Objective To explore the impact of SARS-CoV-2-positive donors on the prognosis of heart transplant recipients. Methods The Medline, EMbase, CENTRAL, CNKI, Wanfang Data, VIP and China Biology Medicine from inception to May 2023 were searched by computer for studies about impact of SARS-CoV-2-positive donors on the prognosis of heart transplant recipients. The data were extracted from all the relevant literatures, and the quality of the data was assessed using the Newcastle-Ottawa Scale (NOS). All statistical analyses were conducted by the Stata 11.0 software. Results A total of 10 studies (NOS score ranging from 5 to 9 points) involving 643 patients were enrolled. The pooled results demonstrated that the pooled mortality of heart transplant recipients from SARS-CoV-2-positive donors was 4% (95%CI 2% to 5%). And the incidence of composite outcome, regarding graft failure, rejection and death as poor prognosis, was 7% (95%CI 5% to 9%). Besides, compared with recipients from SARS-CoV-2-negative donors, the pooled odds ratio (OR) value of death of SARS-CoV-2-positive donors was 0.68 (95%CI 0.38 to 1.22, Z=1.28, P=0.200). The pooled OR value of rejection rate was 0.41 (95%CI 0.27 to 0.64, Z=3.97, P<0.005). For the composite outcome, the pooled OR value was 0.50 (95%CI 0.37 to 0.69, Z=4.30, P<0.005). In addition, there was no statistical difference in the length of hospital stay between heart transplant recipients from SARS-CoV-2-positive donors and negative donors (SMD=–0.03, 95%CI –0.22 to 0.15, Z=0.36, P=0.720). Conclusion The application of heart from SARS-CoV-2-positive donor for transplantation is safe and feasible. However, further prospective studies with longer follow-up are still needed to verify its impact on long-term outcomes.

Background/Aims: Low educational attainment is a well-established risk factor for nonalcoholic fatty liver disease (NAFLD) in developed areas. However, the association between educational attainment and the risk of NAFLD is less clear in China. Methods: A cross-sectional study including over 200,000 Chinese adults across mainland China was conducted. Information on education level and lifestyle factors were obtained through standard questionnaires, while NAFLD and advanced fibrosis were diagnosed using validated formulas. Outcomes included the risk of NAFLD in the general population and high probability of fibrosis among patients with NAFLD. Logistic regression analysis was employed to estimate the risk of NAFLD and fibrosis across education levels. A causal mediation model was used to explore the potential mediators. Results: Comparing with those receiving primary school education, the multi-adjusted odds ratios (95% confidence intervals) for NAFLD were 1.28 (1.16 to 1.41) for men and 0.94 (0.89 to 0.99) for women with college education after accounting for body mass index. When considering waist circumference, the odds ratios (95% CIs) were 0.94 (0.86 to 1.04) for men and 0.88 (0.80 to 0.97) for women, respectively. The proportions mediated by general and central obesity were 51.00% and 68.04% for men, while for women the proportions were 48.58% and 32.58%, respectively. Furthermore, NAFLD patients with lower educational attainment showed an incremental increased risk of advanced fibrosis in both genders. Conclusions In China, a low education level was associated with a higher risk of prevalent NAFLD in women, as well as high probability of fibrosis in both genders.

Objective:To compare the effect of two vs one stitch on outcomes in women with cervical incompetence who undergo emergency transvaginal cervical cerclage.Methods:A retrospective study was conducted on 38 cases of cervical incompetence patients who underwent emergency cervical cerclage at Fujian Maternity and Child Health Hospital from January 2018 to December 2022. These subjects were divided into two groups: one stitch group (loop continuous suture and knot at cervical-vaginal junction level) and two stitches group (the first loop was closed with a single suture set, and the second loop was closed below the first loop near the cervical outlet) with 19 cases in each group. Two independent samples t or t'-test, rank-sum test, Chi-square test and Fisher's exact test were used to compare the differences in perinatal outcomes between the two groups. Kaplan-Meier survival analysis was performed to evaluate the efficacy of the prolongation of gestational age after emergency transvaginal cervical cerclage. Results:There was no statistically significant difference in the gestational age at cervical cerclage between the two stitches and the one stitch group [24.9 weeks (23.9-25.9 weeks) vs 23.6 weeks (22.6-24.9 weeks), Z=－1.61, P=0.108]. The average gestational age at delivery [(33.1±4.8) vs (28.6±4.3) weeks, t=－3.10] and the prolongation of gestational age after cerclage[(8.5±4.6) vs (5.0±2.6) weeks, t=－2.90] were significantly greater in the two stitches group compared to those in the one stitch group, while the rates of preterm birth before 32 weeks (6/19 vs 16/19, χ2=10.80), 34 weeks (8/19 vs 17/19, χ2=9.47), and 37 weeks (14/19 vs 19/19, Fisher's exact test) were lower (all P<0.05). The Kaplan-Meier survival analysis demonstrated that the two stitches group had significantly higher efficacy in prolonging gestational age compared to the one stitch group [log-rank test χ2 (1)=13.10, P<0.05]. Although there was no statistically significant difference in the neonatal mortality between the two groups (2/19 vs 4/19, Fisher's exact test, P=0.660), survival neonates in the two stitches group had significantly higher birth weight [2 370.0 g (1 775.0-2 710.0 g) vs 1 300.0 g (1 210.0-1 660.0 g), Z=－3.14], lower admission rate to the neonatal intensive care unit (9/17 vs 15/15, Fisher's exact test), lower incidence of stage Ⅲ necrotizing enterocolitis (0/17 vs 5/15, Fisher's exact test), moderate-severe respiratory distress syndrome (5/17 vs 10/15, χ2=4.44), and grade Ⅲ-Ⅳ intraventricular hemorrhage (0/17 vs 7/15, Fisher's exact test) compared to those in the one stitch group (all P<0.05). Conclusion:Compared with emergency cervical cerclage with one stitch, the procedure with two stitches can prolong the gestational age and improve the neonatal prognosis more effectively.

Objective:To explore the clinical efficacy of ultrasound-indicated cervical cerclage in twin pregnancies.Methods:This retrospective cohort study included 96 asymptomatic twin pregnancies with cervix length (CL)≤2.5 cm at 16-27 +6 weeks indicated by transvaginal ultrasound from January 2013 to May 2022 in Fujian Maternity and Child Health Hospital. They received either cervical cerclage (cerclage group, n=45) or conservative treatment (conservative group, n=51). The subgroup analysis was further performed after stratifying the subjects into the CL≤1.0 cm subgroup, the CL>1.0-≤1.5 cm subgroup, and the CL>1.5 cm subgroup. Two independent samples t-test, Mann-Whitney U test, and Chi-square test were used to compare the differences in the pregnancy and perinatal outcomes between different groups. Multivariate logistic regression was used to analyze the impact of cervical cerclage on pregnancy outcomes of women with different CLs. Results:The average gestational age at delivery and the prolonged gestation were significantly greater in the cerclage group than those in the conservative group [35.9 (34.9-37.0) weeks vs 34.9 (29.1-36.1) weeks; 10.7 (9.6-13.1) weeks vs 8.7 (4.8-11.0) weeks, Z=－2.59 and -3.63, both P<0.05]. The incidences of preterm birth before 34 weeks and 28 weeks, chorioamnionitis, and preterm premature rupture of membrane were lower in the cerclage group than those in the conservative group [17.8% (8/45) vs 45.1% (23/51), χ2=8.16; 2.2% (1/45) vs 15.7% (8/51), Fisher' exact test; 8.9% (4/45) vs 25.5% (13/51), χ2=4.52; 15.6% (7/45) vs 33.3% (17/51), χ2=4.03; all P<0.05]. There were no statistically significant differences in the proportion of postpartum hemorrhage and live births between the two groups (both P>0.05). In the women with CL≤1.0 cm, the cerclage group had a greater gestational age at delivery [36.0 (34.8-37.3) weeks vs 34.9 (28.6-35.4) weeks, Z=－2.61, P=0.009], greater prolonged gestation [12.3 (9.7-13.9) weeks vs 7.3 (3.4-9.1) weeks, Z=－3.34, P=0.001], higher birthweight [2 430.0 (2 173.8-2 646.3) g vs 1 900.0 (1 372.5-2 435.0) g, Z=－3.06, P=0.002], lower incidence of adverse neonatal outcomes [16.7% (6/36) vs 36.7% (11/30), χ2=4.22, P=0.048] compared with the conservative group. Multivariate Logistic regression analysis showed that cerclage reduced the risks of preterm birth before 34 and 32 weeks [ aOR (95% CI)=0.083 (0.009-0.790) and 0.092 (0.009-0.939), both P<0.05]. However, cerclage did not reduce the risk of preterm birth in women with CL>1.5 cm or CL>1.0-≤1.5 cm (both P>0.05). Conclusion:Ultrasound- indicated cervical cerclage can reduce the risk of preterm birth before 34 and 32 weeks, prolong pregnancy, and improve perinatal outcomes in asymptomatic twin pregnancies with CL≤1.0 cm.

Objective:To investigate the incidence and risk factors associated with preterm premature rupture of membranes (PPROM) following transvaginal cervical cerclage.Methods:This retrospective cohort study involved 170 singleton pregnancies with cervical incompetence who underwent vaginal cervical cerclage at Fujian Maternity and Child Health Hospital from January 2021 to January 2022. Based on the onset of PPROM after cervical cerclage, the patients were divided into the PPROM group ( n=28) and the non-PPROM group ( n=142). Independent samples t-test, rank-sum test, Chi-square test, or Fisher's exact test were used to compare the general condition, pre- and postoperative data, pregnancy complications or comorbidities between the two groups, with a significance level at α=0.1. Multiple logistic regression analysis was conducted to identify the risk factors for PPROM after cerclage surgery. Results:The overall incidence of PPROM after vaginal cervical cerclage was 16.5% (28/170). Logistic regression analysis showed that a history of cervical conization ( OR=11.966, 95% CI:1.695-84.468), the use of Mersilene RS22 tape as the suture material ( OR=3.318, 95% CI:1.064-9.252), cervical length<2.5 cm after cerclage ( OR=3.486, 95% CI:1.116-10.888), and Mycoplasma genitalium- positive results for cervical secretion culture after surgery ( OR=4.856, 95% CI:1.487-15.861) were the independent risk factors for PPROM after cervical cerclage (all P<0.05). Conclusions:The incidence of PPROM following vaginal cervical cerclage is relatively high and can have unfavorable effects on pregnancy outcomes. Factors such as a history of cervical conization, the use of Mersilene RS22 tape for cerclage, cervical length<2.5 cm after cerclage, and Mycoplasma genitalium-positive results for cervical secretion culture after surgery may increase the risk of PPROM after cerclage.

Background: and Purpose We investigated the causal relationships between the gut microbiota (GM), stroke, and potential metabolite mediators using Mendelian randomization (MR). Methods: We leveraged the summary statistics of GM (n=18,340 in the MiBioGen consortium), blood metabolites (n=115,078 in the UK Biobank), and stroke (cases n=60,176 and controls n=1,310,725 in the Global Biobank Meta-Analysis Initiative) from the largest genome-wide association studies to date. We performed bidirectional MR analyses to explore the causal relationships between the GM and stroke, and two mediation analyses, two-step MR and multivariable MR, to discover potential mediating metabolites. Results: Ten taxa were causally associated with stroke, and stroke led to changes in 27 taxa. In the two-step MR, Bifidobacteriales order, Bifidobacteriaceae family, Desulfovibrio genus, apolipoprotein A1 (ApoA1), phospholipids in high-density lipoprotein (HDL_PL), and the ratio of apolipoprotein B to ApoA1 (ApoB/ApoA1) were causally associated with stroke (all P<0.044). The causal associations between Bifidobacteriales order, Bifidobacteriaceae family and stroke were validated using the weighted median method in an independent cohort. The three GM taxa were all positively associated with ApoA1 and HDL_PL, whereas Desulfovibrio genus was negatively associated with ApoB/ApoA1 (all P<0.010). Additionally, the causal associations between the three GM taxa and ApoA1 remained significant after correcting for the false discovery rate (all q-values <0.027). Multivariable MR showed that the associations between Bifidobacteriales order, Bifidobacteriaceae family and stroke were mediated by ApoA1 and HDL_PL, each accounting for 6.5% (P=0.028) and 4.6% (P=0.033); the association between Desulfovibrio genus and stroke was mediated by ApoA1, HDL_PL, and ApoB/ApoA1, with mediated proportions of 7.6% (P=0.019), 4.2% (P=0.035), and 9.1% (P=0.013), respectively. Conclusion The current MR study provides evidence supporting the causal relationships between several specific GM taxa and stroke and potential mediating metabolites.

Objective: Pharmacotherapy including mood stabilizers and antipsychotics are frequently used in bipolar disorder (BD); however, the lack of consensus regarding the definition of polypharmacy hinders conducting comparative studies across different settings and countries. Research on Asian Prescription Pattern (REAP) is the largest and the longest lasting international collaborative research in psychiatry in Asia. The objective of REAP BD was to investigate the prescription patterns of psychotropic medications across Asian countries. The rates of polypharmacy and psychotropic drug load were also analyzed. Methods: The data collection was web-based. Prescription patterns were categorized as (1) mood stabilizer monotherapy: one mood stabilizer; (2) antipsychotic monotherapy: one antipsychotic; (3) simple polypharmacy: one mood stabilizer and one antipsychotic; and (4) complex polypharmacy: ≥ 2 mood stabilizers or/and antipsychotics. The psychotropic drug load in each patient was calculated using the defined daily dose method. Results: Among 2003 patients with BD (52.1% female, 42.4 years) from 12 countries, 1,619 (80.8%) patients received mood stabilizers, 1,644 (82.14%) received antipsychotics, and 424 (21.2%) received antidepressants, with 14.7% mood stabilizer monotherapy, 13.4% antipsychotic monotherapy, 48.9% simple polypharmacy, 20.3% complex polypharmacy, and 2.6% other therapy. The average psychotropic drug load was 2.05 ± 1.40. Results varied widely between countries. Conclusion Over 70% of psychotropic regimens involved polypharmacy, which accords with the high prevalence of polypharmacy in BD under a permissive criterion (2 or more core psychotropic drugs) worldwide. Notably, ≥ 80% of our sample received antipsychotics, which may indicate an increasing trend in antipsychotic use for BD treatment.

Objective: To evaluate the consistency on the determination of target heart rate by simple calculation method based on resting heart rate and by anaerobic threshold method in cardiopulmonary exercise test (CPET) for patients with coronary artery disease after percutaneous coronary intervention (PCI). Methods: This study was a diagnostic test. Patients with coronary artery disease who underwent the first PCI in the Department of Cardiology of Peking University People's Hospital from October 2011 to April 2021 were enrolled. Patients were further divided into subgroups according to gender, age (<60 years group and ≥60 years group), with or without myocardial infarction history (myocardial infarction group and angina pectoris group) and whether β blockers were applied. The general clinical data of patients, resting heart rate (RHR) and anaerobic threshold heart rate in CPET were collected through the electronic medical record system. The simple target rate (RHR plus 20 or 30 bpm) and the target rate calculated by anaerobic threshold (anaerobic threshold heart rate minus 10 bpm) were both calculated in each patient. Consistency test of target heart rate derived by above the two methods was shown by intra-class correlation (ICC) and Bland-Altman plots. Results: A total of 439 patients were included, age was (56.2±8.8) years, body mass index was (25.77±2.34) kg/m², there were 382 males (87.0%). The target heart rate determined by anaerobic threshold method was (90.0±11.8)bpm, and the simple target heart rate determined by RHR plus 20 bpm was (91.0±8.4)bpm. There was no significant difference on the target heart rate derived from the two calculation methods (P=0.091). The simple target heart rate determined by RHR plus 30 bpm was (101.0±8.4)bpm, which was significant higher than that determined by anaerobic threshold method (P<0.001). In the following analysis, RHR plus 20 bpm was defined as the simple target heart rate. The ICC value of target heart rate determined by anaerobic threshold and resting rate plus 20 bpm was 0.529(95%CI 0.458-0.593, P<0.001). Bland-Altman plots analysis showed that the ratio of the simple target heart rate and the target heart rate determined by anaerobic threshold method was 1.03±0.11 and the 95% limits of agreement (LOA) were 0.812-1.245. In the subgroup of patients aged<60 years (n=247), the ICC value was 0.492, the ratio by Bland-Altman plots analysis was 1.02±0.11 and LOA was 0.814-1.234; in the subgroup of patients aged ≥60 years (n=192), the ICC value was 0.566, the ratio by Bland-Altman plots analysis was 1.03±0.11 and LOA was 0.810-1.260. In male subgroup(n=382), the ICC value was 0.540, the ratio by Bland-Altman plots analysis was 1.03±0.11 and LOA was 0.813-1.246; in female subgroup(n=57), the ICC value was 0.445, the ratio by Bland-Altman plots analysis was 1.03±0.11 and LOA was 0.810-1.240.In myocardial infarction subgroup (n=186), the ICC value was 0.568, the ratio by Bland-Altman plots analysis was 1.02±0.11 and LOA was 0.810-1.227; in angina pectoris subgroup (n=253), the ICC value was 0.495, the ratio by Bland-Altman plots analysis was 1.04±0.11 and LOA was 0.813-1.260. In the subgroup of patients with β blockers (n=353), the ICC value was 0.520, the ratio by Bland-Altman plots analysis was 1.03±0.11 and LOA was 0.810-1.252; in the subgroup of patients without β blockers (n=86), the ICC value was 0.570, the ratio by Bland-Altman plots analysis was 1.02±0.10 and LOA was 0.821-1.219. Conclusions: The simple target heart rate determined by RHR plus 20 bpm is consistent with the target heart rate determined by anaerobic threshold in patients with coronary artery disease after PCI. But the simple target heart rate determined by RHR plus 20 bpm can't replace the target heart rate determined by anaerobic threshold in this patient cohort.
Adrenergic beta-Antagonists ; Anaerobic Threshold ; Angina Pectoris ; Coronary Artery Disease ; Female ; Heart Rate/physiology* ; Humans ; Male ; Myocardial Infarction ; Percutaneous Coronary Intervention

OBJECTIVE: To explore the expression of CCN5 in endometriotic tissues and its impact on proliferation, migration and invasion of human endometrial stromal cells (HESCs). METHODS: We collected ovarian endometriosis samples from 20 women receiving laparoscopic surgery and eutopic endometrium samples from 15 women undergoing IVF-ET for comparison of CCN5 expression. Cultured HESCs were transfected with a recombinant adenovirus Ad-CCN5 for CCN5 overexpression or with a CCN5-specific siRNA for knocking down CCN5 expression, and the changes of cell proliferation, migration and invasion were evaluated using CCK-8 assay, wound healing assay and Transwell chamber assay. RT-qPCR and Western blotting were used to examine the expression levels of epithelial-mesenchymal transition (EMT) markers including E-cadherin, N-cadherin, Snail-1 and vimentin in HESCs with CCN5 overexpression or knockdown. RESULTS: CCN5 expression was significantly decreased in ovarian endometriosis tissues as compared with eutopic endometrium samples (P < 0.01). CCN5 overexpression obviously inhibited the proliferation, migration and invasion of HESCs, significantly increased the expression of E-cadherin and decreased the expressions of N-cadherin, Snail-1 and vimentin (P < 0.01). CCN5 knockdown significantly enhanced the proliferation, migration and invasion of HESCs and produced opposite effects on the expressions of E-cadherin, N-cadherin, Snail-1 and vimentin (P < 0.01). CONCLUSION CCN5 can regulate the proliferation, migration and invasion of HESCs and thus plays an important role in EMT of HESCs, suggesting the potential of CCN5 as a therapeutic target for endometriosis.
Cell Movement ; Cell Proliferation ; Endometriosis/metabolism* ; Endometrium/metabolism* ; Epithelial Cells ; Epithelial-Mesenchymal Transition ; Female ; Humans ; Stromal Cells