The role of tubulointerstitial markers in differential diagnosis and prognosis in patients with type 2 diabetes and biopsy proven diabetic kidney disease.

OBJECTIVE: To evaluate the potential application of tubularinterstitial biomarkers in the differential diagnosis of diabetic kidney disease (DKD) from non-diabetic kidney disease (NDKD), as well as investigate key clinical and pathological parameters to help improve the stratification of patients according to end-stage renal disease risk. METHODS: 132 type 2 diabetic patients with chronic kidney disease were enrolled. Patients were categorized into 2 groups according to the renal biopsy results: DKD (n = 61) and NDKD (n = 71).The independent factors of the occurrence of DKD and the diagnostic implications of tubular biomarkers were explored by logistic regression and receiver-operating characteristic curve analysis. Furthermore, predictors were analyzed by least absolute shrinkage and selection operator regression, and constructed a new model for predicting the unfavorable renal outcomes through Cox proportional hazard regression analysis. RESULTS: Serum neutrophil gelatinase-associated lipocalin (sNGAL) (OR = 1.007; 95%CI = [1.003, 1.012], p = 0.001) was identified as an independent risk factor for the occurrence of DKD in diabetic patients with CKD. Tubular biomarkers including sNGAL, N-acetyl-ß-D-glucosaminidase and ß2 microglobulin (ß2-MG) could complement albuminuria for DKD detection (AUC = 0.926, specificity = 90.14%, sensitivity = 80.33%).Moreover, among of the 47 variables, 4 predictors such as sNGAL, interstitial fibrosis and tubular atrophy (IFTA)score, ß2-MG and estimated glomerular filtration rate were selected to construct a new model for predicting the unfavorable renal outcomes through regression analysis. sNGAL (HR = 1.004; 95%CI = [1.001, 1.007], p = 0.013), IFTA score of 2 (HR = 4.283; 95%CI = [1.086, 16.881], p = 0.038), and IFTA score of 3 (HR = 6.855; 95%CI = [1.766, 26.610], p = 0.005) were considered to be independent risk factors for unfavorable renal outcomes. CONCLUSIONS: Tubulointerstitial injury in DKD is independently associated with renal function decline and routinely detected tubular biomarkers are able to enhance the level of non-invasive diagnosis of DKD beyond traditional factors.

A new model to predict acute kidney injury after cardiac surgery in patients with renal insufficiency.

OBJECTIVE: To establish a simple model for predicting postoperative acute kidney injury (AKI) requiring renal replacement therapy (RRT) in patients with renal insufficiency (CKD stages 3-4) who underwent cardiac surgery. METHODS: A total of 330 patients were enrolled. Among them, 226 were randomly selected for the development group and the remaining 104 for the validation group. The primary outcome was AKI requiring RRT. A nomogram was constructed based on the multivariate analysis with variables selected by the application of the least absolute shrinkage and selection operator. Meanwhile, the discrimination, calibration, and clinical power of the new model were assessed and compared with those of the Cleveland Clinic score and Simplified Renal Index (SRI) score in the validation group. Results: The rate of RRT in the development group was 10.6% (n = 24), while the rate in the validation group was 14.4% (n = 15). The new model included four variables such as postoperative creatinine, aortic cross-clamping time, emergency, and preoperative cystatin C, with a C-index of 0.851 (95% CI, 0.779-0.924). In the validation group, the areas under the receiver operating characteristic curves for the new model, SRI score, and Cleveland Clinic score were 0.813, 0.791, and 0.786, respectively. Furthermore, the new model demonstrated greater clinical net benefits compared with the Cleveland Clinic score or SRI score. CONCLUSIONS: We developed and validated a powerful predictive model for predicting severe AKI after cardiac surgery in patients with renal insufficiency, which would be helpful to assess the risk for severe AKI requiring RRT.

Anxiety determination by antibody-conjugated nanoparticles on an interdigitated electrode sensor.

This work focused on the detection of cortisol on an interdigitated electrode sensor surface using an anti-cortisol antibody. To improve immobilization, antibodies were conjugated with silver nanoparticles and attached to the surface of the sensor. Cortisol interacted in a dose-dependent manner on the antibody-immobilized sensor surface, and current changes were observed. Linear regression analysis was performed by a 3σ calculation, and the limit of detection fell into the range of 0.01 and 0.1 ng/mL. The sensitivity of cortisol was calculated to be 0.01 ng/mL and the sensor discriminated against other hormones, namely norepinephrine and progesterone, with higher selectivity for cortisol. This result represented the selective detection of cortisol with high performance, which can help to determine anxiety disorders.

Vowel and tone recognition in quiet and in noise among Mandarin-speaking amusics.

Music and language are two intricately linked communication modalities in humans. A deficit in music pitch processing as manifested in the condition of congenital amusia has been related to difficulties in lexical tone processing for both tone and non-tonal languages. However, it is still unclear whether amusia also affects the perception of vowel phonemes in quiet and in noise. In this study, we examined vowel-plus-tone identification in quiet and noise conditions among Mandarin-speaking amusics with and without speech tone difficulties (tone agnosics and pure amusics, respectively), and IQ- and age-matched controls. Overall, pure amusics showed vowel and tone identification comparable to the controls in both quiet and noise conditions. Compared to pure amusics and controls, tone agnosics showed deficits in tone perception in both quiet and noise conditions. More importantly, their vowel perception was lower than pure amusics and controls in noise conditions, e.g., at a signal-to-noise ratio of -4 dB, although they showed normal-like performance in quiet and at a signal-to-noise ratio of -8 dB. These results suggest that when amusia affected speech tone processing (e.g., tone agnosics), it could also compromise vowel processing in noise. However, amusia alone does not affect tone or vowel perception in Mandarin Chinese either in quiet or in noise. Overall, the current study highlights the necessity of taking heterogeneity within the amusic group into account when considering the related speech deficits in this group.

Potential Beneficial Effects of Probiotics on Human Migraine Headache: A Literature Review.

BACKGROUND: Recent studies have shown that migraine headache is often associated with concomitant gastrointestinal diseases. There is a higher prevalence of headaches in patients with gastrointestinal disorders. These associations between migraine and gastrointestinal disorders suggest a potential link to a bidirectional modulation of gut microbiota and brain function. The underlying working mechanistic links between migraine and gastrointestinal diseases may include increased intestinal epithelial permeability and inflammation. OBJECTIVE: This review presents an overview of the relationship between gut microbiota and brain function, especially with regard to migraine headache. STUDY DESIGN: Literature review. SETTING: Anesthesia and Operation Center, Department of Anesthesiology, Chinese PLA General Hospital. METHODS: The present investigation included a PubMed search using the following terms: migraine headache, gut microbiota, brain function, and probiotics. RESULTS: In this literature review, we mainly discussed the relationship between gut microbiota and brain function, especially with regard to migraine headache. The potential effects of probiotics supplement on migraine headache were also included. LIMITATIONS: There is limited evidence from clinical studies of the positive effects of probiotics in patients with migraine headache. Large-scale randomized, placebo-controlled clinical trials are warranted to evaluate the clinical efficacy and safety of probiotics in patients with migraine headache. CONCLUSIONS: Similar to migraine headache, disorders of the brain involving depression and anxiety have been demonstrated to be associated with increased gut permeability. An improvement in gut microbiota and reduction of inflammation can have positive effects on strengthening gut and brain function. Moreover, it can be inferred that probiotics may have a beneficial effect on the frequency and severity of migraine headache attacks. Large-scale randomized, placebo-controlled studies are warranted in the future to evaluate the clinical efficacy and safety of probiotics in patients with migraine headache.Key words: Migraine headache, gut microbiota, brain function, probiotics.