Effects of Air Pollutants on Mortality of Chronic Kidney Disease Patients with Green Spaces Exposure: A Large Observational Study

With increasing air pollution, the association between green space exposure and health outcomes is a global health concern. The relationship between air pollution and the survival of patients with chronic kidney disease (CKD) who are exposed to residential greenness is yet to be elucidated. This study aimed to determine this relationship in Seoul between 2002 and 2015. A time-varying survival analysis was conducted to investigate the association between long-term exposure to air pollutants and mortality in 29,602 patients with CKD living in residential environments with small and large green infrastructure. The low and high index groups were defined using continuous and percentile thresholds of the satellite data—the derived average Normalized Difference Vegetation Index within 250 m and 1,250 m of residence, respectively. During the observation, 3,863 (14%) deaths occurred. The effect of air pollution exposure on mortality was worse in the low index group than in the high index group. Particularly, exposure to SO2 was associated with increased mortality risk, regardless of the greenness threshold. Consistent results were observed in co-pollutant models. High greenery exposure significantly reduced the risk of air pollution related mortality. Our results emphasize the need for creating environmental infrastructures that include green spaces.

Prenatal stress, anxiety and depression alter transcripts, proteins and pathways associated with immune responses at the maternal-fetal interface

During pregnancy, the immune system is modified to allow developmental developmental tolerance of the semi-allogeneic fetus and placenta to term. Pregnant women suffering from stress, anxiety and depression show dysfunctions of their immune system that may be responsible for fetal and/or newborn disorders, provided that provided that placental gene regulation is compromised. The present study explored the effects of maternal chronic self-perceived stress, anxiety and depression during pregnancy on the expression of immune related-genes and pathways in term placenta. Pregnancies were clinically monitored with the Beck’s Anxiety Inventory (BAI) and Edinburgh Postnatal Depression Scale (EPDS). A cutoff threshold for BAI/EPDS of 10 divided patients into two groups: Index group (≥10, n = 11) and a Control group (<10, n = 11), whose placentae were sampled at delivery. The placental samples were subjected to RNA-Sequencing, demonstrating that stress, anxiety and depression during pregnancy induced a major downregulation of placental transcripts related to immune processes such as T-cell regulation, interleukin and cytokine signaling or innate immune responses. Expression differences of main immune related genes such as CD46, CD15, CD8α & β ILR7α and CCR4 among others, were found in the index group (P < 0.05). Moreover, the key immune-like pathway involved in humoral and cellular immunity named “Primary immunodeficiency” was significantly downregulated in the index group compared to controls. Our results show that mechanisms ruling immune system functions are compromised at the maternal-fetal interface following self-perceived depressive symptoms and anxiety during pregnancy. These findings may help unveil mechanisms ruling the impact of maternal psychiatric symptoms and lead to new prevention/intervention strategies in complicated pregnancies.

Multi-Indicator Intelligent Monitoring of Clinical Observations to Reduce Cesarean Section

In order to analyze multi-index monitoring and the effect of reducing cesarean section, this paper selects March 2018 and March 2019 in two obstetrics and gynecology hospitals, referred to as hospital A and hospital B. As research objects, 313 pregnant women were divided into multi-index group and conventional group, while analyzing various indicators of each group of cesarean collection. The results show that the total CNAXE rate was 48.10% and 39.29%, respectively, for 2018 and 2019, respectively, and the cesarean section of the conventional group was 65.75% and 63.64%. By contrasting data of multi-index group and conventional group, hospital B differences were significant ( P < 0.05), and hospital A difference was extremely significant ( P < 0.01). In Cesarean section, obstetric sectors can help maternal treatment strategies by monitoring a series of related indicators for maternal to reduce Cesarean section and improve prognosis.

Association of Triglyceride-Glucose index with risk of microalbuminuria in Chinese children with type 1 diabetes

Objective The triglyceride-glucose index (TyG index) has been regarded as a useful alternative marker for the early identification of insulin resistance (IR). Accordingly, the objective of the present study is to explore the association of the TyG index with microalbuminuria (MA) in T1DM children. Methods The study retrospectively enrolled 129 patients ((boys/girls = 51/78) with T1DM in the Endocrine inpatient wards of Tianjin Children’s Hospital from June 2017 to May 2019. 43 patients with MA were randomly matched 1:2 with 86 patients without MA based on the Propensity Score Matching. TyG index was calculated as follows: ln[fasting triglycerides (mg/dL)×fasting plasma glucose (mg/dL)/2]. Results TyG index and related lipid parameters were significantly higher in patients with MA compared with those without (all p < 0.05). Multivariable logistic regression analysis revealed that the TyG index in patients with MA was 2.166 times compared with those without (OR = 2.166; 95% CI, 1.559–3.009; p < 0.001). FPG (OR = 1.068; 95% CI, 1.026–1.112; p = 0.001), HBA1c (OR = 1.193; 95%CI, 1.066–1.334; p = 0.002), and the occurrence of DKA (OR = 9.863; 95% CI, 2.764–35.192; p < 0.001) were still associated with a higher MA risk. ROC curves analysis shown that the area under the curve (AUC) of the TyG index for predicting MA was the largest (0.78) compared with fasting plasma glucose (FPG) and HAB1c. The cumulative incidence of MA in the higher TyG index group was significantly higher than that in the lower TyG index group in 15 years (p < 0.001). Conclusions The TyG index was significantly correlated with MA levels. An elevated TyG index had a significantly greater risk of MA events independent of DKA, even after adjusting for confounding risk factors. The TyG index was more specific than FPG and HBA1c in predicting MA. Compared to patients with a lower TyG index, those with a higher TyG index had an apparently higher cumulative incidence of MA.

Positive correlation of serum indoxyl sulfate level with peripheral arterial disease in hemodialysis patients

Objectives Indoxyl sulfate, known for its cardiovascular toxicity, is associated with vascular and coronary artery diseases and increased mortality. Peripheral arterial disease, defined by low ankle–brachial index, is associated with increased mortality in patients on hemodialysis. The present study aimed to determine the relationship between the serum indoxyl sulfate level and peripheral arterial disease in patients on maintenance hemodialysis. Methods The present cross-sectional, single-center study included 75 patients on maintenance hemodialysis. Serum indoxyl sulfate levels were determined by high-performance liquid chromatography–mass spectrometry. Ankle–brachial index values were measured using an automated oscillometric device. Patients with ankle–brachial indexes of < 0.9 were categorized into the low ankle–brachial index group. Results In the study cohort, 12 of the 75 patients (16.0%) had low ankle–brachial indexes. The rates of diabetes mellitus ( p = 0.010) as well as the serum levels of C-reactive protein ( p < 0.001) and indoxyl sulfate ( p < 0.001) were higher in the low ankle–brachial index group than the normal ankle–brachial index group. The multivariable logistic regression analysis revealed that serum levels of indoxyl sulfate (odds ratio = 1.123, 95% confidence interval 1.011–1.249, p = 0.031) and C-reactive protein (each 0.1 mg/dL increase, odds ratio = 1.169, 95% confidence interval 1.018–1.343, p = 0.027) were independently associated with peripheral arterial disease in patients on maintenance hemodialysis. Conclusions Serum indoxyl sulfate levels were associated with peripheral arterial disease in patients on maintenance hemodialysis.

Preoperative Fibrosis-4 (FIB-4) Evaluation May Be Helpful to Evaluate Prognosis of Gastric Cancer Patients Undergoing Operation: A Retrospective Study

BackgroundLiver dysfunction and chronic inflammation influence the prognosis of many tumors and surgical outcomes. This study was performed to determine whether the Fibrosis-4 (FIB-4) index, originally defined as a noninvasive fibrosis marker, can predict the prognosis of patients with gastric cancer undergoing radical gastric cancer surgery.MethodsWe have retrospectively analyzed 594 consecutive patients with gastric cancer who underwent gastrectomy in our database. The FIB-4 index was calculated using laboratory data and age before gastrectomy. The clinical utility of FIB-4 was evaluated by X-tile. Patients were divided into two groups (high and low FIB-4 index groups), and their overall survival (OS) was investigated. Cox regression analysis was used to identify the independent parameters associated with prognosis. Finally, we developed a prognostic prediction model by using R statistical software.ResultsA total of 556 patients, including 422 men and 134 women, were enrolled. Of these, 61 (11.0%) and 495 (89.0%) patients had low and FIB-4 indexes, respectively. In addition to the indicators of FIB-4, preoperative age, tumor site, surgical procedure, TNM stage, and postoperative complications were found to be independent predictors of prognosis (P &lt; 0.05). Among patients, the FIB-4 index group had significantly shorter OS (log-rank P = 0.01) than the low FIB-4 index group. This association was also confirmed in the multivariate analysis (hazard ratio, 4.65; 95% confidence interval, 1.07-4.29; P = 0.031).ConclusionsPreoperative FIB-4 index can predict long-term outcomes of gastric cancer patients who had undergone gastrectomy.

Associations between low body mass index and mortality in patients with sepsis: A retrospective analysis of a cohort study in Japan

Background The distribution of body mass in populations of Western countries differs from that of populations of East Asian countries. In East Asian countries, fewer people have a high body mass index than those in Western countries. In Japan, the country with the highest number of older adults worldwide, many people have a low body mass index. Therefore, this study aimed to determine the association between a low body mass index and mortality in patients with sepsis in Japan. Methods We conducted this retrospective analysis of 548 patients with severe sepsis from a multicenter prospective observational study. Multivariate logistic regression analyses determined the association between body mass index and 28-day mortality adjusted for age, sex, pre-existing conditions, the occurrence of septic shock, Acute Physiology and Chronic Health Evaluation II scores, and Sequential Organ Failure Assessment scores. Furthermore, the association between a low body mass index and 28-day mortality was analyzed. Results The low body mass index group represented 18.8% of the study population (103/548); the normal body mass index group, 57.3% (314/548); and the high body mass index group, 23.9% (131/548), with the 28-day mortality rates being 21.4% (22/103), 11.2% (35/314), and 14.5% (19/131), respectively. In the low body mass index group, the crude and adjusted odds ratios (95% confidence intervals) for 28-day mortality relative to the non-low body mass index (normal and high body mass index groups combined) group were 2.0 (1.1–3.4) and 2.3 (1.2–4.2), respectively. Conclusion A low body mass index was found to be associated with a higher 28-day mortality than the non-low body mass index in patients with sepsis in Japan. Given that older adults often have a low body mass index, these patients should be monitored closely to reduce the occurrence of negative outcomes.

Novel nomogram-based integrated gonadotropin therapy individualization in in vitro fertilization/intracytoplasmic sperm injection: a modeling approach

Objective: This study aimed to characterize a validated model for predicting oocyte retrieval in controlled ovarian stimulation (COS) and to construct model-based nomograms for assistance in clinical decision-making regarding the gonadotropin protocol and dose.Methods: This observational, retrospective, cohort study included 636 women with primary unexplained infertility and a normal menstrual cycle who were attempting assisted reproductive therapy for the first time. The enrolled women were split into an index group (n=497) for model building and a validation group (n=139). The primary outcome was absolute oocyte count. The dose-response relationship was tested using modified Poisson, negative binomial, hybrid Poisson-Emax, and linear models. The validation group was similarly analyzed, and its results were compared to that of the index group. Results: The Poisson model with the log-link function demonstrated superior predictive performance and precision (Akaike information criterion, 2,704; λ=8.27; relative standard error (λ)=2.02%). The covariate analysis included women’s age (p<0.001), antral follicle count (p<0.001), basal follicle-stimulating hormone level (p<0.001), gonadotropin dose (p=0.042), and protocol type (p=0.002 and p<0.001 for short and antagonist protocols, respectively). The estimates from 500 bootstrap samples were close to those of the original model. The validation group (n=139) showed model assessment metrics comparable to the index model. Based on the fitted model, a static nomogram was built to improve visualization. In addition, a dynamic electronic tool was created for convenience of use.Conclusion: Based on our validated model, nomograms were constructed to help clinicians individualize the stimulation protocol and gonadotropin doses in COS cycles.

Whole-Body Muscle MRI Characteristics of LAMA2 Gene Mutation Congenital Muscular Dystrophy Children

Merosin-deficient or LAMA2-related congenital muscular dystrophy (CMD) belongs to a group of muscle diseases with an overlapping diagnostic spectrum. MRI plays an important role in the diagnosis and disease-tracking of muscle diseases. Whole-body MRI is ideal for describing patterns of muscle involvement. Our purpose is to analyze the pattern of muscle involvement in merosin-deficient CMD children employing whole-body muscle MRI. Ten children with merosin-deficient CMD underwent whole-body muscle MRI. We used a control group of other hereditary muscle diseases, which included 13 children. Overall, 37 muscles were graded for fatty infiltration using Mercuri scale modified by Fischer et al 2008. The results showed a fairly consistent pattern of muscle fatty infiltration in index group, which differed from that in control group. There was a highly statistically significant difference between the two groups in regard to the fatty infiltration of the neck, serratus anterior, rotator cuff, deltoid, forearm, gluteus maximus, gluteus medius, gastrocnemius and soleus muscles. Additionally, results showed relative sparing of the brachialis, biceps brachii, gracilis, sartorius, semitendinosus and extensor muscles of the ankle in index group. There is evidence to suggest that whole-body muscle MRI can become a useful contributor to the differential diagnosis of merosin deficient CMD.