Chunping Wang

The consumption of ultra-processed food (UPF) has been linked to bone metabolism in adults, but its impact on bone mineral density (BMD) in children and adolescents remains unclear. This study analysed data from 4809 children and adolescents aged 8–19 years, drawn from the National Health and Nutrition Examination Survey (NHANES) 2011–2018. UPF intake was categorised according to the NOVA classification system, with the percentage of energy derived from UPF divided into quartiles (Q1–Q4). A weighted multiple linear regression model was used to examine the relationship between UPF intake and lumbar spine BMD (LSBMD) and subtotal BMD (SBMD). Stratified analyses were conducted to explore associations across various subgroups. The results indicated that UPF intake was positively associated with LSBMD. This association was significant in girls for both LSBMD and SBMD. Positive correlations with LSBMD also emerged in 12–15 years old and specific subgroups. Moreover, mediation analysis showed total cholesterol mediated 4·8 % of the UPF–LSBMD link, and HDL-cholesterol mediated 0·9 % of the UPF–SBMD one. These findings indicate that UPF intake is associated with increased BMD in children and adolescents. Future research should further investigate the complex effects of UPF on the health of this population.

Cardiovascular-Kidney-Metabolic (CKM) syndrome became the leading cause of death among U.S. adults in 2021. However, the relationship between different stages of CKM and the risk of all-cause mortality in the U.S. population remains unclear. Data from NHANES 2005–2018 and the Public-use Linked Mortality Files (LMF) were utilized in this study. Kaplan–Meier survival curves were generated to estimate survival probabilities across five CKM stages (stages 0 to 4) and compared using the log-rank test. Hazard ratio (HR) and 95% confidence interval (95%CI) for all-cause mortality were estimated using Cox proportional hazards regression models. Stratified analyses were conducted to explore potential effect modifications by age, sex, education, smoking status, drinking status and the Poverty Income Ratio (PIR). A total of 4,376 all-cause deaths were recorded during a median follow-up period of 7.25 years (IQR: 6.92–7.67). The risk of all-cause mortality increased progressively with higher CKM syndrome stages (P < 0.001). After multivariate adjustment, the risk of all-cause mortality for CKM stages 1 through 4 was 1.05 (95% CI: 0.81–1.44), 1.98 (95% CI: 1.54–2.56), 3.09 (95% CI: 2.36–4.06), and 4.47 (95% CI: 3.47–5.76) times higher than that for CKM stage 0, respectively. Additionally, subgroup analyses revealed that the risk of all-cause mortality in CKM stage 4 was higher among individuals under 60 years of age, females, current smokers, current drinkers, those with less than a high school education, and those with a household poverty index below1.3. Studies have found that populations with more advanced CKM staging have a higher risk of all-cause mortality. These findings underscore the need for targeted public health strategies to reduce mortality risk associated with CKM syndrome.

Risk factors at different stages of COVID‐19 may interact with each other, forming a risk network. Identifying the key risk factors within this network and their interrelationships is crucial for reducing the overall risk of COVID‐19. We constructed three Bayesian Belief Network (BBN) models by combining data‐driven approaches with expert validation. Using the Tree‐Augmented Naive Bayes (TAN) algorithm, we developed the INFORM COVID‐19 Risk BBN model and the COVID‐19 Regional Safety Assessment BBN model. The joint BBN model was established using the Greedy Thick Thinning (GTT) algorithm. Parameter learning was performed through maximum likelihood estimation. Expert validation, 10‐fold cross‐validation, and model performance metrics were employed to comprehensively assess the overall performance of the models. Additionally, mutual information analysis and sensitivity analysis were used to explore the importance of risk factors at each stage and their interdependencies. “INFORM Vulnerability” and “INFORM Lack of Coping Capacity” were identified as the two key risk factors influencing the risk of early outbreak. In the mid‐to‐late stages of the pandemic, “Emergency Preparedness” and “Monitoring and Detection” had the greatest impact on regional safety and control measures. Furthermore, the joint BBN model indicated that the most important risk factors affecting the overall COVID‐19 risk were “Lack of Coping Capacity,” “Government Risk Management Efficiency,” and “Regional Resiliency,” while the influence of other variables was relatively minor. The main contribution of this study lies in identifying the key risk factors at different stages of the pandemic and their interdependencies, providing policymakers with valuable insights for the rational allocation of limited health resources and the formulation of appropriate and effective prevention and control policies.

Lead (Pb) is a widespread environmental metal with recognized genotoxicity, yet whether it impairs DNA damage repair via epigenetic regulation remains unclear. Here, human lymphoblastoid TK6 cells were exposed to a series of concentrations of lead acetate solutions at 0, 120, 240, 480 µM for 24 h. We quantified cell viability, oxidative stress indicators (ROS, MDA, SOD, CAT), DNA damage markers (the Comet assay indicators Tail Length, Tail DNA % and Tail Moment and γ-H2AX levels), DNA damage repair capacity using 3-AB method based on the Comet assay, cell cycle and apoptosis, and the mRNA and protein expressions of DNA repair genes (RAD51, CHEK2, BRCA1, Ku80, MSH2, LIG4). We further measured expressions of DNA methyltransferase DNMT1 and demethylase TET2, and methylation of the Ku80 promoter region by Pyrosequencing. The results suggested that Pb exposure decreased cell viability, increased ROS levels and MDA content while reduced SOD and CAT activity. Pb exposure induced dose-dependent increases in DNA single-strand breaks (SSBs) and double-strand breaks (DSBs), as evidenced by elevated Tail Length, Tail DNA%, Tail Moment and fluorescence intensity of γ-H2AX levels. G0/G1-phase arrest and apoptosis also rose with dose. In addition, DNA damage repair capacity of TK6 cells were decreased in a dose-dependent manner after Pb exposure. DNA damage repair genes showed a biphasic response-elevated at lower doses and suppressed at higher doses-at both mRNA and protein levels. The methylation level in promoter region of Ku80 increased with dose and coincided with higher DNMT1 and lower TET2 expression. Collectively, Pb exposure induces oxidative stress and DNA damage in TK6 cells; higher lead concentration inhibited DNA repair capacity, potentially via DNMT1/TET2 mediated hypermethylation of the Ku80 promoter region.

Lead (Pb) is a widespread environmental metal with recognized genotoxicity, yet whether it impairs DNA damage repair via epigenetic regulation remains unclear. Here, human lymphoblastoid TK6 cells were exposed to lead acetate at 0, 120, 240, or 480 µM for 24 h. We quantified cell viability, oxidative stress indicators (ROS, MDA, SOD, CAT), DNA damage markers (single-cell gel electrophoresis/Comet Tail DNA% and γ-H2AX foci), cell-cycle distribution, apoptosis, and the mRNA and protein levels of DNA repair genes (RAD51, CHEK2, BRCA1, Ku80, MSH2, LIG4). We further measured DNMT and TET expression and determined methylation of the Ku80 promoter by pyrosequencing. Our results showed that lead decreased cell viability, increased ROS levels and MDA while reduced SOD and CAT activity; Lead caused dose-dependent increases in DNA single-and double-strand breaks with percentage of Comet tail DNA and the number of γ-H2AX foci. G0/G1-phase arrest and apoptosis also rose with dose. DNA repair genes showed a biphasic response-elevated at lower doses and suppressed at higher doses-at both mRNA and protein levels. Themethylation level in promoter region of Ku80 increased with dose and coincided with higher DNMT1 and lower TET2 expression. Collectively, Pb exposure induces oxidative stress and DNA damage in TK6 cells; higher lead concentration inhibited DNA repair capacity, potentially via DNMT1/TET2 mediated hypermethylation of the Ku80 promoter.

The study aimed to evaluate the relationship between immunonutritional indicators such as the systemic immune-inflammation index (SII), the Naples prognostic score (NPS), nutritional risk index (NRI), serum albumin (ALB), total cholesterol (TC) and all-cause mortality in adult stroke patients. Data were obtained from the National Health and Nutrition Examination Survey (NHANES) databases for 2005–2018. To determine mortality outcomes, participants were matched with National Death Index records until December 31, 2019. Spearman’s correlation analysis and the random survival forest (RSF) were employed to assess the relationships among NPS, NRI, SII, ALB, and TC, and to determine the most predictive indicator for all-cause mortality in stroke patients. For the selected prognostic indicator, Kaplan–Meier survival analysis and Cox proportional hazards regression models were subsequently utilized to evaluate their associations with all-cause mortality in stroke patients. The study included 1076 stroke patients, with a median (IQR) age of 67 (56, 77) years. During a median follow-up of 67 months, a total of 372 (weighted 31%) stroke participants died from all causes. Among the immunonutritional indicators evaluated, NPS had the strongest predictive power for all-cause mortality in stroke patients. The Kaplan–Meier curve and Log-rank test showed that all-cause mortality was higher in the higher NPS group (3–4) compared to the lower NPS group (0–2) (P < 0.001). After adjusting for multiple potential confounders, the Cox regression model indicated that the higher NPS (3–4) group remained an independent predictor for higher all-cause mortality risk (HR = 1.89, 95% CI 1.44–2.47, P < 0.001). As a comprehensive evaluation index of inflammation and nutrition, NPS is a powerful predictor of all-cause mortality in stroke patients.

The potentially risky effects of metabolites of phthalates (mPAEs) on inflammation and immune function have attracted much attention in recent years. However, direct studies on the relationship between these metabolites and the systemic immune inflammatory index (SII) and systemic inflammatory response index (SIRI) are limited. This cross-sectional study used generalized linear regression models (GLM), restricted cubic splines (RCS), weighted quantile sum (WQS), and Bayesian kernel-machine regression (BKMR) to analyze data from 2,763 U.S. adults aged between 20 and 80 years, obtained from the U.S. National Health and Nutrition Examination Survey (NHANES) conducted between 2013 and 2018. The study aimed to investigate the relationship between urine samples of nine mPAEs and levels of SII/SIRI in a single, nonlinear, and mixed relationship and explored the robustness of the findings under single and mixed effects using two sensitivity analyses for completeness. In addition, the effects of six variables (age, sex, BMI, the percentage of total daily energy intake from ultra-processed foods (UPFs), total vegetable intake, and dietary supplements) on the association results were explored through subgroup analyses to identify potentially important confounders. In single exposure analyses, mono-n-butyl phthalate (MnBP), mono-ethyl phthalate (MEP), and monobenzyl phthalate (MBzP) were positively associated with SII/SIRI. The findings from the two mixed exposure models demonstrated a positive association between the collective concentrations of mPAEs and levels of SII/SIRI, with MBzP being identified as a significant contributor to the urinary levels of mPAEs. The subgroup analysis results of the effects of single and mixed exposures show that the association between mPAEs and SII/SIRI is more significant in females, overweight/obese populations, young/middle-aged populations, and populations with high levels of intake of UPFs. Positive associations were identified between mPAEs and SII/SIRI. MBzP was determined to have the most significant impact. The association between mPAEs and SII/SIRI is significantly influenced by female groups, young and middle-aged populations, overweight and obese individuals, as well as those with a higher intake of UPFs.

Objectives: This study examines the recommendation behaviors and influencing factors for the 13-valent Pneumococcal Conjugate Vaccine (PCV13) among 3579 Chinese healthcare workers (HCWs), including 1775 pediatric care providers (Peds-PCPs) and 1804 primary care providers (PCPs). Data were collected from May to July 2023 through a national cross-sectional survey using a structured questionnaire, distributed across hospitals providing pediatric services in five provincial-level administrative divisions. Methods: The sociodemographic data, vaccine knowledge, and recommendation practices were analyzed using Pearson’s chi-square test, Wilcoxson rank-sum test, and multivariate logistic regression. Results show that while PCPs are more likely to recommend PCV13, vaccine hesitancy persists among Peds-PCPs. Logistic regression revealed that higher influenza vaccination intention, salary, vaccine consultation frequency, familiarity with immunization, work ethic, and flexible schedules positively impacted HCWs’ recommendation behavior. Results: Factors influencing Peds-PCPs’ recommendations include vaccine training (OR: 1.470, CI: 1.049–2.509), safety recognition (OR: 1.986, CI: 1.163–3.391), concern over rejection (OR = 1.274, CI: 1.076–1.508) and vaccine cost (OR = 1.203, CI: 1.023–1.414). For PCPs, influencing factors were the perceived susceptibility of children to pneumonia (OR = 2.185, CI: 1.074–4.445), acceptance of herd immunity (OR: 1.717, CI: 1.101–2.677), and belief that parents with better family conditions are more likely to accept vaccine recommendations (OR = 1.229, CI: 1.024–1.477). Conclusion: This survey underscores the need for tailored interventions to address differing perceptions and enhance confidence in the safety and efficacy of vaccines among HCWs, particularly Peds-PCPs.

Background and purpose: This study aims to examine the global, regional, and national burden of ischemic stroke from 1990 to 2021.Method: We used data from the Global Burden of Disease (GBD) 2021 database to comprehensively assess ischemic stroke indicators globally, regionally, and in 204 countries, including incidence, deaths, disability‐adjusted life years (DALYs), estimated annual percentage change (EAPC), and Joinpoint regression analysis.Results: In 2021, there were a total of 7,804,449 cases of ischemic stroke globally (95% uncertainty interval = 6,719,760–8,943,692), with an age‐standardized incidence rate (ASIR) of 92.39. This represents a declining trend compared to 1990, with an EAPC of −0.67 (95% confidence interval [CI] = −0.76 to −0.58). Mortality and DALY rates also showed a downward trend (EAPC in age‐standardized mortality rate: −1.83, 95% CI = −1.92 to −1.74; EAPC in age‐standardized DALY rate = −1.59, 95% CI = −1.68 to −1.50). The burden of ischemic stroke was inversely correlated with gross domestic product. Regionally, from 2014 to 2021, the Caribbean experienced the fastest increase in ASIR (annual percent change = 0.15, 95% CI = 0.13 to 0.18). Among 204 countries, North Macedonia had the highest incidence, mortality, and DALY rates. In addition to metabolic risks, particulate matter pollution and low temperatures were significant environmental and occupational risk factors for ischemic stroke. Smoking and a diet high in sodium were identified as key behavioral risk factors.Conclusions: Ischemic stroke remains a serious global health challenge, and our results from this cross‐sectional study suggest that the burden of disease remains high in Eastern Europe, East Asia, Central Asia, and Sub‐Saharan Africa.