Biphasic alcoholysis coupled with high-speed countercurrent chromatography for high performance on separating phorbol from Croton tiglium Linn extracts.

Phorbol is a tetracyclic diterpenoid found in Euphorbia tirucalli, Croton tiglium, and Rehmannia glutinosa, and is nuclear of various phorbol esters. The rapid obtaining of phorbol with high purity highly contributes to its application, such as synthesizing phorbol esters with designable side chains and particular therapeutic efficacy. This study introduced a biphasic alcoholysis method for obtaining phorbol from croton oil by using polarity imparity organic solvents in both phases and established a high-speed countercurrent chromatography method for simultaneous separation and purification of phorbol. The optimized operation conditions of biphasic alcoholysis were a reaction time of 91 min, a temperature of 14°C, and a croton oil-methanol ratio of 1:30 (g:ml). The phorbol during the biphasic alcoholysis was 3.2-fold higher in content than that obtained in conventional monophasic alcoholysis. The optimized high-speed countercurrent chromatography method was using the ethyl acetate/n-butyl alcohol/water at 4.7:0.3:5 (v:v:v) with Na2 SO4 at 0.36 g/10 ml as the solvent system, using the mobile phase flow rate of 2 ml/min, the revolution of 800 r/min, under which the retention of the stationary phase was achieved at 72.83%. The crystallized phorbol following high-speed countercurrent chromatography was obtained as high purity of 94%.

Preparation and Characterization of Protein Molecularly Imprinted Poly (Ionic Liquid)/Calcium Alginate Composite Cryogel Membrane with High Mechanical Strength for the Separation of Bovine Serum Albumin.

In order to improve the mechanical strength and imprinting efficiency, a novel bovine serum albumin (BSA) molecularly imprinted poly(ionic liquid)/calcium alginate composite cryogel membrane (MICM) was prepared. The results of the tensile test indicated that the MICM had excellent mechanical strength which could reach up to 90.00 KPa, 30.30 times higher than the poly (ionic liquid) membrane without calcium alginate; the elongation of it could reach up to 93.70%, 8.28 times higher than the poly (ionic liquid) membrane without calcium alginate. The MICM had a very high welling ratio of 1026.56% and macropore porosity of 62.29%, which can provide effective mass transport of proteins. More remarkably, it had a very high adsorption capacity of 485.87 mg g-1 at 20 °C and 0.66 mg mL-1 of the initial concentration of BSA. Moreover, MICM also had good selective and competitive recognition toward BSA, exhibiting potential utility in protein separation. This work can provide a potential method to prepare the protein-imprinted cryogel membrane with both high mechanical strength and imprinting efficiency.

MiR-155 aggravated septic liver injury by oxidative stress-mediated ER stress and mitochondrial dysfunction via targeting Nrf-2.

OBJECTIVE: Liver is uniquely vulnerable during sepsis. MicroRNA-155 (miR-155) is confirmed to play crucial roles in septic liver injury. The present study aims to investigate the mechanisms of miR-155 in septic liver injury. METHODS: The sepsis model was established by intraperitoneal injection of lipopolysaccharide (LPS) in mice. Mice were divided into four groups: Vehicle, miR-155 antagomir, LPS, LPS+ miR-155 antagomir. The survival rate and body weight were monitored. Liver injury was assessed by H&E staining. The levels of serum ALT and inflammatory cytokines were determined by ELISA kits. Oxidative stress was detected by MDA and SOD detection kits. The miR-155, Nrf-2, and markers related to oxidative stress, endoplasmic reticulum (ER) stress, mitochondrial injury and apoptosis were detected by western blotting and qPCR. Apoptosis in liver tissues was detected by TUNELstaining. RESULTS: MiR-155 antagomir alleviated liver injury as evidenced by enhancing survival rate and body weight, inhibiting inflammatory cell infiltration, liver cells necrosis and decreasing ALT level. The productions of TNF-α, IL-6 were suppressed, while anti-inflammatory cytokine IL-10 was promoted by miR-155 antagomir. Oxidative stress was inhibited by miR-155 antagomir via enhancing nuclear factor, erythroid 2-like 2 (Nrf-2) expression. ER stress and Cytochrome C (Cyto-C) release were restrained by miR-155 antagomir. Sepsis-induced apoptosis was repressed by miR-155 antagomir as manifested by the decreased levels of Bax, cleaved caspase-12, 9 and 3, and increased levels of Bcl-2 and uncleaved PARP. CONCLUSION: MiR-155 antagomir relieved septic liver injury through inhibiting oxidative stress-mediated ER stress, mitochondrial dysfunction and apoptosis via targeting Nrf-2, suggesting miR-155 as a therapeutic target for septic liver injury.

Effects of Rich-Polyphenols Extract of Dendrobium loddigesii on Anti-Diabetic, Anti-Inflammatory, Anti-Oxidant, and Gut Microbiota Modulation in db/db Mice.

Dendrobium is a traditional Chinese herb with anti-diabetic effects and has diverse bibenzyls as well as phenanthrenes. Little is known about Dendrobium polyphenols anti-diabetic activities, so, a rich-polyphenols extract of D. loddigesii (DJP) was used for treatment of diabetic db/db mice; the serum biochemical index and tissue appearance were evaluated. In order to gain an insight into the anti-diabetic mechanism, the oxidative stress index, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and gut microbiota modulation were determined by ELISA, immunohistochemistry or high throughput sequencing 16S rRNA gene. The results revealed that DJP had the effects to decrease the blood glucose, body weight, low density lipoprotein cholesterol (LDL-C) levels and increase insulin (INS) level in the mice. DJP improved the mice fatty liver and diabetic nephropathy. DJP showed the anti-oxidative abilities to reduce the malondialdehyde (MDA) level and increase the contents of superoxide dismutase (SOD), catalase (CAT) as well as glutathione (GSH). DJP exerted the anti-inflammatory effects of decreasing expression of IL-6 and TNF-α. After treatment of DJP, the intestinal flora balance of the mice was ameliorated, increasing Bacteroidetes to Firmicutes ratios as well as the relative abundance of Prevotella/Akkermansia and reducing the relative abundance of S24-7/Rikenella/Escherichia coli. The function's prediction of gut microbiota indicated that the microbial compositions involved carbohydrate metabolism or lipid metabolism were changed. This study revealed for the first time that DJP improves the mice symptoms of diabetes and complications, which might be due to the effects that DJP induced the decrease of inflammation as well as oxidative stress and improvement of intestinal flora balance.

The mechanism of Jurkat cells apoptosis induced by Aggregatibacter actinomycetemcomitans cytolethal distending toxin.

Cytolethal distending toxin (CDT) which is produced by Aggregatibacter actinomycetemcomitans causes apoptosis in lymphocytes. But the specific mechanism is not clear. The aim of our research was to investigate the effect and mechanism during this process. The wild-type CdtA, CdtB, CdtC (CdtAW, CdtBW, CdtCW) and mutant CdtB (CdtBM) were expressed and purified respectively and the purity of each subunit was examined by BandScan software. And the type I deoxyribonuclease and PI-3,4,5-triphosphate (PI-3,4,5-P3, PIP3) phosphatase activity were detected by DNA agarose gel electrophoresis and enzyme-linked immunosorbent assay respectively. The cell apoptosis rates were analyzed by flow cytometry. The morphological changes of apoptosis cells were observed by confocal laser scanning microscopy. The protein expression of Bax and Bcl-2 was examined by western blot. Differentially expressed apoptosis-related proteins were identified based on isobaric tags for relative and absolute quantitation technology. In the present study we found that: (i) recombinant wild-type CdtA, CdtB and CdtC (CdtAW, CdtBW, CdtCW) and mutant CdtB (CdtBM) were correctly expressed and the purity of each protein was higher than 80%, (ii) the average apoptosis rate in wild-type CDT (CDTW) treated groups was 50.54%, which was significantly higher than the controls (4.71%) and mutant CDT (CDTM) treated groups (5.58%) (p < 0.05), (iii) morphological changes of apoptosis were observed in CDTW treated cells, (iv) the expression of Bax protein was significantly increased in CDTW treated cells, while Bcl-2 protein expression was significantly decreased, (v) 17 apoptosis-related proteins were expressed differentially, among which 10 proteins (SMNDC1, TNFRSF10B, UBE2I, ITM2A, CASP3, P53, EIF1, TCF3, HMGN5, CASP8) were up-regulated and 7 proteins (RRM2, TPX2, KIF11, NUCKS1, TOP2A, XRCC1, PTPLAD1, RRM2) were down-regulated, (vi) one possible apoptotic pathway [Ubc9 (UBE2I)/P53/DR5 (TNFRSF10B)/Caspase-8 (CASP8)/ Caspase-3 (CASP3)] was selected and partially proved.

Clinical and morphologic spectrum of renal involvement in patients with HBV-associated cryoglobulinaemia.

AIM: Cryoglobulinaemic glomerulonephritis related to hepatitis B virus (HBV) infection has been rarely reported. The aim of this study was to investigate the clinical features, renal biopsy findings in patients with HBV-associated cryoglobulinaemia. METHODS: Twelve patients with HBV-associated cryoglobulinaemia were identified in this study. The demographic, clinical, pathological characteristics, treatment and follow-up data were analyzed. RESULTS: Renal involvement was characterized by nephrotic range proteinuria with microscopic haematuria in all patients, and impaired renal function in nine patients (75%). Purpuric rash was the main extrarenal manifestation (58.3%). Type II cryoglobulinaemia was presented in three patients and type III in nine patients. Hypocomplementaemia and positive of rheumatoid factors were present in all patients. Membranoproliferative glomerulonephritis (MPGN) was observed in all kidney specimens. Seven patients also had evidence of prominent cryoglobulins thrombi on renal biopsy, but only three patients had HBV antigen deposits in renal tissues. Antiviral and steroids or immunosuppressive agents have been used in most of patients. During follow-up, two patients died, and four reaching end-stage renal disease; three patients had complete remission, and three patients had renal function improved after therapy. CONCLUSIONS: Nephrotic syndrome with haematuria and renal insufficiency are the main clinical manifestation; cryoglobulinaemic glomerulonephritis are the main renal lesion in patients with HBV-Associated cryoglobulinaemia; half of patients have poor outcome even with antiviral and immunosuppressive therapy. The results of this study indicate that cryoglobulins should be detected in hepatitis B virus-Associated nephropathy in endemic area.

Biodegradable electrospun fibers as sustained-release carriers of insect pheromones for field trapping of Spodoptera litura (Lepidoptera: Noctuidae).

BACKGROUND: Insect pheromones are highly effective and environmentally friendly, and are widely used in the monitoring and trapping of pests. However, many researchers have found that various factors such as ultraviolet light and temperature in the field environment can accelerate the volatilization of pheromones, thus affecting the actual control effect. In recent years, electrospinning technology has demonstrated remarkable potential in the preparation of sustained carriers. Moreover, the utilization of biodegradable materials in electrospinning presents a promising avenue for the advancement of eco-friendly carriers. RESULTS: In this study, homogeneous and defect-free pheromone carriers were obtained by electrospinning using fully biodegradable polyhydroxybutyrate materials and pheromones of Spodoptera litura. The electrospun fibers with porous structure could continuously release pheromone (the longest can be ≤80 days). They also had low light transmission, hydrophobic protection. More importantly, the pheromone-loaded electrospun fiber carriers showed stable release and good trapping effect in the field. They could trap pests for at least 7 weeks in the field environment without other light stabilizers added. CONCLUSION: Sustained-release carriers constructed by electrospinning and green materials could improve the efficacy of pheromones and ensure environmental friendliness, and provided a tool for the management of S. litura and other pests and sustainable development of agricultural. © 2023 Society of Chemical Industry.

Evaluation of metabolic risk marker in obesity-related glomerulopathy.

OBJECTIVE: Insulin resistance is a common metabolic abnormality, which increases the risk of renal events in obesity. The present study is aimed to examine the relation between metabolic factors and obesity-related glomerulopathy (ORG), and then compare the risk markers of insulin resistance for clinical prediction. METHODS: A total of 112 cases with proven renal ORG and 135 age- and gender-matched lean controls were included. The degree of proteinuria, endogenous creatinine clearance rate, body mass index, amylin, fasting glucose, insulin, lipid and lipoprotein concentrations were measured during the steady state. RESULTS: The patients with ORG were clinically characterized by increased body mass index and proteinuria, with higher levels of amylin, homeostasis model assessment of insulin resistance (HOMA-IR), insulin, glucose, and lipid proteins when compared with the lean controls. Multiple logistic regression analysis revealed that amylin and HOMA-IR were significantly associated with the prevalence of ORG. In patients with ORG, proteinuria level correlated with amylin, total cholesterol, fasting insulin, and HOMA-IR. Moreover, proteinuria correlated positively with HOMA-IR and amylin in a multiple regression analysis. In addition, the endogenous creatinine clearance rate did not correlate with any metabolic marker. CONCLUSION: This study suggested that screening for HOMA-IR might have predictive value for renal damage in obese patients. In addition to insulin resistance, amylin also showed positive effects on evaluation of such renal impairment.

Preparation and Characterization of Oleanolic Acid-Based Low-Molecular-Weight Supramolecular Hydrogels Induced by Heating.

The natural-product-based low-molecular-weight supramolecular hydrogels (LMWSHs) induced by heating are rarely reported. In this work, a simple salt of oleanolic acid (OA) and choline ([choline][OA]) was used as the natural product hydrogelator (NPHG) to form LMWSHs. Unlike common sol-gel transitions, the OA-based LMWSH displayed a unique property with which the system could undergo a phase transition from the sol state to the gel state upon heating. Moreover, the phase separation was observed in sol and gel states when the temperature was elevated with nonreversible transparent-turbid transitions. LMWSHs showed good stability and injectability and the potential to be a drug delivery vehicle for sustained release of drugs. In this regard, this work provided a facile approach to designing an OA-based NPHG for preparing heat-induced LMWSHs.

Effect of fluoridated carbamide peroxide gels on enamel microtensile bond strength.

The aim of this study was to examine the resin bond strength on enamel treated with different fluoridated bleaching agents. Forty-eight bovine incisors were divided into four groups to receive bleaching treatments, over a 14-d period, as follows: no treatment; 10% carbamide peroxide (CP) bleaching; 10% CP containing 0.11% fluoride; and 10% CP containing 0.37% fluoride. Immediately, and 7 and 14 d after bleaching, the enamel surfaces were respectively bonded with composite and sectioned to create resin-enamel beams. These beams were subjected to the microtensile bond strength (microTBS) test, then assessed for failure mode under scanning electron microscopy. The results showed that the 0.37% fluoridated group demonstrated a microTBS equivalent to that of the unbleached group at all stages. Non-fluoridated and 0.11% fluoridated groups showed a weaker microTBS after bleaching but regained the bond strength after 14 or 7 d of storage, respectively. In the non-fluoridated group, adhesive failure was the predominant fracture pattern that comprised the enamel prism demineralization change and widely dispersed voids on the resin-enamel interfaces. No evident enamel erosion and fewer microporosities were found in the 0.37% fluoridated group. Accordingly, treatment with 0.37% fluoridated CP maintained the microTBS as effectively as the unbleached enamel. Additional fluoride in the bleaching agents may facilitate subsequent restorative treatment by inhibiting enamel demineralization.

Clinical features and renal outcome in lupus patients with diffuse crescentic glomerulonephritis.

The objectives of the study are to investigate the clinical features and renal outcomes in lupus patients with diffuse crescentic glomerulonephritis (DCGN). Ninety-four DCGN lupus patients were enrolled. Their clinical features and renal outcomes were investigated. There were 84 females and 10 males, with a mean age of 27.9 ± 10.7 years old. They represented: hypertension in 73 cases (77.7%), rapidly progressive glomerulonephritis in 62 cases (66.0%), 46 cases (48.9%) with nephritic syndrome, 35 (37.2%) gross hematuria, and 14 cases (14.9%) with uremic syndrome needed dialysis therapy. There were 25 cases received repeated renal biopsy. Their histological examination showed the decreasing of active lesions and the increasing chronic lesions. All patients were more than 6 months follow-up, and 79 patients (84.0%) were more than 12 months follow-up. At the first time of follow-up (3 months), the renal function, proteinuria, and anemia were improved significantly in all of cases received intensive immunosuppressive therapy. At the last time of follow-up (56.1 ± 18.8 months), only four patients eventually developed to the end-stage renal failure and five died with normal renal function. The lupus patients with DCGN presented more severe clinical syndromes, which were similar to those patients of type II of DCGN. The relative good renal outcomes were observed in those lupus patients, to which may be contribute to the effective induction therapy.

Obesity-related glomerulopathy in China: a case series of 90 patients.

BACKGROUND: The epidemic of obesity has been paralleled by an increase in the incidence of chronic kidney disease. However, epidemiological data for obesity-related glomerulopathy (ORG) from developing countries, including China, are very limited. STUDY DESIGN: Case series. ORG defined as body mass index (BMI) of 28.0 kg/m(2) or greater; urinary protein excretion of 0.4 g/24 h or greater, and glomerulomegaly (glomerular volume > 3.27 x 10(6) microm(3)) with or without focal segmental glomerulosclerosis (FSGS). SETTING & PARTICIPANTS: 10,093 renal biopsy samples from patients obtained from February 2002 to November 2006 at the Research Institute of Nephrology, Nanjing University School of Medicine, China. PREDICTOR: Obesity defined as a BMI of 28.0 kg/m(2) or greater. Subjects were divided into 3 groups: mild-obesity group with BMI of 28.0 to less than 30 kg/m(2), moderate-obesity group with BMI of 30 to less than 35 kg/m(2), and severe-obesity group with BMI of 35 kg/m(2) or greater. OUTCOMES & MEASUREMENTS: Clinicoepidemiological and histopathologic characteristics of patients with ORG at the time of biopsy were described separately. RESULTS: ORG was observed in 90 biopsy specimens (0.89%); frequency increased from 0.62% to 1.0% during the last 5 years (P = 0.02). Mean age was 37.5 +/- 9.3 (SD) years, 67% were men, mean BMI was 31.2 +/- 3.3 kg/m(2), waist circumference was 103 cm (range, 89.4 to 124 cm) in men and 96.5 cm (range, 88.5 to 113 cm) in women, waist-hip ratio was 0.95 +/- 0.07, and 100% had visceral obesity. Of the total, 49%, 37%, and 14% had mild, moderate, and severe obesity, respectively. Mean urinary protein excretion of subjects was 1.48 +/- 1.2 g/24 h; 51%, 39%, and 10% had proteinuria with protein of 0.4 to 1.0, 1.0 to 3.5, and greater than 3.5 g/d, respectively. Mean measured creatinine clearance (Ccr) was 109 +/- 32.2 mL/min/1.73 m(2), with 42%, 36%, and 22% with a Ccr greater than 120, 90 to 120, and less than 90 mL/min/1.73 m(2), respectively. Glucose dysmetabolism, insulin resistance, dyslipidemia, and hypertension were observed in 77%, 88%, 76%, and 63% of patients, respectively. FSGS was observed in 70%. Mean foot-process width was 534 +/- 176 nm. Foot-process fusion was seen in 36% of patients. Greater BMI was associated with greater proteinuria (P < 0.02), greater Ccr (P < 0.03), and greater foot-process width (P < 0.04). LIMITATIONS: Inability to compute prevalence or incidence from case series. BMI was calculated at time of renal biopsy. CONCLUSIONS: Most patients with ORG had mild obesity, visceral obesity, minor proteinuria, preserved Ccr, and FSGS.

Clinicopathological and genetic characteristics in Chinese patients with lipoprotein glomerulopathy.

OBJECTIVE: In this study, we report on 16 Chinese patients with biopsy-proven lipoprotein glomerulopathy (LPG) investigated for clinical manifestations, pathological characteristics and apolipoprotein E (apoE) genetic analysis. METHODS: A retrospective analysis of the clinical and pathological features was made in 16 patients with LPG. Plasma concentrations and genetic analysis of apoE were completed. Glomerular depositions of apoA, apoB and apoE were detected using monoclonal antibodies on cryostatic sections in all patients. RESULTS: All 16 patients presented with edema; 14 presented with nephrotic syndrome. Anemia, microhematuria, hypertension and abnormal levels of serum creatinine were detected in 12 patients (75%), 11 patients (69%), 8 patients (50%) and 6 patients (37.5%), respectively. All the patients showed hypertriglyceridemia, while only 7 showed slight hypercholesterolemia. The characteristic features of hyperlipidemia in these patients were approximately in accord with those of type IV hyperlipoproteinemia. Concentrations of apoB correlated with urine protein, triglycerides and cholesterol (r=0.558, p=0.038; r=0.6, p=0.023; r=0.65, p=0.012; respectively). No correlation was found between serum level of apoE and clinicopathological features in patients with LPG. The genotype of apoE-epsilon3/epsilon4 is the predominant one in Chinese patients with LPG. No mutated forms of apoE were found, compared with previous reports. CONCLUSION: Unique clinicopathological and genetic features were found in this group of Chinese patients with LPG compared with the general population, including lower serum levels of apoE and cholesterol, as well as anemia and microhematuria. Multiple factors other than apoE were involved in the pathogenesis of LPG.

Effect of fluoride containing bleaching agents on enamel surface properties.

OBJECTIVES: To evaluate the effects of fluoridated bleaching agents and post-bleaching fluoridation treatment on the whitening efficiency and microhardness of bovine enamel. METHODS: Twenty five freshly extracted bovine incisors were cut into halves, embedded and then divided into the following five groups: Group 1, untreated controls; Group 2, treatment with 10% carbamide peroxide (CP) bleaching agent; Group 3, treatment with 10% CP followed by a 0.9% sodium fluoride gel application, Group 4, treatment with 10% CP containing 0.11% fluoride; Group 5, treatment with an experimental bleaching agent consisting of 10% CP and 0.37% fluoride. Groups 2-5 were treated 8h per day for 14 days then immersed in saliva for 2 weeks. Enamel morphology changes were evaluated under SEM on Day 14. Changes in enamel color and microhardness were evaluated on Days 7 and 14, and compared with the baseline data. Additionally, microhardness was determined on post-bleaching Days 21 and 28. RESULTS: After 2 weeks, an erosion pattern was noted on the specimens in Groups 2 and 3. Groups 4 and 5 showed a milder demineralized pattern. All the bleached enamel specimens revealed increased whiteness and overall color value. Groups 2 and 3 showed significantly decreased enamel microhardness compared to their baseline data. The specimens treated with fluoridated bleaching agents showed relatively less reduction in enamel microhardness than those treated with nonfluoridated agents during the bleaching treatment. CONCLUSIONS: The fluoridated bleaching agents produced less demineralization of surface morphology and microhardness. The addition of fluoride did not impede the whitening effect.

[Characterization of a Newly Isolated Strain Pseudomonas sp. N3 for Denitrification at Low Temperature].

Based on traditional microbiological methods, a novel denitrifier Pseudomonas sp. N3 with excellent denitrification capacity at low temperature was isolated and identified using phenotypic and phylogenetic analysis. Complete nitrate removal was achieved at C/N=8, that is, 70 mg·L-1 nitrate. In addition, the isolate exhibited a great adaptability for low temperature and can reach 100% removal of 15 mg·L-1 nitrate at a temperature as low as 4℃ within 36 h. The denitrification genes of narG and nirS were highly expressed; they were at the same order of magnitude as those at 30℃. Semicontinuous experiments were conducted to test the stability of N3 immobilized with polyvinyl alcohol and sodium alginate at 10℃. The results show that immobilized N3 can remove 15 mg·L-1 nitrate completely within three days and maintains a strong mechanical performance and stability during the whole 54 days. The cold resistance and high denitrification ability of the strain N3 make it applicable to nitrogen wastewater treatment in winter.

[Dynamic Changes of Nitrogen-Transforming and Phosphorus-Accumulating Bacteria Along with the Formation of Cyanobacterial Blooms].

In order to reveal the dynamic changes of nitrogen-transforming and phosphorus-accumulating bacteria in the process of cyanobacterial bloom formation, bacterial community structure and functional genes associated with nitrogen cycling were analyzed using high-throughput sequencing and real-time quantitative PCR (qPCR). The high-throughput sequencing results showed that the diversity of bacterial communities decreased during cyanobacterial blooms, and the lacustrine free-living and bloom-attached bacterial communities varied with increased bloom density. With increasing density of cyanobacteria, the relative abundance of Actinobacteria and Bacteroidetes decreased, whereas that of Firmicutes increased. Moreover, the growth of phosphate-accumulating organisms was increased in the phycosphere of cyanobacterial blooms, while that of nitrifiers was inhibited. Denitrifiers increased significantly under moderate blooms. The qPCR data also revealed that the abundance of nitrification and denitrification genes decreased or disappeared with the development of cyanobacterial blooms, indicating that the nitrogen transformation process might be inhibited, which showed a positive feedback of bacterial community to the development of Microcystis blooms by satisfying the needs of the nutrients budget.

The do-not-resuscitate order for terminal cancer patients in mainland China: A retrospective study.

With the development of palliative care, a signed do-not-resuscitate (DNR) order has become increasingly popular worldwide. However, there is no legal guarantee of a signed DNR order for patients with cancer in mainland China. This study aimed to estimate the status of DNR order signing before patient death in the cancer center of a large tertiary affiliated teaching hospital in western China. Patient demographics and disease-related characteristics were also analyzed.This was a retrospective chart analysis. We screened all charts from a large-scale tertiary teaching hospital in China for patients who died of cancer from January 2010 to February 2015. Analysis included a total of 365 records. The details of DNR order forms, patient demographics, and disease-related characteristics were recorded.The DNR order signing rate was 80%. Only 2 patients signed the DNR order themselves, while the majority of DNR orders were signed by patients' surrogates. The median time for signing the DNR order was 1 day before the patients' death. Most DNR decisions were made within the last 3 days before death. The time at which DNR orders were signed was related to disease severity and the rate of disease progression.Our findings indicate that signing a DNR order for patients with terminal cancer has become common in mainland China in recent years. Decisions about a DNR order are usually made by patients' surrogates when patients are severely ill. Palliative care in mainland China still needs to be improved.

Attitudes of Chinese Oncology Physicians Toward Death with Dignity.

BACKGROUND: Death with dignity (DWD) refers to the refusal of life-prolonging measures for terminally ill patients by "living wills" forms in advance. More and more oncology physicians are receiving DWD requests from advance cancer patients in mainland China. OBJECTIVE: The study objective was to investigate the attitudes of Chinese oncology physicians toward the legalization and implementation of DWD. METHODS: A questionnaire investigating the understanding and attitudes toward DWD was administered to 257 oncology physicians from 11 hospitals in mainland China. RESULTS: The effective response rate was 86.8% (223/257). The majority of oncology physicians (69.1%) had received DWD requests from patients. Half of the participants (52.5%) thought that the most important reason was the patients' unwillingness to maintain survival through machines. One-third of participants (33.0%) attributed the most important reason to suffering from painful symptoms. Most oncology physicians (78.9%) had knowledge about DWD. A fifth of respondents did not know the difference between DWD and euthanasia, and a few even considered DWD as euthanasia. The majority of oncology physicians supported the legalization (88.3%) and implementation (83.9%) of DWD. CONCLUSIONS: Many Chinese oncology physicians have received advanced cancer patients' DWD requests and think that DWD should be legalized and implemented. Chinese health management departments should consider the demands of physicians and patients. It is important to inform physicians about the difference between DWD and euthanasia, as one-fifth of them were confused about it.

The discordance of information needs between cancer patients and their families in China.

OBJECTIVE: We aimed at studying information needs of patients and their families, and their attitude towards the counterparts' information needs. Factors influencing psychological status of patients were investigated. METHODS: Self-designed questionnaires for information needs and attitude were delivered to participants. Patient Health Questionnaire 9-item and Generalized Anxiety Disorder 7-item scale were used to evaluate psychological status of patients. RESULTS: 183 eligible pairs of patients and families were involved. Except for the patients' expected life span, most patients and families needed information for all other subscales of disease-related information. Most patients wished families know more information; however, caregivers tended to prevent this. The occurrence of patients' psychiatric disorders was related to their needs for expected life span (OR 3.06 95%CI 1.36-6.93), as well as the attitude of caregivers about whether to provide more information about treatment outcomes (OR 0.24 95% CI 0.10-0.63). CONCLUSIONS: Information discordance between cancer patients and their families tended to happen when it came to patients' prognostic information. The psychological status of cancer patients was found in association with their information needs and families' attitude towards it. PRACTICE IMPLICATIONS: To guide oncology professionals and cancer patients' families for information provision.

Serum TGF-ß1 as a Biomarker for Type 2 Diabetic Nephropathy: A Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Abnormal expression of serum TGF-ß1 was found in patients with diabetic nephropathy. However, the association of TGF-ß1 with the risk of diabetic nephropathy remains unknown. The present study was undertaken to investigate whether such an association exists. METHODS: We searched the Chinese VIP, Wangfang, China National Knowledge Infrastructure, PubMed, Embase, and Google Scholar databases for relevant studies and extracted all eligible data. Stata12 software was used for statistical analysis. RESULTS: Nine reports met our criteria and were used for data extraction. There were 264 patients and 227 healthy controls from qualified reports in this meta-analysis. The results suggested that serum TGF-ß1 levels were significantly up-regulated in patients with diabetic nephropathy; the instrumental variable was 3.94 (95% confidence interval 3.20-4.68, p<0.01). CONCLUSIONS: Meta-analysis suggested that elevated serum TGF-ß level in patients with diabetes is associated with a high risk of nephropathy. Further studies are required to validate these observations.