Kisspeptin expression during menstruation in PCOS patients undergoing ovulation induction and the correlation with early pregnancy.

PURPOSE: To examine the pattern of kisspeptin expression throughout the menstrual cycle in polycystic ovary syndrome (PCOS) patients under the ovulation induction and identify any possible associations with early pregnancy. MATERIALS AND METHODS: A prospective cohort of 80 PCOS women who expressed the desire for fertility was enrolled in this study. All of them received the ovulation induction by using letrozole. Levels of kisspeptin, luteinizing hormone (LH), and estradiol (E2) were measured at three different time points during menstruation. The early pregnancy rate was recorded for the study participants after three ovulation cycles. RESULTS: Kisspeptin levels varied regularly during the menstrual cycle, reaching a peak on the day of hCG injection and decreasing after ovulation. There was no significant correlation between kisspeptin and LH levels. Basal kisspeptin levels decreased after letrozole treatment without a significant difference while LH and E2 levels decreased significantly. PCOS participants who became pregnant early had higher basal kisspeptin levels compared to non-pregnant PCOS patients, which had a significant difference (P = 0.006). And the average basal kisspeptin level in pregnant patients was 2293.0 ± 398.7 pg/ml, with a 95% confidence interval of 1511.5-3074.5 pg/ml. CONCLUSION: Kisspeptin levels in PCOS women undergoing ovulation induction showed a regular variation, which was similar with the healthy women reported in previous studies. The use of LE may result in PCOS endocrine improvement and fertility achievement. In a certain range, kisspeptin might be a potential predictor for early pregnancy in PCOS patients as people with slightly higher basal kisspeptin levels seemed more likely to be pregnant.

Synergistic Effects of Lewis Acid-Base Pair Sites─Hf-MOFs with Functional Groups as Distinguished Catalysts for the Cycloaddition of Epoxides with CO2.

The incorporation of Lewis acid-base sites in catalysts has been considered as a significant approach to fabricating bifunctional catalysts with efficient catalytic activity for CO2 fixation. In this paper, a series of Hafnium-based metal-organic frameworks (Hf-MOFs), NU-912(Hf) and NU-912-X(Hf)-X (X = -NH2, -Br, -CN, and -I) derivatives assembled by Lewis acidic Hf6(µ3-O)4(µ3-OH)4(H2O)4(OH)4 (Hf6) clusters and Lewis base-attached organic linkers, are successfully synthesized by a facile ligand functionalization method. These isostructural Hf-MOFs, which exhibit diamond channels of 1.3 nm diameter, great chemical stability, and CO2 adsorption capacity, have been evaluated as catalysts for the CO2 cycloaddition reaction with epoxides. Catalytic experiments reveal that the micropore environments of these MOFs have an outstanding impact on catalytic activity. Remarkably, NU-912(Hf)-I serves as an efficient heterogeneous catalyst for this catalytic reaction under mild conditions due to the high density of Lewis acid Hf6 cluster centers and strong Lewis base functional groups, surpassing most of the reported MOF-based catalysts.

Laparoscopic versus open Hartmann reversal: a propensity score matching analysis.

PURPOSE: The purpose of this study was to compare the short-term outcomes between laparoscopic Hartmann reversal (LHR) and open Hartmann reversal (OHR) in patients who had undergone Hartmann surgery for colorectal cancer (CRC). METHODS: The patients who underwent Hartmann reversal (HR) at the First Affiliated Hospital of Chongqing Medical University from Jun 2013 to Jun 2022 were retrospectively enrolled. The LHR group and the OHR group were compared using propensity score matching (PSM) analysis. RESULTS: A total of 89 patients who underwent Hartmann reversal (HR) were enrolled in this study. There were 48 (53.9%) patients in the LHR group and 41 (46.1%) patients in the OHR group. After 1:1 ratio PSM, no difference in baseline information remained (p > 0.05). There was no significant difference in operation time, blood loss, postoperative hospital stay, and postoperative complications (p > 0.05) before and after PSM. In the multivariable logistic regression analysis, pre-operative albumin < 42.0 g/L was an independent risk factor (p = 0.013 < 0.05, OR = 0.248, 95% CI = 0.083-0.741) for the HR-related complications; however, LHR/OHR was not a predictive risk factor (p = 0.663, OR = 1.250, 95% CI = 0.500-3.122). CONCLUSION: Based on the current evidence, although there was no difference in short-term prognosis, LHR still had some advantages considering that it was less invasive to the patient.

The advanced lung cancer inflammation index is a prognostic factor for gastrointestinal cancer patients undergoing surgery: a systematic review and meta-analysis.

BACKGROUND: The advanced lung cancer inflammation index (ALI) is a comprehensive assessment indicator that can reflect inflammation and nutrition conditions. However, there are some controversies about whether ALI is an independent prognostic factor for gastrointestinal cancer patients undergoing surgical resection. Thus, we aimed to clarify its prognostic value and explore the potential mechanisms. METHODS: Four databases including PubMed, Embase, the Cochrane Library, and CNKI were used for searching eligible studies from inception to June 28, 2022. All gastrointestinal cancers, including colorectal cancer (CRC), gastric cancer (GC), esophageal cancer (EC), liver cancer, cholangiocarcinoma, and pancreatic cancer were enrolled for analysis. We focused on prognosis most in the current meta-analysis. Survival indicators, including overall survival (OS), disease-free survival (DFS), and cancer-special survival (CSS) were compared between the high ALI group and the low ALI group. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was submitted as a supplementary document. RESULTS: We finally included fourteen studies involving 5091 patients in this meta-analysis. After pooling the hazard ratios (HRs) and 95% confidence intervals (CIs), ALI was found to be an independent prognostic factor for both OS (HR = 2.09, I2 = 92%, 95% CI = 1.53 to 2.85, P < 0.01), DFS (HR = 1.48, I2 = 83%, 95% CI = 1.18 to 1.87, P < 0.01), and CSS (HR = 1.28, I2 = 1%, 95% CI = 1.02 to 1.60, P = 0.03) in gastrointestinal cancer. After subgroup analysis, we found that ALI was still closely related to OS for CRC (HR = 2.26, I2 = 93%, 95% CI = 1.53 to 3.32, P < 0.01) and GC (HR = 1.51, I2 = 40%, 95% CI = 1.13 to 2.04, P = 0.006) patients. As for DFS, ALI also has a predictive value on the prognosis of CRC (HR = 1.54, I2 = 85%, 95% CI = 1.14 to 2.07, P = 0.005) and GC (HR = 1.37, I2 = 0%, 95% CI = 1.09 to 1.73, P = 0.007) patients. CONCLUSION: ALI affected gastrointestinal cancer patients in terms of OS, DFS, and CSS. Meanwhile, ALI was a prognostic factor both for CRC and GC patients after subgroup analysis. Patients with low ALI had poorer prognoses. We recommended that surgeons should perform aggressive interventions in patients with low ALI before the operation.

Z-Scheme In2 S3 /NU-1000 Heterojunction for Boosting Photo-Oxidation of Sulfide into Sulfoxide under Ambient Conditions.

Photocatalytic oxidation of sulfide into sulfoxide has attracted extensive attention as an environmentally friendly strategy for chemical transformations or toxic chemicals degradation. Herein, we construct a series of In2 S3 /NU-1000 heterojunction photocatalysts, which can efficiently catalyze the oxidation of sulfides to form sulfoxides as the sole product under LED lamp (full-spectrum) illumination in air at room temperature. Especially, the sulfur mustard simulant, 2-chloroethyl ethyl sulfide (CEES), can also be photocatalytically oxidized with In2 S3 /NU-1000 to afford nontoxic 2-chloroethyl ethyl sulfoxide (CEESO) selectively and effectively. In contrast, individual NU-1000 and In2 S3 show very low catalytic activity on this reaction. The significantly improved photocatalytic activity is ascribed to the constructing of an efficient Z-scheme photocatalysts In2 S3 /NU-1000, which exhibits the enhancement of light harvesting, the promotion of photogenerated electron-hole separation, and the retention of high porosity of the parent MOF. Moreover, mechanism studies in photocatalytic oxidation reveal that the superoxide radical (. O2 - ) and singlet oxygen (1 O2 ) are the main oxidative species in the oxidation system. This work exploits the opportunities for the construction of porous Z-scheme photocatalysts based on the photoactive MOFs materials and inorganic semiconductors for promoting catalytic organic transformations. More importantly, it provides a route to the rational design of efficient photocatalysts for the detoxification of mustard gas.

Comparison of sleep quality among puerperal women before and during the COVID-19 pandemic: a cross-sectional survey in Lanzhou, China.

PURPOSE: Few studies have yet examined sleep quality among puerperal women during the coronavirus disease 2019 (COVID-19) pandemic. This cross-sectional study aimed to compare the sleep quality of puerperal women before and during the COVID-19 pandemic in Lanzhou, China. The study exploreed the factors that affect sleep quality among puerperal women. METHODS: The study population comprised puerperal women who went to the obstetric department of the Gansu Provincial Maternity and Childcare Hospital on the 42nd day after childbirth. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Data were collected by doctors in the obstetric department before the COVID-19 pandemic (Oct.-Dec. 2019) and during the COVID-19 pandemic (Feb.-Apr. 2020) in China. Multiple linear regressions were used to examine the association between the sleep quality of puerperal women and COVID-19 and to identify factors that affect the total PSQI scores. RESULTS: In 2019, 546 puerperal women were assessed compared with 655 who were assessed in 2020. Compared with before COVID-19, the total PSQI scores of puerperal women improved during the COVID-19 pandemic. In addition, the influencing factors of sleep quality among puerperal women were the pandemic itself, age, conception method, and postpartum depression (PPD). CONCLUSIONS: In contrast with other studies, there was no evidence for worsening sleep quality of puerperal women during the COVID-19 pandemic in Lanzhou, China. Puerperal women who underwent assisted pregnancy or developed PPD were more likely to experience poor sleep quality.

Prevalence of anxiety and its associated factors among infertile patients after 'two-child' policy in Chongqing, China: a cross-sectional study.

BACKGROUND: With the prevalence of infertility increasing every year around the world, it has seriously impacted the individual quality of family and social life. Anxiety is one of the most prevalent anxiety disorders among infertile patients. After the two-child policy, whether it affected the prevalence of anxiety is controversial. This study aimed to determine the prevalence of anxiety and its potential risk factors among Chinese infertile women after the enforcement of 'two-child policy'. METHODS: This cross-sectional study included 693 infertile patients in a reproductive medical center in Chongqing, China, between February 2016 and December 2018. Data was collected by Self-filling questionnaires including basic demographic information and the Generalized Anxiety Disorder-7 (GAD-7). SPSS statistical software (IBM SPSS version 25) was used to analyse the obtained data. Descriptive analysis was used to describe basic information and anxiety scores, the chi-square test and binary logistic regression were used to analyse the relationship between anxiety and other variables. RESULTS: The prevalence of anxiety among total infertile patients was 21.8%, and its 23.5% among first-child infertile patients (FI), and 18.4% among second-child infertile patients (SI) respectively (P > 0.05). Binary logistic regression showed that patients with lower education levels were more likely to have anxiety (P < 0.01). Patients with middle salary incomes were more likely to have anxiety (OR = 1.860, 95% CI: 1.068-3.238). Oral contraception taking history (OR = 1.778, 95% CI: 1.186-2.667), and history of allergy (OR = 2.098, 95% CI: 1.219-3.612) were associated with anxiety. CONCLUSIONS: Under the full liberalization of the "two-child policy", the total prevalence of anxiety among Chinese infertile female is comparatively high. Low education levels, middle incomes, oral contraception taking and allergy history can be the related risk factors of anxiety. We promote that all infertile patients should be evaluated for the prevalence of anxiety, especially those with potential risks, and receive consultant or targeted treatment when needed.

The Regulation of Trophoblastic p53 Homeostasis by the p38-Wip1 Feedback Loop is Disturbed in Placentas from Pregnancies Complicated by Preeclampsia.

BACKGROUND/AIMS: Excessive apoptosis of trophoblasts, induced by sustained hypoxia, leads to abnormal placentation and is strongly linked to pregnancy complications such as preeclampsia (PE). Wild-type p53-induced phosphatase (Wip1) positively regulates cellular survival in tumor cells through the p38 and p53 pathways, but its expression pattern and effects in trophoblasts have yet to be reported. This study clarified the effect of Wip1 on the regulatory mechanism of p53-dependent apoptosis in trophoblasts, and thus increases understanding of the etiology of PE. METHODS: In normal and PE placentas, Wip1 mRNA and protein levels were determined by RT-qPCR and Western blotting respectively, while localization of Wip1 in placental tissues and in HTR8/SVneo cells was determined by immunohistochemistry and immunofluorescence. Two in vitro trophoblastic PE models were established by subjecting HTR8/SVneo cells to either hypoxia intervention in incubator (HII) or simulated ischemic buffer (SIB). Wip1 was suppressed in the aforementioned PE models by specific inhibitor or shRNA, and apoptosis was then assessed by flow cytometry, while further validation was done by measurement of cleaved-caspase 9 expression by Western blotting. The p38 inhibitor SB202190, Mdm2 inhibitor NVP-CGM097, and proteasome inhibitor MG-132 were administered in PE models, either in combination or alone, to determine the regulatory order of the component signal molecules of the feedback loop. The impact of Wip1 on p53-Mdm2 interaction was examined by coimmunoprecipitation. Lastly, the upregulation of the p38-Wip1 loop was confirmed in human placentas from pregnancies complicated by PE, using Western blotting. RESULTS: Wip1 expression was significantly elevated in human PE placentas and in vitro trophoblastic PE models; this is opposite to the pattern observed in tumor cells. Inhibition of Wip1 rescued hypoxia-induced p38 activation, cleavage of caspase 9 and apoptosis but significantly compromised p53-Mdm2 binding, while p-p53Ser15 was increased. Inhibition of Mdm2 degradation resulted in p53 destabilization and p38-Wip1 loop down-regulation, while degradation of the p53-Mdm2 complex resulted in p53 accumulation and p38-Wip1 loop hyperactivation. However, the p53-Mdm2 interaction was found to be more important in the regulation of the p38-Wip1 loop than Mdm2 stability. CONCLUSION: Trophoblastic p53 homeostasis is maintained by the p38-Wip1 feedback regulatory loop in response to hypoxic stress, which is dysregulated in the placentas of pregnancies complicated by PE, and thereby leads to excessive apoptosis.

Unprecedented Multicolor Photoluminescence from Hyperbranched Poly(amino ester)s.

A novel kind of water-soluble fluorescent hyperbranched poly(amino ester) (PAE) is prepared through a one-pot polycondensation reaction of citric acid (CA) and N-methyldiethanolamine (NMDEA). The PAE exhibits enhanced and red-shift fluorescence with increasing solution concentration, showing distinct aggregation-induced emission character. Interestingly, the resulting PAE exhibits tunable photoluminescence from blue, cyan, and green to red irradiated by altering the excitation wavelengths. Such unique emission of non-conjugated PAE is attributed to the clustering of ester and tertiary amine groups derived from PAE self-assembly aggregates. Moreover, the fluorescence of PAE is very sensitive to Fe3+ ions. The facile preparation and unique optical features make PAE potentially useful in numerous applications such as multicolor cellular imaging, Fe3+ ions probe, and light-emitting diodes.

AMPK Hyper-Activation Alters Fatty Acids Metabolism and Impairs Invasiveness of Trophoblasts in Preeclampsia.

BACKGROUND/AIMS: Preeclampsia (PE) has long been assumed to be an ischemic disease of the placenta, although there is limited evidence as to how the ischemia impacts on the placenta. AMP-activated protein kinase (AMPK) is a key regulator of cellular energy metabolism and plays an important role in a variety of ischemic diseases by enhancing energy production. The present study investigated placental metabolism in PE, and the role of AMPK in regulating trophoblast function. METHODS: placentas from normal and PE complicated pregnancies were subjected to GC-MS to identify fatty acids (FA) metabolic fingerprints, and total FA oxidation was assessed by malondialdehyde (MDA) measurement. The AMPK-ACC signaling pathway was assessed by q-PCR and Western Blotting. HTR8/SVneo trophoblast cultures were exposed to different oxygenation conditions to establish an in vitro PE cell model; further analysis by GC-MS for metabolite profiling was then undertaken. Trophoblasts invasion was assessed by a matrigel transwell assay in the presence/absence of AMPK expression and after manipulations of AMPK activity, and then further validated by human villi outgrowth experiments. RESULTS: AMPK phosphorylation and MDA production were significantly elevated in placentas from pregnancies complicated by PE. Metabolism of cis double bond FA was inhibited while trans double bond FA metabolism was promoted in PE placentas. HTR8/SVneo cell culture conditions of persistent low oxygenation mimicked the hyper-activation of AMPK and enhanced the FA oxidation that was observed in PE. AMPK activation impaired trophoblast invasion, while AMPK inhibition promoted trophoblast invasion. CONCLUSION: PE complicated placentas are associated with AMPK hyper-activation and consequent alterations in FA oxidation, which inhibit trophoblast invasion.

Altered Circulating Inflammatory Cytokines Are Associated with Anovulatory Polycystic Ovary Syndrome (PCOS) Women Resistant to Clomiphene Citrate Treatment.

BACKGROUND Polycystic ovary syndrome (PCOS) is a common gynecological disease characterized by chronic oligoanovulation, clinical/biochemical hyperandrogenism, polycystic ovaries, and insulin resistance. Accumulating evidence has shown that PCOS-related ovarian dysfunction is the main cause of anovulatory infertility. Clomiphene citrate (CC) is the first-line therapy for PCOS patients; however, approximately 15-40% PCOS patients are resistant to CC treatment. It has been demonstrated that PCOS is a chronic pro-inflammatory state, as some pro-inflammatory cytokines were elevated in the peripheral circulation of PCOS patients, but whether altered inflammatory cytokines expression in PCOS patients is associated with blunted response to CC remains unknown. MATERIAL AND METHODS We recruited 44 CC-resistant PCOS patients, along with 55 age and body mass index (BMI)-matched CC-sensitive PCOS patients. Ovulation was induced by administrating 50-100 mg/day CC on days 5 to 9 of each menstrual cycle. The cytokine profiles were detected by cytokine antibody microarrays and further validated by ELISAs. RESULTS CC-resistant patients had higher levels of high-sensitivity C-reactive protein (hsCRP) than the CC-sensitive individuals. A growth factor, angiopoietin-2, was significantly reduced [1.64 (0.93-1.95) vs. 1.08 (0.85-1.34), p<0.05], while a chemokine CXCL-16 was significantly increased (9.10±2.35 vs. 10.41±2.82, p<0.05) in CC-resistant patients compared to the CC-sensitive subjects. CXCL-16 was positively correlated with hsCRP (r=0.33, p<0.01). Logistic regression analysis showed that angiopoietin-2 and CXCL-16 are associated with CC resistance. CONCLUSIONS Circulating cytokines are disturbed in CC-resistant PCOS patients. Altered angiopoietin-2 and CXCL-16 levels might compromise the responsiveness of the ovary to CC through up-regulating angiogenesis and inflammation.

Aliphatic hyperbranched polyphosphate: a novel multicolor RTP material with AIE character.

Long-lived photoluminescent probes are emerging as significant luminogens for biological imaging. However, currently, most long-lived luminescent materials contain expensive rare elements or cytotoxic bulky aromatic or conjugated units. Herein, a novel hyperbranched polyphosphate (HBPPE) was synthesized using triethyl phosphate (TEP) and ethylene glycol (EG) through a transesterification polycondensation reaction. The obtained HBPPE P1 can emit bright blue photoluminescence under UV light and show significant AIE character. Interestingly, the average photoluminescence lifetime of P1 is 12.82 µs. This suggests the first phosphorescent material without rare elements or aromatic structures attributed to the covalent-crystal-like structure. Besides, P1 shows an obvious red-shift along with the excitation wavelength, which emits blue, cyan, green, yellow and red photoluminescence, covering nearly all the visible light region. This study not only enriches the species of nonconventional multicolor AIE luminogens but also provides a concise method for the synthesis of HBPPE and demonstrates the possibility for phosphorescent materials without rare elements or bulky aromatic units.

The Economic Burden of Brucellosis Care in China: Socioeconomic Status Inequality.

The economic burden of brucellosis care on patients can lead to significant financial strain, despite partial coverage by medical insurance. However, there is limited research on the out-of-pocket costs faced by brucellosis patients. Therefore, our study aimed to investigate the costs and out-of-pocket expenses of brucellosis care, specifically examining the varying socioeconomic status of patients in Xinjiang, China. We collected cost and demographic data from 563 respondents and their hospital bills and employed latent variable analysis to assess socioeconomic status. The majority of patients belonged to the middle and lower socioeconomic status categories (85.97%), and they were primarily farmers and herders (82.77%). The median direct cost per brucellosis episode was USD 688.65, with out-of-pocket expenses amounting to USD 391.44. These costs exceeded both the 2020 Xinjiang and national per capita health expenditures (USD 233.66 and USD 267.21, respectively). Notably, the overall medical reimbursement rate was 48.60%, and for outpatient costs, it was merely 12.82%. Despite higher out-of-pocket costs among high socioeconomic status patients, the percentage of income spent was higher (37.23%) for patients in the lower socioeconomic status group compared to other groups (16.25% and 12.96%). In conclusion, our findings highlight that brucellosis patients are predominantly from the middle and lower socioeconomic status, with high out-of-pocket expenses placing them under significant financial pressure. Moreover, there is notable inequity in economic consequences across different socioeconomic status groups. These results call for policy interventions aimed at reducing brucellosis-related poverty and promoting equitable access to care.

Factors associated with exclusive breastfeeding during postpartum in Lanzhou city, China: a cross-sectional study.

Aim: Breastfeeding generates short-term and long-term benefits for both mother and child. Exclusive breastfeeding (EBF) is promoted in China for years, but its practice still lags far behind the international average, even among low- and middle- income countries. This study aimed to investigate factors associated with EBF during postpartum. Methods: This study was conducted in a tertiary referral hospital in Gansu Province, Northwest China from October 2019 to April 2020. 3,738 postnatal women were finally included and each of them completed an elaborately designed questionnaire. Infant feeding patterns (EBF or not) and reasons for NEBF (non-exclusive breastfeeding) were collected. The feeding knowledge score was based on 17 questions in relation to breastfeeding. The total score ranges from 0 to 17. Higher score means better understanding about breastfeeding knowledge. Multivariate logistic regression models were used to determine associated factors of EBF during postpartum. A subgroup analysis was conducted to investigate the association between feeding knowledge score and exclusive breastfeeding. Results: Six weeks after childbirth, 1891 mothers (50.6%) maintained EBF. Among the NEBF mothers, 57.01% (n = 1,053) of them stopped exclusive breastfeeding due to self-perceived lack of breast milk production. Factors associated with NEBF were higher maternal age, ethnic minorities and cesarean section. Protective factors of EBF included multipara, positive feeding attitude and high breastfeeding knowledge score. In subgroup analysis, we found the breastfeeding knowledge score had a significant impact on the mothers of Han nationality, underwent cesarean or natural delivery, both primiparous and multiparous, and those with positive attitude towards breastfeeding (p < 0.05). Conclusion: We need a comprehensive and individualized framework of strategies to support children, mothers and their families. During puerperium, improving maternal knowledge of breastfeeding is beneficial to EBF practice. However, for ethnic minorities and those with less active breastfeeding attitudes, breastfeeding knowledge is of limited use, more researches are needed to explore the uncovered reasons, so that more personalized interventions could be developed for them.

Effects of Combined Intervention of rTMS and Neurotransmitter Drugs on the Brain Functional Networks in Patients with Cognitive Impairment.

Alzheimer's disease (AD) causes extensive neural network dysfunction. Memantine and donepezil are commonly used as monotherapy or in combination with non-drug interventions, such as repetitive transcranial magnetic stimulation (rTMS), for its treatment. However, no studies have reported any differences between the effects of combined neurotransmitter and rTMS interventions versus rTMS alone on the brain networks of patients with cognitive impairment. Therefore, it is crucial to explore the advantages of different intervention methods to guide clinical practice. We used resting-state functional magnetic resonance imaging (rs-fMRI) to investigate the impact of neurotransmitter superimposed rTMS and rTMS alone on the brain functional network of patients with cognitive impairment. We divided patients with cognitive impairment who had received rTMS into two groups based on whether they received neurotransmitters: the combined intervention group and the rTMS-alone intervention group. We conducted rs-fMRI scans and comprehensively assessed cognitive function in these patients. To examine the effects of the superimposed interventions, we utilized independent component analysis to evaluate the functional connectivity of brain networks in these patients. Compared to the rTMS-alone intervention group, co-intervention of neurotransmitter drugs and rTMS exhibited potential for cognitive enhancement via the reconstructed inter-network connectivity of the cerebellum and the enhanced intra-network connectivity of the frontal-parietal regions in these patients with cognitive impairment. We hypothesized that the combination of neurotransmitter drugs and rTMS intervention could have greater clinical benefits than rTMS intervention alone, leading to improved cognitive function in patients with cognitive impairment.

Risk Factors for Radical Rectal Cancer Surgery with a Temporary Stoma Becoming a Permanent Stoma: A Pooling Up Analysis.

Purpose: The aim of this study was to find out the potential risk factors for the formation of a permanent stoma (PS) for rectal cancer patients with a temporary stoma (TS) after surgery. Methods: PubMed, Embase, and the Cochrane Library were searched for eligible studies until November 14, 2022. The patients were divided into the PS group and the TS group. Odds ratio (ORs) and 95% confidence intervals (CIs) were pooled up for describing dichotomous variables. Stata SE 16 was performed for data analysis. Results: After pooling up the data, a total of 14 studies involving 14,265 patients were included in this study. The outcomes showed that age (OR = 1.03, 95% CI = 0.96 to 1.10, I2 = 1.42%, P = .00 < .1), surgery type (P = .00 < .1), tumor stage (P = .00 < .1), preoperative chemoradiotherapy (P = .00 < .1), preoperative radiotherapy (P = .01 < .1), neoadjuvant therapy (P = .00 < .1), American Society of Anesthesiologists (ASA) score of ≥3 (P = .00 < .1), anastomotic leakage (P = .01 < .1), local recurrence (P = .00 < .1), and distant recurrence (P = .00 < .1) were associated with the patient with PS. However, sex (P = .15 > .1), previous abdominal surgery (P = .84 > .1), adjuvant chemotherapy (P = .87 > .1), and defunctioning stoma (P = .1) had little association with PS. Conclusion: Patients who were elderly, had advanced tumor stages, had a high ASA score, and underwent neoadjuvant therapy should be informed of the high risk of PS before surgery. Meanwhile, those who underwent rectal cancer surgery with a TS should beware of anastomotic leakage, local recurrences, and distant recurrences, which could increase the risk of PS.

Retinal Alterations as Potential Biomarkers of Structural Brain Changes in Alzheimer's Disease Spectrum Patients.

Retinal imaging being a potential biomarker for Alzheimer's disease is gradually attracting the attention of researchers. However, the association between retinal parameters and AD neuroimaging biomarkers, particularly structural changes, is still unclear. In this cross-sectional study, we recruited 25 cognitively impaired (CI) and 21 cognitively normal (CN) individuals. All subjects underwent retinal layer thickness and microvascular measurements with optical coherence tomography angiography (OCTA). Gray matter and white matter (WM) data such as T1-weighted magnetic resonance imaging and diffusion tensor imaging, respectively, were also collected. In addition, hippocampal subfield volumes and WM tract microstructural alterations were investigated as classical AD neuroimaging biomarkers. The microvascular and retinal features and their correlation with brain structural imaging markers were further analyzed. We observed a reduction in vessel density (VD) at the inferior outer (IO) sector (p = 0.049), atrophy in hippocampal subfield volumes, such as the subiculum (p = 0.012), presubiculum (p = 0.015), molecular_layer_HP (p = 0.033), GC-ML-DG (p = 0.043) and whole hippocampus (p = 0.033) in CI patients. Altered microstructural integrity of WM tracts in CI patients was also discovered in the cingulum hippocampal part (CgH). Importantly, we detected significant associations between retinal VD and gray matter volumes of the hippocampal subfield in CI patients. These findings suggested that the retinal microvascular measures acquired by OCTA may be markers for the early prediction of AD-related structural brain changes.

Applying Retinal Vascular Structures Characteristics Coupling with Cortical Visual System in Alzheimer's Disease Spectrum Patients.

Cortical visual system dysfunction is closely related to the progression of Alzheimer's Disease (AD), while retinal vascular structures play an important role in the integrity of the function of the visual network and are a potential biomarker of AD. This study explored the association between the cortical visual system and retinal vascular structures in AD-spectrum patients, and it established a screening tool to detect preclinical AD based on these parameters identified in a retinal examination. A total of 42 subjects were enrolled and were distributed into two groups: 22 patients with cognitive impairment and 20 healthy controls. All participants underwent neuropsychological tests, optical coherence tomography angiography and resting-state fMRI imaging. Seed-based functional connectivity analysis was used to construct the cortical visual network. The association of functional connectivity of the cortical visual system and retinal vascular structures was further explored in these subjects. This study found that the cognitive impairment group displayed prominently decreased functional connectivity of the cortical visual system mainly involving the right inferior temporal gyrus, left supramarginal gyrus and right postcentral gyrus. Meanwhile, we observed that retinal vascular structure characteristics deteriorated with the decline in functional connectivity in the cortical visual system. Our study provided novel insights into the aberrant cortical visual system in patients with cognitive impairment that strongly emphasized the critical role of retinal vascular structure characteristics, which could be used as potential biomarkers for diagnosing and monitoring the progression of AD.

Instrumental activities of daily living trajectories and risk of mild cognitive impairment among Chinese older adults: results of the Chinese longitudinal healthy longevity survey, 2002-2018.

Background: The association between the instrumental activities of daily living (IADL) score and the risk of initial cognitive function impairment is inconclusive. We aimed to identify distinctive IADL trajectories and examine their relationship with the onset of mild cognitive impairment (MCI) among Chinese older people. Methods: The study used six-wave longitudinal data from the Chinese Longitudinal Healthy Longevity Survey conducted between 2002 and 2018. It included a total of 11,044 Chinese people aged 65 years or older. A group-based trajectory model was used to identify distinctive trajectories of the IADL score, and the Cox proportional hazards model was used to explore the hazard ratio of various trajectories at the onset of MCI. Interaction analysis was used to analyze individual modification between the IADL trajectories and the onset of MCI. Finally, we adopted four types of sensitivity analysis to verify the robustness of the results. Results: During a median follow-up of 16 years, the incidence of MCI was 6.29 cases per 1,000 person-years (95% confidence interval [CI] 5.92-6.68). Three distinct IADL trajectory groups were identified: a low-risk IADL group (41.4%), an IADL group with increasing risk (28.5%), and a high-risk IADL group (30.4%). Using the Cox proportional hazards model after adjusting for covariates, we found that compared with the low risk IADL group, the hazard ratio of the IADL group with increasing risk was 4.49 (95% CI = 3.82-5.28), whereas that of the high-risk IADL group was 2.52 (95% CI 2.08-3.05). Treating the IADL group with increasing risk as the reference, the hazard ratio for the high-risk IADL group was 0.56 (95% CI 0.48-0.66). Interaction analyses showed that age and residence were significant moderators (P for interaction <0.05). Conclusion: A group-based trajectory model was developed to classify older people into three distinct trajectory groups of the IADL score. The IADL group with increasing risk had a greater risk of MCI than the high-risk IADL group. In the IADL group with increasing risk, city residents of ≥80 years were the most likely to develop MCI.

Vascularized polypeptide hydrogel modulates macrophage polarization for wound healing.

Wound repair involves a sophisticated process that includes angiogenesis, immunoregulation and collagen deposition. However, weak revascularization performance and the lack of biochemical cues to trigger immunomodulatory function currently limit biomaterial applications for skin regeneration and tissue engineering. Herein, we fabricate a new bioactive polypeptide hydrogel (QK-SF) constituted by silk fibroin (SF) and a vascular endothelial growth factor mimetic peptide KLTWQELYQLKYKGI (QK) for tissue regeneration by simultaneously promoting vascularization and macrophage polarization. Our results showed that this QK-SF hydrogel can be prepared via an easy manufacturing process, and exhibited good gel stability and low cytotoxicity to cultured human umbilical vein endothelial cells (HUVECs) via both live/dead and cell counting kit-8 assays. Importantly, this QK-SF hydrogel triggered macrophage polarization from M1 into M2, as exemplified by the enhanced expression of the M2 marker and decreased expression of the M1 marker in RAW264.7 cells. Furthermore, the QK-SF hydrogel showed high capacity for inducing endothelial growth, migration and angiogenesis, which were proved by increased expression of angiogenesis-related genes in HUVECs. Consistent with in vitro findings, in vivo data show that the QK-SF hydrogel promoted M2 polarization, keratinocyte differentiation, and collagen deposition in the mouse skin wound model in immunohistochemistry assay. Furthermore, this QK-SF hydrogel can reduce inflammation, induce angiogenesis and promote wound healing as exemplified by the increased vessel formation and decreased wound area in the mouse skin wound model. Altogether, these results indicate that the bioactive QK-SF hydrogel plays dual functional roles in promoting angiogenesis and immunoregulation for tissue regeneration. STATEMENT OF SIGNIFICANCE: The QK-SF hydrogel plays dual functional roles in promoting angiogenesis and immunoregulation for tissue repair and wound healing. The QK-SF hydrogel can be prepared via an easy manufacturing process, and exhibited good gel stability and low cytotoxicity to cultured HUVECs. The QK-SF hydrogel triggered macrophage polarization from M1 into M2. The QK-SF hydrogel showed high capacity for inducing endothelial growth, migration and angiogenesis. The QK-SF hydrogel promoted M2 polarization, keratinocyte differentiation, and collagen deposition.