Ophiocordyceps sinensis preparations combined with the renin-angiotensin system inhibitor for diabetic kidney disease treatment: an umbrella review of systematic reviews and network meta-analysis.

Aims: This study aimed to synthesize the evidence of the comparative effectiveness and safety of Ophiocordyceps sinensis (OS) preparations combined with renin-angiotensin system inhibitors (RASi) for diabetic kidney disease (DKD). Methods: Eight databases were searched from their inception to May 2023. Systematic reviews (SRs) of OS preparations combined with RASi for DKD were identified. Randomized controlled trials (RCTs) from the included SRs and additional searching were performed for data pooling. Cochrane risk-of-bias 2 (RoB 2) tool and AMSTAR 2 were used to evaluate the methodological quality of RCTs and SRs, respectively. A Bayesian network meta-analysis was performed to compare the add-on effect and safety of OS preparations for DKD. The certainty of evidence was graded using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results: Fourteen SRs were included, whose methodological quality was assessed as high (1/14) or critically low (13/14). After combining additional searching, 157 RCTs were included, involving 13,143 participants. The quality of the RCTs showed some concerns (155/157) or high risk (2/157). Jinshuibao capsules and tablets, Bailing capsules and tablets, and Zhiling capsules were evaluated. Compared to RASi, adding either of the OS capsular preparations resulted in a decreased 24-h urinary total protein levels. OS preparations ranked differently in each outcome. Jinshuibao capsules plus RASi were beneficial in reducing urinary protein, serum creatinine, serum urea nitrogen, and blood glucose levels, with moderate-certainty evidence. No serious adverse events were observed after adding OS to RASi. Conclusion: Combining OS capsular preparations with RASi appeared to be associated with decreased urinary total protein levels in DKD patients. Further high-quality studies are needed to confirm. Systematic Review Registration: INPASY202350066.

Clinical features of COVID-19-related optic neuritis: a retrospective study.

Objective: This retrospective study aimed to investigate the clinical features of optic neuritis associated with COVID-19 (COVID-19 ON), comparing them with neuromyelitis optica-associated optic neuritis (NMO-ON), myelin oligodendrocyte glycoprotein-associated optic neuritis (MOG-ON), and antibody-negative optic neuritis (antibody-negative ON). Methods: Data from 117 patients (145 eyes) with optic neuritis at the Shantou International Eye Center (March 2020-June 2023) were categorized into four groups based on etiology: Group 1 (neuromyelitis optica-related optic neuritis, NMO-ON), Group 2 (myelin oligodendrocyte glycoprotein optic neuritis, MOG-ON), Group 3 (antibody-negative optic neuritis, antibody-negative ON), and Group 4 (optic neuritis associated with COVID-19, COVID-19 ON). Characteristics of T2 and enhancement in orbital magnetic resonance imaging (MRI) were assessed. Best-corrected visual acuity (BCVA) was compared before treatment, at a short-term follow-up (14 days), and at the last follow-up after treatment. Results: The COVID-19-associated optic neuritis (COVID-19 ON) group exhibited 100% bilateral involvement, significantly surpassing other groups (P < 0.001). Optic disk edema was observed in 100% of COVID-19 ON cases, markedly differing from neuromyelitis optica-related optic neuritis (NMO-ON) (P = 0.023). Orbital magnetic resonance imaging (MRI) revealed distinctive long-segment lesions without intracranial involvement in T1-enhanced sequences for the COVID-19 ON group compared to the other three groups (P < 0.001). Discrepancies in optic nerve sheath involvement were noted between the COVID-19 ON group and both NMO-ON and antibody-negative optic neuritis (antibody-negative ON) groups (P = 0.028). Before treatment, no significant difference in best-corrected visual acuity (BCVA) existed between the COVID-19 ON group and other groups. At the 14-day follow-up, BCVA in the COVID-19 ON group outperformed the NMO-ON (P < 0.001) and antibody-negative ON (P = 0.028) groups, with no significant difference observed compared to the myelin oligodendrocyte glycoprotein optic neuritis (MOG-ON) group. At the last follow-up after treatment, BCVA in the COVID-19 ON group significantly differed from the NMO-ON group (P < 0.001). Conclusion: Optic neuritis associated with COVID-19 (COVID-19 ON) predominantly presents with bilateral onset and optic disk edema. Orbital magnetic resonance imaging (MRI) demonstrates that COVID-19 ON presents as long-segment enhancement without the involvement of the intracranial segment of the optic nerve in T1-enhanced images. Glucocorticoid therapy showed positive outcomes.

Visual outcome of various dose of glucocorticoids treatment in nonarteritic anterior ischemic optic neuropathy- a retrospective analysis.

BACKGROUND AND PURPOSE: The objective of this investigation was to assess the therapeutic efficacy of distinct glucocorticoid therapy dosages in the management of acute nonarteritic anterior ischemic optic neuropathy (NAION). MATERIALS AND METHODS: This retrospective, unmasked, and non-randomized study included a total of 85 patients. The patients were categorized into four groups: Group 1 (control) consisted of 15 patients who did not receive glucocorticoids, Group 2 included 16 patients administered with oral prednisone at a dosage of 1 mg/kg/d for 14 days, Group 3 comprised 30 patients who received 250 units of methylprednisolone once daily for 3 days, followed by oral prednisone at a dosage of 1 mg/kg/d for 11 days, and Group 4 encompassed 24 patients who received 500 units of methylprednisolone once daily for 3 days, followed by oral prednisone at a dosage of 1 mg/kg/d for 11 days. The best-corrected visual acuity (BCVA) was assessed at baseline and the final follow-up (> 7 days post-treatment). The changes in visual acuity between baseline and the 7-14 day follow-up, as well as between baseline and the concluding appraisal, were employed as metrics for assessing the extent of visual enhancement. RESULTS: No significant differences were noted in the final visual outcomes or in the changes between final visual acuity and baseline across the four groups. In Group 1 (control), the best-corrected visual acuity (BCVA) remained unchanged during final follow-ups compared to baseline. Conversely, the intervention groups exhibited statistically significant enhancements in BCVA during final follow-up (p = 0.012, p = 0.03, and p = 0.009 for Group 2, Group 3, and Group 4, respectively) when compared to baseline. During the 7-14 day follow-up, there was a significant difference in the changes between baseline BCVA and follow-up BCVA across the groups (p = 0.035). Go a step further by Bonferroni correction for multiple comparisons, group 4 showed a greater change in vision compared with group1 (p = 0.045). CONCLUSION: Our study on acute nonarteritic anterior ischemic optic neuropathy (NAION) showed no significant final visual outcome differences. Nevertheless, Groups 2, 3, and 4 demonstrated improved best-corrected visual acuity (BCVA) during the final follow-up. Notably, a 500-unit dose of methylprednisolone resulted in short-term BCVA enhancement. This suggests potential consideration of 500 units of methylprednisolone for short-term NAION vision improvement, despite its limited long-term impact.

Bilateral retinal nerve fiber layer thickness reduction in a 9-year-old myopic boy suffering from unilateral optic neuritis: A case report.

BACKGROUND: In this paper, we present a 9-year-old boy who demonstrates a complex interplay between myopia progression, axial length (AL) extension, and retinal nerve fiber layer (RNFL) thickness loss in both eyes. Additionally, concurrent optic neuritis has directly impacted RNFL thickness in his right eye, and its potential indirect influence on RNFL and macular ganglion cell layer (mGCL) thickness in his left eye is also noteworthy. CASE SUMMARY: A 9-year-old boy with bilateral myopia presented with diminished vision and pain in his right eye due to optic neuritis, while his left eye showed pseudopapilledema. Steroid therapy improved his vision in the right eye, and 16-mo follow-up revealed recovery without recurrence despite myopia progression. Follow-up optical coherence tomography conducted 16 mo later revealed a notable thinning of the RNFL in both eyes, especially along with a reduction in mGCL thickness in the left eye. This intricate interaction between optic neuritis, myopia, and retinal changes underscores the need for comprehensive management, highlighting potential long-term visual implications in young patients. CONCLUSION: The progression of myopia and AL extension led to the loss of RNFL thickness in both eyes in a 9-year-old boy. Concurrently, optic neuritis directly affected RNFL thickness in his right eye and may indirectly play a role in the thickness of RNFL and mGCL in his left eye.

Effect of tandem repeats of antimicrobial peptide CC34 on production of target proteins and activity of Pichia pastoris.

Antimicrobial peptides (AMPs) are attracting attention in the fields of medicine, food, and agriculture because of their broad-spectrum antibacterial properties, low resistance, and low-residue in the body. However, the low yield and instability of the prepared AMP drugs limit their application. In this study, we designed a tetramer of the AMP CC34, constructed and transfected two recombinant expression vectors with pGAPZαA containing a haploid CC34 and tetraploid CC34 (CC34-4js) into Pichia pastoris to explore the effect of biosynthesized peptides. The results showed that CC34 and CC34-4js expression levels were 648.2 and 1105.3 mg/L, respectively, in the fermentation supernatant of P. pastoris. The CC34-4js tetramer showed no antibacterial activity, could be cleaved to the monomer using formic acid, and the hemolytic rate of the polyploid was slightly lower than that of monomeric CC34. The average daily gain, average daily feed intake, feed conversion ratio and immune organ index of rats fed CC34 and CC34-4js showed no differences. In conclusion, CC34-4js exhibited a higher yield and lower hemolysis in P. pastoris than those of CC34. Finally, CC34 and CC34-4js enterokinase lysates showed similar antibacterial activity and both expressed peptides potentially improved the growth performance and organ indices of rats.

A systematic review: on the mercaptoacid metabolites of acrylamide, N-acetyl-S-(2-carbamoylethyl)-L-cysteine.

Acrylamide is widely found in a variety of fried foods and cigarettes and is not only neurotoxic and carcinogenic, but also has many potential toxic effects. The current assessment of acrylamide intake through dietary questionnaires is confounded by a variety of factors, which poses limitations to safety assessment. In this review, we focus on the levels of AAMA, the urinary metabolite of acrylamide in humans, and its association with other diseases, and discuss the current research gaps in AAMA and the future needs. We reviewed a total of 25 studies from eight countries. In the general population, urinary AAMA levels were higher in smokers than in non-smokers, and higher in children than in adults; the highest levels of AAMA were found in the population from Spain, compared with the general population from other countries. In addition, AAMA is associated with several diseases, especially cardiovascular system diseases. Therefore, AAMA, as a biomarker of internal human exposure, can reflect acrylamide intake in the short term, which is of great significance for tracing acrylamide-containing foods and setting the allowable intake of acrylamide in foods.

Depression and internet addiction among adolescents:A meta-analysis.

Depression and Internet addiction (IA) are both prevalent and burdensome in adolescents. Findings on the relationship between depression and IA remain equivocal, and we therefore conducted a meta-analysis to confirm their correlation. We searched for relevant studies, with the last search being conducted on November 10, 2022. Adolescents aged 10 to 24 reported objectively measured depression and IA using scales that have been used worldwide and are valid. Random effect models were used to produce combined odds ratios (OR) and coefficient of regression (ß) We included 42 studies presenting data from 102,769 participants. The meta-analysis confirmed that depression is positively correlated with IA and vice versa. Adolescents with depressive disorders were found to have a higher risk of IA. Adolescents with IA were found to have a higher risk of depressive disorders. In addition, IA had a stronger effect on depression risk. Screening for Internet addiction in depressed adolescents is recommended at initial diagnosis and follow-up. Similarly, Internet addicts should be screened regularly for depression.

Constructing a prognostic risk model for Alzheimer's disease based on ferroptosis.

Introduction: The aim of this study is to establish a prognostic risk model based on ferroptosis to prognosticate the severity of Alzheimer's disease (AD) through gene expression changes. Methods: The GSE138260 dataset was initially downloaded from the Gene expression Omnibus database. The ssGSEA algorithm was used to evaluate the immune infiltration of 28 kinds of immune cells in 36 samples. The up-regulated immune cells were divided into Cluster 1 group and Cluster 2 group, and the differences were analyzed. The LASSO regression analysis was used to establish the optimal scoring model. Cell Counting Kit-8 and Real Time Quantitative PCR were used to verify the effect of different concentrations of Aß1-42 on the expression profile of representative genes in vitro. Results: Based on the differential expression analysis, there were 14 up-regulated genes and 18 down-regulated genes between the control group and Cluster 1 group. Cluster 1 and Cluster 2 groups were differentially analyzed, and 50 up-regulated genes and 101 down-regulated genes were obtained. Finally, nine common differential genes were selected to establish the optimal scoring model. In vitro, CCK-8 experiments showed that the survival rate of cells decreased significantly with the increase of Aß1-42 concentration compared with the control group. Moreover, RT-qPCR showed that with the increase of Aß1-42 concentration, the expression of POR decreased first and then increased; RUFY3 was firstly increased and then decreased. Discussion: The establishment of this research model can help clinicians make decisions on the severity of AD, thus providing better guidance for the clinical treatment of Alzheimer's disease.

Teaching behaviours of clinical teachers and professional commitment among nursing students: A moderated mediation model of optimism and psychological well-being.

BACKGROUND: Understanding the paths that influence professional commitment among nursing students is important for helping students continue the nursing profession after graduation. The paths between the teaching behaviours of clinical teachers (TBCT) and professional commitment were unknown. OBJECTIVES: This study aimed to examine whether psychological well-being mediated the relationships between the teaching behaviours of clinical teachers and professional commitment of nursing students. Moreover, we investigated whether the mediating effects of psychological well-being were moderated by optimism. DESIGN: A cross-sectional design was conducted. SETTING AND PARTICIPANTS: A total of 318 students from 24 hospitals in 13 cities in northern, north-eastern, and eastern China were included in the study. METHODS: The instruments used in this study included the scale of teaching behaviours of clinical teachers, a brief inventory of thriving (measuring psychological well-being), a life orientation test (measuring optimism), and a professional commitment scale. The PROCESS macro for SPSS was used to perform mediation analysis and moderated mediation analyses. RESULTS: Psychological well-being of nursing students partially mediated the relationships between the teaching behaviours of clinical teachers and professional commitment of nursing students. Also, optimism moderated the indirect effect of this mediation model. The indirect effect of clinical teachers' teaching behaviours was stronger for nursing students with low levels of optimism. CONCLUSION: The findings suggest that the teaching behaviours of clinical teachers and psychological well-being promote professional commitment. In addition, the mediation of psychological well-being between the teaching behaviours of clinical teachers and professional commitment was conditional on different levels of optimism. Clinical teachers should pay special attention to students with low levels of optimism because teaching behaviours of clinical teachers exert more influence on those students' professional commitment.

Gynostemma pentaphyllum for dyslipidemia: A systematic review of randomized controlled trials.

Objective: To evaluate the lipid-lowering effect and safety of Gynostemma pentaphyllum (GP) used alone or as adjunctive therapy for dyslipidemia. Methods: Eight databases and three clinical trial registries were searched until January 2022. Randomized controlled trials (RCTs) assessing the effectiveness of GP for dyslipidemia were included. Trial quality was assessed using the Cochrane Risk of Bias Tool 2.0. Data were analyzed by RevMan 5.4 with effects estimated as risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI). Results: Twenty-two RCTs involving 2,407 dyslipidemia participants were included. Regarding the risk of bias, 14 RCTs had some concerns, seven RCTs were high, and one trial was low. GP was comparable to n-3 fatty acids (RR 0.89, 95% CI 0.62-1.28) and red yeast rice (RR 0.33, 95% CI 0.1-1.12) on normalization of serum lipids. GP plus n-3 fatty acid was superior in normalization of triglycerides (TG) and total cholesterol (TC) than n-3 fatty acids (RR 1.34, 95% CI 1.01-1.77). GP was similar to lipid-lowering agents (statins, fibrates, and n-3 fatty acids) in regulating TG, TC, and high-density lipoprotein cholesterol (HDL-C). GP plus lipid-lowering agents were superior to lipid-lowering agents in TG (MD -0.65 mmol/L, 95% CI -1.03 to -0.28), LDL-C (MD -0.57 mmol/L, 95% CI -1.07 to -0.08), and HDL-C (MD 0.15 mmol/L, 95% CI 0.11-0.20). GP was inferior to red yeast rice in TC (MD 0.64 mmol/L, 95% CI 0.15-1.13), TG (MD 0.43 mmol/L, 95% CI 0.15-0.71), and HDL-C (MD -0.25 mmol/L, 95% CI -0.47 to -0.04). GP had fewer adverse events than lipid-lowering drugs. Conclusion: Very low certainty evidence showed that GP's effects on TC, TG, and HDL-C were comparable to that of lipid-lowering agents. Low certainty evidence showed that red yeast rice was superior to GP in TC, TG, and HDL-C. Low to moderate certainty evidence showed that the effects of GP plus lipid-lowering agents were superior to that of lipid-lowering agents on TG, LDL-C, and HDL-C. GP use for more than 8 weeks appears safe. Systematic Review Registration: https://inplasy.com/, identifier INPLASY202210135.

Stimulating the expression of sphingosine kinase 1 (SphK1) is beneficial to reduce acrylamide-induced nerve cell damage.

Sphingosine kinase 1 (SphK1) is an important signaling molecule for cell proliferation and survival. However, the role of SphK1 in acrylamide (ACR)-induced nerve injury remains unclear. The purpose of this study was to investigate the role and potential mechanism of SphK1 in ACR-induced nerve injury. Liquid chromatography triple quadrupole tandem mass spectrometry (LC-MS/MS) and reverse transcription-quantitative PCR (RT-qPCR) were used to detect sphingosine 1-phosphate (S1P) content in serum and SphK1 content in whole blood from an occupational work group exposed to ACR compared to a non-exposed group. For in vitro experiments, SphK1 in human SH-SY5Y neuroblastoma cells was activated using SphK1-specific activator phorbol 12-myristate 13-acetate (PMA). Our research also utilized cell viability assays, flow cytometry, western blots, RT-qPCR and related protein detection to assess activity of the mitogen activated protein kinase (MAPK) signaling pathway. The results of the population study showed that the contents of SphK1 and S1P in the ACR-exposed occupational contact group were lower than in the non-exposed group. The results of in vitro experiments showed that expression of SphK1 decreased with the increase in ACR concentration. Activating SphK1 improved the survival rate of SH-SY5Y cells and decreased the apoptosis rate. Activating SphK1 in SH-SY5Y cells also regulated MAPK signaling, including enhancing the phosphorylation of extracellular signal-regulated protein kinases (ERK) and inhibiting the phosphorylation of c-Jun N-terminal kinase (JNK) and p38. These results suggest that activating SphK1 can protect against nerve cell damage caused by ACR.

Path analysis of the association between self-compassion and depressive symptoms among nursing and medical students: a cross-sectional survey.

BACKGROUND: Nursing and medical students are suffering from high rates of depressive symptoms. Mental health benefits students' learning, growth and professional development. Exploring psychological resources to prevent depression is emphasized recently, and self-compassion is shown to be inversely associated with depressive symptoms. However, the mechanism through which self-compassion contributes to decreased depressive symptoms is limited. Therefore, this study aimed to explore and examine a model detailing the potential paths between self-compassion and depressive symptoms. METHODS: A cross-sectional study was conducted and convenient sampling was used. Among the 1800 nursing and medical students targeted from two universities in East and North China, 1341 completed the questionnaires, and 1127 valid questionnaires were analyzed comprising 566 and 561 from medical and nursing students, respectively. Data in May 2020 and July 2020 were collected through Patient Health Questionnaire, self-compassion scale, resilience scale, Life Orientation Test and Perceived Stress Scale. Then, path model analysis was conducted to analyze the data. RESULTS: Finally, this study included 1125 valid questionnaires after excluding two extremes of study variables. Participants consisted of 50.2% medical students and 49.8% nursing students. The model showed an acceptable fit to the data. After controlling for the demographics, self-compassion was directly and indirectly associated with decreased depressive symptoms by increasing resilience and optimism and reducing perceived stress among nursing and medical students. Resilience and optimism were directly and indirectly associated with decreased depressive symptoms by reducing perceived stress among nursing students and indirectly associated with decreased depressive symptoms among medical students. CONCLUSIONS: The study provides evidence that self-compassion significantly influences the decrease in depressive symptoms by increasing resilience and optimism and reducing perceived stress. These findings suggested that programs enhancing students' self-compassion, resilience, and optimism simultaneously can help decrease depressive symptoms and improve mental health in education and healthcare institutes. These findings may facilitate the designing of educational programs for preventing depressive symptoms and promoting mental health among nursing and medical students.

The association of loneliness, mindfulness, and optimism with self-directed learning among nursing students in China: A cross-sectional study.

BACKGROUND: Successful adaption to the increasing demands of the healthcare system involves self-directed learning (SDL) approach, which contributes to professional values and academic and clinical performance. Although many factors are related to SDL, research examining the association between internal factors such as loneliness, mindfulness and optimism with self-directed learning is limited. OBJECTIVE: This study aims to examine the association between loneliness, mindfulness, and optimism with self-directed learning. METHODS: A cross-sectional design was conducted, and study participants included 568 nursing students from higher education institutes in North, East and South China from May 2020 to October 2020. Data collection instruments included socio-demographics, the self-directed learning scale, the loneliness scale, the Five Facet Mindfulness Questionnaire, and the Life Orientation Test. Hierarchical multiple regression and moderation analyses were used to analyze the data. RESULTS: Findings indicated that loneliness was negatively related to SDL, whereas mindfulness and optimism showed a positive relationship to SDL. Optimism did not significantly moderate the relationship between loneliness and SDL, and between optimism and self-directed learning. CONCLUSIONS: The findings suggest that incorporating training programs for reducing loneliness and improving mindfulness and optimism into curricular and extracurricular activities on campuses may help increase SDL.

Cannabinoid receptors promote chronic intermittent hypoxia-induced breast cancer metastasis via IGF-1R/AKT/GSK-3ß.

The progression of breast cancer is closely related to obstructive sleep apnea-hypopnea syndrome (OSAHS). Low concentrations of cannabinoids promote tumor proliferation. However, the role of cannabinoid receptors (CBs) in chronic intermittent hypoxia (CIH)-induced breast cancer has not been reported. The migration and invasion of breast cancer cell lines (MCF-7 and T47D) were measured by scratch assay and transwell assay. Gene and protein expressions were analyzed by qPCR and western blotting. Tumor xenograft mice model were established to evaluate the function of CBs. We observed that chronic hypoxia (CH) and CIH increased CBs expression and promoted migration and invasion in breast cancer. Mice grafted with MCF-7 exhibited obvious tumor growth, angiogenesis, and lung metastasis in CIH compared with CH and control. In addition, CIH induced CBs expression, which subsequently activated insulin-like growth factor-1 receptor (IGF-1R)/AKT/glycogen synthase kinase-3ß (GSK-3ß) axis. Knockdown of CBs alleviated CIH-induced migration and invasion of breast cancer in vitro. Furthermore, CIH exaggerated the malignancy of breast cancer and silencing of CBs suppressed tumor growth and metastasis in vivo. Our study contributed to understanding the role of CIH in breast cancer development modulation.

Artificial neural network application for identifying risk of depression in high school students: a cross-sectional study.

BACKGROUND: Identifying important factors contributing to depression is necessary for interrupting risk pathways to minimize adolescent depression. The study aimed to assess the prevalence of depression in high school students and develop a model for identifying risk of depression among adolescents. METHODS: Cross-sectional study was conducted. A total of 1190 adolescents from two high schools in eastern China participated in the study. Artificial neurol network (ANN) was used to establish the identification model. RESULTS: The prevalence of depression was 29.9% among the students. The model showed the top five protective and risk factors including perceived stress, life events, optimism, self-compassion and resilience. ANN model accuracy was 81.06%, with sensitivity 65.3%, specificity 88.4%, and area under the receiver operating characteristic (ROC) curves 0.846 in testing dataset. CONCLUSION: The ANN showed the good performance in identifying risk of depression. Promoting the protective factors and reducing the level of risk factors facilitate preventing and relieving depression.

[The Liver Injury and Coagulation Dysfunction in the Patients with Severe/Critical COVID-19].

AbstractObjective: To analyze the liver injury and coagulation dysfunction in COVID-19 severe/critical type patients. METHODS: The clinical data of 53 COVID-19 patients were collected from a single center in Wuhan from February 8, 2020 to March 25, 2020. The patients were divided into severe type group (38 patients) and critical type group (15 patients). The clinical characteristics, indexes of liver function, coagulation function and inflammatory markers were analyzed retrospectively. According to the degree of abnormal liver function in the process of diagnosis and treatment, the patients were divided into three groups: combined liver injury, mild abnormal liver function and normal liver function group. Statistical analysis was performed by using Student t test, Mann-Whitney U test, Kruskal-Wallis test and Chi-square test. RESULTS: Among the 53 patients, 29 were male (54.7%) and 24 were female (45.3%), the median age was 57(27－80) years old. The time from onset to admission was (11.5±7.7) days. The levels of AST, TBIL, DBIL, ALP, GGT, LDH, D-dimer, PCT and hsCRP in critical patients were higher than those in severe patients (P<0.05). The levels of Alb in critical patients was lower than those in severe patients (P<0.05). Among the 53 patients, 34 (64%) patients showed abnormal elevation of ALT, AST or TBIL, while 4 (7.5%) patients showed the criteria of COVID-19 with liver injury. After the patients were grouping according to the degree of liver dysfunction, the levels of ALP, GGT and D-dimer of the patients in the liver injury group were significantly higher than those in the normal liver function group, D-dimer levels of the patients in the liver injury group was significantly higher than those in the mild abnormal liver function group, while the levels of ALP and GGT in the mild abnormal liver function group were significantly higher than those in the normal liver function group, and the differences were statistically significant(P<0.05). CONCLUSION: In this group, the patients with COVID-19 severe/critical type have a certain proportion of liver injury accompanied by significantly increased D-dimer levels, critical type patients have more severe liver function and coagulation dysfunction, which may promote the progression of COVID-19.

Obstructive sleep apnea syndrome and causal relationship with female breast cancer: a mendelian randomization study.

Although observational studies have reported a positive association between obstructive sleep apnea syndrome (OSAS) and breast cancer (BC) risk, causality remains inconclusive. We aim to explore whether OSAS is associated with etiology of BC by conducting a two-sample Mendelian randomization (MR) study in a Chinese population and Asian population from the Breast Cancer Association Consortium (BCAC). We found a detrimental causal effect of OSAS on BC risk in the primary analysis of our samples (IVW OR, 2.47 for BC risk per log-odds increment in OSAS risk, 95% CI = 1.86-3.27; P = 3.6×10-10). This was very similar to results of the direct observational case-control study between OSAS and BC risk (OR = 2.80; 95% CI = 2.24-3.50; P =1.4×10-19). Replication in the Asian population of the BCAC study also supported our results (IVW OR, 1.33 for BC risk per log-odds increment in OSAS risk, 95% CI = 1.13-1.56; P = 0.0006). Sensitivity analyses confirmed the robustness of our findings. We provide novel evidence that genetically determined higher risk of OSAS has a causal effect on higher risk of BC. Further studies focused on the mechanisms of the relationship between OSAS and breast carcinogenesis are needed.

The study on analysis of risk factors for severity of white matter lesions and its correlation with cerebral microbleeds in the elderly with lacunar infarction.

This study aimed to explore the risk factors for severity of white matter lesions and its correlation with in the elderly with lacunar infarction.Patients (range, 70-85 years) with lacunar infarction treated in a hospital in China from 2016 to 2017were enrolled. Fazekas rating scale (0-6 points) was used to assess severity of white matter lesions. Risk factors for the severity of white matter lesions and correlation between cerebral microbleeds and white matter lesions in the elderly with lacunar infarction were studied.The elderly (81-85 years' old, odds ratio [OR]: 2.423, 95% confidence interval [CI]: 1.795-3.271, P = .018; 76∼80 years' old, OR: 3.113, 95% CI: 1.723-5.625, P = .043), carotid atherosclerosis (OR: 3.062, 95% CI:1.715-5.468, P < .001), history of hypertension (OR: 3.694, 95% CI: 2.031-6.717, P < .001) were risk factors for the severity of white matter lesions. The white matter lesions score increased corresponding to increase in the cerebral microbleeds grade (P < .001). The white matter lesions score was higher in the cerebral microbleeds combined with the white matter lesions group than in the white matter lesions group (P < .01). After correcting the effects of age, there was a correlation between white matter lesions and cerebral microbleeds (P < .001). Logistic analysis revealed that the patients' age (81-85 years' old, OR: 2.722, 95% CI: 1.985-3.734, P = .019; 76∼80 years' old, OR: 1.857, 95% CI: 1.075-3.207, P = .031), history of hypertension (OR: 2.931, 95% CI: 1.136-7.567, P = 0.0.036), systolic blood pressure (OR: 1.049, 95% CI: 1.015-1.084, P = .007), high-sensitivity C-reactive protein (OR: 1.504, 95% CI: 1.254-1.803, P < .001), homocysteine (OR: 1.076, 95% CI: 1.020-1.136, P = .009), and carotid atherosclerosis (OR: 1.389, 95% CI: 1.103-1.748, P = .010) were significant risk factors for combined cerebral microbleeds with white matter lesions in patients with lacunar infarction.The elderly, carotid atherosclerosis, history of hypertension were risk factors for the severity of white matter lesions. Cerebral microbleeds were positively correlated with the severity of white matter lesions.

Association between diabetes-related self-care activities and positive health: a cross-sectional study.

OBJECTIVES: The study aimed to examine the diabetes-related self-care activities (DRSCA) in association with positive health consisting of resilience, subjective well-being (SWB) and disease-related quality of life (DRQoL), and the associations of background information with resilience, SWB and DRQoL. DESIGN: A cross-sectional study. METHODS: A convenience sample of people with type 2 diabetes (T2DM) was recruited from two tertiary hospitals in eastern China. Self-reported survey data included DRSCA, resilience, SWB, DRQoL, and background information comprising demographics and social support. Data were analysed using hierarchical multiple regression analyses. RESULTS: Two hundred and forty-six valid questionnaires were analysed. Among the components of positive health, hierarchical multiple regression analysis showed that DRSCA were significantly associated with improved SWB (ß=0.140, p=0.020), but not with resilience and DRQoL after adjusting for background information. Participants with higher level of education had higher resilience and men had higher SWB than women. Social support (ß=0.186, p=0.003) in Model 1 and resilience (ß=0.298, p<0.001) in Model 2 were positively associated with SWB. CONCLUSIONS: This study indicated an association between DRSCA and one component of positive health, namely SWB. This finding could help motivate patients to perform DRSCA and to improve SWB in people with T2DM. In addition, the fact that demographics, for example, gender, were associated with SWB and education was associated with resilience also needs to be accommodated when aiming to improve SWB and build resilience. TRIAL REGISTRATION NUMBER: NCT02594748.

The association of diabetes-related self-care activities with perceived stress, anxiety, and fatigue: a cross-sectional study.

PURPOSE: Many people with type 2 diabetes (T2DM) do not sustain sufficient diabetes-related self-care activities (DRSCA) in their daily lives. To provide additional information about the positive influence of DRSCA, this study was conducted to examine whether DRSCA were associated with reduced perceived stress, anxiety, and fatigue among people with T2DM and to explore the level of DRSCA, perceived stress, anxiety, and fatigue and their association with background information. PATIENTS AND METHODS: This study was a cross-sectional survey including 251 participants aged 18 years and older recruited from two hospitals in the eastern part of China. The study utilized self-report questionnaires that consisted of background information, DRSCA, perceived stress, anxiety, and fatigue. Hierarchical multiple regression analysis was conducted to explore the association of DRSCA with perceived stress, anxiety, and fatigue while adjusting for background information. RESULTS: The results indicated that the level of self-care activities, stress, and fatigue was around middle level. The prevalence of anxiety was 19%. A high level of DRSCA was likely to reduce perceived stress but was not linked to anxiety and fatigue. Women were more susceptible to stress and anxiety, and people who had diabetes for >5 years were more likely to have anxiety. The background information included diabetes duration, standardized diabetes education, and high social support, all of which are factors that may influence DRSCA. CONCLUSION: The findings suggest that improving the level of DRSCA might effectively reduce perceived stress. The potential benefits of DRSCA can provide both motivational and evaluative data for self-care programs. In addition, the findings show that DRSCA were not linked to anxiety and fatigue, which implies that their positive influence on anxiety and fatigue may be offset by the load of frequent DRSCA. It is suggested that helping patients to make tailored plans to integrate DRSCA into their daily lives is needed. Meanwhile, in the background information, it is suggested that standardized diabetes education and high social support can benefit DRSCA; in improving psychological health, more attention should be paid to women and patients with diabetes duration <5 years.