Community screening for dementia among older adults in China: a machine learning-based strategy.

BACKGROUND: Dementia is a leading cause of disability in people older than 65 years worldwide. However, diagnosing dementia in its earliest symptomatic stages remains challenging. This study combined specific questions from the AD8 scale with comprehensive health-related characteristics, and used machine learning (ML) to construct diagnostic models of cognitive impairment (CI). METHODS: The study was based on the Shenzhen Healthy Ageing Research (SHARE) project, and we recruited 823 participants aged 65 years and older, who completed a comprehensive health assessment and cognitive function assessments. Permutation importance was used to select features. Five ML models using BalanceCascade were applied to predict CI: a support vector machine (SVM), multilayer perceptron (MLP), AdaBoost, gradient boosting decision tree (GBDT), and logistic regression (LR). An AD8 score ≥ 2 was used to define CI as a baseline. SHapley Additive exPlanations (SHAP) values were used to interpret the results of ML models. RESULTS: The first and sixth items of AD8, platelets, waist circumference, body mass index, carcinoembryonic antigens, age, serum uric acid, white blood cells, abnormal electrocardiogram, heart rate, and sex were selected as predictive features. Compared to the baseline (AUC = 0.65), the MLP showed the highest performance (AUC: 0.83 ± 0.04), followed by AdaBoost (AUC: 0.80 ± 0.04), SVM (AUC: 0.78 ± 0.04), GBDT (0.76 ± 0.04). Furthermore, the accuracy, sensitivity and specificity of four ML models were higher than the baseline. SHAP summary plots based on MLP showed the most influential feature on model decision for positive CI prediction was female sex, followed by older age and lower waist circumference. CONCLUSIONS: The diagnostic models of CI applying ML, especially the MLP, were substantially more effective than the traditional AD8 scale with a score of ≥ 2 points. Our findings may provide new ideas for community dementia screening and to promote such screening while minimizing medical and health resources.

Safety and benefit of modified mesohepatectomy in the treatment of bilobar involvement congenital biliary dilatation.

BACKGROUND: The diseased bile duct in bilobar congenital biliary dilatation is extensive and often requires major hepatectomy or liver transplantation associated with a higher risk. We aimed to evaluate the safety and benefit of modified mesohepatectomy, in comparison with trisectionectomy, to treat bilobar congenital biliary dilatation. METHODS: This study included 28 patients with type IV and V bilobar congenital biliary dilatation. An innovative mesohepatectomy comprising the hepatectomy technique beyond the P/U point and bile duct shaping was applied to 14 patients to address the extensively diseased bile duct and difficulty in hepaticojejunostomy. Another 14 patients received trisectionectomy. The perioperative and long-term outcomes of these patients were compared. RESULTS: The ratio of residual liver volume to standard liver volume in the mesohepatectomy group was higher (78.68% vs. 40.90%, p = 0.005), while the resection rate of the liver parenchyma was lower (28.25% vs. 63.97%, p = 0.000), than that in trisectionectomy group. The mesohepatectomy group had a lower severe complication (>Clavein III, 0% vs. 57.70%, p = 0.019) and incidence of posthepatectomy liver failure (7.14% vs. 42.86%, p = 0.038). No significant difference was observed in blood loss and bile leakage (p > 0.05). All the patients in the mesohepatectomy group achieved optimal results in the long-term follow-up. CONCLUSIONS: mesohepatectomy provides an efficient treatment option for bilobar congenital biliary dilatation and can achieve radical resection, retain more liver parenchyma, and reduce the difficulty of hepaticojejunostomy, especially for patients that are not eligible for major hepatectomy and liver transplantation.

Associations of low-density lipoprotein cholesterol with all-cause and cause-specific mortality in older adults in China.

CONTEXT: Limited information was available on detailed associations of low-density lipoprotein cholesterol (LDL-C) with all-cause and cause-specific mortality in older adults. METHODS: This prospective cohort study included a representative sample of 211,290 adults aged 65 or older, who participated in Shenzhen Healthy Aging Research 2018-2019. The vital status of the participants by 31 December, 2021 was determined. We estimated the hazard ratios (HR) with 95% confidence intervals for all-cause or cause-specific mortality using multivariable Cox proportional hazards models and Cox models with restricted cubic spline(RCS) . RESULTS: The median follow-up time was 3.08 years. A total of 5,333 participants were confirmed to have died. Among them, 2,303 cardiovascular disease (CVD) deaths and 1,881 cancer deaths occurred. Compared to those with LDL-C of 100-129 mg/dL, the all-cause mortality risk was significantly higher for individuals with LDL-C level that was very low (< 70 mg/dL) or low (70-99 mg/dL). Compared with individuals with the reference LDL-C level, the multivariable-adjusted HR for CVD-specific mortality was 1.327 for those with very low LDL-C level (< 70 mg/dL), 1.437 for those with high LDL-C level (160 mg/dL ≦ LDL-C < 190mg/dL), 1.528 for those with very high LDL-C level (≥ 190 mg/dL). Low LDL-C level (70-99 mg/dL) and very low LDL-C level (< 70 mg/dL) were also associated with increased cancer mortality and other-cause mortality, respectively. The results from RCS curve showed similar results. CONCLUSION: Considering the risk of all-causes mortality and cause-specific mortality, we recommended 100-159 mg/dL as the optimal range of LDL-C among older adults in China.

Freestanding Nanofiber-Assembled Aptasensor for Precisely and Ultrafast Electrochemical Detection of Alzheimer's Disease Biomarkers.

Amyloid beta-protein (AßAß) is a main hallmark of Alzheimer's disease (AD), and a low amount of Aß protein accumulation appears to be a potential marker for AD. Here, an electrochemical DNA biosensor based on polyamide/polyaniline carbon nanotubes (PA/PANI-CNTs) is developed with the aim of diagnosing AD early using a simple, low-cost, and accessible method to rapidly detect Aß42 in human blood. Electrospun PA nanofibers served as the skeleton for the successive in situ deposition of PANI and CNTs, which contribute both high conductivity and abundant binding sites for the Aß42 aptamers. After the aptamers are immobilized, this aptasensor exhibits precise and specific detection of Aß42 in human blood within only 4 min with an extremely fast response rate, lower detection limit, and excellent linear detection range. These findings make a significant contribution to advancing the development of serum-based detection techniques for Aß42, thereby paving the way for improved diagnostic capabilities in the field of AD.

Sociodemographic and lifestyle determinants of multimorbidity among community-dwelling older adults: findings from 346,760 SHARE participants.

BACKGROUND: This study aimed to investigate the prevalence of multimorbidity and its associated factors among the older population in China to propose policy recommendations for the management of chronic diseases in older adults. METHODS: This study was conducted based on the 2021 Shenzhen Healthy Ageing Research (SHARE), and involved analysis of 346,760 participants aged 65 or older. Multimorbidity is defined as the presence of two or more clinically diagnosed or non self-reported chronic diseases among the eight chronic diseases surveyed in an individual. The Logistic analysis was adopted to explore the potential associated factors of multimorbidity. RESULTS: The prevalences of obesity, hypertension, diabetes, anemia, chronic kidney disease, hyperuricemia, dyslipidemia and fatty liver disease were 10.41%, 62.09%, 24.21%, 12.78%, 6.14%, 20.52%, 44.32%, and 33.25%, respectively. The prevalence of multimorbidity was 63.46%. The mean count of chronic diseases per participant was 2.14. Logistic regression indicated that gender, age, marriage status, lifestyle (smoking status, drinking status, and physical activity), and socioeconomic status (household registration, education level, payment method of medical expenses) were the common predictors of multimorbidity for older adults, among which, being women, married, or engaged in physical activity was found to be a relative determinant as a protective factor for multimorbidity after the other covariates were controlled. CONCLUSION: Multimorbidity is prevalent among older adults in Chinese. Guideline development, clinical management,and public intervention should target a group of diseases instead of a single condition.

Comprehensive analysis of cuproptosis-related genes on bladder cancer prognosis, tumor microenvironment invasion, and drug sensitivity.

Cuproptosis, a newly discovered form of programmed cell death, plays a vital role in the occurrence and development of tumors. However, the role of cuproptosis in the bladder cancer tumor microenvironment remains unclear. In this study, we developed a method for predicting the prognostic outcomes and guiding the treatment selection for patients with bladder cancer. We obtained 1001 samples and survival data points from The Cancer Genome Atlas database and Gene Expression Omnibus database. Using cuproptosis-related genes (CRGs) identified in previous studies, we analyzed CRG transcriptional changes and identified two molecular subtypes, namely high- and low-risk patients. The prognostic features of eight genes (PDGFRB, COMP, GREM1, FRRS1, SDHD, RARRES2, CRTAC1, and HMGCS2) were determined. The CRG molecular typing and risk scores were correlated with clinicopathological features, prognosis, tumor microenvironment cell infiltration characteristics, immune checkpoint activation, mutation burden, and chemotherapy drug sensitivity. Additionally, we constructed an accurate nomogram to improve the clinical applicability of the CRG_score. qRT-PCR was used to detect the expression levels of eight genes in bladder cancer tissues, and the results were consistent with the predicted results. These findings may help us to understand the role of cuproptosis in cancer and provide new directions for the design of personalized treatment and prediction of survival outcomes in patients with bladder cancer.

Recent Progress on Nanomaterial-Facilitated Electrochemical Strategies for Cancer Diagnosis.

Cancer is a malignant disease that endangers human life, especially owing to its high fatality rate; therefore, rapid and accurate early screening is needed to effectively improve the survival rate. Compared with traditional cancer detection methods, electrochemical biosensors that recognize cancer biomarkers in blood have the advantages of low invasiveness, fast diagnosis, and low cost. However, there is always a trade-off between sensitivity and selectivity, which limits the detection of trace amounts of biomarkers produced in the early stages. To address this issue, an increasing number of nanomaterials with simultaneous improvements in both sensitivity and selectivity have recently been reported. In this review, different categories of state-of-the-art electrochemical biosensors and their operating principles are introduced, and their respective advantages and disadvantages are described. Furthermore, the review discusses the existing detection strategies and performance of nanomaterial-based cancer biosensors for biomarker recognition, providing overall guidance for the material selection of different biomarkers. Finally, the main challenges involving existing electrochemical cancer biosensors are evaluated to present the future development prospects of nanomaterials and detection strategies.

Cathelicidin LL-37 promotes EMT, migration and metastasis of hepatocellular carcinoma cells in vitro and mouse model.

The effect of cathelicidin hCAP18/LL-37 in hepatocellular carcinoma (HCC) metastasis remains unclear. Here, we confirmed that LL-37 expression enhanced endothelial-mesenchymal transition (EMT), migration and invasion in HCC cells. And the HER2/EGFR-MAPK/ERK signal participated in the process above. More frequent lung metastases were observed in an LL-37-overexpressing hematogenous metastasis model. Interestingly, 1,25(OH)2D3 together with si-LL-37 significantly enhanced 1,25(OH)2D3-induced inhibition of migration and invasion in PLC/PRF-5 cells, and also enhanced reversion of the EMT process. Therefore, LL-37 is involved in HCC metastases, and may act as an important factor to attenuate the inhibitory activity of 1,25(OH)2D3 on HCC metastasis. Targeting hCAP18/LL-37 may offer a potential strategy to improve the anticancer activity of 1,25(OH)2D3 in HCC therapy.

Concordance of Non-Alcoholic Fatty Liver Disease and Associated Factors among Older Married Couples in China.

Background: Non-alcoholic fatty liver disease (NAFLD) is one of the most common liver diseases which affects mainly middle-aged and older adults, resulting in a considerable disease burden. Evidence of concordance on NAFLD and lifestyle factors within older married couples in China is limited. This study aimed to evaluate spousal concordance regarding lifestyle factors and NAFLD among older Chinese couples. Methods: We conducted a cross-sectional study using data from 58,122 married couples aged 65 years and over recruited from Shenzhen, China during 2018−2020. Logistic regression analyses were used to estimate the reciprocal associations in NAFLD within couples after incremental adjustment for potential confounders. Results: There was a marked concordance regarding NAFLD among older married couples in our study. After adjustment for confounders, the odds of having NAFLD were significantly related to the person's spouse also having NAFLD (1.84 times higher in husbands and 1.79 times higher in wives). The spousal concordance of NAFLD was similar, irrespective of gender. Couples with both a higher educational level and abdominal obesity were more likely to have a concordance of NAFLD compared to couples with both a lower educational level and no abdominal obesity, respectively (p < 0.05). Conclusion: Our results indicated that health care professionals should bear in mind the marked spousal concordance with respect to risk factors and NAFLD for the prevention and early detection of the highly prevalent disease in older Chinese adults.

Protocol for Shenzhen Ageing Cohort Study (SZ-ageing): a prospective observational cohort study of elderly disability and cognitive impairment.

INTRODUCTION: The incidence and prevalence of disability and cognitive impairment, which are age-related, increase as China has become an ageing society. This study aims to establish the Shenzhen Ageing Cohort Study (SZ-ageing) to explore the epidemiological situation, risk factors and biomarkers of disability and cognitive impairment among Chinese elderly individuals. METHODS: About 3000 participants aged 65 years and older are to be recruited from communities in Shenzhen by using a multistage sampling method. They will receive a baseline investigation between 2022 and 2024. The comprehensive data on disability and cognitive impairment will be collected by using standardised questionnaires, standardised scale assessments, clinical measurements and clinical laboratory tests. Active follow-up surveys with the same content as the baseline investigation will be conducted every 3 years. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the ethics committee of the Shenzhen Center for Chronic Disease Control (SZCCC-2022-001-01-PJ; 21 February 2022). The research findings will be presented at professional conferences and submitted to peer-reviewed journals. TRIAL REGISTRATION NUMBER: Chinese Clinical Trial Registry (ChiCTR2200060055).

Intestinal Ecology Changes in Diarrheic Père David's Deer Revealed by Gut Microbiota and Fecal Metabolites Analysis.

Diarrhea is one of the most common diseases affecting the health of Père David's deer (Elaphurus davidianus). It is believed that an imbalanced intestinal ecology contributes to the etiology of the condition. However, little is known about how the intestinal ecology changes in these diarrheic animals. In this study, 16S rRNA gene sequencing and ultra-high performance liquid chromatography combined with tandem mass spectrometry (UPLC-MS/MS) were used to investigate the gut microbiota and fecal metabolites in five Père David's deer with diarrhea. The results showed that when compared with healthy individuals, considerable changes in the gut microbiome were observed in diarrheic animals, including a significant reduction in microbial diversity and gut microbiota composition alterations. Furthermore, the profiles of numerous fecal metabolites were altered in diarrheic individuals, showing large-scale metabolite dysregulation. Among metabolites, acylcarnitines, lysophosphatidylcholine, bile acids, and oxidized lipids were elevated significantly. Constantly, several metabolic pathways were significantly altered. Interestingly, predicted metabolic pathways based on 16S rRNA gene sequence and differential metabolite analysis showed that lipid metabolism, cofactor, and vitamin metabolism were altered in sick animals, indicating microbiota-host crosstalk in these deer. When combined, the results provide the first comprehensive description of an intestinal microbiome and metabolic imbalance in diarrheic Père David's deer, which advances our understanding and potential future treatment of diarrheic animals.

[Prevalence and factors of nonalcoholic fatty liver disease among elderly in Shenzhen City in 2018].

OBJECTIVE: To analyze the prevalence and influence factors of nonalcoholic fatty liver disease(NAFLD) among elderly in Shenzhen City. METHODS: From January to December in 2018, a convenient sampling method was used to select 121 042 survey subjects from Shenzhen community residents aged 65 years and above through questionnaire survey, physical examination, laboratory biochemical examination and b-ultrasound examination, demographic information, lifestyle, height, weight, waist circumference, blood pressure, fasting blood glucose, blood lipids, past history and liver B ultrasound result were collected. A total of 121 042 of the subjects were selected for the study with complete information. The logistic regression analysis were used to analyze the data. RESULTS: There were 33 179 NAFLD patients(27.41%). The variables adjusted by logistic regression analysis revealed that male(OR=0.633, 95%CI 0.612-0.654), illiteracy(OR=0.761, 95%CI 0.720-0.804), primary school education(OR=0.889, 95%CI 0.862-0.916), current smoking(OR=0.719, 95%CI 0.675-0.767), former smoking(OR=0.802, 95%CI 0.749-0.859), low-weight(OR=0.157, 95%CI 0.128-0.193) was negatively correlated with NAFLD(P<0.01).65-79 years old, obesity(OR=4.744, 95%CI 4.511-4.989), overweight(OR=2.421, 95%CI 2.341-2.504), central obesity(OR=1.823, 95%CI 1.764-1.883), hypertension(OR=1.101, 95%CI 1.069-1.134), diabetes(OR=1.578, 95%CI 1.528-1.630) and dyslipidemia(OR=1.685, 95%CI 1.639-1.734) was positive correlation with NAFLD(P<0.01). CONCLUSION: The prevalence of NAFLD among the elderly in Shenzhen City is relatively low compared with the national level, but its absolute value is higher. The prevalence of NAFLD is higher among the elderly who are female, highly educated, overweight, obese, central obese, suffering from hypertension, diabetes and dyslipidemia.

Long-term exposure to ambient air pollution and serum liver enzymes in older adults: A population-based longitudinal study.

PURPOSE: To investigate the association of long-term exposure to ambient air pollution with serum liver enzymes in older adults. METHODS: In this longitudinal study, we investigated 318,911 adults aged 65 years or older and assessed their long-term residential exposure to particulate matter with an aerodynamic diameter ≤2.5 µm (PM2.5), particulate matter with an aerodynamic diameter ≤10 µm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3). Linear mixed models and generalized linear mixed models were implemented for exposure-response analyses. RESULTS: Each interquartile range (IQR) increase of PM2.5, PM10, SO2, NO2, CO, and O3 exposures was significantly associated with a 4.6%, 4.6%, 5.6%, 4.6%, 6.2%, and 3.6% increase in alanine aminotransferase (ALT), and a 4.6%, 5.2%, 3.6%, 3.3%, 6.1%, and 4.0% increase in aspartate aminotransferase (AST), respectively. Each IQR increase of PM2.5, PM10, SO2, NO2, CO, and O3 exposures was significantly associated with a 23%, 24%, 28%, 17%, 31%, and 19% increase in odds of elevated ALT (>40 U/L), and a 32%, 39%, 40%, 32%, 57%, and 25% increase in odds of elevated AST (>40 U/L), respectively. CONCLUSIONS: Long-term exposure to ambient air pollution was significantly associated with increased serum liver enzyme levels in older adults, suggesting that air pollution exposures may induce hepatocellular injury.

In situ fabrication of urchin-like Cu@carbon nanoneedles based aptasensor for ultrasensitive recognition of trace mercury ion.

Mercury ion (Hg2+) is a strong toxic heavy ion that causes severe damages to the environment and readily accumulates in the food chain. However, it remains a major challenge to realize a sensitive and precise recognition of Hg2+ with a trace concentration for early identifying the pollution source. In this work, a novel electrochemical aptasensor was designed to achieve an ultrasensitive and quantitative detection of trace Hg2+, relying on an urchin-like architecture of Cu@carbon nanoneedles (Cu@CNNs) as the electroactive probe. This specific nanostructure was in-situ constructed through a controllable pyrolysis process, serving as a signal magnifier and DNA loading platform owing to its outstanding electrocatalysis and large specific surface areas. Meanwhile, an exonuclease III-assisted cycling amplification strategy was designed to efficiently amplify the signal strength of trace Hg2+via the consecutive release of report probes in nicking reaction. This as-prepared Hg2+ aptasensor exhibited an ultralow detection limit of 3.7 fM (7 × 10-6 ppm) and a wide linear range from 10 fM to 10 µM, together with the satisfactory stability and reusability for assay in real water samples. It is highly expected that this Cu@CNNs based aptasensor will have tremendous potentials in the early warning and efficient pollution monitoring of heavy metal ions.

Effect of Different Dietary Regimes on the Gut Microbiota and Fecal Metabolites of Père David's Deer.

A deep understanding of the effect of seasonal dietary changes on the nutrition and health of Père David's deer in Dafeng Reserve will contribute greatly to Père David's deer's protection. In this reserve, there were three seasonal dietary regimes: feeding on naturally occurring plants (PLANT diet), silage (SILAGE diet), and a combination of natural plants and silage (COMB diet). To some extent, the COMB diet reflects the seasonal transition from silage to the all-natural plant diet, especially in early spring. However, little is known regarding the gut microbiota changes and metabolic consequences under the COMB diet. Based on 16S rRNA sequencing and ultra-high performance liquid chromatography combined with tandem mass spectrometry, the gut microbiota and fecal metabolites of Père David's deer under these three diets were compared. Results showed the alpha diversity of the gut microbiota was significantly lower under the COMB diet compared to either the SILAGE or PLANT diets. Although no significant changes were observed in the core phyla, Firmicutes and Bacteroidetes, among the three dietary regimes, a significant lower abundance of several other phyla (Spirochaetes, Melainabacteria, Proteobacteria, and Verrucobacteria) was observed in the COMB diet compared to the SILAGE diet. A greater number of fecal metabolite differences was identified between the COMB and SILAGE or COMB and PLANT diets than between the SILAGE and PLANT diets, suggesting that the COMB diet had more of an effect on the metabolism of Père David's deer. The integrated pathway analysis showed that several metabolic pathways were significantly affected by the different dietary regimes, such as tryptophan metabolism, vitamin metabolism, and the platelet activation pathways. These metabolic changes reflect the responses and adaptations of Père David's deer to different diets. Taken overall, our data reveal the difference in the gut microbiota and metabolic pathways of Père David's deer under three dietary regimes in Dafeng Reserve, which provides important information for Père David's deer conservation.

Anaemia and associated factors among older adults in an urban district in China: a large-scale cross-sectional study.

OBJECTIVE: Anaemia leads to poor health outcomes in older adults; however, most current research in China has focused on younger adults. This study aimed to investigate the prevalence of anaemia and its associated factors in older adults in an urban district in China. DESIGN: A cross-sectional study. SETTING: An urbanised region, Shenzhen, China. PARTICIPANTS: A total of 121 981 participants aged ≥65 years were recruited at local community health service centres in Shenzhen from January to December 2018. PRIMARY OUTCOMES: The prevalence of anaemia was analysed and potential associated factors were evaluated. RESULTS: The mean haemoglobin level was 136.40±16.66 g/L and the prevalence of anaemia was 15.43%. The prevalences of mild, moderate and severe anaemia were 12.24%, 2.94% and 0.25%, respectively. Anaemia was positively associated with older age, being underweight (adjusted OR (AOR) 2.06, 95% CI 1.93 to 2.20), diabetes (AOR 1.23, 95% CI 1.19 to 1.28) and chronic kidney disease (AOR 1.41, 95% CI 1.36 to 1.46), and inversely with higher education level, current-smoker (AOR 0.84, 95% CI 0.78 to 0.89), non-habitual drinker (AOR 0.86, 95% CI 0.81 to 0.92), habitual drinker (AOR 0.81, 95% CI 0.75 to 0.87), overweight (AOR 0.67, 95% CI 0.64 to 0.70), obesity (AOR 0.57, 95% CI 0.53 to 0.61), central obesity (AOR 0.86, 95% CI 0.82 to 0.89), hypertension (AOR 0.86, 95% CI 0.83 to 0.89) and dyslipidaemia (AOR 0.81, 95% CI 0.78 to 0.84). CONCLUSION: Anaemia is prevalent among people aged 65 years and older in China. Screening of high-risk populations and treatment of senile anaemia should be a top priority in Shenzhen, and should be listed as important public health intervention measures for implementation.

Cross-sectional and longitudinal associations of apolipoprotein A1 and B with glycosylated hemoglobin in Chinese adults.

Apolipoproteins exert a key role on glucose metabolism; however, scarce data have examined the relationship between apolipoproteins and glycated haemoglobin (HbA1c) in Chinese adults. This study determined the cross-sectional and longitudinal associations of serum Apolipoprotein A1 (ApoA1), Apolipoprotein B (ApoB) and the ApoB/A1 ratio with HbA1c in Chinese adults. A total of 1448 subjects (584 men and 864 women) aged 54.8 years were included in a baseline survey, and the concentrations of Apo and HbA1c were measured. A total of 826 participants were followed up approximately once after 3.94 ± 0.62 years. In cross-sectional analysis, serum ApoA1 was inversely associated with HbA1c, while ApoB and the ApoB/A1 ratio were positively associated with HbA1c. After further adjusting for the potential covariates, a higher ApoA1 was associated with lower HbA1c (Quartile 4 [Q4] vs. Q1 = 5.673% vs. 5.796%, P-trend = 0.014). In contrast, positive association of ApoB concentration and the ApoB/A1 ratio with HbA1c level were showed (Q4 vs. Q1 = 5.805% vs. 5.589% for ApoB; Q4 vs. Q1 = 5.841% vs. 5.582% for ApoB/A1 ratio). The longitudinal results showed no significant associations of ApoA1, ApoB levels and the ApoB/A1 ratio with HbA1c changes (all P-trends > 0.05). Path analysis suggested that body mass index did not have mediating effect on Apo-HbA1c association. Our findings revealed that higher ApoA1, lower ApoB concentrations and the ApoB/A1 ratio were associated with lower HbA1c level in Chinese adults.

Cathelicidin hCAP18/LL-37 promotes cell proliferation and suppresses antitumor activity of 1,25(OH)2D3 in hepatocellular carcinoma.

Cathelicidin hCAP18/LL-37 can resist infection from various pathogens and is an essential component of the human immune system. Accumulating evidence has indicated that hCAP18/LL-37 plays a tissue-specific role in human cancer. However, its function in hepatocellular carcinoma (HCC) is poorly understood. The present study investigated the effects of hCAP18/LL-37 on HCC in vitro and in vivo. Results showed that hCAP18/LL-37 overexpression significantly promoted the proliferation of cultured HCC cells and the growth of PLC/PRF-5 xenograft tumor. Transcriptome sequencing analyses revealed that the PI3K/Akt pathway was the most significant upregulated pathway induced by LL-37 overexpression. Further analysis demonstrated that hCAP18/LL-37 stimulated the phosphorylation of EGFR/HER2 and activated the PI3K/Akt pathway in HCC cells. Furthermore, stronger EGFR/HER2/Akt signals were observed in the PLC/PRF-5LL-37 xenograft tumor. Interestingly, even though the expression of hCAP18/LL-37 was significantly downregulated in HCC cells and tumors, 1,25(OH)2D3 treatment significantly upregulated the hCAP18/LL-37 level both in HCC cells and xenograft tumors. Moreover, 1,25(OH)2D3 together with si-LL-37 significantly enhanced the antitumor activity of 1,25(OH)2D3 in the PLC/PRF-5 xenograft tumor. Collectively, these data suggest that hCAP18/LL-37 promotes HCC cells proliferation through stimulation of the EGFR/HER2/Akt signals and appears to suppress the antitumor activity of 1,25(OH)2D3 in HCC xenograft tumor. This implies that hCAP18/LL-37 may be an important target when aiming to improve the antitumor activity of 1,25(OH)2D3 supplementation therapy in HCC.

Factors associated with treatment and control of hypertension among elderly adults in Shenzhen, China: a large-scale cross-sectional study.

OBJECTIVE: Hypertension has become the leading cause of death worldwide. Data on hypertension management among Shenzhen elderly are sparse. Our study aims to investigate treated and controlled hypertension in Shenzhen elderly, and identify relevant predictors. DESIGN: A cross-sectional study. SETTING: Communities in Shenzhen, Guangdong, China. PARTICIPANTS: A cross-sectional study was conducted. We employed a convenience sampling method to select participants; 124 007 participants aged 65 years and older were recruited from January to December 2018 at local community health centres in Shenzhen. MAIN OUTCOME MEASURES: Data on treatment, control and influencing factors of hypertension were obtained from a standard questionnaire, physical measurements and biochemical analyses. RESULTS: Prevalence of hypertension was 55.8% among the sample population. Among this group of hypertensive patients, those undergoing hypertension treatment and those with hypertension under control were 54.4% and 32.3%, respectively. Employing multivariate analysis, significant associations were found between treatment and older age, junior high school education and above (OR=1.25, p＜0.05), being widowed rather than being married or cohabiting (OR=1.28, p＜0.05), engaging in physical activity (OR=1.14, p＜0.05), ex-smoker (OR=1.19, p＜0.05), habitual drinker (OR=0.72, p＜0.05), history of cardiovascular disease (CVD) (OR=2.20, p＜0.05) and comorbidities, with a higher probability for those with obesity (OR=1.89, p＜0.05), central obesity (OR=1.10, p＜0.05), diabetes (OR=1.49, p＜0.05) or dyslipidaemia (OR=1.20, p＜0.05). Male sex (OR=0.91, p＜0.05), junior high school education and above (OR=1.28, p＜0.05), engaging in physical activity (OR=1.06, p＜0.05), history of CVD (OR=1.82, p＜0.05) and individuals who had diabetes (OR=1.52, p＜0.05) or dyslipidaemia (OR=1.05, p＜0.05) were associated with increased likelihood of control. Aged 80 years and older (OR=0.93, p＜0.05), habitual drinker (OR=0.73, p＜0.05) and central obesity (OR=0.94, p＜0.05) were negatively associated with control of hypertension. CONCLUSIONS: We found a high prevalence of hypertension, but a low prevalence of treatment and control among Shenzhen elderly.

Sarcopenia in heart failure: a systematic review and meta-analysis.

AIMS: Sarcopenia has been found to be frequently associated with co-morbidity among patients with heart failure (HF). However, there remain insufficient data to accurately estimate the global prevalence of sarcopenia in HF. Therefore, the purpose of this research was to conduct a systematic review and meta-analysis to estimate the current overall prevalence of sarcopenia in patients with HF. METHODS AND RESULTS: We searched relevant databases for studies published up to 13 July 2020, assessing sarcopenia in vpatients with HF. After careful screening, data of included articles were extracted with a predesigned Excel form. Then the pooled prevalence of sarcopenia in patients with HF was calculated using the random-effects model. The Q test was used to assess the heterogeneity, and I2 statistic was calculated to quantify and evaluate the heterogeneity. Subgroup analyses were conducted to determine potential sources of heterogeneity. A total of 2852 articles were initially identified, and after removing duplicate publications and applying the selection criteria, we reviewed 79 full-text articles. Finally, 11 articles (n = 1742 patients with HF) were included in this systematic review and meta-analysis. The pooled prevalence of sarcopenia in patients with HF was 34% [95% confidence interval (CI): 22-47%, I2  = 96.59%] and ranged from 10% to 69%. However, substantial heterogeneity between studies (I2  = 96.59%, P < 0.001) was observed. There was no significant heterogeneity between subgroups by sex (P = 0.803) or the method used to define sarcopenia (P = 0.307). While the heterogeneity between subgroups by population setting was statistically significant (P < 0.001), the pooled prevalence of sarcopenia was 55% (95% CI: 43-66%) for hospitalized patients with HF and 26% (95% CI: 16-37%) for ambulatory patients. CONCLUSIONS: Sarcopenia was a common condition in patients with HF, and the prevalence of hospitalized patients was higher than for ambulatory patients. Early detection of sarcopenia was therefore important in patients with HF, and it was important to implement interventions so that physical therapists or managerial dieticians can easily be introduced into clinical practice.