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Oxidative stress and mitochondrial dysfunction are considered to be major contributing factors in the development and progression of many neurodegenerative diseases. Naringenin (NAR) is an abundant flavanone in the Citrus genus and has been found to exert antioxidant, anticarcinogenic and antimutagenic effects. However, the potential underlying mechanism of its antioxidant effects remains unclear. In the present study, the authors investigated the antioxidant effect of NAR on neurons in vitro. Neurons isolated from the brains of Sprague-Dawley rats were randomly divided into a control group, model group, NAR-L group, NAR-M group and NAR-H group. The model group received hypoxia and re-oxygenation treatment, and the NAR-L, NAR-M and NAR-H groups received 20, 40 and 80 μM NAR, respectively. The levels of reactive oxygen species (ROS) in each group were detected by chloromethyl-2′,7′dichlorodihydro fluorescein diacetate staining, and differences in mitochondrial dysfunction were analyzed through measurement of mitochondrial membrane potential (Δψm), adenine nucleotide translocase transport activity and adenine nucleotide levels. MTT and flow cytometry assays were also used to analyze cell proliferation and apoptosis, and the effects of NAR on the nuclear factor erythroid 2-related factor 2 (Nrf2)/antioxidant response element (ARE) signaling pathway were investigated using small interfering RNA methods. The authors detected an increased accumulation of ROS in the model group, and high-dose NAR could significantly reduce the levels of ROS. Furthermore, NAR could improve mitochondrial dysfunction, as indicated by increased levels of high-energy phosphates, enhanced mitochondrial ANT transport activity and increased mitochondrial membrane potential. Moreover, NAR increased cell viability and decreased the rate of cell apoptosis. NAR also increased the expression of Nrf2 and its downstream target genes. These findings demonstrated that NAR could reduce oxidative stress and improve mitochondrial dysfunction via activation of the Nrf2/ARE signaling pathway in neurons.

Obesity is a critical issue in patients with schizophrenia, which is considered to be brought about by both environmental and genetic factors. Apolipoprotein E (APOE) gene polymorphisms might be involved in the pathogenesis of schizophrenia, however, the effect of APOE gene polymorphism on obesity has never been investigated in Chinese aging with schizophrenia. This cross-sectional study was to investigate the effect of obesity on cognitive and psychiatric symptoms in elderly participants with schizophrenia. At the same time, we also discussed the inner link between APOE E4 and obesity. 301 elderly participants with schizophrenia and 156 normal controls were included in the study. Their cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), psychiatric symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS), and APOE gene polymorphism was determined by polymerase chain reaction (PCR). The prevalence of obesity in elderly schizophrenic patients and healthy controls accounted for 15.9% (48/301) and 10.3% (16/156), respectively, with no statistically significant difference. By using stepwise linear regression analysis, we found that elevated fasting blood glucose, hypertension, and hyperlipidemia were risk factors for obesity in elderly schizophrenic patients. Although there was no direct correlation between APOE E4 and obesity in patients with schizophrenia, it was significantly correlated with hyperlipemia(r = − 0.154, p = 0.008), suggesting that APOE E4 may induce obesity in elderly patients with schizophrenia through hyperlipemia, However, the above conclusions do not apply to the normal elderly. What’s more, we did not find a link between obesity and cognitive function or mental symptoms for both patients with schizophrenia and normal controls. APOE E4 is associated with hyperlipidemia in elderly schizophrenic patients, which may be a risk factor for obesity, however, the above conclusion does not apply to the normal elderly.

Background/Aims: Ischemia/reperfusion (I/R) is the most common cause of acute renal injury. I/R-induced oxidative stress is involved in the development of acute renal injury, which can be reversed by supplementation with L-arginine, a precursor of nitric oxide (NO). This study was conducted to evaluate alterations in the expression of transcription factors [nuclear factor kappa B (NF-κB), nuclear factor-E2-related factor-2 (Nrf2), and heme oxygenase 1 (HO-1)] and heat shock protein 70 (HSP70) in the kidney of I/R-induced injury rats. Methods: Sprague-Dawley (SD) rats were subjected to bilateral renal ischemia for 45 min followed by reperfusion for 24 h. Group 1, Sham; group 2, I/R; group 3, L-arginine; and group 4, L-arginine+zinc protoporphyrin (ZnPP). The levels of serum creatinine (Scr), blood urea nitrogen (BUN), serum nitric oxide (NO), histic malondialdehyde (MDA) and reactive oxygen species (ROS) and superoxide dismutase (SOD) activity were determined, and the expression levels of Nrf2, HO-1, NF-κB, and HSP70 were evaluated. Results: The treatment of rats with L-arginine produced a significant reduction in the levels of BUN, Scr, MDA and a significant enhancement in the level of NO and in the activity of SOD compared to renal I/R groups. The expression levels of Nrf2, HO-1, and HSP70 were strongly increased, and the expression of NF-κB and production of ROS were significantly decreased in the L-arginine group compared to that of the I/R group. ZnPP increased renal damage and displayed effects opposite to those of L-arginine. Conclusion: These findings suggested that L-arginine/NO reduces renal dysfunction associated with I/R of the kidney and may act as a trigger to regulate the NF-κB, HSP70 and Nrf2/HO-1 signaling cascades.

Backgrounds To our knowledge, there is no available nationwide data on omicron symptom patterns in China mainland. We aim to determine the acute and long COVID-19 symptoms in the omicron-dominant period and to evaluate its association with risk factors. Methods We designed a cross-sectional nationwide study and data about self-reported symptoms were collected by an online platform named Wenjuanxing. Eligible participants were aged 25–65 years and were symptomatic. In this study, the ratios of the number of people of different ages and genders were weighted by the data from the Seventh National Census (2020 years), and validated by a published nationwide representative study through comparing smoking rates. Descriptive indicators were calculated for demographic characteristics, diagnosis ways, and duration time, acute symptoms, hospitalization, severity and long COVID-19 symptoms. And, the associations between risk factors and acute and long COVID-19 symptoms were analyzed by multivariable logistic regression models. Results A total of 32,528 individuals diagnosed as COVID-19 infection from October 1, 2022 to February 21, 2023 were included. The first three acute symptoms of COVID-19 infection were fever (69.90%), headache (62.63%), and sore throat (54.29%), respectively. The hospitalization rate within 7 days was 3.07% and symptoms disappearance rate within 21 days was 68.84%, respectively. Among 3983 COVID-19 patients with 3 months or more time difference between first infection and participation into the study, the long COVID-19 rate was 19.68% and the primary symptoms were muscle weakness (19.39%), headache (17.98%) and smell/taste disorder (15.18%). Age groups, smoking, marriage status and vaccination were risk factors for numbers of acute phase symptoms and long COVID-19 symptoms. Lastly, female and current smokers also showed more numbers of symptoms during acute infection period. Conclusions In Chinese mainland, our respondent indicated that current smokers and women were associated with acute COVID-19 symptoms, which should be treated with caution due to the lack of representative.

Background We aimed to estimate the changes in, second hand smoke (SHS) and potential drivers of its health outcome from 1990 to 2021 worldwide. Methods The data was derived from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, which covered 204 countries and territories. We reported SHS changes by sex, year and sociodemographic index (SDI) level (a summary measure that identifies where countries or other geographic areas sit on the spectrum of development) from 1990 to 2021. We analyzed the risk-outcome pairs among all age groups to estimate disease burden attributable to SHS exposure and also did a decomposition method to attribute changes in all-cause SHS attributable deaths or disability-adjusted life years (DALYs) to population growth, population aging, and mortality change. Results Worldwide, the age-standardized summary exposure values (SEV) of SHS exposure in 2021 was 30.6% (28.9 to 31.6) for males and 38.0% (35.5 to 39.0) for females, with a percentage change of −0.2 (−0.2 to −0.1) and −0.3 (−0.3 to −0.2), respectively, since 1990. Among the top 10 countries with the highest SEV, there were mainly high-middle SDI countries for male and low-middle SDI and middle SDI countries for female, respectively. Secondly, about 1.29 million deaths (0.68–1.90) and 34.90 million DALYs (17.95–52.21) were attributable to SHS exposure, and about half of them took place in two countries (China and India). Ischemic heart disease (IHD) (29.67%), chronic obstructive pulmonary disease (COPD) (19.04%), and lower respiratory infections (LRIs) (10.87%) were the three leading causes of SHS associated deaths. Lastly, since 2010, the number of SHS related death significantly increased due to population growth and population aging, despite a decrease in mortality attributable to SHS exposure. Conclusion Globally, the age-standardized SEV of SHS exposure decreased from 1990 to 2021. Since 2010, the increased number of deaths attributable to SHS exposure was mainly attributable to population growth and aging.

Background The impact of e-cigarettes on COVID-19 remains unclear. This study aims to assess the relationship between e-cigarette use and COVID-19 diagnosis and other related outcomes. Methods This systematic review and meta-analysis searched studies from 2019 to April 2nd, 2024, in Medline (via OVID), EMBASE, Scopus and the Cochrane Central Register of Controlled Trials for eligible observational studies. Results Among the initially identified 1116 items, a total of 20 studies met the inclusion criteria. The meta-analysis revealed that e-cigarette use was significantly associated with higher odds of COVID-19 diagnosis ( N  = 14, adjusted odds ratio, OR 1.25, 95% confidence interval, CI 1.07 to 1.47, I2 = 62%). This association was more pronounced among the youth ( N  = 4, adjusted OR 1.78, 95% CI 1.17 to 2.72, I2 = 75%) and current e-cigarette users ( N  = 14, adjusted OR 1.30, 95% CI 1.10 to 1.55, I2 = 55%). Though the association was not significant among cohort or case-control studies at first, the robust results were shown excluding low-quality studies ( N  = 3, adjusted OR 1.25, 95% CI 1.03 to 1.50, I2 = 0%). The results remained consistent in leave-one-out analyses. Drawing from the available but limited research, no significance was observed between e-cigarette use or other COVID-19 outcomes including severe COVID-19, COVID-19-related death, symptoms or hospital admission. Heterogeneity and risk of bias should be noticed when explaining our results. Conclusions E-cigarette use was associated with an increased risk of COVID-19 diagnosis, particularly among youth and current users. Further high-quality evidence is needed to assess the overall health effects of e-cigarettes, with a particular focus on the youth and current users.

Background Evidence from cohort studies on the relationship between metabolic dysfunction-associated fatty liver disease (MAFLD) and longitudinal changes in total bile acid (TBA) remains limited. This study aimed to investigate the association of TBA trajectories with new-onset MAFLD and liver fibrosis. Methods A total of 3259 participants who underwent at least three health examinations at a hospital in Zhejiang between 2019 and 2023 were included. MAFLD was diagnosed via abdominal ultrasound, and liver fibrosis was assessed using the NAFLD fibrosis score (NFS) and fibrosis-4 score (FIB-4). Logistic regression models were used to analyse the associations between TBA trajectories and the risk of MAFLD and liver fibrosis. Results During follow-up, 715 participants developed MAFLD. Among them, 15.10% had high NFS status, and 12.17% had high FIB-4 status. Compared with the low-stable TBA trajectory group, the high-stable trajectory group had a significantly higher risk of new-onset MAFLD (adjusted OR = 1.448, 95% CI 1.157–1.812). Subgroup analyses confirmed the robustness of these findings. Multinomial logistic regression revealed that the high-stable trajectory was associated with an increased risk of high NFS (adjusted OR = 2.435, 95% CI 1.568–3.781, P  < 0.001) and high FIB-4 (adjusted OR = 3.194, 95% CI 2.006–5.087, P  < 0.001). Conclusions TBA trajectories are significantly associated with the risk of new-onset MAFLD and advanced liver fibrosis, as indicated by high NFS and FIB-4 scores. These findings highlight the potential role of TBA dynamics in MAFLD progression and fibrosis risk.

ObjectivesPatients with multimorbidity have an increased risk of medication-related problems. Physicians face the dilemmas of multimorbidity management with multiple medications in primary care settings. We aimed to investigate the experiences and perceptions of primary care physicians (PCPs) regarding their decision-making processes in prescribing and deprescribing medications for patients with multimorbidity, and identify the challenges and barriers they face.DesignFrom 5 October 2023 to 27 January 2024, this qualitative study was conducted through semi-structured interviews that encouraged in-depth exploration of the participants’ experiences and perspectives. The interviews were audio-recorded, transcribed verbatim, and independently coded by two investigators. Themes were developed using a conventional content analysis approach.Setting12 community health centers and 8 township health centers across four regions in eastern China were included.Participants26 PCPs from 20 primary care institutions in eastern China were interviewed through purposive sampling, representing a mix of urban and rural healthcare settings.ResultsOf the 26 participants in this study, 14 (53.8%) were women, and the mean age was 36.3 years old. When prescribing and stopping medications for patients with multimorbidity, they often encounter complex challenges. These challenges stemmed from three key areas: (1) difficulties in identifying drug-disease and drug-drug interactions; (2) cognitive biases in medication benefit-risk evaluation and (3) heavy treatment burden. The challenges were further compounded by multiple barriers, including clinical inertia among physicians, patient resistance to medication changes, inadequate decision support and training, and time constraints in clinical consultation.ConclusionsThe complexity of prescribing and deprescribing decisions faced by PCPs in treating patients with multimorbidity in China is influenced by interconnected factors related to physicians, patients, technology and working environment. Future research could develop and evaluate implementation strategies to address specific challenges and barriers to allow PCPs to make effective medication decisions for patients with multimorbidity.

Social media platforms have become influential spaces for disseminating information about electronic cigarettes (e-cigarettes). Concerns persist about the spread of misleading content, particularly among social media vulnerable groups. Xiaohongshu (RedNote), widely used by Chinese youth, plays a growing role in shaping e-cigarette perceptions. Understanding the narratives circulating on this platform is essential for identifying misinformation, assessing public perception, and guiding future health communication strategies. This study aimed to analyze the content, topics, user engagement, and sentiment trends of e-cigarette-related posts on Xiaohongshu and to assess the factors that influence engagement. E-cigarette-related posts published on Xiaohongshu between January 2020 and November 2024 were collected using web scraping, based on a predefined keyword list and a time-stratified random sampling strategy. Posts were categorized into 4 themes: advertising promotion, health hazards, usage interaction, and others. High-frequency keywords were extracted, and representative quotes were included to illustrate user perspectives across each category. Sentiment analysis was performed on posts in the usage interaction category to assess public attitudes. We defined 4 sentiment categories: positive, negative, neutral, and mixed. Logistic regression was conducted to explore the effects of post type, content length, and thematic classification on user engagement metrics such as likes, saves, and comments. A total of 1729 posts were included and analyzed. Usage interaction posts were the most common (681/1729, 39.39%), with keywords such as \"experience,\" \"regulations,\" and \"quit smoking\" dominating this category. Advertising promotion posts (512/1729, 29.61%) frequently used terms like \"flavor,\" \"fashion,\" and \"design\" to attract younger users. Health hazards posts (311/1729, 17.99%) highlighted risks with keywords like \"nicotine,\" \"addiction,\" and \"secondhand smoke,\" while others included policy and industry updates. Representative quotes highlighted typical concerns about aesthetics, health risks, and cessation struggles. Health hazards posts garnered the highest engagement in terms of likes and saves, despite their limited presence (odds ratio [OR] 1.498, 95% CI 1.099-2.042, P=.01). Video posts significantly outperformed text-image posts in generating comments (OR 2.624, 95% CI 2.017-3.439, P<.001). Sentiment analysis of the usage interaction posts (n=681) revealed that 53.45% (364/681) were positive, highlighting reduced harm, convenience, or flavor preferences. Negative sentiment was observed in 33.48% (228/681) of posts, often expressing concerns about addiction and health risks. Mixed sentiments appeared in 6.90% (47/681), acknowledging both pros and cons. In addition, 6.17% (42/681) of posts were classified as neutral without evident emotional tone. The findings underscore the dual role of Xiaohongshu as a platform for both e-cigarette promotion and public discourse. Misleading marketing targeting vulnerable groups, such as adolescents, remains a critical issue. However, the strong user response to health-related content suggests that social media platforms could be leveraged for effective health education. Strengthened regulatory oversight and educational campaigns leveraging engaging content formats are urgently needed to counter misinformation and protect public health.

Randomized controlled trials on text message interventions for smoking cessation have shown they are effective and recommended for tobacco control. However, the effectiveness in real-world settings is largely unknown, especially in low- and middle-income countries. This study aimed to provide real-world evidence about the utilization and effectiveness of a message-based tobacco cessation program (mCessation) in China. From May 2021 to September 2022, 16,746 people from the general population participated in the mCessation program provided by the World Health Organization. All participants received text messages on smoking cessation via instant messaging for 6 months, and they were also required to report smoking status. We randomly selected 2500 participants and interviewed them by telephone to determine the 7-day point prevalence abstinence rate at 6 months. Descriptive statistics were used to analyze population characteristics and abstinence rate. Logistic regression analysis was performed to explore risk factors for the abstinence rate. Among the 2500 participants, the mean age was 35 years, and most (2407/2500, 96.20%) were male. The prevalence of tobacco dependence and light degree of tobacco dependence were 85.70% (2142/2500) and 89.10% (2228/2500), respectively. For respondents (953/2500, 38.10%), the 7-day point prevalence abstinence rate at 6 months was 21.90% (209/953). Participants older than 40 years or with tobacco dependence had significantly higher abstinence rates than those who were younger than 30 years old (odds ratio [OR] 1.77, 95% CI 1.06-3.29) or without dependence (OR 1.64, 95% CI 1.08-2.51), respectively. However, married people or heavily dependent smokers tended to find it more difficult to successfully quit smoking compared with unmarried people (OR 0.57, 95% CI 0.34-0.93) or lightly dependent smokers (OR 0.16, 95% CI 0.02-0.98), respectively. In a real-world setting, mCessation China was generally acceptable to men and lightly dependent smokers, and it could help 1 in 5 smokers aged 18 years to 67 years quit smoking. However, strategies to increase awareness of young and married adults may improve implementation and abstinence rates.