The mediating role of telomere length in multi-pollutant exposure associated with metabolic syndrome in adults.

Metabolic syndrome is a chronic and complex disease characterized by environmental and genetic factors. However, the underlying mechanisms remain unclear. This study assessed the relationship between exposure to a mixture of environmental chemicals and metabolic syndrome (MetS) and further examined whether telomere length (TL) moderated these relationships. A total of 1265 adults aged > 20 years participated in the study. Data on multiple pollutants (polycyclic aromatic hydrocarbons, phthalates, and metals), MetS, leukocyte telomere length (LTL), and confounders were provided in the 2001-2002 National Health and Nutrition Examination Survey. The correlations between multi-pollutant exposure, TL, and MetS in the males and females were separately assessed using principal component analysis (PCA), logistic and extended linear regression models, Bayesian kernel machine regression (BKMR), and mediation analysis. Four factors were generated in PCA that accounted for 76.2% and 77.5% of the total environmental pollutants in males and females, respectively. The highest quantiles of PC2 and PC4 were associated with the risk of TL shortening (P < 0.05). We observed that the relationship between PC2, PC4, and MetS risk was significant in the participants with median TL levels (P for trend = 0.04 for PC2, and P for trend = 0.01 for PC4). Furthermore, mediation analysis revealed that TL could explain 26.1% and 17.1% of the effects of PC2 and PC4 associated with MetS in males, respectively. The results of BKMR model revealed that these associations were mainly driven by 1-PYE (cPIP = 0.65) and Cd (cPIP = 0.29) in PC2. Meanwhile, TL could explain 17.7% of the mediation effects of PC2 associated with MetS in the females. However, the relationships between pollutants and MetS were sparse and inconsistent in the females. Our findings suggest that the effects of the risk of MetS associated with mixed exposure to multiple pollutants are mediated by TL, and this mediating effect in the males is more pronounced than that in the females.

Environmental Exposure to Emerging Alternatives of Per- and Polyfluoroalkyl Substances and Polycystic Ovarian Syndrome in Women Diagnosed with Infertility: A Mixture Analysis.

BACKGROUND: Per- and polyfluoroalkyl substances (PFAS) have been previously linked to polycystic ovarian syndrome (PCOS), but only a few legacy PFAS were examined. OBJECTIVES: This study aimed to explore this association with a variety of PFAS, including legacy, branched-chain isomers, and emerging alternatives, as well as a PFAS mixture. METHODS: From 2014 to 2016, we conducted a multicenter, hospital-based case-control study on environmental endocrine disruptors and infertility in China. Three hundred sixty-six women with PCOS-related infertility and 577 control participants without PCOS were included in the current analysis. Twenty-three PFAS, including 3 emerging PFAS alternatives, 6 linear and branched PFAS isomers, 6 short-chain PFAS, and 8 legacy PFAS, were quantified in the plasma. Logistic regression and two multipollutant models [quantile-based g-computation (QGC) and Bayesian kernel machine regression (BKMR) methods] were used to assess the association of individual PFAS and PFAS mixture with PCOS, as well as the potential interactions among the congeners. RESULTS: After adjusting for potential confounders, Each 1-standard deviation higher difference in ln-transformed 6:2 chlorinated perfluoroalkyl ether sulfonic acid (6:2 Cl-PFESA) and hexafluoropropylene oxide dimer acid (HFPO-DA) level was significantly associated with a 29% (95% CI: 1.11, 1.52) and 39% (95% CI:1.16, 1.68) higher odds of PCOS, respectively. Meanwhile, branched isomers of perfluorooctane sulfonate (PFOS) and perfluorohexane sulfonate (PFHxS) (i.e., br-PFHxS, n-PFOS, 1m-PFOS, Σ3,4,5m-PFOS), short-chain PFAS (i.e., PFPeS and PFHxA) and other legacy PFAS [i.e., total concentrations of PFOS (T-PFOS), and perfluorododecanoic acid (PFDoA)] were significantly associated with increased odds of PCOS. The PFAS mixture was positively related to PCOS in the BKMR model. A similar trend was observed in QGC model, a ln-unit increase in the PFAS mixture was associated with a 20% increased risk of PCOS [adjusted odds ratio (aOR)=1.20 (95% CI: 1.06, 1.37)]. After controlling for other PFAS homologs, 6:2 Cl-PFESA, HFPO-DA, Σ3,4,5m-PFOS, and PFDoA were the major contributors based on the QGC and BKMR models. The associations were more pronounced in overweight/obese women. CONCLUSIONS: In this group of women, environmental exposure to a PFAS mixture was associated with an elevated odds of PCOS, with 6:2 Cl-PFESA, HFPO-DA, Σ3,4,5m-PFOS, and PFDoA being the major contributors, especially in overweight/obese women. https://doi.org/10.1289/EHP11814.

Exposure to bisphenol A and its analogs and polycystic ovarian syndrome in women of childbearing age: A multicenter case-control study.

BACKGROUND/OBJECTIVES: In recent years, the reproductive toxicity of new bisphenol analogs has garnered much interest, but it remains to be determined whether bisphenol analogs affect polycystic ovarian syndrome (PCOS). METHODS: This study utilized data from a multicenter hospital-based case-control study conducted in 2014-2016 to examine the association between endocrine-disrupting chemicals and infertility in China. 321 PCOS cases and 412 controls were included in the current analysis. We quantified seven bisphenol analogs in urine samples, including bisphenol A (BPA), bisphenol AP (BPAP), bisphenol AF (BPAF), bisphenol B (BPB), bisphenol S (BPS), bisphenol P (BPP), and bisphenol Z (BPZ). Spearman correlation and generalized linear regression were used in assessing the relationship between bisphenol analogs and hormonal parameters. To examine the association of bisphenol analogs with odds of PCOS, multiple logistic regression, and two multi-pollutant models [quantile-based g-computation (QGC) and extreme gradient boosting (XGBoost) methods] were used. RESULTS: After covariates adjustment, BPA, BPS, and BPAF were positively correlated with testosterone (T) in the control group (P < 0.05). Dose-response relationships were discovered between BPA, BPS, BPZ, and BPAF quartiles and PCOS. Mixed exposure to seven bisphenol analogs was found to be positively associated with the odds of PCOS (adjusted odds ratio = 1.26; 1.12-1.45), which was primarily driven by BPS (weight = 0.51), BPZ (weight = 0.26), and BPAF (weight = 0.23). Women who were overweight or obese tended to have a stronger association between bisphenol analogs and PCOS than normal-weight women. CONCLUSIONS: Environmental exposure to bisphenol analogs was associated with increased odds of PCOS in this case-control study. This association was stronger among obese and overweight women.

Temporal trends in risk of bisphenol A, benzophenone-3 and triclosan exposure among U.S. children and adolescents aged 6-19 years: Findings from the National Health and Nutrition Examination Survey 2005-2016.

BACKGROUND: Phenolic compounds with potential adverse health effects are gradually being replaced. Little is known about the potential health risks of BPA, BP3, and TCS exposure in children and adolescents aged 6-19 years in the United States. OBJECTIVES: To determine trends and rates of change in hazard indices (HI) for three phenolics in U.S. children and adolescents for BPA, BP3, TCS, and to assess changes in gender, race/ethnicity, age, and potential health risks. METHODS: Metabolic biomonitoring data from field-collected urine samples from the National Health and Nutrition Examination Survey (NHANES) were utilized. Daily intake of three phenols (bisphenol A, benzophenone-3, and triclosan) between 2005 and 2016 in children and adolescents were obtained. Cumulative risk indicators, including hazard quotient (HQ), hazard index (HI), and maximum cumulative ratio (MCR), were used for the health risk assessment of the three phenols. RESULTS: During this period, the change in LSGM HI was -2.9% per cycle [95% Cl: (-3.7%, -2.2%)], and the percentage of participants with HI > 0.1 decreased from 15.6% to 10.5%. Children (6-11 years) had higher mean HI values than adolescents (12-19 years), while female had higher LSGM HI values than male. MCR values were generally low and negatively correlated with HI. However, the average value of MCR increased from 1.722 to 2.107 during this period. CONCLUSION: Exposure to phenolics among U.S. children and adolescents has changed in recent decades. However, gaps in data limit the interpretation of trends but legislative activity and advocacy campaigns by nongovernmental organizations may play a role in changing trends. Moreover, there are growing concerns about the potential health risks associated with exposure to multiple phenols in children and adolescents.

Association between co-exposure to phenols and phthalates mixture and infertility risk in women.

BACKGROUND: Exposure to phenols and phthalates has been separately linked to increased risks of infertility in women of reproductive age. However, the combined effect of phenols and phthalates exposure on infertility has not been explored. METHODS: Data from the National Health and Nutrition Examination Surveys (NHANES) were used. A total of 857 women of reproductive age (18-45 years) with available information on urinary phenol and phthalate metabolites, reproductive questionnaires, and covariates were included in the present study. The definition of infertility was based on self-reports. Multivariable logistic regression, principal component analysis (PCA), and Bayesian kernel machine regression (BKMR) with stratified variable selection were applied to determine what associations were found between combined exposure to these mixtures and risk of infertility among women of reproductive age. RESULTS: After adjusting for potential confounders, bisphenol A (BPA), mono(3-carboxypropyl) phthalate (MCPP) and four di(2-ethylhexyl) phthalate (DEHP) metabolites [mono(2-ethylhexyl) phthalate (MEHP), mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono(2-ethyl-5-oxohexyl) phthalate (MEOHP) and mono(2-ethyl-5-carboxypentyl) phthalate (MECPP)] were positively associated with infertility. PCA revealed that the DEHP-BPA factor's PC score was significantly positively related to the likelihood of infertility [adjusted odds ratio (aOR) = 1.45; 1.08, 1.82]. The DEHP-BPA component consistently had the highest group posterior inclusion probability (PIP) in BKMR models. The BKMR model also found that MEOHP, MEHHP, and BPA were positively associated with infertility risk when the remaining combination concentrations were held at their median values. In addition, we observed that the probability of infertility increased dramatically as the quantiles of total mixture concentration increased. CONCLUSION: Our findings indicate that a combination of phenol and phthalate metabolites is linked to infertility among reproductive-age women. BPA and DEHP, in particular, are significantly related to the risk of infertility.

Associations between organophosphate esters concentrations and markers of liver function in US adolescents aged 12-19 years: A mixture analysis.

Liver disease has become a growing health burden, and little is known about the impairment of liver function caused by exposure to organophosphate esters (OPEs) in adolescents aged 12-19 years in the United States. To investigate the relationship between urinary metabolites of OPEs including diphenyl phosphate (DPHP), bis(1,3-dichloro-2-propyl) phosphate (BDCPP), bis(1-chloroethyl) phosphate (BCPP), bis(2-chloroethyl) phosphate (BCEP), and dibutyl phosphate (DBUP) and liver function in US adolescents aged 12-19 years. Liver function tests (LFTs) include aspartate aminotransferase (AST), albumin (ALB), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), total bilirubin (TBIL), total protein (TP), and AST/ALT. Meanwhile, potential confounding and interaction effects were assessed. The study sample included 592 adolescents aged 12-19 from two consecutive NHANES cycles (2011-2012, 2013-2014). A composite statistical strategy combining traditional linear regression with advanced multi-pollutant models quantile based g-computation (QGC) and eXtreme Gradient Boosting (XGBoost) regression was used to analyze the joint effects of multiple OPEs on liver function indicators, and to describe the interaction between different OPEs in detail. 592 adolescent participants were 15 (14-17) years old, with similar numbers of males and females (304 vs. 288). The analysis results showed that (1) in the linear regression model, individual DPHP, BCEP exposure and ALP changes, BCEP and AST/ALT changes were positively associated. DPHP, BDCPP were negatively associated with TP changes. (2) The combined effects of various OPEs on ALB, ALT, ALP, GGT, TBIL, TP, and AST/ALT were statistically significant. (3) There is no potential interaction between different OPEs. Several OPEs and their combinations are closely related to the 8 LFT indicators. In addition, data suggest that exposure to OPEs in adolescents may be associated with liver damage. Due to limited evidence in the literature and potential limitations of the current study, our findings require more studies to confirm.

Association of Dietary Inflammatory Index (DII) and depression in the elderly over 55 years in Northern China: analysis of data from a multicentre, cohort study.

OBJECTIVES: Our study aimed to assess the association between the Dietary Inflammatory Index (DII) and depression in the elderly over 55 years in Northern China. METHODS: We analysed the data of 2022 Chinese adults aged 55 and over from a community-based neurological disease cohort study from 2018 to 2019. A validated semiquantitative food frequency questionnaire was used to assess eating habits at the time of inclusion. Multiple logistic regression was used for analysis, and social demographics, lifestyle and health-related factors were adjusted. RESULTS: Among the included population, the prevalence of depression was 23.39%. Mean (SD) and range of the DII in the included population were 1.70 (1.42) and -5.20 to +5.68. The risk of depression was significantly higher in participants in the most pro-inflammatory group (quartile 4) than in the participants in the most anti-inflammatory group (quartile 1) (OR 1.53; 1.37 to 1.82; p-trend=0.01). The subgroup analysis of body mass index (BMI) showed that there is a significant association between DII and the risk of depression in overweight and obese people (p＜0.05). The restricted cubic spline results show that the OR value of depression possesses an upward trend with the increase of the DII score. CONCLUSIONS: Aged patients with depression present a higher potential for dietary inflammation. Pro-inflammatory diets might increase the risk of depressive symptoms. Further research in different populations is crucial to confirm the association between DII and depression.

KCC2 receptor upregulation potentiates antinociceptive effect of GABAAR agonist on remifentanil-induced hyperalgesia.

GABAergic system disinhibition played an important role in the pathogenesis of remifentanil-induced hyperalgesia (RIH). K+-Cl--cotransporter-2 (KCC2) has the potential to enhance the strength of GABAergic signaling function. However, few reports have focused on the additive analgesic effect of KCC2 enhancer and GABAA receptor agonist on the spinal dorsal horn. Therefore, we evaluated the role of GABA type A receptor (GABAAR) agonist (muscimol), KCC2 enhancer (CLP257) in remifentanil-induced hyperalgesia, as well as GABA and KCC2 receptors responses in the dorsal spinal horn. Remifentanil started to reduce paw withdrawal mechanical thresholds at postoperative 4 h and lasted to 72 h. The RIH associated decreases in spinal GABA release was transient. The amount of spinal GABA transmitter by microdialysis was observed to be decreased at the beginning and reached bottom at 150 min, then returned to the baseline level at 330 min. The synthesis and transportation of GABA transmitter were inhibited, characterized as spinal GAD67 and GAT1 downregulation after the establishment of RIH model. The effect of RIH on GABA receptor downregulation was linked to the reduced expression of spinal KCC2 receptor. This decrease in KCC2 expression has coincided with an early loss of GABA inhibition. KCC2 enhancer, which is reported to lead to a reduction in intracellular Cl-, can enhance GABA-mediated inhibitory function. Both muscimol and CLP257 could dose-dependently inhibit mechanical hypersensitivity caused by remifentanil-induced downregulation of GABAAα2R and KCC2, respectively. Compared with muscimol acting alone, the joint action of CLP257 and muscimol showed a higher pain threshold and less c-fos expression via upregulation of KCC2 and GABAAα2R. Taken together, these findings suggested that the RIH was initiated by decreased GABA release. Downregulation of GABAAα2R and KCC2 receptor contributed to spinally mediated hyperalgesia in RIH. KCC2 enhancer was proved to potentiate antinociceptive effect of GABAAR agonist in RIH.

The Joint Association Between Multiple Dietary Patterns and Depressive Symptoms in Adults Aged 55 and Over in Northern China.

Background: Depression is a common psychiatric disorder in older adults that affects their health-related quality of life. Two percent of adults over the age of 55 suffer from major depression, and the prevalence of depression increases with age. Even in the absence of major depressive disorder, 10-15% of older adults have clinically significant depressive symptoms. Objectives: Epidemiological studies on the association between different gender eating patterns and depression show inconsistent associations. Our study examined whether different gender eating patterns are related to depression. We consider eating patterns individually and as a joint exposure to predefined eating patterns. Methods: Principal component analysis (PCA) was performed on the data of the 24-h diet recall dietary intake, and the dietary pattern was determined. Linear regression models are used to explore the relationship between different diets and depression of men and women; weighted quantile sum (WQS) regression, quantile g calculation (qgcomp) and Bayesian kernel machine regression (BKMR) are performed as Secondary analysis. Results: In the dietary patterns model, we found that the vegetable and fruit-based diet has a significant inhibitory effect in women, and the egg-milk-based diet has a significant inhibitory effect in men. We found that when all dietary factors are above the 55th percentile, there is a significant positive correlation between multiple dietary patterns and depression risk. We also determined a positive correlation between meat and obesity risk and a negative correlation between egg and milk and vegetables and fruits. Conclusions: In the study population, after controlling for other baseline indicators and predictors of dietary pattern exposure, a fruit and vegetable-based diet was associated with a slightly healthier and lower risk of depression, while a meat-based dietary pattern associated with a higher risk of depression, and this association effect varies between genders.

The Relationship Between Mild Cognitive Impairment and Anti-Inflammatory/Pro-Inflammatory Nutrients in the Elderly in Northern China: A Bayesian Kernel Machine Regression Approach.

OBJECTIVE: This study aims to explore the role of nutrients with pro-inflammatory or anti-inflammatory potential in the risk of mild cognitive impairment in the elderly. METHODS: We evaluated the intake of 22 nutrients in the baseline survey data of 612 elderly people in northern China. Meanwhile, the least absolute contraction and selection operator (LASSO) regression analysis was used to screen the nutrients with strong correlation with MCI. Bayesian kernel machine regression (BKMR) was devoted to explore the possible associations between various nutrients with different inflammatory potentials and the risk of mild cognitive impairment. RESULTS: A total of 253 people (41.3%) were diagnosed with mild cognition. Ten nutrients are significantly related to the risk of MCI and were screened by a lasso regression model, including 5 pro-inflammatory nutrients (inflammation effect score >0) and 5 anti-inflammatory nutrients (inflammation effect score <0). We incorporated the inflammatory effect scores of 10 nutrients into the BKMR model, and the results showed that the inflammatory effect of 10 nutrients continued to rise with the increase in inflammation scores, proposing that the overall effect is pro-inflammatory. The BKMR analysis results of the pro-inflammatory group and the anti-inflammatory group showed that multiple nutrients in the two groups had a significant combined effect on mild cognitive impairment. We found that by comparing the overall effect of inflammation and the effect of a single group, we found that the inflammation effect of the pro-inflammatory diet and the anti-inflammatory diet had a certain offsetting effect (P < 0.005). CONCLUSION: In the elderly population in northern China, pro-inflammatory diets are associated with an increased risk of mild cognitive impairment. However, these results need to be further evaluated and verified in more prospective studies.

Marital status and survival in laryngeal squamous cell carcinoma patients: a multinomial propensity scores matched study.

OBJECTIVE: To explore the correlation between the marital status and prognosis of patients with laryngeal squamous cell carcinoma (LSCC). STUDY DESIGN: MPSM was adopted to minimize the maximum standardized average difference of the covariates among the four groups with different marital status. SETTING: Multinomial propensity scores matching (MPSM) based on data from the surveillance, epidemiology, and end results (SEER) database. METHODS: The Kaplan-Meier method and log-rank test were used to compare the survival outcomes of these groups with different marital status. RESULTS: Totally, 16,981 LSCC patients (median [IQR] age 62 [55-69] years; 829 [76.41%] males) from 2004 to 2016 were included in this study. Among them, 9112 (53.66%) were married, 2708 (15.95%) divorced or separated, 1709 (10.06%) widowed, and 3452 (20.33%) single. After MPSM, the weights make the characteristics of four groups with different marital status sufficient balance. The Kaplan-Meier method and log-rank test showed widowed patients may lead to the highest mortality rate while married patients have a higher survival rate than the other three groups. Single and divorced or separated patients had no significant difference in the survival rate. In addition, multivariate analysis by controlling for confounding factors showed that in male, well-differentiated, and early stage patients, compared with married, unmarried was an independent risk factor for CSS (P < 0.05). CONCLUSION: Marital status showed a significant association with the survival status of LSCC patients. Importantly, the outcome of married patients was better, while widowed patients tended to have worse prognosis.

Association of dietary inflammatory index and metabolic syndrome in the elderly over 55 years in Northern China.

We assessed the association between the dietary inflammatory index (DII) and the development of metabolic syndrome in the elderly over 55 years in Northern China. The data of 1936 Chinese adults aged 55 years and over from a community-based neurological disease cohort study from 2018 to 2019 were analysed. Multiple logistic regression and restricted cubic splines regression were used for analysis, and social demographics, lifestyle and health-related factors were adjusted. In the fully adjusted model, the risk of metabolic syndrome increased by 1·28-fold in people with a pro-inflammatory diet. When we divide the metabolic syndrome by its components, high pro-inflammatory diet and hyperglycaemia, TAG, hypertension and abdominal obesity, we failed to observe a significant association between a high pro-inflammatory diet and HDL-cholesterol. However, these associations are moving in the expected direction. At the same time, the results of BMI subgroup analysis showed that with the increase of DII, obese people are at increased risk of metabolic syndrome, hyperglycaemia, high TAG, hypertension and abdominal obesity. Also in overweight people, the increase in DII is accompanied by an increased risk of hyperglycaemia and abdominal obesity. Higher inflammatory diet is related to metabolic syndrome, hypertension, hyperglycaemia, abdominal obesity and hypertriglyceridaemia. Further research is needed to confirm the role of inflammation and diet in the development of metabolic syndrome; however, it is desirable to reduce the dietary components associated with inflammation.

Associations between Dietary Inflammatory Index (DII) and bone health among postmenopausal women in the United States.

OBJECTIVE: The purpose of this study was to determine the relationship between the Dietary Inflammatory Index (DII® ) score and the bone health of menopausal women. METHODS: A total of 2461 participants were included in the analysis from the NHANES database 2009-2018 and 2005-2006. The association between the DII and Bone mineral density (BMD) and bone mineral content (BMC) was evaluated through a multiple linear regression model. RESULTS: The mean DII in this study was +0.89 (SD 0.18) and the scores ranged from -5.46 (most anti-inflammatory) to +4.58 (most pro-inflammatory). After adjusting for confounding factors, higher DII is associated with an increased risk of decreased total bone density (Model III, ß -0.012; 95% CI -0.023, -0.001). There is a similar correlation found in bone density content and other indicators of bone mineral density. At the same time, we used BMI as a stratified variable for subgroup analysis, we found that higher DII (continuous) was associated with a significantly higher risk of decreased total bone density in overweight/obese postmenopausal women (ß -0.018; 95% CI -0.025, -0.006). CONCLUSION: A higher DII score is significantly associated with lower bone density and bone density in postmenopausal women, especially women who are overweight/obese.

Association of Dietary Inflammatory Index (DII) and Depressive Disorders.

A lot of evidence shows that inflammation is related to the development of depression. However, the heterogeneity of depression hinders efforts to understand, prevent and treat this disease. The purpose of this comprehensive review is to summarize the links between inflammation and the established core features of depression, which show more homogeneity than the syndrome itself: overreaction to negative information, changes in reward processing, and cognitive control decline, and somatic syndrome. For each core feature, we first briefly outline its relevance to depression and neurobiological basis, and then review the evidence to investigate the potential role of inflammation. We mainly focus on the discovery of the experimental paradigm of exogenous inflammation. We concluded that inflammation may play a role in overreaction to negative information, altered reward responses, and physical symptoms. There is less evidence to support the effect of inflammation on cognitive control by standard neuropsychological measures. Finally, we discussed the implications for future research and recommendations on how to test the role of inflammation in the pathogenesis of heterogeneous mental illness.

Role of BMI in the Relationship Between Dietary Inflammatory Index and Depression: An Intermediary Analysis.

Introduction: This study investigated this association and the role of BMI in the inflammatory process in a large population-based observational study. Methods: A total of 1,865 elderly people (≥55 years) were followed from the Community Cohort Study of Nervous System Diseases (CCSNSD) cohort study from 2018 to 2019 (Mean [SD] age, 66.31 [0.32] years; 716 [38.4%] males). The semi-quantitative FFQ and geriatric depression scale (GDS) were used to evaluate the diet and depressive symptoms of the elderly, respectively. The multivariable logistic regression model estimated the OR and 95% CI between Empirical Dietary Inflammatory Index (E-DII) and depression. The interaction of E-DII and BMI on depressive events was tested, and the mediation analysis of BMI was performed. Results: As measured by E-DII, the mean (SE) value of the inflammatory potential of the diet in our study was 1.56 (0.12). E-DII ranged from 5.23 to 5.58. In comparison with the first quartile, the elderly from the second quartile (OR: 1.15 [95% CI: 1.09, 1.28]) to the fourth quartile (OR: 1.31 [95% CI: 1.16, 1.42]) have a higher risk of depression before adjustment for BMI. An interaction was observed between E-DII and BMI in terms of the risk of depression (PInteraction < 0.001). The whole related part is mediated by BMI (31.06%). Conclusion: Our findings indicate that the higher pro-inflammatory potential of diet is associated with a higher risk of depression, and this association may be mediated by BMI. Further research is needed to verify our findings and clarify the latent mechanism.

Epidemiology of uterine rupture among pregnant women in China and development of a risk prediction model: analysis of data from a multicentre, cross-sectional study.

OBJECTIVES: To describe the epidemiology of uterine rupture in China from 2015 to 2016 and to build a prediction model for uterine rupture in women with a scarred uterus. SETTING: A multicentre cross-sectional survey conducted in 96 hospitals across China in 2015-2016. PARTICIPANTS: Our survey initially included 77 789 birth records from hospitals with 1000 or more deliveries per year. We excluded 2567 births less than 24 gestational weeks or unknown and 1042 births with unknown status of uterine rupture, leaving 74 180 births for the final analysis. PRIMARY AND SECONDARY OUTCOME MEASURES: Complete and incomplete uterine rupture and the risk factors, and a prediction model for uterine rupture in women with scarred uterus (assigned each birth a weight based on the sampling frame). RESULTS: The weighted incidence of uterine rupture was 0.18% (95% CI 0.05% to 0.23%) in our study population during 2015 and 2016. The weighted incidence of uterine rupture in women with scarred and intact uterus was 0.79% (95% CI 0.63% to 0.91%) and 0.05% (95% CI 0.02% to 0.13%), respectively. Younger or older maternal age, prepregnancy diabetes, overweight or obesity, complications during pregnancy (hypertensive disorders in pregnancy and gestational diabetes), low education, repeat caesarean section (≥2), multiple abortions (≥2), assisted reproductive technology, placenta previa, induce labour, fetal malpresentation, multiple pregnancy, anaemia, high parity and antepartum stillbirth were associated with an increased risk of uterine rupture. The prediction model including eight variables (OR >1.5) yielded an area under the curve (AUC) of 0.812 (95% CI 0.793 to 0.836) in predicting uterine rupture in women with scarred uterus with sensitivity and specificity of 77.2% and 69.8%, respectively. CONCLUSIONS: The incidence of uterine rupture was 0.18% in this population in 2015-2016. The predictive model based on eight easily available variables had a moderate predictive value in predicting uterine rupture in women with scarred uterus. Strategies based on predictions may be considered to further reduce the burden of uterine rupture in China.

Investigating Associations Between Depressive Symptoms and Anti-/Pro-Inflammatory Nutrients in an Elderly Population in Northern China: A Bayesian Kernel Machine Regression Approach.

BACKGROUD: The potential for dietary inflammation has been shown to be associated with a variety of chronic diseases. The relationship between the potential for dietary inflammation and depression in the elderly is unclear. OBJECTIVE: This study aimed to exam the relationship between different nutrients and the risk of depression symptoms in the elderly. METHODS: In total, 1865 elderly in northern China were investigated at baseline from 2018 to 2019 and followed up in 2020. We measured the baseline intake of 22 nutrients and used Least Absolute Shrinkage and Selection Operator(LASSO) regression analysis and Bayesian Kernel Machine Regression (BKMR) to explore the association between exposure to a variety of nutrients with different inflammatory potentials and the risk of depressive symptoms. RESULTS: A total of 447 individuals (24.0%) were diagnosed with depressive symptoms. Through the lasso regression model, it was found that 11 nutrients are significantly related to the risk of depressive symptoms, of which 6 nutrients are pro-inflammatory nutrients (inflammation effect score>0), and 5 are anti-inflammatory nutrients (inflammation effect score<0). We incorporated the inflammatory effect scores of 11 nutrients into the BKMR model at the same time, and found that the overall inflammatory effect of 11 nutrients increased with the increase of total inflammatory scores, suggesting that the overall effect was pro-inflammatory. BKMR subgroup analysis shows that whether in the pro-inflammatory nutrient group or the anti-inflammatory nutrient group, multiple nutrients have a significant combined effect on depressive symptoms. By comparing the overall and group effects, we found that the inflammatory effects of the pro-inflammatory diet and the anti-inflammatory diet in the study's diet are offset by each other (P<0.005). CONCLUSION: We determined the combined effect of multiple nutrients of different inflammatory potential classifications on depressive symptoms in the elderly.

Visible-light-promoted direct C3-trifluoromethylation and perfluoroalkylation of imidazopyridines.

An efficient method for direct trifluoromethylation and perfluoroalkylation at C3 of imidazopyridines through visible light-promoted C-H bond functionalization was developed. Under the irradiation of a blue LED, a series of C3-perfluoroalkyl-substituted imidazopyridines were synthesized from the corresponding imidazopyridines and perfluoroalkyl iodides in moderate to good yields at room temperature. It should be mentioned that this reaction proceeded in the absence of any transition-metal catalyst, oxidant and photocatalyst.

Development and external validation of a nomogram for predicting preterm birth at < 32 weeks in twin pregnancy.

The purpose of this study was to develop a dynamic model to predict the risk of spontaneous preterm birth at < 32 weeks in twin pregnancy. A retrospective clinical study of consecutively asymptomatic women with twin pregnancies from January 2017 to December 2019 in two tertiary medical centres was performed. Data from one centre were used to construct the model, and data from the other were used to evaluate the model. Data on maternal demographic characteristics, transvaginal cervical length and funnelling during 20-24 weeks were extracted. The prediction model was constructed with independent variables determined by multivariate logistic regression analyses. After applying specified exclusion criteria, an algorithm with maternal and biophysical factors was developed based on 88 twin pregnancies with a preterm birth < 32 weeks and 639 twin pregnancies with a delivery ≥ 32 weeks. It was then evaluated among 34 pregnancies with a preterm birth < 32 weeks and 252 pregnancies with a delivery ≥ 32 weeks in a second tertiary centre without specific training. The model reached a sensitivity of 80.00%, specificity of 88.17%, positive predictive value of 50.33% and negative predictive value of 96.71%; ROC characteristics proved that the model was superior to any single parameter with an AUC of 0.848 (all P < 0.005). We developed and validated a dynamic nomogram model to predict the individual probability of early preterm birth to better represent the complex aetiology of twin pregnancies and hopefully improve the prediction and indication of interventions.

Associations Between Dietary Inflammatory Index and Sex Hormones Among 6- to 19-Year-Old Children and Adolescents in NHANES 2015-2016.

Objectives: This study aimed to assess the relationship between dietary inflammatory index (DII) and sex steroids in children (6-11 years old) and adolescents (12-19 years old) in the U.S. National Health and Nutrition Examination Survey, 2015-2016. Methods: Participants between the ages of 6-19 have 24-hour dietary intake data, serum sex hormones [total testosterone (TT), estradiol (E2)], and sex hormone-binding globulin (SHBG) available data (n = 1382). The free androgen index (FAI) is calculated as TT divided by SHBG and the ratio of TT to E2 (TT/E2). The constructed puberty state is defined as high levels of steroid hormones (TT≥50 ng/dL in men, E2≥20 pg/ml in women) or onset of menarche. Multiple linear regression analysis was stratified by gender-age and gender-pubertal status groups to evaluate the association between DII and sex hormone levels. Results: After adjusting for covariates, the association between consecutive DII and sex hormone indicators by gender and age group. In male adolescents, DII was always negatively associated with TT (P-trend = 0.09), FAI (P-trend = 0.03) and E2 (P-trend = 0.01), and monotonically positively associated with SHBG (P-trend = 0.02).In female adolescents, with the increase of DII, a significant positive correlation with SHBG was observed (ß 0.017, 95%CI: 0.009,0.053) (Table 3). Among female adolescents, a significant negative association between DII and TT and a significant positive association between SHBG were observed in this group. Moreover, DII was positively associated with SHBG of prepubertal males and negatively associated with FAI of prepubertal females. Conclusions: DII was associated with decreased levels of certain sex steroid hormones (TT, FAI, and E2) and increased levels of SHBG in adolescents or pubertal individuals, with the associations presenting somewhat sex-dependent pattern. However, there is little evidence that there is a significant association in children or prepubertal children. Further research needs to be carried out to verify our results.