Allostatic load and women’s brain health: A systematic review

Allostatic load represents the ‘wear and tear’ of chronic stress on the brain and body that may differ between men and women. A small but growing number of studies are assessing allostatic load in relation to mental health. The objective of this systematic review was to (1) assess sex differences in allostatic load and (2) identify allostatic load associations that are specific to women. We systematically searched for allostatic load studies that included psychosocial causes and/or psychiatric consequences. Our search focused on allostatic load studies that disaggregated by sex and that include women. Sixty-two studies were included in this systematic review. First, men appear to have higher allostatic load than women. Second, women show gender-specific variation for numerous factors such as age, race/ethnicity, adversities, social support, and health behaviors that influence associations between allostatic load and mental health. Recommendations are made to guide researchers advance sex and gender approaches.     

原发性IgA肾病的治疗进展

原发性IgA肾病是最普遍的原发性肾小球肾炎,其病理特点为IgA沉积在肾小球系膜细胞区。随着对原发性IgA肾病的逐渐认识,发现其并不是一种良性肾脏疾病,大约在20年内,30%~40%的原发性IgA肾病发展至终末期肾病,需要肾脏替代治疗。因此,原发性IgA肾病需要有效精准的治疗延缓疾病进展。本文主要对原发性IgA肾病治疗的相关研究进行综述,发现目前支持治疗成为原发性IgA肾病的主要治疗方式,另外扁桃体切除、激素、免疫抑制剂等治疗方式在一定情况下也可以用于原发性IgA肾病的治疗,近年来又出现了多种新型治疗方法为原发性IgA肾病的治疗提供了更多选择。     

从慢性肾脏病角度看高尿酸血症与痛风的指南更新要点

随着社会发展及人们生活方式的改变,高尿酸血症（HUA）与痛风的发病率显著上升,并有年轻化趋势。目前HUA已成为仅次于糖尿病的第二大代谢性疾病,其不仅是慢性肾脏病（CKD）的常见并发症,而且是导致CKD发生和发展的重要原因。基于新的研究证据,国内外有关HUA与痛风诊治指南不断更新,并提出较多新观点。本文主要从CKD角度对国内外有关HUA与痛风的指南更新要点进行解读,并结合相关研究证据从初始降尿酸治疗指征、降尿酸治疗药物的选择、痛风急性发作的管理、碱化尿液、维生素C的使用方面进行分析和探讨,旨在为临床综合性、个体化治疗提供借鉴和帮助。     

儿童泌尿道感染合并惊厥的炎性指标及病原菌研究

背景　儿童泌尿道感染是常见的感染性疾病,多由大肠埃希菌感染所致,部分泌尿道感染患儿在疾病发展过程中会出现惊厥发作,从而加重病情、延长治疗时间。然而截至目前,关于儿童泌尿道感染发生惊厥的炎性指标情况、泌尿道感染合并惊厥患儿的病原菌与非惊厥者有无区别尚无报道。目的　分析泌尿道感染患儿合并惊厥的炎性指标、常见病原菌及药物耐药性,为临床治疗提供参考。方法　选取2010-2019年无锡市儿童医院收治的81例泌尿道感染合并惊厥患儿（惊厥组）,同时选取100例泌尿道感染不伴惊厥患儿（非惊厥组）。收集研究对象的性别、年龄、实验室检查结果〔C反应蛋白（CRP）水平、白细胞计数（WBC）、降钙素原（PCT）〕、尿培养+药敏试验结果。结果　惊厥组PCT水平高于非惊厥组（P<0.05）。惊厥组尿培养出病原菌40株（49.4%）,其中革兰阴性菌19株（47.5%）,革兰阳性菌21株（52.5%）,真菌0株。非惊厥组尿培养出病原菌27株（27.0%）,其中革兰阴性菌23株（85.2%）,革兰阳性菌4株（14.8%）,真菌0株。两组间均以大肠埃希菌最多见。两组间病原菌（大肠埃希菌、非大肠埃希菌）比较,差异有统计学意义（P<0.05）。大肠埃希菌对氨苄西林、头孢唑林、头孢曲松耐药率均较高（93.3%、86.7%、73.3%）,对亚胺培南、头孢替坦、厄他培南耐药率均较低（0、0、0）。屎肠球菌对氨苄西林、克林霉素、红霉素、青霉素G 耐药率均在80.0%以上（92.3%、100.0%、84.6%、92.3%）,对万古霉素、利奈唑胺及呋喃妥因耐药率低（0、0、23.1%）。结论　泌尿系感染患儿,临床上要重视炎性指标（PCT）的检测,及时有效地评估感染程度,指导临床治疗、尽快控制感染,减少惊厥发作。同时应特别重视泌尿道感染合并惊厥患儿的中段尿培养检查,注意病原菌耐药性,尽早合理选择有效抗菌药物,及时控制病情进展。     

Association of metabolic syndrome and chronic kidney disease among Uygur adults in Moyu country in Xinjiang Uygur Autonomous Region

Objective To examine the effects of different compositions of metabolic syndrome[Overweight and (or) obesity, hyperglycemia, hypertension, dyslipidemia] on chronic kidney disease. Methods A total of 1552 health data were collected from the survey of chronic kidney diseases among Uygur adults in Moyu country in Xinjiang Uygur Autonomous Region and the relationship between metabolic syndrome and chronic kidney disease was analyzed by using SPSS 15.0 software package. Results Before and after adjusting of age and gender, the prevalence of metabolic syndrome was 14.18% and 14.45% (95% CI 14.30%-14.60%). The prevalence of albuminuria (7.27% vs 3.83%,χ2=5.42, P=0.02), reduced estimated glomerular filtration rate (9.55% vs 3.45%,χ2=16.96, P=0.00) and chronic kidney disease(13.64% vs 6.76%,χ2=12.52, P =0.00) increased in residents diagnosed as metabolic syndrome than those without metabolic syndrome. The prevalence of chronic kidney disease increased with the increasing number of metabolic syndrome elements. Conclusions The prevalence of chronic kidney disease is associated with the accumulation of metabolic syndrome compositions. Early intervention on metabolic risk factors may reduce the risk of chronic kidney disease.     

DC-SIGN expression on podocytes and its role in immune and inflammatory responses of lupus nephritis

Objective To explore the expression of DC-SIGN, the phenotype of dendritic cells (DCs), on podocytes, and its role in immune and inflammatory responses of lupus nephritis (LN). Methods DC-SIGN and IgG1 expression in renal tissues of lupus nephritis patients were observed by immunohistochemistry and immunofluorescence. The 4-week old LN mice were randomly divided into the experimental group and the intervention group. C57BL/6J mice were used as normal control group. Mice of the intervention group were injected anti-DC-SIGN antibody at 6-week old. Mice were sacrificed at 16, 20, 24, 28-week old respectively, to observe the mice renal function and pathological changes. And DC-SIGN and IgG1 expression in renal tissue were observed by immunohistochemistry and immunofluorescence. In addition, mice podocytes were treated with serum of LN mice. Flow cytometry was used to investigate the expression of MHC II, CD80 and DC-SIGN expression on podocytes. Mixed lymphocyte reaction was used to detect the ability of stimulating T cells proliferation. IFN-gamma and IL-4 in supernatant were determined by ELISA. Results (1) Expression of DC-SIGN and IgG1 was found in glomeruli of lupus nephritis patients. (2) Accompanied by increased proteinuria of LN mice from 20-week old (P＜0.01), DC-SIGN and IgG1 expression was found in glomeruli, and the renal function deteriorated up to 24 week-old (P＜0.01). Mice with anti-DC-SIGN antibody intervention appeared reduced proteinuria and remission of renal function (P＜0.01). (3) After stimulated by serum of LN mice, the expression of DC-SIGN, MHC II and CD80 was up-regulated, stimulation of T cell proliferation was enhanced (P＜0.01), and IFN-gamma/IL-4 ratio increased (P＜0.01). Anti-DC-SIGN antibody treatment down-regulated the expressions of DC-SIGN, MHC II and CD80 on podocytes, decreased the ability of stimulating T cell proliferation and lowered the ratio of IFN-gamma/IL-4 (P＜0.01). Conclusions Podocytes in lupus nephritis can play DC-like function through the expression of DC-SIGN, which may be involved in immune and inflammatory responses of renal tissue. However, inhibiton of DC-SIGN can depress immune function of podocytes and have prevention and treatment effect.     

Clinical analysis of 1 371 patients with acute kidney injury after acute myocardial infarction

Objective To investigate the risk factors of acute kidney injury (AKI) in patients after acute myocardial infarction (AMI). Methods A total of 1 371 adult patients diagnosed AMI in the First People's Hospital of Changzhou from January 2008 to December 2012 were analyzed retrospectively. AKI was defined according to the 2012 KDIGO AKI criteria. Based on the occurrence of AKI, the patients were divided into AKI group and non-AKI group. According to the AKI timing, the patients were divided into subgroups including conservative treatment groups, coronary angiography(CAG) groups and coronary artery bypass grafting (CABG) groups, respectively. Related risk factors of AKI were analyzed by univariate and multivariate logistic regression. Results Of the 1 371 patients,410(29.9%) developed AKI. Compared to the non-AKI group, in-hospital mortality increased significantly in the AKI group (17.1% vs 3.9%, χ2=68.0, P＜0.001). Multifactor retrospective analysis showed that decreased baseline eGFR (OR=2.049, 95%CI: 1.246-3.370), increased fasting plasma glucose(FPG) (OR=1.070, 95%CI: 1.018-1.124), diuretics (OR=1.867, 95%CI: 1.220-2.856) and Killip class 4 status (OR=1.362, 95%CI: 1.059-3.170) were all independent risk factors of AKI, while increased DBP on admission was a protective factor (OR=0.986, 95%CI: 0.974-0.998) for the conservative management group. Decreased baseline eGFR (OR=2.371, 95%CI: 1.500-3.747), increased FPG(OR=1.009, 95%CI: 1.005-1.012), diuretics (OR=1.674, 95%CI: 1.042-2.690), intraoperative hypotension (OR=2.276, 95%CI: 1.324-3.575) and acute infection (OR=1.678, 95%CI: 1.023-2.754) were independent risk factors of AKI for the CAG group. Decreased baseline eGFR (OR=2.246, 95%CI:1.340-3.981), increased FPG (OR=1.059, 95%CI: 1.018-1.124), diuretics (OR=1.723, 95%CI: 1.122-2.650), and low cardiac output syndrome after operation (OR=2.331, 95%CI: 1.277-3.286) were independent risk factors of AKI for CABG group. Conclusions AKI is a common complication and associated with increased mortality after AMI. Decreased baseline renal function, increased FPG and diuretics were common independent risk factors of AKI after AMI.     

Astragaloside IV attenuates renal tubulointerstitial fibrosis by inhibiting p38 MAPK signaling

Objective To investigate the effect of astragaloside IV (AS-IV) on renal tubulointerstitial fibrosis and its regulation on p38 MAPK signaling. Methods In vivo, UUO model with renal tubulointerstitial injury was constructed. Mice in AS-IV group were orally administrated AS-IV 20 mg•kg-1•d-1 for 7 days after operation, and mice in other groups were administrated the equal volume vehicle. Bilateral kidneys were collected in 7 and 14 days after operation. Transverse kidney slices were stained with Masson trichrome to evaluate the severity of renal tubule injury. In vitro, normal human renal tubular epithelial cells (HK-2) were stimulated with recombinant TGF-β1 (10 ng/ml) and simultaneously treated with different concentrations of AS-IV (0, 50, 100, 200 μg/ml) for 24 h. SB203580 (10 μmol/L) was also ultilized to pre-treat HK-2 cells for 1 h to inhibit phosphorylation of p38 MAPK signaling. The expression of FN, Col IV, and α-SMA were investigated by western blotting and real-time PCR. The expression of p-p38 MAPKs were also observed by Western Blotting. Results Astragaloside IV morphologically ameliorated renal tubulointerstitial fibrosis. The proteins and mRNA expression of FN, Col IV, α-SMA, and TGF-β1 were also increased significantly in UUO kidney tissues (all P＜0.05), which could be reversed by AS-IV administration (all P＜0.05). In vitro, the expression of FN, Col IV, and α-SMA were up-regulated by TGF-β1 after stimulating for 24 h (all P＜0.05), which were decreased by AS-IV. The inhibition effect on FN and α-SMA were similar between AS-IV and MAPK inhibitor SB203580. AS-IV inhibited p-p38 MAPK signals both in vivo and in vitro. Conclusions AS-IV could attenuate renal tubulointerstitial fibrosis induced by UUO and TGF-β1 through reducing FN、Col IV、α-SMA expression in renal tubular cells. The mechanism of AS-IV protective effect might be associated with inhibition of p38 MAPK phosphorylation.     

Impact of gender on the clinicopathological features of patients with primary IgA nephropathy

Objective To explore the impact of gender on the clinicopathological features of patients with primary IgA nephropathy (IgAN). Methods All patients with IgAN who were biopsy-proven in The First Affiliated Hospital, Sun Yat-sen University from January 2006 to December 2011 were divided into two groups by gender: male group and female group. The clinical manifestations and pathological features of two groups were retrospectively investigated and compared. Results A total of 1512 primary IgAN patients were enrolled in the study, and the ratio of male to female was 1∶1.16, with a median age of 32(26, 39) years old at biopsy. Compared to female patients, male patients with IgAN exhibited more severe clinical manifestations including worse renal function, greater urinary protein excretion, and more frequent occurrence of hypertension, hypertriglyceridemia and hyperuricemia. Besides, male patients had worse histological lesions, including more severe segmental sclerosis, tubular-atrophy/interstitial fibrosis and interstitial infiltration. For female patients, hematuria, including gross and microscopic hematuria, was more frequent. Conclusion Male patients with IgAN were with worse clinicopathological changes than those of female.     

Epidemiological study of the end stage renal disease patients in Gansu province

Objective To investigate the clinical features and treatment of the end stage renal disease (ESRD) patients in Gansu province. Methods Based on the Chinese national renal data system, the investigation and analysis were made on the epidemiological literature of ESRD patients in 22 hospitals of Gansu from 2012 to 2013 by retrospective investigation. Results (1) In Gansu, the number of living ESRD patients was 4379, the point prevalence rate of ESRD was 169.6 per million. Their average age was (47.46±15.57) years, 30 to 59 years old patients accounted for 70.0%, and the male-female ratio was 1:1.15. The prevalence rate was higher in less-educated population and manual laborers. (2) As the leading cause of ESRD, chronic glomerulonephritis accounted for 43.0%, followed by diabetic nephropathy (31.0%), hypertensive nephropathy (11.0%) and allergic diseases (6.9%). (3) The current treatment of ESRD: 51.2% of the patients received hemodialysis, 4.4% received peritoneal dialysis, 1.1% received renal transplantation, 32.2% received no treatment, and 11.1% died. (4) The causes of patients not taking dialytic treatments: economic reasons accounted for 61.0%, lack of blood dialytic conditions accounted for 24.0%, patients ceasing treatment accounted for 3.1%, family factors accounted for 2.3%, religious reasons accounted for 1.8%, other reasons accounted for 7.8%. Conclusions The point prevalence rate of ESRD in Gansu was 169.6 per million. 30 to 59 years old patients were the main population. The major cause of ESRD was chronic glomerulonephritis, followed by diabetic nephropathy and hypertensive nephropathy. 32.2% of ESRD patients did not receive any renal replacement therapy, which was caused mainly by economic difficulties and the lack of dialytic equipments.