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OBJECTIVE: Coagulopathy is one of the characteristics observed in critically ill patients with coronavirus disease 2019 (COVID-19). Antiphospholipid antibodies (aPLs) contribute to coagulopathy, though their role in COVID-19 remains unclear. This study was undertaken to determine the prevalence and characteristics of aPLs in patients with COVID-19. METHODS: Sera collected from 66 COVID-19 patients who were critically ill and 13 COVID-19 patients who were not critically ill were tested by chemiluminescence immunoassay for anticardiolipin antibodies (aCLs), anti-s2 -glycoprotein I (anti-s2 GPI) (IgG, IgM, and IgA), and IgG anti-s2 GPI-domain 1 (anti-s2 GPI-D1) and IgM and IgG anti-phosphatidylserine/prothrombin (anti-PS/PT) antibodies were detected in the serum by enzyme-linked immunosorbent assay. RESULTS: Of the 66 COVID-19 patients in critical condition, aPLs were detected in 31 (47% ). Antiphospholipid antibodies were not present among COVID-19 patients who were not in critical condition. The IgA anti-s2 GPI antibody was the most commonly observed aPL in patients with COVID-19 and was present in 28.8% (19 of 66) of the critically ill patients, followed by IgA aCLs (17 of 66, or 25.8%) and IgG anti-s2 GPI (12 of 66, or 18.2%). For multiple aPLs, IgA anti-s2 GPI + IgA aCLs was the most common antibody profile observed (15 of 66, or 22.7%), followed by IgA anti-s2 GPI + IgA aCL + IgG anti-s2 GPI (10 of 66, or 15.2%). Antiphospholipid antibodies emerge ~35-39 days after disease onset. A dynamic analysis of aPLs revealed 4 patterns based on the persistence or transient appearance of the aPLs. Patients with multiple aPLs had a significantly higher incidence of cerebral infarction compared to patients who were negative for aPLs (P = 0.023). CONCLUSION: Antiphospholipid antibodies were common in critically ill patients with COVID-19. Repeated testing demonstrating medium to high titers of aPLs and the number of aPL types a patient is positive for may help in identifying patients who are at risk of developing cerebral infarction. Antiphospholipid antibodies may be transient and disappear within a few weeks, but in genetically predisposed patients, COVID-19 may trigger the development of an autoimmune condition similar to the antiphospholipid syndrome (APS), referred to as "COVID-19-induced APS-like syndrome." Long-term follow-up of COVID-19 patients who are positive for aPLs would be of great importance in understanding the pathogenesis of this novel coronavirus.

Immunotherapy has produced durable responses in numerous advanced and metastatic cancers, especially advanced non‐small cell lung carcinoma (NSCLC). However, opportunistic infection has become a major risk for patients who have received immune checkpoint inhibitors (ICIs). Early diagnosis of infection is difficult due to an acute disease course and heterogeneity in clinical manifestation. We retrospectively analyzed four cases with NSCLC who received ICIs and developed opportunistic infections. Two of our cases received antecedent glucocorticoids to treat immune‐related adverse events (irAEs), whereas immunosuppressive agents were not used beforehand in the other cases. We highlight that opportunistic infections complicating immunotherapy can be severe and even fatal. When patients deteriorate after initial remission from irAEs by glucocorticoids, infections should be thoroughly investigated and carefully distinguished from an irAE flare. Bronchoscopy and bronchoalveolar lavage (BAL) are essential. In patients where limited results from traditional microbiological tests have been obtained, next‐generation sequencing (NGS) of BAL fluid is beneficial in guiding a precise antimicrobial treatment. An antipneumocystis prophylaxis may also be considered in selected patients.

Invited for the cover of this issue is Qinghua Gong, Guowei Zhou, and co-workers at Qilu University of Technology. The dial represents the etching time of SiOx yolk in NaOH solution and the brightness of the Chinese red lantern represents the electrochemical performance of the composites. Read the full text of the article at 10.1002/chem.202003246.

Aim Previous studies showed that circulating fibroblast growth factor-23 (FGF23) is a new biomarker linked to cardiovascular and kidney diseases. Here, we explored the association between serum FGF23 and aging-related cardiovascular–renal parameters in a healthy Chinese population. Methods A total of 314 healthy participants aged 36–87 years were enrolled. Cardiovascular structure and function were assessed by the left ventricular ejection fraction, the ratio of early diastolic peak flow velocity to late diastolic peak flow velocity at the mitral leaflet tips, carotid intima-media thickness, the diameter of the bilateral common carotid artery, blood systolic peak and end diastolic velocities, which were measured by M-mode ultrasonography. Glomerular filtration rate was evaluated using the Chronic Kidney Disease Epidemiology Collaboration equation and Chronic Kidney Disease Epidemiology Collaboration equation for Asians. Serum FGF23, 1, 25-dihydroxy vitamin D3 and parathyroid hormone were measured by enzyme-linked immunosorbent assay. Results For all participants, intima-media thickness/diameter of the bilateral common carotid artery gradually decreased with the progression from low to high FGF23 concentration (P

The flowers of Abelmoschus manihot (Linnaeus) Medicus (Malvaceae; Flos A. manihot) have been used in China for many centuries as a traditional Chinese medicine for the treatment of chronic kidney disease. The Huangkui capsule is a single-plant drug extracted from the dry corolla of Flos A. manihot that has been approved by China's State Food and Drug Administration for the treatment of chronic glomerulonephritis. The purpose of this paper is to review briefly some of the past experiences in rapid filtration and to present more fully a few facts brought out in recent studies. The primary chemical constituents of Flos A. manihot are flavonoids. In vivo, the flavonoids can be transformed into glucuronide-sulphate conjugates, which are the major metabolites of Flos A. manihot and could contribute to the renoprotective effects in vivo. Flos A. manihot can ameliorate proteinuria, podocyte apoptosis, glomerulosclerosis and mesangial proliferation. The renoprotective effects of Flos A. manihot are related to inhibition of caspase-3 and caspase-8 overexpression, reduction of the infiltration of ED1(+) and ED3(+) macrophages, downregulation of oxidative stress, inhibition of the p38 mitogen-activated protein kinase and serine/threonine kinase pathways and suppression of transforming growth factor-β1 and tumour necrosis factor-α expression. Recently, a multicentre randomized controlled trial demonstrated that Flos A. manihot was more effective than the angiotensin-receptor blocker losartan in reducing proteinuria in patients with primary glomerular disease. Because Flos A. manihot is generally preferred by Chinese patients and clinicians, high-quality trials to test the efficacy and safety of Flos A. manihot are urgently needed.

Summary Two studies have concluded that lithium exposure extends the lifespan of Caenorhabditis elegans. However, the effect of lithium on another widely used model organism, Drosophila melanogaster, remains unclear. Here, we demonstrate that chronic treatment with a low to moderate dose of lithium chloride does not extend lifespan in D. melanogaster and that the drug abolishes the female lifespan advantage in flies.

Pulmonary hypertension has been recognized as being associated with obstructive sleep apnoea (OSA). Continuous positive airway pressure (CPAP) might reduce pulmonary artery pressure in OSA patients; however, evidence from clinical studies is limited and inconsistent. This meta-analysis aims to assess whether CPAP is associated with a decrease in pulmonary artery pressure in patients with OSA. This systematic review was performed in accordance with the Meta-analysis of Observational Studies in Epidemiology guidelines. Published studies were identified through a search in MEDLINE, EMBASE and the Cochrane library through to May 2013. Two reviewers sorted papers and extracted data. A random-effects model was used to combine results across studies comparing pulmonary artery pressure in OSA patients before and after CPAP treatment. Six articles with 181 patients were included in this meta-analysis, including five before-after studies and one matched-control study. The meta-analysis showed that CPAP was associated with a statistically significant reduction in pulmonary artery pressure in OSA patients (standardized mean difference −1.34, 95% confidence interval: −2.33 to −0.34, P = 0.009). Although this meta-analysis has some limitations, it indicates that CPAP is associated with a decrease in pulmonary artery pressure in patients with OSA.

Two polyketides were isolated from the mangrove endophytic fungus, Penicillium sp. sk14JW2P, and one derivative with a modified structure. The structures were elucidated by spectroscopic analyses, the structure of the compound 1 was further confirmed by single-crystal X-ray diffraction, and its absolute configuration was determined. Compound 1 and 2 showed acetylcholinesterase (AchE) inhibitory activities with IC50 values of 12±0.3 and 79±2 nM, respectively.

Background The aims of the present study were to validate the differential diagnostic model of diabetic nephropathy (DN) and non-diabetic renal diseases (NDRD) established in 2003 and to establish a new diagnostic model suitable for the current clinical characteristics of DN. Methods We examined 200 patients with Type 2 diabetes who underwent kidney biopsy from 2004 to 2012. The 2003 differential diagnostic model based on the data collected from 1993 to 2003 was evaluated by the diagnostic test and changes in the clinical differentiation parameters of DN and NDRD were analyzed. Logistic regression, receiver operating characteristics (ROC) curve, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) analysis were applied. Results The 2003 diagnostic model showed an accuracy of 77.5%. A significantly elevated incidence of hematuria, longer history of diabetes, and reduced level of glycated hemoglobin (HbA1c) were observed in the DN group from 2004 to 2012 compared with DN group from 1993 to 2003. Histories of diabetes mellitus (Dm), systolic blood pressure (Bp), HbA1c (Gh), hematuria (Hu), diabetic retinopathy (Dr), and hemoglobin (Hb) are independently related to DN. Thus, a new diagnostic model was constructed as follows: PDN = exp (0.846 + 0.022 Dm + 0.033Bp + 2.050 Gh–2.664 Hu–0.078 Hb + 2.942Dr)/[1 + exp (0.846 + 0.022 Dm + 0.033 Bp + 2.050 Gh–2.664 Hu–0.078 Hb + 2.942 Dr)].Validation tests determined that the accuracy of the new model were 90.9%. Conclusions Changes in people with DN, clinical characteristics have reduced the diagnostic efficacy of the 2003 diagnostic model. The newly established model can provide a better, more current differentiation between DN and NDRD. 摘要 背景：本研究旨在对2003年建立的糖尿病肾病（diabetic nephropathy，DN）和非糖尿病性肾脏疾病（non-diabetic renal diseases，NDRD）的鉴别诊断模型进行验证，并建立适用于目前DN临床特性的诊断模型。 方法：纳入2004–2012年行肾穿刺活检的2型糖尿病合并肾损害患者200例。采用诊断性试验对2003年建立的诊断模型进行验证并对1993–2003年和2004–2012年DN和NDRD鉴别参数的临床变迁进行分析。logistic回归分析、ROC曲线、净重新分类指数（net reclassification improvement，NRI），整体鉴别指数（integrated discrimination improvement，IDI）分析用于新模型的建立及评价。 结果：2003年诊断模型的准确率为77.5%。与1993–2003年相比，2004–2012年的DN患者血尿发生率的明显升高、糖尿病病史显著延长、血糖控制明显改善。糖尿病病史（Dm）、收缩压（Bp）、糖化血红蛋白（Gh）、血尿（Hu）、糖尿病视网膜病变（Dr）、血红蛋白（Hb）与DN诊断独立相关。以此建立的新模型如下：PDN + exp (0.864+0.022 Dm+0.033 Bp+2.050Gh–2.664Hu–0.078 Hb+2.942Dr)]/[1+exp(0.864+0.022 Dm+0.033 Bp+2.050 Gh–2.664 Hu–0.078 Hb+2.942 Dr)]。诊断性试验测得该模型的准确率为90.9%。 结论：DN人群的临床特征较过去相比有较大变迁，造成2003年诊断模型诊断效能下降。新建立的方程能够更好和更准确地对目前的DN和NDRD进行鉴别。

Objectives: Data regarding hypertension in elderly adults with chronic kidney disease (CKD) remains limited. This study aimed to assess the epidemiological characteristics of hypertension in elderly adults with CKD using data from a nationwide survey. Design: A nationwide, multicenter, cross-sectional study with a large sample. Setting: The Survey of Prevalence, Awareness, and Treatment Rates in Chronic Kidney Disease Patients with Hypertension in China (PATRIOTIC). Participants: Participants in PATRIOTIC (aged ?60; n = 2,414). Measurements: Trained physicians measured blood pressure (BP) using a standard protocol with a mercury sphygmomanometer at the time of admission. Results: The prevalence, awareness, and treatment of hypertension in elderly adults with CKD were 82.0%, 90.7%, and 87.3%, respectively. The control of hypertension at BP less than 140/90 mmHg was 29.6% and at BP less than 130/80 mmHg it was 12.1%. No significant differences were noted in the prevalence, awareness, treatment, or control of hypertension in individuals with CKD divided into the age groups of 60 to 69, 70 to 79, and 80 and older (P > .05). With increasing age, the proportion of isolated systolic hypertension in elderly adults with CKD with uncontrolled hypertension increased (P = .02). Obesity (P = .01), CKD Stages 4 and 5 (P < .001), and concomitant diabetes mellitus (P = .002) were significantly associated with uncontrolled hypertension in elderly adults with CKD, using the goal of BP less than 140/90 mmHg. Conclusion: The prevalence of hypertension in elderly adults in China with CKD is high, and its control is poor. Most elderly adults with CKD with uncontrolled hypertension have systolic hypertension. Obesity, CKD Stages 4 and 5, and diabetes mellitus were adversely associated with greater uncontrolled hypertension in elderly adults with CKD.

In the context of China's rapid rise, scholars still debate heatedly and always make contrasted predictions on China's use of force. This article seeks to identify the determining factors of a rising China's use of force and its varying levels. Since the establishment of the People's Republic of China in 1949, China's use of force has been shaped by its high external vulnerabilities. They consist of two major security concerns: the homeland encirclement by superpowers and the increasing support from the outside to domestic splitting factions. Consistency in China's use of force can be explained by the legitimacy of the party involved and the regional power position in East Asia. The level of the use of force has been determined by China's relative capability to its adversaries. Specifically, China will use high levels of force, such as wars or lengthy conflicts, if it enjoys the favorable relative capability. On the contrary, China will use low levels of force, such as blockade, artillery attacks and very short combats, if the opposite is true. Based on these findings and current regional trends in East Asia, the authors are optimistic about China's non-use of force in Taiwan and territorial or maritime disputes in East Asia over the next decade.

O-Trimethylsilyl (TMS)-protected diphenylprolinol-catalyzed Michael addition of a functionalized alkylidene malonate and n-butanal affords an aldehyde. This adduct can serve as the common intermediate for the assembly of secologanin tryptamine and dopamine alkaloids; this is demonstrated by the total syntheses of corynantheidol, dihydrocorynantheol, protoemetinol, and protoemetine, and the formal synthesis of mitragynine. The key steps include reductive amination of this aldehyde with tryptamine, condensation of this aldehyde with 4-methoxytryptamine, condensation of dimethoxyphenethylamine with a lactone derived from this aldehyde, and subsequent Bischler-Napieralski cyclization and reduction.

Eur J Clin Invest 2011; 41 (10): 1077–1086 Abstract Background Age-related changes in kidney structure and function have been well documented. This study aimed to assess the relationship between declines of normal ageing-related kidney function and cardiac diastolic function in a healthy Chinese population. Materials and methods A total of 852 healthy adults aged 30–98 years were enrolled and divided into four groups according to quartiles of estimated glomerular filtration rate (eGFR) and cystatin C (CYSC). Cardiac diastolic function was measured by ratio of peak velocity of early filling to peak velocity of atrial filling (E/A), which was derived by B-mode echocardiography. Lower E/A was defined as measures under the 25th percentile of sample distribution (0·784). Results Age was significantly associated with eGFR (r = −0·102, P

Topologically protected domains, composed of mutually coupled ferroelectric, (anti)ferromagnetic, and antiphase domains, are widespread in hexagonal manganites. We have applied the extended Howie-Whelan equations in hexagonal systems and simulated the electron-diffraction intensities of four kinds of representative hexagonal manganites. Thereby, the polarization directions of domains and charging status of domain walls can be easily determined by electron-diffraction contrast method, which is succinct and reliable. Here, we present a systematic investigation about the polarization structures and pave the way for further study about the properties of domains by transmission electron microscopy. Besides, the dynamic behavior of domains merely under transmission electron beam irradiation was firstly shown as well.

This article addresses the following provocative puzzle: why has China chosen to reassure South-East Asian states during the past decade? The author develops a dual pressure model to explain China's reassurance policy. This dual pressure model maintains that US dominance and China's domestic priorities have combined to compel China to reassure its South-East Asian neighbors. In the shadow of US dominance, a rising China has no other choice but to reassure its neighbors in order to alleviate strategic pressures against it. The reassurance policy not only sends benign signals to the USA, but also neutralizes China's neighbors in the case of US containment of China. At the domestic level, China's top priorities lie in maintaining social stability in the process of economic development and preventing Taiwan's declaration of de jure independence. These tremendous tasks require the cooperation of China's South-East Asian neighbors. Therefore, it is in line with China's domestic priorities to reassure the South-East Asia states. Based on the dual pressure model, the author takes an optimistic view that China will continue to follow the reassurance policy towards its South-East Asian neighbors in order to foster a peaceful and prosperous neighborhood in the decade to come.

SUMMARY Aim: In order to determine the relationship between glomerular filtration rate (GFR) and age, the associated factors, and the accurate method of GFR in healthy adults, we conducted a cross-sectional study in community-dwelling adults in Beijing. Methods: Renal function of 201 clinically healthy subjects was determined using technetium-99 m-labelled diethylene triamine pentacetic acid (99mTc-DTPA). Estimated GFR was calculated with the Cockcroft–Gault (CG) equation, abbreviated Modification of Diet in Renal Disease (MDRD) equation, and plasma clearance of creatinine (Ccr). Serum cystatin C, biomarkers of inflammatory and endothelial cells were analyzed as well. Protein intake, carotid artery intima-media thickness and plaque formation were assayed as well. Results: Glomerular filtration rate was negatively associated with age and the correlation coefficient for 99mTc-GFR, CG-GFR, MDRD-GFR, Ccr were −0.643, −0.736, −0.55 and −0.619, respectively (P

Palitantin (II) and the new analogue, 13-hydroxypalitantin (I), exhibit acetylcholinesterase (AchE) inhibitory activities.

Asperterpenoid A (I) exhibits strong inhibitory activity against the title phosphatase (mPTPB) with an IC50 value of 2.2 μM.