Preconception folic acid supplementation for the prevention of birth defects: a prospective, population-based cohort study in mainland China.

BACKGROUND: Folic acid supplementation is recommended for reducing the risk of birth defects. We aimed to assess the protective association of periconception folic acid supplements with birth defects in real-world setting. METHODS: This prospective, population-based cohort study utilized national preconception registered data of married Chinese couples planning a pregnancy within 6 months between 2010 and 2012 in Mainland China. Participated women are freely provided folic acid starting 3 months before conception till 3 months after conception. Birth defects were self-reported at 42 days postpartumn followup. R software (v4.0.2) was applied for statistical analyses. RESULTS: Complete data of 567,547 couples with pregnancy outcomes and folic acid supplementation were extracted for final analysis. A total of 74.7% women were with folic acid supplementation, and 599 birth defects were self-reported. The odd of birth defects was lower among women taking folic acid compared to their counterparts not taking (0.102% vs 0.116%, P < 0.001). In the multiple logistic regression analyses, the odd of birth defects was lower among couples with maternal folic acid supplementation (OR = 0.78, 95%CI: 0.66-0.95, P = 0.011), especially decreased odd of neural tube defects (NTDs) (OR = 0.56, 95%CI: 0.39-0.82, P = 0.003). This association was confirmed by 1:4 and 1:10 case control analysis. Odds of birth defects were significantly lower among women with folic acid supplementation more than 3 months before pregnancy (P < 0.001), and moreover, the odds of cleft (P = 0.007) and NTDs (P = 0.007) were of notable decrease. CONCLUSION: This retrospective case cohort study provides programmatic evidence for public health strategy-making to for reducing the risk of NTDs and clefts.

Associations of Social Isolation and Loneliness With Later Dementia.

ObjectiveTo investigate the independent associations of social isolation and loneliness with incident dementia and to explore the potential neurobiological mechanisms.MethodsWe utilized the UK Biobank cohort to establish Cox proportional hazard models with social isolation and loneliness as separate exposures. Demographic (sex, age and ethnicity), socioeconomic (education level, household income and Townsend deprivation index), biological (BMI, APOE genotype, diabetes, cancer, cardiovascular disease and other disabilities), cognitive (speed of processing and visual memory), behavioral (current smoker, alcohol intake and physical activity), and psychological (social isolation or loneliness, depressive symptoms and neuroticism) factors measured at baseline were adjusted. Then, voxel-wise brain-wide association analyses were used to identify gray matter volumes (GMV) associated with social isolation and with loneliness. Partial least squares regression was performed to test the spatial correlation of GMV differences and gene expression using the Allen Human Brain Atlas.ResultsWe included 462,619 participants (mean age at baseline 57.0 years [SD 8.1]). With a mean follow-up of 11.7 years (SD 1.7), 4,998 developed all-cause dementia. Social isolation was associated with a 1.26-fold increased risk of dementia (95% CI, 1.15-1.37) independently of various risk factors including loneliness and depression (i.e., full adjustment). However, the fully adjusted hazard ratio for dementia related to loneliness was 1.04 (95% CI, 0.94-1.16); and 75% of this relationship was attributable to depressive symptoms. Structural MRI data were obtained from 32,263 participants (mean age 63.5 years [SD 7.5]). Socially isolated individuals had lower GMVs in temporal, frontal and other (e.g., hippocampal) regions. Mediation analysis showed that the identified GMVs partly mediated the association between social isolation at baseline and cognitive function at follow-up. Social isolation-related lower GMVs were related to under-expression of genes that are down-regulated in Alzheimer's disease and to genes that are involved in mitochondrial dysfunction and oxidative phosphorylation.ConclusionSocial isolation is a risk factor for dementia that is independent of loneliness and many other covariates. Social isolation-related brain structural differences coupled with different molecular functions also support the associations of social isolation with cognition and dementia. Social isolation may thus be an early indicator of an increased risk of dementia.

Hemophagocytosis, hyper-inflammatory responses, and multiple organ damages in COVID-19-associated hyperferritinemia.

Hyperferritinemia comes to light frequently in general practice. However, the characteristics of COVID-19-associated hyperferritinemia and the relationship with the prognosis were not well described. The retrospective study included 268 documented COVID-19 patients. They were divided into the hyperferritinemia group (≥ 500 µg/L) and the non-hyperferritinemia group (< 500 µg/L). The prevalence of fever and thrombocytopenia and the proportion of patients with mechanical ventilator support and in-hospital death were much higher in the hyperferritinemia group (P < 0.001). The hyperferritinemia patients showed higher median IL-6, D-dimer, and hsCRP (P < 0.001) and lowered FIB level (P = 0.036). The hyperferritinemia group had a higher proportion of patients with AKI, ARDS, and CSAC (P < 0.001). According to the multivariate analysis, age, chronic pulmonary disease, and hyperferritinemia were found to be significant independent predictors for in-hospital mortality [HR 1.041 (95% CI 1.015-1.068), P = 0.002; HR 0.427 (95% CI 0.206-0.882), P = 0.022; HR 6.176 (95% CI 2.447-15.587), P < 0.001, respectively]. The AUROC curve was 0.88, with a cut-off value of ≥ 971 µg/L. COVID-19 patients with hyperferritinemia had a high proportion of organ dysfunction, were more likely to show hyper-inflammation, progressed to hemophagocytic lymphohistiocytosis, and indicated a higher proportion of death.

[µ-1,4-Bis(1,2,4-triazol-1-ylmeth-yl)benzene]-bis-[aqua-(pyridine-2,6-dicarboxyl-ato)copper(II)] monohydrate.

The title compound, [Cu(2)(C(7)H(3)NO(4))(2)(C(12)H(12)N(6))(H(2)O)(2)]·H(2)O, displays a discrete dinuclear structure, in which the central Cu(II) atom is five-coordinated in a distorted square-based pyramidal coordination geometry and the flexible ligand 1,4-bis-(1,2,4-triazol-1-ylmeth-yl)benzene adopts a bis-monodentate bridging mode linking the Cu(II) atoms. It is further assembled by O-H⋯O hydrogen-bond inter-actions involving both the coordinated and uncoordinated water molecules. The latter exhibits half-occupancy.

1,4-Bis[(1H-pyrazol-1-yl)meth-yl]benzene.

In the title compound, C(14)H(14)N(4), the center of the phenyl-ene group is a crystallographic center of inversion. The compound is composed of three aromatic rings displaying a Z-like conformation. The dihedral angle between the pyrazole rings and the central phenyl ring is 83.84 (9)°.

1,1'-[1,4-Phenyl-enebis(methyl-ene)]bis-(2-methyl-1H-imidazol-3-ium) 2,4-dicarb-oxy-benzene-1,5-dicarboxyl-ate monohydrate.

In the dication of the title compound, C(16)H(20)N(4) (2+)·C(10)H(4)O(8) (2-)·H(2)O, the dihedral angles formed by mean planes of the imidazolium rings and the benzene ring are 69.05 (18) and 89.1 (2)°. In the crystal, the components are linked into a three-dimensional network by inter-molecular N-H⋯O and O-H⋯O hydrogen bonds.

N-Phenyl-N-(prop-2-en-1-yl)benzene-sulfonamide.

In the mol-ecule of the title compound, C(15)H(15)NO(2)S, the dihedral angle between the two phenyl rings is 41.8 (3)°. The S atom has a distorted tetra-hedral environment. In the crystal structure, C-H⋯O hydrogen bonds link the molecules into a ribbon-like structure along [010].

4-Benzene-sulfonamido-benzoic acid.

In the mol-ecule of the title sulfonamide compound, C(13)H(11)NO(4)S, the dihedral angle between the planes of the benzene ring and the carboxyl substituent group is 6.7 (4)°. The two aromatic rings are inclined at 45.36 (15)° to one another. In the crystal, adjacent mol-ecules are linked via classical inter-molecular N-H⋯O and O-H⋯O, and non-classical C-H⋯O hydrogen bonds, which stabilize the crystal structure.