In contemporary practice, elevated 24-hour urinary copper excretion (24-h UCE) often triggers referral for suspected Wilson disease (WD). In this hypercupriuric referral setting, interpretation of 24-h UCE may be distorted by spectrum effects. In this study, we aimed to compare conventional copper biomarkers in hypercupriuric referrals and evaluate whether a Leipzig-aligned ceruloplasmin (Cp) framework could provide a clinically useful triage approach.

We retrospectively studied consecutive, untreated patients evaluated for suspected WD with hypercupriuria between February 2017 and February 2025. The final diagnosis was established using a prespecified Leipzig-based algorithm, with ATP7B testing when indicated. Diagnostic performance of Cp and 24-h UCE was compared. A prespecified Cp three-zone framework was evaluated using <0.10 g/L, 0.10–0.20 g/L, and >0.20 g/L as high-probability, indeterminate, and low-probability zones, respectively.

Among 541 untreated hypercupriuric patients, 65 had WD and 476 had adjudicated non-WD liver disease. Cp outperformed 24-h UCE for diagnosing WD (AUROC, 0.988 vs. 0.762). The optimal Cp cutoff was 0.15 g/L, with 90.8% sensitivity and 97.7% specificity. Cp < 0.10 g/L defined a high-probability zone with 98.0% WD prevalence, whereas Cp > 0.20 g/L defined a low-probability zone with 0.5% WD prevalence. Among non-WD controls, higher urinary copper was independently associated with higher bilirubin, prolonged international normalized ratio, and lower albumin.

In hypercupriuric referrals for suspected WD, Cp retained strong diagnostic performance and outperformed 24-h UCE. A Leipzig-aligned Cp three-zone framework may support probability-based triage in contemporary referral practice.

Nitric oxide (NO) is a crucial regulator of hepatic and systemic vascular tone. Abnormal distribution of NO in various anatomical locations is a pathogenetic characteristic of portal hypertension. Under normal portal pressure conditions, liver sinusoidal endothelial cells produce NO, which promotes both vasodilation and hepatic stellate cell relaxation. In portal hypertension, endothelial dysfunction, imbalance of asymmetric dimethylarginine levels, and production of superoxide result in impaired intrahepatic NO availability, leading to activation and contraction of hepatic stellate cells and worsening portal hypertension. Excess extrahepatic NO levels in the splanchnic vasculature result in systemic vasodilation, hyperdynamic circulation, and collateral vascular formation, worsening portal pressure. Abnormal clearance and production of NO can lead to extrahepatic complications, including hepatorenal syndrome and hepatopulmonary syndrome. Therapies including statins, phosphodiesterase-5 inhibitors, and midodrine have been developed to restore NO homeostasis but have achieved only partial success in modulating NO production, bioavailability, and distribution. The aim of this review is to update the understanding of the mechanisms and effects of NO dysregulation in cirrhosis as they relate to current and future therapeutic options.

Bladder cancer (BC) remains a major public health concern in China, but comprehensive and up-to-date assessments of its burden and temporal patterns remain limited. This study aimed to systematically evaluate the current burden, temporal trends, and future projections of BC in China using data from the Global Burden of Disease Study 2023.

Data on BC incidence, mortality, disability-adjusted life years, and risk-attributable mortality in China from 1990 to 2023 were extracted from the Global Burden of Disease Study 2023. Temporal trends were assessed using Joinpoint regression, with a maximum of six joinpoints allowed, to estimate annual percentage changes and average annual percentage changes. Age-period-cohort models based on log-linear Poisson regression were used to examine age, period, and cohort effects. Bayesian age-period-cohort models were then applied to project incidence and mortality rates to 2030 while accounting for age-period-cohort effects and demographic changes.

From 1990 to 2023, crude incidence, mortality, and disability-adjusted life year rates increased, whereas age-standardized rates generally declined (average annual percentage changes = −0.32%, −1.31%, and −1.62%, respectively). In 2023, an estimated 38.06% and 10.37% of bladder cancer deaths were attributable to smoking and high fasting plasma glucose, respectively. Recent upward trends were nevertheless observed across all three indicators, particularly for incidence and mortality during 2020–2023 (annual percentage changes = 5.05% and 4.39%, respectively). Local drifts were negative in most age groups but approached or exceeded zero in the oldest groups. The incidence local drift was 0.35% (95% confidence interval [CI]: −0.07%, 0.78%) in the 85–89-year age group and 0.64% (95% CI: −0.31%, 1.61%) in the 90–94-year age group, whereas the corresponding mortality local drifts were −0.70% (95% CI: −0.97%, −0.43%) and −0.18% (95% CI: −0.72%, 0.36%), respectively. Compared with the reference period (2004–2008), the relative risks for incidence and mortality in 2019–2023 were 0.95 (95% CI: 0.91–0.98) and 0.75 (95% CI: 0.71–0.78), respectively. Compared with the reference cohort (1951–1956), earlier birth cohorts had elevated risks; in the 1901–1906 cohort, the relative risks were 1.13 (95% CI: 0.82, 1.57) for incidence and 2.10 (95% CI: 1.75, 2.52) for mortality. During 2024–2030, both crude incidence and crude mortality rates were projected to increase further.

Despite long-term declines in age-standardized rates, BC remains a substantial burden in China, and recent upward trends warrant attention. These findings support targeted primary prevention and risk-stratified early-detection strategies for high-risk populations.

Non-motor symptoms of Parkinson’s disease, including sleep disturbance, cognitive impairment, depression, and anxiety, are common and often undertreated, yet their responsiveness to mind-body exercises remains unclear. This scoping review evaluated the currently available evidence on the effects of Tai Chi and Qigong interventions on non-motor symptoms in patients with Parkinson’s disease.

We searched six databases (PubMed, Google Scholar, EMBASE, CINAHL, Web of Science, and PEDro) through February 28, 2026, for randomized controlled trials (RCTs). We included English-language RCTs that evaluated the effects of Qigong and Tai Chi interventions on non-motor outcomes in Parkinson’s disease and excluded non-RCTs, review articles, and protocol articles. We were predominantly interested in the following non-motor outcome measures: cognition, depression, anxiety, fatigue, and sleep quality.

This review identified 18 RCTs that met the inclusion criteria, including nine Tai Chi studies and nine Qigong studies. Most of the reviewed studies were of high quality according to the PEDro scale, but the small sample sizes limited our analysis to identifying trends in outcomes. A strong trend toward a beneficial effect was found for sleep quality and cognition, a moderate trend toward improvement was found in depression, anxiety and quality of life, and weak or unclear effects were found for other non-motor symptoms such as fatigue. Several studies also had high dropout rates.

Although these studies suggest that Tai Chi and Qigong may improve sleep quality and cognition, the evidence supporting their benefits in alleviating other non-motor symptoms is generally weak, primarily because of small sample sizes. The heterogeneity in methodologies across the reviewed studies and high dropout rates in some studies are significant limitations of previous RCTs.