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BackgroundMobile health interventions are widely used for self-management of diabetes, which is one of the most burdensome noncommunicable chronic diseases worldwide. However, little is known about the distribution of characteristics and functions of in-store mobile apps for diabetes. ObjectiveThis study aimed to investigate the distribution of characteristics and functions of the in-store mobile apps for self-management of diabetes in the United States and China using a predefined functional taxonomy, which was developed and published in our previous study. MethodsWe identified apps by searching diabetes in English or Chinese in the Apple iTunes Store and Android Markets (both in the United States and China) and included apps for diabetes self-management. We examined the validity and reliability of the predefined functional taxonomy with 3 dimensions: clinical module, functional module, and potential risk. We then classified all functions in the included apps according to the predefined taxonomy and compared the differences in the features of these apps between the United States and China. ResultsWe included 171 mobile diabetes apps, with 133 from the United States and 38 from China. Apps from both countries faced the challenges of evidence-based information, proper risk assessment, and declaration, especially Chinese apps. More Chinese apps provide app-based communication functions (general communication: Chinese vs US apps, 39%, 15/38 vs 18.0%, 24/133; P=.006 and patient-clinician communication: Chinese vs US apps, 68%, 26/38 vs 6.0%, 8/133; P.99) are neglected by the 2 countries. ConclusionsThe distribution of characteristics and functions of in-store mobile apps for diabetes self-management in the United States was different from China. The design of in-store diabetes apps needs to be monitored closely.

BackgroundMobile health apps for diabetes self-management have different functions. However, the efficacy and safety of each function are not well studied, and no classification is available for these functions. ObjectiveThe aims of this study were to (1) develop and validate a taxonomy of apps for diabetes self-management, (2) investigate the glycemic efficacy of mobile app-based interventions among adults with diabetes in a systematic review of randomized controlled trials (RCTs), and (3) explore the contribution of different function to the effectiveness of entire app-based interventions using the taxonomy. MethodsWe developed a 3-axis taxonomy with columns of clinical modules, rows of functional modules and cells of functions with risk assessments. This taxonomy was validated by reviewing and classifying commercially available diabetes apps. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Chinese Biomedical Literature Database, and ClinicalTrials.gov from January 2007 to May 2016. We included RCTs of adult outpatients with diabetes that compared using mobile app-based interventions with usual care alone. The mean differences (MDs) in hemoglobin A1c (HbA1c) concentrations and risk ratios of adverse events were pooled using a random-effects meta-analysis. After taxonomic classification, we performed exploratory subgroup analyses of the presence or absence of each module across the included app-based interventions. ResultsAcross 12 included trials involving 974 participants, using app-based interventions was associated with a clinically significant reduction of HbA1c (MD 0.48%, 95% CI 0.19%-0.78%) without excess adverse events. Larger HbA1c reductions were noted among patients with type 2 diabetes than those with type 1 diabetes (MD 0.67%, 95% CI 0.30%-1.03% vs MD 0.37%, 95% CI –0.12%-0.86%). Having a complication prevention module in app-based interventions was associated with a greater HbA1c reduction (with complication prevention: MD 1.31%, 95% CI 0.66%-1.96% vs without: MD 0.38%, 95% CI 0.09%-0.67%; intersubgroup P=.01), as was having a structured display (with structured display: MD 0.69%, 95% CI 0.32%-1.06% vs without: MD 0.69%, 95% CI –0.18%-0.53%; intersubgroup P=.03). However, having a clinical decision-making function was not associated with a larger HbA1c reduction (with clinical decision making: MD 0.19%, 95% CI –0.24%-0.63% vs without: MD 0.61%, 95% CI 0.27%-0.95%; intersubgroup P=.14). ConclusionsThe use of mobile app-based interventions yields a clinically significant HbA1c reduction among adult outpatients with diabetes, especially among those with type 2 diabetes. Our study suggests that the clinical decision-making function needs further improvement and evaluation before being added to apps.

Background Pharmacotherapy is the cornerstone of primary and secondary prevention of atherosclerotic cardiovascular diseases (ASCVD), but the values and preferences of community patients for pharmacotherapy remain unclear. Objective To understand the values and preferences surrounding pharmacotherapy among community patients at risk of or undergoing treatment for ASCVD, which would help clarify the individualized treatment burden and provide patient-centered clinical practice. Methods This study employed a sequential exploratory mixed-methods design. Firstly, we recruited eligible patients in West China Hospital of Sichuan University and Yulin Community Health Service Center in Wuhou District, Chengdu City from November 2021 to January 2022. for a focus group discussion, aiming to collect qualitative insights into their experience, values, and preferences for medication use. The software MAXQDA 2020 was used to support qualitative data analysis, and Colaizzi's seven-step approach was further used to identify themes. After completing the qualitative phase, a questionnaire was designed based on the emergent themes to further quantitatively analyze the values and preferences regarding pharmacotherapy. Results Four themes emerged from the qualitative data, including knowledge and use of medications, barriers of medication use, facilitators of medication use, and need for medical services. A total of 186 valid questionnaires were collected in the quantitative study (response rate of 93.5%). The quantitative data showed a commonality in missed dose and confirmed the existence of social stigma and treatment burden in this group of participants. Although preferences in medication use were highly heterogeneous, participants generally preferred taking fewer medications with less frequency, and were less likely to use injectable medications. Conclusion The study suggests that it may be appropriate to increase the use of compound preparations, and make treatment plans in accordance with patients' daily lives and work to reduce the treatment burden of pharmacotherapy. In addition, we should be active in managing the misconceptions and improper practices in pharmacotherapy in order to improve patients' medication adherence.

Background Clinical practice guidelines in primary care are important tools to guide primary care practice, but they are found with relatively low quality and unstandardized reporting on the whole. Objective To develop the reporting guideline for clinical practice guidelines in primary care based on the Reporting Items for practice Guidelines in HealThcare (RIGHT) . Methods According to the reporting methods recommended by EQUATOR Network, an item development group and an expert consensus group were established to develop reporting guideline for clinical practice guidelines in primary care. Content analysis, brainstorming, and topic analysis were used in developing the initial items. The Delphi survey was conducted to determine the final items. Results Thirteen items (five were modified and eight were added) were developed initially, covering five domains: guideline title, health issues, intended setting, recommendations and suggestions for future research. Then the initial item checklist was revised to a final version consisting of 15 items according to the results of two rounds of Delphi survey (with 100% response rates from 22 experts) conducted from December 2 to December 26, 2022. Conclusion This reporting checklist will provide a detailed guide for developers of guidelines in primary care, which will further improve the reporting quality of guidelines in primary care, especially that of those in China.

Diabetes is a disease frequently encountered in hospitals in China. Good glycemic management can improve clinical outcomes and shorten the length of stay of diabetic patients, enhance healthcare efficiency and save medical resources. To provide a reference for clinical glycemic management and associated research, we reviewed relevant literature, then summarized the characteristics and applicable settings of different blood glucose management modes, and detailed the advantages and limitations of three major glycemic management models, including general-specialist consultation, hospital-wide glycemic management program, and smart decision support system for blood glucose management. With the support of information technology, different glycemic management modes will contribute to the continuous improvement of efficiency and quality of hospital care.

The increased clinical demand for glycemic control in hospitalized patients has led to a new transformation of clinical technologies and medical models, which has brought challenges to medical management. We built an active blood glucose intervention operation and management model for inpatients using the Plan-Do-Check-Action (PDCA) cycle: Firstly, we concertized the practical management problems through root cause analysis, namely man - machine - material - method - environment. Then, we used PDCA cycle quality management tools to facilitate the construction of the operation and management models based on the PDCA cycle. We finally formed an efficient multidepartment cooperation mechanism and tiered management system and process for inpatients, and established an information system of glycemic management, quality control system and operational performance guarantee system. By use of the model, the blood glucose management has been successfully promoted with some achievements obtained, and the rate of blood glucose meeting the target level within 72 hours after glycemic management has increased month by month in West China Hospital, Sichuan University. This model developed by our hospital may be used as a reference for other hospitals to conduct glycemic management, and it also has great significance for improving the inpatient blood glucose management.

Background Diabetes is one of the common diseases among inpatients in non-endocrinology department. Patients with diabetes require assistance from endocrinologists in their blood glucose management. Objective To investigate consultation of blood glucose management for inpatients with diabetes in non-endocrinology department and analyze the quality of consultation and the needs of patients. Methods The inpatients with diabetes in non-endocrinology department consulted by the endocrinologists in West China Hospital, Sichuan University from January 1, 2013 to May 23, 2019 were selected and reviewed. The consultation and medical record information was recorded and organized. The recommended medications for the patients were analyzed to determine the potential contraindications according to drug instructions. Results During the study period, we identified 145 428 inpatients with diabetes in non-endocrinology department, 24 499 of them had 31 369 consultations from endocrinologists (0.17 consultations/inpatients), and 20 486 of them had 24 343 consultations for blood glucose management (0.17 consultations/inpatients). The top three departments with the most blood glucose management consultations per patient were neurology (0.30 consultations/inpatients), respiratory medicine (0.25 consultations/inpatients), and cardiology (0.18 consultations/inpatients). There were 18 306 blood glucose management consultations (16 269 inpatients) with complete suggestions, and the most commonly recommended hypoglycemic regimen was the combination of insulin with a meal and basal insulin, accounting for 32.34% (5 921/18 306). Among the all consultations, 1.16% (212/18 306) patients' hypoglycemic regimens had drug contraindications. Conclusion A large number of inpatients with diabetes in non-endocrinology department need specialized blood glucose management. The overall quality of the consultation for blood glucose management is relatively high but far from meeting the management requirements.

Both continuous aerobic training (CAT) and high-intensity interval training (HIIT) are recommended to promote health and prevent diseases. Exercise-induced circulating extracellular vesicles (EX-EVs) have been suggested to play essential roles in mediating organ crosstalk, but corresponding molecular mechanisms remain unclear. To assess and compare the systemic effects of CAT and HIIT, five healthy male volunteers were assigned to HIIT and CAT, with a 7-day interval between sessions. Plasma EVs were collected at rest or immediately after each training section, prior to proteomics and miRNA profile analysis. We found that the differentially expressed (DE) miRNAs in EX-EVs were largely involved in the regulation of transcriptional factors, while most of the DE proteins in EX-EVs were identified as non-secreted proteins. Both CAT and HIIT play common roles in neuronal signal transduction, autophagy, and cell fate regulation. Specifically, CAT showed distinct roles in cognitive function and substrate metabolism, while HIIT was more associated with organ growth, cardiac muscle function, and insulin signaling pathways. Interestingly, the miR-379 cluster within EX-EVs was specifically regulated by HIIT, involving several biological functions, including neuroactive ligand–receptor interaction. Furthermore, EX-EVs likely originate from various tissues, including metabolic tissues, the immune system, and the nervous system. Our study provides molecular insights into the effects of CAT and HIIT, shedding light on the roles of EX-EVs in mediating organ crosstalk and health promotion. [ABSTRACT FROM AUTHOR]

Aim: To explore the trend of burden and care quality of chronic kidney disease due to type 2 diabetes mellitus (CKD‐T2DM) and their cross‐country inequalities from 1990 to 2021. Materials and Methods: Data were from the Global Burden of Disease 2021 study. Disease burden and care quality were quantified using the disability‐adjusted life years rate and the quality‐of‐care index (QCI). Trend analyses of the age‐standardized disability‐adjusted life years rate (ASDR) and age‐standardized QCI from 1990 to 2021 were conducted using the estimated annual percentage change. The associations of disease burden and care quality with the socio‐demographic index (SDI) were explored. Cross‐country inequalities in disease burden and care quality were assessed using the slope index of inequality (SII) and concentration index. Results: From 1990 to 2021, the global ASDR for CKD‐T2DM increased, while the age‐standardized QCI slightly decreased, with an estimated annual percentage change of 0.81 [95% confidence interval (CI): 0.75, 0.87] and −0.08 (95% CI: −0.09, −0.07). The ASDR escalated with increasing SDI, reaching a peak at mid‐level SDI, followed by a decrease. The age‐standardized QCI was higher with increasing SDI. Globally, ASDR concentrated on countries/territories with a lower SDI. The SII of ASDR was −96.64 (95% CI: −136.94, −56.35) in 1990 and −118.15 (95% CI: −166.36, −69.94) in 2021, with a concentration index of −0.1298 (95% CI: −0.1904, −0.0692) in 1990 and −0.1104 (95% CI: −0.1819, −0.0389) in 2021. In 1990 and 2021, countries/territories at higher SDI levels exhibited increased age‐standardized QCI, indicated by an SII of 15.09 (95% CI: 10.74, 19.45) and 15.75 (95% CI: 10.92, 20.59), and a concentration index of 0.0393 (95% CI: 0.0283, 0.0503) and 0.0400 (95% CI: 0.0264, 0.0536). Conclusions: Our study highlights considerable disparities in the burden and care quality of CKD‐T2DM. Regions experiencing an increasing burden and a declining care quality simultaneously underscore the need for further research and tailored health interventions. [ABSTRACT FROM AUTHOR]

Background: Patient education is a cornerstone of modern healthcare. Health literacy improves health-related quality of life and health outcomes of patients, enhanced by effective patient education. Inadequate competency of patient education in healthcare providers triggered this review to summarize common approaches and recent advancements. Methods: This narrative review summarizes common approaches and recent advancements in patient education with their relations to health literacy, their strengths, limitations, and practical issues. Results: This review highlighted the multifaceted approaches to patient education, emphasizing the importance of tailoring methods to meet the diverse needs of patients. By integrating various strategies, including intrapersonal, interpersonal, and societal/community-level interventions, healthcare providers can create a more comprehensive educational experience that addresses the complexities of patient needs, meanwhile improving the health literacy of patients. With the rise of digital media and artificial intelligence, there is an increasing need for innovative educational resources that can effectively reach and engage patients. Ongoing research and collaboration among healthcare professionals and policymakers will be essential to refine educational strategies and adapt to emerging challenges. It is essential to remain vigilant about potential conflicts of interest that may compromise the integrity of educational content. Conclusion: Effective patient education empowers individuals and their contributions to a healthier society by fostering informed decision-making and encouraging proactive health management. [ABSTRACT FROM AUTHOR]

The article discusses the rising prevalence of obesity in China and the efficacy of weight-lowering medications, particularly NuSH agonists, in addressing this issue. It emphasizes the importance of shared decision-making between clinicians and patients in choosing the most suitable treatment options, considering individual motivations and preferences. Challenges such as weight regain after medication withdrawal are highlighted, underscoring the need for long-term lifestyle changes to maintain weight loss. Overall, the article advocates for a personalized approach to obesity management through motivation interviews and shared decision-making. [Extracted from the article]

A study published in the journal Diabetes, Obesity & Metabolism suggests that long-term use of SGLT2 inhibitors, a type of medication for type 2 diabetes, may increase the risk of prostate and bladder cancer. However, there is still debate on this topic, as some studies have found no link to bladder cancer risk. The mechanisms behind this association are not well understood. Individuals considering long-term use of SGLT2 inhibitors should be aware of the potential risk, especially if they have a family history or other risk factors. Further research is needed to fully understand the relationship between SGLT2 inhibitors and urinary tumors. [Extracted from the article]

Aims: To investigate the sex‐specific associations between predicted skeletal muscle mass index (pSMI) and incident type 2 diabetes in a retrospective longitudinal cohort of Chinese men and women. Materials and Methods: We enrolled Chinese adults without diabetes at baseline from WATCH (West chinA adulT health CoHort), a large health check‐up‐based database. We calculated pSMI to estimate skeletal muscular mass, and measured blood glucose variables and assessed self‐reported history to identify new‐onset diabetes. The nonlinear association between pSMI and incident type 2 diabetes was modelled using the penalized spline method. The piecewise association was estimated using segmented linear splines in weighted Cox proportional hazards regression models. Results: Of 47 885 adults (53.2% women) with a median age of 40 years, 1836 developed type 2 diabetes after a 5‐year median follow‐up. In women, higher pSMI was associated with a lower risk of incident type 2 diabetes (Pnonlinearity = 0.09, hazard ratio [HR] per standard deviation increment in pSMI: 0.79 [95% confidence interval {CI} 0.68, 0.91]). A nonlinear association of pSMI with incident type 2 diabetes was detected in men (Pnonlinearity < 0.001). In men with pSMI lower than 8.1, higher pSMI was associated with a lower risk of incident type 2 diabetes (HR 0.58 [95% CI 0.40, 0.84]), whereas pSMI was not significantly associated with incident diabetes in men with pSMI equal to or greater than 8.1 (HR 1.08 [95% CI 0.93, 1.25]). Conclusions: In females, a larger muscular mass is associated with a lower risk of type 2 diabetes. For males, this association is significant only among those with diminished muscle mass. [ABSTRACT FROM AUTHOR]

A meta-analysis of 25 randomized controlled trials involving 24,595 individuals with heart failure was conducted to examine the effects of sodium-glucose cotransporter-2 (SGLT2) inhibitors. The analysis found that SGLT2 inhibitors reduced hospitalization for heart failure and cardiovascular death in patients with heart failure, regardless of the presence of type 2 diabetes. However, the magnitude of benefit diminished over time. SGLT2 inhibitors also increased the risk of genital infection. The study highlights the importance of considering treatment duration and baseline risk when using SGLT2 inhibitors in patients with heart failure. [Extracted from the article]

Background Older adults with postprandial hypotension (PPH) increase susceptibility to falls, syncope, stroke, acute cardiovascular diseases and even death. However, the prevalence of this condition varies significantly across studies. We aimed to determine the prevalence of PPH in older adults. Methods Web of Science, PubMed, Cochrane Library, Embase and CINAHL were searched from their inception until February 2023. Search terms included 'postprandial period', 'hypotension' and 'postprandial hypotension'. Eligible studies were assessed using the Joanna Briggs Institute tool. Meta-analyses were performed among similar selected studies. Results Thirteen eligible studies were included, and data from 3,021 participants were pooled. The meta-analysis revealed a PPH prevalence of 40.5% [95% confidence interval (CI): 0.290–0.519] in older adults, and this was prevalent in the community (32.8%, 95% CI: 0.078–0.647, n  = 1,594), long-term healthcare facility (39.4%, 95% CI: 0.254–0.610, n  = 1,062) and geriatrics department of hospitals (49.3%, 95% CI: 0.357–0.630, n  = 365). The pooled results showed significant heterogeneity (I 2 > 90%), partially related to the different ages, sex, pre-prandial systolic blood pressure levels of participants, or the different criteria and methodology used to diagnose PPH. Conclusions PPH is a prevalent condition in older adults. Further research is needed to confirm this result, and priority should be given to establishing international consensus on PPH diagnostic criteria and designing its diagnostic procedure. [ABSTRACT FROM AUTHOR]

Aims: To assess the time‐dependent risk of fracture in adults with type 2 diabetes receiving anti‐diabetic drugs. Materials and Methods: We searched MEDLINE, EMBASE, and Cochrane Library up to 18 November 2021, for randomized controlled trials (RCTs) and propensity‐score‐matched non‐randomized studies (NRSs) comparing all anti‐diabetic drugs with standard treatment or with each other on fracture in adults with type 2 diabetes. The study performed a one‐stage network meta‐analysis using discrete‐time hazard regression with reconstructed individual time‐to‐event data. Results: This network meta‐analysis involved seven RCTs (65,051 adults with type 2 diabetes) with a median follow‐up of 36 months and three propensity‐score‐based NRSs (17,954 participants) with a median follow‐up of 27.3 months. Among anti‐diabetic drugs, thiazolidinediones increased the overall hazard of fracture by 42% (95% credible interval [CrI], 3%–97%) and almost tripled the risk after 4 years (hazard ratio [HR], 2.74; 95% CrI, 1.53–4.80). Credible subgroup analysis suggested that thiazolidinediones increased the hazard of fracture only in females (HR, 2.19; 95% CrI, 1.26–3.74) but not among males (HR, 0.81; 95% CrI, 0.45–1.40). Moderate certainty evidence established that thiazolidinediones increase 92 fractures in five years per 1000 female patients. We did not find the risk of fractures with other anti‐diabetic drugs including metformin, sulfonylureas, sodium‐glucose cotransporter‐2 (SGLT2) inhibitors, and dipeptidyl peptidase‐4 (DPP‐4) inhibitors. Conclusions: Long‐term use of thiazolidinediones elevates the risk of fracture among females with type 2 diabetes. There is no evidence eliciting fracture risk associated with other anti‐diabetic drugs. [ABSTRACT FROM AUTHOR]

Background: Clinical practice guidelines (CPGs) are designed to assist health care professionals in medical decision-making, but they often lack effective integration of shared decision-making (SDM) principles to reflect patient values and preferences, particularly in the context of preference-sensitive CPG recommendations. To address this shortcoming and foster SDM through CPGs, the integration of patient decision aids (PDAs) into CPGs has been proposed as an important strategy. However, methods for systematically identifying and prioritizing CPG recommendations relevant to SDM and related decision support tools are currently lacking. Objective: The aim of the project is to develop (1) a tool for systematically identifying and prioritizing CPG recommendations for which SDM is considered particularly relevant and (2) a platform for PDAs to support practical SDM implementation. Methods: The project consists of 6 work packages (WPs). It is embedded in the German health care context but has an international focus. In WP 1, we will conduct a scoping review in bibliographic databases and gray literature sources to identify methods used to foster SDM via PDAs in the context of CPGs. In WP 2, we will conduct semistructured interviews with CPG experts to better understand the concepts of preference sensitivity and identify strategies for fostering SDM through CPGs. WP 3, a modified Delphi study including surveys and focus groups with SDM experts, aims to define and operationalize preference sensitivity. Based on the results of the Delphi study, we will develop a methodology for prioritizing key questions in CPGs. In WP 4, the tool will be developed. A list of relevant items to identify CPG recommendations for which SDM is most relevant will be created, tested, and iteratively refined, accompanied by the development of a user manual. In WP 5, a platform for creating and digitizing German-language PDAs will be developed to support the practical application of SDM during clinical encounters. WP 6 will conclude the project by testing the tool with newly developed and revised CPGs. Results: The Brandenburg Medical School Ethics Committee approved the project (165122023-ANF). An international multidisciplinary advisory board is involved to guide the tool development on CPGs and SDM. Patient partners are involved throughout the project, considering the essential role of the patient perspective in SDM. As of February 20, 2024, we are currently assessing literature references to determine eligibility for inclusion in the scoping review (WP 1). We expect the project to be completed by December 31, 2026. Conclusions: The tool will enable CPG developers to systematically incorporate aspects of SDM into CPG development, thereby providing guideline-based support for the patient-practitioner interaction. Together, the tool for CPGs and the platform for PDAs will create a systematic link between CPGs, SDM, and PDAs, which may facilitate SDM in clinical practice. International Registered Report Identifier (IRRID): DERR1-10.2196/57611 [ABSTRACT FROM AUTHOR]

To examine the effectiveness of azvudine and nirmatrelvir–ritonavir in treating hospitalized patients with moderate‐to‐severe COVID‐19. We emulated a target trial with a multicenter retrospective cohort of hospitalized adults with moderate‐to‐severe COVID‐19 without contraindications for azvudine or nirmatrelvir–ritonavir between December 01, 2022 and January 19, 2023 (during the Omicron BA.5.2 variant wave). Exposures included treatment with azvudine or nirmatrelvir–ritonavir for 5 days versus no antiviral treatment during hospitalization. Primary composite outcome (all‐cause death and initiation of invasive mechanical ventilation), and their separate events were evaluated. Of the 1154 patients, 27.2% were severe cases. In the intent‐to‐treat analyses, azvudine reduced all‐cause death (Hazard ratio [HR]: 0.31; 95% CI: 0.12–0.78), and its composite with invasive mechanical ventilation (HR: 0.47; 95% CI: 0.24–0.92). Nirmatrelvir–ritonavir reduced invasive mechanical ventilation (HR: 0.42; 95% CI: 0.17–1.05), and its composite with all‐cause death (HR: 0.38; 95% CI: 0.18–0.81). The study did not identify credible subgroup effects. The per–protocol analyses and all sensitivity analyses confirmed the robustness of the findings. Both azvudine and nirmatrelvir–ritonavir improved the prognosis of hospitalized adults with moderate‐to‐severe COVID‐19 [ABSTRACT FROM AUTHOR]

Background Clinical observation suggests the atheroprotective effect of chloroquine and its derivatives, while its mechanism remains unclear. This study aimed to observe the protective effect of chloroquine against atherosclerosis and explore the underlying mechanism. Methods Ataxia telangiectasia mutated (ATM) wild-type or haploinsufficient apolipoprotein-E-knockout (ATM+/+ ApoE−/− or ATM+/− ApoE−/−) mice were treated with different dosages of chloroquine. Anti-CD25 antibody was used to deplete natural Tregs in ATM+/+ ApoE−/− mice. The atherosclerotic burden in different groups of mice was comprehensively evaluated by H&E staining and Masson staining. The effect of chloroquine on the regulatory T cells (Tregs) was assessed in vivo and in vitro by flow cytometry and immunohistochemical staining. The expression of related proteins was detected by real-time polymerase chain reaction and western blotting. Results In ATM+/+ ApoE−/− mice, chloroquine alleviated atherosclerotic lesions, stabilized the plaque, and increased Treg counts in the atherosclerotic lesions and spleens. However, in ATM haploinsufficient mice (ATM+/− ApoE−/−), chloroquine no longer prevented atherosclerosis or impacted Treg counts. Abolishing Treg cells using an anti-CD25 antibody in vivo abrogated the atheroprotective effect of chloroquine. In vitro, chloroquine promoted the differentiation of Tregs from naïve T cells, which was accompanied by enhanced ATM/AMP-activated protein kinase (AMPK) activity and reduced downstream mammalian target of rapamycin (mTOR) activity. Discussion These findings suggest that chloroquine ameliorates atherosclerosis and stabilizes plaque by modulating Tregs differentiation through the regulation of the ATM/AMPK/mTOR pathway. [ABSTRACT FROM AUTHOR]

Background: Knee osteoarthritis (KOA) is the most common degenerative joint disease in China, causing a huge economic burden on patients, families, and society. Standardized KOA rehabilitation treatment is an important means to prevent and treat the disease and promote the development of high‐quality medical services. This guideline is updated on the basis of the 2016 and 2019 editions. Methods: Clinical questions regarding rehabilitation assessment and treatment were selected through clinical questions screening and deconstruction, and multiple rounds of Delphi questionnaire consultation. The International Classification of Functioning, Disability and Health (ICF) was used as the theoretical framework, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method was used to grade the quality of evidence and recommendations. Results: The reporting of this guideline followed the standard of Reporting Items for Practice Guidelines in Healthcare (RIGHT). Taking into account patients' preferences and values and the needs of Chinese clinical practice, a total of 11 clinical questions and 28 recommendations were established. The clinical questions were grouped into two categories: KOA assessment (body function, body structure, activity and participation, quality of life, and environmental factors and clinical outcomes assessment, resulting in 9 recommendations) and KOA treatment (health education, therapeutic exercise, therapeutic modalities, occupational therapy, assistive devices, and regenerative rehabilitation approaches, resulting in 19 recommendations). Conclusion: This is the first evidence‐based guideline for KOA rehabilitation in China utilizing the ICF framework. This guideline provides key guidance for developing systematic, standardized, and precise rehabilitation protocols for KOA across various healthcare settings. [ABSTRACT FROM AUTHOR]

Medical journals have adhered to a reporting practice that seriously limits the usefulness of published trial findings. Medical decision makers commonly observe many patient covariates and seek to use this information to personalize treatment choices. Yet standard summaries of trial findings only partition subjects into broad subgroups, typically binary categories. Given this reporting practice, we study the problem of inference on long mean treatment outcomes E[y(t)|x], where t is a treatment, y(t) is a treatment outcome, and the covariate vector x has length K, each component being a binary variable. The available data are estimates of {E[y(t)|xk = 0], E[y(t)|xk = 1], P(xk)}, k = 1,..., K reported in journal articles. We show that reported trial findings partially identify {E[y(t)|x], P(x)}. Illustrative computations demonstrate that the summaries of trial findings in journal articles may imply only wide bounds on long mean outcomes. One can realistically tighten inferences if one can combine reported trial findings with credible assumptions having identifying power, such as bounded-variation assumptions. [ABSTRACT FROM AUTHOR]

Our aim was to investigate the association of glycated haemoglobin A1c (HbA1c) variability score (HVS) with estimated glomerular filtration rate (eGFR) slope in Chinese adults living with type 2 diabetes. This cohort study included adults with type 2 diabetes attending outpatient clinics between 2011 and 2019 from a large electronic medical record-based database of diabetes in China (WECODe). We estimated the individual-level visit-to-visit HbA1c variability using HVS, a proportion of changes in HbA1c of ≥0.5% (5.5 mmol/mol). We estimated the odds of people experiencing a rapid eGFR annual decline using a logistic regression and differences across HVS categories in the mean eGFR slope using a mixed-effect model. The analysis involved 2397 individuals and a median follow-up of 4.7 years. Compared with people with HVS ≤ 20%, those with HVS of 60% to 80% had 11% higher odds of experiencing rapid eGFR annual decline, with an extra eGFR decline of 0.93 mL/min/1.73 m2 per year on average; those with HVS > 80% showed 26% higher odds of experiencing a rapid eGFR annual decline, with an extra decline of 1.83 mL/min/1.73 m2 per year on average. Chinese adults with type 2 diabetes and HVS > 60% could experience a more rapid eGFR decline. [ABSTRACT FROM AUTHOR]

Illness often starts with flu-like unspecific symptoms such as fever, chills, headache, myalgia, back pain, lethargy, and lymphadenopathy during the initial viral invasion period (lasts between 0 and 5 days). Monkeypox, caused by infection with the monkeypox virus, was a rare disease until several new cases appeared in Europe since May 2022, which is now the epicenter of the outbreak.2 According to the WHO document, over 16,000 cases of monkeypox have been reported in more than 70 countries with the number of cases increasing rapidly. On July 23, 2022, the World Health Organization (WHO) alerted the escalating monkeypox outbreak and declared monkeypox a public health emergency of international concern (PHEIC).1 This rare and urgent designation elicits a constituted threat to global health and calls for a coordinated international response to prevent further spreading and potentially escalating into a pandemic. The US Centre for Disease Control (CDC) recommends standard precautions for all suspected and confirmed cases.17 Since monkeypox is usually a self-limited disease, health providers help relieve symptoms through supportive treatments and the prevention of secondary lesions. [Extracted from the article]

Sodium–glucose cotransporter-2 (SGLT2) inhibitors have been found to have benefit in patients with diabetes. This systematic review and meta-analysis used time-to-event individual patient data from published Kaplan–Meier plots to examine the benefits of SGLT2 inhibitors for patients with heart failure with or without diabetes. Background: Randomized controlled trials established the cardiac protection of sodium–glucose cotransporter-2 (SGLT2) inhibitors among adults with type 2 diabetes. New evidence suggests that these results could extend to people without diabetes. Purpose: To evaluate the effect of SGLT2 inhibitors in patients with heart failure, regardless of the presence of type 2 diabetes. Data Sources: PubMed, Web of Science, Cochrane Library, and Embase (OVID interface). Study Selection: Eligible trials randomly assigned adults with heart failure to SGLT2 inhibitors or control. Data Extraction: Time-to-event individual patient data were reconstructed from published Kaplan–Meier plots; time-varying risk ratios (RRs) were calculated in half-, 1-, and 2-year time frames; and anticipated absolute benefits were calculated using simple models applying relative effects to baseline risks. Data Synthesis: Sodium–glucose cotransporter-2 inhibitors reduce hospitalization for heart failure by 37% (95% CI, 25% to 47%) at 6 months, 32% (CI, 20% to 42%) at 1 year, and 26% (CI, 10% to 40%) at 2 years (all high certainty) and reduce cardiovascular death by 14% (CI, 1% to 25%) at 1 year (high certainty). Nevertheless, low-certainty evidence did not indicate protection against all-cause death, kidney disease progression, or kidney failure. Anticipated absolute benefits are greater for patients treated in the first year and for those with poorer prognoses, such as those newly diagnosed with heart failure in the hospital. In addition, SGLT2 inhibitors doubled the risk for genital infections (RR, 2.69 [CI, 1.61 to 4.52]; high certainty). Limitation: Covariates were unavailable in meta-analyses with reconstructed individual patient data. Conclusion: Among people with heart failure, SGLT2 inhibitors reduce hospitalizations for heart failure regardless of the presence of diabetes; absolute benefits are most pronounced in first-year treatment and vary with prognostic factors. Clinicians should note the increased risk for genital infection in patients receiving SGLT2 inhibitors. Primary Funding Source: 1.3.5 Project for Disciplines of Excellence, West China Hospital of Sichuan University. (PROSPERO: CRD42021255544) [ABSTRACT FROM AUTHOR]

Background: We aim to investigate the guideline adherence of β-blocker (BB) initiating dose in Chinese hospitalized patients with heart failure with reduced ejection fraction (HFrEF) and whether the adherence affected the in-hospital outcomes. Methods: This was a retrospective study of patients hospitalized with HFrEF who had initiated BBs during their hospitalization. We defined adherence to clinical practice guidelines as initiating BB with standard dose and non-adherence to guidelines if otherwise, and examined the association between adherence to guidelines and in-hospital BB-related adverse events. Subgroup analyses based on sex, age, coronary heart disease, and hypertension were performed. Results: Among 1,104 patients with HFrEF initiating BBs during hospitalization (median length of hospitalization, 12 days), 304 (27.5%) patients received BB with non-adherent initiating dose. This non-adherence was related to a higher risk (hazard ratio [95% confidence interval]) of BB dose reduction or withdrawal (1.78 [1.42 to 2.22], P < 0.001), but not significantly associated with risks of profound bradycardia, hypotension, cardiogenic shock requiring intravenous inotropes, and severe bronchospasm requiring intravenous steroid during hospitalization. Conclusion: This study identified that over a fourth of patients had received BBs with an initiating dose that was not adherent to guidelines in Chinese hospitalized patients with HFrEF, and this non-adherence was associated with BB dose reduction or withdrawal during hospitalization. [ABSTRACT FROM AUTHOR]