Yong Xu

Objective: Accurate risk stratification is crucial for personalized management in peritoneal dialysis (PD). This study aimed to develop and validate a novel biomarker, the SII-PNI score, integrating systemic immunoinflammatory index (SII) and prognostic nutritional index (PNI), for personalized mortality risk prediction in PD patients. Methods: A retrospective cohort study analyzed data from 330 patients initiating PD between December 2005 and June 2023 at a single center. Patients were stratified into four risk groups based on median cut-off values for SII and PNI. The association between SII-PNI risk groups and mortality (all-cause, cardiovascular [CVD], infection-related) was assessed using Kaplan-Meier survival analysis and multivariable Cox proportional hazard models. The predictive performance of the SII-PNI score was evaluated using receiver-operating characteristic (ROC) curves and compared to individual components (SII, PNI) and CRP. Random survival forests assessed variable importance. Results: The high-risk group (G4: high SII + low PNI) had the shortest PD duration, highest mortality, and worst survival outcomes. Compared to the low-risk group (G3: low SII + high PNI), G4 had significantly increased risks of all-cause mortality (adjusted HR 3.36, 95% CI 1.93–8.67), CVD mortality (adjusted HR 3.74, 95% CI 2.41–19.60), and infection mortality (adjusted HR 4.32, 95% CI 2.58–20.4) in fully adjusted models. The SII-PNI score demonstrated superior predictive ability (AUC: all-cause 0.80, CVD 0.80, infection 0.81) compared to SII, PNI, or CRP alone. Random survival forests confirmed the critical importance of the individual components (platelets, neutrophils, lymphocytes, albumin) for outcomes. Conclusions: The SII-PNI score, derived from readily available blood parameters, is a powerful and convenient tool for personalized risk stratification in PD. Patients identified as high-risk warrant intensified monitoring and early interventions. This composite biomarker represents a significant step towards personalized and precision medicine in PD care, with potential for implementation in routine clinical practice using standard laboratory data.

Background: While plant protein has been suggested to offer renoprotective benefits, the optimal proportion of dietary plant protein and its relationship with outcomes across different stages of chronic kidney disease (CKD) remains unclear.Methods: Using data from the National Health and Nutrition Examination Survey (NHANES), we examined the association between plant protein ratio and estimated glomerular filtration rate (eGFR) across CKD stages. Plant protein ratio was categorized as low (< 33%), medium (33%–66%), and high (≥ 66%). Multiple imputation was performed for missing data. Weighted linear regression models were used to analyze plant protein ratio-eGFR associations, while Cox proportional hazards models assessed mortality risk. Dose-response relationships were evaluated using restricted cubic splines.Results: Among 16,163 participants, distinct patterns emerged across CKD stages. In Non-CKD, high plant protein ratio was associated with significantly higher eGFR compared to low plant protein ratio (β = 0.790, P = 0.039). In CKD G4, medium plant protein ratio showed significantly higher eGFR (β = 1.791, P = 0.025) compared to low plant protein ratio. For mortality risk, CKD G3 patients with medium plant protein ratio demonstrated significantly lower risk (HR = 0.67, 95% CI: 0.44–1.00, P = 0.047) compared to low plant protein ratio. Dose-response analyses revealed stage-specific patterns: U-shaped relationships in early CKD, transitioning to inverted U-shaped and J-shaped patterns in advanced stages.Conclusion: The association between plant protein ratio and outcomes varies across CKD stages, suggesting the need for stage-specific dietary recommendations. While moderate plant protein intake might be beneficial in early CKD, our findings in advanced stages were largely non-significant and require confirmation in larger studies before clinical recommendations can be made. These findings support a more nuanced approach to dietary protein source management in CKD, though further prospective studies are needed to confirm these associations.

Protein-energy wasting (PEW) is a major contributor to the high mortality among maintenance hemodialysis (MHD) patients. Cardiovascular disease (CVD) is the leading cause of death in dialysis patients, and PEW can significantly increase cardiovascular mortality in MHD patients. Previous studies have confirmed that PA may be a good objective indicator for determining the nutritional status and prognosis of MHD patients. Our study aimed to determine the predictive value of phase angle (PA) as detected by bioelectrical impedance analysis (BIA) on PEW and cardiovascular (CV) risk among MHD patients. Our retrospective observational study involved 161 adult patients with HD. The Cardiovascular risk score is a risk model based on the Japan Dialysis Outcome and Practice Patterns Study (J-DOPPS). We established LASSO logistic regression analysis model to identify key parameters related to body composition that can predict PEW in MHD patients. The area under the curve (AUC) values for PA, appendicular skeletal muscle mass index (ASMI), body cell mass (BCM), and mid-arm circumference (MAC) in predicting PEW in male MHD patients were relatively large, with 0.708, 0.674, 0.663, and 0.735, respectively. The predicted PEW values of these parameters were slightly lower in female patients than in men. We incorporated PA, ASMI, BCM, and MAC into a model that predicted the incidence of PEW in maintenance hemodialysis patients using LASSO technology. We discovered that the model predicted a greater AUC of PEW occurrence than any single factor, 0.877 for men and 0.76 for women. The results of the univariate logistic regression analysis showed that the low PA tertile array group had a greater incidence of PEW than the high PA group (P < 0.001). Additionally, we also found that lower PA was associated with higher CV risk scores. The PA detected by bioelectrical impedance analysis could predict the risk of PEW and cardiovascular events among patients with MHD. When used in conjunction, PA, ASMI, BCM, and MAC have a high diagnostic efficacy for PEW in patients on maintenance hemodialysis.

Ethnopharmacological relevance: As a representative classical prescription, Sijunzi decoction has powerful therapeutic effects on spleen–stomach qi insufficiency. Ulcerative colitis (UC) is a chronic, diffuse, and non-specifically inflammatory disorder, the etiology of which still remains unclear. In the traditional Chinese medicine (TCM) perspective, splenic asthenia is the primary cause of UC. Based on this, Sijunzi decoction has been extensively used in TCM clinical practice to alleviate UC in recent years. However, the pharmacological mechanism of Sijunzi decoction in modern medicine is still not completely clear, which limits its clinical application.Aim of the study: The purpose of this study was to investigate the Sijunzi decoction’s curative effect on acute UC mice and probe into its potential pharmacological mechanism.Materials and methods: The UC mouse model was set up by freely ingesting a 3% dextran sulfate sodium (DSS) solution. The relieving role of Sijunzi decoction on UC in mice was analyzed by evaluating the changes in clinical parameters, colon morphology, histopathology, inflammatory factor content, intestinal epithelial barrier protein expression level, and gut microbiota balance state. Finally, multivariate statistical analysis was conducted to elucidate the relationship between inflammatory factors, intestinal epithelial barrier proteins, and gut microbiota.Results: First, the research findings revealed that Sijunzi decoction could visibly ease the clinical manifestation of UC, lower the DAI score, and attenuate colonic damage. Moreover, Sijunzi decoction could also significantly inhibit IL-6, IL-1β, and TNF-α while increasing occludin and ZO-1 expression levels. Subsequently, further studies showed that Sijunzi decoction could remodel gut microbiota homeostasis. Sijunzi decoction was beneficial in regulating the levels of Alistipes, Akkermansia, Lachnospiraceae_NK4A136_group, and other bacteria. Finally, multivariate statistical analysis demonstrated that key gut microbes were closely associated with inflammatory factors and intestinal epithelial barrier proteins.Conclusion: Sijunzi decoction can significantly prevent and treat UC. Its mechanism is strongly associated with the improvement of inflammation and intestinal epithelial barrier damage by regulating the gut microbiota.

Introduction: According to reports, obesity has a significant impact on bone health. And the weight-adjusted-waist index (WWI), superior to BMI and waist circumference (WC), is a new obesity indicator arising in recent years. This research investigated the relationship between WWI and total bone mineral density (BMD) for adults aged 20 to 59.Methods: Using data from the 2011–2018 NHANES, we looked into the independent link between WWI and total BMD as well as its nonlinearity using weighted multiple linear regression and smooth curve fitting. Two-stage linear regression models were employed to calculate the threshold effects. There were additional subgroup analyses and testing for interactions.Results: Multiple linear regression studies on a total of 10,372 individuals showed a significant inverse link between WWI and total BMD in adults between 20 and 59 [β = -0.04, 95% CI: (-0.04, -0.03), P0.05). In addition, we found a nonlinear relationship between WWI and total BMD in diabetic and CKD patients, for which the saturation point was 11.38 cm/√kg in the CKD patient group and 10.29 cm/√kg in the diabetic patient group.Conclusion: Our analysis demonstrated a significant inverse association between WWI and total BMD in adults aged 20-59.

In patients with diabetes mellitus, the urinary microalbumin-to-urine creatinine ratio (UACR) can not only predict the occurrence of diabetic nephropathy but also can be a risk factor for cardiovascular disease and renal function damage. Current studies on subclinical hypothyroidism (SCH) and UACR are mainly cross-sectional studies, and the results suggest that SCH is an independent risk factor for UACR. To further explore the longitudinal effect of SCH on UACR, we carried out this study. This was a retrospective cohort study including 46 patients with type 2 diabetes mellitus and SCH in the Department of Endocrinology, The Affiliated Huai’an Hospital of Xuzhou Medical University from January 2013 to April 2018. At the same time, 96 patients with type 2 diabetes mellitus and euthyroid were chosen according to 1:2 approximately matched with age, sex and duration of diabetes mellitus. Univariate analysis, stratified analysis, and multiple linear regression analysis were used to investigate the effect of SCH on ΔUACR(ΔUACR = UACR after 1 year - baseline UACR) in patients with type 2 diabetes mellitus. There was no significant difference between the baseline UACR, (p > 0.05). However, the ΔUACR was significantly higher in SCH group than euthyroid group, as shown by univariate analysis, stratified analysis and multiple linear regression analysis (β:-1.071, 95% CI: − 1.713--0.428), and the difference was statistically significant (all p < 0.05). SCH is associated with an increased UACR in type 2 diabetes mellitus patients. It is necessary to screen for thyroid function in type 2 diabetes mellitus and increase the follow-up frequency of UACR in patients with SCH.

In chronic infection and cancer, T cells gradually become exhausted because of the persistent stimulation by antigens. In this process, the overexpression of multiple inhibitory receptors is induced, the production of effective cytokines decreases and the cytotoxicity and proliferation of T cells impairs, all contributing to the failure of T cells in fighting against cancer. Reversing T-cell exhaustion is a promising immunotherapy for cancer that has yielded encouraging results. In this review, we discuss the genomic and epigenomic landscape of T-cell exhaustion in cancer. Also, we introduce the relevant therapeutic interventions for T-cell exhaustion in clinical trials.