Oral Chinese Herbal Medicine plus usual care for diabetic kidney disease: study protocol for a randomized, double-blind, placebo-controlled pilot trial.

Background: Diabetic kidney disease (DKD) has become the leading cause of kidney failure, causing a significant socioeconomic burden worldwide. The usual care for DKD fails to achieve satisfactory effects in delaying the persistent loss of renal function. A Chinese herbal medicine, Tangshen Qushi Formula (TQF), showed preliminary clinical benefits with a sound safety profile for people with stage 2-4 DKD. We present the protocol of an ongoing clinical trial investigating the feasibility, efficacy, and safety of TQF compared to placebo in delaying the progressive decline of renal function for people with stage 2-4 DKD. Methods: A mixed methods research design will be used in this study. A randomized, double-blind, placebo-controlled pilot trial will evaluate the feasibility, efficacy, and safety of TQF compared to placebo on kidney function for people with stage 2-4 DKD. An embedded semi-structured interview will explore the acceptability of TQF granules and trial procedures from the participant's perspective. Sixty eligible participants with stage 2-4 DKD will be randomly allocated to the treatment group (TQF plus usual care) or the control group (TQF placebo plus usual care) at a 1:1 ratio for 48-week treatment and 12-week follow-up. Participants will be assessed every 12 weeks. The feasibility will be assessed as the primary outcome. The changes in the estimated glomerular filtration rate, urinary protein/albumin, renal function, glycemic and lipid markers, renal composite endpoint events, and dampness syndrome of Chinese medicine will be assessed as the efficacy outcomes. Safety outcomes such as liver function, serum potassium, and adverse events will also be evaluated. The data and safety monitoring board will be responsible for the participants' benefits, the data's credibility, and the results' validity. The intent-to-treat and per-protocol analysis will be performed as the primary statistical strategy. Discussion: Conducting a rigorously designed pilot trial will be a significant step toward establishing the feasibility and acceptability of TQF and trial design. The study will also provide critical information for future full-scale trial design to further generate new evidence supporting clinical practice for people with stage 2-4 DKD. Trial registration number: https://www.chictr.org.cn/, identifier ChiCTR2200062786.

Novel Bilayer-Shelled N, O-Doped Hollow Porous Carbon Microspheres as High Performance Anode for Potassium-Ion Hybrid Capacitors.

With the advantages of high energy/power density, long cycling life and low cost, dual-carbon potassium ion hybrid capacitors (PIHCs) have great potential in the field of energy storage. Here, a novel bilayer-shelled N, O-doped hollow porous carbon microspheres (NOHPC) anode has been prepared by a self-template method, which is consisted of a dense thin shell and a hollow porous spherical core. Excitingly, the NOHPC anode possesses a high K-storage capacity of 325.9 mA h g-1 at 0.1 A g-1 and a capacity of 201.1 mAh g-1 at 5 A g-1 after 6000 cycles. In combination with ex situ characterizations and density functional theory calculations, the high reversible capacity has been demonstrated to be attributed to the co-doping of N/O heteroatoms and porous structure improved K+ adsorption and intercalation capabilities, and the stable long-cycling performance originating from the bilayer-shelled hollow porous carbon sphere structure. Meanwhile, the hollow porous activated carbon microspheres (HPAC) cathode with a high specific surface area (1472.65 m2 g-1) deriving from etching NOHPC with KOH, contributing to a high electrochemical adsorption capacity of 71.2 mAh g-1 at 1 A g-1. Notably, the NOHPC//HPAC PIHC delivers a high energy density of 90.1 Wh kg-1 at a power density of 939.6 W kg-1 after 6000 consecutive charge-discharge cycles.

Effects of Tiaopi Xiezhuo decoction on constipation and gut dysbiosis in patients with peritoneal dialysis.

CONTEXT: A Chinese herbal formula, Tiaopi Xiezhuo decoction (TXD), is developed from a classical Chinese prescription Sanhuang Xiexin decoction. OBJECTIVE: To investigate the regulatory effect of TXD on gut dysbiosis, as a treatment of constipation in patients with peritoneal dialysis (PD). MATERIALS AND METHODS: The chemical content of TXD was assessed by high-performance liquid chromatography. A total of 29 PD patients were enrolled and treated with TXD orally (3 g crude drug/each/twice/day) for 3 months. Blood and faecal samples were collected at the beginning and end, to determine the changes in biochemical characteristics and gut microbial composition. The stool conditions were asked to be scored. Additional 30 healthy individuals were recruited as a control for the analysis of gut microbiota. RESULTS: Although having no significant effects on serum biochemical characteristics, 3-month TXD intervention improved constipation in PD patients: decreased 80% abdominal distention (p < 0.01), increased 2.6-fold sloppy stools (p < 0.05) and eliminated hard stool completely (p < 0.01). The analysis of gut microbiota showed that, compared to the healthy group, the microbial richness was reduced in PD patients. After a 3-month TXD treatment, this reduced richness was raised, and Paraprevotella clara, Lachnospiraceae bacterium 2-146FA, Phascolarctobaterium succinatutens, Lachnospiraceae bacterium 2-1-58FAA, Fusobacterium mortiferum, and Prevotella copri were accumulated in the intestinal flora. Furthermore, the bacterial species enriched by TXD correlated with the improvement of constipation. DISCUSSION AND CONCLUSIONS: TXD treatment may improve constipation by modulating gut dysbiosis in PD patients. These findings provide data to support the further application of TXD in the adjuvant treatment of PD.

Differing responses of precipitation in Northern Hemisphere mid-latitudes to increased black carbon aerosols and carbon dioxide.

As the most important contributors to global warming in recent decades, anthropogenic carbon dioxide (CO2) and black carbon (BC) play significant roles in driving the global/regional hydrological cycle. Most of previous studies on the climate effects of CO2 and BC focused on tropics and monsoon regions. The influences and their differences of CO2 and BC on the precipitation in Northern Hemisphere mid-latitudes (NHML) have not been paid enough attention. Here we investigate the NHML precipitation responses to a tenfold increase in BC and a doubling of CO2 by analyzing the multi-model simulation results from the Precipitation Driver Response Model Intercomparison Project (PDRMIP). Our results show that the NHML precipitation changes induced by BC and CO2 distinctly differ in trends and seasons. The increased BC will reduce the NHML precipitation, especially in summer, whereas the doubled CO2 will enhance the regional precipitation, mainly in winter. The differences between the BC and CO2 induced NHML precipitation changes are most distinct in Central Asia and central North America. Further analyses reveal the underlying mechanisms of the distinct responses of precipitation: the decrease in NHML precipitation induced by BC aerosols mainly results from the dynamic effect by reducing the temperature gradient, thereby weakening the zonal wind, while the increased precipitation by CO2 is caused by the increase in atmospheric water vapor through the thermodynamic effect. The results of these simulations are helpful for understanding the mechanism of anthropogenic precipitation changes in mid-latitudes.

Anthropogenic sulfate aerosol pollution in South and East Asia induces increased summer precipitation over arid Central Asia.

Precipitation has increased across the arid Central Asia region over recent decades. However, the underlying mechanisms of this trend are poorly understood. Here, we analyze multi-model simulations from the Precipitation Driver and Response Model Intercomparison Project (PDRMIP) to investigate potential drivers of the observed precipitation trend. We find that anthropogenic sulfate aerosols over remote polluted regions in South and East Asia lead to increased summer precipitation, especially convective and extreme precipitation, in arid Central Asia. Elevated concentrations of sulfate aerosols over remote polluted Asia cause an equatorward shift of the Asian Westerly Jet Stream through a fast response to cooling of the local atmosphere at mid-latitudes. This shift favours moisture supply from low-latitudes and moisture flux convergence over arid Central Asia, which is confirmed by a moisture budget analysis. High levels of absorbing black carbon lead to opposing changes in the Asian Westerly Jet Stream and reduced local precipitation, which can mask the impact of sulfate aerosols. This teleconnection between arid Central Asia precipitation and anthropogenic aerosols in remote Asian polluted regions highlights long-range impacts of anthropogenic aerosols on atmospheric circulations and the hydrological cycle.

Is acne in adolescence associated with prostate cancer risk? Evidence from a meta-analysis.

INTRODUCTION: Previous studies regarding the relationship between acne and prostate cancer risk have reported inconsistent results. We performed the present meta-analysis of observational studies to summarize the evidence on this association. METHODS: A comprehensive literature search up to March 2018 was performed in PubMed, Scopus, Web of Science, and Chinese National Knowledge Infrastructure (CNKI) databases. Summary odds ratios (ORs) with 95% confidence intervals (CIs) were estimated with a random effects model. The Q statistic and the I2 index were used to evaluate the heterogeneity across the studies. RESULTS: Eight studies were ultimately included in this meta-analysis. In the overall analysis, no significant association was found between acne and prostate cancer risk (OR = 1.08, 95% CI 0.93-1.25). A significant heterogeneity was observed across studies (P = 0.006, I2 = 64.5%). In the subgroup analysis by study design, a significant association was observed in the cohort studies (OR = 1.51, 95% CI 1.19-1.93) but not in the case-control studies (OR = 0.98, 95% CI 0.86-1.12). CONCLUSIONS: In summary, this meta-analysis did not find an association between acne in adolescence and prostate cancer risk. However, because there was some heterogeneity in the overall analysis and a significant association was observed in the meta-analysis of the cohort studies, further well-designed large prospective studies are warranted to confirm our results.