Speech problems in childhood have profound implications for learning, communication, as well as the development of social and cognitive skills in adulthood. However, research has yet examined how early life speech problems may be associated with subsequent dementia risks in later life. Using nationally representative data from the longitudinal Health and Retirement Study, this study aimed to investigate how the experience of speech problems before age 16 was associated with the risk of dementia among older adults aged 50 and older. The analysis pooled the full life history information about childhood speech problems for N = 17,863 participants who had one to eleven observations for cognitive and sociodemographic information from 2000 to 2020. We constructed person-interval data and estimated discrete-time event history models to examine risks for developing dementia, which was measured using a validated Langa-Weir classification of cognitive function. Results showed that older adults with childhood speech problems had a higher risk of developing dementia in later life, compared to those who never had speech problems in childhood. The effect of childhood speech problems on cognitive function was partially explained by economic status and health conditions in midlife. Findings highlight the long-arm implications of early life health adversity and suggest needs for screening and early intervention programs for childhood speech impairment. What is already known on this subject Literature had documented various developmental and health outcomes of childhood speech impairment. This research addresses the gap in the literature by examining the long-term implications of childhood speech impairment on dementia risk in later life. What this paper adds to existing knowledge Using longitudinal data from the Health and Retirement Study, this study investigated how the experience of childhood speech impairment was associated with the risk of dementia among U.S. older adults. We found about 3% of U.S. older adults had speech impairments in childhood, and they had a higher risk of developing dementia in later life compared to those who did not have speech impairments in childhood. What are the potential or actual clinical implications of this work? Findings suggest needs for screening and early intervention programs for childhood speech impairment.
Dual-use research of concern (DURC) refers to legitimate scientific research that, if misapplied, could cause significant harm. Journal editors play an important role in ensuring that disseminated research does not pose unacceptable risks to society. We conducted a thematic analysis of DURC policies adopted by life science journals. Top 10 journals listed in Google Scholar Metrics (February 2026) across 15 life science categories yielded 133 journals after de-duplication. Each journal's website was screened for a policy addressing DURC, biosafety, or biosecurity. Following de-duplication of policies, a set of unique DURC policies was established. Policies were coded using color-coded identifiers for key stakeholders and actions, and themes were identified through reviewer consensus. Fifty-nine journals (44.36%) had a clear policy addressing DURC, biosafety, or biosecurity. De-duplication yielded 11 distinct policy documents. Thematic analysis revealed five themes: (1) transparency and disclosure; (2) regulatory compliance; (3) editorial oversight and gatekeeping; (4) distributed responsibility; and (5) different definitions of DURC. Many life science journals continue to lack explicit DURC policies. Among those with policies, there is a shared expectation that authors, reviewers, and editors are adequately trained to recognize and manage DURC-related risks, an assumption that may be unwarranted.
To systematically investigate the associations between umbilical cord blood protein expression profiles and early infant neurodevelopment using a prospective birth cohort, to identify potential early biomarkers through high-throughput proteomics, and to explore underlying biological mechanisms, thereby providing scientific evidence for early identification of neurodevelopmental risks and understanding the molecular basis of neurodevelopmental deviations in general populations. Based on the Peking University Birth Cohort in Tongzhou, this study enrolled 96 children who completed ages and stages questionnaires, third edition (ASQ-3) assessments at 1 and 3 years of age. Participants were classified into an abnormal group (n=42) and a control group (n=54) according to ASQ-3 screening results. Non-targeted quantitative proteomics was performed on cryopreserved umbilical cord blood plasma samples collected at birth. Differential expression analysis, principal component analysis (PCA), orthogonal partial least squares discriminant analysis (OPLS-DA), and weighted gene co-expression network analysis (WGCNA) were conducted to identify differentially expressed proteins, followed by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) functional enrichment analyses. The fold change (FC) was calculated. Independent samples t-test was used for statistical comparison, with Benjamini-Hochberg method applied to calculate false discovery rate (FDR) for multiple testing correction. Proteomic analysis identified 8 214 common proteins, among which 385 proteins were differentially expressed (P < 0.05, |log2FC| >0.585), including 189 proteins upregulated and 196 proteins downregulated in the abnormal group. PCA and OPLS-DA revealed systematic differences in protein expression patterns between the two groups. WGCN A identified 10 co-expression modules, with the yellow module showing significant negative correlation with ASQ-3 abnormal grouping (r=-0.233, P=0.024) and the pink module positively correlating with communication domain scores (r=0.342, P=0.003). Enrichment analyses demonstrated that differential proteins and key modules were primarily enriched in two functional categories: (1) genetic information processing pathways, including ribosome, spliceosome, and mRNA processing; and (2) cytoskeleton organization and Wnt signaling pathways. These pathways held significant biological relevance in the pathogenesis of neurodevelopmental disorders. Perturbations in proteins associated with genetic information processing and cytoskeleton/Wnt signaling pathways in umbilical cord blood may represent important molecular characteristics of early neurodevelopmental screening abnormalities in infants. This study provides potential peripheral blood biomarker combinations for early identification of neurodevelopmental risks in general populations and offers novel insights into the biological mechanisms underlying neurodevelopmental deviations. Future research should validate these findings in larger-scale cohorts and elucidate specific functional mechanisms of key proteins through experimental studies.
Noise is a widespread harmful environmental stressor that burdens large urban populations globally. Exposure to environmental noise at elevated levels increases annoyance and disturbance, posing substantial risks to both mental and physical health. While the dangers of noise exposure have been widely recognized, the quantitative relationship between noise exposure and psychological response is not well translated to the environmental noise community. This study attempts to estimate people's annoyance generated by exhaust ventilation noise in a residential community through field measurements and theoretical exposure modeling. The sound pressure levels (SPLs) were sampled at multiple points first, and then a double-layer sound insulation strategy was implemented to reduce the noise levels. Acoustic computations show that the percentage of highly annoyed population in building A before and after duct-borne noise treatment were 11.6% vs. 9.8%, demonstrating reasonable alleviation of noise annoyance and voluntary compliance with the WHO health-based guidelines. Moreover, issues in current environmental noise regulations and their implementation were pointed out, offering suggestions for potential improvements in local legislation. Finally, the methodology and recommendations presented in this study can assist environmental health professionals and policymakers in their efforts to alleviate noise annoyance and develop informative noise control guidelines in the future.
Thyroid dysfunction has been associated with adverse postoperative outcomes, but little is known about its effects on patients undergoing coronary artery bypass grafting (CABG). Here, our goals were (1) to evaluate the incidence of CABG in patients with hypothyroidism receiving thyroid hormone replacement therapy, and (2) to assess short-term and long-term outcomes in patients with hypothyroidism undergoing CABG compared with controls without thyroid disease, and (3) to determine whether abnormal preoperative thyroid-stimulating hormone (TSH) levels modify postoperative surgical risk in this patient population. Retrospective longitudinal study using the TriNetX Global Collaborative Network database. The incidence of CABG was evaluated in about 1.23 million patients with hypothyroidism during a 20-year observation period (median of 4.4 ± 5.9). Post-CABG outcomes, including mortality, cardiovascular events, and postsurgical complications, were evaluated in 6557 patients with hypothyroidism over 10 years after 1:1 propensity score-matching. Over 20 years, patients with a diagnosis of hypothyroidism had a higher incidence of CABG compared with controls (0.27% vs. 0.22%; hazard ratio [HR] 1.08; confidence interval [CI]: 1.03-1.14). Among patients who underwent CABG, the diagnosis of hypothyroidism was associated with mild increased risk of short-term postsurgical infections (HR:1.10, CI:1.01-1.20), CABG-specific complications (HR: 1.24, CI: 1.08-1.42), and critical care utilization (HR:1.14, CI:1.07-1.21). During long-term follow-up, these patients were at increased risk of incident heart failure (HR:1.15, CI:1.04-1.28), stroke (HR:1.18, CI:1.01-1.39), and major adverse cardiovascular events (MACE) (HR:1.15, CI:1.01-1.29). Sensitivity analysis, including only patients with hypothyroidism diagnosis, showed that abnormal preoperative TSH levels, particularly those with elevated TSH, had a higher risk of short-term mortality and long-term embolic events. Hypothyroidism is associated with a higher incidence of coronary disease requiring CABG and increased risks of postoperative complications, heart failure, stroke, and MACE. These findings support the potential value of preoperative thyroid function assessment and optimization to mitigate postoperative complications and improve surgical outcomes in this high-risk group.
This case report presents an updated interpretation of genetic and chronological data from human remains discovered in Bezdanjača Cave, a Bronze Age burial site located in the Lika region of Croatia. The cave contains a complex necropolis with at least 57 graves and up to 200 individuals, which indicates its use as a collective burial site during the Middle and Late Bronze Age. Based on ancient DNA analysis, 13 males were identified among 38 analyzed individuals, with the majority belonging to the Y-chromosome haplogroup R1b, commonly associated with Bronze Age populations. However, two individuals were assigned to haplogroup I2a1a (I-Y3120). The I2a lineage has deep roots in Europe, and its presence has been confirmed in prehistoric contexts in Croatia and the region. However, newly obtained radiocarbon dates from occipital bones reveal that at least one of the two I2a1a individuals from Bezdanjača Cave dates to the Early Modern period (1645-1950 calibrated CE), which indicates that the remains were deposited in the cave much later than previously assumed. At the same time, these new data do not contradict the possible presence of the I2a1a lineage in Bronze Age populations in this area, as Bronze Age I2a1a samples have been reported from other archaeological sites in Croatia and the wider region. These findings, presented here for the first time, highlight the risks of assuming chronological homogeneity based solely on archaeological context and demonstrate the necessity of direct radiocarbon dating when integrating archaeological and genetic data. An interdisciplinary approach and careful chronological verification in ancient DNA research are essential to avoid misinterpretations in broader population genetic studies.
The incidence of infections caused by rare pathogens has increased in recent years. This necessitates the development of effective diagnostic and therapeutic approaches. In this study, we report the first documented case of Aspergillus steynii-induced pulmonary infection in humans. We evaluated the morphological and molecular characteristics of this fungus to elucidate its role in human infections. A 47-year-old woman with immunosuppression after bone marrow transplantation developed symptoms of pulmonary infection. The pathogen was identified as A. steynii through culture techniques, microscopy, mass spectrometry, multigene molecular identification, and whole-genome sequencing. Antifungal susceptibility testing was performed, and comparative genomic analysis was conducted to assess the phylogenetic relationship and genomic characteristics of A. steynii and other pathogenic Aspergillus species. Genomic analysis revealed a high degree of similarity with other pathogenic Aspergillus species. Furthermore, we identified 470 unique gene families primarily associated with ABC transporter pathways linked to multidrug resistance. The strain was sensitive to triazoles and echinocandins but exhibited elevated minimum inhibitory concentrations (MICs) for amphotericin B, flucytosine, and fluconazole. In addition, multiple potential drug resistance genes were identified, indicating the potential for multidrug resistance. The emergence of A. steynii in humans poses new clinical challenges and risks, including cross-species transmission and multidrug resistance. The potential for A. steynii infections, particularly in immunosuppressed patients, highlights the importance of early diagnosis and timely intervention to reduce the risk of misdiagnosis or delayed treatment. Thus, our findings have the potential to improve the clinical and differential diagnosis of this infection and facilitate the development of effective therapeutic approaches.
Drug-induced anaphylaxis during pregnancy, although uncommon, represent potentially serious clinical situation with significant maternal-fetal impact and relevant therapeutic implications. This topic is particularly timely given the need for guidance of health professionals dealing with this challenge and correct labelling patients with drug allergy/hypersensitivity. Recent studies report a high prevalence of self-reported β-lactam allergy during pregnancy, with poor correlation with true allergy, underscoring the value of structured, safe, and effective diagnostic evaluation for appropriate delabeling. These findings highlight the need for a systematic approach to drug-induced anaphylaxis in pregnancy, including accurate diagnosis and protocol-based management. Incorporating allergological evaluation into prenatal care can reduce unnecessary risks, optimize maternal and fetal outcomes, and promote rational medication use. Important knowledge gaps remain, emphasizing the need for prospective studies with standardized methodologies and expanded immunological assessment.
This study aimed to compare the efficacy of administering carbetocin before versus after placental delivery in preventing PPH in low-risk vaginal deliveries. The randomized controlled trial was conducted at Kartal City Hospital, Istanbul, Turkey. A total of 160 primiparous women with uncomplicated pregnancies who underwent vaginal delivery were enrolled. Participants were randomly assigned to receive 100 mcg of carbetocin either before or after placental delivery. The primary outcome was the incidence of PPH. Secondary outcomes included the need for additional uterotonics, manual removal of the placenta with consequent antibiotic administration, blood transfusions, maternal adverse events, and changes in hemoglobin levels at baseline and 24 h postpartum. The incidence of PPH was significantly lower in the carbetocin-before group than in the carbetocin-after group (p=0.015). The carbetocin-before group had a significantly lower mean hemoglobin drop compared to the carbetocin-after group (p<0.001). The need for additional uterotonics was significantly higher in the carbetocin-after group (p<0.001). Manual placenta removal and the need for antibiotics were more frequent in the carbetocin-before group (p=0.017). No significant differences in adverse maternal events were observed between the groups. Administering carbetocin before placental delivery significantly reduces the incidence of PPH, blood loss, and the need for additional uterotonics. However, the increased rate of manual placenta removal necessitates individualized risk-benefit assessment; pre-placental administration may be most advantageous in women at elevated risk for PPH, in whom the hemorrhagic benefit outweighs the risks associated with manual extraction.
Postpubertal cryptorchidism remains clinically challenging, as patients often present with long-standing maldescent, impaired spermatogenesis, and an increased risk of testicular malignancy. However, the optimal management of this population remains controversial, and comprehensive data on clinical characteristics, surgical outcomes, endocrine changes, and spermatogenic damage are still limited. We conducted a single-center retrospective cohort study of 194 patients (210 undescended testes) undergoing primary orchiopexy between January 2018 and June 2024. Clinical characteristics, testicular position, ultrasonographic volume, semen parameters, endocrine parameters, and histopathology findings were collected. Intraoperative biopsies were obtained in 200 testes (95.2%) and graded using the Johnsen score. Severe spermatogenic impairment was defined as a Johnsen score ≤3; analyses of spermatogenic impairment were performed in 164 patients with available histological and endocrine assessments. Surgical outcomes were assessed in 185 testes with ≥3-month follow-up, and oncologic events were assessed in 155 patients (161 testes) with available follow-up data. Univariable and multivariable logistic regression analyses were performed to identify predictors of severe spermatogenic impairment. Most undescended testes were in a high position (196/210, 93.3%), and the affected testis had reduced volume in unilateral cases (median 6 vs. 18 mL). Overall anatomical success at 3 months was 80.0% (148/185), with recurrence and atrophy rates of 9.7% and 10.3%, respectively. Among patients with available semen data, unilateral cases showed no azoospermia, but 16 of 44 patients (36.4%) had at least one abnormality in sperm concentration, progressive motility, or normal morphology; by contrast, bilateral cases frequently presented with azoospermia or extremely low sperm counts. In unilateral cases, testosterone, LH, and FSH remained within the normal range without significant perioperative change; in bilateral cases, testosterone was generally preserved whereas FSH was elevated and remained above normal at follow-up. Histologically, only 17 of 200 biopsied testes (8.5%) had a Johnsen score >8, and 71/164 (43.3%) showed severe spermatogenic impairment. High testicular position was strongly associated with severe impairment (univariable OR 6.50, 95% CI 2.15-19.64, p < 0.001) and remained an independent predictor in multivariable analysis (adjusted OR 6.01, 95% CI 1.95-18.49, p = 0.002); affected testicular volume was independently inversely associated with severe impairment (adjusted OR 0.78 per 1 mL, 95% CI 0.64-0.95, p = 0.013). During a median follow-up of 54.6 months (range 12-78), one patient (0.5%) developed ipsilateral seminoma 48 months after orchiopexy. In postpubertal cryptorchidism, histological and functional spermatogenic impairment is often established before surgery and is unlikely to be substantially reversed by orchiopexy. The main value of orchiopexy lies in anatomical repositioning, pathological assessment, and facilitation of long-term surveillance. High testicular position and smaller preoperative testicular volume identify a subgroup at particularly high risk of severe spermatogenic failure, and malignancy risk is not eliminated, supporting the need for long-term follow-up.
PurposeTo critically analyze the NANDA-I nursing diagnoses "Adult pressure injury" (00312) and "Risk for adult pressure injury" (00304) regarding the expected outcomes and recommended interventions. This contributes to strengthening the linkages between NANDA-I Diagnoses, Nursing Outcomes Classification, and Nursing Interventions Classification taxonomies in clinical practice, education, and nursing research.MethodsThis study adopts a consensus-based approach, with descriptive and analytical components, grounded in clinical reasoning of experts in nursing diagnosis, outcomes and interventions taxonomies and supported by a narrative review of the literature. A structured consensus process was used to reach agreement.FindingsA total of 51 linkages were mapped for the nursing diagnosis "Risk for adult pressure injury" (00304). Additionally, 37 linkages were identified for the nursing diagnosis "Adult pressure injury" (00312). From this analysis, 88 linkages were identified.ConclusionsThe established linkages allow for the distinction between preventive and treatment-oriented outcomes and interventions, enabling a more effective approach to caring for patients with pressure injury. In addition, ongoing efforts to validate and disseminate these linkages are crucial for advancing nursing practice, ensuring high-quality patient care, and creating reliable records that reflect nursing practice.Implications for nursing practiceThis work can assist nurses in their clinical reasoning and decision-making by providing a standardized nursing language in the development of nursing care plans with adjusted diagnoses, outcomes, and interventions appropriate for addressing the needs of patients with pressure injury.
Non-Hodgkin lymphoma (NHL) is a heterogeneous group of cancers. Published recommendations and guidelines for fertility preservation are very general and heterogeneous. Therefore, a very first meta-analysis analyzing the worldwide-published data on the risk of infertility after treatment of NHL is required to better counsel patients regarding fertility issues and to develop further strategies to evaluate the gonadotoxicity of treatments in NHL. A systematic literature search was conducted using Medline, Embase, and Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials (CENTRAL), including articles published since 2000. Exclusion criteria were cases with disease relapse, follow-up of <1 year, testicular NHL, studies with <40% reproductive markers, and case reports. A total of 4602 records were identified. For the systematic review, 58 studies met the inclusion criteria. In this meta-analysis, 51 studies were included. The prevalence of expected infertility is 27% (95% confidence interval [CI] 0.20-0.37) overall, 23% (95% CI: 0.14-0.35) in females, and 35% (95% CI: 0.27-0.44) in males. It is highest after chemotherapy and radiotherapy to the pelvis and testis ± bone marrow transplantation, 43% (95% CI: 0.20-0.69) in females and 57% (95% CI: 0.21-0.86) in males. After alkylating agents in females, it is 24% (95% CI: 0.17-0.34). The results of this review and meta-analysis indicate a broad heterogeneity of data regarding the risk of infertility. Therefore, fertility counseling and, if necessary, fertility preservation measures are mandatory before oncologic treatment for NHL. Prospective studies stratified by chemotherapy regimen and including new treatment regimens are urgently needed.
To explore the relationship between family trauma, school bullying and adolescent suicidal behavior, and the regulatory role of DRD2 gene polymorphism. A total of 98 adolescent patients with depressive disorders who visited our hospital from June 2022 to June 2024 were selected. They were divided into the non-suicide group (n=62) and the suicide group (n=36) based on their suicide behavior in the previous 6 months and their attitudes towards suicide behavior. The general data of the two groups were compared. The relationship between each genotype and suicide behavior, the influencing factors of suicide behavior, the interaction between family trauma and school bullying on suicide behavior, and the regulatory effects of depression and genetic polymorphisms were analyzed. The possible regulatory effects of depression and genetic polymorphisms were also investigated. Compared with the non-suicide group, the duration of illness, non-suicidal self-harm behavior, family trauma, school bullying, anxiety, depression scores in the suicide group increased, while the life meaning score decreased (P < 0.05). The genotype A2A2 was associated with an increased risk of suicidal behavior compared to genotype A1A1 (P < 0.05). In the recessive model, the genotype A2A2 was associated with an increased risk of suicidal behavior compared to genotype A1A1 and A1A2 (P < 0.05); in the additive model, there were significant associations between the genotypes A1A1, A1A2, A2A2 and suicidal behavior (P < 0.05). Non-suicidal self-harm behavior, family trauma, school bullying, depression, and the A2A2 genotype were independent risk factors for suicidal behavior, while life meaning was an independent protective factor. Family trauma > 54.78 points and school bullying > 10.37 points had a multiplicative (OR=6.585, 95%CI: 5.478-7.367) and additive (OR=7.849, 95%CI: 7.231-8.294) interaction effect on adolescent suicidal behavior. Depression exerted a regulatory effect between family trauma (β=0.092, 95%CI: 0.084-0.103), school bullying (β=0.090, 95%CI: 0.081-0.098) and suicidal behavior. In the additive genetic model, the TaqⅠA gene had a significant regulatory effect on "family trauma, school bullying → depression → suicidal behavior" in adolescents with the A1A2/ A2A2 genotype. The risk of suicidal behavior is higher in adolescents with both family trauma and school bullying, and depression plays a part of the mediating effect. The TaqⅠA polymorphism of DRD2 gene has a significant regulatory effect on adolescents carrying A2 allele.
Burn care frequently relies on extensive documentation, including graphic photographic images and detailed clinical records. While these materials are essential for diagnosis, treatment planning, and research, their use after a patient's death raises complex ethical questions. The emergence of new technologies such as artificial intelligence training, alongside the increased visibility of burn images in education and public health campaigns, challenges traditional notions of confidentiality and consent. This narrative review examines the ethical boundaries of using burn patient records and images post-mortem, with a focus on emerging concerns around digital remains and posthumous consent. A narrative review of peer-reviewed literature, professional guidelines, and position statements published between 2000 and 2025 was conducted. Sources included PubMed, Scopus, and Google Scholar, using search terms such as "burn injuries," "medical photography," "post-mortem consent," "digital remains," and "medical ethics." Relevant publications addressing clinical practice, teaching, research, and social media use in burn care were synthesized to identify key ethical themes and gaps. The literature reveals that while ethical frameworks for consent, privacy, and confidentiality are well established during life, guidance becomes inconsistent once the patient has died. A small but growing body of scholarship identifies posthumous privacy as an emerging domain of bioethics. Across studies, concerns included dignity after death, risks of re-identification on digital platforms, and the absence of explicit patient directives regarding posthumous use of images and data. Current medical guidelines provide minimal direction, leaving ambiguity for clinicians and researchers. The ethical use of burn patient images and records after death remains underexplored, particularly in the context of AI training datasets and social media awareness campaigns. The absence of consensus underscores the need for professional societies to establish clearer policies and protocols that honor patient dignity beyond life. Establishing standards for posthumous consent will help clinicians, educators, and researchers navigate the evolving landscape of digital medicine responsibly.
To evaluate the effects of perioperative music interventions on emotional outcomes (preoperative anxiety, postoperative fear, emergence delirium) and related physiological parameters in children and adolescents undergoing surgery, and to examine potential effect modifiers. Nine databases were searched from inception to February 2026. Randomized controlled trials comparing music versus no-music control in pediatric surgical patients (≤ 18 years) were included. Risk of bias was assessed with RoB 2.0. Random-effects meta-analyzes were performed for preoperative anxiety, postoperative pain, heart rate, and blood pressure. Subgroup analyzes were conducted for age, music selection method, intervention timing, and surgery type. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Seventeen RCTs (1871 children) were included. Music significantly reduced preoperative anxiety (SMD = -2.03; 95% CI -3.19 to -0.86; I2 = 97%), postoperative pain (SMD = -0.64; 95% CI -1.01 to -0.27; I2 = 62%), heart rate (MD = -12.92 bpm; 95% CI -19.07 to -6.77; I2 = 88%), and mean arterial pressure (MD = -8.41 mmHg; 95% CI -10.07 to -6.76; I2 = 66%). Effects on systolic blood pressure were not significant. Anxiolytic effects were significant in both children (≤ 12 years) and adolescents (≥ 13 years) with no subgroup difference. Self-selected and pre-selected music were both effective. Sensitivity analyzes confirmed robustness. GRADE assessment indicated very low to low certainty of evidence for all outcomes, primarily due to high heterogeneity, risk of bias, and imprecision. Perioperative music was associated with reduced anxiety and pain, but evidence certainty was very low to low. Pending stronger evidence, music may be considered a low-risk adjunct to standard care.
To identify joint trajectory patterns of direct and indirect maternal mortality ratios (MMR) at the country level from 2000 to 2021, and to compare phase-specific changes during the millennium development goals (MDG, 2000 to 2015) and the sustainable development goals (SDG, 2015 to 2021) periods, as well as differences in health system and policy environments across trajectory groups. Data on maternal mortality among women aged 15-49 years in 204 countries and territories from 2000 to 2021 were obtained from the Global Burden of Disease (GBD) Study. Direct cause MMR and indirect cause MMR at five time points (2000, 2005, 2010, 2015, and 2021) were jointly analyzed using longitudinal K-means clustering (k=2-6). The optimal number of clusters was determined by the Calinski-Harabasz (CH) index. Based on the clustering results, a piecewise linear mixed effects model with random intercepts was fitted with a knot in 2015 to estimate the baseline intercept in 2000 and period-specific slopes for the MDG and SDG phases. For 2021, health system and policy-related indicators, including antenatal care coverage (≥4 visits, ANC4), proportion of women with a demand for contraception that are using a modern method, cesarean section rate, female human immunodeficiency virus (HIV) prevalence, in facility delivery rate, skilled birth attendance, and an abortion legality index were compared across clusters using the Kruskal-Wallis H test. All tests were two-sided, and P < 0.05 was considered statistically significant. The CH index peaked at k=3 (CH=342.63), classifying the 204 countries and territories into three joint trajectory clusters: high burden (n= 66), medium burden (n=88), and low burden (n=50). In 2021, direct MMR was 334.6 (95%CI: 282.5- 386.7), 65.6 (95%CI: 50.4-80.7), and 5.4 (95%CI: 3.7-7.0) per 100 000 live births in the high, medium, and low burden clusters, respectively; indirect MMR was 33.6 (95%CI: 27.9-39.2), 18.2 (95%CI: 13.5-22.9), and 0.9 (95%CI: 0.6-1.3) per 100 000 live births, respectively. The piecewise mixed effects model showed significant declines in direct MMR during the MDG period in all clusters (slopes: -0.020, -0.016, and -0.036; P < 0.001), whereas declines slowed and became non-significant during the SDG period (-0.011, 0.011, and -0.006; P > 0.05). For indirect MMR, modest increases were observed during the MDG period in the high and medium burden clusters (0.029 and 0.015; P < 0.05), with no significant change in the low burden cluster (P > 0.05). During the SDG period, indirect MMR increased markedly in the medium burden cluster (slope: 0.121; 95%CI: 0.092-0.151; P < 0.001), while remaining broadly stable in the high and low burden clusters (P > 0.05). Health system and policy indicators differed significantly across the clusters (P < 0.001): the high burden cluster showed lower ANC4 coverage, lower in facility delivery and skilled birth attendance, lower demand for contraception satisfied by modern methods, and higher female HIV prevalence; the medium burden cluster achieved near universal in facility delivery and skilled birth attendance but had a higher cesarean section rate; the low-burden cluster generally showed more favorable indicator profiles and a higher abortion legality index. Distinct joint trajectories of direct and indirect maternal mortality were observed globally from 2000 to 2021. While reductions in direct maternal mortality were substantial during the MDG era, progress broadly slowed and plateaued during the SDG era. Meanwhile, the pronounced rise in indirect maternal mortality in medium-burden countries during the SDG period suggests potential structural risk accumulation even when overall MMR appears stable. Incorporating joint direct-indirect trajectories into routine monitoring may facilitate stage and cluster specific prioritization of maternal health interventions.
High body-mass index (BMI) defined in the Global Burden of Disease Study as BMI above the theoretical minimum risk exposure level, is an established modifiable risk factor for ovarian cancer, particularly among older women. However, a comprehensive assessment of the global disease burden attributable to high BMI, including its spatiotemporal evolution and underlying drivers, remains lacking, particularly for older women. Using data from the Global Burden of Disease Study 2021, we analyzed disability-adjusted life years (DALYs) and deaths from ovarian cancer attributable to high BMI among women aged ≥55 years from 1990 to 2021. We examined temporal trends, geographic disparities by Socio-Demographic Index (SDI), region, and nation, and performed decomposition analyses to identify contributions from population growth, aging, and epidemiological changes. Globally, the attributable burden increased from 1990 to 2021, with population growth as the main driver. of rising absolute DALYs (86.72) and deaths (85.17). Marked socioeconomic disparities were observed. While high-SDI regions had the highest age-standardized rates in 2021, they showed declining trends., whereas low-middle and low-SDI regions experienced the most rapid increases. Regionally, the fastest increases occurred in South Asia, Southeast Asia, and East Asia, while nationally the largest rises were observed in Timor-Leste, Viet Nam, and Bangladesh. In these settings, epidemiological changes were the dominant contributor to increasing burden. The global burden of ovarian cancer due to high BMI is rising and unequally distributed across SDI regions. While population growth drives the overall increase, escalating obesity prevalence is the key driver in rapidly developing regions. Targeted obesity prevention, improved early detection, and strengthened health-care systems should be prioritized, particularly in high-growth regions. Future studies should improve data quality in low-resource settings and explore cost-effective interventions.
Hypertensive disorders of pregnancy, particularly pre-eclampsia, are recognized not only as major obstetric complications but also as early indicators of future maternal cardiovascular and renal risk. Despite this, postpartum care remains centered on blood pressure surveillance, whereas kidney assessment is not consistently incorporated into routine obstetric follow-up. This narrative review examines the renal implications of hypertensive disorders of pregnancy beyond delivery and translates guidance and observational evidence into a practical obstetric approach to postpartum kidney assessment. Available data indicate that a clinically meaningful subgroup of women have persistent renal abnormalities in the early postpartum period, most often as albuminuria or proteinuria rather than as overt reduction in estimated glomerular filtration rate. Reliance on blood pressure or serum creatinine alone may therefore fail to identify incomplete renal recovery, pregnancy-unmasked chronic kidney disease, or women requiring closer reassessment. We also emphasize pregnancy-associated acute kidney injury as a high-priority phenotype, operationalized by creatinine rise or oliguria using Kidney Disease: Improving Global Outcomes (KDIGO)-type criteria and interpreted against pregnancy-specific creatinine physiology. Patients meriting greater attention include those with severe or preterm disease, persistent hypertension, antenatal renal abnormalities, pregnancy-associated acute kidney injury, or relevant pre-existing comorbidity. We propose a feasible postpartum framework based on blood pressure measurement, serum creatinine with estimated glomerular filtration rate, and urinary assessment of albuminuria or proteinuria, with repeat testing or specialist evaluation guided by postpartum findings and clinical risk. Rather than creating a parallel nephrology pathway, this approach supports obstetric services in identifying women whose renal recovery may be incomplete.
This study focused on the correlations of lipoprotein-associated phospholipase A2 (Lp-PLA2) and angiotensin II (Ang II) levels with the severity of coronary artery stenosis (CAS) in elderly patients with suspected coronary heart disease (CHD). This retrospective case-control study was conducted on 228 elderly patients suspected of CHD. Their clinical data were collected. Patients were grouped by CHD diagnosis and by CAS severity. Correlation analyses were performed between Lp-PLA2, Ang II, lipid profiles, and the atherogenic index of plasma (AIP). Influencing factors for moderate-to-severe CAS in elderly patients were identified by univariate/multivariate logistic regression models. Receiver operating characteristic curves were used to analyze diagnostic performance for the severity of CAS in elderly patients. Lp-PLA2 and Ang II levels were notably elevated in patients with CHD and were positively associated with the severity of CAS. Lp-PLA2 level correlated with lipid levels. Both Lp-PLA2 and Ang II were correlated with AIP. Elevated levels of Lp-PLA2 and Ang II were independent risk factors for moderate-to-severe CAS in elderly patients. Both Lp-PLA2 and Ang II demonstrated certain diagnostic value for identifying moderate-to-severe CAS in this population. The combination of Lp-PLA2 and Ang II demonstrated diagnostic performance comparable to AIP and superior to either marker alone for identifying moderate-to-severe CAS. Lp-PLA2 and Ang II are closely associated with AIP in elderly patients with CHD, are independent risk factors for moderate-to-severe CAS, and may serve as valuable biomarkers for diagnosis and risk stratification.