Representações sociais da autoproteção profissional e pessoal para Enfermeiros no contexto da COVID-19 / Social Representations of Professional and Personal Self-Protection for Nurses in the COVID-19 Context / Representaciones sociales de la autoprotección profesional y personal para enfermeros en el contexto del COVID-19

Objetivo: analisar as representações sociais da autoproteção profissional e pessoal dos enfermeiros no contexto da Covid-19. Método: estudo descritivo, com abordagem qualitativa, pautado na Teoria das Representações Sociais, abordagem processual. Participaram 30 enfermeiros que realizaram cuidados de enfermagem a pacientes com Covid-19, no Estado do Rio de Janeiro. A coleta de dados ocorreu por meio de entrevista semiestruturada entre abril e maio 2021, realizada em plataforma online. O tratamento dos dados foi realizado com a técnica de análise de conteúdo temático-categorial. Resultado: a análise resultou em quatro categorias: Representações sociais e práticas relativas a Covid-19; Representações sociais da autoproteção; Desafios no enfrentamento da Covid-19: autoproteção pessoal e profissional; e Estrutura e fluxo de atendimento e sua relação com a autoproteção profissional. Considerações finais: houve engajamento dos profissionais no uso dos EPI na pandemia, o que aponta uma preocupação quanto à autoproteção na prestação de cuidados à pacientes com a Covid-19.

Objective: to analyze the social representations of professional and personal self-protection among nurses in the context of Covid-19. Method: a descriptive study with a qualitative approach, based on the Social Representations Theory, using a procedural approach. Thirty nurses who provided nursing care to Covid-19 patients in the State of Rio de Janeiro participated in the study. Data collection took place through semi-structured interviews between April and May 2021, conducted on an online platform. Data analysis was performed using the thematic-categorical content analysis technique. Results: The analysis resulted in four categories of social representations and practices related to challenges in coping with Covid-19: personal and professional self-protection; Care structure and flow and its relationship with professional self-protection. Final considerations: There was engagement of professionals in the use of PPE during the pandemic, indicating a concern regarding self-protection in providing care to patients with Covid-19.

Objetivo: analizar las representaciones sociales de la autoprotección profesional y personal de los enfermeros en el contexto del Covid-19. Método: estudio descriptivo, con enfoque cualitativo, basado en la Teoría de las Representaciones Sociales, enfoque procesal. Participaron 30 enfermeros que brindaron cuidados de enfermería a pacientes con Covid-19 en el Estado de Río de Janeiro. La recolección de datos se llevó a cabo a través de entrevistas semiestructuradas entre abril y mayo de 2021, realizadas en una plataforma online. El procesamiento de los datos se realizó mediante la técnica de análisis de contenido temático categorial. Resultado: del análisis surgieron cuatro categorías: Representaciones sociales y prácticas relacionadas con el Covid-19; Representaciones sociales de la autoprotección; Desafíos de enfrentar el Covid-19: autoprotección personal y profesional; y Estructura y flujo de atención y su relación con la autoprotección profesional. Consideraciones finales: los profesionales demostraron compromiso en el uso de EPP durante la pandemia, lo que indica que se preocupaban por autoprotegerse durante la atención a pacientes con Covid-19.

Additive Effects of Esaxerenone, a Nonsteroidal Mineralocorticoid Receptor Blocker, on Cardioplegic Arrest in Rat Hearts.

PURPOSE: Esaxerenone, a mineralocorticoid receptor blocker, attenuates global ischemia-induced myocardial damage and coronary endothelial dysfunction. This study aimed to determine whether esaxerenone exerted cardioprotective effects against cardioplegic arrest in Wistar rat hearts. METHODS: Isolated male Wistar rat hearts aerobically perfused via the Langendorff method for 20 min were randomly allocated to the Control (n = 6; perfused for an additional 10 min and subjected to no treatment) or Esax (n = 6; perfused with 0.1 µmol/L esaxerenone in perfusate for 10 min before ischemia) groups. Hearts in both groups were perfused with St. Thomas' Hospital No. 2 solution (STH2) for 2 min and subjected to 28 min of global ischemia. The recovery of left ventricular developed pressure (LVDP) and total troponin T leakage were measured after reperfusion. RESULTS: The final recovery of LVDP (expressed as a percentage of pre-ischemic value) in the Control and Esax groups was 50.8 ± 3.5% and 62.1 ± 5.6%, respectively (p <0.05, Esax vs. Control). The total troponin T leakage in the Control and Esax groups was 138.8 ± 18.5 ng/g heart wt and 74.3 ± 18.6 ng/g heart wt, respectively (p <0.05, Esax vs. Control). CONCLUSION: The administration of esaxerenone before cardioplegic arrest enhanced the cardioprotective effect exerted by STH2.

Impact of cerebral protection on observed versus predicted in-hospital stroke in a high stroke risk TAVR cohort.

BACKGROUND: Despite impressive improvements in the safety profile of Transcatheter aortic valve replacement (TAVR), the risk for peri-procedural stroke after TAVR has not declined substantially. In an effort to reduce periprocedural stroke, cerebral embolic protection (CEP) devices have been utilized but have yet to demonstrate benefit in all-comers. There is a paucity of data supporting the utilization of CEP in TAVR patients with an anticipated high risk for peri-procedural stroke. METHODS: The Transcatheter Aortic Valve Replacement In-Hospital Stroke (TASK) score is a clinical risk tool for predicting the in-hospital stroke risk of patients undergoing transfemoral TAVR. This score was used to identify high-risk patients and calculate the expected in-hospital stroke risk. This was a single-centre cohort study in all consecutive TAVR patients who had placement of CEP. The observed versus expected ratio for peri-procedural stroke was calculated. To obtain 95% credible intervals, we used 1000 bootstrapped samples of the original cohort sample size without replacement and recalculated the TASK predicted scores. RESULTS: The study included 103 patients. The median age was 83 (IQR 78,89). 63 were male (61.1%) and 45 (43.69%) had a history of previous Stroke or TIA. Two patients had an in-hospital stroke after TAVR (1.94%). The expected risk of in-hospital stroke based on the TASK score was 3.39% (95% CI 3.07-3.73). The observed versus expected ratio was 0.57 (95% CI 0.52-0.64). CONCLUSION: In this single-center study, we found that in patients undergoing TAVR with high stroke risk, CEP reduced the in-hospital stroke risk by 43% when compared with the risk-score predicted rate. CLINICAL TRIAL NUMBER: N/A.

Heterologous mRNA/MVA delivering trimeric-RBD as effective vaccination regimen against SARS-CoV-2: COVARNA Consortium.

Despite the high efficiency of current SARS-CoV-2 mRNA vaccines in reducing COVID-19 morbidity and mortality, waning immunity and the emergence of resistant variants underscore the need for novel vaccination strategies. This study explores a heterologous mRNA/Modified Vaccinia virus Ankara (MVA) prime/boost regimen employing a trimeric form of the receptor binding domain (RBD) of the SARS-CoV-2 spike (S) protein compared to a homologous MVA/MVA regimen. In C57BL/6 mice, the RBD was delivered during priming via an mRNA vector encapsulated in nanoemulsions (NE) or lipid nanoparticles (LNP), followed by a booster with a replication-deficient MVA-based recombinant virus (MVA-RBD). This heterologous mRNA/MVA regimen elicited strong anti-RBD binding and neutralizing antibodies (BAbs and NAbs) against both the ancestral SARS-CoV-2 strain and different variants of concern (VoCs). Additionally, this protocol induced robust and polyfunctional RBD-specific CD4 and CD8 T cell responses, particularly in animals primed with mLNP-RBD. In K18-hACE2 transgenic mice, the LNP-RBD/MVA combination provided complete protection from morbidity and mortality following a live SARS-CoV-2 challenge compared with the partial protection observed with mNE-RBD/MVA or MVA/MVA regimens. Although the mNE-RBD/MVA regimen only protects half of the animals, it was able to induce antibodies with Fc-mediated effector functions besides NAbs. Moreover, viral replication and viral load in the respiratory tract were markedly reduced and decreased pro-inflammatory cytokine levels were observed. These results support the efficacy of heterologous mRNA/MVA vaccine combinations over homologous MVA/MVA regimen, using alternative nanocarriers that circumvent intellectual property restrictions of current mRNA vaccine formulations.

Hybrid Soft Ballistic Panel Packages with Integrated Graphene-Modified Para-Aramid Fabric Layers in Combinations with the Different Ballistic Kevlar Textiles.

The purpose of the research discussed in this article is to explore the possibility of creating hybrid soft ballistic panel (BP) package variants by integrating into their composition layers of graphene-modified para-aramid fabrics in combinations with the different ballistic Kevlar textiles to improve the durability of the first layers of the soft ballistic panel. To address this goal, the liquid-phase exfoliation (LPE) method was used for integrating dispersions into composites to solve a number of topical problems in the stages of the technological sequence development of processing methods and optimizing processing parameters in accordance with the processing specifics of aramid textiles to achieve the desired properties of modified ballistic fabric, including the provision of coating adhesion to the surface to be modified. To test the results, ballistic experiments were performed and the back-face signature (BFS) of bullet impact on a backing material was analysed according to standards. Bullet impacts on the first ballistic protective fabric layers were also studied.

Research on the Application of New Building Recycled Insulation Materials for Walls.

In this paper, a new type of recycled polyurethane material is used as a new type of wall insulation material, and the new building insulation wall made of this paper has high efficiency thermal insulation and energy-saving characteristics and also has certain environmental significance. The thermal conductivity of the new building cold insulation recycled polyurethane material is 0.023 W/(m·K), and the thermal conductivity of the new building insulation wall prepared is 0.297 W/(m·K). Compared with traditional double-sided plastered porous wall tiles, it can save 85.4% of energy consumption per square meter, with higher thermal insulation characteristics and economic benefits. The preparation of a new type of building insulation wall proposed in this paper provides a new and green way for wall insulation.

Polymeric Protective Films as Anticorrosive Coatings-Environmental Evaluation.

The behavior of two polymeric protective paint coatings (epoxy and polyurethane) applied over an epoxy primer coating on steel plates was investigated in this study, focusing on their role in providing anticorrosive protection against various climatic stress factors. Among the numerous climatic factors that can affect the lifetime of anticorrosive coatings, the following were selected for this work: dry heat, UV radiation, humidity, and extreme conditions such as salt fog, marine atmosphere, and alpine atmosphere. The objective was to determine the remaining lifetime of these protective coatings before replacement is needed to prevent damage to the equipment they protect. The behavior of these polymeric materials under the mentioned factors was analyzed based on the variation in the tangent of the dielectric loss angle (tg δ) with frequency. From the interpretation of the experimental results, it was found that the polyurethane paint coating (P2) exhibits superior resistance to climatic degradation compared to the epoxy paint coating (P1). Furthermore, a comparison of tg δ values for the P1 and P2 coatings revealed that the initial (unaged) P2 coating performs better as an insulator (dielectric) than the P1 coating. Comprehensive information is provided to the users of polymeric anticorrosive protection materials, highlighting the extent to which climatic factors can affect the performance of the equipment they protect and determining the appropriate timing for replacing the coatings.

Orally dissolving film as a potential vaccine delivery carrier to prevent influenza virus infection.

Orally dissolving films (ODF) are designed to be dissolved on the tongue and absorbed in the mouth. It offers multiple advantages over the commonly used needle-based vaccines, especially in terms of convenience allowing safe, painless, and easy self-administration. As the efficacy of ODF-encapsulated influenza vaccines has not been demonstrated, we assessed the protection elicited by inactivated influenza virus (A/PR/8/34, PR8) vaccine delivered using ODFs in mice. Trehalose and pullulan components of the ODF ensured that the HA antigens of the inactivated PR8 virus retained their stability while ensuring the rapid release of the vaccines upon exposure to murine saliva. Mice were immunized thrice by placing the PR8-ODF on the tongues of mice at 4-week intervals, and vaccine-induced protection was evaluated upon lethal homologous challenge infection. The PR8-ODF vaccination elicited virus-specific serum IgG and IgA antibody responses, hemagglutinin inhibition (HAI), and viral neutralization. Upon challenge infection, ODF vaccination showed higher levels of IgG and IgA antibody responses in the lungs and antibody-secreting cell (ASC) responses in both lung and spleen compared to unimmunized controls. These results corresponded with the enhanced T cell and germinal center B cell responses in the lungs and spleens. Importantly, ODF vaccination significantly reduced lung virus titers and inflammatory cytokines (IFN-γ, IL-6) production compared to unvaccinated control. ODF vaccination ensured 100% survival and prevented weight loss in mice. These findings suggest that influenza vaccine delivery through ODFs could be a promising approach for oral vaccine development.

Improvement in paediatric CT use and justification: a single-centre experience.

Objectives: To analyse changes in the use of paediatric (≤16 years) CT over the past decade and to evaluate the appropriateness of CT examinations at a tertiary teaching hospital. Methods: Data from 290 paediatric CTs were prospectively collected in 2022 and compared with data from 2017 (358 cases) and 2012 (538 cases). The justification of CTs was evaluated with regard to medical imaging referral guidelines and appropriateness rates were calculated. Results: Paediatric CTs decreased 39.4% over the 10 years, contrasting with a 27.6% increase in overall CTs. Paediatric CTs as the share of overall CTs dropped from 2.5% in 2012 to 1.1% in 2022 (P < .0001), with a concurrent rise in paediatric MRIs (P < .0001). Notable reductions in CT use occurred for head trauma (P = .0003), chronic headache (P < .0001), epilepsy (P = .037), hydrocephalus (P = .0078), chest tumour (P = .0005), and whole-body tumour (P = .0041). The overall appropriateness of CTs improved from 73.1% in 2017 to 79.0% in 2022 (P = .0049). In 15.4% of the cases, no radiological examination was deemed necessary, and in 8.7% of the cases, another modality was more appropriate. Appropriateness rates were the highest for the head and neck angiography (100%) and the chest (96%) and the lowest for the neck (66%) and the head (67%). Conclusions: Justification of CT scans can be improved by regular educational interventions, increasing MRI accessibility, and evaluating the appropriateness of the requested CT before the examination. Interventions for a more effective implementation of referral guidelines are needed. Advances in knowledge: The focus for improvement should be CTs for head and cervical spine trauma, accounting for the majority of inappropriate requests in the paediatric population.

Does environmental regulation promote enterprise environmental protection investments? A quasi-natural experiment from river chief system in the Yangtze river delta of China.

The investment decisions of enterprises are affected by environmental regulations designed to protect the environment, so environmental regulations may change companies' investment behavior in environmental protection. This study focuses on the River Chief System (RCS)1, an innovative environmental regulation related to river governance which officially launched in China in 2014. Based on data collected from heavy-polluting companies in the Yangtze River Delta, we use the difference-in-differences model (DID Model)2 and focus on RCS's impacts on micro-environmental protection investments. Our findings reveal that the RCS is conducive to expanding the scale of enterprises' environmental protection investments. Industrial structural upgrades appear to have a masking effect wherein the one-sided pursuit of industrial structural upgrades may slow economic growth and cause enterprises to reduce the scale of environmental investments. We recommend that the allocation of environmental investment should be based on the characteristics of local markets and public participation, and maintain a balance between secondary and tertiary industries, government and business incentives.

Microbiome signatures associated with flavor development differentiate Protected Designation of origin water Buffalo Mozzarella cheese from different production areas.

Water Buffalo Mozzarella (BM) is a typical cheese from Southern Italy with unique flavor profile and texture. It is produced following a traditional back-slopping procedure and received the Protected Designation of Origin (PDO) label. To better understand the link between the production area, the microbiome composition and the flavor profile of the products, we performed a multiomic characterization of PDO BM collected from 57 different dairies located in the two main PDO production area, i.e. Caserta (n = 35) and Salerno (n = 22). Thus, we assessed the microbiome by high-throughput shotgun metagenomic sequencing and the Volatile Organic Compounds (VOCs) by gas chromatography/mass spectrometry (GC/MS). Streptococcus thermophilus, Lactobacillus helveticus, and Lactobacillus delbrueckii subsp. delbrueckii were identified as the core microbiome present in all samples. However, the microbiome taxonomic profiles resulted in a clustering of the samples based on their geographical origin, also showing that BM from Caserta had a greater microbial diversity. Consistently, Caserta and Salerno samples also showed different VOC profiles. These results suggest that the microbiome and its specific metabolic activity are part of the terroir that shape BM specific features, linking this traditional product with the area of production, thus opening new clues for improving traceability and fraud protection of traditional products.

Current dilemma and future directions over prophylactic cranial irradiation in SCLC: a systematic review in MRI and immunotherapy era.

Small cell lung cancer (SCLC) is the most malignant pathological type of lung cancer with the highest mortality, and the incidence of brain metastasis (BM) is in high frequency. So far, prophylactic cranial irradiation (PCI) has been suggested as an effective treatment for preventing brain metastasis of SCLC. PCI has long been applied to limited-stage SCLC (LS-SCLC) patients who have achieved complete remission after radiotherapy and chemotherapy as a standard treatment. However, the neurocognitive decline is a major concern surrounding PCI. New therapeutic approaches targeting PCI-induced neurotoxicity, including hippocampal protection or memantine, have been increasingly incorporated into the therapeutic interventions of PCI. Helical tomotherapy, RapidArc, and Volumetric-modulated arc therapy (VMAT) with a head-tilting baseplate are recommended for hippocampal protection. Besides, in the MRI and immunotherapy era, the significance of PCI in SCLC patients is controversial. SCLC patients with PCI should be recruited in clinical trials since this is the only way to improve the existing standard of care. This review summarizes the current therapeutic strategy and dilemma over PCI for SCLC, providing a theoretical basis for clinical decision-making and suggestions for PCI practice in clinical.

Ethical considerations for real-world evidence studies.

Real-world evidence (RWE) studies are conducted on patient's data primarily collected for monitoring of health status of patients. The use of real-world data to generate evidence in academic research or for regulatory submission raises a variety of ethical issues such as privacy, confidentiality, data protection, data de-identification, data sharing, scientific design of study, and informed consent requirements. The investigators-researchers and sponsors should adhere to current standards of ethics whilst planning and conduct of RWE studies. The ethics committees should consider ethical issues specific to RWE studies before approval.

Exploring the Exo-Metabolomes and Volatile and Non-Volatile Compounds of Metarhizium carneum and Lecanicillium uredinophilum.

Efforts are intensifying to identify bioactive microbial metabolites from biocontrol agents to manage plant pathogens in critical crops. This study examined both volatile organic compounds (VOCs) and non-volatile compounds from Metarhizium carneum and Lecanicillium uredinophilum strains for their antimicrobial effects against various phytopathogens and analyzed their exo-metabolomes. M. carneum VOCs inhibited four bacterial and eight fungal species by up to 45.45%, while L. uredinophilum VOCs inhibited five bacterial and eight fungal species by up to 50.91%. Additionally, n-BuOH extracts from both biocontrol agents effectively targeted three fungi and five bacteria. The exo-metabolomes of M. carneum and L. uredinophilum included 125 and 102 spectrometric features, respectively, primarily consisting of polyketides, alkaloids, lipids, organic aromatic compounds, terpenoids, and peptides. Our findings revealed a correlation between the phylogenetic relationships of M. carneum strains, their bioactivity patterns against phytopathogens, and their metabolomic profiles. Notably, some compounds detected in both fungi previously demonstrated biological activity against plant pathogens, enhancing their biocontrol potential. This study not only evidences the antimicrobial properties of diffusible compounds from M. carneum and L. uredinophilum, but also documents the antimicrobial potential of their VOCs for the first time, supporting their use in sustainable agricultural practices, reducing reliance on chemical inputs.

Exploiting membrane vesicles derived from avian pathogenic Escherichia coli as a cross-protective subunit vaccine candidate against avian colibacillosis.

Avian pathogenic Escherichia coli (APEC) is a notable pathogen that frequently leads to avian colibacillosis, posing a substantial risk to both the poultry industry and public health. The commercial vaccines against avian colibacillosis are primarily inactivated vaccines, but their effectiveness is limited to specific serotypes. Recent advances have highlighted bacterial membrane vesicles (MV) as a promising candidate in vaccine research. How to produce bacterial MVs vaccines on a large scale is a significant challenge for the industrialization of MVs. The msbB gene encodes an acyltransferase and has been implicated in altering the acylation pattern of lipid A, leading to a decrease in lipid A content in lipopolysaccharides (LPS). Here, we evaluated the immunoprotective efficacy of MVs derived from the LPS low-expressed APEC strain FY26ΔmsbB, which was an APEC mutant strain with a deletion of the msbB gene. The nitrogen cavitation technique was employed to extract APEC MVs, with results indicating a significant increase in MVs yield compared to that obtained under natural culture. The immunization effectiveness was assessed, revealing that FY26ΔmsbB MVs elicited an antibody response of laying hens and facilitated bacterial clearance. Protective efficacy studies demonstrated that immunization with FY26ΔmsbB MVs conferred the immune protection in chickens challenged with the wild-type APEC strain FY26. Notably, LPS low-carried MVs recovered from the mutant FY26ΔmsbB also displayed cross-protective capabilities, and effectively safeguarding against infections caused by O1, O7, O45, O78, and O101 serotypes virulent APEC strains. These findings suggest that MVs generated from the LPS low-expressed APEC strain FY26ΔmsbB represent a novel and empirically validated subunit vaccine for the prevention and control of infections by various APEC serotypes.

Clinical Significance of Diffusion-Weighted Brain MRI Lesions After TAVR: Results of a Patient-Level Pooled Analysis.

BACKGROUND: Acute brain infarction detected by diffusion-weighted magnetic resonance imaging (DW-MRI) is common after transcatheter aortic valve replacement (TAVR), but its clinical relevance is uncertain. OBJECTIVES: The authors investigated the relationship between DW-MRI total lesion number (TLN), individual lesion volume (ILV), and total lesion volume (TLV) and clinical stroke outcomes after TAVR. METHODS: Patient-level data were pooled from 4 prospective TAVR embolic protection studies, with consistent predischarge DW-MRI acquisition and core laboratory analysis. C-statistic was used to determine the best DW-MRI measure associated with clinical stroke. RESULTS: A total of 495 of 603 patients undergoing TAVR completed the predischarge DW-MRI. At 30 days, the rate of clinical ischemic stroke was 6.9%. Acute ischemic brain injury was seen in 85% of patients with 5.5 ± 7.3 discrete lesions per patient, mean ILV of 78.2 ± 257.1 mm3, and mean TLV of 555 ± 1,039 mm3. The C-statistic was 0.84 for TLV, 0.81 for number of lesions, and 0.82 for maximum ILV in predicting ischemic stroke. On the basis of the TLV cutpoint as defined by receiver operating characteristic (ROC), patients with a TLV >500 mm3 (vs TLV ≤500 mm3) had more ischemic stroke (18.2% vs 2.3%; P < 0.0001), more disabling strokes (8.8% vs 0.9%; P < 0.0001), and less complete stroke recovery (44% vs 62.5%; P = 0.001) at 30 days. CONCLUSIONS: Our study confirms that the number, size, and total volume of acute brain infarction defined by DW-MRI are each associated with clinical ischemic strokes, disabling strokes, and worse stroke recovery in patients undergoing TAVR and may have value as surrogate outcomes in stroke prevention trials. (A Prospective, Randomized Evaluation of the TriGuard™ HDH Embolic Deflection Device During TAVI [DEFLECT III]; NCT02070731) (A Study to Evaluate the Neuro-embolic Consequences of TAVR [NeuroTAVR]; NCT02073864) (The REFLECT Trial: Cerebral Protection to Reduce Cerebral Embolic Lesions After Transcatheter Aortic Valve Implantation [REFLECT I]; NCT02536196) (The REFLECT Trial: Cerebral Protection to Reduce Cerebral Embolic Lesions After Transcatheter Aortic Valve Implantation [REFLECT II]; NCT02536196).

[Evaluation of Transmitted X-ray Spectrum, Lead Equivalent, and Uniformity of Radiation Protective Clothing Made of Lead-containing and Lead-free Materials].

PURPOSE: The purpose of this study was to evaluate the protective performance of several new radiation-protective clothing and to clarify issues of quality control. METHODS: The composition of the shielding elements was analyzed using X-ray fluorescence analysis, and the energy spectrum of transmitted X-rays was measured. Furthermore, the lead equivalent and uniformity were measured from the transmitted X-ray doses according to Japanese industrial standards (JIS). Uniformity was evaluated by transmitting X-ray images of each radiation protective clothing in addition to the conventional method. RESULTS: The energy spectrum showed K-absorption edges of lead, bismuth, tin, etc., which were detected in the composition analysis. The multi-layered protective material maintained higher shielding ability at high tube voltages. In addition, X-ray images of the radiation-protective clothing showed uneven density and dots, and the differences in uniformity measurement methods and points that didn't meet the required shielding capacity were seen. CONCLUSION: The current JIS does not allow accurate evaluation of the lead equivalent and uniformity, so visual evaluation of X-ray images is important. It is necessary to establish standardized standards for quality control performed by each facility.

Sanqi oral solution ameliorates renal fibrosis by suppressing fibroblast activation via HIF-1α/PKM2/glycolysis pathway in chronic kidney disease.

ETHNOPHARMACOLOGICAL RELEVANCE: Sanqi oral solution (SQ) is a traditional Chinese patent medicine, widely used to treat chronic kidney diseases (CKD) in the clinic in China. Previous studies have confirmed its anti-renal fibrosis effect, but the specific pharmacological mechanism is still unclear. AIM OF THE STUDY: Focusing on energy metabolism in fibroblasts, the renoprotective mechanism of SQ was investigated in vitro and in vivo. METHODS: Firstly, the fingerprint of SQ was constructed and its elementary chemical composition was analyzed. In the 5/6Nx rats experiment, the efficacy of SQ on the kidney was evaluated by detecting serum and urine biochemical indexes and pathological staining of renal tissues. Lactic acid and pyruvic acid levels in serum and renal tissues were detected. PCNA protein expression in kidney tissue was detected by immunofluorescence assay and Western blot. Expression levels of HIF-1α, PKM2 and HK2 were determined by immunohistochemistry, Western blot or RT-qPCR assay. In addition, the effect of SQ intervention on cell proliferation and glycolysis was evaluated in TGF-ß1-induced NRK-49F cells, and the role of SQ exposure and HIF-1α/PKM2/glycolysis pathway were further investigated by silencing and overexpressing HIF-1α gene in NRK-49F cells. RESULTS: In 5/6 Nx rats, SQ effectively improved renal function and treated renal injury. It reduced the levels of lactic acid and pyruvic acid in kidney homogenates from CKD rats and decreased the expression levels of HIF-1α, PKM2, HK2, α-SMA, vimentin, collagen I and PCNA in kidney tissues. Similar results were observed in vitro. SQ inhibited NRK-49F cell proliferation, glycolysis and the expression levels of HIF-1α, PKM2 induced by TGF-ß1. Furthermore, we established NRK-49F cells transfected with siRNA or pDNA to silence or overexpress the HIF-1α gene. Overexpression of HIF-1α promoted cellular secretion of lactic acid and pyruvic acid in TGF-ß1-induced NRK-49F cells, however, this change was reversed by intervention with SQ or silencing the HIF-1α gene. Overexpression of HIF-1α can further induce increased PKM2 expression, while SQ intervention can reduce PKM2 expression. Moreover, PKM2 expression was also inhibited after silencing HIF-1α gene, and SQ was not effective even when given. CONCLUSION: The mechanism of action of SQ was explored from the perspective of energy metabolism, and it was found to regulate PKM2-activated glycolysis, inhibit fibroblast activation, and further ameliorate renal fibrosis in CKD by targeting HIF-1α.