Objective To systematically assess the spatiotemporal distribution,risk factors,and future trends of chronic obstructive pulmonary disease(COPD)among individuals under 50 years of age globally from 1990 to 2021 based on Global Burden of Disease(GBD)data in order to provide support for the formulation of prevention and control strategies of the disease.Methods The GBD data from 1990 to 2021 were analyzed for the incidence,mortality,disability-adjusted life years(DALYs),and estimated annual percentage change(EAPC)of COPD in<50-year-old individuals across 204 countries and regions.The data were stratified by age,sex,region,country,and sociodemographic index(SDI).The COPD trends until 2035 were predicted.Results In 2021,the global incidence of early-onset COPD was estimated at 2.5 million cases(95%uncertainty interval:2.09～2.96 million),representing a 50.55%increase compared to 1990.Significant regional heterogeneity was observed,with low SDI regions experiencing a 134.08%increase,whereas high SDI regions exhibited a rise-then-fall trend.Risk factor analysis identified environmental and occupational exposures(air pollution,ambient ozone pollution,household air pollution from solid fuels,etc.)and smoking as the primary etiological factors.Notably,household solid fuel exposure accounted for 50.90%of COPD-related deaths in low SDI regions,compared to only 0.03%in high SDI regions.Projections indicated that by 2035,the global burden of early-onset COPD will increase to 2.59 million cases.Conclusion The global disease burden of COPD among people under 50 years increased significantly from 1990 to 2021,with pronounced disparities across regions and socioeconomic levels.COPD deaths in low-SDI regions are strongly associated with solid fuel exposure and particulate matter pollution,and these regions are expected to remain the main drivers of global COPD incidence growth through 2035.

Skeletal muscle dysfunction is a common extrapulmonary comorbidity of chronic obstructive pulmonary disease (COPD) and is associated with decreased quality-of-life and survival in patients. The autophagy lysosome pathway is one of the proteolytic systems that significantly affect skeletal muscle structure and function. Intriguingly, both promoting and inhibiting autophagy have been observed to improve COPD skeletal muscle dysfunction, yet the mechanism is unclear. This paper first reviewed the effects of macroautophagy and mitophagy on the structure and function of skeletal muscle in COPD, and then explored the mechanism of autophagy mediating the dysfunction of skeletal muscle in COPD. The results showed that macroautophagy- and mitophagy-related proteins were significantly increased in COPD skeletal muscle. Promoting macroautophagy in COPD improves myogenesis and replication capacity of muscle satellite cells, while inhibiting macroautophagy in COPD myotubes increases their diameters. Mitophagy helps to maintain mitochondrial homeostasis by removing impaired mitochondria in COPD. Autophagy is a promising target for improving COPD skeletal muscle dysfunction, and further research should be conducted to elucidate the specific mechanisms by which autophagy mediates COPD skeletal muscle dysfunction, with the aim of enhancing our understanding in this field.
Pulmonary Disease, Chronic Obstructive/physiopathology* ; Autophagy/physiology* ; Humans ; Muscle, Skeletal/pathology* ; Mitophagy ; Animals ; Mitochondria/metabolism* ; Lysosomes

Objective To investigate the effects of the gene expression of carbohydrate response element binding protein(ChREBP)on human retinal microvascular endothelial cell(hRMEC)injury and angiogenesis under high-glucose conditions.Methods The hRMECs after 4-6 passages were added to a serum-free medium and cultured for 6 hours.Then,these hRMECs were treated by a normal concentration of glucose(5.6 mmol·L-1),a normal concentration of glu-cose+mannitol(24.4 mmol·L-1),a high concentration of glucose(30.0 mmol·L-1),blank siRNA+a high concentra-tion of glucose,and ChREBP siRNA+a high concentration of glucose,which were designed as the control group,hyperos-motic group,high-glucose alone group,blank siRNA group,and ChREBP knockdown group,respectively.Subsequently,these hRMECs were transfected with Lipofectamine RNAiMAX for 24 hours.Western blot was used to analyze the expression of ChREBP in hRMECs under high-glucose conditions.The terminal deoxynucleotidyl transferase dUTP nick end labeling(TUNEL)assay,cell scratch assay,Transwell migration assay,and tube formation assay were conducted to analyze the apoptosis and migration of these cells and capillary angiogenesis.Normal ChREBP-expressing wild-type mice and ChREBP-knockout mutant mice were selected to construct corresponding animal models,and the number of retinal angiogenic sprouts was counted under a microscope.Results The relative protein expression level of ChREBP in hRMECs after 30 minutes of high-glucose stimulation was significantly higher than that after 15 minutes,1 hour,2 hours,and 3 hours of stimulation(all P＜0.05).Meanwhile,the relative protein expression level of TXNIP in hRMECs after 2 hours of high-glu-cose stimulation was significantly higher than that after 15 minutes,30 minutes,1 hour,and 3 hours of stimulation(all P＜0.05).Under high-glucose conditions,the relative protein expression level of TXNIP and NLRP3 in hRMECs of the ChREBP knockdown group was significantly lower than that of the blank siRNA group and the high-glucose alone group(all P＜0.05).The results of TUNEL assay,cell scratch assay,and capillary tube formation assay showed that the relative apopto-sis rate,relative cell coverage area percentage,and relative migrating cell number percentage of the ChREBP knockdown group were significantly lower than those of the blank siRNA group and the high-glucose alone group,whereas the number of ring structures was significantly lower than that of the blank siRNA group,the high-glucose alone group,and the hyper-osmotic group(all P＜0.05).The relative expression level of p-AKT/AKT and p-mTOR/mTOR in the ChREBP knockdown group was significantly lower than that in the blank siRNA group and the high glucose alone group(all P＜0.05).The num-ber of retinal angiogenic sprouts in ChREBP-knockout mutant mice was(22.81±4.03),which was significantly lower than that of normal ChREBP-expressing wild-type mice(64.35±11.69)(P＜0.05).Conclusion ChREBP can affect the oc-currence and development of diabetic retinopathy by regulating the apoptosis,migration,and tubulogenesis of hRMECs and the development of retinal neovascularization under high-glucose conditions,and hence it can be regarded as a potential target for the treatment of this disease.

Objective:To explore the application effect of a student-faculty collaborative dynamic question bank based on outcome based education (OBE) in the teaching of maternal and infant nursing.Methods:A total of 204 junior nursing undergraduates (Grade 2021 and Grade 2022) enrolled at Shantou University Medical College between September 2023 and January 2025 were selected by convenience sampling. Ninety-two students from Grade 2021 were assigned to the control group, and 112 students from Grade 2022 were assigned to the intervention group. The control group received the traditional teaching syllabus before the course, used the People's Medical Publishing House question bank for self-testing, and the original static self-constructed exam question bank in the Kaoyi system for assessment. The intervention group practiced and was assessed using a student-faculty collaborative dynamic question bank based on OBE. The intervention lasted for one semester. Course performance and satisfaction were compared between the two groups.Results:The number of questions in the bank increased from 347 to 2 058. After course completion, the intervention group had higher stage test scores, final exam scores, and overall course scores than the control group ( P<0.05). The intervention group also reported higher levels of overall course satisfaction, perceived personal ability improvement, and satisfaction with course content and instructors than the control group ( P<0.05) . Conclusions:The student-faculty collaborative dynamic question bank based on OBE can effectively improve students' academic performance and satisfaction, and is worthy of wider application.

In women with high-grade squamous intraepithelial lesion(HSIL)undergoing excision therapy,vaccination with human papillomavirus(HPV)vaccine may reduce the risk of postoperative recurrence.However,research data and clear application guidelines are currently limited in China.The Cervical Cancer Prevention and Control Research Committee of the China Maternal and Child Health Research Association gathered a team of relevant experts to develop the consensus based on the characteristics of clinical practice in China.This expert consensus suggests that women of appropriate age,without contraindications,with histopathological confirmation of HSIL,and who underwent excision treatment should receive a prophylactic HPV vaccine to reduce the risk of recurrence.The recommended vaccination time is as early as possible after HSIL diagnosis or after resection treatment,and the recommended vaccination procedure is three doses.For women who have already received an HPV vaccine before treatment,there is no need to receive again after excision therapy.For women who underwent resection treatment,even if they have received HPV vaccines,regular follow-up should still be conducted in accordance with the post-treatment management guidelines.Vaccination cannot replace routine follow-up.

In women with high-grade squamous intraepithelial lesion(HSIL)undergoing excision therapy,vaccination with human papillomavirus(HPV)vaccine may reduce the risk of postoperative recurrence.However,research data and clear application guidelines are currently limited in China.The Cervical Cancer Prevention and Control Research Committee of the China Maternal and Child Health Research Association gathered a team of relevant experts to develop the consensus based on the characteristics of clinical practice in China.This expert consensus suggests that women of appropriate age,without contraindications,with histopathological confirmation of HSIL,and who underwent excision treatment should receive a prophylactic HPV vaccine to reduce the risk of recurrence.The recommended vaccination time is as early as possible after HSIL diagnosis or after resection treatment,and the recommended vaccination procedure is three doses.For women who have already received an HPV vaccine before treatment,there is no need to receive again after excision therapy.For women who underwent resection treatment,even if they have received HPV vaccines,regular follow-up should still be conducted in accordance with the post-treatment management guidelines.Vaccination cannot replace routine follow-up.

Objective:To explore the application effect of a student-faculty collaborative dynamic question bank based on outcome based education (OBE) in the teaching of maternal and infant nursing.Methods:A total of 204 junior nursing undergraduates (Grade 2021 and Grade 2022) enrolled at Shantou University Medical College between September 2023 and January 2025 were selected by convenience sampling. Ninety-two students from Grade 2021 were assigned to the control group, and 112 students from Grade 2022 were assigned to the intervention group. The control group received the traditional teaching syllabus before the course, used the People's Medical Publishing House question bank for self-testing, and the original static self-constructed exam question bank in the Kaoyi system for assessment. The intervention group practiced and was assessed using a student-faculty collaborative dynamic question bank based on OBE. The intervention lasted for one semester. Course performance and satisfaction were compared between the two groups.Results:The number of questions in the bank increased from 347 to 2 058. After course completion, the intervention group had higher stage test scores, final exam scores, and overall course scores than the control group ( P<0.05). The intervention group also reported higher levels of overall course satisfaction, perceived personal ability improvement, and satisfaction with course content and instructors than the control group ( P<0.05) . Conclusions:The student-faculty collaborative dynamic question bank based on OBE can effectively improve students' academic performance and satisfaction, and is worthy of wider application.

Objective To investigate the effects of the gene expression of carbohydrate response element binding protein(ChREBP)on human retinal microvascular endothelial cell(hRMEC)injury and angiogenesis under high-glucose conditions.Methods The hRMECs after 4-6 passages were added to a serum-free medium and cultured for 6 hours.Then,these hRMECs were treated by a normal concentration of glucose(5.6 mmol·L-1),a normal concentration of glu-cose+mannitol(24.4 mmol·L-1),a high concentration of glucose(30.0 mmol·L-1),blank siRNA+a high concentra-tion of glucose,and ChREBP siRNA+a high concentration of glucose,which were designed as the control group,hyperos-motic group,high-glucose alone group,blank siRNA group,and ChREBP knockdown group,respectively.Subsequently,these hRMECs were transfected with Lipofectamine RNAiMAX for 24 hours.Western blot was used to analyze the expression of ChREBP in hRMECs under high-glucose conditions.The terminal deoxynucleotidyl transferase dUTP nick end labeling(TUNEL)assay,cell scratch assay,Transwell migration assay,and tube formation assay were conducted to analyze the apoptosis and migration of these cells and capillary angiogenesis.Normal ChREBP-expressing wild-type mice and ChREBP-knockout mutant mice were selected to construct corresponding animal models,and the number of retinal angiogenic sprouts was counted under a microscope.Results The relative protein expression level of ChREBP in hRMECs after 30 minutes of high-glucose stimulation was significantly higher than that after 15 minutes,1 hour,2 hours,and 3 hours of stimulation(all P＜0.05).Meanwhile,the relative protein expression level of TXNIP in hRMECs after 2 hours of high-glu-cose stimulation was significantly higher than that after 15 minutes,30 minutes,1 hour,and 3 hours of stimulation(all P＜0.05).Under high-glucose conditions,the relative protein expression level of TXNIP and NLRP3 in hRMECs of the ChREBP knockdown group was significantly lower than that of the blank siRNA group and the high-glucose alone group(all P＜0.05).The results of TUNEL assay,cell scratch assay,and capillary tube formation assay showed that the relative apopto-sis rate,relative cell coverage area percentage,and relative migrating cell number percentage of the ChREBP knockdown group were significantly lower than those of the blank siRNA group and the high-glucose alone group,whereas the number of ring structures was significantly lower than that of the blank siRNA group,the high-glucose alone group,and the hyper-osmotic group(all P＜0.05).The relative expression level of p-AKT/AKT and p-mTOR/mTOR in the ChREBP knockdown group was significantly lower than that in the blank siRNA group and the high glucose alone group(all P＜0.05).The num-ber of retinal angiogenic sprouts in ChREBP-knockout mutant mice was(22.81±4.03),which was significantly lower than that of normal ChREBP-expressing wild-type mice(64.35±11.69)(P＜0.05).Conclusion ChREBP can affect the oc-currence and development of diabetic retinopathy by regulating the apoptosis,migration,and tubulogenesis of hRMECs and the development of retinal neovascularization under high-glucose conditions,and hence it can be regarded as a potential target for the treatment of this disease.

BACKGROUND:The development of tissues and organs in the body is a precise and autonomously regulated process,and the function of biomechanical factors at this macroscale is a basic scientific question worth exploring. OBJECTIVE:To investigate the roles of cell mechanics in morphogenesis of the lobular organoid of 3D Madin-Darby canine kidney(MDCK). METHODS:The formation of MDCK lobular organoid was visualized by fluorescence resonance energy transfer technology,and the influence of different cellular mechanical signals and extracellular matrix environment on lobular organoid formation and corresponding changes in extracellular regulated protein kinases(ERK)activity were examined. RESULTS AND CONCLUSION:(1)Inhibition of ERK signaling pathway can inhibit the growth of MDCK lobular organoid.(2)Inhibition of cell contractile force signals such as ROCK pathway and Myosin Ⅱ activity,reduced ERK activity and lobular organoid size.(3)Selective inhibition of calcium channels in plasma membrane and endoplasmic reticulum led to reduced ERK activity and lobular organoid growth.(4)By inhibiting the mechanically-sensitive receptor Piezo ion channel or integrin signal on the cell membrane,the lobular organoid became smaller or MDCK cells could not generate tissue morphology.(5)Extracellular matrix compositions affected the morphogenesis of lobular organoid.The addition of type I collagen in Matrigel changed the lobular organoid to elongated shape.(6)The results of this study preliminarily show that mechanical signals in the cells and extracellular matrix environment play an important role in culturing MDCK lobular organoid,and provides certain molecular mechanisms.

Objective:To assess the effectiveness of a 6-month Ba Duan Jin exercise program in improving the balance of community-dwelling older adults.Methods:A two arms, parallel-group, cluster randomized controlled trial was conducted in 1 028 community residents aged 60-80 years in 40 communities in 5 provinces of China. Participants in the intervention group (20 communities, 523 people) received Ba Duan Jin exercise 5 days/week, 1 hour/day for 6 months, and three times of falls prevention health education, and the control group (20 communities, 505 people) received falls prevention health education same as the intervention group. The Berg balance scale (BBS) score was the leading outcome indicator, and the secondary outcome indicators included the length of time of standing on one foot (with eyes open and closed), standing in a tandem stance (with eyes open and closed), the closed circle test, and the timed up to test.Results:A total of 1 028 participants were included in the final analysis, including 731 women (71.11%) and 297 men (28.89%), and the age was (69.87±5.67) years. After the 3-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 3.05 (95% CI: 2.23-3.88) points ( P<0.001). After the 6-month intervention, compared with the baseline data, the BBS score of the intervention group was significantly higher than the control group by 4.70 (95% CI: 4.03-5.37) points ( P<0.001). Ba Duan Jin showed significant improvement ( P<0.05) in all secondary outcomes after 6 months of exercise in the intervention group compared with the control group. Conclusions:This study showed that Ba Duan Jin exercise can improve balance in community-dwelling older adults aged 60-80. The longer the exercise time, the better the improvement.