Optimal Timing of Cranioplasty After Decompressive Craniectomy: Timing or Collapse Ratio.

BACKGROUND AND OBJECTIVES: Although cranioplasty (CP) is a relatively straightforward surgical procedure, it is associated with a high complication rate. The optimal timing for this surgery remains undetermined. This study aimed to identify the most suitable timing for CP to minimize postoperative complications. METHODS: We conducted a retrospective analysis of all CP cases performed in our department from August 2015 to March 2022. Data were gathered through case statistics and categorized based on the occurrence of complications. The collapse ratio was determined using 3-dimensional Slicer software. RESULTS: In our retrospective study of 266 patients, 51 experienced postoperative complications, including hydrocephalus, epidural effusion, subdural hematoma, epilepsy, and subcutaneous infection. Logistic regression analysis identified independent predictors of postcranioplasty complications, and a nomogram was developed. The predictive value of the logistic regression model, collapse ratio, and decompression craniotomy-CP operation interval for post-skull repair complications was assessed using receiver operating characteristic curve analysis. No significant differences were observed in postoperative complications and decompression craniotomy-CP intervals between the groups (P = .07, P > .05). However, significant differences were noted in postoperative collapse ratios and CP complications between the groups (P = .023, P < .05). Logistic regression revealed that the collapse ratio (odds ratio = 1.486; 95% CI: 1.001-2.008; P = .01) and CP operation time (odds ratio = 1.017; 95% CI: 1.008-1.025, P < .001) were independent risk factors for postoperative complications. Receiver operating characteristic curve analysis indicated that the collapse ratio could predict CP postoperative complications, with a cutoff value of 0.274, an area under the curve of 0.621, a sensitivity of 62.75%, and a specificity of 63.26%. CONCLUSION: The post-skull repair collapse ratio is a significant predictor of postoperative complications. It is advisable to base the timing of surgery on the extent of brain tissue collapse, rather than solely on the duration between cranial decompression and CP.

Genome-wide analysis in PC6 electroacupuncture to ameliorate carfilzomib-induced cardiotoxicity in mice.

Carfilzomib (CFZ), a proteasome inhibitor commonly used in the treatment of multiple myeloma (MM), exhibits limited clinical application due to its cardiotoxicity. In our study, electroacupuncture (EA) at Neiguan acupoint (PC6) effectively reversed CFZ-induced reduction in ejection fraction (EF) and fractional shortening (FS), demonstrating great potential effect for heart protection. Through comparative analysis of the transcriptome profile from heart samples of mice treated with DMSO control, CFZ injection, and EA stimulation, we identified a total of 770 differentially expressed genes (DEGs) in CFZ (vs. Control) group and 329 DEGs in EA (vs. CFZ) group. Specifically, CFZ (vs. Control) group exhibited 65 up-regulated DEGs and 705 down-regulated DEGs, while EA (vs. CFZ) group displayed 251 up-regulated DEGs and 78 down-regulated DEGs. Metascape analysis revealed that among these treatment groups, there were 137 co-expressed DEGs remarkably enriched in skeletal system development, cellular response to growth factor stimulus, negative regulation of Wnt signaling pathway, and muscle contraction. The expression patterns of miR-8114, Myl4, Col1a1, Tmem163, Myl7, Sln, and Fxyd3, which belong to the top 30 DEGs, were verified by quantitative real-time PCR (RT-qPCR). In summary, this study firstly discloses novel insights into the regulatory mechanisms underlying PC6-based EA therapy against CFZ-induced cardiotoxicity, potentially serving as a theoretical foundation for further clinical applications.

Association of serum lipids with inflammatory bowel disease: a systematic review and meta-analysis.

Background: Serum lipid levels seem to be abnormal in Inflammatory bowel disease (IBD). However, the specific manifestation of abnormal serum lipid levels in IBD are heterogeneous among studies and have not been sufficiently determined yet. Methods: PubMed, EMBASE, and Cochrane Library databases were searched. Serum lipid levels were compared between IBD patients and Health individuals, Crohn's (CD) and ulcerative colitis (UC), active and inactive, mild and non-mild patients, respectively. Meta-analyses were performed by using a random-effect model. Weight mean difference (WMD) with 95% confidence intervals (CIs) were calculated. Results: Overall, 53 studies were included. Compared with healthy controls, IBD patients had significantly lower TC (WMD = -0.506, 95%CI = -0.674 to -0.338, p < 0.001), HDL-c (WMD = -0.122, 95%CI = -0.205 to -0.039, p = 0.004), and LDL-c (WMD = -0.371, 95%CI = -0.547 to -0.194, p < 0.001) levels. CD groups had a significantly lower TC (WMD = -0.349, 95%CI = -0.528 to -0.170, p < 0.0001) level as compared to UC groups. Active IBD and non-mild UC groups had significantly lower TC (WMD = -0.454, 95%CI = -0.722 to -0.187, p = 0.001) (WMD =0.462, 95%CI = 0.176 to 0.748, p = 0.002) and LDL-c (WMD = -0.225, 95%CI = -0.445 to -0.005, p = 0.045) (WMD =0.346, 95%CI = 0.084-0.609, p = 0.010) levels as compared to inactive IBD and mild UC groups, respectively. Conclusion: The overall level of serum lipids in IBD patients is lower than that of healthy individuals and is negatively associated with disease severity. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42022383885.

Artifact Detection and Restoration in Histology Images With Stain-Style and Structural Preservation.

The artifacts in histology images may encumber the accurate interpretation of medical information and cause misdiagnosis. Accordingly, prepending manual quality control of artifacts considerably decreases the degree of automation. To close this gap, we propose a methodical pre-processing framework to detect and restore artifacts, which minimizes their impact on downstream AI diagnostic tasks. First, the artifact recognition network AR-Classifier first differentiates common artifacts from normal tissues, e.g., tissue folds, marking dye, tattoo pigment, spot, and out-of-focus, and also catalogs artifact patches by their restorability. Then, the succeeding artifact restoration network AR-CycleGAN performs de-artifact processing where stain styles and tissue structures can be maximally retained. We construct a benchmark for performance evaluation, curated from both clinically collected WSIs and public datasets of colorectal and breast cancer. The functional structures are compared with state-of-the-art methods, and also comprehensively evaluated by multiple metrics across multiple tasks, including artifact classification, artifact restoration, downstream diagnostic tasks of tumor classification and nuclei segmentation. The proposed system allows full automation of deep learning based histology image analysis without human intervention. Moreover, the structure-independent characteristic enables its processing with various artifact subtypes. The source code and data in this research are available at https://github.com/yunboer/AR-classifier-and-AR-CycleGAN.

Alkali-Amide-Catalyzed One-Pot Aminoallylation of Aldehydes with Allylbenzenes.

The deprotonation of allylbenzene was successfully demonstrated with a catalytic alkali amide base (NaN(SiMe3)2). The deprotonated allyl anion could be trapped by in situ generated N-(trimethylsilyl) aldimines to provide value-added homoallylic amines (39 examples, 68-98% yields) in a one-pot manner with excellent liner selectivity. Compared with the previously reported method for the synthesis of homoallylic amines, this method does not need to use the preinstalled protection groups on the imines, which need to be removed after the reaction to obtain the N-H free homoallylic amine derivatives.

Mine local homogeneous representation by interaction information clustering with unsupervised learning in histopathology images.

BACKGROUND AND OBJECTIVE: The success of data-driven deep learning for histopathology images often depends on high-quality training sets and fine-grained annotations. However, as tumors are heterogeneous and annotations are expensive, unsupervised learning approaches are desirable to obtain full automation. METHODS: In this paper, an Interaction Information Clustering (IIC) method is proposed to extract locally homogeneous features in mutually exclusive clusters. Trained in an unsupervised paradigm, the framework learns invariant information from multiple spatially adjacent regions for improved classification. Additionally, an adaptive Conditional Random Field (CRF) model is incorporated to detect spatially adjacent image patches of high morphological homogeneity in an offset-constraint free manner. RESULTS: Empirically, the proposed model achieves an observable improvement of 11.4% on the downstream patch-level classification accuracy, compared with state-of-the-art unsupervised learning approaches. CONCLUSION: Furthermore, evaluated with our clinically collected histopathology whole-slide images, the proposed model shows high consistency in tissue distribution compared with well-trained supervised learning, which is of important diagnostic significance in clinical practice.

ClusterSeg: A crowd cluster pinpointed nucleus segmentation framework with cross-modality datasets.

The detection and segmentation of individual cells or nuclei is often involved in image analysis across a variety of biology and biomedical applications as an indispensable prerequisite. However, the ubiquitous presence of crowd clusters with morphological variations often hinders successful instance segmentation. In this paper, nuclei cluster focused annotation strategies and frameworks are proposed to overcome this challenging practical problem. Specifically, we design a nucleus segmentation framework, namely ClusterSeg, to tackle nuclei clusters, which consists of a convolutional-transformer hybrid encoder and a 2.5-path decoder for precise predictions of nuclei instance mask, contours, and clustered-edges. Additionally, an annotation-efficient clustered-edge pointed strategy pinpoints the salient and error-prone boundaries, where a partially-supervised PS-ClusterSeg is presented using ClusterSeg as the segmentation backbone. The framework is evaluated with four privately curated image sets and two public sets with characteristic severely clustered nuclei across a variety range of image modalities, e.g., microscope, cytopathology, and histopathology images. The proposed ClusterSeg and PS-ClusterSeg are modality-independent and generalizable, and superior to current state-of-the-art approaches in multiple metrics empirically. Our collected data, the elaborate annotations to both public and private set, as well the source code, are released publicly at https://github.com/lu-yizhou/ClusterSeg.

Paraneoplastic Amyotrophic Lateral Sclerosis: Case Series and Literature Review.

Paraneoplastic amyotrophic lateral sclerosis (ALS) is a rare and special type of ALS. The pathogenesis, clinical presentation, treatment and prognosis remain poorly understood. We herein presented three cases of paraneoplastic ALS. In case 1, we first reported an ALS patient with the positive serum antibodies against both Sry-like high mobility group box 1 (SOX1) and glutamic acid decarboxylase 65 (GAD65). However, immunotherapy did not improve his neurological symptoms. We also reported two ALS patients with renal clear cell carcinoma and chronic myelogenous leukemia. No positive paraneoplastic antibodies were detected in either the serum or the cerebrospinal fluid of the two patients, and their clinical symptoms progressed slowly after tumor treatment. The three cases enriched the existing case pool of this rare disorder. In addition, we have comprehensively reviewed the literature of paraneoplastic ALS. The clinical features, treatment effect and prognosis were summarized to broaden our understanding of paraneoplastic ALS.

Time-Varying Group Formation-Containment Tracking Control for General Linear Multiagent Systems With Unknown Inputs.

Time-varying group formation-containment tracking problems for general linear multiagent systems with unknown control input are investigated. Agents are classified into tracking leaders, formation leaders, and followers and assigned in groups. Tracking leaders with unknown control inputs provide unpredictable trajectories as macroscopic moving references. Formation leaders accomplish desired subformations while following the trails of tracking leaders. At the same time, followers converge into different convex hulls spanned by formation leaders. First, formation-containment tracking protocols are designed with neighboring relative information and effects of unknown input of tracking leaders. Then, the design of group division is analyzed by adjusting the properties in Laplacian matrices, which represent interaction relationships. An algorithm to determine the parameters in control protocols is proposed, and the formation tracking feasible constraint is presented. Next, it is proved that the general linear multiagent system can achieve time-varying group formation-containment control effectively with errors uniformly asymptotically converging to zero under designed protocols. Finally, a numerical simulation is given to verify the effectiveness of obtained theoretical results.

Vertical Jumping for Legged Robot Based on Quadratic Programming.

The highly dynamic legged jumping motion is a challenging research topic because of the lack of established control schemes that handle over-constrained control objectives well in the stance phase, which are coupled and affect each other, and control robot's posture in the flight phase, in which the robot is underactuated owing to the foot leaving the ground. This paper introduces an approach of realizing the cyclic vertical jumping motion of a planar simplified legged robot that formulates the jump problem within a quadratic-programming (QP)-based framework. Unlike prior works, which have added different weights in front of control tasks to express the relative hierarchy of tasks, in our framework, the hierarchical quadratic programming (HQP) control strategy is used to guarantee the strict prioritization of the center of mass (CoM) in the stance phase while split dynamic equations are incorporated into the unified quadratic-programming framework to restrict the robot's posture to be near a desired constant value in the flight phase. The controller is tested in two simulation environments with and without the flight phase controller, the results validate the flight phase controller, with the HQP controller having a maximum error of the CoM in the x direction and y direction of 0.47 and 0.82 cm and thus enabling the strict prioritization of the CoM.

Spatial topological analysis of sympathetic neurovascular characteristic of acupoints in Ren meridian using advanced tissue-clearing and near infrared II imaging.

Acupuncture has been used for treating various medical conditions in traditional Chinese medicine. Both manual and electro-acupuncture stimulate specific acupoints to obtain local and systemic biological effects, but the underlying mechanisms remain unclear. Here, we used three-dimensional tissue-clearing technology to study acupoints on the Ren meridian of mice to reveal the distribution, density, branching, and relationships between blood vessels and nerves. Using topological Mapper methods, we found that sympathetic neurovascular networks were denser in the CV 4 acupoint compared with surrounding non-acupoints. Furthermore, high resolution in vivo real-time vascular imaging using the near infrared-II probe LZ-1105 demonstrated increased blood flow in the CV 4 acupoint compared with neighboring non-acupoints after manual or electro-acupuncture. Consistent with earlier findings, our research indicated that acupuncture could enhance local blood flow, and our high-resolution 3D images show for the first time the important role of sympathetic neurovascular networks in the CV 4 acupoint.

Biped Walking Based on Stiffness Optimization and Hierarchical Quadratic Programming.

The spring-loaded inverted pendulum model is similar to human walking in terms of the center of mass (CoM) trajectory and the ground reaction force. It is thus widely used in humanoid robot motion planning. A method that uses a velocity feedback controller to adjust the landing point of a robot leg is inaccurate in the presence of disturbances and a nonlinear optimization method with multiple variables is complicated and thus unsuitable for real-time control. In this paper, to achieve real-time optimization, a CoM-velocity feedback controller is used to calculate the virtual landing point. We construct a touchdown return map based on a virtual landing point and use nonlinear least squares to optimize spring stiffness. For robot whole-body control, hierarchical quadratic programming optimization is used to achieve strict task priority. The dynamic equation is given the highest priority and inverse dynamics are directly used to solve it, reducing the number of optimizations. Simulation and experimental results show that a force-controlled biped robot with the proposed method can stably walk on unknown uneven ground with a maximum obstacle height of 5 cm. The robot can recover from a 5 Nm disturbance during walking without falling.

Quantitative analysis of abnormalities in gynecologic cytopathology with deep learning.

Cervical cancer is one of the most frequent cancers in women worldwide, yet the early detection and treatment of lesions via regular cervical screening have led to a drastic reduction in the mortality rate. However, the routine examination of screening as a regular health checkup of women is characterized as time-consuming and labor-intensive, while there is lack of characteristic phenotypic profile and quantitative analysis. In this research, over the analysis of a privately collected and manually annotated dataset of 130 cytological whole-slide images, the authors proposed a deep-learning diagnostic system to localize, grade, and quantify squamous cell abnormalities. The system can distinguish abnormalities at the morphology level, namely atypical squamous cells of undetermined significance, low-grade squamous intraepithelial lesion, high-grade squamous intraepithelial lesion, and squamous cell carcinoma, as well as differential phenotypes of normal cells. The case study covered 51 positive and 79 negative digital gynecologic cytology slides collected from 2016 to 2018. Our automatic diagnostic system demonstrated its sensitivity of 100% at slide-level abnormality prediction, with the confirmation with three pathologists who performed slide-level diagnosis and training sample annotations. In the cellular-level classification, we yielded an accuracy of 94.5% in the binary classification between normality and abnormality, and the AUC was above 85% for each subtype of epithelial abnormality. Although the final confirmation from pathologists is often a must, empirically, computer-aided methods are capable of the effective extraction, interpretation, and quantification of morphological features, while also making it more objective and reproducible.

[Bibliometric analysis on the clinical researches of tumor treated with acupuncture-moxibustion on the base of PubMed database].

OBJECTIVE: To analyze the literature characteristics of the clinical researches on tumor treatment with acupuncture-moxibustion in PubMed database so as to provide the references for the study of acupuncture-moxibusion in intervention of tumor. METHODS: The articles on the clinical researches of acupuncture-moxibusion in treatment of tumor were retrieved from PubMed database listed till December 31, 2018. Using bibliometric methodology, the analysis was conducted on publication year, publication journal, author, country or region, research institution, disease spectrum and therapeutic regimen. RESULTS: A total of 143 articles are included. The publications are increased steadily since 2004. The articles are published in 64 international journals, of which, Acupuncture in Medicine (12 articles) and Integrative Cancer Therapies (10 articles) occupy the the largest number of publications. They are distributed in 18 countries and regions, of which, the top two countries are America (44 articles) and China (34 articles. The involved types of cancer include breast cancer, prostate cancer, gastric cancer, etc. Acupuncture-moxibustion is mainly for complication and the comorbid disorders after treatment, such as pain, nausea and vomiting and fatigue at most. The regimen of acupuncture-moxibustion is determined by the symptoms and electroacupuncture is the main measure of treatment. CONCLUSION: Acupuncture-moxibustion is quite extensively involved in the treatment of tumor in the field of nervous (mental) system and digestive system. But the regimen of acupuncture- moxibustion needs to be further optimized and promoted.

Simulation of Disturbance Recovery Based on MPC and Whole-Body Dynamics Control of Biped Walking.

Biped robots are similar to human beings and have broad application prospects in the fields of family service, disaster rescue and military affairs. However, simplified models and fixed center of mass (COM) used in previous research ignore the large-scale stability control ability implied by whole-body motion. The present paper proposed a two-level controller based on a simplified model and whole-body dynamics. In high level, a model predictive control (MPC) controller is implemented to improve zero moment point (ZMP) control performance. In low level, a quadratic programming optimization method is adopted to realize trajectory tracking and stabilization with friction and joint constraints. The simulation shows that a 12-degree-of-freedom force-controlled biped robot model, adopting the method proposed in this paper, can recover from a 40 Nm disturbance when walking at 1.44 km/h without adjusting the foot placement, and can walk on an unknown 4 cm high stairs and a rotating slope with a maximum inclination of 10°. The method is also adopted to realize fast walking up to 6 km/h.

Validation of Revised Chinese Version of PD-CRS in Parkinson's Disease Patients.

There is a high prevalence of mild cognitive impairment (MCI) and dementia in Parkinson's disease (PD) patients, but a Chinese version of cognitive rating scale that is specific and sensitive to PD patients is still lacking. The aims of this study are to test the reliability and validity of a Chinese version of Parkinson's disease-cognitive rating scale (PD-CRS), establish cutoff scores for diagnosis of Parkinson's disease dementia (PDD) and PD with mild cognitive impairment (PD-MCI), explore cognitive profiles of PD-MCI and PDD, and find cognitive deficits suggesting a transition from PD-MCI to PDD. PD-CRS was revised based on the culture background of Chinese people. Ninety-two PD patients were recruited in three PD centers and were classified into PD with normal cognitive function (PD-NC), PD-MCI, and PDD subgroups according to the cognitive rating scale (CDR). Those PD patients underwent PD-CRS blind assessment by a separate neurologist. The PD-CRS showed a high internal consistency (Cronbach's Alpha = 0.840). Intraclass Correlation coefficient (ICC) of test-retest reliability reached 0.906 (95% CI 0.860-0.935, p < 0.001). ICC of inter-rater reliability was 0.899 (95% CI 0.848-0.933, p < 0.001). PD-CRS had fair concurrent validity with MDRS (ICC = 0.731, 95% CI 0.602-0.816). All the frontal-subcortical items showed significant decrease in PD-MCI compared with the PD-NC group (p ≤ 0.001), but the instrument cortical items did not (confrontation naming p=0.717, copying a clock p=0.620). All the frontal-subcortical and instrumental-cortical functions showed significant decline in PDD compared with the PD-NC group (p ≤ 0.001). The cutoff value for diagnosis of PD-MCI is 80.5 with the sensitivity of 75.7% and the specificity of 75.0%, and for diagnosis of PDD is 73.5 with the sensitivity of 89.2% and the specificity of 98.9%. Revised Chinese version of PD-CRS is a reliable, acceptable, valid, and useful neuropsychological battery for assessing cognition in PD patients.

Computerized cognitive training for Chinese mild cognitive impairment patients: A neuropsychological and fMRI study.

BACKGROUND: Computerized multi-model training has been widely studied for its effect on delaying cognitive decline. In this study, we designed the first Chinese-version computer-based multi-model cognitive training for mild cognitive impairment (MCI) patients. Neuropsychological effects and neural activity changes assessed by functional MRI were both evaluated. METHOD: MCI patients in the training group were asked to take training 3-4 times per week for 6 months. Neuropsychological and resting-state fMRI assessment were performed at baseline and at 6 months. Patients in both groups were continuously followed up for another 12 months and assessed by neuropsychological tests again. RESULTS: 78 patients in the training group and 63 patients in the control group accomplished 6-month follow-up. Training group improved 0.23 standard deviation (SD) of mini-mental state examination, while control group had 0.5 SD decline. Addenbrooke's cognitive examination-revised scores in attention (p = 0.002) and memory (p = 0.006), as well as stroop color-word test interference index (p = 0.038) and complex figure test-copy score (p = 0.035) were also in favor of the training effect. Difference between the changes of two groups after training was not statistically significant. The fMRI showed increased regional activity at bilateral temporal poles, insular cortices and hippocampus. However, difference between the changes of two groups after another 12 months was not statistically significant. CONCLUSIONS: Multi-model cognitive training help MCI patients to gained cognition benefit, especially in memory, attention and executive function. Functional neuroimaging provided consistent neural activation evidence. Nevertheless, after one-year follow up after last training, training effects were not significant. The study provided new evidence of beneficial effect of multi-model cognitive training.

Mixed organic solvents induce renal injury in rats.

To investigate the injury effects of organic solvents on kidney, an animal model of Sprague-Dawley (SD) rats treated with mixed organic solvents via inhalation was generated and characterized. The mixed organic solvents consisted of gasoline, dimethylbenzene and formaldehyde (GDF) in the ratio of 2:2:1, and were used at 12,000 PPM to treat the rats twice a day, each for 3 hours. Proteinuria appeared in the rats after exposure for 5-6 weeks. The incidences of proteinuria in male and female rats after exposure for 12 weeks were 43.8% (7/16) and 25% (4/16), respectively. Urinary N-Acetyl-ß-(D)-Glucosaminidase (NAG) activity was increased significantly after exposure for 4 weeks. Histological examination revealed remarkable injuries in the proximal renal tubules, including tubular epithelial cell detachment, cloud swelling and vacuole formation in the proximal tubular cells, as well as proliferation of parietal epithelium and tubular reflux in glomeruli. Ultrastructural examination found that brush border and cytoplasm of tubular epithelial cell were dropped, that tubular epithelial cells were partially disintegrated, and that the mitochondria of tubular epithelial cells were degenerated and lost. In addition to tubular lesions, glomerular damages were also observed, including segmental foot process fusion and loss of foot process covering on glomerular basement membrane (GBM). Immunofluorescence staining indicated that the expression of nephrin and podocin were both decreased after exposure of GDF. In contrast, increased expression of desmin, a marker of podocyte injury, was found in some areas of a glomerulus. TUNEL staining showed that GDF induced apoptosis in tubular cells and glomerular cells. These studies demonstrate that GDF can induce both severe proximal tubular damage and podocyte injury in rats, and the tubular lesions appear earlier than that of glomeruli.

Additional use of trimetazidine in patients with chronic heart failure: a meta-analysis.

OBJECTIVES: The aim of this meta-analysis was to evaluate the effects of additional trimetazidine (TMZ) treatment on patients with chronic heart failure (CHF). BACKGROUND: Conflicting results currently exist on the clinical use of TMZ in CHF patients. METHODS: PubMed, MEDLINE, EMBASE, and EBM Reviews databases were searched through November 2010 for randomized controlled trials (RCTs) assessing TMZ treatment in CHF patients. Data concerning the study design, patient characteristics, and outcomes were extracted. Risk ratio (RR) and weighted mean differences (WMD) were calculated using fixed or random effects models. RESULTS: Sixteen RCTs involving 884 CHF patients were included. Hospitalization for cardiac causes (RR: 0.43, p = 0.03), but not all-cause mortality (RR: 0.47, p = 0.27), was reduced by TMZ treatment. Moreover, TMZ therapy was associated not only with the increase of left ventricular ejection fraction (WMD: 6.46%, p < 0.0001) and total exercise time (WMD: 63.75 seconds, p < 0.0001), but also with the decrease of New York Heart Association functional class (WMD: -0.57, p = 0.0003), left ventricular end-systolic diameter (WMD: -6.67 mm, p < 0.0001), left ventricular end-diastolic diameter (WMD: -6.05 mm, p < 0.0001), and B-type natriuretic peptide (WMD: -203.40 pg/ml, p = 0.0002). CONCLUSIONS: Additional use of TMZ in CHF patients may decrease hospitalization for cardiac causes, improve clinical symptoms and cardiac function, and simultaneously ameliorate left ventricular remodeling.

[Relationship between serum free fatty acid and cytokines, carotid atherosclerosis in chronic kidney disease].

OBJECTIVE: To investigate the serum level of free fatty acid (FFA) and explore its relationship with cytokines and atherosclerosis (AS) in chronic kidney disease (CKD). METHODS: The serum level of FFA was determined with enzymatic colorimetry. IL-1ß, IL-6 and TNFα were determined with ELISA. High-sensitivity C-reactive protein (hsCRP) was measured with immunoturbidimetry. Prevalence of atherosclerosis was detected with carotid ultrasonography. We evaluated the relationship between serum levels of FFA and IL-1ß, IL-6, TNFα, hsCRP as well as the renal function in 130 adult patients with CKD, stratified according to the GFR (based on the National Kidney Foundation/Kidney Dialysis Outcomes Quality Initiatives) and in 58 hemodialytic (HD) patients. The relationship between FFA level and cardiac geometry incidence in CKD patients was analyzed with logistic regression model. RESULTS: The serum level of FFA was significantly higher in CKD patients as compared with that in the healthy controls [(492.63±143.59) vs (302.65±142.18) µmol/L, P<0.01], even in the early stage of CKD. The level of FFA increased with the progression of renal dysfunction. In the non-dialytic CKD group, the level of FFA was negatively related to GFR and positively related to the proteinuria (P<0.05), while in the HD group, it was positively correlated with dialysis duration (P<0.05). The serum levels of FFA were higher in CKD patients with carotid artery atherosclerosis than those in patients without (P<0.05or<0.01). However, in both groups with impairment of renal function, the levels of FFA were positively correlated with hsCRP, IL-1ß, IL-6, TNFα and TG (all P<0.05). A positive correlation between the level of FFA and the clinical manifestations such as carotid intimal medial thickness (IMT) and AS was also found. A negative correlation was found between the level of FFA and the serum level of albumin and GFR (P<0.05). CONCLUSION: Serum levels of FFA are significantly higher either in non-dialytic CKD or in HD patients and it is related with hsCRP, IL-1ß, IL-6, TNFα as well as carotid artery atherosclerosis, indicating that FFA is an independent risk factor of AS in CKD.