Living alone and the risk of depressive symptoms: a cross-sectional and cohort analysis based on the China Health and Retirement Longitudinal Study.

BACKGROUND: There were a few studies that examined the longitudinal association between living alone and depressive symptoms, and the vast majority of them were conducted in patients with certain diseases, such as heart failure, cancer, and glaucoma. This study aimed to examine the association between living alone and depressive symptoms in a large representative older Chinese population. METHODS: The China Health and Retirement Longitudinal Study (CHARLS) data from 2015 to 2018 were used. Living alone was defined as participants who did not live with others ever or more than 11 months in the past year at baseline. Depressive symptoms were measured using the 10-item Center for Epidemiological Studies-Depression Scale (CES-D10). The multivariate logistic regression was used to estimate the relationship between living alone and depressive symptoms. RESULTS: There were 5,311 and 2,696 participants ≥ 60 years old included in the cross-sectional and cohort analysis, respectively. The risk of depressive symptoms in participants who lived alone was significantly higher than those who lived with others in both cross-sectional (OR:1.33; 95%CI:1.14,1.54) and cohort analysis (OR:1.23; 95%CI:0.97,1.55). There was a significant interaction between financial support and living alone (Pinteraction = 0.008) on the risk of depressive symptoms. Stratified analyses showed that, compared to those who lived with others, the risk of depressive symptoms in participants who lived alone increased by 83% (OR:1.83; 95%CI:1.26,2.65) in participants receiving lower financial support. However, we did not find statistically significant associations in participants with medium (OR:1.10; 95%CI: 0.74,1.63) and higher financial support (OR: 0.87; 95%CI: 0.53,1.41). CONCLUSION: Living alone was associated with a higher risk of depressive symptoms in the Chinese older population, and this association was moderated by the receipt of financial support. Living alone may be an effective and easy predictor for early identification of high-risk populations of depression in the older population.

Ketogenic Diet and Multiple Health Outcomes: An Umbrella Review of Meta-Analysis.

Numerous studies have examined the effects of ketogenic diets (KD) on health-related outcomes through meta-analyses. However, the presence of biases may compromise the reliability of conclusions. Therefore, we conducted an umbrella review to collate and appraise the strength of evidence on the efficacy of KD interventions. We conducted a comprehensive search on PubMed, EMBASE, and the Cochrane Database until April 2023 to identify meta-analyses that investigated the treatment effects of KD for multiple health conditions, which yielded 23 meta-analyses for quantitative analyses. The evidence suggests that KD could increase the levels of low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C), the respiratory exchange rate (RER), and could decrease total testosterone and testosterone levels (all p-random effects: <0.05). The combination of KD and physical activity can significantly reduce body weight and increase the levels of LDL-C and cortisol. In addition, KD was associated with seizure reduction in children, which can be explained by the ketosis state as induced by the diet. Furthermore, KD demonstrated a better alleviation effect in refractory childhood epilepsy, in terms of median effective rates for seizure reduction of ≥50%, ≥90%, and seizure freedom. However, the strength of evidence supporting the aforementioned associations was generally weak, thereby challenging their credibility. Consequently, future studies should prioritize stringent research protocols to ascertain whether KD interventions with longer intervention periods hold promise as a viable treatment option for various diseases.

Global, Regional, and National Burden of Cancer in Children Younger Than 5 Years, 1990-2019: Analysis of the Global Burden of Disease Study 2019.

Objectives: To quantify the burden and variation trends of cancers in children under 5 years at the global, regional, and national levels from 1990 to 2019. Methods: Epidemiological data for children under 5 years who were diagnosed with any one childhood cancer were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) from 1990 to 2019. The outcomes were the absolute numbers and rates of incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) for different types of cancer. Results: In 2019, 8,774,979.1 incident cases (95% uncertainty interval [UI]: 6,243,599.2 to11,737,568.5) and 8,956,583.8 (6,446,323.9 to 12,364,520.8) prevalent cases of cancer in children under 5 years were identified worldwide; these cancers resulted in 44,451.6 (36,198.7 to 53,905.9) deaths and 3,918,014.8 (3,196,454.9 to 4,751,304.2) DALYs. From 1990 to 2019, although the numbers of incident and prevalent cases only decreased by -4.6% (-7.0 to -2.2) and -8.3% (-12.6 to -3.4), respectively, the numbers of deaths and DALYs clearly declined by -47.8% (-60.7 to -26.4) and -47.7% (-60.7 to -26.2), respectively. In 2019, the middle sociodemographic index (SDI) regions had the highest incidence and prevalence, whereas the low SDI regions had the most mortality and DALYs. Although all of the SDI regions displayed a steady drop in deaths and DALYs between 1990 and 2019, the low-middle and low SDI regions showed increasing trends of incidence and prevalence. Leukemia remained the most common cancer globally in 2019. From 1990 to 2019, the burdens of leukemia, liver cancer, and Hodgkin's lymphoma declined, whereas the incidence and prevalence of other cancers grew, particularly testicular cancer. Conclusions: The global childhood cancer burden in young children has been steadily decreasing over the past three decades. However, the burdens and other characteristics have varied across different regions and types of cancers. This highlights the need to reorient current treatment strategies and establish effective prevention methods to reduce the global burden of childhood cancer.

PRRT2 Mutation and Serum Cytokines in Paroxysmal Kinesigenic Dyskinesia.

OBJECTIVE: Paroxysmal kinesigenic dyskinesia (PKD) is a rare movement disorder PRRT2 gene mutations have been reported to cause PKD. However, the pathophysiological mechanism of PKD remains unclear, and it is unknown whether an inflammatory response is involved in the occurrence of this disease. We aimed to investigate the symptomatology, genotype, and serum cytokines of patients with PKD. METHODS: We recruited 21 patients with PKD, including 7 with familial PKD and 14 with sporadic PKD. Their clinical features were investigated, and blood samples were collected, and PRRT2 mutations and cytokine levels were detected. RESULTS: The mean age at PKD onset was 12.3±2.2 years old. Dystonia was the most common manifestation of dyskinesia, and the limbs were the most commonly affected parts. All attacks were induced by identifiable kinesigenic triggers, and the attack durations were brief (<1 min). Four different mutations from 9 probands were identified in 7 familial cases (71.4%) and 14 sporadic cases (28.6%). Two of these mutations (c.649dupC, c.620_621delAA) had already been reported, while other 2 (c.1018_1019delAA, c.1012+1G>A) were previously undocumented. The tumor necrosis factor (TNF)-α level in the PKD group was significantly higher than that in the age- and sex-matched control group (P=0.025). There were no significant differences in the interleukin (IL)-1ß, IL-2R, IL-6, IL-8, or IL-10 levels between the two groups. CONCLUSION: In this study, we summarized the clinical and genetic characteristics of PKD. We found that the serum TNF-α levels were elevated in patients clinically diagnosed with PKD, suggesting that an inflammatory response is involved in the pathogenesis of PKD.

The mediating effect of engagement in physical activity over a 24-hour period on chronic disease and depression: Using compositional mediation model.

BACKGROUND: Popular mediation method only considers a single activity as a mediator instead of all 24-hour physical activity, such as a four-way decomposition method. We investigated the mediation of 24-hour movement continuum between chronic diseases (cardiovascular disease [CVD] and diabetes) and depression using a novel compositional mediation model. METHODS: 24-hour activity data measured by accelerometer were obtained from NHANES 2005-2006. Adjusted coefficient with 95% confidence interval (95% CI) for PHQ-9 total score and adjusted odds ratio (OR) with 95% CI for depression were computed from compositional mediation models. RESULTS: In total, 2,375 participants aged ≥ 20 were included in our analysis. Both diabetes and CVD were associated with increased sedentary behavior (SB) and sleep and reduced moderate-to-vigorous physical activity (MVPA) and light-intensity physical activity (LPA), leading to an increased likelihood of depression. Although not all component indirect effects were associated with PHQ-9 total score and depression, the total indirect effect was significantly associated with both PHQ-9 total score (coefficient (95% CI) for diabetes: 0.162 (0.081, 0.261); coefficient (95% CI) for CVD: 1.139 (1.061, 1.240)) and depression (OR (95% CI) for diabetes: 0.235 (0.126, 0.362); OR (95% CI) for CVD: 1.200 (1.088, 1.346)) using the compositional mediation model. CONCLUSION: We developed a compositional mediation model for continuous and binary outcomes, which can handle entire compositional mediators as a unit. The mediation of 24-hour movement continuum mediated the association between diabetes, CVD, and depression. Our findings present potential interventions for reducing risk of depression among patients with CVD and diabetes.

New screening approach to detecting congenital syphilis in China: a retrospective cohort study.

BACKGROUND: Diagnosis of congenital syphilis (CS) is not straightforward and can be challenging. This study aimed to evaluate the validity of an algorithm using timing of maternal antisyphilis treatment and titres of non-treponemal antibody as predictors of CS. METHODS: Confirmed CS cases and those where CS was excluded were obtained from the Guangzhou Prevention of Mother-to-Child Transmission of syphilis programme between 2011 and 2019. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) using receiver operating characteristics (ROC) in two situations: (1) receiving antisyphilis treatment or no-treatment during pregnancy and (2) initiating treatment before 28 gestational weeks (GWs), initiating after 28 GWs or receiving no treatment for syphilis seropositive women. RESULTS: Among 1558 syphilis-exposed children, 39 had confirmed CS. Area under the curve, sensitivity and specificity of maternal non-treponemal titres before treatment and treatment during pregnancy were 0.80, 76.9%, 78.7% and 0.79, 69.2%, 88.7%, respectively, for children with CS. For the algorithm, ROC results showed that PPV and NPV for predicting CS were 37.3% and 96.4% (non-treponemal titres cut-off value 1:8 and no antisyphilis treatment), 9.4% and 100% (non-treponemal titres cut-off value 1:16 and treatment after 28 GWs), 4.2% and 99.5% (non-treponemal titres cut-off value 1:32 and treatment before 28 GWs), respectively. CONCLUSIONS: An algorithm using maternal non-treponemal titres and timing of treatment during pregnancy could be an effective strategy to diagnose or rule out CS, especially when the rate of loss to follow-up is high or there are no straightforward diagnostic tools.

Associations of procalcitonin, C-reaction protein and neutrophil-to-lymphocyte ratio with mortality in hospitalized COVID-19 patients in China.

Coronavirus disease 2019 (COVID-19) is an important and urgent threat to global health. Inflammation factors are important for COVID-19 mortality, and we aim to explore whether the baseline levels of procalcitonin (PCT), C-reaction protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) are associated with an increased risk of mortality in patients with COVID-19. A retrospective study was conducted and a total of 76 patients with confirmed COVID-19 were included between January 17, 2020 to March 2, 2020, of these cases, 17 patients were dead. After adjusting covariates, PCT (≥ 0.10 ng/mL) and CRP (≥ 52.14 mg/L) exhibited independent increasing risks of mortality were used hazard ratio (HR) of 52.68 (95% confidence interval [CI]: 1.77-1571.66) and 5.47 (95% CI: 1.04-28.72), respectively. However, NRL (≥ 3.59) was not found to be an independent risk factor for death in our study. Furthermore, the elevated PCT levels were still associated with increasing risk of mortality in the old age group (age ≥ 60 y), and in the critically severe and severe patients after adjustment for complications. Thu Baseline levels of PCT and CRP have been addressed as independent predictors of mortality in patients with COVID-19.

Effects of dairy products, calcium and vitamin D on ovarian cancer risk: a meta-analysis of twenty-nine epidemiological studies.

Findings for the roles of dairy products, Ca and vitamin D on ovarian cancer risk remain controversial. We aimed to assess these associations by using an updated meta-analysis. Five electronic databases (e.g. PubMed and Embase) were searched from inception to 24 December 2019. Pooled relative risks (RR) with 95 % CI were calculated. A total of twenty-nine case-control or cohort studies were included. For comparisons of the highest v. lowest intakes, higher whole milk intake was associated with increased ovarian cancer risk (RR 1·35; 95 % CI 1·15, 1·59), whereas decreased risks were observed for higher intakes of low-fat milk (RR 0·84; 95 % CI 0·73, 0·96), dietary Ca (RR 0·71; 95 % CI 0·60, 0·84) and dietary vitamin D (RR 0·80; 95 % CI 0·67, 0·95). Additionally, for every 100 g/d increment, increased ovarian cancer risks were found for total dairy products (RR 1·03; 95 % CI 1·01, 1·04) and for whole milk (RR 1·07; 95 % CI 1·03, 1·11); however, decreased risks were found for 100 g/d increased intakes of low-fat milk (RR 0·95; 95 % CI 0·91, 0·99), cheese (RR 0·87; 95 % CI 0·76, 0·98), dietary Ca (RR 0·96; 95 % CI 0·95, 0·98), total Ca (RR 0·98; 95 % CI 0·97, 0·99), dietary vitamin D (RR 0·92; 95 % CI 0·87, 0·97) and increased levels of circulating vitamin D (RR 0·84; 95 % CI 0·72, 0·97). These results show that whole milk intake might contribute to a higher ovarian cancer risk, whereas low-fat milk, dietary Ca and dietary vitamin D might reduce the risk.

Pretreatment lymphocyte-to-monocyte ratio as a predictor of survival among patients with ovarian cancer: a meta-analysis.

INTRODUCTION: In this meta-analysis, we analyzed retrospective cohort studies that assessed the prognostic potential of the pretreatment lymphocyte-to-monocyte ratio (LMR) among patients with ovarian cancer (OC). MATERIALS AND METHODS: We comprehensively searched electronic databases, including PubMed and Embase, from inception through October 2018. A random-effects model was used to calculate pooled HRs and their 95% CIs for overall survival (OS) and progression-free survival (PFS). The low LMR group was treated as the reference group. RESULTS: Twelve studies, including 3,346 OC cases at baseline, were included. Overall, our results indicated that LMR was positively associated with both OS (HR: 1.85, 95% CI: 1.50-2.28, P<0.001; I 2=76.5%) and PFS (HR: 1.70, 95% CI: 1.49-1.94, P<0.001; I 2=24.4%) among OC patients. Stratified analyses indicated that, for OS, the LMR's protective effect was more evident in studies conducted among younger patients (<55 years) than in those conducted among older patients (≥55 years; P for interaction =0.017), which was confirmed by meta-regression analysis (P=0.004). CONCLUSION: This study suggested that a higher pretreatment LMR level was associated with a favorable prognosis among OC patients. Future large-scale prospective clinical trials are needed to confirm the prognostic value of LMR among OC patients.

Dietary inflammatory index and risk of gynecological cancers: a systematic review and meta-analysis of observational studies.

OBJECTIVE: There has been growing body of literatures showing that chronic inflammation might play an important role in cancer development. This meta-analysis aimed to assess the association between the dietary inflammation index (DII) score and gynecological cancers. METHODS: A systematic search of PubMed, EMBASE and Web of Science up until October 20, 2018 was carried out to retrieve all related cohort and case-control studies. The summary risk assessments were pooled using random-effects models. The dose-response relationship was estimated by linear relationship model. RESULTS: Twelve case-control studies (10,774 cases/15,958 controls) and six prospective cohort studies (330,363 participants/23,133 incident cases) were included in this meta-analysis. The pooled adjusted relative risk (RR) of gynecological cancers for the highest DII category compared to the lowest category was 1.38, (95% confidence intervals [CIs], 1.21-1.56, p<0.001]. A positive dose-response relationship was also noticed. Stratified by study design indicated that, the pooled RRs was significantly higher for case-control studies than cohort studies (p for interaction<0.001), for studies conducted among participants with body mass index (BMI) ≥25 kg/m² than participants with BMI <25 kg/m² (p for interaction=0.026), among participants with ovarian cancer and endometrial cancer than participants with breast cancer (p for interaction = 0.038). Meta-regression analysis further confirmed that study design significantly contributed to inter-study heterogeneity (p<0.001). CONCLUSION: This meta-analysis suggests that elevated DII is independently associated with a higher risk of gynecological cancers, especially patients with ovarian cancer and endometrial cancer and among obese participants.

Prognostic implication of the primary tumor location in early-stage breast cancer: focus on lower inner zone.

BACKGROUND: The aim of this study was to investigate the prognostic significance of tumor location of lower inner zone (LIZ) on the survival of patients with early-stage breast cancer. METHODS: We retrospectively identified 961 breast cancer patients from Jan 2000 to Apr 2016 from hospital database. We evaluated overall survival (OS) and disease-free survival (DFS) in patients with tumors in and outside LIZ. Subgroup analyses were performed according to clinicopathological characteristics and treatment strategies. RESULTS: A total of 838 cases were finally included. Patients with tumor location of LIZ showed significantly lower survival rates than tumors in other sites in terms of DFS (p = 0.028) but not OS (p = 0.106). When stratified into subgroups, tumors in LIZ retained a significant worse prognosis in DFS in patients with HER-2-negative, high ki-67 expression breast cancers, those who received neoadjuvant chemotherapy, axillary nodal negative patients, and patients with lymphovascular invasion. Univariate and multivariate analyses suggested that tumor location of LIZ was an independent prognostic factor for DFS (p = 0.022). CONCLUSIONS: Our results suggested that tumor location of LIZ was an independent adverse prognostic factor for DFS in patients with early-stage breast cancer. Multicenter studies with larger sample size are needed to confirm the conclusion and anatomical experiments are desired to elaborate the mechanism.

Off-pump versus on-pump coronary surgery in patients with chronic kidney disease: a meta-analysis.

BACKGROUND: Patients with chronic kidney disease (CKD) have worse adverse cardiovascular outcomes after coronary artery bypass grafting (CABG). However, the adverse cardiovascular outcomes between off-pump coronary artery bypass grafting (OPCAB) versus on-pump coronary artery bypass grafting (ONCAB) in these patients have been a subject of debate. METHODS: We undertook a comprehensive literature search of PubMed, Embase, and the Cochrane Library database to identify all relevant studies comparing techniques between OPCAB and ONCAB in CKD patients. We pooled the odds ratios (ORs) and hazard ratios (HRs) from individual studies and conducted heterogeneity, quality assessment, and publication bias analyses. RESULTS: This meta-analysis includes 17 studies with 201,889 patients. In CKD patients, OPCAB was associated with significantly lower early mortality as compared to ONCAB (OR 0.88; 95% CI 0.82-0.93; p < 0.0001). OPCAB was associated with decreased risk of atrial fibrillation (OR 0.57; 95% CI 0.34-0.97; p = 0.04), cerebrovascular accident (OR 0.46; 95% CI 0.22-0.95; p = 0.04), blood transfusion (OR 0.20; 95% CI 0.08-0.49; p = 0.0005), pneumonia, prolonged ventilation, and shorter hospital stays. No difference was found regarding long-term survival (HR 1.08; 95% CI 0.86-1.36; p = 0.51) or myocardial infarction (OR 0.65; 95% CI 0.30-1.38; p = 0.26). CONCLUSIONS: Compared with ONCAB, OPCAB is associated with superior postoperative morbidity and the early mortality in CKD patients. Long-term survival is comparable between the two surgical revascularizations.

Statin initiation and renal outcomes following isolated coronary artery bypass grafting: a meta-analysis.

INTRODUCTION: The effects of preoperative statin therapy (PST) on renal outcomes in patients with isolated coronary artery bypass grafting (CABG) are in controversial. This study aimed to assess the effects of preoperative statin use on postoperative renal outcomes in patients undergoing isolated CABG. EVIDENCE ACQUISITION: PubMed, EMBASE, and Cochrane Library were searched for studies published up to February 2017. Pooled odds ratio (OR) and its corresponding 95% confidence interval (95% CI) were calculated. Outcomes evaluated were occurrence of postoperative acute kidney injury (AKI)/failure, requirement of any postoperative renal replacement therapy (RRT) and change in serum creatinine (Scr) levels. We used random-effects model and calculated pooled effect estimate of outcome between statin and non-statin use groups. EVIDENCE SYNTHESIS: Eighteen studies consisting of 32,747 patients following CABG were included. PST was associated with a significant protective effect for perioperative renal dysfunction (OR 0.89; 95% CI: 0.82-0.97; P=0.01) and postoperative requirement for RRT (OR 0.54; 95% CI: 0.41-0.72; P=0.001) in patients undergoing CABG surgery. However, there were no effects of preoperative statin therapy on the risk of postoperative AKI and serum creatinine concentration. In the subgroup of patients after on-pump CABG surgery, PST significantly reduced the perioperative renal dysfunction and requirement for RRT (OR 0.69; 95% CI: 0.53-0.89; P=0.005, OR 0.51; 95% CI: 0.30-0.87; P=0.014, respectively). CONCLUSIONS: In patients undergoing isolated CABG, PST might be associated with lower risk of postoperative renal dysfunction and the requirement for RRT. However, PST may not reduce the risk of AKI. Future large well-designed randomized controlled trials are needed on this topic.

The burden and challenges of tuberculosis in China: findings from the Global Burden of Disease Study 2015.

To achieve the End Tuberculosis (TB) Strategy, it is important to understand the characteristics of TB in China, which may provide the government with important clues for controlling TB by 2030. Data from the Global Burden of Disease Study 2015 (GBD 2015) and Institute for Health Metrics and Evaluation (IHME) were reviewed and analysed. The age-standardized death rate decreased by 83.79% [95% uncertainty interval (UI) 73.06-87.10] from 1990 to 2015. The age-standardized prevalence of TB in males decreased steadily by 33.88% (95% UI 29.35-37.67) but nearly increased by 6.24% (95% UI -2.02-15.07) in females from 1990 to 2015. Disability-adjusted life years (DALYs) were higher in males than in females, and the highest TB burden was found in the elderly (70+ years of age). Over the period 1990-2015, the attributable age-standardized DALY rates for smoking decreased by 12.98% (95% UI 2.40-24.27), but increased for alcohol use and high fasting plasma glucose (HFPG). Greater attention should be paid to females especially in the under 5 years of age group, and more latent reasons explaining TB DALYs should be explored in future studies.

Comparison of coronary artery bypass grafting and drug-eluting stents in patients with chronic kidney disease and multivessel disease: A meta-analysis.

BACKGROUND: The optimal revascularization strategy of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention with drug-eluting stent (PCI-DES) in patients with chronic kidney disease (CKD) and multivessel disease (MVD) remains unclear. METHODS: Pubmed, EMBASE and Cochrane Library electronic databases were searched from inception until June 2016. Studies that evaluate the comparative benefits of DES versus CABG in CKD patients with multi-vessel disease were considered for inclusion. We pooled the odds ratios from individual studies and conducted heterogeneity, quality assessment and publication bias analyses. RESULTS: A total of 11 studies with 29,246 patients were included (17,928 DES patients; 11,318 CABG). Compared with CABG, pooled analysis of studies showed DES had higher long-term all-cause mortality (OR, 1.22; p<0.00001), cardiac mortality (OR, 1.29; p<0.00001), myocardial infarction (OR, 1.89; p=0.02), repeat revascularization (OR, 3.47; p<0.00001) and major adverse cardiac and cerebrovascular events (MACCE) (OR, 2.00; p=0.002), but lower short-term all-cause mortality (OR, 0.33; p<0.00001) and cerebrovascular accident (OR, 0.64; p=0.0001). Subgroup analysis restricted to patients with end-stage renal disease (ESRD) yielded similar results, but no significant differences were found regarding CVA and MACCE. CONCLUSIONS: CABG for patients with CKD and MVD had advantages over PCI-DES in long-term all-cause mortality, MI, repeat revascularization and MACCE, but the substantial disadvantage in short-term mortality and CVA. Future large randomized controlled trials are certainly needed to confirm these findings.

Intraclot recombinant tissue-type plasminogen activator reduces perihematomal edema and mortality in patients with spontaneous intracerebral hemorrhage.

The study aimed to investigate the impact of intraclot recombinant tissue-type plasminogen activator (rt-PA) on perihematomal edema (PHE) development in patients with intracerebral hemorrhage (ICH) treated with minimally invasive surgery (MIS) and the effects of intraclot rt-PA on the 30-day survival. We reviewed the medical records of ICH patients undergoing MIS between October 2011 and July 2013. A volumetric analysis was done to assess the change in PHE and ICH volumes at pre-MIS (T1), post-MIS (T2) and day 10-16 (T3) following diagnostic computed tomographic scans (T0). Forty-three patients aged 52.8±11.1 years with (n=30) or without rt-PA (n=13) were enrolled from our institutional ICH database. The median rt-PA dose was 1.5 (1) mg, with a maximum dose of 4.0 mg. The ratio of clot evacuation was significantly increased by intraclot rt-PA as compared with controls (77.9%±20.4% vs. 64%±15%; P=0.046). From T1 to T2, reduction in PHE volume was strongly associated with the percentage of clot evacuation (ρ=0.34; P=0.027). In addition, PHE volume was positively correlated with residual ICH volume at the same day (ρ ranging from 0.39-0.56, P<0.01). There was no correlation between the cumulative dose of rt-PA and early (T2) PHE volume (ρ=0.24; P=0.12) or delayed (T3) PHE volume (ρ=0.19; P=0.16). The 30-day mortality was zero in this cohort. In the selected cohort of ICH patients treated with MIS, intraclot rt-PA accelerated clot removal and had no effects on PHE formation. MIS aspiration and low dose of rt-PA seemed to be feasible to reduce the 30-day mortality in patients with severe ICH. A large, randomized study addressing dose titration and long-term outcome is needed.

Do neuroimaging results impact prognosis of epilepsy surgery? A meta-analysis.

The neuroimaging results of drug-resistant epilepsy patients play an important role in the surgery decision and prognosis. The aim of this study was to evaluate the impact of these results on the efficacy of epilepay surgery, and then to explore surgical benefit for epilepsy patients with negative magnetic resonance (MR) images. Twenty-four subgroups describing the outcomes of 1475 epilepsy patients with positive-neuroimaging results and 696 patients with negative-neuroimaging results were involved in the meta-analysis. Overall, the odds of postoperational seizure-free rate were 2.03 times higher in magnetic resonance imaging-positive (MRI-positive) patients than in MRI-negative patients [odds ratio (OR)=2.03, 95% CI (1.67, 2.47), P<0.00001]. For patients with temporal lobe epilepsy (TLE), the odds were 1.76 times higher in those with MRI-positive results than in those with MRI-negative results [OR=1.76, 95% CI (1.34, 2.32), P<0.0001]. For patients with extra-temporal lobe epilepsy (extra-TLE), the odds were 2.88 times higher in MRI-positive patients than in MRI-negative patients [OR=2.88, 95% CI (1.53, 5.43), P=0.001]. It was concluded that the seizure-free rate of MRI-positive patients after surgery was higher than that of MRI-negative patients. For patients with negative results, an appropriate surgery should be concerned for TLE.

Interleukin-18 among atrial fibrillation patients in the absence of structural heart disease.

AIMS: Inflammation plays a role in the genesis and perpetuation of atrial fibrillation (AF). Interleukin (IL)-18 is a pleiotropic proinflammatory cytokine with a central role in the inflammatory cascade. We hypothesize that the circulating IL-18 concentration is elevated in AF patients. METHODS AND RESULTS: In a case-control study design, 56 cases with AF and 26 controls were enrolled. All AF cases were categorized into paroxysmal and persistent AF or lone AF and AF with hypertension. Circulating levels of IL-18, tumour necrosis factor-α, high-sensitivity C-reactive protein, matrix metalloproteinase (MMP)-9, and tissue inhibitor of MMP-1 were measured. In adjusted analyses, only age, MMP-9, and IL-18 were independently associated with AF, in which IL-18 had the most significant association (P = 0.0011, standardized estimate &bgr = 1.76, OR = 1.02, 95% confidence interval: 1.01-1.03). Interleukin-18 levels in persistent AF patients were higher than those in paroxysmal ones (P = 0.0011). Patients who developed AF within 24 h prior to sampling displayed a higher level of IL-18 than those with sinus rhythm (P = 0.0027). Interleukin-18 was positively correlated with left atrial diameter (r = 0.33, P = 0.0117). CONCLUSION: This study documents the elevated IL-18 in AF patients. Interleukin-18 may be superior to other inflammatory markers which are known to be elevated in AF.

Combined transplantation of neural stem cells and olfactory ensheathing cells improves the motor function of rats with intracerebral hemorrhage.

OBJECTIVE: To investigate the effects of combined transplantation of neural stem cells (NSC) and olfactory ensheathing cells (OEC) on the motor function of rats with intracerebral hemorrhage. METHODS: In three days after a rat model of caudate nucleus hemorrhage was established, NSCs and OEC, NSC, OEC (from embryos of Wistar rats) or normal saline were injected into hematomas of rats in combined transplantation group, NSC group, OEC group, and control group, respectively. Damage of neural function was scored before and in 3, 7, 14, 30 days after operation. Tissue after transplantation was observed by immunocytochemistry staining. RESULTS: The scores for the NSC, OEC and co-transplantation groups were significantly lower in 14 and 30 days after operation than in 3 days after operation (P < 0.05). The scores for the NSC and OEC groups were significantly lower than those for the control group only in 30 days after operation (P < 0.05), while the difference for the NSC-OEC group was significant in 14 days after operation (P < 0.05). Immunocytochemistry staining revealed that the transplanted OEC and NSC could survive, migrate and differentiate into neurons, astrocytes, and oligodendrocytes. The number of neural precursor cells was greater in the NSC and combined transplantation groups than in the control group. The number of neurons differentiated from NSC was significantly greater in the co-transplantation group than in the NSC group. CONCLUSION: Co-transplantation of NSC and OEC can promote the repair of injured tissue and improve the motor function of rats with intracerebral hemorrhage.

Meta-analysis of MSH6 gene mutation frequency in colorectal and endometrial cancers.

Studies on mutations and mutation frequencies of the MSH6 gene, which mainly focus on new types of mutations in small samples, have been published ever since the first report of MSH6 mutation in two atypical hereditary non-polyposis colorectal cancer patients. However, the results remain inconsistent. Therefore, a systematic review was conducted and a meta-analysis was undertaken to determine the frequency of MSH6 mutation in colorectal and endometrial cancers. From 27 studies, 180 cases with MSH6 mutation in a total of 3196 cases were detected. In colorectal and endometrial cancers the MSH6 mutation frequency is 7.2 and 9.6%, respectively. MSH6 mutation frequency was 10.4% in hereditary non-polyposis colorectal cancer patients, 7.1% in atypical hereditary non-polyposis colorectal cancer patients, and 5.9% in sporadic patients. The frequency of MSH6 mutation in high microsatellite instability (MSI-H) was 11.6% and in low microsatellite instability (MSI-L) cases was (13.3%), which were higher than in microsatellite stability (MSS) cases (1.7%). The mean age of the earliest onset of colorectal and endometrial cancers in MSH6 mutation carriers was 51.2 and 56.5 yr, respectively. Data suggest that the frequency of MSH6 mutation is higher in hereditary non-polyposis colorectal cancer patients than in atypical hereditary non-polyposis colorectal cancer and sporadic patients. MSH6 mutation frequency was also higher in endometrial than colorectal cancers. The mean age of earliest onset of endometrial cancer (56.5 yr) is older than for colorectal cancer (51.2 yr) in carriers of MSH6 mutation. Our results provide evidence for clinical genetic testing and counseling.