Clinical significance of glomerular IgM deposit in IgA nephropathy: a 5-year follow-up study.

The significance of glomerular IgM deposit intensity in IgA Nephropathy (IgAN) remained ambiguous and requires further research. Patients with biopsy-proven IgAN in our hospital from January 2018 to May 2023 were recruited into this retrospective single-center study. Patients who presented with positive IgM deposit were included in IgM + cohort while patients with negative IgM deposit were included in IgM- cohort. Of the IgM+, patients whose IF intensity of IgM deposits exceeded 1+ formed IgM-H cohort while patients whose IF intensity of IgM deposits was equal to 1+ consisted IgM-L cohort. Pairwise comparisons were performed among these cohorts to determine clinical disparities, following the propensity score matching process. Among 982 IgAN patients, 539 patients presented with positive IgM deposit. The Kaplan-Meier analysis showed that the IgM deposit did not contribute adversely to the outcomes (eGFR decreased from the baseline ≥ 50% continuously or reached end-stage renal disease). However, the Cox regression analysis showed that increased intensity of IgM deposit was an independent risk factor (p = 0.03) in IgM+. The IgM-H exhibited more pronounced segmental glomerulosclerosis (p = 0.02) than the IgM-L, which may also be associated more directly with higher urine protein levels (p = 0.02). Moreover, our generalized linear mixed model demonstrated a remarkably higher urine albumin/creatinine ratio (p < 0.01) and serum creatinine (p = 0.04) levels as well as lower serum albumin (p < 0.01) level in IgM-H persistently during the 5-year follow-up. This study concluded that increased intensity of glomerular IgM deposits may contribute adversely to clinicopathologic presentation and outcome in those IgM + patients.

Cardiac Lymphatics and Therapeutic Prospects in Cardiovascular Disease: New Perspectives and Hopes.

The lymphatic system is the same reticular fluid system as the circulatory system found throughout the body in vascularized tissues. Lymphatic vessels are low-pressure, blind-ended tubular structures that play a crucial role in maintaining tissue fluid homeostasis, immune cell transport, and lipid absorption. The heart also has an extensive lymphatic network, and as research on cardiac lymphatics has progressed in recent years, more and more studies have found that cardiac lymphangiogenesis may ameliorate certain cardiovascular diseases, and therefore stimulation of cardiac lymphangiogenesis may be an important tool in the future treatment of cardiovascular diseases. This article briefly reviews the development and function of cardiac lymphatic vessels, the interaction of cardiac lymphatic vessels with cardiovascular diseases (including atrial fibrillation, coronary atherosclerosis, and heart failure), and finally discusses the therapeutic potential of targeted cardiac lymphatic therapy for cardiovascular diseases.

Tremor Estimation and Removal in Robot-Assisted Surgery Using Improved Enhanced Band-Limited Multiple Fourier Linear Combiner.

BACKGROUND: During a robot-assisted minimally invasive surgery, hand tremors in a surgeon's manipulation of the master manipulator can cause vibrations of the slave surgical instruments. METHODS: This letter addresses this problem by proposing an improved Enhanced Band-Limited Multiple Linear Fourier Combiner (E-BMFLC) algorithm for filtering the physiological tremor signals of a surgeon's hand. The proposed method uses the amplitude of the input signal to adapt the learning rate and a dense division of the combiner bands for the higher amplitude bands of the tremor signals. RESULTS: By using the proposed improved E-BMFLC algorithm, the compensation accuracy can be improved by 4.5%-8.9%, as well as a spatial position error of less than 1 mm. CONCLUSION: The results show that among all filtering methods, the improved E-BMFLC filtering method has the highest number of successful experiments and the lowest experimental time.

Mortality risk of patients with intestinal obstruction.

BACKGROUND: Intestinal obstruction represents a severe intestinal disease associated with higher mortality rates. However, the determinants of mortality in patients with intestinal obstruction remain inadequately understood. This study sought to elucidate the potential risk factors associated with mortality in the context of intestinal obstruction during the COVID-19 pandemic. METHODS: A retrospective analysis was performed on a cohort of 227 patients diagnosed with intestinal obstruction at the First Hospital of Hebei Medical University, spanning the period from September 7, 2022, to January 7, 2023. The primary endpoint of the study was mortality within four weeks following discharge. Univariate and multivariable logistic regression models were utilized to evaluate the risk factors associated with mortality outcomes. RESULTS: A cohort of 227 patients diagnosed with intestinal obstruction (median age, 59.02 years [IQR, 48.95-70.85 years]) was included in our study. Malignant bowel obstruction (MBO) and COVID-19 were identified as independent risk factors for mortality among these patients. Notably, the mortality rate increased significantly to 38.46% when MBO was concomitant with COVID-19. Furthermore, postoperative pulmonary complications (PPC) (OR, 54.21 [death]; 95% CI, 3.17-926.31), gastric cancer (OR, 9.71 [death]; 95% CI, 1.38-68.18), VTE (Caprini Score ≥ 5) (OR, 7.64 [death]; 95% CI, 1.37-42.51), and COVID-19 (OR, 5.72 [death]; 95% CI, 1.01-32.29) were all determined to be independent risk factors for postoperative mortality. Additionally, gastric cancer could have emerged as one of the most severe risk factors for mortality in individuals with intestinal obstruction within the cohort of cancer patients, of which gastric cancer exhibited higher mortality rates compared to individuals with other forms of cancer. CONCLUSION: The study identifies MBO, gastric cancer, COVID-19, PPC, and VTE as potential risk factors for mortality in cases of intestinal obstruction. These findings highlight the necessity for continuous monitoring of indicators related to these mortality risk factors and their associated complications, thereby offering valuable insights for the management and treatment of intestinal obstruction.

The efficacy of sacubitril/valsartan in patients receiving peritoneal dialysis with diabetes and heart failure with preserved ejection fraction.

OBJECTIVE: To investigate the efficacy of sacubitril/valsartan in the treatment of peritoneal dialysis (PD) in patients with diabetes and heart failure with preserved ejection fraction (HFpEF). MATERIALS AND METHODS: Patients with diabetes who underwent PD and had HFpEF (n = 64) were divided into two groups: the experimental group (n = 31), which was administered sacubitril/valsartan, and the control group (n = 33), administered valsartan alone. Data were collected before and after treatment to compare the inter-group changes in cardiac function indexes, residual renal function (RRF), and PD adequacy indexes. RESULTS: Compared with the control group, the N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were lower in the experimental group after treatment (Wilcoxon test, p < 0.05). The descent ranges of NT-proBNP, left ventricular end-systolic dimension, and left ventricular fraction shortening, as well as increases in the amplitude of left ventricular ejection fraction after treatment were better in the experimental group than in the control group (t-test, p < 0.05). The descent ranges of residual renal glomerular filtration rate, residual renal Kt/Vurea, and residual renal creatinine clearance, as well as increases in the amplitude of ß2-microglobulin, were lower in the experimental group than in the control group (Wilcoxon test, p < 0.05). However, there were no significant differences between the two groups in the descent ranges of the PD adequacy indexes (Wilcoxon test, p > 0.05). Hyperkalemia occurred in 8 cases (25.81%) in the experimental group and 13 cases (39.39%) in the control group, while hypotension occurred in 2 cases (6.45%) and 1 case (3.03%), respectively. No other adverse effects were observed in either group. CONCLUSION: The findings suggest that sacubitril/valsartan can safely and effectively improve RRF and cardiac function in patients with diabetes combined with HFpEF receiving PD, but it has little effect on PD adequacy.

Asymmetric magma plumbing system beneath Axial Seamount based on full waveform inversion of seismic data.

The architecture of magma plumbing systems plays a fundamental role in volcano eruption and evolution. However, the precise configuration of crustal magma reservoirs and conduits responsible for supplying eruptions are difficult to explore across most active volcanic systems. Consequently, our understanding of their correlation with eruption dynamics is limited. Axial Seamount is an active submarine volcano located along the Juan de Fuca Ridge, with known eruptions in 1998, 2011, and 2015. Here we present high-resolution images of P-wave velocity, attenuation, and estimates of temperature and partial melt beneath the summit of Axial Seamount, derived from multi-parameter full waveform inversion of a 2D multi-channel seismic line. Multiple magma reservoirs, including a newly discovered western magma reservoir, are identified in the upper crust, with the maximum melt fraction of ~15-32% in the upper main magma reservoir (MMR) and lower fractions of 10% to 26% in other satellite reservoirs. In addition, a feeding conduit below the MMR with a melt fraction of ~4-11% and a low-velocity throat beneath the eastern caldera wall connecting the MMR roof with eruptive fissures are imaged. These findings delineate an asymmetric shallow plumbing system beneath Axial Seamount, providing insights into the magma pathways that fed recent eruptions.

Ensemble Learning with Supervised Methods Based on Large-Scale Protein Language Models for Protein Mutation Effects Prediction.

Machine learning has been increasingly utilized in the field of protein engineering, and research directed at predicting the effects of protein mutations has attracted increasing attention. Among them, so far, the best results have been achieved by related methods based on protein language models, which are trained on a large number of unlabeled protein sequences to capture the generally hidden evolutionary rules in protein sequences, and are therefore able to predict their fitness from protein sequences. Although numerous similar models and methods have been successfully employed in practical protein engineering processes, the majority of the studies have been limited to how to construct more complex language models to capture richer protein sequence feature information and utilize this feature information for unsupervised protein fitness prediction. There remains considerable untapped potential in these developed models, such as whether the prediction performance can be further improved by integrating different models to further improve the accuracy of prediction. Furthermore, how to utilize large-scale models for prediction methods of mutational effects on quantifiable properties of proteins due to the nonlinear relationship between protein fitness and the quantification of specific functionalities has yet to be explored thoroughly. In this study, we propose an ensemble learning approach for predicting mutational effects of proteins integrating protein sequence features extracted from multiple large protein language models, as well as evolutionarily coupled features extracted in homologous sequences, while comparing the differences between linear regression and deep learning models in mapping these features to quantifiable functional changes. We tested our approach on a dataset of 17 protein deep mutation scans and indicated that the integrated approach together with linear regression enables the models to have higher prediction accuracy and generalization. Moreover, we further illustrated the reliability of the integrated approach by exploring the differences in the predictive performance of the models across species and protein sequence lengths, as well as by visualizing clustering of ensemble and non-ensemble features.

Zinc ions and ciprofloxacin-encapsulated chitosan/poly(ɛ-caprolactone) composite nanofibers promote wound healing via enhanced antibacterial and immunomodulatory.

Antibacterial and anti-inflammatory nanofibrous membranes have attracted extensive attention, especially for the cutaneous wound treatment. In this study, zinc ions and ciprofloxacin-encapsulated chitosan/poly(ɛ-caprolactone) (CS/PCL) electrospun core-shell nanofibers were prepared by employing zinc ions-coordinated chitosan as the shell, and ciprofloxacin-functionalized PCL as the core. The morphology and core-shell structure of the as-prepared composite nanofibers were examined by SEM and TEM, respectively. The physical structure and mechanical property of the electrospun membrane were explored by FTIR, swelling, porosity and tensile test. Tensile strength of the zinc ions-coordinated CS/PCL composite nanofibers was enhanced to ca. 16 MPa. Meanwhile, the composite nanofibers can rapidly release of ciprofloxacin during 11 days and effectively suppress above 98 % of S. aureus proliferation. Moreover, the composite nanofibers exhibited excellent guide cell alignment and cyto-activity, as well as significantly down-regulated the inflammation factors, IL-6 and TNF-α in vitro. Animal experiments in vivo showed that the zinc ions-coordinated CS/PCL membrane by means of the synergistic effect of ciprofloxacin and active zinc ions, could significantly alleviate macrophage infiltration, promote collagen deposition and accelerate the healing process of wounds.

Climatic responses and variability in bark anatomical traits of 23 Picea species.

In woody plants, bark is an important protective tissue which can participate in photosynthesis, manage water loss, and transport assimilates. Studying the bark anatomical traits can provide insight into plant environmental adaptation strategies. However, a systematic understanding of the variability in bark anatomical traits and their drivers is lacking in woody plants. In this study, the bark anatomical traits of 23 Picea species were determined in a common garden experiment. We analyzed interspecific differences and interpreted the patterns in bark anatomical traits in relation to phylogenetic relationships and climatic factors of each species according to its global distribution. The results showed that there were interspecific differences in bark anatomical traits of Picea species. Phloem thickness was positively correlated with parenchyma cell size, possibly related to the roles of parenchyma cells in the radial transport of assimilates. Sieve cell size was negatively correlated with the radial diameter of resin ducts, and differences in sieve cells were possibly related to the formation and expansion of resin ducts. There were no significant phylogenetic signals for any bark anatomical trait, except the tangential diameter of resin ducts. Phloem thickness and parenchyma cell size were affected by temperature-related factors of their native range, while sieve cell size was influenced by precipitation-related factors. Bark anatomical traits were not significantly different under wet and dry climates. This study makes an important contribution to our understanding of variability in bark anatomical traits among Picea species and their ecological adaptations.

Malnutrition accelerates the occurrence of infectious complications in patients with chronic kidney disease: A cross-sectional survey of 682 patients with chronic kidney disease.

BACKGROUND: To investigate the influencing factors of infectious complications in patients with chronic kidney disease (CKD) and provide a basis for clinical diagnosis and prognosis evaluation of CKD. METHODS: A total of 682 patients with CKD were selected and divided into CKD stage 1-5 subgroups according to their glomerular filtration rate. Infectious complications, length of hospital stay, and total cost of hospitalization were recorded. The Global Leadership Initiative on Malnutrition (GLIM) diagnostic tool was used to assess the detection rate of malnutrition among patients. Univariate and multivariate analyses were performed in patients with and without infectious complications. RESULTS: The incidence rates of infectious complications in CKD stages 1-5 were 45.6%, 22.7%, 28.3%, 30.8%, and 40.4%, respectively. The overall detection rate of malnutrition among patients based on the GLIM criteria was 16.7%. The total detection rate of severe malnutrition was 14.2%, with all patients with severe malnutrition in CKD stages 3-5. The incidences of infectious complications in patients with and without malnutrition were 62.3% and 29%, respectively. Binary multivariate logistic regression analysis shows that malnutrition is a risk factor for infectious complications in patients with CKD, who are at 2.41 times higher risk than patients without malnutrition. There were significant differences in length of hospital stay and hospitalization costs between the patients with CKD with and without infectious complications (P < 0.01). CONCLUSION: Infectious complications are relatively common in patients with CKD. As CKD advances, the incidence of infectious complications increases. Moreover, malnutrition accelerates the occurrence of infectious complications in patients with CKD.

Changes in Soil Properties, Microbial Quantity and Enzyme Activities in Four Castanopsis hystrix Forest Types in Subtropical China.

It is well established that forest type can have a profound impact on soil physicochemical properties but the associated changes in soil microbial communities and the mechanisms by which soil quality is improved by various plantations are not fully understood. In this study, soil physicochemical properties and microbial and enzyme activities were investigated in four forest types-Castanopsis hystrix pure forests (CHPF), C. hystrix-Pinus elliottii mixed forests (CHPEF), C. hystrix-Michelia macclurei mixed forests (CHMMF), and C. hystrix-Mytilaria laosensis mixed forests (CHMLF) in the subtropical region of China. The purpose of this study was to assess the effects of afforestation types on characteristics of soil-its physical, chemical, and biological properties. The results showed that the contents of soil total organic carbon (TOC), soil total nitrogen (TN), microbial biomass carbon (MBC), and microbial biomass nitrogen (MBN) were significantly improved in both CHMMF and CHMLF mixed forest stands when compared to the CHPF pure stand. Soil enzyme activities were enhanced in the mixed forests. In particular, high phosphatase activity was observed in CHMLF stands, leading to the transformation of soil phosphorus to available phosphorus in this forest type. Our study demonstrated that the broad-leaved mixed forests, but not coniferous mixed forests, could significantly improve soil quality in the study region. Our research provides a scientific insight into the promotion of vegetation restoration and plantation forest management in plantation regions of subtropical areas.

Domain Adaptation Based on Semi-Supervised Cross-Domain Mean Discriminative Analysis and Kernel Transfer Extreme Learning Machine.

Good data feature representation and high precision classifiers are the key steps for pattern recognition. However, when the data distributions between testing samples and training samples do not match, the traditional feature extraction methods and classification models usually degrade. In this paper, we propose a domain adaptation approach to handle this problem. In our method, we first introduce cross-domain mean approximation (CDMA) into semi-supervised discriminative analysis (SDA) and design semi-supervised cross-domain mean discriminative analysis (SCDMDA) to extract shared features across domains. Secondly, a kernel extreme learning machine (KELM) is applied as a subsequent classifier for the classification task. Moreover, we design a cross-domain mean constraint term on the source domain into KELM and construct a kernel transfer extreme learning machine (KTELM) to further promote knowledge transfer. Finally, the experimental results from four real-world cross-domain visual datasets prove that the proposed method is more competitive than many other state-of-the-art methods.

Ginsenosides and Polysaccharides from Ginseng Co-Fermented with Multi-Enzyme-Coupling Probiotics Improve In Vivo Immunomodulatory Effects.

The active components of ginseng, such as ginsenosides and polysaccharides, have high therapeutic value in treating cancer, decreasing obesity, and enhancing immunity. However, simple primary ginseng treatment cannot maximize this medicinal potential. Therefore, in this study, Panax ginseng was co-fermented with multi-enzyme-coupling probiotics to obtain a fermentation broth with higher levels of ginsenosides, polysaccharides, and probiotics. When compared to other treatment methods for cyclophosphamide-induced immunosuppression in mice, the results reveal that the P. ginseng fermentation broth treated with multi-enzyme-coupling probiotics could significantly improve the immune function of immunosuppressive mice and restore intestinal flora stability. Overall, this processing method will provide a novel strategy for promoting the application of ginseng and the relief of immunosuppression.

Sensing prior constraints in deep neural networks for solving exploration geophysical problems.

One of the key objectives in geophysics is to characterize the subsurface through the process of analyzing and interpreting geophysical field data that are typically acquired at the surface. Data-driven deep learning methods have enormous potential for accelerating and simplifying the process but also face many challenges, including poor generalizability, weak interpretability, and physical inconsistency. We present three strategies for imposing domain knowledge constraints on deep neural networks (DNNs) to help address these challenges. The first strategy is to integrate constraints into data by generating synthetic training datasets through geological and geophysical forward modeling and properly encoding prior knowledge as part of the input fed into the DNNs. The second strategy is to design nontrainable custom layers of physical operators and preconditioners in the DNN architecture to modify or shape feature maps calculated within the network to make them consistent with the prior knowledge. The final strategy is to implement prior geological information and geophysical laws as regularization terms in loss functions for training the DNNs. We discuss the implementation of these strategies in detail and demonstrate their effectiveness by applying them to geophysical data processing, imaging, interpretation, and subsurface model building.

FABP4 Regulates Cell Proliferation, Stemness, Apoptosis, and Glycolysis in Colorectal Cancer via Modulating ROS/ERK/mTOR Pathway.

BACKGROUND: Colorectal cancer is a common digestive tract malignancy. This study aimed to expound the functional role of fatty-acid-binding protein 4 (FABP4) and the potential underlying mechanisms in the development of colorectal cancer. METHODS: Several techniques were utilized to investigate the role of FABP4 in colorectal cancer. FABP4 mRNA expression was quantified using Real time-quantitative PCR (RT-qPCR). Cell counting kit-8 (CCK-8), 5-ethynyl-2'-deoxyuridine (EdU), sphere formation assays and flow cytometry evaluated cell growth, stemness, and apoptosis in SW480 and HT29 cells. Glycolysis was assessed via extracellular acidification rate (ECAR) , lactate production, glucose uptake, adenosine triphosphate (ATP)/adenosine 5'-diphosphate (ADP) ratio, and Glut1 and Elevated lactate dehydrogenase A (LDHA) protein expression. Reactive oxygen species (ROS) levels were analyzed by flow cytometry. Western blot measured the protein expression of FABP4, Proliferating cell nuclear antigen (PCNA), Bax, Bcl-2, Glut1, LDHA, stemness makers (Sox2, Oct4, and ALDHA1), and extracellular regulated protein kinase (ERK)/mammalian target of rapamycin (mTOR) pathway proteins. In vivo experiments, BALB/c nude mice (n = 12) were inoculated with 200 µL HT29 cells (5 × 106 cells) transfected with sh-FABP4 or short hairpin (sh)-negative control (NC), forming two groups with 6 mice each. The in vivo mice tumor model allowed for evaluating FABP4's impact on tumor growth. RESULTS: FABP4 was significantly upregulated in colorectal cancer tissues and cells (p < 0.05). FABP4 knockdown markedly inhibited cell proliferation, stemness, and glycolysis, while promoting apoptosis in these cells (p < 0.05). Additionally, FABP4 depletion led to a significant increase in ROS level (p < 0.05). However, N-acetyl-L-cysteine (NAC) (p < 0.05), a ROS scavenger, mitigates these effects. Furthermore, the effects of FABP4 depletion on cell growth, stemness, glycolysis, and apoptosis in colorectal cancer cells were also retarded by NAC (p < 0.05). Notably, FABP4 knockdown also suppressed the ERK/mTOR pathway, suggesting its regulation via ROS (p < 0.05). In vivo study results showed, FABP4 depletion significantly curbed tumor growth in colorectal cancer (p < 0.05). CONCLUSIONS: These results suggest that FABP4 depletion inhibits colorectal cancer progression by modulating cell growth, stemness, glycolysis and apoptosis. This regulation occurs through the ROS/ERK/mTOR pathway.

Designing an Innovative Electrospinning Strategy to Generate PHBV Nanofiber Scaffolds with a Radially Oriented Fibrous Pattern.

Electrospinning has contributed substantially to the construction of nanofibrous scaffolds for potential tissue engineering and regenerative medicine applications. However, conventional electrospinning only has the ability to generate and collect nanofiber scaffolds with a randomly oriented fibrous pattern, which lack the necessary cell alignment guidance function. In this study, a novel electrospinning fiber-collecting device was designed and developed by setting a series of small pin-ring-structured collectors on a large plain plate. Specifically, we demonstrated that the pin-ring-structured collectors, which were constructed by inserting a metal pin into the center of a metal ring, could collect the as-electrospun nanofibers with radially oriented structures in an innovative manner. We first investigated the suitable polymeric concentration for electrospinning poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV), and the optimum electrospinning concentration of PHBV was found to be 12% (w/v) PHBV dissolved in hexafluoroisopropyl alcohol (HFIP). Then, 12% (w/v) PHBV solution was electrospun into radially oriented nanofiber scaffolds using our novel electrospinning strategy, and their various performances were further compared with conventionally randomly oriented nanofiber scaffolds that were also produced from 12% (w/v) PHBV solution. The results showed that the radially oriented PHBV nanofiber scaffolds exhibited obviously enhanced mechanical properties and decreased hydrophobicity compared with the randomly oriented PHBV nanofiber scaffold controls. Importantly, the biological properties of radially oriented PHBV nanofiber scaffolds were also demonstrated to be enhanced, compared with randomly oriented PHBV nanofiber scaffolds, by effectively inducing cell alignment and significantly promoting cell proliferation. In sum, the present study indicates that our as-prepared nanofiber scaffolds with a radially oriented pattern are of great interest for advanced applications, such as wound dressings and tissue-engineered scaffolds.

Curcumin Functionalized Electrospun Fibers with Efficient pH Real-Time Monitoring and Antibacterial and Anti-inflammatory Properties.

Wound infection has threatened the health of humans, and developing novel dressings by integrating infection detection and wound treatment in biomaterials is urgently required in the medical industry. In this study, we report a facile strategy to develop curcumin functionalized poly(ε-caprolactone) and gelatin composite fibrous membranes with pH real-time monitoring and antibacterial and anti-inflammatory properties. The developed curcumin-functionalized composite fibers displayed highly sensitive and visible response to the variation of the pH value of a buffer solution in the range of 5.6-8.6. In addition, the resultant fibrous membrane showed obviously enhanced antibacterial efficiency against both E. coli and S. aureus and no obvious cytotoxicity to human dermal fibroblasts when the curcumin content was less than 5 wt %. More importantly, 3 wt % curcumin-functionalized composite membrane exhibited excellent anti-inflammatory activities, good antioxidant activity of ca. 82%, and significantly decreased expression levels of pro-inflammatory cytokines like TNF-α and IL-6 in vitro (p < 0.001). Furthermore, subcutaneous embedding experiments showed that the 3 wt % curcumin-functionalized membrane significantly promoted cell penetration, recruited less macrophages, and facilitated collage deposition. Therefore, the curcumin-functionalized composite fibers could be employed to fabricate multifunctional dressings for the future treatment of chronic wounds.

Tannic acid-crosslinked O-carboxymethyl chitosan hydrogels for enhanced antibacterial activity and rapid hemostasis.

Bacterial infection and massive blood loss are major challenges for global public health. Herein, a series of tannic acid encapsulated O-carboxymethyl chitosan (CMC) based hydrogels were prepared using a facile approach for both hemorrhage control and effective anti-bacterium. The results indicated that the tannic acid-cosslinked CMC hydrogels had excellent mechanical property, swelling ability as well as great cytocompatibility. Comparably, with increasing tannic acid loading, the bleeding control and antibacterial performance against both E. coli and S. aureus were improved simultaneously, especially for the 5% tannic acid-cosslinked CMC hydrogel. Moreover, the prepared CMC hydrogel loading with tannic acid could induce hemocytes and platelets aggregation, promote the blood clotting and achieve bleeding control in vivo due to the interconnected fibrous web structure and the chemical activation (the phenol group of tannic acid). Thus, the resultant CMC hydrogel enabled the maintenance of high bioavailability of tannic acid and synchronization with the interconnected fibrous structure of CMC hydrogels, which was expected to be a promising candidate for robust and safe hemostatic dressings.

Prevalence and Management Recommendations for Disease-Related Malnutrition in Chronic Kidney Disease Patients with and without Diabetes.

Objective: To investigate the nutritional risk, malnutrition, severe malnutrition, and malnutrition prevalence of different stages in chronic kidney disease (CKD) patients with and without diabetes mellitus using the Global Leadership Initiative on Malnutrition (GLIM), and to analyze the causes of malnutrition and to improve the clinical outcomes of patients for early intervention. Methods: A total of 683 patients with CKD who were hospitalized in our hospital from January 2020 to January 2021 were enrolled and divided into subgroups 1 to 5 according to whether they were complicated with diabetes and glomerular filtration rate. Using the second step of the malnutrition (GLIM) diagnostic tool and 2 previously commonly used malnutrition assessment methods (body mass index <18.5 kg/m2 with poor general condition, 3 points for nutritional deficiency in nutritional risk screening), combined with clinical research on the main causes of malnutrition, the intervention measures were discussed. Results: The prevalence of malnutrition was 16.7% (114/683) in the patients included in the survey using the diagnostic criteria of malnutrition (GLIM) (excluding whole body muscle mass index). The prevalence of malnutrition in CKD patients with and without diabetes was 23.7% and 12.6%, respectively. The overall prevalence rate of severe malnutrition was 14.2%, and the prevalence rates of those with and without diabetes were 19.0% and 11.4%, respectively; the results of the two methods of malnutrition assessment showed that the prevalence of malnutrition in CKD patients with diabetes was higher than that in the uncombined group. There was no severe malnutrition in patients with CKD stages 1 and 2. From CKD stage 3 onwards, the severe malnutrition in the diabetic group was significantly higher than that in the uncombined group. Conclusion: With the progression of CKD, the incidence of malnutrition also gradually increased, indicating that malnutrition is related to primary diseases and concomitant diseases. Attention should be paid to the malnutrition of CKD patients with diabetes, and clinical medical staff need to pay early attention to various diseases that lead to the progression of CKD, such as diabetes, primary nephropathy, and other factors, to prevent complications and delay the progression of CKD.

The safety and urate-lowering efficacy of febuxostat in patients undergoing peritoneal dialysis: a retrospective single-arm cohort study of 84 patients.

BACKGROUND: Studies have shown that hyperuricemia (HUA) is an independent risk factor for all-cause death and residual kidney function loss in peritoneal dialysis (PD) patients. The control of blood uric acid (UA) is an important link to improve the prognosis of end-stage renal disease (ESRD). As a therapeutic drug for HUA, febuxostat is rarely studied in PD patients. The purpose of our study is to investigate the safety, efficacy, and effect on residual renal function (RRF) of febuxostat in patients undergoing PD. METHODS: This is a retrospective single-arm cohort study. During the study period which from September 2016 to November 2020, 191 patients underwent PD at this hospital. Among these patients, 84 were administrated for over a period of 3 months and were eventually included. These 84 patients (51 males and 33 females; average age: 55.18 years) were undergoing PD complicated with HUA or gout who received febuxostat during a regular follow-up from January 2018 to November 2020. Serum UA (sUA) levels, blood routine, liver function, and RRF were compared before and after febuxostat administration. Adverse events (AEs) resulting from febuxostat treatment were collected from medical records. RESULTS: All 84 patients were administered febuxostat for over 3 months, including 39 for over 6 months and 26 for over 12 months. Some 60 patients were treated with febuxostat dose of 20 mg/day and the remaining 24 patients received 40 mg/day. Compared with pretreatment level, the mean sUA level was observed to be markedly reduced at 1 month after febuxostat administration (320.2±87.27 vs. 498.8±81.47 µmol/L, P<0.0001) and at 3 months (291.6±82.66 vs. 498.8±81.47 µmol/L, P<0.0001) and subsequently remained at a significantly low level for 12 months. Only 5 patients stopped febuxostat because of its associated AEs. An initial dose of 40 mg/day was associated with a higher rate of AEs compared with dose of 20 mg/day (25% vs. 18.33%, respectively). After febuxostat treatment, no significant differences were observed between RRF in the two groups. CONCLUSIONS: Febuxostat may be safe and efficient in patients undergoing PD and may not impair RRF. Febuxostat administration at dose of 20 mg/day may be an appropriate dose for patients undergoing PD.