R-loop and diseases: the cell cycle matters.

The cell cycle is a crucial biological process that is involved in cell growth, development, and reproduction. It can be divided into G1, S, G2, and M phases, and each period is closely regulated to ensure the production of two similar daughter cells with the same genetic material. However, many obstacles influence the cell cycle, including the R-loop that is formed throughout this process. R-loop is a triple-stranded structure, composed of an RNA: DNA hybrid and a single DNA strand, which is ubiquitous in organisms from bacteria to mammals. The existence of the R-loop has important significance for the regulation of various physiological processes. However, aberrant accumulation of R-loop due to its limited resolving ability will be detrimental for cells. For example, DNA damage and genomic instability, caused by the R-loop, can activate checkpoints in the cell cycle, which in turn induce cell cycle arrest and cell death. At present, a growing number of factors have been proven to prevent or eliminate the accumulation of R-loop thereby avoiding DNA damage and mutations. Therefore, we need to gain detailed insight into the R-loop resolution factors at different stages of the cell cycle. In this review, we review the current knowledge of factors that play a role in resolving the R-loop at different stages of the cell cycle, as well as how mutations of these factors lead to the onset and progression of diseases.

Use of bone landmarks for assessing the safety of acupuncture on the posterior midline of the neck region.

OBJECTIVE: Many acupuncture acupoints are located on the posterior midline of the neck region. The needling depth for acupuncture is important for practitioners, and an unsafe needling depth increases the possibility of damage to the spinal cord and brainstem. Can the safety of acupuncture be assessed by examining bone structures? We focused on this aim to carry out this study. METHODS: The shortest distance from the posterior border of the foramen magnum to the line joining both upper ends of the posterior border of the mastoid process was measured on 29 skulls. Distances from the posterior border of the vertebral foramen to the tip of the spinous process and posterior tubercle of the atlas were measured and evaluated from 197 dry cervical vertebrae and 31 lateral cervical radiographs of patient subjects. The anatomic relationships of the vertebral canal with the external occipital protuberance, tip of the spinous process of the axis, tip of the posterior tubercle of the atlas, and upper end of the posterior border of the mastoid process were observed and evaluated via lateral cervical radiography. RESULTS: The shortest distance from the foramen magnum to the line between the mastoid processes was 4.65±1.75 mm, and the distance from the superior border of the vertebral foramen of the atlas to the posterior tubercle was less than the distance from the inferior border. The distance from the superior border of the vertebral canal to the tip of the spinous process in C2-C7 was greater than the distance from the inferior border. The mean lengths of the superior border of the C2 spinous process and the inferior border of the C7 spinous process were greater than 21 mm and 31 mm, respectively. The line from the upper end of the posterior border of the mastoid process to the tip of the C2 spinous process or 10 mm deep to the tip of the C2 spinous process was posterior to the vertebral canal. CONCLUSIONS: On the posterior midline of the neck region between the tip of spinous process of axis and external occipital protuberance, if the needle reaches the depth of the line between the upper end of posterior border of mastoid process and the tip of the spinous process of the axis, approximately 10 mm along the spinous process of the axis, the needle is in the safe region. The mean length of the C2-C7 spinous process is suitable to accommodate the needling depth of the adjacent acupoint. Bone structures can be used to effectively assess the safety of acupuncture on the posterior midline of the neck region.

Assessment in location of sciatic nerve between the ischial tuberosity and the greater trochanter of the femur: A cadaveric study.

Background: The location description of the sciatic nerve (SN) of adult between the ischial tuberosity (IT) and the greater trochanter of the femur (GT) is inconsistent in publications, this impels us to investigate and measure the distance relationship with SN between IT and GT. Methods: Thirty-one adult cadavers were dissected to investigate the distance relationship of SN with the posterior prominent position of the ischial tuberosity (ppIT), the medial edge of IT (mIT) and the lateral prominent position of GT (lGT). Results: SN passed through the point of the junction of medial one-third and middle one-third of a length from ppIT to lGT, and the midpoint of a length from mIT to lGT from the average data of the total studied cadavers. From average data of female and male, the left SN passed through the point of the junction of the medial two-fifths and the lateral three-fifths of the length between mIT and lGT. Between ppIT and lGT, SN located in a range of proportions from 0.1 to 0.6 from medial to lateral. Between mIT and lGT, SN located in a range of proportions from 0.2 to 0.7 from medial to lateral and all SN passed through the middle third of the length. Conclusions: Different bony landmarks draw different location descriptions of anatomic structure. In anatomic study and clinical practice, the utilized bony landmark should be clearly and accurately identified the reference point, inaccurate bony landmark can result in erroneous localization of the interested anatomic structure and lead to operation failure or iatrogenic injury.

Dietary Zinc Intakes Are Associated With Skeletal Muscle Mass and Strength in Children and Adolescents: Zinc and Muscle in Children.

The purpose of this study was to evaluate the relationship between dietary zinc intakes and skeletal muscle mass and strength in children and adolescents. A retrospective study was conducted using data on United States adolescents aged 8 to 19 years. Data were extracted from the National Health and Nutrition Examination Survey 2011-2014 cycles. Subjects were divided into 3 groups based on the tertiles of dietary zinc intakes. The levels of appendicular skeletal muscle mass divided by weight (ASM/Wt, %) and grip in subjects with the highest tertile were higher than those in subjects with the middle and lowest tertiles (P < .05). Dietary zinc intakes were positively correlated with ASM/Wt (r = .221, P < .001) and grip (r = 0.169, P < .001). After a multivariate analysis, dietary zinc intakes were still significantly associated with ASM/Wt (ß = 0.059, P < .001) and grip (ß = 0.245, P < .001). The present study demonstrates that dietary zinc intakes were positively associated with skeletal muscle mass and strength in children and adolescents.

Bone-Targeted Biomimetic Nanogels Re-Establish Osteoblast/Osteoclast Balance to Treat Postmenopausal Osteoporosis.

Insufficient bone formation and excessive bone resorption caused by estrogen deficiency are the major factors resulting in the incidence of postmenopausal osteoporosis (PMOP). The existing drugs usually fail to re-establish the osteoblast/osteoclast balance from both sides and generate side-effects owing to the lack of bone-targeting ability. Here, engineered cell-membrane-coated nanogels PNG@mR&C capable of scavenging receptor activator of nuclear factor-κB ligand (RANKL) and responsively releasing therapeutic PTH 1-34 in the bone microenvironment are prepared from RANK and CXCR4 overexpressed bone mesenchymal stem cell (BMSC) membrane-coated chitosan biopolymers. The CXCR4 on the coated-membranes confer bone-targeting ability, and abundant RANK effectively absorb RANKL to inhibit osteoclastogenesis. Meanwhile, the release of PTH 1-34 triggered by osteoclast-mediated acid microenvironment promote osteogenesis. In addition, the dose and frequency are greatly reduced due to the smart release property, prolonged circulation time, and bone-specific accumulation. Thus, PNG@mR&C exhibits satisfactory therapeutic effects in the ovariectomized (OVX) mouse model. This study provides a new paradigm re-establishing the bone metabolic homeostasis from multitargets and shows great promise for the treatment of PMOP.

Anisotropic Bi-Layer Hydrogel Actuator with pH-Responsive Color-Changing and Photothermal-Responsive Shape-Changing Bi-Functional Synergy.

Stimuli-responsive color-changing and shape-changing hydrogels are promising intelligent materials for visual detections and bio-inspired actuations, respectively. However, it is still an early stage to integrate the color-changing performance and shape-changing performance together to provide bi-functional synergistic biomimetic devices, which are difficult to design but will greatly expand further applications of intelligent hydrogels. Herein, we present an anisotropic bi-layer hydrogel by combining a pH-responsive rhodamine-B (RhB)-functionalized fluorescent hydrogel layer and a photothermal-responsive shape-changing melanin-added poly (N-isopropylacrylamide) (PNIPAM) hydrogel layer with fluorescent color-changing and shape-changing bi-functional synergy. This bi-layer hydrogel can obtain fast and complex actuations under irradiation with 808 nm near-infrared (NIR) light due to both the melanin-composited PNIPAM hydrogel with high efficiency of photothermal conversion and the anisotropic structure of this bi-hydrogel. Furthermore, the RhB-functionalized fluorescent hydrogel layer can provide rapid pH-responsive fluorescent color change, which can be integrated with NIR-responsive shape change to achieve bi-functional synergy. As a result, this bi-layer hydrogel can be designed using various biomimetic devices, which can show the actuating process in the dark for real-time tracking and even mimetic starfish to synchronously change both the color and shape. This work provides a new bi-layer hydrogel biomimetic actuator with color-changing and shape-changing bi-functional synergy, which will inspire new strategies for other intelligent composite materials and high-level biomimetic devices.

Relationship Between Hypertriglyceridemic Waist Phenotype and Disposition Index in Chinese Men With Normal Glucose Tolerance.

The relationship between hypertriglyceridemic waist (HTGW) phenotype, insulin sensitivity, and pancreatic ß-cell function remains still unclear in subjects with normal glucose tolerance (NGT). The objective is to detect whether the disposition index (DI) could be used as a predictive indicator of insulin sensitivity and pancreatic ß-cell function in men with HTGW phenotype and NGT. A total of 180 men without diabetes were recruited in this study and underwent an oral glucose tolerance test (OGTT) to calculate DI based on the OGTT. Subjects were put into Group A (normal waist circumference [WC] and triglyceride [TG] concentrations), B (enlarged WC or elevated TG concentrations), and C (HTGW phenotype, both enlarged WC and elevated TG concentrations) (n = 60 for each group) according to WC and TG concentrations. The OGTT plasma glucose concentrations at 0.5 and 1 hr for patients in Groups B and C were higher than those in Group A (both p < .05). Group C patients had significantly lower 1/[fasting insulin] values and DI than those in Group A (p < .05), and the 1/[fasting insulin] values in Group C were significantly lower than those in Group B (p < .05). DI correlated positively with high-density lipoprotein cholesterol (p < .05), which was independently associated with WC (p = .002) and TG (p = .009). The HTGW phenotype is associated with decreased DI among men with NGT, indicating decreased DI is a strong predictor of future impaired glucose tolerance, which can provide guidance and reference for screening patients with potential impaired glucose tolerance in Chinese community population.

Height-Corrected Definition of Metabolic Syndrome Is a Simple and Effective Method for Identifying Insulin Resistance and Low-Grade Inflammation in Adolescents: Metabolic Syndrome in Adolescents.

The purpose of this study was to evaluate the feasibility of the height-corrected definition of metabolic syndrome(MetS) in adolescents. A retrospective study was conducted on US adolescents aged 12 to 17 years. Waist-to-height ratio and blood pressure-to-height ratio were substituted for waist circumference and blood pressure when defining MetS in adolescents. The proportions of insulin resistance of adolescents with 1 (30.1%), 2 (50.7%), and ≥3 components (77.8%) of MetS were 2.578 (P < .001), 6.882 (P < .001), and 23.992 (P < .001) times than the proportion of adolescents without the component of MetS (14.2%). The proportions of low-grade inflammation of adolescents with 1 (3.4%), 2 (5.3%), and ≥3 components (14.4%) of MetS were 2.050 (P = .106), 3.699 (P = .005), and 10.664 (P < .001) times than the proportion of adolescents without the component of MetS (1.7%). This study demonstrates that height-corrected definition of MetS is a simple and accurate method for identifying insulin resistance and low-grade inflammation in adolescents.

Fast and Robust Infrared Small Target Detection Using Weighted Local Difference Variance Measure.

Infrared (IR) small-target-detection performance restricts the development of infrared search and track (IRST) systems. Existing detection methods easily lead to missed detection and false alarms under complex backgrounds and interference, and only focus on the target position while ignoring the target shape features, which cannot further identify the category of IR targets. To address these issues and guarantee a certain runtime, a weighted local difference variance measure (WLDVM) algorithm is proposed. First, Gaussian filtering is used to preprocess the image by using the idea of a matched filter to purposefully enhance the target and suppress noise. Then, the target area is divided into a new tri-layer filtering window according to the distribution characteristics of the target area, and a window intensity level (WIL) is proposed to represent the complexity level of each layer of windows. Secondly, a local difference variance measure (LDVM) is proposed, which can eliminate the high-brightness background through the difference-form, and further use the local variance to make the target area appear brighter. The background estimation is then adopted to calculate the weighting function to determine the shape of the real small target. Finally, a simple adaptive threshold is used after obtaining the WLDVM saliency map (SM) to capture the true target. Experiments on nine groups of IR small-target datasets with complex backgrounds illustrate that the proposed method can effectively solve the above problems, and its detection performance is better than seven classic and widely used methods.

Multimodal Sentiment Analysis Representations Learning via Contrastive Learning with Condense Attention Fusion.

Multimodal sentiment analysis has gained popularity as a research field for its ability to predict users' emotional tendencies more comprehensively. The data fusion module is a critical component of multimodal sentiment analysis, as it allows for integrating information from multiple modalities. However, it is challenging to combine modalities and remove redundant information effectively. In our research, we address these challenges by proposing a multimodal sentiment analysis model based on supervised contrastive learning, which leads to more effective data representation and richer multimodal features. Specifically, we introduce the MLFC module, which utilizes a convolutional neural network (CNN) and Transformer to solve the redundancy problem of each modal feature and reduce irrelevant information. Moreover, our model employs supervised contrastive learning to enhance its ability to learn standard sentiment features from data. We evaluate our model on three widely-used datasets, namely MVSA-single, MVSA-multiple, and HFM, demonstrating that our model outperforms the state-of-the-art model. Finally, we conduct ablation experiments to validate the efficacy of our proposed method.

Hypertriglyceridemic waist phenotype, hypertriglyceridemic waist-to-height ratio phenotype and abnormal glucose metabolism in adolescents.

OBJECTIVE: The purpose of this study was to evaluate the relationship between hypertriglyceridemic waist (HW) phenotype,hypertriglyceridemic waist-to-height ratio (HWHtR) phenotype and abnormal glucose metabolism in adolescents. METHODS: A secondary analysis was conducted on 2626 adolescents aged 12-19 years in United States. Abnormal glucose metabolism was defined as fasting plasma glucose ≥ 5.6 mmol/L or oral glucose tolerance test 2-h plasma glucose ≥ 7.8 mmol/L or glycohemoglobin A1c ≥ 5.7% or a previous diagnosis of diabetes. The HW phenotype was defined as triglyceride(TG) concentrations ≥ 1.47 mmol/L and waist circumference (WC) ≥ 90th percentile. The HWHtR phenotype was defined as TG concentrations ≥ 1.47 mmol/L and waist-to-height ratio (WHtR) ≥ 0.5. RESULTS: 621(23.6%) adolescents had abnormal glucose metabolism. The prevalences of abnormal glucose metabolism were 22.7% and 40.6% in adolescents without and with HW phenotype. The prevalences of abnormal glucose metabolism were 22.4% and 38.6% in adolescents without and with HWHtR phenotype. Adolescents with HWHtR phenotype were more likely to have abnormal glucose metabolism (OR = 1.548, P = 0.010). The levels of homeostasis model assessment insulin resistance and ß cell fuction index were higher in adolescents with HWHtR phenotype than in adolescents without HWHtR phenotype (P < 0.001). CONCLUSION: The study demonstrates that HWHtR phenotype was closely associated with an increased risk of abnormal glucose metabolism in adolescents. Adolescents with HWHtR phenotype had worsen insulin resistance and increased insulin secretion as a result of compensation. IMPACT STATEMENT: The study provided a simple method, HWHtR phenotype, for evaluating the status of glucose metabolism in adolescents.

The relationship between obesity and bone mineral density in children and adolescents: analysis of the National Health and Nutrition Examination Survey.

Childhood and puberty are important period for the skeleton grows. Fat mass, especially visceral adipose tissue, was negatively correlated with areal bone mineral density in children and adolescents. The present study suggests that fat mass, especially visceral adipose tissue, has a slightly negative association with bone development in children and adolescents. PURPOSE: This study observed the relationship between fat mass and distribution, and areal bone mineral density (aBMD) in children and adolescents. METHODS: A retrospective study was conducted on US children and adolescents aged 8-19 years. Whole body (less head) aBMD was evaluated. Height (Ht) adjusted Z-scores for aBMD were calculated. RESULTS: After controlling for age, gender, race, and lean body mass index (LBMI) Z-score, there were significant negative associations between fat mass index (FMI) Z-score and aBMD Ht-Z-adjusted Z-score (ß = - 0.272, P < 0.001, R2 = 0.033). In the linear regression models with aBMD Ht-Z-adjusted Z-score as the dependent variable, the regression coefficients of android fat mass were - 0.241 (P < 0.05, R2 = 0.002), - 0.473 (P < 0.001, R2 = 0.036), and - 0.474 (P < 0.001, R2 = 0.038) for healthy weight, overweight, and obesity group, respectively. The regression coefficients of visceral adipose tissue (VAT) mass were - 0.218 (P > 0.05, R2 = 0.001), - 2.025 (P < 0.001, R2 = 0.044), and - 1.826 (P < 0.001, R2 = 0.039), and the regression coefficients of subcutaneous adipose tissue (SAT) mass were - 0.467 (P < 0.001, R2 = 0.004), - 0.339 (P < 0.01, R2 = 0.024), and - 0.347 (P < 0.001, R2 = 0.018) for healthy weight, overweight, and obesity group, respectively. CONCLUSIONS: The present study suggests that fat mass has a slightly negative association with bone development in children and adolescents. Trunk fat accumulation, especially visceral adipose tissue, was correlated with the lower level of aBMD. This association was obvious in overweight and obese children.

The dose-response relationship between sex hormones and hyperuricemia in different gender: NHANES 2013-2016.

Objectives: To access the dose-response relationship between sex hormones and hyperuricemia (HUA), and to find the cut-off value in different gender. Methods: 9,685 participants were derived from the database of National Health and Nutrition Examination Survey (NHANES). Restricted cubic spline (RCS) analysis were applied to explore the relationship between sex hormones and HUA after adjusting for confounding factors by propensity score match (PSM). Logistic regression was used to estimate the odds ratio (OR) and 95% CI. Results: The prevalence of HUA was 15.13% in female participants and 22.30% in male participants. Logistic regression analysis showed that estradiol (E2) was independently associated with HUA for a P value of 0.003 and 0.01in female and male participants, respectively. Testosterone (T) was only independently associated with HUA in male participants (P<0.001) but not in female participants (P = 0.59). RCS analysis showed a dose-response relationship between sex hormones and HUA. The risk of HUA increased as E2 lower than 29.6pg/mL in female participants and T lower than 389.1ng/dL in male participants. E2 higher than 23.6pg/ml was an independent risk factor for HUA in male participants. Conclusion: A dose-response relationship was found between sex hormones and HUA. The cut-off value of E2 in male and female participants was 29.6pg/mL and 23.6pg/mL, respectively, and the cut-off value of T in male participants was 389.1ng/dL. These results provide a reference for preventing HUA and hormone supplement therapy.

Hypomagnesemia is associated with increased mortality in the short-term but not the long-term in community-acquired pneumonia patients with type 2 diabetes

Introduction: The present study explored the relationship between hypomagnesemia and outcome in community-acquired pneumonia (CAP) patients with type 2 diabetes mellitus (T2DM). Methods: The study was a retrospective cohort study, conducted on adult CAP patients with T2DM at The First Hospital of Qinhuangdao between January 2015 and December 2018. The primary outcome was all-cause deaths. Results: In total, 480 CAP inpatients with T2DM were enrolled, and 71 patients (14.8%) had hypomagnesemia on admission. After one month and three months of follow-up, the hypomagnesemia group had a higher mortality rate than the normal magnesium group (p<0.05). After six months of follow-up, the mortality rate remained higher in the hypomagnesemia group, however, this was not statistically significant (χ²=2.799, p=0.094). After 12 months and 24 months of follow-up, the mortality rates were similar between the hypomagnesemia and normal magnesium groups (p<0.05). Based on multiple logistic regression analysis, hypomagnesemia was an independent risk factor for one-monthmortality(OR=3.858,95% CI: 1.637~9.088, p=0.002), three-month mortality (OR=3.083, 95% CI: 1.434~6.627, p=0.004) and six-month mortality (OR=2.551, 95% CI: 1.209~5.383, p=0.014). Conclusions: Hypomagnesemia is common in CAP inpatients with T2DM. Moreover, in these patients, hypomagnesemia at admission is associated with increased mortality in the short-term but not the long-term.

Concurrent severe hepatotoxicity and agranulocytosis induced by Polygonum multiflorum: A case report.

BACKGROUND: Various types of drug-induced liver injury are induced by Polygonum multiflorum (PM); however, it rarely causes neutropenia. Herein, we report the case of a 65-year-old woman with concurrent severe hepatotoxicity and agranulocytosis induced by PM. CASE SUMMARY: A 65-year-old woman reported with severe hepatotoxicity and agranulocytosis 17 d after ingestion of PM. The results of the Roussel Uclaf Causality Assessment Method demonstrated a highly probable relationship between hepatotoxicity and PM, with a total score of 10. The Naranjo algorithm results indicated that agranulocytosis had a probable relationship with PM, with an overall score of 6. Granulocyte colony-stimulating factor (for once), a steroid, compound glycyrrhizin, and polyene phosphatidylcholine therapy were initiated. After 15 d of treatment, there was a gradual improvement in liver biochemistry, leukocytes, and neutrophils levels. CONCLUSION: Concurrent hepatotoxicity and agranulocytosis are rare and critical adverse drug reactions of PM, which should be highly valued.

Impact of the Time-Weighted Average Glucose Concentration and Diabetes on In-Hospital Mortality in Critically Ill Patients Older Than 75 Years: A Retrospective Cohort Study.

OBJECTIVE: To evaluate the effects of diabetes and hyperglycemia on in-hospital mortality in critically ill patients older than 75 years. METHODS: This was a single-center retrospective cohort study of patients older than 75 years in the first intensive care unit stay. The patients were divided into the following 4 groups: time-weighted average glucose (TWAG) <140 mg/dL without diabetes (group 1), TWAG ≥140 mg/dL without diabetes (group 2), TWAG <180 mg/dL with diabetes (group 3), and TWAG ≥180 mg/dL with diabetes (group 4). Clinical and laboratory data were analyzed. RESULTS: A total of 6760 patients over 75 years of age were included, including 2089 patients previously diagnosed with diabetes. The patients in group 2 had the highest in-hospital mortality (27.4%). In the fully adjusted regression model, the risk of in-hospital mortality increased by 76% (odds ratio = 1.76, 95% CI: 1.49-2.08) in group 2 as compared with group 1. Those from groups 3 and 4 exhibited risks equivalent to the risks of those in group 1; similar results were observed in the subgroup analysis. A J-shaped curve relationship and threshold effect were observed in patients without diabetes. For those with diabetes, a flatter curve pattern with a small slope was observed. CONCLUSION: Stress hyperglycemia was more detrimental to short-term prognosis than diabetes status in these patients. Looser glucose control may be suitable for patients older than 75 years with diabetes but unnecessary for those without diabetes. Patients with diabetes may be more resistant to the detrimental effects of glucose variations.

Age, Pulse, Urea, and Albumin Score: A Tool for Predicting the Short-Term and Long-Term Outcomes of Community-Acquired Pneumonia Patients With Diabetes.

Objective: The predictive performances of CURB-65 and pneumonia severity index (PSI) were poor in patients with diabetes. This study aimed to develop a tool for predicting the short-term and long-term outcomes of CAP in patients with diabetes. Methods: A retrospective study was conducted on 531 CAP patients with type 2 diabetes. The short-term outcome was in-hospital mortality. The long-term outcome was 24-month all-cause death. The APUA score was calculated according to the levels of Age (0-2 points), Pulse (0-2 points), Urea (0-2 points), and Albumin (0-4 points). The area under curves (AUCs) were used to evaluate the abilities of the APUA score for predicting short-term outcomes. Cox regression models were used for modeling relationships between the APUA score and 24-month mortality. Results: The AUC of the APUA score for predicting in-hospital mortality was 0.807 in patients with type 2 diabetes (P<0.001). The AUC of the APUA score was higher than the AUCs of CURB-65 and PSI class (P<0.05). The long-term mortality increased with the risk stratification of the APUA score (low-risk group (0-1 points) 11.5%, intermediate risk group (2-4 points) 16.9%, high risk group (≥5 points) 28.8%, P<0.05). Compared with patients in the low-risk group, patients in the high-risk group had significantly increased risk of long-term death, HR (95%CI) was 2.093 (1.041~4.208, P=0.038). Conclusion: The APUA score is a simple and accurate tool for predicting short-term and long-term outcomes of CAP patients with diabetes.

The relationship between metabolic syndrome and bone mineral density in adolescents: analysis of the National Health and Nutrition Examination Survey.

OBJECTIVES: The purpose of this study was to observe the relationship between metabolic syndrome (MetS) and height (Ht) adjusted Z-scores for areal bone mineral density (aBMD) in adolescents. METHODS: A retrospective study was conducted on the United States adolescents aged 12-17 years. Data were extracted from the National Health and Nutrition Examination Survey (NHANES) 2011-2012, 2013-2014 and 2015-2016 cycles. Ht adjusted Z-scores for aBMD were calculated. RESULTS: A total of 969 adolescents (493 boys and 476 girls), aged 14.5 ± 1.7 years were enrolled in this study. After control for age, gender, race, 25-hydroxyvitamin D [25(OH)D], and lean body mass index (LBMI) Z-score, adolescents with MetS had significantly lower levels of total body (less head) aBMD Ht-Z-adjusted Z-score than adolescents with one, two components of MetS and without component of MetS (p<0.05) and significantly lower levels of lumbar spine aBMD Ht-Z-adjusted Z-score than adolescents with one component of MetS and without component of MetS (p<0.05). There were significantly negative associations between total body (less head) aBMD Ht-Z-adjusted Z-score and waist circumference (WC) (ß=-0.027, p<0.001, R2=0.057) and homeostasis model assessment insulin resistance (HOMA-IR) (ß=-0.225, p<0.001, R2=0.016). There were significantly negative associations between lumbar spine aBMD Ht-Z-adjusted Z-score and WC (ß=-0.039, p<0.001, R2=0.058) and HOMA-IR (ß=-0.251, p<0.001, R2=0.008). CONCLUSIONS: The present study demonstrates that MetS may have a negative effect on bone mineral density in adolescents. Abdominal obesity and insulin resistance play a major role on the decline of aBMD in adolescents.

Influence of overweight and obesity on the mortality of hospitalized patients with community-acquired pneumonia.

BACKGROUND: Obesity is associated with a better prognosis in patients with community-acquired pneumonia (the so-called obesity survival paradox), but conflicting results have been found. AIM: To investigate the relationship between all-cause mortality and body mass index in patients with community-acquired pneumonia. METHODS: This retrospective study included patients with community-acquired pneumonia hospitalized in the First Hospital of Qinhuangdao from June 2013 to November 2018. The patients were grouped as underweight (< 18.5 kg/m2), normal weight (18.5-23.9 kg/m2), and overweight/obesity (≥ 24 kg/m2). The primary outcome was all-cause hospital mortality. RESULTS: Among 2327 patients, 297 (12.8%) were underweight, 1013 (43.5%) normal weight, and 1017 (43.7%) overweight/obesity. The all-cause hospital mortality was 4.6% (106/2327). Mortality was lowest in the overweight/obesity group and highest in the underweight group (2.8%, vs 5.0%, vs 9.1%, P < 0.001). All-cause mortality of overweight/obesity patients was lower than normal-weight patients [odds ratio (OR) = 0.535, 95% confidence interval (CI) = 0.334-0.855, P = 0.009], while the all-cause mortality of underweight patients was higher than that of normal-weight patients (OR = 1.886, 95%CI: 1.161-3.066, P = 0.010). Multivariable analysis showed that abnormal neutrophil counts (OR = 2.38, 95%CI: 1.55-3.65, P < 0.001), abnormal albumin levels (OR = 0.20, 95%CI: 0.06-0.72, P = 0.014), high-risk Confusion-Urea-Respiration-Blood pressure-65 score (OR = 2.89, 95%CI: 1.48-5.64, P = 0.002), and intensive care unit admission (OR = 3.11, 95%CI: 1.77-5.49, P < 0.001) were independently associated with mortality. CONCLUSION: All-cause mortality of normal-weight patients was higher than overweight/ obesity patients, lower than that of underweight patients. Neutrophil counts, albumin levels, Confusion-Urea-Respiration-Blood pressure-65 score, and intensive care unit admission were independently associated with mortality in patients with community-acquired pneumonia.

The Global Burden of Disease attributable to low physical activity and its trends from 1990 to 2019: An analysis of the Global Burden of Disease study.

Introduction: Low physical activity (LPA) is associated with several major non-communicable diseases (NCDs) and premature mortality. In this study, we aimed to assess the global burden and trends in disease attributable to LPA (DALPA) from 1990 to 2019. Methods: Annual age-standardized disability-adjusted life years (DALYs) and death rates of DALPA [all-cause and five specific causes (ischaemic heart disease, diabetes mellitus, stroke, colon and rectal cancer, and breast cancer)] by sex, age, geographical region and social deprivation index (SDI) score from 1990 to 2019 were available from the Global Burden of Disease (GBD) study 2019. The estimated annual percentage changes (EAPCs) were calculated to quantify the changing trend. A generalized linear model (GLM) was used to explore the relationship between DALYs/death rates of DALPA and sociodemographic factors. Results: Globally, in 2019, the age-standardized DALYs and death rates of DALPA were 198.42/100,000 (95% UI: 108.16/100,000-360.32/100,000) and 11.10/100,000 (95% UI: 5.66/100,000-19.51/100,000), respectively. There were 15.74 million (8.51-28.61) DALYs and 0.83 million (0.43-1.47) deaths attributable to LPA. Overall, age-standardized DALYs and death rates presented significant downward trends with EAPCs [-0.68% (95% CI: -0.85- -0.50%) for DALYs and -1.00% (95% CI: -1.13- -0.86%) for deaths] from 1990 to 2019. However, age-standardized DALYs and death rates of diabetes mellitus attributable to LPA were substantially increased [EAPC: 0.76% (95% CI: 0.70-0.82%) for DALYs and 0.33% (95% CI: 0.21-0.51%) for deaths]. In the 15-49 age group, DALPA presented significant upward trends [EAPC: 0.74% (95% CI: 0.58-0.91%) for DALYs and 0.31% (95% CI: 0.1-0.51%) for deaths]. The GLM revealed that higher gross domestic product and current health expenditure (% of GDP) were negatively associated with DALYs and death rates of DALPA. Conclusion: Although global age-standardized DALYs and death rates of DALPA presented downward trends, they still cause a heavy burden worldwide. These rates showed upward trends in the diabetic and 15-49 age groups, which need more attention and health interventions.