Comparison of intravesical chemotherapy regimens after radical nephroureterectomy for upper tract urothelial carcinoma and analysis of risk factors for postoperative recurrence

OBJECTIVE

Upper tract urothelial carcinoma (UTUC) is a relatively rare but aggressive type of urologic cancer that includes renal pelvic tumors and ureteral tumors with a poor prognosis. Full-length nephroureterectomy plus sleeve bladder resection is the standard treatment for the disease, but patients are prone to recurrence of bladder tumors after surgery. Intravesical infusion therapy is the main means to prevent the recurrence and progression of bladder cancer. Epirubicin and gemcitabine are widely used in clinical practice as first-line or salvage therapy for intravesical chemotherapy; however, the efficacy of these agents is rarely discussed. The purpose of this study was to investigate the effects of epirubicin and gemcitabine on the occurrence of bladder cancer after radical nephroureterectomy for UTUC and to analyze the risk factors affecting the recurrence of postoperative bladder cancer.

PATIENTS AND METHODS

A total of 215 patients with diagnosed UTUC and treated in our hospital from June 2019 to August 2021 were retrospectively selected as the research subjects, and they were divided into an observation group (120 cases) and a control group (95 cases) according to different treatment methods. The patients in the control group were treated with epirubicin, while those in the observation group received gemcitabine. All patients were followed up by telephone or outpatient examination for 12 months to record the occurrence of adverse reactions. The occurrence of bladder cancer was recorded at 3 months, 6 months, and 12 months after the surgery. According to the occurrence of bladder cancer after surgery, the patients were divided into a bladder cancer group (63 cases) and a non-bladder cancer group (152 cases). Multivariate Logistic regression analysis was used to analyze the risk factors of bladder cancer after surgery.

RESULTS

The total incidence of adverse reactions in the control group was 49.47%, which was higher than that in the observation group with 15.00% (p<0.01). The incidence of bladder tumors in the observation group and the control group was 0.00% and 2.11% at 3 months, 5.00% and 8.42% at 6 months, 13.33% and 15.79% at 12 months, without significant difference (p>0.05). After 12 months of perfusion, the levels of acidic fibroblast growth factor (aFGF), basic fibroblast growth factor (bFGF), and vascular endothelial growth factor (VEGF) in the two groups were significantly lower than those before perfusion (p<0.05). In the observation group, the levels of these three factors were slightly decreased compared with those in the control group, without a significant difference (p>0.05). Between the bladder cancer and non-bladder cancer groups, there were significant differences in tumor location, number of lesions, tumor stage, preoperative ureteral examination, and preoperative history of bladder cancer (p<0.05). The above indexes were all risk factors for postoperative bladder cancer (p<0.05).

CONCLUSIONS

Epirubicin and gemcitabine reduced the occurrence of bladder cancer and effectively inhibited tumor angiogenesis after radical nephroureterectomy for UTUC. The tumor location, number of lesions, tumor stage, preoperative ureteral examination, and preoperative history of bladder cancer were risk factors for postoperative bladder cancer.

Magnetic resonance imaging assessment of substantia nigral iron deposition in Parkinson's disease: a meta-analysis

OBJECTIVE

The pathogenesis of Parkinson's disease (PD) is associated with abnormal iron accumulation. Magnetic resonance imaging (MRI) studies have shown that patients with Parkinson's disease have an increased amount of iron in their substantia nigra (SN). We have undertaken a meta-analysis of studies using MRI in PD, to explore the potential role of MRI in diagnosing PD using abnormal iron deposition in SN as a candidate biomarker.

MATERIALS AND METHODS

Searches of PubMed, Embase, and Medline databases revealed 16 studies that compared PD patients and healthy controls (HC). A sensitivity analysis and subgroup analysis were performed to evaluate the reliability of our results. Estimates were pooled by the fixed-effects model. As an expression of I2, we computed the proportion of variation due to heterogeneity.

RESULTS

We included 16 studies with sample sizes of 435 PD and 355 HC in our meta-analysis. Results showed that SN iron deposition was significantly elevated (p<0.00001) in patients with PD compared to HC ones (SMD=0.72, 95% confidence interval 0.57 to 0.87, p<0.00001).

CONCLUSIONS

Our findings, based on a homogeneous group-level analysis, suggest that MRI-based SN iron deposition could be used to distinguish PD from HC. For a more rigorous investigation of SN iron deposition in PD, larger cohort studies are needed.

SAPPHIRE: phase III study of sitravatinib plus nivolumab versus docetaxel in advanced nonsquamous non-small-cell lung cancer

BACKGROUND

Checkpoint inhibitor (CPI) therapy revolutionized treatment for advanced non-small-cell lung cancer (NSCLC); however, most patients progress due to primary or acquired resistance. Sitravatinib is a receptor tyrosine kinase inhibitor that can shift the immunosuppressive tumor microenvironment toward an immunostimulatory state. Combining sitravatinib with nivolumab (sitra + nivo) may potentially overcome initial CPI resistance.

PATIENTS AND METHODS

In the phase III SAPPHIRE study, patients with advanced non-oncogenic driven, nonsquamous NSCLC who initially benefited from (≥4 months on CPI without progression) and subsequently experienced disease progression on or after CPI combined with or following platinum-based chemotherapy were randomized 1 : 1 to sitra (100 mg once daily administered orally) + nivo (240 mg every 2 weeks or 480 mg every 4 weeks administered intravenously) or docetaxel (75 mg/m2 every 3 weeks administered intravenously). The primary endpoint was overall survival (OS). The secondary endpoints included progression-free survival (PFS), objective response rate (ORR), clinical benefit rate (CBR), duration of response (DOR; all assessed by blinded independent central review), and safety.

RESULTS

A total of 577 patients included randomized: sitra + nivo, n = 284; docetaxel, n = 293 (median follow-up, 17.1 months). Sitra + nivo did not significantly improve OS versus docetaxel [median, 12.2 versus 10.6 months; hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.70-1.05; P = 0.144]. The median PFS was 4.4 versus 5.4 months, respectively (HR 1.08, 95% CI 0.89-1.32; P = 0.452). The ORR was 15.6% for sitra + nivo and 17.2% for docetaxel (P = 0.597); CBR was 75.5% and 64.5%, respectively (P = 0.004); median DOR was 7.4 versus 7.1 months, respectively (P = 0.924). Grade ≥3 treatment-related adverse events were observed in 53.0% versus 66.7% of patients receiving sitra + nivo versus docetaxel, respectively.

CONCLUSIONS

Although median OS was numerically longer with sitra + nivo, the primary endpoint was not met in patients with previously treated advanced nonsquamous NSCLC. The safety profiles demonstrated were consistent with previous reports.

Calorie Restriction Impairs Anti-Tumor Immune Responses in an Immunogenic Preclinical Cancer Model

(1) Background: Although the important role of dietary energy intake in regulating both cancer progression and host immunity has been widely recognized, it remains unclear whether dietary calorie restriction (CR) has any impact on anti-tumor immune responses. (2) Methods: Using an immunogenic B16 melanoma cell expressing ovalbumin (B16-OVA), we examined the effect of the CR diet on B16-OVA tumor growth and host immune responses. To further test whether the CR diet affects the efficacy of cancer immunotherapy, we examined the effect of CR against anti-PD-1 monoclonal antibody (anti-PD-1 Ab) treatment. (3) Results: The CR diet significantly slowed down the tumor growth of B16-OVA without affecting both CD4+ and CD8+ T cell infiltration into the tumor. Although in vivo depletion of CD8+ T cells facilitated B16-OVA tumor growth in the control diet group, there was no significant change in the tumor growth in the CR diet group with or without CD8+ T cell-depletion. Anti-PD-1 Ab treatment lost its efficacy to suppress tumor growth along with the activation and metabolic shift of CD8+ T cells under CR condition. (4) Conclusions: Our present results suggest that a physical condition restricted in energy intake in cancer patients may impair CD8+ T cell immune surveillance and the efficacy of immunotherapy.

Towards identifying a learning curve for robotic abdominal wall reconstruction: a cumulative sum analysis

INTRODUCTION

Over the past decade, an increase has been seen in robotics used for hernia repair, specifically robotic abdominal wall reconstruction (rAWR). However, the learning curve for rAWR can be steep and presently, little is understood regarding the optimal case volume required to achieve proficiency. The aim of our study was to review skill acquisition and describe the learning curve for rAWR.

METHODS

A retrospective, single-surgeon case series of consecutive patients who underwent rAWR from 2018 to 2022. The primary outcome was operative time, obtained from console time identified through the MyIntutive application. A one-sided cumulative sum analysis (CUSUM) curve for the total operative time was derived based on the mean operative time of chronological procedures (207 min).

RESULTS

185 patients underwent rAWR between 2018 and 2022. These patients were more likely to be female, Caucasian, and have undergone two previous hernia repairs. ASA complexity increased over time with ASA 3 being predominant from 2020 onwards. The median hernia length was 15.0 cm and the median width was 7 cm. Average operative time was 207.8 min and decreased over time. The CUSUM analysis identified four phases of skill acquisition with the following case volumes: Initial Learning Curve (0-20), Stabilization Phase (21-55), Second Learning Curve (56-70), 4) Skill Proficiency (> 70).

CONCLUSION

In the early learning curve of rAWR, operative time decreased consistently after 70 cases, with an initial inflection after 20 cases. We identified varying stages of skill acquisition that are likely typical of a surgeon as they would progress through the learning curve of advanced robotic surgery. Future studies are needed to confirm the optimal case volume for determining the skill level for the performance of rAWR.

CAMSAP3 negatively regulates lung cancer cell invasion and angiogenesis through nucleolin/HIF-1α mRNA complex stabilization

AIMS

Cancer metastasis is a major cause of lung cancer-related mortality, so identification of related molecular mechanisms is of interest. Calmodulin-regulated spectrin-associated protein 3 (CAMSAP3) has been implicated in lung cancer malignancies; however, its role in metastatic processes, including invasion and angiogenesis, is largely unknown.

MAIN METHOD

The clinical relevance of CAMSAP3 expression in lung cancer was evaluated. The relevance of CAMSAP3 expression to in vitro cell invasion and angiogenesis was assessed in human lung cancer cells and endothelial cells, respectively. The molecular mechanism was identified by qRT-PCR, immunoprecipitation, mass spectrometry, and RNA immunoprecipitation. The in vivo metastatic and angiogenic activities of lung cancer cells were assessed.

KEY FINDINGS

Low CAMSAP3 expression was found in malignant lung tissues and strongly correlated with a poor prognosis in lung adenocarcinoma (LUAD). CAMSAP3-knockout NSCLC exhibited high invasive ability, and CAMSAP3 knockout induced HUVEC proliferation and tube formation; these effects were significantly attenuated by reintroduction of exogenous wild-type CAMSAP3. Mechanistically, in the absence of CAMSAP3, the expression of hypoxia-inducible factor-1α (HIF-1α) was upregulated, which increased the levels of downstream HIF-1α targets such as vascular endothelial growth factor A (VEGFA) and matrix metalloproteinases (MMPs) 2 and 9. Proteomic analysis revealed that nucleolin (NCL) bound to CAMSAP3 to regulate HIF-1α mRNA stabilization. In addition, CAMSAP3-knockout lung cancer cells displayed highly aggressive behavior in metastasis and angiogenesis in vivo.

SIGNIFICANCE

This study reveals that CAMSAP3 plays a negative regulatory role in lung cancer cell metastatic behavior both in vitro and in vivo through NCL/HIF-1α mRNA complex stabilization.

Hydrogen sulfide alleviates lipopolysaccharide-induced myocardial injury through TLR4-NLRP3 pathway

To investigate the effect of hydrogen sulfide (H2S) on myocardial injury in sepsis-induced myocardial dysfunction (SIMD), male C57BL/6 mice were intraperitoneally injected with lipopolysaccharide (LPS) (10 mg/kg, i.p.) to induce cardiac dysfunction without or with the H2S donor sodium hydrosulfide (NaHS) (50 µmol/kg, i.p.) administration 3 h after LPS injection. Six hours after the LPS injection, echocardiography, cardiac hematoxylin and eosin (HE) staining, myocardial damage and inflammatory biomarkers and Western blot results were analyzed. In mice, the administration of LPS decreased left ventricular ejection fraction (LVEF) by 30 % along with lowered H2S levels (35 % reduction). It was observed that cardiac troponin I (cTnI), tumor necrosis factor-alpha (TNF-alpha), and interleukin-1beta (IL-1beta) levels were all increased (by 0.22-fold, 2000-fold and 0.66-fold respectively). HE staining revealed structural damage and inflammatory cell infiltration in the myocardial tissue after LPS administration. Moreover, after 6 h of LPS treatment, toll-like receptor 4 (TLR4) and nod-like receptor protein 3 (NLRP3) expressions were up-regulated 2.7-fold and 1.6-fold respectively. When compared to the septic mice, NaHS enhanced ventricular function (by 0.19-fold), decreased cTnI, TNF-alpha, and IL-1beta levels (by 11 %, 33 %, and 16 % respectively) and downregulated TLR4 and NLRP3 expressions (by 64 % and 31 % respectively). Furthermore, NaHS did not further improve cardiac function and inflammation in TLR4-/- mice or mice in which NLRP3 activation was inhibited by MCC950, after LPS injection. In conclusion, these findings imply that decreased endogenous H2S promotes the progression of SIMD, whereas exogenous H2S alleviates SIMD by inhibiting inflammation via the TLR4-NLRP3 pathway suppression.

Coherent Picture on the Pure Spin Transport between Ag/Bi and Ferromagnets

In a joint effort of both experiments and first-principles calculations, we resolve a hotly debated controversy and provide a coherent picture on the pure spin transport between Ag/Bi and ferromagnets. We demonstrate a strong inverse Rashba-Edelstein effect (IREE) at the interface in between Ag/Bi with a ferromagnetic metal (FM) but not with a ferromagnetic insulator. This is in sharp contrast to the previously claimed IREE at Ag/Bi interface or inverse spin Hall effect dominated spin transport. A more than one order of magnitude modulation of IREE signal is realized for different Ag/Bi-FM interfaces, casting strong tunability and a new direction for searching efficient spintronics materials.

Relationship of resting heart rate and blood pressure with all-cause and cardiovascular disease mortality

OBJECTIVES

This study aimed to investigate associations of resting heart rate (RHR) and blood pressure (BP) with all-cause and cardiovascular disease (CVD) mortality.

STUDY DESIGN

A retrospective cohort study.

METHODS

A total of 67,028 Chinese participants aged ≥60 years were included in the analysis. RHR, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were evaluated according to quartiles ([41-69, 70-74, 75-79, 80-127 beats/min], [80-119, 120-129, 130-139, 140-238 mm Hg], and [40-70, 71-79, 80-84, 85-133 mm Hg]). Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause and CVD mortality with RHR, SBP, and DBP. Restricted cubic splines were used to evaluate the dose-response association.

RESULTS

During the 361,975 person-year follow-up, 9326 deaths were recorded, of which 5039 deaths were due to CVD. The risk of all-cause mortality was increased by 25% with the quartiles four vs quartile one of RHR (HR [95% CI]:1.25 [1.17-1.33]), and CVD mortality was increased by 32% (HR [95% CI]: 1.32 [1.22-1.44]). Similar results were observed when comparing the quartiles four vs quartile one of SBP with the risk of all-cause and CVD mortality (HRs [95% CIs]: 1.14 [1.07, 1.22] and 1.23 [1.12. 1.34]) and DBP with the risk of all-cause and CVD mortality (HRs [95% CIs]: 1.17 [1.11. 1.24] and 1.36 [1.26. 1.47]). We found linear associations of RHR, SBP, and DBP with all-cause and CVD mortality (P_{non-linearity} >0.05), except for the approximately J-shaped association between DBP and all-cause mortality (P_{non-linearity} = 0.008). There was a significant interaction of RHR and SBP with all-cause and CVD mortality (P_interaction <0.05).

CONCLUSIONS

RHR and BP increased the risk of all-cause and CVD mortality, especially fast RHR combined with high SBP.

Magnesium levels in relation to rates of preterm birth: a systematic review and meta-analysis of ecological, observational, and interventional studies

CONTEXT

Experimental studies suggest that magnesium levels in pregnant women may affect the length of gestation, as magnesium affects the activity of smooth muscle in the uterus. Little is known about the association between magnesium levels or supplementation and the rate of preterm birth.

OBJECTIVE

The aim of this systematic review was to summarize the data on magnesium soil levels and preterm birth rates from ecological, observational, and interventional studies.

DATA SOURCES

Soil magnesium levels were obtained from US Geological Survey data, and preterm birth rates were acquired from the March of Dimes Foundation. Relevant epidemiological and clinical studies published until April 2019 in peer-reviewed journals were retrieved from PubMed, Google Scholar, and related reference lists.

STUDY SELECTION

Original studies published in English, conducted in humans, and in which magnesium (dietary/supplemental intake or biomarkers) was an exposure and preterm birth was an outcome were included.

DATA EXTRACTION

Eleven studies were included in the systematic review. Meta-analysis was performed on 6 studies. Overall relative risk (RR) and corresponding 95%CIs for risk of preterm birth in relation to magnesium supplementation were estimated by a random-effects model.

RESULTS

The ecological study revealed an inverse correlation between magnesium content in soil and rates of preterm birth across the United States (r = -0.68; P < 0.001). Findings from 11 observational studies generally support an inverse association between serum magnesium levels and rates of preterm birth. Of the 6 eligible randomized controlled trials, which included 3068 pregnant women aged 20 to 35 years and 352 preterm infants, the pooled RR was 0.58 (95%CI, 0.35-0.96) for women in the magnesium supplementation group compared with women in the control group.

CONCLUSIONS

Accumulated evidence from ecological, observational, and interventional studies consistently indicates that adequate magnesium intake during pregnancy may help reduce the incidence of preterm birth.

Abstract P590: Serum Zinc Levels and Incidence of Ischemic Stroke: The Reasons for Geographic and Racial Differences in Stroke Study

Background and Purpose: Despite zinc’s role as an anti-oxidant and anti-inflammatory agent, prospective studies relating zinc levels to ischemic stroke risk are lacking. We aimed to examine the association between serum zinc levels and incidence of ischemic stroke in a US population.

Methods: Using a case-cohort study nested within the REGARDS (REasons for Geographic and Racial Differences in Stroke) cohort, participants were randomly selected from the REGARDS cohort to generate a sub-cohort ( n= 2,346). All incident ischemic stroke cases as of September 2012 ( n =660) were included, with 62 incident cases overlapping in the sub-cohort. Serum zinc levels were measured at baseline. Barlow-weighted Cox’s proportional hazards regression models were used to calculate multivariable-adjusted hazard ratios (HR) and the corresponding 95% confidence intervals (CI) of ischemic stroke by serum zinc levels.

Results: The median zinc level for the sub-cohort was 121.19 μg/dL (interquartile range 104.86 to 140.39 μg/dL). Serum zinc levels were inversely associated with incidence of ischemic stroke after adjustment for potential confounders (quartile 4 vs. quartile 1: HR=0.78, 95% CI: 0.61-0.98, p=0.03 for trend). When stratified by pre-specified factors (sex, race, region), only sex showed a significant modification (p=0.03 for interaction). The inverse association was more pronounced among females (quartile 4 vs. quartile 1: HR=0.58, 95% CI: 0.41-0.84, p<0.01 for trend) than males (quartile 4 vs. quartile 1: HR=1.08, 95% CI: 0.78-1.51, p=0.92 for trend).

Conclusions: Serum zinc concentration was inversely associated with incidence of ischemic stroke, especially among women, indicating that low zinc levels may be a risk factor for ischemic stroke.

Remote Mesoscopic Signatures of Induced Magnetic Texture in Graphene

Mesoscopic conductance fluctuations are a ubiquitous signature of phase-coherent transport in small conductors, exhibiting universal character independent of system details. In this Letter, however, we demonstrate a pronounced breakdown of this universality, due to the interplay of local and remote phenomena in transport. Our experiments are performed in a graphene-based interaction-detection geometry, in which an artificial magnetic texture is induced in the graphene layer by covering a portion of it with a micromagnet. When probing conduction at some distance from this region, the strong influence of remote factors is manifested through the appearance of giant conductance fluctuations, with amplitude much larger than e^{2}/h. This violation of one of the fundamental tenets of mesoscopic physics dramatically demonstrates how local considerations can be overwhelmed by remote signatures in phase-coherent conductors.

High expression of ACE2 in the human lung leads to the release of IL6 by suppressing cellular immunity: IL6 plays a key role in COVID-19

OBJECTIVE

The pathogenesis of coronavirus disease 2019 (COVID-19) remains clear, and no effective treatment exists. SARS-CoV-2 is the virus that causes COVID-19 and uses ACE2 as a cell receptor to invade human cells. Therefore, ACE2 is a key factor to analyze the SARS-CoV-2 infection mechanism.

MATERIALS AND METHODS

We included 9,783 sequencing results of different organs, analyzed the effects of different ACE2 expression patterns in organs and immune regulation.

RESULTS

We found that ACE2 expression was significantly increased in the lungs and digestive tract. The cellular immunity of individuals with elevated ACE2 expression is activated, whereas humoral immunity is dampened, leading to the release of many inflammatory factors dominated by IL6. Furthermore, by studying the sequencing results of SARS-CoV-2-infected and uninfected cells, IL6 was found to be an indicator of a significant increase in the number of infected cells. However, although patients with high expression of ACE2 will release many inflammatory factors dominated by IL6, cellular immunity in the colorectum is significantly activated. This effect may explain why individuals with SARS-CoV-2 infection have severe lung symptoms and digestion issues, which are important causes of milder symptoms.

CONCLUSIONS

This finding indicates that ACE2 and IL6 inhibitors have important value in COVID-19.

Low- and moderate- levels of arsenic exposure in young adulthood and incidence of chronic kidney disease: Findings from the CARDIA Trace Element Study

BACKGROUND

It is unclear whether arsenic exerts adverse health effects on the kidney at low- and moderate- levels of exposure. We prospectively examined toenail arsenic concentrations measured during young adulthood in relation to incidence of chronic kidney disease (CKD) in midlife.

METHODS

A total of 3768 participants (53 % female and 48 % blacks) in the Coronary Artery Risk Development in Young Adults (CARDIA) study were included. Arsenic concentration in toenail clippings was assessed by using inductively coupled plasma mass spectrometry at CARDIA exam year 2. Incident CKD was identified if having estimated glomerular filtration rate <60 mL/min per 1.73 m² or albuminuria >30 mg/g. The association between toenail arsenic levels and CKD incidence over a mean of 24 years of follow-up was examined using multivariable-adjusted Cox proportional hazards models.

RESULTS

After controlling for potential confounders, including demographics, socioeconomics, lifestyle factors, clinical measurements of blood pressure, lipids, and glucose, and medical history, arsenic exposure measured in toenails was not associated with CKD incidence (quintile 5 versus quintile 1: hazard ratio = 1.04, 95 % confidence interval = 0.78-1.40, P for trend = 0.38).

CONCLUSION

This longitudinal study does not support the hypothesis that low- and moderate- levels of arsenic exposure are associated with elevated incidence of CKD in the US general population. Further studies are need to investigate species of arsenic biomarkers in relation to nephrotoxicity.

Walking pace and the risk of stroke: A meta-analysis of prospective cohort studies

PURPOSE

The extent to which walking pace is associated with a reduced risk for stroke remains unclear. This study examined the association between walking pace and stroke risk based on prospective cohort studies.

METHODS

Databases of PubMed, EMBASE, Web of Science, Scopus, and China National Knowledge Internet were searched from the inception dates to January 31, 2019, for prospective cohort studies focusing on walking pace and risk of stroke in adults. Two reviewers independently extracted data and assessed the quality of the studies. The dependent measure was stroke incidence. Using random-effects models, a meta-analysis was performed to estimate the overall relative risks (RR) of stroke incidence and 95% confidence intervals (CIs) for the individuals with the fastest walking paces vs. individuals with the slowest walking paces. A dose-response relationship was also examined.

RESULTS

After screening 1294 titles/abstracts and 14 full-text studies identified in the search, 7 studies (from 8 cohorts) were included in the meta-analysis. The 7 studies included a total of 135,645 participants (95.2% women; mean age 63.6 years) and 2229 stroke events (median follow-up time = 8.0 years). Compared to individuals in the slowest walking-pace category (median = 1.6 km/h), individuals in the fastest walking-pace category (median = 5.6 km/h) had a 44% lower risk of stroke (pooled RR = 0.56, 95%CI: 0.48-0.65). There was also a linear dose-response relationship (RR = 0.87; 95%CI: 0.83-0.91), with the risk of stroke decreased by 13% for every 1 km/h increment in baseline walking pace. We observed similar results across walking-pace assessment, type of stroke ascertainment, stroke subtypes, sex, sample size, and duration of follow-up.

CONCLUSION

Findings from this meta-analysis indicate that walking pace is inversely associated with the risk of stroke.

Association Between Gestational Weight Gain and Autism Spectrum Disorder in Offspring: A Meta-Analysis

OBJECTIVE

This study aimed to quantitatively examine the association between gestational weight gain (GWG) and risk of autism spectrum disorder (ASD) in offspring.

METHODS

Electronic databases were searched for studies of excessive or inadequate GWG, as compared with recommended GWG, in relation to the risk of ASD in offspring. Measures of the association from primary studies were pooled using a meta-analytic approach and expressed as weighted odds ratios (ORs) with 95% CIs.

RESULTS

Nine studies were identified, including 323,253 participants with 4,135 cases of ASD from five cohort studies and 1,462 cases and 3,265 controls from four case-control studies. Evidence from cohort studies indicates that both excessive and inadequate GWG was significantly associated with a higher risk for ASD in offspring. The pooled OR of ASD was 1.10 (95% CI: 1.02-1.18) for excessive GWG and 1.13 (95% CI: 1.04-1.24) for inadequate GWG using recommended GWG as the reference. Evidence from case-control studies suggests that excessive GWG (1.38 [95% CI: 1.19-1.62]) but not inadequate GWG (0.87 [95% CI: 0.72-1.04]) was significantly associated with a higher risk for ASD.

CONCLUSIONS

The accumulated evidence has supported that gaining weight outside the recommended GWG is associated with a higher risk for ASD in offspring.

[Genes associated with Wolbachia-induced cytoplasmic incompatibility in natural populations of Culex pipiens pallens: a preliminary study]

OBJECTIVE

To investigate the genes involved in Wolbachia-induced cytoplasmic incompatibility among three natural populations of Culex pipiens pallens in eastern China, so as to provide insights into the development of preventive and control measures for mosquito-borne diseases based on Wolbachia.

METHODS

The cytoplasmic incompatibility was tested among three natural populations of C. pipiens pallens collected from Nanjing and Wuxi of Jiangsu Province and Tangkou of Shandong Province using reciprocal crosses. Wolbachia infection was detected in C. pipiens pallens using a PCR assay, and the expression of Wolbachia wsp and WD0513 genes was quantified using a fluorescent quantitative real-time PCR (qPCR) assay.

RESULTS

Bidirectional compatibility was found between the natural populations of C. pipiens pallens collected from Nanjing and Wuxi of Jiangsu Province (t = 0.57 and 0.15, both P values > 0.05), while bidirectional incompatibility was seen between the natural populations of C. pipiens pallens collected from Tangkou of Shandong Province and Wuxi of Jiangsu Province (t = 63.81 and 43.51, both P values < 0.01), and between the natural populations of C. pipiens pallens collected from Nanjing of Jiangsu Province and Tangkou of Shandong Province (t = 39.62 and 43.12, both P values < 0.01). Wolbachia wsp gene was amplified in all three natural populations of C. pipiens pallens, and qPCR assay detected no significant difference in the Wolbachia wsp gene expression among the three natural populations of C. pipiens pallens (F = 2.15, P > 0.05). In addition, there was no significant difference in the WD0513 gene expression between the natural populations of C. pipiens pallens collected from Tangkou of Shandong Province and Nanjing of Jiangsu Province (q = 8.42, P < 0.05) or between the natural populations of C. pipiens pallens collected from Tangkou of Shandong Province and Wuxi of Jiangsu Province (q = 7.84, P < 0.05); however, there was a significant difference detected in the WD0513 gene expression between the natural populations of C. pipiens pallens collected from Nanjing and Wuxi of Jiangsu Province (q = 0.40, P > 0.05).

CONCLUSIONS

Different Wolbachia numbers are detected in natural populations of C. pipiens pallens collected from Nanjing and Wuxi of Jiangsu Province and Tangkou of Shandong Province, and WD0513 gene may be involved in the Wolbachia-induced cytoplasmic incompatibility among three natural populations of C. pipiens pallens.

Cardiolipin inhibitor ameliorates the non-alcoholic steatohepatitis through suppressing NLRP3 inflammasome activation

OBJECTIVE

Non-alcoholic fatty liver disease (NAFLD) has been proven to be the most common liver disease in the world, which is a sterile liver disease and is characterized by chronic hepatic steatosis and inflammation. The first step of the spectrum of the disease is the non-alcoholic fatty liver (NAFL). Based on hepatocellular necrosis and inflammation, NAFL will progress to non-alcoholic steatohepatitis (NASH), which may have the potential to progress cirrhosis, and even hepatocellular carcinoma (HCC) in a few years. Kupffer cells (KCs) are liver-resident macrophages and have been proven to play a crucial role in NAFLD development. Cardiolipin is reported to be effective to trigger the activation of NLRP3 inflammasome through a ROS-independent signaling pathway. However, the exact mechanism of NLRP3 inflammasome activated by cardiolipin in KCs is still unclear.

MATERIALS AND METHODS

To make clear of the specific mechanism mentioned above, we firstly used a MCD-induced NASH mice model to demonstrate that CLS1 suppression reduced hepatic steatosis and inflammation. Secondly, the results of IHC staining indicated that the expressions of CLS1 and NLRP3 in liver tissues were significantly upregulated in the NASH group compared to the ND group. On the contrary, CLS1 inhibition significantly downregulated NLRP3 expression in liver tissues, which indicated that CLS1 probably regulated the level of NLRP3 expression. Furthermore, we demonstrated that CLS1 suppression significantly ameliorated the liver function and decreased the TG level, and interleukin-1β (IL-1β) and IL-18 were markedly reduced upon CLS1 inhibition.

RESULTS

In this work, we reported that cardiolipin is involved in the development of NASH, and the suppression of the cardiolipin synthesis by shRNA-CLS1 could ameliorate the hepatic pathogenic manifestations, as well as the serum inflammatory biomarkers. We further showed that the protein expressions of CLS1, NLRP3, ASC, and Caspase-1 were all upregulated in the NASH liver tissues and palmitic stimulated KCs.

CONCLUSIONS

Our study showed that the upregulation of NLRP3 inflammasome activated by cardiolipin is crucial in NASH pathogenesis, which might provide a novel potential role of cardiolipin blockade in the treatment of NASH.

Intakes of Folate, Vitamin B6, and Vitamin B12 in Relation to Diabetes Incidence Among American Young Adults: A 30-Year Follow-up Study

OBJECTIVE

To prospectively examine intakes of folate, vitamin B₆, and vitamin B₁₂ in relation to diabetes incidence in a large U.S. cohort.

RESEARCH DESIGN AND METHODS

A total of 4,704 American adults aged 18-30 years and without diabetes were enrolled in 1985-1986 and monitored until 2015-2016 in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Dietary assessment was conducted by a validated dietary history questionnaire at baseline, in 1992-1993, and in 2005-2006. The cumulative average intakes of folate, vitamin B₆, and vitamin B₁₂ were used in the analyses. Incident diabetes was ascertained by plasma glucose levels, oral glucose tolerance tests, hemoglobin A_1c concentrations, and/or antidiabetic medications.

RESULTS

During 30 years (mean 20.5 ± 8.9) of follow-up, 655 incident cases of diabetes occurred. Intake of folate, but not vitamin B₆ or vitamin B₁₂, was inversely associated with diabetes incidence after adjustment for potential confounders. Compared with the lowest quintile of total folate intake, the multivariable-adjusted hazard ratios (95% CI) in quintiles 2-5 were 0.85 (0.67-1.08), 0.78 (0.60-1.02), 0.82 (0.62-1.09), and 0.70 (0.51-0.97; P _trend = 0.02). Higher folate intake was also associated with lower plasma homocysteine (P _trend < 0.01) and insulin (P _trend < 0.01). Among supplement users, folate intake was inversely associated with serum C-reactive protein levels (P _trend < 0.01).

CONCLUSIONS

Intake of folate in young adulthood was inversely associated with diabetes incidence in midlife among Americans. The observed association may be partially explained by mechanisms related to homocysteine level, insulin sensitivity, and systemic inflammation.

Erythrocyte omega-3 index, ambient fine particle exposure, and brain aging

OBJECTIVE

To examine whether long-chain omega-3 polyunsaturated fatty acid (LCn3PUFA) levels modify the potential neurotoxic effects of particle matter with diameters <2.5 µm (PM2.5) exposure on normal-appearing brain volumes among dementia-free elderly women.

METHODS

A total of 1,315 women (age 65-80 years) free of dementia were enrolled in an observational study between 1996 and 1999 and underwent structural brain MRI in 2005 to 2006. According to prospectively collected and geocoded participant addresses, we used a spatiotemporal model to estimate the 3-year average PM2.5 exposure before the MRI. We examined the joint associations of baseline LCn3PUFAs in red blood cells (RBCs) and PM2.5 exposure with brain volumes in generalized linear models.

RESULTS

After adjustment for potential confounders, participants with higher levels of RBC LCn3PUFA had significantly greater volumes of white matter and hippocampus. For each interquartile increment (2.02%) in omega-3 index, the average volume was 5.03 cm3 (p < 0.01) greater in the white matter and 0.08 cm3 (p = 0.03) greater in the hippocampus. The associations with RBC docosahexaenoic acid and eicosapentaenoic acid levels were similar. Higher LCn3PUFA attenuated the inverse associations between PM2.5 exposure and white matter volumes in the total brain and multimodal association areas (frontal, parietal, and temporal; all p for interaction <0.05), while the associations with other brain regions were not modified. Consistent results were found for dietary intakes of LCn3PUFAs and nonfried fish.

CONCLUSIONS

Findings from this prospective cohort study among elderly women suggest that the benefits of LCn3PUFAs on brain aging may include the protection against potential adverse effects of air pollution on white matter volumes.

Smoking Cessation and the Risk of Bladder Cancer among Postmenopausal Women

Smoking is the strongest established risk factor for bladder cancer. Former smokers have a lower risk of bladder cancer compared with current smokers, but findings on the dose-response relationship between years after quitting and the risk of bladder cancer are inconsistent. A total of 143,279 postmenopausal women from the Women's Health Initiative Study were included. Cox proportional hazards regression models were applied for estimating age- and multivariable-adjusted HRs and their 95% confidence intervals (CI). There were 870 bladder cancer cases identified over an average of 14.8 years of follow-up. After adjusting for pack-years of smoking, bladder cancer risk among former smokers declined by 25% within the first 10 years of cessation and continued to decrease as cessation time increased but remained higher than never smokers after 30 years of quitting (HR, 1.92; 95% CI, 1.43-2.58). Smokers who quit smoking had a lower risk of bladder cancer compared with current smokers (HR, 0.61; 95% CI, 0.40-0.94). We conclude that among postmenopausal women, there is a significant reduction in the risk of bladder cancer after quitting smoking. In addition to primary prevention, smoking cessation is critical to prevent the incidence of bladder cancer in older women.

Association between selenium intake and breast cancer risk: results from the Women's Health Initiative

PURPOSE

It has been hypothesized that selenium (Se) can prevent cancer, and that Se deficiency may be associated with an increased risk of breast cancer. However, findings from epidemiological studies have been inconsistent. The objective of this study was to assess the association between Se intake and risk of breast cancer in the Women's Health Initiative (WHI).

METHODS

This study included 145,033 postmenopausal women 50-79 years who completed baseline questionnaires between October 1993 and December 1998, which addressed dietary and supplemental Se intake and breast cancer risk factors. The association between baseline Se intake and incident breast cancer was examined in Cox proportional hazards analysis.

RESULTS

During a mean follow-up of 15.5 years, 9487 cases of invasive breast cancer were identified. Total Se (highest versus lowest quartile: HR 1.00, 95% CI 0.92-1.09, P_trend = 0.66), dietary Se (highest versus lowest quartile: HR 0.99, 95% CI 0.89-1.08, P_trend = 0.61), and supplemental Se (yes versus no: HR 0.99, 95% CI 0.95-1.03) were not associated with breast cancer incidence.

CONCLUSIONS

This study indicates that Se intake is not associated with incident breast cancer among postmenopausal women in the United States. Further studies are needed to confirm our findings by using biomarkers such as toenail Se to reduce the potential for misclassification of Se status.

Magnesium Intake Is Inversely Associated with the Risk of Non-Alcoholic Fatty Liver Disease Among American Young adults

Objectives

To examine magnesium (Mg) intake from diet and supplements during young adulthood in relation to risk of non-alcoholic fatty liver disease (NAFLD) in midlife.

Methods

A total of 2712 black and white American adults aged 18 to 30 years were recruited in the Coronary Artery Risk Development in Young Adult (CARDIA) study in 1985–1986 (baseline) with 8 additional examinations during 25 years thereafter. Mg intake was assessed at baseline and exam years 7 and 20 using the CARDIA diet history questionnaires. Computed tomography (CT) scanning was performed at exam year 25 (2010–2011) to ascertain NAFLD cases, which was defined as liver attenuation (LA) ≤51 Hounsfield units after exclusion for other causes of liver fat. Logistic regression was used to examine the association between cumulative average Mg intake and the risk of NAFLD.

Results

At exam year 25, 638 NAFLD cases were documented. An inverse association between total Mg intake (from diet and supplements) and NAFLD risk was observed after adjustment sociodemographics, major lifestyle factors, dietary quality, and clinical measurements (body mass index, blood pressure, lipid profiles, and fasting insulin). Compared with participants in the lowest quintile of Mg intake, those in the highest quintile had a 54% lower risk of NAFLD [multivariable-adjusted odds ratio = 0.46, 95% confidence interval = (0.25, 0.87), P for trend = 0.0498]. Consistently, there was an inverse association between whole grain consumption (a major food source of magnesium) and NAFLD risk.

Conclusions

This study suggests that higher intake of Mg throughout adulthood is associated with a lower risk of NAFLD in middle age.

Funding Sources

The Coronary Artery Risk Development in Young Adults Study is supported by grants from the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with the University of Alabama at Birmingham, Northwestern University, University of Minnesota, and Kaiser Foundation Research Institute.This study is also partially supported by the NIH grants and NHLBI.

0605 Comparison of Sleep Specialist vs Primary Care Driven Home Sleep Apnea Testing in Routine Practice

Introduction

Home sleep apnea testing (HSAT) has largely supplanted diagnostic polysomnography. Primary care (PC) driven HSAT utilization is common especially in rural settings that lack sleep specialist (SS) support. There have been no studies comparing appropriateness of HSAT utilization in veterans managed by SS vs. PC.

Methods

We use hub and spoke model to manage patients with OSA. SS selects testing for hub and PC utilizes HSAT for spoke patients. Testing is interpreted by SS. Patients referred for HSAT using WatchPAT over 4 months were compared on test failure rate, adherence to AASM guidelines for OSA diagnosis, adherence to HSAT use criteria, and diagnostic success rate (AHI ≥5) in high risk patients (STOPBANG ≥5) without significant comorbidities or HSAT contraindications compared to all comers.

Results

There were 125 hub and 170 spoke patients included in the analyses. Baseline characteristics were similar between sites (gender, age, BMI, Epworth sleepiness scale, neck size, STOPBANG, pacemaker dependence, and medication use affecting HSAT). Spoke patients had slightly higher prevalence of comorbidities (hypertension, cardiac arrhythmia, heart failure, COPD, stroke, and long acting opioid use). Complete HSAT failure (no data) was 2% and technical failure (monitoring time &lt;4 hours) was 13% at both sites. Unnecessary studies primarily to confirm OSA in those previously diagnosed on therapy seeking to establish care were 3% (hub) and 21% (spoke). HSAT done in patients without significant comorbidities was 77% (hub) and 68% (spoke). Adherence to HSAT use criteria was 74% at both sites. Diagnostic success rate of prespecified and all comers was 65% vs. 60% at hub and 86% vs. 64% at spoke sites.

Conclusion

Adherence to AASM guidelines and HSAT use criteria was overall fair with low failure rates. Further improving HSAT protocol for SS and PC with the aim to improve diagnostic success rate and minimize unnecessary studies should be pursued.

Support

 

Physical activity and risk of bladder cancer among postmenopausal women

Physical activity is associated with decreased risk for many cancers. Studies on the association between physical activity and risk of bladder cancer are limited, and findings are inconsistent. Postmenopausal women (mean age = 63.3) were recruited into the Women's Health Initiative from 1993 to 1998. Self-reported baseline information on physical activity and other covariates were available in 141 288 participants. Incident bladder cancer cases were collected through 2018 and centrally adjudicated. Hazard ratios (HRs) and 95% confidence intervals (CIs) were determined by Cox proportional hazard regression models. Effect modification due to smoking was assessed. During an average of 18.5 years of follow-up, 817 bladder cancer cases were identified. Compared to physically inactive women, those who engaged in ≥15 MET-hours/week of total physical activity, ≥8.75 MET-hours/week of walking or ≥11.25 MET-hours/week of moderate to vigorous physical activity had lower risk of bladder cancer (HR = 0.74, 95% CI: 0.59-0.94, P for linear trend = .02; HR = 0.79, 95% CI: 0.63-0.98, P for linear trend = .03; and HR = 0.76, 95% CI: 0.61-0.94, P for linear trend = .02, respectively). No effect modification was found by smoking status (P for interaction = .06, 0.91 and 0.27, respectively). We found that total physical activity, walking and moderate to vigorous physical activity were inversely associated with bladder cancer incidence among postmenopausal women in a dose-response manner. Physical activity may play a potential role in the primary prevention of bladder cancer. Further studies with objective measurements of physical activity are needed to confirm these findings.

The association between type 2 diabetes mellitus and bladder cancer risk among postmenopausal women

INTRODUCTION

Evidence on the association between diabetes and risk of bladder cancer has been controversial. In addition, findings on the associations between duration of diabetes, diabetes treatment, and risk of bladder cancer have been inconsistent.

METHODS

A total of 148,208 participants in Women's Health Initiative study were included. Information on diabetes status, diabetes duration, and treatment was collected both at baseline and during follow-up. Information on potential confounders including age, race/ethnicity, education, occupation, family history of cancer, smoking status, alcohol consumption, total physical activity, body mass index, and daily dietary intake were collected at baseline. Bladder cancer cases were collected and confirmed by a centralized review of pathology reports. Cox proportional hazard models with time-varying covariates were used to examine associations of diabetes status, duration of diabetes, and diabetes treatment with bladder cancer risk.

RESULTS

During a median follow-up of 18.5 years, 865 bladder cancer cases were identified. There were no significant associations of diabetes, duration of diabetes, or diabetes treatment with risk of bladder cancer. Participants with prevalent diabetes did not have significantly higher risk of bladder cancer compared with those without diabetes.

CONCLUSION

Diabetes was not significantly associated with risk of bladder cancer among postmenopausal women.

Magnesium intake is inversely associated with risk of obesity in a 30-year prospective follow-up study among American young adults

PURPOSE

Although laboratory studies suggest a potential role of magnesium (Mg) in weight regulation, human studies relating Mg intake to body weight are limited. This study sought to prospectively examine the association between Mg intake and incidence of obesity and related anthropometric and biochemical indicators.

METHODS

The Coronary Artery Risk Development in Young Adults (CARDIA) study recruited 5115 American young adults, aged 18-30 years, at baseline in 1985-6, and re-examined them in eight follow-ups. Incident obesity was defined as body mass index (BMI) ≥ 30 kg/m². Dietary Mg intake was collected using the CARDIA Diet History at baseline and exam years 7 and 20.

RESULTS

During the 30-year follow-up, 1675 incident cases of obesity were identified. After adjustment for potential confounders, Mg intake was inversely associated with incidence of obesity. The multivariable-adjusted hazard ratios (95% confidence interval) from quintile 1 (Q1) (lowest intake group) to quintile 5 (Q5) (highest intake group) were 1 (referent), 0.86 (0.74, 1.00), 0.83 (0.71, 0.97), 0.55 (0.46, 0.66), and 0.49 (0.40, 0.60); P for trend < 0.01. Consistently, Mg intake was inversely associated with the levels of BMI, triceps skinfold, suprailiac skinfold, subscapular skinfold, fasting insulin, and C-reactive protein. The observed associations were not materially modified by age, sex, race, or BMI at baseline. In addition, the intakes of foods rich in Mg, including whole grains, nuts and seeds, legumes, and dark-green vegetables, were associated with lower incidence of obesity.

CONCLUSIONS

This longitudinal study suggests that Mg intake is inversely associated with incidence of obesity.

Intakes of long-chain omega-3 polyunsaturated fatty acids and non-fried fish in relation to incidence of chronic kidney disease in young adults: a 25-year follow-up

PURPOSE

The prevalence of chronic kidney disease (CKD) is increasing rapidly in many countries and has become a major public health concern. Although intakes of long-chain omega-3 polyunsaturated fatty acids (LCω3PUFA) and its food source-fish-may have renal protective effects, little is known about the longitudinal association between these dietary factors and CKD incidence.

METHODS

A total of 4133 healthy individuals of black and white race aged 18-30 at baseline (1985-1986) from the Coronary Artery Risk Development in Young Adults study were enrolled and followed up over 25 years. LCω3PUFA and fish intake were assessed by an interview-based dietary history questionnaire at baseline, year 7 (1992-1993) and 20 (2005-2006).

RESULTS

Four hundred and eighty-nine incident cases of CKD were identified. After adjustment for potential confounders, LCω3PUFA intake was inversely associated with CKD incidence [HR = 0.73 (95% CI 0.60-0.89), P = 0.002, with one standard division (0.19 g/day) increment in LCω3PUFA]. This inverse association was persisted among females [0.64 (95% CI 0.48, 0.84; P = 0.002], but not males (Pinteraction = 0.070). A marginal significant inverse association was also found between non-fried fish consumption and CKD incidence (HR = 0.86, 95% CI 0.73, 1.01; P = 0.073).

CONCLUSIONS

Dietary LCω3PUFA intake was inversely associated with incidence of CKD among American young adults over 25 years of follow-up. The suggestive evidence of the inverse association between non-fried fish consumption with CKD incidence needs further confirmation.

The association between parental weight status and risk of hypertension in children aged 6 to 12 years

BACKGROUND AND OBJECTIVES

Parents may play important roles in the regulation of children's weight status and consequently the development of childhood hypertension. Thus, this study aimed to examine parental weight status, as a marker of parents' diet and lifestyle, in relation to risk of hypertension in their children.

METHODS AND STUDY DESIGN

A total of 1,949 children aged 6 to 12 years (1,012 girls, 52%) and their parents were included. Information on demographics, anthropometrics, lifestyle, diet, and medical history were obtained from the participants and their parents through self-administered questionnaires. Childhood hypertension and elevated blood pressure were defined as SBP and/or DBP ≥95th and ≥90th age- and gender-specific percentile, respectively. Parental overweight was defined as BMI ≥24.0 kg/m2.

RESULTS

The prevalence of childhood hypertension was 8.4%, with no significant gender difference (p=0.36). Parents' weight status, especially maternal, was associated with childhood hypertension. After adjustment for potential confounders, children with two parents being overweight were two times more likely to have hypertension as compared with children who had both parents being of normal weight [multivariable-adjusted odds ratio=2.09; 95% confidence interval: (1.26, 3.46)]. After further adjustment for children's body mass index, the observed association was substantially attenuated and became statistically non-significant.

CONCLUSIONS

Findings from this study suggest that parental weight status is associated with the prevalence of hypertension in children presumably through influencing children's weight. Further studies are needed to establish causal inference. This study highlights the importance of parental lifestyle in children's health.

Insect genomes: progress and challenges

In the wake of constant improvements in sequencing technologies, numerous insect genomes have been sequenced. Currently, 1219 insect genome-sequencing projects have been registered with the National Center for Biotechnology Information, including 401 that have genome assemblies and 155 with an official gene set of annotated protein-coding genes. Comparative genomics analysis showed that the expansion or contraction of gene families was associated with well-studied physiological traits such as immune system, metabolic detoxification, parasitism and polyphagy in insects. Here, we summarize the progress of insect genome sequencing, with an emphasis on how this impacts research on pest control. We begin with a brief introduction to the basic concepts of genome assembly, annotation and metrics for evaluating the quality of draft assemblies. We then provide an overview of genome information for numerous insect species, highlighting examples from prominent model organisms, agricultural pests and disease vectors. We also introduce the major insect genome databases. The increasing availability of insect genomic resources is beneficial for developing alternative pest control methods. However, many opportunities remain for developing data-mining tools that make maximal use of the available insect genome resources. Although rapid progress has been achieved, many challenges remain in the field of insect genomics.

Temperature and excitation wavelength dependence of circular and linear photogalvanic effect in a three dimensional topological insulator Bi2Se3

The circular (CPGE) and linear photogalvanic effect (LPGE) of a three-dimensional topological insulator Bi₂Se₃ thin film of seven quintuple layers excited by near-infrared (1064 nm) and mid-infrared (10.6 [Formula: see text]m) radiations have been investigated. The comparison of the CPGE current measured parallel and perpendicular to the incident plane, together with the comparison of the CPGE current under front and back illuminations, indicates that the CPGE under front illumination of 1064 nm light is dominated by the top surface states of the Bi₂Se₃ thin film. The CPGE current excited by 10.6 [Formula: see text]m light is about one order larger than that excited by 1064 nm light, which may be attributed to the smaller cancelation effect of the CPGE generated in the two-dimensional electron gas when excited by 10.6 [Formula: see text]m light. Under the excitation of 1064 nm light, the LPGE current is dominated by the component which shows an even parity of incident angles, while the LPGE current excited by 10.6 [Formula: see text]m light is mainly contributed by the component which is an odd parity of incident angles. Both of the CPGE and LPGE currents excited by 1064 nm decrease with increasing temperature, which may be owing to the decrease of the momentum relaxation time and the stronger electron-electron scattering with increasing temperature, respectively.

Calcium Intake and Serum Calcium Level in Relation to the Risk of Ischemic Stroke: Findings from the REGARDS Study

BACKGROUND AND PURPOSE

Data on the association between calcium (Ca) and ischemic stroke are sparse and inconsistent. This study aimed to examine Ca intake and serum Ca levels in relation to risk of ischemic stroke.

METHODS

The primary analysis included 19,553 participants from the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study. A subcohort was randomly selected to create a case-cohort study (n=3,016), in which serum Ca levels were measured. Ischemic stroke cases were centrally adjudicated by physicians based on medical records. Cox proportional hazards regression for the cohort and weighted Cox proportional hazard regression with robust sandwich estimation method for the case-cohort analysis with adjustment for potential confounders were performed.

RESULTS

During a mean 8.3-year follow-up, 808 incident cases of ischemic stroke were documented. Comparing the highest quintile to the lowest, a statistically significant inverse association was observed between total Ca intake and risk of ischemic stroke (hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.55 to 0.95; Plinear-trend=0.183); a restricted cubic spline analysis indicated a threshold effect like non-linear association of total Ca intake with ischemic stroke (Pnon-linear=0.006). In the case-cohort, serum Ca was inversely associated with the risk of ischemic stroke. Compared to the lowest, the highest quintile of serum Ca had a 27% lower risk of ischemic stroke (HR, 0.73; 95% CI, 0.53 to 0.99; Plinear-trend=0.013). Observed associations were mainly mediated by type 2 diabetes, hypertension, and cholesterol.

CONCLUSION

s These findings suggest that serum Ca has inverse and Ca intake has threshold effect like association with risk of ischemic stroke.

Impact of Postnatal Antibiotics and Parenteral Nutrition on the Gut Microbiota in Preterm Infants During Early Life

BACKGROUND

The early-life gut microbiota, which is critically important for the long-term health of infants, is normally sensitive to perturbations, especially in preterm infants. However, how the gut microbiota develops and what key factors affect the preterm gut microbiota remain largely unknown. We hypothesized that preterm microbial dysbiosis exists from the beginning after birth, and microbial alteration is associated with parenteral nutrition and antibiotic therapy interventions.

METHODS

Fecal samples were collected from fifty-one preterm and fifty full-term vaginally delivered (FTVD) infants at 7 time points for 90 days after birth. The microbial profiles of 558 fecal DNA samples were analyzed by sequencing their 16S ribosomal RNA amplicons. A random-effects generalized least square regression was used to identify factors that influence the bacterial composition over time.

RESULTS

The altered gut microbiota in preterm infants existed from the meconium, having significantly lower levels of Escherichia-Shigella than those in FTVD infants. The developmental trajectories of 7 predominant bacterial groups successfully fitted with exponential/linear function curves (R² , 0.921-0.993) in both groups. By day 90, depleted levels of Bacteroides and Parabacteroides and an overabundance of Peptoclostridium were characteristic of the preterm group. The prolonged use of antibiotics and parenteral nutrition had significant adverse effects on the Lactobacillus and Bifidobacterium levels in preterm infants. Moreover, gestational age, sex, and birth weight were factors impacting specific genera in preterm infants.

CONCLUSION

The early-life microbial composition and functions were markedly different in preterm infants, being associated with the prolonged use of postnatal antibiotics and parenteral nutrition.