Analysis of dietary patterns on cardiovascular risks in children: from a cross-sectional and a longitudinal study.

OBJECTIVES: Diet is one of the main risk factors for cardiovascular disease (CVD), while the evidence about the relationship between dietary pattern (DP) and CVD in children is scarce. This study aims to explore the association between DP and CVD risk in children. STUDY DESIGN: This was a cross-sectional and longitudinal study. METHODS: This research was conducted among 4351 children aged 6-12 years old in 2014, then the subgroup children in 2014 were followed up in 2019. Dietary intakes were assessed using a food frequency questionnaire. DP was clustered based on 15 food items, and finally, four main DPs were obtained. RESULTS: Four major DPs were identified: (1) low intake of nuts and algae pattern, (2) low-energy intake pattern, (3) high-energy intake pattern, and (4) regular DP. Compared with the regular diet pattern, the low intake of nuts and algae pattern was associated with the increased risk of higher systolic blood pressure (107.71 mm Hg vs 105.78 mm Hg, P < 0.001), diastolic blood pressure (64.98 mm Hg vs 63.91 mm Hg, P = 0.0056), hypertension (odds ratio [OR]:1.44, 95% confidence interval [CI]: 1.10, 1.88; P = 0.0036), dyslipidemia (OR: 2.41, 95% CI: 1.28, 4.52; P = 0.0194), and obesity (OR: 1.48, 95% CI: 1.16, 1.89; P = 0.0003) in children from a cross-sectional aspect in 2014 and it was also found associated with an increased risk of hypertension (OR: 2.67, 95% CI: 1.45, 4.92; P = 0.0017) in 2019. CONCLUSIONS: Low nuts and algae intake combinations in children seemed associated with increased CVD risk. Such findings are imperative for national development of dietary recommendation for the prevention of CVDs.

THE EFFECT OF ADIPONECTIN VIA REGULATING THE BONE MICROENVIRONMENT OXIDATIVE STRESS ON OSTEOGENESIS IN TYPE 2 DIABETIC RATS.

OBJECTIVE: To observe the effect of adiponectin on osteogenesis in type 2 diabetic rats. METHODS: The 4th-week-old male SD rats were divided into normal control group (n=18) and diabetic model group (n = 42). Type 2 diabetes was induced by high-fat and high-sugar diet and intraperitoneal injection of a low dose of streptozotocin (STZ). The successfully-induced diabetic rats were divided into diabetic group (DM=18) and adiponectin intervention group (APN=18). APN group was injected with APN 10 µg/kg*d. The rats were separately sacrificed at the 4th, 8th and 12th week after the intervention. Bone microstructure and adipose tissue were observed via HE staining. Bone marrow was extracted from one side of the femur, and the supernatant was achieved by centrifugation. After BMD assessed by DXA, the other side of the femur was for further HE staining. Runx-2 expression in the bone marrow cells was detected by RT-PCR. BALP and AOPPs in bone marrow supernatant were assayed by ELISA. AGEs were detected by immunohistochemical staining. RESULTS: With the feeding time over, blood glucose, AOPP, and AGEs were increased, and Runx-2 mRNA, BALP, BMD were decreased in diabetic rat group(P<0.05). Oxidative stress (OS) maker (AOPP) was decreased and osteogenesis makers (Runx2 mRNA, BALP) were increased after intervention with exogenous adiponectin (P<0.05). At the 8th and 12th week, the trabecular bone became thinner and broken, and the fat cell number increased in all 3 groups, especially in the DM group. The adiponectin intervention group showed that the trabecular bone structure was moderately restored. CONCLUSIONS: OS is obvious in bone micro-environment in diabetic rats. OS may have an inhibitory effect on regulation of osteogenic differentiation factor Runx2, causing down regulation of osteoblast differentiation and bone formation. Adiponectin may improve OS response and protect the bone structure.

[Association of maternal anxiety with congenital heart disease in offspring based on case-control study].

Objective: To explore the association of maternal anxiety with congenital heart disease (CHD) in offspring. Methods: A case-control study design was used in this study. The data were collected in Shaanxi province from January 2014 to December 2016. Neonatal information is provided through specialized hospitals or institutions. Logistic regression model with adjustment for confounding factors was established to analyze the association between maternal perinatal anxiety and CHD in offspring. Meanwhile, subgroup analysis was carried out to explore its stability. Results: Our study included 2 429 subjects, consisting of 773 cases and 1 656 controls. Women with anxiety during pregnancy accounted for 10.3% in the case group, while 7.8% in the control group. After adjusting for confounding factors, the level of maternal anxiety during pregnancy was positively correlated with CHD in the offspring (OR=1.04, 95%CI: 1.01-1.07). The risk of CHD in the offspring of mothers with anxiety during pregnancy was 1.43 times higher than that in those whose mothers had no anxiety (OR=1.43, 95%CI: 1.00-2.05). Conclusion: Maternal anxiety during pregnancy is probably a risk factor for congenital heart disease in offspring.

[The application of narrative therapy in convalescent patients with occupational acute chemical toxic encephalopathy].

Objective: To explore the effects of narrative therapy on cognition, emotion and treatment satisfaction of convalescent patients with occupational acute chemical toxic encephalopathy. Methods: From June to July 2019, 60 convalescent patients with occupational chemical poisoning encephalopathy were randomly divided into narrative group and control group, with 30 cases in each group. The control group received routine clinical treatment. On the basis of receiving the original clinical treatment, patients in the narrative group added narrative treatment once a week to explain discomfort in specific life situations through conversation from the perspective of disease and psychology. 30 min each time for 6 weeks. The patients were investigated with Montreal Cognitive Assessment Scale (MoCA scale) every 2 weeks to evaluate the degree of cognitive impairment. The changes of depression, anxiety and treatment satisfaction were investigated before and after intervention. Results: There was no significant difference in MoCA scores between the two groups before intervention (P>0.05) . After 6 weeks of treatment, MoCA scores of narrative group and control group gradually increased with the extension of treatment time, and the increase degree of MoCA score of narrative group was greater than that of control group (P<0.01) . Before intervention, there was no significant difference in depression, anxiety score, prevalence and satisfaction index between narrative group and control group (P>0.05) . After the intervention, the scores and prevalence of depression and anxiety in the narrative group were significantly lower than those in the control group, and the scores of feeling in the process of seeing a doctor and how to obtain their own disease information were significantly higher than those in the control group (P<0.05) . Conclusion: Narrative therapy can improve the cognitive function and emotion of patients with occupational chemical poisoning, and improve the treatment satisfaction of patients.

[Effect of body mass index on the assisted reproductive outcome of frozen-thawed embryo transfer in patients with polycystic ovary syndrome].

Objective: To investigate the effect of body mass index (BMI) on clinical pregnancy and neonatal outcomes in patients with polycystic ovary syndrome (PCOS) during frozen-thawed embryo transfer. Methods: A total of 650 patients with PCOS who received routine in vitro fertilization or intracytoplasmic sperm injection treatment for frozen-thawed embryo transfer from June 2014 to June 2019 in Tianjin Central Hospital of Gynecology Obstetrics were retrospectively analyzed. According to BMI, PCOS patients were divided into group A (18.5≤BMI<23 kg/m2, n=253), group B (23≤BMI<25 kg/m2, n=167), and group C (BMI≥25 kg/m2, n=230). The general information, clinical pregnancy outcomes, pregnancy complications, the incidence of macrosomia and low-birth-weight infants were compared in the three groups, and the influencing factors of neonatal birth weight were analyzed. Results: The embryo implantation rate, clinical pregnancy rate, and ongoing pregnancy rate all showed downward trend with the increase of BMI, but the differences were not statistically significant (all P>0.05). The live birth rate in group C [47.0% (108/230)] was significantly lower than those in groups A and B, with statistical significance (χ²=7.43, P=0.024). The late miscarriage rate was higher in group C [9.4% (13/139)] than in groups A and B (χ²=7.66, P=0.022). The birth rates of macrosomia in groups B [22.2% (16/72)] and group C [21.1% (16/76)] were significantly higher than that in group A, and the difference was statistically significant (χ²=14.15, P=0.001). There was no statistically significant difference in the incidence of gestational diabetes between the three groups (χ²=3.81, P=0.149). The incidence of hypertension disorders complicating pregnancy increased with the increase of BMI, and the difference was not statistically significant (P>0.05). Regression analysis showed that macrosomia was significantly associated with maternal pre-pregnancy BMI and gestational weeks, and the risk of macrosomia increased by 15% (95%CI: 3%-28%) for every increase in maternal BMI. Conclusions: The embryo implantation rate, clinical pregnancy rate, and ongoing pregnancy rate of PCOS patients in frozen-thawed embryo transfer cycles show downward trend with the increase of BMI. Obese patients with PCOS have a significant increase in late miscarriage rate and a significant decrease in live birth rate. The incidence of hypertension disorders complicating pregnancy in PCOS patients in the obese group has an increasing trend, and the birth rate of macrosomia has increased significantly. Therefore, it is recommended that obese women with PCOS lose weight scientifically before pregnancy to improve pregnancy and neonatal outcomes.

[Impact of previous cesarean delivery on pregnancy outcomes of in vitro fertilization and frozen-thawed embryo transfer].

Objective: To investigate the impact of a previous cesarean delivery on pregnancy outcomes of in vitro fertilization and frozen-thawed embryo transfer (FET). Methods: The clinical data of 1 179 patients who received in vitro fertilization and FET in Tianjin Central Hospital of Gynecology Obstetrics from January 2014 to May 2019 and had a history of the previous delivery were retrospectively analyzed. The patients were divided into four groups according to different previous delivery history and the number of embryo transferred: group A (single embryo transfer group with cesarean delivery history, n=338), group B (single embryo transfer group with vaginal delivery history, n=78), group C (double embryo transfer group with cesarean delivery history, n=444), and group D (double embryo transfer group with vaginal delivery history, n=319). The 1∶1 propensity score based on age, body mass index (BMI), infertility duration, basal FSH, basal LH, number of oocytes retrieved and high-quality embryo rate was used to match group A and B (caliper value=0.15), group C and D (caliper value=0.05), and group A and C (caliper value=0.01) respectively to reduce the influence of selection bias. The clinical pregnancy outcomes of patients were compared. Results: (1) Group A and group B were single embryo transfer groups with a total of 77 pairs of matched patients. There were no statistically significant differences in clinical pregnancy rate [42.9% (33/77) vs 45.5% (35/77)], miscarriage rate, preterm birth rate, and neonatal birth weight (all P>0.05). (2) Group C and group D were double embryo transfer groups with a total of 304 pairs of matched patients. The clinical pregnancy rate [42.4% (129/304)] and twin pregnancy rate [9.5% (29/304)] of Group C were significantly lower than those of Group D [53.0% (161/304), 15.5% (47/304) respectively; both P<0.05). There were no statistically significant in miscarriage rate, preterm birth rate and neonatal birth weight between the two groups (all P>0.05). (3) Groups A and C matched 318 pairs of patients. The two groups had no statistical significances in clinical pregnancy rate [38.4% (122/318) vs 45.6% (145/318)], miscarriage rate and preterm birth rate (all P>0.05), but the twin pregnancy rate in group C was significantly higher than that of group A [11.3% (36/318) vs 0.3% (1/318), P<0.01). (4) The occurrence of the low-birth-weight infant were related to gestational age (OR=0.41, 95%CI: 0.32-0.54) and twin pregnancy (OR=4.44, 95%CI: 1.93-10.21), and the occurrence of macrosomia was related to BMI (OR=1.18, 95%CI: 1.06-1.32). Moreover, the previous delivery method was not related to the neonatal birth weight (P>0.05). Conclusions: Patients with different delivery histories receive FET therapy, the pregnancy outcomes of single embryo transfer are not significantly different, and the success rate of double embryo transfer in patients with a cesarean delivery history is low. The neonatal birth weight is not related to the history of the cesarean section. It is recommended that patients with a cesarean delivery history choose elective single embryo transfer to ensure the success rate and to reduce the risk.

Regulator of cullins-1 (ROC1) negatively regulates the Gli2 regulator SUFU to activate the hedgehog pathway in bladder cancer.

BACKGROUND: The regulator of cullins-1 (ROC1) is an essential subunit in the cullin-RING ligase (CRL) protein complex and has been shown to be critical in bladder cancer cell survival and progression. This study aimed to explore the molecular mechanism of ROC1 action in the malignant progression of bladder cancer. METHODS: This study utilized ex vivo, in vitro, and in vivo nude mouse experiments to assess the underlying mechanisms of ROC1 in bladder cancer cells. The expression of the components of the sonic hedgehog (SHH) pathway was determined by western blot analysis. ROC1 expression in human tumors was evaluated by immunohistochemistry. RESULTS: ROC1 overexpression promoted the growth of bladder cancer cells, whereas knockdown of ROC1 expression had the opposite effect in bladder cancer cells. Mechanistically, ROC1 was able to target suppressor of fused homolog (SUFU) for ubiquitin-dependent degradation, allowing Gli2 release from the SUFU complex to activate the SHH pathway. Furthermore, knockdown of SUFU expression partially rescued the ROC1 knockdown-suppressed SHH activity as well as cancer cell growth inhibition. In ex vivo experiments, tissue microarray analysis of human bladder cancer specimens revealed a positive association of ROC1 expression with the SHH pathway activity. CONCLUSION: This study demonstrated that dysregulation of the ROC1-SUFU-GLI2 axis plays an important role in bladder cancer progression and that targeting ROC1 expression is warranted in further investigations as a novel strategy for the future control of bladder cancer.

Cardiac Disease Associated Genetic Variants in Yi Nationality in Regions with High Incidence of Yunnan Sudden Unexplained Death.

ABSTRACT: Objective To explore the association of cardiac disease associated genetic variants and the high incidence of Yunnan sudden unexplained death （YNSUD） in Yi nationality. Methods The genomic DNA was extracted from peripheral blood samples collected from 205 Yi villagers from YNSUD aggregative villages （inpatient group） and 197 healthy Yi villagers from neighboring villages （control group）. Fifty-two single nucleotide variants （SNVs） of 25 cardiac disease associated genes were genotyped using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry （MALDI-TOF-MS）. The SPSS 17.0 was used to analyze data. The pathogenicities of variants with differences between the two groups that have statistical significance were predicted by protein function prediction software PolyPhen-2 and SIFT. All villagers from inpatient group were given electrocardiogram （ECG） examination using a 12-lead electrocardiograph. Results The allele frequency and the genotype frequency of missense mutation DSG2 （rs2278792, c.2318G>A, p.R773K） of pathogenic genes of arrhythmogenic right ventricular cardiomyopathy （ARVC） in inpatient group was higher than that in control group （P<0.05）. Abnormal ECG changes were detected in 71 individuals （34.6%） in the inpatient group, among which 54 individuals carried R773K mutation, including clockwise （counterclockwise） rotation, left （right） axis deviation, ST segment and T wave alteration and heart-blocking. Conclusion Definite pathogenic mutations have not been found in the 52 cardiac disease genes associated SNVs detected in Yi nationality in regions with high incidence of YNSUD. The cause of high incidence of YNSUD in Yi nationality needs further study.

[Epidemiological characteristics of serum vitamin B(12) and folate levels in women awaiting delivery].

Objectives: To analyze the epidemiological characteristics and levels of vitamin B(12) and folate as well as their relationship in women awaiting delivery, in Shaanxi province. Methods: Data were collected from healthy pregnant women who gave birth at six top hospitals in Shaanxi, from January 2014 to December 2016. Blood samples were taken prenatally to determine the levels of vitamin B(12) and folate. Quantile regression model was used to analyze the relationship between the levels of vitamin B(12) and folates in women awaiting delivery. Results: A total of 1 277 women awaiting delivery were included in this study. Among them, the median level of serum vitamin B(12) was 164.7 pg/ml, in women at late pregnancy, with the deficiency rate as 69.6%, while the median level of serum folate was 7.6 ng/ml, with the deficiency rate as 12.1%. 58.4% of these women presented simple vitamin B(12) deficiency and 0.9% with simple folate deficiency. Women living in rural areas showed lower levels of both vitamin B(12) and folate than the women from the urban areas. Both the levels of vitamin B(12) and folate increased with age but were significantly lower in women under the age of 25. Among those with or without folate deficiency, the average difference in the levels of vitamin B(12) was 37.62 pg/ml. Quantile regression models showed that the vitamin B(12) levels in women with folate deficiency were significantly lower than those without, despite the different levels of vitamin B(12). This difference appeared increasing along with the increase of the vitamin B(12) levels. Conclusions: Our data showed that both vitamin B(12) and folate were deficient in women awaiting delivery, in Shaanxi. We suggest that vitamin B(12) should also be added into the folic acid supplementation program, together with the reinforcement on health education program to improve the awareness of nutrient supplementation in rural and young women. Hopefully, these strategies could increase the levels of both vitamin B(12) and folate, in the province.

[Association between maternal passive smoking during perinatal period and congenital heart disease in their offspring-based on a case-control study].

Objective: To explore the association between maternal passive smoking during perinatal period and congenital heart disease (CHD) in their offspring. Methods: A case-control study was designed. Data being used was based on a case-control study of congenital heart disease collected in Shaanxi province from January 2014 to December 2016. Cases under this study were perinatal infants diagnosed as CHD from 28 weeks of gestation to 7 days after birth, and fetus less than 28 weeks of gestation but diagnosed as CHD by ultrasonography. The controls would include newborn infants without any birth defects, born at the same period of the cases. Logistic regression model with confounding factors adjusted was established to analyze the association between maternal passive smoking status during perinatal period and CHD in their offspring. Subgroup analysis was carried out to explore its stability. Results: A total of 2 259 subjects, consisting 695 cases and 1 564 controls were included in this study. Passive smokers accounted for 26.76% in the case group while only 6.01% in the control group. After adjusting for related confounding factors, the risk of CHD in the offspring of passive smokers was 3.32 times higher than that of the non-passive smokers (OR=3.32, 95%CI: 2.41-4.56), during the perinatal period. Results also showed that related risk accumulated with the increase of exposure frequency to passive smoking. For mothers who smoked passively for 1-3 days per week, the risk of CHD in their offspring was 2.75 times higher than that of those non-passive smokers (OR=2.75, 95%CI: 1.62-4.66). For mothers who smoked passively for more than 3 days per week, the risk was 3.62 times higher than the non-passive smokers (OR=3.62, 95%CI: 2.48-5.29). Data from the subgroup analysis showed that the association between maternal passive smoking during perinatal period and CHD in their offspring appeared stable. Conclusions: Maternal passive smoking during perinatal period seemed a risk factor for congenital heart disease related to their offspring. Pregnant women should avoid exposure to second-hand smoke as much as possible, so as to prevent the harm from passive smoking.

[Partial superficial parotidectomy versus superficial parotidectomy for treatment of parotid benign tumors: evidence-based medicine analysis].

Objective:The aim of this study is to systematically assess the postoperative outcomes of partial superficial parotidectomy（PSP） and superficial parotidectomy（SP） by systematic literature review and Meta-analysis, and to provide a theoretical basis for the selection of the appropriate surgical approach in clinical process. Method:Relevant studies that compared the outcomes of PSP and SP for the parotid benign tumors were searched in Pubmed, CNKI and Wanfangdata databases, and Meta-analysis was performed using software RevMan 5.0. Result:24 studies were selected for the Meta-analysis. A total of 2 795 participants were included in those studies, of whom 1 301 underwent PSP and 1 494 underwent SP. The recurrence rates for PSP and SP were 1.14%（10 of 874） and 0.6%（6 of 993）, respectively. There were no statistically significant difference in recurrence rate between PSP and SP. The rates of transient facial nerve paresis for PSP and SP were 11.60%（122 of 1 052） and 27.37%（350 of 1 279）, respectively. The rates of permanent facial nerve paralysis for PSP and SP were 1.04%（6 of 579） and 4.46%（31 of 695）, respectively. The incidences of Frey's syndrome in PSP group and SP group were 9.20%（95 of 1 033） and 30.32%（409 of 1 349）, respectively. The rate of salivary fistulafor PSP and SP were 5.38%（37 of 688） and 11.25%（65 of 578）. PSP could reduce the risk for complications compared with SP. Conclusion:This systematic review with meta-analysis suggests that PSP has a similar recurrence rate as SP, but PSP can significantly reduce the postoperativecomplications.

[Influencing factors and antenatal assessment of the vaginal birth after cesarean section].

Objective: To explore the influencing factors of the vaginal birth after cesarean section (VBAC), and establish a model for predicting the risk of trial of the trial of labor after cesarean section (TOLAC). Methods: From January 2016 to December 2018, total 694 pregnant women who underwent TOLAC in Northwest Women's and Children's Hospital were retrospectively analyzed. Those cases were divided into two groups according to the mode of delivery: the VBAC group and the failed TOLAC group. At the same time, 700 cases in the elective repeat cesarean section (ERCS) group were randomly selected as control group. The influencing factors of VBAC were analyzed by univariate and multivariate logistic regression, and the pregnancy outcomes between the three groups were compared. Results: (1) The VBAC rate was 76.1% (528/694) and 166 women underwent the failed TOLAC (23.9%, 166/694). (2) Univariate analysis found that, the pre-pregnancy body mass index (BMI) [(22.0±3.0), (23.3±2.7) kg/m(2)], the previous vaginal delivery history [10.4%(55/528), 3.6%(6/166)], the cervical score (5.2±1.9,4.3±1.6) and the neonatal birth weight [(3 315±468), (3 484±274) g] of the VBAC group were significantly different from the failed TOLAC group (P<0.05). (3) The comparison of pregnancy outcomes: the neonatal birth weight was (3 315±468) g, and the intrapartum hemorrhage volume was (255±121) ml in the VBAC group, which were significantly lower than those in the failed TOLAC group [intrapartum hemorrhage (325±173) ml] and the ERCS group [(3 572±344) g, (281±125) ml], there were statistically significant differences in the comparison among the three groups (all P<0.05). Two cases of bladder injury occurred during cesarean section in the TOLAC failure group (1.2%,2/166). The rates of the blood transfusion, puerperal infection, 5-minute Apgar score and neonatal ICU admission among the three groups were no statistically significantly different (all P>0.05). There was no maternal or perinatal death. (4) Multivariate logistic regression analysis showed that the delivery age of pregnant women (OR=0.92, 95%CI: 0.87-0.98), pre-pregnancy BMI (OR=0.92, 95%CI:0.86-0.98), vaginal delivery history (OR=3.31, 95%CI: 1.35-8.01), cervical score (OR=1.29, 95%CI: 1.13-1.42) and the birth weight of the neonates <3 300 g (OR=3.15, 95%CI: 2.02-4.90) were independent influencing factors for VBAC. The area under curve of the receiver operating characteristic curve was 0.74. Conclusions: The influencing factors of VBAC are delivery age, pre-pregnancy BMI, vaginal delivery history, cervical score and neonatal birth weight <3 300 g. The adequate individualized management and assessment of the TOLAC may be helpful to improve the VBAC rate.

Effect of ticagrelor and clopidogrel on platelet aggregation function after percutaneous coronary intervention in patients with acute coronary syndrome.

In this study, phosphorylation levels of vasodilator stimulated phosphoprotein (VASP) were detected by flow cytometry (FCM) to investigate the effects of ticagrelor and clopidogrel on platelet aggregation function (PAF) after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS).

Interaction of obesity with smoking and inflammatory arthropathies increases the risk of periprosthetic joint infection: a propensity score matched study in a Chinese Han population.

BACKGROUND: Although a large number of studies have identified obesity as an independent risk factor for the development of periprosthetic joint infection (PJI), the synergistic impacts of obesity with other factors on PJI remain unknown. Additionally, few studies have specifically explored the risk factors of PJI within a Chinese population. AIMS: To investigate the association between obesity and PJI in a Chinese population, and identify synergistic impacts of obesity with other risk factors on the development of PJI. METHODS: Three hundred and seven patients at a single institution with a diagnosis of PJI following primary total hip or knee arthroplasty, treated from 2008 to 2015, were identified. Each case was matched with two controls who did not develop PJI after primary total hip or knee arthroplasty in the study period using propensity score matching for several important parameters. Multi-variable logistic regression models were used to estimate the association between body mass index (BMI) and the risk of developing PJI. Interaction and stratified analyses were conducted according to age, sex, type of surgery, smoking status, alcohol use, diabetes, inflammatory arthritis, liver disease and renal disease. FINDINGS: The multiple logistic analyses showed that obesity was associated with increased risk of PJI [odds ratio (OR) 2.48; 95% confidence interval (CI) 1.66-3.69]. When analysed as a continuous variable, BMI was also associated with increased risk of PJI (OR per 1 kg/m2 increase in BMI 1.08; 95% CI 1.02-1.14). In the interaction analysis, patients who were obese and smoked had a higher OR of developing PJI than non-smokers who were obese (OR 3.54 vs 1.55, P-value for interaction=0.031). Similarly, the OR was much higher for patients with both obesity and inflammatory arthritis than for patients who were obese with no history of inflammatory arthritis (OR 3.9 vs 1.55, P-value for interaction=0.029). No other significant interactions were found in the association between obesity and PJI. CONCLUSION: Obesity is an independent risk factor for the development of PJI in the Chinese Han population. Surgeons should be aware that obese patients who smoke or have inflammatory arthritis are at additional increased risk of PJI.

Does simultaneous bilateral total joint arthroplasty increase deep infection risk compared to staged surgeries? A meta-analysis.

BACKGROUND: Several studies have compared the incidence of periprosthetic joint infection (PJI) between simultaneous bilateral total joint arthroplasty (SBTJA) and staged bilateral total joint arthroplasty (StBTJA) patients following primary total joint arthroplasty. However, these studies lacked statistical power. AIM: To determine by meta-analysis whether SBTJA increases deep infection risk compared to StBTJA. METHODS: All studies were retrieved from PubMed, Embase, Cochrane Library databases, Web of Science, PEDro, CINAHL, SPORTDiscus, and Scopus. A meta-analysis was conducted to compare PJI rate between SBTJA and StBTJA patients. FINDINGS: Overall, there were 16 studies with 36,765 patients who underwent SBTJA and 71,558 patients who underwent StBTJA. The pooled data showed that the PJI rate of SBTJA was lower than that of StBTJA (0.84% vs 1.57%; odds ratio (OR): 0.57; 95% confidence interval (CI): 0.49-0.66; heterogeneity, I2 = 0%; P = 0.74). In subgroup analysis, the pooled data revealed that there was no significant difference between SBTJA and StBTJA groups for PJI if the two groups had similar baseline demographics (four studies; OR: 0.55; 95% CI: 0.21-1.40; heterogeneity, I2 = 0%; P = 0.77). The pooled data showed that the PJI rate of SBTJA patients was comparable with that of StBTJA patients within a three-month staging interval (three studies; OR: 1.22; 95% CI: 0.38-3.88; heterogeneity, I2 = 0%; P = 0.42). CONCLUSION: SBTJA does not increase the risk of subsequent PJI compared to StBTJA. Further studies are needed to provide higher quality evidence to evaluate the two modes of procedure.

Forensic Pathology Analysis of 363 Sudden Death Cases in Yunnan Province.

OBJECTIVES: To study the epidemiological and pathological features of sudden death （SD） in Yunnan Province and to provide scientific evidence for prevention and forensic identification of sudden death. METHODS: Totally 363 SD cases were collected from the autopsies between 2009 and 2017 in the Forensic Centre of Kunming Medical University. The related factors such as etiology, age, inducing factor, time interval between the onset of disease and death, morbidity season and pathological change were retrospectively analysed. RESULTS: The incidence of SD in males was significantly higher than that of females. The peak age was ≥35-55 years. The mortality rate was relatively high within 6 h after the onset of disease. The season order with descending number of deaths was spring, summer, winter and autumn. The top ten causes of SD were coronary heart disease, sudden unexplained death （SUD）, cerebral hemorrhage, acute hemorrhagic necrotic pancreatitis, aortic dissection rupture, cardiomyopathy, pneumonia, pulmonary thromboembolism, amniotic fluid embolism and allergy. Exercise, infusion, surgery, medication and minor injury were the most common predisposing factors of sudden coronary death. Consciousness disorder or coma, chest pain or chest tightness, and abdominal pain were the most common premortem symptoms of sudden coronary death. CONCLUSIONS: The SD is more common in middle-aged males, which is the key population for the prevention of SD. For the forensic identification and prevention of SD, the attention on SUD should be paid.

[A propensity score-matched study on relationship between maternal respiratory infection in early pregnancy and gestational age].

Objective: To explore the association between maternal respiratory infection in early pregnancy and gestational age of single live birth. Methods: A face to face questionnaire survey was conducted among child bearing aged women in 30 counties (district) of Shaanxi province selected through stratified multistage sampling. Propensity score (PS) matched (1∶1) analysis was used to match participants with respiratory infections to those without respiratory infections. A multilevel linear model was used to investigate the association between respiratory infections and gestational age. Through the control of the confounders step by step, three models were established in this study: model 1 for the variable of respiratory infections before PS matching, model 2 was adjusted for variables in model 1 plus some other individual differences of mother and baby, and model 3 for the variable of respiratory infections after PS matching. Results: Of 28 848 child bearing aged women surveyed, 3 676 (12.74%) had respiratory infections in early pregnancy. After PS matching, 2 762 pairs were matched. Analysis with model 1 indicated that a decrease of 0.111 week (P<0.001) in gestational age was associated with a respiratory infection during the first trimester. Analysis with model 2 and model 3 indicated that a decrease of 0.058 week (P=0.025) and a decrease of 0.076 week (P=0.036) were associated with respiratory infection during the first trimester, respectively. Conclusion: The respiratory infection during the first trimester was associated with the decrease of the gestational age of newborn.

Effect of NF-κB inhibitor on Toll-like receptor 4 expression in left ventricular myocardium in two-kidney-one-clip hypertensive rats.

OBJECTIVE: To investigate the effects of an inhibitor of NF-κB, PDTC (pyrrolidine dithiocarbamate), on TLR4 (Toll-like receptor 4) expression in the left ventricle of Goldblatt hypertension rats. MATERIALS AND AND METHODS: Goldblatt rat model of two-kidney, one-clip (2K1C) hypertension was established in 70 healthy male rats. The rats were randomly divided into sham operation group (S group, n=20), non-drug intervention hypertension group (H group, n=25), and PDTC intervention group (P group, n=25). P group was injected with PDTC. The clip was inserted in the left renal artery of H group and P group (2K1C). Eight weeks after the operation, the rats were sacrificed and the samples of the left ventricle were collected. The concentration of AngII in the left ventricle was assessed by radioimmunoassay. RT-PCR was used to examine the mRNA expression of TLR4 in the left ventricle. Immunohistochemistry was adopted to examine the location of TLR4 and NF-κB in the myocardium. Victoria blue-Ponceau staining of Cardiac collagen was used to evaluate the degree of myocardial fibrosis. RESULTS: Eight weeks after the operation, caudal SBP, meridional end-systolic stress, left ventricular mass index, relative wall thickness, cardiac fibrosis degree, and the concentration of AngII in the left ventricle in P group were significantly lower than those in H group (p<0.01). In cardiac myocytes of S group and P group, TLR4 expression was diffused and presumably cytoplasmic. TLR4 mRNA expression in P group was significantly lower than that of H group (p<0.01). CONCLUSIONS: PDTC not only inhibited the activation of NF-κB, but decreased TLR4 expression and AngII content, indicating that the inflammatory signals and oxidative stress mediated by TLR4/NF-κB are involved in the occurrence and development of left ventricular remodeling. Intervention with TLR4/NF-κB and anti-inflammatory and anti-oxidative therapy may be a new target to reverse left ventricular remodeling.

Expression of IFNAR1 and IFNAR2 in cattle placenta during early pregnancy.

Interferon-tau (IFNT), a type I interferon, is an antiluteolytic factor secreted by trophoderm during pregnancy. IFNT transmitted signals or stimulated the expression of some factors to build maternal recognition and keep pregnancy by binding its receptors, IFNT receptor 1(IFNAR1) and IFNT receptor 2 (IFNAR2). Up to now, the expression model and roles of IFNAR1 and IFNAR2 in placenta have not been investigated in cattle. In this study, the localization and expression of IFNAR1 and IFNAR2 in the cattle placenta at days 18-50 of pregnancy were detected by histological examination, immunofluorescence staining and real-time qPCR. The results showed that IFNAR1 mainly distributed in chorioallantoic membrane, endometrial epithelium, cotyledon and caruncle during the early pregnancy of cattle with change in time- and position-dependent. IFNAR1 and IFNAR2 mRNA expression were mainly detected in chorioallantoic membrane and cotyledon, and markedly increased along with pregnancy process. Moreover, the mRNA expression level of IFNAR1 in chorioallantoic membrane and cotyledon was higher than that of IFNAR2. IFNAR mRNA was also expressed in caruncle tissues, which experienced a tendency of decrease from days 21 to 36, followed by increase after days 36. These results provide morphological basis and quantitative data for investigating the roles of IFNAR1 and IFNAR2 on development of cattle placenta and pregnancy maintenance.

[Prenatal supplementations of iron, iron-containing multimicronutrients and antianemic Chinese patent medicines in women in Shaanxi province, 2010-2013].

Objective: To understand the prevalence of prenatal supplementations of iron, iron-containing multi-micronutrients (IMMN) and antianemic Chinese patent medicines (ACPM) and associated factors in women in Shaanxi province. Methods: A sample of 28 367 childbearing-age women who gave birth during 2010-2013 and had specific information of the prenatal nutrients supplementation were recruited using stratified multistage cluster random sampling in Shaanxi province. The information about their basic characteristics and prenatal supplementation of nutrients were collected by a questionnaire survey. Descriptive analysis method was used to analyze the intake rate of iron, IMMN and ACPM during each period of pregnancy, and logistic regression model was used to identify associated factors. Results: The overall prevalence of prenatal iron, IMMN and ACPM supplementation was low (28.99%), and the intake rate of iron was the lowest (5.33%). The prevalence of prenatal supplementation of iron, IMMN and ACPM were lower before pregnancy and in the first trimester than in the second and third trimester. The intake rates for consecutive 2 periods were very low (all were lower than 2.00%). The intake rates of iron, IMMN and ACPM significantly increased year by year. Women living in central Shaanxi had relatively high intake rates of iron (7.22%) and IMMN (16.55%), and women in southern Shaanxi had relatively high intake rate of ACPM (18.50%). The results of logistic regression analysis showed that higher educational level (OR=1.920, 95%CI: 1.617-2.279), antenatal care times≥6 (OR=1.832, 95%CI: 1.604-2.091), etc. were the positive factors for iron intake, and these positive factors were similar to those for IMMN intake. Additionally, rural residence was the negative factor for IMMN intake (compared with urban residence, OR=0.872, 95%CI: 0.788-0.966). Conversely, higher educational level (OR=0.855, 95%CI: 0.746-0.979), higher household income (OR=0.864, 95%CI: 0.796-0.938) were negative factors for ACPM intake, and rural residence was its positive factor (OR=1.285, 95%CI: 1.141-1.447). Conclusions: The prevalence of prenatal supplementation of iron, IMMN and ACPM were low in women in Shaanxi, especially the intake rate of iron was the lowest. The prophylactic iron supplementation before pregnancy or in the first trimester was rare. Measures should be taken to improve the prenatal supplementation of iron in Shaanxi and to standardize the clinical use of ACPM.