Altered Cerebral Blood Flow in the Progression of Chronic Kidney Disease.

Background: In chronic kidney disease (CKD), cognitive impairment is a definite complication. However, the mechanisms of how CKD leads to cognitive impairment are not clearly known. Methods: Cerebral blood flow (CBF) information was collected from 37 patients with CKD (18 in stage 3; 19 in stage 4) and 31 healthy controls (HCs). For CKD patients, we also obtained laboratory results as well as neuropsychological tests. We conducted brain perfusion imaging studies using arterial spin labeling and calculated the relationship between regional CBF changes and various clinical indicators and neuropsychological tests. We also generated receiver operator characteristic (ROC) curves to explore whether CBF value changes in certain brain regions can be used to identify CKD. Results: Compared with HCs, CBF decreased in the right insula and increased in the left hippocampus in the CKD4 group; through partial correlation analysis, we found that CBF in the right insula was negatively correlated with the number connection test A (NCT-A) (r = −0.544, p = 0.024); CBF in the left hippocampus was positively correlated with blood urea nitrogen (r = 0.649, p = 0.005) and negatively correlated with serum calcium level (r = −0.646, p = 0.005). By comparing the ROC curve area, it demonstrated that altered CBF values in the right insula (AUC = 0.861, p < 0.01) and left hippocampus (AUC = 0.862, p < 0.01) have a good ability to identify CKD. Conclusions: Our study found that CBF alterations in the left hippocampus and the right insula brain of adult patients with stage 4 CKD were correlated with disease severity or laboratory indicators. These findings provide further insight into the relationship between altered cerebral perfusion and cognitive impairment in patients with non-end-stage CKD as well as, additional information the underlying neuropathophysiological mechanisms.

Multigenerational effects modify the tolerance of mosquito larvae to chlorpyrifos but not to a heat spike and do not change their synergism.

While interactions with global warming and multigenerational effects are considered crucial to improve risk assessment of pesticides, these have rarely been studied in an integrated way. While heat extremes can magnify pesticide toxicity, no studies tested how their combined effects may transmit to the next generation. We exposed mosquito larvae in a full factorial, two-generation experiment to a heat spike followed by chlorpyrifos exposure. As expected, the heat spike magnified the chlorpyrifos-induced lethal and sublethal effects within both generations. Only when preceded by the heat spike, chlorpyrifos increased mortality and reduced the population growth rate. Moreover, chlorpyrifos-induced reductions in heat tolerance (CTmax), acetylcholinesterase (AChE) activity and development time were further magnified by the heat spike. Notably, when parents were exposed to chlorpyrifos, the chlorpyrifos-induced lethal and sublethal effects in the offspring were smaller, indicating increased tolerance to chlorpyrifos. In contrast, there was no such multigenerational effect for the heat spike. Despite the adaptive multigenerational effect to the pesticide, the synergism with the heat spike was still present in the offspring generation. Generally, our results provide important evidence that short exposure to pulse-like global change stressors can strongly affect organisms within and across generations, and highlight the importance of considering multigenerational effects in risk assessment.

Acute warming increases pesticide toxicity more than transgenerational warming by reducing the energy budget.

There is increasing awareness that the toxicity of pesticides can to a large extent be modulated by warming, and that temporal exposure scenarios may strongly affect the impact of two stressors. Nevertheless, we lack information on how the exposure duration to warming may shape pesticide toxicity under warming. Furthermore, despite that bioenergetic responses have the potential to generate mechanistic insights in how toxicants interact with warming, this has been understudied in ecotoxicology. To investigate whether warming duration modifies pesticide toxicity, mosquito larvae were exposed to a control temperature at 20 °C or three warming treatments at 24 °C (acute, developmental and transgenerational warming), and to four pesticide treatments (solvent control, and three chlorpyrifos concentrations) in a full factorial design. Chlorpyrifos increased mortality, growth rate and the energy consumed, and reduced the AChE (acetylcholinesterase) activity, the energy available, and the net energy budget (estimated as cellular energy allocation). The warming treatments did not affect mortality, AChE activity, and the energy consumed. However, acute warming increased the growth rate and decreased the energy available, while both acute and developmental warming decreased the cellular energy allocation. A first key finding was that the lethal and sublethal effects of chlorpyrifos were less strong under warming because of a higher degradation in the medium under warming. A second key finding was that, among the warming treatments, the pesticide toxicity was more increased under acute warming than under transgenerational warming. This could be explained by the negative impact of acute warming but not transgenerational warming on the net energy budget. The results in this study provide mechanistic insights that the exposure duration to warming can play an important role in modulating the impact of pesticides under warming. Therefore, including ecologically relevant temporal scenarios of exposure to warming is important in ecotoxicological studies.

Transgenerational exposure to warming reduces the sensitivity to a pesticide under warming.

Despite the increased attention for temporal aspects of stressor interactions and for effects of warming in ecotoxicological studies, we lack knowledge on how different exposure durations to warming may affect pesticide sensitivity. We tested how three types of exposure duration to 4 °C warming (acute, developmental and transgenerational exposure to 24 °C vs 20 °C) shape the effect of the pesticide chlorpyrifos on two ecologically relevant fitness-related traits of mosquito larvae: heat tolerance and antipredator behaviour. Transgenerational (from the parental generation) and developmental (from the egg stage) warming appeared energetically more stressful than acute warming (from the final instar), because (i) only the latter resulted in an adaptive increase of heat tolerance, and (ii) especially developmental and transgenerational warming reduced the diving responsiveness and diving time. Exposure to chlorpyrifos decreased the heat tolerance, diving responsiveness and diving time. The impact of chlorpyrifos was lower at 24 °C than at 20 °C indicating that the expected increase in toxicity at 24 °C was overruled by the observed increase in pesticide degradation. Notably, although our results suggest that transgenerational warming was energetically more stressful, it did reduce the chlorpyrifos-induced negative effects at 24 °C on heat tolerance and the alarm escape response compared to acute warming. Our results provide important evidence that the exposure duration to warming may determine the impact of a pesticide under warming, thereby identifying a novel temporal aspect of stressor interactions in risk assessment.

Altered Spontaneous Brain Activity and Functional Integration in Hemodialysis Patients With End-Stage Renal Disease.

PURPOSE: Using the amplitude of low-frequency fluctuation (ALFF) and functional connectivity (FC) algorithm to study the alteration of brain function in hemodialysis patients with end-stage renal disease (ESRD). PATIENTS AND METHODS: We recruited 20 patients with ESRD on regular hemodialysis and 17 healthy controls (HCs). All of the participants underwent resting-state fMRI (rs-fMRI), neuropsychological tests, and blood biochemical examination. The individual ALFF values between the two groups were tested by an independent sample t-test. Then, we set the altered ALFF brain areas as seed regions of interest (ROIs), and FC analysis was used to investigate the functional integration patterns between the seed ROI and the voxels within the whole brain. RESULTS: The ALFF values of the right precuneus and angular gyrus (RAG) in the ESRD group were lower than those in the HC subjects, but the right precentral gyrus showed higher ALFF values in patients. Hemoglobin (Hb) was negatively correlated with the ALFF values of the right precentral gyrus, and the ALFF values of the right precuneus were negatively correlated with line-tracing test (LTT) scores in patients with ESRD. Patients with ESRD show decreased connectivity between the RAG and the left precuneus, right superior frontal gyrus (RSFG), and the connectivity within the RAG was weak. In addition, FC in the RAG-right cuneus, right precuneus-left supramarginal gyrus was enhanced in the patient group. CONCLUSION: Our research suggested that, in hemodialysis patients with ESRD, the brain areas with abnormal spontaneous brain activity and FC are mainly located in the default mode network (DMN) regions. Hb and the LTT results were correlated with abnormal spontaneous brain activity. These findings provide additional evidence to understand the possible underlying neuropathological mechanisms in patients with ESRD.

The Exposure Order Strongly Modifies How a Heat Spike Increases Pesticide Toxicity.

The exposure order may strongly affect the impact of stressors, yet is largely ignored for the frequently occurring combinations of toxicants with natural stressors. We tested how exposure order shaped the interactive effects of serial exposure to the pesticide chlorpyrifos and to a heat spike in the larvae of the mosquito Culex pipiens. Notably, the chlorpyrifos-induced mortality was much more magnified by the heat spike and a synergism was already detected at the low concentration when exposure to chlorpyrifos followed the heat spike. This suggests that the preceding heat spike weakened the larvae as reflected in their lower net energy budget, moreover the chlorpyrifos-induced inhibition of its target enzyme (acetylcholinesterase) was only magnified by the heat spike when it was the first stressor. Also the chlorpyrifos-induced reduction in heat tolerance was stronger when the pesticide pulse followed the heat spike, and was buffered by the heat spike when this was the second stressor. Our results provide the first evidence that the exposure order can strongly change the magnifying effect of an important climate change factor on the toxicity of a pesticide. This highlights the importance of exposure order in ecological risk assessment of toxicants under realistic combinations with natural stressors.

Mosquito larvae that survive a heat spike are less sensitive to subsequent exposure to the pesticide chlorpyrifos.

While extreme high temperatures are an important aspect of global warming, their effects on organisms are relatively understudied, especially in ecotoxicology. Sequential exposure to heat spikes and pesticides is a realistic scenario as both are typically transient stressors and are expected to further increase in frequency under global warming. We tested the effects of exposure to a lethal heat spike and subsequently to an ecologically relevant lethal pulse exposure of the pesticide chlorpyrifos in the larvae of mosquito Culex pipiens. The heat spike caused direct and delayed mortality, and resulted in a higher heat tolerance and activity of acetylcholinesterase, and a lower fat content in the survivors. The chlorpyrifos exposure caused mortality, accelerated growth rate, and decreased the heat tolerance and the activity of acetylcholinesterase. The preceding heat spike did not change how chlorpyrifos reduced the heat tolerance. Notably, the preceding heat spike did lower the lethal effect of the pesticide, which makes an important novel finding at the interface of ecotoxicology and global change biology, and adds a new dimension to the "climate-induced toxicant sensitivity" (CITS) concept. This may be due to both survival selection and cross-tolerance, and therefore likely a widespread phenomenon. Our results emphasize the importance of including extreme high temperatures as an important transient global change stressor in ecotoxicology.

The Value of Older Donors' Klotho Level in Predicting Recipients' Short-Term Renal Function.

BACKGROUND The present organ shortage has led to increased use of kidneys from expanded-criteria donors, but the prognosis is disappointing due to poor graft quality. As a promising kidney protector, the Klotho gene's role in predicting short-term prognosis has not been assessed. MATERIAL AND METHODS We retrospectively analyzed data from 41 recipients and 25 donors. Multiple clinical variables were compared between different subgroups of donors or their corresponding recipients. The area under the receiver operating characteristic curve (AUROC) was used to evaluate the distinguishing ability. Dynamic changes in serum Klotho, FGF-23, and urinary NGAL were assessed. RESULTS Serum Klotho level was significantly lower in donors age ≥50 years (p=0.017), and there was a moderate negative correlation between serum Klotho expression and age (r=-0.464, p=0.019). Moreover, detection of Klotho mRNA and immunohistochemical analysis in kidneys revealed the same trend as in serum. Furthermore, for older donors (age ≥50 years), serum Klotho level had a strong negative correlation with recipient eGFR 1 month post-transplant (r=-0.686, p=0.007), which was proved to be a good predictor for estimating graft function by ROC analysis. Additionally, during the post-transplant follow-up, serum Klotho levels increased slightly after a temporary decline, while serum FGF-23 and urinary NGAL decreased significantly and then stayed low thereafter. CONCLUSIONS Klotho level, which decreases with age, may be a potential predictor of short-term renal function, especially for grafts from older donors.

The protective effects of ischemic preconditioning on rats with renal ischemia-reperfusion injury and the effects on the expression of Bcl-2 and Bax.

The aim of the present study was to investigate the protective effects of ischemic preconditioning on rats with renal ischemia-reperfusion injury and the effects on the expression of Bcl-2 and Bax. Thirty-six SD rats were randomly divided into three groups (n=12) including sham operation (S) group, ischemia-reperfusion group (I/R) group and ischemic preconditioning (IP) group. After anesthesia with intraperitoneal injection of chloral hydrate, bilateral renal pedicles were clipped for 45 min, followed by perfusion for 6 h to establish the I/R model. Both kidneys in rats of S group were separated and exposed for 45 min, but renal pedicles were not clipped. In IP group, bilateral renal pedicles were clipped for 5 min, followed by perfusion for 5 min, this procedure was repeated 3 times. Then bilateral renal pedicles were clipped for 45 min, followed by perfusion for 6 h. Blood samples were collected and rats were sacrificed to collect renal tissue. Levels of serum creatinine (Cr) and blood urea nitrogen (BUN) were measured. Activity of superoxide dismutase (SOD) was measured by xanthine oxidase assay. Degree of renal injury was evaluated by H&E staining. TUNEL kit was used to detect the number of apoptotic cells in renal tissue. Expression levels of Bcl-2 and Bax were detected by semi-quantitative PCR and western blot analysis at mRNA and protein levels, respectively. Results showed that levels of Cr and BUN in I/R and IP groups were significantly higher than those in S group, and levels of Cr and BUN in I/R group were significantly higher than that in IP group (P<0.05). Activity of SOD in I/R group and IP group were significantly lower than those in S group, and activity of SOD in I/R group were significantly lower than those in IP group (P<0.05). H&E staining showed that, compared with S group, renal injury in the I/R and IP groups was more serious than that in the S group, and I/R group was more serious than the IP group (P<0.05). TUNEL apoptosis assay showed that number of apoptotic cells in IP and I/R groups were significantly higher than that in the S group (P<0.01). Semi-quantitative PCR and western blot analysis showed that, compared with the S group, expression levels of Bcl-2 mRNA and protein were significantly decreased, expression levels of Bax mRNA and protein were significantly increased, and the ratio of Bcl-2/Bax was significantly decreased in the IP and I/R groups (P<0.01). Compared with the I/R group, expression level of Bcl-2 was significantly increased, the level of Bax was significantly deceased, and the ratio of Bcl-2/Bax was significantly increased in the IP group (P<0.01). As a result, ischemic preconditioning can protect rats with renal ischemia-reperfusion injury possibly by increasing the expression level of Bcl-2 and decreasing the expression level of Bax.

[CD4(+) T lymphocyte detection in renal transplant recipients and its clinical value for cytomegalovirus pneumonia treatment].

OBJECTIVE: To explore the clinical value of CD4(+)T lymphocyte detection in the treatment of cytomegalovirus(CMV) pneumonia following kidney transplantation. METHODS: From January 2005 to May 2008, 133 recipients of kidney transplantation were enrolled in this study. The number of CD4(+)T cells in peripheral blood was examined. According to the changes of CD4(+)T cell, immunosuppressive agents (CsA/FK506+MMF+Pred) were adjusted, and the effects of CMV pneumonia occurring were investigated. RESULTS: In the period of 45-72 day after renal transplantation, 36 cases were found to have significantly lower number of CD4(+)T cells than that before operation. Of the 133 recipients, 12(9.0%, 12/133) had severe pneumonia, during 58-118 days after operation, including 7 with acute respiratory distress syndrome(ARDS); 4 patients(33.3%, 4/12) died and 8(66.7%, 8/12) were cured. The incidence of CMV pneumonia(27.8%, 10/36) in the low- CD4(+)T cell recipients was significantly higher than that(2.1%, 2/97) in patients with normal T cell level(P<0.01). During the withdrawal of immunosuppressive agents, 34 patients had normal kidney function(serum creatinine 71-126 micromol/L), except 2 cases underwent mild acute rejection. In 24 non-pneumonia recipients, the number of CD4(+)T cell kept growing as the withdrawal, on 14, 21 day after the withdrawal increased markedly compared with that on 0 day. In 8 survival patients with CMV pneumonia, the number of CD4(+)T cell rose slowly,on 21 day after the withdrawal increased to the normal level. But in 4 non-survival patients, the number of CD4(+)T cell kept continuously in lower level. CONCLUSION: CMV pneumonia is associated with lower CD4(+)T cell level in kidney transplant recipients. Determination of CD4(+) T cell could reflect the status of cellular immunity and give directions of the withdrawal. Discontinuance of immunosuppressive agents in severe CMV pneumonia patients was safe. However, it may be helpful to guide the clinical treatment.

[Cytomegalovirus infection accompanied with acute pancreatitis after kidney transplantation].

OBJECTIVE: To explore the prevention and management of human cytomegalovirus (HCMV) infection accompanied with acute pancreatitis after kidney transplantation. METHODS AND RESULTS: A retrospective analysis of 5 patients with acute pancreatitis after kidney transplantation was conducted. The incidence of acute pancreatitis after kidney transplantation was 2.3% (5/217). All the 5 cases were complicated by active HCMV infection, 3 of which had hyperlipemia and 2 had liver dysfunction. Three cases were finally cured while the other 2 died, one of which was due to respiration failure arising from HCMV interstitial pneumonia accompanied with hemorrhagic necrotizing pancreatitis, and the other due to fulminating liver function failure because of active HCMV infection accompanied with hemorrhagic necrotizing pancreatitis. CONCLUSION: Active HCMV infection is the most important factor responsible for acute pancreatitis, and early diagnosis and treatment are crucial to lower mortality rate.