.5 μm (PM _2.5 ), particulate matter with diameter less than 10 μm (PM ₁₀ ), nitrogen dioxide (NO ₂ ), and sulfur dioxide (SO ₂ ) increased the risk of CVD by 6.2%, 4.4%, 9.3%, and 6.1%, respectively, with all showing a linear association. Of the four air pollutants, PM ₁₀ and PM _2.5 were identified as the most significant contributors to the CVD risk, accounting for 61% and 20%, respectively. Genetically predicted methylation at the PM _2.5 -related CpG site cg01065697 was linked to a higher risk of myocardial infarction (MI) and coronary heart disease (CHD), the NO ₂ -related CpG site cg07091220 was associated with increased MI risk, the NO ₂ -related sites cg15474579, cg16348358, and cg19869422 were linked to a higher risk of heart failure (HF). Conclusion: Our study confirms a significant association between air pollution, DNAm and CVD risk, and provides new insights into the pathogenic effects of air pollution on CVD.

Background: While coronary computed tomography angiography (CTA) is widely used for diagnosing chronic coronary syndrome (CCS), its potential for assessing physiological function and plaque vulnerability—through AI-derived fractional flow reserve (CT-FFR) and high-risk plaque characteristics (HRPC)—is not fully leveraged in clinical practice. The combined prognostic value of these non-invasive tools in newly diagnosed CCS patients remains underexplored. Objective: To evaluate the individual and combined prognostic value of AI-based CT-FFR and HRPC in predicting major adverse cardiovascular events (MACE) in patients with newly diagnosed CCS. Methods: In this observational cohort study, 222 inpatients newly diagnosed with CCS who were admitted for non-acute chest pain and underwent coronary CTA were included. Patients were stratified into four groups based on their CT-FFR and HRPC values. Kaplan–Meier survival curves and multivariate Cox proportional hazards models were used to assess the predictive value of CT-FFR and HRPC for MACE. Model performance was evaluated using the C-index, area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Results: Vessels with CT-FFR ≤0.8 had a higher prevalence and number of HRPC compared to those with CT-FFR >0.8. Over a median follow-up period of 22 months, 52 patients (23.4%) experienced MACE. Both CT-FFR ≤0.8 [hazard ratio (HR): 2.62, 95% confidence interval (CI): 1.06–6.47; P = 0.036] and HRPC ≥2 (HR: 2.39, 95% CI: 1.20–4.77; P = 0.014) independently predicted MACE. Patients with both CT-FFR ≤0.8 and HRPC ≥2 had a 6.06-fold increased risk of MACE compared to those with CT-FFR >0.8 and HRPC P = 0.017). Combining CT-FFR and HRPC significantly improved the predictive accuracy of risk models, reflected in increases in C-index, AUC, NRI, and IDI ( P ≤ 0.038), providing superior predictive performance compared to using either metric alone. Conclusion: The combined use of AI-derived CT-FFR and HRPC significantly improves risk stratification in patients with newly diagnosed CCS, offering better predictive accuracy for adverse cardiovascular events. This enhanced risk assessment could enable clinicians to identify high-risk patients more effectively and tailor management strategies accordingly. Further multicenter studies are warranted to validate these findings across diverse populations.

Objective: Early-signet-ring cell carcinoma has a low malignancy and good prognosis, while advanced signet-ring cell carcinoma has high malignancy and high mortality. So, we need to understand the risk factors of early-signet-ring cell carcinoma, analyze the relationship between early gastric signet-ring cell carcinoma and non-Signet-ring cell carcinoma, and between pure signet-ring cell carcinoma and mixed signet-ring cell carcinoma, in order to provide the basis for the early diagnosis and treatment of signet-ring cell carcinoma. Methods: In this study, a retrospective analysis of 424 cases of early gastric cancer that underwent endoscopic submucosal dissection and surgical treatment between March 2019 and March 2023 in Shanghai Oriental Hospital was carried out. Among the cases, the two groups, namely, the signet-ring cell carcinoma and non-signet-ring cell carcinoma group, and the pure signet-ring cell carcinoma and mixed signet-ring cell carcinoma group, were compared and analyzed. With the help of logistic regression analysis, gender, age, smoking history, alcohol consumption history, tumor site, pathological characteristics, disease progression, tumor size, infiltration depth, and H. pylori infection were investigated between the two groups. Result: The results of the univariate regression analyses in the signet-ring cell carcinoma and non-signet-ring cell carcinoma groups showed that being female (p = 0.001), age < 60 years (p = 0.001), with cancer foci in the middle part of the stomach (p = 0.001), and with a mixed type of cancer foci (p = 0.007) were the risk factors for signet-ring cell carcinoma. In the multifactorial regression analysis, age < 60 years (OR = 1.037, CL = 1.008–1.067, p = 0.012), cancer foci in the middle part of the stomach (OR = 2.094, CL = 1.488–2.948, p = 0.001), mixed-type patients (OR = 0.702, CL = 0.519–0.951, p = 0.022), and women (OR = 0.421, CL = 0.254–0.698, p = 0.001) were the risk factors for signet-ring cell cancer. These are independent risk factors for signet-ring cell carcinoids. Univariate regression analysis on the pure and mixed signet-ring cell carcinoma groups showed that Helicobacter pylori infection (p = 0.001), Kimura–Takemoto classification O1–O3 (p = 0.013), flat and concave types (p = 0.004), and age < 60 years (p = 0.013) were risk factors affecting the development of pure signet-ring cell carcinoma. In the multifactorial regression analysis, age (OR = 0.233, CL = 0.059–0.930, p = 0.039) was the main independent risk factor for pure signet-ring cell carcinoma. Conclusions: Age < 60 years, cancer foci located in the middle of the stomach, mixed type, and female are associated with the development of early gastric signet-ring cell carcinoma; age < 60 years is related to the development of pure signet-ring cell carcinoma, so we need to pay attention to these clinical and pathological factors to prevent the growth of ring cell carcinoma.

BACKGROUND Hypertension is associated with a high rate of disability and mortality and leads to a substantial socioeconomic burden. Moxibustion is an external treatment in traditional Chinese medicine that has been used to treat mild to moderate hypertension in individuals with phlegm-dampness constitution and has demonstrated acupoint specificity. However, a standard large-scale randomized controlled trial is still needed to verify its effectiveness. This study is proposed to examine the clinical effectiveness and potential cardioprotective benefits of moxibustion performed at home as a treatment for individuals with phlegm-dampness hypertension. OBJECTIVE The objective of this trial is to evaluate the cardio-cerebral protective clinical efficacy of moxibustion for phlegm-dampness type hypertension and to explore its acupoint specific effects. METHODS This study is a multicenter, randomized controlled trial. A total of 120 patients with mild to moderate hypertension and phlegm-dampness constitution will be recruited and randomly assigned in a 1:1 ratio to the treatment group (acupoint: Zusanli, ST36) or the control group (acupoint: Xuanzhong, GB39). All patients will receive 12 weeks of treatment and a 12-week follow-up period. The primary outcome measure is the change in morning systolic blood pressure from baseline to week 12. The secondary outcome measures include blood pressure–related indicators (morning diastolic blood pressure, average systolic blood pressure, average diastolic blood pressure, nighttime systolic blood pressure, nighttime diastolic blood pressure, and blood pressure circadian rhythm) and short-term blood pressure variability coefficient, all of which will be measured by 24-hour ambulatory blood pressure monitoring. Additionally, cardiac-related indicators measured by 24-hour Holter monitoring, metabolic disorder-related indicators, liver and kidney function indicators, transformed scores of the traditional Chinese medicine phlegm-dampness constitution scale, and the Montreal Cognitive Assessment will also be evaluated. RESULTS This study was registered on July 5, 2024, with the Chinese Clinical Trial Registry. Data collection began in June 2023 and ended in February 2025. Currently, data from this trial are in the collection phase, and no data analysis has been performed. As of January 2025, we have collected data from 118 patients. The results of this trial are expected to be submitted for publication in May 2026. CONCLUSIONS This multicenter, randomized, controlled clinical trial will provide evidence on the clinical effectiveness and potential cardioprotective benefits of moxibustion performed at home as a treatment for individuals with phlegm-dampness type of hypertension. CLINICALTRIAL Chinese Clinical Trial Registry ChiCTR2400086582; https://www.chictr.org.cn/showproj.html?proj=211688 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/79158

Cardiovascular disease (CVD) is the top cause of death in China. We aimed to identify trends in cause-specific CVD mortality in a rapidly developing country, thereby providing evidence for CVD prophylaxis. Using raw data from the Chinese National Mortality Surveillance (CNMS) system, we assessed the mortalities of all CVD and cause-specific CVD during 2009-2019. Temporal trends of crude mortality rates (CMRs) and age-standardized mortality (ASMRs) of CVD were evaluated using joinpoint regression models. Age-sex-specific CVD mortality rates were predicted by using age-period-cohort Poisson regression model. A total of 10,608,402 CVD death occurred during 2009-2019, accounting for 49.8% of all-cause of death in China. The three major CVD types [cerebrovascular disease, ischemic heart disease (IHD) and hypertensive disease (HD)] accounted for 94.6% of total CVD deaths. The CMR of all CVD increased [the annual average percentage change (AAPC) = 3.4%, 95% confidence interval (CI) 2.6% to 4.1%] while the ASMR decreased (AAPC = -2.0%, 95% CI -3.5% to -0.6%). Cerebrovascular disease is predicted to be the leading cause of CVD death in men and IHD will be the top cause of CVD death in women over the period 2025-2029. Although the ASMR of total CVD decreased, CVD remained the leading cause of death in China. Cerebrovascular disease, IHD and HD were the major three leading causes of CVD-related death. Inflammatory heart disease-associated death increased in the young population. Attention should be paid to premature deaths associated with cerebrovascular disease and rheumatic heart disease among rural residents.