Increased risk of preterm birth due to heat exposure during pregnancy: Exploring the mechanism of fetal physiology.

BACKGROUND: Heat exposure during pregnancy can increase the risk of preterm birth (PTB) through a range of potential mechanisms including pregnancy complications, hormone secretion and infections. However, current research mainly focuses on the effect of heat exposure on pathophysiological pathways of pregnant women, but ignore that that maternal heat exposure can also cause physiological changes to the fetus, which will affect the risk of PTB. OBJECTIVE: In this study, we aimed to explore the mediating role of fetal heart rate (FHR) in the relationship between maternal heat exposure and PTB incidence. METHODS: We assigned heat exposure to a multi-center birth cohort in China during 2015-2018, which included all 162,407 singleton live births with several times FHR measurements during the second and third trimesters. We examined the associations between heat exposure, FHR and PTB in the entire pregnancy, each trimester and the last gestational month. The inverse odds ratio-weighted approach applied to the Cox regression was used to identify the mediation effect of heat exposure on PTB and its clinical subtypes via FHR. FINDINGS: Exposure to heat significantly increased the risk of PTB during the third trimester and the entire pregnancy, hazard ratios and 95 % CIs were 1.266 (1.161, 1.379) and 1.328 (1.218, 1.447). Heat exposure during the third trimester and entire pregnancy increased FHR in the third trimester by 0.24 bpm and 0.14 bpm. The proportion of heat exposure mediated by FHR elevation on PTB and its subtype ranged from 3.68 % to 24.06 %, with the significant mediation effect found for both medically indicated PTB and spontaneous PTB. CONCLUSIONS: This study suggests that heat exposure during pregnancy has an important impact on fetal health, and FHR, as a surrogate marker of fetal physiology, may mediate the increased risk of PTB caused by extreme heat. Monitoring and managing physiological changes in the fetus would constitute a promising avenue to reduce adverse birth outcomes associated with maternal heat exposure.

Independent and interactive associations of heart rate and obesity with type 2 diabetes mellites: A population-based study.

BACKGROUND: Although obesity and heart rate (HR) were closely related to the prevalence and development of type 2 diabetes mllitus (T2DM), few studies have shown a co-association effect of them on T2DM. We aimed at assessing the interactive effects of HR and obesity with prevalence of T2DM in Chinese population, providing the exact cutpoint of the risk threshold for blood glucose with high HR. MATERIALS AND METHODS: In the Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal study (REACTION) cohorts (N = 8398), the relationship between HR and T2DM was explored by linear regression, logistic regression, and restricted cubic spline, and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Interaction terms between HR and body mass index (BMI) and HR and waist circumference (WC) were introduced into the logistic regression model. RESULTS: In those with HR > 88.0 beats/min, fasting plasma glucose and oral glucose tolerance tests were significantly correlated with HR, and the prevalence of T2DM was highly correlated with HR (all p < .05). There were interactive associations of HR and obesity in patients with T2DM with HR < 74 beats/min. CONCLUSION: High HR was in interaction with obesity, associating with prevalence of T2DM. The newly subdivided risk threshold for HR with T2DM might be HR > 88 beats/minute.

Intermittent fasting improves glucose homeostasis not entirely dependent on caloric restriction in db/db male mice.

Intermittent fasting (IF), which involves prolonged fasting intervals accompanied by caloric restriction, is an effective dietary treatment for obesity and diabetes. Although IF offers many benefits, it is difficult to determine whether these benefits are the consequences of caloric restriction. Every-other-day feeding (EODF) is a commonly used IF research model. This study was designed to identify other effectors of EODF, in addition to caloric restriction, and the possible underlying mechanisms. Diabetic db/db mice were divided into three groups: ad libitum (AL), meal-feeding (MF) and EODF. The MF model was employed to attain a level of caloric restriction comparable to EODF, with food distribution evenly divided between 10 AM and 6 PM, thereby minimizing the fasting interval. EODF yielded greater improvements in glucose homeostasis than MF in db/db mice by reducing fasting glucose levels and enhancing glucose tolerance. However, these effects on glucose metabolism were less pronounced in lean mice. Furthermore, ubiquitination of the liverspecific glucocorticoid receptor (GR) facilitated its degradation, and downregulating Kruppel-like factor 9 (KLF9), which ultimately suppressed liver gluconeogenesis in diabetic EODF mice. Although GR and KLF9 might mediate the metabolic benefits of EODF, the potential benefits of EODF might be limited by elevated serum glucocorticoid (GC) levels in diabetic EODF mice. Overall, this study suggests that the metabolic benefits of EODF in improving glucose homeostasis are independent of caloric restriction, possibly due to the downstream effects of liver-specific GR degradation.

[C(NH2)3][B(C2O2H4)2]: An Organic-Inorganic Hybrid Borate Containing Nonlinear-Optical Active Unit [B(C2O2H4)2]- with Solar-Blind-Region Optical Nonlinearity.

We herein report an unprecedented organic-inorganic hybrid borate incorporating a novel nonlinear-optical (NLO) active unit, namely, [C(NH2)3][B(C2O2H4)2]. The novel NLO active unit was derived from the condensation reaction between two glycol molecules and one (BO4)5- group. The title compound exhibits a moderate second-harmonic-generation effect (0.7 × KDP), a significant band gap (5.76 eV), and a suitable birefringence (0.078 at 550 nm). The optical properties are determined by the synergistic interaction between the C(NH2)3+ cation and the [B(C2O2H4)2]- group, as indicated by theoretical calculations.

Discovery of N-benzyl-6-methylpicolinamide as a potential scaffold for bleaching herbicides.

BACKGROUND: In pesticide research, bleaching herbicides have always been a hot topic. Our previous research showed that N-(4-fluorobenzyl)-2-methoxybenzamide is an innovative lead compound for bleaching herbicides. RESULTS: A total of 40 derivatives of picolinamides were prepared and evaluated for their herbicidal activity by Petri dish tests and postemergence trials. The structure-activity relationship (SAR) revealed that introducing electron-withdrawing groups at the 3- or 4-positions of the benzyl significantly enhances herbicidal activity. Furthermore, ZI-04 induced similar symptoms such as bleaching effect in treated weeds and accumulation of biosynthetic precursors for carotenoids as observed with diflufenican. ZI-04 also exhibited significant cross-resistance to diflufenican and had a lower resistance risk than diflufenican. CONCLUSION: N-benzyl-6-methylpicolinamides were discovered as a novel scaffold for bleaching herbicides. The accumulation of phytoene, phytofluene and ζ-Carotene in radish cotyledons, and cross-resistance observed with diflufenican, showed that title compounds can interfere with carotenoid biosynthesis. © 2024 Society of Chemical Industry.

[C(NH2)3]6Mo7O24: A Guanidinium Molybdate as a UV Nonlinear Optical Crystal with Large Birefringence.

The key to searching novel nonlinear optical (NLO) crystals was effectively combining the NLO-active units to obtain a noncentrosymmetric structure. Nevertheless, the present predicament lies in the growing challenge of discovering novel crystals within conventional inorganic frameworks that surpass the properties of the current NLO materials. In view of this, researchers expanded their research focus to the organic-inorganic hybridization system; it is foreseeable to concentrate the advantages from several kinds of NLO-active units to acquire novel NLO crystals with superior properties. We herein report an organic-inorganic hybrid molybdate crystal, namely, [C(NH2)3]6Mo7O24 (GMO). It was successfully obtained via combining inorganic NLO-active MoO6 octahedra and organic π-conjugated [C(NH2)3]+ groups. GMO demonstrates a moderate second-harmonic-generation response, specifically measuring about 1.3 times the value of KDP. Additionally, it exhibits a significant birefringence value of 0.203 at the wavelength of 550 nm and possesses a wide band gap of 3.31 eV. Theoretical calculations suggest that the optical properties of the GMO are primarily influenced by the synergy effect of [C(NH2)3]+ groups between MoO6 octahedra.

The intersection of virus infection and liver disease: A comprehensive review of pathogenesis, diagnosis, and treatment.

Liver disease represents a significant global burden, placing individuals at a heightened risk of developing cirrhosis and liver cancer. Viral infections act as a primary cause of liver diseases on a worldwide scale. Infections involving hepatitis viruses, notably hepatitis B, C, and E viruses, stand out as the most prevalent contributors to acute and chronic intrahepatic adverse outcome, although the hepatitis C virus (HCV) can be effectively cured with antiviral drugs, but no preventative vaccination developed. Hepatitis B virus (HBV) and HCV can lead to both acute and chronic liver diseases, including liver cirrhosis and hepatocellular carcinoma (HCC), which are principal causes of worldwide morbidity and mortality. Other viruses, such as Epstein-Barr virus (EBV) and cytomegalovirus (CMV), are capable of causing liver damage. Therefore, it is essential to recognize that virus infections and liver diseases are intricate and interconnected processes. A profound understanding of the underlying relationship between virus infections and liver diseases proves pivotal in the effective prevention, diagnosis, and treatment of these conditions. In this review, we delve into the mechanisms by which virus infections induce liver diseases, as well as explore the pathogenesis, diagnosis, and treatment of liver diseases. This article is categorized under: Infectious Diseases > Biomedical Engineering.

Negative Lattice Expansion in an O3-Type Transition-Metal Oxide Cathode for Highly Stable Sodium-Ion Batteries.

The sodium extraction/insertion in layered transition-metal oxide (TMO) cathode materials are typically accompanied by slab sliding and lattice changes, leading to microstructure destruction and capacity decay. Herein, negative lattice expansion is observed in an O3 type Ni-based layered cathode of Na0.9 Ni0.32 Zn0.08 Fe0.1 Mn0.3 Ti0.2 O2 upon Na+ extraction. It is attributed to the weak Zn2+ -O2- orbital hybridization and increased electron density of the surrounding oxygen for reinforced interlayer O-O repulsive force. This enables gliding of TMO slabs for the intergrowth phase transition of P3→OP2 to alleviate lattice strain with moderate lattice shrinkage, which exhibits general interslab spacings and volume changes as low as 2.4 % and 1.9 %, respectively. The strong Ti-O bonds accommodate the internal distortion of TMO6 octahedra due to the flexibility of TiO6 octahedra during cycling. These endow a high specific capacity of 144.9 mAh g-1 and excellent cycling performance of pouch-type sodium-ion batteries with 93 % capacity retention after 3600 cycles.

Enhanced fertilizer utilization and heavy metals immobilization by ball-milling bentonite with NH4Cl: Experiments and DFT calculations.

Over-application of nitrogen fertilizer induces soil acidification, which activates heavy metals availability and poses significant challenge to crop production and food safety. In this study, we prepared a clay-based material by ball-milling bentonite with NH4Cl (NH4Cl@bentonite) and assessed its synergistic performance in enhancing nitrogen fertilizer utilization efficiency, immobilizing heavy metals, and improving crop yield and safety. The results showed that the optimal performance of NH4Cl@bentonite was achieved by milling bentonite with NH4Cl at a 4:1 mass ratio for 9 h. NH4Cl@bentonite significantly improved soil water holding and retention capacity by 1.6 and 4.3 times, respectively. In comparison to NH4Cl alone, NH4Cl@bentonite led to a 22.3% increase in N-use efficiency and a 1.5 times enhancement in crop yield. The Pb and Cd content in water spinach shoots decreased by 55.3% and 57.5%, respectively, attributed to the transformation of heavy metals into lower bioavailability states by NH4Cl@bentonite. Experiments and Density Functional Theory (DFT) calculations indicated that NH4Cl@bentonite could immobilize Pb and Cd through processes such as cation exchange, surface adsorption, complexation, and enhancement of soil pH. This work proposes a simple and efficient method for improving cropland fertilizer utilization while ensuring healthy and sustainable development. ENVIRONMENTAL IMPLICATION: Soil acidification, caused using chemical fertilizers, especially nitrogen-based ones, threatens crop production and food safety by damaging soil structure, speeding up nutrient loss, and increasing the solubility of heavy metals. To tackle this problem, we made a clay material by mixing bentonite with NH4Cl (NH4Cl@bentonite) in a ball mill. NH4Cl@bentonite increased N-use efficiency by 22.3%, boosted crop yield by 1.5 times, and reduced the Pb and Cd levels in water spinach shoots by 55.3% and 57.5%, respectively. This work suggests a simple and effective way to enhance fertilizer use in croplands while ensuring healthy and sustainable development.

Highly Crystalized Cl-Doped SnO2 Nanocrystals for Stable Aqueous Dispersion Toward High-Performance Perovskite Photovoltaics.

Tin dioxide (SnO2 ) with high conductivity and low photocatalytic activity has been reported as one of the best candidates for highly efficient electron transport layer (ETL) in perovskite solar cell (PSC). The state-of-the-art SnO2 layer is achieved by chemical bath deposition with tunable properties, while the commercial SnO2 nanocrystals (NCs) with low tunability still face the necessity of further improvement. Here, a kind of highly crystallized Cl-doped SnO2 NCs is reported that can form very stable aqueous dispersion with shelf life up to one year without any stabilizer, which can facilitate the fabrication of PSCs with satisfactory performance. Compared to the commercial SnO2 NCs regardless of the extrinsic Cl-doping conditions, the intrinsic Cl-doped SnO2 NCs effectively suppress the energy barrier and reduces the trap state density at the buried interface between perovskite and ETL. Consequently, stable PSCs based on such Cl-doped SnO2 NCs achieve a champion efficiency up to ≈25% for small cell (0.085 cm2 ) and ≈20% for mini-module (12.125 cm2 ), indicating its potential as a promising candidate for ETL in high-performance perovskite photovoltaics.

Molecular mechanism of α-Hederin in tumor progression.

α-Hederin is a monosaccharide pentacyclic triterpene saponin compound derived from the Chinese herb, Pulsatilla. It has garnered considerable attention for its anti-tumor, anti-inflammatory, and spasmolytic pharmacological activities. Given the rising incidence of cancer and the pronounced adverse reactions associated with chemotherapy drugs-which profoundly impact the quality of life for cancer patients-there is an immediate need for safe and effective antitumor agents. Traditional drugs and their anticancer effects have become a focal point of research in recent years. Studies indicate that α-Hederin can hinder tumor cell proliferation and impede the advancement of various cancers, including breast, lung, colorectal, and liver cancers. The principal mechanism behind its anti-tumor activity involves inhibiting tumor cell proliferation, facilitating tumor cell apoptosis, and arresting the cell cycle process. Current evidence suggests that α-Hederin can exert its anti-tumor properties through diverse mechanisms, positioning it as a promising agent in anti-tumor therapy. However, a comprehensive literature search revealed a gap in the comprehensive understanding of α-Hederin. This paper aims to review the available literature on the anti-tumor mechanisms of α-Hederin, hoping to provide valuable insights for the clinical treatment of malignant tumors and the innovation of novel anti-tumor medications.

Neuromodulatory effects of high-definition theta transcranial alternating current stimulation on the parietal cortex: a pilot study of healthy males.

Introduction: Transcranial alternating current stimulation (tACS) can regulate brain functions by modulating endogenous brain rhythms. Theta-band neural oscillations are associated with memory function. In particular, theta neural oscillatory power evoked in the parietal cortex is closely related to memory retrieval processes. In this study, the immediate effects of high-definition theta transcranial alternating current stimulation (HDθ-tACS) on the human left parietal cortex were investigated using short-latency afferent inhibition (SAI) and electroencephalography (EEG). Methods: Ten subjects participated in this study. We used 6-Hz HD tACS to stimulate the left parietal cortex for 15 min. SAI was calculated, and non-linear dynamic analysis of the EEG was performed to analyze neuronal function after HD θ-tACS. Results: The results showed a significant decrease in SAI (p < 0.05), while the left frontoparietal network was reinforced, leading to brain lateralization after HD θ-tACS. During performance of a memory task, F3 signals showed a significant upward trend in approximate entropy following treatment (p < 0.05). There was also a significant decrease in cross-approximate entropy in the C3-C4 and P3-P4 connections following the intervention (p < 0.05) in a resting eyes-open condition and in the memory task condition. Discussion: In conclusion, HD θ-tACS could alter cholinergic transmission and cortical excitability between the parietal and motor cortices, as well as reinforcing the frontoparietal network and the left-lateralization phenomenon, which may facilitate memory formation, encoding, and consolidation.

Surface Termination on Unstable Methylammonium-based Perovskite Using a Steric Barrier for Improved Perovskite Solar Cells.

Compared to widely adopted low-dimensional/three-dimensional (LD/3D) heterostructure, functional organic cation based surface termination on perovskite can not only realize advantage of defect passivation but also prevent potential disadvantage of the heterostructure induced intercalation into 3D perovskite. However, it is still very challenging to controllably construct surface termination on organic-inorganic hybrid perovskite because the functional organic cations' substitution reaction is easy to form LD/3D heterostructure. Here, we report using a novel benzyltrimethylammonium (BTA) functional cation with rational designed steric hindrance to effectively surface terminate onto methylammonium lead triiodide (MAPbI3 ) perovskite, which is composed of the most unstable MA cations. The BTA cation is difficult to form a specific 1.5-dimensional perovskite of BTA4 Pb3 I10 by cation substitution with MA cation, which then provides a wide processing window (around 10 minutes) for surface terminating on MAPbI3 films. Moreover, the BTAI surface terminated BTAI-MAPbI3 shows better passivation effect than BTA4 Pb3 I10 -MAPbI3 heterojunction. Finally, BTAI surface terminated solar cell (0.085 cm2 ) and mini-module (11.52 cm2 ) obtained the efficiencies of 22.03 % and 18.57 %, which are among the highest efficiencies for MAPbI3 based ones.

Clinical Research Progress of the Post-Stroke Upper Limb Motor Function Improvement via Transcutaneous Auricular Vagus Nerve Stimulation.

Stroke is a disease with high morbidity and disability, and motor impairment is a common sequela of stroke. Transcutaneous auricular vagus nerve stimulation (taVNS) is a type of non-invasive stimulation, which can effectively improve post-stroke motor dysfunction. This review discusses stimulation parameters, intervention timing, and the development of innovative devices for taVNS. We further summarize the application of taVNS in improving post-stroke upper limb motor function to further promote the clinical research and application of taVNS in the rehabilitation of post-stroke upper limb motor dysfunction.

Comprehensive evaluation of the risk system for heavy metals in the rehabilitated saline-alkali land.

A comprehensive assessment of the heavy metal system in the rehabilitated saline-alkali land holds significant importance, as the in-situ remediation process utilizing amendments substantially alters the initial physicochemical properties of the soil, which could lead to the migration or reactivation of previously stabilized heavy metals. In this context, the present study aims to evaluate the heavy metal content and health risk within the improved saline-alkali soil-plant system. Moreover, a comprehensive evaluation based on the TOPSIS-RSR method is carried out to accurately gauge the soil health status. The findings indicate that the modification process has an impact on the concentrations of heavy metals in the soil and crops, causing either an increase or decrease. However, the level of heavy metal pollution in the improved saline-alkali soil and rape remains within safe limits. The results of the migration of heavy metals after amendment application indicated that the migration of heavy metals in the soil was influenced by the properties of the heavy metals, the composition of the amendment, and leaching. Furthermore, the total non-carcinogenic hazard quotients in the soil and rape were within the safe threshold for all populations. The findings provided novel insights into the status and risk assessment of the pollution of improved saline-alkali soil.

Prediction models of fire spread rate of Pinus koraiensis plantation's surface fuel.

Pinus koraiensis plantation has high fire risks due to high oil content in branches and leaves. The spread of surface fire is the main way of forest fire expansion. Understanding the surface fire spread rate can provide scientific guidance for fire fighting. We carried out a laboratory experiment with surface fuel of Pinus koraiensis plantation in Maoershan area of Heilongjiang Province. We set different levels of fuel moisture contents (5%, 15%, 25%), fuel loads (0.5, 0.7, 0.9, 1.1 kg·m-2), and slope (0°, 10°, 20°, 30°, 40°) to simulate the characteristics of fuel bed in the field, and quantified the spread rate by thermocouple method. We further compared and analyzed the prediction accuracy of Rothermel model, modified Rothermel model and random forest model, and evaluated the optimal model for predicting the surface fire spread rate of P. koraiensis plantation. The results showed that the overall efficacy of directly using the Rothermel model to predict the surface fire spread rate of P. koraiensis plantations was good, but the prediction result of the spread rate under the conditions of high slope and high moisture content was not satisfied. The Rothermel model after refitting the slope parameters and the random forest model had good prediction efficacy and similar prediction accuracy. The random forest model needed to be further evaluated and verified due to its own characteristics. The modified Rothermel model was more suitable for predicting the surface fire spread rate of P. koraiensis plantations at a slope range of 0°-40° than the others.

Exploration of the preterm birth risk-related heat event thresholds for pregnant women: a population-based cohort study in China.

Background: Heat events increase the risk of preterm birth (PTB), and identifying the risk-related event thresholds contributes to developing early warning system for pregnant women and guiding their public health response. However, the event thresholds that cause the risk remain unclear. We aimed to investigate the effects of heat events defined with different intensities and durations on PTB throughout pregnancy, and to determine thresholds for the high-risk heat events. Methods: Using a population-based birth cohort data, we included 210,798 singleton live births in eight provinces in China during 2014-2018. Daily meteorological variables and inverse distance weighted methods were used to estimate exposures at a resolution of 1 km × 1 km. A series of cut off temperature intensities (50th-97.5th percentiles, or 18 °C-35 °C) and durations (at least 1, 2, 3, 4 or 5 consecutive days) were used to define the heat events. Cox regression models were used to estimate the effects of heat events on PTB in various gestational weeks during the entire pregnancy, and event thresholds were determined by calculating population attributable fractions. Findings: The hazard ratios of heat event exposure on PTB ranged from 1.07 (95% CI: 1.00, 1.13) to 1.43 (1.15, 1.77). Adverse effects of heat event exposure were prominently detected in gestational week 1-4, week 21-32 and the four weeks before delivery. The heat event thresholds were determined to be daily maximum temperature at the 90th percentile of the distribution or 30 °C lasting for at least one day. If pregnant women were able to avoid the heat exposures from the early warning systems triggered by these thresholds, approximately 15% or 17% of the number of total PTB cases could have been avoided. Interpretation: Exposure to heat event can increase the risk of PTB when thermal event exceeds a specific intensity and duration threshold, particularly in the first four gestational weeks, and between week 21 and the last four weeks. This study provides compelling evidence for the development of heat-health early warning systems for pregnant women that could substantially mitigate the risk of PTB. Funding: National Key R&D Program of China (No. 2018YFA0606200), National Natural Science Foundation of China (No. 42175183), Sanming Project of Medicine in Shenzhen (No. SZSM202111001).

Effective strategies for reclamation of saline-alkali soil and response mechanisms of the soil-plant system.

The combination of amendments has emerged as a potential strategy to efficiently alleviate salt stress in saline-alkali soil. However, knowledge regarding how to optimize the proportion of different amendment materials, comprehensively assess the contribution of each component, and clarify the response mechanisms of the amendment-saline-alkali soil-plant system is incomplete. Based on this, we conducted a pot experiment to evaluate the improvement effect of the combined application of different amendment materials at varying levels and the contribution of the amendment components to alleviating salt stress. Overall, T6 exhibited the most significant improvement effect on the physicochemical and biological properties of the saline-alkali soil and promoted the growth of oilseed rape, with the levels of 2.0 % phosphogypsum, 2.0 % humic acid, 0.25 % bentonite, and 0.03 % sodium carboxymethyl cellulose. Compared with the control group, the EC decreased by 1.51 % to 33.49 %, the soil salt content dropped by 11.40 % to 35.46 %, and the soil soluble Na + concentration significantly declined by 39.47 % to 63.20 %. Additionally, the soil nutrient content and soil microbial community structure were enhanced in treatment groups. Meanwhile, amendments alleviated salt stress in the oilseed rape plant by activating anti-oxidative enzymes and osmoregulatory substances such as soluble sugar and proline, thus improving their ability to remove reactive oxygen species (ROS). The anti-oxidative enzymes such as superoxide dismutase (SOD), peroxidase (POD), and catalase (CAT) were significantly increased, with an increase of 10.68 % (SOD, T2) ∼207.31 % (CAT, T6) compared to the control group. The structural equation modeling (SEM) analysis and simulation experiments indicated that the amendment components synergically promoted the amelioration effect on salt stress, and effectively improved soil properties, which affected the response of oilseed rape to soil environment. This research paper provides the relevant reference for the combined application of different amendment materials for soil reclamation.

The association of FGF-21 with the risk of newly diagnosed type-2 diabetes mellitus: a cross-sectional study in Southern China.

BACKGROUND: This study investigated the relationship between fibroblast growth factor 21 (FGF-21) and newly diagnosed type-2 diabetes mellitus (T2DM). METHODS: In this cross-sectional study, FGF-21 and T2DM risk were analyzed using restricted cubic splines with univariate or multivariate logistic regression analysis. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated via logistic regression analysis. Cluster and subgroup analyses were conducted to evaluate the associations between FGF-21 and diabetes in different subpopulations. Nomograms and ROC curves were used to explore the clinical utility of FGF-21 in the diabetes assessment model. RESULTS: High levels of FGF-21 were significantly associated with a high risk of T2DM after adjusting for confounding factors in both the total population and subpopulations (P for trend < 0.001). In the total population, the ORs of diabetes with increasing FGF-21 quartiles were 1.00 (reference), 1.24 (95% CI 0.56-2.80; quartile 2), 2.47 (95% CI 1.18-5.33; quartile 3), and 3.24 (95% CI 1.53-7.14; quartile 4) in Model 4 (P < 0.001), and the trend was consistent in different subpopulations. In addition, compared with the model constructed with conventional noninvasive indicators, the AUC of the model constructed by adding FGF-21 was increased from 0.668 (95% CI: 0.602-0.733) to 0.715 (95% CI: 0.654-0.777), indicating that FGF-21 could significantly improve the risk-assessment efficiency of type-2 diabetes. CONCLUSION: This study demonstrated that a high level of circulating FGF-21 was positively correlated with diabetes, and levels of FGF-21 could be an important biomarker for the assessment of diabetes risk.

Glucose Metabolism Indices and the Development of Chronic Kidney Disease: A Cohort Study of Middle-Aged and Elderly Chinese Persons.

Objective: Chronic kidney disease (CKD) has become a major global health issue, and abnormalities of glucose metabolism are a risk factor responsible for development of CKD. We aimed to investigate associations between glucose metabolism indices and CKD in a Chinese population and determine which index is superior for predicting incident CKD. Methods: We performed a community-based population on 5232 subjects aged ≥40 years without baseline CKD. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 or urinary albumin-to-creatinine ratio (UACR) ≥30 mg/g. We examined the associations of glucose metabolism indices, including fasting plasma glucose (FPG), 2-hour (2 h) oral glucose tolerance test (OGTT), hemoglobin A1c (HbA1c), fasting insulin level, homeostasis model assessment of insulin resistance (HOMA-IR), and HOMA-ß and the development of CKD. Results: With an average follow-up of 3.6 years, 6.4% of the subjects developed CKD. Pearson's correlation analysis revealed that FPG, HbA1c, fasting insulin, and HOMA-IR were all significantly correlated with UACR and eGFR. The association persisted in multivariate linear regression analysis adjusted for age and sex. Compared with other glucose indices, HOMA-IR exhibited the strongest associations with CKD in COX multivariate regression analysis (HR = 1.17, 95% CI: 1.04-1.31). Conclusion: HOMA-IR is superior to other routine indices of glucose metabolism for predicting the development of CKD in middle-aged Chinese persons. Screening with HOMA-IR may help prevent the development of CKD in the general population.