Antimicrobial resistance (AMR) is a global health crisis exacerbated by policies like China’s Volume-Based Procurement (VBP), which may inadvertently increase antimicrobial overuse. This study evaluates a clinical pharmacist-led Antimicrobial Stewardship (AMS) program with prospective audit for special-restricted antimicrobials under VBP.

A retrospective quasi-experimental interrupted time-series analysis compared pre-intervention (2022) and post-intervention (2023–2024) data at Tongji Hospital, a tertiary hospital in Wuhan, China. Key metrics included Antimicrobial Use Density (AUD), prescription rationality, antimicrobial costs, and multidrug-resistant infection rates.

The intervention significantly improved prescription appropriateness for special-restricted antimicrobials (80.24% vs. 93.83%, P < 0.005) and reduced AUD (47.87 vs. 34.25, P < 0.001). Total antimicrobial costs decreased by 41.26%, with a reduction in the incidence of multidrug-resistant infections from 0.084% to 0.062% (P < 0.05). Carbapenem use correlated with CRKP isolation rates (R = 0.62, P < 0.05). Clinical pharmacists rejected 10.24% of prescriptions, all accepted by physicians.

Pharmacist-led prospective audits optimize antimicrobial use under VBP, mitigate resistance risks, and reduce costs, while acknowledging that concurrent infection control measures may have contributed to these trends. This model may inform similar interventions in other institutions, particularly those in resource-limited settings.

This study aimed to update the incidence of device-associated healthcare-associated infections (DA-HAIs), and to characterize pathogen distribution and carbapenem-resistant Enterobacteriaceae (CRE) detection among ICU patients in Shanghai, China.

Prospective surveillance in 223 ICUs using standardized International Nosocomial Infection Control Consortium methodology (INICC) protocols collected patient-level data on demographics, microbiology, device use, and DA-HAIs. Trends, annual percent change (APC) and average annual percent change (AAPC) were estimated using Joinpoint regression models.

The overall DA-HAIs incidence density in ICUs was 1.67 per 1000 catheter-days for catheter-associated urinary tract infection (CAUTI) (95% CI: 1.62–1.73), 0.59 per 1000 central line-days for central line-associated bloodstream infection (CLABSI) (95% CI: 0.56–0.63), and 4.63 per 1000 ventilator-days for ventilator-associated pneumonia (VAP) (95% CI: 4.51–4.76). Significant reductions were observed in VAP (AAPC: −15.36%; P < 0.001) and CLABSI (AAPC: −11.23%; P < 0.001). Pathogen distributions varied by infection type, with Enterococcus faecium (17.22%) and Klebsiella pneumoniae (16.63%) predominating in CAUTI patients, Klebsiella pneumoniae (26.87%) in CLABSI patients, and Acinetobacter baumannii (37.60%) in VAP patients. The overall CRE detection rate was 33.67% in CAUTI patients, 37.56% in CLABSI patients, and 35.24% in VAP patients.

Although DA-HAI rates showed significant declines, the persistently high CRE prevalence underscores substantial antimicrobial resistance challenges in Chinese ICUs.

MicroRNAs (miRNAs) alterations in patients with bipolar disorder (BD) are pivotal to the disease’s pathogenesis. Since obtaining brain tissue is challenging, most research has shifted to analyzing miRNAs in peripheral blood. One innovative solution is sequencing miRNAs in plasma extracellular vesicles (EVs), particularly those neural-derived EVs emanating from the brain.

We isolated plasma neural-derived EVs from 85 patients with BD and 39 healthy controls (HC) using biotinylated antibodies targeting a neural tissue marker, followed by miRNA sequencing and expression analysis. Furthermore, we conducted bioinformatic analyses and functional experiments to delve deeper into the underlying pathological mechanisms of BD.

Out of the 2,656 neural-derived miRNAs in EVs identified, 14 were differentially expressed between BD patients and HC. Moreover, the target genes of miR-143-3p displayed distinct expression patterns in the prefrontal cortex of BD patients versus HC, as sourced from the PsychENCODE database. The functional experiments demonstrated that the abnormal expression of miR-143-3p promoted the proliferation and activation of microglia and upregulated the expression of proinflammatory factors, including IL-1β, IL-6, and NLRP3. Through weighted gene co-expression network analysis, a module linking to the clinical symptoms of BD patients was discerned. Enrichment analyses unveiled these miRNAs’ role in modulating the axon guidance, the Ras signaling pathway, and ErbB signaling pathway.

Our findings provide the first evidence of dysregulated plasma miRNAs within neural-derived EVs in BD patients and suggest that neural-derived EVs might be involved in the pathophysiology of BD through related biological pathways, such as neurogenesis and neuroinflammation.

To assess the association between coffee consumption and life expectancy among the US adults.

Prospective cohort.

National representative survey in the United States, 2001–2018.

A total of 43 114 participants aged 20 years or older with complete coffee consumption data were included from National Health and Nutrition Examination Survey 2001–2018.

Over a median follow-up of 8·7 years, 6234 total deaths occurred, encompassing 1929 deaths from CVD and 1411 deaths from cancer. Based on the nationally representative survey, we found that coffee consumption is associated with longer life expectancy. The estimated life expectancy at age 50 was 30·06 years (95 % CI, 29·68, 30·44), 30·82 years (30·12, 31·57), 32·08 years (31·52, 32·70), 31·24 years (30·29, 32·19), and 31·45 years (30·39, 32·60) in participants consuming 0, ≤ 1, 1 to ≤ 2, 2 to ≤ 3, and > 3 cups of coffee per day, respectively. Consequently, compared with non-coffee drinkers, participants who consumed 1 to ≤ 2 cups/day had a gain of 2·02 years (1·17, 2·85) in life expectancy on average, attributable to a 0·61-year (29·72 %) reduction in CVD deaths. Similar benefits were found in both males and females.

Our findings suggest that moderate coffee consumption (approximately 2 cups per day) could be recommended as a valuable component of a healthy diet and may be an adjustable effective intervention measure to increase life expectancy.

Social determinants of health (SDHs) exert a significant influence on various health outcomes and disparities. This study aimed to explore the associations between combined SDHs and mortality, as well as adverse health outcomes among adults with depression.

The research included 48,897 participants with depression from the UK Biobank and 7,771 from the US National Health and Nutrition Examination Survey (NHANES). By calculating combined SDH scores based on 14 SDHs in the UK Biobank and 9 in the US NHANES, participants were categorized into favourable, medium and unfavourable SDH groups through tertiles. Cox regression models were used to evaluate the impact of combined SDHs on mortality (all-cause, cardiovascular disease [CVD] and cancer) in both cohorts, as well as incidences of CVD, cancer and dementia in the UK Biobank.

In the fully adjusted models, compared to the favourable SDH group, the hazard ratios for all-cause mortality were 1.81 (95% CI: 1.60–2.04) in the unfavourable SDH group in the UK Biobank cohort; 1.61 (95% CI: 1.31–1.98) in the medium SDH group and 2.19 (95% CI: 1.78–2.68) in the unfavourable SDH group in the US NHANES cohort. Moreover, higher levels of unfavourable SDHs were associated with increased mortality risk from CVD and cancer. Regarding disease incidence, they were significantly linked to higher incidences of CVD and dementia but not cancer in the UK Biobank.

Combined unfavourable SDHs were associated with elevated risks of mortality and adverse health outcomes among adults with depression, which suggested that assessing the combined impact of SDHs could serve as a key strategy in preventing and managing depression, ultimately helping to reduce the burden of disease.

Multimorbidity, especially physical–mental multimorbidity, is an emerging global health challenge. However, the characteristics and patterns of physical–mental multimorbidity based on the diagnosis of mental disorders in Chinese adults remain unclear.

A cross-sectional study was conducted from November 2004 to April 2005 among 13,358 adults (ages 18–65years) residing in Liaoning Province, China, to evaluate the occurrence of physical–mental multimorbidity. Mental disorders were assessed using the Composite International Diagnostic Interview (version 1.0) with reference to the Diagnostic and Statistical Manual of Mental Disorders (3rd Edition Revised), while physical diseases were self-reported. Physical–mental multimorbidity was assessed based on a list of 16 physical and mental morbidities with prevalence ≥1% and was defined as the presence of one mental disorder and one physical disease. The chi-square test was used to calculate differences in the prevalence and comorbidity of different diseases between the sexes. A matrix heat map was generated of the absolute number of comorbidities for each disease. To identify complex associations and potential disease clustering patterns, a network analysis was performed, constructing a network to explore the relationships within and between various mental disorders and physical diseases.

Physical–mental multimorbidity was confirmed in 3.7% (498) of the participants, with a higher prevalence among women (4.2%, 282) than men (3.3%, 216). The top three diseases with the highest comorbidity rate and average number of comorbidities were dysphoric mood (86.3%; 2.86), social anxiety disorder (77.8%; 2.78) and major depressive disorder (77.1%; 2.53). A physical–mental multimorbidity network was visually divided into mental and physical domains. Additionally, four distinct multimorbidity patterns were identified: ‘Affective-addiction’, ‘Anxiety’, ‘Cardiometabolic’ and ‘Gastro-musculoskeletal-respiratory’, with the digestive-respiratory-musculoskeletal pattern being the most common among the total sample. The affective-addiction pattern was more prevalent in men and rural populations. The cardiometabolic pattern was more common in urban populations.

The physical–mental multimorbidity network structure and the four patterns identified in this study align with previous research, though we observed notable differences in the proportion of these patterns. These variations highlight the importance of tailored interventions that address specific multimorbidity patterns while maintaining broader applicability to diverse populations.

Patients with chronic insomnia are characterized by alterations in default mode network and alpha oscillations, for which the medial parietal cortex (MPC) is a key node and thus a potential target for interventions.

Fifty-six adults with chronic insomnia were randomly assigned to 2 mA, alpha-frequency (10 Hz), 30 min active or sham transcranial alternating current stimulation (tACS) applied over the MPC for 10 sessions completed within two weeks, followed by 4- and 6-week visits. The connectivity of the dorsal and ventral posterior cingulate cortex (vPCC) was calculated based on resting functional MRI.

For the primary outcome, the active group showed a higher response rate (≥ 50% reduction in Pittsburgh Sleep Quality Index (PSQI)) at week 6 than that of the sham group (71.4% versus 3.6%) (risk ratio 20.0, 95% confidence interval 2.9 to 139.0, p = 0.0025). For the secondary outcomes, the active therapy induced greater and sustained improvements (versus sham) in the PSQI, depression (17-item Hamilton Depression Rating Scale), anxiety (Hamilton Anxiety Rating Scale), and cognitive deficits (Perceived Deficits Questionnaire-Depression) scores. The response rates in the active group decreased at weeks 8–14 (42.9%–57.1%). Improvement in sleep was associated with connectivity between the vPCC and the superior frontal gyrus and the inferior parietal lobe, whereas vPCC-to-middle frontal gyrus connectivity was associated with cognitive benefits and vPCC-to-ventromedial prefrontal cortex connectivity was associated with alleviation in rumination.

Targeting the MPC with alpha-tACS appears to be an effective treatment for chronic insomnia, and vPCC connectivity represents a prognostic marker of treatment outcome.