Characteristics of deceleration capacity and deceleration runs in vasovagal syncope.

PURPOSE: Increased vagal activity plays a prominent role in vasovagal syncope (VVS). The aim of this study was to characterize vagal function in VVS by evaluating the heart rate (HR) deceleration capacity (DC) and the HR deceleration runs (DRs) in patients with VVS between attacks. METHODS: A total of 188 consecutive VVS patients were enrolled in the study, of whom 129 had positive head-up tilt test (HUTT); 132 healthy participants were enrolled as controls. DC, DRs (DR2, i.e., episodes of 2 consecutive beat-to-beat HR decelerations), and the sum of DR8-10 (very long DR [VLDR]) were calculated using 24-h electrograms. Clinical characteristics, DC, and DRs were compared among syncope groups and controls. RESULTS: Patients with VVS had higher DC (10.63 ± 2.1 vs. 6.58 ± 1.7 ms; P < 0.001) and lower minimum HR and DR6-10 than controls. No significant differences in DC or DR6-10 were found between the patients with positive and those with negative HUTT results. In multivariate logistic regression analysis, minimum HR ≥ 40 bpm (odds ratio [OR] 0.408, 95% confidence interval [CI] 0.167-0.989; P = 0.048), daytime DC ≥ 7.37 ms (OR 3.040, 95% CI 1.220-7.576; P = 0.013), and VLDR ≥ 0.046% (OR 0.306, 95% CI 0.138-0.679; P = 0.004) were demonstrated to be risk factors significantly associated with VVS. CONCLUSION: Compared to healthy controls, patients with VVS demonstrated distinct HR deceleration profiles between attacks, including overall higher DC and lower DR6-10.

Modelling the capacitance of the elongated plasma in tokamak.

The capacitance model suitable for the non-circular cross-section plasma is studied based on the capacitance model of the circular cross-section plasma. The coaxial elliptic-torus capacitor property is further derived and used to determine the capacity of non-circular cross-section tokamak plasma, such as EAST (Experimental Advanced Superconducting Tokamak). By testing all the physical terms in this model, we find that the capacitance [Formula: see text]) is increasing exponentially with the increase of elongation ratio (k2/k1), while the minor radius ratio (a2/a1) is just reversed at the flat-top of plasma current, and the capacitance property is implicitly included in the H-mode study during the L-H transition. It is noted that Cp-H mode is the least and Cp-I mode is approximately equal to Cp-L mode under the L-mode, I-mode and H-mode regimes based on this capacitance model in EAST. Consequently, it may be integrated into an equivalent circuit of the tokamak transformer or transport computer code of the edge plasma for use in precise simulations of fusion plasma behavior in the future, such as ITER (International Tokamak Experimental Reactor) or BEST (Burning-plasma Experimental Superconducting Tokamak) in China.

Reversible Adhesive Bio-Toe with Hierarchical Structure Inspired by Gecko.

The agile locomotion of adhesive animals is mainly attributed to their sophisticated hierarchical feet and reversible adhesion motility. Their structure-function relationship is an urgent issue to be solved to understand biologic adhesive systems and the design of bionic applications. In this study, the reversible adhesion/release behavior and structural properties of gecko toes were investigated, and a hierarchical adhesive bionic toe (bio-toe) consisting of an upper elastic actuator as the supporting/driving layer and lower bionic lamellae (bio-lamellae) as the adhesive layer was designed, which can adhere to and release from targets reversibly when driven by bi-directional pressure. A mathematical model of the nonlinear deformation and a finite element model of the adhesive contact of the bio-toe were developed. Meanwhile, combined with experimental tests, the effects of the structure and actuation on the adhesive behavior and mechanical properties of the bio-toe were investigated. The research found that (1) the bending curvature of the bio-toe, which is approximately linear with pressure, enables the bio-toe to adapt to a wide range of objects controllably; (2) the tabular bio-lamella could achieve a contact rate of 60% with a low squeeze contact of less than 0.5 N despite a ±10° tilt in contact posture; (3) the upward bending of the bio-toe under negative pressure provided sufficient rebounding force for a 100% success rate of release; (4) the ratio of shear adhesion force to preload of the bio-toe with tabular bio-lamellae reaches approximately 12, which is higher than that of most existing adhesion units and frictional gripping units. The bio-toe shows good adaptability, load capacity, and reversibility of adhesion when applied as the basic adhesive unit in a robot gripper and wall-climbing robot. Finally, the proposed reversible adhesive bio-toe with a hierarchical structure has great potential for application in space, defense, industry, and daily life.

Gene Regulation during Carapacial Ridge Development of Mauremys reevesii: The Development of Carapacial Ridge, Ribs and Scutes.

The unique topological structure of a turtle shell, including the special ribs-scapula relationship, is an evolutionarily novelty of amniotes. The carapacial ridge is a key embryonic tissue for inducing turtle carapace morphologenesis. However, the gene expression profiles and molecular regulatory mechanisms that occur during carapacial ridge development, including the regulation mechanism of rib axis arrest, the development mechanism of the carapacial ridge, and the differentiation between soft-shell turtles and hard-shell turtles, are not fully understood. In this study, we obtained genome-wide gene expression profiles during the carapacial ridge development of Mauremys reevesii using RNA-sequencing by using carapacial ridge tissues from stage 14, 15 and 16 turtle embryos. In addition, a differentially expressed genes (DEGs) analysis and a gene set enrichment analysis (GSEA) of three comparison groups were performed. Furthermore, a Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis was used to analyze the pathway enrichment of the differentially expressed genes of the three comparative groups. The result displayed that the Wnt signaling pathway was substantially enriched in the CrTK14 vs. the CrTK15 comparison group, while the Hedgehog signaling pathway was significantly enriched in the CrTK15 vs. the CrTK16 group. Moreover, the regulatory network of the Wnt signaling pathway showed that Wnt signaling pathways might interact with Fgfs, Bmps, and Shh to form a regulatory network to regulate the carapacial ridge development. Next, WGCNA was used to cluster and analyze the expression genes during the carapacial ridge development of M. reevesii and P. sinensis. Further, a KEGG functional enrichment analysis of the carapacial ridge correlation gene modules was performed. Interesting, these results indicated that the Wnt signaling pathway and the MAPK signaling pathway were significantly enriched in the gene modules that were highly correlated with the stage 14 and stage 15 carapacial ridge samples of the two species. The Hedgehog signaling pathway was significantly enriched in the modules that were strongly correlated with the stage 16 carapacial ridge samples of M. reevesii, however, the PI3K-Akt signaling and the TGF-ß signaling pathways were significantly enriched in the modules that were strongly correlated with the stage 16 carapacial ridge samples of P. sinensis. Furthermore, we found that those modules that were strongly correlated with the stage 14 carapacial ridge samples of M. reevesii and P. sinensis contained Wnts and Lef1. While the navajo white 3 module which was strongly correlated with the stage 16 carapacial ridge samples of M. reevesii contained Shh and Ptchs. The dark green module strongly correlated with the stage 16 carapacial ridge samples of P. sinensis which contained Col1a1, Col1a2, and Itga8. Consequently, this study systematically revealed the signaling pathways and genes that regulate the carapacial ridge development of M. reevesii and P. sinensis, which provides new insights for revealing the molecular mechanism that is underlying the turtle's body structure.

Effect of the Structural Characteristics on Attachment-Detachment Mechanics of a Rigid-Flexible Coupling Adhesive Unit.

The terminal toes of adhesive animals are characterized by rigid-flexible coupling, and their structure-function relationship is an urgent problem to be solved in understanding bioinspired adhesive systems and the design of biomimetic adhesive units. In this paper, inspired by the rigid-flexible coupling adhesive system of the gecko toe, a rigid-flexible coupling adhesive unit was designed, the interface strength of the adhesives under different preloads was tested, and the model and analysis method of the compression and peeling process of the rigid-flexible coupling adhesive unit was established. Meanwhile, combined with the experimental test, the effect of the coupling mechanism of the rigid-flexible structure on the interfacial stress and the final peeling force during the compression and peeling process of the adhesive unit was studied. The research found that the length of the adhesive unit L has no apparent effect on the normal peel force of the system within a specific range, and the normal peeling force increases linearly with the increase in the compression force P; while the influence of the inclination angle θ0 of the adhesive unit and the thickness of the rigid backing layer hb on the final normal peeling force of the system presents nonlinear characteristics, when the inclination angle θ0 of the adhesive unit is 5°, and the thickness of the rigid backing layer hb is 0.2 mm or 0.3 mm, the normal peel force and the ratio of adhesion force to preload the system reaches its maximum value. Compared with the flexible adhesive unit, the compressed zone formed by the rigid-flexible coupling adhesive unit during the same compression process increased by 6.7 times, while under the same peeling force, the peel zone increased by 8 times, and the maximum normal tensile stress at the peeling end decreased by 20 times. The rigid-flexible coupling mechanics improves the uniformity of the contact stress during the compression and peeling process. The research results provide guidelines for the design of the rigid-flexible coupling adhesive unit, further providing the end effector of the bionic wall-climbing robot with a rigid-flexible coupled bionic design.

Incline-dependent adjustments of toes in geckos inspire functional strategies for biomimetic manipulators.

Geckos show versatility by rapidly maneuvering on diverse complex terrain because they benefit from their distributed, setae-covered toes and thus have the ability to generate reliable and adaptive attachment. Significant attention has been paid to their adhesive microstructures (setae), but the effectiveness of the gecko's adaptive attachment at the level of toes and feet remains unclear. In order to better understand the geckos' attachment, we first focused on the deployment of toes while challenging geckos to locomote on varying inclines. When the slope angle was less than 30°, their feet mainly interacted with the substrate using the bases of the toes and generated anisotropic frictional forces. As the slope angle increased to 90°, the participation of the toe bases was reduced. Instead, the setae contribution increased for the middle three toes of the front feet and for the first three toes of the hind feet. As the incline changed from vertical to inverted, the adhesive contribution of the toes of the front feet became more equal, whereas the effective adhesion contact of the hind feet gradually shifted to the toes oriented rearwards. Second, a mathematical model was established and then suggested the potential advantages of distributed control among the toes to regulate foot force. Finally, a physical foot model containing five compliant, adjustable toes was constructed and validated the discoveries with regard to the animals. Using the gecko toes' control strategies, the artificial foot demonstrated diverse behavior regulating attachment forces. The success of the foot prototype not only tested our understanding of the mechanism of biological attachment, but also provided a demonstration for the design and control of gecko-inspired attachment devices, grippers and other manipulators.

Circadian Misalignment Rather Than Sleep Duration is Associated with MAFLD: A Population-Based Propensity Score-Matched Study.

BACKGROUND AND AIMS: Circadian misalignment (CM) leads to metabolic disorder. Metabolic (dysfunction) associated fatty liver disease (MAFLD) is a novel definition for fatty liver disease that requires the presence of metabolic dysfunction. As the association between CM and MAFLD remains unclear, this study is designed to explore whether there is an association between CM and MAFLD. METHODS: NHANES 2017-2018 database was used in this study. Liver steatosis and fibrosis were diagnosed by Fibroscan®. CM was defined by the presence of mistimed sleep, late sleep or irregular chronotype. Propensity score matching (PSM) was used to match subjects for their age and gender. RESULTS: A total of 4552 participants were included in the study, with 2089 (45.89%) identified as MAFLD and 894 (19.64%) as CM. Participants with CM were significantly younger than those without (46.06 ± 18.06 vs 50.93 ± 17.78, p<0.001). PSM for age and gender resulted in 894 participants with CM and 892 with non-CM. CM group had higher body mass index, liver enzymes, glucose and lipid levels. The prevalence of MAFLD was higher in the CM group than the non-CM group (45.41% vs 28.48%, p<0.001). The presence of CM increased the risk of MAFLD by more than twofold. Short sleep duration (<6 hours) was not independently associated with MAFLD or fibrosis if additionally adjusting for CM. CONCLUSION: CM is independently associated with MAFLD, while short sleep duration (<6 hours) is not an independent risk factor for MAFLD or liver fibrosis after adjusting for CM.

Lymphopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A systemic review and meta-analysis.

OBJECTIVES: Coronavirus Disease 2019 (COVID-19) is a new respiratory and systemic disease which needs quick identification of potential critical patients. This meta-analysis aimed to explore the relationship between lymphocyte count and the severity of COVID-19. METHODS: A comprehensive systematic literature search was carried out to find studies published from December 2019 to 22 March 2020 from five databases. The language of literatures included English and Chinese. Mean difference (MD) of lymphocyte count in COVID-19 patients with or without severe disease and odds ratio (OR) of lymphopenia for severe form of COVID-19 was evaluated with this meta-analysis. RESULTS: Overall 13 case-series with a total of 2282 cases were included in the study. The pooled analysis showed that lymphocyte count was significantly lower in severe COVID-19 patients (MD -0.31×109/L; 95%CI: -0.42 to -0.19×109/L). The presence of lymphopenia was associated with nearly threefold increased risk of severe COVID-19 (Random effects model, OR=2.99, 95% CI: 1.31-6.82). CONCLUSIONS: Lymphopenia is a prominent part of severe COVID-19 and a lymphocyte count of less than 1.5×109/L may be useful in predicting the severity clinical outcomes.

[Predictive factors of left ventricular reverse remodeling in patients with idiopathic or secondary dilated cardiomyopathy].

OBJECTIVE: To investigate the occurrence of left ventricular reverse remodeling (LVRR) and its predictive factors in patients with idiopathic or secondary dilated cardiomyopathy (DCM). METHODS: A cross-sectional survey was conducted in a consecutive cohort of patients with DCM admitted in our department between January, 2012 and June, 2016. Based on dynamic echocardiographic findings, LVRR was defined as an absolute increase in left ventricular ejection fraction (LVEF) by ≥100% or an absolute value of LVEF ≥45% with simultaneously an absolute decrease in end-diastolic diameter (LVEDD) ≥10 mm or an absolute value of LVEDD ≤55 mm (in men) or ≤50 mm (in women). The patients with LVRR and those without LVRR were compared for clinical data at admission to identify the potential factors for predicting LVRR. RESULTS: A total of 462 patients, who were followed up for 24.13±15.60 months, were included in this survey. In patients with idiopathic DCM who had LVRR, LVEDD was reduced (P < 0.01), LVEF was improved (P < 0.01) and the mean exercise tolerance was increased significantly (P < 0.01) compared with those in patients without LVRR. Multiple logistic regression analysis showed that a shorter course of heart failure (OR=0.913, P < 0.01), a high systolic blood pressure (OR=1.062, P < 0.01), absence of electrolyte imbalance (OR=0.347, P < 0.01), a low red cell distribution width (OR=0.205, P < 0.01), a smaller LVEDD (OR=0.799, P < 0.01) and a greater LVEF (OR= 1.142, P < 0.01) were independent predictors of LVRR in the idiopathic patients. In patients with secondary DCM, LVEDD was reduced (P < 0.01), LVEF was improved (P < 0.01), and the mean exercise tolerance was increased significantly (P < 0.01) compared with those in patients without LVRR. Multiple logistic regression analysis showed that a shorter course of heart failure (OR= 0.954, P < 0.01), a low red cell distribution width (OR=1.011, P < 0.01), and implementation of etiological treatment (OR=1.073, P < 0.01) were independent predictors of LVRR in patients with secondary DCM. CONCLUSIONS: The exercise tolerance, cardiac structure and function can be reversed in some of the patients with idiopathic or secondary DCM by administration of standard therapy for heart failure and etiological treatment.

Antiviral Therapy in Chronic Hepatitis B With Mild Acute Exacerbation.

BACKGROUND: The aim of this study was to assess the efficacy and safety of peginterferon α-2a (pegIFN) and nucleos(t)ide analogues (NA) treatments in patients with hepatitis B envelope antigen (HBeAg)-positive chronic hepatitis B (CHB) with mild acute exacerbation (AE). METHODS: Treatment-naive HBeAg-positive CHB patients with AE who received pegIFN or NA (entecavir (ETV) or telbivudine (LDT)) therapies were retrospectively selected. The HBeAg seroconversion rate, hepatitis B surface antigen (HBsAg) loss rate and the cost-effectiveness of different treatments were compared. RESULTS: A total of 63 patients with pegIFN therapy and 78 with NA (38 with ETV and 40 with LDT) therapy were included. The HBsAg loss rate was significantly higher in the pegIFN group when compared with the NA group (on week 96: 9/63 (14.29%) vs. 1/78 (1.28%), P = 0.005). No significant difference in hepatitis B virus (HBV) DNA negativity or the HBeAg/HBsAg seroconversion rate was found between ETV and LDT group. One year of pegIFN therapy resulted in 18.56 quality-adjusted life years (QALYs) per patient, and the incremental cost per additional QALY gained was $3,709. CONCLUSIONS: PegIFN therapy is safe in HBeAg-positive CHB patients with mild AE, as it results in a higher HBsAg loss rate and longer QALYs than NA therapy.

Hemorrhagic Complications Following Abdominal Paracentesis in Acute on Chronic Liver Failure: A Propensity Score Analysis.

ABSTARCT: Patients with acute on chronic liver failure (ACLF) usually present with severe coagulopathy. Abdominal paracentesis is often performed in these patients. The aim of this study was to analyze the prevalence of hemorrhagic events after paracentesis and the predictive factors of this condition in ACLF populations.ACLF patients who underwent paracentesis were retrospectively enrolled within a 5-year period. A propensity score (PS) matching analysis was used to select matched cases from the overall nonhemorrhagic group to be used as the control group. Hemorrhagic complications and risk factors were examined using logistic regression analysis.A total of 602 abdominal paracenteses were carried out on 218 ACLF patients and 18 (2.99%) hemorrhagic complications were identified. The MELD scores were higher in hemorrhagic patients than overall patients before PS matching (25.77±6.65 vs 21.04 ±â€Š7.93, P = 0.013). We matched 18 cases with bleeding events to 72 unique cases without. The hemorrhagic group had significantly lower fibrinogen levels and higher PT levels than nonhemorrhagic cases. Logistic regression analysis revealed that lower fibrinogen levels could independently predict hemorrhagic complications (OR: 0.128, 95% CI: 0.023-0.697, P = 0.017). The best cut-off value for reliable measurement of fibrinogen levels was 0.70 g/L, with a sensitivity of 76.4% and a specificity of 80.0%. The area under curve was 0.733 (95% CI 0.604-0.862, P value 0.002).Severe hemorrhagic complications occur more commonly in ALCF patients than previously thought. A low fibrinogen level is an independent predictor of bleeding events in patients with MELD >25.

Interleukin-6 as an early diagnostic marker for bacterial sepsis in patients with liver cirrhosis.

OBJECTIVE: Liver cirrhosis is associated with frequent bacterial infections that increase the mortality rate. However, the early diagnosis and treatment of these infections are often difficult. In this retrospective-prospective observational study, the serum levels of interleukin-6 (IL-6) and procalcitonin (PCT) were measured in 233 cirrhotic patients to evaluate the early diagnostic and prognostic values of IL-6 and PCT for cirrhotic patients. METHODS: Cirrhotic patients admitted to the Liver Research Center of the First Affiliated Hospital of Fujian Medical University between 1 October 2012 and 30 June 2014 were enrolled. They showed no evidence of infection on admission, and all had first onset of fever and met the systemic inflammatory response syndrome criteria 72 hours after admission. The serum IL-6 and PCT levels were determined on admission, at the onset of fever (0 hour) and 24 and 48 hours after fever onset. RESULTS: A total of 233 cirrhotic patients, including 183 men and 50 women, with a median age of 56 (46-65) years were enrolled. A training group of 159 patients was retrospectively enrolled from 1 October 2012 to 31 December 2013, and a validation group of 74 patients was prospectively enrolled from 1 January 2014 to 30 June 2014. Among these patients, 134 were diagnosed with bacterial sepsis, 96 of whom were in the training group and 38 of whom were in the validation group; infections were ultimately ruled out in 99 patients: 63 training patients and 36 validation patients. At 0 hour, the IL-6 and PCT levels as well as the proportion of neutrophils were much higher in septic patients than in nonseptic ones. The IL-6 level and proportion of neutrophils peaked upon the onset of fever, 24 hours before the PCT levels and white blood cell count, and then sharply declined. The area under the receiver operating characteristic curve of IL-6 for diagnosing sepsis was largest at the onset of fever (area under the receiver operating characteristic curve, 0.983; 95% confidence interval, 0.967-0.999). The threshold of IL-6 for diagnosis was 135 pg/mL, with a sensitivity of 94.8% and a specificity of 93.7%. These diagnostic values were also confirmed in the validation group, with a sensitivity of 97.4% and specificity of 80.6%. Eleven (11.5%) patients died, and 85 (88.5%) patients recovered in the sepsis group of training patients after a 4-week follow-up. The IL-6 level was significantly higher in the nonsurvival group than that in the survival group (1813.00 vs 472.10 pg/mL, P = .004) at the onset of sepsis. The cutoff value for predicting prognosis was 1105 pg/mL, with a sensitivity of 81.8% and a specificity of 76.5%. CONCLUSIONS: The serum IL-6 levels increased earlier than the PCT in septic cirrhotic patients. The direct measurement of the serum IL-6 level can help to rapidly detect bacterial infection, thus allowing for early therapeutic decisions and prognostic predictions.

The association of four common polymorphisms from four candidate genes (COX-1, COX-2, ITGA2B, ITGA2) with aspirin insensitivity: a meta-analysis.

OBJECTIVE: Evidence is mounting suggesting that a strong genetic component underlies aspirin insensitivity. To generate more information, we aimed to evaluate the association of four common polymorphisms (rs3842787, rs20417, rs201184269, rs1126643) from four candidate genes (COX-1, COX-2, ITGA2B, ITGA2) with aspirin insensitivity via a meta-analysis. METHODS AND RESULTS: In total, there were 4 (353/595), 6 (344/698), 10 (588/878) and 7 (209/676) articles (patients/controls) qualified for rs3842787, rs20417, rs20118426 and rs1126643, respectively. The data were extracted in duplicate and analyzed by STATA software (Version 11.2). The risk estimate was expressed as odds ratio (OR) and 95% confidence interval (95% CI). Analyses of the full data set indicated significant associations of rs20417 (OR; 95% CI; P: 1.86; 1.44-2.41; <0.0005) and rs1126643 (2.37; 1.44-3.89; 0.001) with aspirin insensitivity under allelic model. In subgroup analyses, the risk estimate for rs1126643 was greatly potentiated among patients with aspirin semi-resistance relative to those with aspirin resistance, especially under dominant model (aspirin semi-resistance: 5.44; 1.42-20.83; 0.013 versus aspirin resistance: 1.96; 1.07-3.6; 0.03). Further grouping articles by ethnicity observed a stronger prediction of all, but rs20417, examined polymorphisms for aspirin insensitivity in Chinese than in Caucasians. Finally, meta-regression analyses observed that the differences in percentage of coronary artery disease (P = 0.034) and averaged platelet numbers (P = 0.012) between two groups explained a large part of heterogeneity for rs20417 and rs1126643, respectively. CONCLUSION: Our findings provide strong evidence that COX-2 and ITGA2 genetic defects might increase the risk of having aspirin insensitivity, especially for aspirin semi-resistance and in Chinese populations.

A study of multiple biliary hamartomas based on 1697 liver biopsies.

OBJECTIVE: Multiple biliary hamartomas (MBHs) are rare benign malformations of the intrahepatic bile ducts. There are only a handful of clinical studies based on large populations on the incidence of MBHs. MATERIALS AND METHODS: A series of 1697 consecutive liver needle biopsies was examined for the occurrence of MBHs. RESULTS: A total of six patients (0.35%, four men and two women, a 2 : 1 ratio) were confirmed by histology to have MBHs. Of the total of 1697 patients, 59 (3.5%) patients were younger than 18 years of age, 828 patients (48.8%) were between 18 and 38 years of age, and 810 patients (47.7%) were older than 38 years of age. Of the six MBHs patients, one was 17 years of age and the other five patients were older than 39 years of age. The median (range) age of the patients was 42 (17-63) years. Although nearly half (48.8%) of the biopsied patients were between 18 and 38 years of age, no MBH was found in this group. All MBHs patients were diagnosed with fibrosis/cirrhosis by initial ultrasound scanning; however, only two patients were confirmed to have cirrhosis by histological examination. Of those two patients with cirrhosis, one had concomitant congenital hepatic fibrosis and the other had concomitant cirrhotic hepatitis B. The latter patient developed hepatocellular carcinoma 1 year after biopsy. No kidney cysts were found in any of the six MBHs patients. MRI scanning was performed in four patients and the results were consistent with the histological diagnosis. CONCLUSION: MBHs are not common in patients who undergo liver biopsy and, in this study, the occurrence was higher in the older age group.

[Effects of fosinopril on proliferation and secretion of extracellular matrix of rat glomerular mesangial cell].

OBJECTIVE: To observe the effects of fosinopril (FOS) on proliferation and secretion of extracellular matrix of rat glomerular mesangial cell induced by LPS. METHODS: In vitro culture method for glomerular mesangial cells (GMC) of rat was established and passages 3 - 10 of the cells were used in the experiment after identification. The experiment included the following 5 groups: control group (Ctrl), LPS group (LPS), high, medium and low dose FOS groups (FOS1, FOS2 and FOS3 groups, respectively). GMC proliferation was detected by methyl thiazolyl tetrazolium (MTT) incorporation method at 24 and 48 h; the changes of laminin (LN), fibronectin (FN) and ColIV protein secretion was detected by the enzyme-linked immunosorbent assay (ELISA). The changes of LNbeta(2) mRNA expression was detected by semi-quantitative real-time RT-PCR. RESULTS: (1) LPS could induce the mesangial cell proliferation, FOS inhibited this effect of proliferation induced by LPS. (2) Mesangial cells could secrete some extracellular matrix (ECM) protein in normal culture medium, mesangial cell secreted ECM protein was significantly higher in LPS group than that in Ctrl group (P < 0.01), but significantly lower in all FOS groups than that in LPS group (P < 0.01). (3) Mesangial cell could express LNbeta(2) mRNA in normal culture medium, LNbeta(2) mRNA expression was significantly higher in LPS group than that in Ctrl group at all time points, but was significantly lower in FOS group than that in LPS group. CONCLUSIONS: LPS could induce increased secretion of the ECM, including LN, FN, ColIV; FOS could inhibit the secretion of ECM in GMC in a dose-dependent manner at mRNA and protein levels.

[Therapeutic effect of Ginkgo biloba leaf extract on hypercholestrolemia in children with nephrotic syndrome].

OBJECTIVE: To explore the therapeutic effects of the extract of Ginkgo biloba leaf on hypercholestrolemia in children with primary nephritic syndrome (NS). METHODS: Thirty-five children with NS were randomized into 2 groups for treatment with prednisone plus Ginkgo biloba leaf extract (18 cases) or with prednisone plus dipyridamole (17 cases) for 8 weeks. After completion of the treatments, the therapeutic effects were evaluated and the changes in the blood biochemical markers assayed. RESULTS: The 8-week treatment with the extract significantly ameliorated the clinical symptoms and blood biochemistry as compared with prednisone plus dipyridamole group (P<0.01). The levels of urinic protein and blood lipid in Ginkgo leaf group were significantly lower than those in prednisome plus dipyridamole group (P<0.05). CONCLUSION: The extract from Ginkgo biloba leaf can lower blood lipid levels and urinic protein in children with NS and improve their clinical syptoms and the renal function, therefore has much clinical value as an adjuvant treatment of steroid therapy in such children.

[Change of transforming growth factor beta in peripheral blood mononuclear cell of children with nephrotic syndrome and its significance].

OBJECTIVE: Idiopathic nephrotic syndrome (INS) is a common glomerular disease. The pathogenesis of the disease remains unclear. Recent studies indicate that transforming growth factor beta (TGF beta) is the main cytokine involved in glomerular disease. It plays an important role in the development of INS and in occurrence of glomerulosclerosis. The present study aimed to study changes and significance of TGF beta in children with idiopathic nephrotic syndrome (INS). METHODS: Totally 35 cases with INS (13 males, 22 females) were studied. The age of onset was between 2 years and 1 months and 14 years with an average of 8 years and 3 months. The active stage group had 35 cases and the remission stage groups had 25 cases. The cases in active stage group had first onset of the disease with obvious clinical symptoms and abnormal laboratory findings without use of corticosteroids. The cases in remission stage group were asymptomatic without abnormal laboratory findings. Protein in urine was negative over 4 weeks after oral administration of prednisone for 8 weeks. Twenty five cases were steroid responsive and 10 cases were steroid non-responsive among the 35 cases. Thirty healthy young children were enrolled as control. TGF beta was detected by ELISA in peripheral blood mononuclear cell (PBMC) culture medium. The TGF beta mRNA gene expression was measured by in situ PCR in PBMC. RESULTS: (1) Concentration of TGF beta(247 +/- 26) ng/L and TGF beta mRNA expression (0.57 +/- 0.18) in active stage of simple type or nephritis type INS were higher than those of remission stage and control (P < 0.01). Concentration of TGF beta[(125 +/- 16) ng/L] and TGF beta mRNA expression (0.30 +/- 0.12) in remission stage were higher than that of control (P < 0.05). (2) The level of TGF beta protein in nephritis type [(275 +/- 26) ng/L] was significantly higher than that in simple type [(220 +/- 18) ng/L] in active stage INS (t = 6.45, P < 0.01). No significant difference in TGF beta mRNA expression was found between the nephritis type (0.58 +/- 0.15) and simple type (0.55 +/- 0.16) in active stage INS, either (P > 0.05). But these two types were different from the control (P < 0.01). (3) Concentration of TGF beta and TGF beta mRNA expression after therapy was clearly lower than that before therapy in steroid responsive group (P < 0.01). Whereas no significant change was seen in steroid non-responsive group. Both indicators were higher in steroid non-responsive group than in steroid responsive group whether before or after therapy. CONCLUSION: TGF beta may play an important role in the mechanism of INS and its level in PBMC can be used as an immunological indicator for the illness state, therefore, determination of TGF beta level and mRNA may be of some clinical significance.