Background: The long-term health effects of weight cycling in mid to late adulthood remain uncertain, and previous studies have provided limited data on the safety of weight change. To guide lifelong weight management strategies, we investigated the association between annual changes in obesity parameters and risks of incident cardiometabolic outcomes, cancer, and mortality in multinational cohorts. Methods: Repeated anthropometric data from five large European and North American longitudinal cohorts were leveraged, which comprised 151,600 adults with at least 15 years of follow-up. Individual trajectories of body mass index (BMI), weight, waist circumference (WC), and waist-to-hip ratio (WHR) were constructed, their annual change rates were calculated, and the predictive performance for major outcomes was compared. We defined annual change rate thresholds stratified by baseline BMI and assessed the risks of outcomes across weight change categories. Matched case-control analysis and two-sample Mendelian randomization were also conducted for validation. Findings: The annual BMI change rate showed the best predictive performance for adverse outcomes across these cohorts. In analyses stratified by baseline BMI and restricted to a 5-year time window, the moderate BMI loss group revealed risk profiles comparable to, or better than, those of the stable group, whereas rapid loss and gain were both linked to higher risks of adverse outcomes. This pattern was more evident among individuals suffering from overweight or obesity and concomitant pre-existing cardiovascular diseases. Interpretation: From a life-course perspective, our convergent observational and genetic evidence indicated that maintaining a moderate weight-loss trajectory in middle-aged and older adults is associated with more favorable cardiometabolic, cancer, and mortality outcomes than either rapid weight loss or gain. The relatively safe annual BMI change ranges differ by baseline adiposity, underscoring the need for BMI-stratified, rate-based targets in lifelong weight management guidelines and highlighting the importance of monitoring weight change slopes in clinical practice.

BACKGROUND:Effective management of severe cancer pain remains challenging. Our phase II study suggested that intravenous patient-controlled analgesia with hydromorphone (IPCA-HM), delivered either as bolus-only or continuous infusion, is superior to oral morphine for patients with severe cancer pain, with bolus-only potentially providing comparable efficacy to infusion while resulting in a lower rate of morphine equivalent dose (MED) escalation. This phase III study aimed to validate these findings. PATIENTS AND METHODS:Patients with solid tumors and severe cancer pain (≥7 at rest on an 11-point Numeric Rating Scale [NRS]) who achieved successful 24-hour IPCA-HM dose-finding were randomized (2:2:1) to bolus-only IPCA-HM (bolus), continuous infusion IPCA-HM (infusion), or oral morphine (oral) for 6 days. The primary outcome was average NRS score over days 1-3 (3DNRS). RESULTS:Of 1,349 patients from 48 oncology centers, 542 received bolus, 540 infusion, and 267 oral. Mean [SD] 3DNRS scores were 2.36 [0.89], 2.26 [0.87], and 2.94 [1.16], respectively. Both IPCA-HM arms were statistically significantly better than the oral arm in 3DNRS scores (bolus vs oral: mean difference, 0.58 [95% CI, 0.42 to 0.74]; infusion vs oral: 0.68 [95% CI, 0.52 to 0.84]; both P<.001). Bolus was noninferior to infusion (mean difference, 0.10 [95% CI, -0.01 to 0.20]; predefined noninferiority margin, 0.3; P<.001), achieving noninferiority in opioid-naïve, but not opioid-tolerant, patients. Median (IQR) total MEDs over days 1-6 were 400 (260-692) mg, 643 (380-1,117) mg, and 867 (540-1,313) mg for the bolus, infusion, and oral arms, respectively. Opioid-related adverse events (all grade 1 or 2) were comparable between the bolus (20.1%) and infusion (23.0%) arms, and both were lower than in the oral arm (33.7%). CONCLUSIONS:For severe cancer pain, both IPCA-HM regimens provided statistically significantly better pain relief compared with oral morphine. The bolus regimen achieved noninferior efficacy compared with infusion while requiring lower opioid doses, providing a safe and effective analgesic option.

Pregnancy is a critical period for emotional adjustment in expectant couples. Antenatal depression in pregnant women is associated with significant risks to maternal and infant health and warrants research attention. The mental health of expectant fathers during this period, which is equally important, remains relatively overlooked. Antenatal stress and marital satisfaction may be associated with antenatal depression through interpersonal dynamics within couples. This study examined the relationships among antenatal stress, marital satisfaction, and antenatal depression within the couple dyad, and tested whether marital satisfaction mediates this association. This cross-sectional study enrolled 244 couples at a maternal and child health hospital in China. Participants completed the Perceived Stress Scale, Edinburgh Postnatal Depression Scale, and Quality of Marriage Index. The Actor-Partner Interdependence Model extended to Mediation was employed to analyze dyadic data, assessing both actor and partner effects. Structural equation modeling with bootstrap resampling was used to estimate direct and indirect effects. Significant gender differences were found in antenatal stress, marital satisfaction, and antenatal depression (P < 0.001), with pregnant women reporting higher levels. The APIMeM revealed significant actor effects: individuals’ antenatal stress was positively associated with their own depression (β = 0.361, P < 0.001) and negatively associated with their own marital satisfaction (β=-0.065, P = 0.008). Individuals’ marital satisfaction was negatively associated with their own depression (β=-0.116, P < 0.001). A significant partner effect was observed between individuals’ stress and partners’ depression (β = 0.048, P = 0.009). Marital satisfaction mediated the actor effect of stress on depression in wives (indirect effect β = 0.008, P = 0.005) but not in husbands. Additionally, marital satisfaction significantly mediated the partner effect of husbands’ stress on wives’ depression (indirect effect β = 0.005, P = 0.023). Individual antenatal stress was directly associated with both one’s own and one’s spouse’s antenatal depression (actor and partner effects). Marital satisfaction was associated with the actor effect of antenatal stress on depression for wives, as well as the partner effect of husbands’ stress on wives’ depression. These findings suggest that early identification of stressors, promotion of positive marital interactions, and attention to emotional exchanges between partners are relevant to better antenatal mental health outcomes.

The effect of behavioral shifts in physical activity (PA) and sedentary behavior (SB) on coronary heart disease (CHD), along with the potential mechanisms involved, remains to be fully elucidated. Therefore, this study included 1,699 participants (638 with CHD) and used isotemporal substitution modeling to quantify the CHD risk associated with reallocating time between PA intensities and SB. Mediation analysis assessed creatinine, uric acid (UA), urea nitrogen, and systemic immune-inflammation index (SII), while ELISA examined IgG glycoprotein and its fucosylation. Replacing light, moderate, or vigorous PA with 1 h/day of SB increased CHD risk (ORs: 1.177-1.352). Creatinine and UA mediated 3.66%-6.89% of these associations; SII mediated 17.37%-20.21%. Notably, IgG glycoprotein mediated 24.63%, with CHD patients and those with low PA/high SB exhibiting lower IgG fucosylation modifications. These findings suggest that reduced PA and prolonged SB are associated with CHD risk through pathways involving creatinine/UA dysregulation, systemic immune-inflammation, and altered IgG fucosylation.

Background:Lipoprotein(a) [Lp(a)] is a well-established independent risk factor for cardiovascular disease. However, the long-term effects of Lp(a) on coronary plaque phenotype remain unclear. Objective:To explore the potential association between Lp(a) levels and coronary plaque volume, composition, and progression using coronary computed tomography angiography (CCTA). Methods:Patients with available data for Lp(a) and underwent baseline CCTA examinations between January 2009 to December 2015 and subsequently underwent a follow-up coronary CTA were retrospectively enrolled. Quantitative CCTA analyses measured plaque length, total plaque volume and composition volume. Patients were categorized into an elevated Lp(a) group (≥30 mg/dL) and a normal Lp(a) group (<30 mg/dL). The association between Lp(a) and baseline plaque characteristic and progression were investigated in linear mixed-effects models adjusted for clinical factors. Subgroup analyses were also conducted. Results:Among 453 patients (mean age 64.7 years, 77.7% male) with a median follow-up of 6.15 years. elevated Lp(a) was linked to higher baseline plaque burden (all p < 0.001) and accelerated LAP volume progression (β = 0.55 mm3/year, 95% CI: 0.04-1.06; p = 0.036) after adjusting for confounders. In addition, patients with diabetes, female gender, family history of CAD, or aged <60 years and with normal lipid profiles showed higher progression in total plaque volume and LAP, fibro-fatty, and fibrous components. Increased calcification volume progression was also seen in those with diabetes, female gender, smoking, drinking, or normal LDL-C levels. The association between Lp(a) and calcification progression was more pronounced in statin users. Conclusions:Elevated Lp (a) level was associated with high coronary artery plaque burden at baseline and rapid progression of LAP at follow-up. Lp(a) may serve as a significant residual risk factor in seemingly "low-risk" populations.

Rheumatoid arthritis (RA), a chronic autoimmune disease linked to higher mortality, benefits from physical activity (PA), which has been shown to reduce disease activity and improve physical function. However, PA’s association with all-cause mortality in RA patients remains unclear. To investigate the relationship between various levels of PA and all-cause mortality among patients with RA. This dual-cohort observational study used data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018 and the UK Biobank database. PA was assessed using self-reported questionnaires in NHANES and 7-day wrist-worn accelerometers in the UK Biobank. Cox proportional-hazards models and restricted cubic spline (RCS) analysis were employed to evaluate the association between PA and all-cause mortality. Subgroup and interaction analyses were conducted to examine the robustness of the findings. Stratified analyses were performed using polygenic risk scores for RA in the UK Biobank cohort. An analysis combining results from both cohorts was conducted using random-effects models to estimate pooled associations and assess heterogeneity. A total of 1493 patients with RA from the NHANES cohort and 1724 from the UK Biobank cohort were included. Across both cohorts, PA was significantly associated with a lower risk of all-cause mortality. In fully adjusted models, active and highly active groups showed reduced mortality risks compared with the inactive group [NHANES: hazard ratio (HR): active = 0.381, highly active = 0.675; UK Biobank: HR: active = 0.557, highly active = 0.491]. RCS analysis revealed a U-shaped association between PA and mortality in the NHANES cohort, with moderate PA levels showing the greatest protective effect. However, an L-shaped pattern was observed in the UK Biobank cohort, where the highly active group had the lowest mortality risk. A joint analysis in NHANES revealed that active work-related PA combined with inactive recreational PA yielded the greatest mortality reduction. In the UK Biobank, moderate-to-vigorous PA remained protective even among patients with high genetic risk. A pooled analysis combining both cohorts confirmed a robust inverse association between PA and all-cause mortality (HR: active = 0.48, highly active = 0.61), with low heterogeneity across studies. PA is associated with reduced all-cause mortality in patients with RA. Question What is the relationship between various levels of PA and all-cause mortality among patients with RA? Findings In two large cohorts (NHANES, UK Biobank), higher PA levels significantly reduced death risk. Active (150–300 min/week) and highly active (>300 min/week) groups had lower mortality vs inactive groups (HRs: 0.381–0.675). Meaning PA is robustly linked to longer survival in RA, supporting personalized recommendations balancing activity type (work vs. recreational) and intensity to optimize outcomes.

OBJECTIVES:This study aims to explore the dynamics of neurological functional disability in patients with intracerebral haemorrhage (ICH) using a multistate Markov model and to investigate the factors influencing the shift in neurological functional disability. DESIGN:A prospective cohort study. SETTING:Electronic medical record data for adults, from July 2019 and October 2023 in neurosurgery at 27 national centres in China. PARTICIPANTS:Patients with ICH with cerebral haemorrhage in the supratentorial parenchyma confirmed by CT of the brain within 48 hours of onset of symptoms. Secondary cerebral haemorrhage due to aneurysm, vascular malformation, haemorrhagic infarction, tumour or coagulation disorders was excluded. PRIMARY AND SECONDARY OUTCOME MEASURES:Participants evaluated neurological functional status through the modified Rankin Scale, which we graded to construct a multistate Markov model. RESULTS:After treatment, patients with ICH who achieve good recovery of neurological function are 2.66 times more likely to transition to a state of no neurological impairment than to severe impairment. Patients in states of no neurological impairment and mild impairment tend to remain relatively stable, while those with severe impairment are at higher risk of transitioning to states that could result in mortality. A person with no disability post-ICH can expect to spend 19.42 (12.87~29.30) months in that state, and 9.99 (8.39~11.89) months in state S2 and 8.87 (7.79~10.09) months in state 3 during their lifetime. CONCLUSIONS:In the year following treatment and discharge, the neurological functional disability of most patients with ICH tends to remain stable. For patients undergoing state transitions, the probability of neurological improvement is higher than the likelihood of deterioration. Risk factors associated with deterioration include advanced age, preonset neurological impairment, a history of cerebrovascular disease, larger haematoma volume, and critical conditions. Patients with these risk factors should receive close monitoring after discharge.

While aging is a well-established contributor to cardiovascular disease, the specific relation between biological aging—as assessed by PhenoAge and PhenoAge acceleration—and the risk of coronary heart disease (CHD) requires further evidence to elucidate. This study conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES), alongside both cross-sectional and prospective analyses using data from the UK Biobank, to investigate the association between biological aging and CHD risk across two large cohorts. The results indicated that each unit increase in PhenoAge and PhenoAge acceleration was significantly associated with a higher risk of CHD. Compared to individuals without accelerated aging, those experiencing accelerated aging face a significantly higher risk. These findings suggest that PhenoAge and its acceleration are significant risk factors for CHD development. Moreover, surrogate markers of biological aging may serve as valuable tools for both the primary and secondary prevention of CHD.

The relationship between mixed metal exposure and metabolic syndrome (MetS) remains controversial, and the underlying mechanisms of this relationship are not yet fully understood. We evaluated the association between urinary metals and MetS and investigated the potential mediating effect of ageing. This study utilized National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2018 and included 11,541 adults aged 20 years and above. We explored the association between urinary concentrations of nine metals and MetS using weighted quantile sum (WQS) regression, grouped weighted quantile sum (GWQS) regression, and Bayesian kernel machine regression (BKMR). In addition, various methodologies have been used to assess biological ageing, encompassing the examination of cellular senescence through the evaluation of telomere length, as well as a comprehensive evaluation of overall body ageing through the determination of biological age. The contribution of biological ageing to the association between urinary metals and MetS was investigated in a mediation analysis. After adjusting for confounders, the WQS and GWQS analyses found positive and negative correlations between metal exposure and MetS, and the main metals affecting MetS risk were cadmium (Cd) and lead (Pb), respectively. A positive relationship was found between exposure to mixed metals and the risk of MetS in the BKMR results. Mediation analysis showed that ageing biomarkers, including biological age and telomere length, mediated 68.43

Objective:Quality of life (QoL) is increasingly recognized as an important prognostic indicator and has been identified to be associated with reduced survival in patients with advanced cancer during the last months of life. This study aimed to compare the initial QoL and influencing factors of patients with advanced cancer receiving home hospice care with less than 3-month survival period. Methods:A secondary data analysis study was conducted using the data from a Fujian provincial home hospice center, in China, between 2010 and 2020. Propensity score matching was performed in 2761 cases to match patients with a less than 1 month survival period and those with a 1-3 months survival period. Differences in QoL between the two groups were analyzed using the ANOVA or Wilcoxon Mann-Whitney test, and the influencing factors were analyzed using multiple linear regression analysis. Results:No significant differences in QoL were identified between cancer patients with a 1-3 month survival period and those with a survival period of less than 1 month. However, a significant difference was detected after the propensity score matching adjustment (P ​< ​0.05). Sources of living, awareness of disease, and performance status commonly affected the QoL of patients with different survival periods (P ​< ​0.05). Chemotherapy, weight loss, anorexia, and tumor type only affected the QoL of patients with a survival period of less than 1 month (P ​< ​0.05). Conclusions:The QoL of patients with advanced cancer receiving home hospice care is poor but does not necessarily deteriorate continuously during the last 3 months. Notably, the complexity of factors influencing QoL increases significantly as patients approach death.

Background:Evidence on the relationship between no-insulin-based insulin resistance (IR) surrogates and the prevalence of coronary heart disease (CHD) in remains limited. Here, we assess the associations between multiple non-insulin-based IR surrogates and CHD, delineating subgroups at heightened susceptibility across demographic and cardiometabolic strata. We further explore plausible mechanistic pathways and perform mediation analyses to elucidate the pathophysiological links between IR and CHD. Methods:This study analyzed 7,419 participants from Fujian Medical University affiliated hospital (2018-2024). Multivariate logistic regression and restricted cubic splines (RCS) were performed to evaluate the relationship between the atherogenic index of plasma (AIP index), triglyceride glucose index (TyG index), the metabolic score for insulin resistance (METS-IR), and triglyceride(TG)/high density lipoprotein cholesterol(HDL-C) ratio (TG/HDL-C ratio) and the prevalence of CHD. Subgroup analysis and interaction analysis were employed to identify effect modifiers associated with the IR-CHD relationship, whilst bioinformatics analysis and mediation analysis were utilized to identify and quantify potential mediating effects within this association. Results:In primary analyses, surrogate markers of IR were positively associated with the prevalence of CHD, with odd ratios ranging between 1.039 and 1.612. Moreover, physical inactivity was the predominant effect modifier (interaction P-value < 0.05), with a possible additional influence of younger age, so that sedentary adults <60 years with elevated IR surrogates appeared particularly vulnerable. Mechanistically, bioinformatic enrichment analyses highlighted three core pathways, including AGE-RAGE signaling in diabetic complications, FoxO signaling, and adipocytokine signaling, providing context for the observed patterns. Finally, mediation analyses indicated that fasting plasma glucose mediated 8.15%-55.33% of the associations, including AIP index, TyG index, METS-IR, and ln(TG/HDL-C). Conclusion:In this large hospital-based cross-sectional sample, non-insulin-based IR surrogates were positively associated with the prevalence of CHD and may help identify groups with a higher likelihood of having CHD. Glycemic pathways and physical inactivity emerged as important correlates of these associations and deserve further evaluation in longitudinal studies.

Objective This study aims to investigate the prevalence of familial cerebral cavernous malformations (FCCMs) in first-degree relatives (FDRs) using familial screening, to describe the distribution of initial symptoms, lesion count on cranial MRI and pathogenic gene in patients.Methods Patients with multiple CCMs who enrolled from the Treatments and Outcomes of Untreated Cerebral Cavernous Malformations in China database were considered as probands and FDRs were recruited. Cranial MRI was performed to screen the CCMs lesions, and whole-exome sequencing was performed to identify CCM mutations. MRI and genetic screening were combined to diagnose FCCM in FDRs, and the results were presented as prevalence and 95% CIs. The Kaplan-Meier (KM) method was used to calculate the cumulative incidence of FCCM.Results 33 (76.74%) of the 43 families (110 FDRs) were identified as FCCM (85 FDRs). Receiver operating characteristic analysis revealed three lesions on T2-weighted imaging (T2WI) were the strong indicator for distinguishing probands with FCCM (sensitivity, 87.10%; specificity, 87.50%). Of the 85 FDRs, 31 were diagnosed with FCCM, resulting in a prevalence of 36.5% (26.2%–46.7%). In families with FCCMs, the mutation rates for CCM1, CCM2 and CCM3 were 45.45%, 21.21% and 9.09%, respectively. Furthermore, 53.13% of patients were asymptomatic, 17.19% were intracranial haemorrhage and 9.38% were epilepsy. The mean age of symptom onset analysed by KM was 46.67 (40.56–52.78) years.Conclusion Based on MRI and genetic analysis, the prevalence of CCMs in the FDRs of families with FCCMs in China was 36.5%. Genetic counselling and MRI screening are recommended for FDRs in patients with more than three CCM lesions on T2WI.

ObjectivePregnant women exhibit heightened stress susceptibility and elevated depression risk during gestation, factors associated with adverse outcomes including postpartum depression. Current research predominantly examines maternal experiences while neglecting spousal influences.MethodsThe study surveyed 282 Chinese married couples using validated scales to assess prenatal stress and depression. And analysed dyadic data from expectant parents using the Actor-Partner Interdependence Model (APIM) to determine the pattern of action of prenatal stress on prenatal depression between couples by calculating the magnitude of the ratio k between the partner effect and the actor effect.ResultsThe analysis revealed k1 = 0.064, 95% CI: (-0.113, 0.260) and k2 = 0.064, 95% CI: (-0.118, 0.249). The confidence intervals for both k1 and k2 included zero, indicating an actor-only pattern in the APIM. Specifically, prenatal stress positively predicted one’s own prenatal depression but did not significantly influence the partner’s depression.ConclusionIt is crucial to encourage couples to actively manage their stress levels during the prenatal period. This can help to reduce the negative psychological effects of prenatal stress, which may lead to improved pregnancy outcomes and postnatal health.

Greenness has been linked to cardiovascular disease. However, the specific biological mechanisms through which greenness impacts coronary heart disease (CHD) remain unclear. We aim to explore the underlying epigenetic mechanisms linking greenness and CHD by using proteomics and miRNA microarray. A total of 2387 participants were included in the population study, 816 of whom were diagnosed with CHD. Residential greenness exposure was characterized using the normalized difference vegetation index (NDVI). Generalized additive models and restricted cubic splines investigated the association between greenness and CHD. Mediation analysis examined whether cardiovascular metabolic risk factors (blood pressure, inflammation indicators, and glucose) mediated the association. After proteomics and miRNA microarray screening, Elisa and qRT-PCR validated selected proteins (THBS1, FCN3, and LTBP1) and miRNAs (miR-671-5p, miR-124-3p, and miR-379-5p) in CHD. Among these, LTBP1 and miR-379-5p showed significant differential expression (P < 0.05) and were examined as potential molecular mediators. Higher greenness exposure within a 1000-m area was associated with a lower risk of CHD (OR: 0.86, 95 % CI: 0.81, 0.92). Systolic blood pressure (6.32 % [95 % CI: 1.49 %, 13.12 %]), lymphocyte (10.98 % [95 % CI: 3.76 %, 22.00 %]), monocyte (9.94 % [95 % CI: 3.42 %, 20.87 %]), and fasting blood glucose (3.41 % [95 % CI: 0.56 %, 7.84 %]) mediated this association. LTBP1 and miR-379-5p were differentially expressed in CHD and mediated 7.19 % [95 % CI: 0.01 %, 23.37 %] and 20.03 % [95 % CI: 2.85 %, 69.71 %] of greenness effect on CHD, respectively. Combining the population study and experiments, we found that miR-379-5p and LTBP1 may jointly modulate vascular constriction and immune inflammation in the association between greenness and CHD.

Objective: This study aimed to investigate the influence of exposure to ambient fine particulate matter (PM2.5) and its components during pregnancy on the prevalence of preterm birth (PTB). Additionally, we sought to identify the susceptible exposure window. Furthermore, we explored the potential mediating role of blood analysis and a comprehensive metabolic panel in the association between pollutant exposure and PTB incidence. Methods: This birth cohort study recruited 139 participants with PTB outcomes and 1713 controls from Fujian Maternal and Child Health Hospital between January 2021 and June 2023. Sociodemographic characteristics and clinical treatment data during participants' first pregnancies were collected. The exposure levels to pollutants during pregnancy were estimated via a combined geographic-statistical model utilising satellite remote sensing data. The distributional lag nonlinear modelling was employed to assess associations between pollutant exposure during pregnancy and the prevalence of PTB. Weighted quantile regression was used to identify key components associated with PM2.5 and PTB during pregnancy. Additionally, a mediating effect analysis was conducted to evaluate the role of blood analysis. The metabolic profile was used to screen for differentially abundant metabolites associated with PTB and explore their relative expression in relation to air pollutants and PTB incidence. Results: Following the adjustment for potential confounding variables, the mean weekly susceptibility windows for PM 2.5 were identified as 7-10, 16-19, and 22-28 weeks; 8-10, and 15-19 weeks for inorganic sulfate; 6-10, and 15-28 weeks for nitrate; 6-12, and 15-28 weeks for ammonium (NH4+); 4 + ); and 7-9, 18-20, and 22-36 weeks for organic matter. During mixed exposure to PM 2.5 components, the key component is NH4+. 4 + . In the mixed exposure to PM 2.5 components, NH4+ 4 + emerged as a key contributor. The results of the mediation analysis revealed that haemoglobin played a mediating role, accounting for 21.53 % of the association between exposure to environmental pollutants and the prevalence of PTB. It is noteworthy that, no mediating effects were observed for the other variables. Furthermore, non-targeted metabolomics identified 17 metabolites associated with PTB. Among these factors, hydrogen phosphate may impact metabolic pathways such as oxidative phosphorylation, influencing the risk of PTB. The interplay between environmental pollutants and metabolites, particularly through oxidative phosphorylation pathways, may contribute to PTB incidence. Conclusions: The evidence indicates that exposure to PM 2.5 and its components during pregnancy were a significant risk factor for PTB. Notably, specific weekly exposure windows were identified for pollutants during pregnancy. Among the PM 2.5 components, NH4+ 4 + exhibited the most substantial weight in the association analysis between exposure to the mixture of components and PTB. Furthermore, our mediation analysis revealed that haemoglobin serves as a partial mediator in the relationship between exposure to pollutants during pregnancy and the prevalence of PTB. Additionally, maternal serum metabolic profiles differed between the preterm and control groups. Notably, a combined effect involving hydrogen phosphate and mixed exposure to PM 2.5 fractions further contributed to the development of PTB. Oxidative phosphorylation pathways may play pivotal roles in this intricate association.

Immune checkpoint inhibitor (ICI) therapy is the new standard treatment for advanced or metastatic hepatocellular carcinoma (HCC); however, many patients still fail to respond. This study explored the expression and prognosis of programmed death ligand 1 (PD-L1), cluster of differentiation 24 (CD24), and cluster of differentiation 47 (CD47) in patients with hepatitis B virus-associated HCC (HBV-associated HCC). We analyzed sequencing data from the Cancer Genome Atlas (TCGA) and investigated the expression of PD-L1, CD24, and CD47 in HBV-associated HCC patients by immunohistochemistry and their relationship with prognosis and clinicopathological factors. HCC data from the TCGA database show that PD-L1 was substantially correlated with various immune cells. In 67 patients with HBV-associated HCC, high PD-L1 and CD24 expression levels were related to poor overall survival (OS) and progression-free survival (PFS). PD-L1 expression was significantly associated with the staging of HBV-associated HCC (p = 0.011) and Ki67 expression (p = 0.024). Correlation analysis between variables reveals that PD-L1 was significantly positively correlated with CD24 and CD47. High expression of PD-L1 and CD24 are risk factors for poor prognosis in HBV-associated HCC patients following curative resection. PD-L1 is significantly correlated with CD24 and CD47.

BACKGROUND:Endoscopic bariatric surgery (EBS) is a new treatment for obesity. We compared the efficacy, safety, and probability of metabolic complications of different EBSs with laparoscopic sleeve gastrectomy (LSG). METHODS:This systematic review and network meta-analysis (NMA) included searches of PubMed, Web of Science, and the Cochrane Library from January 1, 2017, to December 27, 2022, to find comparative trials of EBS procedures and EBS with LSG. We performed a frequentist model NMA to summarize the evidence and ranked the interventions according to SUCRA scores. RESULTS:The search for this NMA yielded 14,160 articles, of which 18 eligible trials recruited 766,135 participants for procedures including LSG, endoscopic sleeve gastroplasty (ESG), nonadjustable intragastric balloon (NIB), BioEnterics Intragastric Balloon (BIB), and adjustable intragastric balloon (AIB). Definitive evidence suggests that LSG is most effective for weight reduction. Compared with LSG, NIB, SMD = -0.49 [95% CI -0.79, -0.18]; AIB, SMD = -0.41 [95% CI -0.76, -0.06] and ESG, SMD = -0.31 [95% CI -0.33, -0.29] in the index of percentage total weight loss under six months. In terms of safety outcomes, ESG had the lowest incidence of adverse events; the order of the observed incidence of adverse events from small to large was ESG, NIB, AIB, LSG, and BIB. CONCLUSIONS:ESG is an effective and safe minimally invasive surgical method for people with overweight and obesity. Its 12-month effect is better than that of NIB, and its influence on lipid metabolism makes it more protective of the cardiovascular system and liver. PROSPERO:CRD42022375343.

Background To identify the optimal primary treatment strategy for small cell neuroendocrine carcinoma of the cervix (SCNECC). Methods This retrospective study included consecutive patients who received treatment for stage I-III SCNECC at Fujian Cancer Hospital from February 6, 2006 to July 30, 2019. Relapse-free survival (RFS) was analyzed using multivariate Cox proportional hazard regression. Results are shown as hazard ratio (HR) and 95% confidence interval (CI). Results The final analysis included 69 patients. Disease stage, as assessed by the 2018 FIGO criteria, was early (I–IIA) in 34 (49%) patients and advanced (IIB–IIIC) in the remaining 35 (51%) patients. Twenty patients (29%) received curative-intent radiotherapy followed by chemotherapy. The remaining 49 patients received curative surgical resection, followed by adjuvant chemotherapy in 16 (23%) patients or adjuvant chemoradiotherapy in 33 (48%) patients. Forty patients received neoadjuvant therapy prior to curative surgical resection. Within a median follow-up of 100 months (interquartile range: 59–120), recurrence or metastases occurred in 36 patients (52%). In patients with early-stage disease, the median RFS did not differ between patients undergoing curative-intent surgery vs radiotherapy (86 months, 95% CI 63–109 vs 86 months, 95% CI 56–116, P = 0.790). In patients with advanced-stage disease, there was a statistically non-significant trend for shorter median RFS in patients undergoing curative-intent surgery vs radiotherapy (61 months, 95% CI 38–85 vs 88 months, 95% CI 46–130, P = 0.590). In patients undergoing curative-intent surgery, patients with an extensive pathologic response to neoadjuvant chemotherapy had longer RFS than moderate response and minor response ( P = 0.033). In multivariate Cox regression analysis, longer RFS was independently associated with extensive pathologic response to neoadjuvant therapy (HR = 0.01, 95% CI 0.00-0.41; P = 0.017) and neoadjuvant therapy (HR = 10.10, 95% CI 1.02–99.78; P = 0.048). Conclusions In patients with early-stage SCNECC, RFS did not differ patients undergoing curative-intent radiotherapy vs surgery. For advanced-stage SCNECC, curative-intent radiotherapy followed by chemotherapy seemed to be compatible with better prognosis.

Background Interaction identification is important in epidemiological studies and can be detected by including a product term in the model. However, as Rothman noted, a product term in exponential models may be regarded as multiplicative rather than additive to better reflect biological interactions. Currently, the additive interaction is largely measured by the relative excess risk due to interaction (RERI), the attributable proportion due to interaction (AP), and the synergy index (S), and confidence intervals are developed via frequentist approaches. However, few studies have focused on the same issue from a Bayesian perspective. The present study aims to provide a Bayesian view of the estimation and credible intervals of the additive interaction measures. Methods Bayesian logistic regression was employed, and estimates and credible intervals were calculated from posterior samples of the RERI, AP and S. Since Bayesian inference depends only on posterior samples, it is very easy to apply this method to preventive factors. The validity of the proposed method was verified by comparing the Bayesian method with the delta and bootstrap approaches in simulation studies with example data. Results In all the simulation studies, the Bayesian estimates were very close to the corresponding true values. Due to the skewness of the interaction measures, compared with the confidence intervals of the delta method, the credible intervals of the Bayesian approach were more balanced and matched the nominal 95% level. Compared with the bootstrap method, the Bayesian method appeared to be a competitive alternative and fared better when small sample sizes were used. Conclusions The proposed Bayesian method is a competitive alternative to other methods. This approach can assist epidemiologists in detecting additive-scale interactions.

Background Pregnant women exhibit heightened vulnerability to stress and an elevated risk of depression during gestation. Antenatal depression increases the likelihood of adverse outcomes, including postpartum depression. Current research often overlooks the spouse's role, focusing solely on the pregnant woman. Aims To explore couple-based antenatal stress interactions on depression and the mediating role of marital satisfaction. Methods Convenience sampling method was used to select 244 couples attending Maternal and Child Health Hospital of Fujian province as the study subiects. The path relationships between antenatal stress, marital quality and antenatal depression of couples were analysed by APIMeM. Results Individual antenatal stress exerts a direct effect on antenatal depression, both within the individual and in their spouse. Furthermore, marital satisfaction mediated the actor effect of antenatal stress and depression in wives, as well as the partner effect of antenatal stress in husbands on their wives’ antenatal depression. Conclusion Antenatal emotions exhibit cross-partner effects, and the marital satisfaction may serve as a potential mediating factor in the relationship between antenatal stress and antenatal depression. Couples are encouraged to prioritize stress management during pregnancy, enhancing marital satisfaction can mitigate the harmful effects of antenatal stress on depression, potentially improving pregnancy outcomes and postnatal health.