With the accelerating global aging process, maintaining intrinsic capacity (IC) among middle-aged and older adults has become a major public health priority. Multiple chronic conditions (MCC) are highly prevalent in later life and may contribute to declines in physical and mental functioning. However, evidence regarding the association between MCC and IC, as well as variations across disease types and socioeconomic contexts, remains limited. This study aimed to examine the association between MCC and IC among middle-aged and older adults and to explore heterogeneity across chronic disease categories, regional contexts, and individual characteristics. Data were obtained from the 2011, 2015, and 2018 waves of the China Health and Retirement Longitudinal Study. Using 28,613 pooled repeated cross-sectional person-wave observations, regression models incorporating survey-year and regional fixed effects were applied to examine the association between MCC and IC. Respondent-level cluster-robust standard errors were used to account for the nonindependence of repeated observations. Robustness analyses, instrumental variable estimation, and propensity score matching were conducted to assess the stability of the findings. Subgroup analyses were performed across macro-level (urban/rural residence and regional economic zones) and micro-level (sex, education, and household income) characteristics. MCC was significantly associated with lower IC (β = -0.076, P < .01). Disease-specific analyses showed that neurodegenerative diseases, including Parkinson disease and Alzheimer disease, demonstrated the strongest negative association with IC (β = -0.587, P < .01), followed by cardiovascular diseases (β = -0.135, P < .01). The negative association between MCC and IC was stronger among individuals living in rural areas and western regions, as well as among men, individuals with lower educational attainment, and those with lower household income. Robustness analyses, instrumental variable estimation, and propensity score matching yielded findings that were directionally consistent with the main analysis. MCC is significantly associated with reduced IC among middle-aged and older adults, with substantial heterogeneity across disease types and socioeconomic contexts. These findings highlight the importance of integrated chronic disease management, IC assessment, and targeted interventions for vulnerable populations, particularly those in socioeconomically disadvantaged regions, to promote healthy aging.

Fibroblast growth factor 23 (FGF23) is involved in the regulation of phosphate metabolism and has been linked to vascular calcification. However, the genetic association between FGF23 and abdominal aortic calcification (AAC) remains unclear. We conducted a bidirectional two-sample Mendelian randomization (MR) study to evaluate the association between genetically predicted circulating FGF23 levels and AAC. Univariable MR was performed to assess the primary association, followed by multivariable MR adjusting for serum calcium, 25-hydroxyvitamin D, parathyroid hormone, and chronic kidney disease. In addition, a two-step MR mediation analysis was used to assess whether phosphate might mediate this association. Univariable MR analysis suggested a modest association between genetically predicted circulating FGF23 levels and a higher risk of AAC (odds ratio = 1.082, 95% confidence interval = 1.016-1.151, P = .013). This association remained directionally consistent after separate adjustment for serum calcium, 25-hydroxyvitamin D, parathyroid hormone, and chronic kidney disease. In a secondary multivariable Mendelian randomization analysis using an alternative FGF23 genome-wide association study, the association was no longer statistically significant after adjustment for phosphate (odds ratio = 1.064, 95% confidence interval = 0.962-1.179, P = .224). Two-step MR mediation analysis suggested that serum phosphate may partially mediate the association between FGF23 and AAC, with a marginally significant indirect effect (inverse-variance weighted: β = 0.024, P = .049), accounting for approximately 30% of the total effect. Our findings provide suggestive evidence that genetically predicted higher FGF23 levels may be modestly associated with an increased risk of AAC, with serum phosphate potentially acting as a partial mediator.

Metabolic syndrome (MetS) is common in Chinese adults, but evidence regarding its burden and cardiovascular relevance among young healthcare workers (HCWs) remains limited. Different MetS definitions can yield materially different prevalence estimates and risk classifications. This retrospective cross-sectional study included 420 HCWs aged 20 to 45 years who underwent mandatory annual health examinations at a tertiary hospital in China from 2022 to 2024. Demographic, occupational, anthropometric, and biochemical data were extracted from health examination and personnel records. MetS was defined using the International Diabetes Federation (IDF), revised National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), and Chinese Diabetes Society (CDS) criteria. Ten-year atherosclerotic cardiovascular disease risk was estimated using the China-PAR equations, with elevated estimated risk defined as ≥10%. We compared MetS prevalence, sex differences, agreement among definitions, diagnostic performance using NCEP ATP III. Participants had a mean age of 32.4 ± 5.8 years, and 30.0% were men. MetS prevalence was 15.5%, 18.6%, and 10.2% according to IDF, NCEP ATP III, and CDS criteria, respectively, and was consistently higher in men. Agreement was almost perfect between IDF and NCEP ATP III (κ = 0.82) and substantial between IDF and CDS (κ = 0.64) and between NCEP ATP III and CDS (κ = 0.61). Using an internally reconstructed 2 × 2 table that preserves the reported prevalence counts and pairwise κ values, IDF showed sensitivity 78.2%, specificity 98.8%, PPV 93.8%, and NPV 95.2%, whereas CDS showed sensitivity 51.3%, specificity 99.1%, PPV 93.0%, and NPV 89.9% relative to NCEP ATP III. These reconstructed diagnostic-performance values require verification against the original participant-level data before submission. MetS defined by any criterion was strongly associated with elevated China-PAR-estimated risk, with adjusted odds ratio of 6.5, 7.1, and 5.1 for IDF, NCEP ATP III, and CDS, respectively. atherosclerotic cardiovascular disease-risk AUCs were 0.80, 0.82, and 0.76, respectively. In this single-center cohort of young Chinese HCWs, estimated MetS prevalence differed substantially by diagnostic definition. IDF and NCEP ATP III identified more cases than CDS and showed stronger mutual agreement. The observed associations with China-PAR-estimated risk support the potential value of MetS assessment within occupational health screening.

Cardiovascular diseases (CVDs) are the primary reason for mortality worldwide. Patients with CVD were at higher risk of drug-related adverse events and functional impairment and were more likely to be admitted to the hospital. This study aims to study trends for CVD hospital admission (HA) in England and Wales during the past 21 years. A secular-trend analysis study design was utilized to explore the trend of CVD HAs. Poisson regression was used to examine the trend in HAs. To determine trends in admission rates over time, we implemented Joinpoint regression analysis. The permutation test was employed to determine the optimal number of Joinpoints, with the Bayesian information criterion being the basis for model selection, and robust standard errors were calculated to account for overdispersion. During the study period, CVD HAs increased 24.8%, although Joinpoint regression showed different patterns by disease category, age, and gender. Acute rheumatic fever declined in females (annual percent change [APC] = -7.3%) and children under 15 (APC = -4.49%) from 1999 to 2010, but increased after 2010. From 2005 to 2009, chronic rheumatic heart disease grew significantly in both sexes (APC ≈ 18%-20%) and gradually in those aged ≥75 (average annual percent change [AAPC] = 8.60%). Hypertensive diseases fluctuated, with spikes (1999-2010, APC = 8.90%), falls (2010-2013, APC ≈ -31% to -36%), and subsequent increases (APC ≈ 13%-14%). Significantly, pulmonary heart disease, circulation illnesses, and other heart and vascular diseases increased across all age groups (APCs = 5.32%-9.40%), particularly among those aged ≥75 (AAPC = 4.78%). Although ischemic heart disease declined with age (AAPC = -1.72% to -2.51%), cerebrovascular disease showed mixed trends, rising early and late but decreasing after 2009 in those ≥75 years. APCs exhibited short-term surges and dips within intervals, while AAPCs indicated long-term increases for pulmonary and hypertensive illnesses (mainly in younger adults) but declines for ischemic heart disease and cerebrovascular disease in older adults. In England and Wales, HAs owing to CVD have increased during the last 2 decades. Prevention programs for CVD are needed to improve public awareness about this common and serious group of diseases. The focus should be on reducing the prevalence of modifiable risk factors for these diseases.

Cardiovascular-kidney-metabolic (CKM) syndrome represents a pathophysiological continuum from metabolic dysregulation to cardiovascular injury. However, whether dietary interventions confer stage-specific benefits remains unknown. We aimed to examine the association between flavonoid intake and CKM stages and to assess baseline intake and mortality across stages. We analyzed 10,754 US adults from National Health and Nutrition Examination Survey (2007-2010, 2017-2018). CKM stages (0-4) were defined at baseline. Flavonoid intake was assessed via two 24-hour recalls. Mortality was ascertained using the National Death Index linkage in December 2019 (median follow-up, 9.6 years). Cross-sectional associations with CKM stages were examined using multinomial logistic regression. Prospective associations with all-cause, cardiovascular, and cancer mortality were examined using survey-weighted Cox models stratified by CKM stage. Restricted cubic splines and weighted quantile sum regression further characterized dose-response relationships and mixture effects. Higher flavonoid intake was associated with lower odds of advanced CKM stage (stage 2 vs 0: Q4 odds ratio: 0.53; 95% confidence interval [CI]: 0.33-0.83). Stage-specific mortality associations emerged: Q4 reduced cancer mortality in stages 1 to 2 (hazard ratio [HR] = 0.60; 95% CI: 0.37-0.96) and all-cause mortality in stages 3 to 4 (HR = 0.80; 95% CI: 0.65-0.99). An L-shaped dose-response showed an inflection at 218.8 mg/d; below this, each 50 mg/d increment reduced the risk by 9% (HR = 0.91). The inverse associations were stronger in adults aged <65 years and nonusers of lipid-lowering medications (P < .05). Weighted quantile sum regression identified anthocyanidins (50.6%) and flavones (24.8%) as primary contributors to cancer mortality reduction in the early stages, whereas isoflavones contributed 49.7% to all-cause mortality protection. These findings suggest potential stage-specific benefits: anthocyanidin- and flavone-rich diets may warrant further investigation for prevention, whereas isoflavone-focused intake may have relevance for survival in advanced stages. The observed threshold of approximately 219 mg/d provides a potential quantitative target for future research.

Brainstem hemorrhage is a rare but devastating subtype of intracerebral hemorrhage that frequently presents with impaired consciousness, quadriplegia, and recurrent infections. Integrative personalized medicine care (IPMC), which combines essential conventional treatments with personalized traditional Korean medicine interventions, has been suggested to improve functional outcomes and support immune regulation. By closely monitoring a patient with massive brainstem hemorrhage treated with IPMC, we observed neurological improvement, effective control of recurrent infections and inflammation, and sustained safety of long-term herbal medications.

A 48-year-old female patient with a brainstem hemorrhage was managed at Kyung Hee University Hospital with IPMC for posthemorrhagic functional impairment and recurrent infection.

The patient was diagnosed with a massive pontine hemorrhage with posthemorrhagic functional impairment and recurrent infection.

The patient received conventional treatment and integrative personalized traditional Korean medicine interventions, including herbal medications and acupuncture.

We retrospectively analyzed the 2-year clinical course of the patient who received IPMC to evaluate the efficacy and safety of the treatment. Functional outcomes and inflammation control were assessed using standardized scales (modified Barthel index, Korean mini-mental state examination, Glasgow Coma Scale, global deterioration scale, level of consciousness, manual muscle testing, and Fugl-Meyer assessment) and hematological markers (C-reactive protein, neutrophil-to-lymphocyte ratio, and systemic inflammation response index). Liver and renal functions were monitored through laboratory tests (alanine aminotransferase, aspartate aminotransferase, γ-glutamyltransferase, blood urea nitrogen, serum creatinine, and estimated glomerular filtration rate). Regarding the efficacy of IPMC, functional improvements in neurological and motor outcomes were observed throughout the treatment period. Dependence on antibiotics progressively decreased, whereas the proportion of herbal medication-centered treatments increased. Infections with C-reactive protein levels <2.0 mg/dL were effectively managed with herbal medications alone. Furthermore, despite the long-term use of combined treatments, no hepatotoxicity or nephrotoxicity was observed, confirming the safety of IPMC.

This case demonstrates the efficacy and safety of IPMC, which integrates herbal medications with conventional treatment, for managing posthemorrhagic functional impairment and recurrent infections. These findings provide a foundation for future prospective studies. Further research is required to strengthen this evidence and validate the effectiveness of IPMC.

Severe trauma is a leading cause of mortality worldwide; however, contemporary data on mechanism-specific incidence trends and factors associated with in-hospital mortality remain limited. We conducted a nationwide cohort study using a South Korean severe trauma registry spanning 2016 to 2024. Severe trauma was defined as an Injury Severity Score (ISS) ≥ 16. Annual incidence trends were assessed using negative binomial regression with incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Factors associated with in-hospital mortality were identified using multivariable logistic regression, performed separately for patients with and without prehospital cardiac arrest. A total of 73,232 patients were included, of whom 44.9% had prehospital cardiac arrest. Overall in-hospital mortality was 58.2% (26.0% vs 97.7% for patients without versus with prehospital cardiac arrest, respectively). Transport-related injuries were the most common (53.5%), followed by falls/slips (38.2%). Transport-related severe trauma declined by 3.6% annually (IRR, 0.964; 95% CI, 0.955-0.974; P < .001), whereas falls/slips increased by 3.7% annually (IRR, 1.037; 95% CI, 1.024-1.050; P < .001). Among patients without prehospital cardiac arrest, higher ISS (ISS 25-40: adjusted odds ratio [aOR], 3.45; 95% CI, 3.26-3.64; ISS 41-75: aOR, 6.12; 95% CI, 5.40-6.93) and older age (≥65 years: aOR, 2.87; 95% CI, 2.16-3.84) were the strongest independent predictors of in-hospital mortality. Male sex, unintentional injury, lower-level receiving emergency departments, and falls/slips as the injury mechanism (aOR, 1.19; 95% CI, 1.13-1.26) were also independently associated with increased mortality. Among patients with prehospital cardiac arrest, conventional trauma system factors lost prognostic significance; self-harm was the strongest independent predictor (aOR, 2.14; 95% CI, 1.53-3.08). Female sex and injury in nonmetropolitan areas were also independently associated with increased mortality. The epidemiology of severe trauma in South Korea is evolving, with transport-related injuries declining and falls/slips increasing. Preventive strategies for falls/slips should become a public health priority. Given the near-universal mortality among patients with prehospital cardiac arrest, in whom conventional trauma system factors lose prognostic significance, primary prevention strategies, including suicide prevention and injury awareness programs, may yield greater reductions in severe trauma mortality than trauma system development alone.

Central poststroke pain (CPSP) is neuropathic pain caused by a cerebrovascular lesion. Repetitive transcranial magnetic stimulation has been shown to effectively reduce CPSP. Intermittent theta burst stimulation (iTBS), an alternative stimulation method to conventional repetitive transcranial magnetic stimulation, has been shown to have beneficial effects for neuropathic pain. The objective of this study was to investigate the effects of iTBS on CPSP and demonstrate the effects using clinical assessment scales.

Patients with CPSP who met the neuropathic pain criteria of the PainDetect questionnaire (PD-Q), Leeds assessment of neuropathic symptoms and signs (LANSS), and Douleur neuropathique 4 questions (DN4) were recruited. Twenty patients were randomly assigned to a real or sham iTBS and underwent 5 sessions of iTBS to the motor cortex. Before the initial stimulation and after the completion of 5 sessions, PD-Q, LANSS, DN4, and numeric rating scale were assessed.

PD-Q, LANSS, DN4, and numeric rating scale decreased significantly in the real iTBS group but not in the sham iTBS group. There were no adverse effects regarding the iTBS sessions.

iTBS was effective in reducing CPSP. Considering the safety and convenience of application, iTBS can be suggested as an effective treatment for patients with CPSP.

Lower-extremity motor impairment after stroke is a major determinant of mobility limitation and persistent disability. Acupuncture is frequently used as an adjunct to conventional rehabilitation, but the magnitude and consistency of its effects on lower-limb recovery remain uncertain.

This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to December 31, 2025, without language restrictions. Randomized controlled trials evaluating needle-based acupuncture for poststroke lower-limb recovery were included. Risk of bias was assessed using the Cochrane Risk of Bias tool for randomized trials version 2.0, and the certainty of evidence for the main outcomes was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. Meta-analyses were conducted in Stata 18.0 using random-effects models, and treatment effects for continuous outcomes were pooled as standardized mean differences (SMDs) with Hedges g correction and 95% confidence intervals (CIs). Because fewer than 10 studies contributed to each outcome, formal funnel-plot asymmetry tests, including Egger test, were not performed; publication bias was considered qualitatively.

Six trials met the inclusion criteria. Acupuncture was associated with improved lower-extremity motor function, as measured by the Fugl-Meyer Assessment Lower Extremity (SMD = 0.51, 95% CI = 0.32-0.71; I2 = 53.9%; low certainty). Balance assessed by the Berg Balance Scale also favored acupuncture but showed substantial heterogeneity (SMD = 0.96, 95% CI = 0.35-1.56; I2 = 91.5%; very low certainty). The Modified Barthel Index did not demonstrate a statistically significant benefit (SMD = 0.26, 95% CI = 0.16-0.68; I2 = 86.3%; very low certainty). The high heterogeneity for Berg Balance Scale and Modified Barthel Index indicates that these pooled estimates should be interpreted cautiously.

Acupuncture may provide low-certainty incremental improvements in poststroke lower-extremity motor impairment. Evidence for balance and activities of daily living remains very uncertain because of substantial heterogeneity, limited sample size, and variability in acupuncture protocols and control conditions. Larger, prospectively registered, methodologically rigorous trials with standardized protocols, comparable rehabilitation dose, and clinically interpretable outcome reporting are needed.

Cerebral venous sinus thrombosis (CVST) and carotid web (CW) are distinct cerebrovascular disorders where vascular geometry, disturbed hemodynamics, and endothelial activation interact to drive thrombosis. Both conditions disproportionately affect women, yet remain understudied because of the inability of traditional platforms to replicate complex three-dimensional lumen profiles. This perspective positions light-based lithography as a powerful biofabrication strategy for patient-specific modeling. Digital light processing and volumetric bioprinting render enclosed, perfusable hydrogel networks with high-fidelity surface topography. When integrated into dynamic vessel-on-chip perfusion loops guided by clinical imaging and computational fluid dynamics, these platforms simulate pathological flow stasis and recirculation zones, heterogeneous shear-stress gradients, and site-specific cellular aggregation. This biofabrication approach enables personalized disease modeling and translationally relevant risk assessment, providing a critical platform for advancing women's cerebrovascular health.