Objective
To appraise the quality of guidelines on intravenous iodinated contrast media (ICM) use in patients with kidney disease, and to compare the recommendations among them.
Methods
We searched ...four literature databases, eight guideline libraries, and ten homepages of radiological societies to identify English and Chinese guidelines on intravenous ICM use in patients with kidney disease published between January 2018 and June 2023. The quality of the guidelines was assessed with the Scientific, Transparent, and Applicable Rankings (STAR) tool.
Results
Ten guidelines were included, with a median STAR score of 46.0 (range 28.5–61.5). The guidelines performed well in “Recommendations” domain (31/40, 78%), while poor in “Registry” (0/20, 0%) and “Protocol” domains (0/20, 0%). Nine guidelines recommended estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m
2
as the cutoff for referring patients to discuss the risk-benefit balance of ICM administration. Three guidelines further suggested that patients with an eGFR < 45 mL/min/1.73 m
2
and high-risk factors also need referring. Variable recommendations were seen in the acceptable time interval between renal function test and ICM administration, and that between scan and repeated scan. Nine guidelines recommended to use iso-osmolar or low-osmolar ICM, while no consensus has been reached for the dosing of ICM. Nine guidelines supported hydration after ICM use, but their protocols varied. Drugs or blood purification therapy were not recommended as preventative means.
Conclusion
Guidelines on intravenous ICM use in patients with kidney disease have heterogeneous quality. The scientific societies may consider joint statements on controversial recommendations for variable timing and protocols.
Critical relevance statement
The heterogeneous quality of guidelines, and their controversial recommendations, leave gaps in workflow timing, dosing, and post-administration hydration protocols of contrast-enhanced CT scans for patients with kidney diseases, calling for more evidence to establish a safer and more practicable workflow.
Key points
• Guidelines concerning iodinated contrast media use in kidney disease patients vary.
• Controversy remains in workflow timing, contrast dosing, and post-administration hydration protocols.
• Investigations are encouraged to establish a safer iodinated contrast media use workflow.
Graphical Abstract
The use of a noncontact photoalignment method to fabricate in‐plane optical structures, defined by the local uniaxial ordering of liquid crystalline conjugated polymer chains, is reported. Molecular ...orientation is demonstrated for both green‐light‐emitting fluorene‐benzothiadiazole alternating copolymer F8BT and F8BT/red light emitting complex copolymer Red‐F binary blend films deposited on a well‐known azobenzene sulphonic dye photoalignment material SD1. Absorption anisotropy ratios of up to 9.7 are readily achieved for 150 nm thickness F8BT films. Spatial pattern definition, afforded by masking the UV polarized light exposure of the photoalignment layer, allows the fabrication of optical structures with a resolution down to the micron scale. The alignment process is further extended to enable the serial, independent orientation of films deposited on top of each other and to permit the molecular orientation to follow curvilinear patterns. In the former case, this allows F8BT bilayer structures to be fabricated that show even higher absorption anisotropy ratios, up to ≈12, close to the theoretical limit for the previously deduced ≈22° optical transition dipole moment angle relative to the chain axis.
Spatial patterning, with linear and curvilinear features and linewidths down to ≈3 µm, is achieved with both chain oriented F8BT and a F8BT/Red F blend using SD1 as a photoalignment material. The chain‐oriented areas show strong optical anisotropies, allowing the fabrication of both single‐ and multi‐layer liquid crystalline conjugated polymer optical structures.
Two dimensional (2D) boron nitride (h-BN) nanosheets are well known as their tunable electric properties and well compatible with graphene. Studying the dielectric properties carefully is essential ...for their promised applications. Most previous first principle studies treated 2D h-BN as a strict 2D system, where the contribution of ion polarization is neglected. The results show obvious deviation from experimental values, and the situations are worse with the stacking layer increasing. Thus, in present works, the dielectric properties of 2D h-BN nanosheets are studied with involving the ion contributions appropriately. The evolution of dielectric performance with stacking layers varying is also studied. Obvious layer dependent anisotropic dielectric properties are predicted, which reaches the bulk h-BN level as the thickness approaching 5.8nm (20L). There should be a balance between dielectric properties and the thickness (stacking layers) for the dielectric applications of 2D h-BN nanosheets.
Ulcerative colitis (UC) is an unknown-cause inflammatory disease of colorectum. At present, there are no specific therapeutic drugs. We found that rosmarinic acid (RA) can significantly improve UC ...and further explored the relevant cellular and molecular mechanisms. Firstly, using F4/80 as marker for mouse macrophages, we found there were large numbers of macrophages infiltrating into colonic tissue of dextran sulfate sodium (DSS)-induced mice UC model. Meanwhile, RA markedly improved weight loss, diarrhea, hematochezia and colonic inflammation in mice with DSS treatment. Further, RA changed macrophage polarization in mouse colon, showing that classical activation (M1) phenotype decreased, alternative activation (M2) phenotype increased, and M1/M2 ratio reversed by Real-time PCR. In vitro, we cultured the peripheral blood macrophages (PBM) and found that RA inhibited PBM M1 polarization and favored M2 polarization directly. Heme oxygenase-1 (HO-1) mediated the anti-inflammatory effect of RA. RA induced HO-1 expression in PBM, and the HO-1 inhibitor, zinc protoporphyrin, blunted the inhibitory effect of RA on lipopolysaccharide (LPS)-induced nuclear factor-kappa B (NF-κB) translocation and M1 polarization. In addition, blocking NF-κB signal has no effect on the role of RA. In conclusion, RA protects against UC by regulating macrophage polarization depending on HO-1. These data suggest that reversing macrophage polarization can be used as a strategy for UC treatment and RA is an effective drug to cure UC by regulating macrophage polarization.
To investigate the safety and efficacy of dual antithrombotic regimen of warfarin and clopidogrel in patients who underwent coronary stenting and were with chronic oral anticoagulation.
Two ...investigators independently searched Pubmed, Embase and Cochrane for all reported studies, and yielding 6 articles, published before April 2015, enrolling 4 825 patients, follow-up for at least 12 months. Two investigators independently recorded the data regarding interventions and the occurrence of major bleeding, ischemic stroke, myocardial infarction and death. RevMan5.3 was used to do analysis.
Patients on dual antithrombotic regimen had insignificant reduction in major bleeding (odds ratioORwas 0.73, 95% confidence intervalCIwas from 0.46 to 1.14, and P=0.16) as compared with triple therapy. While the risk of ischemic stroke (OR= 0.78, 95%CI:0.44-1.38, P=0.39), myocardial infarction (OR= 1.19, 95%CI:0.92-1.53, P=0.18) and the overall incidence of death (OR=0.95, 95%CI:0.56-1.60, P=0.84) were also comparable betwee
BioH is one of the key enzymes to produce the precursor pimeloyl-ACP to initiate biotin biosynthesis de novo in bacteria. To date, very few bioH genes have been characterized. In this study, we ...cloned and identified a novel bioH gene, bioHx, from an environmental metagenome by a functional metagenomic approach. The bioHx gene, encoding an enzyme that is capable of hydrolysis of p-nitrophenyl esters of fatty acids, was expressed in Escherichia coli BL21 using the pET expression system. The biochemical property of the purified BioHx protein was also investigated.
Screening of an unamplified metagenomic library with a tributyrin-containing medium led to the isolation of a clone exhibiting lipolytic activity. This clone carried a 4,570-bp DNA fragment encoding for six genes, designated bioF, bioHx, fabG, bioC, orf5 and sdh, four of which were implicated in the de novo biotin biosynthesis. The bioHx gene encodes a protein of 259 aa with a calculated molecular mass of 28.60 kDa, displaying 24-39% amino acid sequence identity to a few characterized bacterial BioH enzymes. It contains a pentapeptide motif (Gly76-Trp77-Ser78-Met79-Gly80) and a catalytic triad (Ser78-His230-Asp202), both of which are characteristic for lipolytic enzymes. BioHx was expressed as a recombinant protein and characterized. The purified BioHx protein displayed carboxylesterase activity, and it was most active on p-nitrophenyl esters of fatty acids substrate with a short acyl chain (C4). Comparing BioHx with other known BioH proteins revealed interesting diversity in their sensitivity to ionic and nonionic detergents and organic solvents, and BioHx exhibited exceptional resistance to organic solvents, being the most tolerant one amongst all known BioH enzymes. This ascribed BioHx as a novel carboxylesterase with a strong potential in industrial applications.
This study constituted the first investigation of a novel bioHx gene in a biotin biosynthetic gene cluster cloned from an environmental metagenome. The bioHx gene was successfully cloned, expressed and characterized. The results demonstrated that BioHx is a novel carboxylesterase, displaying distinct biochemical properties with strong application potential in industry. Our results also provided the evidence for the effectiveness of functional metagenomic approach for identifying novel bioH genes from complex ecosystem.
With the population aging and declining incidence of rheumatic heart disease, calcific aortic valve disease (CAVD) has become the most frequent valve disease and the common cause of aortic valve ...replacement. Patients with CAVD need to cope with a deteriorating quality of life and valve replacement is the only effective clinical option for the patients. Therefore, early pharmacotherapy is of great significance in prevention or slow-down of the progression of CAVD. For years CAVD was considered to be a passive wear and tear process of valves, but now it is recognized as an active and multi-factorial process. Histopathologic studies have revealed that inflammation, disorder of calcium and phosphorus metabolism and dyslipidemia are involved in the process of CAVD. Clinical trials of CAVD pharmacotherapy have been carried out based on those histopathologic studies. Statin, renin-angiotensin inhibitors and anti-osteoporosis drug are well studied in recent years. This article reviews the recent research progress of
Mixtures of model lipid systems containing high‐melting and low‐melting lipid classes were crystallized and microscope images obtained for analysis of crystal morphology and microstructure. ...Rheological properties of these semisolid systems were tested by use of a texture analyzer. The nature of the highmelting component in a mixture dominated the crystal morphology and, combined with interactions between crystalline and liquid materials, resulted in different microstructures that influenced the rheological properties. In addition to size, shape, and amount (solid fat content) of crystalline material, the crystal packing density, representing how densely the crystalline particles in every level (individual, aggregate, or floc) were arranged, and the nature (or strength) of the link (or bridge) connecting the crystalline particles were important microstructural factors to determine rheological properties. Depending on different crystal packing densities and linking bridges, two different systems were identified in terms of microstructure type—mobile and immobile—in which the relative mobility of microstructural components had different levels. These mobility levels led to different rheological responses.
Background and Purpose
Muscle protein catabolism in patients with diabetic nephropathy (DN) results in striking loss of muscle proteins, which increases morbidity and mortality risks. Evidence shows ...that short‐chain fatty acids (SCFAs) play an important role in health maintenance and disease development. Recently, the connection between butyrate (a SCFA) and DN has been revealed, although the relationship between butyrate and muscle atrophy remains unclear.
Experimental Approach
We studied changes in serum butyrate levels in DN patients using metabolomic analyses. In db/db mice, protective effects of butyrate on DN‐induced muscle atrophy. were explored. Inhibition of muscle atrophy by butyrate and the underlying mechanism(s) were studied in C2C12 cells exposed to high glucose/lipopolysaccharide (HG/LPS).
Key Results
Butyrate levels in DN patients were significantly decreased. In db/db mice, supplementing normal diet with butyrate improved intestinal barrier function. Concurrently, butyrate alleviated muscle atrophy, promoted PI3K/Akt/mTOR signalling, and suppressed oxidative stress and autophagy in skeletal muscle of db/db mice, and in HG/LPS‐exposed C2C12 cells. Further, FFA2 receptors, key components of SCFA signalling, were decreased in skeletal muscle of db/db mice and in HG/LPS‐exposed C2C12 cells. Overexpression of FFA2 receptors activated PI3K/Akt/mTOR signalling and inhibited oxidative stress and autophagy in HG/LPS‐exposed C2C12 cells. Silencing of FFA2 blocked PI3K/Akt/mTOR signalling that was improved by butyrate, as well as the suppression of oxidative stress and reduction of autophagy.
Conclusion and Implication
Butyrate exerts protective effects on muscle atrophy induced by DN by enhancing intestinal barrier function and activating the FFA2 receptor‐mediated PI3K/Akt/mTOR pathway.
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