Associations between the number of siblings, parent-child relationship and positive youth development of adolescents in mainland China: A cross-sectional study

BACKGROUND

Positive development plays an important role in youth when dealing with stressful circumstances. According to the resource dilution theory, adolescents with or without siblings may receive different levels of emotional and material resources from their parents. The purpose of this study is to examine the association between the positive development of adolescents in China today with their family characteristics such as the number of siblings.

METHODS

A total of 2072 junior high and senior high school students (13 to 18 years old) in Chengdu, Sichuan, China, were investigated by cluster sampling. The Chinese Positive Youth Development scales (CPYDs) were used to measure positive youth development. The generalized linear model was used to explore the relationships among the number of siblings, parent-child relationships and positive youth development.

RESULTS

Adolescents from only-child families had better performance on positive development (H = 21.87, P < 0.001) and better relationships with parents (H = 15.1, P < 0.05). The positive development of male and female adolescents does not significantly differ in families with different numbers of siblings. The generalized linear model showed that a positive parent-child relationship is positively correlated with adolescent positive development (P < 0.05).

CONCLUSION

Positive youth development is not only associated with the number of siblings but also other modifiable familial factors. The positive relationship between parents and adolescents is of great practical value in daily life to improve youth development, and this might be the real lesson the resource dilution theory tells.

[Real-time localization for port-implanted catheter tip by echocardiographic guidance]

The clinical data of 23 patients undergoing real-time echocardiography-guided infusion port implantation in the Breast Center of Tsinghua Changgung Hospital in Beijing from January to July 2021 were analyzed. The length of catheter insertion L1 was initially estimated using surface measurement method in all patients. Intraoperatively, transthoracic echocardiography was applied using the parasternal four-chamber view to visualize the catheter image within the right atrium, and the length of catheter insertion L2 was recorded under the guidance of echocardiography. Postoperatively, chest radiographs were taken in the upright position to observe the position of the catheter tip. According to chest CT scans, the ideal length (L) for catheter tip placement was calculated when it was located at the junction of superior vena cava and right atrium. Bland-Altman scatter plot analysis and linear regression fitting test were used on L1 and L2 respectively with L to evaluate the consistency. A total of 23 patients were included in this study, among which one case of left breast cancer patient undergoing breast-conserving surgery had difficulty in identifying the catheter tip position due to residual pleural effusion obscuring the imaging of the cardiac apex four-chamber view. In 22 patients, the results of intraoperative ultrasound imaging were good, including 1 case of catheter ectopic to azygos vein, and 21 cases of right atrial catheter could be detected by ultrasound. Statistical analysis showed that there was a good consistency between L1 and L, L2 and L, and the difference between them was d=0.28 cm (95%CI:-1.76-2.31 cm) and d=0.20 cm(95%CI:-0.84-1.23 cm), respectively, with no statistical significance (P>0.05). In the linear regression model, L2 and L had a higher fit than L1, and the difference was statistically significant (R²=0.954, P<0.001). This study found that real-time echocardiographic localization technique can be applied in adult port surgery to replace X-ray-guided real-time catheter tip detection and adjustment to the optimal position.

One-year trajectories of nutritional status in perimenopausal women: a community-based multi-centered prospective study

BACKGROUND

Nutritional status is a modifiable factor associated with perimenopausal women's health and quality of life. Assessing body composition indicators helps to comprehensively understand nutritional status compared with using body mass index (BMI) only. However, few published studies measured the trends in body composition among perimenopausal women.

OBJECTIVES

To assess the one-year trajectory of the nutritional status of perimenopausal women and to explore its influential factors.

METHODS

A community-based observational study with 3-wave repeated measurements at 6-month intervals was carried out. The nutritional status indicators include weight, body mass index (BMI), and body composition variables. Bioelectrical impedance analysis was used to assess body composition. Repeated measures ANOVA and Chi-square test were used to calculate the changes in nutritional status and generalized estimating equations were performed to explore their influential factors.

RESULTS

2760 participants completed the study. Increasing trajectories in weight (from 56.05 ± 7.55 to 57.02 ± 7.60), fat mass (from 17.99 ± 4.80 to 20.49 ± 4.90), and waist-hip ratio (from 0.86 ± 0.04 to 0.91 ± 0.15) were found (P < 0.001). Decreasing trajectories in skeletal muscle (from 20.30 ± 2.38 to 19.19 ± 2.46), protein level (from 7.39 ± 0.79 to 7.06 ± 0.81), and total body water (from 27.87 ± 2.92 to 27.00 ± 3.01) were found (P < 0.001). Being married/unmarried with a partner and without negative life events were associated with higher total body water, skeletal muscle, and protein level, while negatively associated with fat mass and waist-hip ratio. Age was positively associated with fat mass (P < 0.001). Participants with junior high school education were prone to increased fat mass (P = 0.018) compared with those holding primary school education and below. A per capita monthly income of 1500 to 3000 Yuan was associated with higher total body water, skeletal muscle, and protein level (P < 0.001) compared with a per capita monthly income of less than 1500 Yuan.

CONCLUSION

Worsening nutritional status exists in perimenopausal women, which is characterized by increased weight, fat mass, and waist-hip ratio, and decreased skeletal muscle, total body water, and protein level. For greater efficiency, precision nutritional interventions are needed, and recipients should be classified into different risk levels based on their sociodemographic background.

Assessment of Factors Associated With Anti-Tubercular Treatment Compliance in Children: A Cross-Sectional Study

Objective. This study aims to investigate compliance and the influencing factors related to pediatric tuberculosis patients who are undergoing treatment with anti-tuberculosis drugs in the Sichuan Province of China. Methods. A questionnaire survey was conducted between March 2019 and March 2021. The survey was distributed to caregivers of children aged 0 to 14 who had been diagnosed with pulmonary tuberculosis. These children had been receiving oral anti-tuberculosis drug treatment for more than 1 month. The survey was administered at the pediatric infection departments of West China Second University Hospital, Sichuan University, and The First People's Hospital of Ganzi Prefecture. Results. The study revealed a notable lack of medication adherence among the pediatric patients. Through multiple linear regression analysis, it was determined that several factors played a role in influencing medication adherence among children with tuberculosis. These factors include the educational level of the parents, the frequency of daily anti-tuberculosis drug prescriptions, and the parents' comprehension of the disease. All of these factors showed statistically significant influence on medication adherence among pediatric tuberculosis patients (all P < .05). Conclusion. In order to enhance adherence among pediatric patients undergoing anti-tuberculosis treatment, it is imperative to focus on reinforcing health education, particularly for parents with lower educational attainment and limited understanding of the disease.

Effect of lite touch on the anxiety of low-risk pregnant women in the latent phase of childbirth: a randomized controlled trial

Introduction

Women with perinatal anxiety have reduced coping capacity during labor, which affects labor progress and increases the likelihood of a cesarean section. Several non-pharmacological interventions for anxiety during childbirth are available. This study used the "lite touch" method, a non-pharmacological intervention based on physiological responses and obstetric clinical experience in women. We aimed to evaluate whether lite touch could relieve perinatal anxiety and investigate the effect of light skin stroking on the maternal hormones, catecholamine, and cortisol.

Methods

This randomized clinical trial involved women with low-risk singleton pregnancies at full term or near term. Eligible pregnant women who were latent and did not undergo epidural anesthesia were randomized into two groups. Participants in the intervention group underwent routine prenatal care, including lite touch, whereas the control group underwent routine prenatal care alone. Demographic data were collected through a questionnaire. Labor anxiety was assessed using the State Anxiety Inventory, and saliva was collected before and after the intervention. Changes in saliva cortisol and catecholamine levels were analyzed using a double-antibody sandwich enzyme-linked immunosorbent assay.

Results

In total, 83 participants were included, with 43 and 40 in the intervention and control groups, respectively. In the intervention group, pre-intervention anxiety scores were significantly lower (p < 0.01) than post-intervention anxiety scores, whereas the control group showed no difference in anxiety scores before and after intervention (p > 0.05). Cortisol and catecholamine levels in saliva were significantly lower in the intervention group than in the control group after the intervention (p < 0.01).

Discussion

Lite touch can reduce the latent anxiety state of low-risk pregnant women, thereby maintaining in vivo stability and facilitating labor.

Clinical trial registration

https://www.chictr.org.cn/aboutEN.html, ChiCTR2300070905, Retrospectively Registered Date: April 26, 2023.

Effects of mHealth-Based Lifestyle Interventions on Gestational Diabetes Mellitus in Pregnant Women With Overweight and Obesity: Systematic Review and Meta-Analysis

BACKGROUND

The increasing incidence of gestational diabetes mellitus (GDM) is a global health problem that is more likely to occur in pregnant women with overweight or obesity. Adhering to a healthy lifestyle is associated with a reduced risk of GDM. With the development of IT, mobile health (mHealth) interventions have become widely available in health care. However, there are no definitive conclusions on the effectiveness of mHealth-based lifestyle interventions in preventing GDM.

OBJECTIVE

This study aims to evaluate the impact of mHealth-based lifestyle interventions on GDM and other pregnancy outcomes in pregnant women with overweight or obesity.

METHODS

A systematic literature search was conducted in 5 English databases (MEDLINE, Embase, Web of Science, CENTRAL, and CINAHL) and 4 Chinese databases (CBM, CNKI, Vip, and Wanfang) to identify randomized controlled trials (RCTs) on the effectiveness of mHealth-based interventions for GDM from inception to January 10, 2023. In total, 2 authors independently screened the studies and extracted the data. The quality of the included studies was examined using the Cochrane risk-of-bias tool. Data synthesis was conducted using Review Manager (version 5.4; The Cochrane Collaboration).

RESULTS

A total of 16 RCTs with 7351 participants were included in this study. The included studies were published between 2014 and 2021 and were conducted in China, the United States, Australia, New Zealand, the United Kingdom, Ireland, and Norway. The sample sizes of the studies ranged from 75 to 2202, and the duration of the mHealth-based lifestyle interventions ranged from 4 to 28 weeks. Compared with usual care, mHealth-based lifestyle interventions significantly reduced the incidence of GDM (odds ratio [OR] 0.74, 95% CI 0.56-0.96; P=.03; I2=65%), preterm birth (OR 0.65, 95% CI 0.48-0.87; P=.004; I2=25%), macrosomia (OR 0.59, 95% CI 0.40-0.87; P=.008; I2=59%), and gestational weight gain (mean difference=-1.12 kg, 95% CI -1.44 to -0.80; P<.001; I2=43%). The subgroup analysis showed that interventions delivered via apps (OR 0.55, 95% CI 0.37-0.83; P=.004; I2=44%), provided by obstetricians (OR 0.69, 95% CI 0.51-0.93; P=.02; I2=60%), and targeted at Asian populations (OR 0.44, 95% CI 0.34-0.58; P<.001; I2=0%) and that used the International Association of Diabetes and Pregnancy Study Groups diagnostic criteria (OR 0.58, 95% CI 0.39-0.86; P=.007; I2=69%) showed a statistically significant reduction in the risk of GDM.

CONCLUSIONS

mHealth-based lifestyle interventions had a favorable impact on the prevention of GDM in pregnant women with overweight and obesity. Future studies need to further explore the potential of mHealth-based interventions for GDM through better design and more rigorous large-scale RCTs.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42021286995; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=286995.

Explore the use of complementary and alternative medicine among Chinese gynaecological patients with cancer undergoing chemotherapy: a qualitative phenomenological study

OBJECTIVES

To explore the use of complementary and alternative medicine (CAM) by Chinese gynaecological oncology patients undergoing chemotherapy and discuss measures to address the existing gaps.

DESIGN

Qualitative phenomenology. Semistructured in-depth interview. Colaizzi's method data analysis.

SETTING

A tertiary general hospital.

PARTICIPANTS

16 gynaecological oncology patients (mean age 51.7) having undergone ≥1 chemotherapy cycle were recruited by purposive sampling.

RESULTS

Six themes were generated. The participants were under-informed about CAM concept and options. They were open to explore various modalities after chemotherapy as long as it could alleviate symptoms. The gynaecological patients with cancer sought information about CAM from diverse sources, with professional expertise being the most desirable way to seek information. They used CAM as a strategy to support continued chemotherapy and for symptom alleviation. Financial burden was not stressed but they had concerns about sustainability of some therapies. Their attitudes toward different CAM types varied. Some were sceptical about the efficacy.

CONCLUSIONS

The Chinese gynaecological oncology patients may be under-informed about CAM. They are open to use various CAM therapies for symptom relief and as a support strategy. However, their attitudes toward specific therapies may vary. Some may host scepticism about certain CAM modalities. The patients actively seek information on CAM and treatment resources but prefer professional expertise to other sources. Financial burden due to continued CAM use is inconclusive due to possible sampling bias. Sustainability of CAM therapies is a common concern because of limited resources and access. Education on CAM should be incorporated into the curriculum of healthcare professionals. Oncologists and nurses should educate gynaecological patients with cancer on the concept and options of CAM, preferably with information tailored to patient's individual needs. Health authorities should advocate provisions of diverse CAM services and develop the necessary technologies such as network of local care resources.

Associations between problematic internet use, life satisfaction, and deliberate self-harm among Chinese adolescents: A multi-centered longitudinal study

INTRODUCTION

Problematic Internet use (PIU), which is associated with deliberate self-harm (DSH), has become a common problem among adolescents. Life satisfaction (LS) may be able to mitigate the negative influences of PIU and DSH. But the longitudinal associations among them are yet to be well-researched.

METHODS

A longitudinal study with three-wave data collection involving 6092 adolescents was carried out in China. PIU, LS, and DSH were assessed using the Young Internet Addiction Test, the Satisfaction with Life Scale, and the Deliberate Self-Harm Inventory Nine-Item Version, respectively. A cross-lagged model was used to analyze the longitudinal interactions between them. Generalized Estimating Equations were adopted to identify their influential factors.

RESULTS

The prevalence of single DSH behaviors from wave 1 to wave 3 was 5.04%, 5.00%, and 4.67%, and the repeated DHS from wave 1 to wave 3 was 2.9%, 3.2%, and 3.4%, respectively. Bidirectional longitudinal predictive associations were revealed between PIU and LS (p＜0.001), and LS and DSH (p＜0.001). DSH could longitudinally predict PIU (p＜0.001). Gender and age were associated with PIU, LS, and DSH (p＜0.001), and PIU was influenced by ethnicity (p＜0.001).

CONCLUSION

PIU and LS, LS and DSH were associated bidirectionally. Adolescents with more severe DSH behaviors were inclined to become addicted to the Internet, and adolescents with a history of DSH had a higher risk of recurring DSH. Parents, schools, and administrators need to improve the LS of adolescents, with a particular focus on older, female adolescents.

Marital adjustment and depressive symptoms among Chinese perinatal women: a prospective, longitudinal cross-lagged study

OBJECTIVES

The objective was to assess the prevalence of perinatal depressive symptoms and determine the trajectories of marital adjustment and depressive symptoms and their reciprocal relationships among Chinese perinatal women.

DESIGN

This was a prospective, longitudinal cross-lagged study.

SETTING

The study was conducted at the outpatient department of the largest women's and children's hospital in China, which is located in Chengdu, Sichuan Province.

PARTICIPANTS

Four hundred and sixty-three mothers were conveniently sampled.

MAIN OUTCOME MEASURES

The Dyadic Adjustment Scale and the Chinese version of the Edinburgh Postnatal Depression Scale were used to evaluate marital adjustment and depressive symptoms, respectively, at three time points: the first trimester of pregnancy (T1), the third trimester of pregnancy (T2) and 6 weeks after childbirth (T3). Descriptive statistics were used to assess the prevalence of perinatal depressive symptoms, and repeated-measures analysis of variance (ANOVA) was used to determine the trajectories of marital adjustment and depressive symptoms among the participants. A cross-lagged model was used to explore the reciprocal relationship between marital adjustment and depressive symptoms.

RESULTS

The prevalence of perinatal depressive symptoms among our participants ranged from 21.2% to 24.0%. Repeated-measures ANOVA showed that during the perinatal period there was a significant tendency towards worse marital adjustment (F=33.031, p=0.000) and a slight but not significant reduction in depressive symptoms (F=1.883, p=0.153) among the participants. The cross-lagged model showed that maternal marital adjustment at T1 significantly and negatively predicted depressive symptoms at T2 (β=-0.165, p<0.001), and that depressive symptoms at T2 significantly and negatively predicted marital adjustment at T3 (β=-0.135, p<0.001). However, the predictive effects of depressive symptoms at T1 on marital adjustment at T2 and that of marital adjustment at T2 on depressive symptoms at T3 were not significant.

CONCLUSION

The prevalence of perinatal depressive symptoms ranged from 21.2% to 24.0% among the participants. During the perinatal period, the marital adjustment of women tended to be worse; however, there was no significant change in depressive symptoms. This study showed that better marital adjustment at T1 was a protective factor against maternal depressive symptoms at T2, and a higher level of depressive symptoms at T2 was a risk factor for worse marital adjustment at T3.

Association between Maternal Body Composition in Second Trimester and Risk of Fetal Macrosomia: A Population-Based Retrospective Study in China

(1) Background: Female body composition undergoes significant changes to support fetal growth and development during pregnancy. This study investigated the association of maternal body composition in the second trimester and macrosomia and explored whether body-composition-related indicators could be used to predict macrosomia. (2) Methods: This study was conducted in China from December 2016 to December 2021. Women with singleton pregnancies, gestational ages between 37 and 42 weeks, and an absence of pregnancy complications were included. In the second trimester, bioelectric impedance analysis (BIA) was used to measure body-composition-related indicators. Logistic regression analysis was performed to explore the risk factors for macrosomia. The predictive performance of maternal body composition and clinical indicators for macrosomia were assessed using the area under the receiver-operating-characteristics curve (AUC). (3) Results: This retrospective study involved 43,020 pregnant women; we collected 2008 cases of macrosomia. Gravidity, gestational age, body mass index (BMI), gestational weight gain (GWG), total body water, fat mass, fat-free mass (FFM), skeletal muscle mass, and visceral fat level were risk factors for macrosomia (p < 0.05 for all). In the prediction model, the AUC of FFM for predicting macrosomia was the largest (0.742). (4) Conclusions: Body-composition-related indicators associated with macrosomia and body composition measurements in the second trimester can predict the risk of macrosomia, enabling clinicians to implement interventions earlier to reduce adverse perinatal outcomes.

Efficacy and safety of non-vitamin K antagonist oral anticoagulants in patients (≥80 years of age) with atrial fibrillation: systematic review and meta-analysis

Findings of prior studies about the efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOACs) in patients (≥80 years of age) with atrial fibrillation (AF) are controversial. So we performed a meta-analysis to evaluate the efficacy and safety of NOACs versus vitamin K antagonists (VKAs) in patients (≥80 years of age) with AF. A systematic review of PubMed, Cochrane, Embase, Web of Science and Chinese BioMedical databases was conducted until 1 October 2022. Studies reporting the effects and safety of NOACs versus warfarin in patients (≥80 years of age) with AF were included. Two authors independently performed study selection and data extraction. Discrepancies were resolved by consensus or through an independent third reviewer. Data were synthesised according to the Preferred Reporting Items for Systematic Reviews guidelines. We identified 15 studies providing data of 70 446 participants (≥80 years of age) suffering from AF. According to the meta-analysis (odds ratio (OR) (95% confidence interval, CI)), NOACs conferred better efficacy profile than VKAs in stroke and systemic embolism (0.8 (0.73-0.88)) and all-cause mortality (0.61 (0.57-0.65)). Otherwise, NOACs conferred a better safety profile than VKAs in major bleeding (0.76 (0.70-0.83)) and intracranial haemorrhage (ICH; 0.57 (0.47-0.68)). In conclusion, for patients (≥80 years of age) with AF, the risks of stroke and systemic embolism, all-cause mortality, were lower in NOACs compared to warfarin. The risks of major bleeding and ICH were also lower in NOACs compared to warfarin. NOACs showed better efficacy and safety than warfarin.

[Membrane anatomy in right colon cancer: definition and identification of mesocolic completeness]

Complete mesocolic excision (CME) and D3 resection of right colon cancer have been widely implemented, but the definition and identification of the completeness of the mesentery have not been fully agreed, especially the dorsal and medial borders. In this paper, we proposed the dorsal fascia of the colonic mesentery as the dorsal border of the mesocolon and the line connecting the roots of the ileocolic artery and the middle colic artery (ICA-MCA line) as the medial border of the CME by systematically studying the relationship between the mesentery and the mesenteric bed from the theory of membrane anatomy, combined with surgical experience and in-depth review of ontogenetic anatomy. We also proposed the visible "superior mesenteric vein notch" and "middle colic artery triangle" on surgical specimens as identifiers of mesocolic completeness.

Exploring the knowledge, attitudes, behaviors and training needs of obstetric and gynecological nurses regarding COVID-19 during the peak period of the pandemic in middle-risk areas of China: A cross-sectional study

Background

COVID-19 has become a global pandemic, which necessitates that health workers be capable of protecting themselves and their patients. This article aimed to describe knowledge levels, attitudes, behaviors and training needs regarding COVID-19 among obstetric and gynecological nurses in medium-risk areas during the pandemic.

Method

A cross-sectional survey of obstetric and gynecological nurses in medium-risk areas was performed during the peak period of the pandemic in China. The main survey tool was the self-designed COVID-19 Knowledge, Attitude, Behavior and Training Needs Questionnaire. Pearson correlation analysis was conducted to analyze the relationships among knowledge, attitudes, behaviors and training needs.

Results

A total of 599 nurses were recruited, of whom 27.7% failed the knowledge part of the questionnaire. Positive correlations were found between knowledge and attitudes (r = 0.100, P = 0.015) and between attitudes and behaviors (r = 0.352, P = 0.000) regarding occupational protection against COVID-19. A total of 88.5% of nurses preferred online training to traditional training, and more than 70% believed that demonstration of and training in operations by their own department were effective ways to learn about how to protect themselves against COVID-19.

Conclusion

The higher the level of knowledge about the disease was, the more positive the attitude toward occupational protection, and consequently, the more actively protective behaviors were adopted. Training affected nurses' knowledge of COVID-19 occupational protection and promoted positive attitudes, which further facilitated the effective prevention and control of the disease. Online training with demonstrations are recommended for COVID-19 training of nurses.

Exercises in activating lymphatic system on fluid overload symptoms, abnormal weight gains, and physical functions among patients with heart failure: A randomized controlled trial

Background

Fluid overload remains a vexing problem in management of heart failure. The lymphatic system that plays the central role in fluid homeostasis has recently been explored as a potential target to counteract tissue fluid overload. The goal of the study was to evaluate the preliminary effects of exercises in activating lymphatic system on fluid overload symptoms, abnormal weight gains, and physical functions for patients with heart failure.

Methods and results

A pilot, pre- and post-test, randomized clinical trial was conducted to recruit a total of 66 patients who were randomized to receive either a 4-week The-Optimal-Lymph-Flow for Heart Failure (TOLF-HF) program or usual care alone. The primary outcome was the prevalence and burden of the fluid overload symptoms. Findings of the trial showed that the TOLF-HF intervention was effective in reducing the prevalence or burden of the majority of fluid overload symptoms. TOLF-HF intervention also demonstrated significant improvement in the outcomes of abnormal weight gains (MD: -0.82; 95% CI: -1.43 to -0.21; P = 0.010) and physical functions (F = 13.792, P < 0.001).

Conclusions

The TOLF-HF program focusing on activating lymphatic system through the performance of therapeutic lymphatic exercises holds the promise as an adjuvant therapy for patients with heart failure to manage fluid overload symptoms, reduce abnormal weight gains, and improve physical functions. Future larger-scale study with longer duration of follow-up is needed.

Clinical Trial Registration

http://www.chictr.org.cn/index.aspx, identifier ChiCTR2000039121.

Associations between adolescents' empathy and prosocial attributes before and during the COVID-19 pandemic

BACKGROUND

Adolescence is a formative period of social development. Adolescents have experienced considerable changes in their lives due to the COVID-19 pandemic. We conducted a longitudinal study to examine the effects of the COVID-19 pandemic on adolescents' prosocial attributes and empathy, as well as their longitudinal bilateral relationships.

METHODS

A total of 2,510 students from five junior schools in Sichuan Province were recruited via random cluster sampling. Data were collected in December 2019 (Wave 1, before the outbreak of the pandemic) and July 2020 (Wave 2, during the pandemic) in Chengdu, Sichuan, China. Prosocial attributes and empathy were measured with the Positive Youth Development Scale (GPYDS) subscale and Chinese Empathy Scale, respectively.

RESULTS

During the pandemic, both empathy and prosocial attributes decreased significantly from 49.89 (9.12) and 49.89 (8.80) before to 48.29 (8.72) and 49.39 (9.26) (p < 0.001), respectively. A higher level of empathy at Wave 1 significantly predicted higher prosocial attributes at Wave 2 (β = 0.173, SE = 0.021, t = 8.430, p < 0.001). A lower prosocial attributes score predicted a significantly lower empathy score from Wave 1 to Wave 2 (β = 0.100, SE = 0.021, t = 4,884, p < 0.001).

CONCLUSIONS

The COVID-19 pandemic has had detrimental effects on adolescents' empathy and prosocial attributes. Special attention should be given to these two longitudinally associated factors in any social crisis, such as the COVID-19 pandemic, considering their importance for adolescents' physical, mental, and social development.

The psychological impact of the COVID-19 pandemic in the elderly in southwest China: A longitudinal study based on generalized estimating equations

The objectives of this study were to assess the trends in anxiety and depression levels in older adults nearly 10 months after the outbreak of coronavirus disease 2019 (COVID-19) and explore its determinants. A longitudinal study was performed between October 2019 and December 2020. The Patient Health Questionnaire 9-Item Scale and the Generalized Anxiety Disorder 7-Item Scale were used to assess depression and anxiety. Data were collected before (wave 1), during (wave 2), and 10 months after the COVID-19 outbreak (wave 3). The prevalence of depressive symptoms in the elderly was found to be 18.9%, 28.1%, and 35.9% at wave 1, wave 2, and wave 3 respectively. The prevalence of depressive symptoms at wave 1 was lower than that at wave 2 (χ ²  = 15.544, P < 0.001) and wave 3 (χ ² = 44.878, P < 0.001). There was no significant change in the prevalence of anxious symptoms (wave 1, 28.5%, wave 2, 30.3%, and wave 3, 30.3%). Older adults who were single/divorced/widowed had higher levels of anxiety compared with those who were married (OR = 2.306 95%CI 1.358-3.914, P = 0.002). The pandemic appeared to be associated with increases in depressive symptoms in older persons. Targeted interventions could be carried out among those with higher risk of maladjustment.

Development and validation of a prediction model for intrapartum cesarean delivery based on the artificial neural networks approach: a protocol for a prospective nested case-control study

INTRODUCTION

Although intrapartum caesarean delivery can resolve dystocia, it would still lead to several adverse outcomes for mothers and children. The obstetric care professionals need effective tools that can help them to identify the possibility and risk factors of intrapartum caesarean delivery, and further implement interventions to avoid unnecessary caesarean birth. This study aims to develop a prediction model for intrapartum caesarean delivery with real-life data based on the artificial neural networks approach.

METHODS AND ANALYSIS

This study is a prospective nested case-control design. Pregnant women who plan to deliver vaginally will be recruited in a tertiary hospital in Southwest China from March 2022 to March 2024. The clinical data of prelabour, intrapartum period and psychosocial information will be collected. The case group will be the women who finally have a baby with intrapartum caesarean deliveries, and the control group will be those who deliver a baby vaginally. An artificial neural networks approach with the backpropagation algorithm multilayer perceptron topology will be performed to construct the prediction model.

ETHICS AND DISSEMINATION

Ethical approval for data collection was granted by the Ethics Committee of West China Second University Hospital, Sichuan University, and the ethical number is 2021 (204). Written informed consent will be obtained from all participants and they can withdraw from the study at any time. The results of this study will be published in peer-review journal.

[Serum lipoprotein-associated phospholipase A2 level is positively correlated with the recurrence risk of acute ischemic cerebral infarction in hypertensive patients]

OBJECTIVE

To explore the relationship between serum lipoprotein-associated phospholipase A2 (Lp-PLA2) level and the risk of acute ischemic stroke (AIS) recurrence in hypertensive patients.

METHODS

This retrospective case-control study was conducted among 211 hypertensive patients with AIS treated in Foshan First People's Hospital, including 35 patients with recurrence of AIS during the 1-year follow-up as confirmed by head CT/MR. In the overall patients, 60 had grade 1 hypertension (including 5 recurrent cases), 76 had grade 2 hypertension (with 11 recurrent cases), and 75 had grade 3 hypertension (with 19 recurrent cases). Univariate analysis, multivariate logistic regression analysis, trend analysis, and smooth curve fitting analysis were performed to explore the correlation between serum Lp-PLA2 level within 24 h after admission and the risk of AIS recurrence. The predictive efficacy of serum Lp-PLA2 level for AIS recurrence in different hypertension grades was evaluated using ROC curve analysis.

RESULTS

Serum Lp-PLA2 level, age, NIHSS score at admission, mRS scores at 7 days, homocysteine level and smoking status differed significantly between patients with and without AIS recurrence (P < 0.05). After adjustment for confounding factors, multivariate regression analysis showed that the highest tertile of Lp-PLA2 level was associated with a 4.13-fold increase of AIS recurrence risk compared with the lowest tertile (OR=5.13, 95% CI: 1.35-19.40), and each 1 ng/mL increase of Lp-PLA2 level was associated with a 1% increase of AIS recurrence risk (OR= 1.01, 95% CI: 1.01-1.02). Serum Lp-PLA2 level was shown to positively correlate with AIS recurrence risk, and in patients with grade 3 hypertension, its areas under the ROC curve for predicting AIS recurrence was 0.869 with a specificity of 0.893 and a sensitivity of 0.737.

CONCLUSION

Serum Lp-PLA2 concentration is an independent risk factor and potentially an effective predictor for AIS recurrence in patients with grade 3 hypertension.

Depressive symptoms and physical activity among community-dwelling perimenopausal women: a prospective longitudinal study

BACKGROUND

Women in perimenopause are vulnerable to depressive symptoms, and physical activity was reported to be a potential protective factor. The trajectories of physical activity and depressive symptoms over time and their longitudinal relationships in Chinese perimenopausal women have not been explored yet, leaving a research gap hindering us from better understanding and managing perimenopause depressive symptoms.

METHODS

A multi-center prospective longitudinal study was conducted in four cities in Sichuan Province, China. Depressive symptoms and physical activity in perimenopausal women were collected in March 2019, June 2019, September 2019, and December 2019, respectively. Multivariable linear regression by generalized estimation equation was used to identify the relevant factors associated with depressive symptoms and physical activity. A four-wave autoregressive and cross-lagged panel model was performed to explore their longitudinal relationships.

RESULTS

A total of 1875 women who completed the four-wave data collection were included in the data analysis. Depressive symptoms exacerbated over time and were associated with women's age, monthly income, marital status, chronic disease, and negative life events. Physical activity decreased over time and was associated with educational background and monthly income. According to the cross-lagged panel model, perimenopausal women with more severe depressive symptoms tended to be less physically active, and similarly, perimenopausal women with less physical activity were more prone to report more severe depressive symptoms.

CONCLUSION

The cross-lagged panel model disclosed longitudinal bidirectional relationships between depressive symptoms and physical activity in perimenopausal women. Appropriate physical activity should be recommended for perimenopausal women to improve their mental well-being. Tailored physical activity duration and maintenance measures should be proposed based on different sociodemographic statuses.

The role and molecular mechanism of gut microbiota in Graves' orbitopathy

PURPOSE

Graves' orbitopathy (GO) is an autoimmune orbital disorder. Gut microbiota dysfunction plays a vital role in autoimmune diseases, including Graves' disease (GD) and GO. In the present study, we aimed to investigate the change of gut microbiota in GD/GO using mouse model.

METHODS

The murine model of GD/GO was established by the challenge of adenovirus expressing thyroid-stimulating hormone (TSH) receptor (TSHR) (Ad-TSHR). The histological changes of orbital and thyroid tissues were analyzed by hematoxylin and eosin (H&E), Masson staining, and immunohistochemistry (IHC) staining. The fecal samples were collected for 16S rRNA gene sequencing and bioinformatics analysis.

RESULTS

The GD/GO model was established successfully, as manifested as the broadened eyelid, exophthalmia and conjunctive redness, severe inflammatory infiltration among thyroid glands and between extraocular muscle space, hypertrophic extraocular muscles, elevated thyroxine (T4) and decreased TSH, and positive CD34, CD40, collagen I, and α-SMA staining. A total of 222 operational taxonomic units (OUTs) were overlapped between mice in the Ad-NC and Ad-TSHR groups. The microbial composition of the samples in the two groups was mainly Bacteroidia and Clostridia, and the Ad-NC group had a significantly lower content of Bacteroidia and higher content of Clostridia. KEGG orthology analysis results revealed differences in dehydrogenase, aspartic acid, bile acid, chalcone synthase, acetyltransferase, glutamylcyclotransferase, glycogenin, and 1-phosphatidylinositol-4-phosphate 5-kinase between two groups; enzyme commission (EC) analysis results revealed differences in several dehydrogenase, oxidase, thioxy/reductase between two groups; MetaCyc pathways analysis results revealed differences in isoleucine degradation, oxidation of C1 compounds, tricarboxylic acid (TCA) cycle IV, taurine degradation, and biosynthesis of paromamine, heme, colonic acid building blocks, butanediol, lysine/threonine/methionine, and histidine/purine/pyrimidine between two groups.

CONCLUSION

This study induced a mouse model of GD/GO by Ad-TSHR challenge, and gut microbiota characteristics were identified in the GD/GO mice. The Bacteroidia and Clostridia abundance was changed in the GD/GO mice. These findings may lay a solid experimental foundation for developing personalized treatment regimens for GD patients according to the individual gut microbiota. Given the potential impact of regional differences on intestinal microbiota, this study in China may provide a reference for the global overview of the gut-thyroid axis hypothesis.

Longitudinal associations between sleep quality and menopausal symptoms among community-dwelling climacteric women: A multi-centered study

STUDY OBJECTIVES

Menopausal symptoms exist in most climacteric women, which can harm the quality and satisfaction of life for them. Moreover, a series of ineluctable negative life changes experienced in middle-age usually make the situation more complicated and stressful. We aimed to determine the trajectories and influential factors of sleep quality and menopausal symptoms and their longitudinal interrelationships among climacteric women.

METHODS

A total of 1875 community-dwelling climacteric women were included in this study. The Pittsburgh Sleep Quality Index (PSQI) and the Menopause Rating Scale (MRS) were adopted to assess sleep quality and menopausal symptoms, respectively. Data were collected 4 times from March 2019 to December 2019, at a 3-month interval.

RESULTS

The Cross-lagged analysis showed that worse sleep quality and more severe menopausal symptoms over time after controlling for specified covariates, and more severe menopausal symptoms were predicted by declined sleep quality. The Generalized estimation equation model showed that education level, marital status, chronic diseases, life events, income, and age were the influential factors of sleep quality, while menopausal symptoms were impacted by marital status and income.

CONCLUSIONS

Increasing negative sleep quality and more severe menopausal symptoms over time contribute to the health burden of climacteric women. Menopausal symptoms could be alleviated by sleep quality improvement, which is influenced by education level, marital status, chronic diseases, life events, age, and economic factors.

[Correlation analysis between drought and outpatient visits for diarrhea in children aged 0-6 in Lanzhou city and Tianshui city, Gansu Province]

In this study, the data of pediatric diarrhea clinic of Gansu Provincial Maternal and Child Health Hospital from January 1, 2014 to December 31, 2018 and Tianshui First Hospital from January 1, 2015 to December 31, 2018 were collected. Standardized precipitation index (SPI) and meteorological drought composite index (MCI) were used as drought indicators. Quasi-Poisson generalized additive model was used to analyze the correlation between drought and pediatric diarrhea outpatient visits. During the study period, the dry days in Lanzhou city and Tianshui city were 298 and 379 days according to SPI-1, 303 and 398 days according to MCI, respectively. There were 57 147 and 18 703 cases of diarrhea in children aged 0-6 years in Gansu Provincial Maternal and Child Health Hospital and Tianshui First Hospital, respectively. MCI and SPI (SPI-1) based on monthly precipitation were negatively correlated with the number of pediatric diarrhea outpatients. Compared with the non-drought period, SPI-1 showed the strongest correlation between middle drought and pediatric diarrhea outpatients, with an increase of 13.4% (95%CI: 7.9%-19.3%) and 20.0% (95%CI: 12.7%-27.8%) in Lanzhou city and Tianshui city, respectively. According to MCI, the outpatients with diarrhea in Tianshui children increased by 60.5% (95%CI: 3.4%-149.0%) due to extreme drought.

Effectiveness of early essential newborn care on breastfeeding and maternal outcomes: a nonrandomized controlled study

Background

Breastfeeding and maternal health play crucial roles in improving newborn health, which is closely related to the development of families and society. Early essential newborn care, which emphasizes early exclusive breastfeeding and skin-to-skin contact, is recommended by the World Health Organization. This study aimed to explore the association of early essential newborn care with breastfeeding and maternal outcomes.

Methods

A nonrandomized controlled study was carried out from May 2020 to January 2021 in a tertiary hospital in Chengdu city, China. Pregnant women were recruited from the maternity ward before they gave birth. Early essential newborn care was performed for 91 mother-newborn pairs after birth in the intervention group, while routine birth care was performed for 91 mother-newborn pairs in the control group. Data on breastfeeding and maternal outcomes were collected pre-test and post-test and were recorded by trained data collectors and retrieved from hospital case record files.

Results

Compared with the control group, the intervention group had a higher incidence of early breastfeeding initiation, an earlier initiation and longer duration for the first breastfeeding, a higher incidence of successful first breastfeeding, more exclusive breastfeeding at hospital discharge, higher maternal breastfeeding self-efficacy, a shorter duration of the third stage of labour, lower postpartum blood loss, and lower scores of maternal pain and anxiety postpartum; the differences were statistically significant (p < 0.05).

Conclusion

The implementation of high-quality early essential newborn care can help mothers initiate early breastfeeding, improve exclusive breastfeeding rates at hospital discharge, enhance breastfeeding self-efficacy, promote the woman’s recovery from labour, and reduce maternal anxiety and pain in the postpartum period. High-quality early essential newborn care is recommended to policymakers and medical professionals to improve breastfeeding and maternal outcomes.

Trial registration

Chinese Clinical Trial Registry, Retrospective Registration (27/7/2021), registration number: ChiCTR2100049231.

Knowledge, attitude and practice regarding occupational protection against COVID-19 among midwives in China: A nationwide cross-sectional study

Midwives assume the roles in protecting perinatal women and newborns, meanwhile defending their own safety during the epidemic of COVID-19. Since there is currently no specific treatment available that targets the disease, strictly compliance with various infection prevention and control measures appears utmost important to achieve their occupational safety. We then explored the status quo and influencing factors of the knowledge, attitude and practice (KAP) of occupational protection against the COVID-19 among midwives in China. This online cross-sectional survey was conducted on 2663 midwives across the China during the early stages of the pandemic with a self-reported structured questionnaire. 97.4% and 92.9% of them were identified with positive attitude and appropriate practice, respectively, whereas only 6.4% showed good level of knowledge about the occupational protection toward the COVID-19. Midwives with older age, keeping on working during the breakout period, completing the training programs, caring the confirmed COVID-19 cases and having family members with cold-like symptoms were significantly associated with their KAP status. This study could provide valuable information not only for policy makers and administrators to optimize resource allocation and design education programs on targeted midwives, but also serve as a baseline for measuring changes in subsequent, post-intervention KAP studies.

The relationship between family functioning and non-suicidal self-injury in adolescents: A structural equation modeling analysis

BACKGROUND

Previous research has suggested that depressive symptoms, emotional competence, and posttraumatic stress symptoms (PTSS) may mediate the association between family functioning and non-suicidal self-injury (NSSI). Therefore, this study aimed to evaluate the mediation effects of depressive symptoms, emotional competence, and COVID-related PTSS on the relationship between family functioning and NSSI in adolescents.

METHOD

A sample of 5854 adolescents was recruited from June 16 to July 8, 2020. The data for family functioning, depressive symptoms, emotional competence, COVID-related PTSS, and NSSI behavior of adolescents were collected via self-reported questionnaires. A structural equation model was constructed to examine the relationship, and a bootstrap analysis was conducted to evaluate the mediation effects.

RESULTS

The reporting rate of adolescent NSSI was 30.2%. The poor family functioning was positively associated with adolescent NSSI (β = 0.130, 95% CI = 0.093-0.182), which was mediated by depression with effect size of 0.231 (95% CI = 0.201-0.257). The pathway coefficients between emotional competence and NSSI, and depression, COVID-related PTSS and NSSI, though statistically significant were unlikely to be clinically meaning with values of 0.057 and 0.015. There was no mediating effect by COVID-related PTSS. The pathways initially constructed between family functioning and COVID-related PTSS, emotional capacity and COVID-related PTSS were not been verified.

LIMITATIONS

It was unclear whether this mediational effect would be supported in a longitudinal design. The application and extension of this model toward other regions and countries, and different ages need to be further explored.

CONCLUSION

The interventions of adolescent NSSI should focus on both the family level and individual levels. Improving family environment, screening depressive symptoms, enhancing emotional competence and lessening COVID-related PTSS may reduce NSSI.

Breastfeeding education in Chinese hospitals: A cross-sectional study

BACKGROUND

Breastfeeding education plays a crucial role in improving breastfeeding outcomes and has been employed in many medical institutions across China.

OBJECTIVES

To describe the current situation of breastfeeding education provided by hospitals to women in China, and to identify relevant factors associated with the exclusive breastfeeding rate at hospital discharge and the early breastfeeding initiation rate.

DESIGN

A cross-sectional study design.

SETTINGS AND PARTICIPANTS

We used an online survey platform called WenjuanXing to collect data from 2985 hospitals in China.

METHODS

We designed a questionnaire to collect data. The Mann-Whitney U test and Pearson's chi-square test were used to identify the differences between the different types and levels of hospitals. Binary logistic regression analysis was used to analyze the factors associated with the exclusive breastfeeding rate at hospital discharge and the early breastfeeding initiation rate.

RESULTS

A total of 2941 hospitals were included in the data analysis. In 86% of hospitals midwives were providing breastfeeding education on weekdays during the daytime. Information on how to deal with mastitis (80.8%) and weaning methods (71.5%) was less commonly provided to women. The hospitals often conducted breastfeeding education through antenatal education sessions and bedside health education, while 34.2% of hospitals used smartphone applications. The obstacles to conducting breastfeeding education in hospitals were a lack of full-time staff dedicated to breastfeeding education (43.3%) and limited funds invested in breastfeeding education (42.5%). A lack of full-time staff dedicated to breastfeeding education (OR, 0.689; 95% CI, 0.498-0.953) and a lack of space (OR, 0.697; 95% CI, 0.487-0.997) were associated with the exclusive breastfeeding rate at hospital discharge. Furthermore, a lack of full-time staff dedicated to breastfeeding education (OR, 0.372; 95% CI, 0.235-0.589) was associated with the early breastfeeding initiation rate.

CONCLUSIONS

To improve breastfeeding outcomes, hospital managers and policymakers should increase the number of midwives and full-time staff who are dedicated to breastfeeding education, resolve the obstacles of limited funds and space for breastfeeding education, and explore more approaches to providing knowledge on breastfeeding to women and their families.

A WeChat-Based Rehabilitation Platform for Children and Adolescents with Congenital Heart Disease to Promote Cardiac FITness (HeartFIT): Protocol for a Mixed-Methods Strategy from Evidence-Based Design to Pilot Study

Progress in medical and surgical care has tremendously improved the survival rates of children with congenital heart disease (CHD). However, reduced aerobic capacity and health-related issues remain a threaten to quality survival and prevention of related complications among children and adolescents with CHD. This research program aims to develop and evaluate a WeChat-based health platform (HeartFIT) to facilitate cardiac rehabilitation and promote physical fitness for this rapidly expanding young population. The study protocol describes the use of an iterative process of using a mixed-methods strategy to develop, refine, and pilot test the proposed HeartFIT platform. A sequential problem-solving process comprising four iterative phases with ongoing end-user input will be implemented. In phase 1, relevant literature was systematically reviewed (completed) and then child-parent dyads will be interviewed to understand the broad context and the requirements and considerations of the target population toward the WeChat-based rehabilitation platform. In phase 2, key features and priority functionalities for the platform will be ideated and refined, and a digital interactive prototype will be created. In phase 3, heuristic evaluation and three rounds of end-user testing will be conducted to ensure further refinement and usability of the prototype. In phase 4, a prospective pilot study will be performed to investigate the feasibility, acceptability, and preliminary efficacy of the developed platform over a 12-week intervention period. If HeartFIT intervention is feasible, acceptable, and demonstrates promising efficacy, an adequately powered randomized controlled trial (future work) will be deployed to test the real-world effectiveness of the intervention.

Effects of early essential newborn care versus routine birth care on physiological variables and sleep state among newborn infants: a quasi-experimental design

Background

Early essential newborn care (EENC) was introduced to medical practice in China in 2016, but the number of medical institutions that have put EENC into practice remains low due to insufficient clinical evidence and the absence of awareness among health professionals. This study aimed to explore the effect of EENC on physiological variables and sleep state among newborn infants and to provide evidence to support the implementation of EENC.

Methods

A quasi-experimental design was conducted among 182 newborn infants in a tertiary maternity hospital in China from May 2020 to January 2021. A total of 91 newborn infants were included in the intervention group, and 91 were included in the control group to receive EENC or routine birth care, respectively.

Results

The newborn infants in the intervention group had a lower incidence of hypothermia than those in the control group at 75 min, 90 min, 105 min, and 120 min after birth (p < 0.05). The time of first breathing after birth in the intervention group was earlier than that in the control group (5 s vs. 7 s, p < 0.05), and the infants had a better sleep state at 30 min, 60 min, 90 min, and 120 min after birth (p < 0.05).

Conclusions

EENC can decrease the incidence of hypothermia, promote the initiation of breathing, and improve the sleep state among newborn infants compared to routine birth care in China. More coaching should be provided to health professionals to promote the implementation of EENC in China.

Trial registration

Chinese Clinical Trial Registry, Retrospective Registration (27/7/2021), registration number: ChiCTR2100049231.

Physical activity and depressive symptoms among community-dwelling older adults in the COVID-19 pandemic era: A three-wave cross-lagged study

The aim of the study is to determine the trajectories of physical activity and depressive symptoms and their reciprocal relationship among community-dwelling older adults in the COVID-19 pandemic era. The study population consisted of a cohort of 511 participants aged 60 years and over, who were recruited from eight community health centers in Ya'an, China. The Physical Activity Scale for the Elderly and the Patient Health Questionnaire were respectively used to measure physical activity and depressive symptoms at three time points: before the COVID-19 outbreak (T₀), during the outbreak period (T₁), and after the subsidence of COVID-19 (T₂). The results revealed that physical activity and depressive symptoms fluctuated substantially across T₀, T₁, and T₂. In addition, more severe depressive symptoms at T₀ and T₁ were significantly associated with lower levels of physical activity at T₁ and T₂, but the obverse direction of physical activity being associated with subsequent depressive symptoms was not observed in the current study. These findings highlight the importance of supporting old people to remain physically active and combat mental distress early in a pandemic, and prevention and management of depressive symptoms may also be beneficial to promote physical activity.

Readiness for hospital discharge in primary caregivers for children with acute lymphoblastic leukaemia

AIM

To investigate existing status and factors affecting the readiness for hospital discharge in primary caregivers for children with acute lymphoblastic leukaemia in China.

BACKGROUND

Acute lymphoblastic leukaemia is the most common childhood cancer, but there is not enough research on the readiness for hospital discharge.

DESIGN

A cross-sectional study was performed by convenience sampling and questionnaire survey.

METHODS

A self-developed questionnaire of general and clinical characteristics of patients, self-developed questionnaire of general status of family and primary caregivers, questionnaire of readiness of hospital discharge scale and social support rating scale for primary caregivers were delivered to 264 primary caregivers of childhood acute lymphoblastic leukaemia patients. Data collection was carried out 24 h before discharge at bedside. In this study, the STROBE checklist was followed.

RESULTS

In total, 253 patients aged 0-16 years, including their primary caregivers in the hospital, were included from November 2016 to August 2017. Based on the readiness scale, the total mean score of readiness was 157.36. Based on the social support scale, the total mean score was 42.17. According to multivariate analysis, periods of chemotherapy (p < .001), complications (p = .019), family economic situation (p = .023), understanding of leukaemia (p < .001), objective support (p = .004), subjective support (p < .001) and availability of support (p = .045) were the main influencers of readiness.

CONCLUSIONS

The readiness for hospital discharge in primary caregivers for childhood lymphoblastic leukaemia patients is not satisfactory in China.

RELEVANCE TO CLINICAL PRACTICE

This study has implications for public health administration, asking for better community services and disease education. In addition, more effort should be made to provide high-quality family and primary caregiver assessments and discharge education by nurses.

Periodontitis Salivary Microbiota Worsens Colitis

Evidence suggests that periodontitis contributes to the pathogenesis of inflammatory bowel disease, including Crohn's disease and ulcerative colitis. However, few studies have examined the role of swallowing and saliva in the pathogenesis of gastrointestinal diseases. Saliva contains an enormous number of oral bacteria and is swallowed directly into the intestine. Here, we explored the influence of periodontitis salivary microbiota on colonic inflammation and possible mechanisms in dextran sulfate sodium (DSS)-induced colitis. The salivary microbiota was collected from healthy individuals and those with periodontitis and gavaged to C57BL/6 mice. Periodontitis colitis was induced by DSS for 5 d and ligature for 1 wk. The degree of colon inflammation was evaluated through hematoxylin and eosin staining, ELISA, and quantitative real-time polymerase chain reaction. Immune parameters were measured with quantitative real-time polymerase chain reaction, flow cytometry, and immunofluorescence. The gut microbiota and metabolome analyses were performed via 16S rRNA gene sequencing and liquid chromatography-mass spectrometry. Although no significant colitis-associated phenotypic changes were found under physiologic conditions, periodontitis salivary microbiota exacerbated colitis in a periodontitis colitis model after DSS induction. The immune response more closely resembled the pathology of ulcerative colitis, including aggravated macrophage M2 polarization and Th2 cell induction (T helper 2). Inflammatory bowel disease-associated microbiota, such as Blautia, Helicobacter, and Ruminococcus, were changed in DSS-induced colitis after periodontitis salivary microbiota gavage. Periodontitis salivary microbiota decreased unsaturated fatty acid levels and increased arachidonic acid metabolism in DSS-induced colitis, which was positively correlated with Aerococcus and Ruminococcus, suggesting the key role of these metabolic events and microbes in the exacerbating effect of periodontitis salivary microbiota on experimental colitis. Our study demonstrated that periodontitis contributes to the pathogenesis of colitis through the swallowing of salivary microbiota, confirming the role of periodontitis in systemic disease and providing new insights into the etiology of gastrointestinal inflammatory diseases.

Effect of nurse-led hospital-to-home transitional care interventions on mortality and psychosocial outcomes in adults with heart failure: a meta-analysis

AIMS

To determine the effectiveness and dose-response of nurse-led hospital-to-home transitional care interventions (TCIs) on patient mortality and psychosocial outcomes of health-related quality of life (HRQoL), self-care behaviours, and emotional well-being in adults hospitalized with heart failure (HF) and to recognize pertinent characteristics that potentially affect the overall effectiveness.

METHODS AND RESULTS

Relevant studies were identified through electronic database searches, including MEDLINE, Embase, CINAHL, and Cochrane Library from January 2000 until January 2021. Two independent authors performed study selection, data abstraction, and risk-of-bias assessment. When appropriate, we used random-effects meta-analysis to derive pooled effect estimates, investigated dose-response relationships, and ran meta-regressions to locate the source of heterogeneity. A total of 27 studies with 7635 participants were included. Our findings revealed that nurse-led hospital-to-home TCIs reduced the risk of all-cause mortality by 21% [risk ratio = 0.79; 95% confidence interval (CI) 0.68-0.92; P = 0.003] and improved HRQoL (mean difference = -3.29; 95% CI -6.51 to -0.07; P = 0.04) compared to usual care, but non-significant effects were found for emotional well-being. The narrative summary of evidence for self-care behaviours showed positive intervention effects. Meta-regression did not find any covariates that were significantly related to mortality or HRQoL. Dose-response analysis showed that mortality risk was reduced with increased intensity and complexity of the nurse-led TCIs.

CONCLUSION

Generally, nurse-led hospital-to-home TCIs may play a beneficial role in decreasing mortality, and improving HRQoL and self-care behaviours for adults with HF. Additional studies are warranted to characterize the optimal nurse-led TCIs for HF management.

Risk of type 2 diabetes mellitus after gestational diabetes mellitus: A systematic review & meta-analysis

Background &objectives:

Women with gestational diabetes are at an increased risk of being diagnosed as type 2 diabetes, but the postpartum screening rate is low. To provide evidence-based data for health providers and promote postpartum screening, this systematic review and meta-analysis was conducted to access the risks of type 2 diabetes mellitus (T2DM) diagnosis after gestational diabetes mellitus (GDM) in different demographic and maternal subgroups.

Methods:

MEDLINE, Embase and Cochrane Library were searched systematically. Unadjusted relative risks (RRs) and 95 per cent confidence intervals (CIs) were calculated and pooled using a random-effects model. Heterogeneity was assessed with Cochrane’s Q text and by calculating I² values. Subgroup analyses were conducted to address the disparities of type 2 diabetes conversion after gestational diabetes in different demographic and maternal subgroups.

Results:

1809 publications were screened and 39 cohort studies including 2,847,596 women were selected. In these studies, 78,893 women were diagnosed as T2DM at six weeks or later after delivery. The unadjusted RRs of women diagnosed T2DM at six weeks or later after delivery ranged from 1.32 (95% CI, 0.46-3.37) to 47.25 (95% CI, 2.95-758.01) with a pooled unadjusted RR of 8.92 (95% CI, 7.84-10.14). Older women, women with a family history of diabetes, Black and non-Hispanic White women and women living in Europe and South-East Asia had a higher risk of developing T2DM after GDM.

Interpretation & conclusionsxs:

It is suggested that healthcare providers may focus on older women with GDM and women with GDM and a family history of diabetes. Black and non-Hispanic White women with GDM may receive more attention, and healthcare providers, especially those in Europe and South-East Asia, may pay more attention to preventive measures for postpartum T2DM.

The association between soy intake and risk of gestational diabetes mellitus: a prospective cohort study

BACKGROUND

The association between soy intake and adverse pregnancy outcomes remains unclear. The objectives of this study were to investigate the soy consumption of pregnant women in the second trimester and explore the prospective association between soy intake and the risk of adverse pregnancy outcomes.

METHODS

Pregnant women between 13 and 24 weeks of gestation were recruited at a women's and children's hospital in southwest China from June to December 2019. Dietary intakes in the middle trimester were assessed by a semi-quantitative food frequency questionnaire. Participants were divided into the insufficient group (< 40 g/day) and the control group (≥40 g/day) according to daily soy consumption. Participants were followed up until delivery. Pregnancy outcomes including gestational diabetes mellitus (GDM), cesarean section, and macrosomia were obtained. Multiple logistic regression was used to analyze the association between soy intake and risk of adverse pregnancy outcomes. Sociodemographic information, histories of diseases, and duration of physical activities were obtained and used for covariate adjustments.

RESULTS

A total of 224 participants were included in this study, of which identified 36 (16.1%) cases of GDM, and 120 (53.6%) cases of cesarean section. More than half (125, 55.8%) pregnant women consumed less soy than 40 g/day. Daily soy intake less than 40 g was associated with the increased risk of GDM (OR = 2.755 95%CI 1.230-6.174, P = 0.014) and cesarean section (OR = 1.792 95%CI 1.035-3.101, P = 0.037) without adjustment for confounders such as age, pre-pregnancy body mass index, parity, daily intake of vegetables, fruits, seafood and, nuts. After adjusting for these factors, daily soy intake of less than 40 g increased 2.116-fold risk of GDM (95%CI 1.228-7.907, P = 0.017), but not with the significantly increased risk of cesarean section.

CONCLUSION

Insufficient soy intake may increase the risk of GDM, suggesting adequate soy intake may have a beneficial role in the prevention of GDM.

TRIAL REGISTRATION

Registration number: ChiCTR1900023721 . Date of registration: June 9, 2019.

[Radical surgery for colon cancer guided by membrane anatomy theory]

Like other solid tumors, colon cancer surgery has undergone a century-old journey from lumpectomy to organ resection and then to lymphadenectomy. From the Toldt fascia to complete mesenteric resection, and from local resection to D3 radical treatment, local recurrence rates have been reduced, but remain a nuisance to surgeons and patients. Based on the theory of membrane anatomy, radical surgery for colon cancer will focus more on removing the mesocolon from the mesentery bed while maintaining the integrity of the posterior fascia to avoid the occurrence of "fifth metastasis" as much as possible. Thanks to the membrane anatomy theory, its strong reproducibility and replicability, a new phase of colorectal surgery is on the horizon.

Sex Differences in Pulmonary Eicosanoids and Specialized Pro-Resolving Mediators in Response to Ozone Exposure

Ozone (O3) is a criteria air pollutant known to increase the morbidity and mortality of cardiopulmonary diseases. This occurs through a pulmonary inflammatory response characterized by increased recruitment of immune cells into the airspace, pro-inflammatory cytokines, and pro-inflammatory lipid mediators. Recent evidence has demonstrated sex-dependent differences in the O3-induced pulmonary inflammatory response. However, it is unknown if this dimorphic response is evident in pulmonary lipid mediator metabolism. We hypothesized that there are sex-dependent differences in lipid mediator production following acute O3 exposure. Male and female C57BL/6J mice were exposed to 1 part per million O3 for 3 hours and were necropsied at 6 or 24 hours following exposure. Lung lavage was collected for cell differential and total protein analysis, and lung tissue was collected for mRNA analysis, metabololipidomics, and immunohistochemistry. Compared to males, O3-exposed female mice had increases in airspace neutrophilia, neutrophil chemokine mRNA, pro-inflammatory eicosanoids such as prostaglandin E2, and specialized pro-resolving mediators (SPMs) such as resolvin D5 in lung tissue. Likewise, precursor fatty acids (arachidonic and docosahexaenoic acid; DHA) were increased in female lung tissue following O3 exposure compared to males. Experiments with ovariectomized females revealed that loss of ovarian hormones exacerbates pulmonary inflammation and injury. However, eicosanoid and SPM production were not altered by ovariectomy despite depleted pulmonary DHA concentrations. Taken together, these data indicate that O3 drives an increased pulmonary inflammatory and bioactive lipid mediator response in females. Furthermore, ovariectomy increases susceptibility to O3-induced pulmonary inflammation and injury, as well as decreases pulmonary DHA concentrations.

Bilateral associations between sleep duration and depressive symptoms among Chinese adolescents before and during the COVID-19 pandemic

Depression is one of the most prevalent psychiatric disorders and the leading cause of disability among adolescents, with sleep duration as its vital influential factor. Adolescents might be mentally sensitive to the stress caused by the COVID-19 pandemic. Yet, the alteration of adolescents' sleep duration, depression, and their associations within the context of the COVID-19 pandemic have not been well documented. We conducted a longitudinal study, recruiting 2496 adolescents from 3 junior high schools to examine the alteration of their sleep duration and depressive symptoms before and during the pandemic, and to explore their potential association(s). Data were collected before (December 2019) and during the pandemic (July 2020). Paired samples t-test revealed a significant decrease in sleep duration and a significant increase in depressive symptoms during the COVID-19 pandemic. Higher grades, COVID-19 infection history, higher CES-DC score, and the COVID-19 pandemic itself might contribute to decreased sleep duration, while longer exercise duration during the pandemic might be a protective factor. According to the cross-lagged analysis, the existence of depressive symptoms before the pandemic was significantly associated with a shorter sleep duration during the pandemic (β = -0.106, p < 0.001). Previously shortened sleep duration was significantly associated with a greater likelihood of depressive symptoms during the pandemic (β = -0.082, p < 0.001). Our findings revealed that the COVID-19 pandemic has a negative influence on adolescents' mental health and sleep. Mental preparedness should be highlighted to mitigate the psychosocial influences of any possible public emergencies in the future. Sleep duration represents a viable home-based intervention for depressive symptoms.

Exploring the relationship between spiritual well-being and death anxiety in patients with gynecological cancer: a cross-section study

Background

In recent years, spiritual well-being has gradually gained the attention of health care providers in China, especially those in oncology departments, who have recognized the importance of improving spiritual well-being in cancer patients. Since most of the current research on spiritual well-being has been carried out in areas with religious beliefs, this study was conducted in the context of no development of formal religion. The purpose of this study was to explore the relationship between death anxiety and spiritual well-being and the related factors of spiritual well-being among gynecological cancer patients.

Methods

This cross-section study was conducted among 586 gynecological cancer patients. The European Organization for Research and Treatment for Cancer Quality of Life Questionnaire-spiritual well-being32 (EORTC QLQ-SWB32) and Templer's Death Anxiety Scale (T-DAS) were used to measure spiritual well-being and death anxiety. The Multiple Linear Regression Model was used to determine the relationship between spiritual well-being and death anxiety.

Results

For all participants, the highest QLQ-SWB32 centesimal score was 75.13 on the Relationship with Other scale, and the lowest was 60.33 on the Relationship with Someone or Something Greater Scale. The mean Death Anxiety score was 5.31 (SD 3.18). We found that Relationship with Someone or Something Greater was the only scale not associated with death anxiety. Overall, patients with lower death anxiety have a higher level of spiritual well-being. Besides, a high Relationship with Other score was associated with living with a partner (B = 2.471, P < 0.001) and married (B = -6.475, P = 0.001). Patients with higher Global-SWB were retired (B = 0.387, P = 0.019).

Conclusions

Our study found that the spiritual well-being of patients with gynecological cancer in China was no worse than in other countries with religious beliefs and patients with lower death anxiety have a higher level of spiritual well-being. Clinical staff should pay attention to the spiritual health of cancer patients, and spiritual care should be regarded as an essential element in cancer care.

High-fat diet exacerbates periodontitis: is it because of dysbacteriosis or stem cell dysfunction?

Previous studies have shown that high-fat diet (HFD) may aggravate periodontitis, however the underlining mechanism remains to be further clarified. This study aims to explore whether HFD promotes periodontitis by inducing periodontal microbiota dysbiosis or stem cell dysfunction. A high-fat diet was given to four-week-old male Sprague-Dawley rats for 12 weeks. Periodontitis was induced during the latter 4 weeks. At the end of the 12th week, samples were collected after euthanasia. Maxillae were harvested for histological or microbial analysis. The microbial 16S rRNA gene sequencing was performed with the Illumina MiSeq platform. The data was analyzed through RDP Classifier against the SILVA database. The mandible molars were harvested for isolating periodontal ligament stem cells (PDLSCs). The protein level of p27, p21, and p16, which are negative regulators of the cell cycle, in PDLSCs were detected. Markers of osteogenic differentiation and pro-inflammatory mediators were detected by real-time polymerase chain reaction. Activation of pro-inflammatory signaling pathways was detected by Western blotting. We found that HFD significantly increased ligature-induced alveolar bone loss. HFD resulted in a less diverse periodontal microbiota, with increased proportions of Lactococcus, Bacillus, Alloprevotella, Carnobacterium, and Exiguobacterium and decreased proportion of Nitrospira. HFD increased the protein levels of p27, p16, and p21, and upregulated the expression of osteogenic biomarkers, IL-1β and IL-10 with the ERK1/2 signaling pathway activated in PDLSCs.

MiR-22-3p regulates the proliferation and invasion of Wilms' tumor cells by targeting AKT3

OBJECTIVE

In this study, the regulatory mechanism of miR-22-3p/AKT3 in the development of Wilms' tumor (WT) was investigated.

PATIENTS AND METHODS

Twenty-seven pairs of surgical tumor specimens and adjacent normal tissues were obtained from Jining No. 1 People's Hospital. The expression level of miR-22-3p in WT tissues and cell lines was measured by quantitative RT-PCR. MTT and transwell assays were performed to analyze cell proliferation and invasion in WT. The relationship between miR-22-3p and AKT3 was verified by a Dual-Luciferase assay. The protein expression of AKT3 was evaluated by Western blotting analysis.

RESULTS

MiR-22-3p was downregulated and AKT3 was upregulated in WT. Functionally, overexpression of miR-22-3p inhibited cell proliferation and invasion in WT. Moreover, miR-22-3p directly targets AKT3. The knockdown of AKT3 suppressed cell proliferation and invasion in WT. In addition, upregulation of AKT3 restored the tumor suppressive effect of miR-22-3p in WT.

CONCLUSIONS

MiR-22-3p inhibits the proliferation and invasion of WT cells by downregulating AKT3, indicating that miR-22-3p may be developed as a new biomarker for the diagnosis of WT.

Forensic Analysis of 43 Medical Disputes Caused by Death after Cardiac Surgery

Abstract

Objective To explore the causes and characteristics of medical disputes caused by death after cardiac surgery and to analyze the pathological changes after cardiac surgery and the key points of forensic anatomy, thus to provide pathological evidence for clinical diagnosis and treatment of cardiac surgery and judicial appraisal as well as reference for the prevention of medical disputes in such cases. Methods Forensic pathological cases of medical disputes caused by death after cardiac surgery which were accepted by the Center for Medicolegal Expertise of Sun Yat-Sen University from 2013 to 2018 were analyzed retrospectively from aspects such as causes of death, pathological diagnosis, surgery condition, medical misconduct, and so on. Results The causes of death after cardiac surgery of 43 patients were abnormal operation, low cardiac output syndrome, postoperative infection, postoperative thrombosis, and other diseases. Among the 43 cases, there were 18 cases without medical fault while 25 cases had medical fault. Conclusion The medical disputes caused by death after cardiac surgery are closely related to the operative technique and postoperative complications. The causes of medical faults include defects in diagnosis and treatment technique, as well as unfulfillment of duty of care.

The effectiveness of transitional care interventions for adult people with heart failure on patient-centered health outcomes: A systematic review and meta-analysis including dose-response relationship

BACKGROUND

Transitional care interventions that bridge the care gap from hospital to home have proven to be effective in lessening the burden of healthcare systems by reducing hospital readmissions. Yet, the effects of transitional care interventions on patient-centered health outcomes of mortality, quality of life, and emotional distress remains unclear.

OBJECTIVES

To evaluate the effectiveness and dose-response of transitional care interventions on patient-centered health outcomes of mortality, quality of life, and emotional distress among individuals with heart failure and to identify the trial-level characteristics potentially affecting the overall effectiveness.

DESIGN

Systematic review with random-effects meta-analysis, meta-regression, and dose-response analysis of randomized controlled trials comparing transitional care interventions with usual care in adult people hospitalized with heart failure.

DATA SOURCES

Electronic databases including MEDLINE, Embase, Cochrane Library, and CINAHL were systematically searched from January 1, 2000 to June 31, 2020.

REVIEW METHODS

Authors independently reviewed the retrieved articles based on inclusion and exclusion criteria, extracted data, and assessed risk of bias using the Cochrane risk-of-bias tool version 2.0. We pooled data from each study using random-effects meta-analysis and performed meta-regression to explore the impact of pre-specified trial-level factors. Dose-response meta-analysis was conducted to examine the relationship between the intensity (i.e., frequency and duration of interventions) and complexity (i.e., number of intervention components) of transitional care interventions and the treatment effects.

RESULTS

Data were synthesized from 42 trials covering a total of 10,784 people with heart failure. Comparing to usual care, transitional care interventions achieved pooled evidence of a mean 18% risk reduction on mortality (0.82, 95% CI 0.71 to 0.95, P = 0.009) and better improvement in quality of life (-4.37, 95% CI -7.20 to -1.54, P = 0.002). There were insufficient data to determine with certainty the effects on anxiety and depression. Meta-regression showed greater efficacy in trials that delivered the intervention by a multidisciplinary team. Dose-response analyses demonstrated that mortality and quality of life were improved with increased intensity and complexity of the transitional care interventions.

CONCLUSIONS

Transitional care interventions were effective in reducing mortality and improving quality of life for adult people with heart failure. The effects on emotional distress were inconclusive due to insufficient data, highlighting the need for further research.

REGISTRATION NUMBER

CRD42019132732.

Effects of lncRNA MALAT1-mediated β-catenin signaling pathway on myocardial cell apoptosis in rats with myocardial ischemia/reperfusion injury

OBJECTIVE

To investigate the effects of long non-coding ribonucleic acid (lncRNA) metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) on myocardial ischemia/reperfusion (I/R) injury in rats and its mechanism, and to provide a certain reference for the clinical prevention and treatment of myocardial infarction.

MATERIALS AND METHODS

A total of 60 male Sprague-Dawley rats were divided into 3 groups using a random number table, including the Sham group (n=20), I/R group (n=20) and I/R + MALAT1 small interfering RNA (siRNA) group (n=20). An I/R model was established by means of recanalization after ligation of the left anterior descending coronary artery of the rats. The rats in the I/R + MALAT1 siRNA group were used to establish a model of MALAT1 knockdown by injecting MALAT1 siRNA from the tail vein. The myocardial infarction area in each group was detected via 2,3,5-triphenyl tetrazolium chloride (TTC) staining. The ejection fraction% (EF%) and fractional shortening% (FS%) of the heart in each group were measured through echocardiography. Hematoxylin and eosin (H&E) staining was adopted to determine the morphological changes in myocardial cells in each group. Terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) staining was performed to detect the apoptosis levels of myocardial cells and fibroblasts in the cardiac tissues in each group, and Western blotting assay was conducted to measure the expression levels of apoptosis-related proteins [B-cell lymphoma-2 (Bcl-2) and Bcl-2-associated X protein (Bax)]. In addition, the content of β-catenin in the three groups of rats was determined via immunohistochemical staining. Finally, the impacts of MALAT1 siRNA on the expression level of β-catenin protein were detected using Western blotting assay.

RESULTS

MALAT1 siRNA could prominently ameliorate the I/R-induced cardiac insufficiency in the rats and improve the EF% and FS% of the heart (p<0.05). Moreover, MALAT1 siRNA was able to remarkably inhibit the I/R injury-induced myocardial infarction, reducing the infarction area from (59.54±3.45) to (24.85±1.30; p<0.05). The results of the H&E staining indicated that compared with those in the I/R group, the myofilaments of the myocardial cells were well-arranged, the degrees of degradation and necrosis of the myofilaments declined, and the cellular edema was relieved markedly in the I/R + MALAT1 siRNA group. It was shown in the results of immunohistochemistry and Western blotting that MALAT1 siRNA could notably reverse the I/R-induced up-regulation of β-catenin expression (p<0.05).

CONCLUSIONS

MALAT1 knockdown can significantly ameliorate the I/R-induced myocardial injury and improve the cardiac function of the rats, whose mechanism is probably correlated with the inhibition of MALAT1 siRNA on β-catenin. Therefore, MALAT1 siRNA is expected to become a new target for the treatment of myocardial infarction.

The Effectiveness of Transitional Care Interventions on Health Care Utilization in Patients Discharged From the Hospital With Heart Failure: A Systematic Review and Meta-Analysis

OBJECTIVES

Heart failure (HF) heavily burdens the global health system. Transitional care interventions attempt to streamline the hospital-to-home transition to ease the burden. This systematic review and meta-analysis aimed to evaluate the effectiveness of transitional care interventions on health care utilization after hospitalization for HF.

DESIGN

Systematic review and meta-analysis including dose-response relationship.

SETTING AND PARTICIPANTS

Randomized controlled trials (RCTs) of transitional care interventions vs usual care in older patients discharged from the hospital with HF.

METHODS

Electronic databases including MEDLINE, Embase, Cochrane Library, and CINAHL, were systematically searched from January 2009 to October 2019 to locate relevant systematic reviews or meta-analyses. The original RCTs included in the review articles were identified, and an additional search for recently published RCTs was performed from January 2014 to June 2020. This systematic review focused on health care utilization outcomes, including hospital readmissions for HF or any cause, emergency department (ED) visits, and length of hospital stay (LOS).

RESULTS

Data were summarized from 38 RCTs covering 10,871 patients. Pooled evidence suggested a mean 11% [risk ratio (RR) 0.89, 95% confidence interval (CI) 0.82, 0.97] and 22% (RR 0.78, 95% CI 0.68, 0.89) risk reduction on all-cause and HF-specific readmissions, but no significant reduction (RR 0.94, 95% CI 0.83, 1.07) on ED visits. Findings were mixed for LOS. Subgroup analysis by different types of transitional care interventions indicated that multidisciplinary interventions currently have the best evidence for reducing readmissions up to 6 months post the index HF hospitalization. In addition, we observed an inverse linear dose-response relationship between intervention intensity (ie, frequency and duration of interventions) and complexity (ie, number of intervention components) and the risk of HF readmissions.

CONCLUSIONS AND IMPLICATIONS

Transitional care interventions for hospitalized patients with HF reduced all-cause and HF-specific readmissions, but did not decrease ED visits. Multidisciplinary interventions are highly recommended if adequate resources are available.

MicroRNA-579-3p promotes the progression of osteoporosis by inhibiting osteogenic differentiation of mesenchymal stem cells through regulating Sirt1

OBJECTIVE

To explore whether microRNA-579-3P was involved in the development of osteoporosis, and to investigate the possible molecular mechanisms.

PATIENTS AND METHODS

The messenger RNA (mRNA) expression levels of microRNA-579-3P, alkaline phosphatase (ALP), runt-related transcription factor 2 (RUNX2) and bone sialoprotein (BSP) in serum samples of osteoporosis patients and normal controls were detected by quantitative Real-time polymerase chain reaction (qRT-PCR), respectively. Meanwhile, the expressions of the above genes during osteogenic differentiation of human bone marrow mesenchymal stem cells (hMSCs) were examined as well. To investigate the effect of microRNA-579-3P on osteogenesis, microRNA-579-3P was overexpressed and knocked down in hMSCs. Subsequently, the mRNA and protein expression levels of osteogenesis-related genes, such as ALP, RUNX2 and BSP, were detected by qRT-PCR and Western blot, respectively. In addition, ALP activity and mineralization forming ability were evaluated by ALP staining and alizarin red staining. Bioinformatics predicted that Sirt1 was the target gene of microRNA-579-3P. Subsequent luciferase reporter gene assay was performed to verify the binding relationship of microRNA-579-3P to Sirt1. Meanwhile, qRT-PCR and Western blot were used to detect the changes in the mRNA and protein expression levels of Sirt1, respectively. After overexpression of microRNA-579-3P and Sirt1, qRT-PCR, Western blot, ALP staining and alizarin red staining assays were performed to detect the osteogenic differentiation of hMSCs.

RESULTS

The expression of microRNA-579-3P in serum of patients with osteoporosis was significantly higher than that of normal controls. Meanwhile, the expression of microRNA-579-3P decreased gradually during osteogenic differentiation of hMSCs. Overexpression of microRNA-579-3P significantly reduced the expressions of osteogenic related genes, including ALP, RUNX2 and BSP. Besides, ALP activity and mineralized nodule formation ability decreased obviously as well. Luciferase reporter gene assay showed that microRNA-579-3P could bind to Sirt1. After overexpression of microRNA-579-3P, the mRNA and protein expression levels of Sirt1 were significantly reduced, which were reversed after silence of microRNA-579-3P. Simultaneous overexpression of microRNA-579-3P and Sirt1 could reverse the inhibition of osteogenic differentiation of hMSCs caused by overexpression of microRNA-579-3P alone.

CONCLUSIONS

MicroRNA-579-3P could inhibit osteogenic differentiation of hMSCs by regulating Sirt1, thereby promoting the development of osteoporosis.

<p>Frontline Health-Care Workers in Combating the COVID-19: Respect and Reflect</p>

The ongoing coronavirus disease has heightened enormous concern in the global community. China implemented extraordinary public health measures to take the major transmission hotspots under control at great socioeconomic cost. Frontline health-care workers have shown their commitment and accountability in the fight against the epidemic outbreak. This commentary acknowledges their contribution and offers important insights for devising future strategies in enhancing preparedness and response competencies among the health-care workforce to manage future epidemic events.