An anatomical study of the tibial nerve branches innervating the posterior tibial artery.

The arteries of the lower limbs are innervated by vascular branches (VBs) originating from the lumbar sympathetic trunk and branches of the spinal nerve. Although lumbar sympathectomy is used to treat nonreconstructive critical lower limb ischemia (CLLI), it has limited long-term effects. In addition, the anatomical structure of tibial nerve (TN) VBs remain incompletely understood. This study aimed to clarify their anatomy and better inform the surgical approach for nonreconstructive CLLI. Thirty-six adult cadavers were dissected under surgical microscopy to observe the patterns and origin points of VBs under direct vision. The calves were anatomically divided into five equal segments, and the number of VB origin points found in each was expressed as a proportion of the total found in the whole calf. Immunofluorescence staining was used to identify the sympathetic nerve fibers of the VBs. Our results showed that the TN gave off 3-4 VBs to innervate the posterior tibial artery (PTA), and the distances between VBs origin points and the medial tibial condyle were: 24.7 ± 16.3 mm, 91.7 ± 66.1 mm, 199.6 ± 52.0 mm, 231.7 ± 38.5 mm, respectively. They were mainly located in the first (40.46%) and fourth (31.68%) calf segments, and immunofluorescence staining showed that they contained tyrosine hydroxylase-positive sympathetic nerve fibers. These findings indicate that the TN gives off VBs to innervate the PTA and that these contain sympathetic nerve fibers. Therefore, these VBs may need to be cut to surgically treat nonreconstructable CLLI.

Effects of sleep duration and sleep quality in early pregnancy and their interaction on gestational diabetes mellitus.

PURPOSE: To examine the association of sleep duration and quality in early pregnancy with gestational diabetes mellitus (GDM), and explore their interaction effect on GDM. METHODS: Participants from 2 hospitals were enrolled in this case-control study between April 2018 and November 2020. Sleep duration and quality were measured using the Pittsburg Sleep Quality Index (PSQI). RESULTS: A total of 1300 participants (396 GDM and 904 controls) were included. After adjusting for potential confounders, higher global PSQI scores or poor sleep quality were associated with GDM with odds ratios of 1.13 (95% CI 1.07, 1.19, p < 0.001) and 1.75 (95% CI 1.29, 2.38, p < 0.001), respectively; sleep duration < 7 h, 9-9.9 h and ≥ 10 h were all associated with increased GDM with odds ratios of 4.28 (95% CI 2.51, 7.31, p < 0.001), 1.69 (95% CI 1.20, 2.39, p = 0.003), and 4.42 (95% CI 3.01, 6.50, p < 0.001), respectively. In the stratified analysis based on sleep duration, the effect of poor sleep quality on GDM in the < 7 h group (OR 5.47, 95% CI 2.57, 11.64, p < 0.001) was much stronger than that in the 7-8.9 h group (OR 1.24, 95% CI 0.81, 1.91, p = 0.327), and the p value of the interaction was 0.011. CONCLUSIONS: Poor sleep quality and short or long sleep duration in early pregnancy were all associated with GDM, and an interaction effect between short sleep duration and poor sleep quality on GDM was noted.

The association between previous induced abortion and in vitro fertilization outcomes: A retrospective cohort study in Hefei, China.

OBJECTIVES: To assess the association between previous induced abortion and in vitro fertilization (IVF) outcomes among Chinese women. STUDY DESIGN: In this retrospective cohort study, a total of 1436 infertility patients treated with IVF for the first time in the reproductive centre of Anhui Province Maternity and Child Health Hospital from February 2014 to April 2018 were selected as the study population, and 95 (6.6 %) had a history of induced abortion. Data were assessed from the hospital electronic database and medical records in the reproductive centre. RESULTS: In total, 818 women (57.0 %) achieved clinical pregnancy, and 501 (34.9 %) achieved live birth. After adjustments for a series of potential confounding factors, women with a history of induced abortion had a significantly decreased probability of clinical pregnancy per transfer (OR: 0.71, 95 % CI: 0.53, 0.95, p = 0.037) and live birth per pregnancy (OR: 0.52, 95 % CI: 0.30, 0.90, p = 0.021) and a higher risk of miscarriage per pregnancy (OR: 1.89, 95 % CI: 1.24, 2.88, p = 0.009) than those without. Because relevant information was unavailable, the impacts of different types of previous induced abortion were not assessed. CONCLUSIONS: Previous induced abortion may have an adverse effect on IVF outcomes among infertility patients.

Effect of nighttime sleep duration and midday napping in early pregnancy on gestational diabetes mellitus.

PURPOSE: To explore the effect of nighttime sleep duration and midday napping in early pregnancy on gestational diabetes mellitus (GDM) among Chinese women. METHODS: Information on midday napping and nighttime sleep duration was assessed by a questionnaire. Diagnostic information of GDM was derived from the routine oral glucose tolerance test (OGTT) during the second trimester of pregnancy. RESULTS: A total of 500 pregnant women, including 196 patients with GDM and 304 controls, were included in the present study. In the case group, 47% of women took a midday nap > 1 h/day, and the proportion was 22% in the control group. Compared with women who had a midday nap ≤ 1 h/day, women who had a nap > 1 h/day had a significantly increased risk of GDM (OR 3.00, 95% CI 1.87, 4.82, p < 0.001). Compared with women who had a nighttime sleep of 7 to 8.9 h/night, women who slept < 7 or ≥ 9 h/night all had a significantly increased risk of GDM. Stratified analyses showed that compared with the nighttime sleep duration of 7 to 8.9 h/day, the GDM risk of the < 7 h/night group increased among mothers who had a midday nap ≤ 1 h/day. The impact was stronger than among women who had a nap > 1 h/day (p = 0.006). CONCLUSIONS: Shorter or longer nighttime sleep duration and longer midday napping duration in early pregnancy were all related to GDM. Midday napping would reduce the risk of GDM among mothers with shorter nighttime sleep duration.

Lipoxin A4 inhibits 5-lipoxygenase translocation and leukotrienes biosynthesis to exert a neuroprotective effect in cerebral ischemia/reperfusion injury.

Lipoxin A(4) (LXA(4)), a biologically active eicosanoid with anti-inflammatory and pro-resolution properties, was recently found to have neuroprotective effects in brain ischemia. As 5-lipoxygenase (5-LOX) and leukotrienes are generally considered to aggravate cerebral ischemia/reperfusion (I/R) injury, we investigated their effects on LXA(4)-mediated neuroprotection by studying middle cerebral artery occlusion (MCAO)/reperfusion in rats and oxygen-glucose deprivation (OGD)/recovery in neonatal rat astrocyte primary cultures. LXA(4) effectively reduced infarct volumes and brain edema, and improved neurological scores in the MCAO/reperfusion experiments; this effect was partially blocked by butoxycarbonyl-Phe-Leu-Phe-Leu-Phe (Boc2), a specific antagonist of the LXA(4) receptor (ALXR). Total 5-LOX expression did not change, regardless of treatment, but LXA(4) could inhibit nuclear translocation induced by MCAO or OGD. We also found that LXA(4) inhibits the upregulation of both leukotriene B(4) (LTB(4)) and leukotriene C(4) (LTC(4)) and the phosphorylation of extracellular signal-regulated kinase (ERK) induced by MCAO or OGD. The phosphorylation of the 38-kDa protein kinase (p38) and c-Jun N-terminal kinase (JNK) was not altered throughout the experiment. These results suggest that the neuroprotective effects of LXA(4) are probably achieved by anti-inflammatory mechanisms that are partly mediated by ALXR and through an ERK signal transduction pathway.