Ruoling Chen

Background: Nut consumption reduces risks of cardiovascular disease, respiratory disease and depression. However, its association with dementia and Alzheimer’s disease (AD) remains unclear. Methods: A population-based case–control study was conducted in China, including 466 participants aged 52–100 years (233 with dementia). Data on socio-demographic characteristics, lifestyle factors, comorbidities, and dietary intake over the past two years were collected through structured face-to-face interviews. Nut consumption was categorised as non-consumption or <monthly, ≥monthly but <weekly, ≥weekly but <daily, daily, and ≥twice daily. Multiple adjusted logistic regression models were employed to examine the association of nut consumption with dementia and AD. Results: Of the 466 participants, 59.0% reported consuming nuts at non-consumption or <monthly, 22.5% monthly, 11.8% weekly, 6.0% daily, and 0.6% ≥ twice daily. Compared with non-consumption or <monthly consumption, the age-adjusted odds ratio (OR) for dementia was 0.31 (95% CI 0.18–0.52) for monthly intake, 0.52 (0.28–0.97) for weekly intake, and 0.32 (0.14–0.72) for daily or higher intake. After further adjustment for gender, education, family income, marital status, smoking, stroke, chronic bronchitis, depression, and other dietary intakes, OR was 0.27 (0.13–0.55) for monthly intake and 0.47 (0.23–0.99) for ≥weekly intake. Among 133 participants with AD, similar associations were observed, with a fully adjusted OR of 0.34 (0.17–0.69) for ≥monthly nut consumption. Conclusions: Higher nut consumption was associated with reduced risks of dementia and AD. Increasing nut intake may represent a potential strategy for dementia and AD prevention. However, large-scale cohort and interventional studies are needed to further clarify the association and determine the magnitude of the effect.

Refractory Status Epilepticus (RSE) is a neurological emergency associated with considerable morbidity and mortality. The molecular mechanisms contributing to neuroinflammation in RSE are increasingly being recognized. Despite its severity, high‐quality and conclusive evidence is lacking for many RSE treatments, especially regarding the optimization of antiseizure medications and emerging immunotherapies. In this manuscript, the use of immunotherapy as a valuable treatment option in RSE is reviewed. The example of Toclizumab is used, its potential efficacy demonstrated by a case series from our center. Traditional clinical trial designs have proven inadequate in efficiently addressing these evidence gaps for this complex and heterogeneous condition. In examining the wider evidence for the use of anti‐inflammatory agents, including early immunotherapy, the scope for adaptive platform trials is explored to be utilized to develop an evidence base in this area. Neuroinflammation plays a role in propagating seizures and associated neuronal injury in RSE; these pathways may be amenable to immunomodulation. In this review, the limitations of existing observational data and the need for efficient, quickly translatable clinical trials are highlighted to evaluate multiple interventions for RSE. Innovative trial designs, such as adaptive platform trials, help generate robust evidence for rapid uptake in RSE.

It remains unclear whether there is an independent association of paternal age with implantation failure (IF) in couples undergoing Assisted Reproductive Technology (ART) treatment. Little is known about the interactive effects of paternal age with maternal age, paternal smoking and alcohol consumption on IF. The Anhui Maternal-Child Health Cohort Study (AMCHS) interviewed 1910 infertile couples (paternal age ranged 22–57 years) to look for risk factors associated with IF. Implantation outcome was assessed using serum β-HCG between 0 and 25 IU/L 14 days post-embryo transfer. Odds ratios (ORs) for IF in relation to paternal age, and its interactions with maternal age, paternal smoking and alcohol consumption were evaluated using logistic regression models. The risk of IF (n = 735) increased with paternal age ≥ 35, while it remained similarly lower among males aged 22–34. After adjusting for socioeconomic status, paternal lifestyles and semen factors, the OR for IF was 1.50 (95%CI 1.16–1.93) at paternal age of 35- 30, paternal smoking or alcohol consumption, but not in their counterparts, respectively. Among those with a paternal age ≥ 35, each additional year of smoking was associated with a 7.0% increased risk of IF (OR = 1.07, 95% CI: 1.01–1.14); however, no such association was observed in younger paternal age groups. Significant interaction effects were observed between advanced paternal age and maternal age, as well as paternal alcohol consumption. The AMCHS had demonstrated that paternal age ≥ 35 years elevates the risk of IF, with additional impacts from advanced maternal age and paternal alcohol consumption. The findings of the AMCHS highlight the need to consider paternal and maternal ages in fertility planning and suggest that IF can be reduced by stopping paternal smoking and alcohol consumption.

Objectives: Significant associations between pregnancy loss and risk of future maternal cardiovascular disease (CVD) have been found in Western countries, but the association in China is still unclear. Therefore, this study aimed to investigate the associations of pregnancy loss, number of pregnancy losses, subtype of pregnancy loss (i.e. induced abortion, miscarriage and stillbirth) and age at the first pregnancy loss with CVD risk in Chinese population. Methods: We examined data of 7,486 middle-aged women (mean age 58.1 years) from the China Health and Retirement Longitudinal Study. Pregnancy loss and CVD including coronary heart disease (CHD) and stroke were self-reported and documented in surveys. Results: In the cohort, 1,850 (24.7%) women experienced pregnancy loss. Over 39 years follow-up, 2,055 (27.5%) women developed CVD. After adjusting covariates, pregnancy loss was associated with the risk of CVD (HR 1.73, 95% CI 1.56 to 1.92). Specifically, pregnancy loss due to induced abortion and miscarriage instead of stillbirth increased CVD (HR 2.11, 95% CI 1.82 to 2.44, and 1.47, 95% CI 1.16 to 1.72, respectively). The risk of CVD gradually increased from ≤23 years to 23–25, 26–29 and ≥30 years with HR 1.29, 95% CI 1.24 to 1.34. Conclusion: Chinese women that have experienced pregnancy loss due to induced abortion and miscarriage had increased risk of CVD. The risk increased with the number of pregnancy losses and older age at the first pregnancy loss.

Background/Objectives: The association between egg consumption and dementia is unclear. We carried out a population-based case-control study in China to determine the independent association of egg consumption with dementia. Methods: We randomly recruited 233 participants with dementia and 233 without dementia from the community health service clinics and the dementia management system in Guangzhou, China to examine their dietary intakes over the past two years and other risk factors for chronic diseases. Egg consumption was categorised by frequency as Non-consuming/<monthly, Monthly, Weekly, Daily or ≥Twice a day. Results: Participants with dementia, compared to controls, were more likely to consume eggs at Monthly (15.5% vs. 8.6%) but less likely to consume at Daily (28.3% vs. 41.6%). The age-adjusted odds ratio (OR) of dementia was 1.76 (95% CI 1.10–2.84) in participants who consumed eggs Weekly and 4.34 (2.16–8.72) in Monthly consumption compared to Daily. However, no significant associations were found for those Non-consuming/<monthly 1.35 (0.71–2.56) and ≥Twice a day 3.49 (0.83–14.67). After further adjustments, including gender, education, family income, smoking, alcohol consumption, dietary intakes (including red meats, poultry, fish, vegetables and fruits), cardiovascular disease and other co-morbidities, the corresponding ORs were 2.10 (1.10–4.02), 4.82 (1.90–12.27), 0.73 (0.29–1.88) and 4.16 (0.80–21.63), respectively. Among participants who consumed eggs Monthly, Weekly or Daily, an inverse association between egg consumption and dementia was observed; the multiple adjusted OR of dementia was 0.48 (0.30–0.76) per average increment in egg consumption. Compared to Monthly consumption, the OR for Weekly consumption was 0.44 (0.18–1.08) and 0.22 (0.08–0.59) for Daily consumption. Conclusions: This study suggests that Daily egg consumption could help reduce the risk of dementia, while uncertainties regarding the association of non-consuming/<monthly or ≥Twice a day consumption with dementia warrant further research.

Many studies have identified that adverse childhood experiences (ACEs) are associated with non-suicidal self-injury (NSSI) and suicidality. However, most studies have been restricted to a few types of ACEs. This study aims to investigate the association of 13 common types of ACEs with NSSI, suicidal ideation (SI), and suicide attempts (SA), as well as the mediation of depressive and anxiety symptoms therein. A total of 1771 (994 male, 777 female) students aged 11–16 (12.9 ± 0.6) years who participated in the baseline survey of the Chinese Adolescent Health Growth Cohort study were included in the analysis. ACEs, including childhood maltreatment, other common forms of ACEs, and smoking, were measured via the Chinese version of the Child Trauma Questionnaire (CTQ) and a series of valid questionnaires that were derived from previous studies. NSSI was measured using the Chinese version of the Functional Assessment of Self-mutilation. SI and SA were measured using questions derived from the Global School Based Student Health Survey. Depressive symptoms were measured via the Chinese version of the Center for Epidemiologic Studies Depression Scale, and anxiety symptoms were measured via the General Anxiety Disorder-7. Of the included participants, 92.0% reported one or more category of ACEs. Smoking, parent–child separation, emotional abuse, physical abuse, and being bullied were positively associated with NSSI; smoking, parent–child separation, emotional abuse, physical abuse, emotional neglect, and being bullied were positively associated with SI; smoking, emotional abuse, and being bullied were positively associated with SA. The associations of ACEs with NSSI, SI, and SA were each partially or completely mediated through depressive and anxiety symptoms. Children and adolescents who had experiences of smoking, physical abuse, and being bullied during childhood are consistently and independently associated with NSSI and suicidality, and these associations may be largely mediated through depressive and anxiety symptoms. In conclusion, not all the types of ACEs are independently associated with NSSI, and suicidality and other associations may mediate through depressive and anxiety symptoms. Target interventions for adolescents’ NSSI and suicidality should focus on those who have a history of ACEs and depressive and anxiety symptoms.

Many researches have identified that adverse childhood experiences (ACEs) are associated with non-suicidal self-injury (NSSI) and suicidality. However, most studies have been restricted to a few types of ACEs. This study aims to investigate associations of 13 common types of ACEs with NSSI, suicidal ideation (SI) and suicide attempt (SA), as well as the mediation of depressive and anxiety symptoms therein. A total of 1771 students aged 11-16 years who participated in the baseline survey of the Chinese Adolescent Health Growth Cohort study were included for the analysis. ACEs, SI, SA, depressive and anxiety symptoms were recorded by standard questionnaire. Of included participants, 92.0% reported one or more category of ACEs. Smoking, parent-child separation, emotional abuse, physical abuse and being bullied were positively associated with NSSI, with the adjusted odds ratio (aOR) of 2.41(95%CI, 1.01-5.75), 1.80(1.28-2.54), 1.69(1.21-2.37), 2.08(1.44-3.01) and 1.87(1.35-2.59), respectively; smoking (4.03, 1.66-9.81), parent-child separation (1.42, 1.07-1.90), emotional abuse (1.91, 1.41-2.59), physical abuse (1.80, 1.27-2.57), emotional neglect (1.78, 1.28-2.49) and being bullied (2.08, 1.54-2.81) were positively associated with SI; smoking(4.30, 1.67-11.10), emotional abuse (2.42, 1.58-3.72) and being bullied (1.75, 1.17-2.60) were positively associated with SA. The associations of ACEs with NSSI, SI and SA were each partially or completely mediated through depressive and anxiety symptoms. Children and adolescents who had experiences of smoking, physical abuse and being bullied during childhood are consistently and independently associated with NSSI and suicidality, and these associations may be largely mediated through depressive and anxiety symptoms.