Elevated circulating trimethylamine N-oxide (TMAO) concentrations have been observed in patients with chronic kidney disease (CKD). We aimed to systematically estimate and quantify the association between TMAO concentrations and kidney function. The PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science databases were systematically searched from 1995 to 1 June, 2020, for clinical studies on circulating TMAO concentrations and kidney function indicators. We used R software to conduct meta-analyses of the extracted data. A cumulative meta-analysis was applied to test whether health status affected the pooled effect value. Meta-regression and subgroup analyses were performed to identify possible sources of heterogeneity. Ultimately, we included a total of 32 eligible clinical studies involving 42,062 participants. In meta-analyses of continuous-outcome variables, advanced CKD was associated with a 67.9 μmol/L (95% CI: 52.7, 83.2; P < 0.01) increase in TMAO concentration, and subjects with high concentrations of TMAO had a 12.9 mL/(min·1.73 m2) (95% CI: −16.6, −9.14; P < 0.01) decrease in glomerular filtration rate (GFR). In meta-analyses of the correlations, TMAO was strongly inversely correlated with GFR [Fisher's z-transformed correlation coefficient (ZCOR): −0.45; 95% CI: −0.58, −0.32; P < 0.01] and positively associated with the urine albumin-to-creatinine ratio (UACR; ZCOR: 0.26; 95% CI: 0.08, 0.43; P < 0.01), serum creatinine (sCr; ZCOR: 0.43; 95% CI: 0.28, 0.58; P < 0.01), urine albumin excretion rate (UAER; ZCOR: 0.06; 95% CI: 0.04, 0.09; P < 0.01), blood urea (ZCOR: 0.50; 95% CI: 0.29, 0.72; P < 0.01), blood uric acid (ZCOR: 0.32; 95% CI: 0.25, 0.38; P < 0.01), and serum cystatin C (CysC; ZCOR: 0.47, 95% CI: 0.44, 0.51; P < 0.01). This is the first systematic review and meta-analysis to reveal a negative association between circulating TMAO concentrations and kidney function.
Purpose. Using retinal optical coherence tomography angiography (OCTA), we aimed to investigate the changes in important indicators of cerebral microcirculatory disorders, such as the properties of the radial peripapillary capillaries, vascular complexes, and the retinal nerve fiber layer, caused by carotid stenosis and postoperative reperfusion. Methods. In this prospective longitudinal cohort study, we recruited 40 carotid stenosis patients and 89 healthy volunteers in the First Affiliated Hospital of Harbin Medical University (Harbin, China). Eyes with ipsilateral carotid stenosis constituted the experimental group, while the fellow eyes constituted the contralateral eye group. Digital subtraction angiography, CT perfusion imaging (CTP), and OCTA examinations were performed in all subjects. The vessel density of the radial peripapillary capillaries (RPC), superficial retinal vascular complexes (SVC), deep vascular complexes (DVC), choriocapillaris (CC), and the thickness of the retinal nerve fiber layer (RNFL) were assessed. Propensity-matched analysis was undertaken to adjust for covariate imbalances. Intergroup comparative analysis was conducted, and the paired sample t -test was used to evaluate the preoperative and postoperative changes in OCTA variables. Results. The ocular vessel density in the experimental group was significantly lower than that in the control group (RPC: 55.95 vs. 57.24, P = 0.0161 ; SVC: 48.65 vs. 52.22, P = 0.0006 ; DVC: 49.65 vs. 57.50, P < 0.0001 ). Participants with severe carotid stenosis have reduced contralateral ocular vessel density (RPC 54.30; SVC 48.50; DVC 50.80). Unilateral stenosis removal resulted in an increase in vessel density on both sides, which was detected by OCTA on the 4th day (RPC, P < 0.0001 ; SVC, P = 0.0104 ; DVC, P = 0.0104 ). Moreover, the ocular perfusion was consistent with that established by CTP. Conclusion. OCTA can be used for sensitive detection and accurate evaluation of decreased ocular perfusion caused by carotid stenosis and may thus have the potential for application in noninvasive detection of cerebral microcirculation disorders. This trial is registered with NCT04326842.
BackgroundTo develop a Cancer Self-Perceived Discrimination Scale (CSPDS) for Chinese cancer patients and to assess its reliability and validity.MethodA total of 178 patients were recruited and the classical test theory was used to develop the CSPDS. Item analysis was adapted to improve the preliminary version of the CSPDS, then the reliability, the validity and the acceptability of the final version of CSPDS were assessed.ResultsThis CSPDS contained 14 items classified into 3 subscales: social withdrawal with 7 items, stigma with 4 and self-deprecation with 3. Good validity (χ2/df = 1.216, GFI = 0.935, AGFI = 0.903, I-CVIs> 0.80) and good reliability (Cronbach’s alpha = 0.829, Spearman-Brown coefficient = 0.827, test-retest reliability coefficient = 0.944) were found. The completion time was 6.06 ± 1.80 min. Participants who were female and reported poor self-rated health tended to have higher CSPDS scores (P < 0.05).ConclusionsThe results indicated that this CSPDS could be used to assess the level of self-perceived discrimination and to preliminarily screen perceived discrimination among Chinese cancer patients, especially in Southwest China. It may provide a basis for scientific assessment of targeted patient education, psychological counseling, social interventions, and psychotherapy in the future.
Processing technology for microwave pyrolysis of municipal solid waste was studied by a self-made 20 KW microwave pyrolysis apparatus of wastes in this paper.Microwave pyrolysis temperature of wastes, pressure, pyrolysis products, rate of gas yield and energy consumption were analyzed in detail. The results showed that the appropriate pyrolysis temperature was not higher than 600 'C. Total content of combustible gases such as CH4, C2H2, C2H4, C2H6, etc. was 74.88%, the average of pyrolysis gas calorific value was 36.02 MJ/m 3 , and tar calorific value was 54.7 MJ/m 3 • Energy consumption for microwave pyrolysis of wastes ranges from 0.58 KWh/Kg to 0.7 KWh/Kg. Keywords-municipal solid waste; microwave pyrolysis; microwave pyrolysis furnace; resource utilization 1.
Ketogenic diet (KD) and β-Hydroxybutyrate (βOHB) has been widely reported as an effective therapy for metabolic diseases. β-hydroxybutyrate dehydrogenase 1 (Bdh1) is the rate-limiting enzyme of ketone metabolism. In this study, we investigated the Bdh1-mediated βOHB metabolic pathway in pathogenesis of diabetic kidney disease (DKD). Human renal tubule epithelial cells (HK-2 cells) induced by high glucose (HG) or palmitic acid (PA) were used to transfect with Bdh1 siRNA or plasmid-flag-Bdh1. Reactive oxygen species (ROS) levels, nuclear factor red 2-related factor 2 (Nrf2) protein expression, and βOHB-acetoacetate (AcAc)-succinate-fumarate metabolic flux were detected. Five-week-old C57 BKS db/db obese diabetic mice (db/db) and their littermate controls (+/+) were treated with KD, βOHB, and adeno-associated virus (AAV9)-Bdh1, respectively. Renal function was determined by urinary albumin/creatinine ratio (ACR), and histopathological, immunohistochemistry (IHC), TUNEL staining of kidney were also performed. The renal expression of Bdh1 was down-regulated in DKD mouse models, diabetic patients and HG or PA induced HK-2 cells. Bdh1 overexpression or βOHB treatment protected HK-2 cells from glucotoxicity and lipotoxicity by inhibiting ROS overproduction. Mechanistically, Bdh1-mediated βOHB metabolism activated Nrf2 through enhancement of metabolic flux composed of βOHB-acetoacetate-succinate-fumarate. Moreover, in vivo studies showed that AAV9-mediated Bdh1 renal expression successfully reversed the fibrosis, inflammation and apoptosis in kidneys from C57 BKS db/db mice. Notably, either βOHB supplementation or KD feeding could elevate the renal expression of Bdh1 and reverse the progression of DKD. Our results revealed a Bdh1-mediated molecular mechanism in pathogenesis of DKD and identified Bdh1 as a potential therapeutic target for DKD.
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