Vascular calcification is an active, adjustable and complex biological process. It is an independent hazard factor for cardiovascular events and there is a lack of effective treatment. As a newly discovered regulated cell death, ferroptosis is closely related to iron metabolism, lipid metabolism, glutathione metabolism and so on. In recent years, studies have shown that ferroptosis may be implicated in the occurrence and progression of vascular calcification. Based on the introduction of ferroptosis, this review will discuss the close relationship between ferroptosis and vascular calcification from intimal calcification, medial calcification and heart valve calcification, in order to provide new ideas for the prevention and treatment of vascular calcification.
ObjectiveTo study and analyze the clinical characteristics, treatment and prognosis of chronic kidney disease (CKD) patients with tuberculosis.MethodsThe cases of CKD with tuberculosis treated in respiratory department, nephrology department and infection department of the Affiliated Hospital of Southwest Medical University during January 2014 to December 2018 and followed up for at least half a year were collected as the study subjects. The clinical characteristics of CKD patients with tuberculosis and to observe the treatment, prognosis and adverse reactions were analyzed.ResultsA total of 74 patients were enrolled in the analysis, including 51 males (68.91%) and 23 females (31.08%), and with a mean age of (52.1±15.5) years. The use rate of immunosuppress drug in CKD G1\G2\G3 stage was very high (100%, 100%, 70%, respectively), and patients in G5 stage had the highest TB infection by 49 cases. There were 58 cases of pulmonary tuberculosis, which was the main form of tuberculosis. Extrapulmonary tuberculosis was very common too, and there were 40 cases including 29 cases of lymph node tuberculosis. Among 53 cases of acid fast bacilli smear, 8 cases were positive; lung biopsy positive in 1; lymph node biopsy was positive in 5 cases; 53 cases were initially treated and 21 cases were retreated. The main symptoms of 74 patients were emaciation (33 cases), fever (30 cases), and fatigue (25 cases); the common symptoms of 58 patients with pulmonary tuberculosis were cough and expectoration (41 cases). Pulmonary tuberculosis mainly infected the upper field of lung (39 cases). The most common imaging features was patchy shadow in 17 cases, followed by single or multiple nodules in 15 cases. The number of cases with lymph node enlargement in drainage area, pleural effusion, and pleural thickening were 36, 34 and 24, respectively. The sensitivity of tuberculosis interferon-gamma release assays (TB-IGRA), tuberculosis polymerase chain reaction (TB-PCR) and Mycobacterium tuberculosis protein chip was 79.6%, 18.8% and 61.7%, respectively. After tuberculosis treatments, 51 cases were successful, 14 cases failed, 5 cases died, and 4 cases could not be evaluated. Sixteen cases had serious and typical adverse reactions, including 12 cases of drug-induced liver injury, and 11 cases of treatment failure due to these serious adverse reactions.ConclusionsThe incidence rate of tuberculosis is high in CKD patients and the clinical manifestations are atypical. Pulmonary tuberculosis is the main form of tuberculosis, extrapulmonary tuberculosis is very common and mainly lymph node tuberculosis. The sensitivity of TB-IGRA, TB-PCR and Mycobacterium tuberculosis protein chip detection are lower than that of common patients. The success rate of tuberculosis treatment in CKD patients is low, the adverse reaction rate is high, and the adverse reactions are the main causes of treatment failure.
Objective To evaluate the efficacy and safety of endoscopic variceal ligation (EVL) versus endoscopic variceal sclerotherapy (EVS) for acute esophageal variceal bleeding in patients with liver cirrhosis.Methods We searched CBMdisc (1979 to 2006), CNKI (1994 to 2006) and VIP for randomized controlled trials (RCTs) and quasi-RCTs comparing EVL and EVS for acute esophageal variceal bleeding patients with liver cirrhosis. The methodogical quality of included trials was critically assessed and the data were extracted by two reviewers, working independently. The Cochrane Collaboration’s RevMan 4.2.7 software was used for meta-analysis. Results Nine RCTs involving a total of 1371 patients were included: 688 in EVL group and 683 in EVS. The meta-analyses showed a significant reduction for mortality [RR 0.60, 95%CI (0.36, 0.98)], and non-significant reductions in complications, rebleeding and emergency hemostasis in the EVL group compared to the EVS group. EVS was non-significantly better than EVL for the rate of eradication varices and recurrent varices. Conclusions For acute esophageal variceal bleeding in patients with liver cirrhosis, EVL has better effect and fewer complications than EVS. However, because the quality of included RCTs was poor, the strength of our conclusions was limited. Further high-quality RCTs are required.
Objective To assess the effectiveness and safety of mycophenolate mofetil (MMF) in the treatment of proliferative lupus nephritis. Methods We searched CBM (November 1979 to February 2006), Chinese Cochrane Centre Database (2005), The Cochrane Library (Issue 4, 2005), MEDLINE (November 1966 to February 2006) and EMBASE (1975 to February 2006) for randomize controlled trials. Data were extracted and analyzed using The Cochrane Collaboration’s RevMan 4.2.7. Results Nine randomize controlled trials involving 512 patients met the inclusion criteria. The meta-analysis showed that the total clinical effective rate and complete remission rate were not significantly higher for MMF than for cyclophosphamide, azathioprine, or both. Renal survival rate and relapse rate of MMF were not significantly different from those for cyclophosphamide, azathioprine, or both. Patient survival rate and safety of MMF were significantly improved compared with cyclophosphamide, azathioprine, or both. Conclusion More large-scale multi-center randomized trials are needed to investigate the role of MMF in the treatment of proliferative lupus nephritis.
Objective To explore the expression and changes of serum irisin in adenine-induced chronic kidney disease (CKD) model, and the role of irisin and related pathway in CKD renal fibrosis. Methods Twenty male SD rats were randomly divided into a control group and a model group (CKD group) using a simple randomization method, with 10 rats in each group. At the end of the 2nd and 4th week, biochemical indicators, serum irisin and serum bone morphogenetic protein 7 (BMP7) levels, renal pathologic changes and interstitial fibrosis of renal tubules were measured in two groups of rats. The protein expression levels and messenger RNA (mRNA) expression levels of alpha-smooth muscle actin (α-SMA), collagen type I (Col-Ⅰ), BMP7, and Smad1 in rat kidney tissue were detected and compared. Results Compared with the control group at the end of the 2nd and 4th week, the CKD group showed that the serum creatinine (Scr), serum urea nitrogen (BUN), and 24-hour urinary protein level were increased (P<0.05), the protein expression levels and mRNA expression levels of α-SMA and Col-Ⅰ were increased (P<0.05), while the serum irisin and serum BMP7 were decreased (P<0.05), the protein expression levels and mRNA expression levels of BMP7 and Smad1 were reduced (P<0.05). Compared with the end of the 2nd week, the CKD group at the end of the 4th week showed that the serum Scr, serum BUN, and 24-hour urinary protein level were increased (P<0.05), the protein expression levels and mRNA expression levels of α-SMA and Col-Ⅰ were increased (P<0.05), while the serum irisin and serum BMP7 were decreased (P<0.05), the protein expression levels and mRNA expression levels of BMP7 and Smad1 were reduced (P<0.05). Compared to the control group, the renal tissue structure of the CKD group showed significant structural disorders and interstitial fibrosis of the renal tissue, which worsened over time. Serum irisin was negatively correlated with α- SMA and Col - Ⅰ (r=−0.917, −0.902, P<0.001) respectively, while serum irisin was positively correlated with serum BMP7 (r=0.842, P<0.001); Kidney tissue BMP7 was positively correlated with Smad1 (r=0.884, P<0.001). The cluster heat map showed that compared with the control group, BMP7 and recombinant fibronectin type Ⅲ domain containing were significantly decreased, α-SMA and Col-Ⅰ were significantly increased in CKD group; recombinant fibronectin type Ⅲ domain containing were positively correlated with BMP7, and negatively correlated with α-SMA and Col-Ⅰ. Conclusions irisin may be involved in the process of renal fibrosis in adenine-induced CKD via the BMP7/Smad1 axis. This will provide new ideas for the prevention and treatment of renal fibrosis.