A diagnostic model for minimal change disease based on biological parameters

Machine learning-based diagnostic prediction of minimal change disease: model development study

Minimal change disease (MCD) is a common cause of nephrotic syndrome. Due to its rapid progression, early detection is essential; however, definitive diagnosis requires invasive kidney biopsy. This study aims to develop non-invasive predictive models for diagnosing MCD by machine learning. We retrospectively collected data on demographic characteristics, blood tests, and urine tests from patients with nephrotic syndrome who underwent kidney biopsy. We applied four machine learning algorithms-TabPFN, LightGBM, Random Forest, and Artificial Neural Network-and logistic regression. We compared their performance using stratified 5-repeated 5-fold cross-validation for the area under the receiver operating characteristic curve (AUROC) and the area under the precision-recall curve (AUPRC). Variable importance was evaluated using the SHapley Additive exPlanations (SHAP) method. A total of 248 patients were included, with 82 cases (33%) were diagnosed with MCD. TabPFN demonstrated the best performance with an AUROC of 0.915 (95% CI 0.896-0.932) and an AUPRC of 0.840 (95% CI 0.807-0.872). The SHAP methods identified C3, total cholesterol, and urine red blood cells as key predictors for TabPFN, consistent with previous reports. Machine learning models could be valuable non-invasive diagnostic tools for MCD.

Thrombin Time is a Diagnostic Biomarker of Sudden Sensorineural Hearing Loss and Predicts the Prognosis

OBJECTIVES

The aim of this study is to determine whether thrombin time (TT) could be used as diagnostic biomarkers and predict the prognosis for sudden sensorineural hearing loss (SSNHL).

METHODS

Sixty-one patients diagnosed with SSNHL and 65 people who underwent physical examination were recruited. Data on the patient's background, clinical course, and laboratory findings were collected. SSNHL patients were divided into the effective and ineffective groups according to the hearing recovery from the treatment and were assessed by binary logistic regression. Receiver-operating characteristic (ROC) analysis was carried out for the best discriminating cutoff value of the biomarker with the corresponding sensitivity and specificity was calculated.

RESULTS

The SSNHL group exhibited prolonged TT (19.11 ± 1.12 seconds) compared to the control group (17.58 ± 2.18 seconds, P < .001). Binary logistic regression analysis found a significant positive association between TT and SSNHL and was observed with an odds ratio (OR) 1.769 [95% confidence interval (CI) 1.344-2.330, P < .001] in the unadjusted model. Even after adjustment using the variables included in the multivariate models, TT was significantly predictive of SSNHL. A TT cutoff value of 17.65 seconds provides optimal separation between patients with SSNHL and controls in the ROC analysis [Area Under the Curve (AUC) 0.773, 95% CI 0.689-0.856; sensitivity, 0.918; and specificity, 0.569]. TT in the effective group of SSNHL patients was shorter (18.76 ± 1.06 seconds) than that in the ineffective group (19.43 ± 1.09 seconds, P = .018). The cutoff value of TT as progress predictors was 19.85 seconds. The TT < 19.85 seconds showed an effective rate 59.09% (26/44) higher than 17.65% (3/17) of TT ≥ 19.85 seconds.

CONCLUSIONS

TT is a potential biomarker of SSNHL and is independently associated with the prognosis of patients with SSNHL.

Astragalus polysaccharides affects multidrug resistance gene 1 and Pglycoprotein 170 in adriamycin nephropathy rats via regulating microRNA16/NFκB axis

OBJECTIVES

Nephrotic syndrome is a common disease of the urinary system. The aim of this study is to explore the effect of astragalus polysaccharides (APS) on multidrug resistance gene 1 (MDR1) and P-glycoprotein 170 (P-gp170) in adriamycin nephropathy rats and the underlying mechanisms.

METHODS

A total of 72 male Wistar rats were divided into a control group, a model group, an APS low-dose group, an APS high-dose group, an APS+micro RNA (miR)-16 antagomir group and an APS+miR-16 antagomir control group, with 12 rats in each group. Urine protein (UP) was detected by urine analyzer, and serum cholesterol (CHOL), albumin (ALB), blood urea nitrogen (BUN), and creatinine (SCr) were detected by automatic biochemical analyzer; serum interleukin-6 (IL-6), IL-1β, tumor necrosis factor α (TNF-α) levels were detected by ELISA kit; the morphological changes of kidney tissues were observed by HE staining; the levels of miR-16 and MDR1 mRNA in kidney tissues were detected by real-time RT-PCR; the expression levels of NF-κB p65, p-NF-κB p65, and P-gp170 protein in kidney tissues were detected by Western blotting; and dual luciferase was used to verify the relationship between miR-16 and NF-κB.

RESULTS

The renal tissue structure of rats in the control group was normal without inflammatory cell infiltration. The renal glomeruli of rats in the model group were mildly congested, capillary stenosis or occlusion, and inflammatory cell infiltration was obvious. The rats in the low-dose and high-dose APS groups had no obvious glomerular congestion, the proliferation of mesangial cells was significantly reduced, and the inflammatory cells were reduced. Compared with the high-dose APS group and the APS+miR-16 antagomir control group, there were more severe renal tissue structure damages in the APS + miR-16 antagomir group. Compared with the control group, the levels of UP, CHOL, BUN, SCr, IL-6, IL-1β, TNF-α, and MDR1 mRNA, and the protein levels of p-NF-κB p65 and P-gp170 in the model group were significantly increased (all P<0.05); the levels of ALB and miR-16 were significantly decreased (both P<0.05). Compared with the model group, the levels of UP, CHOL, BUN, SCr, IL-6, IL-1β, TNF-α, and MDR1 mRNA, and the protein levels of pNF-κB p65 and P-gp170 in the low-dose and high-dose APS groups were significant decreased (all P<0.05); and the levels of ALB and miR-16 were significantly increased (both P<0.05). Compared with APS+miR-16 antagomir control group, the UP, CHOL, BUN, SCr, IL-6, IL-1β, and TNF-α levels, MDR1 mRNA, and the protein levels of p-NF-κB p65 and P-gp170 were significantly increased (all P<0.05). The levels of ALB and miR-16 were significantly decreased in the APS+miR-16 antagomir group compared with the APS+miR-16 antagomir control group (both P<0.05).

CONCLUSIONS

APS can regulate the miR-16/NF-κB signaling pathway, thereby affecting the levels of MDR1 and P-gp170, and reducing the inflammation in the kidney tissues in the adriamycin nephropathy rats.

The Association of Muscle Dysmorphia, Social Physique Anxiety, and Body Checking Behavior in Male College Students With Weight Exercise

Objectives: To investigate the association between muscle dysmorphia (MD), social physique anxiety, and body-checking behavior in male college students with weight exercise, and to reveal the association between them.

Methods: A total of 492 male college students with weight exercise from 18 Fitness Clubs or bodybuilding centers in Chengdu, China, participated in this study.

Results: First, the social physique anxiety scores, body checking frequency, and weight exercise behavior (i.e., frequency, time, and intensity) in male college students with MD were significantly higher than those without MD; it indicated that the higher the exercise frequency they had, the longer the exercise time they cost, and the higher exercise intensity carried out, and the higher the social physique anxiety scores tended to be, the higher the frequency of body checking on “global muscles,” “chest and shoulder muscles,” “comparison with others” and “posture measurement” they did. Second, the mediating effect of the social physique anxiety on MD and body checking was established in the “MD → global muscle checking,” “MD → chest and shoulder muscle checking,” “MD → comparison with others,” and “muscle dysmorphia → posture measurement.”

Conclusion: Male college students with MD not only have a higher social physique anxiety, but also a higher frequency of body-checking behavior than the ordinary individuals. Social physique anxiety is one of the important mediating factors to those with MD which affects the body-checking behavior.

Prediction of steroid resistance and steroid dependence in nephrotic syndrome children

Background

Steroid resistant (SR) nephrotic syndrome (NS) affects up to 30% of children and is responsible for fast progression to end stage renal disease. Currently there is no early prognostic marker of SR and studied candidate variants and parameters differ highly between distinct ethnic cohorts.

Methods

Here, we analyzed 11polymorphic variants, 6 mutations, SOCS3 promoter methylation and biochemical parameters as prognostic markers in a group of 124 Polish NS children (53 steroid resistant, 71 steroid sensitive including 31 steroid dependent) and 55 controls. We used single marker and multiple logistic regression analysis, accompanied by prediction modeling using neural network approach.

Results

We achieved 92% (AUC = 0.778) SR prediction for binomial and 63% for multinomial calculations, with the strongest predictors ABCB1 rs1922240, rs1045642 and rs2235048, CD73 rs9444348 and rs4431401, serum creatinine and unmethylated SOCS3 promoter region. Next, we achieved 80% (AUC = 0.720) in binomial and 63% in multinomial prediction of SD, with the strongest predictors ABCB1 rs1045642 and rs2235048. Haplotype analysis revealed CD73_AG to be associated with SR while ABCB1_AGT was associated with SR, SD and membranoproliferative pattern of kidney injury regardless the steroid response.

Conclusions

We achieved prediction of steroid resistance and, as a novelty, steroid dependence, based on early markers in NS children. Such predictions, prior to drug administration, could facilitate decision on a proper treatment and avoid diverse effects of high steroid doses.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12967-021-02790-w.

Clinical significance of T lymphocyte subsets, immunoglobulin and complement expression in peripheral blood of children with steroid-dependent nephrotic syndrome/frequently relapsing nephrotic syndrome

OBJECTIVE

To investigate the clinical significance of T lymphocyte subsets, immunoglobulin and complement expression in the peripheral blood of children with steroid-dependent nephrotic syndrome/frequently relapsing nephrotic syndrome (SDNS/FRNS).

METHODS

A prospective study was conducted on 285 children with nephrotic syndrome (NS). Among the 285 patients, 187 children had steroid-sensitive nephrotic syndrome (SSNS) and 98 children had SDNS/FRNS according to their sensitivity to hormones. Meanwhile, 50 healthy children in the same period were selected as the control group. Serum albumin (ALB), blood urea nitrogen (BUN), serum creatinine (SCr), estimated glomerular filtration rate (eGFR), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), CD3+, CD4+, CD8+, immunoglobulin IgA, IgG, IgM and complement C3 and C4 were measured upon admission, and the content of urinary CD80 was also determined.

RESULTS

Compared with the control group, BUN, SCr, hs-CRP and IL-6 levels, urinary CD80, IgA, IgM and C3 in the SDNS/FRNS and SSNS groups were significantly higher, while ALB, eGFR, CD3+, CD4+, CD4+/CD8+, IgG and IgG/IgM were significantly lower (all P<0.05). Compared with the SSNS group, BUN, SCr, hs-CRP and IL-6 levels in the SDNS/FRNS group were significantly higher, while ALB and eGFR levels were significantly lower (all P<0.05). Compared with the SDNS/FRNS group, IgM in the SSNS group was significantly lower, while CD4+/CD8+, urinary CD80 and IgG/IgM were significantly higher (all P<0.001).

CONCLUSION

Renal function decline and inflammatory response existed in children with NS. CD3+, CD4+, CD4+/CD8+ and IgG/IgM in peripheral blood were decreased, while IgA, IgM, C3 and urinary CD80 were increased. Moreover, renal function decline, increase of inflammatory factors, decrease of IgG/IgM and CD4+/CD8+ were more obvious in the SDNS/FRNS group.

Non-enzymatic electrochemical approaches to cholesterol determination

Cholesterol plays a vital role in a human body. It is known as one of the most important sterols, because it forms cell walls and participates in signal transduction. Moreover, cholesterol was recognized as biomarker of cardiovascular diseases and of some metabolic disorders. As a result, cholesterol blood levels should be controlled in a variety of diseases such as ischemic heart disease, cerebrovascular ischemia, stroke, hypertension, type II diabetes, and many others. Hence, the accurate cholesterol quantification plays an important role in diagnosis and treatment of these diseases. Modern voltammetric and amperometric methods are increasingly used for cholesterol monitoring. Consequently, the problem of electrode fabrication for cholesterol detection has high importance for clinical tests. Novel electrode materials initiated the fast growth of electrochemical biosensors. Biomaterials are still the most frequently used modifiers for cholesterol sensors due to their high selectivity. However, biomaterials have low stability complicating their practical applications. This fact is crucial for analytical parameters such as limit of detection (LOD) and sensitivity. Therefore, nanomaterials are used to eliminate disadvantages of biomaterials and to improve sensors performance by increasing the electrode surface, conductivity and sensitivity. This review is focused on the use of non-enzymatic electrodes for cholesterol quantification and on different approaches to their fabrication. Firstly, the necessity and role of modifier is discussed. Afterwards, the advantages and disadvantages of currently used modifiers are critically compared together with all aspects and approaches to sensors fabrication. Finally, the prospects of non-enzymatic electrodes application for cholesterol sensors engineering are summarised.

Analytical methods for cholesterol quantification

Cholesterol is an important lipid molecule in cell membranes and lipoproteins. Cholesterol is also a precursors of steroid hormones, bile acids, and vitamin D. Abnormal levels of cholesterol or its precursors have been observed in various human diseases, such as heart diseases, stroke, type II diabetes, brain diseases and many others. Therefore, accurate quantification of cholesterol is important for individuals who are at increased risk for these diseases. Multiple analytical methods have been developed for analysis of cholesterol, including classical chemical methods, enzymatic assays, gas chromatography (GC), liquid chromatography (LC), and mass spectrometry (MS). Strategy known as ambient ionization mass spectrometry (AIMS), operating at atmospheric pressure, with only minimal sample pretreatments for real time, in situ, and rapid interrogation of the sample has also been employed for quantification of cholesterol. In this review, we summarize the most prevalent methods for cholesterol quantification in biological samples and foods. Nevertheless, we highlight several new technologies, such as AIMS, used as alternative methods to measure cholesterol that are potentially next-generation platforms. Representative examples of molecular imaging of cholesterol in tissue sections are also included in this review article.

Hydrochlorothiazide Test as a Tool in the Diagnosis of Gitelman Syndrome in Chinese Patients

Traditional clinical diagnostic criteria for Gitelman syndrome (GS) including hypomagnesemia and hypocalciuria have been challenged by reports of atypical manifestations recently, as well as the development of genetic testing. Hydrochlorothiazide (HCT) test is a diagnostic method different from the traditional biochemical parameters, which could evaluate the function of thiazide-sensitive sodium-chloride co-transporter (NCC) in vivo by a small dose of NCC inhibitor HCT. In this retrospective study, we compared the diagnostic significance of hypomagnesemia, hypocalciuria, and the reaction of HCT test, among Chinese patients with GS confirmed by genetic test. For patients who were clinically suspected of GS manifestations, SLC12A3 gene was sequenced to make genetic diagnosis. A total of 83 GS and 19 control patients were recruited, among which 37 underwent HCT test according to the standard process. Compared with the gold standard of genetic diagnosis, both the diagnostic sensitivity (93.10%) and specificity (100.00%) of the HCT test were much higher than those of hypomagnesemia and/or hypocalciuria. The area under the receiver operating characteristic (ROC) curve was 1.000 (95% CI 0.905-1.000) for HCT test, higher than the values using hypomagnesemia and/or hypocalciuria. The cost of HCT test was around $54, much lower than genetic diagnosis. In conclusion, besides traditional hypomagnesemia and hypocalciuria, HCT test could be a valuable tool in the clinical diagnosis of Chinese GS patients.