Evidence for disruption of diurnal salivary cortisol rhythm in childhood obesity: relationships with anthropometry, puberty and physical activity.

BACKGROUND: The aim of this study was to examine the characteristics of diurnal cortisol rhythm in childhood obesity and its relationships with anthropometry, pubertal stage and physical activity. METHODS: Thirty-five children with obesity (median age: 11.80[interquartile range 10.30, 13.30] and median BMI z-score: 3.21[interquartile range 2.69, 3.71]) and 22 children with normal weight (median age: 10.85[interquartile range 8.98, 12.13] and median BMI z-score: - 0.27[interquartile range - 0.88, 0.35]) were recruited. Saliva samples were collected at 08:00, 16:00 and 23:00 h. Cortisol concentrations at 3 time points, corresponding areas under the curve (AUCs) and diurnal cortisol slope (DCS) were compared between the two groups. Anthropometric measures and pubertal stage were evaluated, and behavioural information was obtained via questionnaires. RESULTS: Children with obesity displayed significantly lower cortisol08:00 (median [interquartile range]: 5.79[3.42,7.73] vs. 8.44[5.56,9.59] nmol/L, P = 0.030) and higher cortisol23:00 (median [interquartile range]: 1.10[0.48,1.46] vs. 0.40[0.21,0.61] nmol/L, P < 0.001) with a flatter DCS (median [interquartile range]: - 0.29[- 0.49, 0.14] vs. -0.52[- 0.63, 0.34] nmol/L/h, P = 0.006) than their normal weight counterparts. The AUC increased with pubertal development (AUC08:00-16:00:P = 0.008; AUC08:00-23:00: P = 0.005). Furthermore, cortisol08:00 was inversely associated with BMI z-score (ß = - 0.247, P = 0.036) and waist-to-height ratio (WHtR) (ß = - 0.295, P = 0.027). Cortisol23:00 was positively associated with BMI z-score (ß = 0.490, P<0.001), WHtR (ß = 0.485, P<0.001) and fat mass percentage (FM%) (ß = 0.464, P<0.001). Absolute values of DCS were inversely associated with BMI z-score (ß = - 0.350, P = 0.009), WHtR (ß = - 0.384, P = 0.004) and FM% (ß = - 0.322, P = 0.019). In multivariate analyses adjusted for pubertal stage and BMI z-score, Cortisol08:00, AUC08:00-16:00 and absolute values of DCS were inversely associated with the relative time spent in moderate to vigorous intensity physical activity (P < 0.05). AUC16:00-23:00 was positively associated with relative non-screen sedentary time and negatively associated with sleep (P < 0.05). CONCLUSIONS: The disorder of diurnal salivary cortisol rhythm is associated with childhood obesity, which is also influenced by puberty development and physical activity. Thus, stabilizing circadian cortisol rhythms may be an important approach for childhood obesity.

Highly Stretchable and Tough Physical Silk Fibroin-Based Double Network Hydrogels.

Regenerated silk fibroin (RSF) is a promising biomedical material, but the poor mechanical properties of RSF hydrogels may hinder the use as structural components. Herein, an equilibrium RSF hydrogel is prepared and optimized based on the double network (DN) concept. After sufficient soaking in water and removal of small molecules, the equilibrium RSF DN hydrogels prove stable in water, strong, highly extensible, and tough with 0.26-0.44 MPa tensile strength, 500-900% elongation, and 2 MJ m-3 work of extension. The combination of high strength and extensibility is attributed to the homogeneous morphology and the hydrophobic interactions and hydrogen bonding between the two networks. The strategy in this work overcomes the previous issue of swelling and eventual fracture of as-prepared RSF/SDS DN hydrogels in water. In addition, such mechanically superior RSF DN hydrogels also display low cytotoxicity. It concludes that the elastic and tough RSF DN hydrogels could be engineered by introducing widely used polymer networks, and the hydrogels from inexpensive, environmentally friendly, and biocompatible silk fibroin may hold great potential in biomedical applications.

Suitability and Trueness of the Removable Partial Denture Framework Fabricating by Polyether Ether Ketone with CAD-CAM Technology.

The object of the study was to evaluate the suitability and trueness of the removable partial denture (RPD) framework fabricated by polyether ether ketone (PEEK) with the CAD-CAM technology in vitro. Four different types of dentition defects were selected. In each type, five PEEK RPD frameworks were fabricated by the CAD-CAM technology, while five Co-Cr RPD frameworks were made by traditional casting. The suitability of the framework was evaluated by silicone rubber film slice measurement and the three-dimensional image overlay method. The trueness of the PEEK framework was detected by the three-dimensional image overlay method. Data were statistically analyzed with the use of an independent samples t-test (α = 0.05). The suitability values by silicone rubber film slice measurement of the PEEK group were lower than those of the Co-Cr group in four types, with the differences indicating statistical significance (p < 0.05) in type one, type two, and type four. The suitability values using the three-dimensional image overlay method showed no statistical differences (p > 0.05) between the two groups in four types. The trueness values of the PEEK group were within the allowable range of clinical error. The suitability and trueness of the PEEK RPD framework fabricated by CAD-CAM technology met the requirements of the clinical prosthesis.

Porous titanium-6 aluminum-4 vanadium cage has better osseointegration and less micromotion than a poly-ether-ether-ketone cage in sheep vertebral fusion.

Interbody fusion cages made of poly-ether-ether-ketone (PEEK) have been widely used in clinics for spinal disorders treatment; however, they do not integrate well with surrounding bone tissue. Ti-6Al-4V (Ti) has demonstrated greater osteoconductivity than PEEK, but the traditional Ti cage is generally limited by its much greater elastic modulus (110 GPa) than natural bone (0.05-30 GPa). In this study, we developed a porous Ti cage using electron beam melting (EBM) technique to reduce its elastic modulus and compared its spinal fusion efficacy with a PEEK cage in a preclinical sheep anterior cervical fusion model. A porous Ti cage possesses a fully interconnected porous structure (porosity: 68 ± 5.3%; pore size: 710 ± 42 µm) and a similar Young's modulus as natural bone (2.5 ± 0.2 GPa). When implanted in vivo, the porous Ti cage promoted fast bone ingrowth, achieving similar bone volume fraction at 6 months as the PEEK cage without autograft transplantation. Moreover, it promoted better osteointegration with higher degree (2-10x) of bone-material binding, demonstrated by histomorphometrical analysis, and significantly higher mechanical stability (P < 0.01), shown by biomechanical testing. The porous Ti cage fabricated by EBM could achieve fast bone ingrowth. In addition, it had better osseointegration and superior mechanical stability than the conventional PEEK cage, demonstrating great potential for clinical application.

Comparison of the Retention and Fit of Polyether Ether Ketone Clasps during Fatigue Circulation Tests.

Purpose: The purpose of this study was to evaluate the fit and retention of clasps made of polyether ether ketone (PEEK) or cobalt-chromium alloy (Co-Cr) at different tooth positions in experimental simulations of in vitro wear and removal for 5 years. Methods: Standard crowns of the right mandibular first premolar (44) and first molar (46) were selected, and a circular three-arm clasp was designed, scanned and fabricated. Ten PEEK clasps were used as the experimental group, and 10 Co-Cr clasps were used as the control group. The seating channel was parallel to the side of the abutment base in both groups. The oral environment was simulated, and each clasp was tested in artificial saliva for 7200 cycles while the change in clasp retention force was recorded. The fit before and after the fatigue cycles was measured by the silicone rubber film copying method. Data were statistically analyzed using the independent samples t-test (α = 0.05). Results: Before circulation, the retention forces of the clasps at position 44 were 4.61 ± 0.91 N (PEEK) and 47.50 ± 10.59 N (Co-Cr), and the forces at position 46 were 3.38 ± 0.49 N (PEEK) and 28.79 ± 10.99 N (Co-Cr). After circulation, the retention forces of the clasps at position 44 were 4.15 ± 0.91 N (PEEK) and 13.90 ± 6.59 N (Co-Cr), and the forces at position 46 were 2.93 ± 0.25 N (PEEK) and 11.56 ± 3.93 N (Co-Cr). Before circulation, the fit of each clasp at the reference points (clasp tip, clasp arm, and occlusal rest) was between 41.70 µm and 170.29 µm, and after circulation, they were between 64.05 µm and 182.59 µm. The retention force and fit of the PEEK clasps did not undergo statistically significant changes from before to after circulation (P > 0.05). However, there were statistically significant (P < 0.05) decreases in the retention force of the Co-Cr clasps and the fit of the clasp tip during circulation. In addition, there was a sudden and large change in the retention force of the Co-Cr clasps after approximately 360 cycles. Conclusions: The retention force and suitability of the PEEK clasps met the requirements for clinical use during testing that simulated the in vitro wear and removal procedure for 5 years. Compared with the Co-Cr clasp, the PEEK clasp underwent less fatigue deformation, which makes it feasible for clinical applications.

Processing, mechanical properties and bio-applications of silk fibroin-based high-strength hydrogels.

Hydrogels are an attractive class of materials that possess similar structural and functional characteristics to wet biological tissues and demonstrate a diversity of applications in biomedical engineering. Silk fibroin (SF) is a unique natural polymer due to its fibrous protein nature, versatile formats, biocompatibility, tunable biodegradation and is thus a good hydrogel candidate for bio-applications. Compared to synthetic polymer hydrogels, poor mechanical performance is still a fatal drawback that hinders the application of SF hydrogels as structural materials. Researchers have attempted to develop strategies to construct silk fibroin-based high-strength hydrogels (SF-HSHs). Herein, we firstly provide an overview of the approaches of processing SF-HSHs with a focus on the physical/non-covalent crosslinking mechanisms. The examples of SF-HSHs are discussed in detail under four categories, including physical-crosslinked, dual-crosslinked, double network and composite hydrogels respectively. A brief section follows to elucidate on the gelation mechanisms of SF-HSHs before a description of the utility of SF-HSHs in biomedicine and devices is presented. Finally, the potential challenges and future development of SF-HSHs are briefly discussed. This review aims to enhance our understanding of the structure-mechanical property-function relationships of soft materials made from natural polymers and guide future research of silk fibroin-based hydrogels for biomedical applications. STATEMENT OF SIGNIFICANCE: Silk fibroin (SF) extracted from silk fibres is increasingly applied in the biomedical field, and SF hydrogel has been an emerging area for frontier bio-research. Since SF biopolymer has an intrinsic tendency to form regular ß-sheet stacks, it can be processed into purely physically crosslinked hydrogels, thus avoiding the use of chemical crosslinkers. Nevertheless, akin to other natural polymers, lab-produced SF is variable (i.e. the molecular weight and distribution), and the gelation of SF hydrogel is challenging to control. In addition, hydrogels made from SF are usually weak and brittle, which hinders the wide use of this biofriendly and biodegradable hydrogel. Recently, there is a pressing need for high strength hydrogels from natural polymers for biomedical applications, and SF is proposed as a strong candidate. Therefore, we have studied the literature in the past 10 years and would like to focus on the gelation mechanism and mechanical strength of SF hydrogels for the review.

Optimization of a quasi-solid-state dye-sensitized solar cell employing a nanocrystal-polymer composite electrolyte modified with water and ethanol.

A quasi-solid-state dye-sensitized solar cell employing a poly(ethylene oxide)-poly(vinylidene fluoride) (PEO-PVDF)/TiO2 gel electrolyte modified by various concentrations of water and ethanol is described. It is shown that the introduction of water and ethanol prevents the crystallization of the polymer matrix, and enhances the free I(-)/I(3)(-) concentration and the networks for ion transportation in the electrolyte, thus leading to an improvement in conductivity. A high energy conversion efficiency of about 5.8% is achieved by controlling the additive concentration in the electrolyte. Optimization of the additive-modified electrolyte performance has been obtained by studying the cross-linking behavior of water and ethanol with Fourier transform infrared (FTIR), differential scanning calorimetry (DSC) and viscosity measurements, and the electrical conduction behavior of the electrolyte with impedance spectra measurements.

Design, synthesis and biological evaluation of PEGylated Xenopus glucagon-like peptide-1 derivatives as long-acting hypoglycemic agents.

In order to develop novel long-acting GLP-1 derivatives, a peptide hybrid (1a) from human GLP-1 and Xenopus GLP-1 discovered in our previous research was selected as the lead compound. Exendin-4 inspired modification resulted in peptide 1b with enhanced glucose-lowering activity. Cysteine mutated 1b derivatives with reserved bioactivity were further site-specifically connected with mPEG2000-MAL to provide conjugates 3a-h, among which 3d and 3e were found to have significantly improved hypoglycemic activity and insulinotropic ability than GLP-1. The hypoglycemic durations of 3d and 3e were remarkably prolonged to ∼20 h in type 2 diabetic db/db mice, compared with the 5.3 h of exendin-4 in the same test. Finally, chronic in vivo studies revealed that a once-daily treatment of 3d or 3e for five weeks resulted in recovered glucose-controlling ability of type 2 diabetic db/db mice, along with other benefits, such as reduced body weight gains, food intake amounts and HbA1c values. Collectively, our results suggest 3d and 3e as potential long-acting glucose-lowering agents for treating type 2 diabetes.

Vitamin C plus hydrogel facilitates bone marrow stromal cell-mediated endometrium regeneration in rats.

BACKGROUND: Intrauterine adhesion (IUA) is a common uterine cavity disease which can be caused by mechanical damage that may eventually lead to infertility and pregnancy abnormalities. Since the effect of therapeutic drugs appears disappointing, cell therapy has emerged as an alternative choice for endometrium regeneration. The aim of this study is to investigate whether the combination of hydrogel Pluronic F-127 (PF-127), Vitamin C (Vc), and a bone marrow stromal cell (BMSC) mixture could be a feasible strategy to improve the endometrial regeneration in a mechanical damage model of IUA in rats. METHODS: Firstly, PF-127 cytotoxicity and the effect of Vc was tested in vitro using the Annexin V/propidium iodide (PI) apoptosis test, cell count kit (CCK) growth test, and enzyme-linked immunosorbent assay (ELISA). For the establishment of the rat IUA model, a 2-mm transverse incision in the uterus was prepared at the upper end, and 1.5- to 2.0-cm endometrial damage was scraped. Rats were randomly assigned to five groups to investigate the combined strategy on IUA uterine regeneration: a sham group, an IUA control group, an IUA BMSC encapsulated in PF-127 plus Vc group, an IUA BMSC plus Vc group, and an IUA PF-127 plus Vc group. A cell mixture was injected into the uterine horn while making the IUA model. Eight weeks after cell transplantation, the rats were sacrificed and the uterine was dissected for analysis. Endometrial thickness, gland number, fibrosis area, and the expression of marker proteins for endometrial membrane were examined by hematoxylin and eosin staining, Masson's staining, and immunohistochemistry. RESULTS: Vc promoted the survival and health of PF-127-encapsulated BMSCs in vitro. When this combination was transplanted in vivo, the endometrium showed better restoration as the endometrium membrane became thicker and had more glands and less fibrosis areas. The expression of cytokeratin, von Willebrand Factor (vWF), was also restored. The proinflammatory cytokine interleukin-1ß (IL-1ß) was significantly lower compared with the control group. CONCLUSIONS: Vc alleviates the cytotoxic effect of PF-127 and promotes cell survival and growth in rat BMSC encapsulation. Thus, a cell therapy strategy containing biomaterial scaffold, BMSCs and the modulatory factor Vc promotes the restoration of damaged IUA endometrium.

Parathyroid hormone-related peptide (1-34) reduces alveolar bone loss in type 1 diabetic rats.

OBJECTIVE: To investigate the role of parathyroid hormone related protein (PTHrP) in diabetic periodontitis. METHODS: After injected with 55mg/kg streptozotocin, diabetic rats were treated subcutaneously with low-dose (40µg/kg, once daily for 5days per week), middle-dose (80µg/kg) or high-dose (160µg/kg) PTHrP(1-34) peptide. Treatment continued for 12 weeks. Changes in periodontal tissues were confirmed by micro-computerized tomography assay and H&E analysis. We used tartrate resistant acid phosphatase (TRAP) staining to identify osteoclast cells. The expression of TNF-α, IL-1ß and IL-6 was assessed by immunohistochemistry and Western blot. RESULTS: Tooth-supporting structure loss was observed in periodontal tissues of diabetic rats. PTHrP (1-34) attenuated alveolar bone loss, especially in the middle-dose and high-dose group. Whereas TNF-α, IL-1ß and IL-6 protein levels were increased in the diabetic gingival tissues, PTHrP (1-34) treatment inhibited the increase of IL-1ß and IL-6, but had no effect on TNF-α. CONCLUSION: Type 1 diabetes increased the susceptibility to periodontal disease. Intermittent administration of PTHrP (1-34) exhibited an inhibitory effect on alveolar bone resorption and the gingival inflammation in periodontal tissues of diabetic rats.

Effect of type I collagen on the adhesion, proliferation, and osteoblastic gene expression of bone marrow-derived mesenchymal stem cells.

OBJECTIVE: To investigate the effects of porous poly lactide-co-glycolide (PLGA) modified by type I collagen on the adhesion, proliferation, and differentiation of rabbit marrow-derived mesenchymal stem cells (MSCs). METHODS: The third generation MSCs isolated from mature rabbits by density gradient centrifugation were cultured at different initial concentrations on 0.3 cm x 1.2 cm x 2.0 cm 3-D porous PLGA coated by type I collagen in RPMI 1640 containing 10% fetal calf serum, while cultured on PLGA without type I collagen as control. The cells adhesive and proliferative behavior at 7, 14, and 21 days after inoculation was assessed by determining the incorporation rate of [(3)H]-TdR. In order to examine MSCs differentiation, the expression of osteoblasts marker genes, osteocalcin (OCN), alkaline phosphatase (ALP), osteopontin (OPN) mRNA, were evaluated by reverse transcription-polymerase chain reaction (RT-PCR), and further more, the cell morphology at 21 days was also observed by scanning electron microscope (SEM). RESULTS: Type I collagen promoted cell adhesion on PLGA. The valve was significantly higher than controls (6 h, 2144 cpm+/-141 cpm vs. 1797 cpm+/-118 cpm, P=0.017; 8 h, 2311 cpm+/-113 cpm vs. 1891 cpm+/-103 cpm, P=0.01). The cells which cultured on PLGA coated with type I collagen showed significantly higher cell proliferation than controls on the 7 th day (1021 cpm+/-159 cpm vs. 451 cpm+/-67 cpm, P=0.002), the 14th day (1472 cpm+/-82 cpm vs. 583 cpm+/-67 cpm, P<0.001) and 21 th day (1728 cpm+/-78 cpm vs. 632 cpm+/-55 cpm, P<0.001). Osteoblasts markers, OCN, ALP, OPN mRNA, were all detected on PLGA coated by type I collagen on the 21 th day, but OCN, OPN mRNA could not be found in controls. Spindle and polygonal cells well distributed on the polymer coated by type I collagen while cylindric or round cells in controls. CONCLUSIONS: Type I collagen is effective in promoting the adhesion, proliferation and differentiation of MSCs on PLGA.

A polycaprolactone-tricalcium phosphate composite scaffold as an autograft-free spinal fusion cage in a sheep model.

Titanium (Ti) based spinal fusion cages are frequently used in the clinics for the treatment of spinal degeneration and related diseases, however, their further clinical application is generally harassed by several drawbacks such as stress shielding, non-biodegradability and additional bone grafting procedure. Our earlier work has demonstrated the efficacy of a biodegradable macro-porous polycaprolactone-tricalcium phosphate (PCL-TCP) composite scaffold in promoting bony tissue ingrowth as well as its ability to sustain mechanical loads upon implantation into an orthotopic defect site. In this study, we investigated the use of PCL-TCP scaffold as an autograft-free spinal fusion cage in a preclinical sheep model over 12 months, and compared the fusion efficacy against Ti cages incorporated with autografts. Results showed that despite PCL-TCP scaffold as an autograft-free cage attaining a slower fusion rate at early stage (6 month), it achieved similar degree of spinal fusion efficacy as Ti cages aided with autograft at 12 month post-operation as evidenced by the radiographic and histological evaluation. PCL-TCP cages alone demonstrated better bone ingrowth with 2.6 fold higher bone/interspace ratio (B/I) and more homogeneous bone tissue distribution compared with that of the Ti cages (88.10  ±  3.63% vs. 33.74  ±  2.78%, p < 0.05) as seen from the histological and micro-CT analysis. Moreover, besides the bone tissue ingrowth, a quantitative approach was illustrated to accurately evaluate the osteointegration of fusion cage with surrounding bone tissue, and showed a 1.36 fold higher degree of osteointegration occurred in PCL-TCP cage group than Ti cage group (CS/PC: 79.31  ±  3.15% vs 58.44  ±  2.43%, p < 0.05). Furthermore, biomechanical analysis showed comparable mechanical strength of fused segments in both groups in terms of the range of motion and stiffness at 12 month (p > 0.05). The degradation profile of the PCL-TCP cages was noted to increase in tandem with new bone ingrowth into the pores, while maintaining good structural integrity necessary for supporting the spinal interbody segments. Therefore, with the better osteointegration, more bone tissue ingrowth as well as its favorable biodegradable and radiolucent properties, PCL-TCP cage has been demonstrated to be a promising candidate as an autograft-free fusion cage for clinical application.

Cellulose 2,3-di(p-chlorophenylcarbamate) bonded to silica gel for resolution of enantiomers.

In this study, 6-azido-2,3-di(p-chlorophenylcarbamoylated) cellulose was synthesized and bonded onto aminized silica gel to obtain a new chiral stationary phase. Enantioselectivity of the chiral stationary phase and Chiralcel OF suggested promising chiral separation ability of the new cellulose chiral stationary phase. In addition, the effect of trifluoroacetic acid, diethylamine on enantioselectivity and retention factors on the chiral stationary phase in high performance liquid chromatography was investigated. Experimental results revealed that resolution increased as the trifluoroacetic acid concentration increased to 0.3% while resolution declined as the diethylamine concentration increased. Therefore, the optimal concentrations of trifluoroacetic acid and diethylamine were determined to be 0.3 and 0.1%, respectively. In most cases, trifluoroacetic acid shortened the retention of the first eluted enantiomer while it increased the retention of the other. For acidic compounds, with the existence of diethylamine in the mobile phase, the retention of both enantiomers decreased. But for basic compounds, the retention of both enantiomers increased.

A de novo 1.38 Mb duplication of 1q31.1 in a boy with hemifacial microsomia, anophthalmia, anotia, macrostomia, and cleft lip and palate.

We reported a 2-year-old boy with developmental delay, mild mental retardation, and severe craniofacial malformation, including facial asymmetry with hypoplasia of the left zygoma, maxilla, and mandible, and left anophthalmia and anotia. A genome-wide screen revealed a 1.38 Mb duplication on chromosome 1q31.1, which was absent in his parents and 27 healthy controls. The duplication region contains two Refseq genes, PLA2G4A and C1orf99, which have not been reported to be implicated in craniofacial malformation. Functional studies of these genes and additional clinical analysis are necessary to elucidate the pathogenesis of craniofacial malformation.

Preparation and chiral separation of a novel immobilized cellulose-based chiral stationary phase in high-performance liquid chromatography.

The chiral selector 6-azido-2, 3-di(p-chlorophenylcarbamoylated) cellulose was synthesized and further chemically immobilized onto 5-µm amino functionalized spherical porous silica gel. It was used as chiral stationary phase in high-performance liquid chromatography. Thirty racemates were successfully separated into enantiomers in either normal phase mode or reversed-phase mode. Good reproducibility and stability of the chiral stationary phase have been demonstrated.

Modulation of hemocompatibility of polysulfone by polyelectrolyte multilayer films.

Polyelectrolyte multilayer (PEM) films have been recently applied to surface modification of biomaterials. Cellular interactions with PEM films consisted of weak polyelectrolytes are greatly affected by the conditions of polyelectrolyte deposition, such as pH of polyelectrolyte solution. Previous studies indicated that the adhesion of several types of mammalian cells to PAH/PAA multilayer films was hindered by low pH and high layer numbers. The objective of this study is to evaluate whether the hemocompatibility of polysulfone can be modulated by deposition of poly(allylamine hydrochloride) (PAH)/poly(acrylic acid) (PAA) multilayer films. PAH/PAA multilayer films with different layer numbers were assembled onto polysulfone at either pH 2.0 or pH 6.5. The number of platelet adhesion and the morphology of adherent platelets were determined to evaluate hemocompatibility of modified substrates. Compared to non-treat polysulfone, the PEM films developed at pH 2.0 decreased platelet adhesion, while those built at pH 6.5 enhanced platelet deposition. Platelet adhesion was found positively correlated to polyclonal antibodies binding to surface-bound fibrinogen. The extent of platelet spreading was increased with layer numbers of PEM films, suggesting that the adherent platelets on thick PEM films were prone to activation. In conclusion, PAH/PAA films with few layers developed at pH 2.0 possessed better hemocompatibility compared to other substrates.

Cardiac troponin and C-reactive protein for predicting all-cause and cardiovascular mortality in patients with chronic kidney disease: A meta-analysis

Elevated serum levels of cardiac troponin and C-reactive protein are associated with all-cause and cardiovascular mortality in patients with end-stage renal disease. However, the relationship between these two biomarker levels and mortality in patients with chronic kidney disease remains unclear. We conducted a meta-analysis to quantify the association of cardiac troponin and C-reactive protein levels with all-cause and cardiovascular mortality in patients with chronic kidney disease. Relevant studies were identified by searching the MEDLINE database through November 2013. Studies were included in the meta-analysis if they reported the long-term all-cause or cardiovascular mortality of chronic kidney disease patients with abnormally elevated serum levels of cardiac troponin or C-reactive protein. Summary estimates of association were obtained using a random-effects model. Thirty-two studies met our inclusion criteria. From the pooled analysis, cardiac troponin and C-reactive protein were significantly associated with all-cause (HR 2.93, 95% CI 1.97-4.33 and HR 1.21, 95% CI 1.14-1.29, respectively) and cardiovascular (HR 3.27, 95% CI 1.67-6.41 and HR 1.19, 95% CI 1.10-1.28, respectively) mortality. In the subgroup analysis of cardiac troponin and C-reactive protein, significant heterogeneities were found among the subgroups of population for renal replacement therapy and for the proportion of smokers and the C-reactive protein analysis method. Elevated serum levels of cardiac troponin and C-reactive protein are significant associated with higher risks of all-cause and cardiovascular mortality in patients with chronic kidney disease. Further studies are warranted to explore the risk stratification in chronic kidney disease patients.