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We present a case of a 71-year-old male Chamorro patient from Guam who presented with progressive supranuclear palsy (PSP)-Richardson’s syndrome. Considering his strong family history of parkinsonism and a PSP phenotype, he was clinically diagnosed with Guam parkinsonism-dementia complex (PDC). Magnetic resonance imaging (MRI) of the brain revealed prominent midbrain atrophy with preserved pontine volume, forming the ‘hummingbird’ sign, which has not been described before in Guam PDC. Molecular analysis of the chromosome 9 open reading frame 72 gene (C9orf72) showed only 6 GGGGCC repeats. We discuss the clinico-pathological similarities and differences between PSP and Guam PDC, and highlight the topography of neuropathological changes seen in Guam PDC to explain the appearance of the ‘hummingbird’ sign on MRI.

The folate cycle has been implicated in the pathophysiology of autism due to its role in the glutathione oxidative stress pathway, amino acid and DNA methylation reactions, and neurotransmitter synthesis pathway. Previous research on folinic acid supplementation in autistic children has suggested potential benefits. The primary aim of this pilot study was to determine the safety, feasibility and efficacy of oral folinic acid in improving communication and behaviour in autistic children. Ten autistic children were recruited into an open-label pre-post treatment within-subjects design study. At T = 0, 12 and 24 weeks, participants underwent safety evaluations, standardized assessments of language, autism symptoms, adaptive skills and global illness severity, and eye-gaze tracking. During the control period (0-12 weeks), participants continued with standard care. In the treatment period (12-24 weeks), participants took oral folinic acid at 2 mg/kg/day. All 10 children (nine boys, one girl; aged 4-8 years), successfully consumed oral folinic acid supplements with no adverse events. There was a reduction in Pervasive Developmental Disorder Behavior Inventory (PDDBI) Autism Composite T-score with treatment (mean [SD] T-score 49.2 [8.89] pre-treatment, 44.6 [6.19] post-treatment, p = 0.103). Although this difference was not statistically significant due to the small sample size, the effect size was medium-large, indicating that, as a group, there were clinically meaningful changes in PDDBI T-scores. There were also trends towards gains in communication scores and overall Clinical Global Impression scores. Folinic acid is a safe and feasible potential treatment for autism, and results from this pilot justify the need for a larger placebo-controlled trial., (© 2024 International Society for Developmental Neuroscience.)

Atherosclerosis-induced cardiovascular diseases are a leading cause of disability and mortality worldwide. Currently, clinical diagnosis of atherosclerosis relies on analysis and assessment by large medical equipment and specialized professionals, involving invasive testing, which limits early detection and prognosis of atherosclerosis. Herein, this work develops a flexible wearable ring sensor for non-invasive real-time in situ monitoring of biomarkers associated with atherosclerosis. The device integrates electrochemical biosensing and microfluidic technology, utilizing screen-printing to create high-precision multi-channel electrodes. It can be worn on fingers to detect sweat flow rate and biomarkers including C-reactive protein (CRP), cholesterol, and potassium ions (K + ), with the aim of improving disease management efficiency and enhancing patient experience. The synthesized ZIF-67@AuNPs was used as the signal amplification layer of the adapter sensor. The resulting sensor exhibites sensitive and linear responses within the concentration ranges of 0-100 ng mL -1 for CRP, 0-120 μM for cholesterol, and 10 -6 -1 M for K + . Further tests on specificity, reproducibility, and stability of the sensor confirm its potential for practical applications. In this work, the wearable ring sensor achieves accurate detection of atherosclerosis biomarkers in sweat samples, providing a new technological approach for non-invasive real-time monitoring that has the potential to contribute to early disease warning and personalized management., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025. Published by Elsevier B.V.)

When observing chip-to-free-space light beams from silicon photonics (SiPh) to free space, manual adjustment of camera lens is often required to obtain a focused image of the light beams. In this Letter, we demonstrated an auto-focusing system based on the you-only-look-once (YOLO) model. The trained YOLO model exhibits high classification accuracy of 99.7% and high confidence level of >0.95 when detecting light beams from SiPh gratings. A video demonstration of real-time light beam detection, real-time computation of beam widths, and auto-focusing of light beams is also included.

Ethnopharmacological Relevance: Ophiocordyceps sinensis (O. sinensis) is a genus of Ascomycete fungus that is endemic to the alpine meadows of the Tibetan Plateau and adjoining Himalayas. It has been used traditionally as a tonic to improve respiratory health in ancient China as well as to promote vitality and longevity. Bioactive components found in O. sinensis such as adenosine, cordycepin, 3-deoxyadenosine, L-arginine and polysaccharides have gained increasing interest in recent years due to their antioxidative and other properties, which include anti-asthmatic, antiviral, immunomodulation and improvement of general health., Aim of the Study: This study's primary aim was to investigate the effect of a cultivated fruiting body of O. sinensis strain (OCS02®) on airways patency and the secondary focus was to investigate its effect on the lifespan of Caenorhabditis elegans., Materials and Methods: A cultivated strain, OCS02®, was employed and the metabolic profile of its cold-water extract (CWE) was analysed through liquid chromatography-mass spectrometry (LC-MS). Organ bath approach was used to investigate the pharmacological properties of OCS02® CWE when applied on airway tissues obtained from adult male Sprague-Dawley rats. The airway relaxation mechanisms of OCS02® CWE were explored using pharmacological tools, where the key regulators in airway relaxation and constriction were investigated. For the longevity study, age-synchronised, pos-1 RNAi-treated wild-type type Caenorhabditis elegans at the L4 stage were utilised for a lifespan assay., Results: Various glycopeptides and amino acids, particularly a high concentration of L-arginine, were identified from the LC-MS analysis. In airway tissues, OCS02® CWE induced a significantly greater concentration-dependent relaxation when compared to salbutamol. The relaxation response was significantly attenuated in the presence of NG-Nitro-L-arginine methyl ester (L-NAME), 1H-[1,2,4]oxadiazolo [4,3-a]quinoxalin-1-one (ODQ) and several K + channel blockers. The longevity effect induced by OCS02® CWE (5 mg/mL and above) was observed in C. elegans by at least 17%., Conclusions: These findings suggest that the airway relaxation mechanisms of OCS02® CWE involved cGMP-dependent and cGMP-independent nitric oxide signalling pathways. This study provides evidence that the cultivated strain of OCS02® exhibits airway relaxation effects which supports the traditional use of its wild O. sinensis in strengthening respiratory health., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Major society guidelines recommend transarterial chemoembolization (TACE) as the standard of care for intermediate-stage hepatocellular carcinoma (HCC) patients. However, predicting treatment response remains challenging., Aims: As artificial intelligence (AI) may predict therapeutic responses, this systematic review aims to assess the performance and effectiveness of radiomics and AI-based models in predicting TACE outcomes in patients with HCC., Methods: A systemic search was conducted on Medline and Embase databases from inception to 7th April 2024. Included studies generated a predictive model for TACE response and evaluated its performance by area under the curve (AUC), specificity, or sensitivity analysis. Systematic reviews, meta-analyses, case series and reports, pediatric, and animal studies were excluded. Secondary search of references of included articles ensured comprehensiveness., Results: 64 articles, with 13,412 TACE-treated patients, were included. AI in pre-treatment CT scans provided value in predicting the efficacy of TACE in HCC treatment. A positive association was observed for AI in pre-treatment MRI scans. Models incorporating radiomics had numerically better performance than those incorporating manual measured radiological variables. 39 studies demonstrated that combined predictive models had numerically better performance than models based solely on imaging or non-imaging features., Conclusion: A combined predictive model incorporating clinical features, laboratory investigations, and radiological characteristics may effectively predict response to TACE treatment for HCC., Competing Interests: Declarations. Conflict of interest: DQH served on the advisory board for Gilead and Roche. RK receives travel grants from Gilead and AbbVie. Ethical approval: The study was conducted in accordance with the Declaration of Helsinki. The study was exempt from IRB review was no confidential patient information was involved., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Epitranscriptomic modifications modulate diverse biological processes like regulation of gene expression, abundance, location and function. N6-methyladenosine (m 6 A) methylation has been shown to regulate various diseases, including cancer and inflammation. While there is evidence that m 6 A modification is functionally relevant in neural development and differentiation, the role of m 6 A modification in HIV neuropathogenesis is unknown., Methods: Here, we used anti-N6-methyladenosine (m 6 A) antibody immunoprecipitation and microarray profiling to identify m 6 A modifications in miRNAs in basal ganglia (BG) of Rhesus macaques (RMs) that were uninfected (VEH) and SIV-infected on combination anti-retroviral therapy (cART) and either VEH-treated (VEH/SIV/cART), or THC:CBD-treated (THC:CBD/SIV/cART). Ingenuity pathway analysis was conducted to understand the biological implications of miRNA m 6 A methylation in HIV neuropathogenesis. Finally, to understand the functional significance of m 6 A modifications in miRNAs, we overexpressed FAM-labeled wild-type or m 6 A-modified miR-194-5p in SCC-25 cells and determined its impact on the expression of its target, STAT1, an interferon-stimulated transcription factor known to drive persistent neuroinflammation in several neurodegenerative diseases., Results: HIV/SIV infection promoted an overall hypomethylated miRNA m 6 A profile. While the overall hypomethylated m 6 A profile was not significantly impacted by THC:CBD, specific miRNAs predicted to target proinflammatory genes showed markedly reduced m 6 A methylation levels compared to the VEH-treated RMs. Additionally, specific BG tissue miRNAs bearing m 6 A epi-transcriptomic marks were transferred and detected in BG-derived extracellular vesicles. Mechanistically, the DRACH motif in the seed region of miR-194-5p was significantly m 6 A hypomethylated in THC:CBD/SIV/cART RMs. In SCC-25 cells, unlike wild-type miR-194-5p, transfected m 6 A-modified miR-194-5p mimics failed to downregulate STAT1 protein expression. Further, compared to VEH/SIV/cART RMs, THC:CBD administration significantly reduced m 6 A methylation of 44 miRNAs directly involved in regulating CNS network genes., Conclusions: These results underscore the need for investigating the qualitative, and posttranscriptional modifications in RNA along with the more traditional, quantitative alterations in pathological conditions or in response to disease modifying treatments. Our findings indicate that m 6 A epitranscriptomic marks in the seed nucleotide region can impair miRNA function and that cannabinoids may preserve it by reducing m 6 A methylation levels. Finally, these findings provide a novel mechanistic (miRNA m 6 A hypomethylation) explanation underlying the anti-neuroinflammatory effects of phytocannabinoids in HIV/SIV infection.

Aim: The use of tobacco is responsible for many preventable diseases and deaths worldwide. Digital interventions have greatly improved patient health and clinical care and have proven to be effective for quitting smoking in the general population due to their flexibility and potential for personalization. However, there is limited evidence on the effectiveness of digital interventions for smoking cessation in Asian countries., Methods: Three major databases - Web of Science (WOS), Scopus, and PubMed - for relevant studies published between 1 January 2010 and 12 February 2023 were searched for studies evaluating the effectiveness of digital intervention for smoking cessation in Asian countries., Results: A total of 25 studies of varying designs were eligible for this study collectively involving a total of n  = 22,005 participants from 9 countries. Among different digital tools for smoking cessation, the highest abstinence rate (70%) was reported with cognitive behavioural theory (CBT)-based smoking cessation intervention via Facebook followed by smartphone app (60%), WhatsApp (59.9%), and Pharmacist counselling with Quit US smartphone app (58.4%). However, WhatsApp was preferred over Facebook intervention due to lower rates of relapse. WeChat was responsible for 15.6% and 41.8% 7-day point prevalence abstinence. For telephone/text messaging abstinence rate ranged from 8-44.3% and quit rates from 6.3% to 16.8%. Whereas, no significant impact of media/multimedia messages and web-based learning on smoking cessation was observed in this study., Conclusion: Based on the study findings the use of digital tools can be considered an alternative and cost-effective smoking cessation intervention as compared to traditional smoking cessation interventions.

Neuroblastoma (NB) is a significant pediatric cancer associated with high mortality rates, demanding innovative and appropriate approaches for its accurate detection. This paper described the design of a dual-target electrochemical aptasensor capable of simultaneously detecting neuroblastoma-associated microRNAs (miRNA-181 and miRNA-184) with exceptional sensitivity. Screen-printed carbon electrodes (SPCEs) were utilized with gold nanorods (AuNRs), and aptamers functionalized gold nanoparticles (AuNPs) to improve sensitivity, specificity, and portable detection ability. The detection method employed in this study includes differential pulse voltammetry (DPV) and cyclic voltammetry (CV). Our aptasensor exhibited remarkable limits of detections (LODs) of 5.10 aM for miRNA-181 and 9.39 aM for miRNA-184, respectively, along with a broad linear range spanning from 0.1 fM to 100 pM for both miRNAs. The practical significance of neuroblastoma diagnosis was shown through the validation of serum samples and comparison with quantitative polymerase chain reaction (qPCR). Our electrochemical aptasensor is user-friendly, easy to engineer, and offers a promising approach for accurately and selectively detecting important miRNA biomarkers in cancer screening and diagnosis, showing potential application in various clinical scenarios., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Cherie S. Tan reports financial support was provided by National Natural Science Foundation of China. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background and Aim: A critical causative factor of oxidative stress and inflammation leading to several skin complications is ultraviolet-B (UVB) irradiation. Lignosus rhinocerus (LR), or tiger milk mushroom, is native to Southeast Asia. Cold water extract of an LR cultivar, TM02® (xLr®) is a promising anti-oxidant and anti-inflammatory source. However, the effects of xLr® on UVB-induced photoaging have never been elucidated., Experimental Procedure: This study investigated the protective effects of xLr® and its high, medium, and low molecular weight (HLR, MLR, and LLR, respectively) fractions against UVB irradiation using in vivo Caenorhabditis elegans ( C. elegans ) model., Results and Conclusion: The investigation revealed a significant lifespan extension of xLr® and its fractions in UVB-irradiated C. elegans , which could be mediated by the regulation of genes associated with anti-oxidant ( daf-16 and sod-3 ) and apoptosis ( cep-1 , hus-1 , ced-13 , and egl-1 ) pathways. xLr® significantly reduced the ROS production in C. elegans and increased the DAF-16 nuclear translocation compared to untreated worms. Additionally, the SOD-3 expression was increased in the xLr®-treated worms. Hence, it suggests that the different components in xLr® work synergistically to protect against UVB irradiation. Our findings may be beneficial for the application of xLr® as a treatment against UVB-induced cellular damage and photoaging., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 Center for Food and Biomolecules, National Taiwan University. Production and hosting by Elsevier Taiwan LLC.)

Introduction: There is a lack of real-world evidence on direct comparisons between COVID-19 vaccines in multiethnic low- and middle-income settings. Cancer patients have an impaired vaccine response due to the disease itself or the effects of treatment. Hence, identifying the best vaccine to use for cancer patients is important. We aimed to compare the antibody response between cancer patients and healthy individuals following COVID-19 vaccination and assess seroconversion rates, vaccine efficacy, and the impact of sex on antibody response, as well as document adverse events in cancer patients., Materials and Methods: A prospective cohort study of cancer patients and healthy individuals receiving vaccines was conducted in Malaysia. All participants were aged 18 or above at recruitment and received at least two doses of vaccine. We excluded patients who had missing serum antibody data post-first dose and post-second dose. Sociodemographic and clinical data were collected at baseline, prior to vaccination. Data on self-reported breakthrough infection was collected at six months. Multivariable linear mixed-effects regression models were used to investigate the association between the type of vaccine and serum IgG titer., Results: A total of 389 patients with solid (n=276, 71.0%) or hematologic cancers (n=113, 29.0%) were included, along with 246 healthy individuals. Most cancer patients received BNT162b2 (n=358, 92.0%), followed by AZ1222 (n=19, 4.9%) and Coronavac (n=12, 3.1%). Most healthy individuals received BNT162b2 (n=151, 61.4%), followed by Coronavac (n=95, 38.6%). Vaccination, after adjustment for confounders (pre-vaccine infection, age, ethnicity, comorbidity, timepoint, income, cancer type, and booster), with Coronavac was associated with lower log IgG titer (-3.09 U/ml, 95% confidence interval=-4.37 to -1.80, p<0.01) than that of BNT162b2 in patients with cancer and also lower log IgG titer (-2.64 U/ml, 95% confidence interval=-2.97 to -2.30, p<0.01) than that of BNT162b2 in healthy individuals. No effect modification by sex was observed. Among the cancer cohort, 76 patients (19.5%) reported breakthrough infections after vaccination, while 33 (13.4%) participants in the healthy cohort reported breakthrough infections after vaccination. Coronavac was associated with greater odds of breakthrough infection among healthy individuals (odds ratio=7.34 compared to BNT162b2, confidence interval=1.40 to 33.49, p=0.02)., Conclusion: Vaccination with BNT162b2 yields higher IgG titer than Coronavac in all groups and fewer breakthrough infections in healthy subjects. The effect of vaccination is not modified by sex., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Medical Ethics Committee of Universiti Malaya Medical Centre issued approval 2021728-10423/NMRR-21-978-60010. The study was conducted in accordance with the Declaration of Helsinki. The approval number of the ASSeSS cohort is 2021728-10423. The approval number of the iRESPOND cohort is NMRR-21-978-60010. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: Roche Malaysia and Novartis Malaysia provided unrestricted educational grants to conduct the study. Roche Diagnostics (Malaysia) Sdn Bhd provided research materials to conduct the study. The ASSeSS Working Group was supported by ASEAN Science, Technology, and Innovation FUND (ASTIF) and Temasek Foundation. Financial relationships: Carla van Gils declare(s) a grant and non-financial support from Various Institutions/ Companies. Carla van Gils (CVG) receives research grants from Bayer and Hologic outside of the submitted work. Outside her academic work as a professor of clinical epidemiology of cancer, she is director of the Dutch Cancer Society. Nirmala Bhoo-Pathy declare(s) a grant, personal fees, non-financial support and receipt of research materials, travel support from Various Institutions/ Companies. Nirmala Bhoo-Pathy (NBP) reports receiving grants from Novartis, Pharmaceutical Association of Malaysia, Pfizer, Roche, Zuellig Pharma, Takeda and City Cancer Challenge Foundation, outside of the submitted work. NBP also reports receiving payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Novartis, Pfizer, Roche and Zuellig Pharma; received support for attending meetings or travel from Novartis, Roche, Takeda and the Pharmaceutical Association of Malaysia; reports participating on a Data Safety Monitoring Board or Advisory Board with Zuellig- Pharma, Malaysia; reports leadership or a fiduciary role in other board, society, committee, or advocacy groups, paid or unpaid with the National Cancer Society Malaysia, reports receipt of research materials from Roche Diagnostics, and reports serving as an editorial board member of eCancer and the Academic Editor of the PLOS Global Health journal, all outside of the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Song et al.)

Human papillomavirus (HPV) is a sexually transmitted virus, whose persistent infection is the main reason for invasive cervical cancer (ICC), which is the fourth most common type of cancer in women, with more than 500 000 new cases every year. After infection, various alterations occur in the host, facilitating the virus's evasion of immune system clearance and promoting its proliferation. Oral probiotic consumption can influence the whole body's immunity, inflammatory reflection, neural, endocrine humoral, metabolic pathways and other organs by adjusting the components of gut microbiota (GM). Some evidence shows there is a tight connection between GM and vaginal microbiota (VM), which is referred to as the gut-vaginal axis. This review investigates the potential role of probiotics in clearing HPV via the gut-vagina axis, emphasizing the effectiveness of Lactobacillus in preventing vaginal diseases and suggesting its potential for HPV clearance. Understanding the role of probiotics in the gut-vagina axis could pave the way for new strategies to reduce and eliminate HPV and related diseases., (© 2024 International Federation of Gynecology and Obstetrics.)

Over the past decade, there has been extensive work in developing integrated silicon photonics (SiPh) gratings for the optical addressing of trapped ion qubits among the ion trap quantum computing community. However, when viewing beam profiles from gratings using infrared (IR) cameras, it is often difficult to determine the corresponding heights where the beam profiles are located. In this work, we developed transformer models to recognize the corresponding height categories of beam profiles in light from SiPh gratings. The models are trained using two techniques: (1) input patches and (2) input sequence. For the model trained with input patches, the model achieved a recognition accuracy of 0.924. Meanwhile, the model trained with input sequence shows a lower accuracy of 0.892. However, when repeating the model training for 150 cycles, a model trained with input patches shows inconsistent accuracy ranges between 0.289 to 0.959, while the model trained with input sequence shows accuracy values between 0.75 to 0.947. The obtained outcomes can be expanded to various applications, including auto-focusing of light beams and auto-adjustment of the z-axis stage to acquire desired beam profiles.

Modern medicines often follow a "single-compound, single-target" paradigm, which may not be effective against complex diseases with multifactorial causes. Medicinal plants, such as Orthosiphon stamineus-widely used in Southeast Asia for its significant vasodilatory and antihypertensive properties-offer an alternative. These effects are largely attributed to the synergistic actions of sinensetin, eupatorin, and 3'-hydroxy-5,6,7,4'- tetramethoxyflavone (TMF). The present study was designed to explore the interactions among these compounds and their collective impact on vasodilation. The current investigation utilized in vitro aortic ring assays and an orthogonal stimulus-response compatibility approach to unveil the synergistic interactions of sinensetin, eupatorin, and TMF in specific combination ratios within compatibility groups. The current results showed that G2, G7, G27, and G28 achieved vasodilatory efficacies exceeding 100%, with recorded efficacies of 190%, 148%, 117.6%, and 116.25%, respectively. Conversely, formulation F1 exhibited only additive effects with an efficacy of 88.02%. The dose-response study revealed G28 exhibited the strongest concentration-dependent vasodilatory responses, with a maximum response (R MAX ) of 119.05 ± 3.29% and an EC 50 of 6.78 ± 0.70 µg/mL. Conversely, G2, despite showing the highest efficacy in the orthogonal stimulus-response compatibility study, demonstrated a lower vasodilatory effect, with R MAX R and EC 50 recorded at 85.78 ± 12.67% and 15.32 ± 3.07 µg/mL, respectively. These findings highlight the complexities of compound interactions in plants and underscore the potential of botanical medicines as comprehensive healthcare solutions for multifactorial diseases., (© 2024. The Author(s), under exclusive licence to The Japanese Society of Hypertension.)

Background: A multidisciplinary care model involving the interventional radiologist, vascular surgeon, interventional nephrologist, renal advanced nurse practitioner, and renal coordinators was implemented to improve the care for the patient admitted with dysfunctional hemodialysis access. This study aims to evaluate the effectiveness and sustainability of this multidisciplinary care model., Method: A dedicated interventional nephrology suite was established to perform endovascular procedures for patients admitted with hemodialysis access dysfunction via the emergency department of the hospital. We retrospectively collected data from electronic medical records 1-year before and after the implementation (April 2015). Outcome measures include waiting time for intervention, length of stays (LOS), number of dialysis catheter insertions before the intervention, number of inpatient dialysis required, and success rates of the interventions. The waiting time for intervention and LOS was tracked over the next 3 years to determine the sustainability of the care model., Results: Eight hundred eighty-one endovascular interventions (314 angioplasties, 567 thrombolysis) were performed on 554 patients. Post-implementation, a greater proportion of intervention was performed within 24 h (238 (50.2%) vs 70 (17.2%), p  < 0.001) with lesser proportion of patients requiring bridging hemodialysis via temporary catheter, 156 (32.9%) versus 215 (52.8%), p  < 0.001. A shorter median LOS and days-to-intervention were reported, 3 (IQR 2-6) versus 5 days (IQR 3-8), p  < 0.001 and 1 (IQR 1-2) versus 3 days (IQR 2-4), p  < 0.001 respectively. Less hemodialysis session/patient required, 2 (IQR 1-3) versus 3 (IQR 2-4), p  < 0.001. The procedural success rate was greater, 440 (92.8%) versus 355 (87.2%), p  = 0.020. Three years following implementation, the proportion of patients who received intervention within 24 h and were discharged within 48 h was reported to be persistently greater, 43% versus 13%, p  < 0.001, and 27% versus 6%, p  < 0.001 respectively., Discussion: This multi-disciplinary collaboration demonstrated a sustainable care model in improving the delivery of healthcare services for patients with dysfunctional hemodialysis access., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: This study aims to evaluate the safety and efficacy of a short-term, low dose, weight-based subcutaneous enoxaparin protocol (SEP) in maintaining the patency of arteriovenous (AV) access with recurrent thrombosis., Methods: Prospective follow-up of 25 patients who presented to a tertiary institution with recurrent AV access thrombosis and treated with anticoagulation according to SEP following successful thrombectomy. Patency and safety outcomes of SEP were studied., Results: The participants were 66.4 ± 10.2 years old and predominantly male (60%) and of Chinese ethnicity (72%). The AV accesses had a median age of 1.4 (0.6, 5.6) years with 60% being non-autogenous arteriovenous access while 40% were autogenous arteriovenous access. Thrombolytic agents (urokinase (72%) or alteplase (28%)) were used in all procedures while adjunct thrombectomy device was used in only four procedures. The mean dose of enoxaparin was 36.0 ± 8.2 mg or 0.64 ± 0.1 mg/kg/day for a mean duration 30.0 days (Interquartile range: 27.5, 31.0). One patient developed minor bleeding episode. Kaplan-Meier analysis demonstrated that the mean thrombosis-free survival pre- versus post-SEP adoption was 27.3 (95% CI 17.9-36.7) versus 183.5 (95% CI 100.1-266.9) days ( p  < 0.001). After adjusting for the type of thrombolytic agent, use of adjunct thrombectomy device, cutting balloon, drug-coated balloon, and stent graft, SEP remained a significant factor associated with longer thrombosis-free patency (HR 0.166: 95% CI 0.070-0.392, p  < 0.001)., Discussion: SEP appears to be a feasible and safe thromboprophylaxis method to improve thrombosis-free patency for AV access with recurrent thrombosis., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Preventive strategies for cytomegalovirus (CMV) in the posttransplant period have changed the pattern of CMV infections, now more commonly manifesting as late-onset occurrences known as post-prophylaxis delayed-onset CMV disease (PPDOC). We conducted a survey to investigate provider practices in managing PPDOC., Methods: A web-based provider survey on the management of PPDOC was developed using Research Electronic Data Capture (REDCap). It was distributed to the online forums of the American Society of Transplantation communities of practice (COP) for Infectious Diseases (IDCOP), Kidney and Pancreas (KPCOP), Liver and Intestinal (LICOP), and Thoracic and Critical Care (TCCOP). The survey was posted twice within a span of a month., Results: Fifty-six respondents, comprising 50 (89%) transplant physicians and 6 (11%) transplant pharmacists, from 46 distinct transplant centers, completed the survey. Universal antiviral prophylaxis (UAP) was the predominant preventive approach for both high-risk (85%) and moderate-risk (85%) transplant recipients. Out of 56, 51 respondents completed the questions regarding management of PPDOC. Regular surveillance with nucleic acid amplification tests (NAAT) (88%) was the most commonly used approach in high-risk recipients, while symptom monitoring (73%) was the most common strategy in moderate-risk recipients. Immunologic monitoring was used only by a few respondents who found it moderately useful in high-risk recipients., Conclusion: Management of PPDOC was highly variable among providers and strategies differed based on patient risk profile. These findings could help shape future studies and guidelines to harmonize CMV management., (© 2024 The Author(s). Clinical Transplantation published by John Wiley & Sons Ltd.)

Filial piety and perfectionism are associated with life satisfaction and are influenced by family values. This study examined the roles of filial piety beliefs and perfectionism in life satisfaction among 379 young adults aged 18 to 25 in Malaysia ( n  = 199) and the United Kingdom ( n  = 180). In both samples, reciprocal and authoritarian filial piety beliefs showed positive correlations with life satisfaction, while maladaptive perfectionism correlated negatively with life satisfaction. There was a positive correlation between adaptive perfectionism and life satisfaction only in the Malaysian sample. In both samples, adaptive and maladaptive perfectionism mediated the relationship between reciprocal filial piety and life satisfaction, but in opposite directions. That is, higher reciprocal filial piety was related to higher adaptive perfectionism and greater life satisfaction; higher reciprocal filial piety was also related to lower maladaptive perfectionism and better life satisfaction. Furthermore, maladaptive perfectionism mediated the relationship between authoritarian filial piety and life satisfaction in both samples; higher authoritarian filial piety was related to higher maladaptive perfectionism and reduced life satisfaction. However, specifically in the Malaysian sample, higher authoritarian filial piety predicted greater adaptive and maladaptive perfectionism. Findings highlight the importance of considering traditional family values, individual differences, and their interaction when evaluating subjective wellbeing.

Background and Aims: Chronic liver disease is a known risk factor for cholangiocarcinoma (CCA), but the proportion of people with CCA who have concurrent chronic liver disease is unclear. We aimed to evaluate the prevalence of chronic liver diseases in people with CCA., Methods: In this single-arm meta-analysis, we searched MEDLINE and EMBASE from inception to August 10, 2024, for articles in English containing data for CCA with and without chronic liver diseases. Data were pooled to obtain the prevalence of different chronic liver diseases, with further stratification by geographical location and tumor location., Results: In total, 118,068 individuals diagnosed with CCA were included, of whom 16,771 had chronic liver diseases. A pooled analysis of 109 studies determined that the prevalence of chronic liver disease was 25.23% (95% confidence interval [CI], 20.82%-30.23%; I 2  = 99.0%), and 10.21% (7.75%-13.35%; I 2  = 98.6%) of CCA patients had cirrhosis. Chronic liver diseases were associated more with intrahepatic CCAs, compared with extrahepatic CCAs (relative risk, 2.46; 95% CI, 2.37-2.55; P < .0001). This was observed across all etiologies of liver disease, except for primary sclerosing cholangitis, which was associated with extrahepatic CCAs (relative risk, 0.49; 95% CI, 0.43-0.57; P < .0001)., Conclusions: Around 1 in 4 people with CCA have chronic liver diseases, and 1 in 10 have cirrhosis., (Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Background: Literature indicates that L-carnosine may be deficient in autism spectrum disorder (ASD) children. The aim of the present study was to estimate the level of L-carnosine in plasma and correlate it with the Autism Treatment Evaluation Checklist (ATEC) and Childhood Autism Rating Scale 2nd Edition, Standard Version (CARS2-ST) scores. To measure L-carnosine level, a bio-analytical method was developed using reverse phase high- liquid chromatography and validated as per International Conference on Harmonization guidelines., Method: Children were supplemented with L-carnosine (10-15 mg/kg) along with standard care therapies for 2 months. Before and after supplementation, scores on the ATEC, CARS2-ST, BEARS sleep screening tool, 6-item Gastrointestinal Severity Index, and Parental Stress Scale were evaluated, and L-carnosine was measured at the end of the trial., Results: The calibration curve was linear in the range of 100-600 ng/mL (R 2 = 0.998). The level of L-carnosine quantified was 33.7 ± 0.2 ng/mL. There was no significant difference found in any of the outcome measures ( p > 0.05)., Conclusions: Despite the fact that L-carnosine is detectable in the blood, it was found to be ineffective in the management of ASD in children., Clinical Trial Registration: The study was registered in the Clinical Trial Registry-India, registration number: CTRI/2019/07/020102., (© 2024 The Author(s). Published by IMR Press.)

Background: Published studies have suggested a link between chronic kidney disease (CKD) and sleep disorders, although the exact nature of this association has not been uniformly described. Clarifying this relationship may facilitate evidence-based interventions that address the interplay between these disease entities. Such interventions could prevent obstructive sleep apnea (OSA) from worsening CKD and improve the quality of life for CKD patients by reducing the risk of developing OSA. Therefore, the objective of this meta-analysis is to assess the bidirectional association between sleep disorders and CKD., Methods: Following a PROSPERO-registered protocol, three blinded reviewers conducted a systematic review of the Medline/PubMed, Embase, Cochrane Library and Cumulative Index of Nursing and Allied Health (CINAHL) databases for observational studies pertaining to the relationship between sleep disorders and CKD. A meta-analysis was conducted in risk ratios (RRs)., Results: From 63 studies (26 777 524 patients), OSA [RR 1.68; 95% confidence interval (CI) 1.45 to 1.93], albuminuria (RR 1.54; 95% CI 1.18 to 1.99), restless leg syndrome (RLS) (RR 1.88; 95% CI 1.48 to 2.38) and insomnia (RR 1.24; 95% CI 1.01 to 1.54) were significantly associated with CKD. There was a significant association between OSA (RR 1.77; 95% CI 1.56 to 2.01) with incident CKD. There was a significant association of OSA (RR 1.74; 95% CI 1.55 to 1.96), RLS (RR 1.73; 95% CI 1.32 to 2.25) and insomnia (RR 1.14; 95% CI 1.03 to 1.27) in patients with CKD compared with healthy controls. CKD was also significantly associated with incident OSA (RR 1.60; 95% CI 1.35 to 1.89)., Conclusion: The bidirectional associations of obstructive sleep apnea with CKD remained consistent across different stages of CKD, modes of diagnosis of sleep disorder and geographical region. A bidirectional association was observed between CKD and obstructive sleep apnea, RLS and insomnia. The treatment of sleep disorders may reduce the risk of CKD, and vice versa., Competing Interests: The authors declare no conflicts of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.)

Background: Increasing physical inactivity is a primary risk factor for diabetes and hypertension, contributing to rising health care expenditure and productivity losses. As Singapore's aging population grows, there is an increased disease burden on Singapore's health systems. Large-scale physical activity interventions could potentially reduce the disease burden but face challenges with the uncertainty of long-term health impact and high implementation costs, hindering their adoption., Objective: We examined the cost-effectiveness of the Singapore National Steps Challenge (NSC), an annual nationwide mobile health (mHealth) intervention to increase physical activity, from both the health care provider perspective, which only considers the direct costs, and the societal perspective, which considers both the direct and indirect costs., Methods: We used a Markov model to assess the long-term impact of increased physical activity from the NSC on adults aged 17 years and older. A Monte Carlo simulation with 1000 samples was conducted to compare two situations: the NSC conducted yearly for 10 years against a no-intervention situation with no NSC. The model projected inpatient and outpatient costs and mortality arising from diabetes and hypertension, as well as their complications. Health outcomes were expressed in terms of the quality-adjusted life-years (QALYs) gained. All future costs and QALYs were discounted at 3% per annum. Sensitivity analyses were done to test the robustness of our model results., Results: We estimated that conducting the NSC yearly for 10 years with a mean cohort size of 654,500 participants was projected to prevent 6200 diabetes cases (95% credible interval 3700 to 9100), 10,500 hypertension cases (95% credible interval 6550 to 15,200), and 4930 deaths (95% credible interval 3260 to 6930). This led to a reduction in health care costs of SGD (Singapore dollar) 448 million (95% credible interval SGD 132 million to SGD 1.09 billion; SGD 1=US $0.73 for the year 2019). There would be 78,800 (95% credible interval 55,700 to 102,000) QALYs gained. Using a willingness-to-pay threshold of SGD 10,000 per QALY gained, the NSC would be cost-saving. When indirect costs were included, the NSC was estimated to reduce societal costs by SGD 1.41 billion (95% credible interval SGD 353 million to SGD 3.80 billion). The model was most sensitive to changes in the inpatient cost of treatment for diabetes complications, time horizon, and program compliance., Conclusions: In this modeling study, increasing physical activity by conducting a yearly nationwide physical activity intervention was cost-saving, preventing diabetes and hypertension and reducing mortality from these diseases. Our results provide important information for decision-making in countries that may consider introducing similar large-scale physical activity programs., (© Gregory Ang, Chuen Seng Tan, Yot Teerawattananon, Falk Müller-Riemenschneider, Cynthia Chen. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org).)

Background: Physical activity (PA), sedentary behavior (SB), and sleep are collectively referred to as 24-h movement behaviors, which may be linked to cognitive development in children. However, most of the evidence was based on cross-sectional studies and/or solely relied on parent-reported information on children's behaviors, and it remains uncertain whether all domains/contexts of PA and SB are similarly associated with executive function and academic achievement., Objective: We investigated the prospective associations of accelerometer-measured 24 h-movement behaviors and domain-specific PA and SB with executive function and academic achievement among school-aged children in Singapore., Methods: The Growing Up in Singapore Toward healthy Outcomes (GUSTO) cohort used a wrist-worn accelerometer (Actigraph-GT3x+) to measure 24 h-movement behaviors data at ages 5.5 and 8 years. Executive function and academic achievement were assessed using NEuroPSYchology (NEPSY) and Wechsler Individual Achievement Tests at ages 8.5 and 9-years, respectively. Compositional data analyses were conducted to explore the associations of 24 h-movement behavior with outcomes, and multiple linear regression models to examine the associations of domain-specific PA and SB with outcomes ( n  = 432)., Results: Among 432 children whose parents agreed to cognitive assessments (47% girls and 58% Chinese), the composition of 24 h-movement behaviors at ages 5.5 and 8 years was not associated with executive function and academic achievement. However, higher moderate-to-vigorous PA (MVPA) relative to remaining movement behaviors at age 5.5 years was associated with lower academic achievement [Mean difference (95% confidence interval): -0.367 (-0.726, -0.009) z-score], and reallocating MVPA time to sleep showed higher academic achievement scores [30 min from MVPA to sleep: 0.214 (0.023, 0.404) z-score]. Certain domains of PA and SB, notably organized PA/sports, outdoor play, and reading books were favorably associated with outcomes of interest, while indoor play and screen-viewing were unfavorably associated., Conclusion: The associations between movement behaviors and cognitive outcomes are multifaceted, influenced by specific domains of PA and SB. This study underscores the importance of participation in organized PA/sports, outdoor active play, and reading books, while ensuring adequate sleep and limiting screen viewing, to enhance cognitive outcomes. These findings underscore the need for further research into time-use trade-offs. Such studies could have major implications for revising current guidelines or strategies aimed at promoting healthier 24 h-movement behaviors in children., Study Registration: https://clinicaltrials.gov/, NCT01174875., Competing Interests: KMG receiving reimbursement for speaking at conferences sponsored by companies selling nutritional products. KMG and S-YC report being part of an academic consortium that has received research funding from Abbott Nutrition, Nestle and Danone. No other disclosures were reported. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Padmapriya, Bernard, Tan, Chu, Goh, Tan, Shek, Chong, Tan, Chan, Yap, Godfrey, Lee, Meaney, Eriksson, Tan, Law and Müller-Riemenschneider.)

Hesperetin is one of the prominent flavonoids found in citrus fruit. Several research studies have reported that hesperetin can promote vasodilation in vascular tissue by increasing the level of nitric oxide and cyclic nucleotides. However, these may not be the only pathway for hesperetin to exert its vasodilatory effect. In addition to vasodilation, hesperetin has been found to carry an antihypertensive effect through intraperitoneal injection, although no study has comprehensively investigated the antihypertensive effect of hesperetin through oral administration. Therefore, this study aimed to determine the possible mechanism pathways involved in hesperetin-induced vasodilation and investigated its antihypertensive effects on hypertensive rats' model via oral administration. The ex vivo experimental findings showed that the NO/sGC/cGMP signalling pathway was involved in hesperetin-mediated vasodilation. Moreover, hesperetin activated the AC/cAMP/PKA pathway through PGI 2 and activated the β 2 -adrenergic receptor. Hesperetin can act as a voltage-gated potassium channel (K V ) and ATP-sensitive potassium channel (K ATP ) opener. The intracellular calcium in vascular smooth muscle was reduced by hesperetin through blocking the voltage-operated calcium channels (VOCC) and inositol triphosphate receptor (IP 3 R). In the in vivo assessment, hesperetin shows a significant decrease in Spontaneously Hypertensive rats' blood pressure following 21 days of oral treatment. The sub-chronic toxicity assessment demonstrated that hesperetin exhibited no deleterious effects on the body weights, clinical biochemistry and haematological profile of Sprague-Dawley rats. This study implies that hesperetin holds promise as a potential medication for hypertension treatment, devoid of undesirable side effects., (© 2024. The Author(s), under exclusive licence to The Japanese Society of Hypertension.)

In this study, a simplified transformer model is used to perform next-value prediction on light coupled out from silicon photonics gratings to free space. Finite-difference time-domain (FDTD) simulation is performed to simulate the electric field (E-field) in laser light coupled from gratings with pitches of 0.6, 0.8, 1.0, 1.2, 1.4 and 1.6 µm, to free-space. Only E-field distribution from 0.6 µm is used in model training, and the trained transformer model is used to predict the E-field from the rest of the gratings. Prediction of accuracy up to 92.5% is obtained. The time taken for model training is 1908.4 seconds, which is significantly shorter than the conventional three-dimensional FDTD simulation that takes up to several hours. To further reduce the training time, transformer models can be trained with stepped datasets, but with compromised prediction accuracies. In summary, we demonstrated that the transformer model can be used to perform next-value E-field prediction using minimal training data. The developed and trained transformer model can be integrated to the state-of-the-art FDTD software to further expedite the existing FDTD simulation.

Mechanical forces induced by high-speed oscillations provide an elegant way to dynamically alter the fundamental properties of materials such as refractive index, absorption coefficient and gain dynamics. Although the precise control of mechanical oscillation has been well developed in the past decades, the notion of dynamic mechanical forces has not been harnessed for developing tunable lasers. Here we demonstrate actively tunable mid-infrared laser action in group-IV nanomechanical oscillators with a compact form factor. A suspended GeSn cantilever nanobeam on a Si substrate is resonantly driven by radio-frequency waves. Electrically controlled mechanical oscillation induces elastic strain that periodically varies with time in the GeSn nanobeam, enabling actively tunable lasing emission at >2 μm wavelengths. By utilizing mechanical resonances in the radio frequency as a driving mechanism, this work presents wide-range mid-infrared tunable lasers with ultralow tuning power consumption., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

This study aimed to document the safety and efficacy of a single infusion of autologous umbilical cord blood (UCB) in 20 autistic children aged 24-72 months. A pre-post treatment within-subjects open label design was used. At T = 0, 6, 12, and 18 months, participants underwent detailed and structured safety evaluations (via caregiver report), Vineland Adaptive Behavior Scale (Vineland-3), Stanford Binet Intelligence Scale (SB-5), Expressive One-Word Picture Vocabulary Test, Brief Observation of Social Communication Change (BOSCC), Pervasive Developmental Disorder-Behavior Inventory, Repetitive Behavior Scale-Revised, Sensory Experience Questionnaire (SEQ-2.1), Child Behavior Checklist, Clinical Global Impression-Severity and Improvement (CGI-I) Scales, and eye-gaze tracking. UCB infusion was conducted at T = 6 months, hence, 0-6 months was the control period, and 6-18 months the follow-up period. Of 20 children recruited, 19 completed the study and 1 was withdrawn due to UCB not meeting quality control criteria for infusion. There were 15 males and 4 females with an overall mean (SD) age of 4.15 (0.62) years. Mean (SD) cell dose administered was 38.16 (9.82) million cells/kg. None suffered serious adverse events although there were mild behavioral side effects and one unit grew coagulase negative staphylococcus from a post-thaw sample. There were no significant differences in Vineland-3, SB-5, BOSCC, and SEQ-2.1 scores at T = 12 and T = 18 months. Twelve participants had T = 18 CGI-I scores of 2-3 (minimally to much improved), seven participants had scores of 4 (no change). Autologous UCB infusion in autistic children is generally safe but not without risks, including that of infection. In this within-subjects study, some children showed global symptom improvements while others showed no change. Stem cell therapies for autism should only be conducted under strict clinical trial conditions with clear risk discussions., (© 2024 International Society for Autism Research and Wiley Periodicals LLC.)

Introduction: Singapore phased in standardized tobacco packaging on 1 July 2020 following a three-month grace period. This pre-post study evaluated its impacts on smoking-related behaviors and perceptions among adults who currently smoke., Methods: Baseline and follow-up data were collected in a pre- and post-questionnaire from a cohort of 1873 Singaporean adults who were currently smoking at baseline. Baseline data were collected from December 2019 to May 2020, and follow-up data from July 2021 to September 2021. We used descriptive statistics and bivariate analyses to assess pre-post changes (Bhapkar's test, Wilcoxon signed rank test) and to identify characteristics of participants who had quit or cut down smoking at follow-up (Pearson's chi-squared, Fisher's exact test)., Results: At follow-up, 11.7% (n=220) had quit smoking. There was a higher proportion of those smoking non-daily (pre: 13.1%, post: 16.9%; p<0.001), and those intending to quit within the next year (pre: 14.8%, post: 17.5%; p<0.05) or six months (pre: 10.4%, post: 13.2%; p<0.01). Tobacco products were scored more negatively in relation to packaging, quality, satisfaction, value for money and overall appeal (scores pre: 15.9, post: 14.3; p<0.001), harmfulness (scores pre: 0.61, post: 0.54; p<0.05), noticing others smoking the same brand (scores pre: 1.92, post: 1.65; p<0.001), and considering quitting due to health warnings (scores pre: 0.81, post: 0.86, p<0.05). Fewer reported that some cigarette brands have higher prestige (pre: 58.0, post: 54.3%; p<0.01), and more reported using flavored cigarettes (pre: 42.2%, post: 60.1%; p<0.001) and e-cigarettes (pre: 4.2%, post: 6.1%; p<0.01)., Conclusions: In Singapore, the changes observed before and after the implementation of standardized packaging suggest that it might be associated with quit-related outcomes, reduced tobacco product appeal, and increased effectiveness of graphic health warnings., Competing Interests: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors declare that they have no competing interests, financial or otherwise, related to the current work. Y. van der Eijk reports that since the initial planning of the work this research was supported by the Singapore Ministry of Health and Payment were made to the School of Public Health to cover data collection and recruitment costs and by the Singapore Ministry of Education (Grant A-0002078-00-00) to cover the publication fee. She also reports that in the past 36 months, she received Research grant from the Singapore Ministry of Health (A-8001107-00-00), the Singapore Social Sciences Research Council (A-8001438-00-00) and the Singapore Ministry of Education (A-8000238-00-00)., (© 2024 Ng L. et al.)

Background and Hypothesis: Published literature suggests that sleep duration and quality may be affected in adults with chronic kidney disease. However, the relationship between these two entities remains a matter of debate. The objective of this systematic review and meta-analysis is to assess the effect of sleep duration and quality on chronic kidney disease., Methods: A systematic review of the Medline/PubMed, Embase, Cochrane Library, and CINAHL databases was conducted for articles pertaining to the association between sleep duration and quality on chronic kidney disease. The main outcome was the hazard/risk ratio of chronic kidney disease in patients of varying sleep durations and quality., Results: In total, 42 studies (2 613 971 patients) with a mean age of 43.55 ± 14.01 years were included in the meta-analysis. Compared with a reference range of 7 to 8 hours of sleep, short sleep durations of ≤4 hours (RR 1.41, 95% CI: 1.16 to 1.71, P  < 0.01), ≤5 hours (RR 1.46, 95% CI: 1.22 to 1.76, P  < 0.01), ≤6 hours (RR 1.18, 95% CI: 1.09 to 1.29, P  < 0.01), and ≤7 hours (RR 1.19, 95% CI: 1.12 to 1.28, P  < 0.01) were significantly associated with an increased risk of incident chronic kidney disease. Long sleep durations of ≥8 hours (RR 1.15, 95% CI: 1.03 to 1.28, P  < 0.01) and ≥9 hours (RR 1.46, 95% CI: 1.28 to 1.68, P  < 0.01) were also significantly associated with an increased risk of incident chronic kidney disease. Meta-regression did not find any significant effect of age, gender, geographical region, and BMI and an association with sleep duration and risk of incident chronic kidney disease., Conclusion: Both short and long sleep durations were significantly associated with a higher risk of chronic kidney disease. Interventions targeted toward achieving an optimal duration of sleep may reduce the risk of incident chronic kidney disease., Competing Interests: The authors declare no conflicts of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.)