Objective: To analyze the differences in efficacy and safety of different types of novel coronavirus pneumonia (COVID-19) vaccines in different age groups (young adults and elderly). Methods: Randomized controlled trials (RCTs) on COVID-19 vaccine in PubMed, Embase, Web of Science, and Cochrane library were searched by computer, and eight eligible studies were analyzed. Meta-analysis was performed using Stata 16.0 and RevMan5.4 software. Results: The mean geometric titer (GMT) of the virus in the elderly was significantly higher than that in the placebo group (SMD = 0.91, 95% CI (0.68, 1.15), p < 0.01), presenting no obvious difference compared with the young adults (SMD = 0.19, 95% CI (0.38, 0.01), p = 0.06). Meanwhile, the effect of multiple vaccinations was better than that of single vaccination (SMD = 0.83, 95% CI (0.33, 1.34), p < 0.01). However, the number of adverse events (AEs) in the elderly was lower than that in the young adults (OR = 0.35, 95% CI (0.29, 0.42), p < 0.01). Conclusions: The immunization effect of COVID-19 vaccine in the elderly is obvious, especially after multiple vaccinations, and the incidence of AEs in the elderly is low, which proves that the vaccination of the elderly is safe and effective.

Importance: With rapidly aging populations globally, there is a lack of evidence on effective fall prevention strategies among community-dwelling older people in resource-constrained areas.Objective: To assess the effectiveness of a fall prevention program integrated in primary health care systems on the risk of falls among Chinese rural older adults.Design, Setting, and Participants: A 12-month, open-label, cluster randomized clinical trial, conducted in 128 rural villages from 4 Chinese provinces, involving adults 60 years or older at risk of falls (recruitment from September 19, 2023, to November 15, 2023; last follow-up, January 15, 2025).Interventions: The fall prevention intervention, consisting of balance and functional exercises and community-engaged health education, was integrated with the rural primary health care system. The control group received usual care, health education alone, without active involvement with the communities.Main Outcomes and Measures: The primary outcome was the proportion of participants who reported at least 1 fall in 12 months following the intervention. Six secondary outcomes included the rate of falls, 3 measures of functional mobility, the proportion of participants who reported fall-related injury, and health-related quality of life. Fall-related data were collected via quarterly participant self-reports supported by a calendar; functional mobility was measured at baseline and 12-month follow-up using validated measures.Results: Of the 2616 participants recruited, 6 died before randomization and 2610 (median age, 70.0 years [IQR, 66.4-74.2]; 1553 female [59.5%]) were randomized either to the intervention group (1311 from 64 villages) or to the control group (1299 from 64 villages). During a mean follow-up of 358.0 (SD, 31.3) days, 388 participants (29.7%) in the intervention group reported falling at least once during the 12-month follow-up compared with 497 (38.3%) in the control group (odds ratio, 0.67; 95% CI, 0.48-0.91; P = .01). All secondary outcomes favored the intervention except the Timed Up and Go Test (for functional mobility), which showed no significant difference.Conclusions and Relevance: This cluster randomized trial found that integrating a fall prevention program in a primary health care system was associated with a significant reduction in the risk of self-reported falls among Chinese rural older people. This intervention, comprising balance and functional exercises and community-engaged health education, has the potential to be scaled-up in China and other low- and middle-income countries with rapidly growing aging populations.Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2300075879

Background and aim: Benchmarking is a management approach for implementing best medical practices at the lowest cost. The objectives of this study were to set achievable performance benchmarks for individual quality indicators to determine the predicted quality achievement related to better adherence, and to select optimal quality indicators for improving the quality of acute ischemic stroke care. Methods: We analyzed data on 500,331 patients diagnosed with acute ischemic stroke who were treated at 518 hospitals in China from January 2011 to May 2017. The primary outcome was independence (modified Rankin Scale score ≤2) at discharge. Data-driven achievable benchmarking used the “pared-mean” approach to set objective performance targets. Hierarchical logistic regression models were employed to evaluate the process–outcome association, as well as the predicted quality improvement if all hospitals were to operate at the benchmark level. Results: Of the overall population, 64.01% were independent patients at discharge. The performance benchmarks were >90% for most of the quality indicators. After adjusting for patient-level and hospital-level characteristics and unifying hospital performance to the benchmark level, the quality indicators with high increase in both overall adherence rate and independence rate were thrombolytic therapy, anticoagulant therapy, venous thrombosis prophylaxis. Conclusions: Performance targets for three acute treatments, including thrombolytic therapy, anticoagulant therapy, venous thrombosis prophylaxis, could best motivate improvements in both overall adherence rate and independence rate at discharge. The finding suggests that the above three types of acute treatment should be given priority to improve the quality of acute ischemic stroke care.

The association between low serum testosterone levels and all-cause mortality in male and female patients with cardiovascular disease (CVD) was investigated. This study extracted data on CVD patients from the National Health and Nutrition Examination Survey (NHANES) database (1999–2000, 2003–2004, 2011–2012, and 2013–2014). The association between low serum testosterone levels (≤ 300 ng/dL) and all-cause mortality in male and female CVD patients was evaluated using univariate and multivariate Cox regression analyses, with hazard ratios (HR) and 95% confidence intervals (CI). A total of 1,177 participants (689 males) with a mean age of 66.01 ± 12.52 years were included in the study. The median follow-up time was 55 (44, 71) months. Low serum testosterone levels occurred in 487 (70.68%) males and 394 (80.74%) females. Additionally, 202 (29.32%) male patients and 94 (19.26%) female patients with CVD were dead. After adjusting for covariates, low serum testosterone levels were associated with an increased risk of all-cause mortality in male CVD patients (HR = 1.48, 95% CI 1.08–2.02, P = 0.013), while the association was not significant in females. Low serum testosterone levels may be associated with an increased risk of all-cause mortality in male CVD patients, but not in female patients.

Ulcerative colitis (UC) is a common chronic nonspecific intestinal inflammation of unknown etiology associated with a low cure rate and a high relapse rate. Hair follicle mesenchymal stem cells (HF‐MSCs) are a class of pluripotent stem cells that have differentiation potential and strong proliferation ability. Nuclear factor red system related factor (Nrf-2) is a key factor in the oxidative stress response. Dextran sulfate sodium‐ (DSS‐) induced rat UC models closely mimic human UC in terms of symptoms and histological changes. Animals were divided into five groups, including a healthy group and UC model rats treated with normal saline, Nrf-2, HF‐MSCs, or Nrf-2‐expressing HF‐MSC group. Based on the expression of intestinal stem cells, inflammatory factors, anti‐inflammatory factors, and disease activity index scores, Nrf-2‐expressing HF‐MSCs had the most obvious therapeutic effect under the same treatment regimen. This study provided a new potential clinical treatment option for ulcerative colitis.