Serum levels of vitamin B12 combined with folate and plasma total homocysteine predict ischemic stroke disease: a retrospective case-control study.

PURPOSE: This study aimed to identify and quantify the association and investigate whether serum vitamin B12 alone or vitamin B12 combined with folate and plasma total homocysteine (tHcy) levels could be used to predict the risk of acute ischemic stroke. MATERIALS AND METHODS: This retrospective case-control study was conducted in the Department of Neurology, First Affiliated Hospital of Chongqing Medical University. It included 259 inpatients experiencing their first-ever acute ischemic stroke and 259 age-matched, sex-matched healthy controls. Patients were categorized into groups based on the etiology of their stroke: large-artery atherosclerosis (LAAS, n = 126), cardio embolism (CEI, n = 35), small vessel disease (SVD, n = 89), stroke of other determined etiology (ODE, n = 5), and stroke of undetermined etiology (UDE, n = 4). The associations of serum vitamin B12, folate, and plasma tHcy levels with the risk of ischemic stroke were evaluated using multivariable logistic regression analysis. Receiver operator characteristic (ROC) curves were used to assess the diagnostic power of vitamin B12, folate, and tHcy levels for ischemic stroke. RESULTS: Serum vitamin B12 and folate levels were significantly lower in ischemic stroke patients compared to controls, while plasma tHcy levels were significantly higher. The first quartile of serum vitamin B12 levels was significantly associated with an increased risk of LAAS (aOR = 2.289, 95% CI = 1.098-4.770), SVD (aOR = 4.471, 95% CI = 1.110-4.945) and overall ischemic stroke (aOR = 3.216, 95% CI = 1.733-5.966). Similarly, the first quartile of serum folate levels was associated with an increased risk of LAAS (aOR = 3.480, 95% CI = 1.954-6.449), CEI (aOR = 2.809, 95% CI = 1.073-4.991), SVD (aOR = 5.376, 95% CI = 1.708-6.924), and overall ischemic stroke (aOR = 3.381, 95% CI = 1.535-7.449). The fourth quartile of tHcy levels was also significantly associated with an increased risk of LAAS (aOR = 2.946, 95% CI = 1.008-5.148), CEI (aOR = 2.212, 95% CI = 1.247-5.946), SVD (aOR = 2.957, 95% CI = 1.324-6.054), and overall ischemic stroke (aOR = 2.233, 95% CI = 1.586-4.592). For predicting different types of ischemic stroke, vitamin B12 alone demonstrated the best diagnostic value for SVD, evidenced by a sensitivity of 71.0% and negative predictive value of 90.3%, along with the highest positive likelihood ratio (+ LR) for SVD. Vitamin B12 + tHcy + folate are valuable in predicting different types of ischemic stroke, with the most significant effect observed in SVD, followed by LAAS, and the weakest predictive effect in CEI. Additionally, vitamin B12 alone in combination with other indicators, such as folate alone, tHcy alone, and folate + tHcy could reduce negative likelihood ratio (-LR) and improve + LR. CONCLUSIONS: Vitamin B12 was an independent risk factor for acute ischemic stroke. The risk calculation model constructed with vitamin B12 + tHcy + folate had the greatest diagnostic value for SVD.

Sigmoidal relationship between liver fat content and nonalcoholic fatty liver disease in Chinese adults.

PURPOSE: To explore the relationship between liver fat content (LFC) and nonalcoholic fatty liver disease (NAFLD) and determine the new threshold of LFC to diagnose NAFLD. METHODS: The data from questionnaire survey, general physical examination, laboratory examination, and image examination were collected. Multivariate regression analysis, receiver operating characteristic curve analysis, smooth curve fitting, and threshold effect analysis were performed using the R software to investigate the relationship between LFC and NAFLD and to identify the new threshold of LFC to diagnose NAFLD. RESULTS: The prevalence of NAFLD was 30.42%, with a significantly higher prevalence in men than in women. Regression analyses demonstrated that LFC odds ratio [95% confidence interval (CI)] was 1.28 (95% CI: 1.24-1.31) in fully-adjust model. Analysis of the LFC quartile, with Q1 as a reference, revealed that the odds ratios of NAFLD were 1.47 (95% CI: 1.08-1.99), 2.29 (95% CI: 1.72-3.06), and 10.02 (95% CI: 7.45-13.47) for Q2, Q3, and Q4 groups, respectively. Smooth curve fitting and threshold effect analysis displayed a nonlinear relationship between LFC and NAFLD, and the threshold was 4.5%. The receiver operating characteristic curve indicated that when LFC was 4.5%, the area under curve (95% CI) was 0.80 (0.79-0.82), and the sensitivity and specificity of LFC in diagnosing NAFLD were 0.64% and 0.82%, respectively. CONCLUSION: The relationship between LFC and NAFLD was sigmoidal, with an inflection point of 4.5%.

Association Between Circulating Zinc Levels and Risk Factors of Metabolic Syndrome: Insights from a Bi-directional Mendelian Randomization Analysis and Cross-Sectional Study.

Previous studies on the relationship between zinc and metabolic syndrome (MetS) have yielded inconsistent results. This comprehensive study aimed to elaborately explore the impact of zinc on MetS risk factors. The bi-directional Mendelian randomization (MR) analyses were performed to estimate the causal relationship between zinc and MetS risk factors. Additionally, a retrospective cross-sectional study incorporated 4389 subjects to provide a broader perspective in conjunction with the MR analyses. In the MR analyses, genetically instrumented zinc was positively associated with five of the MetS components in Europeans, including BMI, FBG, HbA1c, TC, and LDL-c (ß (95%CI) = 0.023 (0.019-0.027), 0.019 (0.013-0.025), 0.041 (0.022-0.060), 0.027 (0.013-0.042), and 0.018 (0.010-0.026), respectively). In the cross-sectional study, higher concentration of zinc was strongly associated with increased BMI, LDL-c, and UA (ß (95%CI) = 0.040 (0.010-0.085), 0.026 (0.018-0.035), and 1.529 (0.614-2.445), respectively). Moreover, these unfavorable associations were more obvious in women compared to men, with a borderline significant interaction effect for BMI (P=0.051). Our study showed that higher blood concentration of zinc, an essential trace element, was associated with unfavorable changes of the component metabolic risk factors of MetS, especially with BMI and LDL-c. Notably, these associations seemed to be more pronounced in women rather than in men. Further studies are warranted to elucidate the role of zinc status in the underlying mechanisms of MetS.

Associations of psychological status and ultrasonic characteristics of thyroid nodules in adults during the COVID-19 pandemic.

Background: The morbidity of thyroid cancer has been increasing in the last decades all over the world. In addition to the more sensitive thyroid nodule screening technology, several social and environmental factors might represent credible candidates for this increase. They include psychological stress, lifestyle-associated risk factors, nutritional deficiencies, and environmental pollutants. Foremost, psychological stress had gained high interest as a possible promoter and a modifiable risk factor for thyroid nodules in recent years. The present study was to investigate the clinical characteristics and psychological status of the population during the peak of coronavirus disease 2019 (COVID-19) and assessed the association of psychosocial determinants and the ultrasonic characteristics of thyroid nodules. Methods: In this cross-sectional study, 490 adult subjects who had received at least two doses of COVID-19 vaccine and were not infected with COVID-19, and did not know whether they had thyroid nodules, received thyroid color ultrasound examination and psychological questionnaire survey. Depression, anxiety, and stress were assessed using Depression Anxiety Stress Scales-21 (DASS-21). Sleep quality was rated using the Pittsburgh sleep quality index (PQSI). The characteristics of 243 subjects with thyroid nodules were described and recorded in detail by thyroid color ultrasound, and the correlations between anxiety, depression, sleep quality, clinical indicators, and thyroid nodule ultrasound characteristics were analyzed. Associations between psychological status (mutually adjusted predictors) and ultrasonic characteristics of thyroid nodules (outcome) were modeled using binary logistic regression controlling for sex, age, BMI, TSH, FT3, and FT4. Results: Depression was positively correlated with thyroid hypoechoic nodule (OR = 3.720, 95%CI 1.615-8.570), microcalcification of thyroid nodule (OR = 3.638, 95%CI 1.476-8.966), the aspect ratio of thyroid nodule>1 (OR = 3.860, 95%CI 1.052-14.161), the unclear boundary of thyroid nodule (OR = 4.254, 95%CI 1.359-13.312), and the irregular edge of thyroid nodule (OR = 4.134, 95%CI 1.810-9.439). Anxiety was positively correlated with microcalcification of thyroid nodules (OR = 4.319, 95%CI 1.487-11.409). Stress was positively correlated with thyroid hypoechoic nodules (OR = 4.319, 95%CI 1.487-11.409), microcalcification of thyroid nodules (OR = 2.724, 95%CI 1.038-7.151), and the irregular edge of thyroid nodules (OR = 2.478, 95%CI 1.077-5.705). Conclusion: This study demonstrates that depression, anxiety, and stress were associated with the morbidity of thyroid nodules and thyroid ultrasound characteristics. During COVID-19, people's negative emotions increased significantly compared to before. Negative emotions might be harmful to thyroid health. Therefore, during periods of high stress, strategies to prevent psychological problems should be implemented to improve thyroid health.

Revocable and Traceable Undeniable Attribute-Based Encryption in Cloud-Enabled E-Health Systems.

The emerging cloud storage technology has significantly improved efficiency and productivity in the traditional electronic healthcare field. However, it has also brought about many security concerns. Ciphertext policy attribute-based encryption (CP-ABE) holds immense potential in achieving fine-grained access control, providing robust security for electronic healthcare data in the cloud. However, current CP-ABE schemes still face issues such as inflexible attribute revocation, relatively lower computational capabilities, and key management. To address these issues, this paper introduces a revocable and traceable undeniable ciphertext policy attribute-based encryption scheme (MA-RUABE). MA-RUABE not only enables fast and accurate data traceability, effectively preventing malicious user key leakage, but also includes a direct revocation feature, significantly enhancing computational efficiency. Furthermore, the introduction of a multi-permission mechanism resolves the issue of centralization of power caused by single-attribute permissions. Furthermore, a security analysis demonstrates that our system ensures resilience against chosen plaintext attacks. Experimental results demonstrate that MA-RUABE incurs lower computational overhead, effectively enhancing system performance and ensuring data-sharing security in cloud-based electronic healthcare systems.

The SON2A2 score: A novel grading scale for predicting hemorrhage and outcomes after thrombolysis.

Objectives: This study aimed to develop a score including novel putative predictors for predicting the risk of sICH and outcomes after thrombolytic therapy with intravenous (IV) recombinant tissue-type plasminogen activator (r-tPA) in acute ischemic stroke patients. Methods: All patients with acute ischemic stroke treated with IV r-tPA at three university-based hospitals in Chongqing, China, from 2014 to 2019 were retrospectively studied. Potential risk factors associated with sICH (NINDS criteria) were determined with multivariate logistic regression, and we developed our score according to the magnitude of logistic regression coefficients. The score was validated in another independent cohort. Area under the receiver operating characteristic curve (AUC-ROC) was used to assess the performance of the score. Calibration was evaluated using the Hosmer-Lemeshow goodness-of-fit method. Results: The SON2A2 score (0 to 8 points) consisted of history of smoking (no = 1, yes = 0, ß = 0.81), onset-to-needle time (≥3.5 = 1,<3.5=0, ß = 0.74), NIH Stroke Scale on admission (>10 = 2, ≤10 = 0, ß = 1.22), neutrophil percentage (≥80.0% = 1, <80% = 0, ß = 0.81), ASPECT score (≤11 = 2, >11 = 0, ß = 1.30), and age (>65 years = 1, ≤65 years = 0, ß = 0.89). The SON2A2 score was strongly associated with sICH (OR 1.98; 95%CI 1.675-2.34) and poor outcomes (OR 1.89; 95%CI 1.68-2.13). AUC-ROC in the derivation cohort was 0.82 (95%CI 0.77-0.86). Similar results were obtained in the validation cohort. The Hosmer-Lemeshow test revealed that predicted and observed event rates in derivation and validation cohorts were very close. Conclusion: The SON2A2 score is a simple, efficient, quick, and easy-to-perform scale for predicting the risk of sICH and outcome after intravenous r-tPA thrombolysis within 4.5 h in patients with ischemic stroke, and risk assessment using this test has the potential for early and personalized management of this disease in high-risk patients.

COVID-19 Pandemic Impact on Cardiometabolic Markers in Adults in Chongqing, China: A Retrospective Cohort Study.

The influx of COVID-19 infection and government-enforced lockdowns and social isolation changed people's lifestyles. Concerns regarding the health impact of the COVID-19 pandemic due to the new sedentary lifestyle. This study aims to investigate the impact of the COVID-19 pandemic on cardiovascular health factors. A retrospective observational study was conducted using historical medical records. The cohort consisted of healthy adults (without chronic non-communicable diseases) over 18 years of age who have undertaken a health examination at the Chongqing Medical University from 2019 to 2020. The analysis of covariance (ANCOVA) test was used to compare variables between 2019 and 2020. The effect of exposure time to COVID-19 on cardiometabolic markers was analyzed using multiple linear regression models. 29,773 participants took part in this study. The average age was 42.5 ± 13.44 years at baseline, and the average follow-up period was 12.7 ± 2.8 months. Analysis showed that weight, BMI, waist circumference, hip circumference, WHR, fasting blood glucose, TG, LDL, uric acid, and liver enzymes increased significantly during the COVID-19 pandemic (P < 0.05). This study showed evidence that the COVID-19 pandemic and its control measures negatively impacted cardiometabolic profiles.

[Distribution Characteristics of Selenium in a Soil-Crop System and the Threshold of Selenium-Rich Soils].

In order to determine the distribution characteristics of Se in soil-crop systems, we carried out a study on the Se-rich soil threshold by collecting 8789 surface soils and 155 deep soils in the Qianjiang District of Chongqing City, China, and 141 corn seeds and 159 rice seeds (simultaneously collecting 141 and 159 corresponding root soil samples, respectively). We then analyzed the Se content, organic matter, S, Mn, TFe2O3, Al2O3, and K2O in soils and crops, and soil pH. We also analyzed the surface layer using geostatistical methods and the distribution characteristics of Se in deep soils using multiple regression analysis to study the factors influencing the bioavailability of Se. Based on the contents of each component of root soil and the Se contents of crops, the Se rich threshold was examined. The results showed that the high-Se soils in the study area account for 32.72% of the total area; the distribution of Se contents in the surface and deep soils is mainly controlled by the parent material, the source of soil Se is stable, and the surface enrichment is obvious. The Se-rich rates of corn and rice were 75.35% and 46.81%, respectively, and soil organic matter and S content will limit the bioavailability of Se. If the planted crop is corn, it is recommended to use 0.3 mg·kg-1 as the Se-rich soil threshold; if the planted crop is rice, when the soil pH is ≤ 7.5, it is recommended to use 0.3 mg·kg-1 as the Se-rich soil threshold, while at a soil pH>7.5, it is recommended to use 0.4 mg·kg-1 as the threshold. Similarly, if other large crops are planted in the study area, this method can also be used to carry out a study on the proposed Se-rich soil threshold.

[Assessment and Source Analysis of Heavy Metal Pollution in Farmland Soils in Southern Youyang County, Chongqing].

To investigate the impact of mining activities and geological background on the soil environment, 156 soil samples were collected from an agricultural land in southern Youyang County, Chongqing. The content and pH of heavy metals in the soil were analyzed, and the Nemerow index method was used to evaluate the pollution status of soil heavy metals. The source of soil heavy metals was discussed using the principal component analysis/absolute principal component score (PCA/APCS) receptor model. The results showed that the soil Cd pollution was distributed in a planar shape, while soil Hg mainly appeared as point pollution. The medium-severe soil pollution was mainly distributed at the junction of Tushi Town, Mawang Town, and Longtan Town, where the soil was predominantly acidic and there was a higher risk of crop contamination; the indicator Kriging evaluation results showed that there was a higher probability of soil contamination at the junction of the three towns and the northern part of Tushi Township. The results of the PCA/APCS receptor model analysis showed that the sources of soil As, Cd, Cr, and Ni were mainly controlled by geological background; soil Hg, Pb, and Zn were mainly controlled by mining activities; further, soil Cu was affected by both geological background and mining activities. In addition, the agricultural activities were also one of the sources of soil As, Cd, Pb, Cu, and Zn. The medium-heavy pollution of the soil in the study area was mainly caused by mining activities, while the heavy metal pollution of the soil caused by geological background was mainly light pollution. This study can provide a theoretical basis for the safe use of land and the prevention and control of soil pollution in typical regions.

[Effect of Conditioning Agent Combined with Flooding Measures on Absorption and Accumulation of Cadmium in Rice].

In order to evaluate the effects and mechanisms of flooding measures, soil conditioner, silicon mineral fertilizer and sprayed foliar fertilizer, gypsum powder, and their multiple treatments for reducing Cd accumulation in rice grown in Cd-contaminated soil. A plot experiment was conducted in three different Cd-contaminated soils. The results showed that flooding measures, a single application of conditioning agents, and combined application and flooding treatment can reduce soil-available Cd and the Cd content in various organs of rice with 6.58%-30.01% reduction in soil available-Cd and 12.64%-68.68% reduction in Cd content in brown rice, respectively. The Cd reduction decreased in the following order:comprehensive treatment (T6) > basic application of gypsum powder (T5) > base Xiangrunbang state soil conditioner (T3) > mineral silicon fertilizer and spray foliar fertilizer (T4) > flood treatment (T2). In addition, the average value of the reduction effect of the Cd content in brown rice was calculated. The five treatments in the experiment reduced the enrichment of various parts of the rice, which is a main reason for the decrease in Cd content in the brown rice. According to the field plot test, the combined application of the basic conditioning agent, mineral silicon fertilizer, and sprayed foliar fertilizer, and gypsum powder and flooding measures can be used as an effective method for Cd pollution control in Cd-contaminated cultivated rice.

miR-92b-3p Functions As A Key Gene In Esophageal Squamous Cell Cancer As Determined By Co-Expression Analysis.

BACKGROUND: Esophageal squamous cell carcinoma (ESCC) is a highly aggressive malignancy. The aims of the present study were to screen the critical miRNA and corresponding target genes that related to development of ESCC by weighted gene correlation network analysis (WGCNA) and investigate the functions by experimental validation. METHODS: Datasets of mRNA and miRNA expression data were downloaded from GEO. The R software was used for data preprocessing and differential expression gene analysis. The differentially expressed protein-coding genes (DEGs) and miRNAs (DEMs) were selected (FDR <0.05 or |Fold Change (FC)| >1.5). Meanwhile, 81 expression data of ESCC patients in TCGA combined with clinic information were applied by WGCNA to create networks. The correlational analyses between each module and clinical parameters were conducted, and enrichment analyses of GO and KEGG were subsequently performed. Then, a series of experiments were conducted in ESCC cells by use of miRNA mimics. RESULTS: In total, 4,023 DEGs and 328 DEMs were screened. After checking good genes and samples, 3,841 genes (3,696 DEGs and 145 DEMs) were used for WGCNA. As a consequence, altogether 11 gene modules were found. Among them, the brown modules were found to be strongly inversely associated with pathological grade. Meanwhile, has-mir-92b, the only miRNA in brown module, had a positive correlation with grade and negatively correlated with potential target gene (KFL4 and DCS2) in the same module. Furthermore, an increased expression of miR-92b-3p and down-regulated KLF4 and DSC2 protein was detected in the ESCC clinical samples. Up-regulated miR-92b-3p shortened G0/G1 phase and promote ESCC cells invasion and migration. Furthermore, we verified that DSC2 and KFL4 was target genes of miR-92b-3p by luciferase report assay. CONCLUSION: WGCNA is an efficient approach to system biology. By this procedure, miR-92b-3p was identified as an ESCC-promoting gene by target KLF4 and DCS2.

Resveratrol Activated Sonic Hedgehog Signaling to Enhance Viability of NIH3T3 Cells in Vitro via Regulation of Sirt1.

BACKGROUND/AIMS: Injuries of the brain and spinal cord result in the formation of glial (reactive gliosis) and fibrotic (formed by fibroblasts) scars. Recent studies have shown that the fibrotic scar was much more important for hindering regeneration after brain or spinal cord injury than the astrocytic scar. However, it has been given much less attention for effects and mechanism of fibroblasts during formation of the fibrotic scar. Resveratrol may be a potential anti-scarring agent in burn-related scarring and keloid fibroblasts. However, it is unclear whether and how resveratrol affects formation of the fibrotic scar after brain or spinal cord injury. Earlier studies have shown that the activated Shh signaling has anti-apoptosis, anti-oxidation, anti-inflammation properties. Moreover, resveratrol can activate the Shh signaling. However, it is unclear how resveratrol activates the Shh signaling. Resveratrol is a activator of Sirt1. It is unknown whether resveratrol activates the Shh signaling via Sirt1. METHODS: NIH3T3 cells, a fibroblast cell line, were used as model cells and treated with drugs. Cell viability was assessed by Cell Counting Kit 8. The expressions and activity of Shh signaling pathway proteins were evaluated by immunocytochemistry and Western blotting. Transcriptional activity of Gli-1 was detected with Dual-Luciferase Reporter Gene Assay Kit. RESULTS: Resveratrol, Sirt1 agonist STR1720 and recombinant mouse Shh protein, an activator of hedgehog signaling, enhanced the viability of NIH3T3 cells, promoted Smo to translocated to the primary cilia and Gli-1 entered into the nuclei from cytoplasm, and upregulated expressions of Shh, Ptc-1, Smo, and Gli-1 proteins, which can be reversed by Smo antagonist cyclopamine and Sirt1 antagonist Sirtinol. Additionally, resveratrol increased transcriptional activity of Gli-1. CONCLUSION: We indicate in the first time that it may be mediated by Sirt1 for resveratrol activating the Shh signaling to enhance viability of NIH3T3 cells, and Sirt1 may be a regulator for upstream of the Shh signaling pathway.This study provides a basis for further investigating effects and mechanism of resveratrol during the formation of fibrous scar after brain or spinal cord injury.

A Dendritic Cell Vaccine Combined With Radiotherapy Activates the Specific Immune Response in Patients With Esophageal Cancer.

Dendritic cells (DC) are highly efficient antigen-presenting cells. DC may be used to create DC vaccines against cancer, but the optimal strategies remain to be elucidated. This study aimed to examine the benefits and adverse effects of using esophageal cancer cell antigens to stimulate DC to trigger the specific immune response in patients with esophageal cancer undergoing radiotherapy. This was an observational cohort study performed at Lianshui County People's Hospital between September 2010 and June 2012. Forty patients with esophageal cancer planned to receive radiotherapy were selected, and 28 received the DC vaccine. DC were isolated, loaded with antigens, and intradermally injected after being cultured for 1 week. One week after injection, the patients underwent a delayed-type hypersensitivity test. Serum Th1 cytokines [interleukin (IL)-2, IL-12, and interferon (IFN)-γ] and antigen-specific IFN-γCD8 T cells were tested before and after vaccination. Patients were followed up for 2 years. Adverse events were monitored. Patients in the vaccine group tolerated the DC vaccine. Levels of serum IL-2 (+92.4%), IL-12 (+70.9%), and IFN-γ (+214.3%) as well as the proportion of IFN-γCD8 T cells (3.0-16.4-fold) were significantly increased compared with baseline and the control group (all P<0.05). The 1- (82.1% vs. 50.0%, P=0.04) and 2-year survival (67.8% vs. 33.3%, P=0.04) was improved by vaccination. Only 2 patients showed mild fever. In conclusion, the DC vaccine triggered the specific immune response and induced the secretion of Th1 cytokines. The vaccine may lead to better survival, but this have to be confirmed. Adverse events were rare and mild.