Luwen Zhu

Osteosarcopenia—defined as the coexistence of sarcopenia and osteoporosis—is increasingly recognized as a clinically important geriatric syndrome associated with falls, fractures, frailty, disability, and mortality. Beyond the simple coexistence of bone and muscle loss, emerging data suggest that osteosarcopenia may reflect systemic dysregulation of the bone–muscle–immune–metabolic network. In this narrative review, we synthesize evidence linking inflammaging, immune-cell polarization, mitochondrial dysfunction, nutrient metabolic dyshomeostasis, and gut-derived metabolites to the pathogenesis of osteosarcopenia. Multiple pathological processes—including chronic low-grade inflammation, Th17/Treg imbalance, macrophage polarization, oxidative stress, impaired mitophagy, insulin resistance, ectopic fat accumulation, and altered microbial metabolites—may converge to disrupt bone–muscle crosstalk. Notably, direct evidence from osteosarcopenic populations remains limited, and many mechanistic insights are extrapolated from osteoporosis, sarcopenia, and aging models. We further discuss current and emerging therapeutic strategies, including exercise, nutritional interventions, anti-osteoporotic agents, metabolic modulators, mitochondrial-targeted therapies, and gut-directed approaches. Longitudinal cohorts, multi-omics studies, and randomized controlled trials are urgently required to validate immunometabolic biomarkers and develop integrated interventions for osteosarcopenia.

Introduction: Ischemic stroke (IS) exhibits pronounced geographic variation across China, with a consistently greater burden observed in colder regions. However, whether the strength of associations between major risk factors and IS differs between cold and non-cold regions remains unclear. Methods: We systematically searched observational studies in PubMed, Embase, Web of Science, CNKI, Wanfang, VIP, and CBM from inception through September 6, 2025. Data were analyzed using Stata 16.0. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Regional differences were evaluated using subgroup analysis. Results: Ninety-six studies involving 800,741 participants were included. In the overall analysis, the largest pooled effect estimates were observed for atrial fibrillation (OR 4.48, 95% CI 2.41–8.36, I2 = 62.1%), coronary heart disease (OR 3.20, 95% CI 2.29–4.46, I2 = 86.2%), and hypertension (OR 3.05, 95% CI 2.55–3.64, I2 = 92.9%), all of which were accompanied by moderate to substantial between-study heterogeneity. Subgroup analysis demonstrated significantly larger pooled associations in cold regions for hypertension (OR 4.31 vs. 2.69, I2 = 94.8% vs. 92.0%), diabetes mellitus (OR 2.60 vs. 1.77, I2 = 71.6% vs. 90.7%), triglycerides (OR 3.41 vs. 1.48, I2 = 96.7% vs. 92.4%), and low-density lipoprotein cholesterol (OR 1.91 vs. 1.43, I2 = 0.0% vs. 67.2%) (all p < 0.05). In contrast, age was more strongly associated with IS in non-cold regions (OR 1.31 vs. 1.05, I2 = 91.4% vs. 91.8%). Conclusion: Our analysis identified substantial geographic heterogeneity in the reported associations between selected cardiometabolic risk factors and IS in China. These exploratory, study-level findings generate hypotheses regarding contextual modification of risk factor associations, warranting confirmation in prospective, individual-level studies before informing region-specific prevention strategies.

Depression is a globally prevalent, highly disabling mental disorder, and its etiology, pathological mechanisms, and treatment approaches have long been a focus of intensive research. Programmed cell death (PCD) refers to a process in which cells actively undergo death to maintain internal homeostasis via specific signals or stimuli. Modern medical studies have demonstrated that the dysregulation of PCD modalities, including apoptosis, pyroptosis, autophagy, ferroptosis, necroptosis, and cuproptosis, is closely associated with the onset and progression of depression. Elucidating the molecular mechanisms of PCD in depression could provide critical insights for an in-depth understanding, prevention, and treatment of this disorder. In recent years, extensive research has been conducted in the field of traditional Chinese medicine (TCM) that targets PCD for depression treatment, yielding significant phased achievements. Therefore, this narrative review, covering literature primarily from the past decade, synthesizes preclinical evidence on six PCD modalities in depression. It further explores the potential mechanisms and current status of TCM interventions that target these PCD pathways, and discusses the crosstalk between them. By emphasizing mechanistic insights, this work aims to provide a theoretical foundation and guidance for future clinical prevention, treatment, and research on depression.

Background: Traumatic brain injury is a heterogeneous disease with multiple injury patterns and secondary injury patterns, which is a major public health and socio-economic problem. Many drugs have been used to improve limb dysfunction caused by traumatic brain injury, but cannot avoid the side effects of drug treatment, which is not conducive to the long-term prognosis of patients. Rood concept based task-oriented training intervention can maximize the advantages of both, make up for the gaps and deficiencies in the treatment of both, and fully meet patients’ personalized treatment needs, which is the focus of the treatment framework of traumatic brain injury at home and abroad. In this study, we will conduct the first systematic review and meta-analysis to investigate the efficacy and safety of task-oriented training based on the Rood concept for improving limb function in patients with traumatic brain injury. Methods: We will search the randomized controlled trial literatures involving effect of Rood concept based task-oriented training on limb function in patients with traumatic brain injury, including PubMed, Web of Science, EMBASE, the Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Wanfang Database, and Technology Periodical Database (VIP). The search period was from the establishment of the database to April 2023. We defined the National Institute of Health stroke scale and Fugl-Meyer Motor Function Rating Scale as primary outcomes. Activity of daily living, The expression levels of CRP and neuron specific enolase in peripheral blood were detected as a secondary outcome. Literature screening and data extraction were conducted independently by two reviewers, and literature quality was evaluated according to the standards of the Cochrane Collaboration network. Review Manager 5.3 and stata14.0 software were used for data analysis. Results: This study will provide a high-quality review to evaluate the efficacy and safety of Rood concept based task-oriented training in improving limb dysfunction in patients with traumatic brain injury, providing medical basis for better clinical decision-making in patients with traumatic brain injury. Conclusion: The conclusion of this review will provide evidence for whether Rood concept based task-oriented training is effective in improving limb dysfunction in patients with traumatic brain injury.

Subarachnoid hemorrhage (SAH) is a rare but serious stroke subtype that accounts for approximately 5% of all strokes. This study analyzed SAH epidemiology in Asia from 1990 to 2021 using the Global Burden of Disease (GBD) 2021 data. This study assessed the burden of SAH in Asia using four indicators: incidence, prevalence, mortality, and disability-adjusted life years (DALYs). An autoregressive integrated moving average (ARIMA) model was used to conduct a long-term trend analysis and forecast the changing trends of various indicators from 2022 to 2041. Between 1990 and 2021, the age-standardized incidence rates (ASIR) of SAH in Asia increased and then decreased, while the age-standardized prevalence rates (ASPR), age-standardized mortality rates (ASMR), and age-standardized disability-adjusted life years rates (ASDR) of SAH continued to decline. The Arima model predictions suggest that Asian age-standardized rates will typically show a decreasing trend over the next 20 years, except for the ASIR, which shows an increasing trend. Over the next 20 years, the ASIR of SAH in Asia is expected to increase. The ASPR, ASMR, and ASDR were expected to show decreasing trends. The burden of SAH in older patients remains high, highlighting the need to strengthen the health management of the older population.

Purpose: To compare the efficacy differences between acupuncture and sham acupuncture in adult primary insomnia through Bayesian network meta-analysis, analyze the impact of different types of sham acupuncture on efficacy, and explore the basis for the control setting. Methods: A literature search of seven databases, including PubMed and Embase, until April 23, 2025, included randomized controlled trials (RCTs) comparing AT with noninvasive sham acupuncture (NISA), superficial acupuncture (SA), and non-acupuncture therapy (NAT) for treating PI in adults. The statistical analyses were conducted using R (version 4.4.1) and Stata (version 15.1). The protocol was registered with the International Prospective Register of Systematic Reviews (CRD420251012912). Results: This meta-analysis incorporated 33 RCTs encompassing 3004 participants, with most studies originating from China. The results showed that at the treatment endpoint and after 4 weeks, AT significantly improved subjective sleep quality (Pittsburgh Sleep Quality Index, PSQI) compared to SA and NISA, exceeding the minimum clinically important difference (MCID: 2.5 points). Specifically, at the endpoint, AT vs SA (MD: − 3.66; 95% CI: − 4.48 to − 2.84) and AT vs NISA (MD: − 4.35; 95% CI: − 5.67 to − 3) were significant, while differences among SA, NISA, and NAT were not. Based on the surface under the cumulative rank curve (SUCRA), AT ranked first (99.9%), followed by SA (47.8%), NAT (31.9%), and NISA (20.4%). No significant differences were found between AT, NISA, and SA regarding objective sleep parameters. Conclusion: AT significantly improved subjective sleep quality in patients with PI, though its impact on objective sleep measures was limited. When designing RCTs of acupuncture for PI, NISA is recommended as the sham acupuncture control. However, due to geographical limitations, the study results may be difficult to generalize. Future research should focus on monitoring objective sleep parameters and conducting international, multicenter RCTs involving diverse cultural populations.