Non-pharmacological interventions for older adults with depressive symptoms: a network meta-analysis of 35 randomized controlled trials.

Objective: To assess the effectiveness of non-pharmacological interventions for seniors with depressive symptoms.Methods: A comprehensive literature search was performed. We conducted network meta-analysis in two ways, intervention classes (psychosocial, psychotherapy, physical activity, combined, treatment as usual) and individual intervention (11 categories). Whenever included studies used different scales, the different instruments were converted to the units of the scale most frequently used (the Geriatric Depression Scale), such that the effect size was reported as a mean difference (MD) with 95% confidence interval (CI). The risk of bias of RCTs included in this review was assessed according to the Cochrane Handbook. Bayesian NMA was conducted using R-3.4.0 software.Results: A total of 35 RCTs with 3,797 enrolled patients were included. Compared to conventional treatment, physical activity and psychotherapy resulted in significant improvements in depressive symptoms (MD: 2.25, 95%CrI: 0.99-3.56; SUCRA = 86.07%; MD: 1.75, 95% CrI: 0.90-2.64; SUCRA = 66.44%, respectively). Similar results were obtained for music (MD: 2.6; 95% CrI: 0.84-4.35;SUCRA = 80.53%), life review (MD:1.92; 95% CrI:0.71-3.14; SUCRA = 65.62%), cognitive behavioral therapy (MD: 1.27; 95% CrI: 0.23-2.38; SUCRA = 45.4%), aerobic (MD: 1.84; 95% CrI: 0.39-3.36; SUCRA = 63%) and resistance training (MD: 1.72; 95% CrI: 0.06-3.42; SUCRA = 59.24%). Network meta-regression showed that there were no statistically significant subgroup effects.Conclusions: Physical activity and psychotherapy demonstrated statistically significant superiority over conventional treatment. Music and life review therapy proved the most promising individual interventions. However, conclusions are limited by the lack of sufficient sample size and consensus regarding intervention categories and so an adequately powered study is necessary to consolidate these findings.

Health education interventions for older adults with hypertension: A systematic review and meta-analysis.

OBJECTIVE: The study aimed to evaluate the effectiveness of health education intervention for the control of blood pressure (BP) in older adults with hypertension. METHODS: Five databases were searched in March 2018 for randomized controlled trials to manage hypertension in older adults by health education. The primary outcomes were changes in systolic and diastolic BP. RevMan5 was used for meta-analysis. RESULTS: Seven articles with 1,105 participants were included. In them, 393 (35.56%) older adults participated in health education interventions in the form of courses, and 226 (20.45%), in health education sessions. The meta-analysis suggested an overall reduction in systolic BP after health education courses (SMD, standardized mean difference = 4.80, 95% CI: 7.01-2.59, p < .05). Similar results were observed after health education sessions (SMD = 11.73, 95% CI: 17.63-5.82, p < .05). The diastolic BP reduction showed no difference after the health education course (p = .09). The random effects meta-analysis suggested an overall reduction in diastolic BP after health education sessions (SMD = 5.39, 95% CI: 7.98-2.79, p < .05). CONCLUSION: Although different health education methods had different effects on hypertension control, overall, educational interventions can potentially lead to improved BP control.

Joint Trajectories of Lifestyle Indicators and Their Associations with Blood Pressure among Chinese Middle School Students.

Lifestyle behaviors, defined as a combination of dietary behavior, physical activity (PA), screen time (ST), and sleep duration indicators, are strongly associated with blood pressure (BP) in students. Our aim was to characterize the joint trajectories of lifestyle behaviors among middle school students and evaluate their association with BP. Data were obtained from the monitoring dataset on common diseases and health factors among students in Jiading District, Shanghai, China, conducted from 2019 to 2023. Lifestyle behavior data were collected annually from middle school students aged 12-18 years through questionnaires covering dietary behavior score, PA, ST, and sleep duration. Students' BP was measured in 2023. Joint trajectories of lifestyle behaviors were determined using group-based multi-trajectory modeling. Associations between lifestyle trajectories and students' BP were examined using multiple linear regression and modified Poisson regression. A total of 1378 middle school students (759 [58.98%] boys, median age 14.36 years [IQR: 13·30-13.28]) with lifestyle behaviors data assessed at least three times were included, and they were categorized into four joint lifestyle trajectories as follows: "remain unhealthy with low PA and increasing ST" (n = 141, 10.46%), "remain unhealthy with only low PA" (n = 305, 22.63%), "change towards unhealthy with decreasing sleep duration" (n = 776, 57.57%), and "relatively healthy" (n = 126, 9.35%). After adjusting for important confounders, the "remain unhealthy with low PA and increasing ST" group was associated with higher diastolic BP (DBP) [ß: 3.49, 95% CI: 0.55-6.44] and higher mean arterial pressure (MAP) [ß: 3.19, 95% CI: 0.37-6.01] in students compared with the "relatively healthy" group. Additionally, compared with the "relatively healthy" group, students in the "remain unhealthy with low PA and increasing ST" group had a 1.12-fold increase in the risk of hypertension (risk ratios: 1.12, 95% CI: 1.03-1.24). All trend p values in DBP, MAP, and hypertension from the "relatively healthy" group to the "remain unhealthy with low PA and increasing ST" group were less than 0.05. Four distinct lifestyle trajectories were identified among middle school students. Students who remained in the "unhealthy with low PA and increasing ST" lifestyle trajectory were associated with later elevations in BP.

Prospective associations of maternal cardiometabolic health with children cardiometabolic health at ages 3 to 6 years.

OBJECTIVE: Maternal cardiometabolic health (MCMH) may have critical effects on offspring lifetime CMH, whereas evidence on the relationship between MCMH during pregnancy and children CMH (CCMH) at ages 3∼6 years remains unknown. METHOD: The study included 1478 mother-child dyads from the Shanghai Maternal-Child Pairs Cohort study. MCMH was examined at a mean of 27.8 (24-36) weeks' gestation based on 8 metrics of 'Life Essential 8' framework involving pre-pregnancy body mass index, total cholesterol, glucose level, blood pressure, physical activity, sleep, diet quality, and nicotine exposure. CCMH was examined at the age of 3 to 6 based on 5 metrics including body mass index, physical activity, sleep health, diet quality, and nicotine exposure. To validate the robustness of main analysis, 499 children were selected to reevaluate CCMH by six metrics (adding blood pressure) for sensitivity analysis. RESULTS: Among 1478 mother-child dyads, the mean (SD) MCMH during pregnancy and CCMH scores were 67.07 (SD 8.82) and 73.80 (SD 10.75), respectively. After adjusting important confounders, each 10 points increase in (more favorable) MCMH score was significantly associated with a higher CCMH score (ß: 0.85, [95% confidence interval (CI): 0.22, 1.47]). Subgroup analysis showed similar results in girls but not in boys. For cardiometabolic risks factors in children, the risk of overweight/obesity and hypertension in children decreased with increased MCMH score (overweight/obesity, Relative Risks [RRs]: 0.98, 95%CI: [0.96, 0.99]); hypertension, RRs: 0.66, 95%CI: [0.47, 0.92]). Sensitivity analysis showed similar result. CONCLUSIONS: Better MCMH in pregnancy was associated with better CCMH at ages 3∼6 years.

Longitudinal association between maternal cardiovascular health in pregnancy and child birth outcomes.

The American Heart Association has updated its definition of cardiovascular health (CVH) with a new framework known as Life's Essential 8 (LE8). Although gestational CVH assessment has been recommended, its significance based on LE8 for birth outcomes is unknown. We thus evaluated the status of gestational CVH based on LE8 in 3036 pregnant women of the Shanghai Maternal-Child Pairs Cohort and the population of China Maternal Nutrition and Health Sciences Survey, and also examined the association between gestational CVH and child birth outcomes. We found that only a small proportion (12.84%) had high CVH, while 1.98% had low CVH in this cohort study. In adjusted models, a 10-point increase in the gestational CVH score, indicating a more favorable score, was associated with lower neonatal size such as birth weight (ß: - 37.05 [95% confidence interval: - 52.93, - 21.16]), birth length (- 0.12[- 0.22, - 0.01]), weight-for-height z-score (- 0.07[- 0.12, - 0.03]), body mass index z-score (- 0.09 [- 0.13, - 0.04]), length-for-age Z-score (- 0.03 [- 0.06, - 0.01]), and weight-for-age z-score (- 0.08 [- 0.12, - 0.05]). Also, a 10-point increase in the gestational CVH score was associated with the lower risk of large for gestational age (LGA) (0.82 [0.73, 0.92]) and macrosomia infant (0.75 [0.64, 0.88]). CVH categories showed similar results. That is, better maternal CVH status in pregnancy was associated with lower neonatal size and lower risks for LGA and macrosomia in newborns.

The Relationship Between Heavy Metals and Missed Abortion: Using Mediation of Serum Hormones.

Accumulating evidence suggests that heavy metal exposure may have adverse effects on the fetal development. Furthermore, disruption of serum hormone homeostasis can result in the adverse pregnancy outcomes. Therefore, this study aimed to investigate the potential association between heavy metals and missed abortion, with a focus on whether serum hormones mediate this relationship. The concentrations of heavy metals and hormones in serum were measured in this case-control study. Statistical models including, logistic regression model, principal component analysis (PCA), and weighted quantile sum (WQS) regression model were employed to examine the relationship between heavy metals, serum hormones, and missed abortion. Furthermore, the mediation analysis was performed to assess the role of serum hormones as potential mediators in this relationship. This study revealed significant associations between heavy metal exposure and missed abortion. Notable, the WQS index weight, which was mainly influenced by copper (Cu) and zine (Zn), is associated with missed abortion. Moreover, heavy metals including manganese (Mn), nickel (Ni), Zn, arsenic (As), Cu, cadmium (Cd), and lead (Pb) were found to be associated with serum levels of ß-human chorionic gonadotropin (ß-hCG), progesterone (P), estradiol (E2), and lactogen (HPL). In addition, the mediation analysis indicated that ß-hCG explained a portion of the association (ranging from 18.77 to 43.51%) of between Mn, Ni, Zn, and As exposure and missed abortion. Serum P levels explained 17.93 to 51.70% of the association between Ni, Cu, and As exposure and missed abortion. Serum E2 levels played a significant mediating role, explaining a portion of the association (ranging from 22.14 to 73.60%) between Mn, Ni, Cu, As, Cd, and Pb exposure and missed abortion. Our results suggested that ß-hCG, P, and E2 are one of the potential mediators in the complex relationship between heavy metals exposure and missed abortion. These results highlight the importance of considering both heavy metal exposure and serum hormone levels in understanding the etiology of missed abortion.

In missed abortion the decrease of IGF-1 down-regulates PI3K/AKT signaling pathway reducing the secretion of progesterone and ß-hCG.

OBJECTIVE: To explore whether the reduction of IGF-1 in missed abortion down-regulates PI3K/AKT signaling pathway, thereby causing trophoblast cell apoptosis and reducing the secretion of ß-hCG and progesterone. DESIGN: 12 pairs of serum and villous tissues were selected from missed abortion patients and normal early pregnant women who had terminated pregnancy by artificial abortion. The subjects in two groups had same age and gestational week. Wes Simple Western system and qRT-PCR were used to detect the expression of IGF-1, IGF-1R, PI3K/AKT signaling pathway and apoptosis-related factors in villous tissues. Radioimmunoassay and Enzyme-linked immunosorbent assay were used to detect ß-hCG, progesterone and IGF-1 in serum. RESULTS: The serum levels of ß-hCG, progesterone and IGF-1 were decreased in missed abortion group than those in normal early pregnant women. In addition, compared with normal early pregnant women, the genes and proteins levels of IGF-1 and PI3K/AKT signaling pathway and anti-apoptosis related factors were significantly decreased. CONCLUSIONS: Our results suggested that the reduction of IGF-1 in missed abortion patients could down-regulate the expression of PI3K/AKT signaling pathway, thereby increasing the apoptosis of trophoblast cells, leading to decreased secretion of ß-hCG and progesterone, which may be one of the important mechanisms of missed abortion.

The role of ß-HCG and VEGF-MEK/ERK signaling pathway in villi angiogenesis in patients with missed abortion.

OBJECTIVE: To analyze the effects of the Human Chorionic Gonadotropin beta (ß-hCG) and the VEGF-MEK/ERK signaling pathway on villi angiogenesis in early missed abortion. METHODS: A total of 12 cases of women with missed abortion and 12 cases of women who had induced abortion voluntarily without any disease were included in the present study. The age, pregnancy time and gestation period in the control group corresponded to the missed abortion group. Wes Simple Western system and qRT-PCR were used to detect the expression of VEGF-MEK/ERK signaling pathway related proteins and genes in villous. Radioimmunoassay and Enzyme-linked immunosorbent assay were used to detect ß-hCG and VEGF levels in serum. The microvascular density (MVD) in villous tissue was analyzed by immunohistochemical staining. RESULTS: The levels of ß-hCG and VEGF in serum, the expression of VEGF-MEK/ERK signaling pathway and MVD in villous tissue of the missed abortion group were lower than those of the control group. In addition, compared with the control group, the layers of trophoblasts of the villous tissue in the missed abortion group became thinner significantly, the number of cells reduced, the cell structures were disorganized, and parts of the trophoblast cells were absent. Correlational analysis showed that the protein expression of ERK1/2 was positively correlated with MVD in missed abortion group. CONCLUSIONS: Our results reveal that decreased production of ß-hCG in early pregnant women could down-regulate the expression of VEGF-MEK/ERK signal pathway, then reduce angiogenesis and eventually leading to the abnormal angiogenesis of villous, which may be an important mechanism of missed abortion.

Apigenin attenuates acrylonitrile-induced neuro-inflammation in rats: Involved of inactivation of the TLR4/NF-κB signaling pathway.

Acrylonitrile (ACN) is often found in the productions of synthetic fibers, rubber, and plastics. Exposure to ACN could cause pathological changes of the nervous system, which appeared early and were very serious. Current studies have found that the neurotoxicity is mainly related to oxidative damage and inflammation induced by ACN. Apigenin (AP) is a flavonoid subtype compound that is less toxic, non-mutagenic, and widely distributed in many types of vegetables and fruits. Studies have confirmed that it has nice antioxidant, anti-inflammatory and anti-apoptotic properties in the nervous system and related disease models, such as Alzheimer's disease. In this study, we used AP (117, 234 and 351 mg·kg-1) pretreatment intragastrically to resist the neurotoxicity caused by ACN gavage (46 mg·kg-1) for 28 days, and then detected the oxidative stress, inflammation mediated by the TLR4/NF-κB signaling pathway, and apoptosis to evaluate the protective effect of AP. The results showed that AP could lessen the autonomic activities of rats, and improve the abnormal morphology of neurons induced by ACN. AP could also reduce the oxidative stress, downregulate the TLR4/NF-κB signaling pathway, decrease the levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α), and inhibit the mitochondria-mediated neuron apoptosis. Immunofluorescence result showed that AP could decrease the activation and nuclear transfer of NF-κB induced by ACN. These results suggested that AP could protect the brain against ACN-induced neurotoxicity by inhibiting the TLR4/NF-κB signaling pathway and could exhibit a neuroprotective effect.