Retinal nerve fiber layer defects and chronic kidney disease:the Kailuan Eye Study

AIM:To investigate whether retinal nerve fiber layer defects(RNFLDs)is a potential risk factor for chronic kidney disease(CKD)in Chinese adults.METHODS:The Kailuan Eye Study was a populationbased study that included 14440 participants.All participants underwent detailed assessments,RNFLDs were diagnosed using color fundus photographs.RESULTS:Overall,12507 participants[8533 males(68.23%)]had complete systemic examination data and at least one evaluable fundus photograph.RNFLDs were found in 621 participants[5.0%;95%confidence interval(CI):4.6%-5.34%],and 70 cases of multiple RNFLDs were found(11.27%).After adjusting multiple factors,RNFLDs was significantly associated with CKD severity,the ORs of CKD stage 3,stage 4 and stage 5 were 1.698,4.167,and 9.512,respectively.Multiple RNFLDs were also associated with CKD severity after adjusting multiple factors,the ORs of CKD stage 3 and stage 5 were 4.465 and 11.833 respectively.Furthermore,2294 participants had CKD(18.34%,95%CI:17.68%-18.99%).After adjusting for other factors,CKD presence was significantly correlated with the presence of RNFLDs.CONCLUSION:The strongest risk factors for RNFLDs are CKD and hypertension.Conversely,RNFLDs can be an ocular feature in patients with CKD.Fundoscopy can help detect systemic diseases,and assessment for RNFLDs should be considered in CKD patients.

Hepatocellular carcinoma:An analysis of the expression status of stress granules and their prognostic value

BACKGROUND Hepatocellular carcinoma(HCC)is a global popular malignant tumor,which is difficult to cure,and the current treatment is limited.AIM To analyze the impacts of stress granule(SG)genes on overall survival(OS),survival time,and prognosis in HCC.METHODS The combined The Cancer Genome Atlas-Liver Hepatocellular Carcinoma(TCGA-LIHC),GSE25097,and GSE36376 datasets were utilized to obtain genetic and clinical information.Optimal hub gene numbers and corresponding coefficients were determined using the Least absolute shrinkage and selection operator model approach,and genes for constructing risk scores and corresponding correlation coefficients were calculated according to multivariate Cox regression,respectively.The prognostic model’s receiver operating characteristic(ROC)curve was produced and plotted utilizing the time ROC software package.Nomogram models were constructed to predict the outcomes at 1,3,and 5-year OS prognostications with good prediction accuracy.RESULTS We identified seven SG genes(DDX1,DKC1,BICC1,HNRNPUL1,CNOT6,DYRK3,CCDC124)having a prognostic significance and developed a risk score model.The findings of Kaplan-Meier analysis indicated that the group with a high risk exhibited significantly reduced OS in comparison with those of the low-risk group(P<0.001).The nomogram model’s findings indicate a significant enhancement in the accuracy of OS prediction for individuals with HCC in the TCGA-HCC cohort.Gene Ontology and Gene Set Enrichment Analysis suggested that these SGs might be involved in the cell cycle,RNA editing,and other biological processes.CONCLUSION Based on the impact of SG genes on HCC prognosis,in the future,it will be used as a biomarker as well as a unique therapeutic target for the identification and treatment of HCC.

Influencing factors for peripheral and posterior lesions in mild non-proliferative diabetic retinopathy--the Kailuan Eye Study

AIM:To explore the influencing factors of diabetes type 2 patients with mild non-proliferative diabetic retinopathy(NPDR)in the Kailuan area of Tangshan,Hebei Province,China.METHODS:In this non-interventional,retrospective study,683 patients with type 2 diabetes were included in the Kailuan Diabetic Retinopathy Study involving participants with diabetes in the community-based longitudinal Kailuan Study.Based on the undilated ultrawide field(200°;UWF)images and partial dilated digital fundus images,the diabetic retinopathy(DR)of the surveyed population was graded.Interobserver agreement was estimated by using Cohen’s Kappa statistics.The main outcome indicators included gender,age,weight,height,body mass index,blood pressure,circumferences of neck,waist and hip,current smoking,levels of fasting plasma glucose(FPG),hypersensitive C-reactive protein,creatinine,and cholesterol,etc.According to different lesions’locations of patients with mild NPDR,logistic regression models were used to estimate the odds ratios(ORs)and their 95%Cls of each risk factor.RESULTS:The study group of 683 patients included 570 males and 113 females.The mean age of the patients was62.18±9.41 y.Compared with dilated fundus examinations,there was fair agreement with the level of DR identified on UWF images in 63.91%of eyes(k=0.369,95%CI,0.00-0.00).Detected by UWF images,there were 98 patients with mild NPDR having peripheral retinal lesions,35 patients with mild NPDR having posterior lesions,44 patients with mild NPDR whose lesions were detected both in and out the standard two fields area,and 336 patients with non obvious DR.Parameters that conferred a statistically significant increased risks for mild NPDR with having peripheral retinal lesions were neck circumstance(OR,1.124;95%CI,1.044-1.211),and with posterior lesions were FPG(OR,1.052;95%CI,1.007-1.099).CONCLUSION:UWF is an effectiveness means of DR screening.Moreover,it is necessary to evaluate peripheral diabetic retinal lesions which can help to estimate the severity of DR.The phenomenon that nonuniform and inhomogeneous distribution of DR lesions has been found.And the influencing factors in mild NPDR are differing by different lesions’locations.

The Influence of Diabetes, Hypertension, and Hyperlipidemia on the Onset of Age-Related Macular Degeneration in North China: The Kailuan Eye Study

Objective To analyze the prevalence of dry and wet age-related macular degeneration(AMD)in patients with diabetes,hypertension and hyperlipidemia,and to analyze the risk factors for AMD.Methods A population-based cross-sectional epidemiologic study was conducted involving 14,440 individuals.We assessed the prevalence of dry and wet AMD in diabetic and non-diabetic subjects and analyzed the risk factors for AMD.Results The prevalence of wet AMD in diabetic and non-diabetic patients was 0.3%and 0.5%,respectively,and the prevalence of dry AMD was 17%and 16.4%,respectively.The prevalence of wet AMD in healthy,hypertensive,hyperlipidemic,and hypertensive/hyperlipidemic populations was 0.5%,0.3%,0.2%,and 0.7%,respectively.The prevalence of dry AMD in healthy,hypertensive,hyperlipidemic,and hypertensive/hyperlipidemic populations was 16.6%,16.2%,15.2%,and 17.2%,respectively.Age,sex,body mass index,and use of hypoglycemic drugs or lowering blood pressure drugs were corrected in the risk factor analysis of AMD.Diabetes,diabetes/hypertension,diabetes/hyperlipidemia,and diabetes/hypertension/hyperlipidemia were analyzed.None of the factors analyzed in the current study increased the risk for the onset of AMD.Conclusion There was no significant difference in the prevalence of wet and dry AMD among diabetic and non-diabetic subjects.Similarly,there was no significant difference in the prevalence of wet and dry AMD among subjects with hypertension and hyperlipidemia.Diabetes co-existing with hypertension and hyperlipidemia were not shown to be risk factors for the onset of dry AMD.

糖尿病前期成年人综合健康生活方式与糖尿病、心血管疾病、癌症和死亡的关联--来自中、美、英三个国家的四个队列研究

在糖尿病前期人群中,采取健康的生活方式可以有效预防糖尿病的发生。然而,健康生活方式与心血管疾病(cardiovascular disease,CVD)、癌症和死亡的长期风险之间的关联尚未阐明。本文旨在探究糖尿病前期人群中综合健康生活方式与上述多种健康结局之间的关联。本研究纳入的121254名糖尿病前期参与者来自以下4个前瞻性队列,包括中国的东风-同济队列(Dongfeng-Tongji,DFTJ)和开滦研究,英国生物银行(UK Biobank,UKB)和美国的国家健康与营养调查(National Health and Nutrition Examination Survey,NHANES;仅用于死亡分析)。随访期间,共诊断了18333例新发糖尿病病例、10829例新发心血管疾病病例、6926例新发癌症病例和9877例全因死亡。本文基于5个因素(从不吸烟或戒烟超过10年、适量饮酒、充足的体力活动、健康膳食和理想的腰围)构建综合健康生活方式评分。各因素均被分为健康水平(赋1分)和不健康水平(赋0分),评分的加和为综合健康生活方式评分(0~5分)。首先,采用Cox比例风险回归模型计算每个队列中综合健康生活方式评分与健康结局之间的关联;然后,通过随机效应模型的荟萃分析合并各独立队列结果的多变量校正的风险比(hazard ratio,HR)和95%置信区间(confidence interval,CI)。与生活方式最不健康(评分为0~1分)的研究对象相比,生活方式最健康(评分为4~5分)的研究对象具有更低的糖尿病、心血管疾病、癌症和死亡风险,合并的HR(95%CI)分别为0.57(0.48~0.69)、0.67(0.62~0.73)、0.80(0.73~0.88)和0.54(0.42~0.70)。根据研究对象的基线人口学特征和代谢健康状况进行亚组分析的结果也与主要分析的结果一致。总而言之,本研究对来自三个国家的4个队列的合并分析表明,在糖尿病前期人群中,坚持更健康的生活方式与糖尿病及主要并发症的发生风险降低有关。本研究的发现为临床指南和公共卫生政策提供了可靠证据。

Evaluation of bronchoscopic direct vision glottis anesthesia method in bronchoscopy

BACKGROUND Fibrobronchoscopy is a common adjunct tool that requires anesthesia and is widely used in the diagnosis and treatment of various respiratory diseases.However,current anesthesia methods,such as spray,nebulized inhalation,and cricothyroid membrane puncture,have their own advantages and disadvantages.Recently,studies have shown that bronchoscopic direct-view glottis anesthesia is a simple and inexpensive method that shortens the examination time and provides excellent anesthetic results.AIM To evaluate the effectiveness of bronchoscopic direct vision glottis anesthesia for bronchoscopy.METHODS The study included 100 patients who underwent bronchoscopy during thoracic surgery.A random number table method was used to divide the patients into control and observation groups(50 patients each).The control and observation groups were anesthetized using the nebulized inhalation and bronchoscopic direct vision glottis method,respectively.Hemodynamic indices[systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),and oxygen saturation(SpO_(2))before(T1),5 min after anesthesia(T2),and at the end of the operation(T3)]serum stress hormone indices[norepinephrine(NE),epinephrine(E),adrenocorticotropic hormone(ACTH),and cortisol(Cor)before and after treatment]were compared between the 2 groups.Adverse effects were also RESULTS At T2 and T3,SBP,DBP,and HR were lower in the observation group than the control group,whereas SpO_(2) was higher than the control group[(119.05±8.01)mmHg vs(127.05±7.83)mmHg,(119.35±6.66)mmHg vs(128.39±6.56)mmHg,(84.68±6.04)mmHg vs(92.42±5.57)mmHg,(84.53±4.97)mmHg compared to(92.57±6.02)mmHg,(74.25±5.18)beats/min compared to(88.32±5.72)beats/min,(74.38±5.31)beats/min compared to(88.42±5.69)beats/min,(97.36±2.21)%vs(94.35±2.16)%,(97.42±2.36)%vs(94.38±2.69%],with statistically significant differences(all P<0.05).After treatment,NE,E,ACTH,and Cor were significantly higher in both groups than before treatment,but were lower in the observation group than in the control group[(68.25±8.87)ng/mL vs(93.35±14.00)ng/mL,(53.59±5.89)ng/mL vs(82.32±10.70)ng/mL,(14.32±1.58)pg/mL vs(20.35±3.05)pg/mL,(227.35±25.01)nmol/L vs(322.28±45.12)nmol/L],with statistically significant differences(all P<0.05).The incidence of adverse reactions was higher in the control group than in the observation group[12.00%(12/50)vs 6.00%(3/50)](P<0.05).CONCLUSION The use of bronchoscopic direct vision glottis anesthesia method for bronchoscopy patients is beneficial for stabilizing hemodynamic indices during bronchoscopy and reducing the level of patient stress,with good safety and practicality.

Analysis of risk and protective factors associated with retinal nerve fiber layer defect in a Chinese adult population

AIM:To investigate the risk and protective factors associated with the retinal nerve fiber layer defect(RNFLD)in a Chinese adult population.METHODS:This study was a cross-sectional populationbased investigation including employees and retirees of a coal mining company in Kailuan City,Hebei Province.All the study participants underwent a comprehensive systemic and ophthalmic examination.RNFLD was diagnosed on fundus photographs.Binary logistic regression was used to investigate the risk and protective factors associated with the RNFLD.RESULTS:The community-based study included 14440 participants.There were 10473 participants in our study,including 7120 males(68.0%)and 3353 females(32.0%).The age range was 45-108y,averaging 59.56±8.66y.Totally 568 participants had RNFLD and the prevalence rate was 5.42%.A higher prevalence of RNFLD was associated with older age[P<0.001,odds ratio(OR):1.032;95%confidence interval(CI):1.018-1.046],longer axial length(P=0.010,OR:1.190;95%CI:1.042-1.359),hypertension(P=0.007,OR:0.639;95%CI:0.460-0.887),and diabetes mellitus(P=0.019,OR:0.684;95%CI:0.499-0.939).The protective factors of RNFLD were visual acuity(P=0.038,OR:0.617;95%CI:0.391-0.975),and central anterior chamber depth(P=0.046,OR:0.595;95%CI:0.358-0.990).CONCLUSION:In our cross-sectional community-based study,with an age range of 45-108y,RNFLD is associated with older age,longer axial length,hypertension,and diabetes mellitus.The protective factors of RNFLD are visual acuity and central anterior chamber depth.These can help to predict and evaluate RNFLD related diseases and identify high-risk populations early.

Apoptosis during β-mercaptoethanol-induced differentiation of adult adipose-derived stromal cells into neurons

β-mercaptoethanol can induce adipose-derived stromal cells to rapidly and efficiently differentiate into neurons in vitro.However,because of the short survival time of the differentiated cells,clinical applications for this technique are limited.As such,we examined apoptosis of neurons differentiated from adipose-derived stromal cells induced with β-mercaptoethanol in vitro using terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling and transmission electron microscopy.The results revealed that the number of surviving cells decreased and apoptosis rate increased as induction time extended.Taken together,these results suggest that apoptosis occurring in the process of adipose-derived stromal cells differentiating into neurons is the main cause of cell death.However,the mechanism underlying cellular apoptosis should be researched further to develop methods of controlling apoptosis for clinical applications.

Ultrastructure of neuronal-like cells differentiated from adult adipose-derived stromal cells

β-mercaptoethanol induces in vitro adult adipose-derived stromal cells （ADSCs） to differentiate into neurons. However, the ultrastructural features of the differentiated neuronal-like cells remain unknown. In the present study, inverted phase contrast microscopy was utilized to observe β-mercaptoethanol-induced differentiation of neuronal-like cells from human ADSCs, and immunocytochemistry and real-time polymerase chain reaction were employed to detect expression of a neural stem cells marker （nestin）, a neuronal marker （neuron-specific enolase）, and a glial marker （glial fibrillary acidic protein）. In addition, ultrastructure of neuronal-like cells was observed by transmission election microscopy. Results revealed highest expression rate of nestin and neuron-specific enolase at 3 and 5 hours following induced differentiation; cells in the 5-hour induction group exhibited a neuronal-specific structure, i.e., Nissl bodies. However, when induction solution was replaced by complete culture medium after 8-hour induction, the differentiated cells reverted to the fibroblast-like morphology from day 1. These results demonstrate that β-mercaptoethanol-induced ADSCs induced differentiation into neural stem cells, followed by morphology of neuronal-like cells. However, this differentiation state was not stable.

A novel ethanol-based method to induce differentiation of adipose-derived stromal cells into astrocytes

The quantity and survival time of astrocytes,which were differentiated from adult adipose-derived stromal cells after exposure to an inducer containing 3-isobutyl-1-methylxanthine,have thus far been unsatisfactory.The present study investigated the growth and differentiation characteristics of induced astrocytes by observing their growth curves.After induction for 48 hours with an inducer containing 0.5% ethanol,some adult adult adipose-derived stromal cells displayed typical astrocytic morphology.The cell quantity gradually decreased with prolonged induction time.Nestin,glial fibrillary acidic protein,and S-100 expression reached peak levels at 14 days,but neuron-specific enolase was not expressed.These results suggest that the induced astrocytes reached their peak at 14 days.Further optimization of the culture environment may yield mature astrocytes with normal functions,in greater quantity,and prolonged survival time.

Adult adipose-derived stromal cells differentiate into neurons with normal electrophysiological functions

β-mercaptoethanol was used to induce in vitro neuronal differentiation of adipose-derived stromal cells. Within an 8-hour period post-differentiation, the induced cells exhibited typical neuronal morphology, and expression of microtubule-associated protein 2 and neuron-specific enolase, which are markers of mature neurons, reached a peak at 5 hours. Specific organelle Nissl bodies of neurons were observed under transmission electron microscopy. Results of membrane potential showed that fluorescence intensity of cells was greater after 5 hours than adipose-derived stromal cells prior to induction. In addition, following stimulation with high-concentration potassium solution, fluorescence intensity increased. These experimental findings suggested that neurons differentiated from adipose-derived stromal cells and expressed mature K^＋ channels. In addition, following stimulation with high potassium solution, the membrane potential depolarized and fired an action potential, confirming that the induced cells possessed electrophysiological functions.

Compensatory recombination phenomena of neurological functions in central dysphagia patients

We speculate that cortical reactions evoked by swallowing activity may be abnormal in patients with central infarction with dysphagia. The present study aimed to detect functional imaging features of cerebral cortex in central dysphagia patients by using blood oxygen level-depen- dent functional magnetic resonance imaging techniques. The results showed that when normal controls swallowed, primary motor cortex （BA4）, insula （BA13）, premotor cortex （BA6/8）, supramarginal gyrus （BA40）, and anterior cingulate cortex （BA24/32） were activated, and that the size of the activated areas were larger in the left hemisphere compared with the right. In re- current cerebral infarction patients with central dysphagia, BA4, BA13, BA40 aild BA6/8 areas were activated, while the degree of activation in BA24/32 was decreased. Additionally, more areas were activated, including posterior cingulate cortex （BA23/31）, visual association cortex （BA18/19）, primary auditory cortex （BA41） and parahippocampal cortex （BA36）. Somatosen- sory association cortex （BA7） and left cerebellum in patients with recurrent cerebral infarction with central dysphagia were also activated. Experimental findings suggest that the cerebral cortex has obvious hemisphere lateralization in response to swallowing, and patients with recurrent cerebral infarction with central dysphagia show compensatory recombination phenomena of neurological functions. In rehabilitative treatment, using the favorite food of patients can stimu- late swallowing through visual, auditory, and other nerve conduction pathways, thus promoting compensatory recombination of the central cortex functions.

Autophagy and apoptosis during adult adipose-derived stromal cells differentiation into neuron-like cells in vitro

β-mercaptoethanol can induce adult adipose-derived stromal cells to rapidly and efficiently differentiate into typical neuron-like cells in vitro. Immunohistochemistry showed that neuron specific enolase and neurofilament-200 expression gradually increased with the extension of induction time, and peaked at 5 hours. By contrast, glial fibrillary acidic protein was negatively expressed at all time points. Induced cells possessed a typical Nissl body, apoptosis showing condensed chromatin in the nucleus, autophagosomes with a bilayered membrane and autolysosomes in the cytoplasm at 5 hours. TUNEL assay and immunohistochemistry and immunofluorescence demonstrated that apoptosis and caspase-3 expression increased and peaked at 8 hours. Immunohistochemistry and immunofluorescence showed that microtubuleassociated protein light chain 3 gradually increased with induction and reached a peak at 5 hours These results indicate that autophagy played an important role in protecting cells during adult adipose-derived stromal cells differentiation into neuron-like cells in vitro.

High Physical Activity is Associated with an Improved Lipid Profile and Resting Heart Rate among Healthy Middle-aged Chinese People

Objective To investigate the effects of physical activity （PA） on dyslipidemia and elevated resting heart rate （RHR） in a large-scale cross-sectional study in China. Methods We recruited community-based individuals who were 40-60 years old using a cluster sampling method. The PA levels of the participants were classified as low, moderate, or high, using the International Physical Activity Questionnaire. Dyslipidemia was defined as the detection of abnormalities in lipid indicators, and 4 lipid parameters were evaluated using fasting blood samples. Multivariate logistic regression analyses were used to evaluate the associations of PA with dyslipidemia and RHR. Results A total of 10,321 participants （38.88% men） were included in this study. The percentages of individuals with high, moderate, and low PA levels were 46.5%, 43.9%, and 9.6%, respectively. In both men and women, high PA provided odds ratios of 0.88 [95% confidence interval （CI）： 0.83, 0.94] for dyslipidemia and 0.82 （95% CI： 0.73, 0.92） for elevated RHR, compared to participants with low PA. Conclusion Our data suggested that substantial health benefits （related to dyslipidemia and elevated RHR） occurred at higher intensity PA, with greater energy consumption, in middle-aged Chinese people, and particularly in men.

Association between Physical Activity and Higher Serum Creatinine/Uric Acid by Dose-response Association

Serum creatinine （Scr） and serum uric acid （sUA）arecloselyrelatedchronicdiseaseorassociated morbidity.Epidemiologicalevidenceshowsthat elevated Scr or higher sUA level are independent risk factors for cardiovascular disease as well as gout and insulin resistance[1].Physicalactivity（PA）isgenerallyconsidered importantinregulatinghealth.

The association between orthostatic blood pressure changes and subclinical target organ damage in subjects over 60 years old

Background Although recent studies have indicated that both orthostatic hypotension and orthostatic hypertension independently predict cardiovascular events,the underlying mechanisms are still controversial.The aim of the study was to investigate the relationships between orthostatic changes and organ damage in subjects over 60 years old.Methods This is a prospective observational cohort study.One thousand nine hundred and ninety-seven subjects over 60 years old were enrolled.Participants were grouped according to whether they had a drop>20 mmHg in systolic or>10 mmHg in diastolic BP(orthostatic hypotension),an increase in mean orthostatic systolic blood pressure>20 mm Hg(orthostatic hypertension),or normal changes within 3 min of orthostatism.Multiple regression modeling was used to investigate the relationship between orthostatic hypotension,orthostatic hypertension and subclinical organ damage with adjustment for confounders.Results Orthostatic hypotension and orthostatic hypertension were found in 461(23.1%)and 189(9.5%)participants,respectively.Measurement of carotid intima-media thickness(IMT),brachial-ankle pulse wave velocity(baPWV),clearance of creatinine,and microalbuminuria were associated with orthostatic hypotension;measurement of IMT and baPWV were associated with orthostatic hypertension in a cruse model.After adjustment,IMT[odds ratio(OR),95%confidence interval(CI)per one-SD increment:1.385,1.052-1.823;P=0.02],baPWV(OR=1.627,95%CI:1.041-2.544;P=0.033)and microalbuminuria(OR=1.401,95%CI:1.002-1.958;P=0.049)were still associated with orthostatic hypotension,while orthostatic hypertension was only associated with IMT(OR=1.730,95%CI:1.143-2.618;P=0.009).Conclusions Orthostatic hypotension seems to be independently correlated with increased carotid atherosclerosis,arterial stiffness and renal damage in subjects over 60 years old.Orthostatic hypertension correlates with carotid atherosclerosis only.

Autophagy activator promotes neuronal differentiation of adult adipose-derived stromal cells

Preliminary research from our group found altered autophagy intensity during adipose-derived stromal cell differentiation into neuronal-like cells, and that this change was associated with morphological changes in differentiated cells. This study aimed to verify the role of rapamycin, an autophagy activator, in the process of adipose-derived stromal cell differentiation into neuronal-like cells. Immunohistochemical staining showed that expression of neuron-specific enolase and neurofilament-200 were gradually upregulated in adipose-derived stromal cells after 5 mM 13-mercaptoethanol induction, and the differentiation rate gradually increased with induction time. Using transmission electron microscopy, induced cells were shown to exhibit cytoplasmic autophagosomes, with bilayer membranes, and autolysosomes. After rapamycin （200 IJg/L） induction for 1 hour, adipose-derived stromal cells began to extend long processes, similar to the morphology of neuronal-like cells, while untreated cells did not exhibit similar morphologies until 3 hours after induction. Moreover, the differentiation rate was significantly increased after rapamycin treatment. Compared with untreated cells, expression of LC3, an autophagy protein, was also significantly upregulated. Positive LC3 expression tended to concentrate at cell nuclei with increasing induction times. Our experimental findings indicate that autophagy can significantly increase the speed of adipose-derived stromal cell differentiation into neuronal-like cells.

Apoptosis is an obstacle to the differentiation of adipose-derived stromal cells into astrocytes

Previous studies have demonstrated that nerve cells differentiated from adipose-derived stro-mal cells after chemical induction have reduced viability;however, the underlying mechanisms remained unclear. In this study, we induced the differentiation of adult adipose-derived stromal cells into astrocytes using chemical induction. 3-（4,5-Dimethylthiazol-2-yl）-2,5-diphenyltetra-zolium bromide assay and flow cytometry showed that, with increasing induction time, the apoptotic rate gradually increased, and the number of living cells gradually decreased. Im-munohistochemical staining demonstrated that the number of glial fibrillary acidic protein-, caspase-3- and caspase-9-positive cells gradually increased with increasing induction time. Transmission electron microscopy revealed typical signs of apoptosis after differentiation. Taken together, our results indicate that caspase-dependent apoptosis is an obstacle to the differentia-tion of adipose-derived stromal cells into astrocytes. Inhibiting apoptosis may be an important strategy for increasing the efifciency of induction.

Correlation of the history of stroke and the retinal artery occlusion: a nested case-control study

AIM:To analyze the systemic factors including stroke history related to the retinal artery occlusion(RAO).METHODS:Patients with an exact diagnosis of RAO in the medical database of the Kailuan Corporation were identified as the case group.Five patients without RAO were added for each case from the Kailuan Study and matched for sex and age(age±2)as the control group.The Kailuan Study is a general population-based cohort study in northern China,in which a total of 101510 individuals(81110 men)aged 18-98 y were recruited to participate in the study.And the participants were bi-annually reexamined.The database of both groups was from Kailuan study of 2010 cohort.All the information,including the demographic characteristics,lifestyle behaviors,medical comorbidities,medical history,family medical history,drug usage,anthropometric measurements,blood pressure measurement,blood sample laboratory assessment,urine tests,and other physical examinations were all collected.A retrospective nested case-control method was used for this study.Conditional multivariate logistic regression was used to analyze the risk factors with SPSS 13.0 software and SAS 9.3 software.RESULTS:A total of 45 patients were included as the case group,and the control group included 225 patients.In the case group,28 patients(62.2%)had a central retinal artery occlusion(CRAO),and 17 patients(37.8%)had a branch retinal artery occlusion(BRAO).A total of 18 patients(40.0%)had a stroke before the RAO(mean 4.04±3.88 y before the RAO),and 31 patients(81.6%)had infarctions or malacia identified by the cranial computed tomography(CT)scans.The basal ganglia and centrum semiovale were the most frequently involved regions.Plaques in the common carotid artery were present in 32 patients(88.9%).Conditional multivariate logistic regression analysis showed that the RAO was found to be associated with the history of stroke(P=0.0023,OR=28.794;95%CI:3.322-249.586).CONCLUSION:A history of stroke can significantly increase the incidence of RAO.Exists of plaque in the carotid artery is mean more than its severe stenosis for RAO.

Evaluation of menopausal status among breast cancer patients with chemotherapy-induced amenorrhea

Objective： In patients with chemotherapy-induced amenorrhea （CIA）, the menopausal status is ambiguous anddifficult to evaluate. This study aimed to establish a discriminative model to predict and classify the menopausalstatus of breast cancer patients with CIA.Methods： This is a single center hospital-based study from 2013 to 2016. The menopausal age distribution andaccumulated incidence rate of CIA are described. Multivariate models were adjusted for established and potentialconfounding factors including age, serum concentration of estradiol （E2） and follicle-stimulating hormone （FSH）,feeding, pregnancy, parity, abortions, and body mass index （BMI）. The odds ratio （OR） and 95% confidenceinterval （95% CI） of different risk factors were estimated.Results： A total of 1,796 breast cancer patients were included in this study, among whom, 1,175 （65.42%） werepremenopausal patients and 621 （34.58%） were post-menopause patients. Five hundred and fifty patients wereincluded in CIA analysis, and a cumulative CIA rate of 81.64% was found in them. Age （OR： 1.856, 95% CI：1.732-1.990）, serum concentration of E2 （OR： 0.976, 95% CI： 0.972-0.980） and FSH （OR： 1.060, 95% CI：1.053-i.066）, and menarche age （OR： 1.074, 95% CI： 1.009-1.144） were found to be associated with the patients＇menopausal status. According to multivariate analysis, the discriminative model to predict the menopausal status isLogit （P）=-28.396＋0.536Age-0.014E2＋0.031FSH. The sensitivities for this model were higher than 85%, and itsspecificities were higher than 89%.Conclusions： The discriminative model obtained from this study for predicting menstrual state is important forpremenopausal patients with CIA. This model has high specificity and sensitivity and should be prudently used.