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The treatment of acute pancreatitis (AP) induced by hypertriglyceridemia (HTG) remains controversial with regard to plasmapheresis vs conventional treatment. We reviewed relevant articles to explore the efficacy of plasmapheresis in the management of HTG-induced AP.We systematically reviewed studies that compared plasmapheresis with conventional treatment for HTG-induced AP using three databases: PubMed, Embase, and Cochrane Library, as well as relevant references. The primary outcomes were 24 h triglyceride reduction rate and in-hospital mortality.A total of 791 articles were retrieved. Finally, 15 observational studies (1080 participants) were included, most of which were historical cohort studies. Compared with conventional treatment, plasmapheresis assisted in the reduction of serum triglyceride (TG) levels in the first 24 h after hospital admission (standardized mean difference [SMD]: 0.58; 95% confidence interval [CI]: 0.17 to 0.99; P = 0.005). However, it resulted in increased hospitalization costs (thousand yuan) (weighted mean difference [WMD]: 24.32; 95% CI: 12.96 to 35.68; P 0.001). With regard to in-hospital mortality, although the mortality rate in the plasmapheresis group was higher than that in the conventional treatment group (relative risk [RR]: 1.74; 95% CI: 1.03 to 2.94; P = 0.038), the result was disturbed by confounding factors as per the subgroup and sensitivity analysis, as well as trial sequential analysis (TSA). No significant differences were found in other outcomes, including systematic complications, local complications, the requirement for surgery, and hospitalization duration.The effect of plasmapheresis in HTG-induced AP is not superior to that of conventional treatment, even resulting in a greater economic burden to patients and health care system. High quality randomized control trials are required to obtain a more a definitive understanding of this issue.

BACKGROUND Dialysis unit blood pressure (BP) pattern showed superiority in prognostic evaluation and interdialytic BP burden assessment. However previous studies mainly focused on the recurrent BP pattern within a session (intradialytic BP change or intradialytic BP slope), the clinical value of the weekly pattern of dialysis unit BP is unknown. METHODS We performed a prospective cohort study in adult end stage renal disease (ESRD) patients on thrice weekly hemodialysis (HD). The slope and the change of the postdialysis systolic BP (SBP) in the course of a week (post-SBP slope and post-SBP change) were used to characterize the weekly pattern of dialysis unit BP. Outcomes included all-cause mortality, cardiovascular mortality, and first cardiovascular event. We also measured the home BP in our cohort. RESULTS One hundred and twenty-nine subjects were followed over a median of 31 months. Higher post-SBP slope (≥0.185) was independently associated with increased risk of all-cause mortality, cardiovascular mortality, and first cardiovascular event. Results were similar for increased post-SBP change. HD patients with a higher post-SBP slope or an increased post-SBP change also had significant increased interdialytic BP burden measured by home SBP on both dialysis days and non-dialysis days. CONCLUSIONS Post-SBP slope and post-SBP change might be promising dialysis unit BP markers for prognostic evaluation and interdialytic BP burden assessment.

Background: Cardiovascular disease (CVD) is the leading cause of death in haemodialysis (HD) patients. Vascular calcification (VC) is dramatically accelerated and is strongly associated with CVD events and mortality in HD patients. VC coexists with osteoporosis in many studies. Fibroblast growth factor 21 (FGF21) as an adipocytokines is a new hypoglycemic strategy and is inversely related to bone mineral density.Methods: To evaluate the contribution of FGF21 to VC in HD patients, we preliminary sreened 802 HD patients of two large HD centers in China. At last 388 HD patients were entered this cross-sectional study. We detected circulating FGF21 levels and measured the whole thoracic aorta calcification scores (TACS) and calcification scores of the three segments of thoracic aorta (TA), including ascending thoracic aorta (ATACS), aortic arch (AoACS), and descending thoracic aorta (DTACS) of our 388 HD patients. In addition, we pre-incubated human aortic endothelial cells (HAECs) with FGF21 in the presence or absence of parathyroid hormone (PTH) in vitro.Results: The median serum FGF21 level in HD patients was 11-fold higher than that in healthy controls. Ln(FGF21) was positively correlated with Ln(TACS+1), Ln(ATACS+1), Ln(AoACS+1) and Ln(DTACS+1) respectively in HD patients. Serum FGF21 was independently associated with TACS and ATACS, AoACS, and DTACS. FGF21 combined with age, calcium and intact parathyroid hormone demonstrated a high area under the curve (AUC=0.84) with optimal sensitivity (84%) and specificity (71%) for the prediction of VC in HD patients. Our vitro results showed that FGF21 enhanced the calcification effect of PTH on HAECs by increasing calcium deposition and endothelial-to-mesenchymal transition (EndMT).Conclusions: Circulating FGF21 was notably higher and was a potential predictor and promoter of VC in HD patients.Trial registration Chinese Clinical Trial Registry, identifier: ChiCTR1900028249. Registered 16 December 2019-Retrospectively registered,http://www.medresman.org.cn/uc/project/projectedit.aspx?proj=5981

Hot deformation behavior of a high-Mn austenitic steel was investigated employing hot compression tests at different temperatures and strain rates. The flow behavior related to deformation temperature and strain rate was analyzed. Microstructures and grain boundary characteristics of the deformed specimens quenched at selected conditions were examined using SEM-EBSD. It was observed that the flow stress and critical characteristic parameters were sensitive to deformation temperature and strain rate. Grain boundary bulging was the main nucleation mechanism which signified discontinuous dynamic recrystallization played a vital role in microstructure evolution. Strain rate had a complex influence on DRX kinetics and the formation of Σ3 boundaries. At high strain rates, the higher stored energy and adiabatic temperature rise induced the boundary to migrate at a higher velocity, thus accelerating the nucleation of DRX grains and increasing the frequency of twinning. At low strain rates, longer time was available for grain boundary migration which facilitated the growth of DRX grains and the nucleation of annealing twins. However, at intermediate strain rates, sluggish recrystallization kinetics and annealing twins evolution were observed as the stored energy was not sufficiently high and the time available for grain boundary migration was also fairly short.

An Fe–19Cr–0.6Al–12Mn duplex stainless steel with an optimized alloy composition of Ni replaced by Mn and Cr partially replaced by Al was developed to avoid the edge cracking, which is a common defect in the hot rolling of traditional two-phase stainless steels. The newly developed duplex stainless steel could be hot-rolled in the single-phase ferrite (α) region by controlling rolling temperature and the single-phase ferrite microstructure was retained on water cooling. To obtain the two-phase stainless steel product with ferrite and austenite (γ) microstructure, cold rolling and annealing were carried out, and appropriate cold rolling reduction and annealing process parameters were determined. The significant impact of annealing on microstructure, mechanical properties and pitting resistance of the experimental steel was studied. It was observed that with the increase in cold rolling reduction, the number of γ nucleation points was dramatically increased leading to the precipitation of more γ at α grain boundaries after annealing. During annealing at 800 °C and with the increase in annealing time, the austenite fraction was increased with a lower rate and remained almost constant when the annealing time was greater than 4 h. With the increase in annealing temperature, the austenite fraction decreased gradually in the temperature range of 750–860 °C. Good combination of strength, ductility and excellent pitting resistance was obtained by cold rolling to 80% reduction and annealing at 800 °C for 4 h. Grain refinement and the existence of Σ3 boundaries played a vital role in improving the pitting resistance of the experimental steel. With good combination of strength, ductility and corrosion resistance, the newly developed duplex stainless steel is expected to be a new resource-saving dual-phase stainless steel.

The influences of cold-rolling deformation and annealing on the damping capacity of Fe–19Mn–8Cr alloy were investigated. It was observed that the cold-rolled Fe–19Mn–8Cr alloy with a reduction of 10% showed the relatively excellent damping capacity because of the relatively more e-martensite and lower dislocation density, and the reduction of slopes of different damping curves increased along with increasing the cold-rolling reduction. Besides, the subsequent annealing process can further enhance the damping capacity. After 70% cold-rolling deformation, the austenite grain would grow up with the increase in the annealing temperature, which resulted in a significant change in the content and morphology of e-martensite influencing the damping capacity of the experimental steel. The damping capacity was optimum when annealed at 800 °C for 30 min, displaying that the size of e-martensite has a vital influence on the damping capacity of the experimental alloy. This study may enrich the fundamental knowledge about how to ameliorate the damping capacity of Fe–Mn–Cr damping steels.

Muscle wasting is associated with increased mortality and morbidity in chronic kidney disease (CKD) patients, especially in the haemodialysis (HD) population. Nevertheless, little is known regarding diaphragm dysfunction in HD patients. We conducted a cross-sectional study at the Institute of Nephrology, Southeast University, involving 103 HD patients and 103 healthy volunteers as normal control. Ultrasonography was used to evaluate diaphragmatic function, including diaphragm thickness and excursion during quiet and deep breathing. HD patients showed lower end-inspiration thickness of the diaphragm at total lung capacity (0.386 ± 0.144 cm vs. 0.439 ± 0.134 cm, p

Introduction Osteoporosis is one of the important bone abnormalities in chronic kidney disease-mineral and bone disorder (CKD-MBD) and still lacks a sensitive biomarker to diagnose. Fibroblast growth factor 21 (FGF21) can stimulate bone loss in patients with diabetes and increase in CKD patients. In this study, we investigated whether FGF21 could serve as a biomarker to predict osteoporosis in a haemodialysis cohort. Methods We recorded demographic information, biochemical data, and serum FGF21 and FGF23 levels and measured the CT attenuation values of 339 haemodialysis patients from two large medical centres. We assessed the correlation of CT attenuation values with serum FGF21 and FGF23 levels and tested whether they were independent factors for osteoporosis. ROC curves were constructed to compare the prognostic value of FGF21 and FGF23 for osteoporosis. Results Based on the CT attenuation value, serum FGF21 levels were higher in our osteoporosis group (median 640.86 pg/ml vs. 245.46 pg/ml, P ˂ 0.01). Meanwhile, FGF21 (r = -0.136, P r = -0.151, P β = -0.067, P Conclusions FGF21 has a positive relationship with the incidence of osteoporosis in patients on haemodialysis. FGF21 combined with age is a good predictive biomarker for osteoporosis in patients on haemodialysis, especially those with less residual renal function.

AIM Lipoprotein(a) [Lp(a)] is considered a risk factor for cardiovascular disease. However, the role of Lp(a) in chronic kidney disease (CKD) patients is not well understood. The aim of this study was to evaluate the association between Lp(a) levels and the presence of coronary artery disease (CAD) and the severity of coronary artery stenosis (CAS) in patients with stage 3-5 CKD. PATIENTS AND METHODS We retrospectively studied patients who were diagnosed with stage 3-5 CKD and underwent coronary artery angiography in Zhongda Hospital. The Gensini scoring system was used to assess the severity of coronary stenosis. RESULTS A total of 1003 patients were enrolled in this cross-sectional study, and 776 of these patients were diagnosed with CAD. The Lp(a) levels were significantly higher in the CAD group than the non-CAD group [271.50 (168.00-459.25) vs. 195.00 (131.00-347.00) mg/l, P

Artemisinin (Art) is isolated from Artemisia annua L. and known as the most effective antimalaria drugs. Previous studies demonstrated that it could exert an immune-regulatory effect on autoimmune diseases. In this study, we first investigated its potential role in tubulointerstitial inflammation and fibrosis in rats with 5/6 nephrectomy. Subtotal nephrectomized (SNx) rats were orally administered Art (100 mg·kg -1 ·d - 1) for 16 weeks. Blood and urine samples were collected for biochemical examination. Kidney tissues were collected for immunohistochemistry and Western blot analyses. Ang II-induced injury of the human kidney 2 (HK-2) cells was used for in vitro study. It was shown that Art could significantly attenuate the renal function decline in SNx rats compared with control. More importantly, Art treatment significantly reduced the tubulointerstitial inflammation and fibrosis, as demonstrated by the evaluation of renal pathology. Furthermore, Art inhibited the activation of NLRP3 inflammasome and NF-κB in the kidneys. In in vitro study, Art pretreatment could significantly prevent the activation of NLRP3 inflammasome and NF-κB in Ang II-treated HK-2 cells, while BAY11-7082 (an inhibitor of NF-κB) significantly inhibited Ang II-induced NLRP3 inflammasome activation. This study suggested that Art could provide renoprotective role by attenuating the tubulointerstitial inflammation and fibrosis in SNx rats by downregulating the NF-κB/NLRP3 signaling pathway.

Blood pressure (BP) management posed great challenge in hemodialysis (HD) population. We conducted a dose-response meta-analysis to investigate the quantitative features and the potential threshold effect of the associations between peridialysis BP levels and all-cause mortality risk in HD population. We searched all of the prospective cohort studies (published before 18 March 2017) on the associations between peridialysis BP levels and all-cause mortality risk. A total of 229,688 prevalent HD patients from 8 studies were included. Significant non-linear associations were noted between peridialytic BP levels and all-cause mortality risk. Significant increased risk of death was found in four peridialysis BP ranges, that is, low levels of predialysis SBP (135 mmHg, 140 mmHg as the reference), two extremes of predialysis DBP (55 and95 mmHg, 90 mmHg as the reference), high levels of postdialysis SBP (180 mmHg, 130 mmHg as the reference), and low levels of postdialysis DBP (75 mmHg, 80 mmHg as the reference). Threshold effect was determined in the associations between peridialysis BP and all-cause mortality risk, and potential BP thresholds were identified (149 mmHg for predialysis SBP, 79 mmHg for predialysis DBP, 147 mmHg for postdialysis SBP and 76 mmHg for postdialysis DBP). In conclusion, the proposed peridialysis BP ranges and the threshold values could help clinicians identify high risk HD patients. The interpretation of the peridialysis BP mortality associations should be based on the features of HD population (especially the cardiovascular conditions, volume status and the dialysis vintage).

Inflammation is a major contributor to the pathogenesis of ischemic acute kidney injury (AKI), which complicates the post-operative outcomes of large numbers of hospitalized surgical patients. Hydroxychloroquine (HCQ), a well-known anti-malarial drug, is commonly used in clinical practice for its anti-inflammatory actions. However, little is known about its role in renal ischemia/reperfusion (I/R) injury. In the current study, mice were subjected to I/R injury and HCQ was administered for seven days by gavage prior to surgery. In parallel, HK-2 human renal proximal tubule cells were prophylactically treated with HCQ and then were exposed to hypoxia/reoxygenation (H/R). The results showed that HCQ significantly attenuated renal dysfunction evidenced by blunted decreases in serum creatinine and kidney injury molecular-1 expression and the improvement of HK-2 cell viability. Additionally, HCQ markedly reduced macrophage and neutrophil infiltration, pro-inflammatory cytokine production, and NLRP3 inflammasome activation. Mechanistic studies showed that HCQ could inhibit the priming of the NLRP3 inflammasome by down-regulating I/R or H/R-induced NF-κB signaling. Moreover, HCQ reduced cathepsin (CTS) B, CTSD and CTSL activity, and their redistribution from lysosomes to cytoplasm. CTSB and CTSL (not CTSD) were implicated in I/R triggered NLRP3 inflammasome activation. Notably, we found that HCQ attenuated renal injury through downregulation of CTSB and CTSL-mediated NLRP3 inflammasome activation. This study provides new insights into the anti-inflammatory effect of HCQ in the treatment of AKI.

Background: Muscle wasting is associated with increased mortality and morbidity in chronic kidney disease (CKD) patients, especially in the haemodialysis (HD) population. Little is known regarding diaphragmatic dysfunction under CKD conditions. Methods: We conducted a cross-sectional study at the Institute of Nephrology, Southeast University, involving 103 HD patients and 103 healthy volunteers as normal control. Ultrasonography was used to evaluate diaphragmatic function, including diaphragm thickness and excursion. We further examined the prevalence of diaphragmatic dysfunction and its influence factor and relationship with debilitating symptoms (dyspnoea, hiccups, and fatigue) in HD patients. Results: HD patients showed lower end-inspiration thickness of the diaphragm at total lung capacity and thickening fraction compared to controls. The velocity and excursion of the diaphragm were significantly lower in the HD patients during deep breathing. Changes in diaphragm displacement from quiet breathing to deep breathing (△m) were lower in HD patients than in controls. After multivariate adjustment, hemoglobin level may have effects on diaphragmatic functions such as diaphragm excursion at total lung capacity (DMTLC) and △m. Diaphragm thickness during deep breathing was positively correlated with weight and was greater in males than in females. We also found that the incidence of dyspnoea and snoring and the fatigue scores, all of which were related to diaphragmatic dysfunction, were significantly higher in HD patients than in controls (all p < 0.01). In addition, diaphragmatic dysfunction was confirmed in a CKD mouse model. Conclusions: Improving diaphragm function through targeted therapies may positively impact clinical outcomes in HD patients. Trial Registration Information: Chinese Clinical Trials Registry, 2018ZDKYSB167. Retrospectively registered on May 18, 2018. Funding Statement: This work was supported by grants from the National Natural Science Foundation of China (81700618), the Natural Science Foundation of Jiangsu Province (BK20181487), the China Young Nephrologist Research Project, and a Southeast University High Level Thesis Project to Bin Wang. It was supported by additional grants from the National Natural Science Foundation of China (81720108007, 81470922, 31671194, 81720108007, and 81670696), the National Key Research Programme (2018YFC130046, 2018YFC1314000) and the Clinic Research Center of Jiangsu Province (BL2014080) to Bi-cheng Liu. Declaration of Interests: None of the authors has any conflict of interest to declare. Ethics Approval Statement: The study protocol was approved by the Ethics Committee of Zhongda Hospital affiliated to Southeast University. The details of the study were explained to each patient; if he or she agreed to participate, a written informed consent was signed.

Age is an independent risk factor for acute kidney injury (AKI). The causes and outcomes of AKI in children, middle-aged, and older patients are different. The objective of this country-based study was to identify the characteristics and mortality factors for AKI in different age groups in China.Using data from 374,286 adult patients (≥18 years) admitted to 44 study hospitals, we investigated the characteristics and mortality risk factors for AKI in four different age groups: 18-39 years of age, 40-59 years of age, 60-79 years of age, and ≥80 years of age. The identification criteria for AKI included the 2012 KDIGO AKI definition and an expanded criterion.The country-based survey included 7604 AKI patients (7604/374,286, 2.03%). The proportions of AKI in the four age groups were 11.52%, 30.79%, 41.03%, and 16.66%, respectively. In any age group, the patients with AKI stage 1 were the majority (43.4%, 42.4%, 46.4%, and 52.2%, respectively), and the most common classification of AKI was pre-renal AKI (44.3%, 51.3%, 52.3%, and 56.4%, respectively). The higher AKI peak stage occurred for the in-hospital mortality factors for AKI in all age groups; except for the AKI stage 2 patients in the 18-39 age group.The characteristics and mortality factors for AKI vary by age in China. Elderly patients were the primary population with AKI, and the most common type of AKI was pre-renal AKI. Special caution should be taken to the old population in hospitalized patients to prevent the pre-renal AKI.

Experimental studies found that cinacalcet (CINA) markedly attenuated vascular calcification in uremic rats, but its underlying mechanisms are still largely unknown. Recent evidence have demonstrated that endothelial cells (ECs) participate in ectopic calcification in part by mediating endothelial-to-mesenchymal transition (EndMT). In this study, we investigated whether CINA ameliorated aortic calcification in uremic rats via suppression of EndMT. Uremia was induced in rats by feeding rats a 0.75% adenine diet for 4 weeks. After adenine withdrawal, the rats were maintained on a 1.03% phosphorus diet for next 8 weeks. At initiation of the adenine diet, rats were orally administered CINA (10mg/kg one day) for 12 weeks. The aortic expression of EndMT- and chondrocyte- markers was examined. The effect of elevated PTH on EndMT was also studied in aortic ECs. In uremic rats, CINA treatment significantly decreased the serum PTH concentrations, but did not affect the elevated levels of serum calcium (Ca), phosphorus (P) and Ca×P product. Besides, CINA significantly attenuated aortic calcification, and inhibited the expression of chondrocyte markers (SOX9 and COL2A1) and chondrocyte proteoglycan in uremic aortas. Moreover, CINA treatment largely abolished the up-regulation of mesenchymal markers (FSP1 and α-SMA) and down-regulation of the endothelial marker (CD31), which accompanied aortic calcification in uremic aorta samples. In vitro, PTH increased the expression of EndMT-markers in a concentration- and time-dependent manner. These findings suggest that strategies aiming at reducing serum PTH might prevent uremic aortic calcification by abrogating EndMT.

The determining role of C- and Si-content on the shape memory effect of Fe–Mn–Si–Cr–Ni alloys, where Si was partly replaced by Co. In this regard, three alloys, Fe–15Mn–5Si–8Cr–5Ni, Fe–15Mn–5Si–8Cr–5Ni-0.1C, and Fe–15Mn–3Si–8Cr–5Ni-0.1C–2Co were designed to simultaneously study the shape memory effect and mechanical properties in relation to the microstructure. The microstructure of the alloys after cold rolling and annealing was analyzed by EBSD and X-ray diffraction techniques. The results indicated that grain size and the addition of C influenced the shape memory effect of Fe–Mn–Si–Cr–Ni-based memory alloy. With the increase of grain size, the annealing twin density was decreased, reducing the constraint on phase transformation of γ-austenite to e-martensite. Furthermore, the austenite stability was decreased, such that the martensite-content was increased, and then reduced the shape memory effect of the experimental alloy. With the addition of C, the content of thermally-induced martensite was reduced, and the probability of stress-induced transformation of martensite to obtain α′-martensite was reduced, with consequent enhancement of the shape memory effect for the experimental steel. Additionally, the strength of parent phase was enhanced by the addition of C, and the plastic deformation by slip during stress-induced martensite was minimized, leading to low α′-martensite content and promotion of reversal of stress-induced martensite.

Fe–Mn–Si bearing shape memory alloys are used as structural and functional materials, and have the potential for application in industrial and architectural fields. Fe–Mn–Si–Cr–Ni based shape memory alloys were selected to elucidate the impact of C and Si content on shape memory effect, where Si was replaced by Co. In this regard, Fe–15Mn–5Si–8Cr–5Ni, Fe–15Mn–5Si–8Cr–5Ni-0.1C, and Fe–15Mn–3Si–8Cr–5Ni-0.1C–2Co alloys were designed to simultaneously elucidate the shape memory effect (SME) and mechanical properties in relation to the microstructure. The study indicated that the addition of 0.1 wt% C significantly improved the SME of Fe–Mn–Si–Cr–Ni alloy, and the shape recovery rate of Fe–15Mn–5Si–8Cr–5Ni-0.1C alloy aged at 750 °C for 4 h was maximum at 55.45%. The content of thermally-induced martensite was reduced, which led to decrease in the probability of α′-martensite formation, and promoted inverse transformation of stress-induced martensite and enhanced the shape memory effect. In addition, the strength of the parent phase was enhanced by segregation of elements during aging. Furthermore, the plastic deformation involving slip during stress-induced martensitic transformation was reduced. The reduced content of α′-martensite promoted reversal of stress-induced martensite. On the other hand, Co increased the stacking fault energy and reduced nucleation of stress-induced martensite, such that the number density of stacking faults decreased the shape memory effect of the experimental steel.

Edge cracking phenomenon occurs in ‘Mn + N′ duplex stainless steels because of inferior thermoplasticity that is mainly induced by the non-uniform deformation between ferrite and austenite phase with different strength during hot rolling, limiting its application. To address this problem, a Fe–19Cr-0.6Al–1Ni–12Mn duplex stainless steel with an optimized alloy composition was trial-prepared, where Ni is substituted by Mn and Cr is partially substituted by Al. This enabled a high content ferrite to be present during hot rolling to reduce the adverse effect of austenite on thermoplasticity. Thus, the edge cracking of hot rolled plates was solved. Furthermore, the formation of austenite was governed by annealing after cold rolling. In view of this, it is significant to study phase transformation and precipitation in duplex stainless steel during annealing. A large number of experimental results indicated that there were two types of transformation during the annealing process: the transformation of ferrite to austenite and recovery and recrystallization of ferrite. After annealing at lower temperature, the austenite was characterized by the banded structure at the grain boundaries of ferrite. Besides, the formation of austenite restricted recrystallization of ferrite. With the increase of annealing temperature, the growth of austenite grain would be enhanced, and the banded austenite evolved into bamboo morphology or island morphology. When the annealing temperature was greater than 900 °C, recrystallization of ferrite was promoted, and transformation of ferrite to austenite was inhibited. However, the precipitation of σ phase increased with the decrease of annealing temperature below 800 °C, reducing plasticity and pitting resistance for the investigated steel.

Ischemia/reperfusion (I/R) is a critical risk factor for acute kidney injury (AKI). Recent studies provided evidence that tubular epithelial cells (TEC)-associated inflammation aggravates kidney injury and impairs tissue repair after I/R injury. Here we demonstrated that the Nod-like receptor protein 3 (NLRP3) inflammasome is activated by mitochondrial reactive oxygen species (mROS) during I/R injury via direct interactions between the inflammasome and thioredoxin-interacting protein (TXNIP). Firstly, we found that NLRP3 inflammasome activation was induced by I/R injury, peaking at day 3 after reperfusion. Consistent with this observation, NLRP3 deletion significantly attenuated I/R-induced kidney damage and markers of inflammasome activation. Then, we observed mitochondrial dysfunction, characterized by ultrastructural changes and cytochrome C (Cyt c) redistribution. Mitochondria-targeted antioxidant MitoTEMPO prevented mROS overproduction and the decline in mitochondrial membrane potential (MMP) in vitro. MitoTEMPO treatment also inhibited NLRP3 inflammasome activation and co-localization of NLRP3 and TXNIP after simulated ischemia/reperfusion (SI/R) injury. Finally, we transfected HK-2 cells with TXNIP siRNA to explore the role of TXNIP in mROS-induced NLRP3 inflammasome activation. We found that TXNIP siRNA significantly inhibited NLRP3 inflammasome activation. These results demonstrate that NLRP3 inflammasome is activated through the mROS-TXNIP-NLRP3 pathway and provide a potential therapeutic target in ischemic AKI.

The objective of this study was to determine whether the baseline estimated glomerular filtration rate (eGFR) level was independently associated with in-hospital mortality in generalized patients with hospital-acquired acute kidney injury (HA-AKI) in China. All of the patients admitted to a tertiary medical center of Nanjing, China, between January 1, 2013, and December 31, 2013, were involved. Through the use of an electronic database and the Acute Kidney Injury Network (AKIN) classification, the patients with HA-AKI were indentified. We included the hospitalized adult patients with HA-AKI. Epidemiological information and in-hospital outcomes were collected and were analyzed according to different baseline eGFR strata of the included individual patients. Of the 42,664 admissions during the study period, 1327 patients were identified as AKI. The incidence of HA-AKI was 3.1 %. HA-AKI patients with a compromised baseline eGFR tended to be older and had a higher prevalence of various comorbid conditions. With the gradual deterioration of the baseline eGFR, the odds ratio of in-hospital mortality increased incrementally and a graded independent association between the baseline eGFR and in-hospital mortality was observed when the baseline eGFR dropped below 60 ml/min per 1.73 m2. Baseline eGFR was a potential risk factor for in-hospital mortality in HA-AKI. Serum Creatinine (SCr)-based definition of AKI needs to incorporate baseline eGFR to optimize or refine risk stratification.

It has been suggested that the Traditional Chinese herbal preparation Cordyceps sinensis (CS) may have a beneficial effect in renal disease. We have previously demonstrated bio-activity of naturally occurring CS. To satisfy increasing demand, CS derivatives have been produced by aseptic mycelia cultivation. The aim of this work was to compare and contrast the bio-activity of natural CS and two specific products derived from cultured Cordyceps mycelia, “Jinshuibao Capsule” (Paecilomyces sinensis) and “Corbrin Capsule” (Hirsutella sinensis). In addition using two different cell systems we examined the potential anti-fibrotic potential of these products beyond the kidney. All three preparations antagonised the activity of the pro-fibrotic cytokine TGF-β1 in renal epithelial cells. Activity was seen in the raw water-soluble components, and the hydrophilic and hydrophobic extracts from each preparation suggesting that the bio-activity is not confined to one component of the raw material. In addition to the effects in the renal cell line, similar effects of antagonism of phenotypic activation of pulmonary fibroblasts by TGF-β1 was also seen suggesting an applicability of these observations to solid organ fibrosis beyond the kidney. Mechanistically the data demonstrate antagonism of TGF-β1 activation of Smad signalling and specifically of induction of the hyaladherin TSG-6, which we have previously demonstrated to orchestrate the formation of a hyaluronan, peri-cellular coats driving phenotypic cellular activation. In summary the data support the claim that both naturally occurring and products derived from cultured Cordyceps mycelia have similar bio-activity which may have particular relevance for solid organ fibrosis and associated organ dysfunction.

Cardiac fibrosis is a common feature in patients with chronic kidney disease (CKD). Increasing evidence has shown that elevated parathyroid hormone (PTH) is causally involved in cardiac fibrosis [1–4]. Cinacalcet (CINA), a calcimimetic agent, reduces PTH levels without increasing circulating levels of calcium and phosphorus [5,6]. Recent studies have shown that CINA treatment markedly attenuated myocardial fibrosis and vascular remodeling [6,7]. However, the underlying mechanisms of this action are still unknown. Endothelial-to-mesenchymal transition (EndMT) plays an important role in the development of cardiac fibrosis [8,9]. The purpose of this study was to investigate whether CINA ameliorated cardiac fibrosis in rats with uremia was mediated by suppression of EndMT. Study protocols were approved by the Ethical Committee of Southeast University. The rat model of uremia and secondary hyperparathyroidism was established as previously described [10]. Briefly, 8-week-old male Wistar rats were randomly divided into three groups: the control group (CTL, n = 6), the uremia group (U, n = 8) and the CINA-treated uremia group (U + CINA, n = 8). Uremia was induced by feeding rats a 0.75% adenine diet for 4 weeks. After adenine withdrawal, all animals were maintained on a 1.03% phosphorus diet for next 8 weeks. At initiation of the adenine diet, rats in the U + CINA group were orally treated with CINA (Santa Cruz Biotechnology, USA) once daily (10 mg/kg) until the end of experiment. The effect of elevated PTH on EndMT was also studied in primary aortic endothelial cells (ECs). It was demonstrated that the area of cardiac fibrosis in the U group was significantly increased compared to controls, and it was significantly attenuated by the administration of CINA (Fig. 1A–B). And CINA also inhibited the expression of the extracellular matrix elements type I collagen and fibronectin in uremic hearts (Fig. 1C–E). Furthermore, there was significant up-regulation of mesenchymal markers FSP1 and α-SMA, and down-regulation of the endothelial marker CD31, while CINA markedly abrogated expression of EndMT-associated markers in uremic hearts (Fig. 2). Compared with the U group, serum PTH concentrations were significantly lower in uremic rats treated with CINA (440.64 ± 43.25 vs 326.54 ± 47.86, p < 0.05). To further confirm the causal effect of elevated PTH on induction of EndMT, an in vitro experiment with primary aortic ECs was performed. The results showed that PTH incubation increased expression of FSP1 and α-SMA and decreased expression of CD31 at mRNA and protein levels in a concentration and time dependent manner (p < 0.05). Fig. 1 Effect of CINA on fibrotic lesions in uremic hearts. (A) Cardiac fibrosis was assessed by Masson’s trichrome staining. Images with different magnifications are shown. (B) Quantitative determination of cardiac fibrosis in the different groups. ... Fig. 2 Effect of CINA on the expression of EndMT-related markers in uremic hearts. (A) Representative micrographs showing immunohistochemical staining for cardiac expression of CD31 and FSP1 (original magnification is ×200). (B) Representative micrographs ... In conclusion, our data demonstrated that elevation of PTH induces EndMT and contributes to cardiac fibrosis in uremic rats, which could be prevented by CINA treatment. These results suggest that strategies aiming at lowering PTH levels might exert cardiac protective effects through an anti-EndMT mechanism.

Aims Podocyte injury plays an important role in the pathogenesis of kidney disease. Urinary exosomes are microvesicles released by tubular epithelial cells and podocytes containing information of their originated cells. This study investigated for the first time whether podocyte related mRNA in urinary exosome could serve as novel biomarkers for kidney disease. Methods Urine samples were collected from 32 patients of kidney disease who underwent kidney biopsy and 7 controls. CD2AP, NPHS2 and synaptopodin were detected by real-time RT-PCR on RNA isolated from urinary exosome. Results The pellet microvesicles were positively stained with exosome and podocyte marker, AQP2, CD9 and nephrin. CD2AP mRNA was lower (p = 0.008) in kidney disease patients compared with controls and decreased with the increasing severity of proteinuria (p = 0.06). CD2AP correlated with serum creatinine (r = − 0.373, p = 0.035), BUN (r = − 0.445, p = 0.009) and eGFR (r = 0.351, p = 0.046). Neither NPHS2 nor synaptopodin correlated with parameters of renal function. CD2AP mRNA correlated negatively with 24 hour urine protein (r = − 0.403, p = 0.022), severity of tubulointerstitial fibrosis (r = − 0.394, p = 0.026) and glomerulosclerosis (r = − 0.389, p = 0.031) and could discriminate kidney disease from controls with AUC of 0.821 (p = 0.008). Conclusions Urinary exosome mRNA of CD2AP might be a non-invasive tool for detecting both renal function and fibrosis of kidney disease.

Prion protein (PrP) is a ubiquitous conserved glycoprotein predominantly expressed in neurons of the central nervous system (CNS). To elucidate on its cellular function, we performed a yeast two-hybrid screen within an adult human brain cDNA library for potential PrP-binding molecules. A novel protein, HS-1 associated protein X-1 (HAX-1), was identified to be able to bind with PrP strongly. The interaction between the two proteins has been further verified by glutathione-S-transferase (GST) pull-down and immunoprecipitation assays. The minimal binding regions were mapped to the segments of residues aa 91–163 for PrPC and residues aa 38–129 for HAX-1. Immunofluorescent assays of co-expressions of human PrP and HAX-1 in 293T and SHSY-5Y cells revealed marked co-localizations of those two proteins in cytoplasm. Moreover, the co-expression of HAX-1 and wild-type PrP (PG5) was found to enhance the cellular resistance to the challenge of H2O2. Contrarily, co-transfection of HAX-1 did not reverse but aggravated the cytotoxicities of the genetic CJD (gCJD) associated PrP mutants with nine- (PG9) and fourteen-octarepeats (PG14). Our data provide for the first time a new PrP-interacting partner that may play role in cell oxidative stress and anti-apoptosis physiologically and cell damage pathologically.

Nerve growth factor (NGF), a member of the neurotrophin family, is essential for the development and maintenance of sensory neurons and for the formation of central pain circuitry. The current study was designed to evaluate the expression of NGF in the brain of rats with spared nerve injury (SNI), using immunohistochemical technique. The results showed that the level of NGF in the Red nucleus (RN) of SNI rats was apparently higher than that of sham-operated rats. To further study the effect of NGF in the development of neuropathic pain, different doses of anti-NGF antibody (20, 2.0 and 0.2 microg/ml) were microinjected into the RN contralateral to the nerve injury side of SNI rats. The data suggested that the higher doses of anti-NGF antibody (20 and 2.0 microg/ml) significantly attenuated the mechanical allodynia of neuropathic rats, while the 0.2 microg/ml antibody showed no analgesic effect. These results suggest that the NGF of RN is involved in the development of neuropathic allodynia in SNI rats.

To observe the effect of Cordyceps sinensis (CS) powder on renal oxidative stress and mitochondria functions in 5/6 nephrectomized rats, and to primarily explore its possible mechanisms.Totally 30 male Sprague-Dawley rats were divided into the sham-operation group, the model group, and the treatment group by random digit table, 10 in each group. A chronic kidney disease (CKD) rat model was prepared by one step 5/6 nephrectomy. Rats in the treatment group were intragastrically administered with CS powder solution at the daily dose of 2 g/kg, once per day. Equal volume of double distilled water was intragastrically administered to rats in the sham-operation group and the model group. All medication lasted for 12 weeks. The general condition of rats, their body weight, blood pressure, 24 h proteinuria, urinary N-acetyl-β-D-glucosaminidase (NAG), serum creatinine (SCr) , and blood urea nitrogen (BUN) were assessed before surgery, at week 2, 4, 6, 8, 10, and 10 after surgery. Pathological changes of renal tissues were observed under light microscope. Morphological changes of mitochondria in renal tubular epithelial cells were observed under transmission electron microscope. Activities of antioxidant enzymes including reduced glutathione (GSH), manganese superoxide dismutase (MnSOD), and malondialdehyde (MDA) in fresh renal tissue homogenate were detected. Mitochondria of renal tissues were extracted to detect levels of mitochondrial membrane potential and changes of reactive oxygen species (ROS). And expressions of cytochrome-C (Cyto-C) and prohibitin in both mitochondria and cytoplasm of the renal cortex were also measured by Western blot.(1) Compared with the sham-operation group, body weight was significantly decreased at week 2 (P0. 01), but blood pressure increased at week 4 (P0. 05) in the model group. Compared with the model group, body weight was significantly increased at week 12 (P0. 01), but blood pressure decreased at week 8 (P0. 01) in the treatment group. (2) Compared with the sham-operation group, 24 h proteinuria, urinary NAG, blood SCr and BUN significantly increased in the model group (all P0. 01). Compared with the model group, blood and urinary biochemical indices all significantly decreased in the treatment group (all P0. 01). (3) Results of pathological renal scoring: Glomerular sclerosis index, scoring for tubulointerstitial fibrosis, degree of tubulointerstitial inflammatory infiltration were all obviously higher in the model group than in the sham-operation group (all P0. 01). All the aforesaid indices were more obviously improved in the treatment group than in the model group (all P0. 01). (4) Compared with the sham-operation group, activities of MnSOD and GSH-Px were significantly reduced, but MDA contents obviously increased in the renal cortex of the model group (all P0. 01). Compared with the model group, activities of MnSOD and GSH-Px obviously increased (P0. 05, P0. 01), but MDA contents obviously decreased in the renal cortex of the treatment group (P0. 01). (5) Compared with the sham-operation group, the mitochondrial membrane potential significantly decreased, but ROS levels significantly increased in the model group (all P0.01). Compared with the model group, mitochondrial transmembrane potential increased in the treatment group, thereby inhibiting the tendency of increased production of ROS (both P0. 01). (6) Results of Western blot showed that, compared with the sham-operation group, expression levels of mitochondrial Cyto-C and Prohibitin were significantly reduced in the renal cortex (P0. 01), but significantly elevated in the cytoplasm of the model group (P0. 01). Compared with the model group, each index was obviously improved in the treatment group with statistical difference (P0. 05, P0. 01).CS powder had renal protection, and its mechanism might partially depend on in- hibition of oxidative stress and protection for mitochondria.

To describe the clinical manifestations and diagnosis of pulmonary mucormycosis.We presented 5 proven diagnosed cases of pulmonary mucormycosis in our hospital and reviewed all proven cases of pulmonary mucormycosis previously reported in mainland China. Publications in the form of case reports and articles between January 1982 and December 2011 were searched from Wan Fang Data and China Hospital Knowledge Database.Of the 5 patients in our hospital, the main symptoms included cough, fever, and hemoptysis. Two cases were diagnosed by transbronchial lung biopsy (TBLB), 1 by surgery, 1 by CT-guided percutaneous lung biopsy, and 1 by blood culture. Three patients were cured by antifungal chemotherapy alone, 1 was cured by surgery, and 1 died. Forty-six proven diagnosed cases of pulmonary mucormycosis were retrieved from Wan Fang Data and China Hospital Knowledge Database using key word (pulmonary mucormycosis). Of the 51 patients in total, there were 31 males and 20 females, with a mean age of (47 ± 13)years. The most common risk factors for pulmonary mucormycosis were poorly controlled diabetes mellitus (18 cases), administration of immunosuppressants (7 cases), malignancy (5 cases) and kidney diseases (5 cases). Chest CT showed nodules (27 cases), infiltrates (21 cases), and cavities (18 cases). White blood cell count and neutrophil percentage were elevated in 26 patients. Eighteen cases were diagnosed by histological study of transbronchial biopsy or TBLB specimen. The diagnosis was proven with surgical specimen in 15 patients, CT-guided percutaneous lung biopsy specimen in 7 patients, autopsy in 4 patients, skin biopsy in 1 patient, and renal biopsy in one patient. Three cases were diagnosed by pleural effusion cultures and 2 were diagnosed by blood cultures. Administration of low-dose liposomal amphotericin B (AMB) alone or combined with posaconazole in 12 patients were effective and safe. Fourteen patients who had received surgical resection were cured.There were no specific clinical features of pulmonary mucormycosis. Transbronchial biopsy and CT-guided percutaneous lung biopsy are useful diagnostic tools for pulmonary mucormycosis. Surgical resection and administration of low-dose liposomal AMB alone or combined with posaconazole were all effective and safe.

Elevated serum parathyroid hormone (PTH) is an important complicated phenomenon in patients with chronic kidney disease (CKD). Emerging evidence indicates the involvement of PTH in organ fibrosis, and suppression of PTH by cinacalcet (CINA) ameliorates the progression of fibrotic disorders. However, the underlying mechanisms are largely unknown. The endothelial-to-mesenchymal transition (EndMT) has been shown to be an important mechanism involved in renal fibrosis. The present study aimed to investigate whether CINA treatment attenuated renal EndMT in rats with adenine-induced chronic renal failure (CRF). Compared with the control group, serum PTH was significantly higher in the CRF group and was suppressed after CINA treatment. Serum calcium, phosphorus, and calcium × phosphorus product levels were similar in the CRF group and CINA-treated CRF group. Renal collagen accumulation was significantly increased in the CRF group, which was markedly ameliorated by CINA treatment. Expression of the endothelial marker CD31 was significantly downregulated in rats with CRF, whereas expression of the mesenchymal markers fibroblast specific-protein 1 and α-smooth muscle actin was markedly upregulated. These changes were inhibited by CINA treatment. The protein levels of these EndMT-related markers were strongly correlated with serum PTH concentrations. Furthermore, the in vitro study showed that PTH could significantly increase the expression of fibroblast specific-protein 1 and α-smooth muscle actin and decrease CD31 in mRNA and protein levels in a concentration- and time-dependent manner. In conclusion, our study suggests that reducing serum PTH by CINA treatment could attenuate renal fibrosis via suppression of EndMT in the adenine-induced CRF rat model.

Tubulointerstitial fibrosis is a common pathway that leads to kidney failure, and persistent tubulointerstitial inflammation is a key event in the development of tubulointerstitial fibrosis. The new immunosuppressive drug FTY720 modifies lymphocyte migration into injured tissues by sequestering lymphocytes within secondary lymphoid organs. However, its therapeutic effect on tubulointerstitial inflammation and fibrosis had not been well understood. This study was designed to explore the effect of FTY720 on tubulointerstitial inflammation and fibrosis in subtotally nephrectomized (SNX) rats. In total, 24 male Sprague-Dawley rats were used. Seven days after 5/6 nephrectomy, rats were randomized to FTY720 (1 mg/kg/d) and placebo-treated groups. Sham-operated rats served as controls. FTY720 significantly attenuated the rise in proteinuria, serum creatinine, urea nitrogen and N-acetyl-β-D-glucosaminidase activity in SNX rats, and reduced the count of peripheral white blood cells and lymphocytes in SNX rats. Morphological analysis revealed that there was severe tubulointerstitial inflammation and fibrosis in SNX group and much more tubulointerstitial infiltrating inflammatory cells with high expression of CD3, CD4, CD8, CD20, CD68, CD163 and CCR-7 in SNX group, as compared with the controls, but the lesions were attenuated significantly by treatment with FTY720. Furthermore, the expressions of proinflammatory molecules (IL-6, TNF-α and MCP-1), profibrotic molecule (TGF-β1) and production of extracellular matrix proteins such as fibronectin and types I and III collagens were upregulated in SNX rats. FTY720 administration significantly reduced these abnormalities. In summary, FTY720 exerts therapeutic effects on tubulointerstitial fibrosis in SNX rats by inhibiting the tubulointerstitial inflammatory response.

Recent studies have shown that chronic endothelial dysfunction can impair multiple aspects of renal physiology and, in turn, contribute to renal fibrosis. Sphingosine 1-phosphate (S1P) has been highlighted as an endothelial barrier-stabilizing mediator. The aim of our study was to investigate the effect of FTY720, an S1P analog, on the progression of renal fibrosis by inhibiting renal microvasculature endothelial dysfunction in a rat model of chronic kidney disease. Thirty male Sprague–Dawley rats were used in this study. Seven days after surgery, we placed the animals into three groups: sham surgery; 5/6 nephrectomized (Nx) rats; and 5/6Nx + FTY720 (1 mg/kg/day). All of the animals were sacrificed 12 weeks after surgery. We obtained and analyzed blood and kidney tissue samples from all of the groups. Glomerular capillary density and peritubular capillary (PTC) density were determined by CD31 immunostaining. The expression of transforming growth factor beta 1 (TGF-β1), collagen IV, fibronectin, endothelial nitric oxide synthase (eNOS) and vascular endothelial growth factor (VEGF) were analyzed by immunohistochemistry, reverse transcription-polymerase chain reaction and western blotting. The 5/6Nx group exhibited increased blood urea nitrogen and serum creatinine, visible renal histological changes, pro-fibrotic molecule (TGF-β1) and production of extracellular matrix proteins such as collagen IV and fibronectin and decreased glomerular and PTC density, compared to the sham controls (P < 0.01). We observed that treatment with FTY720 reduced these abnormalities. Furthermore, the level of NO, the expression levels of eNOS and VEGF were downregulated in the kidney tissue in 5/6Nx rats, FTY720 treatment significantly attenuated this decrease. FTY720 prevents the progression of renal fibrosis by inhibiting renal microvasculature endothelial dysfunction in a rat model of chronic kidney disease.

The present study aimed to investigate the effects of Cordyceps sinensis on renal fibrosis and its possible mechanisms. Sprague-Dawley rats were randomly divided into three groups: sham operation (SHAM) group, 5/6 subtotal nephrectomy (SNx) untreated group, and 5/6 subtotal nephrectomy treated with C. sinensis (2.0 g/kg d) (CS) group. Rats were studied 12 weeks after the surgery, and the CS group presented with significantly lower proteinuria, and better renal function compared with the SNx group (p0.05). Pathological study showed that the glomerulosclerosis tubulointerstitial injury score was significantly reduced in the CS group compared with the SNx group. Furthermore, the mRNA expression of TGF-β1, Smad2 and Smad3 and the protein expression of TGF-β1, TβRI, TβRII and p-Smad2/3 were attenuated by the C. sinensis treatment. In constrast, the mRNA and protein expression of Smad7 was upregulated. Furthermore, the expression of α-SMA and FSP1 was also significantly attenuated, accompanied by the increasing expression of E-cadherin, suggesting the inhibition of the epithelial-mesenchymal transition (EMT).C. sinensis exerted its antifibrotic effect on the SNx rats through the inhibition of the TGF-β1/Smad pathway.

Tubulointerstitial macrophage infiltration is a hallmark of chronic kidney disease involved in the progression of renal fibrosis. Pirfenidone is a newly identified antifibrotic drug, the potential mechanism of which remains unclear. The aim of this study was to investigate the effects of pirfenidone on M1/M2 macrophage infiltration in nephrectomized rats. Nephrectomized rats were treated with pirfenidone by gavage for 12 wk. Twenty-four hour urinary protein, N-acetyl-β-d-glycosaminidase (NAG) activity, systolic blood pressure, and C-reactive protein were determined. Paraffin-embedded sections were stained for CD68, CCR7, and CD163 macrophages. Monocyte chemoattractant protein-1 (MCP-1) and macrophage inflammatory protein-1α (MIP-1α), as well as M1 and M2 macrophages secretory markers, were evaluated by real-time RT-PCR and Western blotting analysis. Pirfenidone significantly improved the elevated proteinuria and NAG activity from week 2 onward after surgery. Pirfenidone attenuated interstitial fibrosis and decreased expression of fibrotic markers including transforming growth factor-β1, connective tissue growth factor, α-smooth muscle actin, fibronectin, and fibroblast-specific protein-1. Pirfenidone significantly decreased the infiltrating macrophages. The number of M1 and M2 macrophages was significantly lower after pirfenidone treatment. MCP-1 and MIP-1α were increased in nephrectomized rats at mRNA and protein levels. Pirfenidone treatment significantly inhibited their expression. The TNF-α, IL-6, and nitric oxide synthases-2 expressed by M1 macrophages were increased in nephrectomized rats, and pirfenidone significantly attenuated their expression. Pirfenidone treatment also significantly decreased arginase-1, dectin-1, CD206, and CD86 expressed by M2 macrophages. Thus pirfenidone inhibits M1 and M2 macrophage infiltration in 5/6 nephrectomized rats, which suggests its efficacy in the early and late periods of renal fibrosis.

To compare the effect on erythropoietin (Epo) resistance between acupoint injection and subcutaneous injection of rHuEpo in patients with chronic renal failure (CRF).Thirty-eight cases were randomly divided into two groups, 19 cases in each one. In subcutaneous injection group (control group), subcutaneous injection of rHuEpo was administered, 3 times a week, lasting 2 months. In acupoint group (observation group), rHuEpo was injected on unilateral Shenshu (BL 23) and Zusanli (ST 36), one point was chosen each time, the bilateral acupoints were injected alternatively, 3 times a week, for 2 months. Meanwhile, a normal control group of 19 healthy persons was set up. The levels of CRP, IL-6, TNF-alpha, Scr, BUN, Hb, Hct and SF were observed.Before treatment, the values of CRP, IL-6 and TNF-alpha in two groups were all higher than those in normal control group (all P0.01). After treatment for 2 months, the values of CRP, IL-6,TNF-alpha, Scr and BUN in two groups decreased apparently and those of Hb, Hct and SF increased obviously, indicating statistic significant differences as compared with the values before treatment separately (P0.05, P0.01). In comparison between two groups after treatment, every index above in observation group was improved much significantly (P0.05, P0.01).Acupoint injection of rHuEpo at Zusanli (ST 36) and Shenshu (BL 23) increases significantly the values of Hb, Hct and SF, and decreases apparently the values of BUN, Scr and inflammatory factors, such as CRP, IL-6 and TNF-alpha as compared with subcutaneous injection. Acupoint injection improves Epo resistance and enhances Epo efficacy via alleviating micro-inflammatory state of the body.

HPV-2 is a very common type of HPV which causes common warts. The E2 protein of virus can repress the activity of the viral early promoter through binding to the specific binding sites in viral LCR. Previously we reported that the repression of a mutated E2 protein of HPV-2 isolated from a patient with huge common wart on the viral early promoter was obviously decreased, and A338V mutation located at the C terminal DNA binding region of E2 protein. In this study, we expressed and purified the recombinant mutated and prototype E2 fusion proteins, both in the contexts of the C terminal and the full length, by prokaryotic expression system. The electrophoretic mobility shift assay showed E2 protein could bind to double-stranded DNA oligos labeled with biotin that covered two E2 binding sites. The DNA binding abilities of both C terminal and full-length mutated E2 proteins were stronger than the prototype analogs. This result indicates that the enhancement of the mutated E2 DNA binding ability may be the molecular mechanism for its impact on the activity of viral promoter, which correlates with the phenotype of extensive common wart.

To investigate the expression of toll-like receptor-2 (TLR2), TLR4 on the CD14+ monocytes of patients with stable chronic obstructive pulmonary disease (COPD) and healthy smokers, and to explore the role of TLR2 and TLR4 in COPD pathogenesis.Thirty COPD patients without evidence of acute exacerbation, 21 healthy smokers, and 25 healthy non-smokers underwent measurement of forced expiratory volume in 1 second (FEV(1))% predicted and FEV(1)/forced vital capacity (FVC) by spirometry. The expression of TLR2 and TLR4 surface molecules on human CD14+ monocytes was assessed using fluorescence activated cell sorter analysis by flow cytometry, expressed as relative mean fluorescence intensity (rmfi) and relative positive cell percent (rpcp), and the correlation of TLR expression with lung function parameters was analyzed.The rmfi and rpcp of TLR2 on CD14+ monocytes of the COPD patients were (6.3 +/- 1.4)% and (52.9 +/- 20.5)% respectively, both significantly lower than those of the healthy smokers [(8.2 +/- 2.2)% and (73.5 +/- 19.0)% respectively] and those of the nonsmokers [(11.0 +/- 2.4)% and (82.8 +/- 17.9)% respectively, all P0.01)]. The rmfi of TLR4 of the COPD patients was 2.2 +/- 0.9, significantly lower than that of the nonsmokers (3.0 +/- 0.5, P0.01), while similar to that of the healthy smokers (2.5 +/- 0.6, P0.05). The rpcp of TLR4 of the COPD patients (M = 1.3%, Q(1) - Q(3): 0.7% - 2.4%) was significantly lower than that of the healthy smokers (M = 4.7%, Q(1) - Q(3): 2.7% - 9.4%, P0.01) and nonsmokers (M = 5.3%, Q(1) - Q(3): 2.6% - 8.4%, P0.01). The rmfi of TLR2 and TLR4 on CD14+ monocytes of the healthy smokers was lower than that of the nonsmokers (P0.05), while the rpcp of TLR2 and TLR4 on CD14+ monocytes of the healthy smokers was similar to that of the nonsmoker (P0.05). The expression of TLR2 and TLR4 on monocytes was positively correlated with the lung function parameters, including FEV(1)% predicted and FEV(1)/FVC (all P0.01).The expression levels of TLR2 and TLR4 on CD14+ monocytes of the stable COPD patients and healthy smokers decreased significantly. The innate immune response may be depressed in the COPD patients and smokers, and the down-regulation of TLR is associated with reduced lung function parameters.

Background The human papillomavirus (HPV) E2 protein is a multifunctional DNA-binding protein. The transcriptional activity of HPV E2 is mediated by binding to its specific binding sites in the upstream regulatory region of the HPV genomes. Previously we reported a HPV-2 variant from a verrucae vulgaris patient with huge extensive clustered cutaneous, which have five point mutations in its E2 ORF, L118S, S235P, Y287H, S293R and A338V. Under the control of HPV-2 LCR, co-expression of the mutated HPV E2 induced an increased activity on the viral early promoter. In the present study, a series of mammalian expression plasmids encoding E2 proteins with one to five amino acid (aa) substitutions for these mutations were constructed and transfected into HeLa, C33A and SiHa cells. Results CAT expression assays indicated that the enhanced promoter activity was due to the co-expressions of the E2 constructs containing A338V mutation within the DNA-binding domain. Western blots analysis demonstrated that the transiently transfected E2 expressing plasmids, regardless of prototype or the A338V mutant, were continuously expressed in the cells. To study the effect of E2 mutations on its DNA-binding activity, a serial of recombinant E2 proteins with various lengths were expressed and purified. Electrophoresis mobility shift assays (EMSA) showed that the binding affinity of E2 protein with A338V mutation to both an artificial probe with two E2 binding sites or HPV-2 and HPV-16 promoter-proximal LCR sequences were significantly stronger than that of the HPV-2 prototype E2. Furthermore, co-expression of the construct containing A338V mutant exhibited increased activities on heterologous HPV-16 early promoter P97 than that of prototype E2. Conclusions These results suggest that the mutation from Ala to Val at aa 338 is critical for E2 DNA-binding and its transcriptional regulation.