Cross-sectional Relationship Between Dietary Protein Intake, Energy Intake and Protein Energy Wasting in Chronic Kidney Disease Patients.

The potential threshold for dietary energy intake (DEI) that might prevent protein-energy wasting (PEW) in chronic kidney disease (CKD) is uncertain. The subjects were non-dialysis CKD patients aged ≥ 14 years who were hospitalized from September 2019 to July 2022. PEW was measured by subjective global assessment (SGA). DEI and dietary protein intake (DPI) were obtained by 3-days diet recalls. Patients were divided into adequate DEI group and inadequate DEI group according to DEI ≥ 30 or < 30 kcal/kg/d. Logistic regression analysis and restricted cubic spline (RCS) were used in this study. We enrolled 409 patients, with 53.8% had hypertension and 18.6% had diabetes. The DEI and DPI was 27.63 ± 5.79 kcal/kg/day and 1.00 (0.90,1.20) g/kg/day, respectively. 69.2% of participants in inadequate DEI group. Malnutrition occurred in 18.6% of patients. Comparing to patients in adequate DEI group, those in inadequate DEI group had significantly lower total lymphocyte count (TLC), serum cholesterol (Chol) and low-density cholesterol (LDL), and a higher prevalence of PEW. For every 1kcal/kg/day increase in DEI, the incidence of PEW was reduced by 12.0% [odds ratio (OR): 0.880, 95% confidence interval (CI): 0.830 to 0.933, P < 0.001]. There was a nonlinear curve relationship between DEI and PEW (overall P < 0.001), and DEI ≥ 27.6 kcal/kg/d may have a preventive effect on PEW in CKD. Low DPI was also significantly associated with malnutrition, but not when DEI was adequate. Decreased energy intake may be a more important factor of PEW in CKD than protein intake.

The effect of letrozole overlapped with gonadotropin on IVF outcomes in women with DOR or aged over 40 years old with repeated cycles.

BACKGROUND: Evaluating the efficacy of letrozole overlapped with gonadotropin-modified letrozole protocol (mLP) for diminished ovarian reserve (DOR) or advanced-age women with repeated cycles. METHODS: This is a retrospectively registered, paired-match study including 243 women with DOR and 249 women aged over 40 years old who received in vitro fertilization (IVF) treatment. 123 women received stimulation with mLP (mLP group). GnRH agonist (GnRH-a) long, GnRH antagonist (GnRH-anta), and mild stimulation protocol were used as controls with 123 women in each group. We further analyzed 50 of 123 patients in the mLP group who have experienced more than one failed cycles with other ovarian stimulation protocols (non-mLP group). Clinical pregnancy rate (CPR), cumulative clinical pregnancy rate (CCPR), and live birth rate (LBR) were main outcomes. RESULTS: The CPR in the mLP group (38.46%) was significantly higher than mild stimulation (17.11%), but not significantly different from GnRH-a long (26.13%) and GnRH-anta (29.17%) group. The CCPR showed an increasing trend in the mLP group (33.33%) although without significance when compared with controls. The CCRP of GnRH-a long, GnRH-anta, mild stimulation group were 21.68%, 29.03%, and 13.04%, respectively. In women with repeated cycles, mLP achieved the higher available embryo rate (P < 0.05), the top-quality embryo rate, the CPR (P < 0.001), and the LBR (P < 0.001). Further study showed a positive correlation between testosterone and the number of oocytes retrieved in the mLP group (r = 0.395, P < 0.01). CONCLUSION: The mLP may be effective for aged or DOR women who have experienced previous cycle failure by improving the quality of embryos, the CPR, and the LBR. An increasing serum testosterone level may reflect follicular growth during ovarian stimulation.

Well-shaped poly(dimethylsiloxane)-based copolymer nanowires from spherical micelles via kinetic shape evolution.

The formation of self-assembled arrays or superstructures from copolymers has attracted intense research interest. Herein, we propose a kinetic approach to form self-assembled nanowires using a PDMS-based block copolymer consisting of poly(dimethylsiloxane)-b-poly[2-(cinnamoyloxy)ethyl methacrylate] (PDMS-b-PCEMA). The copolymer was synthesized by using the macroinitiator PDMS-Br to initiate 2-(trimethylsiloxy)ethyl methacrylate (HEMA-TMS) via ATRP, followed by hydrolysis of the TMS group and gradual esterification with cinnamoyl chloride. PDMS-b-PCEMA presented core-shell spherical micelles in tetrahydrofuran, which transformed into nanowires within 5 days self-assembly via a typical kinetic shape evolution. The diameter of the assembled nanowires with a PCEMA inner core and PDMS shell was about 25-35 nm. The formation of these nanowires reflected a balance between the PDMS and PCEMA components: the PDMS segment was soluble enough to form a corona block, which was beneficial for the transformation of the micellar shape. Meanwhile, the PCEMA segment was able to control the diameter of the nanowire micelles but had no decisive effect on their formation. The effect of solvents on the self-assembled micelles indicated that nanowires were formed in tetrahydrofuran and dichloromethane, while core-shell micelles were formed in acetone. This was due to the different permittivities of these solvents. The nanowires were fixed by cross-linking the PCEMA group under UV irradiation, which enhanced their stability. We believe that this work provides a new strategy for the formation of nanowires and offers a guide for the diversified self-assembly of nanostructures from copolymers.

A high neutrophil to lymphocyte ratio is associated with poor nutritional status in chronic kidney disease patients.

We aimed to investigate the relationship between the neutrophil to lymphocyte ratio (NLR) and nutritional parameters in chronic kidney disease (CKD) patients. In this cross-sectional study, 187 non-dialysis CKD patients were enrolled. Daily dietary energy intake (DEI) and daily dietary protein intake (DPI) were assessed by 3-d dietary records. Protein-energy wasting (PEW) was defined as Subjective Global Assessment (SGA) class B and C. Spearman correlation analysis, logistic regression analysis and receiver operating characteristic (ROC) curve analysis were performed. The median NLR was 2·51 (1·83, 3·83). Patients with CKD stage 5 had the highest NLR level. A total of 19·3 % (n 36) of patients suffered from PEW. The NLR was positively correlated with SGA and serum P, and the NLR was negatively correlated with BMI, waist and hip circumference, triceps skinfold thickness, mid-arm muscle circumference, DPI and Hb. Multivariate logistic regression analysis adjusted for DPI, DEI, serum creatinine, blood urea nitrogen, uric acid and Hb showed that a high NLR was an independent risk factor for PEW (OR = 1·393, 95 % CI 1·078, 1·800, P = 0·011). ROC analysis showed that an NLR ≥ 2·62 had the ability to identify PEW among CKD patients, with a sensitivity of 77·8 %, a specificity of 62·3 % and an AUC of 0·71 (95 % CI 0·63, 0·81, P < 0·001). The NLR was closely associated with nutritional status. NLR may be an indicator of PEW in CKD patients.

An optimal glycemic load range is better for reducing obesity and diabetes risk among middle-aged and elderly adults.

BACKGROUND: Due to the lack of evidence, advice pertaining to glycemic load (GL) can be misleading. Does the excessive restriction of GL, mostly through an extreme reduction in carbohydrate intake, result in a relatively high intake of fat and protein and result in overweight and obesity? This study was performed to initially explore the optimal GL range. METHODS: A cross-sectional study involving 2029 participants aged 40 years or older in Guangzhou, China was conducted. Participants were divided into four groups according to cluster analysis. Dietary data were assessed using a previously validated 3-day food record. RESULTS: Instead of participants with the highest [cluster 1, median (interquartile ranges) GL was 112(107-119)/1000 kcal] and the lowest GL intake [cluster 4, 90(82-96)/1000 kcal], those with moderate GL intakes [clusters 2 and 3, 93(85-102) and 93(85-99)/1000 kcal, respectively] had a lower prevalence of overweight, obesity and diabetes. In addition, clusters 2 and 3 were more consistent with the macronutrient intake reference with adequate micronutrient intake. Therefore, the optimal GL range was determined to be (85-100)/1000 kcal, rather than "lower is better". CONCLUSIONS: Reducing the GL intake to prevent diabetes deserves more attention in the context of a balanced diet. An appropriate GL may be better than excessive restriction.

Neutrophil and Neutrophil-to-Lymphocyte Ratio as Clinically Predictive Risk Markers for Recurrent Pregnancy Loss.

We aimed at exploring the value of neutrophil and neutrophil-to-lymphocyte ratio (NLR) as predictive risk markers for recurrent pregnancy loss (RPL) by conducting a retrospective case-control study and a systematic review and meta-analysis. This retrospective case-control study was conducted in an academic hospital from January 2012 to June 2018 and 133 cases of women with RPL and 140 control women. In parallel, we conducted a systematic review and meta-analysis on the value of NLR and neutrophil in RPL risk assessment. Neutrophil and NLR were higher in the women with RPL than those in the controls (median [interquartile range]: 4.32 [3.31-6.18] vs. 3.76 [2.78-4.81], p = 0.001; 2.17 [1.47-3.16] vs. 1.74 [1.40-2.34], p = 0.001). After the cut-off value of the neutrophil and NLR was determined to be 6.3 × 109/L and 3.16, the prevalence of RPL became significantly increased in the high-neutrophil and the high-NLR group compared to the low-neutrophil and the low-NLR group (76.3% vs. 44.2%, p < 0.001; 66.6% vs. 44.5%, p < 0.001). Univariate logistic regression analysis indicated that high-neutrophil and high-NLR were risk factors for RPL, with ORs of 4.06 (95% CI: 1.84-8.95) and 2.49 (95% CI: 1.31-4.71), respectively. Multivariate logistic regression analysis indicated that high-neutrophil was a risk factor for RPL, with OR of 4.91 (95% CI: 1.66-14.50). Meta-analysis of 5 case-control studies (including the present study) indicated that increased neutrophil and NLR may be risk factors for RPL, with SMDs of 0.63 (95% CI: 0.45-0.80) and 0.61 (95% CI: 0.39-0.83). Based on current findings and the meta-analysis, this study indicated that neutrophil and NLR might be valuable for predicting RPL; more studies with large sample are needed to verify this conclusion. The mechanism of the association between neutrophil and RPL needs to be explored in further studies.

Multiple ectopic goiter in the retroperitoneum, abdominal wall, liver, and diaphragm: A case report and review of literature.

BACKGROUND: Ectopic thyroid is a rare developmental disorder, typically found in lingual areas, and most distantly in the abdomen. Thyroid ectopia in multiple regions is extremely rare. To date, there are no reports of ectopic goiter in four regions of the abdominal cavity in a single patient. CASE SUMMARY: We present a case of thyroid ectopia in four areas of the abdomen, comprising normal orthotopic thyroid tissue. A 36-year-old woman, who underwent ovarian teratoma resection 10 years previously due to symptomatic ovarian teratoma, was referred to our hospital for treatment of an incidental hepatic mass. Magnetic resonance imaging and computed tomography (CT) of the abdomen showed a heterogeneously enhanced lobulated lesion in the sixth and seventh hepatic segment adjacent to the diaphragm. The mass was surgically excised, and histologic examination determined an ectopic nodular goiter. At the one-year follow-up, the abdominal CT scan, whole-body radionuclide I131 examination, and abdominal wall biopsy showed similar lesions in the left renal fascia and anterior abdominal wall. CONCLUSION: Multiple para-ectopic thyroid is often misdiagnosed, owing to its extremely rare incidence and non-specific clinical manifestations and imaging features. A combination of multiple examinations is necessary for diagnostic accuracy.

Acupuncture PC6 for postoperative nausea and vomiting at different times: A protocol for systematic review and meta analysis.

BACKGROUND: Postoperative nausea and vomiting (PONV) is a condition that commonly following anesthesia and surgery, antiemetics can lead to some side effects in treating PONV. Acupuncture PC6(Neiguan) has been widely used in the prevention and treatment of postoperative nausea and vomiting. However, there still exists controversy towards its effectiveness, appropriate, and effective intervention time. We, therefore, design this meta-analysis to assess the effectiveness and confirm the optimal time of acupuncture PC6 point for PONV. METHODS: The following electronic databases will be searched from their inception to April 2020, including PubMed, Cochrane Library, EMBASE, Web of Science, WHO International Clinical Trials Registry Platform, Chinese National Knowledge Infrastructure, WanFang Database, Chinese Biomedical Literature Database, the Chongqing VIP Chinese Science, and Technology Periodical Database. All randomized controlled trials in English or Chinese involving acupuncture PC6 for patients with PONV will be included. Two reviewers will independently responsible for the data extraction, study selection, risk of bias assessment and assessment of study quality. The primary outcome was the number of postoperative nausea, postoperative vomiting and PONV during 0 to 6 hours and after 6 hours of the postoperatively. The secondary outcome is the number of people with side effects and the use of rescue therapy. The meta-analysis will be conducted using RevMan V.5.3.5 statistical software. RESULTS: This systematic review will evaluate the efficacy and appropriateness time of acupuncture PC6 in the treatment of PONV. CONCLUSION: This study will provide high-quality current evidence of the effectiveness and optimal time of acupuncture PC6 point for the patient with PONV. ETHICS AND DISSEMINATION: Ethical approval is not required; this review will not involve individuals' information. The results will be published in a peer-reviewed publication or disseminated in relevant conferences. INPLASY REGISTRATION NUMBER: DOI 10.37766/inplasy2020.4.0012.

Short and long-term efficacy of massage for functional constipation: A protocol for systematic review and meta analysis.

BACKGROUND: Functional constipation (FC) is one of the most common diseases throughout the world, which brings a bad influence on life quality as well as mental health. Massage has been widely used in the treatment of functional constipation in china. In several randomized controlled trials indicate that massage has a positive effect on FC. However, there remain exist controversy towards its effectiveness and safety. What's more, how about the short and long-term efficacy? We, therefore, design this systematic review to assess the short and long-term effects of massage for FC. METHODS: The following electronic databases will be searched from their inception to May 2020, including PubMed, Cochrane Library, EMBASE, Web of Science, WHO International Clinical Trials Registry Platform, Chinese National Knowledge Infrastructure (CNKI), WanFang Database, Chinese Biomedical Literature Database (CBM), the Chongqing VIP Chinese Science, and Technology Periodical Database (VIP). RESULTS: This systematic review will assess the short and long-term effects of massage in the treatment of FC. CONCLUSION: This study will provide high-quality current evidence of short and long-term effects of massage for FC. ETHICS AND DISSEMINATION: Ethical approval is not required, for this review will not involve individuals' information. The results will be published in a peer-reviewed publication or disseminated in relevant conferences.INPLASY Registration number: INPLASY202050001.

The maintenance effect of acupuncture on the side effects of breast cancer endocrine therapy: A protocol for systematic review and meta analysis.

BACKGROUND: Breast cancer is common among women throughout the world and endocrine therapy is an established part of its treatment. But, unfortunately, this has also resulted in intolerable side effects affecting the quality of life. Acupuncture has been widely used to treat endocrine-related side effects in patients with breast cancer, but how long its effect can be maintained has not been published. The systematic review is designed to evaluate the maintenance efficacy of acupuncture for related side effects after breast cancer endocrine therapy. METHODS AND ANALYSIS: We will search for the following databases: PubMed, Embase, Cochrane Library, Web of Science, including China National Knowledge Infrastructure (CNKI), WanFang Data, Technology Periodical Database (VIP), and China Biology Medicine (CBM) from inception to May 2020. Two reviewers will search these databases, collect all articles, and assess the quality of studies separately, and there will be no limitations on language. The primary outcomes will be assessed using acupuncture for endocrine-related hot flashes and joint pain duration (1 month, 3 months, 6 months). Measurement tools include the Kupperman index, Brief Pain Inventory Short Form (BPI-SF), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Brief Pain Inventory-Short (BPI-SF). We will use RevMan V.5.3 for meta-analysis and employ the Grading of Recommendations Assessment, Development and Evaluation System to assess the quality of evidence. RESULTS: This systematic review will evaluate the maintenance efficacy of acupuncture on the side effects of breast cancer endocrine therapy. CONCLUSION: This study will provide high-quality current evidence of how long its effect can be maintained after acupuncture for related side effects after breast cancer endocrine therapy. ETHICS AND DISSEMINATION: Ethical committee approval is not required for this systematic review as patient data will not be collected. This study will help to inform doctors and researchers on the duration of acupuncture treatment for endocrine-related hot flashes and joint pain. The results will be published in a peer-reviewed journal and will be disseminated in relevant conferences. INPLASY REGISTRATION NUMBER: INPLASY202040024.

Association of Serum Retinol-Binding Protein 4 Levels and the Risk of Incident Type 2 Diabetes in Subjects With Prediabetes.

OBJECTIVE: To explore the association of serum retinol-binding protein 4 (RBP4) levels and risk for the development of type 2 diabetes in individuals with prediabetes. RESEARCH DESIGN AND METHODS: A population-based prospective study was conducted among 1,011 Chinese participants with prediabetes (average age 55.6 ± 7.2 years). Incident type 2 diabetes was diagnosed according to the American Diabetes Association 2010 criteria. Serum RBP4 levels were measured using a commercially available ELISA. We analyzed the association of serum RBP4 levels with the risk of incident type 2 diabetes using the Cox proportional hazards model. RESULTS: During a median follow-up period of 3.1 years, 153 participants developed incident type 2 diabetes. A U-shaped association was observed between serum RBP4 levels and the risk of incident type 2 diabetes, with the lowest risk in the RBP4 range of 31-55 µg/mL. Multivariate Cox regression model analysis showed that serum RBP4 levels <31 µg/mL and RBP4 levels >55 µg/mL were associated with an increased risk of incident type 2 diabetes. The adjusted hazard ratios (95% CI) were 2.01 (1.31-3.09) and 1.97 (1.32-2.93), respectively, after adjusting for age, sex, BMI, waist circumference, γ-glutamyltransferase, HOMA of insulin resistance index, fasting plasma glucose, 2-h plasma glucose, and glycated hemoglobin (HbA1c) levels. CONCLUSIONS: A U-shaped relationship exists between serum RBP4 levels and the risk of incident type 2 diabetes in subjects with prediabetes.

Association between dietary protein intake and type 2 diabetes varies by dietary pattern.

BACKGROUND: Epidemiological studies have demonstrated that high total protein intake was related to type 2 diabetes mellitus (T2DM) risks. However, few studies considered the impact of dietary pattern. OBJECTIVE: We examined the associations between protein intake and T2DM in different dietary patterns. METHODS: We used the demographic and dietary information of adults aged 18-75 years from the China Health and Nutrition Survey (2009), consisting of 4113 women and 4580 men. Dietary data was collected by using 24-h recalls combined with a food inventory for 3 consecutive days. Cluster analysis was used to classify subjects into groups, as determined by major sources of protein. Logistic regression models were used to calculate odds ratios (OR) and 95% confidence interval (95% CI) of T2DM according to the energy-adjusted protein intake. RESULTS: All participants were divided into three patterns according to the dietary source of protein (legumes and seafood, red meat, refined grains). Overall, plant protein intake was significantly and inversely associated with T2DM. In the subgroup analysis by dietary patterns, extreme quartile of plant protein intake was also inversely related to T2DM in the "legumes and seafood" group [OR = 0.58, 95% CI (0.33-0.96)]. Total protein intake and animal protein intake were positively related to T2DM in the "red meat" group [OR: 3.12 (1.65-5.91) and 3.48 (1.87-6.60), respectively]. However, the association of animal protein intake was reversed in the "refined grains" group [OR = 0.55, 95% CI 0.32-0.89]. CONCLUSIONS: The association between protein intake and T2DM varies by dietary pattern. Dietary pattern may be considered into the recommendation of protein intake for diabetes prevention.

Glycemic load is associated with diabetes and prediabetes among middle-aged and elderly adults in Guangzhou, China.

BACKGROUND AND OBJECTIVES: Previous studies have obtained conflicting findings regarding the possible associations between glycemic load (GL) indices and diabetes. In the present study, we examined cross-sectional associations between several GL indices, including the total dietary GL, the energy-adjusted GL, and the prevalence of abnormal glucose metabolism, including prediabetes and diabetes. METHODS AND STUDY DESIGN: This study was conducted in Guangzhou, China from July 2011 to December 2011. It included 2,022 participants (602 men and 1,420 women), between 45 and 75 years of age. The prevalence of abnormal glucose metabolism was compared across the quartiles of GL indices to discover any potential linear correlations. Stratified analysis was conducted according to the body mass index (BMI) and waist circumference (WC) measurements. RESULTS: Energy-adjusted GL was positively associated with the prevalence of diabetes and the multivariable-adjusted estimate of the OR comparing the highest versus the lowest quartile was 2.50 (95% CI, 1.49-4.19). For the stratified analysis by sex, BMI or WC, similar associations were observed. For the overweight and obese (BMI ≥24.0 kg/m2) or centrally obese (WC ≥85 cm for men or ≥80 cm for women) participants, compared to participants in the lowest quartile of energy-adjusted GL, those in the highest quartile showed an increased risk of abnormal glucose metabolism. The OR estimates were 2.25 (95% CI: 1.45-3.52) and 1.54 (95% CI: 1.06-2.25), respectively. CONCLUSIONS: High dietary energy-adjusted GL is associated with the prevalence of diabetes as well as abnormal glucose metabolism among middle-aged and elderly adults.

A greater glycemic load reduction was associated with a lower diabetes risk in pre-diabetic patients who consume a high glycemic load diet.

Few prospective studies evaluating the association between dietary glycemic load (GL) and diabetes have accounted for changes in GL. However, the diet of patients could be modified in response to an awareness of pre-diabetes. The aim of this study was to examine the longitudinal associations between changes in GL and the incidence of diabetes among pre-diabetic patients. We hypothesized that subjects with low and high baseline GL would show different correlations with diabetes. A total of 493 pre-diabetic patients (142 men and 351 women) between 40 and 79 years of age were included in this study. Dietary records and oral glucose tolerance tests were conducted every year. The participants were divided into low- and high-GL groups based on baseline GL. During a median 4 years of follow-up, 108 incident cases of diabetes were identified. Among participants with a high baseline GL, the incidence of diabetes increased with decreasing GL reduction, and the multivariate-adjusted HR (95% CI) was 2.34 (1.27-4.29) when comparing the lowest to the highest tertiles; however, among those with a low baseline GL, no significant association was observed. Regardless of baseline GL status, the incidence of diabetes was higher in individuals with a high follow-up GL than in those with a low follow-up GL, and the multivariate-adjusted HR (95% CI) was 1.64 (1.09-2.45). In conclusion, a greater GL reduction was associated with a lower diabetes risk in pre-diabetic patients with a high dietary GL. In patients with pre-diabetes and a low dietary GL, further reductions in GL did not show any additional effects.

Dietary glycemic load and metabolic status in newly diagnosed type 2 diabetes in southeastern China.

BACKGROUND AND OBJECTIVES: Large-scale epidemiological investigations worldwide have shown that dietary glycemic load is associated with metabolic diseases, including diabetes. However, only a few studies have examined the correlations between glycemic load and blood glucose and lipids in Chinese diabetic patients. Therefore, this study aimed to determine these correlations in southeastern China. METHODS AND STUDY DESIGN: 201 patients with newly diagnosed type 2 diabetes and 126 participants with normal blood glucose were enrolled at the Sun Yat-sen Memorial Hospital, Guangdong Province. Carbohydrate intake and glycemic load were assessed based on 3-day dietary records. Using glycemic load as the dependent variable, a correlation analysis and multiple regression analyses were used to analyze the correlations between glycemic load and blood glucose and lipids. RESULTS: The mean glycemic load in diabetic patients was significantly higher than that in the control group (p<0.05). Correlation analysis showed that glycemic load was positively correlated with body mass index and glycated hemoglobin in diabetic patients (p<0.05) but negatively correlated with high-density lipoprotein cholesterol in all subjects (p<0.05). Multivariable regression analysis indicated that, among participants in southeastern China, a higher glycemic load increased the odds of having diabetes, a low high-density lipoprotein cholesterol, and higher Charlson weighted index of comorbidities score, as well as being overweight. CONCLUSIONS: A high-glycemic load diet may be associated with a risk of diabetes, glycemic control, lipid metabolism, prognosis of diseases, and body composition. It is necessary to control dietary glycemic load for both patients with diabetes and healthy people in southeastern China.