Objective:This study aimed to develop and validate a novel risk score for death within the next 3 months in patients with maintenance hemodialysis (MHD). Methods:All the data were derived in the Wuhan Hemodialysis Quality Control Center and were divided into the training set (2019-2021, n = 19,735) and the validation set (2022-2023, n = 15,265). The primary outcome was the all-cause mortality within 3 months after regular monthly laboratory tests. The predictive model was displayed as a nomogram and modified into a novel scoring system based on the coefficients of multivariable logistic regression. Results:There were 1684 (8.5%) patients and 1670 (10.9%) patients who died in the development and validation set, respectively. The final novel score system was calculated based on the five predictors: age ≥60 years (2 points), dialysis duration <1 year (2 points), catheter usage (1 point), hemoglobin <110 g/L (1 point), and albumin <35 g/L (3 points). This model with a C-index of 0.72 and 0.73 on the two sets and exhibited a significant ability in stratification of patients into low-risk, intermediate-risk, and high-risk groups (P < 0.0001). Conclusion:This easy-to-use applicable scoring system accurately predicts 3-month mortality in HD patients, facilitating risk stratification and personalized care.

Objective:To investigate the effects of combined Levocarnitine and Alprostadil therapy on renal function, oxidant-antioxidant balance, and systemic inflammation in patients with end-stage diabetic nephropathy (ESDN). Methods:This retrospective study included 104 ESDN patients admitted to our hospital between April 2021 and April 2023 who met all inclusion criteria. All patients were on maintenance hemodialysis for chronic kidney failure due to ESDN. Based on the treatment regimen received, patients were divided into two groups: the control (n=51) received intravenous Alprostadil (20 μg/day) for 30 days in addition to standard care, and the observation group (n=53) received additional intravenous Levocarnitine (1.0 g/day) for 30 days. Clinical efficacy, renal function parameters [blood urea nitrogen (BUN), cystatin C (Cys-C), 24-hour urinary protein (24 h Upro)], oxidative stress markers [malondialdehyde (MDA), superoxide dismutase (SOD), reactive oxygen species (ROS)], inflammatory factors [C-reactive protein (CRP), interleukin-1β (IL-1β), interleukin-6 (IL-6)], and adverse reactions were compared between groups. Results:The cumulative treatment effectiveness (defined as the sum of patients with "markedly effective" and "effective" outcomes) was significantly higher in the observation group (92.45%) compared to the control group (78.43%, P<0.05). Post-treatment, the observation group demonstrated significantly greater improvements in all parameters: lower BUN (4.35±1.06 vs 5.29±1.12 mmol/L), Cys-C (1.21±0.34 vs 1.75±0.46 mg/L), 24 h Upro (66.79±18.37 vs 75.17±19.54 mg/24h), MDA (3.54±0.89 vs 4.63±1.08 nmol/mL), ROS (371.34±46.32 vs 417.53±48.16 U/mL), CRP (5.02±0.83 vs 6.63±0.94 mg/L), IL-1β (11.04±2.38 vs 13.61±2.67 pg/mL), and IL-6 (12.78±3.51 vs 16.84±4.53 pg/mL), alongside higher SOD (88.17±9.34 vs 72.49±8.71 U/mL) (P<0.05). Adverse reaction incidence showed no significant difference (16.98% vs 13.73%, P>0.05). Conclusion:In ESDN patients, the combination of Levocarnitine and Alprostadil demonstrates superior cumulative treatment effectiveness over Alprostadil monotherapy in improving renal function, reducing oxidative stress, and attenuating inflammation, without increasing the incidence of adverse reactions.

Background Health literacy ability is a very important foundational skill for elderly people to achieve effective self-care of their health. However, there are differences in health literacy abilities among elderly patients with knee osteoarthritis, and various factors that affect this ability have not been fully studied. This study explores the potential cross-sectional characteristics and influencing factors of health literacy in elderly patients with knee osteoarthritis. Method This study analyzed cross-sectional survey data on health literacy of 330 elderly patients with knee osteoarthritis. Latent profile analysis was used to identify potential categories of elderly knee osteoarthritis, and binary logistic regression analysis was used to explore the influencing factors of health literacy potential profiles in elderly knee osteoarthritis patients. Result The health literacy of elderly patients with knee osteoarthritis was divided into two potential profiles: low acquired health literacy group (22.0%) and high acquired health literacy group (78.0%). Logistic regression analysis showed that household per capita income, household per capita income, family members with arthritis, comorbidities with chronic diseases, family support, and general self-efficacy were the influencing factors of health literacy in different categories of elderly patients with knee osteoarthritis. Conclusion Elderly patients with knee osteoarthritis have good health literacy and exhibit group heterogeneity. Medical staff can develop targeted intervention measures based on the characteristics of different categories, with a particular focus on patients in the low acquisition health literacy group, to improve their health literacy abilities and promote their health.

Objective: The relationship between different types of vascular access in maintenance hemodialysis (MHD) patients and patient prognosis is controversial. The vascular access of patients from various dialysis centers in Wuhan was summarized, and its relationship with prognosis was analyzed. Methods: The characteristics of MHD patients treated at 70 dialysis centers in the Wuhan Hemodialysis Quality Control System from 2017 to 2023 were collected. The demographic characteristics, laboratory indicators, compliance rates with laboratory indicators, annual mortality changes, survival time, and risk of death were compared in patients with various types of vascular access. Results: A total of 45,830 MHD patients were included in the study. Overall, arteriovenous fistulas (AVFs) and tunneled and cuffed catheters (TCCs) remain the most common types of vascular access. Non‐tunneled and cuffed catheters (NCC) use decreases annually, whereas arteriovenous graft (AVG) use increases annually. Male patients mostly had AVFs. The vascular access types of patients with diabetic nephropathy were mainly TCCs (28.6%) and AVGs (29.4%). AVG patients had the highest average hemoglobin level. NCC patients had the lowest average hemoglobin, albumin, and potassium levels. AVF patients had the highest average albumin, potassium, calcium, phosphorus, and parathyroid hormone levels. TCC patients had the lowest calcium and phosphorus levels. From 2017 to 2023, the mortality rates of AVF, TCC, and AVG patients were significantly higher in 2022 (11%, 19.9%, and 11.7%, respectively). The median survival time of AVF patients was 4.92 (2.75, 7.75) years, which was significantly longer than that of TCC patients (2.83 [1.42, 4.92]) and NCC patients (1.00 [0.25, 2.25]). After multivariate adjustment, the risk of death in patients with internal fistulas was 50.6% lower than that in patients with catheters, according to the Cox regression analysis model (hazard ratio = 0.494, 95% CI: 0.439–0.556, p < 0.001). Conclusions: Among MHD patients with different vascular access types who were treated in Wuhan from 2017 to 2023, the numbers of AVF, AVG, and TCC patients increased with increasing overall number of MHD patients, whereas the number of NCC patients decreased. The overall condition and survival time of AVF patients were significantly better than those of MHD patients with other vascular access types, and the risk of death was lower.

Background:Maintenance hemodialysis (MHD) is an effective treatment for patients with end-stage renal disease. Although MHD can prolong the survival of patients, their quality of life is lower and the fatality rate is higher. This work analyzed the factors related to the autogenous arteriovenous fistula (AVF)-like expansion of non-diabetic MHD patients by vascular ultrasound (VUS). Methods:A retrospective analysis of 96 non-diabetic patients with stone hemodialysis treatment was conducted. The patients were assigned to a loss group (n = 32) and a non-loss group (n = 64) based on selection criteria. The laboratory indicators, biochemical indicators, ultrasound indicators, hemodynamic indicators, and cardiac function-related indicators at 1, 3, and 6 months of patients in different groups were analyzed and compared. Logistic multivariate regression analysis (LMRA) was employed to analyze the factors influencing AVF loss. Log rank was used to test the survival time of the internal fistula. Results:Significant differences were observed in calcium and phosphorus product, serum albumin (ALB), blood phosphorus, and C-reactive protein (CRP) between patients in different groups (P < .05), unlike urea, serum bicarbonate, blood calcium, and blood phosphorus levels (P > .05). In addition, the biochemical indexes of ferritin, unsaturated iron, serum iron, platelet, and parathyroid hormone (PTH) (P > .05). The hemodynamic indexes of patients in the two groups differed greatly (P < .05). LMRA showed that diabetes, ALB, radial diameter, and blood phosphorus were independent risk factors (IRFs) for AVF loss. Log-rank test of patients' internal fistula survival time showed that the median survival curve (MSC) of diabetic patients was lower than that of non-diabetic patients (P < .05). Conclusion:Diabetes, ALB, radial diameter, and blood phosphorus levels were IRFs for AVF loss. Long-term AVFs were associated with hemodynamics and cardiac function to a certain extent, and appropriate flow should be selected clinically according to the patient's condition.

Most information used to evaluate diabetic statuses is collected at a special time-point, such as taking fasting plasma glucose test and providing a limited view of individual’s health and disease risk. As a new parameter for continuously evaluating personal clinical statuses, the newly developed technique “continuous glucose monitoring” (CGM) can characterize glucose dynamics. By calculating the complexity of glucose time series index (CGI) with refined composite multi-scale entropy analysis of the CGM data, the study showed for the first time that the complexity of glucose time series in subjects decreased gradually from normal glucose tolerance to impaired glucose regulation and then to type 2 diabetes ( P for trend < 0.01). Furthermore, CGI was significantly associated with various parameters such as insulin sensitivity/secretion (all P < 0.01), and multiple linear stepwise regression showed that the disposition index, which reflects β-cell function after adjusting for insulin sensitivity, was the only independent factor correlated with CGI ( P < 0.01). Our findings indicate that the CGI derived from the CGM data may serve as a novel marker to evaluate glucose homeostasis.

Mitochondrial dysfunction occurs in the early stage of axonal degeneration after spinal cord injury and involves oxidative stress, energy deficiency, imbalance of mitochondrial dynamics, etc., which play a key role in axonal degeneration and regeneration under physiological and pathological conditions. Failure of axonal regeneration can lead to long-term structural and functional damage. Several recent studies have shown that improved mitochondrial energy metabolism provides conditions for axonal regeneration and central nervous system repair. Here, we describe the role of mitochondrial energy metabolism in neuroprotection and axonal regeneration after spinal cord injury and review recent advances in targeted mitochondrial therapy.

Abstract Background Low-carbohydrate diet (LCD) is effective for weight loss and glycaemic control in humans. Here, the study aimed to explore the effects of LCD/high-fat diet (HFD) in both humans and mice. Methods Twenty-two overweight or obese participants received LCD for 3 weeks. Based on carbohydrate intake > 10% or ≤ 10% of calories, the participants were divided into moderate LCD (MLCD) and very LCD (VLCD) groups. The participants completed a 10-question food preference survey. Meanwhile, C57BL/6J mice were assigned to five groups: chow diet (CD, 10% fat), HFD with 60%, 70%, and 75% fat from cocoa butter (HFD-C), and HFD with 60% fat from lard (HFD-L) and fed for 24 weeks. Eight mice were acclimatised for the food-choice test. Results LCD decreased the total energy intake in humans. The VLCD group showed greater weight loss and better glycaemic control than the MLCD group. A food preference survey showed that 65% of participants tended to choose high-carbohydrate foods. In mice, HFD resulted in energy overconsumption, obesity, and metabolic disorders. When CD and HFD-L were administered simultaneously, mice rarely consumed CD. In the HFD-C groups, the energy intake and body weight increased with increasing dietary fat content. Compared with the HFD-C group, the HFD-L group consumed more energy and had poorer metabolism. Conclusions Lower carbohydrate intake contributed to lower energy intake and improved metabolism in humans. In mice, diets with a higher proportion of fat become more attractive and obesogenic by fixing the fat sources. Since the mice preferred lard to cocoa butter, lard induced excess energy intake and poorer metabolism. Different food preferences may be the underlying mechanism behind the opposite effects of the LCD/HFD in humans and mice. Trial registration The clinical trial was registered with the Chinese Clinical Trial Registry ( www.chictr.org.cn ). The registration number is ChiCTR1800016786. All participants provided written informed consent prior to enrolment.

ABSTRACT Glucose monitoring is an important part of medical care in diabetes mellitus, which not only helps assess glycemic control and treatment safety, but also assists with treatment adjustment. With the development of continuous glucose monitoring (CGM), the use of CGM has increased rapidly. With the wealth of glucose data produced by CGM, new metrics are greatly needed to optimally evaluate glucose status and guide the treatment. One of the parameters that CGM provides, time in range (TIR), has been recognized as a key metric by the international consensus. Before the adoption of TIR in clinical practice, several issues including the minimum length of CGM use, the setting of the target range, and individualized TIR goals are summarized. Additionally, we discussed the mounting evidence supporting the association between TIR and diabetes-related outcomes. As a novel glucose metric, it is of interest to compare TIR with other conventional glucose markers such as glycated hemoglobin A1c. It is anticipated that the use of TIR may provide further information on the quality of glucose control and lead to improved diabetes management.

Spinal cord injury (SCI), which causes loss of sensory and motor function in the body below the level of injury, is a devastating disease of the central nervous system. SCI leads to severe secondary immunosuppression, called SCI-induced immunodeficiency syndrome (SCI-IDS), which is characterized by increased susceptibility to infection and further exacerbates neurological dysfunction. Several studies have suggested that SCI-IDS is an independent risk factor for poor neurological prognosis. SCI-IDS predominantly occurs following injury above the T5 levels and eventually leads to systemic immune failure, possibly via the sympathetic–adrenal medullary axis and the hypothalamic‒pituitary‒adrenal (HPA) axis. However, the mechanism remains unclear. The concentrations of adrenocorticotropic hormone and cortisol in plasma, as well as changes in sympathetic activity (blood pressure and catecholamine levels in plasma), were assessed in rats in the high-level (T3) spinal cord injury (T3-SCI) group and the low-level (T10) spinal cord injury (T10-SCI) group. Second, the differential regulation of the gene network between the sympathetic–adrenal medullary axis and the HPA axis was explored by histology and multitissue transcriptomics, and the neuroendocrine–immune network associated with SCI-IDS was further elucidated. The spleen and thymus gland, which are secondary immune organs, were significantly atrophied in rats in the T3-SCI group, and the white pulp of the spleen was significantly atrophied. The level of cortisol, which is mediated by the adrenal glands, was markedly elevated, but norepinephrine levels were markedly decreased. There was no difference in adrenocorticotropic hormone expression between any of the groups. The transcriptome analysis results showed that the downregulated differentially expressed genes (DEGs) in the T3-SCI group were enriched in the GO term immunoregulation, indicating that splenic immune function was markedly impaired after high-level SCI. The upregulated DEGs in the hypothalamus (hub genes: Nod2, Serpine1, Cebpb, Nfkbil1, Ripk2, Zfp36, Traf6, Akap8, Gfer, Cxcl10, Tnfaip3, Icam1, Fcgr2b, Ager, Dusp10, and Mapkapk2) were significantly enriched in inflammatory pathways, and the downregulated genes (hub genes: Grm4, Nmu, P2ry12, rt1-bb1, Oprm1, Zfhx2, Gpr83, and Chrm2) were enriched in pathways related to inhibitory Gi-mediated G protein-coupled receptor (Gi-GPCR) neurons and neuropeptide changes. The upregulated genes in the adrenal glands (hub genes: Ciart, per2, per3, cry1, and cry2) were enriched in cortisol secretion and circadian rhythm changes, and the downregulated genes (hub genes: IL7r, rt1-bb, rt1-bb1, rt1-da, rt1-ba, cd74, cxcr3, vcam1, ccl5, bin1, and IL8) were significantly enriched in MHC-mediated immune responses. To explore the possible mechanism underlying SCI-IDS, this study assessed the differential regulation of the gene network associated with neuroendocrine immunity after SCI. Progressive neuroinflammation spreads after injury, and neurotransmission through Gi-mediated G protein-coupled receptors in the HPA axis and neuropeptide production by the hypothalamus are inhibited. Disruption of the connection between the hypothalamus and the adrenal glands causes autonomous regulation of the adrenal glands, disturbance of circadian rhythm and finally hypercortisolemia, leading to general suppression of peripheral adaptive immunity. Neuraxial nerve inflammation caused by SCI persists indefinitely, blocking nerve repair; persistent system-wide immunosuppression in the periphery results in increased susceptibility to infection, leading to poor neurological prognosis.

ObjectiveTo retrospectively analyze the epidemiology of mortal maintenance hemodialysis （MHD） patients in 2020 and provide rationales for improving the quality of life of hemodialysis.MethodsFor84 mortal MHD patients in 2020，the relevant clinical data were collected，including general status，original disease history，previous history，dialysis access，dialysis frequency，duration of dialysis and cause of mortality. Standard Operating Procedures of Blood Purification （2020 Edition） served as a reference standard. And the compliance status of the last biochemical results was recorded. The cohort was grouped by dialysis access，frequency of dialysis and pre-dialysis biochemical parameters. And dialysis survival between groups were compared.ResultsThe mortality rate was13.3%. Most cases （n=47，56.0%） occurred during February-April. Arteriovenous fistula（AVF） group was younger than the non-AVF group （median 61 vs 71 years）； AVF group had longer dialysis time than non-AVF group （median 54 vs 30.5 months）. The primary cause of mortality was chronic nephritis （29.8%），the most frequent previous history hypertension （83.3%），the primary cause of mortality infection （28.6%）and the highest frequency of dialysis thrice a week （60.0%）.The compliance rates of the last biochemical parameters of hemoglobin （Hb），ferritin，albumin （Alb），calclum，phosphorus，potassium and iPTHpre-dialysis were 25%，52.9%，13.4%，55.7%，48.6%，71.4%，16.1%. The median survival time on dialysis was longer in AVF group than that in non-AVF group （54 vs 30.5 months），the median survival time on dialysis 5 times per 2 weeks longer than 3 times a week and twice a week （62.5 vs 47 vs 23.5 months），Ca <2.1mmol/L or >2.5mmol/L median survival time on dialysis greater than 2.1-2.5 mmol/L group （62 vs 30 months）.ConclusionChronic nephritis was the primary original disease of mortal hemodialysis patients in 2020 and infectiona leading cause of mortality. Patients with arteriovenous fistula as vascular accessand those with dialysis frequency of 5 times per 2 weeks had a longer survival time on dialysis.

Background and Objectives: Patients on maintenance hemodialysis (MHD) are at high risk for coronavirus disease 2019 (COVID-19). However, patients undergoing MHD who are infected with COVID-19 are not fully studied. The objective of this study is to describe the characteristics of patients with COVID-19 undergoing MHD and provide a basis for the recognition and prevention of COVID-19 infection. Materials and Methods: Patients undergoing MHD were assigned into the normal group (537 cases), diagnosed group (66 cases), and suspected group (24 cases). General data, clinical symptoms, hemodialysis indicators, and laboratory indicators were collected and compared. Results: A total of 627 patients undergoing MHD were evaluated. The prevalence of COVID-19 was 10.53% (66/627), mortality was 18.18% (12/66), and death rate was 1.91% (12/627). In addition, 26% of patients were asymptomatic. Cough was the most common symptom (36%), followed by fatigue (16%), dyspnea (16%), and fever (13%). Ultrafiltration volume, ultrafiltration rate, and the duration of weekly dialysis in the diagnosed group were significantly lower than those in the other two groups. Moreover, neutrophil ratio and neutrophil, monocyte, and total carbon dioxide levels in the diagnosed group were significantly higher than those in the normal group, and the lymphocyte ratio was considerably lower than in the normal group. Sixty-five of the suspected and diagnosed patients had positive pulmonary CT findings. Conclusion: Compared with the general population, patients on hemodialysis have a significantly higher risk of contracting COVID-19 and postinfection mortality. Moreover, most patients undergoing hemodialysis have no obvious clinical symptoms after infection with COVID-19 but only have pulmonary changes which make it particularly important to screen and manage patients undergoing hemodialysis on outpatient basis.

Background: Pancreatic ductal adenocarcinoma (PDAC) is one of the most malignant tumors with a poor prognosis. Recently, necroptosis has been reported to participate in the progression of multiple tumors. However, few studies have revealed the relationship between necroptosis and PDAC, and the role of necroptosis in PDAC has not yet been clarified. Methods: The mRNA expression data and corresponding clinical information of PDAC patients were downloaded from the TCGA and GEO databases. The necroptosis-related genes (NRGs) were obtained from the CUSABIO website. Consensus clustering was performed to divide PDAC patients into two clusters. Univariate and LASSO Cox regression analyses were applied to screen the NRGs related to prognosis to construct the prognostic model. The predictive value of the prognostic model was evaluated by Kaplan-Meier survival analysis and ROC curve. Univariate and multivariate Cox regression analyses were used to evaluate whether the risk score could be used as an independent predictor of PDAC prognosis. Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) and single-sample gene set enrichment analysis (ssGSEA) were used for functional enrichment analysis. Finally, using qRT-PCR examined NRGs mRNA expression in vitro . Results: Based on the TCGA database, a total of 22 differential expressed NRGs were identified, among which eight NRGs (CAPN2, CHMP4C, PLA2G4F, PYGB, BCL2, JAK3, PLA2G4C and STAT4) that may be related to prognosis were screened by univariate Cox regression analysis. And CAPN2, CHMP4C, PLA2G4C and STAT4 were further selected to construct the prognostic model. Kaplan-Meier survival analysis and ROC curve showed that there was a significant correlation between the risk model and prognosis. Univariate and multivariate Cox regression analyses showed that the risk score of the prognostic model could be used as an independent predictor. The model efficacy was further demonstrated in the GEO cohort. Functional analysis revealed that there were significant differences in immune status between high and low-risk groups. Finally, the qRT-PCR results revealed a similar dysregulation of NRGs in PDAC cell lines. Conclusion: This study successfully constructed and verified a prognostic model based on NRGs, which has a good predictive value for the prognosis of PDAC patients.

Growth differentiation factor 15 (GDF15) was newly discovered to be a promising target of metformin. The study was aimed to investigate the relationship between GDF15 and glycemic control after metformin treatment in patients with type 2 diabetes mellitus. The study was a post-hoc analysis of AIM (the effect of Acarbose on glycemic variability in patients with type 2 diabetes mellitus using premixed Insulin compared to Metformin) study. The participants were randomly assigned to 12 weeks of metformin (MET) or acarbose (ACA) treatment combined with insulin. Serum GDF15 levels of 51 subjects from MET group and 53 subjects from ACA group were measured at baseline and after a 12-week treatment. Fasting plasma glucose (FPG), 2-h postprandial plasma glucose (2-h PG) and glycated hemoglobin A1c (HbA1c) were measured at baseline and endpoint. After a 12-week treatment, serum GDF15 levels significantly increased in MET group [baseline vs. endpoint, 936.70 (741.00, 1205.40) pg/mL vs. 1265.20 (1027.90, 1634.00) pg/mL, P < 0.001], but not in ACA group [baseline vs. endpoint, 920.60 (701.45, 1332.55) pg/mL vs. 893.80 (663.25, 1284.05) pg/mL, P = 0.944]. However, there were no significant differences of glycemic control parameters (ΔFPG, Δ2-h PG and ΔHbA1c) between subgroups of MET group divided by median of ΔGDF15 (all P > 0.05). Spearman correlation coefficient and analysis of covariance after adjustment for baseline HbA1c levels showed that ΔGDF15 was not correlated with ΔFPG, Δ2-h PG and ΔHbA1c (all P > 0.05). Serum GDF15 levels were significantly elevated after metformin treatment in patients with type 2 diabetes mellitus. However, the increase was not an indicator of the glucose-lowering effect of metformin. Clinicaltrials.gov, NCT02438397 . Registered 8 May 2015.

ObjectiveTo evaluate the incidence and risk factors of cognitive impairment （CI） in patients on continuous ambulatory peritoneal dialysis （CAPD）.MethodsFrom August 1， 2020 to July 31， 2021， a total of 323 CAPD patients were recruited. Cognitive functions were evaluated by Montreal Cognitive Assessment Scale （MoCA） and CI was defined as MoCA <26 points. The independent risk factors for CI were selected by LASSO and Logistic regressions.ResultsAmong them， 208（64.4%） fulfilled the criteria for CI. LASSO and Logistic regressions indicated that age （OR=1.089， 95%CI 1.058-1.211， P<0.001）， history of diabetes mellitus （OR=2.530， 95%CI 1.256-5.095， P=0.009）， education level， serum uric acid （OR=1.005， 95%CI 1.002-1.007， P=0.002） and total cholesterol （OR=1.836， 95%CI 1.310-2.572， P<0.001） were independent risk factors for CI. Low density lipoprotein （OR=0.973， 95%CI 0.948-0.998， P=0.043） and marital status （OR=0.161， 95%CI 0.047-0.548， P=0.002） were independent protective factors for CI in CAPD patients.ConclusionCAPD patients have a high incidence of CI. Age， history of diabetes mellitus， education level， serum uric acid and total cholesterol are independent risk factors for CI. Low density lipoprotein and marital status are independent protective factors for CI in CAPD patients.

Aim: Dickkopf-1 (DKK-1) is a major inhibitor of Wingless protein signaling pathway, which is involved in glucose metabolism and cardiovascular diseases. The aim of the study was to investigate the changes of serum DKK-1 levels after hypoglycemic treatments and the relationship between DKK-1 and clinical parameters.Materials and Methods: The study was a sub-study of a previously published clinical trial (the effect of Acarbose on glycemic variability in patients with type 2 diabetes mellitus using premixed insulin compared to metformin). All subjects underwent anthropometric and biochemical assessments at baseline and endpoint. Serum DKK-1 levels of 92 subjects were measured at baseline and after 12-week hypoglycemic treatment.Results: DKK-1 levels were significantly decreased after hypoglycemic treatment for 12 weeks (P < 0.001). Delta DKK-1 levels were not correlated with improvement of metabolic parameters (all P > 0.05) but were negatively correlated with baseline DKK-1 levels (r = -0.263, P = 0.011). Spearman correlation showed that baseline DKK-1 levels were positively related to baseline total cholesterol (r = 0.226, P = 0.030) and low-density lipoprotein cholesterol (LDL-C) (r = 0.277, P = 0.007). Compared with the higher baseline DKK-1 group (>= 3700 pg/mL), subjects in the lower baseline DKK-1 group (<3700 pg/mL) had significantly lower baseline glycated hemoglobin A1c levels (P = 0.008) and LDL-C levels (P = 0.048). Systolic and diastolic pressure were decreased more significantly in the lower baseline DKK-1 group than that in the higher baseline DKK-1 group (both P < 0.05). Conclusion: Serum DKK-1 levels were decreased after hypoglycemic treatments. Patients with lower baseline DKK-1 levels were featured by more favorable cardiometabolic factors.

ObjectiveTo explore the clinical efficacy of Shenshuai Mixture plus colonic dialysis in patients with chronic kidney disease stage 4 （CKD4）.MethodsA total of 90 patients with CKD stage 4 （spleen and kidney Qi deficiency syndrome） were hospitalized from December 2018 to December 2020. There were 46 males and 44 females with an average of （48.9±10.5）（31-84） years. They were randomized into three groups of control （group A，basic treatment），colon dialysis （group B，basic treatment plus colon dialysis） and colon dialysis plus Shenshui Mixture （group C，basic treatment plus colon dialysis plus Shenqi Shenshui Mixture orally. Colon dialysis was offered twice weekly for 6 months. Renal function，electrolytes and hemoglobin and changes in TCM syndromes were recorded.ResultsTotal effective rates of groups A，B and C were 55.17%，79.31% and 96.42% respectively； effective rates of groups A，B and C differed greatly （χ2=13.747，P=0.001） and group C had a significant curative effect. It was better than group A （χ2=13.086，P=0.001），efficacy was significantly better in group C than that in group B （χ2=3.875，P=0.049） and efficacy better in group B than that in group A （χ2=3.835，P=0.05）； No significant improvement occurred in TCM syndromes among groups A，B and C （P>0.05）. TCM syndrome showed no significant improvement （P>0.05）. As compared with pre-treatment，sour back/knee，lassitude，anorexia，nausea，vomiting，dry stool and edema improved greatly （P<0.05）. Clinical symptoms improved more in group C than group A/B （P<0.05，P<0.01）； The values of serum creatinine （Scr），blood urea nitrogen （BUN） and estimated glomerular filtration rate （eGFR） declined after treatment （P<0.05）. And Scr and eGFR were better in group C than group A/B （P<0.01） and group A better than group B （P<0.05）. The level of hemoglobin （Hb） rose in group B/C group （Hb） after treatment （P<0.05）. Effiacy was better in group C than that in group A/B （P<0.05）. However，no significant difference existed between groups A and B. And there was no significant difference in electrolyte （K/P） or albumin （Alb） before and after treatment （P>0.05）.ConclusionIn patients with stage CKD4，Shenshuai Mixture plus colon dialysis can improve renal function，delay the progression of renal disease and improve body fatigue. Wider clinical popularization is worthy.

目的·建立小鼠持续葡萄糖监测(continuous glucose monitoring,CGM)技术,并对其血糖时间序列进行多尺度熵(multiscale entropy,MSE)分析.方法·选取饮食诱导肥胖型(diet-induced obesity,DIO)小鼠(n=3,DIO组)及对照组小鼠(n=3)为研究对象,利用全植入式血糖遥测系统分别收集2组小鼠的血糖及体温数据,取术后第10-14日数据进行分析,并统计系统的记录时间.利用MATLABR2019b软件对2组小鼠术后第11?17日的血糖时间序列进行MSE分析,计算每个时间尺度上对应的熵值.结果·成功建立了以全植入式血糖遥测系统为基础的小鼠CGM技术.6只小鼠的平均记录时间为(27.3±9.3)d,共获得232 887个血糖数值.DIO组小鼠平均血糖水平为(7.04±0.71)mmol/L,平均体温为(33.34±0.18)°C.与对照组相比,DIO组小鼠血糖时间序列复杂度较低,但差异无统计学意义.结论.成功建立了小鼠CGM技术;MSE分析发现,DIO型小鼠血糖时间序列复杂度降低,可能县S早期糖代谢异常的表现之一?

AIM:Growth differentiation factor 15 (GDF15) is closely related to obesity. This study aimed to explore the influence of weight loss intervention on serum GDF15 levels and the relationship between GDF15 and metabolism.MATERIALS AND METHODS:Forty-four overweight and obese adults either adopted a low-carbohydrate diet or performed moderate-to-vigorous exercise for 3 weeks. Weekly follow-ups were conducted to measure body composition, glucose and lipid metabolism and serum GDF15 levels.RESULTS:After 3 weeks of intervention, body weight, fat mass and waist circumference in both groups decreased (P < 0.05). No significant change in GDF15 levels was observed in the two groups. Among all the subjects, 10 of them (22.7%, group of Down) showed a decrease in GDF15 and 34 (77.3%, group of Up) showed an increase in GDF15 after the intervention. We found that GDF15 increased significantly with the follow-up time in the UP group and waist circumference, fasting serum insulin (FINS), homeostasis model assessment of insulin resistance (HOMA-IR) and triglycerides (TG) decreased (P for trend <0.05). However, no significant differences in all parameters were detected in Down group. In addition, GDF15 was elevated between 30 mins and 120 mins in a 75-g oral glucose tolerance test. Its trend was negatively correlated with plasma glucose and serum insulin.CONCLUSION:Increased serum GDF15 was associated with improvement in metabolism by lifestyle intervention among young overweight and obese adults. The increase of GDF15 could be an indicator to evaluate metabolic improvements in overweight and obese people.CLINICAL TRIAL REGISTRATION:www.chictr.org.cn, registration number ChiCTR1800016786.

Objective: Although elevated glucose levels are reported to be associated with adverse outcomes of coronavirus disease 2019 (COVID-19), the optimal range of glucose in patients with COVID-19 and diabetes remains unknown. This study aimed to investigate the threshold of glycemia and its association with the outcomes of COVID-19. Research design and methods: Glucose levels were assessed via intermittently scanned continuous glucose monitoring in 35 patients with an average period of 10.2 days. The percentages of time above range (TAR), time below range (TBR), time in range (TIR), and coefficient of variation (CV) were calculated. Composite adverse outcomes were defined as either the need for admission to intensive care unit, need for mechanic ventilation, or morbidity with critical illness. Results: TARs with the threshold from 160 mg/dL - 200 mg/dL were all significantly associated with composite adverse outcomes after adjustment of covariates. Both TBR (<70 mg/dL) and TIR of 70 mg/dL - 160 mg/dL, but not mean sensor glucose level, were significantly associated with composite adverse outcomes and prolonged hospitalization. The multivariate-adjusted odds ratios of the CV of sensor glucose across its tertiles for composite adverse outcomes of COVID-19 were 1.00, 1.18, and 25.2, respectively. Conclusions: Patients with diabetes and COVID-19 have an increased risk of adverse outcomes with glucose levels over 160 mg/dL, below 70 mg/dL, and a high CV. Therapies that improve these metrics of glycemic control may result in better prognoses for these patients.