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In a cluster-randomized trial, villages were assigned in a 1:1 ratio to use a salt substitute (75% sodium chloride and 25% potassium chloride by mass) or regular salt. Among persons who had a history of stroke or were 60 years of age or older and had hypertension, rates of stroke, major cardiovascular events, and death were lower with the salt substitute, which had no apparent serious adverse effects.

Background To explore the role of family with sequence similarity 13 member A (FAM13A) in TGF-β1-induced EMT in the small airway epithelium of patients with chronic obstructive pulmonary disease (COPD). Methods Small airway wall thickness and protein levels of airway remodeling markers, EMT markers, TGF-β1, and FAM13A were measured in lung tissue samples from COPD and non-COPD patients. The correlations of FAM13A expression with COPD severity and EMT marker expression were evaluated. Gain- and loss-of-function assays were performed to explore the functions of FAM13A in cell proliferation, motility, and TGF-β1-induced EMT marker alterations in human bronchial epithelial cell line BEAS-2B. Results Independent of smoking status, lung tissue samples from COPD patients exhibited significantly increased small airway thickness and collagen fiber deposition, along with enhanced protein levels of remodeling markers (collagen I, fibronectin, and MMP-9), mesenchymal markers (α-SMA, vimentin, and N-cadherin), TGF-β1, and FAM13A, compared with those from non-COPD patients. FAM13A expression negatively correlated with FEV 1 % and PO 2 in COPD patients. In small airway epithelium, FAM13A expression negatively correlated with E-cadherin protein levels and positively correlated with vimentin protein levels. In BEAS-2B cells, TGF-β1 dose-dependently upregulated FAM13A protein levels. FAM13A overexpression significantly promoted cell proliferation and motility in BEAS-2B cells, whereas FAM13A silencing showed contrasting results. Furthermore, FAM13A knockdown partially reversed TGF-β1-induced EMT marker protein alterations in BEAS-2B cells. Conclusions FAM13A upregulation is associated with TGF-β1-induced EMT in the small airway epithelium of COPD patients independent of smoking status, serving as a potential therapeutic target for anti-EMT therapy in COPD.

Objective To investigate the diagnostic values of D-dimer, plasminogen activator inhibitor-1 (PAI-1), thrombin–antithrombin (TAT), and prothrombin fragment F1 + 2 (F1 + 2) for predicting venous thromboembolism (VTE) after total knee arthroplasty (TKA). Methods Ultrasonography and CTPA were performed to diagnose VTE in 252 patients who underwent TKAs. Plasma D-dimer, PAI-1, TAT, and F1 + 2 levels were assessed 1–3 days prior to operation (T1), second hour (T2), first (T3), and third day (T4) after the operation. Receiver–operating characteristic curves (ROC) analysis was conducted and pairwise compared to evaluate the diagnostic value of those biomarkers. Results Plasma D-dimer levels differed between patients with and without VTE significantly on T4, PAI-1, TAT, and F1 + 2 levels differed on T3 and T4. The areas under ROC of D-dimer, PAI-1, TAT and F1 + 2 levels were 0.645, 0.773, 0.771 and 0.797, respectively. The most feasible cutoff values of D-dimer, PAI-1, TAT and F1 + 2 in predicting VTE after TKA were 2.24 ug/ml, 35.96 ng/ml, 13.36 ng/mg and 11.1 ng/ml, respectively. Pairwise comparison of ROC curves revealed that D-dimer level had the lowest diagnostic accuracy, whereas PAI-1, TAT and F1 + 2 level had similar diagnostic accuracy. There were significant differences in duration of tourniquet time and duration of anesthesia between patients with and without VTE. Conclusion After TKA, using 2.24ug/mL as the threshold value of D-dimer is more accurate than using 0.5ug/mL in the monitoring of VTE, PAI-1, TAT and F1 + 2 are more valuable than D-dimer in predicting VTE. Duration of tourniquet and duration of anesthesia are risk factors for the development of VTE.

This study aimed to assess the potential of home monitoring using a monitoring application for the early prediction of acute exacerbations (AEs) in patients with fibrosing interstitial lung diseases (F-ILDs) by tracking symptoms, peripheral blood oxygen saturation (SpO 2 ), and heart rate (HR). Data on symptoms, SpO 2 , and HR before and after a 1-min sit-to-stand test (1STST) were collected using an online home monitoring application. Symptoms were recorded at least 3 times a week, including cough intensity and frequency (Cough Assessment Test scale (COAT) score), breathlessness grade (modified Medical Research Council (mMRC) score), and SpO 2 and HR before and after 1STST. Eighty-five patients with stable F-ILDs were enrolled. We observed a significant increase in COAT and mMRC scores, alongside a significant decrease in SpO 2 before and after 1STST, 2 weeks before the first recorded AE. Furthermore, a combination of variables-an increase in COAT (≥ 4) and mMRC(≥ 1) scores, a decrease in SpO 2 at rest (≥ 5%), and a decrease in SpO 2 after 1STST (≥ 4%)- proved the most effective in predicting AE onset in patients with F-ILDs at 2 weeks before the first recorded AE. Home telemonitoring of symptoms, SpO 2 holds potential value for early AE detection in patients with F-ILDs.

Glioblastoma multiform (GBM) is considered the deadliest brain cancer. Standard therapies are followed by poor patient's survival outcomes, so novel and more efficacious therapeutic strategies are imperative to tackle this scourge. Metformin has been reported to have anti-cancer effects. However, the precise mechanism underlying these effects remains elusive. A better understanding of its underlying mechanism will inform future experimental designs exploring metformin as a potential adjuvant therapy for GBM. This research aimed to elucidate the potential molecular mechanism of metformin in GBM by integrating proteomics and transcriptomics. The study examined the effects of metformin on GBM cell lines using various methods. The U87, U251 and HA1800 were cultured and modified through PER2 knockdown and overexpression. Cell viability was assessed using the CCK8 assay, and G6PDH activity and intracellular NADPH levels were measured with specific kits. ROS levels, mitochondrial membrane potential, cell cycle distribution and apoptosis were analyzed by flow cytometry. RNA was extracted for transcriptomic analysis through RNA sequencing, while proteomic analysis was performed on total protein from treated cells. WB detected specific proteins, and RT-qPCR quantified gene expression. In vivo experiments, GBM xenograft on nude mice treated with metformin combining radiotherapy was evaluated and received IHC and TUNEL staining for protein expression and apoptosis assessment. Statistical analyses were conducted using Prism software to identify significant group differences. We found that differential expressional genes and proteins relating to circadian rhythm were enriched in proteomic or transcriptomic. The expression of PER2, the key circadian gene, was up-regulated in GBM cell lines when treated with metformin. Furthermore, the expression of silent information regulator 2(SIRT2) was down-regulated, while the expression of the G6PD protein just slightly increased in GBM cell lines. Meanwhile, NADPH+ production and G6PDH enzyme activity significantly decreased. Further study validated that metformin inhibited the cell growth of GBM cell lines through up-regulating and inhibited SIRT2/G6PD signaling pathway, enhancing radiotherapy(RT) sensitivity. We also found that the inhibition of SIRT2 caused by metformin is mediated by PER2. We found the pivotal role of metformin as an effective circadian rhythm regulator. Targeting circadian clock gene to modify and rescue the dysfunctional circadian clock of GBM cells at molecular level might be an innovative way to administer cancer chronotherapy and maintain metabolic homeostasis in real world practice.

Our aim was to clarify the main factors associated with lung function and to analyze the correlation between fine particulate matter (PM 2.5 ) and lung function in a rural Chinese population. We analyzed data of 5195 participants in the China Northwest Natural Population Cohort: Ningxia Project who were ≥ 30 years old. They were recruited from 2018 to 2019, underwent spirometry during the physical examination, and completed a self-report questionnaire. A satellite-based spatiotemporal model was used to estimate the 2-year average PM 2.5 exposure based on participants’ home addresses. A generalized linear mixed model was used to test the relationship between PM 2.5 concentration and lung function. Sex, age, exposure to cooking oil fumes, and occupational exposure were negatively correlated ( P  < 0.05) with forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV 1 ). Educational status, economic level, tea consumption, and alcohol consumption were positively correlated ( P  < 0.05) with FVC and FEV 1 . The adjusted results of each model revealed that FVC and FEV 1 decreased with increased exposure to PM 2.5 . There was a strong negative correlation between a PM 2.5 concentration of 35.66 μg/m 3 and FVC, FEV1, and FEV1/FVC, with unadjusted hazard ratios of − 0.06 (95% confidence interval, − 0.10 to − 0.01), − 0.13 (− 0.17 to − 0.10), and − 22.10 (− 24.62 to − 19.26), respectively. In conclusion, long-term exposure to high concentrations of ambient PM 2.5 is related to reduce lung function among people in rural areas in northwestern China.

Related evidences of metabolically unhealthy profile of adults with normal weight are not well characterized in the Chinese population. This is because they cannot be effectively identified by regular measurements (such as body mass index [BMI]). To overcome this gap in literature, this study aimed at investigating the association between body composition and metabolically unhealthy profile in Chinese adults with normal weight. A total of 5427 individuals with normal-weight were recruited from 15820 people living in Ningxia Hui Autonomous Region in Northwest China. Normal-weight was defined as a BMI of 18.5-23.9 kg/m2. Metabolically unhealthy profile was assessed by the National Cholesterol Education Program Adult Treatment Panel III (ATP III). Metabolically unhealthy normal-weight (MUHNW) profile was defined in individuals who had normal weight and at least two cardiometabolic risk factors. Generalized linear model was used to investigate the association between body composition measured by bioelectrical impedance and metabolically unhealthy profile in adults with normal-weight. The percentage of metabolically unhealthy profile was 35.86% in adults with normal weight. Different MUHNW distributions were found between males and females depending on age. The percentage of the MUHNW profile significantly increased in women after the age of 55, contrary to men. The association between body composition and MUHNW was affected by age and sex. The increased adiposity indices (fat mass index [FMI], visceral fat level [VFL], waist circumference [WCF]), and reduced skeletal muscle mass ratio [SMR] showed significant differences between MUHNW and metabolically healthy with normal weight (MHNW) (p < 0.05). The distribution of MUHNW differed between ages and sexes. FMI, VFL, WCF and SMR could be responsible for the MUHNW adults, providing a new insight into the potential metabolic risks for the adults with normal weight in China. This directs us in the management of the MUHNW for their early prevention.

Background This study aimed to investigate risk factors for acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) based on baseline high-resolution computed tomography (HRCT). Methods This prospective observational study enrolled patients with IPF treated at the General Hospital of Ningxia Medical University between January 2019 and January 2021. HRCT-derived quantitative parameters at baseline were analyzed. Results A total of 102 patients [92 (90.2%) males with a mean age of 67 years] with IPF were included, with a median follow-up of 32 (24-40.5) months. AE occurred in 30 (29.4%) IPF patients. Multivariable logistic regression analysis identified Doppler transthoracic echocardiography suggestive of pulmonary hypertension (PH) (13.43; 95% CI: 4.18–41.09; P  < 0.001), honeycombing (OR 1.08; 95% CI: 1.02–1.14; P  = 0.013), and whole lung volume (OR 0.99; 95% CI: 0.99-1.00; P  = 0.037) as independent risk factors for AE-IPF. The combination of PH, honeycombing, whole lung volume, and the percentage of predicted forced vital capacity (FVC% pred) showed a high area under the curve from receiver operating characteristic curves of 0.888, with a sensitivity of 90% and specificity of 78%. Conclusions This study emphasizes that quantitative CT parameters (honeycombing, whole lung volume) may serve as risk factors for AE-IPF. The combination of honeycombing, whole lung volume, FVC% pred, and PH may aid in predicting AE-IPF.

Background Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have considerably high mortality and re-hospitalisation rate. Diaphragmatic dysfunction (DD) is common in COPD patients. However, whether diaphragmatic dysfunction is related to acute exacerbation is yet to be elucidated. This study aimed to evaluate the diaphragm function by magnetic resonance imaging (MRI) in COPD patients and assess whether the impact of DD may help predict AECOPD. Methods 20 healthy adult volunteers and 80 COPD patients were enrolled. The diaphragms function parameters were accessed by MRI. Patients were guided to start self-management by the Telehealth-based monitoring system following the enrolment. Events of acute exacerbation of COPD were recorded by the system and confirmed by healthcare providers. Binary univariate and multivariate logistic regression analyses were performed to investigate the factors associated with the frequency of AECOPD. Receiver operating characteristic (ROC) curves were further used to assess the value of prediction indexes. Results Fifty-nine COPD patients completed a one-year follow-up based on the Telehealth-based monitoring system. The clinical outcomes showed that the diaphragm function parameters at the end of maximal breathing were lower in the COPD group than in the healthy control group ( P  < 0.05). ANOVA showed significant differences among Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages for diaphragm function parameters, including chest wall motion, lung area, upper-lower diameter, and the diaphragm thickening fraction at the end of maximal breathing ( P  < 0.05). Moreover, significant differences in diaphragm function parameters were observed between patients with infrequent AECOPD (n = 28) and frequent AECOPD (n = 31) based on the frequency of AECOPD ( P  < 0.05). The diaphragm thickening fraction and the chest wall motion were associated with AECOPD after adjusting for age, sex, BMI, and lung functions, and the combination of predictions showed better accuracy in predicting the frequency of AECOPD. Conclusions In COPD patients, diaphragm function parameters correlate with the severity of airflow limitation. The diaphragm thickening fraction and the chest wall motion were associated with the frequency of AECOPD and can predict it.

Background In this study, we aimed to explore the association between baseline and early changes in the neutrophil-to-lymphocyte ratio (NLR) and the 30-day mortality rate in patients having anti-melanoma differentiation-associated gene 5 (MDA5)-positive dermatomyositis with interstitial lung disease (DM-ILD). Methods Overall, 263 patients with anti-MDA5 DM-ILD from four centers in China were analyzed. Multivariate logistic regression analysis was used to evaluate the impact of baseline NLR on the 30-day mortality rate in patients with anti-MDA5-positive DM-ILD. Furthermore, a generalized additive mixed model (GAMM) was applied to compare the NLR variations over time between 30-day survival group and non-survival group. Results Two hundred sixty-three patients with anti-MDA5-positive DM-ILD were divided into different groups based on their NLR and whether they survived or not within 30 days. The multivariate logistic regression analysis, accounting for confounding factors, identified an elevated baseline NLR as a prognostic indicator for 30-day mortality in patients with anti-MDA5-positive DM-ILD (hazard ratio 2.68, 95% confidence interval [CI] 1.18,6.00, P  = 0.019). Furthermore, the GAMM results indicated that the NLR gradually increased more in the non-survival group compared with the survival group within 14 days of admission, with a daily average increase of 1.03 (β = 1.03; 95% CI, 0.75–1.31; P  < 0.001). Conclusions We found that an elevated baseline NLR and its progressive increase are associated with 30-day mortality in patients with anti-MDA5-positive DM-ILD.