Associations of air pollutants and related metabolites with preterm birth during pregnancy.

OBJECTIVE: This study aimed to investigate the influence of exposure to ambient fine particulate matter (PM2.5) and its components during pregnancy on the prevalence of preterm birth (PTB). Additionally, we sought to identify the susceptible exposure window. Furthermore, we explored the potential mediating role of blood analysis and a comprehensive metabolic panel in the association between pollutant exposure and PTB incidence. METHODS: This birth cohort study recruited 139 participants with PTB outcomes and 1713 controls from Fujian Maternal and Child Health Hospital between January 2021 and June 2023. Sociodemographic characteristics and clinical treatment data during participants' first pregnancies were collected. The exposure levels to pollutants during pregnancy were estimated via a combined geographic-statistical model utilising satellite remote sensing data. The distributional lag nonlinear modelling was employed to assess associations between pollutant exposure during pregnancy and the prevalence of PTB. Weighted quantile regression was used to identify key components associated with PM2.5 and PTB during pregnancy. Additionally, a mediating effect analysis was conducted to evaluate the role of blood analysis. The metabolic profile was used to screen for differentially abundant metabolites associated with PTB and explore their relative expression in relation to air pollutants and PTB incidence. RESULTS: Following the adjustment for potential confounding variables, the mean weekly susceptibility windows for PM2.5 were identified as 7-10, 16-19, and 22-28 weeks; 8-10, and 15-19 weeks for inorganic sulfate; 6-10, and 15-28 weeks for nitrate; 6-12, and 15-28 weeks for ammonium (NH4+); and 7-9, 18-20, and 22-36 weeks for organic matter. During mixed exposure to PM2.5 components, the key component is NH4+. In the mixed exposure to PM2.5 components, NH4+ emerged as a key contributor. The results of the mediation analysis revealed that haemoglobin played a mediating role, accounting for 21.53 % of the association between exposure to environmental pollutants and the prevalence of PTB. It is noteworthy that, no mediating effects were observed for the other variables. Furthermore, non-targeted metabolomics identified 17 metabolites associated with PTB. Among these factors, hydrogen phosphate may impact metabolic pathways such as oxidative phosphorylation, influencing the risk of PTB. The interplay between environmental pollutants and metabolites, particularly through oxidative phosphorylation pathways, may contribute to PTB incidence. CONCLUSIONS: The evidence indicates that exposure to PM2.5 and its components during pregnancy were a significant risk factor for PTB. Notably, specific weekly exposure windows were identified for pollutants during pregnancy. Among the PM2.5 components, NH4+ exhibited the most substantial weight in the association analysis between exposure to the mixture of components and PTB. Furthermore, our mediation analysis revealed that haemoglobin serves as a partial mediator in the relationship between exposure to pollutants during pregnancy and the prevalence of PTB. Additionally, maternal serum metabolic profiles differed between the preterm and control groups. Notably, a combined effect involving hydrogen phosphate and mixed exposure to PM2.5 fractions further contributed to the development of PTB. Oxidative phosphorylation pathways may play pivotal roles in this intricate association.

Association between maternal lipid profiles and lipid ratios in early to middle pregnancy as well as their dynamic changes and gestational diabetes mellitus.

BACKGROUND: Unfavourable lipid and glucose levels may play a crucial role in the pathogenesis of gestational diabetes mellitus (GDM). However, there is a lack of prospective studies on the relationship between lipid profiles, lipid ratios and GDM during pregnancy. AIMS: To prospectively investigate the relationship between lipid profile and lipid ratios in early and mid-pregnancy and their pattern of change from early to mid-pregnancy and the risk of GDM. METHODS: This nested case-control study was based on maternal and child healthcare hospitals from Fujian Province, China. We included pregnant women who delivered in the hospital from January 2021 to June 2023. Lipid profiles (TC, TG, ApoA1, ApoB, HDL-c, LDL-c) and fasting glucose were measured before 14 weeks of gestation and between 20 and 28 weeks of gestation, and lipid ratios (triglyceride glucose index, TG/HDL-c and TC/HDL-c) was constructed. Logistic regression was used to assess the relationship between lipid profile, lipid ratios and GDM. RESULTS: Of 1586 pregnant women, 741 were diagnosed with GDM. After adjusting for potential confounders, TG, ApoA1, ApoB, LDL-c, triglyceride glucose index, TG/HDL-c, and TC/HDL-c in early pregnancy were positively associated with the risk of GDM (odds ratios [95% CI] for extreme interquartile comparisons were 2.040 (1.468-2.843), 1.506 (1.091-2.082), 1.529 (1.110-2.107), 1.504 (1.086-2.086), 1.952 (1.398-2.731), 2.127 (1.526-2.971), and 2.370 (1.700-3.312), all trend P < 0.05). HDL-c was negatively associated with the risk of GDM (0.639: 0.459-0.889, trend P all less than 0.05). Similarly, in mid-pregnancy, lower levels of HDL-c, higher levels of triglyceride glucose index, TG/HDL-c ratio, and TC/HDL-c ratio were associated with increased risk of GDM (all trends P < 0.05). Stably high levels (both ≥ median for early and mid-pregnancy) of triglyceride glucose index, TG/HDL-c and TC/HDL-c were associated with increased risk of GDM (OR [95% CI]: 2.369 (1.438-3.940), 1.588 (1.077-2.341), 1.921 (1.309-2.829), respectively). The opposite was true for HDL-c, where stable high levels were negatively associated with GDM risk (OR [95% CI]: 0.599 (0.405-0.883)). CONCLUSION: Increases in triglyceride glucose index, TG/HDL-c ratio, and TC/HDL-c ratio in early and mid-pregnancy, as well as their stable high levels from early to mid-pregnancy, are associated with a higher risk of GDM. In contrast, increased levels of HDL-c, both in early and mid-pregnancy, and their stable high levels from early to mid-pregnancy were associated with a lower risk of GDM. That highlighted their possible clinical relevance in identifying those at high risk of GDM.

The risk of suicidal intention in severe mental illness: An ecological perspective.

OBJECTIVE: Guided by the ecosystem theory model framework, we aimed to explore the influence of three ecological dimensions (social, family and psychological factors) on suicidal intention in people with severe mental illness (SMI). We hypothesized that three factors influence suicidal intention, and that psychological factors may play a mediating role in the influence of social and family factors on suicidal intention. METHODS: We collected 994 patients with SMI aged 18 and above from May 2021 to March 2022 in the Fourth Hospital of Fuzhou City. We used logistic regression to analyse the association between social, family, psychological factors and suicidal intention. Furthermore, we explored the mediating effects among the influencing factors. RESULTS: Younger male patients with schizophrenia were more likely to have suicidal intention due to psychosocial family factors (p < .05). Social factors (poor interpersonal relations, social retreat, social activities outside the home), family factors (parental functions, activities within the family, family functions), psychological factors (anxiety, depression, interest in the outside world, overt aggression, lack of accountability and planning) were all independent risk factors for suicidal intention in patients. Mediation analysis showed anxiety and depression mediated the role of social and family factors on suicidal intention (p < .05). CONCLUSION: Social, family and psychological factors were important risk factors for suicidal intention, with anxiety and depression being partial mediators for suicidal intention. Therefore, interventions that enhance family and social functioning and reduce anxiety and depression may be effective in reducing suicidal intention in SMI.

Peer Attachment Style Moderates the Effect of Mood on Creativity.

The present study investigated the moderating role of peer attachment style in the relationship between mood and creativity. An experiment was conducted with a sample of 267 undergraduate students (Mage = 19.85, range = 17-24 years). First, participants' peer attachment style was measured, following which positive, neutral, or negative mood was induced; subsequently, two creative tasks were conducted. A MANOVA revealed significant interactions between peer attachment and mood. Specifically, for secure participants, creativity was significantly higher in the positive mood state compared to the neutral and negative mood states; for insecure participants, the effect of positive mood was not pronounced. Moreover, negative mood exerted a significant beneficial effect on the originality dimension for participants with an anxious-ambivalent peer attachment style; they showed higher creativity in the negative mood state than in the neutral or positive mood states. In general, peer attachment style moderated the relationship between mood and creativity; specifically, positive mood was beneficial to creativity among secure persons, and negative mood was beneficial to creativity among anxious-ambivalent persons.

Physical Changes of Preschool Children during COVID-19 School Closures in Fujian, China.

The COVID-19 pandemic may constitute an "obesogenic lifestyle" that results in exacerbating childhood obesity. However, studies investigating regional sociodemographic factors including different age groups or sexes in children with obesity are lacking. We aimed to clarify the high obesity prevalence populations of preschool children to provide a regional basis for children's health policy during the COVID-19 school closures. From May to September 2019, a total of 29,518 preschool children were included in a large sample, multicenter cross-sectional study to explore physical status in Fujian Province by stratified cluster random sampling. In October 2019 and October 2020, we also conducted a cross-sectional study exploring physical development including changes in height, weight, and BMI of 1688 preschool children in Fuzhou before and after the COVID-19 school closures. Student' s t-test, Mann-Whitney U test, or chi-square test was used to assess differences in physical development and overweight and obesity rates among preschool children before and after school closures. For regional factors, the weight of urban preschool children of all ages became higher after the outbreak (p (age 3-4) = 0.009; p (age 4-5) < 0.001; p (age 5-6) = 0.002). For sex factors, overweight and obesity in boys had a greater prevalence than in girls before and after the outbreak. In four age groups, overweight and obesity rates in the 5-year-old group (15.5% and 9.9%) were higher than before (11.4% and 6.0%). The weight and BMI of 4- to 5-year-old children also increased faster than before (p < 0.001). The COVID-19 pandemic has promoted the epidemic of childhood obesity. Living in urban/coastal (economically developed) areas, boys, and aged 4-6 years old may be a susceptible population to obesity development after the outbreak.

Cefoperazone and sulbactam-related eosinophilic peritonitis: a case report and literature review.

Eosinophilic peritonitis (EP) is a well-described complication of peritoneal dialysis that occurs because of an overreaction to constituents that are related to the catheter or tubing, peritoneal dialysate, pathogenic infection, or intraperitoneal drug use. EP caused by antibiotic use is rare. We present the case of a patient with cefoperazone and sulbactam-related EP. A 59-year-old woman who was undergoing peritoneal dialysis presented with peritonitis with abdominal pain and turbid peritoneal dialysis. Empiric intraperitoneal cefazolin in combination with cefoperazone and sulbactam was started after peritoneal dialysis effluent cultures were performed. Her peritonitis achieved remission in 2 days with the help of cephalosporin, but she developed EP 1 week later, when her dialysate eosinophil count peaked at 49% of the total dialysate white blood cells (absolute count, 110/mm3). We excluded other possible causes and speculated that cefoperazone and sulbactam was the probable cause of EP. The patient continued treatment with cefoperazone and sulbactam for 14 days. EP resolved within 48 hours after stopping cefoperazone and sulbactam. Thus, EP can be caused by cefoperazone and sulbactam use. Physicians should be able to distinguish antibiotic-related EP from refractory peritonitis to avoid technique failure.

Prevention of peritoneal dialysis-related peritonitis by regular patient retraining via technique inspection or oral education: a randomized controlled trial.

BACKGROUND: There has been little research on strategies for prevention of peritoneal dialysis (PD)-related peritonitis. We explored whether regular retraining on bag exchanges (via two methods: technique inspection and oral education) every other month could help reduce the risk of peritonitis in PD patients through a randomized controlled trial (RCT). METHOD: This is an RCT conducted at Peking University First Hospital. A total of 150 incident patients receiving PD at our centre were included between December 2010 and June 2016 and followed up until June 2018. Patients were randomly assigned 1:1:1 to receive retraining on bag exchange via technique inspection, oral education or usual care. The primary outcome was time to the first peritonitis episode. Secondary outcomes were time to organism-specific peritonitis, transfer to haemodialysis and all-cause death. RESULTS: Patients in the technique inspection group, oral education group and usual care group (n = 50 for each group) were followed up for 47.5 ± 22.9 months. Time to first peritonitis was comparable between the groups. The technique inspection group showed a lower risk of first non-enteric peritonitis than the usual care group, while the oral education group did not show a significant benefit. The incidence of first non-enteric peritonitis in the usual care group (0.07/patient-year) was significantly higher than that in the technique inspection group (0.02/patient-year; P < 0.01) but was comparable with that in the oral education group (0.06/patient-year). Transfer to haemodialysis and all-cause mortality were not significantly different between the groups. CONCLUSIONS: Neither technique inspection nor oral education significantly altered the risk of all-cause peritonitis compared with usual care, despite technique inspection showing a trend towards reducing the risk of non-enteric PD-related peritonitis. TRIAL REGISTRATION: ClinicalTrials.gov (NCT01621997).

Clinical characteristics and outcomes of peritoneal dialysis-related peritonitis with different trends of change in effluent white cell count: a longitudinal study.

BACKGROUND: Effluent white cell count (WCC) is among the important prognostic factors for peritonitis outcome, but its trend has never been studied. We aimed to explore the clinical characteristics and outcomes of peritonitis episodes having different trends in effluent WCC change in the first 5 days. METHODS: For each peritonitis episode, we examined the patient's demographic and biochemical data, serial effluent WCC, and organisms cultured. Peritonitis-associated death and transfer to hemodialysis were defined as treatment failure. RESULTS: Based on the trend of effluent WCC in the first 5 days, we divided 190 peritonitis episodes into group A (WCC persistently declined), group B (WCC declined after a transient increase), group C (WCC increased after a transient decline), and group D (WCC persistently increased). In group A, peritonitis was caused mostly by gram-positive organisms, and effluent WCC declined the most quickly, leading to a good prognosis. Although the elevation of effluent WCC was prolonged in group B, and the infections were, compared with those in group A, more often caused by gram-negative organisms, outcomes were not worse. In group C, the effluent WCC was more likely to be higher than 100/µL on day 5, and the infection was, compared with those in groups A and B, less likely to be caused by gram-positive organisms. Accordingly, membership in group C independently predicted the worst outcome of peritonitis even adjusted for age, sex, and causative organism. CONCLUSIONS: Different trends of change in effluent WCC during the early stage of peritonitis represent different clinical patterns and outcomes. Further investigation for optimizing outcomes is required.

Peritoneal protein leakage, systemic inflammation, and peritonitis risk in patients on peritoneal dialysis.

BACKGROUND: Whether peritoneal protein leakage predicts risk for peritonitis in patients on peritoneal dialysis (PD) is unknown. In this observational cohort study, we aimed to determine that association and, further, to explore if it might be explained by systemic inflammation. ♢ METHODS: We prospectively followed 305 incident PD patients to first-episode peritonitis, censoring, or the end of the study. Demographics, comorbidity score, biochemistry, and peritoneal protein clearance (PrC) were collected at baseline. The predictors of first-episode peritonitis were analyzed prospectively. ♢ RESULTS: During follow-up, 14 868 patient months and 251 episodes of peritonitis were observed. The baseline PrC was 73.2 mL/day (range: 53.2 - 102 mL/day). Patients with a high PrC were prone to be older and malnourished. They also had a higher comorbidity score and higher C-reactive protein values. In 132 first episodes of peritonitis, baseline PrC was shown to be a significant independent predictor after adjustment for age, sex, body mass index, diabetes, residual renal function, hemoglobin, and peritoneal transport rate. Systemic inflammatory markers such as serum albumin, C-reactive protein, and interleukin-6 could not explain the association of PrC and high risk for peritonitis. ♢ CONCLUSIONS: Baseline peritoneal protein leakage was able to independently predict risk for peritonitis, which is not explained by systemic inflammation. The underlying mechanisms should be explored in future.

Clinical characteristics and outcomes of "silent" and "non-silent" peritonitis in patients on peritoneal dialysis.

OBJECTIVES: We compared the clinical characteristics and outcomes of "silent" peritonitis (meaning episodes without fever and abdominal pain) and "non-silent" peritonitis in patients on peritoneal dialysis (PD). METHODS: Our cohort study collected data about all peritonitis episodes occurring between January 2008 and April 2010. Disease severity score, demographics, and biochemistry and nutrition data were recorded at baseline. Effluent cell counts were examined at regular intervals, and the organisms cultured were examined. Treatment failure was defined as peritonitis-associated death or transfer to hemodialysis. RESULTS: Of 248 episodes of peritonitis occurring in 161 PD patients, 20.9% led to treatment failure. Of the 248 episodes, 51 (20.6%) were not accompanied by fever and abdominal pain. Patients with these silent peritonitis episodes tended to be older (p = 0.003). The baseline values for body mass index, triglycerides, and daily energy intake were significantly lower before silent peritonitis episodes than before non-silent episodes (p = 0.01, 0.003, and 0.001 respectively). Although silent peritonitis episodes were more often culture-negative and less often caused by gram-negative organisms, and although they presented with low effluent white cell counts on days 1 and 3, the risk for treatment failure in those episodes was not lower (adjusted odds ratio: 1.33; 95% confidence interval: 0.75 to 2.36; p = 0.33). CONCLUSIONS: Silent peritonitis is not a rare phenomenon, especially in older patients on PD. Although these episodes were more often culture-negative, silent presentation was not associated with a better outcome.

Disease severity score could not predict the outcomes in peritoneal dialysis-associated peritonitis.

BACKGROUND: We aim to explore if disease severity score (DSS) at onset is associated with dialysate white cell counts, the severity of causative organisms and the risk for treatment failure of peritoneal dialysis (PD)-associated peritonitis in an adult PD cohort. METHODS: Our prospective cohort study recorded all peritonitis episodes between 2008 and 2010. The DSS, demographic data and clinical characteristics were recorded at the onset of peritonitis. The dialysate cells were counted at regular intervals and organism culture were examined too. Treatment failure of peritonitis was defined as peritonitis-associated death and transfer to haemodialysis. RESULTS: A total of 219 episodes of peritonitis in 146 PD patients were recorded, 21.9% of which resulted in treatment failure. There were no significant differences in dialysate white cell counts on the fifth and seventh day and the distribution of causative organism between groups with varied DSS level. DSS could not predict treatment failure including peritonitis-related death and transfer to haemodialysis after adjusting for age, gender, diabetes, dialysis duration, dialysate white cell count on the third day, the presence of Staphylococcus aureus, gram-negative organisms and polymicrobial organisms. CONCLUSION: Our study demonstrated that DSS at onset was not associated with prolonged elevation of dialysate white cell counts, severity of causative organisms and outcome of peritonitis episodes in adult PD patients.