Cadmium exposure and risk of breast cancer: A meta-analysis

BACKGROUND

Cadmium is a heavy metal with carcinogenic properties, highly prevalent in industrialized areas worldwide. Prior reviews evaluating whether cadmium influences breast cancer have been inconclusive and not reflected several recent studies.

OBJECTIVE

To evaluate the association between cadmium exposure and female breast cancer incidence, with an emphasis on separately estimating dietary vs. airborne vs. biomarker measures of cadmium and studies published until October 2022.

METHODS

We evaluated risk of bias using set criteria and excluded one study judged to have high risk based on self-report of breast cancer and insufficient adjustment. We conducted a random effects meta-analysis of epidemiological studies, including subgroups by exposure route and by menopausal status.

RESULTS

A total of 17 studies were eligible for our meta-analysis. Only 2 studies addressed airborne cadmium directly. Breast cancer risk was elevated in women exposed to higher levels of cadmium across all studies - pooled odds ratio: 1.13 (95% confidence interval: 1.00, 1.28), with notable heterogeneity between studies (I² = 77%). When examining separately by exposure route, dietary cadmium was not linked with an elevated risk - (OR: 1.05; 95%CI: 0.91, 1.21; I² = 69%), consistent with prior reviews, but biomarker-based studies showed an elevated but non-significant pooled measure (OR: 1.37; 95%CI: 0.96, 1.94; I² = 84%). We did not observe any clear patterns of different risk by menopausal status.

CONCLUSION

Findings from our meta-analysis suggest that exposure to higher cadmium increases the risk of breast cancer in women, but with remaining questions about whether non-dietary exposure may be more risky or whether residual confounding by constituents of tobacco smoke may be at play.

Base MRI Imaging Characteristics of Meningioma Patients to Discuss the WHO Classification of Brain Invasion Otherwise Benign Meningiomas

PURPOSE

Compared and analyzed the MRI imaging features of brain invasion otherwise benign (BIOB) meningiomas and WHO grade 1, grade 2 meningiomas, discussed the WHO grading of BIOB from the perspective of imaging.

MATERIALS AND METHODS

A retrospective analysis was performed on 675 meningiomas patients who carried on MRI examination from January 2006 to February 2022. Setting the 2022 Central nervous system (CNS) WHO Guidelines as the gold standard for pathological diagnosis. Statistical analysis of age, gender, and MRI features of meningiomas in relation to WHO grade and brain invasion.

RESULTS

Among 675 cases meningiomas, 543 (80.4%) were WHO grade 1, 123 (18.2%) were WHO grade 2, and 9 (1.3%) were WHO grade 3. There were 108 cases meningiomas with brain invasion (BI) (16.0%) and 567 cases without BI (84.0%). Among BI cases, 67 cases were BIOB. Compared the MRI features between BIOB and WHO grade 1 meningiomas, multivariate analysis demonstrated that the most strongly factors associated with distinguish them were enhancement degree, peritumoral edema, tumor-brain interface, fingerlike protrusion, mushroom sign, and bone invasion (AUC: 0.925 (0.901∼0.945), sensitivity: 0.925, specificity: 0.801). Compared the MRI features between BIOB and WHO grade 2 meningiomas, multivariate analysis demonstrated that the most strongly factors associated with distinguish them were enhancement degree and the tumor-brain interface (AUC: 0.779 (0.686∼0.841), sensitivity: 0.746, specificity: 0.732), their efficacy was slightly weaker.

CONCLUSIONS

BIOB is more similar to WHO grade 2 meningiomas in clinical and imaging features than WHO grade 1, so we think that it may be reasonable to classify BIOB as WHO Grade 2 meningiomas in the guidelines.

Effect of food additives on key bacterial taxa and the mucosa-associated microbiota in Crohn's disease. The ENIGMA study

Food additives have been linked to the pro-inflammatory microbial dysbiosis associated with Crohn's disease (CD) but the underlying ecological dynamics are unknown. Here, we examine how selection of food additives affects the growth of multiple strains of a key beneficial bacterium (Faecalibacterium prausnitzii), axenic clinical isolates of proinflammatory bacteria from CD patients (Proteus, Morganella, and Klebsiella spp.), and the consortia of mucosa-associated microbiota recovered from multiple Crohn's disease patients. Bacterial growth of the axenic isolates was evaluated using a habitat-simulating medium supplemented with either sodium sulfite, aluminum silicate, carrageenan, carboxymethylcellulose, polysorbate 80, saccharin, sucralose, or aspartame, intended to approximate concentrations found in food. The microbial consortia recovered from post-operative CD patient mucosal biopsy samples were challenged with either carboxymethylcellulose and/or polysorbate 80, and the bacterial communities compared to unchallenged consortia by 16S rRNA gene amplicon profiling. Growth of all F. prausnitzii strains was arrested when either sodium sulfite or polysorbate 80 was added to cultures at baseline or mid-exponential phase of growth, and the inhibitory effects on the Gram-negative bacteria by sodium sulfite were conditional on oxygen availability. The effects from polysorbate 80, saccharin, carrageenan, and/or carboxymethylcellulose on these bacteria were strain-specific. In addition to their direct effects on bacterial growth, polysorbate 80 and/or carboxymethylcellulose can drive profound changes in the CD mucosa-associated microbiota via niche expansion of Proteus and/or Veillonellaceae - both implicated in early Crohn's disease recurrence. These studies on the interaction of food additives with the enteric microbiota provide a basis for dietary management in Crohn's disease.

Global Prevalence and Factors Associated with Frailty among Community-Dwelling Older Adults with Hypertension: A Systematic Review and Meta-Analysis

BACKGROUND

Frailty may increase the risk of adverse outcomes and the presence of comorbidities in hypertension. Understanding the prevalence of frailty in older adults with hypertension is of great importance, whereas estimates of the prevalence of frailty in this population vary greatly.

OBJECTIVES

A systematic review and meta-analysis was conducted to estimate the pooled prevalence of frailty and prefrailty among community-dwelling older adults with hypertension, and to examine the risk factors associated with (pre)frailty in this population.

METHODS

PubMed, Web of Science, The Cochrane Library, EMBASE, and CINAHL were searched from the inception to May 10, 2023. Investigators assessed eligibility, extracted data, and evaluated methodological quality. The pooled prevalence of frailty and prefrailty was calculated using the random-effects model. Meta-regression analysis and subgroup analysis were conducted to explore sources of heterogeneity. Sensitivity analysis was undertaken by the leave-one-out method and by removing studies with moderate/high risk of bias. The Mantel-Haenszel or inverse variance method was used to estimate risk factors of frailty.

RESULTS

A total of 14 studies met the inclusion criteria, involving 185,249 participants. The pooled prevalence in older adults with hypertension was 23% (95% CI 0.09-0.36) for frailty and 46% (95% CI 0.38-0.54) for prefrailty. The pooled prevalence of frailty was greater in studies with a higher proportion of females (24%, 95% CI 0.05-0.50), using multidimensional tools to define frailty (30%, 95% CI 0.10-0.51) and conducted in Western Pacific (27%, 95% CI 0.17-0.39). Age, female sex, depression, and previous hospitalizations were risk factors of frailty among older adults with hypertension.

CONCLUSION

Frailty and prefrailty are prevalent in community-dwelling older adults with hypertension, and limited risk factors are identified. This implicates the importance of frailty assessment integrated into the routine primary care for older adults with hypertension in community settings as well as the understanding of potential factors.

High Dietary Zinc Intake Is Associated with Shorter Leukocyte Telomere Length, Mediated by Tumor Necrosis Factor-α: A Study of China Adults

OBJECTIVES

Diet can influence peripheral leukocyte telomere length (LTL), and various micronutrients have been reported to correlate with it. Zinc is known for its antioxidant properties and immunomodulatory effects. However, there are few epidemiological investigations on the relationship between dietary zinc intake and LTL. This study analyzed the association between dietary zinc and LTL and the potential role of inflammation and oxidative stress among them.

DESIGN

Cross-sectional and community-based study.

SETTING AND PARTICIPANTS

599 participants from rural communities in the Changping suburb of Beijing, China, were recruited.

MEASUREMENTS

Serum lipid profile, glycosylated hemoglobin (HbA1c), oxidative stress marker, and inflammatory cytokines levels were measured. Detailed dietary data were obtained using a 24 h food recall. LTL was assessed using a real-time PCR assay. Spearman analysis, restricted cubic splines (RCS), and general linear regression models were used to determine the association between dietary zinc intake and LTL. Simple regulatory models were also applied to analyze the role of inflammation and oxidative stress among them.

RESULTS

A total of 482 subjects were ultimately included in this analysis. Spearman analysis showed that dietary zinc intake and zinc intake under energy density were negatively correlated with LTL (r=-0.142 and -0.126, all P <0.05) and positively correlated with tumor necrosis factor-α (TNF-α) (r=0.138 and 0.202, all P <0.05) while only dietary zinc without energy adjustment had a positive correlation with superoxide dismutase (SOD). RCS (P for non-linearity=0.933) and multiple linear regression (B=-0.084, P=0.009) indicated a negative linear association between dietary zinc and LTL. The adjustment of TNF-α rather than SOD could abolish the relationship. The mediation model suggested that the unfavorable effect of dietary zinc on LTL was mediated by TNF-α.

CONCLUSIONS

High dietary zinc may correlate with telomere attrition, and TNF-α can act as a mediator in this relationship. In the future, more extensive cohort studies are needed to further explore the relationship between dietary zinc and cellular aging and the specific mechanisms.

[A two-stitch continuous suture method for single-lumen ileostomy]

Objective: To explore the value of a two-stitch continuous suture in single- lumen ileostomy. Methods: This was a retrospective cohort study. Data for 98 patients who underwent single-lumen enterostomy were retrospectively collected between 1 January 2021 and 1 May 2022 at Zhujiang Hospital of Southern Medical University. All patients met the indications for prophylactic single-lumen ileostomy. Those older than 80 years of age, with complex underlying diseases, extremely poor systemic conditions who could not tolerate surgery, poor blood supply at the end of the bowel, and severe edema or severe infection at the end of the bowel were excluded. Among the included patients, patients who underwent surgery before 1 October 2021 underwent ileostomy with interrupted suture (control group, n=60), and patients operated on and after 1 October 2021 routinely underwent two-stitch continuous suture ileostomy (two-stitch stoma group, n=38). Two-stitch continuous suture ileostomy is performed as follows: the first continuous suture is used to suture the intestinal seromuscular layer, peritoneum, posterior sheath, and anterior sheath from deep to superficial layers. The bowel wall is then opened. The second continuous suture is used to suture the full thickness of the bowel and the skin. The differences in postoperative ostomy-related complications and operation time were compared between the groups. Results: There were no significant differences in baseline data between the groups (all, P>0.05). The operative time in the two-stitch stoma group was shorter than that of the control group (16.6±2.2 minutes vs. 25.1±2.4 minutes, respectively; t=-17.874;P<0.001). The incidences of mucocutaneous separation, dermatitis, and stoma rebound in the two-stitch stoma group were lower than those of the control group [5.3% (2/38) vs. 31.7% (19/60), χ²=9.633, P=0.002;5.3% (2/38) vs. 28.3% (17/60), χ²=7.923, P=0.005; and 2.6% (1/38) vs. 18.3% (11/60), P=0.026, respectively], while the incidences of parastomal hernia and stoma prolapse, and the postoperative visual analog scale scores in the two groups were similar (all P>0.05). Conclusion: Compared with traditional single-lumen ileostomy, two-stitch continuous suture ileostomy has the advantages of short operation time, simplicity, esthetic appearance of the stoma, and a significant reduction in the postoperative complications associated with ileostomy.

BACH1 regulates the proliferation and odontoblastic differentiation of human dental pulp stem cells

Background

The preservation of biological and physiological vitality as well as the formation of dentin are among the main tasks of human dental pulp for a life time. Odontoblastic differentiation of human dental pulp stem cells (hDPSCs) exhibits the capacity of dental pulp regeneration and dentin complex rebuilding. Exploration of the mechanisms regulating differentiation and proliferation of hDPSCs may help to investigate potential clinical applications. BTB and CNC homology 1 (BACH1) is a transcription repressor engaged in the regulation of multiple cellular functions. This study aimed to investigate the effects of BACH1 on the proliferation and odontoblastic differentiation of hDPSCs in vitro.

Methods

hDPSCs and pulpal tissues were obtained from extracted human premolars or third molars. The distribution of BACH1 was detected by immunohistochemistry. The mRNA and protein expression of BACH1 were examined by qRT-PCR and Western blot analysis. BACH1 expression was regulated by stable lentivirus-mediated transfection. Cell proliferation and cell cycle were assessed by cell counting kit-8 assay, 5-Ethynyl-2'-deoxyuridine assay and flow cytometry. The expression of mineralization markers, alkaline phosphatase (ALP) activity and alizarin red S staining were conducted to assess the odontoblastic differentiation ability.

Results

BACH1 expression was stronger in the odontoblast layer than in the cell rich zone. The total and nuclear protein level of BACH1 during odontoblastic differentiation was downregulated initially and then upregulated gradually. Knockdown of BACH1 greatly inhibited cell proliferation, arrested cell cycle, upregulated the heme oxygenase-1 (HO-1) expression and attenuated ALP activity, decreased calcium deposits and downregulated the expression of mineralization markers. Treatment of Tin-protoporphyrin IX, an HO-1 inhibitor, failed to rescue the impaired odonto/osteogenic differentiation capacity. Overexpression of BACH1 increased cell proliferation, ALP activity and the expression of mineralization markers.

Conclusions

Our findings suggest that BACH1 is an important regulator of the proliferation and odontoblastic differentiation of hDPSCs in vitro. Manipulation of BACH1 expression may provide an opportunity to promote the regenerative capacity of hDPSCs.