Feng Hong

Background: Epidemiological research has indicated a potential association between the triglyceride-glucose (TyG) index and the risk of major adverse cardiocerebrovascular events (MACCE). Nevertheless, the precise nature and magnitude of this relationship remain to be fully elucidated. Objectives: This study aims to assess the dose–response relationship between the TyG index and MACCE among individuals with cardiovascular-kidney-metabolic (CKM) syndrome. Methods: A comprehensive literature search was conducted using the PubMed and Web of Science databases to identify relevant studies on the TyG-MACCE relationship up to 16 June 2026. Data were synthesized using both random- and fixed-effects models, and nonlinear dose–response meta-analyses were performed using restricted cubic spline models. Results: The analysis incorporated eight cohort studies, encompassing over two million participants and 179 thousand MACCE cases. The aggregated risk estimate for MACCE, comparing the highest to the lowest categories of TyG index exposure, was 1.20 (95% confidence interval [CI] = 1.11–1.30, I ² = 77.2%, p _{heterogeneity} < 0.001). The dose–response analysis revealed a nonlinear positive association between the TyG index and MACCE risk ( p _nonlinear < 0.001), with summary risk estimates calculated for each 1-unit increment in the TyG index being 1.05 (95% CI = 1.02–1.08, I ² = 81.1%, p _{heterogeneity} < 0.001). Subgroup and sensitivity analyses yielded similar results. Conclusions: This suggests that the TyG index may contribute to adverse MACCE in individuals with CKM syndrome. Further studies are needed to confirm causality and the predictive power of the TyG index. The research was prospectively registered in the Prospective Register for Systematic Reviews (registration number: CRD420261278535). Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261278535 , identifier CRD420261278535.

Gamma-glutamyl transferase (GGT) regarded as a biomarker of liver dysfunction or excessive alcohol consumption; however, existing genome-wide association studies (GWAS) have been conducted predominantly in European populations and East Asian populations from Japan and the Taiwan region, with limited investigation in ethnic minorities from Guizhou Province. Previous genetic studies have demonstrated that Guizhou ethnic minorities share an East Asian genetic background while exhibiting specific genetic structures, a pattern that is also confirmed by our principal component analysis (PCA) results. We therefore performed a GWAS in this population and identified a genome-wide significant signal at 8q12.3 in female ethnic minorities from Guizhou. Fine-mapping and functional annotation analyses suggest that a regulatory pathway involving Runt-related transcription factor 1 (Runx1)–Cytochrome P450 family 7 subfamily B member 1 (CYP7B1)–cholesterol–reactive oxygen species (ROS)–glutathione (GSH) may contribute to the regulation of GGT levels. Mendelian randomization (MR) analyses further supported a causal relationship between GGT levels and autoimmune hepatitis (AIH). These findings uncover a genetic mechanism underlying GGT variation at 8q12.3 in female ethnic minorities from Guizhou, implicating a pathway linked to cholesterol metabolism and oxidative stress, and providing potential targets and insights for precision prevention and treatment of related diseases. Graphical abstract

Background/ObjectivesThe association between strontium (Sr) and type 2 diabetes mellitus (T2DM) remains inconclusive, and the potential role of Sr in multi-element exposure mixtures is overlooked. This study aimed to investigate the independent contribution of serum Sr to T2DM risk within a multi-element exposure framework.MethodsBaseline serum concentrations of 9 trace elements were measured by inductively coupled plasma mass spectrometry (ICP-MS) in 4,766 Guizhou Population Health Cohort Study (GPHCS) participants. Cox regression assessed Sr's independent association with T2DM incidence. Factor analysis, weighted quantile sum regression (WQS) and Bayesian kernel machine regression (BKMR) were used to identify Sr-related exposure patterns and quantify its contribution to multi-element mixture effects.ResultsDuring a median follow-up of 6.63 years, 504 incident T2DM cases were documented. Serum Sr levels were significantly higher in cases (P<0.05). Compared with the lowest Sr quartile, the highest quartile was associated with a hazard ratio(HR) of 1.819 (95%CI: 1.380-2.397), with a significant increasing trend (Ptrend<0.05). Restricted cubic spline analysis confirmed a positive linear association between Sr levels above 33.08 μg/L and T2DM risk (Poverall<0.001). Factor analysis showed Sr loaded predominantly on a single factor, whose score was independently linked to increased T2DM risk (HR=1.150, 95%CI: 1.053-1.257). Both WQS and BKMR identified multi-element exposure as positively associated with T2DM risk (WQS index=0.182, 95%CI: 0.017-0.348, P=0.031), with Sr as the primary contributor.ConclusionsIn conclusion, serum Sr plays a positively predominant role in T2DM risk within a multi-element mixture framework, suggesting reducing excessive Sr exposure may aid in diabetes prevention.

Introduction: Skeletal fluorosis patients face a markedly elevated risk of cardiovascular metabolic abnormalities, including endothelial dysfunction, excessive oxidative stress, and impaired calcium-phosphate metabolism. Current clinical interventions for this condition are limited to symptomatic analgesia and conventional anti-osteoporotic treatments, and lack targeted therapeutic strategies for the “kidney deficiency and blood stasis” pathogenesis of skeletal fluorosis that can synergistically protect both the skeletal and cardiovascular systems. Methods: This multicenter randomized controlled trial was conducted on 1,480 skeletal fluorosis patients from the China Fluorosis Cohort (CFC), to investigate the synergistic therapeutic effects of three traditional Chinese medicine (TCM) combinations— Ginkgo biloba combined with Epimedium (Drug 1), Xianling Gubao combined with Eucommia ulmoides (Drug 2), and Gusongbao combined with Rosa roxburghii (Drug 3)—in conjunction with lifestyle modifications on cardiovascular metabolic outcomes. Results: Smoking and alcohol consumption were identified as independent risk factors for reduced therapeutic efficacy in skeletal fluorosis patients with comorbid cardiovascular metabolic abnormalities (OR = 2.755, 95% CI: 1.400 –5.421). Among the three TCM combinations, Drug 2 and Drug 3 significantly counteracted these adverse risk factors, reducing the risk of treatment failure by 53.9% (OR = 0.461) and 57.0% (OR = 0.430), respectively. Drug 3 exhibited superior efficacy in reducing diastolic blood pressure ( β = −2.263, P = 0.010), while its systolic blood pressure-lowering effect diminished with increasing age. Drug 2 showed synergistic benefits with improved sleep quality ( β = 1.596, P = 0.002) and healthy dietary habits ( β = −1.180, P = 0.001), which enhanced its antihypertensive effects and led to a significant reduction in low-density lipoprotein cholesterol (LDL-C) levels ( P < 0.05). Additionally, the interaction models outperformed the main-effect models, confirming the dynamic synergistic effect between lifestyle interventions and TCM pharmacotherapy. Discussion: These findings highlight the clinical necessity of integrating behavioral interventions with pharmacotherapy to optimize cardiovascular metabolic safety in the clinical management of skeletal fluorosis. Based on these results, we propose a novel theoretical framework—Personalized Behavioral-Integrated Therapy (PBIT)—which guides the incorporation of patient-specific behavioral and demographic factors into tailored treatment strategies, thereby improving the precision and clinical outcomes of skeletal fluorosis treatment.

Migratory birds facilitate the cross-regional spread of pathogens such as avian influenza virus (AIV). Interspecies interactions among multiple migratory bird species within shared spatiotemporal habitats can substantially enhance pathogen transmission and evolution, thereby posing potential risks to public health and livestock safety. Recent advances in tracking technologies, such as GPS, combined with publicly accessible databases like Movebank, have enabled the reconstruction of avian migratory pathways. However, existing tracking data are largely collected from individual species, remain species-specific and are insufficient for characterizing interspecies contact during migration. By integrating available tracking data from 62 migratory bird species (comprising 3,944 individual records), this study constructed a co-occurrence dataset comprising 50 migratory bird species that exhibited spatial and temporal overlap at shared locations, with a daily temporal resolution and spatial resolution aligned with first-level administrative divisions. This dataset can facilitate the identification of potential hotspots for migratory bird-associated pathogen evolution, thereby providing data-driven support for the prevention and control of emerging infectious diseases.

Objective: The burden of migraine is influenced by a complex interplay of headache characteristics, psychiatric comorbidities, and sleep disturbances. This study aimed to examine factors independently associated with migraine‐related disability and severe functional impairment in a large clinical cohort. Methods: This cross‐sectional study included 1186 patients diagnosed with migraine according to ICHD‐3 criteria. We collected data on demographics, headache characteristics (monthly headache days [MHD] and intensity [VAS]), and potential medication overuse (pMOH). Disease burden was assessed using the Migraine Disability Assessment (MIDAS) score. Psychiatric comorbidities and sleep quality were evaluated using the Patient Health Questionnaire‐9 (PHQ‐9), Generalized Anxiety Disorder‐7 (GAD‐7), and Pittsburgh Sleep Quality Index (PSQI). Multiple linear and binary logistic regression analyses were performed. Candidate variables were selected a priori based on clinical relevance and data availability. Multicollinearity diagnostics, sensitivity analyses using available medication‐related variables, and model performance assessments were also conducted. Results: The cohort had a mean age of 39.5 ± 12.1 years, with a high prevalence of moderate‐to‐severe disability (64.7%), anxiety symptoms (52.4%), and poor sleep (48.2%). In the multiple linear regression model (adjusted R ² = 0.518, p < 0.001), MHD ( β = 0.581, p < 0.001) and PHQ‐9 score ( β = 0.152, p < 0.001) showed the strongest independent associations with the MIDAS score. Headache intensity (VAS) was also significant but had a smaller effect size ( β = 0.055, p = 0.031). GAD‐7 and PSQI were not independently associated with MIDAS after full adjustment. Sensitivity analyses additionally adjusting for available medication‐related variables yielded similar results. The logistic regression model showed acceptable discrimination (AUC = 0.86, 95% CI: 0.83–0.89) and calibration (Hosmer–Lemeshow χ ² = 7.42, p = 0.492). Conclusion: In this cross‐sectional cohort of patients with migraine, headache frequency and depressive symptoms were the factors most robustly associated with migraine‐related disability among the available variables. The associations of anxiety symptoms and poor sleep with disability were attenuated after adjustment for headache frequency and depressive symptoms, which may reflect shared variance rather than a confirmed mediation pathway. These findings support routine assessment of headache frequency and depressive symptoms in migraine care, while longitudinal studies with detailed medication and psychosocial data are needed to clarify temporal and causal relationships.

Chronic fluorosis, characterized by excessive exposure to fluoride, is associated with a greater risk of frailty in endemic populations. While fluoride cor

Objective: This study explored the relationship between age at first childbirth and hypertension-diabetes comorbidity (HDC) risk in postmenopausal women, focusing on whether obesity metrics (BMI, waist-to-hip ratio, and lipid accumulation product) mediate this association. Methods: Data were extracted from the baseline survey of the China Multi-Ethnic Cohort study. The association between age at first childbirth and HDC was examined via logistic regression analysis. Then, the effect of obesity on the association between age at first childbirth and hypertension was determined via mediation analysis. Furthermore, subgroup analyses were conducted, followed by multivariable logistic regression modeling to assess the primary association. Results: Included in this cross-sectional study were 5,741 postmenopausal women, with an average age at first childbirth of 23.56 years and current age of 59.44 years. The prevalence of hypertension-diabetes comorbidity (HDC) was 7.5% (429/5,741). Age at first childbirth was significantly associated with HDC prevalence (OR=0.737; 95% CI: 0.579-0.940). After adjustment, women who first gave birth at 21-25 (OR=0.739), 26-30 (OR=0.591), and >30 (OR=0.417) had lower HDC prevalence than those who first gave birth at ≤20 years. BMI, waist-to-hip ratio, and lipid accumulation product mediated this association, with mediation proportions of 29.42%, 18.97%, and 21.52%, respectively. Conclusions: In postmenopausal women of minority Chinese descent, age at first childbirth is significantly associated with HDC. Obesity mediates the effect of age at first childbirth on the development of the HDC.