Prevalence and disparities in sexual and reproductive health of women of reproductive age (20-49 years) in China: A national cross-sectional study.

Background: Ensuring women's sexual and reproductive health (SRH) is a fundamental human right and key to 2030 agenda of the UN Sustainable Development Goals (SDGs), yet limited evidence exists on SRH in China, including national estimates and disparities of women's SRH experiences, gynaecological diseases, and sexually transmitted diseases (STDs). Methods: A national cross-sectional survey based on a multistage stratified sampling from 15 provinces of China was performed from May 2019 to April 2021. A total of 12 815 reproductive-aged (20-49 years) women were involved. The SRH experiences (including age at menarche, age at first sexual activity, history of abortion, miscarriage, recurrent miscarriage, stillbirth, age at first delivery, types of delivery), the history of gynaecological diseases and STDs, as well as the environmental factors of participants were investigated. Human development index (HDI) was utilised to categorise and describe the socioeconomic status of the regions. The prevalence rates of diseases were compared among different HDI regions. Results: We observed a decrease in the mean age at menarche, an increase in the proportion of women who became sexually active before 20, and a modest rise in mean age at first childbirth across generations. Age-standardised prevalence estimates of miscarriage, recurrent miscarriage, artificial abortion, ectopic pregnancy, and stillbirth were 9.3, 1.4, 55.7, 3.3, and 2.1%, respectively. Approximately 50% of participants reported a history of gynaecological diseases, with vulvovaginitis, cervicitis, and pelvic infection diseases being the most prevalent. The overall prevalence of STDs was estimated at 22.2‰, with mycoplasma genitalium infection having the highest reported prevalence. Disease prevalence varies across HDI regions. Conclusions: Women's SRH behaviours and experiences have evolved, along with shifts in the spectrums of gynaecological diseases and STDs in China. Urgent recalibration of health care policies and disease control strategies is necessary, aligning them with women's changing SRH needs, ultimately ensuring their reproductive health and rights.

Ultrasound based radiomics model for assessment of placental function in pregnancies with preeclampsia.

The goal of our research is to elucidate and better assess placental function in rats with preeclampsia through an innovative application of ultrasound-based radiomics. Using a rat model induced with L-NAME, we carefully investigated placental dysfunction via microstructural analysis and immunoprotein level assessment. Employing the Boruta feature selection method on ultrasound images facilitated the identification of crucial features, consequently enabling the development of a robust model for classifying placental dysfunction. Our study included 12 pregnant rats, and thorough placental evaluations were conducted on 160 fetal rats. Distinct alterations in placental microstructure and angiogenic factor expression were evident in rats with preeclampsia. Leveraging high-throughput mining of quantitative image features, we extracted 558 radiomic features, which were subsequently used to construct an impressive evaluation model with an area under the receiver operating curve (AUC) of 0.95. This model also exhibited a remarkable sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 88.7%, 91.5%, 90.2%, 90.4%, and 90.0%, respectively. Our findings highlight the ability of ultrasound-based radiomics to detect abnormal placental features, demonstrating its potential for evaluating both normative and impaired placental function with high precision and reliability.

CircRNA based multivalent neuraminidase vaccine induces broad protection against influenza viruses in mice.

Developing broad-spectrum influenza vaccines is crucial for influenza control and potential pandemic preparedness. Here, we reported a novel vaccine design utilizing circular RNA (circRNA) as a delivery platform for multi-subtype neuraminidases (NA) (influenza A N1, N2, and influenza B Victoria lineage NA) immunogens. Individual NA circRNA lipid nanoparticles (LNP) elicited robust NA-specific antibody responses with neuraminidase inhibition activity (NAI), preventing the virus from egressing and infecting neighboring cells. Additionally, the administration of circRNA LNP induced cellular immunity in mice. To achieve a universal influenza vaccine, we combined all three subtypes of NA circRNA-LNPs to generate a trivalent circRNA vaccine. The trivalent vaccine elicited a balanced antibody response against all three NA subtypes and a Th1-biased immune response in mice. Moreover, it protected mice against the lethal challenge of matched and mismatched H1N1, H3N2, and influenza B viruses, encompassing circulating and ancestral influenza virus strains. This study highlights the potential of delivering multiple NA antigens through circRNA-LNPs as a promising strategy for effectively developing a universal influenza vaccine against diverse influenza viruses.

Relieving effect of jiao-tune of 5-element music on negative emotions in patients with decompensated hepatitis B virus cirrhosis: A randomized and controlled experiment study.

BACKGROUND: Depression and anxiety are common in patients with decompensated hepatitis B virus (HBV) cirrhosis. This study aimed to evaluate the relieving effects of the jiao-tune of 5-element music on negative emotions in patients with decompensated HBV cirrhosis. METHODS: The patients were randomly allocated into the control group (standard nursing care) and the jiao-tune group (standard nursing care plus a 2-month course of music therapy with the jiao-tune of 5-element music). The negative emotions of patients were assessed before intervention treatment and at the end of the 2-month follow-up using the Zung Self-Rating Depression Scale (SDS) and Zung Self-Rating Anxiety Scale (SAS). RESULTS: The analysis included 209 patients, with 102 in the control group and 107 in the jiao-tune group, all of whom returned their completed questionnaires. Baseline clinical characteristics and length of hospital stay were comparable between 2 groups. Before intervention treatment, there were no significant differences in SAS score (55.78 ±â€…5.64 vs 56.47 ±â€…3.28) and SDS score (65.13 ±â€…3.12 vs 64.48 ±â€…4.47) between the jiao-tune group and control group. After 2-month follow-up, the jiao-tune group had a significantly lower SAS score (53.17 ±â€…5.61) and SDS score (61.28 ±â€…1.52) compared with the control group (55.49 ±â€…3.37 and 63.08 ±â€…2.76), there were significant differences between 2 groups (P < .001). CONCLUSIONS: The jiao-tune of 5-element music can relieve the negative emotions in patients with decompensated HBV cirrhosis.

More online interaction, more stock liquidity:--Evidence from Chinese stock exchange online interaction platform.

This paper investigates the impact of online interaction between investors and enterprises on stock liquidity, using data from A-share listed companies in China from 2010 to 2021. Firstly, our findings reveal that more frequent interaction leads to better stock liquidity, and this result remains consistent across various robustness tests. Secondly, we observe that the expected tenure of senior executives and the ratio of institutional investor ownership exert a significant moderating effect on this relationship. Thirdly, this effect varies across enterprises at different development stages and with different ownership structures, being more pronounced in growing and privately-owned companies. Furthermore, this paper finds an inverted U-shaped relationship between reply length and stock liquidity, indicating that excessively long replies may introduce noise and negatively affect liquidity. This study provides new insights into how online interactions can improve market efficiency and offers practical implications for corporate governance and investor relations.

Omission of sentinel lymph node biopsy in patients with clinically axillary lymph node-negative early breast cancer (OMSLNB): protocol for a prospective, non-inferiority, single-arm, phase II clinical trial in China.

INTRODUCTION: Sentinel lymph node biopsy (SLNB) is a standard procedure for patients with clinically assessed negative axillary lymph nodes (cN0) during early-stage breast cancer (EBC). However, the majority of EBC patients have a negative pathological confirmation of the sentinel lymph node (SLN), and axillary surgery is inevitably associated with postoperative complications. Considering that SLNB has no therapeutic benefit, this trial aims to determine the safety of omitting SLNB in patients with cN0 early invasive breast cancer. METHODS AND ANALYSIS: The OMSLNB trial is a prospective, single-arm, non-inferiority, phase II, open-label study design involving female breast cancer patients with a tumor of ≤3 cm in diameter, who are considered axillary lymph-node-negative based on two or more radiological examinations, including axillary lymph node ultrasonography. Eligible patients will avoid axillary surgery but will undergo breast surgery, which is not limited to breast-conserving surgery. The trial begins in 2023 and is scheduled to end in 2027. The primary endpoint is 3 year invasive disease-free survival (iDFS). The secondary endpoints include the incidence of breast cancer-related lymphoedema, patient-reported outcomes, locoregional recurrence, local recurrence and regional recurrence. It is expected that the 3 year iDFS in patients undergoing SLNB is about 90%, combined with a non-inferiority cut-off of 5%, 80% power, 95% CIs, 0.05 test level, and 10% loss to follow-up rate, the planned enrollment is 311 patients. All enrolled patients will be included in the intention-to-treat analysis. ETHICS AND DISSEMINATION: This trial was approved by the Ethics Committee of the First Affiliated Hospital of Nanjing Medical University (No.2023-SR-193). All participants must provide written informed consent to be eligible. The protocol will be described in a peer-reviewed manuscript, and the results will be published in scientific journals and/or at academic conferences. TRIAL REGISTRATION NUMBER: NCT05935150.

Functional Identification of miR2119 Targeting ADHs in Modulating Soybean Resistance to Heterodera glycines.

Soybean cyst nematode (SCN, Heterodera glycines) is a sedentary endoparasite nematode that results in severe economic losses in soybean crops. miRNAs play crucial roles in plant responses to nematode. However, the role of miR2119 responding to SCN stress in soybean. Here, we demonstrated that the transcript levels of polycistronic precursors containing miR2119 and miR398a were significantly reduced in soybean upon nematode infection. Promoter of the miR2119-398a precursor analysis was conducted containing a GUS reporter gene. GUS activity assays demonstrated a decrease in miR2119-398a promoter during SCN infection. Overexpression of polycistronic precursor miR2119-398a (OE-premiR2119-398a) and miR2119 precursor (OE-premiR2119) rendered soybean more susceptible to SCN. Conversely, silencing miR2119 (STTM2119) increased soybean resistance against SCN. Furthermore, RNA-seq analysis revealed that miR2119 is involved in many defense signaling pathways. GUS reporter gene assays demonstrated that miR2119 targets GmADH1.1a and GmADH1.1b. Functional analysis indicated that ADHs act as a major role in responding to H. glycines by modulating reactive oxygen species (ROS) levels. Together, the findings reveal a novel mechanism by which the polycistronic precursor miR2119-398a coordinately regulates in response to H. glycines. Additionally, miR2119 becomes an essential element contributing to H. glycines by modulating ADH activity and ROS homeostasis in soybean.

Ion exchange in semiconductor magic-size clusters.

As a crucial post-synthesis method, ion exchange allows for precise control over the composition, interface, and morphology of nanocrystals at the atomic scale, achieving material properties that are difficult to obtain with traditional synthesis techniques. In nanomaterial science, semiconductor magic-size clusters (MSCs), with their atomic-level precision and unique quantum confinement effects, serve as a bridge between molecules and nanocrystals. Despite this, research on ion exchange in MSCs is still in its infancy. This review introduces the principles of ion exchange and reactions in colloidal nanocrystals and MSCs, analyzing the importance and challenges of ion exchange in studying MSCs. This paper begins with a focus on the current research progress of cation and anion exchange in II-VI and III-V semiconductor MSCs. Then, the common methods for characterizing MSCs during the ion exchange process are discussed. Finally, the article envisions future research directions based on MSCs' ion exchange. Research on MSCs' ion exchange not only aids in designing MSCs with complex functionalities, but also plays an essential role in elucidating the ion exchange mechanisms in nanocrystals, providing new insights for the innovative design and synthesis of nanomaterials.

Advancing cerebral small vessel disease diagnosis: Integrating quantitative susceptibility mapping with MRI-based radiomics.

Cerebral small vessel disease (CSVD) is a neurodegenerative disease with hidden symptoms and difficult to diagnose. The diagnosis mainly depends on clinical symptoms and neuroimaging. Therefore, we explored the potential of combining clinical detection with MRI-based radiomics features for the diagnosis of CSVD in a large cohort. A total of 118 CSVD patients and 127 healthy controls underwent quantitative susceptibility mapping and 3D-T1 scans, and all completed multiple cognitive tests. Lasso regression was used to select features, and the radiomics model was constructed based on the regression coefficients of these features. Clinical cognitive and motor tests were added to the model to construct a hybrid model. All models were cross-validated to analyze the generalization ability of the models. The AUCs of the radiomics and hybrid models in the internal test set were 0.80 and 0.87, respectively. In the validation set, the AUCs were 0.77 and 0.79, respectively. The hybrid model demonstrated higher decision efficiency. The Trail Making Test, which enhances the diagnostic performance of the model, is associated with multiple brain regions, particularly the right cortical nuclei and the right fimbria. The hybrid model based on radiomics features and cognitive tests can achieve quantitative diagnosis of CSVD and improve the diagnostic efficiency. Furthermore, the reduced processing capacity due to atrophy of the right cortical nucleus and right fimbria suggests the importance of these regions in improving the diagnostic accuracy of the model.

N6-methyladenine RNA methylation epigenetic modification and diabetic microvascular complications.

N6-methyladensine (m6A) has been identified as the best-characterized and the most abundant mRNA modification in eukaryotes. It can be dynamically regulated, removed, and recognized by its specific cellular components (respectively called "writers," "erasers," "readers") and have become a hot research field in a variety of biological processes and diseases. Currently, the underlying molecular mechanisms of m6A epigenetic modification in diabetes mellitus (DM) and diabetic microvascular complications have not been extensively clarified. In this review, we focus on the effects and possible mechanisms of m6A as possible potential biomarkers and therapeutic targets in the treatment of DM and diabetic microvascular complications.

IPNet: An Interpretable Network with Progressive Loss for Whole-stage Colorectal Disease Diagnosis.

Colorectal cancer plays a dominant role in cancer-related deaths, primarily due to the absence of obvious early-stage symptoms. Whole-stage colorectal disease diagnosis is crucial for assessing lesion evolution and determining treatment plans. However, locality difference and disease progression lead to intra-class disparities and inter-class similarities for colorectal lesion representation. In addition, interpretable algorithms explaining the lesion progression are still lacking, making the prediction process a "black box". In this paper, we propose IPNet, a dual-branch interpretable network with progressive loss for whole-stage colorectal disease diagnosis. The dual-branch architecture captures unbiased features representing diverse localities to suppress intra-class variation. The progressive loss function considers inter-class relationship, using prior knowledge of disease evolution to guide classification. Furthermore, a novel Grain-CAM is designed to interpret IPNet by visualizing pixel-wise attention maps from shallow to deep layers, providing regions semantically related to IPNet's progressive classification. We conducted whole-stage diagnosis on two image modalities, i.e., colorectal lesion classification on 129,893 endoscopic optical images and rectal tumor T-staging on 11,072 endoscopic ultrasound images. IPNet is shown to surpass other state-of-the-art algorithms, accordingly achieving an accuracy of 93.15% and 89.62%. Especially, it establishes effective decision boundaries for challenges like polyp vs. adenoma and T2 vs. T3. The results demonstrate an explainable attempt for colorectal lesion classification at a whole-stage level, and rectal tumor T-staging by endoscopic ultrasound is also unprecedentedly explored. IPNet is expected to be further applied, assisting physicians in whole-stage disease diagnosis and enhancing diagnostic interpretability.

Effects of soy protein isolate interaction with brown rice starch on the multiscale structure of brown rice bread.

BACKGROUND: Gluten-free bread (GFB) has technical bottlenecks such as hard texture, rough taste and low nutrition in practical production. In order to solve these problems, this study used germinated brown rice starch as the main raw material, and investigated the effects of soybean isolate protein (SPI) on the multiscale structure of germinated brown rice starch and bread quality. RESULTS: A gluten-free rice bread process simulation system was established, and the interaction between SPI and starch in the simulation system was characterized. The result shows that the interaction forces between SPI and germinated brown rice starch were mainly represented by hydrogen bonds, and with the addition of SPI, the crystallinity of starch showed a downward trend. At the same time, when the amount of SPI was 3%, the appearance quality was the best and the specific volume of bread was 1.08 mL g-1. When the amount of SPI was 6%, the texture quality was the best. Compared with the bread without SPI, the hardness of the bread with 6% SPI was reduced by 0.13 times, the springiness was increased by 0.03 times, the color was the most vibrant, the L* value being 1.02 times the original, and the baking loss was reduced to 0.98 times the original. CONCLUSIONS: The interaction force between SPI and germinated brown rice starch and its effect on bread quality were clarified, and these results inform choices about providing a theoretical basis for the subsequent development of higher-quality GFB. © 2024 Society of Chemical Industry.

Effect of 5:2 intermittent fasting diet versus daily calorie restriction eating on metabolic-associated fatty liver disease-a randomized controlled trial.

Objective: Both 5:2 IF diet (intermittent fasting) and daily caloric restriction eating had been suggested for management of MAFLD (Metabolic-Associated Fatty Liver Disease), this study aimed to evaluate the effects of 5:2 IF diet on body weight and metabolic parameters in adults with MAFLD, in comparison to daily caloric restriction eating. Methods: This single-center, double-blind, prospective, randomized controlled trial included 60 patients with MAFLD, who were administered either a 5:2 IF diet limited calories consumed for 2 days each week with no restrictions on the remaining 5 (Group 5:2 IF diet) or a daily calorie restriction eating (Group daily calorie restriction). Fibrotouch-B instrument assessment, ultrasound assessment of hepatic steatosis, anthropometric indices and body composition analysis, blood sample measurements were conducted during two distinct visits: initially on the day of study commencement (T1), and subsequently at the conclusion of the 12-week intervention period (T2). Results: In comparison to daily calorie restriction eating, the 5:2 IF diet significantly decreased the proportion of hepatic steatosis ≥moderate (29.6% vs. 59.3%, p = 0.028) and the degree of hepatic fibrosis F ≥ 2 (3.7% vs. 25.9%, p = 0.05), and fewer percentage of patients were diagnosed with fatty liver via upper abdominal ultrasound in the 5:2 intermittent fasting diet group (33.3% vs. 63.0%, p = 0.029). Additionally, the CAP (controlled attenuation parameter) and LSM (liver stiffness measurements) value were significantly lower in the 5:2 IF diet group (p < 0.05). No statistically significant differences were observed between the two groups in terms of weight, BMI (body mass index), WC (waist circumference), HC (hip circumference), and WHR (waist to hip ratio). Similarly, there were no significant differences in lipid profile, glycemic indices and adverse events (p > 0.05). Conclusion: In summary, although both 5:2 IF diet and daily caloric restriction eating achieved similar effect on body weight, liver enzymes, lipid profile and glycemic indices after 12 weeks treatment, 5:2 IF diet demonstrates better improvement in fibrosis and steatosis scores independently from weight regulation. Consequently, it is anticipated to emerge as a viable dietary modality for lifestyle intervention among patients diagnosed with MAFLD. Clinical trial registration: https://www.crd.york.ac.uk/PROSPERO, identifier ChiCTR2400080292.

TOB1 inhibits the gastric cancer progression by focal adhesion pathway and ERK pathway based on transcriptional and metabolic sequencing.

Gastric cancer is one of the most malignant digestive tract tumors worldwide and its progression is associated with gene expression and metabolic alteration. We revealed that the gastric cancer patients with lower expression level of TOB1 exhibited poorer overall survivals according to the data in Kaplan-Meier Plotter. The unphosphorylated TOB1 protein which is effective expressed lower in gastric cancer cells. The gastric cancer cells with TOB1 gene depletion performed higher abilities of proliferation, migration and invasion and lower ability of apoptosis in vitro. The TOB1 gene depletion also promoted the tumorigenesis of gastric cancer cells in vivo. The gastric cancer cells with TOB1 gene overexpression had the converse behaviors. The transcriptional and metabolic sequencing was performed. The analyzation results showed that genes correlate-expressed with TOB1 gene were enriched in the pathways related to ERK pathway, including focal adhesion pathway, which was verified using real-time quantitative PCR. After inhibiting ERK pathway, the proliferation, colony formation and migration abilities were reduced in gastric cancer cells with low phosphorylated TOB1 protein expression level. Moreover, Pearson correlation analysis was adopted to further analyze the correlation of enriched metabolic products and differentially expressed genes. The expression of Choline, UDP-N-acetylglucosamine, Adenosine and GMP were related to the function of TOB1. This study demonstrates the genes and metabolites related to focal adhesion pathway and ERK pathway are the potential diagnosis and therapeutic targets to gastric cancer with TOB1 depletion.

Prognostic and immunological roles of RSPO1 in pan-cancer and its correlation with LUAD proliferation and metastasis.

Aberrant RSPO1 expression is implicated in tumor progression across various cancers and correlates with anti-cancer immune cell characteristics. However, the specific role of R-spondin 1 (RSPO1) in lung adenocarcinoma (LUAD) remains unclear. In this study, we utilized data from The Cancer Genome Atlas (TCGA) to assess RSPO1 expression across 33 tumor types. Kaplan-Meier (K-M) analysis revealed the prognostic significance of RSPO1 in various cancers. Using statistical software R, we examined RSPO1's associations with immune cell infiltration, methylation, mutation, and competing endogenous RNA (ceRNA) networks. Exploration via the Tumor Immune Single Cell Hub (TISCH) database uncovered RSPO1's link to the tumor microenvironment (TME) and identified potential small molecule drug targets. We further investigated RSPO1's impact on LUAD cell proliferation, metastasis, and the Wnt pathway in vitro. Our findings highlight RSPO1's role in cancer progression and suggest its potential as both a prognostic marker and therapeutic target in LUAD, implicating the modulation of the Wnt pathway.

High-Temperature Excitonic Condensation in 2D Lattice.

Exploration of high-temperature bosonic condensation is of significant importance for the fundamental many-body physics and applications in nanodevices, which, however, remains a huge challenge. Here, in combination of many-body perturbation theory and first-principles calculations, a new-type spatially indirect exciton can be optically generated in two-dimensional (2D) Bi2S2Te because of its unique structure feature. In particular, the spin-singlet spatially indirect excitons in Bi2S2Te monolayer are dipole/parity allowed and reveal befitting characteristics for excitonic condensation, such as small effective mass and satisfied dilute limitation. Based on the layered Bi2S2Te, the possibility of the high-temperature excitonic Bose-Einstein condensation (BEC) and superfluid state in two dimensions, which goes beyond the current paradigms in both experiment and theory, are proved. It should be highlighted that record-high phase transition temperatures of 289.7 and 72.4 K can be theoretically predicted for the excitonic BEC and superfluidity in the atomic thin Bi2S2Te, respectively. It therefore can be confirmed that Bi2S2Te featuring bound bosonic states is a fascinating 2D platform for exploring the high-temperature excitonic condensation and applications in such as quantum computing and dissipationless nanodevices.

Aberrant brain structural-functional connectivity coupling associated with cognitive dysfunction in different cerebral small vessel disease burdens.

AIMS: Emerging evidence suggests that cerebral small vessel disease (CSVD) pathology changes brain structural connectivity (SC) and functional connectivity (FC) networks. Although network-level SC and FC are closely coupled in the healthy population, how SC-FC coupling correlates with neurocognitive outcomes in patients with different CSVD burdens remains largely unknown. METHODS: Using multimodal MRI, we reconstructed whole-brain SC and FC networks for 54 patients with severe CSVD burden (CSVD-s), 106 patients with mild CSVD burden (CSVD-m), and 79 healthy controls. We then investigated the aberrant SC-FC coupling and functional network topology in CSVD and their correlations with cognitive dysfunction. RESULTS: Compared with controls, the CSVD-m patients showed no significant change in any SC-FC coupling, but the CSVD-s patients exhibited significantly decreased whole-brain (p = 0.014), auditory/motor (p = 0.033), and limbic modular (p = 0.011) SC-FC coupling. For functional network topology, despite no change in global efficiency, CSVD-s patients exhibited significantly reduced nodal efficiency of the bilateral amygdala (p = 0.024 and 0.035) and heschl gyrus (p = 0.001 and 0.005). Notably, for the CSVD-s patients, whole-brain SC-FC coupling showed a significantly positive correlation with MoCA (r = 0.327, p = 0.020) and SDMT (r = 0.373, p = 0.008) scores, limbic/subcortical modular SC-FC coupling showed a negative correlation (r = -0.316, p = 0.025) with SCWT score, and global/local efficiency (r = 0.367, p = 0.009 and r = 0.353, p = 0.012) showed a positive correlation with AVLT score. For the CSVD-m group, whole-brain and auditory/motor modular SC-FC couplings showed significantly positive correlations with SCWT (r = 0.217, p = 0.028 and r = 0.219, p = 0.027) and TMT (r = 0.324, p = 0.001 and r = 0.245, p = 0.013) scores, and global/local efficiency showed positive correlations with AVLT (r = 0.230, p = 0.020 and r = 0.248, p = 0.012) and SDMT (r = 0.263, p = 0.008 and r = 0.263, p = 0.007) scores. CONCLUSION: Our findings demonstrated that decreased whole-brain and module-dependent SC-FC coupling associated with reduced functional efficiency might underlie more severe burden and worse cognitive decline in CSVD. SC-FC coupling might serve as a more sensitive neuroimaging biomarker of CSVD burden and provided new insights into the pathophysiologic mechanisms of clinical development of CSVD.

Assessment of male creatinine levels and fecundity in couples planning pregnancy: a national cohort study in China.

STUDY QUESTION: Is there an association between male creatinine levels and time to pregnancy (TTP) in couples planning pregnancy? SUMMARY ANSWER: Low and high male creatinine concentrations were associated with reduced couple fecundity. WHAT IS KNOWN ALREADY: Abundant evidence suggests male creatinine dysfunction is associated with infertility in males with kidney diseases. However, the association of preconception creatinine levels with reduced fecundity among general reproductive-aged couples lacks evidence from an in-depth population study. STUDY DESIGN, SIZE, DURATION: Based on the population-based cohort study from the National Free Preconception Check-up Projects, 4 023 204 couples were recruited and met the inclusion criteria from 1 January 2015 to 31 December 2017. They were planning pregnancy and were followed up every 3 months until achieving pregnancy as detected by gynaecological ultrasonography or were followed up for 1 year for the analysis of TTP. PARTICIPANTS/MATERIALS, SETTING, METHODS: Cox regression models were used to estimate hazard ratios (HRs) and 95% CI for creatinine deciles. Restricted cubic spline regression was adopted for the dose-response relationship of creatinine with HRs. R statistical software was used for data analysis. MAIN RESULTS AND THE ROLE OF CHANCE: Of the included participants, 2 756 538 (68.52%) couples successfully conceived. The median male serum creatinine was 81.50 µmol/l. Compared with the reference group (78.00-81.49 µmol/l) including the median creatinine, fecundity in the first (≤64.89 µmol/l), second (64.90-69.99 µmol/l), third (70.00-73.99 µmol/l), and tenth (≥101.00 µmol/l) deciles decreased by 8%, 5%, 2%, and 1%, respectively (Decile 1 Adjusted HR 0.92, 95% CI 0.91-0.92; Decile 2 Adjusted HR 0.95, 95% CI 0.95-0.96; Decile 3 Adjusted HR 0.98, 95% CI 0.97-0.99; Decile 10 Adjusted HR 0.99, 95% CI 0.98-0.99). An inverse-U-shaped association was consistently presented among males such that non-inferiority for fecundity was shown when creatinine was in the 81.66-104.90 µmol/l range (P for non-linearity < 0.001). For males over 40 years old, the risk of fecundity impairment was more obvious and the recommended range of creatinine levels for TTP was reduced and more narrow, compared with that for younger males. LIMITATIONS, REASONS FOR CAUTION: Not including the time couples spend preparing for pregnancy before enrolment would lead to an overestimation of fecundity; additionally some couples place pregnancy plans on hold due to special emergencies, which would not have been recognized. Due to the lack of information regarding semen quality, psychological factors, sexual intercourse frequencies, and hazardous environmental factors, we could not adjust for these factors. Some variates were self-reported and dichotomized, which were prone to bias. Direct variables reflecting muscle mass and impaired kidney function were lacking. Thus, extrapolation should be done with caution. WIDER IMPLICATIONS OF THE FINDINGS: Male creatinine is associated with couples' fecundity and the relationship varied by age. This study provides a better understanding of the potential implications and significance of different creatinine levels and their association with the clinical significance regarding couples' fecundity. STUDY FUNDING/COMPETING INTEREST(S): This research has received funding from the National Natural Science Foundation of China (Grant No. 81872634), the Basic Research Funds of Central Public Welfare Research Institutes of China (Grant No. 2023GJZ03), the National Key Research and Development Program of China (Grant No. 2016YFC1000307), and the Project of National Research Institute for Family Planning (Grant No. 2018NRIFPJ03), People's Republic of China. The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER: N/A.

Application of cognitive load theory in reading English academic articles on medical education among Chinese undergraduate medical students.

Reading English academic articles is the cornerstone of innovative medical education and scientific research. However, limited by both language and professional knowledge, many nonnative English-speaking undergraduate medical students have a fear of reading English academic articles. The purpose of this study was to explore whether cognitive load theory can be a useful guiding strategy to promote English medical education article reading among Chinese undergraduates, while also evaluating students' attitudes toward the reading activities and cognitive load entailed in the last article they read. In the reading activities, students needed to read 19 English academic articles that are closely related to their courses. A questionnaire was administered after the students finished reading the 19th article to determine their attitudes toward reading English medical education articles and the cognitive load involved in reading the 19th article. The results showed that students' overall perceptions of reading English medical education articles were positive. Most students felt that their ability to read English academic articles and related skills had improved. The mean scores for students' intrinsic and germane cognitive loads in reading the 19th article were 6.44 ± 1.81 and 6.92 ± 2.05, respectively. The mean score for the extraneous cognitive load was 2.31 ± 2.63. In conclusion, the cognitive load theory can serve as the basis for an effective strategy to guide English medical education article reading activities among undergraduates in China. Meanwhile, students' attitudes toward the reading activities were favorable, and they read the latest article within an acceptable cognitive load.NEW & NOTEWORTHY Many nonnative English-speaking undergraduates have a fear of reading English academic articles. This study was performed to explore whether cognitive load theory can be a useful guiding strategy to promote English article reading among Chinese medical undergraduates. The results showed that cognitive load theory can serve as the basis for an effective strategy to guide English medical education article reading activities among undergraduates in China, and students' attitudes toward the reading activities were favorable.