[Effect of hemoperfusion on protein energy wasting and long-term prognosis in patients on maintenance hemodialysis].

Objective: To explore the effect of hemoperfusion (HP) combined with hemodialysis (HD) (HD+HP) on protein energy wasting (PEW) and long-term prognosis in patients on maintenance HD (MHD). Methods: A prospective multicenter cohort study was conducted. Adult MHD patients who completed PEW assessment and underwent regular dialysis between July 2015 and July 2021 at 23 hemodialysis centers in Guizhou Province were selected. Demographic characteristics, physical indicators, laboratory indicators, 3-day diet diary and HP treatment data of the subjects were collected. The patients were divided into different groups according to the presence or absence of HP, the frequency of HP treatment and the type of cartridge, and then relevant indicators were compared. Multivariate logistic regression model and Cox proportional regression model were used to analyze the influence of HP treatment on PEW risk in MHD patients. Meanwhile, Kaplan-Meier method was used to plot the survival curve. Results: A total of 4 623 MHD patients (2 789 males and 1 834 females) aged (53.7±15.9) years were included in the study, with a median dialysis age of 64.3 (44.3, 92.3) months. There were 3 429 (74.2%) MHD patients treated with HD+HP, and 1 194 patients (25.8%) were not treated with HP. According to the 2008 diagnostic criteria of the International Society for Renal Nutrition and Metabolism (ISRNM), the incidence of PEW was 26.0% (1 204/4 623). Multivariate logistic regression analysis showed that female (OR=2.48, 95%CI: 1.55-3.95, P<0.001), diabetes (OR=1.75, 95%CI: 1.08-2.83, P=0.024) and high-sensitivity C-reactive protein (hs-CRP) (OR=1.02, 95%CI: 1.01-1.03, P=0.003) were risk factors for PEW, while treatment with HD+HP (OR=0.51, 95%CI: 0.31-0.87, P=0.012) and elevated triglyceride levels (OR=0.62, 95%CI: 0.48-0.80, P<0.001) were protective factors. Cox hazard ratio regression showed that among different HP treatment frequencies and cartridge types, 2 times/month (HR=0.40, 95%CI: 0.17-0.95, P=0.037), 3 times/month (HR=0.44, 95%CI: 0.23-0.85, P=0.014), 4 times/month (HR=0.54, 95%CI: 0.34-0.85, P=0.008), HA130 (HR=0.57, 95%CI: 0.36-0.89, P=0.014) and HA230 (HR=0.30, 95%CI: 0.15-0.63, P=0.001) had protective effects on the occurrence of PEW in MHD patients. The all-cause mortality rate was 11.3% (521/4 623) at 33 (24, 48) months of follow-up. Kaplan-Meier analysis showed that patients undergoing 4 times/month HP treatment (χ2=36.78, P<0.001) and using HA230 (χ2=9.46, P=0.002) had the highest survival rate. Conclusion: Treatment with HD+HP is a protective factor for PEW in patients with MHD, and 4 times/month HP treatment or HA230 significantly reduces the risk of PEW and all-cause mortality in patients with MHD.

[Association of systemic immune-inflammation index with protein-energy wasting and prognosis in patients on maintenance hemodialysis].

Objective: To explore the association of systemic immune-inflammation index (SII) with protein-energy wasting (PEW) and prognosis in maintenance hemodialysis (MHD) patients. Methods: A multicenter cohort study was conducted in 11 hemodialysis centers of Guizhou province from July to September 2019. The patients were divided into the PEW group and non-PEW group. After 12 months of follow-up, death was the endpoint event. Multivariate logistic regression analysis was used to assess the independent risk factors of PEW in MHD patients. The receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of SII for PEW, and the optimal cut-off value of SII was calculated. The Kaplan-Meier method was used to draw the survival curve, and log-rank test was employed to compare the difference of survival rate between the two groups. Results: A total of 859 patients were included [540 males and 319 females, aged (54±15) years], and there were 220 cases (25.6%) and 639 cases (74.4%) in PEW and non-PEW groups, respectively. SII was higher in the PEW group than that of the non-PEW group [600 (440, 915) vs 475 (353, 633), P<0.01]. Multivariate logistic regression analysis showed that SII was an independent predictor for PEW (OR=1.001, 95%CI: 1.000-1.002, P=0.02). ROC curve analysis showed that the area under the curve for SII to predict PEW in MHD patients was 0.725 (95%CI: 0.683-0.766), with the sensitivity and specificity of 69% and 70%, respectively. All patients were followed up for 12 months, and 45 died (with a mortality rate of 5.24%). Patients were divided into SII>520 group and SII≤520 group according to the optimal cut-off value, and subsequent Kaplan-Meier survival analysis showed that the 1-year cumulative survival rate of the SII>520 group (92.3%) was lower than that of SII≤520 group (97.1%) (χ2log-rank=9.707, P=0.002). Further subgroup analysis revealed that, in PEW patients with MHD, the 1-year cumulative survival rate of the SII>520 group (88.5%) was also lower than that of SII≤520 group (92.3%) (χ2log-rank=7.226, P=0.007). Conclusion: SII is an independent risk factor for PEW in MHD patients, and the higher the SII level, the lower the long-term survival rate and the prognosis.

[Influencing factors of protein energy wasting in maintenance hemodialysis patients].

Objective: To analyze the influencing factors of protein energy wasting (PEW) in maintenance hemodialysis (MHD) patients. Methods: A multicenter cross-sectional study was conducted in eleven hemodialysis centers of Guizhou province between June and August 2018. Clinical data, physical parameters, body composition data and laboratory values of MHD patients were collected. Analysis of variance was used to assess the impact of the indicators on the prevalence of PEW. Factor analysis was carried out after further classifing the factors into several common factors, and logistic regression was used to analyze the impact of common factors on PEW. Results: The results of univariate analysis showed that somatic cell mass, lean weight, fat content, body mass index (BMI), grip strength, leg circumference, hip circumference, waist circumference, midpoint circumference of upper arm, triceps skin fold thickness, hemoglobin, albumin, prealbumin, serum calcium, phosphorus, serum magnesium, creatinine, parathyroid hormone were the influential factors of PEW (all P<0.05). Factor analysis indicated that the above indicators can be classified into five common factors. Logistic regression model showed that with the increase of the prevalence of PEW, the scores of common factors decreased, the absolute value of regression coefficient beta in sequence, was common factor 2 (ß=-2.258, P<0.001), common factor 4 (ß=-1.589, P<0.001), common factor 1 (ß=-1.144, P=0.001) and common factor 3 (ß=-0.740, P=0.016). Conclusion: The reduction of fat content, anemia, hypoproteinemia, disorder of calcium and phosphorus metabolism were important factors influencing PEW.

Epigenetic mechanism of maternal post-traumatic stress disorder in delayed rat offspring development: dysregulation of methylation and gene expression.

Maternal post-traumatic stress disorder (PTSD) increases the risk of adverse neurodevelopmental outcomes in the child. Epigenetic alternations may play an essential role in the negative effects of PTSD. This study was aimed to investigate the possible epigenetic alterations of maternal PTSD, which underpins the developmental and behavioral impact. 24 pregnant Sprague-Dawley (SD) rats were randomly grouped into PTSD and control groups. Open-field tests (OFTs), elevated pull maze (EPM) assays, gene expression profile chip tests, and methylated DNA immunoprecipitation sequencing (MeDIP-Seq) were performed on the offsprings 30 days after birth. The results showed that PTSD offsprings had lower body weights and OFT scores than control offsprings. Enzyme-linked immunosorbent assays showed that serotonin receptor (5-HT) and dopamine levels were significantly lower in PTSD offsprings than in control offsprings. In contrast, corticosterone levels were higher in the PTSD group than in the control group. In a comparison of the PTSD group versus the control group, 4,160 significantly differentially methylated loci containing 30,657 CpGs were identified; 2,487 genes, including 13 dysmethylated genes, were validated by gene expression profiling, showing a negative correlation between methylation and gene expression (R = -0.617, P = 0.043). In conclusion, maternal PTSD could delay the physical and behavioral development of offsprings, and the underlying mechanism could contribute to changes in neurotransmitters and gene expression, owing to dysregulation of whole-genome methylation. These findings could support further clinical research on appropriate interventions for maternal PTSD to prevent methylation dysregulation and developmental retardation.

First Report of Cylindrocarpon destructans var. destructans Causing Black Root Rot of Sanqi (Panax notoginseng) in China.

Sanqi (Panax notoginseng (Burk.) F. H. Chen) is planted on >10,000 ha in China and is a popular Chinese medicinal material (2). Black root rot is a recently identified but worsening problem on Sanqi since 2010 in Wenshan, China. Of the plant tubers examined from 185 ha, 8.5 to 27.4% were black with necrotic lesions. The base of leaves of infected plants had brown, sunken, necrotic lesions, and symptomatic plants had one to three chlorotic leaves. A fungus was isolated consistently from the basal leaves, bulb, and tubers of symptomatic plants. Six single-spore isolates were cultured on potato sucrose agar (PSA) at 25 ± 1°C in the dark. The mycelium of each culture was white initially on PSA, and then became rust-colored. The adaxial surfaces of the plates were black. Conidiophores were 13.6 to 167.3 × 1.4 to 21.8 µm (avg. 68.6 × 2.9 µm), single or with up to four levels of branching and two to three branches (or phialides) per level. The basal branches were often divergent, whereas the terminal branches were usually more appressed. Sporodochia were not present. Microconidia were 0-septate, 4.1 to 9.5 × 2.7 to 4.1 µm (avg. 8.2 × 2.9 µm). Conidia were 1- to 3-septate and occasionally 4-septate. One- to 3-septate conidia were clavate, with a truncate or slightly protruding conidial base, 9.2 to 40.8 × 3.5 to 6.8 µm (avg. 26.7 × 5.2 µm); whereas 4-septate conidia were 32.6 to 50.3 × 5.4 to 6.8 µm (avg. 40.9 × 6.5 µm). Chlamydospores were abundant, golden to brown, single or in chains or clumps, and up to 21.8 µm in diameter. PCR amplification was carried out for one isolate, RR926, using rDNA internal transcribed spacer (ITS) primer pairs ITS1F and ITS4 (4). Sequencing of the PCR product (GenBank Accession No. KC904953) revealed 99% similarity (99% coverage) with the ITS sequence of Cylindrocarpon destructans var. destructans (AM419065). Phylogenetic analysis (MEGA 4.1) using the neighbor-joining algorithm placed the isolate in a well-supported cluster (>90% bootstrap value based on 1,000 replicates) with AM419065. Therefore, the pathogen was identified as C. destructans (Zinssm.) Scholten var. destructans (teleomorph Ilyonectria radicicola (Gerlach & L. Nilsson) P. Chaverri & C. Salgado) based on morphological characteristics and rDNA-ITS sequence analysis (1,3). Pathogenicity tests of the six isolates were conducted on five 1-year-old and five 3-year-old plants/isolate. The roots of all plants were washed with sterilized water, and then surface-sterilized with 75% ethanol. Inoculum (1 ml of 106 conidia/ml) of each isolate was brushed onto the roots of each plant with a paintbrush. Inoculated plants were planted in pots in a mixture of sterilized quartz sand:vermiculite:pearlite (2:1:1, v/v). The pots were placed under black shadecloth. The roots of five 1-year-old and five 3-year-old plants were brushed similarly with sterilized water as control treatments. After 30 days, symptoms similar to those on the original diseased plants were observed on the roots of all plants inoculated with the six isolates. The roots of non-inoculated plants remained healthy. The experiment was repeated. The same pathogen was re-isolated from the inoculated plants, but no pathogen was isolated from roots of the control plants. C. destructans var. destructans is widely distributed in soils (1), but to our knowledge, this is the first report of this fungus causing black root rot of Sanqi in China. References: (1) P. Charerri et al. Stud. Mycol. 68:57, 2011. (2) C. Y. Hu. New Rural Technol. 2:59, 2013 (in Chinese). (3) K. A. Seifert and P. E. Axelrood. Can. J. Plant Pathol. 20:115, 1998. (4) K. A. Seifert et al. Phytopathology 93:1533, 2003.

[Digitalized analysis of the gingival and bone morphology in the maxillary anterior teeth in patient with posterior dental implant].

Objective: To explore and analyze the correlation between labial gingival morphology and alveolar bone morphology of maxillary anterior teeth in patients with posterior dental implant, so as to provide reference basis for restoration design and esthetic reconstruction of anterior teeth. Methods: Sixty-four patients [24 males, 40 females (25.6±3.3) years old] who planned to receive posterior dental implant restoration were recruited randomly with the inclusion and exclusion criteria in Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University from May 2020 to May 2021. According to the visibility of periodontal probe through gingival margin, the subjects were divided into thin and thick gingival biotypes, including 29 cases of thin biotype and 35 cases of thick biotype. The 3Shape software was used to perform oral scanning, and cone beam CT (CBCT) was taken for each patient. Geomagic and Mimics software were used to measure and record the labial crown width and length, gingival papilla height, gingival angle, bone papilla height and bone margin angle of maxillary anterior teeth. Results: The crown width length ratios of maxillary central incisors, lateral incisors and canines were 0.85±0.08, 0.80±0.08 and 0.86±0.09 (F=10.71, P<0.01). The height of gingival papilla between maxillary central incisors, between central incisors and lateral incisors, between lateral incisors and canines were (3.93±0.86), (3.47±0.84) and (3.38±0.91) mm respectively (F=7.44, P<0.01), and the height of corresponding bone papilla were (3.44±0.88), (3.12±0.75) and (2.72±0.63) mm respectively (F=14.26, P<0.01). The gingival margin angles of maxillary central incisors, lateral incisors and canines were 88.3°±7.7°, 84.7°±8.9° and 81.2°±6.6° (F=13.15, P<0.01), and the bone margin angles were 103.2°±13.1°, 99.5°±11.2° and 110.6°±13.0° (F=13.25, P<0.01). The crown width length ratio (0.81±0.08), gingival margin angle (82.2°±7.4°) and bone margin angle (99.4°±12.9°) of thin gingival subjects were significantly lower than those of thick gingival subjects (0.85±0.09, 86.5°±8.6°, 108.5°±11.4°) (t=-2.79, 3.63, 5.20, P<0.01). The height of gingival papilla [(3.93±0.81) mm] and bone papilla [(3.43±0.80) mm] in thin gingival subjects were significantly lower than those in thick gingival subjects [(3.34±0.84) and (2.85±0.71) mm, respectively] (t=-4.89, -5.36, P<0.01). The height of labial gingival papilla of upper anterior teeth was positively correlated with that of bone papilla in all patients (r=0.66, P<0.01); the ratio of crown width to length of upper anterior teeth was positively correlated with the angle of bone margin (r=0.42, P<0.01); the height of anterior gingival papilla was negatively correlated with the angle of bone margin (r=-0.58, P<0.01), and the height of bone papilla was negatively correlated with the angle of bone margin (r=-0.82, P<0.01). Conclusions: The crown shape, gingival shape and alveolar bone shape of maxillary anterior teeth were different in different tooth positions. Patients with different periodontal phenotypes had different crown width length ratio, gingival papilla height, bone papilla height, gingival margin angle, and bone margin angle.

Replenishment of urban landscape ponds with reclaimed water: Spatiotemporal variations of water quality and mechanism of algal inhibition with alum sludge.

Algal blooms caused by high concentrations of nutrients (especially phosphorus) limit the use of recycled water (RW) for replenishing landscape ponds in the context of global water scarcity. Previous studies have demonstrated that alum sludge is a low cost phosphorus sorption medium, which could potentially be applied in constructed wetlands and sewage treatment plants. However, whether alum sludge can be used for algae inhibition in reclaimed water urban landscape ponds (RWULPs) should be explored. In this study, phosphorus removal and algae inhibition by alum sludge were investigated in a RWULP in China. The results highlight that there is a serious risk of algal blooms in RWULPs. The algal density was found to be 1.58 × 105 cell·mL-1, which is 6.84 times higher than that of the surface water ponds. The algal blooms presented a Cyanophyta-Chlorophyta-Bacillariophyta-type, and the dominant algae species were Microcystis flos-aquae (Wittr.) Kirchner, Chlorella vulgaris, and Scenedesmus quadricauda. Moreover, the removal rate of phosphorus by alum sludge was as high as 98% and eventually leads to phosphorus stress, which has an important effect on algae growth and algae inhibition rate of 80%. In addition, the proportion of phosphorus and nitrogen in the adsorbed alum sludge increased by 3.12% and 0.32%, respectively, and Al3+ was reduced by only 2.18%. Alum sludge is a potential inhibitor of algae in RWULPs that does not negatively impact the environment. These results are of great importance in algal bloom control of RWULPs and may help alleviate the problem of urban water resource scarcity.

Superconductivity in HfTe5 across weak to strong topological insulator transition induced via pressures.

Recently, theoretical studies show that layered HfTe5 is at the boundary of weak &strong topological insulator (TI) and might crossover to a Dirac semimetal state by changing lattice parameters. The topological properties of 3D stacked HfTe5 are expected hence to be sensitive to pressures tuning. Here, we report pressure induced phase evolution in both electronic &crystal structures for HfTe5 with a culmination of pressure induced superconductivity. Our experiments indicated that the temperature for anomaly resistance peak (Tp) due to Lifshitz transition decreases first before climbs up to a maximum with pressure while the Tp minimum corresponds to the transition from a weak TI to strong TI. The HfTe5 crystal becomes superconductive above ~5.5 GPa where the Tp reaches maximum. The highest superconducting transition temperature (Tc) around 5 K was achieved at 20 GPa. Crystal structure studies indicate that HfTe5 transforms from a Cmcm phase across a monoclinic C2/m phase then to a P-1 phase with increasing pressure. Based on transport, structure studies a comprehensive phase diagram of HfTe5 is constructed as function of pressure. The work provides valuable experimental insights into the evolution on how to proceed from a weak TI precursor across a strong TI to superconductors.

Feocromocitoma maligno: importância do acompanhamento cintilográfico com I131-meta iodo benzilguanidina (I131-MIBG) / Malignant pheochromocytoma: the importance of a scintigraphic investigation with I131 meta iodo benzylguanidine (MIBG I131)

Os autores apresentam um caso de feocromocitoma rastreado com metaiodobenzilguanidina marcada com 131I (MIBG-131I). Esta metodologia identifica a lesäo primitiva, sua recorrência e sua metastatizaçäo. Säo apontadas as vantagens do ensaio pela sua especificidade, sensibilidade e inoqüidade, oferecendo informaçöes ímpares de natureza morfofuncional no diagnóstico e acompanhamento evolutivo dessa doença