Publications by authors named "Kun Tang"

294 Publications

Theaflavin protects against oxalate calcium-induced kidney oxidative stress injury via upregulation of SIRT1.

Int J Biol Sci 2021 2;17(4):1050-1060. Epub 2021 Mar 2.

Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Renal tubular cell injury induced by calcium oxalate (CaOx) is a critical initial stage of kidney stone formation. Theaflavin (TF) has been known for its strong antioxidative capacity; however, the effect and molecular mechanism of TF against oxidative stress and injury caused by CaOx crystal exposure in kidneys remains unknown. To explore the potential function of TF on renal crystal deposition and its underlying mechanisms, experiments were conducted using a CaOx nephrocalcinosis mouse model established by glyoxylate intraperitoneal injection, and HK-2 cells were subjected to calcium oxalate monohydrate (COM) crystals, with or without the treatment of TF. We discovered that TF treatment remarkably protected against CaOx-induced kidney oxidative stress injury and reduced crystal deposition. Additionally, miR-128-3p expression was decreased and negatively correlated with SIRT1 level in mouse CaOx nephrocalcinosis model following TF treatment. Moreover, TF suppressed miR-128-3p expression and further abolished its inhibition on SIRT1 to attenuate oxidative stress . Mechanistically, TF interacted with miR-128-3p and suppressed its expression. In addition, miR-128-3p inhibited SIRT1 expression by directly binding its 3'-untranslated region (UTR). Furthermore, miR-128-3p activation partially reversed the acceerative effect of TF on SIRT1 expression. Taken together, TF exhibits a strong nephroprotective ability to suppress CaOx-induced kidney damage through the recovery of the antioxidant defense system regulated by miR-128-3p/SIRT1 axis. These findings provide novel insights for the prevention and treatment of renal calculus.
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http://dx.doi.org/10.7150/ijbs.57160DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8040307PMC
March 2021

A Carbazole-Bridged Biscyclometalated Diplatinum Complex: Synthesis, Characterization, and Dual-Mode Aggregation-Enhanced Phosphorescence.

Inorg Chem 2021 May 16;60(9):6607-6615. Epub 2021 Apr 16.

Beijing National Laboratory for Molecular Sciences, CAS Key Laboratory of Photochemistry, CAS Research/Education Center for Excellence in Molecular Sciences, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, China.

A cationic carbazole-bridged biscyclometalated diplatinum complex has been synthesized and characterized. Single-crystal X-ray analysis demonstrates that complex displays a dimeric structure with noncovalent π-π stacking and unique double Pt-Pt interactions. In aerated dilute CHCN, complex is characterized by a very weak monomeric yellow emission (λ = 547 nm; Φ = 0.51%), which is attributed to the triplet intraligand (LC) excited state mixing with some charge transfer characters. In contrast, under aerated conditions, the dispersion of in a mixed solvent of CHCN/EtO (1/9, v/v) or CHCN/HO (1/9, v/v) displays intense yellow (λ = 550 nm; Φ = 35.5%; τ = 11.10 μs) and red emission (λ = 635 nm; Φ = 14.1%; τ = 7.00 μs), respectively. These aggregation-induced phosphorescent emission enhancements are considered being caused by the oxygen-shielding effect and the molecular rigidification-induced decrease of nonradiative decays in the aggregate state. The morphology and size of the aggregates under these two conditions are examined by scanning electron microscope and dynamic light scattering analysis. The absorption and emission properties of are further rationalized by time-dependent density functional theory calculations on a model compound.
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http://dx.doi.org/10.1021/acs.inorgchem.1c00403DOI Listing
May 2021

Retroperitoneoscopic nephrectomy versus open surgery for non-tuberculous pyonephrotic nonfunctioning kidney: a single-center experience.

Transl Androl Urol 2021 Mar;10(3):1212-1221

Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Background: Patients with obstructive pyonephrotic nonfunctioning kidney (OPNK) often require simple nephrectomy for long-term severe clinical symptoms. We aimed to analyze the outcomes of retroperitoneal laparoscopy versus open surgery for OPNK.

Methods: The study included clinical data of 69 patients with non-tuberculous OPNK from January 2015 to June 2019 in a single center. The patients were divided into laparoscopic group (LS, N=33) and open surgery group (OS, N=36). Those whose pathological findings were xanthogranulomatous inflammation or tuberculous granuloma were excluded. Statistical analysis compared the two groups in terms of basic demographic characteristics, preoperative laboratory examination results, and intraoperative and postoperative observation indicators.

Results: The results showed that non-tuberculous OPNK were more common in women (female/male =4:1). Compared with the LS group, patients in the OS group had higher white blood cells (WBC; P=0.010) and neutrophils (P=0.005) counts before surgery. The main clinical symptoms were low back pain, pyuria, and fever; among them, low back pain combined with pyuria was in the majority. More intraoperative hypotension events were observed in the OS group (P=0.007). Notably, subgroup analysis showed larger stone size happened in the OS group (OR 3.538, 95% CI, 1.337, 9.208). No statistical difference was found in the duration of surgery between the two groups while the length of postoperative hospitalization and retroperitoneal drainage, and postoperative blood transfusion rate increased significantly in the OS group. Postoperative use of non-steroidal anti-inflammatory drugs was more common in the LS group, while opioid analgesics were in the OS group (P=0.0006). There was no statistical difference in other complications.

Conclusions: In conclusion, considering the advantages of LS in terms of postoperative blood transfusion, surgical drainage and length of hospital stay, we recommend it for non-tubercular OPNK when the stone load of pyonephrosis side was less than 280 mm and the preoperative WBC and neutrophil count were within the normal range.
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http://dx.doi.org/10.21037/tau-20-1449DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8039631PMC
March 2021

The Uncounted Casualties of a Hidden COVID-19 Epidemic in China: Cross-sectional Study on Deaths Related to Overwork.

J Med Internet Res 2021 04 20;23(4):e23311. Epub 2021 Apr 20.

Vanke School of Public Health, Tsinghua University, Beijing, China.

Background: During the COVID-19 response, nonclinical essential workers usually worked overtime and experienced significant work stress, which subsequently increased their risk of mortality due to cardiovascular diseases, stroke, and pre-existing conditions. Deaths on duty, including deaths due to overwork, during the COVID-19 response were usually reported on web-based platforms for public recognition and solidarity. Although no official statistics are available for these casualties, a list of on-duty deaths has been made publicly available on the web by crowdsourcing.

Objective: This study aims to understand the trends and characteristics of deaths related to overwork among the frontline nonclinical essential workers participating in nonpharmaceutical interventions during the first wave of COVID-19 in China.

Methods: Based on a web-based crowdsourced list of deaths on duty during the first wave of the COVID-19 response in China, we manually verified all overwork-related death records against the full-text web reports from credible sources. After excluding deaths caused by COVID-19 infection and accidents, a total of 340 deaths related to overwork among nonclinical essential workers were attributed to combatting the COVID-19 crisis. We coded the key characteristics of the deceased workers, including sex, age at death, location, causes of death, date of incidence, date of death, containment duties, working area, and occupation. The temporal and spatial correlations between deaths from overwork and COVID-19 cases in China were also examined using Pearson correlation coefficient.

Results: From January 20 to April 26, 2020, at least 340 nonclinical frontline workers in China were reported to have died as a result of overwork while combatting COVID-19. The weekly overwork mortality was positively correlated with weekly COVID-19 cases (r=0.79, P<.001). Two-thirds of deceased workers (230/340, 67.6%) were under 55 years old, and two major causes of deaths related to overwork were cardiovascular diseases (138/340, 40.6%) and cerebrovascular diseases (73/340, 21.5%). Outside of Hubei province, there were almost 2.5 times as many deaths caused by COVID-19-related overwork (308/340, 90.6%) than by COVID-19 itself (n=120).

Conclusions: The high number of deaths related to overwork among nonclinical essential workers at the frontline of the COVID-19 epidemic is alarming. Policies for occupational health protection against work hazards should therefore be prioritized and enforced.
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http://dx.doi.org/10.2196/23311DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8059783PMC
April 2021

Characterization of F-fluorodeoxyglucose metabolic spatial distribution improves the differential diagnosis of indeterminate pulmonary nodules and masses with high fluorodeoxyglucose uptake.

Quant Imaging Med Surg 2021 Apr;11(4):1543-1553

Department of PET/CT, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.

Background: The aim of this study was to investigate the value of visual assessment of F-fluorodeoxyglucose (F-FDG) metabolic spatial distribution (V-FMSD) in the diagnosis of indeterminate pulmonary nodules and masses with high F-FDG uptake.

Methods: A total of 301 patients with indeterminate pulmonary nodules or masses who underwent F-FDG positron emission tomography/computed tomography (PET/CT) imaging were retrospectively studied. The characteristics of F-FDG metabolic spatial distribution (FMSD) in the proximal and distal regions of the lesions were visually analyzed using a 5-point scoring system. The sensitivity, specificity, accuracy, and area under receiver operating characteristic curve (AUC) were compared between V-FMSD and conventional PET/CT methods for the diagnosis of hypermetabolic indeterminate pulmonary nodules and masses.

Results: The V-FMSD results showed that 180 (92.8%) malignant lesions had a score of ≥3 and 78 (72.9%) benign lesions had a score of ≤2. This indicated that the FMSD in the proximal region of malignant lesions was significantly higher than that of the distal region, and the FMSD in the proximal region of benign lesions was significantly lower than that of the distal region. V-FMSD had a specificity of 72.9%, which was markedly higher than those of the maximum standard uptake value (SUV; 0%, P<0.001) and the retention index (RI; 26.2%, P<0.001). The AUC of V-FMSD was 0.886, which was significantly larger than those of the SUV (0.626, P<0.001), RI (0.670, P<0.001), and PET/CT (0.788, P<0.05).

Conclusions: Our study found that pulmonary benign and malignant lesions have distinct FMSD characteristics. V-FMSD can therefore be used as a novel auxiliary marker to improve the diagnostic accuracy of hypermetabolic indeterminate pulmonary nodules and masses.
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http://dx.doi.org/10.21037/qims-20-768DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7930690PMC
April 2021

Characterization of F-fluorodeoxyglucose metabolic spatial distribution improves the differential diagnosis of indeterminate pulmonary nodules and masses with high fluorodeoxyglucose uptake.

Quant Imaging Med Surg 2021 Apr;11(4):1543-1553

Department of PET/CT, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.

Background: The aim of this study was to investigate the value of visual assessment of F-fluorodeoxyglucose (F-FDG) metabolic spatial distribution (V-FMSD) in the diagnosis of indeterminate pulmonary nodules and masses with high F-FDG uptake.

Methods: A total of 301 patients with indeterminate pulmonary nodules or masses who underwent F-FDG positron emission tomography/computed tomography (PET/CT) imaging were retrospectively studied. The characteristics of F-FDG metabolic spatial distribution (FMSD) in the proximal and distal regions of the lesions were visually analyzed using a 5-point scoring system. The sensitivity, specificity, accuracy, and area under receiver operating characteristic curve (AUC) were compared between V-FMSD and conventional PET/CT methods for the diagnosis of hypermetabolic indeterminate pulmonary nodules and masses.

Results: The V-FMSD results showed that 180 (92.8%) malignant lesions had a score of ≥3 and 78 (72.9%) benign lesions had a score of ≤2. This indicated that the FMSD in the proximal region of malignant lesions was significantly higher than that of the distal region, and the FMSD in the proximal region of benign lesions was significantly lower than that of the distal region. V-FMSD had a specificity of 72.9%, which was markedly higher than those of the maximum standard uptake value (SUV; 0%, P<0.001) and the retention index (RI; 26.2%, P<0.001). The AUC of V-FMSD was 0.886, which was significantly larger than those of the SUV (0.626, P<0.001), RI (0.670, P<0.001), and PET/CT (0.788, P<0.05).

Conclusions: Our study found that pulmonary benign and malignant lesions have distinct FMSD characteristics. V-FMSD can therefore be used as a novel auxiliary marker to improve the diagnostic accuracy of hypermetabolic indeterminate pulmonary nodules and masses.
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http://dx.doi.org/10.21037/qims-20-768DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7930690PMC
April 2021

Preparation of Functionalized Mesoporous Silica as a Novel Carrier and Immobilization of Laccase.

Appl Biochem Biotechnol 2021 Mar 30. Epub 2021 Mar 30.

College of Environment and Safety Engineering, Qingdao University of Science & Technology, Qingdao, 266042, Shandong, China.

Amino-modified mesoporous silica (SBA-15-NH) was prepared by hydrothermal method, which is a kind of excellent carrier for enzyme immobilization. The structure of SBA-15 was characterized by SEM and FTIR, which proved that amino group was successfully attached to the surface of SBA-15. The carrier had good mesoporous structure proved by nitrogen adsorption and desorption test. Using SBA-15-NH as the carrier, the optimal conditions of laccase immobilization by two different cross-linking methods were explored. At the same time, the properties of the immobilized enzyme and free enzyme were compared. The results showed that the activity of immobilized laccase by two-step method (2977.5 U/g) was much higher than that by one-step method (239.5 U/g). The optimal conditions were as follows: free laccase (35°C, pH=4.5), two-step immobilized laccase (40°C, pH=4.0), one-step immobilized laccase (35°C, pH=4.0). The two-step method was more adaptable to temperature. The pH adaptation range of the immobilized enzyme is wider, and the thermal stability is greatly enhanced. After five cycles of repeated reaction, the residual enzyme activity of two-step and one-step methods was 56% and 43% of the original. The treatment of simulated wastewater containing 2,4-dichlorophenol (2,4-DCP) by immobilized laccase was also studied. Under optimum conditions (40°C, pH=5.0, 20 mg/L), the removal of 2,4-DCP reached 89.06%. The immobilized laccase is really effective for treatment of 2,4-DCP-containing wastewater.
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http://dx.doi.org/10.1007/s12010-021-03556-2DOI Listing
March 2021

18F-PSMA-1007 Uptake in Pulmonary Lymphangitic Carcinomatosis Metastasis From Prostate Cancer.

Clin Nucl Med 2021 Mar 16. Epub 2021 Mar 16.

From the Department of PET/CT, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.

Abstract: A 55-year-old man with cough, bone pain, and cervical lymphadenopathy underwent both 18F-FDG and 18F-PSMA-1007 PET/CT scans with clinical suspicion of malignant disease. Compared with 18F-FDG PET/CT, 18F-PSMA PET/CT showed intense tracer uptake in the prostate gland, lungs, osteogenic lesions, and multiple lymph nodes. Interestingly, we also found the high tracer concentration of pulmonary lymphangitic carcinomatosis, a very rare form of prostate cancer metastasis to the lung, on 18F-PSMA-1007 PET/CT images.
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http://dx.doi.org/10.1097/RLU.0000000000003582DOI Listing
March 2021

Driving style recognition and comparisons among driving tasks based on driver behavior in the online car-hailing industry.

Accid Anal Prev 2021 May 23;154:106096. Epub 2021 Mar 23.

Jiangsu Key Laboratory of Urban ITS, School of Transportation, Southeast University, No. 2, Southeast University Road, Jiangning District, Nanjing, 211189, China. Electronic address:

As a product of the shared economy, online car-hailing platforms can be used effectively to help maximize resources and alleviate traffic congestion. The driver's behavior is characterized by his or her driving style and plays an important role in traffic safety. This paper proposes a novel framework to classify driving styles (defined as aggressive, normal, and cautious) based on online car-hailing data to investigate the distinct characteristics of drivers when performing various driving tasks (defined as cruising, ride requests, and drop-off) and undergoing certain maneuvers (defined as turning, acceleration, and deceleration). The proposed model is constructed based on the detection and classification of driving maneuvers using a threshold-based endpoint detection approach, principal component analysis, and k-means clustering. The driving styles that the driver exhibits for the different driving tasks are compared and analyzed based on the classified maneuvers. The empirical results for Nanjing, China demonstrate that the proposed framework can detect driving maneuvers and classify driving styles accurately. Moreover, according to this framework, driving tasks lead to variations in driving style, and the variations in driving style during the different driving tasks differ significantly for turning, acceleration, and deceleration maneuvers.
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http://dx.doi.org/10.1016/j.aap.2021.106096DOI Listing
May 2021

The role of melatonin in sarcopenia: Advances and application prospects.

Exp Gerontol 2021 Jul 19;149:111319. Epub 2021 Mar 19.

Department of Orthopedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, Hunan, China. Electronic address:

Sarcopenia is an age-related disease that has gradually become a serious health problem for elderly individuals. It not only greatly increases the risk of falls, weakness, and disability but also reduces the ability of patients to take care of themselves. Sarcopenia can directly affect the quality of life and disease prognosis of elderly individuals. However, drug interventions for this disease are lacking. Melatonin is a biological hormone produced by the body that has good free radical scavenging effects, antioxidant effects and other effects. It was originally used as a sleep aid and is now being used for an increasing number of new indications. Its effect on sarcopenia has also begun to attract attention. It is currently known that it can protect the mitochondria of skeletal muscle cells, maintain the number of muscle fibres, partially reverse the pathological changes of ageing muscle tissue, and increase muscle strength in patients with sarcopenia. A large number of microRNAs are expressed during cell ageing, that in turn provides a biological background to age-related diseases, like sarcopenia. Increasing studies have found an interaction between melatonin and miRNAs, suggesting that melatonin can be used in the treatment of sarcopenia. The increased expression of inflammation-associated miRNA-483 in elderly patients may be the basis for the age-dependent decrease in melatonin secretion,that may play a role in the morbidity of sarcopenia. Melatonin is closely related to sarcopenia. It has a wide range of effects on sarcopenia and has good application prospects for the prevention and treatment of sarcopenia.
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http://dx.doi.org/10.1016/j.exger.2021.111319DOI Listing
July 2021

A radiomic-based model of different contrast-enhanced CT phase for differentiate intrahepatic cholangiocarcinoma from inflammatory mass with hepatolithiasis.

Abdom Radiol (NY) 2021 Mar 17. Epub 2021 Mar 17.

The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.

Background: Intrahepatic cholangiocarcinoma (ICC) is hard to distinguish from inflammatory mass (IM) complicated with hepatolithiasis in clinical practice preoperatively. This study looked to develop and confirm the radiomics models to make a distinction between ICC with hepatolithiasis from IM and to compare the results of different contrast-enhanced computed tomography (CT) phase.

Methods: The models were developed in a training cohort of 110 patients from January 2005 to June 2020. Radiomics features were extracted from both arterial phase and portal venous phase contrast-enhanced computed tomography (CT) scans. The radiomics scores based on radiomics features, were built by logistic regression after using the least absolute shrinkage and selection operator (LASSO) method. The rad-scores of two contrast -enhanced CT phases and clinical features were incorporated into a novel model. The performance of the models were determined by theirs discrimination, calibration, and clinical usefulness. The models were externally validated in 35 consecutive patients.

Results: The radiomics signature comprised two features in arterial phase (training cohort, AUC = 0.809, sensitivity 0.700, specificity 0.848, and accuracy 0.774;validation cohort, AUC = 0.790, sensitivity 0.714, specificity 0.800, and accuracy 0.757) and three related features in portal venous phase (training cohort, AUC = 0.801, sensitivity 0.800, specificity 0.717, and accuracy 0.759; validation cohort, AUC = 0.830, sensitivity 0.700, specificity 0.750, and accuracy 0.775) showed significant association with ICC in both cohorts (P < 0.05).We also developed a model only based on clinical variables (training cohort, AUC = 0.778, sensitivity 0.567, specificity 0.891, and accuracy 0.729; validation cohort, AUC = 0.788, sensitivity 0.571, specificity 0.950, and accuracy 0.761). The radiomics-based model contained rad-score of two phases and two clinical factors (CEA and CA19-9) showed the best performance (training cohort, AUC = 0.864, sensitivity 0.867, specificity 0.804, and accuracy 0.836; validation cohort, AUC = 0.843, sensitivity 0.643, specificity 0.980, and accuracy 0.821).

Conclusions: Our radiomics-based models provided a diagnostic tool for differentiate intrahepatic cholangiocarcinoma (ICC) from inflammatory mass (IM) with hepatolithiasis both in arterial phase and portal venous phase. To go a step further, the diagnostic accuracy will improved by a clinico-radiologic model.
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http://dx.doi.org/10.1007/s00261-021-03027-6DOI Listing
March 2021

Machine learning-assisted decision-support models to better predict patients with calculous pyonephrosis.

Transl Androl Urol 2021 Feb;10(2):710-723

Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.

Background: To develop a machine learning (ML)-assisted model capable of accurately identifying patients with calculous pyonephrosis before making treatment decisions by integrating multiple clinical characteristics.

Methods: We retrospectively collected data from patients with obstructed hydronephrosis who underwent retrograde ureteral stent insertion, percutaneous nephrostomy (PCN), or percutaneous nephrolithotomy (PCNL). The study cohort was divided into training and testing datasets in a 70:30 ratio for further analysis. We developed 5 ML-assisted models from 22 clinical features using logistic regression (LR), LR optimized by least absolute shrinkage and selection operator (Lasso) regularization (Lasso-LR), support vector machine (SVM), extreme gradient boosting (XGBoost), and random forest (RF). The area under the curve (AUC) was applied to determine the model with the highest discrimination. Decision curve analysis (DCA) was used to investigate the clinical net benefit associated with using the predictive models.

Results: A total of 322 patients were included, with 225 patients in the training dataset, and 97 patients in the testing dataset. The XGBoost model showed good discrimination with the AUC, accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 0.981, 0.991, 0.962, 1.000, 1.000, and 0.989, respectively, followed by SVM [AUC =0.985, 95% confidence interval (CI): 0.970-1.000], Lasso-LR (AUC =0.977, 95% CI: 0.958-0.996), LR (AUC =0.936, 95% CI: 0.905-0.968), and RF (AUC =0.920, 95% CI: 0.870-0.970). Validation of the model showed that SVM yielded the highest AUC (0.977, 95% CI: 0.952-1.000), followed by Lasso-LR (AUC =0.959, 95% CI: 0.921-0.997), XGBoost (AUC =0.958, 95% CI: 0.902-1.000), LR (AUC =0.932, 95% CI: 0.878-0.987), and RF (AUC =0.868, 95% CI: 0.779-0.958) in the testing dataset.

Conclusions: Our ML-based models had good discrimination in predicting patients with obstructed hydronephrosis at high risk of harboring pyonephrosis, and the use of these models may be greatly beneficial to urologists in treatment planning, patient selection, and decision-making.
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http://dx.doi.org/10.21037/tau-20-1208DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7947454PMC
February 2021

Effects of Surgical Masks on Cardiopulmonary Function in Healthy Subjects.

J Vis Exp 2021 02 12(168). Epub 2021 Feb 12.

Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University; The Rehabilitation Medicine Lab of Guangzhou Medical University; Department of Rehabilitation Therapy, Guangzhou Medical University;

We study the effect of surgical masks on cardiopulmonary function based on a cardiopulmonary exercise test (CPET). This study shows that surgical masks reduce cardiopulmonary exercise capacity and ventilation in healthy young subjects and wearing masks might affect aerobic exercise capacity more in female subjects than in male subjects.
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http://dx.doi.org/10.3791/62121DOI Listing
February 2021

Comparison of contrast-enhanced ultrasound versus conventional ultrasound-guided percutaneous nephrolithotomy in patients with nondilated collecting system: a randomized controlled trial.

Eur Radiol 2021 Feb 26. Epub 2021 Feb 26.

Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.

Objective: To compare the safety, effectiveness, and feasibility of contrast-enhanced ultrasound (CEUS) versus conventional ultrasound-guided percutaneous nephrolithotomy (PCNL) in patients with nondilated collecting system.

Methods: Between July 2018 and July 2020, 160 kidney stone patients with nondilated collecting system planned for PCNL were randomly assigned into two groups, CEUS with retrograde ureteral contrast injection and conventional ultrasound with retrograde ureteral normal saline injection. Patient's demographics, the success rate of puncture, success rate of a single-needle puncture, number of punctures, puncture time, perioperative outcomes, stone-free rate, and incidence of complications were compared.

Results: The success rate of a single-needle puncture for CEUS-guided PCNL was higher than that in the conventional ultrasound group (88.5% vs. 73.7%, p = 0.02). Patients performed with CEUS-guided PCNL required less needle passes (p = 0.02), shorter needle puncture time (p = 0.031), and shorter channel establishment time (p = 0.04) than those guided with conventional ultrasound. The postoperative hemoglobin decrease in the CEUS-guided PCNL group was less than that of the control group (p = 0.02). There was no significant difference in operating time, length of hospital stays, kidney function change, and complications between the two groups (p > 0.05). The 1-month stone-free rate was 94.9% in the CEUS group and 90.8% in the control group (p > 0.05).

Conclusions: Compared with conventional ultrasound, CEUS-guided PCNL may facilitate ultrasound-guided PCNL for patients without hydronephrosis, and benefited with a higher success rate of a single-needle puncture, less needle passes, shorter puncture time, and lower postoperative Hb drop.

Trial Registration: Chinese Clinical Trial Registry: ChiCTR1800016981 KEY POINTS: • Compared with conventional ultrasound, CEUS-guided PCNL is a safe and efficacious procedure for kidney stone patients with nondilated collecting system. • Compared with conventional ultrasound, CEUS-guided PCNL benefited with a higher success rate of a single-needle puncture, less needle passes, shorter puncture time, and lower postoperative Hb drop. • CEUS-guided PCNL associated with the more accurate needle puncture and acceptable complications.
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http://dx.doi.org/10.1007/s00330-021-07804-1DOI Listing
February 2021

Clinical characteristics, treatment and outcomes of paediatric COVID-19: a systematic review and meta-analysis.

Arch Dis Child 2021 Feb 16. Epub 2021 Feb 16.

Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada

Objective: Compare paediatric COVID-19 disease characteristics, management and outcomes according to World Bank country income level and disease severity.

Design: Systematic review and meta-analysis.

Setting: Between 1 December 2019 and 8 January 2021, 3350 articles were identified. Two reviewers conducted study screening, data abstraction and quality assessment independently and in duplicate. Observational studies describing laboratory-confirmed paediatric (0-19 years old) COVID-19 were considered for inclusion.

Main Outcomes And Measures: The pooled proportions of clinical findings, treatment and outcomes were compared according to World Bank country income level and reported disease severity.

Results: 129 studies were included from 31 countries comprising 10 251 children of which 57.4% were hospitalised. Mean age was 7.0 years (SD 3.6), and 27.1% had a comorbidity. Fever (63.3%) and cough (33.7%) were common. Of 3670 cases, 44.1% had radiographic abnormalities. The majority of cases recovered (88.9%); however, 96 hospitalised children died. Compared with high-income countries, in low-income and middle-income countries, a lower proportion of cases were admitted to intensive care units (ICUs) (9.9% vs 26.0%) yet pooled proportion of deaths among hospitalised children was higher (relative risk 2.14, 95% CI 1.43 to 3.20). Children with severe disease received antimicrobials, inotropes and anti-inflammatory agents more frequently than those with non-severe disease. Subgroup analyses showed that a higher proportion of children with multisystem inflammatory syndrome (MIS-C) were admitted to ICU (47.1% vs 22.9%) and a higher proportion of hospitalised children with MIS-C died (4.8% vs 3.6%) compared with the overall sample.

Conclusion: Paediatric COVID-19 has a favourable prognosis. Further severe disease characterisation in children is needed globally.
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http://dx.doi.org/10.1136/archdischild-2020-321385DOI Listing
February 2021

A genome-wide association study of facial morphology identifies novel genetic loci in Han Chinese.

J Genet Genomics 2020 Nov 9. Epub 2020 Nov 9.

Chinese Academy of Sciences Key Laboratory of Computational Biology, CAS-MPG Partner Institute for Computational Biology, Shanghai Institute of Nutrition and Health, Shanghai Institutes for Biological Sciences, University of Chinese Academy of Sciences, CAS, Shanghai, 200031, China. Electronic address:

The human face is a heritable surface with many complex sensory organs. In recent years, many genetic loci associated with facial features have been reported in different populations, yet there is a lack of studies on the Han Chinese population. Here, we report a genome-wide association study of 3D normal human faces of 2,659 Han Chinese with autosegment phenotypes of facial morphology. We identify single-nucleotide polymorphisms (SNPs) encompassing four genomic regions showing significant associations with different facial regions, including SNPs in DENND1B associated with the chin, SNPs among PISRT1 associated with eyes, SNPs between DCHS2 and SFRP2 associated with the nose, and SNPs in VPS13B associated with the nose. We replicate 24 SNPs from previously reported genetic loci in different populations, whose candidate genes are DCHS2, SUPT3H, HOXD1, SOX9, PAX3, and EDAR. These results provide a more comprehensive understanding of the genetic basis of variation in human facial morphology.
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http://dx.doi.org/10.1016/j.jgg.2020.10.004DOI Listing
November 2020

Factors influencing the acceptability of HIV/AIDS voluntary counselling and testing: a quantitative study of 41336 female university students in China.

Sex Health 2021 Mar;18(1):119-121

Chaoyang District Center for Disease Control and Prevention of Beijing, Beijing 100020, China; and Corresponding authors. Emails:

This study shows that there is a huge gap between young females' willingness and practice of accepting voluntary counselling and testing (VCT). Only 2.16% (894/41336) of the participants have had HIV/AIDS tests. The study identified age, education major, confidentiality, attitude, accuracy, self-assessment and expense as major factors associated with young female people's acceptance of VCT in China. Therefore, in order to promote HIV VCT among young females, it is necessary for future programs to be sensitive to the targeted population's needs.
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http://dx.doi.org/10.1071/SH20038DOI Listing
March 2021

Optimize the management of urological tube-related emergencies during the coronavirus disease 2019 (COVID-19) pandemic.

Transl Androl Urol 2021 Jan;10(1):466-474

Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Background: To introduce and determine the value of optimized strategies for the management of urological tube-related emergencies with increased incidence, complexity and operational risk during the global spread of coronavirus disease 2019 (COVID-19).

Methods: All emergent urological patients at Tongji Hospital, Wuhan, during the period of January 23 (the beginning of lockdown in Wuhan) to March 23, 2020, and the corresponding period in 2019 were recruited to form this study's COVID-19 group and control group, respectively. Tongji Hospital has the most concentrated and strongest Chinese medical teams to treat the largest number of severe COVID-19 patients. Patients in the control group were routinely treated, while patients in the COVID-19 group were managed following the optimized principles and strategies. The case incidence for each type of tube-related emergency was recorded. Baseline characteristics and management outcomes (surgery time, secondary complex operation rate, readmission rate, COVID-19 infection rate) were analyzed and compared across the control and COVID-19 periods.

Results: The total emergent urological patients during the COVID-19 period was 42, whereas during the control period, it was 124. The incidence of tube-related emergencies increased from 53% to 88% (P<0.001) during the COVID-19 period. In particular, the incidence of nephrostomy tube-related (31% 15%, P=0.027) and single-J stent-related problems (19% 6%, P=0.009) increased significantly. The mean surgery times across the two periods were comparable. The number of secondary complex operations increased from 12 (18%) to 14 (38%) (P=0.028) during the COVID 19-period. The number of 2-week postoperative readmission decreased from 10 (15%) to 1 (3%) (P=0.049). No participants contracted during the COVID-19 period.

Conclusions: Urological tube-related emergencies have been found to have a higher incidence and require more complicated and dangerous operations during the COVID-19 pandemic. However, the optimized management strategies introduced in this study are efficient, and safe for both urologists and patients.
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http://dx.doi.org/10.21037/tau-20-1194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844486PMC
January 2021

Sexual and reproductive health and attitudes towards sex of young adults in China.

BMJ Sex Reprod Health 2021 Jan 27. Epub 2021 Jan 27.

Vanke School of Public Health, Tsinghua University, Beijing, China

Background: The study aimed to discuss the importance of socioeconomic status (SES) and family sexual attitudes and investigate their association with sexual and reproductive health in a large sample of Chinese young adults.

Methods: We analysed a large sample of 53 508 youth aged 15-24 years from an internet-based survey from November 2019 to February 2020. Multivariable logistic regression analyses were employed to examine the association between SES, family sexual attitudes, and sexual and reproductive health (SRH), stratified by sex and adjusting for potential confounders.

Results: Individuals with the highest expenditure were more likely to engage in early sexual intercourse (female: OR 4.19, 95% CI 3.00 to 5.87; male: OR 3.82, 95% CI 2.84 to 5.12). For both sexes, the likelihood of young adult sexual risk-taking such as first intercourse without using a condom, acquiring sexually transmitted infections, and pregnancy was lower in those with higher maternal educational attainment, whereas it was higher in those with open family sexual attitudes.

Conclusions: Lower SES and open family attitudes toward sex had a significant association with a range of adverse young adulthood SRH outcomes. Public health policies should focus on more deprived populations and advocate suitable parental participation to reduce risky sexual behaviours in youth.
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http://dx.doi.org/10.1136/bmjsrh-2020-200766DOI Listing
January 2021

Sustainable Solar Evaporation from Solute Surface via Energy Downconversion.

Glob Chall 2021 Jan 26;5(1):2000077. Epub 2020 Oct 26.

School of Electronic Science and Engineering Nanjing University Nanjing 210093 China.

Solar-powered interfacial evaporation, a cost-effective and ecofriendly way to obtain freshwater from contaminated water, provides a promising path to ease the global water crisis. However, solute accumulation has severely impacted efficient light-to-heat-to-vapor generation in conventional solar evaporators. Here, it is demonstrated that an interfacial solar thermal photo-vapor generator is an efficient light-to-heat photo-vapor generator that can evaporate water stably in the presence of solute accumulation. An energy downconversion strategy which shifts sunlight energy from visible-near infrared to mid infrared-far infrared bands turns water from transparent to its own absorber, thus changing the fixed evaporation surface (black absorber) in a traditional solar evaporator to a dynamic front (solute surface). Light reflected from the solute can be recycled to drive evaporation. The prototype evaporator can evaporate at a high speed of 1.94 kg m h during a persistent solute accumulation process for 32 h. Such an ability to produce purified water while recycle valuable heavy metals from waste water containing heavy metal ions can inspire more advanced solar-driven water treatment devices.
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http://dx.doi.org/10.1002/gch2.202000077DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7788599PMC
January 2021

Sustainable Solar Evaporation while Salt Accumulation.

ACS Appl Mater Interfaces 2021 Feb 12;13(4):4935-4942. Epub 2021 Jan 12.

School of Electronic Science and Engineering, Nanjing University, Nanjing 210093, China.

Solar-driven water evaporation, as a cost-effective and eco-friendly way to produce high-quality freshwater from saline water, is a burgeoning and promising force in the battle against global thirst. However, unsustainable vapor generation caused by salt accumulation has always plagued researchers. Here, it is revealed that a solar thermal photo vapor generator (STPV), which utilizes infrared photons as a heat source, can evaporate water stably in the presence of salt accumulation. Thanks to the low reflection of the wet salt in the infrared band and the porous structure of the salt layer, the energy can be used effectively and the vapor escapes without hindrance. The STPV evaporates water at a stable rate of 1.04-1.19 kg m h under 2 sun illumination for 8 h in a highly concentrated sea salt solution (20 wt %). In contrast, the evaporation rate of conventional solar thermal vapor generators (STVs) decreased by >50% in 1 h and ≈70% in 8 h. This finding could inspire the future development of more advanced solar evaporators so as to ease the global water scarcity.
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http://dx.doi.org/10.1021/acsami.0c17177DOI Listing
February 2021

Clinical characteristics and predictors of mortality in young adults with severe COVID-19: a retrospective observational study.

Ann Clin Microbiol Antimicrob 2021 Jan 6;20(1). Epub 2021 Jan 6.

Department of Respiratory and Critical Care Medicine, National Clinical Research Center of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.

Background And Objective: Little is yet known whether pathogenesis of COVID-19 is different between young and elder patients. Our study aimed to investigate the clinical characteristics and provide predictors of mortality for young adults with severe COVID-19.

Methods: A total of 77 young adults with confirmed severe COVID-19 were recruited retrospectively at Tongji Hospital. Clinical characteristics, laboratory findings, treatment and outcomes were obtained from electronic medical records. The prognostic effects of variables were analyzed using logistic regression model.

Results: In this retrospective cohort, non-survivors showed higher incidence of dyspnea and co-existing laboratory abnormalities, compared with young survivals in severe COVID-19. Multivariate logistic regression analysis showed that lymphopenia, elevated level of d-dimer, hypersensitive cardiac troponin I (hs-CTnI) and high sensitivity C-reactive protein (hs-CRP) were independent predictors of mortality in young adults with severe COVID-19. Further analysis showed that severely young adults with two or more factors abnormalities above would be more prone to death. The similar predictive effect of above four factors had been observed in all-age patients with severe COVID-19.

Conclusion: Lymphopenia, elevated level of d-dimer, hs-CTnI and hs-CRP predicted clinical outcomes of young adults with severe COVID-19.
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http://dx.doi.org/10.1186/s12941-020-00412-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787410PMC
January 2021

Brachial-ankle pulse wave velocity is associated with the risk of osteoporosis: a cross-sectional evidence from a Chinese community-based cohort.

J Orthop Surg Res 2021 Jan 4;16(1). Epub 2021 Jan 4.

Department of Endocrinology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550000, China.

Background: Association of arterial stiffness and osteoporosis has been well documented in elderly population. However, it is not clear whether they co-progress from the early stages through common mechanisms. The object of this study was to evaluate possible associations between arterial stiffness and osteoporosis by measuring brachial-ankle pulse wave velocity (baPWV) and the Osteoporosis Self-Assessment Tool for Asia (OSTA) index among a healthy population of Chinese aged 40 years and older. Whether baPWV can be used as a predictor of osteoporosis on OSTA was further assessed.

Methods: This study was cross-sectional in design. Of 3984 adults aged 40 years and older in the Yunyan district of Guiyang (Guizhou, China) who underwent both OSTA and baPWV measurements within 1 month, 1407 were deemed eligible for inclusion (women, 1088; men, 319).

Results: The mean baPWV was 1475 ± 302 cm/s (range,766-3459 cm/s). baPWV in 110 individuals with high risk of osteoporosis (OSTA index < - 4) was higher than that of individuals with non-high risk (1733 ± 461 cm/s vs. 1447 ± 304 cm/s, P < 0.001). OSTA index was negatively correlated with baPWV(ρ = - 0.296, P < 0.001) after adjusting for age, sex, body mass index, waist circumference, diastolic blood pressure, and creatinine clearance rate. baPWV was an independent predictor for the presence of high risk of osteoporosis (β = - 0.001, P < 0.001) and was consistent across age and sex subgroups, and the optimal baPWV cutoff value for predicting the presence of high risk of osteoporosis and fracture was 1693 cm/s. The AUC was 0.722 (95% confidence interval [CI], 0.667-0.777; P < 0.001, sensitivity of 52.8% and specificity of 83.6%).

Conclusions: We conclude that arterial stiffness measured by baPWV is well correlated with the severity of osteoporosis evaluated by OSTA. baPWV index may be a valuable tool for identifying individuals with risk of developing osteoporosis.
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http://dx.doi.org/10.1186/s13018-020-02125-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7783987PMC
January 2021

Expression profiles, biological functions and clinical significance of circRNAs in bladder cancer.

Mol Cancer 2021 01 4;20(1). Epub 2021 Jan 4.

Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Circular RNAs (circRNAs), which are single-stranded closed-loop RNA molecules lacking terminal 5' caps and 3' poly(A) tails, are attracting increasing scientific attention for their crucial regulatory roles in the occurrence and development of various diseases. With the rapid development of high-throughput sequencing technologies, increasing numbers of differentially expressed circRNAs have been identified in bladder cancer (BCa) via exploration of the expression profiles of BCa and normal tissues and cell lines. CircRNAs are critically involved in BCa biological behaviours, including cell proliferation, tumour growth suppression, cell cycle arrest, apoptosis, invasion, migration, metastasis, angiogenesis, and cisplatin chemoresistance. Most of the studied circRNAs in BCa regulate cancer biological behaviours via miRNA sponging regulatory mechanisms. CircRNAs have been reported to be significantly associated with many clinicopathologic characteristics of BCa, including tumour size, grade, differentiation, and stage; lymph node metastasis; tumour numbers; distant metastasis; invasion; and recurrence. Moreover, circRNA expression levels can be used to predict BCa patients' survival parameters, such as overall survival (OS), disease-free survival (DFS), and progression-free survival (PFS). The abundance, conservation, stability, specificity and detectability of circRNAs render them potential diagnostic and prognostic biomarkers for BCa. Additionally, circRNAs play crucial regulatory roles upstream of various signalling pathways related to BCa carcinogenesis and progression, reflecting their potential as therapeutic targets for BCa. Herein, we briefly summarize the expression profiles, biological functions and mechanisms of circRNAs and the potential clinical applications of these molecules for BCa diagnosis, prognosis, and targeted therapy.
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http://dx.doi.org/10.1186/s12943-020-01300-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7780637PMC
January 2021

F-FDG PET-based radiomics model for predicting occult lymph node metastasis in clinical N0 solid lung adenocarcinoma.

Quant Imaging Med Surg 2021 Jan;11(1):215-225

Department of PET/CT, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.

Background: This study aimed to develop a preoperative positron emission tomography (PET)-based radiomics model for predicting occult lymph node metastasis (OLM) in clinical N0 (cN0) solid lung adenocarcinoma.

Methods: The preoperative fluorine-18-fludeoxyglucose (F-FDG) PET images of 370 patients with cN0 lung adenocarcinoma confirmed by histopathological examination were retrospectively reviewed. Patients were divided into training and validation sets. Radiomics features and relevant data were extracted from PET images. A nomogram was developed in a training set via univariate and multivariate logistic analyses, and its performance was assessed by concordance-index (C-index), calibration curves, and decision curve analysis (DCA) in the training and validation sets.

Results: The multivariate logistic regression analysis showed that only carcinoembryonic antigen (CEA), metabolic tumor volume (MTV), and the radiomics signature had statistically significant differences between patients with and without OLM (P<0.05). A nomogram was developed based on the logistic analyses, and its C-index was 0.769 in the training set and 0.768 in the validation set. The calibration curve demonstrated good consistency between the nomogram-predicted probability of OLM and the actual rate. The DCA also confirmed the clinical utility of the nomogram.

Conclusions: A PET/computed tomography (CT)-based radiomics model including CEA, MTV, and the radiomics signature was developed and demonstrated adequate predictive accuracy and clinical net benefit in the present study, and was conveniently used to facilitate the individualized preoperative prediction of OLM.
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http://dx.doi.org/10.21037/qims-20-337DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7719913PMC
January 2021

Predicting Prostate Cancer Upgrading of Biopsy Gleason Grade Group at Radical Prostatectomy Using Machine Learning-Assisted Decision-Support Models.

Cancer Manag Res 2020 22;12:13099-13110. Epub 2020 Dec 22.

Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, People's Republic of China.

Objective: This study aimed to develop a machine learning (ML)-assisted model capable of accurately predicting the probability of biopsy Gleason grade group upgrading before making treatment decisions.

Methods: We retrospectively collected data from prostate cancer (PCa) patients. Four ML-assisted models were developed from 16 clinical features using logistic regression (LR), logistic regression optimized by least absolute shrinkage and selection operator (Lasso) regularization (Lasso-LR), random forest (RF), and support vector machine (SVM). The area under the curve (AUC) was applied to determine the model with the highest discrimination. Calibration plots and decision curve analysis (DCA) were performed to evaluate the calibration and clinical usefulness of each model.

Results: A total of 530 PCa patients were included in this study. The Lasso-LR model showed good discrimination with an AUC, accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 0.776, 0.712, 0.679, 0.745, 0.730, and 0.695, respectively, followed by SVM (AUC=0.740, 95% confidence interval [CI]=0.690-0.790), LR (AUC=0.725, 95% CI=0.674-0.776) and RF (AUC=0.666, 95% CI=0.618-0.714). Validation of the model showed that the Lasso-LR model had the best discriminative power (AUC=0.735, 95% CI=0.656-0.813), followed by SVM (AUC=0.723, 95% CI=0.644-0.802), LR (AUC=0.697, 95% CI=0.615-0.778) and RF (AUC=0.607, 95% CI=0.531-0.684) in the testing dataset. Both the Lasso-LR and SVM models were well-calibrated. DCA plots demonstrated that the predictive models except RF were clinically useful.

Conclusion: The Lasso-LR model had good discrimination in the prediction of patients at high risk of harboring incorrect Gleason grade group assignment, and the use of this model may be greatly beneficial to urologists in treatment planning, patient selection, and the decision-making process for PCa patients.
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http://dx.doi.org/10.2147/CMAR.S286167DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7765752PMC
December 2020

Revealing the role of glycerophospholipid metabolism in asthma through plasma lipidomics.

Clin Chim Acta 2021 Feb 9;513:34-42. Epub 2020 Dec 9.

Department of Respiratory and Critical Care Medicine, National Clinical Research Center of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Electronic address:

Lipid mediators play an essential role in the pathogenesis of asthma. Many studies on the differential expression of sphingolipids and fatty acid exist, but relatively few concerned about glycerophospholipid (GP) metabolites in asthma. Here, plasma samples from 20 healthy controls and 24 asthmatic patients were collected and analyzed. High-performance liquid chromatography with quadrupole time-of-flight mass spectrometry (HPLC-QTOF-MS) revealed that 29 GPs were identified and relatively quantified as differential metabolites for discriminating asthma patients and healthy subjects, consisting of six major subclasses of GPs. Moreover, a significant relevance was found between the selected metabolites and diagnostic and prognostic indicators of asthma. Remarkably, in subgroup analyses, plasma phosphatidic acid (PA), phosphatidylglycerol (PG), and phosphatidylethanolamine (PE) levels were higher in patients with eosinophilic asthma than non-eosinophilic asthma. Receiver-operating characteristic curve analysis revealed that the power of plasma PA and PG levels to distinguish between asthmatic patients and healthy subjects was strong (all areas under the curves > 0.9; P < 0.05). Our study characterized circulating GP metabolites in patients with asthma and explored their clinical relevance which may help to develop reliable biomarkers for early and accurate diagnosis based on lipid metabolites and provide novel insight into the role of GPs in asthma.
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http://dx.doi.org/10.1016/j.cca.2020.11.026DOI Listing
February 2021

Prevalence and associated socioeconomic factors of multimorbidity in 10 regions of China: an analysis of 0.5 million adults.

J Public Health (Oxf) 2020 Dec 10. Epub 2020 Dec 10.

Vanke School of Public Health, Tsinghua University, Beijing 100084, China.

Background: The epidemiology of multiple chronic conditions in China is poorly understood. We investigated the prevalence of multimorbidity among the middle-aged and elderly population in China and analyzed its demographic and socioeconomic correlates.

Methods: Data were obtained from the baseline of the China Kadoorie Biobank Study, which recruited over 0.5 million participants between 2004 and 2008. We calculated the prevalence by the characteristics of multimorbidity. The demographic and socioeconomic correlates were analyzed using a multivariable logistic regression model.

Results: 15.9% of the participants were multimorbid. Although the prevalence of multimorbidity increased with age, the absolute number of people with multimorbidity was much higher among middle-aged adults (30-60 years, n = 42 041) than the elderly group (>60 years, n = 38 834). The odd of multimorbidity was higher in males (aOR =1.09, 95% CI: 1.07-1.11) and among those who were unemployed (aOR = 1.58, 95% CI: 1.55-1.62). Those who received the highest level of education were most likely to be multimorbid compared with those with no education (aOR = 1.14, 95% CI: 1.09-1.19). Such an association was similar when treating multimorbidity as multinomial variable.

Conclusions: Multimorbidity is a public health concern, with higher prevalence among the elderly, males and those who belong to a lower socioeconomic stratum. Actions are needed to curb multimorbidity epidemic in China.
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http://dx.doi.org/10.1093/pubmed/fdaa204DOI Listing
December 2020

A novel comprehensive predictive model for obstructive pyonephrosis patients with upper urinary tract stones.

Int J Clin Exp Pathol 2020 1;13(11):2758-2766. Epub 2020 Nov 1.

Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan 430030, Hubei, China.

Background: Calculous pyonephrosis tended not to be accurately diagnosed before operations. It is mostly confirmed during percutaneous nephrolithotripsy or percutaneous nephrostomy. We aimed to evaluate the risk factors for predicting obstructive pyonephrosis patients with upper urinary tract stones.

Methods: Clinical data of 322 patients with upper urinary tract stones and obstructive hydronephrosis were retrospectively searched and analyzed in our study. The patients were divided into two groups; pyonephrosis and non-pyonephrosis groups. Both disease related factors and infection-associated indicators were analyzed. Univariate and multivariate logistic analyses were performed on preoperative variables. Accordingly, ROC curves were drawn, and a novel comprehensive model was constructed to predict the pyonephrosis.

Outcomes: Compared to the non-pyonephrosis group, patients in the pyonephrosis group showed statistical differences in sex, urinary tract infection (UTI) within 3 months, stone density, computerized tomography (CT) value of hydronephrosis, serum creatinine, hydronephrosis, contralateral kidney severe hydronephrosis or atrophy, preoperative white blood cells, neutrophils, serum C-reactive protein, urine leukocyte, nitrite, and urine culture revealed statistical difference (<0.05). Univariate analysis showed that there were significant differences for sex, UTI history, degree of hydronephrosis, contralateral severe hydronephrosis or atrophy, serum creatinine, and CT value of hydronephrosis (<0.001). Multivariate analysis demonstrated several independent risk factors for pyonephrosis, including degree of hydronephrosis (=0.02), CT value of hydronephrosis (=0.001), urine leukocyte (=0.002), urine culture (=0.001) and blood neutrophils (=0.009). Based on these risk factors, we constructed a novel comprehensive model and confirmed it was an effective method to predict pyonephrosis (AUC, 0.970). Bootstrapped calibration curves showed no untoward deviation in both training and validation dataset (mean absolute error of 0.027, 0.036).

Conclusions: Hydronephrosis, CT value of hydronephrosis, blood neutrophils, urine leukocyte, and urine culture were independent risk factors to predict pyonephrosis. The novel comprehensive model was found to be an effective method to predict pyonephrosis and needed to be further confirmed in prospective studies.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7716127PMC
November 2020

Association between bone marrow fluorodeoxyglucose uptake and recurrence after curative surgical resection in patients with T1-2N0M0 lung adenocarcinoma: a retrospective cohort study.

Quant Imaging Med Surg 2020 Dec;10(12):2285-2296

Department of PET/CT, Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.

Background: Evidence regarding the relationship between fluorodeoxyglucose (FDG) uptake in the bone marrow of patients with lung adenocarcinoma and prognosis is limited. This study aimed to identify whether bone marrow FDG uptake is a risk factor for recurrence in patients after curative surgical resection of T1-2N0M0 lung adenocarcinoma.

Methods: From January 2012 to December 2016, we retrospectively enrolled 195 pT1-2N0M0 lung adenocarcinoma patients who underwent both preoperative FDG positron emission tomography/computed tomography (PET/CT) and surgical resection from the lung adenocarcinoma database maintained by the PET/CT department at our hospital. After surgical resection, patients were followed up mainly through regular outpatient examinations. The maximum standardized uptake value (SUV) of the primary tumor, the mean FDG uptake of bone marrow (BM SUV), bone marrow-liver uptake ratio (BLR), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were measured from the pretreatment FDG PET/CT images. Multi-adjusted Cox proportional hazards models were built to evaluate the independent prognostic value of BLR in predicting recurrence-free survival (RFS). A restricted cubic spline regression model was conducted to provide more precise estimates and examine the shape of the associations between BLR and the risk of recurrence.

Results: The follow-up results showed that 30 of the 195 patients (15.4%) had tumor recurrence. Compared with non-recurrent patients, the primary tumor size in recurrent patients was larger, and the SUV, TLG, and serum C-reactive protein (CRP) levels were higher. Univariate analysis showed that BLR, tumor size, SUV, TLG, and CRP were significantly correlated with postoperative tumor recurrence. After adjustment for conventional confounding factors, the hazard ratio of BLR was 5.01 (95% CI, 1.32, 18.98) for the highest tertile of BLR compared with the lowest tertile. The multi-adjusted spline regression showed that BLR had a linear relationship with log relative risk (RR) for recurrence when BLR was lower than 0.7. Over this level, the effect stabilized, suggesting a saturation effect for BLR at a level of approximately 0.7 at recurrence.

Conclusions: BLR was an independent risk factor for predicting RFS in T1-2N0M0 lung adenocarcinoma patients after curative surgical resection. BLR can be used as a biomarker for evaluating the risk of lung cancer recurrence.
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http://dx.doi.org/10.21037/qims-19-962DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7596406PMC
December 2020