Analysis of hemorrhage upon ultrasound-guided percutaneous renal biopsy in China: a retrospective study.

PURPOSE: Ultrasound-guided percutaneous renal biopsy (PRB) has been considered as a golden standard for CKD diagnosis and is employed to identify potential therapeutic targets since 1950s. Post-biopsy hemorrhage is the most common complication, while severe bleeding complication might cause nephrectomy or death. Therefore, how to reduce the occurrence of complications while ensuring the success of PRB is always a clinical research topic. METHODS: This study retrospectively collected and established a renal biopsy database of each patient who underwent ultrasound-guided PRB at a tertiary teaching hospital from September 2017 to December 2020 through the Health Information System. All the data were statistically processed by SPSS software. RESULTS: A total of 1146 patients underwent PRB for various reasons. The overall rate of post-biopsy hemorrhage was 37.70% (432/1146). Of those bleedings, minor bleeding after PRB was found in 337 (29.41%), middle bleeding 84 (7.33%), major bleeding 11 (0.96%). Besides that, there were 96 patients (8.38%) reported their discomfort symptoms. There was no death. Females were at significantly increased risk of hemorrhagic complication than males (OR = 2.017, CI = 1.531-2.658). While the risk for hemorrhagic complication significantly decreased as BMI and platelet before renal biopsy increased (OR = 0.956, CI = 0.924-0.989; OR = 0.998, CI = 0.996-1.000). As the APTT time prolonged, the risk for hemorrhagic complication significantly increased (OR = 1.072, CI = 1.023-1.123). Those patients whose albumin were higher, also had higher risk for hemorrhagic complication than other patients (OR = 1.020, CI = 1.000-1.041). Specifically, postoperative urination within 4 h increased the risk for hemorrhagic complication (OR = 1.741, CI = 1.176-2.576). CONCLUSION: Our analysis finds that the incidence of post-biopsy bleeding complication is 37.70%, and its risk is associated with female, lower BMI, lower platelet before renal biopsy, prolonged APTT, higher albumin, and postoperative urination within 4 h. The findings highlighted the importance of perioperative management for renal biopsy, including adequate risk assessment, tailored careful observation after PRB. And medical staff should pay more attention to fluid management after ultrasound-guided PRB.

Glucocorticoids ameliorate cardiorenal syndrome through the NPR1/SGK1 pathway in natriuretic peptide receptor A­heterozygous mice.

Natriuretic peptides, which are produced by the heart, bind to natriuretic peptide receptor A (NPR1 encoded by natriuretic peptide receptor 1 gene) and cause vasodilation and natriuresis. Thus, they serve an important role in regulating blood pressure. In the present study, microinjection of CRISPR associated protein 9/single guide RNA into fertilized C57BL/6N mouse eggs was performed to generate filial generation zero (F0) Npr1 knockout homozygous mice (Npr1-/-). F0 mice mated with wild-type (WT) mice to obtain F1 Npr1 knockout heterozygous mice with stable heredity (Npr1+/-). F1 self-hybridization was used to expand the population of heterozygous mice (Npr1+/-). The present study performed echocardiography to investigate the impact of NPR1 gene knockdown on cardiac function. Compared with those in the WT group (C57BL/6N male mice), the left ventricular ejection fraction, myocardial contractility and renal sodium and potassium excretion and creatinine-clearance rates were decreased, indicating that Npr1 knockdown induced cardiac and renal dysfunction. In addition, expression of serum glucocorticoid-regulated kinase 1 (SGK1) increased significantly compared with that in WT mice. However, glucocorticoids (dexamethasone) upregulated NPR1 and inhibited SGK1 and alleviated cardiac and renal dysfunction caused by Npr1 gene heterozygosity. SGK1 inhibitor GSK650394 ameliorate cardiorenal syndrome by suppressing SGK1. Briefly, glucocorticoids inhibited SGK1 by upregulating NPR1, thereby ameliorating cardiorenal impairment caused by Npr1 gene heterozygosity. The present findings provided novel insight into the understanding of cardiorenal syndrome and suggested that glucocorticoids targeting the NPR1/SGK1 pathway may be a potential therapeutic target to treat cardiorenal syndrome.

Evaluation of Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis in Southwest China.

The purpose of this study was to determine the diagnostic efficacy of Xpert MTB/RIF assay for rapid diagnosis of Tuberculosis (TB) and detection of rifampicin (RIF) resistance in patients suspected of having EPTB, assessing it against traditional culture and drug susceptibility test (DST) by proportional method, and the ability to predict multidrug resistance TB by Xpert MTB/RIF assay. In this study, the Xpert MTB/RIF assay was applied to 1,614 extrapulmonary specimens. Compared with TB culture and Composite Reference Standard (CRS), the Xpert MTB/RIF assay had a high sensitivity and specificity for detection of EPTB. Depending on the culture method or CRS as the standard, sensitivity of the Xpert MTB/RIF assay for detection of MTB in pleural effusion, cerebrospinal fluid, thoracic drainage fluid and throat swabs specimens were lower than that of other specimens. According to the experimental results, we have reason to believe that Xpert MTB/RIF assay is a rapid and simple technique with high sensitivity and specificity for diagnosing EPTB and detecting drug resistance in variety of specimens. Xpert MTB/RIF assay combined with DST maybe identify more cases of multi-drug resistant tuberculosis (MDR-TB).

Effects of N fertilizer reduction combined with straw biochar application on the yield, Si, and N nutrition of double-cropping rice.

Nitrogen (N) and silicon (Si) are important nutritional elements for rice. However, excessive N fertili-zer application and the ignorance of Si fertilizer are common in practice. Straw biochar is rich in Si, which can be used as a potential Si fertilizer. In this study, we conducted a consecutive 3-year field experiment to explore the effects of N fertilizer reduction combined with straw biochar application on rice yield, Si and N nutrition. There were five treatments: conventional N application (180 kg·hm-2, N100), 20% N reduction (N80), 20% N reduction with 15 t·hm-2 biochar (N80+BC), 40% N reduction (N60), and 40% N reduction with 15 t·hm-2 biochar (N60+BC). The results showed that compared with N100, 20% N reduction did not affect the accumulation of Si and N in rice; 40% N reduction reduced foliar N absorption, but significantly increased foliar Si concentration by 14.0%-18.8%; while combined application of biochar significantly increased foliar Si accumulation, with an increase of Si concentration by 38.0%-63.3% and Si absorption by 32.3%-49.9%, but further reduced foliar N concentration. There was a significant negative correlation between Si and N concentration in mature rice leaves, but no correlation between Si and N absorption. Compared with N100, N reduction or combined application of biochar did not affect soil ammonium N and nitrate N, but increased soil pH. Nitrogen reduction combined application of biochar significantly increased soil organic matter by 28.8%-41.9% and available Si content by 21.1%-26.9%, with a significant positive correlation between them. Compared with N100, 40% N reduction reduced rice yield and grain setting rate, while 20% N reduction and combined application of biochar did not influence rice yield and yield components. In summary, appropriate N reduction and combined with straw biochar can not only reduce N fertilizer input, but also improve soil fertility and Si supply, which is a promising fertilization method in double-cropping rice fields.

Glial cells and neurologic autoimmune disorders.

Neurologic autoimmune disorders affect people's physical and mental health seriously. Glial cells, as an important part of the nervous system, play a vital role in the occurrence of neurologic autoimmune disorders. Glial cells can be hyperactivated in the presence of autoantibodies or pathological changes, to influence neurologic autoimmune disorders. This review is mainly focused on the roles of glial cells in neurologic autoimmune disorders and the influence of autoantibodies produced by autoimmune disorders on glial cells. We speculate that the possibility of glial cells might be a novel way for the investigation and therapy of neurologic autoimmune disorders.

Caregiving burden and positive aspects of caregiving among family caregivers of people living with schizophrenia: Two sides of the same coin.

BACKGROUND: Caring for a family member with schizophrenia is associated with a significant burden, but may also bring about positive transformation among caregivers, which were rarely studied simultaneously. AIMS: The current study aims to investigate the association between caregiver burden and positive aspects of caregiving (PAC), as well as explore and compare the correlates of each. METHODS: A cross-sectional study was conducted on a representative urban sample of schizophrenia family caregivers in China (N = 406). Participants were interviewed individually to complete questionnaires regarding socio-demographics, caregiver burden, PAC, and psychosocial factors that included social support, coping, and family functioning. RESULTS: The caregivers reported moderate levels of both caregiver burden (mean:43.05 ± 18.26, range: 0-88) and PAC (mean: 25.88 ± 9.59, range: 0-36), which were not significantly associated with each other (r = -0.06, p = 0.25) and had different correlates. Parent caregivers, middle and high school education, additional dependents, lower level of social support, and frequent endorsement of active and passive coping were all associated with more caregiver burden. Higher levels of social support, active coping, and family functioning were associated with higher PAC. CONCLUSIONS: Caring for a family member with schizophrenia can be both burdensome and rewarding. Caregiver burden and PAC coexist yet are unrelated with different correlates. Future research and intervention programs should not only focus on mitigating caregiver burden but also enhancing PAC, which may be realized through the improvement of social support, active coping, and family functioning while paying special attention to various socio-demographics.

Personal Recovery and Its Determinants Among People Living With Schizophrenia in China.

Objective: The past few decades have seen an evolution in the understanding of recovery from a clinical-based view that focuses on symptoms and functioning to a more consumer-oriented perspective that focuses on personal recovery. The present study aimed to assess personal recovery among people living with schizophrenia and determine its predictors. Methods: This cross-sectional study recruited a random sample of 400 people living with schizophrenia (PLS) from twelve community health centers of Hunan, China. Recovery was assessed using the short-form 8-item Recovery Assessment Scale (RAS-8). PLS disability and functioning were assessed using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) and the Global Assessment of Functioning (GAF), respectively. Results: Participants had a mean personal recovery score of 20.29 (SD: 9.31, Range: 8-40). Personal recovery was predicted by both socio-demographic and clinical characteristics. Older age (r = -0.17, p < 0.001), being female (r = -2.29, p = 0.019), and higher disability (r = -0.22, p < 0.001) were independently associated with worse personal recovery, while having a college education (r = 5.49, p = 0.002), and higher functioning (r = 0.09, p = 0.017) were independently associated with better personal recovery. Conclusion: Interventions to improve recovery among PLS may be best served by reducing the impact of disability and improving functioning, with targeted interventions for individuals who are older, female and less educated in order to increase their likelihood of recovery.

Test of the stress process model of family caregivers of people living with schizophrenia in China.

Across the world, people living with schizophrenia (PLS) are often cared for by family caregivers. This is especially true in China where community-based systems of care for PLS are underdeveloped. Thus, family caregivers of PLS may experience emotional distress and burden in the absence of community-based services. Pearlin (1990) proposed a highly influential model for understanding the stress process and its relationship to health and wellbeing. Although the model has been examined worldwide, it has yet to be studied in China for caregivers of PLS. In the present study, we use Pearlin's stress process model to examine the mediating effect of perceived caregiver burden, family functioning, and caregivers' positive feelings about caregiving on PLS global functioning and caregiver depressive symptoms. We also examine whether the model differs for parent and spouse caregivers. A total of 327 primary family caregivers of PLS in Hunan province, China, were assessed cross-sectionally using culturally-validated measures. Bootstrap methods with Hayes's PROCESS Macro were used to test multiple mediation models of global functioning scores of PLS and caregiver depressive symptoms. In this first study of the stress process model of family caregivers of PLS in China, the results generally support the model. Caregiver perceived burden, family functioning, and positive caregiver feelings about caregiving all mediate the relationship between PLS global functioning and caregiver depression, with perceived caregiver burden having the strongest indirect effect. Analyses also show that the stress process differs between parent and spouse caregivers, with perceived caregiver burden a mediator for both groups but family functioning only a mediator for parent depressive symptoms. We discuss implications of these findings for extending the stress process model cross-culturally; suggest hypotheses for future research to examine parent and spouse differences; and discuss fruitful directions for intervention.

A cross-sectional study on spouse and parent differences in caregiving experiences of people living with schizophrenia in rural China.

BACKGROUND: Conflicting evidence exists on whether parent or spouse caregivers experience better outcomes when caring for family members with schizophrenia. The current study aims to examine relative caregiving experiences and impacts of spouse and parent caregivers for people living with schizophrenia (PLS) in China. METHODS: A cross-sectional study was conducted in a sample of 264 community-dwelling primary family caregivers of PLS. Face-to-face interviews were conducted to collect information on family caregiving activities; negative caregiving impacts including objective and subjective burden, and caregiver psychological distress such as depression and anxiety; positive caregiving impacts including caregiving rewarding feelings, and family functioning for spouse and parent caregivers. RESULTS: Both types of caregivers report engaging in similar caregiving activities and report comparable levels of objective burden. However, parent caregivers report significantly higher subjective burden than spouse caregivers (b = 7.94, 95%CI:2.08, 13.80, P < 0.01), which is also reflected in significantly higher depression (b = 3.88, 95%CI:1.35, 6.41, P < 0.01) and anxiety (b = 2.53, 95%CI: 0.22, 4.84, P < 0.05), and lower family functioning (b = - 1.71, 95%CI: - 2.73, - 0.49, P < 0.01). Despite these differences, both groups of caregivers report comparable rewarding feelings about caregiving. CONCLUSIONS: Our findings have implications for family caregivers globally, but especially for countries that adhere to Confucian cultural values and provide guidance for future family intervention programs. Such programs may do well to incorporate cultural values and beliefs in understanding caregiving and kinship family dynamics so as to support family caregivers, and in particular, the specific vulnerabilities of parent caregivers.

A comparison of psychometric properties of two common measures of caregiving burden: the family burden interview schedule (FBIS-24) and the Zarit caregiver burden interview (ZBI-22).

PURPOSE: The Family Burden Interview Schedule (FBIS-24) and the Zarit Caregiver Burden Interview (ZBI-22) are among the most widely used measures for assessing caregiving burden, but their psychometric performances have not been compared in the same study of caregivers of people living with schizophrenia (PLS). This is important because the measures assess overlapping constructs- the FBIS-24 assesses objective burden (e.g., completion of manual tasks) and the ZBI-22 assesses subjective burden (e.g., perceived distress, stigma). This study seeks to fill this gap by comparing the reliability and validity of the FBIS-24 and the ZBI-22 in a Chinese community sample of caregivers of PLS. METHODS: A Cross-sectional stud was conducted in a community-based mental health service program in Central South part of China. A total of 327 primary family caregivers of PLS completed face-to-face interviews of the FBIS-24, the ZBI-22, the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder Scale (GAD-7), and the Family Adaptation, Partnership, Growth, Affection and Resolve Index scale (APGAR), and PLS were assessed using the Global Assessment of Function scale (GAF). RESULTS: Our findings show that both the FBIS-24 and ZBI-22 have comparable psychometric performance in terms of the internal consistency, convergent validity and known group's validity. CONCLUSION: Both the FBIS-24 and the ZBI-22 are psychometrically sound measures of caregiving burden but the choice of which measure to use will depend on the research question.