Uremic toxin indoxyl sulfate induces dysfunction of vascular smooth muscle cells via integrin-ß1/ERK signaling pathway.

BACKGROUND: Protein-bound uremic toxins (PBUTs) are reported to be one of the major culprits in chronic kidney disease-cardiovascular disease (CKD-CVD) development, yet its mechanism is not fully clear. Our previous study confirmed elevated expression of integrin-ß1 (ITGß1) in vascular smooth muscle cells of uremic patients. Thus, this study aimed to explore the relationship between PBUTs and ITGß1 in uremic vasculature injury. METHODS: Human umbilical vein smooth muscle cells (HUVSMCs) and endothelial cells (HUVECs) were treated with two representative PUBTs, indoxyl sulfate (IS) and p-cresyl sulfate (PC). Both cells were measured for the expression of ITGß1 and downstream signaling pathways and assayed for proliferation, migration, adhesion and apoptosis. RESULTS: The IS treatments were observed with significantly up-regulated ITGß1 in HUVSMCs but not in HUVECs, while PC did not induce ITGß1 alteration in either HUVSMCs or HUVECs. Furthermore, overexpression of ITGß1 revealed activated downstream signal-regulated kinase (ERK) signaling pathway with promoted focal adhesion, migration, proliferation but no apoptosis in HUVSMCs by IS. These functional and pathway alterations could be significantly suppressed by RNA interference of ITGß1. More importantly, the application of ERK1/2 inhibitor significantly suppressed the focal adhesion, migration and proliferation of HUVSMCs. CONCLUSION: We first demonstrated that ITGß1/ERK signaling pathway mediated abnormal focal adhesion, migration and proliferation of vascular smooth muscle cells stimulated by IS. ITGß1/ERK signaling may serve as a novel therapeutic target for CKD-CVD.

Correlation between menopausal symptoms and everyday cognition in Chinese (peri)menopausal women.

OBJECTIVE: The aim of this study was to evaluate the relationship between the severity of menopausal symptoms and everyday cognitive decline in Chinese peri and postmenopausal women. METHODS: The peri and postmenopausal Chinese Han female who first visited the menopausal clinic of Shanghai Jiao Tong University Affiliated Sixth People's Hospital was selected as the study participants. The general questionnaire was used to obtain the sociodemographic characteristics of the study participants. The menopausal rating scale (MRS) was used to assess the severity of menopausal symptoms. The short version of the Everyday Cognition (ECog-12) scales was used to assess everyday cognitive performance. RESULTS: A total of 295 women were included, with an average age of 51.12 ± 5.15 years. The average ECog scores were 1.51 ± 0.49 and the average MRS scores were 6.89 ± 4.77. In multiple linear regression analysis, after adjusting for confounding factors age, body mass index (BMI), monthly income, occupational status, education level, menopausal status, parity, regular exercise, and history of chronic diseases, complaints of anxiety and physical/mental fatigue were positively correlated with everyday cognitive decline. CONCLUSIONS: Menopausal anxiety and physical/mental fatigue were the independent predictors of everyday cognition.

Lithium targeting of AMPK protects against cisplatin-induced acute kidney injury by enhancing autophagy in renal proximal tubular epithelial cells.

Autophagy has been demonstrated to be vital for kidney homeostasis and is centrally implicated in the pathogenesis of cisplatin-induced acute kidney injury (AKI). Lithium is a potent autophagy inducer in a number of cell types. However, it remains uncertain whether its autophagic activity is associated with a beneficial effect on renal tubular cells in AKI. This study aimed to examine the effect of lithium on renal autophagy in cisplatin-induced AKI. Mice or renal proximal tubular epithelial cells in culture were exposed to cisplatin-induced acute injury in the presence or absence of lithium treatment. AKI or tubular cell injury was evaluated, and cell signaling associated with autophagy was examined. Lithium pretreatment prominently ameliorated acute renal tubular damage in mice exposed to cisplatin insult, associated with enhanced autophagy in renal tubules, as assessed by measuring microtubule-associated protein 1A/1B-light chain 3 (LC3)BII/I expression and autophagosome formation. Consistently, in cisplatin-injured renal tubular cells in vitro, lithium enhanced autophagic activities, improved cell viability, and attenuated cell death. Mechanistically, lithium triggered AMPK-α phosphorylation and activation, which in turn positively correlated with the induced expression of autophagy-related molecules, like mammalian target of rapamycin and LC3BII/I. AMPK-α activation is likely required for lithium-induced tubular cell autophagy and protection in cisplatin-induced AKI because blockade of AMPK-α phosphorylation by compound C markedly abrogated lithium-induced autophagosome formation and mitigated the protective effect of lithium on AKI. Our findings suggest that lithium represents a promising therapeutic strategy for protecting renal tubular cells against cisplatin-induced AKI by enhancing autophagy via AMPK-α activation.-Bao, H., Zhang, Q., Liu, X., Song, Y., Li, X., Wang, Z., Li, C., Peng, A., Gong, R. Lithium targeting of AMPK protects against cisplatin-induced acute kidney injury by enhancing autophagy in renal proximal tubular epithelial cells.

Association of snoring and body composition in (peri-post) menopausal women.

BACKGROUND: Little attention has been paid to whether snoring frequency is associated with body composition in menopausal women, particularly in China. This study objected to investigate the association between self-reported snoring and body composition in (peri-post) menopausal Chinese women as well as metabolic indicators. METHODS: This cross-sectional study enrolled 715 participants aged 40-67 years from the Menopause Clinic in the Shanghai Sixth People's Hospital. Participants were categorized into four subgroups stratified by self-reported snoring frequency: never, rarely (< 1 night per week), occasionally (1-2 nights per week), regularly (≥3 nights per week), while body composition was measured using bioelectrical impedance analysis (BIA). Besides, blood sample were collected to test the glycolipid indicators. RESULTS: In our sample of investigation, regular snoring (≥3 nights per week) was found to be an independent risk factor for higher fat mass (total, upper limbs, trunk), with the highest risk of 2.4 times for fat mass of trunk after adjusting for metabolic confounders(p = 0.003). Meanwhile, regular snoring was independently associated with higher fat mass (total and each segment) only in menopausal transition (p = 0.023). CONCLUSIONS: We suggested that self-reported regular snoring may be taken as a simple alternative to predict higher fat mass (≥17.11 kg, upper quartile) in menopausal women. Similarly, body composition should be attached to the great importance to those who in menopausal transition in order to help to prevent obstructive sleep apnea (OSA).

Epoxide metabolites of arachidonate and docosahexaenoate function conversely in acute kidney injury involved in GSK3ß signaling.

Acute kidney injury (AKI) causes severe morbidity and mortality for which new therapeutic strategies are needed. Docosahexaenoic acid (DHA), arachidonic acid (ARA), and their metabolites have various effects in kidney injury, but their molecular mechanisms are largely unknown. Here, we report that 14 (15)-epoxyeicosatrienoic acid [14 (15)-EET] and 19 (20)-epoxydocosapentaenoic acid [19 (20)-EDP], the major epoxide metabolites of ARA and DHA, respectively, have contradictory effects on kidney injury in a murine model of ischemia/reperfusion (I/R)-caused AKI. Specifically, 14 (15)-EET mitigated while 19 (20)-EDP exacerbated I/R kidney injury. Manipulation of the endogenous 19 (20)-EDP or 14 (15)-EET by alteration of their degradation or biosynthesis with selective inhibitors resulted in anticipated effects. These observations are supported by renal histological analysis, plasma levels of creatinine and urea nitrogen, and renal NGAL. The 14 (15)-EET significantly reversed the I/R-caused reduction in glycogen synthase kinase 3ß (GSK3ß) phosphorylation in murine kidney, dose-dependently inhibited the hypoxia/reoxygenation (H/R)-caused apoptosis of murine renal tubular epithelial cells (mRTECs), and reversed the H/R-caused reduction in GSK3ß phosphorylation in mRTECs. In contrast, 19 (20)-EDP dose-dependently promoted H/R-caused apoptosis and worsened the reduction in GSK3ß phosphorylation in mRTECs. In addition, 19 (20)-EDP was more metabolically stable than 14 (15)-EET in vivo and in vitro. Overall, these epoxide metabolites of ARA and DHA function conversely in I/R-AKI, possibly through their largely different metabolic stability and their opposite effects in modulation of H/R-caused RTEC apoptosis and GSK3ß phosphorylation. This study provides AKI patients with promising therapeutic strategies and clinical cautions.

Nitrogen Fertilizer Levels Affect the Growth and Quality Parameters of Astragalus mongolica.

Owing to overexploitation, wild resources of Astragalus mongolica, a Chinese herbal plant that is widely distributed in the arid and semi-arid areas of Northern China, have gradually become exhausted, and therefore, commercial cultivation is increasingly important to meet the growing demand for astragalus and reduce the pressure on wild populations. Nitrogen level is an important factor that affects the yield and quality of A. mongolica. However, uniform standards for fertilization among production areas have not yet been determined. In this study, the effect of nitrogen fertilizer treatment on the yield and quality of A. mongolica in the Qinghai-Tibet Plateau was explored using a control treatment (no added nitrogen, N0) and five different nutrient levels: 37.5 kg/ha (N1), 75 kg/ha (N2), 112.5 kg/ha (N3), 150 kg/ha (N4), and 187.5 kg/ha (N5). According to grey relational analysis, the optimal nitrogen fertilizer treatment was the N4 level followed by the N5 and N2 levels. Nitrogen fertilizer significantly increased the root biomass, plant height, root length, and root diameter. However, nitrogen fertilization had no significant effect on the content of Astragaloside IV and mullein isoflavone glucoside. The content of ononin and calycosin continually accumulated throughout the growing period. The results showed that the ononin and calycosin content under N4 and N2 is higher than other levels and there is not significantly different between different nitrogen fertilizer levels about them. The content of formononetin decreased gradually with the progression of the growing season. The optimal nitrogen fertilizer treatment for A. mongolica is recommended to be 150 kg/ha and the content of active compounds and yield were observed to reach the maximum in October.

Histopathological and proteomic analyses identify integrin-ß1 as a potential mediator of phlebosclerosis in uremic patients.

BACKGROUND: Patients with uremia have an excessive mortality from cardiovascular disease (CVD). Arterial remodeling is mainly responsible for uremia-induced CVD and has been well studied, yet venous remodeling is poorly understood. Here we investigate the histopathology and proteomic profiles of venous remodeling in uremic patients. METHODS: Forearm cephalic veins were isolated from nine uremic patients during surgeries for arteriovenous fistula, and from nine healthy controls when applying surgical debridement. Hematoxylin-eosin, Masson's trichrome, von Kossa, and immunohistochemistry (IHC) against proliferating cell nuclear antigen were stained for histopathology. Isobaric tags for relative and absolute quantitation (iTRAQ) proteomic analysis was executed to explore the proteome of the veins. The core regulatory protein was validated by western blot, IHC, and immunofluorescence. RESULTS: Phlebosclerosis, characterized by intimal rarefaction and medial thickening with disordered proliferation of vascular smooth muscle cells (VSMCs), was the prominent pathological manifestation of peripheral veins in uremic patients, while inflammatory cell infiltration, atherosclerosis or calcification were not obviously detected. iTRAQ analysis showed that 350 proteins were significantly changed in phlebosclerosis of uremic patients compared with healthy controls, of which integrin-ß1 (ITGß1) exhibited the strongest regulatory ability by intermolecular interaction network analysis. The enhanced ITGß1 expression was mainly co-expressed with the disordered proliferation of VSMCs while a little with vascular endothelial cells in the forearm cephalic veins of uremic patients. CONCLUSIONS: Phlebosclerosis is the prominent pathological manifestation in peripheral veins of uremic patients. This pathological alteration mainly attributes to the disordered proliferation of VSMCs, which is potentially mediated by ITGß1.

Prevalence and predictors of sexual function in midlife partnered Chinese women assessed by two simple indicators: Sexual frequency and sexual desire.

AIM: To investigate the prevalence and predictors of sexual frequency, sexual desire in midlife partnered Chinese women. METHODS: Sexual frequency, sexual desire over the past 3 months, menopausal symptoms and other socioeconomic information were assessed for women aged 40-65 years in the Shanghai Sixth People's Hospital. RESULTS: Among 3485 eligible partnered participants, the prevalence of low sexual frequency (less than once per week) and low sexual desire (less than 5 scores) were 72.74% (95% confidence interval (CI) = 71.16%-74.23%) and 71.79% (95% CI = 70.30-73.17%), respectively. Multivariable logistic regression analysis revealed that age (odds ratio (OR) = 1.20, 95% CI = 1.17-1.23), more educated (>15 years) (compared with<10 years, OR = 0.62, 95% CI = 0.48-0.82), perimenopause, postmenopause (compared with premenopause, OR = 1.48, 95% CI = 1.02-2.15, OR = 2.76, 95% CI = 1.80-4.23), sleep disorder (OR = 1.24, 95% CI = 1.02-1.50), unemployment (OR = 2.05, 95% CI = 1.45-2.92) were independently associated with low sexual frequency, while multiple linear regression revealed that age ß = -0.126, 95% CI = -0.139--0.114), unemployment (ß = -0.792, 95% CI = -0.954 to -0.629),chronic diseases (compared with no disease, single disease (ß = -0.200, 95% CI = -0.020 to -0.077, multiple diseases (ß = -0.792, 95% CI = -0.859 to -0.372), body mass index (ß = -0.615, 95% CI = -0.859 to -0.372), postmenopause (ß = -0.915, 95% CI = -1.143 to -0.759) were independent indicators for low sexual desire after adjusting for confounders. CONCLUSION: Low sexual frequency and low sexual desire were quite prevalent in midlife Chinese partnered women. Some factors, such as sleep disorder, obesity are modifiable or can be prevented or treated with safe and effective therapies.

Treatment Outcome of Combined Continuous Venovenous Hemofiltration and Hemoperfusion in Acute Paraquat Poisoning: A Prospective Controlled Trial.

OBJECTIVES: To investigate whether combined continuous venovenous hemofiltration and hemoperfusion among paraquat-poisoned patients would improve survival. DESIGN: Prospective, controlled interventional study over 4 years. SETTING: Single, tertiary, academic medical center. PATIENTS: We recruited patients admitted to Shanghai Tenth People's Hospital within 48 hours after paraquat ingestion. Exclusions were under 14 years old, ingestion of paraquat with other toxicants, pregnant, a history of chronic pulmonary disease, psychosis, hyperthyroidism, or diabetes with impaired liver or renal function. INTERVENTIONS: All patients were assigned to receive continuous venovenous hemofiltration with hemoperfusion therapy (continuous venovenous hemofiltration group) and to receive conventional therapy (conventional group). The study outcomes were death from any cause within 90 days after paraquat ingestion and the frequencies of hypoxia, acute kidney injury, or adverse events. MEASUREMENTS AND MAIN RESULTS: Of the 110 enrolled patients, 59 were assigned to continuous venovenous hemofiltration group and 51 to conventional group. The two groups had similar baseline demographics and clinical features. At 90 days after paraquat ingestion, 19 of 59 patients (32.2%) in the continuous venovenous hemofiltration group and 29 of 51 patients (56.9%) in the conventional group had died (hazard ratio, 0.43; 95% CI, 0.24-0.76; p = 0.004). In multivariable Cox proportional hazard models controlling for baseline characteristics, combined continuous venovenous hemofiltration and hemoperfusion was independently associated with reduced risk of death compared with conventional therapy (adjusted hazard ratio, 0.35; 95% CI, 0.19-0.64; p = 0.001). Patients in the continuous venovenous hemofiltration group, as compared to the conventional group, had a reduced occurrence rate of hypoxia (40.7% vs 72.5%; p = 0.001) and of acute kidney injury (59.3% vs 78.4%; p = 0.03). Hypophosphatemia and thrombocytopenia were more common in the continuous venovenous hemofiltration group (p < 0.05). CONCLUSIONS: In patients with paraquat poisoning, treatment with combined continuous venovenous hemofiltration and hemoperfusion significantly improved 90-day survival rates.

Oxylipin profiling of human plasma reflects the renal dysfunction in uremic patients.

INTRODUCTION: Nearly all the enzymes that mediate the metabolism of polyunsaturated fatty acids (PUFAs) are present in the kidney. However, the correlation of renal dysfunction with PUFAs metabolism in uremic patients remains unknown. OBJECTIVES: To test whether the alterations in the metabolism of PUFAs reflect the renal dysfunction in uremic patients. METHODS: LC-MS/MS-based oxylipin profiling was conducted for the plasma samples from the uremic patients and controls. The data were analyzed by principal component analysis (PCA) and orthogonal partial least squares-discriminant analysis (OPLS-DA). The receiver operating characteristic (ROC) curves and the correlation of the estimated glomerular filtration rate (eGFR) with the key markers were evaluated. Furthermore, qPCR analysis of the whole blood cells was conducted to investigate the possible mechanisms. In addition, a 2nd cohort was used to validate the findings from the 1st cohort. RESULTS: The plasma oxylipin profile distinguished the uremic patients from the controls successfully by using both PCA and OPLS-DA models. 5,6-Dihydroxyeicosatrienoic acid (5,6-DHET), 5-hydroxyeicosatetraenoic acid (5-HETE), 9(10)-epoxyoctadecamonoenoic acid [9(10)-EpOME] and 12(13)-EpOME were identified as the key markers to discriminate the patients from controls. The excellent predictive performance of these four markers was validated by ROC analysis. The eGFR significantly correlated with plasma levels of 5,6-DHET and 5-HETE positively but with plasma 9(10)-EpOME and 12(13)-EpOME negatively. The changes of these markers may account for the inactivation of cytochrome P450 2C18, 2C19, microsome epoxide hydrolase (EPHX1), and 5-lipoxygenase in the patients. CONCLUSION: The alterations in plasma metabolic profile reflect the renal dysfunction in the uremic patients.

The diagnostic value of glycated albumin in gestational diabetes mellitus.

PURPOSE: Our objective was to compare the diagnostic performance of glycated hemoglobin (HbA1c), GA, and fasting plasma glucose (FPG) for the diagnosis of GDM. METHODS: Women at their late second or early third trimesters seen from October 2011 to April 2012 were studied. GDM was diagnosed based on oral glucose tolerance test results, and GA and HbA1c were measured at the same time. Patients were divided into two groups (with and without GDM), and areas under the receiver-operating characteristic curves (AUCs) were calculated to determine the diagnostic value of FPG, GA, and HbA1c. RESULTS: A total of 698 women were included, of which 232 (33.2%) had GDM. Overall, FPG had the highest AUC for the detection of GDM, and was significantly higher than that of GA (0.692 vs. 0.568, p < 0.001) and HbA1c (0.692 vs. 0.619, p = 0.014). The AUC of FPG was significantly greater than that of GA and HbA1c. At 24-28 weeks' gestation, the AUCs of FPG were significantly greater than those of GA and HbA1c. CONCLUSIONS: These results do not support the use of GA as a screening tool for GDM.

Linkages of plant stoichiometry to ecosystem production and carbon fluxes with increasing nitrogen inputs in an alpine steppe.

Unprecedented levels of nitrogen (N) have entered terrestrial ecosystems over the past century, which substantially influences the carbon (C) exchange between the atmosphere and biosphere. Temperature and moisture are generally regarded as the major controllers over the N effects on ecosystem C uptake and release. N-phosphorous (P) stoichiometry regulates the growth and metabolisms of plants and soil organisms, thereby affecting many ecosystem C processes. However, it remains unclear how the N-induced shift in the plant N:P ratio affects ecosystem production and C fluxes and its relative importance. We conducted a field manipulative experiment with eight N addition levels in a Tibetan alpine steppe and assessed the influences of N on aboveground net primary production (ANPP), gross ecosystem productivity (GEP), ecosystem respiration (ER), and net ecosystem exchange (NEE); we used linear mixed-effects models to further determine the relative contributions of various factors to the N-induced changes in these parameters. Our results showed that the ANPP, GEP, ER, and NEE all exhibited nonlinear responses to increasing N additions. Further analysis demonstrated that the plant N:P ratio played a dominate role in shaping these C exchange processes. There was a positive relationship between the N-induced changes in ANPP (ΔANPP) and the plant N:P ratio (ΔN:P), whereas the ΔGEP, ΔER, and ΔNEE exhibited quadratic correlations with the ΔN:P. In contrast, soil temperature and moisture were only secondary predictors for the changes in ecosystem production and C fluxes along the N addition gradient. These findings highlight the importance of plant N:P ratio in regulating ecosystem C exchange, which is crucial for improving our understanding of C cycles under the scenarios of global N enrichment.

The ß isoform of GSK3 mediates podocyte autonomous injury in proteinuric glomerulopathy.

Converging evidence points to glycogen synthase kinase (GSK) 3 as a key player in the pathogenesis of podocytopathy and proteinuria. However, it remains unclear if GSK3 is involved in podocyte autonomous injury in glomerular disease. In normal kidneys, the ß isoform of GSK3 was found to be the major GSK3 expressed in glomeruli and intensely stained in podocytes. GSK3ß expression in podocytes was markedly elevated in experimental or human proteinuric glomerulopathy. Podocyte-specific somatic ablation of GSK3ß in adult mice attenuated proteinuria and ameliorated podocyte injury and glomerular damage in experimental adriamycin (ADR) nephropathy. Mechanistically, actin cytoskeleton integrity in podocytes was largely preserved in GSK3ß knockout mice following ADR insult, concomitant with a correction of podocyte hypermotility and lessened phosphorylation and activation of paxillin, a focal adhesion-associated adaptor protein. In addition, GSK3ß knockout diminished ADR-induced NFκB RelA/p65 phosphorylation selectively at serine 467; suppressed de novo expression by podocytes of NFκB-dependent podocytopathic mediators, including B7-1, cathepsin L, and MCP-1; but barely affected the induction of NFκB target pro-survival factors, such as Bcl-xL. Moreover, the ADR-elicited podocytopenia and podocyte death were significantly attenuated in GSK3ß knockout mice, associated with protection against podocyte mitochondrial damage and reduced phosphorylation and activation of cyclophilin F, a structural component of mitochondria permeability transition pores. Overall, our findings suggest that the ß isoform of GSK3 mediates autonomous podocyte injury in glomerulopathy by integrating multiple podocytopathic signalling pathways.

A modified nontransposed brachiobasilic arteriovenous fistula versus brachiocephalic arteriovenous fistula for maintenance hemodialysis access.

OBJECTIVE: With the growing need for reliable and durable upper arm hemodialysis access, we sought to compare the performance of a novel modified nontransposed brachiobasilic arteriovenous fistula (mNT-BBAVF) with that of the more traditional brachiocephalic arteriovenous fistula (BCAVF). METHODS: Briefly, to construct an mNT-BBAVF, an incision is made on the ulnar side of the elbow. The brachial artery and basilic vein are then isolated, and a side-to-side anastomosis is performed without transposition of the basilic vein. Next, the proximal basilic vein and the perforating veins within the surgical field are ligated. In this study, we retrospectively reviewed the medical records of all patients who underwent either an mNT-BBAVF or a BCAVF between January 2011 and October 2014 to compare 1-year primary unassisted patency, cumulative patency, and complications. We also examined hemodynamic parameters of vessels in each fistula type. RESULTS: We identified a total of 84 patients: 45 had a BCAVF, and 39 had an mNT-BBAVF. The two groups were well matched for baseline characteristics. Maturation rates at 1 month were 97% for mNT-BBAVF and 96% for BCAVF. The 1-year primary unassisted patency was significantly higher in the mNT-BBAVF group than that in the BCAVF group (87% vs 67%; hazard ratio, 2.86; 95% confidence interval, 1.11-6.40; P = .03), although cumulative patency did not differ (90% vs 73%; hazard ratio, 2.80; 95% confidence interval, 0.98-6.96 ; P = .06). There were no differences in thrombosis, failure of maturation, bleeding, steal syndrome, arm swelling, aneurysm, and stenosis between the two groups during the 12-month study. Importantly, diameters and blood flow volumes of the proximal cephalic vein, distal cephalic vein, and distal basilic vein in patients who received an mNT-BBAVF increased significantly after 12 months. All three vessels met the Kidney Disease Outcomes Quality Initiative (KDOQI) criteria for fistula maturation and were available for dialysis cannulation, whereas only the proximal cephalic vein in the BCAVF group met the maturation criteria and could be used for cannulation. CONCLUSIONS: mNT-BBAVF appeared to be an effective alternative to BCAVF for upper arm hemodialysis access.

Hyperamylasemia as an Early Predictor of Mortality in Patients with Acute Paraquat Poisoning.

BACKGROUND Paraquat (PQ) is a non-selective and fast-acting contact herbicide which has been widely used in developing countries. Hyperamylasemia was reported in patients with PQ poisoning. This study investigated the predictive value and clinical characteristics of hyperamylasemia in patients with PQ poisoning. MATERIAL AND METHODS This study included 87 patients with acute PQ poisoning admitted from July 2012 to May 2015. Data were collected from medical records. Receiver operating characteristic (ROC) analysis was conducted to analyze the discriminatory potential of serum amylase with respect to 90-day mortality. RESULTS Of 87 patients, 29 patients had elevated serum amylase. We found that serum amylase was significantly higher among patients with AKI than those with non-AKI (p<0.001), and was an independent predictor of mortality (hazard ratio [HR]=3.644; 95% [CI], 1.684-7.881; p=0.001). The area under the ROC curve for the serum amylase (area under curve [AUC]=0.796; 95% [CI], 0.690-0.903) had a better discriminatory potential than plasma PQ concentration (0.698;0.570-0.825) or urinary PQ concentration (0.647;0.514-0.781) in predicting 90-day mortality. CONCLUSIONS Hyperamylasemia is a valuable early predictor of 90-day mortality in PQ poisoning.

Paraquat Poisoning Followed by Toxic Epidermal Necrolysis: A Report of Two Cases and Published Work Review.

Toxic epidermal necrolysis (TEN) is a life-threatening, typically drug-induced, mucocutaneous disease. Whether paraquat, one of the most widely used herbicides, could induce TEN is not known. We describe 2 paraquat-poisoned patients with TEN. Both patients presented erythema after hospital discharge following initial paraquat poisoning and then developed a widespread eruption of diffuse erythema on almost the whole body, with bullae, epidermal necrosis and sloughing. They were successfully treated with intravenous immunoglobulin and methylprednisolone. These clinical features were consistent with TEN caused by medications with a high risk to induce Stevens-Johnson syndrome/TEN. Moreover, it is suggested that both skin exposure and ingestion of paraquat could induce TEN. To our knowledge, this is the first case report of TEN related to paraquat poisoning.

N-acetylcysteine for the prevention of contrast-induced nephropathy in patients with pre-existing renal insufficiency or diabetes: a systematic review and meta-analysis.

PURPOSE: To identify benefit of N-acetylcysteine (NAC) on patients with pre-existing renal insufficiency or diabetes. BACKGROUND: NAC administration is a common method for prevention of contrast-induced nephropathy (CIN). Nevertheless, its benefit on patients with pre-existing renal insufficiency or diabetes remains uncertain and controversial. METHODS: Randomized controlled trials (RCTs) to evaluate the efficacy of NAC for the prevention of CIN in patients with pre-existing renal insufficiency or diabetes were searched from the databases of MEDLINE, EMBASE, and Cochrane library. Pooled odds ratio (OR) with 95% confidence interval (95% CI) were calculated using fixed-effects model by the Mantel-Haenszel test. RESULTS: Twenty RCTs involving 3466 subjects (1756 assigned to NAC and 1710 assigned to the control) were included in the pre-existing renal dysfunction group. Pooled analysis suggested a significant reduction in CIN among this group (OR, 0.76; 95% CI, 0.61-0.93; p = 0.008). However, the nine trials comparing NAC versus control among patients with diabetes (NAC, 367 subjects; control, 358 subjects) showed no benefit of NAC for prevention of CIN (OR = 0.87; 95% CI, 0.58-1.30; p = 0.50). No significant heterogeneity was detected (p = 0.07; I2 = 34% for the group of pre-existing renal dysfunction; p = 0.40; I2 = 5% for the group of diabetes). CONCLUSION: Our results suggest that NAC decreases the incidence of contrast-induced nephropathy among patients with pre-existing renal insufficiency. The benefit was not existed in patients with diabetes.

Adoptive transfer of bone marrow dendritic cells failed to localize in the renal cortex and to improve renal injury in adriamycin nephropathy.

BACKGROUND AND AIMS: Murine bone marrow (BM) dendritic cells (DCs) can be modulated to be tolerogenic by cytokines, such as interleukin (IL)-10 and transforming growth factor (TGF)-ß, and may play a regulatory role and sustain immune hemostasis in cognate kidney disease. However, it is unknown whether BM-DCs can be used to protect against renal injury in murine Adriamycin nephropathy (AN). METHODS: In this study, by adoptive in vivo transfer of BM-DCs, including immature DCs, mature DCs (lipopolysaccharide-stimulated DCs) and BM regulatory DCs (IL-10/TGF-ß-modified DCs, DCregs), we addressed the potential benefits of BM-DCs in chronic kidney disease. RESULTS: We found that after adoptive transfer of DCregs, renal injury, including glomerulosclerosis, interstitial fibrosis and tubular atrophy, was not changed compared to AN controls. Correspondingly, renal functions measured by serum creatinine, 12-hour urine protein and creatinine clearance were also not improved by transfusion with DCregs compared to AN controls. CONCLUSION: This study showed that the adoptive transfer of BM-DCs was unable to improve renal injury in an AN model, and this failure related to their inability to access the kidney.

Mechanical Properties of Fully Recycled Aggregate Concrete Reinforced with Steel Fiber and Polypropylene Fiber.

The study and utilization of fully recycled aggregate concrete (FRAC), in which coarse and fine aggregates are completely replaced by recycled aggregates, are of great significance in improving the recycling rate of construction waste, reducing the carbon emission of construction materials, and alleviating the ecological degradation problems currently faced. In this paper, investigations were carried out to study the effects of steel fiber (0.5%, 1.0%, and 1.5%) and polypropylene fiber (0.9 kg/m3, 1.2 kg/m3 and 1.5 kg/m3) on the properties of FRAC, including compressive strength, splitting tensile strength, the splitting tensile load-displacement curve, the tensile toughness index, flexural strength, the load-deflection curve, and the flexural toughness index. The results show that the compressive strength, splitting tensile strength, and flexural strength of fiber-reinforced FRAC were remarkably enhanced compared with those of ordinary FRAC, and the maximum increase was 56.9%, 113.3%, and 217.0%, respectively. Overall, the enhancement effect of hybrid steel-polypropylene fiber is more significant than single-mixed fiber. Moreover, the enhancement of the crack resistance, tensile toughness, and flexural toughness obtained by adding steel fiber to the FRAC is more significant than that obtained by adding polypropylene fiber. Furthermore, adding polypropylene fiber alone and mixing it with steel fiber showed different FRAC splitting tensile and flexural properties.

A fNIRS investigation of menopausal-related symptoms and brain cortical activity in menopause.

BACKGROUND: This study aimed to delineate the association between menopausal-related symptoms and brain cortical hemodynamics in peri-postmenopause women. METHODS: Cross-sectional data from a total of 358 Han-Chinese women who visited the Menopause Clinic in the Shanghai Sixth People's Hospital from August 2019 to August 2022. Menopausal-related symptoms were analyzed through Kupperman index (KMI) scale and PSQI scale, while cerebral blood flow was measured using a functional near-infrared spectroscopy (fNIRS). Multiple linear regression model was used to assess the risk factors for subregions of brain hemodynamic response. RESULTS: After adjusting for confounding factors, we identified that menopausal symptom (B = -1.575, 95 % CI (-2.661, -0.488), p = 0.005) and duration of menopause (B = -14.583, 95 % CI (-26.753, -4.192), p = 0.007) were independently associated with the lower brain hemodynamic response in the prefrontal lobe, while in the temporal lobe, overweight (BMI ≥ 24 kg/m2) was negatively associated with the lower brain cortical activity (B = -36.882, 95 % CI (-72.708, -1.056), p = 0.044) after adjusting for other confounding variables. CONCLUSIONS: Our findings proposed that menopausal symptom and overweight should be attached great importance to the postmenopausal women, which provides clinical evidence for the feasible early detection and effective prevention such as menopausal hormone therapy (MHT) of brain health in postmenopausal women.