Hongwei Liu

Background: Falls and physical inactivity are both linked to increased dementia risk, but their joint impact has not been well studied. It remains unclear whether physical activity can mitigate the elevated dementia risk after a fall and whether it also lowers the likelihood of future falls. Methods: We used data from 44,488 adults aged ≥ 60 years in three cohorts. Falls and physical activity were self-reported. Incident dementia was tracked during follow-up. Cox proportional hazards models estimated the associations of falls with dementia and physical activity with dementia and falls, stratified by fall history. Results: Over a median follow-up of 5.9–7.9 years, 3,492 dementia cases were identified. Falls were associated with a 70% higher risk of dementia (pooled HR = 1.70, 95% CI: 1.57–1.84). In the no-fall group, compared with inactivity, low, moderate, and high physical activity were progressively associated with lower risks of dementia (HRs = 0.63, 0.53, 0.43) and falls (HRs = 0.77, 0.68, 0.58). These protective effects were consistent among fallers, with similar dose–response gradients. Conclusions: Falls substantially increased dementia risk. Higher levels of physical activity were linked to lower risks of both dementia and falls, regardless of fall history. Graphical

Background: Exercise is a non-pharmacological strategy for enhancing cognitive function among various populations. The aim of our systematic review was to synthesise evidence of the effects of exercise on cognitive function in children and adolescents with overweight or obesity. Methods: A comprehensive search of four databases (Web of Science, PubMed, Scopus, EMBASE was conducted from each database inception through 1 April, 2025. This review investigates the impact of exercise intervention on the cognitive function of children and adolescents with overweight or obesity through randomized controlled trials (RCTs). The quality of the included studies was evaluated using the Cochrane Risk of Bias Tool 2, and the treatment effects were analyzed through random-effects or fixed-effects models, with Hedges’ g serving as the metric for effect size estimation. I ² statistics assessed heterogeneity, and leave-one-out analysis verified result stability. Subgroup analyses were conducted based on the FITT principle, including exercise frequency, intensity, and time. Results: The meta-analysis of 15 RCTs, including 1,210 children and adolescents with overweight or obesity revealed that exercise significantly improved executive function ( g = 0.39, 95% CI:0.12 to 0.66, p = 0.0043). No significant effects were observed for other aspects of attention and memory ( p >0.05). Subgroup analysis identified that exercise with a frequency of >3 sessions per week (g = 0.39, p = 0.0257), moderate-to-vigorous intensity ( g = 0.50, p = 0.0132), exercise interventions ≥10 weeks ( g = 0.41, p = 0.0184), single session duration >30 min ( g = 0.41, p = 0.0139), and weekly exercise volume > 120 min ( g = 0.28, p = 0.00236) had higher effect sizes in improving executive function in children and adolescents with overweight or obesity. Subgroup analyses revealed that exercise frequencies 15 weeks ( g = 0.98) significantly enhanced attention ( p < 0.05). Conclusion: This study demonstrates that exercise interventions significantly improve executive function and attention in children and adolescents with overweight or obesity. In particular, moderate-intensity aerobic exercise performed more than three times per week, for over 30 min per session, and sustained for at least 10 weeks appears to represent the optimal training parameters for improving executive function. These findings support the use of exercise as a cognitive enhancement strategy. However, larger-scale studies are needed to confirm its effects on other cognitive domains. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251078572 , Identifier: CRD420251078572.

Background: This systematic review and meta-analysis aimed to quantify the association between environmental and occupational lead exposure and the risk of various hypertension subtypes. We further evaluated this relationship through a dose–response analysis to provide a scientific basis for targeted public health interventions. Methods: Observational studies on lead exposure and hypertension were searched from Chinese/English databases (inception to June 9, 2025). Two researchers independently screened studies, extracted data, and assessed bias risk. Random-effects meta-analysis calculated pooled ORs (95% CIs); meta-regression/subgroup analyses explored heterogeneity. Egger’s test evaluated publication bias, sensitivity analyses verified result robustness, and dose–response analysis was applied to multi-level exposure data. Result: 24 studies (181,500 participants) were included. Lead exposure correlated significantly with hypertension (pooled OR = 1.27, 95% CI: 1.20–1.34) with high heterogeneity (I ² = 91.4%, p < 0.001). Stronger associations were found for blood lead (OR = 1.32), essential hypertension (OR = 1.31), and resistant hypertension (OR = 1.36); no significant associations for bone lead or gestational hypertension. Hypertension risk rose sharply at blood lead ≥ 0.107 μg/dl, reaching OR = 4.85 at 8.435 μg/dl. Potential publication bias existed, but sensitivity analyses confirmed robustness. Conclusion: Lead exposure is a hypertension risk factor with a clear dose–response relationship. It is recommended to include blood lead in hypertension risk assessment and set a blood lead action level of < 0.107 μg/dl for high-risk groups to reduce hypertension burden from lead pollution. Systematic review registration: https://inplasy.com/inplasy-2025-9-0008/ .

The study’s objective was to assess the connection between ramelteon usage and mortality from any cause in ischemic stroke patients in the intensive care unit (ICU). Utilizing the MIMIC-IV database, we analyzed a cohort of adult patients who had been diagnosed with ischemic stroke. During their time in the hospital, patients were sorted into ramelteon and non-ramelteon groups according to drug exposure. To achieve balance in baseline covariates, propensity score matching (PSM) was utilized. The primary focus was on mortality from all causes over 28 days, with secondary focuses on all-cause mortality over 90 and 365 days. Using Cox proportional hazards models, hazard ratios (HR) and 95% confidence intervals (CI) were estimated, taking into account potential confounding factors. Subgroup analyses were done to assess effect modification across clinical strata. The study encompassed 3413 patients, with 535 pairs matched after PSM. Ramelteon use was significantly associated with decreased 28-day all-cause mortality rates both before and after PSM, with adjusted HR of 0.34 and 0.23, both with P < 0.001. The fully adjusted post-PSM models showed similar protective associations for 90-day (HR = 0.43) and 365-day (HR = 0.55) all-cause mortality, both with P < 0.001. Prolonged use of ramelteon for more than 14 days and cumulative doses exceeding 300 mg were consistently linked to lower all-cause mortality at all time intervals. Through subgroup and sensitivity analyses, the associations were confirmed to be consistent across different clinical strata. In critically ill patients with ischemic stroke, ramelteon usage was independently associated with lower short- and long-term all-cause mortality. Graphical Abstract

Background: With rapid population ageing, depressive symptoms in older adults have become a pressing public health concern. While functional dependency is a known risk factor, the impact of changes in dependency over time remains unclear. Objective: To examine the association between changes in daily living dependency and incident depressive symptoms in older adults across international cohorts. Methods: We used data from 46 327 adults aged ≥50 years across four longitudinal ageing studies: China Health and Retirement Longitudinal Study (China), Health and Retirement Study (USA), English Longitudinal Study of Ageing (England) and Survey of Health, Ageing and Retirement in Europe (Europe). Daily living dependency was classified into three levels based on difficulties in activities of daily living (ADLs) and instrumental ADLs (IADLs). Change in dependency was assessed using baseline and 2-year follow-up data. Depressive symptoms were measured using the Center for Epidemiologic Studies depressive symptoms Scale or the European Depression Scales (EURO-D). Cox proportional hazard models estimated HRs and 95% CIs for incident depressive symptoms over a median follow-up of 4.2–5.1 years. Findings: A total of 12 902 new depressive symptom cases occurred during follow-up. Compared with participants whose dependency status remained unchanged, those who recovered to independency had a significantly reduced risk of depressive symptoms. Functional deterioration, including transitions from independency to ADL or IADL dependency, was associated with increased risk of depressive symptoms (both pooled HRs 1.55), while functional improvement, from ADL or IADL dependency to independency, was linked to reduced risk (HRs 0.83 and 0.80, respectively). Conclusions: Improvement in ADL dependency is linked to a lower risk of depressive symptoms, while worsening dependency significantly increases depressive symptoms risk. Clinical implications: Routine assessment of functional status and early interventions to maintain or restore daily living independency may help prevent depressive symptoms in older adults. Targeted rehabilitation and support services could play a key role in reducing the mental health burden of ageing populations.

Zhu Y, et al. Yonsei Med J. 2025 Sep;66:e84. https://doi.org/10.3349/ymj.2024.0463

Background: Cavernous hemangioma is a congenital insidious disease that can occur in any part of the central nervous system. In clinical practice, cavernous hemangioma is mostly found in the brain and rarely in the spinal cord. Case summary: This study describes a case of a 34-year-old Chinese man of Han ethnicity with lumbar intramedullary cavernous hemangioma. On admission, lumbar intramedullary hemorrhage was observed in the patient, as well as a spindle-shaped hematoma sign was detected on the spinal magnetic resonance imaging. We suspected that the spinal hemorrhage could be associated with spinal cord cavernous hemangioma. The patient was started on dehydration and glucocorticoid therapy of mannitol on the day of admission and was diagnosed with cavernous hemangioma on the basis of his magnetic resonance imaging presentation and spinal cord histopathology results. However, there was no significant improvement in clinical manifestations following conservative treatment. It was exciting that the patient’s condition improved after the surgical removal of hematomas. Conclusion: Clinicians should consider lumbar intramedullary cavernous hemangioma in the differential diagnosis of early spinal cord hemorrhage with a spindle-shaped hematoma sign on the spinal magnetic resonance imaging.

Background: Isolated Prevotella intermedia, a rare gram-negative, rod-shaped, anaerobic bacterium, is rarely detected in clinical practice. It has been associated with infections of the oral cavity and female genital tract, but has never been detected in cerebrospinal fluid (CSF) of patients in China. Accurate detection of causative pathogens is still an arduous task owing to the difficult conditions of anaerobic bacterial culture. Isolated Prevotella intermedia can be detected by metagenomic next generation sequencing (mNGS) of the CSF. Correct diagnosis and antibiotic treatment can help patients avoid life-threatening events. Case presentation: Herein, we describe the case of a 64-year-old Chinese woman who presented with typical features of meningoencephalitis. Routine CSF culture failed to identify the causative pathogen. Isolated Prevotella intermedia was detected by mNGS, and the patient was treated with antibacterial agents including ceftriaxone, vancomycin, moxifloxacin, meropenem, metronidazole, and linezolid. The patient underwent surgical treatment for abscess of left frontal parietal lobe, which was observed on magnetic resonance imaging (MRI) and was suspected to be caused by Prevotella intermedia. It was further confirmed that it was a secondary infection from the oral cavity, and the possible etiology might have been dental surgery. Treatment was rendered to the patient based on metagenomic test result, and her condition improved after two months. Conclusions: This case highlights the role of mNGS in accurate diagnosis of patients with central nervous system infection. In particular, mNGS can be used to identify rare pathogens and confirm the diagnosis in patients with unknown etiology.