The Lancet Regional Health: Western Pacific最新文献

{"title":"Reversing fertility decline in Japan with foreign pro-natalist policies, 1990–2035: a systematic review and secondary data analysis","authors":"Md Mizanur Rahman ,&nbsp;Haruka Sakamoto ,&nbsp;Sabera Sultana ,&nbsp;Miho Sassa ,&nbsp;Md Ashraful Alam ,&nbsp;Kenji Shibuya","doi":"10.1016/j.lanwpc.2025.101596","DOIUrl":"10.1016/j.lanwpc.2025.101596","url":null,"abstract":"<div><h3>Background</h3><div>Several high-income countries, including Japan, have adopted pro-natalist policy to counteract declining fertility rates. However, the effectiveness of these policies varied across different studies and countries. This study aims to conduct an initial systematic review to identify effective policies that have reversed declining fertility rates. Subsequently, it will apply them to Japan’s context through scenario-based secondary analysis. The goals are to project Japan’s total fertility rate (TFR) up to the year 2035.</div></div><div><h3>Methods</h3><div>We conducted searches in major electronic databases from their inception until March 27 2025 to investigate the impact of fertility policies. We also extracted a variety demographic and public expenditure data from the OECD, World Bank, and IMF databases for the years 1990–2022. A Bayesian hierarchical regression model was used to estimate and project Japan’s TFR trends up to 2035 in Japan, analyzing the effects of significant fertility policies on these trends.</div></div><div><h3>Findings</h3><div>Our analysis included a total of 61 studies focusing on pro-natalist policies, identifying cash benefit policies—such as payment at birth, allowances, paid maternity and paternal leave, childcare coverage, and tax exemptions—as the most influential. Unpaid maternity leaves, universal two-child policy, and Assisted Reproductive Technology health insurance coverage also showed potential to boost fertility, although further research is needed. Countries like Australia, Greece, Hungary, France, and the UK allocate over 1.3% of their GDP to family cash benefits, contrasting Japan and Korea, where the allocation is less than 1%. Our findings indicate that Japan’s current cash benefit policies are unlikely to significantly reverse the fertility decline by 2030 (12% likelihood) and 2035 (29% likelihood). However, should Japan enhance its cash benefits to levels observed in Australia, Hungary, and France by 2030, the probability of reversing Japan’s fertility decline could rise significantly to 79%, 70%, and 69%, respectively. Even if cash benefit policies are scaled up by 2035, the probability of reversing the decline fertility rate is projected to be around 60 or more.</div></div><div><h3>Interpretation</h3><div>Cash benefits emerged as the most effective fertility policy in high-income countries, although such benefits in Japan were notably modest. Elevating Japan’s cash benefit scheme could potentially lead to higher TFR.</div></div><div><h3>Funding</h3><div><span>HIAS Health</span>, <span>Hitotsubashi University</span>; Tokyo Foundation for Policy Research, Japan.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"59 ","pages":"Article 101596"},"PeriodicalIF":7.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144280367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emerging tick-borne diseases in mainland China over the past decade: a systematic review and mapping analysis","authors":"Ya-Fei Wu ,&nbsp;Ming-Zhu Zhang ,&nbsp;Xiao-Ling Su ,&nbsp;Yi-Fei Wang ,&nbsp;Li-Feng Du ,&nbsp;Xiao-Ming Cui ,&nbsp;Wenqiang Shi ,&nbsp;Dai-Yun Zhu ,&nbsp;Lin Zhao ,&nbsp;Luo-Yuan Xia ,&nbsp;Na Jia ,&nbsp;Jia-Fu Jiang ,&nbsp;Li-Li Ren ,&nbsp;Wu-Chun Cao","doi":"10.1016/j.lanwpc.2025.101599","DOIUrl":"10.1016/j.lanwpc.2025.101599","url":null,"abstract":"<div><h3>Background</h3><div>Emerging tick-borne infectious diseases have become increasingly prevalent worldwide. In a previous review, we summarized tick-borne infections in mainland China from 1980 to May, 2015. Here we conducted systematic review and mapping analysis of emerging tick-borne diseases over the past decade.</div></div><div><h3>Methods</h3><div>We searched multiple sources for publications regarding tick-borne diseases in mainland China from June, 2015 to January, 2025. Subsequently, we collected data on tick infections of related pathogens from secondary literature review, GenBank, and our field survey, without time limitation. The clinical manifestations of each kind of tick-borne diseases were summarized. The thematic maps showing geographical distribution of emerging tick-borne diseases and related tick infections were produced by ArcGIS.</div></div><div><h3>Findings</h3><div>Over the past decade, 28 emerging tick-borne diseases have been identified in mainland China, including 11 viral diseases, ten rickettsiosis, one anaplasmosis, one ehrlichiosis, two spirochetal diseases, and three protozoan diseases. These emerged diseases, caused by diverse pathogens, exhibit distinct geographic distribution patterns. Clinically, they are primarily characterized by febrile and non-specific symptoms, underscoring the importance of pathogen-specific diagnostic methods for accurate diagnosis. The tick-borne pathogens responsible for these emerging diseases were identified in 40 tick species and more widely distributed across China, implying cases of the emerging tick-borne diseases underdiagnosed.</div></div><div><h3>Interpretation</h3><div>Emerging tick-borne diseases have become an unprecedented public health threat in mainland China. Increased awareness and enhanced surveillance are required to understand the burden of tick-borne diseases in China and countries where tick vectors are present.</div></div><div><h3>Funding</h3><div><span>National Key Research and Development Program of China</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"59 ","pages":"Article 101599"},"PeriodicalIF":7.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144253695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Personalized information support for hypertension management: an open-label cluster randomized controlled trial in rural Anhui, China","authors":"Xingrong Shen ,&nbsp;Ruirui Cui ,&nbsp;Nana Li ,&nbsp;Xin Yang ,&nbsp;Tongqing Xu ,&nbsp;Shumin Zeng ,&nbsp;Xuanhe Liu ,&nbsp;Yuning Wang ,&nbsp;Ying Li ,&nbsp;Dongying Xiao ,&nbsp;Xuewu Zhang ,&nbsp;Rong Liu ,&nbsp;Tingting Zhang ,&nbsp;Xiyan Kong ,&nbsp;Jing Chai ,&nbsp;Dongxiao Gu ,&nbsp;Debin Wang","doi":"10.1016/j.lanwpc.2025.101588","DOIUrl":"10.1016/j.lanwpc.2025.101588","url":null,"abstract":"<div><h3>Background</h3><div>Lack of personalized hypertension management (PHM) is the main driver of low treatment and control rates of blood pressure (BP). Digital intervention has great potential in realizing PHM.</div></div><div><h3>Methods</h3><div>This two-arm cluster randomized controlled trial aimed at assessing the added value of personalized information for leveraging commonly recognized objective behaviors facilitated by pragmatic digital applications. Implemented in Jieshou of Anhui Province, China, the intervention lasted for 12 months starting from August 2021. The primary outcome measure was systolic BP (SBP); and the secondary measures, diastolic BP (DBP), BP control rate, quality adjusted of life years (QALYs), deaths of and admissions for all-causes and hypertension complications and behavior scores. These measures were analyzed using mainly generalized linear mixed modeling controlled for clustering with or without imputation.</div></div><div><h3>Findings</h3><div>The trial recruited 2392 patients at a response rate of 96.84%. At 12-month follow-up, the intervention group demonstrated (via intent-to treat analysis) superior SBP, −5.60 mmHg (95% CI: −8.10, −3.09; <em>p</em> &lt; 0.001). Compared with 24-months follow-up, the adjusted difference decreased moderately to −3.93 mmHg (95% CI: −5.80, −2.05; <em>p</em> &lt; 0.001). The intervention arm demonstrated non-greater risks of all the adverse effects observed.</div></div><div><h3>Interpretation</h3><div>The study provides evidence to support the use of the personalized information support in controlling hypertension and its complications. The next step is an implementation strategy to incorporate the intervention into daily practice and realize its benefits.</div></div><div><h3>Funding</h3><div>The trial was supported by <span>National Natural Science Foundation of China</span> (No. <span><span>72004002</span></span>) and <span>Scientific Research Foundation of Education Department of Anhui Province of China</span> (No. <span><span>KJ2021A0259</span></span>).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"59 ","pages":"Article 101588"},"PeriodicalIF":7.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing and testing AI-based voice biomarker models to detect cognitive impairment among community dwelling adults: a cross-sectional study in Japan","authors":"Eri Kiyoshige ,&nbsp;Soshiro Ogata ,&nbsp;Namhee Kwon ,&nbsp;Yuriko Nakaoku ,&nbsp;Chisato Hayashi ,&nbsp;Nate Blaylock ,&nbsp;Raymond Brueckner ,&nbsp;Vinod Subramanian ,&nbsp;Henry Joseph OConnell ,&nbsp;Yusuke Yoshikawa ,&nbsp;Kanako Teramoto ,&nbsp;Kiyomasa Nakatsuka ,&nbsp;Satoshi Saito ,&nbsp;Masafumi Ihara ,&nbsp;Misa Takegami ,&nbsp;Kunihiro Nishimura","doi":"10.1016/j.lanwpc.2025.101598","DOIUrl":"10.1016/j.lanwpc.2025.101598","url":null,"abstract":"<div><h3>Background</h3><div>Voice is a potential biomarker of cognitive impairment because mild cognitive impairment (MCI) can cause changes in speech patterns and tempo. Artificial intelligence (AI) can deliver voice biomarkers as prediction features, leading to a timely, noninvasive, and cost-effective detection of cognitive impairment. This study aimed to develop and test prediction models utilizing voice biomarkers to detect cognitive impairment, which AI derived from voice data of unstructured conversations in community-dwelling adults in Japan.</div></div><div><h3>Methods</h3><div>This observational study with a cross-sectional design, included 1461 community-dwelling adults. The outcome was cognitive impairment assessed by the Memory Performance Index score from the MCI screen. Voice data was collected from 3-min open-question interviews and extracted voice biomarkers based on acoustic and prosodic features as a 512-dimensional vector of individual voice information using the voice generator, Wav2Vec2. Other considerable predictors were age, sex, and education. We developed cognitive impairment prediction models by applying the extreme gradient boosting decision tree algorithm and a deep neural network model using 979 participants. Prediction performances were tested by area under the curves (AUCs) in 482 participants who were not used for model development.</div></div><div><h3>Findings</h3><div>We had 967 women (66·2%), 526 cognitive impairment (36·0%) participants with mean (standard deviation) age and education years of 79·5 (6·3) years old and 11·6 (2·2) years, respectively. The inclusion of voice biomarkers significantly improved AUCs (95% confidence intervals), from 0·80 (0·76, 0·84) to 0·88 (0·84, 0·91) for the age sex model and from 0·78 (0·73, 0·82) to 0·89 (0·86, 0·92) for the age sex and education model (p &lt; 0·0001 for both comparisons by DeLong test).</div></div><div><h3>Interpretation</h3><div>Our prediction models for cognitive impairment using voice biomarkers can provide significantly timesaving MCI screening with high prediction performances (AUC = 0·89). Voice biomarkers significantly contributed to improving prediction performance.</div></div><div><h3>Funding</h3><div><span>Small Business Innovation Research (SBIR Phase 3 Fund)</span>, the <span>Intramural Research Fund of Cardiovascular Diseases</span> of the <span>National Cerebral and Cardiovascular Center</span>, and <span>JSPS KAKENHI</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"59 ","pages":"Article 101598"},"PeriodicalIF":7.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144513693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term exposure to outdoor fine particulate and physical activity with mortality and cardiovascular events: an analysis of the Prospective Urban Rural Epidemiology (PURE)-China cohort study","authors":"Jun Hao ,&nbsp;Zhiguang Liu ,&nbsp;Bo Hu ,&nbsp;Duolao Wang ,&nbsp;Sumathy Rangarajan ,&nbsp;Yang Wang ,&nbsp;Chuangshi Wang ,&nbsp;Lap Ah Tse ,&nbsp;Weida Liu ,&nbsp;Sidong Li ,&nbsp;Minghai Yan ,&nbsp;Qiujing Cai ,&nbsp;Salim Yusuf ,&nbsp;Wei Li ,&nbsp;PURE-China Investigators","doi":"10.1016/j.lanwpc.2025.101584","DOIUrl":"10.1016/j.lanwpc.2025.101584","url":null,"abstract":"<div><h3>Background</h3><div>Long-term exposure to PM2.5 and low physical activity are independently associated with an increased risk of cardiovascular disease (CVD). However, there is limited research investigating the combined effects of PM2.5 exposure and physical activity on CVD risk. This study aims to explore these interactions related to CVD and mortality.</div></div><div><h3>Methods</h3><div>We analysed data from the PURE-China cohort, including 39,970 adults aged 35–70 years, with a median follow-up of 11.9 years. PM2.5 exposure was estimated using a Bayesian hierarchical model. Physical activity was quantified using metabolic equivalent task (MET)-minutes per week. The primary outcome was a composite of all-cause mortality and major cardiovascular events. Cox frailty models and restricted cubic splines were used to assess associations. Interaction effects were evaluated using measures of multiplicative and additive interaction, including the relative excess risk due to interaction (RERI) and the proportion attributable to interaction (AP).</div></div><div><h3>Findings</h3><div>Participants were divided into high and low PM2.5 exposure groups by the median concentration (47.70 μg/m³). In low-exposure areas, higher total physical activity significantly reduced the risk of composite outcome (HR: 0.84, 95% CI: 0.73–0.97, p trend = 0.012) and major cardiovascular events (HR: 0.80, 0.67–0.95, p trend = 0.022). However, in high-exposure regions, physical activity showed no protective effect for the composite outcome (HR: 0.97, 0.85–1.09, p trend = 0.551) and major cardiovascular events (HR: 0.98, 0.85–1.13, p trend = 0.864). Higher non-recreational physical activity reduced the risks of composite outcome and major CVD in low-exposure areas but provided no benefit in high-exposure regions (p interaction = 0.011, 0.024, respectively). Significant antagonistic interaction was observed between high PM2.5 exposure and low non-recreational physical activity for the composite outcome (RERI: −0.215, 95% CI: −0.406 to −0.024; AP: −0.155, 95% CI: −0.294 to −0.017).</div></div><div><h3>Interpretation</h3><div>Long-term exposure to high PM2.5 concentrations diminishes the cardiovascular benefits of physical activity, particularly non-recreational activities. These findings underscore the need for tailored physical activity guidelines and air quality interventions in heavily polluted regions to maximize public health benefits.</div></div><div><h3>Funding</h3><div>Funding sources are listed at the end of the Article.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"59 ","pages":"Article 101584"},"PeriodicalIF":7.6,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing outcomes: adherence to the ABC (Atrial fibrillation Better Care) pathway in Asian atrial fibrillation patients with chronic kidney disease","authors":"Boyoung Joung","doi":"10.1016/j.lanwpc.2025.101583","DOIUrl":"10.1016/j.lanwpc.2025.101583","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"59 ","pages":"Article 101583"},"PeriodicalIF":7.6,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144146734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to Associations of reallocating sedentary leisure-time to alternative discretionary movement behaviours with incident cardiometabolic diseases in 0.5 million Chinese adults. The Lancet Regional Health—Western Pacific, Volume 57, 101524","authors":"Paul J. Collings ,&nbsp;Mengyao Wang ,&nbsp;Harrison Hin Sheung Ho ,&nbsp;Shiu Lun Au Yeung ,&nbsp;Parco M. Siu ,&nbsp;Benjamin J. Cowling ,&nbsp;Stephen J. Sharp ,&nbsp;Søren Brage ,&nbsp;Nicholas J. Wareham ,&nbsp;Huaidong Du ,&nbsp;Derrick A. Bennett ,&nbsp;Youngwon Kim","doi":"10.1016/j.lanwpc.2025.101580","DOIUrl":"10.1016/j.lanwpc.2025.101580","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"59 ","pages":"Article 101580"},"PeriodicalIF":7.6,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intergenerational association of adverse childhood experiences and perinatal mental health in adult female offspring: evidence from the longitudinal grandmothers, mothers, and their Children's health study in China","authors":"Hui Wang ,&nbsp;Yue Zhang ,&nbsp;Weijie Ding ,&nbsp;Jiyue Dai ,&nbsp;Xiaoqin Zhu ,&nbsp;Xiaolin Xu","doi":"10.1016/j.lanwpc.2025.101579","DOIUrl":"10.1016/j.lanwpc.2025.101579","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The cycle of maltreatment theory posits a linkage between mothers' and offspring's exposures to adverse childhood experiences (ACEs), and their associations with offspring's early-life mental health; however, such associations in adulthood remain unclear. This study aims to examine the intergenerational association between mothers' ACEs, offspring's ACEs, and offspring's mental health from pregnancy to three years after childbirth, and to explore the potential pathways.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We used data on 1931 mother-offspring dyads from the longitudinal Grandmothers, Mothers, and Their Children's Health study in Huai'an city, China. ACEs were retrospectively assessed based on the Childhood Trauma Screener. Offspring's symptoms of anxiety and depression were measured through self-reported diagnoses or symptoms and standard questionnaires (the 7-item Generalized Anxiety Disorder Scale for anxiety and the 10-item Centre for Epidemiological Studies Depression Scale for depression) during pregnancy, one year and three years after childbirth. Logistic regression models were conducted to estimate the associations. The structural equation model (SEM) was used to examine the potential mediating pathways.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;A total of 367 (19.0%) mothers and 271 (14.0%) female offspring reported the history of ACEs. Female offspring of mothers with ACEs also had higher odds of exposure to ACEs (odds ratio [OR] = 3.37, 95% confidence interval [CI]: 2.51–4.53). Mothers' and female offspring's exposures to ACEs were both associated with higher odds of offspring experiencing mental disorders during the perinatal period. For example, female offspring with ACEs had 2.05-fold (95% CI: 1.54–2.72), 2.41-fold (95% CI: 1.75–3.33), and 2.30-fold (95% CI: 1.58–3.33) increased odds of the anxious or depressive symptoms during pregnancy, one year, and three years after childbirth, respectively, compared to offspring without ACEs. Results from the SEM indicated that mothers' ACEs and female offspring's perinatal mental health were linked mainly through the mediation role of female offspring's ACEs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;Mothers' and female offspring's likelihood of exposure to ACEs are intergenerationally associated and are both related to offspring's perinatal mental health. Female offspring's ACEs mediate the association between mothers' ACEs and female offspring's adulthood mental health. Our findings highlight the need for policies to break the cycle of maltreatment and promote women's mental health across multiple generations, in particular through family-based interventions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Funding&lt;/h3&gt;&lt;div&gt;This study was supported by the &lt;span&gt;National Natural Science Foundation of China&lt;/span&gt; (&lt;span&gt;&lt;span&gt;72474197&lt;/span&gt;&lt;/span&gt;), &lt;span&gt;China Medical Board&lt;/span&gt; Open Competition Program (21-416), Key Medical Program of &lt;span&gt;Jiangsu Health Commission&lt;/span&gt; (&lt;span&gt;&lt;span&gt;ZD","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"59 ","pages":"Article 101579"},"PeriodicalIF":7.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143946683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic factors driving the Mycoplasma pneumoniae outbreak among children post-COVID-19 in China: a whole genome analysis","authors":"Weiwei Jiao ,&nbsp;Jie Wang ,&nbsp;Cuidan Li ,&nbsp;Peihan Wang ,&nbsp;Sihong Xu ,&nbsp;Jing Bi ,&nbsp;Liya Yue ,&nbsp;Fang Liu ,&nbsp;Lin Sun ,&nbsp;Hui Qi ,&nbsp;Tingting Jiang ,&nbsp;Xue Tian ,&nbsp;He Tang ,&nbsp;Xu Li ,&nbsp;Min Li ,&nbsp;Xuemei Yang ,&nbsp;Xiaoxuan Yang ,&nbsp;Yuting Sun ,&nbsp;Haitao Niu ,&nbsp;Wenbao Zhang ,&nbsp;Fei Chen","doi":"10.1016/j.lanwpc.2025.101578","DOIUrl":"10.1016/j.lanwpc.2025.101578","url":null,"abstract":"<div><h3>Background</h3><div><em>Mycoplasma pneumoniae (M. pneumoniae)</em> is a leading cause of community-acquired pneumonia in children. Post-COVID-19, a significant resurgence of <em>M. pneumoniae</em> infections has been observed in China, but whole-genome analyses on the genetic mechanisms driving this resurgence remain limited.</div></div><div><h3>Methods</h3><div>We performed whole-genome sequencing on 169 <em>M. pneumoniae</em> isolates from Beijing and Baoding, collected before and after COVID-19. All <em>M. pneumoniae</em> genomes from GenBank were included for analysis. Genotypes were identified using multilocus variable-number tandem-repeat analysis (MLVA), multilocus sequence typing (MLST), phylogenetic analysis. Genomic conservation and transmission patterns were assessed via SNP distance.</div></div><div><h3>Findings</h3><div>We identified a post-COVID-19 resurgence of <em>M. pneumoniae</em> infections among children, with infection rates peaking at 60%–70% in late 2023, higher than during the pandemic (10%–20%) and pre-pandemic (∼30%). Genomic analysis revealed distinct genotypes, with T1-2 (4-5-7-2) dominating in Beijing, and both T1-2 and T2-2 (3-5-6-2) prevalent in Baoding. Minimal SNP distances and genomic conservation indicated rapid spread of <em>M. pneumoniae</em>. Genomic analysis uncovered key genetic factors driving the outbreak: near-100% macrolide resistance and increased prevalence of the 4-5-7-2 genotype (enriched in virulence and metabolism-related genes).</div></div><div><h3>Interpretation</h3><div>This study provides a comprehensive genomic analysis of genetic factors driving the outbreak. With near-100% macrolide resistance in China, urgent changes in treatment policies are needed. The rising prevalence of 4-5-7-2 and its functional advantages warrant close monitoring. Our findings offer insights into the outbreak causes and guide future prevention and control strategies.</div></div><div><h3>Funding</h3><div><span>National Key R&amp;D Program of China</span>; Training Plan for <span>High level Public Health Technical Talents</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"59 ","pages":"Article 101578"},"PeriodicalIF":7.6,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143937416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of late gadolinium enhancement in the risk stratification of pediatric hypertrophic cardiomyopathy: based on a Chinese cohort","authors":"Xingrui Chen ,&nbsp;Wei Xiangli ,&nbsp;Xuan Ma ,&nbsp;Yun Tang ,&nbsp;Jiaxin Wang ,&nbsp;Zhixiang Dong ,&nbsp;Kankan Zhao ,&nbsp;Zhuxin Wei ,&nbsp;Xi Jia ,&nbsp;Pengyu Zhou ,&nbsp;Yujie Liu ,&nbsp;Yanyan Song ,&nbsp;Chen Cui ,&nbsp;Minjie Lu ,&nbsp;Kai Yang ,&nbsp;Xiuyu Chen ,&nbsp;Shujuan Yang ,&nbsp;Shihua Zhao","doi":"10.1016/j.lanwpc.2025.101573","DOIUrl":"10.1016/j.lanwpc.2025.101573","url":null,"abstract":"<div><h3>Background</h3><div>Recently, late gadolinium enhancement (LGE) has been identified as an important risk factor in pediatric hypertrophic cardiomyopathy (HCM). However, its prognostic significance in pediatric HCM remains to be fully validated, particularly in Asian population. This study aims to assess the prognostic value of LGE and explore its incremental utility in predicting sudden cardiac death (SCD) in pediatric HCM using data from a Chinese cohort.</div></div><div><h3>Methods</h3><div>231 primary HCM patients ≤18 years of age with cardiac magnetic resonance (CMR) were retrospectively and consecutively enrolled in a single center. The composite outcomes included SCD or equivalent events and heart failure-related events.</div></div><div><h3>Findings</h3><div>Of 231 patients (median age 15, IQR: 12–16), LGE was present in 195 (84.4%) with a median LGE extent of 4.7% (IQR: 2.0%–9.2%). During a median follow-up of 62 months (IQR: 39–85), 26 (11.3%) patients reached composite outcomes, and 13 (5.6%) patients experienced SCD events. Kaplan–Meier analysis showed a significantly increased risk of composite outcomes (log-rank P &lt; 0.001) and SCD (log-rank P &lt; 0.001) in the group with LGE extent ≥5%. In multivariable Cox analysis adjusted by clinical and imaging factors, LGE extent was independently associated with composite outcomes (adjusted HR: 1.15; P &lt; 0.001) and SCD (adjusted HR: 1.11; P = 0.009). For SCD events, the addition of LGE extent could improve the model performance of HCM Risk-Kids model (C-statistics: 0.65 versus 0.79, P = 0.015) and PRIMaCY model (C-statistics: 0.62 versus 0.82, P = 0.002), respectively.</div></div><div><h3>Interpretation</h3><div>In Chinese pediatric HCM, LGE serves as a risk factor in predicting adverse outcomes and may enhance SCD risk stratification strategies.</div></div><div><h3>Funding</h3><div>This study was funded by the <span>National Key Research and</span> Development Program of China (<span><span>2021YFF0501400</span></span> and <span><span>2021YFF0501404</span></span>), the Key Project of the <span>National Natural Science Foundation of China</span> (<span><span>82430066</span></span>), and the <span>Yunnan Province Science and Technology</span> Platform and Talent Project (<span><span>202305AF150033</span></span>).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"58 ","pages":"Article 101573"},"PeriodicalIF":7.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144069988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}