A Combined Scoring Method Based on 18F-FDG PET/CT for Distinguishing Spinal Infection From Malignancy.

STUDY DESIGN: Retrospective study. OBJECTIVE: This study aimed to explore the additional value of fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for the detection of early-stage and atypical spinal infections and to find the best combination of indicators from laboratory and imaging systems for higher diagnostic efficiency. SUMMARY OF BACKGROUND DATA: Diagnosis of early-stage and atypical spinal infections may be challenging for clinicians. It is particularly important to distinguish spinal infection from malignancy to develop a timely treatment strategy and avoid unnecessary biopsy or surgery. MATERIALS AND METHODS: All patients with a discharge diagnosis of spinal infection or malignancy who underwent 18F-FDG PET/CT scans before spinal biopsy between January 1, 2014, and July 30, 2021, were included. Laboratory and imaging data were assessed. A receiver operating characteristic (ROC) curve was created, and the best cut-off point and cumulated area under the curve (AUC) were obtained to distinguish between spinal infection and malignancy. Kappa values were used to assess the agreement between the 18F-FDG PET/CT and MRI findings. Binary logistic regression was used to screen for statistically significant indicators and imaging findings. RESULTS: A total of 71 patients with confirmed spinal infections (n=30) or malignancies (n=41) were included in this study. Elevated ESR and significantly elevated tumor biomarkers or positive FLCs assay were significantly different between the two groups. In addition to the total lesion glycolysis of the involved vertebral bodies derived from 18F-FDG PET/CT, four imaging findings (consecutive multilevel vertebral lesions, intervertebral disc, vertebral arch, and extraspinal involvement) also showed significant differences between the two groups (P≤0.010). A combined scoring method based on the above seven indicators was designed with an overall classification accuracy of 95.2%, and it identified all patients with spinal infections (100%, 28/28). In addition, moderate-to-excellent agreement could be reached for the involvement of intervertebral discs, paravertebral soft tissues, and vertebral arches derived from MRI and18F-FDG PET/CT. CONCLUSIONS: The combined scoring method based on 18F-FDG PET/CT provided excellent overall accuracy in distinguishing spinal infections from malignancies. This approach may prove useful for patients with MRI contraindications or with equivocal results following laboratory tests or traditional imaging when there is high suspicion for spinal infections or malignancy.

Correlations of peripheral blood neutrophil-lymphocyte ratio and lymphocyte-monocyte ratio with renal function and prognosis in patients with lupus nephritis.

OBJECTIVE: To explore the correlations of neutrophil-lymphocyte ratio (NLR) and lymphocyte-monocyte ratio (LMR) with renal function and prognosis in patients with lupus nephritis (LN). METHODS: A total of 115 patients with LN (research group) admitted to the Second Affiliated Hospital of Shandong First Medical University during January 2018 and January 2021 and 60 healthy controls (control group) who concurrently underwent physical examination were included in this study. Peripheral blood NLR and LMR were recorded in both arms. According to the estimated glomerular filtration rate (eGFR) at admission, patients with LN were assigned to a normal renal function group and a renal insufficiency group to compare their NLR and LMR values. Further, the cases were divided into good and poor prognosis groups based on the follow-up results, and the NLR and LMR were observed. Pearson test was used to analyze the relationship between NLR, LMR, and eGFR. Independent risk factors for poor prognosis of renal function were analyzed by multivariate logistic analysis. RESULTS: The cases showed higher NLR and lower LMR than the controls (P<0.001). The NLR was lower in patients with normal renal function than in those with renal insufficiency (P<0.001). Patients with poor prognosis presented with significantly higher NLR and lower LMR than those with good prognosis (P<0.001). In cases, eGFR decreased with the increase of NLR, presenting an inverse association (r=-0.572, P<0.001). eGFR increased as the LMR increased, showing a positive correlation (r=0.582, P<0.001). Multivariate logistic analysis identified that infection, hypoproteinemia, moderate or above lupus disease activity, high NLR, and low LMR were independent risk factors for poor prognosis in LN. CONCLUSIONS: Peripheral blood NLR and LMR are plausible biologic indicators to predict renal function and prognosis in patients with LN.

Liraglutide promotes autophagy by regulating the AMPK/mTOR pathway in a rat remnant kidney model of chronic renal failure.

BACKGROUND: We aimed to determine whether the glucagon-like peptide-1 receptor (GLP-1R) agonist liraglutide (LRG) could ameliorate renal function through promoting autophagy via regulating the AMPK/mTOR pathway in a rat remnant kidney model of chronic renal failure. METHODS: Rats were divided into four groups (n = 10 per group) as follows: (1) sham, (2) nephrectomy (NPX), (3) LRG control (LRG control), and (4) LRG treatment (LRG). Except for rats in the sham group, all rats underwent 5/6 nephrectomy surgery to establish a remnant kidney model of chronic renal failure. In addition, rats in LRG group received LRG as a subcutaneous injection at a dose of 10 mg/kg (once daily) for 4 consecutive weeks, whereas rats in the LRG control group received treatment similar to that of rats in the LRG group, except saline was used instead of LRG. After 4 weeks of treatment, serum creatinine (Scr), blood urea nitrogen (BUN), and urinary albumin excretion were determined. Immunofluorescence assay, immunoprecipitation assay, and Western blot analysis were performed to evaluate the AMPK/mTOR pathway expression of proteins. RESULTS: Nephrectomized rats (including rats in the NPX, LRG control, and LRG groups) showed higher levels of the Scr, BUN, and urinary albumin excretion, as well as down-regulation of GLP-1R, LC3-II, and AMPK phosphorylation, and up-regulation of mTOR phosphorylation when compared with rats in the sham group. However, those changes were blocked by liraglutide. CONCLUSION: Liraglutide may promote autophagy through regulating the AMPK/mTOR pathway to exert renoprotective effects in a rat remnant kidney model of chronic renal failure.

Fractal features of soil particle size distributions and their potential as an indicator of Robinia pseudoacacia invasion1.

To study the fractal dimensions of the soil particle size distributions (PSDs) within different plantations (of Pinus densiflora, Quercus acutissima, Robinia pseudoacacia, and Larix kaempferi) and evaluate PSDs as an indicator of the likelihood of Robinia pseudoacacia invasion, the soil porosity of 0-20 cm soil layers was measured at different plantations in the Yaoxiang Forest Farm, Shandong Province, China. The results showed that the fractal dimension (Dm) values varied from 2.59 to 2.70 among the different plantations and were significantly negatively correlated to sand content and positively correlated to silt content and clay content. Significant negative correlations were observed between Dm and both soil organic matter (SOM) (P < 0.05) and available phosphorus (P < 0.01). The multifractal entropy dimension (D1) and entropy dimension/capacity dimension (D1/D0) parameters were not significantly correlated with SOM, although significant correlations were found between SOM and each of D0, Δα, and Δf(α). Compared with the other plantations, the Robinia pseudoacacia plantation had higher nutrient contents, higher D0 and D1 values and lower Dm values. Based on principal component analysis (PCA) ordination, we concluded that Robinia pseudoacacia and Pinus densiflora shared a similar habitat and that Robinia pseudoacacia is more likely to invade Pinus densiflora plantations for soil.

Benazepril hydrochloride improves diabetic nephropathy and decreases proteinuria by decreasing ANGPTL-4 expression.

BACKGROUND: This study aimed to investigate the effects of benazepril hydrochloride (BH) on proteinuria and ANGPTL-4 expression in a diabetic nephropathy (DN) rat model. METHODS: A total of 72 Wistar male rats were randomly divided into three groups: normal control (NC), DN group and BH treatment (BH) groups. The DN model was induced by streptozotocin (STZ). Weight, glucose, proteinuria, biochemical indicators and the kidney weight index were examined at 8, 12 and 16 weeks. In addition, ANGPTL-4 protein and mRNA expressions were assessed by immunohistochemistry and qRT-PCR, respectively. Relationships between ANGPTL-4 and biochemical indicators were investigated using Spearman analysis. RESULTS: Weight was significantly lower but glucose levels were significantly higher in both the DN and BH groups than in the NC group (P < 0.05). Compared with the DN group, proteinuria, urea, creatinine, triglycerides and total cholesterol levels were decreased, whereas the albumin level was increased after BH treatment (all P < 0.05). Furthermore, BH diminished kidney volume and ameliorated the pathological changes associated with DN. ANGPTL-4 expression was significantly decreased after BH treatment, and ANGPTL-4 expression was highly correlated with biochemical indicators of DN (P < 0.05). CONCLUSIONS: Benazepril hydrochloride improves DN and decreases proteinuria by decreasing ANGPTL-4 expression.

Prevalence of chronic kidney disease and associated factors among the Chinese population in Taian, China.

BACKGROUND: This study was designed to assess the prevalence of chronic kidney disease (CKD) and associated risk factors among the Chinese population in Taian, China. METHODS: A primary care-based cross-sectional study was conducted in Taian, China, from September to December 2012. Participants selected by a multi-stage stratified cluster sampling procedure were interviewed and tested for hematuria, albuminuria, estimated glomerular filtration rate (eGFR) and other clinical indices. Factors associated with CKD were analyzed by univariate and multivariate logistic regression analysis. RESULTS: A total of 14,399 subjects were enrolled in this study. The rates of hematuria, albuminuria and reduced eGFR were 4.20%, 5.25% and 1.89%, respectively. Approximately 9.49% (95% CI: 8.93%-10.85%) of the participants had at least one indicator of CKD, with an awareness of 1.4%. Univariate analyses showed that greater age, body mass index, and systolic and diastolic blood pressure; higher levels of serum creatinine, uric acid, fasting blood glucose, triglycerides, total cholesterol and low-density lipoprotein cholesterol; and lower eGFR were associated with CKD (p < 0.05 each). Multivariate analysis showed that age, female gender, educational level, smoking habits, systolic blood pressure, and history of diabetes mellitus, hyperlipidemia, hypercholesterolemia and hyperuricemia were independent risk factors for CKD. CONCLUSIONS: The prevalence of CKD in the primary care population of Taian, China, is high, although awareness is quite low. Health education and policies to prevent CKD are urgently needed among this population.