Acute kidney injury in patients with cancer receiving anti-PD-1/PD-L1 antibodies: incidence, risk factors, and prognosis

Anti-PD-1/PD-L1 antibodies are widely used in anti-cancer therapy. While they have improved cancer prognoses, immune-related adverse events, which can cause acute kidney injury (AKI), cannot be ignored. The purpose of this retrospective cohort study was to assess the incidence, risk factors, and prognosis of AKI associated with anti-PD-1/PD-L1 antibodies. Patients who received anti-PD-1/PD-L1 antibody treatment at our hospital between January 2018 and December 2022 were enrolled. Clinical information, combined medications, concomitant diseases, tumor types, and laboratory indicators were collected from patient records, and the incidence of AKI was determined. The risk factors for AKI were assessed using univariate and multivariate logistic regression analyses. Overall, 1418 patients were enrolled. The median follow-up time was 112 days and 92 (6.5%) developed AKI. The median time from the initial anti-PD-1/PD-L1 antibody treatment to AKI was 99.85 days. Head and neck cancer and combined use of diuretics, non-steroidal anti-inflammatory drugs (NSAIDs), lower hemoglobin level, and other types of chemotherapeutic drugs were independent risk factors for AKI. The complete recovery, partial recovery, non-recovery, and unknown AKI rates were 7.6%, 28.3%, 52.2%, and 11.9%, respectively. Kidney biopsies were performed on two patients with AKI and pathology confirmed diagnosis of acute tubulointerstitial nephritis. In this cohort, AKI was not uncommon in patients treated with anti-PD-1/PD-L1 antibodies; therefore, it is necessary to monitor renal function and identify AKI early, especially in patients with head and neck tumors. Improving anemia and minimizing the use of diuretics, NSAIDs, and chemotherapeutics may reduce AKI.

An optimized machine learning model for predicting hospitalization for COVID-19 infection in the maintenance dialysis population

COVID-19 has a high rate of infection in dialysis patients and poses a serious risk to human health. Currently, there are no dialysis centers in China that have analyzed the prevalence of COVID-19 infection in dialysis patients and the mortality rate. Although machine learning-based disease prediction methods have proven to be effective, redundant attributes in the data and the interpretability of the predictive models are still worth investigating. Therefore, this paper proposed a wrapper feature selection classification model to achieve the prediction of the risk of COVID-19 infection in dialysis patients. The method was used to optimize the feature set of the sample through an enhanced JAYA optimization algorithm based on the dispersed foraging strategy and the greedy levy mutation strategy. Then, the proposed method combines fuzzy K-nearest neighbor for classification prediction. IEEE CEC2014 benchmark function experiments as well as prediction experiments on the uremia dataset are used to validate the proposed model. The experimental results showed that the proposed method has a high prediction accuracy of 95.61% for the prevalence risk of COVID-19 infection in dialysis patients. Furthermore, it was shown that proalbumin, CRP, direct bilirubin, hemoglobin, albumin, and phosphorus are of great value for clinical diagnosis. Therefore, the proposed method can be considered as a promising method.

A risk prediction model for contrast-induced nephropathy associated with gadolinium-based contrast agents

OBJECTIVE

This is the first study to explore the risk factors for nephropathy caused by gadolinium-based contrast agents and establish a prediction model to identify high-risk patients.

METHODS

A total of 1404 patients who received gadolinium-based contrast agents in our hospital were included. The participants were randomly assigned in a 7:3 ratio to the modeling and validation groups. The modeling group was divided into a contrast-induced nephropathy group and a non-contrast-induced nephropathy group. The clinical characteristics before the use of contrast agents were compared between the two groups. The risk factors for contrast-induced nephropathy were analyzed by logistic regression. A nomogram that could predict the incidence of contrast-induced nephropathy was plotted. The validation group was used to verify the predictive model.

RESULTS

The incidence of contrast-induced nephropathy caused by gadolinium-based contrast agents was 3.92% (55/1404). The logistic stepwise regression analysis showed that sex, systolic pressure (SBP), absolute neutrophil count, albumin, fasting blood glucose level, and furosemide use were significant predictors of contrast-induced nephropathy caused by gadolinium-based contrast agents. The above predictors were then included in the nomogram construction. The area under the receiver operating characteristic (ROC) curve was 0.82 (p < 0.001). The specificity and sensitivity corresponding to the optimal cutoff point (0.039) based on the area under the ROC curve were 71.9% and 80.5%, respectively.

CONCLUSION

Sex, SBP, absolute neutrophil count, albumin, fasting blood glucose levels, and furosemide use are significant predictors of contrast-induced nephropathy caused by gadolinium-based contrast agents. Therefore, the incidence of contrast-induced nephropathy may be estimated by the prediction model established in this study before the use of contrast agents.

Mussel-inspired nanofibrous sheet for suture-less stomach incision surgery

We report a dopamine-based crosslinker-conjugated gelatin/polycaprolactone nanofibrous sheet. The nanosheet was then employed to treat stomach incisions without sutures during surgery.

Physician-patient-companion communication and decision-making: a systematic review of triadic medical consultations

OBJECTIVE

To systematically review quantitative and qualitative studies exploring physician-adult patient-adult companion (triadic) communication and/or decision-making within all medical encounters.

METHODS

Studies were identified via database searches and reference lists. One author assessed eligibility of studies, verified by two co-authors. Data were extracted by one author and cross-checked for accuracy. Two authors assessed the quality of included articles using standardized criteria.

RESULTS

Of the 8409 titles identified, 52 studies were included. Summary statements and tables were developed for each of five identified themes. Results indicated companions regularly attended consultations, were frequently perceived as helpful, and assumed a variety of roles. However, their involvement often raised challenges. Patients with increased need were more often accompanied. Some companion behaviours were felt to be more helpful (e.g. informational support) and less helpful (e.g. dominating/demanding behaviours), and preferences for involvement varied widely.

CONCLUSION

Triadic communication in medical encounters can be helpful but challenging. Based on analysis of included studies, preliminary strategies for health professionals are proposed.

PRACTICE IMPLICATIONS

Preliminary strategies for health professionals include (i) encourage/involve companions, (ii) highlight helpful companion behaviours, (iii) clarify and agree upon role preferences of patient/companions. Future studies should develop and evaluate specific strategies for optimizing triadic consultations.

Recovery of nickel ions from simulated electroplating rinse water by electrodeionization process

Pure water production and recovery of Ni(2+) from dilute NiSO(4) solution via improved electrodeionization (EDI) process were investigated. It was indicated that, with the feed water containing 50 mg L(-1) Ni(2+), the dilute resistivity of the EDI could achieve 3 MOmega cm which gave a Ni(2+) rejection more than 99.8% while the Ni(2+) was concentrated as high as 1,583 mg L(-1) in the concentrate stream. The current efficiency was as high as 40% and the concentrate factor could reach 31.7. The experiment results demonstrated that, just in a single process, it was feasible to purifying and concentrating dilute nickel wastewater synchronously by the EDI technology.

GroEL-GroES solubilizes abundantly expressed xylulokinase in Escherichia coli

AIMS

The aims of the present work were to solubilize the abundantly expressed recombinant xylulokinase in Escherichia coli and to develop a reliable xylulokinase assay.

METHODS AND RESULTS

Three mutants of xylulokinase of Bacillus megaterium that were expressed at high level but formed insoluble protein in E. coli BL21(DE3)pLysS were selected for solubility study. The solubility of xylulokinase increased eight to 77-fold after introduction of molecular chaperones GroEL-GroES into the host.

CONCLUSION

This investigation reports that GroEL-GroES minimizes the formation of insoluble protein in three highly expressed recombinant xylulokinases and an improved xylulokinase assay.

SIGNIFICANCE AND IMPACT OF THE STUDY

Commercial production of bioethanol is critically dependent on the development of an efficient and low-cost process of enzymatic conversion of xylan, a major component in lignocellulose biomass, to xylulose-5-phosphate, which can then be channelled into pentose phosphate pathway and metabolized to ethanol. The improved intracellular xylulokinase activity is expected to facilitate the xylose degradation.

Control of hyperchaos

A general method for controlling chaotic systems with one or more positive Lyapunov exponents is investigated analytically and numerically. The method retains the formal features of the adaptive adjustment mechanism and can be equally applied to various types of the unstable fixed points. It is shown that the method proposed here neither asks for any prior analytical knowledge of the system, nor any internal or external controlling parameters in advance.

Stabilizing unstable discrete systems

A general method for stabilizing unstable discrete systems to a fixed point or high-period orbit is developed analytically and numerically in this paper. It is shown that the method can be equally applied to the systems with one or more positive Lyapunov exponents. Moreover, the method does not require a prior analytical knowledge of the system under investigation, nor any additional control parameters.

Smad7 mediates apoptosis induced by transforming growth factor beta in prostatic carcinoma cells

Transforming growth factor beta (TGF-beta) is an important regulator of apoptosis in some cell types, but the underlying molecular mechanisms are largely unknown. TGF-beta signals through type I and type II receptors and downstream effector proteins, termed Smads. TGF-beta induces the phosphorylation of Smad2 and Smad3 (receptor-activated Smads) which associate with Smad4 and translocate to the nucleus, where they regulate gene transcription [1]. Smad7 protein is induced by TGF-beta1 and has been classified as an inhibitory Smad. Smad7 prevents phosphorylation of receptor-activated Smads, thereby inhibiting TGF-beta-induced signaling responses [1]. Smad7 expression is increased in rat prostatic epithelial cells undergoing apoptosis as a result of castration [2]. Here we have shown that TGF-beta1 treatment or ectopic expression of Smad7 in human prostatic carcinoma cells (PC-3U) induces apoptosis. Furthermore, TGF-beta1-induced apoptosis was prevented by inhibition of Smad7 expression, by antisense mRNA in stably transfected cell lines or upon transient transfection with antisense oligonucleotides in several investigated cell lines. These findings provide evidence for a new effector function for Smad7 in TGF-beta1 signaling.

Effects of enzyme inducers and inhibitor on the pharmacokinetics of intravenous 2-(allylthio)pyrazine, a new chemoprotective agent, in rats

In order to find what types of hepatic cytochrome P450 (CYP) isozymes are involved in the metabolism of 2-(allylthio)pyrazine (2-AP) in rats, enzyme inducers, such as phenobarbital, 3-methylcholanthrene, dexamethasone, or isoniazid, and an enzyme inhibitor, such as SKF 525-A were pretreated. After 1-min intravenous administration of 2-AP, 50 mg/kg, to rats pretreated with SKF 525-A (a non-specific CYP inhibitor in rats), the plasma concentrations were significantly higher, and the area under plasma concentration-time curve from time zero to time infinity (AUC) was significantly greater (1365 compared with 1034 microg min/mL) as a result of significantly slower total body clearance (Cl) (36.6 compared with 48.3 mL/min/kg) than those in control rats, indicating that 2-AP was metabolized by CYP isozymes. After 1-min intravenous administration of 2-AP, 50 mg/kg, to rats pretreated with dexamethasone (an inducer of CYP3A in rats), phenobarbital (an inducer of CYP2B1/2, 2C6, 2C7, and 3A1/2 in rats), and 3-methylcholanthrene (an inducer of CYP1A1/2 and 2A1 in rats), the plasma concentrations were significantly lower, and AUC was significantly smaller (27, 41 and 60% decrease, respectively, compared with respective control rats) owing to faster Cl [37 (p>0.05), 70 (p<0.001), and 150% (p<0.001) increase, respectively, compared with respective control rats].

[Effect of Saikosaponin-d on up-regulating GR mRNA expression and inhibiting cell growth in human leukemia cells]

OBJECTIVE

To study the effect of Saikosaponin-d (SSd) on the expression of glucocorticoid receptor (GR) mRNA and cell growth in HL60 cells.

METHODS

Antiproliferation effects of SSd on HL60 cells were determined by 3H-thymidine incorporation. Cell cycle analysis was also performed by flow cytometry. GRmRNA was analyzed by northern blot analysis.

RESULTS

After 48 hours treatment with 10 micrograms/ml SSd, 3H-thymidine incorporation decreased in HL60 cells and the effect was time and dose dependent. The flow cytometry analysis showed HL60 cells were arrested at G0/G1 phase. The expression of GR mRNA increased.

CONCLUSION

SSd exhibits the inhibition effects on cell growth in HL60 cells and could up-regulate the expression of GR mRNA in HL60 cells.

[The influence of nerve growth factor on inferior alveolar nerves regeneration in the silicone tubes]

OBJECTIVE

To explore the effect of exogenous nerve growth factor(NGF) in the regeneration of adult white rabbits inferior alveolar nerve within the silicone tubes.

METHODS

In 24 adults white rabbits. A bilateral 8 mm inferior alveolar nerve gaps were created, and the proximal and distal stumps were inserted into a 12 mm silicone tube. The silicone tube of the right side was filled with exogenous NGF(experimental group) and the contralateral side was filled with saline (control group). Regeneration of the nerves was assessed by histological exam and nerve electrophysiological appreciation. Total number of the regenerating myelinated nerve fibers, the conduction velocities of nerves the thickness of myelin sheaths and the cross section area of myelinated nerve fibers between the experimental and the control groups were compared.

RESULTS

The results showed that: 1. The experimental groups demonstrated more myelinated nerve fibers than that of the controls in 12 and 18 weeks. 2. At the same time following surgery, the myelin sheath thickness and the cross section area of myelinated nerves in the experimental groups were significantly greater than that in the controls. 3. In 12 and 18 weeks, the conduction velocities of regenerating nerves in the experimental groups were faster than that of the controls.

CONCLUSION

This study suggested that exogenous NGF can enhance regeneration of inferior alveolar nerve with necovery of its sensory function.

[Saikosaponin-d up-regulates GR mRNA expression and induces apoptosis in HL-60 cells]

OBJECTIVE

To research the effect of saikosaponin-d (SSd) on the expression of glucocorticoid receptor (GR) mRNA and induction of apoptosis in HL-60 cells.

METHODS

Antiproliferation effects of SSd on HL-60 cells were determined by 3H-thymidine incorporation. Apoptosis of the SSd-treated cells was determined by DNA fragmentation analysis and flow cytometry. GR mRNA was analyzed by Northern blot analysis.

RESULTS

After 48 h treatment with 10 micrograms/ml SSd, 3H-thymidine incorporation was decreased in HL-60 cells and the effects were time and dose dependent. DNA ladder appeared after 60 h treatment with SSd. The flow cytometry analysis showed HL-60 cells was arrested at G0/G1 phase and apoptotic peak appeared in sub-G1 phase. The expression of GR mRNA was increased.

CONCLUSION

SSd up-regulates the expression of GR mRNA, inhibits the cell growth and induces apoptosis in HL-60 cells.

[Surgical reconstruction of laryngeal and tracheal stenosis]

OBJECTIVE

Reconstruction of laryngotracheal stenosis.

METHOD

According to the pathologic condition of the larynx and trachea, various surgical procedures were designed for the treatment of laryngotracheal stenosis. These techniques included endoscopic management, laser therapy and laryngotrachoetomy with autogenous tissue and stent.

RESULT

Among 36 patients, 32 were decannulated. The success rate was 88.8%.

CONCLUSION

In order to improve the curation effects of laryngjotrachal stenosis, the choice of surgical procedure must be individualized to the pathologic condition of larynx and trachea, as well as the experience of the surgeon. Learning previous successful experience is also very important for a good result.

[Effect of Gengnianjian on up regulated estrogen receptor mRNA to substance P and beta-endorphin in hypothalamus of aging female rats]

OBJECTIVE

To investigate the effect of Chinese herbal formula Gengnianjian on estrogen receptor (ER), ERmRNA substance P (SP) and beta-endorphin (beta-EP) in the hypothalamus of aging female rats.

METHODS

ER proteins were determined by radioligand binding assay, ER mRNA was analyzed by Northern blot analysis and the levels of beta-EP and SP were detected by immunohistochemistry.

RESULTS

In aging rats, lowered ER and ER mRNA in the hypothalamus were still up-regulated by low serum E2 level, but not in rats of after the age of 21 months; Gengnianjian significantly increased ER protein level and ER mRNA expression, decreased SP and increased the level of beta-EP in the hypothalamus in aging female rats before 21 months of age, without changing of serum E2 level. In EB group, serum E2 and beta-EP levels increased and SP level decreased but ER expression suppressed in the hypothalamus except after 21 months.

CONCLUSION

Enhance estrogen bioactivity can decrease the level of SP and increase the level of beta-EP in hypothalamus of aging female rats. Herbal formula Gengnianjian increase-EP level and decrease SP level by raising the level of ER and ER mRNA.

[Clinical experience of coronal flap approach in surgery of anterior skull base tumor]

Surgery of the anterior skull base tumor has been undertaken in 7 cases by coronal flap approach, of which 4 cases were malignant tumors and 3 cases were benign tumors. The dura became torn in 3 cases and resected in 2 cases due to tumor invasion. The dura and bony defects could be repaired with galea, pericranial flaps and fascia flaps of temporalis. The bigger bony defect was consolidated with scalp flap. Three out of 4 cases with malignant tumors were free of tumors for 6 years, 4 years and 17 months, respectively: 1 case died of tumor recurrence after 18 months. No case had postoperative complications.