Non-pharmacological therapies for treating non-motor symptoms in patients with Parkinson’s disease: a systematic review and meta-analysis

ObjectiveThe non-motor symptoms of Parkinson’s disease (PD) are an important part of PD. In recent years, more and more non-drug interventions have been applied to alleviate the non-motor symptoms of PD, but the relevant evidence is limited. This systematic review and meta-analysis was designed to evaluate the efficacy of non-drug interventions in patients with non-motor symptoms in patients with PD.MethodsSeven databases, including Pubmed, Embease, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang database (WANFANG), VIP database (VIP), and China Biomedical Literature Service System (CBM) were searched from the establishment of the database to December 2023. Non-drug interventions such as acupuncture, cognitive behavioral therapy (CBT), exercise, repetitive transcranial magnetic stimulation (rTMS), and non-motor symptoms of Parkinson’s disease were selected as search words, and two independent evaluators evaluated the included literature’s bias risk and data extraction. The therapeutic efficacy was evaluated by the Parkinson’s Disease Sleep Scale (PDSS), Hamilton Depression Scale (HAMD), Beck Depression Inventory (BDI), Hamilton Anxiety Scale (HAMA), Montreal Cognitive Assessment (MoCA), Minimum Mental State Examination (MMSE), and Parkinson’s Disease Questionnaire-39 (PDQ-39). RevMan 5.4.1 (Reviewer Manager Software 5.4.1). Cochrane Collaboration, Oxford, United Kingdom analyzed the data and estimated the average effect and the 95% confidence interval (CI). A heterogeneity test is used to assess differences in the efficacy of different non-drug treatments.ResultsWe selected 36 from 4,027 articles to participate in this meta-analysis, involving 2,158 participants. Our combined results show that: PDSS: [mean difference (MD) = −19.35, 95% CI (−30.4 to −8.28), p < 0.0006]; HAMD: [MD = −2.98, 95% CI (−4.29 to −1.67), p < 0.00001]; BDI: [MD = −2.69, 95% CI (−4.24 to 4.80), p = 0.006]; HAMA: [MD = -2.00, 95% CI (−2.83 to −1.17), p < 0.00001]; MMSE: [MD = 1.20, 95% CI (0.71 to 1.68), p < 0.00001]; CoMA: [MD = 2.10, 95% CI (−0.97 to 3.23), p = 0.0003]; PDQ-39: [MD = −4.03, 95% CI (−5.96 to −1.57), p < 0.00001].ConclusionThe four non-drug measures used in our review showed significant improvements in sleep, depression, anxiety, cognition, constipation, and quality of life compared with the control group, and no serious adverse events were reported in the included research evidence, and we found that there were some differences among the subgroups of different intervention methods, but due to the less literature included in the subgroup, and the comparison was more indirect. So, we should interpret these results carefully.Systematic review registrationwww.crd.york.ac.uk/PROSPERO, identifier CRD42023486897

The association between a body shape index and elevated urinary albumin–creatinine ratio in Chinese community adults

BackgroundObesity, especially visceral obesity, seems to be one of the most decisive risk factors for chronic kidney disease. A Body Shape Index (ABSI) is an emerging body size measurement marker of visceral obesity. This study aimed to explore whether ABSI is associated with albuminuria in Chinese community adults.MethodsThis cross-sectional study enrolled 40,726 participants aged 40 or older from seven provinces across China through a cluster random sampling method. ABSI was calculated by body mass index, waist circumference, and height. Increased albuminuria was defined as urinary albumin–creatinine ratio (UACR) ≥ 30 mg/g, indicating kidney injury. For ABSI, we divided it by quartile cutoff points and tried to determine the association between ABSI levels and UACR by multiple regression analysis. DAG (Directed Acyclic Graph) was plotted using literature and expert consensus to identify potential confounding factors.ResultsThe average age of subjects with elevated UACR was 61.43 ± 10.07, and 26% were men. The average age of subjects with normal UACR was 57.70 ± 9.02, and 30.5% were men. Multiple logistic regression analysis was conducted and demonstrated that the ABSI quartiles were related to elevated UACR positively (OR [95% CI] Q2 vs. Q1: 1.094 [1.004, 1.197]; OR [95% CI] Q3 vs. Q1: 1.126 [1.030, 1.231]; OR [95% CI] Q4 vs. Q1: 1.183 [1.080, 1.295], p for trend < 0.001) after adjustments for confounding factors. The stratified analysis further showed that with the mounting for ABSI levels, elevated UACR more easily occurred in the people characterized by the elderly, men, and hypertension.ConclusionsIn Chinese community adults, people with higher ABSI levels can be deemed as high-risk individuals with UACR elevation, and it will be beneficial for them to lose weight and significantly reduce visceral fat

The Relative Body Weight Gain From Early to Middle Life Adulthood Associated With Later Life Risk of Diabetes: A Nationwide Cohort Study

AimTo determine the effect of decade-based body weight gain from 20 to 50 years of age on later life diabetes risk.Methods35,611 non-diabetic participants aged ≥ 50 years from a well-defined nationwide cohort were followed up for average of 3.6 years, with cardiovascular diseases and cancers at baseline were excluded. Body weight at 20, 30, 40, and 50 years was reported. The overall 30 years and each 10-year weight gain were calculated from the early and middle life. Cox regression models were used to estimate risks of incident diabetes.ResultsAfter 127,745.26 person-years of follow-up, 2,789 incident diabetes were identified (incidence rate, 2.18%) in 25,289 women (mean weight gain 20-50 years, 7.60 kg) and 10,322 men (7.93 kg). Each 10-kg weight gain over the 30 years was significantly associated with a 39.7% increased risk of incident diabetes (95% confidence interval [CI], 1.33-1.47); weight gain from 20-30 years showed a more prominent effect on the risk of developing diabetes before 60 years than that of after 60 years (Hazard ratio, HR = 1.084, 95% CI [1.049-1.121], P <0.0001 vs. 1.015 [0.975-1.056], P = 0.4643; PInteraction=0.0293). It showed a stable effect of the three 10-year intervals weight gain on risk of diabetes after 60 years (HR=1.055, 1.038, 1.043, respectively, all P < 0.0036).ConclusionsThe early life weight gain showed a more prominent effect on developing diabetes before 60 years than after 60 years; however, each-decade weight gain from 20 to 50 years showed a similar effect on risk developing diabetes after 60 years

Modification effect of changes in cardiometabolic traits in association between kidney stones and cardiovascular events

BackgroundsWhether longitudinal changes in metabolic status influence the effect of kidney stones on cardiovascular disease (CVD) remains unclarified. We investigated the modification effect of status changes in metabolic syndrome (MetS) in the association of kidney stones with risk of incident CVD events.MethodsWe performed a prospective association and interaction study in a nationwide cohort including 129,172 participants aged ≥ 40 years without CVDs at baseline and followed up for an average of 3.8 years. Kidney stones information was collected by using a questionnaire and validated by medical records. The repeated biochemical measurements were performed to ascertain the metabolic status at both baseline and follow-up.Results4,017 incident total CVDs, 1,413 coronary heart diseases (CHDs) and 2,682 strokes were documented and ascertained during follow-up. Kidney stones presence was significantly associated with 44%, 70% and 31% higher risk of CVDs, CHDs and stroke, respectively. The stratified analysis showed significant associations were found in the incident and sustained MetS patients, while no significant associations were found in the non-MetS at both baseline and follow-up subjects or the MetS remission ones, especially in women. For the change status of each single component of the MetS, though the trends were not always the same, the associations with CVD were consistently significant in those with sustained metabolic disorders, except for the sustained high blood glucose group, while the associations were consistently significant in those with incident metabolic disorders except for the incident blood pressure group. We also found a significant association of kidney stone and CVD or CHD risk in the remain normal glucose or triglycerides groups; while the associations were consistently significant in those with incident metabolic disorders except for the incident blood pressure group. We also found a significant association of kidney stone and CVD or CHD risk in the remain normal glucose or triglycerides groups.ConclusionsA history of kidney stones in women with newly developed MetS or long-standing MetS associated with increased risk of CVD. The mechanisms link kidney stones and CVD risk in the metabolic and non-metabolic pathways were warranted for further studies

Association between triglyceride glucose index and breast cancer in 142,184 Chinese adults: findings from the REACTION study

BackgroundThe triglyceride glucose (TyG) index has been associated with an increased risk in breast cancer. However, this association remains unclear among the Chinese population. This study aimed to investigate whether the TyG index is associated with the risk of prevalent breast cancer in Chinese women.MethodsThis cross-sectional study included 142,184 women from the REACTION (Risk Evaluation of Cancers in Chinese Diabetic Individuals: A Longitudinal) Study, which recruited adults aged 40 years or older from 25 centers across mainland China between 2011 and 2012. The TyG index was calculated according to the formula: Ln (fasting triglycerides [mg/dL] × fasting glucose [mg/dL]/2). Multivariable-adjusted logistic regression models were used to evaluate odds ratios (ORs) and 95% confidence intervals (CIs) regarding the associations between the TyG index and breast cancer.ResultsMultivariable-adjusted logistic regression analysis showed that compared with the lowest quartile of the TyG index, the highest quartile of the TyG index was significantly associated with an increased risk of prevalent breast cancer, with an OR (95% CI) of 1.61 (1.19–2.17). In the stratified analysis, the association of each 1 SD increase in the TyG index with risk of prevalent breast cancer was more dominant in individuals with menarche at age 13–17, those who were postmenopausal, those with a history of breastfeeding, and those who had two to four children, with the ORs (95% CIs) of 1.35 (1.09–1.68), 1.27 (1.05–1.54), 1.26 (1.05–1.52), and 1.32 (1.08–1.62), respectively. Moreover, among those without discernible insulin resistance (homeostatic model assessment-insulin resistance [HOMA-IR] ≥2.5), hyperglycemia and dyslipidemia, each 1 SD increase in the TyG index was associated with a 1.36-fold increase in breast cancer risk, with an OR (95% CI) of 2.36 (1.44–3.87).ConclusionThe TyG index is significantly associated with the prevalent breast cancer risk among middle-aged and elderly Chinese women

Prediction Model of Pumpkin Rootstock Seedlings Based on Temperature and Light Responses

Temperature and light are the key factors that affect the quality of pumpkin rootstock seedlings’ growth process. Responses to temperature and light are an important basis for optimizing the greenhouse environment. In order to determine the quantitative effects of temperature and light on the growth and development of pumpkin (Cucurbita moschata cv. RTWM6018) rootstock seedlings, relationships between temperature, light, and pumpkin rootstock seedlings growth were established using regression analysis. The results indicated that the daily average temperature had a significant negative correlation with the development time of pumpkin rootstock seedlings, and the shoot dry weight of pumpkin rootstock seedlings increased within a certain range of the daily light integral (DLI). We established a prediction model of pumpkin rootstock seedling quality indicators (hypocotyl length, stem diameter, shoot dry weight, root dry weight, root shoot ratio, and seedling quality index) based on thermal effectiveness and photosynthetic photon flux density (TEP). The coefficient of determinations (R2) of the hypocotyl length and seedling quality index prediction models of pumpkin rootstock seedlings, based on accumulated TEP, were 0.707 and 0.834, respectively. The hypocotyl length and seedling quality index prediction models of pumpkin rootstock seedlings, based on accumulated TEP, were y1 = 0.001 x2 − 0.180 x + 13.057 and y2 = 0.008 x0.722, respectively, which could be used for predicting the growth of pumpkin rootstock seedlings grown under different temperature and light conditions

Prediction Model of Pumpkin Rootstock Seedlings Based on Temperature and Light Responses

Temperature and light are the key factors that affect the quality of pumpkin rootstock seedlings’ growth process. Responses to temperature and light are an important basis for optimizing the greenhouse environment. In order to determine the quantitative effects of temperature and light on the growth and development of pumpkin (Cucurbita moschata cv. RTWM6018) rootstock seedlings, relationships between temperature, light, and pumpkin rootstock seedlings growth were established using regression analysis. The results indicated that the daily average temperature had a significant negative correlation with the development time of pumpkin rootstock seedlings, and the shoot dry weight of pumpkin rootstock seedlings increased within a certain range of the daily light integral (DLI). We established a prediction model of pumpkin rootstock seedling quality indicators (hypocotyl length, stem diameter, shoot dry weight, root dry weight, root shoot ratio, and seedling quality index) based on thermal effectiveness and photosynthetic photon flux density (TEP). The coefficient of determinations (R2) of the hypocotyl length and seedling quality index prediction models of pumpkin rootstock seedlings, based on accumulated TEP, were 0.707 and 0.834, respectively. The hypocotyl length and seedling quality index prediction models of pumpkin rootstock seedlings, based on accumulated TEP, were y1 = 0.001 x2 − 0.180 x + 13.057 and y2 = 0.008 x0.722, respectively, which could be used for predicting the growth of pumpkin rootstock seedlings grown under different temperature and light conditions

The Combinations of White, Blue, and UV-A Light Provided by Supplementary Light-Emitting Diodes Promoted the Quality of Greenhouse-Grown Cucumber Seedlings

Insufficient solar light in winter inside the greenhouse may lead to a lower quality of vegetable seedlings, and supplemental light is an effective technique to solve this problem. This study evaluated the impacts of supplementary white (W)-light-emitting diodes (LEDs), ultraviolet A LEDs (UV-A), white and blue LEDs (WB), the combinations of white and UV-A LEDs (W-UVA), and white, blue, and UV-A LEDs (WB-UVA) on the leaf morphology, photosynthetic traits, biomass accumulation, root architecture, and hormone content of cucumber (Cucumis sativus L. cv. Tianjiao No. 5) seedlings grown in the greenhouse. The results indicated that supplementary LED lighting led to a decreased plant height, shorter hypocotyl length, bigger leaf area, and thicker leaf compared with those grown with solar light only, regardless of light quality. The shoot fresh weight, root fresh weight, and seedling quality index of cucumber seedlings grown under the combinations of white, blue, and UVA radiations increased by 30.8%, 3.2-fold, and 1.8-fold, respectively, compared with those grown with natural light only. However, no significant differences were exhibited in the biomass accumulation of greenhouse-grown cucumber seedlings between the control and the UVA treatment. The cellulose content and stem firmness of greenhouse-grown cucumber seedlings grown under the combinations of white, blue, and UVA radiations increased by 49.9% and 13.1%, respectively, compared with those grown under white light only. Additionally, the cytokinin content of cucumber seedlings was promoted by over 36.7% by applying supplementary light. In summary, the combinations of white, blue, and UVA radiations led to compact morphological characteristics, superior mechanical properties, and preferable growth performance, which could be applied as an available lighting strategy to obtain the desired morphological and quality properties of vegetable seedlings

The Combinations of White, Blue, and UV-A Light Provided by Supplementary Light-Emitting Diodes Promoted the Quality of Greenhouse-Grown Cucumber Seedlings

Insufficient solar light in winter inside the greenhouse may lead to a lower quality of vegetable seedlings, and supplemental light is an effective technique to solve this problem. This study evaluated the impacts of supplementary white (W)-light-emitting diodes (LEDs), ultraviolet A LEDs (UV-A), white and blue LEDs (WB), the combinations of white and UV-A LEDs (W-UVA), and white, blue, and UV-A LEDs (WB-UVA) on the leaf morphology, photosynthetic traits, biomass accumulation, root architecture, and hormone content of cucumber (Cucumis sativus L. cv. Tianjiao No. 5) seedlings grown in the greenhouse. The results indicated that supplementary LED lighting led to a decreased plant height, shorter hypocotyl length, bigger leaf area, and thicker leaf compared with those grown with solar light only, regardless of light quality. The shoot fresh weight, root fresh weight, and seedling quality index of cucumber seedlings grown under the combinations of white, blue, and UVA radiations increased by 30.8%, 3.2-fold, and 1.8-fold, respectively, compared with those grown with natural light only. However, no significant differences were exhibited in the biomass accumulation of greenhouse-grown cucumber seedlings between the control and the UVA treatment. The cellulose content and stem firmness of greenhouse-grown cucumber seedlings grown under the combinations of white, blue, and UVA radiations increased by 49.9% and 13.1%, respectively, compared with those grown under white light only. Additionally, the cytokinin content of cucumber seedlings was promoted by over 36.7% by applying supplementary light. In summary, the combinations of white, blue, and UVA radiations led to compact morphological characteristics, superior mechanical properties, and preferable growth performance, which could be applied as an available lighting strategy to obtain the desired morphological and quality properties of vegetable seedlings

Morphological and Physiological Properties of Greenhouse-Grown Cucumber Seedlings as Influenced by Supplementary Light-Emitting Diodes with Same Daily Light Integral

Insufficient light in autumn–winter may prolong the production periods and reduce the quality of plug seedlings grown in greenhouses. Additionally, there is no optimal protocol for supplementary light strategies when providing the same amount of light for plug seedling production. This study was conducted to determine the influences of combinations of supplementary light intensity and light duration with the same daily light integral (DLI) on the morphological and physiological properties of cucumber seedlings (Cucumis sativus L. cv. Tianjiao No. 5) grown in a greenhouse. A supplementary light with the same DLI of 6.0 mol m−2 d−1 was applied with the light duration set to 6, 8, 10, or 12 h d−1 provided by light-emitting diodes (LEDs), and cucumber seedlings grown with sunlight only were set as the control. The results indicated that increasing DLI using supplementary light promoted the growth and development of cucumber seedlings over those grown without supplementary light; however, opposite trends were observed in the superoxide dismutase (SOD) and catalase (CAT) activities. Under equal DLI, increasing the supplementary light duration from 6 to 10 h d−1 increased the root surface area (66.8%), shoot dry weight (24.0%), seedling quality index (237.0%), root activity (60.0%), and stem firmness (27.2%) of the cucumber seedlings. The specific leaf area of the cucumber seedlings decreased quadratically with an increase in supplementary light duration, and an opposite trend was exhibited for the stem diameter of the cucumber seedlings. In summary, increased DLI or longer light duration combined with lower light intensity with equal DLI provided by supplementary light in insufficient sunlight seasons improved the quality of the cucumber seedlings through the modification of the root architecture and stem firmness, increasing the mechanical strength of the cucumber seedlings for transplanting