Three-dimensional pseudo-continuous arterial spin-labelled perfusion imaging for diagnosing upper cervical lymph node metastasis in patients with nasopharyngeal carcinoma: a whole-node histogram analysis

AIM

To evaluate whole-node histogram parameters of blood flow (BF) maps derived from three-dimensional pseudo-continuous arterial spin-labelled (3D pCASL) imaging in discriminating metastatic from benign upper cervical lymph nodes (UCLNs) for nasopharyngeal carcinoma (NPC) patients.

MATERIALS AND METHODS

Eighty NPC patients with a total of 170 histologically confirmed UCLNs (67 benign and 103 metastatic) were included retrospectively. Pre-treatment 3D pCASL imaging was performed and whole-node histogram analysis was then applied. Histogram parameters and morphological features, such as minimum axis diameter (MinAD), maximum axis diameter (MaxAD), and location of UCLNs, were assessed and compared between benign and metastatic lesions. Predictors were identified and further applied to establish a combined model by multivariate logistic regression in predicting the probability of metastatic UCLNs. Receiver operating characteristic (ROC) curves were used to analyse the diagnostic performance.

RESULTS

Metastatic UCLNs had larger MinAD and MinAD/MaxAD ratio, greater energy and entropy values, and higher incidence of level II (upper jugular group), but lower BF10th value than benign nodes (all p<0.05). MinAD, BF10th, energy, and entropy were validated as independent predictors in diagnosing metastatic UCLNs. The combined model yielded an area under the curve (AUC) of 0.932, accuracy of 84.42 %, sensitivity of 80.6 %, and specificity of 90.29 %.

CONCLUSIONS

Whole-node histogram analysis on BF maps is a feasible tool to differentiate metastatic from benign UCLNs in NPC patients, and the combined model can further improve the diagnostic efficacy.

Polygonum cillinerve polysaccharide inhibits transmissible gastroenteritis virus by regulating microRNA-181

Transmissible gastroenteritis virus (TGEV) is an important pathogen capable of altering the expression profile of cellular miRNA. In this study, the potential of Polygonum cillinerve polysaccharide (PCP) to treat TGEV-infected piglets was evaluated through in vivo experiments. High-throughput sequencing technology was employed to identify 9 up-regulated and 17 down-regulated miRNAs during PCP-mediated inhibition of TGEV infection in PK15 cells. Additionally, miR-181 was found to be associated with target genes of key proteins in the apoptosis pathway. PK15 cells were treated with various concentrations of PCP following transfection with miR-181 mimic or inhibitor. Real-time PCR assessed the impact on TGEV replication, while electron microscopy (TEM) and Hoechst fluorescence staining evaluated cellular functionality. Western blot analysis was utilized to assess the expression of key signaling factors-cytochrome C (cyt C), caspase 9, and P53-in the apoptotic signaling pathway. The results showed that compared with the control group, 250 μg/mL PCP significantly inhibited TGEV gRNA replication and gene N expression (P < 0.01). Microscopic examination revealed uniform cell morphology and fewer floating cells in PCP-treated groups (250 and 125 μg/mL). TEM analysis showed no typical virus structure in the 250 μg/mL PCP group, and apoptosis staining indicated a significant reduction in apoptotic cells at this concentration. Furthermore, PCP may inhibit TGEV-induced apoptosis via the Caspase-dependent mitochondrial pathway following miR-181 transfection. These findings provide a theoretical basis for further exploration into the mechanism of PCP's anti-TGEV properties.

Effects of light perception on visual function recovery in patients with traumatic optic neuropathy

This study aimed to assess the impact of light perception presence or absence on visual function recovery in patients with traumatic optic neuropathy (TON). A retrospective analysis was conducted on the clinical data of 206 TON patients. Based on the presence or absence of light perception after injury, patients were categorized into a light perception group and a non-light perception group. A comparison was made between the two groups regarding visual acuity recovery before and after treatment. The non-light perception group comprised 63 patients, with a treatment effectiveness rate of 39.68%. The light perception group consisted of 143 patients, with a treatment effectiveness rate of 74.83%. The difference between the two groups was statistically significant (χ2 = 23.464, P < 0.01). Subgroup analysis indicated that surgical treatment appeared to be more effective than steroid hormone therapy for patients with light perception. Conversely, for patients without light perception, there was no significant difference in the effectiveness of the two methods. The total effectiveness rate of the light perception group was significantly higher than that of the non-light perception group, suggesting that patients with light perception before treatment experience better outcomes compared to those without light perception. Treatment choices should be individualized to ensure optimal results.

Metformin ameliorates valve interstitial cell calcification by promoting autophagic flux

Calcific aortic valve disease (CAVD) is the most common heart disease of the developed world. It has previously been established that metformin administration reduces arterial calcification via autophagy; however, whether metformin directly regulates CAVD has yet to be elucidated. In the present study we investigated whether metformin alleviates valvular calcification through the autophagy-mediated recycling of Runx2. Calcification was reduced in rat valve interstitial cells (RVICs) by metformin treatment (0.5-1.5 mM) (P < 0.01), with a marked decrease in Runx2 protein expression compared to control cells (P < 0.05). Additionally, upregulated expression of Atg3 and Atg7 (key proteins required for autophagosome formation), was observed following metformin treatment (1 mM). Blocking autophagic flux using Bafilomycin-A1 revealed colocalisation of Runx2 with LC3 puncta in metformin treated RVICs (P < 0.001). Comparable Runx2 accumulation was seen in LC3 positive autolysosomes present within cells that had been treated with both metformin and hydroxychloroquine in combination (P < 0.001). Mechanistic studies employing three-way co-immunoprecipitation with Runx2, p62 and LC3 suggested that Runx2 binds to LC3-II upon metformin treatment in VICs. Together these studies suggest that the utilisation of metformin may represent a novel strategy for the treatment of CAVD.

The Potential Ability of Plan Complexity Metrics on the Dose Calculation and Plans Delivery in Intensity Modulated Radiotherapy

PURPOSE/OBJECTIVE(S)

The excessive modulation of treatment plan during radiotherapy (RT) increases the complexity. Evaluation of the multidimensional relationship between program complexity metrics, computation-based patient-specific quality assurance (PSQA), and conventional measurement-based PSQA could assist in enhancing the robustness of treatment planning, guide the allocation of clinical QA resources, and ultimately lessen QA workload.

MATERIALS/METHODS

The fifty-five metrics affecting RT planning and delivery accuracy were calculated by a house-built program to describe the complexity of 404 dynamic IMRT plans, with sensitivity to the small field, aperture position, MLC edge, low MUs, MLC leaf motion, leaf speed/acceleration, etc. The calculation-based PSQA was performed using Monte Carlo (MC) method and Collapsed Cone Convolution (CCC) algorithm, implemented in SciMoCa and Mobius 3D, respectively. The measurement-based PSQA was performed using 3D diode arrays with different geometries covering "O", "+" and " × " shapes which exist in ArcCheck, Delta4 phantom+ (Delta4) and Delta4PT phantom (Delta4PT), respectively. Gamma passing rates (GPRs) were recorded to measure the results of each QA system. This multidimensional relationship was evaluated using correlation analysis and principal component linear regression (PCR) analysis.

RESULTS

A total of 4448 GPRs for various QA systems corresponding to two Linacs were counted. The modulation index for speed (MIs) and modulation index for acceleration (MIa) were consistently located at the high points of the radarplots of the Spearman correlation coefficient |rs| between metrics and GPRs of the four QA systems, just except Delta4. Besides, the rs between SciMoCa and ArcCheck were 0.275-0.531 (P ≤ 0.001), SciMoCa and Delta4 were 0.32-0.418 (P ≤ 0.001), and Mobius 3Dand Delta4PT were 0.124-0.226 (P ≤ 0.05). The PCR model's coefficients determination (R2) for SciMoCa were 0.461-0.756 (P ≤ 0.001), ArcCheck were 0.243-0.440 (P ≤ 0.001), Delta4 were 0.268-0.402 (P ≤ 0.001), Mobius 3D were 0.299-0.407 (P ≤ 0.001), and Delta4PT were 0.087-0.141 (P ≤ 0.05).

CONCLUSION

This study is the first overall assessment of the impact of various complexity metrics on the accuracy of TPS calculation and Linac delivery. Of the metrics studied, MIs and MIa metrics have a standout impact on the ability of the TPS calculation and delivery system, extra attention should be paid during the planning process. It is inappropriate to utilize calculation-based QA to predict the results of measurement-based QA since there is a poor correlation between the two. Furthermore, calculation-based QA outperforms measurement-based QA in identifying highly complex plans, which can further guide clinical QA process optimization and save limited clinical resources.

Complexity Metrics and Planning Dose-Based Pretreatment Patient-Specific Quality Assurance Prediction: Classification, Gamma Passing Rates, and DVH Deviation

PURPOSE/OBJECTIVE(S)

Patient-specific quality assurance (QA) prediction before treatment is beneficial to the clinical resource allocation and the dosimetric monitoring of the patient plans. The aim of this study is to investigate the potential of complexity metrics of radiotherapy plan and patient planning dose to predict QA result, gamma passing rates and dose-volume indices deviation.

MATERIALS/METHODS

Planning dose from treatment planning system (TPS), reconstructed dose from a vendor provided QA phantom and complexity metrics of the 499 radiotherapy plans of patients in our institution from March 2022 to September 2022 were used for methodology verification. Gamma passing rate (3%/2mm,10% threshold) 90% was regarded as criterion of QA pass or fail. A deep learning model ResNet-50 was modified to 3D dose processing and a multilayer perceptron (MLP) with three layers were adopted to extract features from 3D dose and 1D metrics in two parallel ways, then, the features were concatenate together to predict QA results. The dataset was split into 349 for train, 50 for validation and 100 for testing. Evaluation of predictions was based on absolute value deviation and area under the curves (AUC) of receiver operator characteristic (ROC) curve.

RESULTS

In this dataset, 71% (355/499) plans pass the pretreatment QA test. For QA passing prediction in 100 testing cases, the AUC of ROC could achieve 0.92. For gamma passing rates prediction, a mean absolute error (MAE) of 1.8% could be observed for cases with gamma passing rates bigger than 90%, and a MAE of 4.5% deviation could be observed for cases with gamma passing rates from 80% to 90%. For PTV ΔD95 (%) and PTV ΔHI (%), the MAE of prediction and ground truth is 1%. The model with only complexity metrics and only 3D dose could achieve the AUC of ROC 0.91 and 0.84, respectively.

CONCLUSION

The complexity metrics and 3D planning dose-based model could predict pretreatment patient specific QA results with high accuracy and the complexity metrics play a leading role in the model. Dose-volume metrics deviations of PTV could be predicted and more clinically useful information could be provided.

Prediction Analysis of Dose Verification Based on Plan Complexity Metrics during Radiotherapy

PURPOSE/OBJECTIVE(S)

Plan validation in radiotherapy includes pre-treatment and in-treatment validation. It is feasible to leverage plan complexity to optimize validation processes, because some research reports that the consistency between planning and measurement or execution decreases as plan complexity increases. Therefore, starting from the plan complexity, this study comprehensively and systematically explores these factors affecting whether the plan verification is passed or not and the strength of their correlations, so as to establish a regression model and optimize the verification process.

MATERIALS/METHODS

The IMRT and model-based validation information were retrospectively collected for patients who received tumor radiotherapy at our institution from January 2020 to May 2022. The seventy-eight metrics characterizing the plan complexity were calculated and checked for each plan by an in-house developed computing platform. The comparisons of plan verification results under different tumor species and different verification methods were carried out, and the plan complexity metrics was also compared. Subsequently, Spearman correlation analysis between plan complexity and plan validation under different tumor species, different verification methods and different evaluation indexes was analyzed to provide the basis for regression analysis.

RESULTS

One thousand two hundred twenty-six patients were enrolled in the study. The plans in Eclipse TPS were performed by Varian Edge and iX linear accelerators and their verification were executed by EPID, Delat4, and ArcCheck. The gamma index under evaluation index of 3%/3mm, 3%/2mm, 2%/2mm, 1%/1mm were respectively 97.4% (7.1%), 94.8% (10.9%), 86.1% (20.1%), 50.7% (22.6%). The γ and DD of EPID and Detla4 decreased with the increase of TH, and the change of DD was the most significant, while the DTA of Detla4 did not change significantly with TH, and the passing rate of DTA and γ in thoracic and abdominal was the highest in ArcCheck group. Contrast and Variance were the most different between tumor types. The pelvic MIs and MIa were larger than those planned for the other three sites. Except for head and neck CLS and MD, other metrics did not vary significantly among tumor species. The correlation between the metrics characterizing the static characteristics of leaves was more significant for head and neck tumors; the correlation between metrics characterizing the flux complexity were significantly different in pelvic. There was a correlation between plan complexity and γ indicators, and the overall strength was ArcCheck > EPID > Delta4 for head and neck, Delta4 > EPID and ArcCheck for thorax-abdomen, Delta4 and EPID > ArcCheck for pelvic, Delta4 > ArcCheck > EPID for arms and legs.

CONCLUSION

There was a correlation between different plan complexity metrics. Based on this study, it is feasible to predict the verification results based on these complexity metrics, but the regression models were respectively established according to tumor types and validation methods.

[Analysis of distribution characteristics of specific immunoglobulin E in 8 092 children with eczema and urticaria in a hospital of pediatric in Tianjin City]

To investigate the common specific immunoglobulin E(sIgE) in children with eczema and urticaria, compare the allergies in children with different diseases, genders and ages, and provide the scientific basis for the prevention, diagnosis and treatment. A retrospective study was conducted to analyze the children who were suspected of eczema and urticaria and tested for serum sIgE in the Tianjin Children's Hospital from December 2019 to August 2021. A total of 8 092 serum samples were tested for ten food allergens and ten inhaled allergens. The method was the enzyme-linked immune capture assay. The allergen epidemiological characteristics were statistically analyzed by Chi square test based on the children's characteristics and factors such as different sexes and ages and by the mass data. The results showed that the positive rate of eczema was 64.42%(5 213/8 092), and the urticaria was 35.58%(2 879/8 092). The positive rate of specific IgE was 66.65%(5 393/8 092), the food allergens was 61.74%(4 996/8 092), and the inhaled allergens was 34.85%(2 820/8 092). The top three positive rates of food allergens were egg 46.65%(3 775/8 092), milk 32.64%(2 641/8 092) and wheat flour 15.08%(1 220/8 092). The top three positive rates of inhaled allergens were house dust 21.40%(1 732/8 092), Alternaria 11.78%(953/8 092) and Dermatophagoides farinae 7.33%(593/8 092). The positivity of food allergens and inhaled allergens was significantly different in different age groups. The positive rates of food allergens in different age groups were 48.92%(947/1 936) in<1 year old, 72.28%(2 680/3 708) in 1-3 years old, 64.58%(919/1 423) in 4-6 years old and 43.90%(450/1 025) in>6 years old. The positive rates of inhaled allergens in different age groups were 17.67%(342/1 936) in<1 year old, 36.35%(1 348/3 708) in 1-3 years old, 46.38%(660/1 423) in 4-6 years old and 45.85%(470/1 025) in>6 years old. The top six positive rates of allergens of eczema were the same with urticaria, which were egg, milk, house dust, wheat flour, Alternaria and Dermatophagoides farinae. The allergens (greater than or equal to grade 4) differed in children with eczema and urticaria. Moreover, there were significant differences in the positive rates of Alternaria, egg, wheat flour, crab and shrimp. In conclusion, this study can reflect the epidemic characteristics of allergens in children with eczema and urticaria to a certain extent. There were significant differences in the positive rates of allergens between different age groups. It is necessary to reasonably avoid the high-risk allergens according to the epidemiological characteristics and clinical symptoms, which provide valuable information for the prevention, diagnosis and treatment of allergic diseases.

Optimization of adsorption performance of cerium-loaded intercalated bentonite by CCD-RSM and GA-BPNN and its application in simultaneous removal of phosphorus and ammonia nitrogen

Excessive phosphorus (P) and ammonia nitrogen (NH₃-N) in water bodies can lead to eutrophication of the aquatic environment. Therefore, it is important to develop a technology that can efficiently remove P and NH₃-N from water. Here, the adsorption performance of cerium-loaded intercalated bentonite (Ce-bentonite) was optimized based on single-factor experiments using central composite design-response surface methodology (CCD-RSM) and genetic algorithm-back propagation neural network (GA-BPNN) models. Based on the determination coefficient (R²), mean absolute error (MAE), mean square error (MSE), mean absolute percentage error (MAPE), and root mean square error (RMSE), the GA-BPNN model was found to be more accurate in predicting adsorption conditions than the CCD-RSM model. The validation results showed that the removal efficiency of P and NH₃-N by Ce-bentonite under optimal adsorption conditions (adsorbent dosage = 1.0 g, adsorption time = 60 min, pH = 8, initial concentration = 30 mg/L) reached 95.70% and 65.93%. Furthermore, based on the application of these optimal conditions in simultaneous removal of P and NH₃-N by Ce-bentonite, pseudo-second order and Freundlich models were able to better analyze adsorption kinetics and isotherms. It is concluded that the optimization of experimental conditions by GA-BPNN has some guidance and provides a new approach to explore adsorption performance after optimizing the conditions.

Role of chemokine receptor 2 in rheumatoid arthritis: A research update

Rheumatoid arthritis (RA) is a multisystemic and inflammatory autoimmune disease characterized by joint destruction. The C-C motif chemokine receptor 2 (CCR2) is mainly expressed in monocytes and T cells, initiating their migration to sites of inflammation, ultimately leading to cartilage damage and bone destruction. CCR2 has long been considered a prospective target for treating autoimmune diseases. However, clinical studies on inhibitors or neutralizing antibodies against CCR2 in RA have exhibited limited efficacy. Recent evidence indicates that CCR2 may play different roles in RA. Hence, a comprehensive understanding regarding the role of CCR2 may facilitate the development of targeted drugs and provide novel insights for improving CCL2-mediated inflammatory diseases. This review summarizes the biological characteristics of CCR2, the related signaling pathways, and recent developments in CCR2-targeting therapeutics.

PU.1 promotes development of rheumatoid arthritis via repressing FLT3 in macrophages and fibroblast-like synoviocytes

OBJECTIVES

To uncover the function and underlying mechanism of an essential transcriptional factor, PU.1, in the development of rheumatoid arthritis (RA).

METHODS

The expression and localisation of PU.1 and its potential target, FMS-like tyrosine kinase 3 (FLT3), in the synovium of patients with RA were determined by western blot and immunohistochemical (IHC) staining. UREΔ (with PU.1 knockdown) and FLT3-ITD (with FLT3 activation) mice were used to establish collagen antibody-induced arthritis (CAIA). For the in vitro study, the effects of PU.1 and FLT3 on primary macrophages and fibroblast-like synoviocytes (FLS) were investigated using siRNAs. Mechanistically, luciferase reporter assays, western blotting, FACS and IHC were conducted to show the direct regulation of PU.1 on the transcription of FLT3 in macrophages and FLS. Finally, a small molecular inhibitor of PU.1, DB2313, was used to further illustrate the therapeutic effects of DB2313 on arthritis using two in vivo models, CAIA and collagen-induced arthritis (CIA).

RESULTS

The expression of PU.1 was induced in the synovium of patients with RA when compared with that in osteoarthritis patients and normal controls. FLT3 and p-FLT3 showed opposite expression patterns compared with PU.1 in RA. The CAIA model showed that PU.1 was an activator, whereas FLT3 was a repressor, of the development of arthritis in vivo. Moreover, results from in vitro assays were consistent with the in vivo results: PU.1 promoted hyperactivation and inflammatory status of macrophages and FLS, whereas FLT3 had the opposite effects. In addition, PU.1 inhibited the transcription of FLT3 by directly binding to its promoter region. The PU.1 inhibitor DB2313 clearly alleviated the effects on arthritis development in the CAIA and CIA models.

CONCLUSIONS

These results support the role of PU.1 in RA and may have therapeutic implications by directly repressing FLT3. Therefore, targeting PU.1 might be a potential therapeutic approach for RA.

Differences in cardiometabolic risk profiles between Chinese and Finnish older adults with glucose impairment and central obesity

BACKGROUND

Obesity and ethnicity play important roles in cardiovascular complications in patients with type 2 diabetes mellitus (T2DM). This study aimed to compare cardiometabolic risk profiles between Chinese and Finnish older adults of central obesity with prediabetes or T2DM.

METHODS

Study subjects were 60-74 years old and originated from two population samples. The Finnish subjects came from the Kuopio Ischemic Heart Disease (KIHD) study (n = 1089), and the Chinese subjects came from the Shanghai High-risk Diabetic Screen (SHiDS) study (n = 818). The KIHD and SHiDS studies used similar questionnaires to determine participants' baseline characteristics regarding the history of medication use and diseases and lifestyle factors. All study subjects participated in glucose tolerance tests and anthropometry assessments, including waist circumference measurements.

RESULTS

Among study subjects of central obesity with prediabetes (n = 298), fasting and 2-h glucose, and fasting insulin and insulin resistance were significantly higher in Chinese than in Finnish (p < 0.0001-0.016). In addition, triglyceride (TG) level was higher and the low-density lipoprotein cholesterol (LDL) and LDL to high-density lipoprotein cholesterol (HDL) ratio were lower in Chinese than in Finnish (p < 0.0001-0.003). Among subjects of central obesity with T2DM (n = 251), Chinese subjects had significantly less proportions of antihypertensive, glycaemic control medication, and statin users as well as lower level of physical activity (p < 0.0001 for all), while higher blood pressure (p = 0.002 for systolic blood pressure and p < 0.0001 for diastolic blood pressure), TG levels (p < 0.05) and HDL (p = 0.002) than the Finnish counterparts. There were no differences in β-cell function (HOMA-β) between Chinese and Finnish both in prediabetes and T2DM.

CONCLUSIONS

Our results indicated that Chinese and Finnish older adults of central obesity with prediabetes and T2DM had similar β-cell function. However, Chinese individuals with prediabetes are prone to insulin resistance. Meanwhile, lipid metabolism dysfunction is also different between Chinese and Finnish. Chinese older adults of central obesity with prediabetes showed higher TG, but Finnish showed higher LDL and LDL/HDL. Strategic for T2DM prevention and treatment should be ethnically specific.

GAS5 represses endometrial cancer development via promoting anti-tumor function of tumor-associated macrophages

The tumor-suppressor role of Long non-coding RNA (lncRNA) growth arrest-specific transcript 5 (GAS5) have been proven in various types of cancer. However, the specific function of GAS5 in tumor-associated macrophages (TAMs) of endometrial cancer (EC) is elusive. qPCR results showed that GAS5 expression increased in EC tissues and primary TAMs from EC tumors. TAMs infiltration was significantly positively associated with the developmental stage of EC. Direct co-culture of GAS5-overexpressing TAMs and EC cells showed that GAS5 enhanced phagocytosis, antigen presentation, and activation of cytotoxic T cells, and repressed "Don't eat me" signals between TAMs and EC cells. Tumor formation in immunodeficient mice showed that GAS5-overexpressing macrophages could repress EC formation in vivo. GAS5 promoted M1 polarization by activating the miR-21-PTEN-AKT signaling pathway and directly repressing the nuclear accumulation and phosphorylation of oncogenic yes-associated protein 1 (YAP1) in TAMs. GAS5 inhibited the development of EC from both innate and adaptive immunity by transforming TAMs from a pro-tumor to an anti-tumor phenotype. These anti-tumor effects of GAS5 on TAMs were mediated by the activation of the miR-21-PTEN-AKT pathway and inhibition of YAP1.

[Research progress of anesthesia methods in prostate biopsy]

Prostate biopsy is the gold standard for the diagnosis of prostate cancer. In order to successfully and effectively complete the biopsy, clinicians should not only select the correct puncture method, but also pay attention to the pain control of patients undergoing puncture. It is necessary to select a reasonable anesthetic method for biopsy. The pain during biopsy comes from the skin, muscle and other structures in the puncture approach, and also comes from the prostate capsule. Therefore, the anesthesia emphasis of transperineal and transrectal biopsy approaches will also be different. The use of appropriate anesthesia is of great significance to improve the patient's cooperation and ensure the success rate of biopsy. With the continuous maturity of the technology and concept of prostate biopsy, a single anesthesia method has been unable to meet the actual anesthetic needs of biopsy, and the use of multi-site and multi-phase combined anesthesia for different sources of pain has become the mainstream anesthetic option.

Three-dimensional Quantification of Enamel Preservation in Tooth Preparation for Porcelain Laminate Veneers: A Fully Digital Workflow In Vitro Study

OBJECTIVE

This in vitro study aimed to evaluate the preservation of enamel after tooth preparation for porcelain laminate veneers (PLVs) at different preparation depths based on a fully digital workflow.

METHODS AND MATERIALS

Sixty extracted human maxillary anterior teeth, including 20 maxillary central incisors (MCIs), 20 maxillary lateral incisors (MLIs), and 20 maxillary canines (MCs) underwent microcomputed tomography (CT) scanning, and were reconstructed as three-dimensional (3D) enamel and dentin models. Subsequently, the three-dimensional (3D) enamel models were imported into Materialise, where each enamel model underwent seven types of virtual preparation for PLVs at preparation depths at 0.1-mm increments from 0.1-0.3-0.5 mm (D1) to 0.7-0.9-1.1 mm (D7). The enamel surface was depicted by merging the virtual preparation and, respective, dentin models. The enamel area and prepared surface were measured to calculate the percentage of enamel (R%). The data were statistically analyzed using one-way analysis of variance (ANOVA) (α=0.05).

RESULTS

The group-wise mean (standard deviation) R values for the MCIs were as follows: D1-D3: 100.00 (0) each, and D4-D7: 74.70 (2.45), 51.40 (5.12), 24.40 (3.06), and 0.00 (0), respectively. The group-wise mean R values for the MLIs were 100.00 (0), 73.70 (3.40), 53.50 (3.44), 25.20 (3.79), and 0.90 (0.99) for the D1-D5 groups, respectively; and 0.00 (0) each for the D6-D7 groups. The group-wise mean (standard deviations) R values for the MCs were as follows: D1-D3: 100.00 (0) each, and D4-D7: 99.00 (1.34), 77.10 (3.28), 74.20 (3.61), and 52.20 (4.09), respectively. The one-way ANOVA revealed significant differences between the seven groups in the MCIs, MLIs, and MCs (p<0.05).

CONCLUSIONS

Our results recommended preparation depths of up to 0.3-0.5-0.7 mm (MCIs), 0.1-0.3-0.5 mm (MLIs), and 0.4-0.6-0.8 mm (MCs) to facilitate complete intraenamel preparation. Moreover, 50% enamel was preserved at preparation depths of 0.5-0.7-0.9 mm (MCIs), 0.3-0.5-0.7 mm (MLIs), and 0.7-0.9-1.1 mm (MCs).

Hydrokinetic pancreatic function and insulin secretion are moduled by Cl- uniporter Slc26a9 in mice

AIM

Slc26a9 is a member of the Slc26 multifunctional anion transporter family. Polymorphisms in Slc26a9 are associated with an increased incidence of meconium ileus and diabetes in cystic fibrosis patients. We investigated the expression of Slc26a9 in the murine pancreatic ducts, islets and parenchyma, and elucidated its role in pancreatic ductal electrolyte and fluid secretion and endocrine function.

METHODS

Pancreatic Slc26a9 and CFTR mRNA expression, fluid and bicarbonate secretion were assessed in slc26a9^-/- mice and their age- and sex-matched wild-type (wt) littermates. Glucose and insulin tolerance tests were performed.

RESULTS

Compared with stomach, the mRNA expression of Slc26a9 was low in pancreatic parenchyma, 20-fold higher in microdissected pancreatic ducts than parenchyma, and very low in islets. CFTR mRNA was ~10 fold higher than Slc26a9 mRNA expression in each pancreatic cell type. Significantly reduced pancreatic fluid secretory rates and impaired glucose tolerance were observed in female slc26a9^-/- mice, whereas alterations in male mice did not reach statistical significance. No significant difference was observed in peripheral insulin resistance in slc26a9^-/- compared to sex- and aged-matched wt controls. In contrast, isolated slc26a9^-/- islets in short term culture displayed no difference in insulin content, but a significantly reduced glucose-stimulated insulin secretion compared to age- and sex-matched wt islets, suggesting that the impaired glucose tolerance in the absence of Slc26a9 expression these is a pancreatic defect.

CONCLUSIONS

Deletion of Slc26a9 is associated with a reduction in pancreatic fluid secretion and impaired glucose tolerance in female mice. The results underline the importance of Slc26a9 in pancreatic physiology.

[RIP1/RIP3-MLKL signaling pathway correlates with occurrence, progression and prognosis of chronic heart failure]

OBJECTIVE

To detect plasma levels of receptor-interacting protein kinase 1 (RIP1), RIP3 and mixed lineage kinase domain-like protein (MLKL) in patients with chronic heart failure and explore the expression pattern of programmed necrosis signaling pathway RIP1/RIP3-MLKL in the progression of heart failure.

METHODS

The patients with chronic heart failure (NYHA class Ⅱ-Ⅳ) admitted in our hospital between February, 2020 and March, 2021 were prospectively enrolled in this study, with 21 healthy volunteers as the control group. The enrolled patients included 20 with grade Ⅱ, 33 with grade Ⅲ, and 43 with grade Ⅳ cardiac function. Fasting venous blood was collected from all the participants for detecting plasma levels of RIP1, RIP3, and MLKL and protein expressions of RIP1/RIP3-MLKL pathway using enzyme-linked immunosorbent assay (ELISA) and Western blotting. The patients with grade Ⅳ cardiac function were followed up for 5 months to evaluate the clinical prognostic indicators.

RESULTS

Compared with the healthy volunteers, the patients with grade Ⅱ, Ⅲ and Ⅳ cardiac function had significantly increased plasma levels of RIP1, RIP3, and MLKL (P < 0.01), and their levels were significantly higher in grade Ⅲ/Ⅳ patients than in those with grade Ⅱ cardiac function (P < 0.01); the plasma levels of RIP1 and MLKL were significantly higher in grade Ⅳ patients than in grade Ⅲ patients (P < 0.05). The results of Western blotting also showed increased expressions of the proteins in the RIP1/RIP3-MLKL pathway in patients with heart failure. Pearson correlation analysis suggested that in patients with heart failure, the expression levels of RIP1, RIP3, and MLKL were positively correlated with SCR, AST, LVEDD and NT-proBNP (P < 0.05). Follow-up study of the patients with grade Ⅳ cardiac function showed that higher expression levels of RIP1/RIP3-MLKL were associated with a poorer prognosis of the patients.

CONCLUSION

The expressions of RIP1, RIP3 and MLKL are significantly upregulated in patients with heart failure in positive correlation with the severity of the disease condition, and the activation of the RIP1/RIP3-MLKL signaling pathway may contribute to the occurrence, development and prognosis of chronic heart failure.

[Exploring the therapeutic mechanism of quercetin for heart failure based on network pharmacology and molecular docking]

OBJECTIVE

To investigate the molecular mechanism of quercetin in the treatment of heart failure (HF) based on network pharmacology and molecular docking.

METHODS

Quercetin and HF-related targets were obtained using TCMSP, PharmMapper, CTD and GeneCards databases, and quercetin-HF intersection targets were obtained through the online website Venn; the protein interaction network was constructed and imported into Cytoscape 3.7.2 to identify the core targets of quercetin in the treatment of HF.GO and KEGG pathway enrichment analyses were performed using R package, and molecular docking was performed using Auto Dock Vina.The protein levels of AKT1, phospho-AKT(Ser473), eNOS, MMP9, and caspase-3 in quercetin-treated HF cell models were detected using protein immunoblotting.

RESULTS

We identified 80 quercetin-HF intersectional targets (AKT1, CASP3, MAPK1, MMP9, and MAPK8) and 5 core targets of quercetin for treatment of HF.GO analysis suggested that the therapeutic effect of quercetin for HF was mediated mainly by such biological processes as responses to peptide hormones, phosphatidylinositol-mediated signalling, responses to lipopolysaccharides, responses to molecules of bacterial origin and regulation of inflammatory responses.KEGG pathway enrichment analysis identified lipid and atherosclerosis pathway, proteoglycans in cancer, PI3K-AKT signaling pathway, diabetic cardiomyopathy and MAPK signaling pathway as the most significantly enriched signaling pathways.Molecular docking showed a good binding activity of quercetin to the 5 core targets.The results of protein immunoblotting showed that 100 μmol/L quercetin significantly reduced AKT1, phospho-AKT (Ser473), eNOS, MMP9 and caspase-3 levels in the cell models of HF (P < 0.01).

CONCLUSION

Quercetin improves the pathological changes in HF possibly by regulating the AKT1-eNOS-MMP9 pathway to inhibit cell apoptosis.

CAR-macrophage: A new immunotherapy candidate against solid tumors

Chimeric antigen receptor (CAR)-T cell therapy has been shown to be an effective treatment for hematological tumors, but the treatment of solid tumors still lacks effectiveness. In the tumor microenvironment, macrophages are the innate immune cells with the highest infiltration rate. Tumor-associated macrophages (TAMs) stimulate angiogenesis, increase tumor invasion, and mediate immunosuppression. Because macrophages can infiltrate solid tumor tissue and interact with almost all cellular components in the tumor microenvironment (including tumor cells, immune cells such as T-cells, NK cells, DCs, and other resident non-immune cells), researchers are trying to use macrophages modified with CAR (CAR-M) against solid tumors. This review describes recent reports of CAR-M-based tumor treatments and summarizes their shortcomings and future applications.

Circ_0001971 regulates oral squamous cell carcinoma progression and chemosensitivity by targeting miR-194/miR-204 in vitro and in vivo

OBJECTIVE

Circular RNAs (circRNAs) play a wide role in human cancers, including oral squamous cell carcinoma (OSCC). The purpose of this study was to investigate the biological functions of circ_0001971 and associated mechanisms in OSCC.

MATERIALS AND METHODS

The expression of circ_0001971, miR-194, and miR-204 was detected by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). Cell proliferation and viability were assessed using cell counting kit-8 (CCK-8) assay. Cell migration and invasion were examined using the transwell assay. Cell apoptosis was monitored by flow cytometry assay. The protein levels of proliferation marker (CyclinD1), epithelial mesenchymal-transition (EMT) markers (E-cadherin (E-cad) and N-cadherin (N-cad)) and apoptosis markers (Cleaved-caspase-3 (Cleaved-cas-3) and Cleaved-caspase-9 (Cleaved-cas-9)) were measured by Western blot. The relationship between circ_0001971 and miR-194 or miR-204 was predicted by online tool starBase and verified by the Dual-Luciferase reporter assay and RNA immunoprecipitation (RIP) assay. Tumor formation assay in nude mice was conducted to observe the role of circ_0001971 in vivo.

RESULTS

The expression of circ_0001971 was significantly increased in tumor tissues and cell lines. Circ_0001971 knockdown inhibited cell proliferation, migration, and invasion but promoted cisplatin (DDP) sensitivity and cell apoptosis. It was confirmed that miR-194 and miR-204 were targets of circ_0001971, and miR-194 inhibition or miR-204 inhibition reversed the effects of circ_0001971 knockdown in OSCC cells. Moreover, circ_0001971 knockdown impeded tumorigenesis and development in vivo.

CONCLUSIONS

Circ_0001971 regulates cell proliferation, migration, invasion, apoptosis, and chemosensitivity of OSCC by interacting with miR-194 and miR-204 in vitro and in vivo. We provided a theoretical basis for the action mechanism of circ_0001971 on OSCC progression and chemosensitivity.

[Effect of piRNA NU13 in regulating biological behaviors of human Wilms tumor cells in vitro]

OBJECTIVE

To investigate the role of the differential piRNA NU13 derived from piwil2-induced cancer stem-like cells (piwil2-iCSCs) in regulating biological behaviors of Wilms tumor cells (G401).

OBJECTIVE

The expressions of piRNA NU13 and NOP56 were detected in Wilms tumor cell line G401 using RT-qPCR. G401 cells were transfected with piRNA NU13 mimics and inhibitor for its over-expression and inhibition, and the transfection efficiency was verified with RT-qPCR. The changes in proliferation of G401 cells after transfection were detected using CCK8 assay, and cell apoptosis was analyzed using flow cytometry. Wound healing assay and Transwell assay were performed to examine the changes in migration and invasion abilities of the transfected cells. The binding of NOP56 and piRNA NU13 was detected using dual luciferase experiment. The protein expressions of MMP2, MMP9, BAX, Bcl2, and NOP56 in the cells were detected with Western blotting.

OBJECTIVE

RTqPCR showed that the expression of piRNA NU13 decreased significantly in human Wilms tumor G401 cells as compared with that in renal tubular epithelial cell line HK2 (P < 0.05), and NOP56 was highly expressed in G401 cells and Wilms tumor tissues (P < 0.05). Over-expression of piRNA NU13 significantly suppressed the proliferation, migration and invasion of G401 cells, promoted cell apoptosis (P < 0.05), inhibited the expression of MMP2, MMP9 and Bcl2, and enhanced the expression of BAX (P < 0.05). The results of dual luciferase experiment showed that piRNA NU13 did not bind to NOP56 directly but regulated the expression of NOP56 in an indirect manner.

OBJECTIVE

piRNA NU13 is down-regulated and NOP56 is highly expressed in Wilms tumor. piNU13 may regulate the expression of NOP56 indirectly to inhibit the proliferation, migration and invasion and promote apoptosis of Wilms tumor cells in vitro.

Predictive Value of Serum Creatinine/Cystatin C in Acute Ischemic Stroke Patients under Nutritional Intervention

BACKGROUND AND PURPOSE

As a very common risk of adverse outcomes of the ischemic stroke patients, sarcopenia is associated with infectious complications and higher mortality. The goal of this retrospective study is to explore the predictive value of serum Cr/CysC ratio in acute ischemic stroke patients receiving nutritional intervention.

METHODS

We reviewed adult patients with AIS from December 2019 to February 2020. Patients with acute kidney injury were excluded and all patients received nutritional intervention during a 3-month follow-up period. We collected baseline data at admission including creatinine and cystatin C. The primary poor outcome was major disability (modified Rankin Scale score ≥ 4) at 3 months after AIS.

RESULTS

A total of 217 patients with AIS were identified for this study. Serum Cr/CysC ratio was significantly correlated with NIHSS at discharge, 1-month modified Rankin Scale score, and 3-month modified Rankin Scale score. During 3 months, 34 (15.70%) patients had a poor outcome after AIS and 11 (5.10%) patients died within 30 days. In multivariable logistic regression analyses, serum Cr/CysC ratio at admission was independently associated with 3-month poor outcomes (OR: 0.953, 95% CI: 0.921-0.986, p = .006) and 30-day mortality (OR: 0.953, 95% CI: 0.921-0.986, p = .006).

CONCLUSION

As a blood biochemical indexes reflecting the muscle mass and aiding in risk stratification, Cr/CysC ratio at admission could be used as a predictor of 30-day mortality and long-term poor prognosis in AIS patients.

The essential role of long non-coding RNA GAS5 in glioma: interaction with microRNAs, chemosensitivity and potential as a biomarker

Glioma is a malignant brain tumor with a generally poor prognosis. Dysregulation of a long non-coding RNA, GAS5, has been detected in numerous cancers, including glioma. Previous studies have suggested that GAS5 plays a significant functional role in glioma, affecting proliferation, metastasis, invasion, and apoptosis. In this review, we describe the roles and mechanisms of GAS5 in glioma. GAS5 may be a biomarker for diagnosis and prognosis, and even a potential target for glioma treatment, and therefore warrants further investigation.

Activation of nuclear factor-κB in the angiogenesis of glioma: Insights into the associated molecular mechanisms and targeted therapies

Glioma is the most commonly observed primary intracranial tumour and is associated with massive angiogenesis. Glioma neovascularization provides nutrients for the growth and metabolism of tumour tissues, promotes tumour cell division and proliferation, and provides conditions ideal for the infiltration and migration of tumour cells to distant places. Growing evidence suggests that there is a correlation between the activation of nuclear factor (NF)‐κB and the angiogenesis of glioma. In this review article, we highlighted the functions of NF‐κB in the angiogenesis of glioma, showing that NF‐κB activation plays a pivotal role in the growth and progression of glioma angiogenesis and is a rational therapeutic target for antiangiogenic strategies aimed at glioma.

MiR-491 suppresses migration and invasion via directly targeting TPX2 in breast cancer

OBJECTIVE

Breast cancer (BC) is one of the primary causes of tumor-related female mortalities. Although in recent years, we have made great progress in the systemic therapy and earlier diagnosis for BC patients, recurrence or distant metastasis remains leading obstacles for the successful therapy of BC. Therefore, a comprehensive understanding of the molecular mechanism underlying the progression may be crucial in developing an effective strategy against BC. The current research aimed to explore the expressions, functions and molecular mechanism of microRNA-491 (miR-491) in BC.

PATIENTS AND METHODS

Quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) was performed to examine the level of miR-491 expression in 52 pairs of BC tissues and para-cancerous specimens, and the relation between miR-491 level and the clinical features of BC patient prognosis was analyzed. Transwell invasion and migration assays were conducted to determine whether miR-491 had effects on the regulation of BC metastasis. Potential target genes of miR-491 were found out using TargetScan to explore the molecular functions of miR-491 in inhibiting breast cancer cell invasion and migration. To elucidate the mechanism of TPX2 in suppressing cell invasion and migration medicated by miR-491in breast cancer, we further transfected TPX2 siRNAs into MCF-7 cells to delete endogenous TPX2, along with the transfections with miR-491 inhibitor into MCF-7 cell lines.

RESULTS

The findings demonstrated that miR-491 expressions were significantly decreased in BC tissues and cells. The miR-491 restoration suppressed the invasion and migration of BC cells. In addition, we identified the targeting protein for Xklp2 (TPX2) as a direct target of miR-491 in BC. The knockdown of TPX2 markedly reversed miR-491-medicated inhibition of cell invasion and migration in BC cell lines.

CONCLUSIONS

In short, all the results suggested that miR-491 functioned as a tumor suppressor by targeting TPX2 in BC and the miR-491 restoration may be an effective therapy for the BC treatment in the future.

Super-factors associated with transmission of occupational COVID-19 infection among healthcare staff in Wuhan, China

BACKGROUND

Globally, there have been many cases of coronavirus disease 2019 (COVID-19) among medical staff; however, the main factors associated with the infection are not well understood.

AIM

To identify the super-factors causing COVID-19 infection in medical staff in China.

METHODS

A cross-sectional study was conducted between January 1st and February 30th, 2020, in which front-line members of medical staff who took part in the care and treatment of patients with COVID-19 were enrolled. Epidemiological and demographic data between infected and uninfected groups were collected and compared. Social network analysis (SNA) was used to establish socio-metric social links between influencing factors.

FINDINGS

A total of 92 medical staff were enrolled. In all participant groups, the super-factor identified by the network was wearing a medical protective mask or surgical mask correctly (degree: 572; closeness: 25; betweenness centrality: 3.23). Touching the cheek, nose, and mouth while working was the super-factor in the infected group. This was the biggest node in the network and had the strongest influence (degree: 370; closeness: 29; betweenness centrality: 0.37). Self-protection score was the super-factor in the uninfected group but was the isolated factor in the infected group (degree: 201; closeness: 28; betweenness centrality: 5.64). For family members, the exposure history to Huanan Seafood Wholesale Market and the contact history to wild animals were two isolated nodes.

CONCLUSION

High self-protection score was the main factor that prevented medical staff from contracting COVID-19 infection. The main factor contributing to COVID-19 infections among medical staff was touching the cheek, nose, and mouth while working.

[Expression, purification and polyclonal antibody preparation of the Schistosoma japonicum SjGrpE protein]

OBJECTIVE

To investigate the biological properties of Schistosoma japonicum SjGrpE protein, and to express and purify the recombinant SjGrpE protein and test its immunogenicity.

METHODS

The amino acid composition, molecular weight, hydrophilicity and hydrophobicity, transmembrane region, signal peptide, localization, phosphorylation site, ubiquitination site, glycosylation site, secondary and tertiary structures and B cell epitopes of the SjGrpE protein were predicted using bioinformatics analyses. The SjGrpE gene was amplified using PCR assay using S. japonicum cDNA as a template, double enzyme-digested and linked to the pET28a vector to yield the recombinant plasmid pET28a-SjGrpE. The recombinant plasmid pET28a-SjGrpE was transformed into Escherichia coli BL21, and then IPTG was employed to induce the expression of the target protein, which was purified by nickel ion affinity chromatography. After mice were immunized with the recombinant SjGrpE protein, mouse sera were collected, and the polyclonal antibody against the SjGrpE protein was characterized.

RESULTS

SjGrpE protein, which was identified as a hydrophilic protein, was predicted to have a molecular weight of approximately 24.3 kDa without transmembrane regions or signal peptides, and locate in the mitochondrion. SjGrpE protein contained 18 phosphorylation sites and 2 ubiquitination sites, but had no glycosylation sites. In addition, SjGrpE protein contained 5 B-cell epitopes. The full length of SjGrpE gene was approximately 660 bp. The recombinant pET28a-SjGrpE plasmid was successfully generated, and the recombinant SjGrpE protein was obtained following the affinity chromatography, which stimulated mice to secrete high-titer antibodies.

CONCLUSIONS

The recombinant SjGrpE protein has been successfully prepared and this recombinant protein has a high immunogenicity, which provides a basis for evaluating its value as a vaccine candidate for S. japonicum infections.

The emerging role of fibroblast-like synoviocytes-mediated synovitis in osteoarthritis: An update

Osteoarthritis (OA), the most ubiquitous degenerative disease affecting the entire joint, is characterized by cartilage degradation and synovial inflammation. Although the pathogenesis of OA remains poorly understood, synovial inflammation is known to play an important role in OA development. However, studies on OA pathophysiology have focused more on cartilage degeneration and osteophytes, rather than on the inflamed and thickened synovium. Fibroblast-like synoviocytes (FLS) produce a series of pro-inflammatory regulators, such as inflammatory cytokines, nitric oxide (NO) and prostaglandin E₂ (PGE₂ ). These regulators are positively associated with the clinical symptoms of OA, such as inflammatory pain, joint swelling and disease development. A better understanding of the inflammatory immune response in OA-FLS could provide a novel approach to comprehensive treatment strategies for OA. Here, we have summarized recently published literatures referring to epigenetic modifications, activated signalling pathways and inflammation-associated factors that are involved in OA-FLS-mediated inflammation. In addition, the current related clinical trials and future perspectives were also summarized.

0836 Self-Reported Difficulty Initiating Sleep and Early Morning Awakenings are Associated With Nocturnal Diastolic Non-Dipping in Older Men

Introduction

Aging increases the risk of insomnia and elevated blood pressure (BP). Here, we examined in older men whether reports of difficulty falling asleep (DIS) and early morning awakenings (EMA) are associated with 24-h BP and heart rate.

Methods

We utilized variables from 995 men (mean age: 71 years) who participated in the Uppsala Longitudinal Study of Adult Men (ULSAM). BP and heart rate were measured over 24 hours.

Results

Non-dippers (night-to-day BP ratio &gt; 0.90) had a higher risk of hypertension than dippers (systolic non-dippers vs. systolic dippers, OR [95%CI]: 1.64 [1.21, 2.21], P=0.001; diastolic non-dippers vs. diastolic dippers, 1.50 [1.10, 2.04], P=0.01). Compared to men without DIS, men who reported DIS (10% of the cohort) had a higher risk of diastolic non-dipping (1.85 [1.19, 2.87], P=0.006). Similarly, men who reported EMA (19% of the cohort) had a higher risk of diastolic non-dipping than those without EMA (1.59 [1.12, 2.24], P=0.009). Despite a slightly higher nocturnal diastolic BP among men with EMA vs. those without EMA (+1.4 mmHg, P=0.035), no other differences in BP and heart rate were found between men with and those without insomnia complaints.

Conclusion

Our findings uncover a link between disruption in nocturnal dipping of diastolic BP and insomnia symptoms related to difficulty initiating sleep and early morning awakening in older men.

Support

Authors’ work is funded by the Novo Nordisk Foundation (C.B., NNF19OC0056777), Swedish Brain Research Foundation (C.B., FO2019-0028), Swedish Research Council (C.B., 2015-03100), Åke Wiberg Foundation (X.T., M18-0169, M19-0266), Fredrik and Ingrid Thuring Foundation (X.T., 2018-00365), and the Swedish Medical Research Society (X.T., P18-0084).

0411 Association Between Healthy Dietary Patterns and Self-Reported Sleep Disturbances in Older Men

Introduction

Ageing is often accompanied by an increased prevalence of sleep problems. Healthy lifestyle choices, including diet, are especially important to mitigate such impairments. To date, little is known about how dietary patterns may link to measures of sleep quality in older subjects. Therefore, we investigated in a Swedish older male population, whether adherence to the Mediterranean Diet (MD) or the Healthy Diet Indicator (HDI; based on recommendations from the World Health Organization) is linked to a decrease in sleep disturbances.

Methods

We studied 970 men (age: 71 ± 1yr) from the ULSAM dataset. Sleep initiation or maintenance problems were evaluated by self-reporting questionnaires. Dietary intake was recorded with a pre-coded seven-day food diary. To calculate the adherence scores, intake of dietary components was assessed. Traditional MD components included fat quality, vegetables, fruits, cereals, fish, meat, dairy, and alcohol. The HDI components included saturated-, polyunsaturated fatty acids, proteins, carbohydrates, sucrose, fiber, fruits and vegetables, cholesterol, and fish. Reasonable dietary reporting was calculated to identify possible under- or over-reporters.

Results

When adjusted for potential confounders, no associations between dietary scores and sleep parameters were found. In contrast, low consumption of dairy products —one of the dietary features of the MD —was associated with better subjective sleep initiation. This association was, however, not found in men with adequate reports of daily energy intake (~54% of the cohort).

Conclusion

Our findings do not suggest that older men can mitigate perceived sleep problems by adhering to the MD or HDI. Whether low consumption of dairy products can facilitate sleep initiation must be confirmed in future studies by utilizing objective measures of sleep, such as polysomnography. Finally, when investigating associations between dietary patterns and sleep, particular attention should be paid to the potential confounder of inadequate reporting of energy intake.

Support

This research was funded by Novo Nordisk Foundation (NNF14OC0009349), Swedish Brain Foundation, Swedish Research Council (2015-03100), Åke Wiberg Foundation (M17-0088), Fredrik and Ingrid Thuring Foundation (2017-00313) and the Swedish Medical Research Society.