New Insights into Stroke Prevention and Treatment: Gut Microbiome.
Cellular and molecular neurobiology. 2022;(2):455-472
Stroke, a lethal neurological disease, accounts for a grave economic burden on society. Despite extensive basic and clinical studies on stroke prevention, a precise effective treatment approach for stroke at this stage remains unavailable. The majority of our body's gut microbiota plays a vital role in food digestion, immune regulation, and nervous system development, which is highly associated with the development of some diseases. Multiple clinical studies have documented variation in the composition of gut microbiota between stroke patients and healthy counterparts. Moreover, the intervention of intestinal symbiotic microorganisms via several mechanisms plays an active role in stroke prognosis. In the prevention and treatment of stroke, the gut microbiota gives off a seductive glow, this is a promising therapeutic target. This paper summarizes the current knowledge of stroke and gut microbiota, and systematically describes the possible mechanisms of interaction between stroke and gut microbiota, the relationship between stroke-related risk factors and gut microbiota, and the treatment of gut flora using microorganisms. Thus, it could valuably elucidate the correlation of gut microbiota with stroke incidence, providing stroke researchers with a new strategy for stroke prevention and treatment by regulating gut microbiota.
Physical Exercise Modalities for the Management of Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta-Analysis.
Journal of cardiovascular pharmacology. 2022;(5):698-710
ABSTRACT Different physical exercise modalities have been widely studied in patients having heart failure with preserved ejection fraction (HFpEF) but with variably reported findings. We, therefore, conducted a systematic review and meta-analysis to evaluate whether the efficacy of physical activity in the management of HFpEF is related to exercise modalities. PubMed and Embase were searched up to July 2021. The eligible studies included randomized controlled trials that identified effects of physical exercise on patients with HFpEF. Sixteen studies were included to evaluate the efficiency of physical exercise in HFpEF. A pooled analysis showed that exercise training significantly improved peak oxygen uptake (VO2), ventilatory anaerobic threshold, distance covered in the 6-minute walking test, the ratio of early diastolic mitral inflow to annular velocities, the Short Form 36 physical component score, and the Minnesota Living with Heart Failure Questionnaire total score. However, the changes in other echocardiographic parameters including the ratio of peak early to late diastolic mitral inflow velocities, early diastolic mitral annular velocity, and left atrial volume index were not significant. Both high-intensity and moderate-intensity training significantly improved exercise capacity (as defined by peak VO2), with moderate-intensity exercise having a superior effect. Furthermore, exercise-induced improvement in peak VO2 was partially correlated with exercise duration. Physical exercise could substantially improve exercise capacity, quality of life, and some indicators of cardiac diastolic function in patients with HFpEF. A protocol of moderate-intensity exercise training lasting a longer duration might be more beneficial compared with high-intensity training for patients with HFpEF.
Frailty in Older Patients Undergoing Hemodialysis and Its Association with All-Cause Mortality: A Prospective Cohort Study.
Clinical interventions in aging. 2022;:265-275
Purpose: The study aimed to determine the prevalence and risk factors of frailty among a Chinese cohort of hemodialysis patients and to assess the degree to which frailty was associated with all-cause mortality. Participants and Methods: We enrolled a group of older adults (≥60 years old) in a prospective cohort study of cognitive impairment in Chinese patients undergoing hemodialysis (registered in Clinical Trials.gov, ID: NCT03251573). We assessed the prevalence of frailty using Fried's definition in the Cardiovascular Health Study, then we evaluated the associated risk factors of frailty using multivariate logistic regression analysis. Finally, we assessed the association of frailty and all-cause mortality with multivariable Cox proportional hazard regression analyses. Results: The prevalence of frailty in these 204 enrolled hemodialysis patients was 72.1%. Patients with frailty were more inclined to have composite abnormal components that included poor physical functioning, exhaustion, low physical activity, and undernutrition. Multivariable logistic regression analysis suggested that increased age, female gender, history of diabetes, longer dialysis vintage, lower Kt/V, lower serum level of albumin concentrations, and increased serum iPTH concentrations were independently associated with frailty. Cox regression analysis indicated that frailty as a dichotomous construct was strongly associated with an increased risk of mortality (HR 6.092, 95% CI 1.886-19.677, P = 0.003) in unadjusted analyses. After adjusting (Model I = no adjusted; II = adjusted for age, gender; III = adjusted for age, gender, history of diabetes; IV = adjusted for all covariates associated at the p ≤ 0.10 level with death in unadjusted analyses, including age, history of diabetes, MoCA<26, single-pool Kt/V, and the levels of albumin and iPTH), the association was slightly affected but observed consistent as before. Conclusion: Frailty is extremely common and is associated with serious clinical outcomes among older hemodialysis patients. Based on those clinical features of frailty, future studies should focus on exploring effective interventions aimed to prevent or attenuate frailty in the older hemodialysis population.
Internet-based platform for a low-calorie dietary intervention involving prepackaged food for weight loss in overweight and obese individuals in China: protocol for a randomised controlled trial.
BMJ open. 2022;(1):e048106
INTRODUCTION Obesity is a global health issue that impacts quality of life. A calorie-restricted diet with high-intensity consultation provided via the internet may be an effective way to lose weight. The objective of this study was to assess the effectiveness of a practitioner-guided, mobile internet-based low-energy dietary intervention in overweight and obese populations in China. METHODS AND ANALYSIS This open-label randomised controlled trial enrolled 220 overweight and obese adults aged 18-70 years who met the inclusion criteria. Participants were assigned to the control group (n=110) or trial group (n=110). The trial group will be enrolled in the MetaWell programme, a weight loss programme using diet replacement products, wireless scales and a mobile phone app. Participants in the control group will receive paper material containing a sample diet for weight loss. The follow-up period will be 1 year, and measurements will occur at 3, 6 and 12 months. Dual-emission X-ray absorptiometry and abdominal quantitative CT will be performed to estimate the percentage of overall body fat and areas of visceral and subcutaneous fat, alongside several cardiometabolic measurements. The primary outcome of this study is the change in body mas index (BMI) at 6 months after enrolment. A mixed-effects model will be used to compare BMI and body fat changes between the two groups. ETHICS AND DISSEMINATION This study was approved by the ethics committee of the Hospital of Chengdu Office of the People's Government of the Tibetan Autonomous Region. Advertisements for recruitment will be sent via official accounts using WeChat. The results will be disseminated via publications in academic journals and our clinic. Our study group will maintain contact with the participants to inform them of the study findings. TRIAL REGISTRATION NUMBER ChiCTR1900021630.
Bike Share Usage and the Built Environment: A Review.
Frontiers in public health. 2022;:848169
Bike share engages riders in physical activity, beneficial to health. In addition, it promotes green mobility and contributes to carbon neutrality. An understanding of the association between bike share usage and the built environment is essential for system operation/management and urban/transportation planning. Limited reviews of the existing literature exist now. Therefore, we review previous studies to decipher the complex relationship between bike share usage and the built environment. We focus on a few built environment dimensions (e.g., land use, transportation system, and urban design) and find that many attributes affect bike share usage differently across mobility cultures, between docked and dockless bike share, and between arrival and departure usage patterns. The effects of several attributes (e.g., proximity to a park or university and metro station density) on bike share usage also vary between weekdays and weekends and across trip purposes. The findings of this paper advance knowledge on the connection between bike share usage and the built environment.
Positive Coping as a Mediator of Mobile Health Intervention Effects on Quality of Life Among People Living With HIV: Secondary Analysis of the Randomized Controlled Trial Run4Love.
Journal of medical Internet research. 2022;(2):e25948
BACKGROUND The effectiveness of psychosocial interventions on quality of life (QOL) among people living with HIV has been validated, including mobile health (mHealth) interventions. However, it is unclear which components of such interventions account for these effects. OBJECTIVE This study aims to examine positive coping as a potential mediator of the effects of an mHealth intervention on QOL among people living with HIV. METHODS For this secondary analysis, we used data from an mHealth-based randomized controlled trial, Run4Love, which was conducted to improve QOL and mental health outcomes of people living with HIV. A total of 300 participants were randomly assigned to the intervention group to receive the adapted cognitive-behavioral stress management courses and regular physical activity promotion or the waitlist control group in a 1:1 ratio. Our analysis focused on positive coping and QOL, which were repeatedly measured at baseline and at 3-, 6-, and 9-month follow-ups. Latent growth curve models were constructed to explore the mediating role of positive coping in the effects of the mHealth intervention on QOL. RESULTS Positive coping served as a mediator in the effect of the mHealth intervention on QOL for up to 9 months. The mHealth intervention had a significant and positive indirect effect on the slope of QOL via the slope of positive coping (b=2.592×1.620=4.198, 95% CI 1.189-7.207, P=.006). The direct effect of the intervention was not significant (b=0.552, 95% CI -2.154 to 3.258, P=.69) when controlling for the mediator. CONCLUSIONS The longitudinal findings suggest that positive coping could be a crucial mediator of the mHealth intervention in enhancing QOL among people living with HIV. These findings underscore the importance of improving positive coping skills in mHealth interventions to improve QOL among people living with HIV.
Microplastics: A review of analytical methods, occurrence and characteristics in food, and potential toxicities to biota.
The Science of the total environment. 2022;(Pt 1):150263
Microplastics (MPs) are ubiquitous in various environment compartments, including food. Here, we collected research reports of MPs in food published during 2010-2020, and summarized the analytical methods developed and utilized by researchers (e.g., digestion, separation and identification, as well as related QA/QC measures implemented), the occurrence, and the characteristics of MPs in six kinds of food. The potential effects on biota from exposure to MPs were also reviewed. The results showed that most researchers digested food samples using chemical solutions such as HNO3, H2O2, KOH, or NaOH. FT-IR and Raman spectroscopy were the main technique for identifying MPs, and microscopes were used to count MP particles. The abundances MPs were in the ranges of 0-5860, 2.00-1100, 0-698, 4.00-18.7, 0-5.68 × 104 and 900-3000 particles/kg in beverages, condiments, honey, meat, seafood and vegetables, respectively. The "maximum" annual human intake of MPs from these foods is approximately 1.42 × 105-1.54 × 105 particles/capita, equivalent to the consumption of 50 plastic bags (size: 0.04 mm × 250 mm × 400 mm, density: 0.98 g/cm3) each year. Blue-colored and fiber-shaped MP particles were the most commonly observed in food, predominated by PA, PE, PES, PET and PP types. Toxicity studies indicated that MPs, additives of MPs and adsorbents or microorganisms on the surfaces of MPs were all somewhat toxic to cells or biota. Exposure to MPs may induce oxidative stress, inflammation, neurotoxicity, and reproductive toxicity, and change the structure of intestinal microflora in cells or biota. Therefore, we call for more investigation into the residual, excretion and bioavailability of MPs or related absorbents/additives in biota and humans.
Multi-ancestry genetic study of type 2 diabetes highlights the power of diverse populations for discovery and translation.
Nature genetics. 2022;(5):560-572
We assembled an ancestrally diverse collection of genome-wide association studies (GWAS) of type 2 diabetes (T2D) in 180,834 affected individuals and 1,159,055 controls (48.9% non-European descent) through the Diabetes Meta-Analysis of Trans-Ethnic association studies (DIAMANTE) Consortium. Multi-ancestry GWAS meta-analysis identified 237 loci attaining stringent genome-wide significance (P < 5 × 10-9), which were delineated to 338 distinct association signals. Fine-mapping of these signals was enhanced by the increased sample size and expanded population diversity of the multi-ancestry meta-analysis, which localized 54.4% of T2D associations to a single variant with >50% posterior probability. This improved fine-mapping enabled systematic assessment of candidate causal genes and molecular mechanisms through which T2D associations are mediated, laying the foundations for functional investigations. Multi-ancestry genetic risk scores enhanced transferability of T2D prediction across diverse populations. Our study provides a step toward more effective clinical translation of T2D GWAS to improve global health for all, irrespective of genetic background.
Long-term Effects of a Social Media-Based Intervention (Run4Love) on Depressive Symptoms of People Living With HIV: 3-Year Follow-up of a Randomized Controlled Trial.
Journal of medical Internet research. 2022;(6):e36809
BACKGROUND Emerging studies have shown the effectiveness of mobile health (mHealth) interventions in reducing depressive symptoms among people living with HIV. Most of these studies included only short-term follow-up, with limited data on long-term effects. OBJECTIVE The purpose of this study is to assess the long-term effects of a randomized controlled trial called Run4Love on depressive symptoms among people living with HIV at 1-year and 3-year follow-ups. METHODS A total of 300 people living with HIV with depressive symptoms were recruited and randomized to an intervention or a control group in Guangzhou, China, from September 2017 to January 2018. The intervention group received a 3-month Run4Love program, including adapted evidence-based cognitive behavioral stress management courses and exercise promotion via WeChat (Tencent), a popular social media app. The control group received usual care and a brochure on nutrition. The primary outcome was reduction in depressive symptoms, measured using the Center for Epidemiological Studies-Depression (CES-D) scale. Data used in this study were collected at baseline and at the 1-year and 3-year follow-ups. Generalized estimating equations were used to examine the group differences at 1-year and 3-year follow-ups. RESULTS Approximately half of the participants completed the assessment at 1-year (149/300, 49.7%) and 3-year (177/300, 59%) follow-ups. At 1-year follow-up, participants in the intervention group reported significant reduction in depressive symptoms compared with the control group (CES-D: from 23.9 to 18.1 in the intervention group vs from 24.3 to 23.3 in the control group; mean -4.79, SD 13.56; 95% CI -7.78 to -1.81; P=.002). At 3-year follow-up, between-group difference in CES-D remained statistically significant (from 23.9 to 20.5 in the intervention group vs from 24.3 to 24.4 in the control group; mean -3.63, SD 13.35; 95% CI -6.71 to -0.54; P=.02). No adverse events were reported during the 3-year follow-up period. CONCLUSIONS The mHealth intervention, Run4Love, significantly reduced depressive symptoms among people living with HIV, and the intervention effects were sustained at 1-year and 3-year follow-ups. Further research is needed to explore the mechanisms of the long-term effects of mHealth interventions such as Run4Love and to implement these effective interventions among people living with HIV. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR-IPR-17012606; https://trialsearch.who.int/Trial2.aspx?TrialID=ChiCTR-IPR-17012606. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/10274.
Traditional Chinese exercise potential role as prevention and adjuvant therapy in patients with COVID-19.
Complementary therapies in clinical practice. 2021;:101379
The epidemic situation of COVID-19 is a great public health emergency worldwide characterized by fastest spreading, widest infection range and the mostly difficult to prevent and control in recent years. According to medical experience, traditional Chinese exercises (TCE) have been applied for COVID-19 prevention, adjuvant treatment or rehabilitation, and achieved some curative effects. They can enhance the body immunity, improve the function of organs, especially cardiopulmonary function, promote physical and mental rehabilitation by adjusting the body, regulating the breath, regulating the mind. This paper aims to investigate the potential value of TCE for health preservation in the prevention and adjuvant treatment for COVID-19 according to an overview of application and analysis of existing evidence. On this basis, this review proposed the TCE plan by visiting clinical and practice experts, so as to provide some references for the prevention and treatment of COVID-19 with TCE in the world.