Relationship of serum total cholesterol and triglyceride with risk of mortality in maintenance hemodialysis patients: a multicenter prospective cohort study.

OBJECTIVE: The relationship between serum total cholesterol (TC) and triglyceride (TG) levels and mortality in maintenance hemodialysis (MHD) patients remains inconsistent. We aimed to explore the individual and combined association of TC and TG levels with the risk of mortality in Chinese MHD patients. METHODS: 1036 MHD patients were enrolled in this multicenter, prospective cohort study. The serum levels of total cholesterol and triglycerides were measured at baseline. The primary outcome was all-cause mortality and secondary outcome was cardiovascular disease (CVD) mortality. RESULTS: During a median follow-up duration of 4.4 years (IQR= 2.0-7.9 years), 549 (53.0%) patients died, and 297 (28.7%) deaths were attributed to CVD. Compared with patients with TC levels in the first three quartiles (<182.5 mg/dL), a significantly higher risk of all-cause mortality was found in participants with TC in the fourth quartile (hazard ratio [HR], 1.43; 95% confidence interval [CI], 1.17-1.76). However, a significantly lower risk of all-cause mortality was observed in participants with TG in the fourth quartile (≥193.9 mg/dL) (HR, 0.78; 95%CI: 0.63-0.98), compared with participants with TG in the first three quartiles. Similar trends were observed in CVD mortality. When analyzed jointly, patients with lower TC (<182.5 mg/dL) and higher TG (≥193.9 mg/dL) levels had the lowest risk of all-cause mortality and CVD mortality.Conclusions: In MHD patients in southern China, higher TC levels were associated with higher risk of mortality, while higher TG levels were related to lower risk of mortality. Patients with lower TC and higher TG levels had the best survival prognosis.

The association between lymphocyte to high-density lipoprotein ratio and depression: Data from NHANES 2015-2018.

INTRODUCTION: The relationship of lymphocyte to high-density lipoprotein ratio (LHR) with depression remains uncertain. We aimed to evaluate the association between LHR and depression in US adults. METHODS: In this cross-sectional study, a total of 4216 participants were enrolled from the National Health and Nutrition Examination Survey (2015-2018). Depressive symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9). Participants were classified as having depression if PHQ-9 scores were ≥10. Multiple logistic regression models were used to explore the relationship between the LHR and depression. RESULTS: Overall, the LHR was significantly associated with depression (per standard deviation increment; adjusted odds ratio (OR), 1.31; 95% confidence interval (CI) [1.14, 1.50]) after adjusted potential variables. Interactions between LHR with metabolic syndrome (MetS) and body mass index (BMI) on the risk of depression were found in stratified analysis (p for interaction < .05). CONCLUSIONS: A higher level of LHR was significantly associated with higher odds of having depression in US adults, and it was strengthened in participants with MetS or BMI ranging from 25 to 30 kg/m2 .

Association between serum uric acid levels and depressive symptoms according to menopausal status.

INTRODUCTION: The menopause-specific relationship between serum uric acid (SUA) and depressive symptoms were not known. We aimed to explore the association between SUA and depressive symptoms stratified by menopausal status. METHODS: This is a cross-sectional study, a total of 4845 females were enrolled from China health and retirement longitudinal study (CHARLS) in China. The Center for Epidemiologic Studies Depression Scale (CESD) were used to measure depressive symptoms. A cut-off score of CES-D ≥ 10 was defined as depression. Multiple regression models were used to assess the relationship between SUA and depression stratified by menopausal status. RESULTS: Overall, SUA was significantly associated with depressive symptoms/depression in post-menopause women (ß = -0.39, 95 % CI: -0.60, -0.17) after adjusted potential confounders. Compared with those whose SUA levels were in the first tertile, participants with their SUA in the second (ß = -0.76, 95 % CI: -1.30, -0.22) and third tertile (ß = -1.24, 95 % CI: -1.80, -0.68) had milder depressive symptoms. However, SUA was not associated with depressive symptoms in pre-menopause women (ß = 0.1, 95 % CI: -0.25, 0.46). An interaction between menopausal status and SUA on depressive symptoms were found in this study (P = 0.02). Similar results were found for depression. LIMITATIONS: Some potential covariates like diet that could affect SUA levels were not considered in this study. CONCLUSIONS: Higher SUA was associated with depressive symptoms/depression in post-menopause women. An interaction between menopausal status and SUA on depressive symptoms were found. SUA was not associated with depressive symptoms/depression in pre-menopause women.

Integrated single-cell and spatial transcriptomic profiling reveals higher intratumour heterogeneity and epithelial-fibroblast interactions in recurrent bladder cancer.

BACKGROUND: Recurrent bladder cancer is the most common type of urinary tract malignancy; nevertheless, the mechanistic basis for its recurrence is uncertain. Innovative technologies such as single-cell transcriptomics and spatial transcriptomics (ST) offer new avenues for studying recurrent tumour progression at the single-cell level while preserving spatial data. METHOD: This study integrated single-cell RNA (scRNA) sequencing and ST profiling to examine the tumour microenvironment (TME) of six bladder cancer tissues (three from primary tumours and three from recurrent tumours). FINDINGS: scRNA data-based ST deconvolution analysis revealed a much higher tumour heterogeneity along with TME in recurrent tumours than in primary tumours. High-resolution ST analysis further identified that while the overall natural killer/T cell and malignant cell count or the ratio of total cells was similar or even lower in the recurrent tumours, a higher interaction between epithelial and immune cells was detected. Moreover, the analysis of spatial communication reveals a marked increase in activity between cancer-associated fibroblasts (CAFs) and malignant cells, as well as other immune cells in recurrent tumours. INTERPRETATION: We observed an enhanced interplay between CAFs and malignant cells in bladder recurrent tumours. These findings were first observed at the spatial level.

Paper mulberry leaves as a potential sterilant: evidence from Microtus fortis-a laboratory study.

Introduction: The Yangtze vole (Microtus fortis) is a small herbivorous rodent that usually causes damage to crops and forests in China. Various measures were used to control their population including chemical rodenticides. However, rodenticides may cause secondary damage to the environment and the ecosystem. Therefore, the development of new rodent sterilants is urgent. Considering that some compounds of paper mulberry leaves have been verified that can inhibit the biosynthesis of sexual hormone, we aimed to explore the antifertility effect of paper mulberry leaves on M. fortis. Methods: In this study, voles were divided into three groups including a male group, a female group, and a breeding group, and paper mulberry leaves were added into basal fodder of voles maintained in laboratory, of which the proportion of leaf weight was 50%. In each group, voles were fed with mixed fodder as treatment (BP) and voles were fed with basal fodder as contrast (CK). Results and discussion: After feeding for more than 1 month, the results indicated that paper mulberry leaves attracted voles to feed, but inhibited their growth and reproduction. Since the second week, food intakes of BP have been significantly higher than CK (p< 0.05). However, weights of voles in male and female groups were 72.283 ± 7.394 g and 49.717 ± 2.278 g in the fifth week, and both were significantly reduced compared with their original weight (p< 0.05). Meanwhile, testicular volumes of male voles fed with BP were significantly smaller than CK (former: 318.000 ± 44.654 mm3, latter: 459.339 ± 108.755 mm3); the testosterone level, sperm number, and vitality of BP were obviously weaker than CK. Female uteruses and oophoron of BP grew slower, and the organ coefficients of uterus and oophoron fed BP were both significantly lower than CK (p< 0.05). The first reproduction of BP couple voles spent 45 days, while CK spent only 21 days. These results suggest that paper mulberry leaves could be the potential resource to produce sterilants to control rodent populations by delaying their sexual growth and reproduction. If it was practical, the apparent advantages of paper mulberry are that it is an abundant resource and the inhibitory effect could be effective in both male and female individuals. Our conclusion also supports the transformation of rodent management from lethal management to fertility control, which would be more ecologically friendly to agriculture and the ecosystem.

Low BMI and high waist-to-hip ratio are associated with mortality risk among hemodialysis patients: a multicenter prospective cohort study.

Background: Data are limited on the relationship between waist-to-hip ratio (WHR) and mortality risk among maintenance hemodialysis (MHD) patients. Moreover, the combined association of body mass index (BMI) and WHR with mortality remains uncertain. Therefore, we aimed to explore the individual and combined association of BMI and WHR with the all-cause and cardiovascular disease (CVD) mortality. Methods: In this multicenter prospective cohort study, we enrolled 1034 MHD patients. The primary outcome was all-cause mortality and secondary outcome was CVD mortality. Multivariable Cox proportional hazards models were used to evaluate the individual and combined association of BMI and WHR with the risk of mortality. Results: A nonlinear inverse relationship was found between BMI and risk of all-cause mortality (P for nonlinearity <.05). Being underweight (<18.5 kg/m2) was associated with higher all-cause mortality risk (HR 1.45; 95% CI 1.08-1.94) compared with normal weight (18.5-23.9 kg/m2), while being overweight (24-27.9 kg/m2; HR 0.96; 95% CI 0.70-1.31) and obese (≥28 kg/m2; HR 1.19; 95% CI 0.62-2.26) showed no significant differences. Of note, WHR was independently and positively associated with all-cause mortality (per standard deviation increase, HR 1.13; 95% CI 1.00-1.27). When analyzed jointly, patients with low BMI (<18.5 kg/m2) and high WHR (≥0.95) had the highest risk of all-cause mortality. Similar results were obtained for CVD mortality. Conclusions: In patients undergoing hemodialysis from China, low BMI and high WHR were individually and jointly associated with higher risk of mortality. Our results emphasize that BMI and WHR may jointly affect the prognosis of MHD patients.

Woody plants have the advantages in the phytoremediation process of manganese ore with the help of microorganisms.

The serious ecological damage caused by mining activities cannot be ignored. The use of an environmentally friendly restoration method to rebuild the vegetation and soil environment in the mining area has attracted more and more attention. This paper aims to study soil quality as well as vegetation characteristics of four woody species including Pinus massoniana (P. massoniana), Broussonetia papyrifera (B. papyrifera), Koelreuteria paniculata (K. paniculata), Osmanthus fragrans (O. fragrans), and two herbaceous species including Setaria viridis (S. viridis) and Cynodon dactylon (C. dactylon). In addition, we further clarified the effects of B. papyrifera and K. paniculata on soil nutrients and microbial communities after restoration. The results showed that the vegetation restoration area had better soil quality and plant community diversity, and the woody plants restoration effect were better. Compared with slag, B. papyrifera and K. paniculata remediation could improve soil pH and mitigate heavy metal contamination in mining areas, but was not effective in enhancing Soil Organic Matter (SOM), Total Nitrogen (TN), Total Potassium (TK) and Total Phosphorus (TP). In addition, the abundance and diversity of soil bacterial communities were increased. Of all the study sites, Proteobacteria had the greatest dominance. Vegetation restoration resulted in an increase in the relative abundance of Acidobacteria, while a decrease in Actinobacteria, Cyanobacteria and Firmicutes. With the restoration of vegetation, the increase of pH, the change of TN, SOM, TK, TP and the mitigation of Manganese (Mn) pollution were the main reasons affecting the soil microbial community. This study has great significance for understanding the ecological changes in the mining area after artificially mediated vegetation restoration, including changes in soil environment, plant community and microbial community, and woody plants will be more encouraged for the restoration of manganese mining areas.

A flagship species-based approach to efficient, cost-effective biodiversity conservation in the Qinling Mountains, China.

Prioritizing threatened species protection has been proposed as an efficient response to the global biodiversity crisis. We used in-situ conservation data to predict the potential habitat area of four flagship species: the giant panda (Ailuropoda melanoleuca), golden monkey (Rhinopithecus roxella quinlingensis), takin (Budorcas taxicolor bedfordi), and crested ibis (Nipponia nippon). We then designed systematic conservation planning schemes for various scenarios given species habitat preferences and anthropogenic activities and conducted a cost-effectiveness assessment. Broadly, the geographical distributions of suitable habitats for giant pandas, golden monkeys, and takins exhibited high spatial congruence (correlation coefficients of 0.59-0.90), and areas of high congruence were concentrated in the northern portion of the Qinling Mountains at high elevation (>1500 m). By contrast, the crested ibis was negatively correlated in space with its sympatric species (-0.47 to -0.29). Crested ibis habitats were clustered in the southern portion of the region at low elevation (<1500 m). A hypothetical conservation priority area (CPA) based on the giant panda, golden monkey, and takin included 39.64% of the Qinling Mountains and 100%, 99.99%, 99.59%, and 7.84% of the suitable habitats for giant pandas, golden monkeys, takins, and crested ibises, respectively. The same area included 99.07%, 70.87%, and 39.96% of the highly important areas for the ecosystem services of biodiversity conservation, water supply, and soil retention, respectively, and only 4.62%, 16.83%, and 13.4% of the area were associated with high-density residential area, impervious surfaces, and cropland, respectively. Therefore, we conclude that a CPA approach based on the specialist species could result in effective, low-cost biodiversity conservation in the Qinling Mountains. However, we note that existing protected areas account for only 26.52% of the CPA. We recommend that the main area of the proposed Qinling National Park should be based on the CPA developed here.

The Effects of Oral Energy-Dense Supplements on Nutritional Status in Nondiabetic Maintenance Hemodialysis Patients: A Randomized Controlled Trial.

BACKGROUND AND OBJECTIVES: Fat-based energy-dense nutritional supplements may offer benefits over protein- or carbohydrate-dense supplements for patients receiving dialysis because of the adverse metabolic consequences of the latter. We conducted a randomized controlled trial to assess the effects of the short-term use of a fat-based nutritional supplement on various measures of nutritional status in patients receiving maintenance hemodialysis who have low dietary energy intake. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We enrolled nondiabetic patients receiving hemodialysis for >3 months who had inadequate dietary energy intake (<30 kcal/kg per day). The participants were randomly assigned in a 1:1 ratio to receive an oral fat-based energy-dense supplement (300 kcal daily) or routine care for 12 weeks (n=120 per group). The primary outcome was the change in phase angle measured by bioelectrical impedance analysis, a marker of cell integrity and body cell mass, from the baseline to week 12. The secondary outcomes were changes in quality of life. Other outcomes included laboratory nutritional indicators and physical examinations. RESULTS: The average age of the total population was 47 (SD: 12) years, and 55% were men. The median of dialysis vintage was 43.4 (22.5-76.3) months; 240 participants were randomly assigned to the intervention (n=120) or control group (n=120). In total, 228 (95%) participants completed the trial. The change in phase angle did not differ significantly between the intervention and control groups (estimate, 0.0; 95% confidence interval, -0.1 to 0.1 versus estimate, 0.0; 95% confidence interval, -0.1 to 0.1; estimated difference, 0.0; 95% confidence interval -0.2 to 0.2; P=0.99). None of the 19 domains of quality of life differed between the groups. Adverse events were reported in 23 (19%) participants in the control group and 40 (33%) participants in the intervention group. CONCLUSIONS: In nondiabetic patients on maintenance hemodialysis, short-term administration of fat-based energy-dense nutritional supplement has no clinically significant effect on nutritional status as measured by phase angle. PODCAST: This article contains a podcast at https://https://www.asn-online.org/media/podcast/CJASN/2021_08_03_CJN16821020.mp3.

Dietary Plant Protein and Mortality Among Patients Receiving Maintenance Hemodialysis: A Cohort Study.

RATIONALE & OBJECTIVE: Although greater dietary intake of protein has been associated with beneficial health effects among patients receiving maintenance hemodialysis (MHD), the effects of plant protein intake are less certain. We studied the association of the proportion of protein intake derived from plant sources with the risk of mortality among patients receiving MHD and explored factors that may modify these associations. STUDY DESIGN: Prospective observational cohort study. SETTING & PARTICIPANTS: 1,119 Chinese hemodialysis patients aged over 18 years receiving MHD in 2014-2015. PREDICTORS: The proportion of plant protein intake to total protein intake. OUTCOMES: All-cause mortality and cardiovascular disease (CVD) mortality. ANALYTICAL APPROACH: Segmented regression models were fit to examine the association of plant protein intake proportion with the risk of all-cause mortality and CVD mortality. Multivariable-adjusted Cox proportional and cause-specific hazards models were used to estimate the hazard ratios (HR) and 95% CI for these outcomes. RESULTS: The means of plant protein intake normalized to ideal body weight and plant protein intake proportion were 0.6±0.2 (SD) g/kg per day and 0.538±0.134, respectively. During a median follow-up period of 28.0 months, 249 deaths occurred, with 146 of these deaths resulting from CVD. Overall, there was a U-shaped association between plant protein intake proportion and the risk of all-cause mortality, with an inflection point at 45%. Among patients with a plant protein intake proportion<45%, there was a 17% lower rate of mortality with each 5% greater plant protein intake proportion (HR, 0.83 [95% CI, 0.73-0.96]). Among patients with plant protein intake proportion≥45%, there was a 9% greater rate of mortality with each 5% greater plant protein intake proportion. A similar U-shaped association was observed for CVD mortality, with an inflection point at 44%. LIMITATIONS: Observational study, potential unmeasured confounding. CONCLUSIONS: There was a U-shaped association between plant protein intake proportion and the risk of all-cause and cardiovascular mortality in MHD patients. If confirmed, these findings suggest a potential avenue to improve outcomes in this patient population.

Relationship between Serum Uric Acid and Mortality Risk in Hemodialysis Patients: A Multicenter Prospective Cohort Study.

BACKGROUND: Several studies have reported that low serum uric acid (SUA) levels are related to increased risk of mortality in maintenance hemodialysis (MHD) patients. However, the possible detrimental effects of high SUA on the mortality risk have not been well examined. Moreover, the possible effect modifiers for the SUA-mortality association have not been fully investigated. To address the aforementioned gap, we aimed to explore the nonlinear relationship between SUA levels and all-cause and cardiovascular disease (CVD) mortality risk, and to examine any possible effect modifiers in MHD patients. METHODS: We conducted a multicenter, prospective cohort study among 1,018 MHD patients from 8 hemodialysis centers. The primary outcome was all-cause mortality, and the secondary outcomes were CVD mortality and non-CVD mortality. RESULTS: The mean value for SUA in the total population was 8.5 ± 1.9 mg/dL. The lowest and highest quintiles of SUA were <7.0 and >10.1 mg/dL, respectively. Over a median follow-up of 45.6 months, 343 deaths were recorded, of which 202 (58.9%) were due to CVD. When SUA was assessed as quintiles, a significantly higher risk of all-cause mortality was found in patients in quintile 1 (<7.0 mg/dL; hazard ratio [HR], 1.33; 95% confidence interval [CI]: 1.02-1.73) or quintile 5 (≥10.1 mg/dL; HR, 1.47; 95% CI: 1.09-2.00), compared to those in quintiles 2-4 (7-10.1 mg/dL). Moreover, the U-shaped SUA-mortality association was mainly found in those with lower C-reactive protein levels (<3 compared with ≥3 mg/L; p for interaction = 0.018). Similar trends were found for CVD mortality and non-CVD mortality. CONCLUSION: There was a U-shaped relationship between SUA levels and the risk of all-cause mortality, CVD mortality, and non-CVD mortality in MHD patients.

Liquid nitrogen waterless fracking for the environmental protection of arid areas during unconventional resource extraction.

Many arid and semi-arid regions are rich in shale gas or coalbed methane. However, hydraulic-fracturing, commonly used for reservoir stimulation, has serious environmental impacts such as the consumption of large quantities of water, damage of residual organic compounds and the disposal of process water. This paper presents liquid nitrogen (LN2) as an environmentally friendly, waterless fracking technology, which could potentially replace hydraulic fracturing. Laboratory experiments on LN2 fracturing were conducted on coal samples, and high-resolution micro X-ray computed tomography was used for 3D visualization and evaluation of fracture evolution characteristics, including liquid nitrogen cyclic quenching, effect of initial fracture size (IFS) and coal saturation. The findings of this study testify to the effectiveness of fracturing by LN2 quenching on coalbed methane reservoirs. This technique would help protect water resources and alleviate other environmental concerns in arid districts during unconventional resource recovery.

Comparison of three nutritional screening tools for predicting mortality in maintenance hemodialysis patients.

OBJECTIVES: The aim of this study was to compare the effect of different nutritional screening tools on predicting the risk for mortality in patients on maintenance hemodialysis (MHD). METHODS: A cohort of 1025 patients on MHD were enrolled from eight hospitals. The malnutrition-inflammation score (MIS), objective score of nutrition on dialysis (OSND), and geriatric nutritional risk index (GNRI) were measured at baseline. All-cause mortality and cardiovascular (CV) mortality were the major study outcomes. RESULTS: The median follow-up duration was 28.1 mo. The MIS (per SD increase, hazard ratio [HR], 1.35; 95% confidence interval [CI], 1.18-1.55), the OSND (per SD decrease, HR, 1.24; 95% CI, 1.09-1.42), and the GNRI (per SD decrease, HR, 1.26; 95% CI, 1.10-1.43) were significantly associated with the risk for all-cause mortality. More importantly, the mortality predictability of the MIS appears similar to the GNRI (P = 0.182) and greater than the OSND (MIS versus OSND: P = 0.001; GNRI versus OSND: P = 0.045). Similar results were found for CV mortality. CONCLUSIONS: Each of the three nutritional screening tools was significantly associated with an increased risk for all-cause and CV mortality. The mortality predictability of the MIS was similar to the GNRI and greater than the OSND.

Choledochoscope manometry about different drugs on the Sphincter of Oddi.

AIM: To assess the effects of H(2)-receptor blocking pharmacon, protease inhibitor, and gastro kinetic agents on the human Sphincter of Oddi (SO) motility by choledochoscope manometry. METHODS: One hundred and seventy-five patients with T tube installed after cholecystectomy and choledochotomy were assessed by choledochoscope manometry. They were randomly assigned into groups of H(2)-receptor blocking pharmacon, protease inhibitor, and gastro kinetic agents. The Sphincter of Oddi basal pressure (SOBP), amplitude (SOCA), frequency of contractions (SOF), duodenal pressure (DP), and common bile duct pressure (CBDP) were scored and analyzed. RESULTS: SOBP and SOCA were significantly decreased after cimetidine administration, and no statistical difference was seen in the famotidine group. In the gabexate mesilate group, SOBP had decreased significantly. In the ulinastatin group, SOCA decreased when ulinastatin was given at the rate of 2500 U/min; when ulinastatin administration was raised to 5000 U/min, SOBP, SOF and SOCA all experienced a fall. SOBP and SOCA for domperidone and SOCA for mosapride groups all decreased distinctly after administration. CONCLUSION: The regular dosage of cimetidine showed an inhibitory effect on the motility of SO, while famotidine had no obvious effects otherwise. Gabnexata mesilate, ulinastatin and gastro kinetic agents also showed inhibitory effects on the SO motility.