Functions of Epimedin C in a zebrafish model of glucocorticoid-induced osteoporosis.

Epimedium is thought to enhance the integrity of tendons and bones, ease joint discomfort and rigidity and enhance kidney function. Although glucocorticoids are commonly used in clinical practice, the mechanism by which the active compound Epimedin C (EC) alleviates glucocorticoid-induced osteoporosis (GIOP) is not well understood. The therapeutic potential of EC in treating GIOP was evaluated using alizarin red S staining, calcein immersion and fluorescence imaging, and bone mineralization, bone mass accumulation and bone density in zebrafish larvae were determined. Using the Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis, the key signalling pathways related to bone development were identified. A protein-protein interaction network (PPIN) was constructed to identify osteoclast characteristic genes and the findings were verified using real-time quantitative PCR (RT-qPCR). The bone tissue damage caused by prednisolone was reduced by EC. It also altered physiological processes, improved bone density, boosted mineralization and increased bone mass and activity. Subsequent empirical investigations showed that EC impacted the major signalling pathways involved in bone development, such as osteoclast differentiation, oestrogen, MAPK, insulin resistance, PPAR and AMPK signalling pathways. It also decreased the expression of genes typical of osteoclasts. The results of our study uncover a previously unknown function of EC in controlling bone formation and emphasize the potential of EC as a therapeutic target. The osteoprotective effect of EC indicates its potential as a cost-effective strategy for treating GIOP.

Climate Change Drove the Decline in Yangtze Estuary Net Primary Production Over the Past Two Decades.

Net primary productivity (NPP) is highly sensitive to multiple stressors under progressive and intensifying climate change and anthropogenic impacts. The importance of understanding spatiotemporal distribution patterns and the associated driving factors that govern estuary NPP is paramount for regional carbon (C) budget assessments. Using a combined remote sensing and machine learning (ML) approach, the average NPP of the Yangtze Estuarine-offshore continuum (YEOC) was measured at 273.19 ± 21.26 mgC m-2 day-1 over the past two decades. Temporally, NPP exhibited a significant downward trend between 2002 and 2022. Climate factors (climate fluctuations, sea level rise, and discharge) drove phytoplankton biomass (Chl-a) while light conditions (PAR and Kd490) affected photosynthesis rates. Together, they can explain 65% of the NPP variation. Anthropogenic disturbances (i.e., damming and nutrient emissions) were not significant. Additionally, changes in NPP decreased phytoplankton C sequestration rates from 11.9 to 10.4 Tg C year-1, reducing the estuary's C sink capacity, which relies on biological C fixation. This study highlights the climate's influence on the spatiotemporal transformation of YEOC NPP while enhancing our understanding of the response of EOC C budgets to climate change and anthropogenic activities.

A Comparative Study of the Early Postoperative Outcome of Three Intramedullary Fixation Modalities in the Treatment of Intertrochanteric Fractures of the Femur in the Elderly.

OBJECTIVES: To compare early outcomes of proximal femoral bionic nail (PFBN), Inter-TAN, proximal femoral nail antirotation (PFNA) for intertrochanteric fractures in elderly patients. METHODS: Eighty-two elderly patients with intertrochanteric femoral fractures treated at Xiangyang No. 1 People's Hospital affiliated with Hubei University of Medicine from December 2021 to 2022 were retrospectively analyzed. They were categorized into three surgical groups: PFBN (22 cases), Inter-TAN (20 cases), and PFNA (40 cases). Preoperative demographics and fracture characteristics were compared, alongside intraoperative and postoperative metrics like operative time and complication rates. RESULTS: In the PFBN group, operative time, fluoroscopy use, blood loss, and transfusion were higher, but postoperative weight-bearing, healing, and hospital stay were shorter compared to the Inter-TAN and PFNA groups (P<0.05). Inter-TAN had a significantly shorter postoperative weight-bearing time than PFNA (P<0.001). Other compared factors showed no significant differences between groups (P>0.05), including complication rates and scores at 6-month follow-up. CONCLUSIONS: PFBN, a novel surgical approach for intertrochanteric fractures in elderly patients, outperforms Inter-TAN and PFNA by accelerating early weight-bearing and hastening fracture recovery.

Enhanced Cr(VI) stabilization in soil by chitosan/bentonite composites.

In this study, chitosan/bentonite composites (CSBT) was synthesized and applied to the immobilization of chromium in the soil. The influence of passivating agents on various forms of chromium was investigated by batch experiment. The results showed that CSBT could reduce the content of exchangeable form and oxidizable form, while increase the content of residual form of chromium. The addition of 0.2 g·kg-1 CSBT had the best effect, with the concentration of exchangeable, reducible and oxidizable form decreased by 46.74%, 8.15%, and 14.46%, respectively. During the experiment time, the passivation effect increased rapidly within 14 days, and the content of residual form in the total Cr increased from 0.76% to 14.23%, the equilibrium was reached at the 28th day and was basically maintained in the subsequent period. CSBT had little impact on soil pH, and soil pH maintained constant during the experiment period. The amino, carboxyl and hydroxyl groups of CSBT promoted the conversion of available chromium to residual state in soil, and reduced the bioavailability of chromium in soil.

Identification of cleavage of NS5A of C-strain classical swine fever virus.

NS5A is a multifunctional non-structural protein of classical swine fever virus (CSFV) that plays an important role in viral replication, but how it exerts its functions is unknown. Here, we report the cleavage of NS5A of the vaccine C-strain, resulting in two truncated forms (b and c). Further experiments using calpain- and caspase-family-specific inhibitors, followed by a caspase-6-specific shRNAs and inhibitor, showed that the cleavage of C-strain NS5A to produce truncated form c is mediated by caspase-6, mapping to 272DTTD275, while the cleavage producing truncated form b is probably mediated by another unknown protease. shRNA-mediated downregulation of caspase-6 and blocking of enzyme activity in ST cells significantly impaired genome replication and virus production, indicating that NS5A cleavage is required for CSFV replication.

Complete genome sequence of a novel sub-subgenotype 2.1g isolate of classical swine fever virus from China.

Current subgenotype 2.1 isolates of classical swine fever virus (CSFV) play a dominant role in CSF outbreaks in China, and a novel sub-subgenotype 2.1g of CSFV was recently identified, but the complete genome sequence of this new sub-subgenotype has not been reported. In this study, complete genome of 2.1g isolate GD19/2011 collected from Guangdong province of China in 2011 was sequenced. It was found to be 12,298 nucleotides (nt) in length, including a 375-nt 5'UTR, a 11,697-nt opening reading frame (ORF), and a 227-nt 3'UTR. GD19/2011 shared 91.0-93.7 % and 95.6-97.5 % nt and amino acid sequence identity, respectively, with other subgenotype 2.1 isolates. The topology of a phylogenetic tree constructed based on complete genome sequences of GD19/2011 and other CSFV isolates was identical to that obtained with full-length E2 gene sequences, but it was significantly different from those obtained with the 5'UTR and core sequences. Serial passages of GD9/2011 in PK-15 cells generated a highly cell-adapted virus stock with an infectious titer of 10(7.8) TCID50/ml at the 12(th) passage in which two amino acid substitutions, S476R and N2494S, were observed in comparison with the complete polyprotein sequence of the original isolate from kidney tissue, GD19/2011. This is the first report of the complete genome sequence of a 2.1g isolate, and the GD19/2011 isolate will be useful for further analysis of the evolution and virulence of CSFV isolates.

In vitro adaptation and genome analysis of a sub-subgenotype 2.1c isolate of classical swine fever virus.

Classical swine fever (CSF) still causes substantial economic losses in the pig industry in China. This study reports the isolation and characterization of a field CSF virus named GD53/2011 from pig kidney tissue collected during a CSF outbreak in Guangdong province, China. Phylogenetic analysis based on the full-length E2 gene sequence revealed that this isolate belongs to CSFV sub-subgenotype 2.1c. To further understand the replication characteristics, GD53/2011 was subsequently adapted in PK-15 cells, and its full-length genome was sequenced. After adaptation in PK-15 cells, the titer of GD53/2011 was significantly increased from 10(3.39) TCID50/ml at passage 6 (F6) to 10(8.50) TCID50/ml at passage 46 (F46) with the peak titer obtained at 48 h post-inoculation. Sequence comparison revealed that the E(rns) gene at passages 6, 15, and 25 of GD53/2011 was identical to that in the original tissue, but one amino acid substitution (S476R) was detected at passages 35 and 46. Furthermore, E2 gene sequences at passages 6, 15, 25, 35, and 46 was found identical to that in the original tissue, indicating that the E2 gene was stable during CSF virus adaptation in PK-15 cells. Full-length protein sequence comparison of GD53/2011 with other 2.1 sub-subgenotype isolates showed that Core and NS5A, rather than E2, are more genetically variable. Taken together, a field CSFV strain GD53/2011 was isolated, fully sequenced, and adapted to high growth titer in PK-15 cells, which might be suitable for future studies on CSFV infection, replication, and vaccine development.

The regularity of wind-induced sediment resuspension in Meiliang Bay of Lake Taihu.

Contaminants released by wind-induced sediment resuspension could influence the water quality in shallow lakes. This study aims to reveal the quantitative relationship between wind speed (v) and sediment resuspension rate (r) in Meiliang Bay of Lake Taihu. The study was conducted in three steps. First, the in situ wind speed and current velocity were measured over a period of 2 days in Meiliang Bay to establish the relationship between wind and hydrodynamic conditions; second, an indoor experiment was conducted in a cylindrical simulator with sediment from the study area to determine sediment resuspension rates under different hydrodynamic conditions; and third, linkages between sediment resuspension and wind were determined. The average sediment resuspension rate was highly correlated with the wind speed (R(2) = 0.99), and was expressed by r = 20.72v(2.034) at wind speeds in the range of 0-14 m/s. The critical wind speed for sediment resuspension is about 7 m/s. Under these conditions, the average resuspension rate could reach 1,000 g/(m(2)d), with a total phosphorus release rate of 1.1 g/(m(2)d) and a total nitrogen release rate of 18.1 g/(m(2)d).

Structural characteristics, biomechanics and clinical significance of calcar femorale: A review.

The calcar femorale, first identified by Merkel in 1874, plays a pivotal role in the weight-bearing capacity of the proximal femur, and its structural integrity is crucial for the efficient distribution of mechanical loads. Originating at the vertical ridge where the pubofemoral ligament anchors, this bony prominence extends laterally behind the neutral axis from the medial to lateral aspects. Its presence is not merely an anatomical curiosity but significantly influences the biomechanics of the hip joint by providing additional strength and support against compressive forces encountered during activities such as walking or jumping. Despite its clear description in orthopedic texts, misconceptions persist about its exact function and importance. This article delves into the nuanced anatomy and biomechanical properties of the calcar femorale, offering a detailed literature-based examination that demonstrates its relevance in clinical practice. The review highlights how the robustness of the calcar femorale contributes to the prevention of femoral neck fractures as well as the stabilization of hip prostheses. Furthermore, the indispensable role of the calcar femorale in surgical outcomes is discussed, especially in the context of fracture repair and joint replacement, thus illustrating its enduring significance in contemporary medical applications.

A LiI doped MoS6 composite for room temperature all-solid-state lithium batteries.

All-solid-state batteries using transition metal sulfide cathodes have received a lot of attention because of both their high safety and energy density. In this work, a 95MoS6·5LiI composite is employed as the active material in all-solid-state batteries, showing improved capacity and cycle life due to the increase in electrochemical reaction kinetics. This work provides a reliable cathode material with high reversible capacity and cyclability for all-solid-state rechargeable batteries.

Decadal shifts in Qingzang Plateau lake carbon dynamics (1970-2020): From predominant carbon sources to emerging sinks.

The evasion of carbon dioxide (CO2) from lakes significantly influences the global carbon equilibrium. Amidst global climatic transformations, the role of Qingzang Plateau (QZP) lakes as carbon (C) sources or sinks remains a subject of debate. Furthermore, accurately quantifying their contribution to the global carbon budget presents a formidable challenge. Here, spanning half a century (1970-2020), we utilize a synthesis of literature and empirical field data to assess the CO2 exchange flux of QZP lakes. We find markedly higher CO2 exchange flux in the southeast lakes than that in the northern and western regions from 1970 to 2000. During this time, both freshwater and saltwater lakes served primarily as carbon sources. The annual CO2 exchange flux was estimated at 2.04 ± 0.37 Tg (Tg) C yr-1, mainly influenced by temperature fluctuations. The CO2 exchange flux patterns underwent a geographical inversion between 2000 and 2020, with increased levels in the west and decreased levels in the east. Notably, CO2 emissions from freshwater lakes diminished, and certain saltwater lakes in the QTP transitioned from carbon sources to sinks. From 2000 to 2020, the annual CO2 exchange flux from QZP lakes is estimated at 1.34 ± 0.50 Tg C yr-1, with solar radiation playing a more pronounced role in carbon emissions. Cumulatively, over the past five decades, QZP lakes have generally functioned as carbon sources. Nevertheless, the total annual CO2 emissions have declined since the year 2000, indicating a potential shift trend from being a carbon source to a sink, mirroring broader patterns of global climate change. These findings not only augment our understanding of the carbon cycle in plateau aquatic systems but also provide crucial data for refining China's carbon budget.

Estimated microplastic stress and potential affiliated toxic elements on phytoplankton in a floodplain-lake system.

Hazards associated with microplastics (MPs) and the pollutants they absorb in freshwater lake ecosystems have become a hot research topic in academia. In this study, in order to investigate potential affiliated MP hazards, lake MP samples were collected from a typical subtropical freshwater lake system in China (Poyang Lake) during the dry season (here, you should show the specific months) to explore their potential toxic element (PTE) response (i.e., exposure to Cu, Pb, and Zn) respective to the ecological environment and resident phytoplankton. Results show that average MP abundance in surface water can reach up to 1800 items m-3, which higher in the Nanjishan Wetland National Nature Reserve (NWNNR) (1175 items m-3). Polyester (i.e., purified terephthalic acid [PTA]) and polyethylene (PE) were the main polymer types found in surface water, fiber was the main MP shape, and most of the MP particle sizes are greater than 100 µm. Moreover, phytoplankton biomass was significantly higher in the NWNNR compared to Poyang Lake's retention basin and water channel. It indicated that MP pollutant status of Poyang Lake is mild; however, the ecological risks that MPs pose should not be ignored. The significant positive correlation between MPs and PTEs indicated that PTE absorption and desorption by MPs may cause potential ecological stress. Although we anticipate no direct link between ecotoxicity and phytoplankton, MPs may have indirect effects on phytoplankton through their regulatory effects on PTE levels in water.

Daidzein alleviates osteoporosis by promoting osteogenesis and angiogenesis coupling.

Background: Postmenopausal osteoporosis and osteoporosis-related fractures are world-wide serious public health problem. Recent studies demonstrated that inhibiting caveolin-1 leads to osteoclastogenesis suppression and protection against OVX-induced osteoporosis. This study aimed to explore the mechanism of caveolin-1 mediating bone loss and the potential therapeutic target. Methods: Thirty C57BL/6 female mice were allocated randomly into three groups: sham or bilateral ovariectomy (OVX) surgeries were performed for mice and subsequently daidzein or vehicle was administrated to animals (control, OVX + vehicle and OVX + daidzein). After 8-week administration, femurs were harvested for Micro-CT scan, histological staining including H&E, immunohistochemistry, immunofluorescence, TRAP. Bone marrow endothelial cells (BMECs) were cultured and treated with inhibitors of caveolin-1 (daidzein) or EGFR (erlotinib) and then scratch wound healing and ki67 assays were performed. In addition, cells were harvested for western blot and PCR analysis. Results: Micro-CT showed inhibiting caveolin-1with daidzein alleviated OVX-induced osteoporosis and osteogenesis suppression. Further investigations revealed H-type vessels in cancellous bone were decreased in OVX-induced mice, which can be alleviated by daidzein. It was subsequently proved that daidzein improved migration and proliferation of BMECs hence improved H-type vessels formation through inhibiting caveolin-1, which suppressed EGFR/AKT/PI3K signaling in BMECs. Conclusions: This study demonstrated that daidzein alleviates OVX-induced osteoporosis by promoting H-type vessels formation in cancellous bone, which then promotes bone formation. Activating EGFR/AKT/PI3K signaling could be the critical reason.

Musculoskeletal Ultrasound Evaluates Renal Injury and Predicts Renal Outcome in Patients with Gout.

Introduction: Kidney injury diagnosis is often delayed in patients with gout. We aimed to determine the characteristics of gout patients with CKD using musculoskeletal ultrasound (MSUS) and whether MSUS could be used as an auxiliary assessment to evaluate kidney injury and predict renal outcome in patients with gout. Methods: Clinical information, laboratory indicators, and MSUS findings were collected and compared between gout-only patients (gout - CKD) and gout patients with CKD (gout + CKD). Multivariate logistic regression was applied to identify risk factors for clinical and MSUS characteristics in both groups. Correlation analysis between MSUS signs and kidney-related indicators was performed, and the effects of MSUS characteristics on renal prognosis were evaluated. Results: In total, 176 patients with gout were included, namely, 89 gout - CKD and 87 gout + CKD cases. After adjusting for confounders, the gout patients with CKD showed more frequent episodes in the previous year, higher ultrasound semiquantitative scores, and more tophi than gout patients without CKD. Additionally, the number of tophi, bone erosion, and synovial hypertrophy measured by MSUS was found to be negatively correlated with the eGFR. The existence of tophi was independently associated with an increased risk of a ≥10% decline in eGFR in the first-year follow-up (OR, 3.56; 95% CI, 1.382-9.176). Conclusions: Ultrasound-detected tophi, bone erosion, and synovial hypertrophy were associated with kidney injury in gout patients. The existence of tophi was associated with faster renal function deterioration. MSUS could be a potential auxiliary diagnostic method to evaluate kidney injury and predict renal outcome in gout patients.

Thermoelectric Properties of One-Pot Hydrothermally Synthesized Solution-Processable PEDOT:PSS/MWCNT Composite Materials.

The combination of organic and inorganic materials has been considered an effective solution for achieving ambient thermoelectric energy harvesting and has been developing rapidly. Here, PEDOT:PSS/MWCNT (PPM) composite hydrogels were synthesized using the self-assembled gelation process of poly(3,4-ethylenedioxythiophene)-poly(styrenesulfonate) (PEDOT:PSS) and the interaction between PEDOT:PSS and multi-walled carbon nanotubes (MWCNTs) without the addition of any surfactant. After immersion in dimethyl sulfoxide and freeze-drying, the hydrogel is easily dispersed in water and used as a direct ink writing (DIW) 3D printing ink. At room temperature, the PPM-20 printed film with 20 wt% MWCNT solids achieved a maximum power factor of 7.37 µW m-1 K-2 and maintained stable thermoelectric properties during repeated bending cycles. On this basis, a thermoelectric generator (TEG) consisting of five legs was printed, which could be produced to generate an open circuit voltage of 6.4 mV and a maximum output power of 40.48 nW at a temperature gradient of 50 K, confirming its great potential for application in high-performance flexible organic/inorganic thermoelectric materials.

In Vivo Intravascular Optical Coherence Tomography (IVOCT) Structural and Blood Flow Imaging Based Mechanical Simulation Analysis of a Blood Vessel.

INTRODUCTION: Computer modelling of blood vessels based on biomedical imaging provides important hemodynamic and biomechanical information for vascular disease studies and diagnosis. However due to lacking well-defined physiological blood flow profiles, the accuracy of the simulation results is often not guaranteed. Flow velocity profiles of a specific cross section of a blood vessel were obtained by in vivo Doppler intravascular optical coherence tomography (IVOCT) lately. However due to the influence of the catheter, the velocity profile imaged by IVOCT can't be applied to simulation directly. METHODS: A simulation-experiment combined method to determine the inlet flow boundary based on in vivo porcine carotid Doppler IVOCT imaging is proposed. A single conduit carotid model was created from the 3D IVOCT structural images using an image processing-computer aided design combined method. RESULTS: With both high- resolution arterial model and near physiological blood flow profile, stress analysis by fluid-structure interaction and computational fluid dynamics were performed. The influence of the catheter to the wall shear stress, the hemodynamics and the stresses of the carotid wall under the measured inlet flow and various outlet pressure boundary conditions, are analyzed. CONCLUSION: This study provides a solution to the difficulty of getting inlet flow boundary for numerical simulation of arteries. It paves the way for developing IVOCT based vascular stress analysis and imaging methods for the studies and diagnosis of vascular diseases.

Effect of live and inactivated Chlamydomonas reinhardtii on the removal of tetracycline in aquatic environments.

With the development of medical drugs, the widely used tetracycline has brought many adverse effects on the ecosystem and human health. Tetracycline pollution of water environment is becoming more and more serious, and has become an emerging environmental problem. As single celled organisms, microalgae are not only model organisms for risk assessment of aquatic ecosystems, but also can efficiently purify sewage. Microalgae-mediated pollutant remediation has attracted more and more attention from researchers. In this paper, Chlamydomonas reinhardtii (C. reinhardtii) was used to remove tetracycline in aqueous solution, and the removal efficiency and mechanism of microalgae on tetracycline were studied. The results showed that the removal rates of tetracycline by active and inactivated microalgae at a density of 5 × 106 cells·mL-1 were 81.9% and 89.8%, respectively. C. reinhardtii removed tetracycline through biosorption and nonmetabolic processes. Microalgal cell supernatant and hydroxyl radicals could significantly promote the removal of tetracycline. The positively charged tetracycline was electrostatically adsorbed on the microalgae surface and extracellular polymeric substances. Microalgae biomass can promote the production of ROS and enhance the ability of microalgae to remove tetracycline.

Determining whether hydrological processes drive carbon source and sink conversion shifts in a large floodplain-lake system in China.

Lake carbon (C) cycling is a key component of the global C cycle and associated C source and sink processes. The partial pressure of carbon dioxide (pCO2) and carbon dioxide (CO2) exchange flux at the lake-air interface (Fc) are controlled by complex physical, chemical, and biological mechanisms. It would be instructively significant to determine whether hydrological processes drive conversion shifts between C sources and sinks in floodplain-lake systems. Findings from this study show that exogenous input and in situ metabolism related to photosynthesis, respiration, and organic matter degradation were the main driving mechanisms of CO2 absorption and release in a large floodplain-lake system (i.e., Lake Poyang). Moreover, the intense and frequent water-level fluctuations inherent to floodplain-lakes may also have a direct or indirect impact on C cycling processes and CO2 exchange rates in floodplain-lake systems via their effect on physical processes, inorganic C transport, in-situ metabolic processes. We confirmed the potential of C source and sink conversion in floodplain-lakes under hydrological fluctuations, and strengthen the understanding of driving mechanisms of C source and sink conversion in floodplain systems.

Determining whether Qinghai-Tibet Plateau waterbodies have acted like carbon sinks or sources over the past 20 years.

Half of all of China's lakes are on the Qinghai-Tibet Plateau (QTP), which are mainly distributed at altitudes above 4000 m asl. Being under conditions of progressively intensifying anthropogenic activities and climate change, the debate on whether QTP lakes act as carbon (C) sinks or sources remains unresolved. This study explores QTP lake C exchange processes and characteristics over the past two decades through field monitoring and data integration. Results reveal high lake carbon dioxide (CO2) exchange flux distribution patterns in its western and southern regions and correspondingly low values in its eastern and northern regions. Lake CO2 exchange flux rates also show significant temporal differences where those in the 2000s and 2010s were significantly higher compared to the 2020s. Annual total CO2 emission flux from QTP lakes has increased from 1.60 Tg C a-1 in the 2000s to 6.87 Tg C a-1 in the 2010s before decreasing to 1.16 Tg C a-1 in the 2020s. However, QTP lakes have generally acted as C sinks when annual ice-cover periods are included in the estimation of annual C budgets. Consequently, QTP lakes are gradually evolving towards C sinks. Some small-sized freshwater lakes on the QTP exhibit C sequestration characteristics while low-mid altitude saltwater lakes also act as C sinks. Therefore, owing to the high uncertainties in the estimation of C exchange flux, the QTP lake C sink capacity has been largely underestimated.

Severe 25-Hydroxyvitamin D Deficiency May Predict Poor Renal Outcomes in Patients With Biopsy-Proven Diabetic Nephropathy.

Aims: This study aims to investigate the role of 25-hydroxyvitamin D (25(OH)D) levels in predicting renal survival in biopsy-proven diabetic nephropathy (DN) with type 2 diabetes mellitus (DM). Methods: In this retrospective study, a total of 161 biopsy-proven DN patients were enrolled and divided into four groups (normal group: 25(OH)D>20ng/ml; mild group: 10<25(OH)D ≤ 20ng/ml; moderate group: 5<25(OH)D ≤ 10 ng/ml; severe group: 25(OH)D ≤ 5 ng/ml). The effect of the 25(OH)D level on renal survival was evaluated by multivariate Cox regression. Results: A total of 161 type 2 DM patients with biopsy-proven DN were enrolled in this study. Patients with lower 25(OH)D levels had higher serum creatinine, urinary albumin creatinine ratio (UACR), total cholesterol, and parathyroid hormone levels as well as lower estimated glomerular filtration rate (eGFR), hemoglobin, albumin, and calcium levels and were more prone to diabetic retinopathy (DR). Rather than proteinuria and renal function, glomerular class and interstitial fibrosis and tubular atrophy (IFTA) had a significant correlation with 25(OH)D levels. Multivariate Cox regression indicated that severe deficiency of 25(OH)D levels was associated with adverse renal outcomes. Compared to the level in the normal group, after adjusting for clinicopathological characteristics, a lower 25(OH)D level remained a risk factor for renal outcomes. The HRs were 3.446 (95% CI 0.366-32.406, p=0.279) for the mild group, 8.009 (95% CI 0.791-81.102, p=0.078) for the moderate group, and 14.957(95%CI 1.364-163.995, P=0.027) for the severe group. Conclusion: Levels of 25(OH)D less than 5 ng/ml were correlated with worse renal function, more pathological injury and poorer renal prognosis in patients with biopsy-proven DN.