Long-term renal outcomes in a cohort of 1814 Chinese patients with biopsy-proven lupus nephritis

In the present study, we observed the renal outcomes in a cohort of 1814 Chinese patients with biopsy-proven lupus nephritis (LN) and evaluated the risk factors associated with poor renal prognosis. The 5 -, 10 -, 15 - and 20-year renal survival rates were 93.1%, 87.9%, 81.0% and 68.3%, respectively. Gender, LN duration, mean arterial pressure (MAP), proteinuria, serum creatinine, haemoglobin and pathological classification at the time of biopsy were independent risk factors for end-stage renal disease (ESRD). The long-term renal outcomes of patients with class II LN were unfavorable as opposed to those with class V. Additionally, the time-average proteinuria (TA-Pro) and the time-average mean arterial pressure (TA-MAP) during the follow-up were important risk factors for ESRD, with better predictive values than the baseline proteinuria and MAP. The results underscore the need for proteinuria and blood pressure control during follow-up in patients with LN; proteinuria levels should be controlled at least to < 1.0 g/24 h, and optimally to < 0.5 g/24 h; MAP should not exceed 96.5 mmHg. More attention should be paid to class II LN and emphasis should be placed on recurrence prevention of class II LN.

Treatment escalation options for patients with type 2 diabetes after failure of exenatide twice daily or glimepiride added to metformin: results from the prospective European Exenatide (EUREXA) study

AIMS

To evaluate third-line thiazolidinedione (TZD) or glimepiride therapy in patients inadequately controlled on metformin + exenatide twice daily, and third-line exenatide twice daily in patients inadequately controlled on metformin + glimepiride.

METHODS

In this randomized, open-label, multicentre trial, 144 patients with type 2 diabetes inadequately controlled [glycated haemoglobin (HbA1c) >9% (75 mmol/mol) after 3 months' treatment or >7% (53 mmol/mol) at two consecutive visits 3 months apart, after 6 months' treatment] on metformin + exenatide twice daily were re-randomized to add-on TZD or glimepiride, and 166 patients inadequately controlled on metformin + glimepiride received add-on exenatide twice daily. Changes in HbA1c, body mass index (BMI), lipids, hypoglycaemia and vital signs were evaluated.

RESULTS

The median duration of triple therapy was ∼2 years. In patients inadequately controlled on metformin + exenatide twice daily, add-on TZD decreased HbA1c levels significantly better than add-on glimepiride: 130-week difference 0.48% [95% confidence interval (CI) 0.19-0.77] or 5.2 mmol/mol (95% CI 2.1-8.4; p = 0.001), but with significantly increased BMI and systolic blood pressure. The ratio of documented symptomatic (blood glucose ≤70 mg/dl [3.9 mmol/l]) hypoglycaemia rates for add-on glimepiride to add-on TZD was 8.48 (p < 0.0001). Add-on exenatide twice daily after metformin + glimepiride significantly reduced HbA1c levels: mean [standard deviation (s.d.)] change from baseline -0.35 (0.89)% [-3.8 (9.7) mmol/mol] and BMI: mean (s.d.) change from baseline -0.82 (1.9) kg/m(2) at 130 weeks, with a slightly increased rate of documented symptomatic hypoglycaemia from metformin + glimepiride (ratio 1.49).

CONCLUSIONS

TZD, but not glimepiride, was an effective and well tolerated third-line therapy in patients without glycaemic control after long-term therapy with metformin + exenatide twice daily. Exenatide twice daily was an effective and well tolerated third-line therapy in patients inadequately controlled on metformin + glimepiride.

Stromal miR-200s contribute to breast cancer cell invasion through CAF activation and ECM remodeling

The activation of cancer-associated fibroblasts (CAFs) is a key event in tumor progression, and alternative extracellular matrix (ECM) proteins derived from CAFs induce ECM remodeling and cancer cell invasion. Here we found that miR-200 s, which are generally downregulated in activated CAFs in breast cancer tissues and in normal fibroblasts (NFs) activated by breast cancer cells, are direct mediators of NF reprogramming into CAFs and of ECM remodeling. NFs with downregulated miR-200 s displayed the traits of activated CAFs, including accelerated migration and invasion. Ectopic expression of miR-200 s in CAFs at least partially restored the phenotypes of NFs. CAF activation may be governed by the targets of miR-200 s, Fli-1 and TCF12, which are responsible for cell development and differentiation; Fli-1 and TCF12 were obviously elevated in CAFs. Furthermore, miR-200 s and their targets influenced collagen contraction by CAFs. The upregulation of fibronectin and lysyl oxidase directly by miR-200 or indirectly through Fli-1 or TCF12 contributed to ECM remodeling, triggering the invasion and metastasis of breast cancer cells both in vitro and vivo. Thus, these data provide important and novel insights into breast CAF activation and ECM remodeling, which trigger tumor cell invasion.

Sonocatalytic degradation of RhB over LuFeO3 particles under ultrasonic irradiation

LuFeO3 particles with an average particle size of ∼200 nm were synthesized via a polyacrylamide gel route. The sonocatalytic activity of LuFeO3 particles was evaluated by the degradation of Rhodamine B (RhB) under ultrasonic irradiation, revealing that they exhibit a good sonocatalytic activity. The effects of various experimental factors including ultrasonic frequency (f), reaction solution temperature (T), catalyst dosage (Ccatalyst), initial RhB concentration (CRhB), and pH value on the sonocatalysis efficiency were investigated. It is found that the former four factors have an important influence on the sonocatalytic degradation of RhB, where the best degradation conditions are obtained to be f=60 kHz, T=40 °C, Ccatalyst=4 g L(-1), and CRhB=5 mg L(-1). The pH value has a relatively small effect on the sonocatalytic degradation of RhB compared with other experimental factors. Hydroxyl (·OH) radicals were detected by fluorimetry using terephthalic acid as a probe molecule, revealing that they are produced over the ultrasonic-irradiated LuFeO3 particles. The addition of ethanol leads to a quenching of ·OH radicals and a simultaneous decrease in the RhB degradation. This indicates that ·OH radicals are the primary active species responsible for the dye degradation.

Results from the IQ-CSRC prospective study support replacement of the thorough QT study by QT assessment in the early clinical phase

The QT effects of five "QT-positive" and one negative drug were tested to evaluate whether exposure-response analysis can detect QT effects in a small study with healthy subjects. Each drug was given to nine subjects (six for placebo) in two dose levels; positive drugs were chosen to cause 10 to 12 ms and 15 to 20 ms QTcF prolongation. The slope of the concentration/ΔQTc effect was significantly positive for ondansetron, quinine, dolasetron, moxifloxacin, and dofetilide. For the lower dose, an effect above 10 ms could not be excluded, i.e., the upper bound of the confidence interval for the predicted mean ΔΔQTcF effect was above 10 ms. For the negative drug, levocetirizine, a ΔΔQTcF effect above 10 ms was excluded at 6-fold the therapeutic dose. The study provides evidence that robust QT assessment in early-phase clinical studies can replace the thorough QT study.

Iatrogenic urological triggers of autonomic dysreflexia: a systematic review

STUDY DESIGN

This is a systematic review.

OBJECTIVE

The objective of this study was to review the literature on iatrogenic urological triggers of autonomic dysreflexia (AD).

SETTING

This study was conducted in an international setting.

METHODS

A systematic review was conducted from PubMed search using AD/ autonomic hyperreflexia and spinal cord injury (SCI). Studies selected for review involved iatrogenic urological triggers of AD in individuals with SCI, including original articles, previous practice guidelines, case reports and literature reviews. Studies that did not report AD or blood pressure (BP) assessments during urological procedures were excluded.

RESULTS

Forty studies were included for analysis and categorized into four groups: (1) urodynamics and cystometry; (2) cystoscopy and transurethral litholapaxy; (3) extracorporeal shock-wave lithotripsy (ESWL); and (4) other procedures. During urodynamics, the incidence of AD ranged from 36.7% to 77.8%. The symptomatic rate ranged from 50% to 65%, with AD symptoms seen predominantly in cervical SCI patients. The studies imply no consensus regarding the relationship between AD, neurogenic detrusor overactivity and detrusor sphincter dyssynergia. Without anesthesia, the majority of individuals develop AD during cystoscopy, transurethral litholapaxy and ESWL. The effectiveness of different anesthesia methods relies on blocking the nociceptive signals from the lower urinary tract (LUT) below the level of the neurological lesion. Other iatrogenic urological triggers were commonly associated with bladder filling.

CONCLUSION

The LUT triggers of episodes of AD are often associated with iatrogenic urological procedures. AD was more prevalent in cervical SCI than in thoracic SCI. To detect this potential life-threatening complication following cervical and high thoracic SCI, routine BP monitoring during urological procedures is highly recommended.

Soluble expression and one-step purification of recombinant mouse interferon-λ3 in Escherichia coli

Interferon (IFN)-λ3, a member of the type III IFN family, is a pleiotropic cytokine that exhibits potent antiproliferative, antiviral, and immunoregulatory activities. For further functional study of IFN-λ3, we developed an efficient procedure that includes cloning, expression, and purification to obtain relatively large quantity of mouse IFN-λ3 fusion protein. The mature IFN-λ3 protein-coding region was cloned into the prokaryotic expression vector pET-44. IFN-λ3 contains a hexahistidine tag at its C-terminus. We used Ni(2+)-nitrilotriacetic acid agarose-affinity chromatography to purify the expressed soluble protein. The purified IFN-λ3 inhibited significantly IL-13 production in stimulated RAW264.7 macrophages. Our findings show that the production of soluble IFN-λ3 proteins by the pET-44 vector in Escherichia coli is a good alternative for the production of native IFN-λ3 and could be useful for the production of other IFN proteins.

Expression of IMP3 and IGF2 in giant cell tumor of spine is associated with tumor recurrence and angiogenesis

PURPOSE

Giant cell tumor (GCT) of bone is a vessel-rich and infiltrative tumor, but the fundamental knowledge of its biological behavior remains unknown now.

METHODS

In this study, we evaluated the expression levels of Insulin-like growth factor 2 mRNA-binding protein 3 (IMP3), Insulin-like growth factor 2 (IGF2) and CD105 in 38 patients with GCT of spine by Immunohistochemical staining. Additionally, we also analyzed their correlations with clinicopathological factors of giant cell tumor of spine.

RESULTS

The results showed that positive expression of IMP3 and IGF2 was tightly related to the tumor extension and local recurrence of GCT (P < 0.05), but it did not indicate any association with patients' age, gender, tumor location and size. The mean microvessel densities (MVDs) of IMP3 and IGF2 were significantly higher in positive group than negative group (P < 0.05). Moreover, a significant correlation was found between IMP3 and IGF2 expression (r = 0.355, P = 0.029). The log-rank test revealed that local recurrence-free survival time was significantly shorter in the IMP3 positive group (P = 0.004), and the difference in the IGF2 positive group and negative group was also statistically significant (P = 0.008).

CONCLUSION

IMP3 and IGF2 might be potential biomarkers for GCT of spine in regulating the angiogenesis of giant cell tumor of bone and predicting the patients' prognosis.

First Report of Alternaria alternata Causing Black Leaf Spot of Rubber Tree in China

We first reported Alternaria heveae (E.G. Simmons ) to be the pathogen that caused black leaf spot of rubber tree (Hevea brasiliensis Muell. Arg) in Heikou county in July 2014 (1). Black leaf spots that resembled the symptoms caused by A. heveae were observed on the leaves of rubber trees of the whole propagule collection nursery in Jingping County (22°68' N and 103°05' E) of Yunnan Province. Black foliar spots (0.1 to 2 mm in diameter) surrounded by a yellow halo with lesions slightly sunken on the leaf surface were observed. To confirm whether the disease was caused by the same pathogen, 5-mm² sections were removed from the leading edge of the lesion and were surface-sterilized in 75% ethanol, air-dried, plated on potato carrot agar (PCA), and incubated at 28°C in the dark. Colonies of the fungus on PCA had round margins and little aerial mycelia with gray-black coloration after 6 days of growth on PCA (2). Medium brown conidia were found to be in short chains of two to eight spores, ovoid, obclavate, and obpyriform, with or without a short conical or cylindrical-shaped apical beak. Conidia ranged from 22.5 to 67.5 μm long (mean 39.9 μm) × 10 to 15 μm wide (mean 12.5 μm; 100 colodia were measured), with three to six transverse septa and zero to three longitudinal or oblique septa. Morphological characteristics matched the descriptions of A. alternata [(Fries) Keissler] (4).The ITS1-5.8S-ITS2 region of one single-spore isolate, Ah02JP1, was amplified with primers ITS1 and ITS4. The PCR product was sequenced directly and deposited in GenBank (Accession No. KM111289). A BLAST search of the GenBank database revealed 100% similarity with A. alternata isolates KJ829535.1, KJ677246.1, and KF813070.1. Therefore, the pathogen was identified as A. alternata on the basis of its morphological characteristics and ITS sequence. Pathogenicity of a representative isolate, Ah02JP1 was confirmed using a field rubber tree inoculation method. Three rubber plants (the clone of rubber tree Yunyan77-4) were grown to the copper-colored leaf stage. Leaves were spray-inoculated (10⁴ conidia per milliliter spore suspension) until drops were equally distributed using a manual pressure sprayer. Three rubber plants sprayed with sterile distilled water were used as controls. After inoculation, the plants were covered with plastic bags to maintain high relative humidity. The plastic bags were removed 2 days post-inoculation (dpi), and the plants were monitored daily for symptom development. Five days post-inoculation, spots similar to the original ones seen on the field trees developed on all inoculated leaves, while control leaves remained symptomless. A. alternata was re-isolated from spray-inoculated leaves, confirming Koch's postulates. A. alternata has been reported as the causal agent of leaf blight of rubber tree in India, which initially appeared as minute spots on leaves and enlarged with the growth of the leaves (3). However, in the present study, the symptoms (black leaf spots) remained small over time after inoculation. To our knowledge, this is the first report of A. alternata on rubber tree in China. Correct identification of pathogens is essential for disease management strategies. This report will establish a foundation for the further study of Alternaria alternata to address the disease effectively. References: (1) Z. Y. Cai et al. Plant Dis. 98:1011, 2014. (2) E. Mirkova. J. Phytopathol. 151:323, 2003. (3) C. B. Roy et al. J. Plantation Crops 34:499, 2006. (4) T. Y. Zhang. Page 32 in: Flora Fungorum Sinicorum, Vol. 16: Alternaria. Science Press, Beijing, 2003.

Folic acid supplementation and dietary folate intake, and risk of preeclampsia

BACKGROUND/OBJECTIVES

Folic acid supplementation has been suggested to reduce the risk of preeclampsia. However, results from few epidemiologic studies have been inconclusive. We investigated the hypothesis that folic acid supplementation and dietary folate intake before conception and during pregnancy reduce the risk of preeclampsia.

SUBJECTS/METHODS

A birth cohort study was conducted in 2010-2012 at the Gansu Provincial Maternity & Child Care Hospital in Lanzhou, China. A total of 10,041 pregnant women without chronic hypertension or gestational hypertension were enrolled.

RESULTS

Compared with nonusers, folic acid supplement users had a reduced risk of preeclampsia (OR=0.61, 95% CI: 0.43-0.87). A significant dose-response of duration of use was observed among women who used folic acid supplemention during pregnancy only (P-trend=0.007). The reduced risk associated with folic acid supplement was similar for mild or severe preeclampsia and for early- or late-onset preeclampsia, although the statistical significant associations were only observed for mild (OR=0.50, 95% CI: 0.30-0.81) and late-onset (OR=0.60, 95% CI: 0.42-0.86) preeclampsia. The reduced risk associated with dietary folate intake during pregnancy was only seen for severe preeclampsia (OR=0.52, 95% CI: 0.31-0.87, for the highest quartile of dietary folate intake compared with the lowest).

CONCLUSIONS

Our study results suggest that folic acid supplementation and higher dietary folate intake during pregnancy reduce the risk of preeclampsia. Future studies are needed to confirm the associations.

Linking waterlogging tolerance with Mn²⁺ toxicity: a case study for barley

Vast agricultural areas are affected by flooding, causing up to 80% yield reduction and resulting in multibillion dollar losses. Up to now, the focus of plant breeders was predominantly on detrimental effects of anoxia, while other (potentially equally important) traits were essentially neglected; one of these is soil elemental toxicity. Excess water triggers a progressive decrease in soil redox potential, thus increasing the concentration of Mn(2+) that can be toxic to plants if above a specific threshold. This work aimed to quantify the relative contribution of Mn(2+) toxicity to waterlogging stress tolerance, using barley as a case study. Twenty barley (Hordeum vulgare) genotypes contrasting in waterlogging stress tolerance were studied for their ability to cope with toxic (1 mm) amounts of Mn(2+) in the root rhizosphere. Under Mn(2+) toxicity, chlorophyll content of most waterlogging-tolerant genotypes (TX9425, Yerong, CPI-71284-48 and CM72) remained above 60% of the control value, whereas sensitive genotypes (Franklin and Naso Nijo) had 35% less chlorophyll than 35% of controls. Manganese concentration in leaves was not related to visual Mn(2+) toxicity symptoms, suggesting that various Mn(2+) tolerance mechanisms might operate in different tolerant genotypes, i.e. avoidance versus tissue tolerance. The overall significant (r = 0.60) correlation between tolerance to Mn(2+) toxicity and waterlogging in barley suggests that plant breeding for tolerance to waterlogging traits may be advanced by targeting mechanisms conferring tolerance to Mn(2+) toxicity, at least in this species.

Respiratory cancers and pollution

Cancer is the major public health problem worldwide, irrespective of the socio-economic status of the countries. Even though the overall mortality from cancer is higher in the western countries, the cancer burden is on the rise in under-developed countries, with a projected 81-100% increase by 2030, mostly due to pollution and tobacco use. Respiratory cancers affect the lung, larynx, trachea, and bronchus and depending on the location of the cancer, the symptoms change and also the risks, incidence and survival outcomes differ accordingly. Besides tobacco use, chronic exposure to household pollution is known to be associated with elevated risk of lung cancer and other cancers. Women and children living in severe poverty in the underdeveloped countries are exposed most to household air pollution and, thus, suffer its consequences maximally, and household air pollution, specifically arising from solid fuel burning, which accounts for nearly 4 million deaths throughout the world annually. Cancers affecting the respiratory tract, including both nasopharyngeal cancer and lung cancer, are strongly associated with pollution from coal and other solid fuel burning. Lung cancer, which is of two types, small cell lung carcinoma and the non-small cell lung cancer, is the most common and fatal cancer. Even though tobacco has been viewed as the major risk for respiratory cancers, it is now evident that household pollution, exposure to asbestos, chromium and arsenic etc, all pose a significant risk for respiratory cancers. Preventive steps to curtail the many sources of air pollution by improving living conditions and reducing the occupational exposure hazards like welding, industrial work etc., are markedly needed to control the incidence of respiratory cancers.

Glycolysis recycling of rigid waste polyurethane foam from refrigerators

Rapid growth of rigid waste polyurethane (WPUR) foam from refrigerators attracts the attention all over the world. In this study, glycolysis was chosen to treat WPUR from scrapped refrigerators collected in Shanghai, China. Glycolysis reagents and catalysts were selected. The results indicated that the glycolysis efficiency of ethylene glycol (EG) was higher than that of diethylene glycol, and the catalytic efficiency of alkali metal salts (NaOH) was more excellent than that of triethanolamine and organic salts of alkali metal (NaAc). When EG was 100%WPUR as a glycolysis reagent and NaOH was 1%WPUR as a catalyst at a constant temperature of 197.85°C for 2 h, the glycolysis product had the highest glycolysis conversion rate. In order to maximize the recycling of WPUR, regenerative Polyurethane was performed by adding 10% distilled mixed polyol, which conformed to the QB/T 26689-2011 requirements.

Confining Pt nanoparticles in porous carbon structures for achieving durable electrochemical performance

Carbon-supported Pt catalysts have been widely employed as electrocatalysts for energy storage/conversion applications, but have encountered challenging instability issues. In this work, we investigated the degradation behaviors of pore-confined and surface-located Pt nanocatalysts, employing hollow porous carbon spheres with precisely controlled structure as catalyst supports. It is found that by uniformly confining Pt nanoparticles in porous carbon structures, remarkably improved stability and long-term performance of Pt electrocatalysts can be achieved. The nanopore-confined Pt exhibits high retention ratios of both ECSA (54%) and electrocatalytic activity after accelerated degradation tests (ADTs), both of which are almost two times higher than those of the surface-located ones. TEM analysis of the degraded electrocatalysts further revealed that the pore-confinement effect can significantly suppress the Pt degradation processes, including particle migration/agglomeration and detachment from the carbon support.