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Introduction: This study aimed to investigate the prospective role of serum irisin – a novel adipo-myokine – in all-cause mortality and cardiovascular (CV) mortality in patients on peritoneal dialysis (PD). Methods: A prospectively observational study was conducted with 154 PD patients. Baseline clinical data were collected from the medical records. Serum irisin concentrations were determined using enzyme-linked immunosorbent assay. Patients were divided into the high irisin group (serum irisin ≥113.5 ng/mL) and the low irisin group (serum irisin <113.5 ng/mL) based on the median value of serum irisin. A body composition monitor was used to monitor body composition. Cox regression analysis was utilized to find the independent risk factors of all-cause and CV mortality in PD patients. Results: The median serum irisin concentration was 113.5 ng/mL (interquartile range, 106.2–119.8 ng/mL). Patients in the high irisin group had significantly higher muscle mass and carbon dioxide combining power (CO2CP) than those in the low irisin group (p < 0.05). Serum irisin was positively correlated with pulse pressure, CO2CP, and muscle mass, while negatively correlated with body fat percentage (p < 0.05). During a median of follow-up for 60.0 months, there were 55 all-cause deaths and 26 CV deaths. Patients in the high irisin group demonstrated a higher CV survival rate than those in the low irisin group (p = 0.016). Multivariate Cox regression analysis showed that high irisin level (hazard ratio [HR], 0.341; 95% confidence interval [CI], 0.135–0.858; p = 0.022), age, and diabetic mellitus were independently associated with CV mortality in PD patients. However, serum irisin level failed to demonstrate a statistically significant relationship with all-cause mortality. Conclusion: Low serum irisin levels at baseline were independently predictive of CV mortality but not all-cause mortality in PD patients. Therefore, serum irisin could be a potential target for monitoring CV outcomes in PD patients. [ABSTRACT FROM AUTHOR]

Introduction: Lipid disturbances are common in ESRD patients. In peritoneal dialysis (PD) patients, dyslipidemia is even more common. This study aimed to examine whether serum lipids were associated with prognosis of PD patients. Methods: Patients from a multicenter retrospective cohort were used for the present study. The primary endpoint was all-cause mortality. Cox regression was used to analyze the association between serum lipids including total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein, and triglycerides and the prognosis. Results: The results showed that lower total cholesterol and LDL levels at the initiation of PD predicted higher all-cause mortality in PD patients. Multivariate analysis reveal that the association disappeared after adjusting for age, gender, albumin, prealbumin, protein catabolic rate normalized to body weight, C-reactive protein, and residual renal function. Further analysis showed that patients with lower total cholesterol/LDL had a higher mortality only during the first 24 months of follow-up. In the patients who survived >2 years after PD, lower total cholesterol/LDL was not associated with higher long-term all-cause mortality any more. Conclusion: Lower total cholesterol/LDL levels at the initiation of PD were associated with overall mortality in PD patients. The association could be potentially modified by malnutrition, inflammation, and residual renal function or disappeared after 24 months. [ABSTRACT FROM AUTHOR]

Introduction: Worldwide, people who use drugs (PWUD) are among the populations at highest risk for HIV infection. In China, PWUD are primarily sentenced to compulsory detainment centres, in which access to healthcare, including HIV treatment and prevention services, is limited or non-existent. In 2008, China's 2008 Anti-Drug Law encouraged the development and use of community-based drug dependence rehabilitation, yet there is limited evidence evaluating the efficacy and challenges of this model in China. In this study, we explore these challenges and describe how cooperation between law enforcement and health departments can meet the needs of PWUD. Methods: In 2015, we conducted semi-structured, in-depth interviews with all four staff members and 16 clients of the Ping An Centre No. 1 for community-based drug treatment, three local police officers and three officials from the local Centre for Disease Control. Interviews explored obstacles in implementing community-based drug dependence treatment and efforts to resolve these difficulties. Transcripts were coded and analyzed with qualitative data analysis software (MAXQDA 11). Results: We identified three challenges to community-based drug treatment at the Ping An Centre No. 1: (1) suboptimal coordination among parties involved, (2) a divergence in attitudes towards PWUD and harm reduction between law enforcement and health officials and (3) conflicting performance targets for police and health officials that undermine the shared goal of treatment. We also identified the take-home methadone maintenance treatment model at the Ping An Centre No. 1 as an example of an early successful collaboration between the police, the health department and PWUD. Conclusions: To overcome barriers to effective community-based drug treatment, we recommend aligning the goals of law enforcement and public health agencies towards health-based performance indicators. Furthermore, tensions between PWUD and police need to be addressed and trust between them fostered, using community-based treatment centres as mediators. The preliminary success of the take-home methadone maintenance treatment pilot can serve as an example of how collaboration with the police and other government agencies can meet the needs of PWUD and contribute to the success of community- based treatment. Keywords: community-based treatment; drug use; policy; harm reduction; police; China., Introduction In the 1980s and 1990s, China experienced a surge in drug use, predominantly involving heroin, in which the number of registered drug users increased more than 15-fold between 1990 [...]

Introduction: Worldwide, people who use drugs (PWUD) are among the populations at highest risk for HIV infection. In China, PWUD are primarily sentenced to compulsory detainment centres, in which access to healthcare, including HIV treatment and prevention services, is limited or non‐existent. In 2008, China's 2008 Anti‐Drug Law encouraged the development and use of community‐based drug dependence rehabilitation, yet there is limited evidence evaluating the efficacy and challenges of this model in China. In this study, we explore these challenges and describe how cooperation between law enforcement and health departments can meet the needs of PWUD. Methods: In 2015, we conducted semi‐structured, in‐depth interviews with all four staff members and 16 clients of the Ping An Centre No. 1 for community‐based drug treatment, three local police officers and three officials from the local Centre for Disease Control. Interviews explored obstacles in implementing community‐based drug dependence treatment and efforts to resolve these difficulties. Transcripts were coded and analyzed with qualitative data analysis software (MAXQDA 11). Results: We identified three challenges to community‐based drug treatment at the Ping An Centre No. 1: (1) suboptimal coordination among parties involved, (2) a divergence in attitudes towards PWUD and harm reduction between law enforcement and health officials and (3) conflicting performance targets for police and health officials that undermine the shared goal of treatment. We also identified the take‐home methadone maintenance treatment model at the Ping An Centre No. 1 as an example of an early successful collaboration between the police, the health department and PWUD. Conclusions: To overcome barriers to effective community‐based drug treatment, we recommend aligning the goals of law enforcement and public health agencies towards health‐based performance indicators. Furthermore, tensions between PWUD and police need to be addressed and trust between them fostered, using community‐based treatment centres as mediators. The preliminary success of the take‐home methadone maintenance treatment pilot can serve as an example of how collaboration with the police and other government agencies can meet the needs of PWUD and contribute to the success of community‐based treatment., Introduction In the 1980s and 1990s, China experienced a surge in drug use, predominantly involving heroin, in which the number of registered drug users increased more than 15‐fold between 1990 [...]

Fatty acid binding protein 4 (FABP4) is an adipokine that was mainly derived from adipocytes and macrophages. Vascular calcification (VC) is highly prevalent in peritoneal dialysis (PD) patients and could predict their cardiovascular mortality. The pathogenesis of VC is complex, and adipokines may play an important role in it. This study aimed to examine the relationship between serum FABP4 and VC in PD patients. Serum FABP4 was measured by enzyme-linked immunosorbent assay. According to the median value of serum FABP4, the participants were divided into the low FABP4 group and the high FABP4 group. Lateral plain X-ray films of abdomen were used to evaluate the abdominal aortic calcification (AAC) score. The participants were divided into the high AAC score group (AAC score ≥4, indicating moderate or heavy VC) and the low AAC score group (AAC score <4, indicating no or mild VC). 116 PD patients were involved in the study. The AAC score and the proportion of patients with an AAC score ≥4 of the high FABP4 group were significantly higher than those of the low FABP4 group. Serum FABP4 of the high AAC score group was significantly higher than that of the low AAC score group [164.5 (138.4, 362.8) ng/mL versus 144.7 (123.8, 170.1) ng/mL, p = 0.002]. Serum FABP4 was positively associated with the AAC score according to the multivariate linear regression analysis. In the multivariate logistic regression analysis, serum FABP4 was the independent influencer of an AAC score ≥4. Serum FABP4 is positively associated with the AAC score and is an independent marker of AAC in PD patients. [ABSTRACT FROM AUTHOR]

Background: Peritoneal dialysis (PD) is increasingly used for long-term management of Cardiorenal Syndrome (CRS). We compared outcomes in incident PD patients according to their baseline heart failure status. Methods: This retrospective cohort study evaluated all-cause and cardiovascular mortality in incident PD patients with different heart failure status (non-CRS, acute heart failure [AHF], type II CRS, type IV CRS) who started PD between 2006 and 2016 in the Peking University Third Hospital. Results: Of 748 patients included in the study, there were 466 (62.3%), 214 (28.6%), 27 (3.6%), and 41 (5.5%) patients in the non-CRS, AHF, type II CRS and type IV CRS groups, respectively. Patients with CRS were older (p<0.001), with more diabetes mellitus (p<0.001), coronary heart history (p<0.001), higher estimated glomerular filtration rate (eGFR) (p<0.001), lower serum creatinine (p<0.001) and phosphorus levels (p = 0.003) compared to non-CRS patients. Respective all-cause survival rates for patients with non-CRS, AHF, type II CRS and type IV CRS were 90.6%, 87.1%, 85.2% and 84.8% at 1 year, and 63.1%, 47.7%, 27.3% and 35.1% at 5 years (p<0.001). The corresponding figures for cardiovascular survival were 93%, 92%, 84% and 81% at 1 year, and 67%, 59%, 55% and 54% at 5 years (p<0.001). However, after adjusting for confounding factors, the presence of CRS was not independently associated with all-cause mortality whereas type IV CRS (HR 2.10, 95% CI 1.03–4.28, p = 0.04) was associated with higher cardiovascular mortality as compared to without CRS. Conclusion: Incident PD patients with different types of CRS had higher rates of both all-cause and cardiovascular mortality compared with patients without CRS. However, these observed adverse outcomes may be related to associated older age and higher prevalence of comorbidities, rather than CRS per se, except for type IV CRS, treatment strategies to reduce high cardiovascular CVD mortality may needed. [ABSTRACT FROM AUTHOR]

Conservation tillage is an important approach to prevent water loss and soil erosion and promote soil fertility that has been adopted widely throughout the world. However, despite promotion of the benefits of conservation tillage, obstacles are still encountered in some regions. A survey of 385 farmer households in the semi-arid Loess Plateau of China was conducted to assess the adoption of conservation tillage (ACT). This investigation was located in two counties that have run conservation tillage demonstrations with wheat for at least eight years. A binary logistic regression model was used to quantify the factors determining whether or not farmers adopt conservation tillage. Farmer’s education level, the influence of training, and field demonstrations by agricultural departments had significant positive effects on ACT. Although the adoption rate of conservation tillage in this paper was very high (89%), farmers were reluctant to continue practicing conservation tillage based on their experiences, which is contrary to the expectations of the government. The area available for planting winter wheat and the number of arable plots per household also had significant positive effects on ACT. However, the total cultivated area of land per household had a significant negative impact on ACT. Farmer awareness of conservation tillage technology, the distance from a farmer’s house to the nearest agricultural market, and the size of the active labor force in the family had significant negative impacts on ACT. These results will help in the development of more effective and targeted policies to improve the sustainability of farming systems on the semi-arid Loess Plateau. [ABSTRACT FROM AUTHOR]

Background:Diabetic patients on peritoneal dialysis (PD) have lower survival and are more likely complicated with inflammation than their non-diabetic counterparts. Here, we explored the interaction effects between diabetes and inflammation on the survival of PD patients. Methods:Overall, 2,264 incident patients were enrolled from a retrospective cohort study in China. Patients were grouped according to the baseline levels of high-sensitive C-reactive protein (hsCRP, ≤3 mg/L or >3 mg/L) or serum albumin (SA, ≥38 g/L or <38 g/L). Then, several multivariable adjusted stratified Cox regression models were constructed for these groups to explore the predicted role of diabetes on all-cause or cardiovascular death under inflammatory or non-inflammatory conditions. Results:Diabetics on PD were more likely to have inflammation than non-diabetics on PD, and they presented with elevated hsCRP (52.7% vs. 47.3%, P = 0.03) or decreased SA (77.9% vs. 62.7%, P < 0.001) levels. After stratification by size of center and controlling for confounding factors, diabetes was found to predict all-cause death in patients with hsCRP >3 mg/L or SA <38 g/L but not in patients with hsCRP ≤3 mg/L or SA ≥38 g/L. Similarly, the presence of diabetes was an indication of cardiovascular death in patients with hsCRP >3 mg/L or SA <38 g/L. However, if further adjusted by baseline cardiovascular disease, the predicted role of diabetes on death related to cardiovascular disease in patients with SA <38 g/L disappeared. Conclusion:Diabetic patients could do as well as non-diabetic patients without inflammation on peritoneal dialysis. Active strategies should be implemented to improve inflammation status in diabetic patients on PD. [ABSTRACT FROM AUTHOR]

Background: To explore the prospective role of serum fatty acid-binding protein 4 (FABP4) in the outcomes of peritoneal dialysis (PD) patients., Methods: A prospective observational study was conducted with 159 patients on PD. Demographic and clinical data at baseline were collected from medical records. Biochemical data were recorded based on blood samples measured in a central laboratory. Serum FABP4 concentrations were determined using enzyme-linked immunosorbent assay. Body composition was measured using a Body Composition Monitor. Abdominal lateral plain radiography was used to evaluate vascular calcification. The primary endpoints were all-cause and cardiovascular death., Results: The median of serum FABP4 concentration was 154.6 ng/mL (interquartile range, 132.8-269.7 ng/mL). Increased serum FABP4 was associated with increased vascular calcification proportion, time on dialysis, body mass index, high-sensitivity C-reactive protein (hs-CRP), intact parathyroid hormone (iPTH), triglycerides, body fat mass, and body fat percentage ( p  < 0.05). Increased serum FABP4 was associated with decreased residual kidney Kt/V urea ( p  < 0.05). Patients with hs-CRP≥ 3 mg/L had significantly higher serum FABP4 than those with hs-CRP< 3 mg/L ( p  < 0.05). Patients with vascular calcification had significantly higher serum FABP4 than those without vascular calcification ( p  < 0.05). During a median follow-up of 58.0 months, 58 all-cause deaths and 26 cardiovascular deaths occurred. High serum FABP4 levels were independently predictive for all-cause [hazard ratio (HR), 1.003; 95% confidence interval (CI), 1.001-1.005; p  = 0.016] and cardiovascular death (HR, 1.005; 95% CI, 1.001-1.008; p  = 0.006) in PD patients., Conclusions: Increased serum FABP4 levels can independently predict all-cause and cardiovascular death in patients on PD.

Colorectal cancer remains the third most common cause of death from cancer worldwide. MicroRNA emerges as a good area of research for current cancer therapy. Here, we identified miR-135b to be a contributor to anti-apoptosis and chemoresistance in colorectal cancer. We observed high levels of miR-135b in colorectal cancer cell lines and clinical tissues, compared to colorectal epithelium cell line and noncancerous tissues. Furthermore, enforced expression of miR-135b attenuated doxorubicin-induced apoptosis in colorectal cells. (Doxorubicin alone can trigger significant apoptosis). In elucidating the molecular mechanism by which miR-135b participate in the regulation of apoptosis and chemoresistance in colorectal cancer, we discovered that large tumor suppressor kinase 2 (LATS2) is a direct target of miR-135b. The role of miR-135b was confirmed in colorectal tumor xenograft models. The growth of established tumors was suppressed by an inhibition of miR-135b expression and enhanced apoptosis was further assessed by TUNEL assay. Taken together, our results reveal that miR-135b and LATS2 axis may be a novel therapeutic target for colorectal cancer.