The impact of kidney function on plasma neurofilament light and phospho-tau 181 in a community-based cohort: the Shanghai Aging Study.

BACKGROUND: The blood-based biomarkers are approaching the clinical practice of Alzheimer's disease (AD). Chronic kidney disease (CKD) has a potential confounding effect on peripheral protein levels. It is essential to characterize the impact of renal function on AD markers. METHODS: Plasma phospho-tau181 (P-tau181), and neurofilament light (NfL) were assayed via the Simoa HD-X platform in 1189 dementia-free participants from the Shanghai Aging Study (SAS). The estimated glomerular filter rate (eGFR) was calculated. The association between renal function and blood NfL, P-tau181 was analyzed. An analysis of interactions between various demographic and comorbid factors and eGFR was conducted. RESULTS: The eGFR levels were negatively associated with plasma concentrations of NfL and P-tau181 (B = - 0.19, 95% CI - 0.224 to - 0.156, P < 0.001; B = - 0.009, 95% CI - 0.013 to -0.005, P < 0.001, respectively). After adjusting for demographic characteristics and comorbid diseases, eGFR remained significantly correlated with plasma NfL (B = - 0.010, 95% CI - 0.133 to - 0.068, P < 0.001), but not with P-tau181 (B = - 0.003, 95% CI - 0.007 to 0.001, P = 0.194). A significant interaction between age and eGFR was found for plasma NfL (Pinteraction < 0.001). In participants ≥ 70 years and with eGFR < 60 ml/min/1.73 m2, the correlation between eGFR and plasma NfL was significantly remarkable (B = - 0.790, 95% CI - 1.026 to - 0,554, P < 0.001). CONCLUSIONS: Considering renal function and age is crucial when interpreting AD biomarkers in the general aging population.

Single-cell RNA sequencing reveals transdifferentiation of parathyroid chief cells into oxyphil cells in patients with uremic secondary hyperparathyroidism.

The parathyroid gland is one of the main organs that regulate calcium and phosphorus metabolism. It is mainly composed of chief cells and oxyphil cells. Oxyphil cell counts are low in the parathyroid glands of healthy adults but are dramatically increased in patients with uremia and secondary hyperparathyroidism (SHPT). Increased oxyphil cell counts are related to drug treatment resistance, but the origin of oxyphil cells and the mechanism of proliferation remain unknown. Herein, three types of parathyroid nodules (chief cell nodules, oxyphil cell nodules and mixed nodules, respectively) excised from parathyroid glands of uremic SHPT patients were used for single-cell RNA sequencing (scRNA-seq), other molecular biology studies, and transplantation into nude mice. Through scRNA-seq of parathyroid mixed nodules from three patients with uremic SHPT, we established the first transcriptomic map of the human parathyroid and found a chief-to-oxyphil cell transdifferentiation characterized by gradual mitochondrial enrichment associated with the uremic milieu. Notably, the mitochondrial enrichment and cellular proliferation of chief cell and oxyphil cell nodules decreased significantly after leaving the uremic milieu via transplantation into nude mice. Remarkably, the phenotype of oxyphil cell nodules improved significantly in the nude mice as characterized by decreased mitochondrial content and the proportion of oxyphil cells to chief cells. Thus, our study provides a comprehensive single-cell transcriptome atlas of the human parathyroid and elucidates the origin of parathyroid oxyphil cells and their underlying transdifferentiating mechanism. These findings enhance our understanding of parathyroid disease and may open new treatment perspectives for patients with chronic kidney disease.

Phosphorus balance calculator: an individualized tool for treatment of hyperphosphatemia in hemodialysis patients.

BACKGROUND AND HYPOTHESIS: Lack of evaluations of the dietary phosphorus and dialysis phosphorus removal in daily clinical practice are the common obstacle to assess phosphorus balance and control phosphorus in hemodialysis patients. We aimed to investigate whether the individualized therapy using phosphorus balance calculator improves phosphorus control. METHODS: A randomized, open-label, multicenter, 4-week clinical trial was conducted. 119 maintenance hemodialysis patients aged 18 to 85 years old and with serum phosphorus level higher than 1.45mmol/l from 3 university teaching hospitals in Shanghai were enrolled. Patients were randomized in a 1:1 ratio to individualized therapy (n=60), or conventional therapy (n=59). The primary outcome was the serum phosphorus concentration after 4-week treatment. Secondary outcomes included the serum calcium and parathyroid hormone (PTH) concentrations, changes in serum phosphorus, calcium and PTH concentrations, and the proportion of patients achieving target ranges of serum phosphorus, calcium and PTH after 4-week treatment. RESULTS: Among 119 randomized participants (mean age, 62 years; 68 male[57%]), 116 completed the trial. By using the phosphorus balance calculator, the individualized group achieved a better phosphorus balance state, significantly reduced the serum phosphorus (1.62±0.45mmol/l versus 1.85±0.45 mmol/l, P=0.006), increased the proportions of patients achieving target serum phosphorus range (41% versus 18%, P=0.006), and had greater adjusted mean difference in change in serum phosphorus over the 4 weeks (-0.47 versus -0.23mmol/l, P=0.010) when compared to conventional therapy. No significant changes were observed in serum calcium and PTH levels, the proportion of patients achieving target serum calcium or PTH levels, and adjusted mean difference of serum calcium and PTH levels over the treatment period. CONCLUSION: Phosphorus balance calculator was proved to improve serum phosphorus control in patients undergoing maintenance hemodialysis, offering a new tool for managing hyperphosphatemia.

Unveiling the Microfiber Release Footprint: Guiding Control Strategies in the Textile Production Industry.

Microplastic fibers from textiles have been known to significantly contribute to marine microplastic pollution. However, little is known about the microfiber formation and discharge during textile production. In this study, we have quantified microfiber emissions from one large and representative textile factory during different stages, spanning seven different materials, including cotton, polyester, and blended fabrics, to further guide control strategies. Wet-processing steps released up to 25 times more microfibers than home laundering, with dyeing contributing to 95.0% of the total emissions. Microfiber release could be reduced by using white coloring, a lower dyeing temperature, and a shorter dyeing duration. Thinner, denser yarns increased microfiber pollution, whereas using tightly twisted fibers mitigated release. Globally, wet textile processing potentially produced 6.4 kt of microfibers in 2020, with China, India, and the US as significant contributors. The study underlined the environmental impact of textile production and the need for mitigation strategies, particularly in dyeing processes and fiber choice. In addition, no significant difference was observed between the virgin polyesters and the used ones. Replacing virgin fibers with recycled fibers in polyester fabrics, due to their increasing consumption, might offer another potential solution. The findings highlighted the substantial impact of textile production on microfiber released into the environment, and optimization of material selection, knitting technologies, production processing, and recycled materials could be effective mitigation strategies.

Plasma Aß42:Aß40 ratio as a biomarker for cognitive impairment in haemodialysis patients: a multicentre study.

Background: Mild cognitive impairment (MCI) and dementia are more prevalent in patients undergoing haemodialysis (HD). Although the cerebrospinal fluid amyloid beta (Aß) and tau (τ) have proven to be valid biomarkers for the diagnosis of Alzheimer's disease (AD) in the general population, the roles of plasma Aß and τ for the diagnosis of cognitive impairment in HD patients remain unknown. Methods: We conducted a cross-sectional study including patients receiving HD in three hospitals in Shanghai. All patients completed the Montreal Cognitive Assessment-Basic (MoCA-B). To validate the effectiveness of the MoCA-B score for screening MCI, a subset group underwent neuropsychological batteries. Serum proteomes were compared in HD patients with normal cognitive function and dementia. Plasma Aß42, Aß40 and total τ were measured using a single molecule array. Results: A total of 311 HD patients were enrolled (mean age 63 years, 55% male). The best cut-off score of MoCA-B for differentiating MCI and normal cognition was 24, with an area under the curve of 0.94. Serum proteomics revealed that neurodegenerative pathways related to AD were enriched in HD patients with dementia. The plasma Aß42:Aß40 ratio was significantly reduced in patients with MCI and dementia and was independently associated with cognitive function after adjusting for age, sex and education levels. Conclusions: We validated the MoCA-B as an optimal cognitive function screening instrument for MCI in HD patients. The plasma Aß42:Aß40 ratio was a potential biomarker in distinguishing normal cognition, MCI and dementia in HD populations.

A missing jigsaw within the hygiene hypothesis: Low-dose bisphenol A exposure attenuates lipopolysaccharide-induced asthma protection.

The rising occurrence of allergic asthma in early life across industrialized countries suggests that environmental factors play a crucial role in determining asthma susceptibility and severity. While prior exposure to microbial lipopolysaccharides (LPSs) has been found to offer protection against allergic asthma, infants residing in urban environments are increasingly exposed to environmental pollutants. Utilizing limulus lysate test screens and virtual screening models, we identified pollutants that can modulate LPS bioactivity. This investigation revealed that bisphenol A (BPA), a chemical commonly used in numerous household items and previously implicated in obesity and cancer, effectively neutralizes LPS. In-depth mechanistic analyses showed that BPA specifically binds to the lipid A component of LPS, leading to inactivation. This interaction eliminates the immunostimulatory activity of LPS, making mice more susceptible to house dust mite (HDM)-induced allergic asthma. BPA reactivates lung epithelial cells, consequently amplifying type 2 responses to HDMs in dendritic cells. This chemical interplay provides new insights into the pathophysiology of asthma in relation to human exposure. Understanding the intricate relationships between environmental chemicals and microbial antigens, as well as their impacts on innate immunity, is critical for the development of intervention strategies to address immune disorders resulting from urbanization.

Infiltration of freshwater food chain by nanoplastics: An examination of trophic transfer and biological impact.

The contamination of freshwater by nanoplastics (NPs) poses a significant threat to various organisms. However, the influence of food factors on the NPs toxicity and the associated risks to water safety remains poorly understood. In this study, we employed highly fluorescent NPs incorporating aggregation-induced emission fluorogens to quantify and visualize the interactions of NPs with freshwater phytoplanktonic alga Chlamydomonas reinhardtii and zooplankton Daphnia magna, including the uptake of NPs by algae and daphnids, as well as gut environment responses through both waterborne and foodborne routes. NPs at environmentally relevant concentrations were capable of aggregating and internalizing in planktonic algae, thus permeating the food chain and potentially causing ecological risks. Notably, positively charged NPs exhibited greater infiltration than the negatively charged NPs. Our findings indicated that NPs had a greater tendency to accumulate in Daphnia via the food chain rather than through direct exposure to water. This was attributed to the loss of selectivity, suggesting a potential mechanism for NP accumulation in aquatic food chains. However, daphnids exposed to NPs through waterborne route exhibited more gut pH acidification, esterase activity, and gut inflammation compared to those exposed via the foodborne route. Moreover, chronic exposure to NPs through waterborne routes significantly disrupted the growth, molting, and reproduction of Daphnia compared to the foodborne group. These findings provided valuable insights into the complexities of plastic pollution on primary trophic levels in aquatic environments.

A New Calculation Model for Calcium Requirements After Parathyroidectomy in Patients With Secondary Hyperparathyroidism.

OBJECTIVES: We aimed to develop a new calculation model for calcium requirements in dialysis patients following parathyroidectomy. METHODS: A total of 98 patients with secondary hyperparathyroidism receiving parathyroidectomy from January 2014 to January 2022 were enrolled in this study. Among these patients, 78 were randomly selected for construction of the calcium requirement calculation model, and the remaining 20 patients were selected for model validation. The calcium requirement model estimated the total calcium supplementation for 1 week after surgery using variables with significant relationships in the derivation group by stepwise multiple linear regression analysis. Bias, precision, and accuracy were measured in the validation group to determine the performance of the model. RESULTS: The model was as follows: calcium requirement for 1 week after surgery=33.798-8.929×immediate postoperative calcium+0.190×C-reactive protein-0.125×age+0.002×preoperative intact parathyroid hormone+0.003×preoperative alkaline phosphatase (R2=0.8). The model was successfully validated. CONCLUSION: We generated a novel model to guide calcium supplementation. This model can assist in stabilizing the serum calcium levels of patients during the early postoperative period. Furthermore, it contributes to the individualized and precise treatment of hypocalcemia in patients following parathyroidectomy.

Selective ingestion and response by Daphnia magna to environmental challenges of microplastics.

Our current understandings of the effects of microplastics and nanoplastics (MNPs) on aquatic animals are predominantly based on the single types of plastic particles. In the present study, we employed the highly fluorescent MNPs that incorporated aggregation-induced emission fluorogens and investigated the selective ingestion and response of Daphnia exposed to different types of plastics at environmentally relevant concentrations simultaneously. When daphnids were exposed to a single MNP, D. magna ingested them instantly in significant amounts. However, even low concentrations of algae had a significant negative impact on the MNP uptake. Specifically, algae caused the MPs to pass through the gut faster, reduced acidification and esterase activity, and changed the distribution of MPs in the gut. In addition, we also quantified the influences of size and surface charge on the selectivity of D. magna. The daphnids selectively ingested larger and positively charged plastics. MPs effectively reduced the uptake of NP and increased its gut passage time. Aggregation of positively and negatively charged MNPs also influenced the gut distribution and increased the gut passage time. The positively charged MPs accumulated in the middle and posterior gut, while aggregation of MNPs also increased acidification and esterase activity. These findings provided fundamental knowledge on the selectivity of MNPs and the microenvironmental responses of zooplankton guts.

New insights into the distribution, potential source and risk of microplastics in Qinghai-Tibet Plateau.

Microplastics (MPs) as emerging contaminants have become a major global concern, however, the distribution and origin of MPs in Qinghai-Tibet Plateau (QTP) and their impacts on ecosystem are poorly known. Hence, we systematically evaluated the profile of MPs on the representative metropolitan locations of Lhasa and Huangshui Rivers and the scenic sites of Namco and Qinghai Lake. The average abundance of MPs in the water samples was 7020 items/m3, which was 34 and 52 times higher than those for the sediment (206.7 items/m3) and soil samples (134.7 items/m3), respectively. Huangshui River had the highest levels, followed by Qinghai Lake, Lhasa River and Namco. Human activities rather than altitude and salinity impacted the distribution of MPs in those areas. Besides the consumption of plastic products by locals and tourists, laundry wastewater and exogenous tributary inputs, the unique prayer flag culture also contributed to the MPs emission in QTP. Notably, the stability and fragment of MPs were crucial for their fate. Multiple assessment models were employed to evaluate the risk of MPs. PERI model took MP concentration, background value and toxicity into account, comprehensively describing the risk differences of each site. The large PVC proportion in Qinghai Lake posed the highest risk. Furthermore, concerns should be raised about PVC, PE and PET in Lhasa and Huangshui Rivers, and PC in Namco Lake. Risk quotient suggested that aged MPs in sediments slowly released biotoxic DEHP and should be cleaned up promptly. The findings offer baseline data of MPs in QTP and ecological risks, providing important support for the prioritization of future control measures.

Focusing on Phosphorus Loads: From Healthy People to Chronic Kidney Disease.

Phosphorus is an essential micromineral with a key role in cellular metabolism and tissue structure. Serum phosphorus is maintained in a homeostatic range by the intestines, bones, and kidneys. This process is coordinated by the endocrine system through the highly integrated actions of several hormones, including FGF23, PTH, Klotho, and 1,25D. The excretion kinetics of the kidney after diet phosphorus load or the serum phosphorus kinetics during hemodialysis support that there is a "pool" for temporary phosphorus storage, leading to the maintenance of stable serum phosphorus levels. Phosphorus overload refers to a state where the phosphorus load is higher than is physiologically necessary. It can be caused by a persistently high-phosphorus diet, renal function decline, bone disease, insufficient dialysis, and inappropriate medications, and includes but is not limited to hyperphosphatemia. Serum phosphorus is still the most commonly used indicator of phosphorus overload. Trending phosphorus levels to see if they are chronically elevated is recommended instead of a single test when judging phosphorus overload. Future studies are needed to validate the prognostic role of a new marker or markers of phosphorus overload.

Accumulation Kinetics and Gut Microenvironment Responses to Environmentally Relevant Doses of Micro/Nanoplastics by Zooplankton Daphnia Magna.

Microplastics are emerging pollutants that have been widely reported in aquatic ecosystems. Based on the analysis of environmentally relevant concentrations of microplastics in global freshwater systems, herein, we employed aggregated-induced emission (AIE) microplastic fluorogens and imaged and quantified the bioaccumulation of differentially charged micro- (20 µm)/nano- (200 nm) plastics (MNPs) in zooplankton Daphnia magna. We found that all particles of different sizes and charges were readily ingested, especially larger-sized and positively charged MNPs, with over 50% of the ingested particles accumulating in the gut. Bioaccumulation of MNPs reached 50% of steady-state condition within 1 h. The presence of algae inhibited the ingestion and depuration of MNPs. To further demonstrate the effects of such accumulation on gut health, we further applied the AIE probes for visualizing the pH and esterase in the digestive tract, as well as the gut inflammation. An accumulation of MNPs in D. magna significantly and rapidly induced the acidification of gut pH while inducing esterase activity. The NPs apparently induced gut inflammation in contrast to the MPs, demonstrating the size-dependent effects on oxidative stress. Our results highlighted that MNP exposure at environmentally relevant concentrations perturbed the microenvironments of zooplankton guts, which may significantly affect their digestion and assimilation of food materials as well as contaminant uptake.

Two-Dimensional Violet Phosphorus P11: A Large Band Gap Phosphorus Allotrope.

The discovery of novel large band gap two-dimensional (2D) materials with good stability and high carrier mobility will innovate the next generation of electronics and optoelectronics. A new allotrope of 2D violet phosphorus P11 was synthesized via a salt flux method in the presence of bismuth. Millimeter-sized crystals of violet-P11 were collected after removing the salt flux with DI water. From single-crystal X-ray diffraction, the crystal structure of violet-P11 was determined to be in the monoclinic space group C2/c (no. 15) with unit cell parameters of a = 9.166(6) Å, b = 9.121(6) Å, c = 21.803(14)Å, ß = 97.638(17)°, and a unit cell volume of 1807(2) Å3. The structure differences between violet-P11, violet-P21, and fibrous-P21 are discussed. The violet-P11 crystals can be mechanically exfoliated down to a few layers (∼6 nm). Photoluminescence and Raman measurements reveal the thickness-dependent nature of violet-P11, and exfoliated violet-P11 flakes were stable in ambient air for at least 1 h, exhibiting moderate ambient stability. The bulk violet-P11 crystals exhibit excellent stability, being stable in ambient air for many days. The optical band gap of violet-P11 bulk crystals is 2.0(1) eV measured by UV-Vis and electron energy-loss spectroscopy measurements, in agreement with density functional theory calculations which predict that violet-P11 is a direct band gap semiconductor with band gaps of 1.8 and 1.9 eV for bulk and monolayer, respectively, and with a high carrier mobility. This band gap is the largest among the known single-element 2D layered bulk crystals and thus attractive for various optoelectronic devices.

Oligomer nanoparticle release from polylactic acid plastics catalysed by gut enzymes triggers acute inflammation.

The health risks of exposure to 'eco-friendly' biodegradable plastics of anthropogenic origin and their effects on the gastrointestinal tract are largely unknown. Here we demonstrate that the enzymatic hydrolysis of polylactic acid microplastics generated nanoplastic particles by competing for triglyceride-degrading lipase during gastrointestinal processes. Nanoparticle oligomers were formed by hydrophobically driven self-aggregation. In a mouse model, polylactic acid oligomers and their nanoparticles bioaccumulated in the liver, intestine and brain. Hydrolysed oligomers caused intestinal damage and acute inflammation. A large-scale pharmacophore model revealed that oligomers interacted with matrix metallopeptidase 12. Mechanistically, high binding affinity (Kd = 13.3 µmol l-1) of oligomers to the catalytic zinc-ion finger domain led to matrix metallopeptidase 12 inactivation, which might mediate the adverse bowel inflammatory effects after exposure to polylactic acid oligomers. Biodegradable plastics are considered to be a solution to address environmental plastic pollution. Thus, understanding the gastrointestinal fates and toxicities of bioplastics will provide insights into potential health risks.

Prevalence, evolution, replication and transmission of H3N8 avian influenza viruses isolated from migratory birds in eastern China from 2017 to 2021.

The continued evolution and emergence of novel influenza viruses in wild and domestic animals poses an increasing public health risk. Two human cases of H3N8 avian influenza virus infection in China in 2022 have caused public concern regarding the risk of transmission between birds and humans. However, the prevalence of H3N8 avian influenza viruses in their natural reservoirs and their biological characteristics are largely unknown. To elucidate the potential threat of H3N8 viruses, we analyzed five years of surveillance data obtained from an important wetland region in eastern China and evaluated the evolutionary and biological characteristics of 21 H3N8 viruses isolated from 15,899 migratory bird samples between 2017 and 2021. Genetic and phylogenetic analyses showed that the H3N8 viruses circulating in migratory birds and ducks have evolved into different branches and have undergone complicated reassortment with viruses in waterfowl. The 21 viruses belonged to 12 genotypes, and some strains induced body weight loss and pneumonia in mice. All the tested H3N8 viruses preferentially bind to avian-type receptors, although they have acquired the ability to bind human-type receptors. Infection studies in ducks, chickens and pigeons demonstrated that the currently circulating H3N8 viruses in migratory birds have a high possibility of infecting domestic waterfowl and a low possibility of infecting chickens and pigeons. Our findings imply that circulating H3N8 viruses in migratory birds continue to evolve and pose a high infection risk in domestic ducks. These results further emphasize the importance of avian influenza surveillance at the wild bird and poultry interface.

Exposure to bisphenol A alternatives bisphenol AF and fluorene-9-bisphenol induces gonadal injuries in male zebrafish.

Bisphenol A (BPA), present in many household products, can damage the male reproductive system. Accordingly, we summarized urine samples from 6921 human in National Health and Nutrition Examination Survey and found urinary BPA levels were inversely linked with blood testosterone in the children group. Currently, BPA replacements, such as fluorene-9-bisphenol (BHPF) and Bisphenol AF (BPAF), have been introduced to produce "BPA-free" products. Here we demonstrated that BPAF and BHPF could induce delayed gonadal migration and reduce the number of progenitors of germ cell lineage in zebrafish larvae. A close receptor analysis study reveals that BHPF and BPAF can strongly bind to androgen receptors, leading to the downregulation of meiosis-related genes and the overexpression of inflammatory markers. Furthermore, BPAF and BPHF can induce activation of the gonadal axis via negative feedback, leading to the hypersecretion of some upstream hormones and an increase in the expression of upstream hormone receptors. Our findings call for further research on the toxicological effects of BHPF and BPAF on human health and recommend that BPA replacements be investigated for anti-estrogenic action.

Associations of phthalates with prostate cancer among the US population.

Human exposure to harmful phthalates has raised global health concerns. According to cellular and molecular investigations, phthalates and their metabolites can promote prostate cancer (PCa). Despite being a prevalent cancer afflicting the global male population, the epidemiological association between phthalates and prostate cancer remains understudied. This work aims to investigate whether phthalate metabolites are related to prostate cancer. Moreover, we sought to understand whether their elevated concentrations are associated with increased serum concentrations of prostate-specific antigen (PSA), among non-prostate cancer interviewees. According to National Health and Nutrition Examination Survey (NHANES) data from 2003 to 2010, we screened eligible men aged 20 years or older. Then, crude and multivariate regression models were constructed to assess the relationship. The phthalates significantly related to PCa were analyzed based on variables associated with PCa status and PSA. The molar sum ∑di-2-ethylhexyl phthalate (∑DEHP) was simultaneously associated with increased risk of PCa and increasing PSA concentrations. Among PCa-related phthalates, high molecular weight phthalate metabolites included mono-benzyl phthalate (MBzP) and three metabolites of DEHP. In summary, phthalates are potentially associated with prostate tumorigenesis in the US population. However, additional in-depth prospective studies in different ethnic groups are required to validate the causality between both.

Risk Factors Affecting Muscle Mass Decline in Maintenance Hemodialysis Patients.

Objective: There is a high prevalence of sarcopenia in maintenance hemodialysis (MHD) patients, which is known to be associated with increased mortality. This study is aimed at analyzing the risk factors affecting muscle mass decline in MHD patients. Methods: This retrospective study included MHD patients who underwent two body composition assessments in October 2013 and November 2017. Depending on whether there was muscle loss or not, the patients were divided into a normal muscle mass (NMM) group and a muscle mass decline (MMD) group. According to the muscle mass decline rate, patients in the MMD group were further classified into a low-rate group and a high-rate group. Biochemical variables, serum vitamin concentrations, anthropometric data, SGA, muscle mass, handgrip, and daily steps were assessed. Risk factors for muscle mass decline were screened by multivariate logistic analysis and linear regression analysis. Results: Of the 72 MHD patients included in this study, 33 were male and 39 were female with a mean age of 56.80 ± 10.86 years and a mean dialysis duration of 7.50 ± 5.20 years. Age (P = .014) and serum 25(OH)D (P = .040) were found to be associated with a higher risk of muscle mass decline after adjusting for gender, dialysis vintage, albumin, and hs-CRP (P = .040). Further analysis found that dialysis vintage (ß = 0.285, P = .030), 25(OH)D (ß = -0.351, P = .007), and log NT-proBNP (ß = 0.312, P = .020) were risk factors associated with the muscle mass decline rate in MHD patients. Conclusion: Age and serum 25(OH)D were associated with a higher risk of muscle mass decline, while 25(OH)D, dialysis vintage, and NT-proBNP were associated with the muscle mass decline rate in MHD patients.

Comparative effectiveness of external therapies of traditional Chinese medicine and surgical treatments in pain management of postherpetic neuralgia: A protocol for a systematic review and network meta-analysis.

BACKGROUND: As the most common long-term complication of herpes zoster (HZ), postherpetic neuralgia (PHN) is characterized by chronic, persistent, and debilitating neuropathic pain. PHN seriously harms human health and currently becomes a topic of clinical importance. To date, the common methods of pain management in PHN include external therapies of traditional Chinese medicine and surgical treatments. However, there is no high-quality or direct evidence of their comparative effectiveness. This review aims to provide a network meta-analysis to compare the efficacy of external therapies of traditional Chinese medicine and surgical treatments in the pain management of PHN. METHODS: Databases such as PubMed, Cochrane Central Register of Controlled Trials, EMBASE, China National Knowledge Infrastructure, China Biology Medicine Disc will be searched for relevant randomized controlled trials to obtain literatures on the treatment of PHN with external therapies of traditional Chinese medicine and surgical treatments, and clinical randomized controlled trials will be screened out from their inception to August 5, 2022. The participant intervention comparator outcomes of this study are as flowing: P, patients with PHN; I, external therapies of traditional Chinese medicine and surgical treatments; C, no treatment, pharmacological placebo, treatment as usual or sham acupuncture groups; O, primary outcome is pain intensity, and secondary outcomes are onset of pain relief time, quality of life, therapeutic effective rate and reverse effects. Cochrane Risk of Bias Tool will be used in assessing literature's quality. Network meta-analyses will be conducted to generate estimates of comparative effectiveness of each intervention class and rankings of their effectiveness, in terms of pain management. RESULT: This systematic review and network meta-analysis will provide evidence of the efficacy of different therapeutic methods for pain management in PHN, to show which forms of therapy are more commonly used with higher effectiveness. DISCUSSION: The results will systematically provide suggestions for medical practitioners to choose effective, time-saving and economical pain management method for PHN.