Search

The cell wall mechanical properties are an important indicator for evaluating the overall mechanical properties of natural bamboo fibers. Using the nanoindentation technique, the variation of the mechanical properties of the fiber cell wall of Bambusa pervariabilis culms with different ages and different positions (both radial and longitudinal) was studied. Moreover, x-ray diffraction (XRD) was employed to measure the microfibril angle (MFA), and the correlation between the MFA and the mechanical properties of the fiber cell wall. The results showed that there was a remarkable difference in the fiber cell wall mechanical properties at different ages and at different radial and longitudinal positions. However, at different ages and at different positions, the absolute value of variation of MFA was less than 1° and was very minor. Furthermore, there was no significant correlation between the fiber cell wall mechanics and MFA, indicating that the mechanical property of the fiber cell walls might be synergistically affected by many factors.

Water exists in lignocellulosic materials throughout the whole process from the plant growth to raw materials processing and utilization. The fiber saturation point (FSP) is the inflection point of the physical and mechanical properties of lignocellulosic materials and has an important influence on their physical and mechanical properties. This paper investigates the FSP of Calamus simplicifolius by the low-field nuclear magnetic resonance (LF-NMR) method and two conventional methods including the saturated salt solution method and dynamic vapor sorption (DVS) method. The average FSP values determined by the LF-NMR method, the saturated salt solution method and the DVS method are 38.15%, 32.54% and 28.96%, respectively. The study showed that the FSP values determined by the LF-NMR method were higher than those determined by the two conventional methods. The two conventional methods are simple and cost-effective and are able to directly measure whether the rattan properties are changing with moisture content. From the thermodynamics standpoint, even within the ideal solution limit, free water is present at relative humidity (RH) of less than 100%. Therefore, extrapolation to 100% RH was not strictly correct. The amount of water in rattan in different states could be quantified by the LF-NMR method, and the FSP value was determined by the ratio of the measurements above and below the water melting point. Furthermore, the LF-NMR method is faster and non-destructive compared to the two conventional methods.

Objective: To investigate whether serum bisphenol A (BPA) concentration is related to the occurrence of dyslipidemia. Methods: A total of 574 adults were enrolled at baseline and followed up for 5 years. Concentrations of serum BPA, triglycerides (TGs), low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein (HDL) cholesterol were measured. Dyslipidemia was defined as the existence of one or more of the following conditions: high-LDL-cholesterolemia (LDL ≥140 mg/dL), hypertriglyceridemia (TGs ≥150 mg/dL), or low-HDL-cholesterolemia (HDL

Background A total of 44.7% adults in China have hypertension, but the prevalence of primary aldosteronism (PA) in Chinese hypertensive patients is unknown. Objectives This study prospectively investigated the prevalence, characteristics, and outcomes of PA in newly diagnosed hypertensive patients. Methods In a large community health center, consecutive hypertensive patients with an aldosterone-renin ratio >20 ng/mIU and plasma aldosterone concentration >10 ng/dl underwent captopril challenge test and/or saline infusion test for confirmation of PA. Adrenal computed tomography scan and adrenal vein sampling were used for subtyping. PA patients treated with surgery or medication were followed up for 1 year, and outcomes after treatment were evaluated. Results In total, 1,020 newly diagnosed hypertensive patients were screened over 16 months, of whom 40 were diagnosed with PA, 948 with non-PA, 32 with probable PA, resulting in a prevalence of more than 4.0%. Compared with non-PA, PA patients more frequently displayed microalbuminuria (p = 0.031), but the incidence of cardiovascular events was not different (p = 0.927). For surgically treated patients (n = 7), a complete biochemical success rate was 100% and a complete clinical success rate was 85.7%. For medically treated patients (n = 29), the proportion with optimal blood pressure control was 79%, and among them, 91% (21 of 23) only needed 1 antihypertensive drug: the mineralocorticoid receptor antagonist. Conclusions The prevalence of PA in patients with newly diagnosed hypertension in China was at least 4%. PA screening in newly diagnosed hypertensive patients leads to good clinical outcomes. (Primary Aldosteronism In Hypertensive Patients in China [PA-China]; NCT03155139)

Density (D) and moisture content (MC) are two important physical properties of wood and bamboo, which are highly correlated with many other physical and mechanical properties. In this study, the X-ray computed tomography (CT) technique was used to determine the D and MC of poplar (Populus xiangchengensis) and bamboo (Phyllostachys edulis). There was a statistically significant difference in the CT-measured numbers for D and MC between these species. The D-CT and MC-CT linear models for both species were independently established: Dpoplar = 0.00098 × H + 1.02603, Dbamboo = 0.00118 × H + 0.98684, MCpoplar = 0.00309 × H + 1.89982, and MCbamboo = 0.00131 × H + 0.31488, where H is the CT number. The determination coefficients, R2, of the models were all higher than 0.97. Additionally, the R2 values obtained for model validation were also all higher than 0.97. These results indicated that it is feasible to reliably determine D and MC of wood and bamboo using the X-ray CT technique. This study aims to provide reference data for CT detection of the D and MC of wood and bamboo.

N6-methyladenine (N6-mA) of DNA is an emerging epigenetic mark in mammalian genome. Levels of N6-mA undergo drastic fluctuation during early embryogenesis, indicative of active regulation. Here we show that the 2-oxoglutarate-dependent oxygenase ALKBH1 functions as a nuclear eraser of N6-mA in unpairing regions (e.g., SIDD, Stress-Induced DNA Double Helix Destabilization regions) of mammalian genomes. Enzymatic profiling studies revealed that ALKBH1 prefers bubbled or bulged DNAs as substrate, instead of single-stranded (ss-) or double-stranded (ds-) DNAs. Structural studies of ALKBH1 revealed an unexpected “stretch-out” conformation of its “Flip1” motif, a conserved element that usually bends over catalytic center to facilitate substrate base flipping in other DNA demethylases. Thus, lack of a bending “Flip1” explains the observed preference of ALKBH1 for unpairing substrates, in which the flipped N6-mA is primed for catalysis. Co-crystal structural studies of ALKBH1 bound to a 21-mer bulged DNA explained the need of both flanking duplexes and a flipped base for recognition and catalysis. Key elements (e.g., an ALKBH1-specific α1 helix) as well as residues contributing to structural integrity and catalytic activity were validated by structure-based mutagenesis studies. Furthermore, ssDNA-seq and DIP-seq analyses revealed significant co-occurrence of base unpairing regions with N6-mA in mouse genome. Collectively, our biochemical, structural and genomic studies suggest that ALKBH1 is an important DNA demethylase that regulates genome N6-mA turnover of unpairing regions associated with dynamic chromosome regulation.

This research aimed to investigate the compressive fracture behavior and the compressive strength parallel to the grain in relation to moisture contents (MC) below and above the fiber saturation point (FSP) in Calamus simplicifolius cane. FSP of the rattan was investigated using a dynamic vapor sorption (DVS) apparatus, and the fracture behaviors of compression parallel to grain were analyzed by three-dimensional X-ray microcomputed tomography. The study indicated that the value of FSP derived from the DVS method was 25 percent. The average compressive strength parallel to the grain was found to be 39 MPa at 3 percent MC, 30 MPa at 10 percent MC, 17 MPa at 12 percent MC, 12 MPa at 27 percent MC, and 10 MPa at 45 percent MC. The strains of the yield and densification stage were prolonged with increasing MC, whereas the stress in the linear elastic stage decreased with increasing MC. The cracks of the rattan core and the deflection angle at higher MC were larger than that of low MC. Below the FSP, the compressive failure of the rattan showed a shear band oriented around 45° to the loading axis, and the surface was rough. Above the FSP, the rattan samples showed brooming failure. The interface among fiber bundles was delaminated and the fiber surface in the failure area was smooth. The fracture toughness of the rattan was higher than that of wood, which suggests that the rattan might be more suitable for modeling and curved materials.

The anatomical characteristics of culms in Bambusa pervariabilis bamboo at different ages and heights were investigated by microscopy and image analysis. Among the two vascular bundle types found in culms, the broken-waist type was considered typical, with the following measurements: average proportion of fibrous tissue, 41.53 percent; length, 1.75 mm; slenderness ratio, 117; and Runkel ratio, 4.00. These values were close to those of the moso bamboo (Phyllostachys edulis), which is commercially relevant in China. Age and height significantly influenced the anatomical characteristics of B. pervariabilis: with an increase in age, both the length and double-wall thickness of the fiber gradually increased, whereas its lumen diameter decreased. The width of vascular bundles and the length, width, double-wall thickness, and lumen diameter of fiber markedly decreased from the bottom to the top. Therefore, B. pervariabilis is an ideal raw material for pulping and papermaking, and its performance is close to that of moso bamboo.

Context The saline infusion test (SIT) is a common confirmatory test for primary aldosteronism (PA). According to the guideline, a postinfusion plasma aldosterone concentration (PAC) of 5-10 ng/dL is considered indeterminate, and recommendations for diagnostic strategies are currently limited in this situation. Objective To explore whether an addition of the captopril challenge test (CCT) could improve the diagnostic accuracy in patients with indeterminate SIT. Methods A total of 280 hypertensive patients with high risk of PA completed this study. Subjects were defined as SIT indeterminate based on their PAC post-SIT. These patients then underwent the CCT where PACs post-CCT >11 ng/dL were considered positive. Using fludrocortisone suppression test (FST) as the reference standard, diagnostic parameters including area under the receiver-operator characteristic curves (AUC), sensitivity and specificity were calculated. Results There were 65 subjects (23.2%) diagnosed as PA indeterminate after SIT. With the addition of CCT, true-positive numbers increased from 134 to 147, and false-negative numbers decreased from 27 to 14. Compared to SIT alone, a combination of SIT and CCT showed a higher AUC (0.91 [0.87,0.94] vs 0.87 [0.83,0.91], P = .041) and an increased sensitivity for the diagnosis of PA (0.91 [0.86,0.95] vs 0.83 [0.76,0.89], P = .028), while the specificity remained similar. In the subgroup with indeterminate SIT results, using PAC post-CCT resulted in a 36% higher AUC than using PAC post-SIT alone for the diagnosis of PA. Conclusion For patients under investigation for possible PA who have indeterminate SIT results, an addition of CCT improves the diagnostic accuracy.

Density and moisture content (MC) are two of the most important wood performance indexes, which are highly correlated with many other physical and mechanical properties of wood. X-ray computed tomography (X-CT) technology was used to analyze the difference in the CT number of the heartwood and sapwood of Chinese white poplar (Populus tomentosa) and Masson pine (Pinus massoniana) under different MC. Additionally, the fitted models of CT number-density and CT number-MC were established and validated for the heartwood and sapwood of P. tomentosa and P. massoniana. The methodological improvement has been described in detail regarding the established models, which are contrasted and discussed with previous models. The results showed that the CT number-density fitted models of the heartwood and sapwood of P. tomentosa and P. massoniana adopted the linear model: $$ D = k \times H + b $$, where D is the density, H is the CT number, k is the slope, and b is the intercept. R2 values obtained in the validation models were all higher than 0.98, indicating that the CT number-density fitted models can reliably predict wood density. The CT number-MC fitted models for the heartwood and sapwood of P. tomentosa and P. massoniana adopted the logarithmic model: $$ M = \ln ((a + b \times H)^{100} ) $$, where M is the MC, H is the CT number, and a and b are the correlation coefficients in the model. R2 values obtained in the validation models were all higher than 0.95, indicating that this model is valid for the accurate prediction of wood MC. The fitted model parameters of heartwood and sapwood indicated that the X-CT technology was effective for identifying the difference in density and MC of heartwood and sapwood. Therefore, it is feasible to use non-destructive testing technology when studying density and MC of heartwood and sapwood based on X-CT technology. The study results provide reference data for the non-destructive testing of wood properties and reasonable utilization.

The vascular bundle is an important structural unit that determines the growth and properties of bamboo. A high-resolution X-ray microtomography (μCT) was used to observe and reconstruct a three-dimensional (3D) morphometry model of the vascular bundle of the Qiongzhuea tumidinoda node due to its advantages of quick, nondestructive, and accurate testing of plant internal structure. The results showed that the morphology of vascular bundles varied significantly in the axial direction. In the cross-section, the number of axial vascular bundles reached a maximum at the lower end of the sheath scar, and the minimum of it was at the middle of the diaphragm. The frequency of axial vascular bundles decreased from the lower end of the node to the nodal ridge, and subsequently increased until the upper end of the bamboo node. The proportion of parenchyma, fibers, and conducting tissue was 65.7%, 30.5%, and 3.8%, respectively. The conducting tissues were intertwined to form a complex 3D network structure, with a connectivity of 94.77%. The conducting tissue with the largest volume accounted for 60.26% of the total volume of the conducting tissue. The 3D-distribution pattern of the conducting tissue of the node and that of the fibers were similar, but their thickness changed in the opposite pattern. This study revealed the 3D morphometry of the conducting tissue and fibers of the bamboo node, the reconstruction of the skeleton made the morphology more intuitive. Quantitative indicators such as the 3D volume, proportion, and connectivity of each type of tissue was obtained, the bamboo node was enlarged mainly caused by the particularly developed fibers. This work laid the foundation for a better understanding of the mechanical properties and water transportation of bamboo and revealed the mystery of bamboo node shedding of Q. tumidinoda.

Chinese hamster ovary (CHO) cells are known not to express appreciable levels of the sialic acid residue N-glycolylneuraminic acid (NGNA) on monoclonal antibodies. However, we actually have identified a recombinant CHO cell line expressing an IgG with unusually high levels of NGNA sialylation (30%). Comprehensive multi-OMICs based experimental analyses unraveled the root cause of this atypical sialylation: (1) expression of the cytidine monophosphate-N-acetylneuraminic acid hydroxylase (CMAH) gene was spontaneously switched on, (2) CMAH mRNA showed an anti-correlated expression to the newly discovered Cricetulus griseus (cgr) specific microRNA cgr-miR-111 and exhibits two putative miR-111 binding sites, (3) miR-111 expression depends on the transcription of its host gene SDK1, and (4) a single point mutation within the promoter region of the sidekick cell adhesion molecule 1 (SDK1) gene generated a binding site for the transcriptional repressor histone H4 transcription factor HINF-P. The resulting transcriptional repression of SDK1 led to a downregulation of its co-expressed miR-111 and hence to a spontaneous upregulation of CMAH expression finally increasing NGNA protein sialylation.

BackgroundAdrenocorticotropic hormone (ACTH) is widely used in adrenal vein sampling (AVS) and can be administered as a bolus injection or continuous infusion. The optimal administration method has not been determined. We aimed to compare the effects of ACTH bolus with infusion on cannulation success, lateralization assessment and adverse events (AEs).MethodsRetrospectively collected data from patients with primary aldosteronism who underwent AVS with ACTH at a tertiary hospital in China. Rate of successful cannulation, lateralization index (LI), complete biochemical remission and AEs related to AVS were analyzed.ResultsThe study included 80 patients receiving ACTH bolus and 94 receiving infusions. The rate of successful cannulation was comparable between bolus and infusion groups (75/80, 93.4% vs 88/94, 93.6%). In those with successful cannulation, the bolus group had a higher selectivity index than the infusion group, while LI [6.4(1.8-17.5) vs. 7.6(2.0-27.8), P=0.48] and rate of complete biochemical remission (43/44, 97.7% vs 53/53, 100%, P=0.45) did not significantly differ between the two groups. One in the bolus and one patient in the infusion group had adrenal vein rupture but they recovered with conservative treatment. The bolus group reported more transient AEs such as palpitation (52.9% vs 2.2%) and abdominal discomfort (40.0% vs 2.2%) than the infusion group.ConclusionsDue to their similar effects on cannulation success and lateralization, but a lower rate of transient AEs in the infusion group, the continuous infusion method should be recommended for ACTH stimulation in AVS.

Surfaces with nanostructure patterning are broadly encountered in nature, and they play a significant role in regulating various phenomena such as phase transition at the liquid/solid interface. Here, we designed two kinds of template substrates with periodic nanostructure patterns [i.e., nanotrench (NT) and nanopore (NP)]. Surface nanodroplets produced on these nanostructure surfaces were characterized to acquire their morphology and wetting properties. We show that nanostructure patterning could effectively regulate the shape, contact radius, and nucleate site of nanodroplets. While nanodroplets on the NT structure are constrained in one dimension, nanodroplets on the NP structure have enhanced the wetting property with constraints from two dimensions. Further numerical analysis indicates that the morphology and contact angles of nanodroplets on the NT structure depend on the substrate wettability and the droplet volume. These observations demonstrate how physical geometry and chemical heterogeneity of a substrate surface affect the growth and spreading of surface nanodroplets, which deepens our understanding on nanoscale phase separation.

ObjectivesPrimary aldosteronism (PA) is characterized by the autonomous excessive production of aldosterone in the adrenal cortex. Aldosterone is associated with damages to heart muscle and skeletal muscle. The purpose of this study was to evaluate serum levels of muscle injury markers and their associated factors in patients with primary aldosteronism.MethodsWe retrospectively enrolled subjects with PA and essential hypertension (EH) who had completed testing for serum high sensitivity troponin T (hs-TnT), creatine kinase isoenzyme MB (CK-MB) and myoglobin from the database of the Chongqing Primary Aldosteronism Study (CONPASS). Univariate and multivariate linear regression analyses were performed to analyze the influencing factors of myocardial injury markers.ResultsIn total, 278 patients with PA and 445 patients with EH were enrolled in this study. Compared with EH patients, serum concentrations of hs-TnT [7.0 (4.0–12.0) vs. 6.0 (3.0–11.0) ng/L; p=0.005] and myoglobin [24.2 (21.0–38.1) vs. 21.8 (21.0–31.9) μg/L; p=0.023] were significantly higher among PA patients, while no significant difference of CK-MB was found between two groups [1.4 (1.0–2.0) vs. 1.3 (0.9–1.9) μg/L; p=0.154]. Univariate linear regression analysis showed that myoglobin was negatively correlated with serum potassium (β=-0.31; ppppConclusionsThe serum level of myoglobin was significantly increased in PA patients, and myoglobin was independently correlated with plasma aldosterone concentration.

Angiotensin receptor blockers (ARBs) and sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been used as the standard therapy for patients with diabetic kidney disease (DKD). However, how these two drugs possess additive renoprotective effects remains unclear. Here, we conducted single-cell RNA sequencing to profile the kidney cell transcriptome of db/db mice treated with vehicle, ARBs, SGLT2i, or ARBs plus SGLT2i, using db/m mice as control. We identified 10 distinct clusters of kidney cells with predominant proximal tubular (PT) cells. We found that ARBs had more anti-inflammatory and anti-fibrotic effects, while SGLT2i affected more mitochondrial function in PT. We also identified a new PT subcluster, was increased in DKD, but reversed by the treatments. This new subcluster was also confirmed by immunostaining of mouse and human kidneys with DKD. Together, our study reveals kidney cell-specific gene signatures in response to ARBs and SGLT2i and identifies a new PT subcluster, which provides new insight into the pathogenesis of DKD.

Context Current guidelines recommend adrenal venous sampling (AVS) to identify unilateral primary aldosteronism (UPA) before offering adrenalectomy. However, AVS is costly and technically challenging, limiting its use to expert centres. Objective To establish a model to predict UPA and therefore bypass the need for AVS prior to surgery. Design and Setting: The model was developed in a Chinese cohort and validated in an Australian cohort. Previously published prediction models of UPA were also tested. Participants: PA patients with a definite subtyping diagnosis based on AVS and/or surgery. Main Outcome Measure: Diagnostic value of the model. Results In the development cohort (268 UPA and 88 bilateral PA), combinations of different levels of low serum potassium (≤3. 0 or 3.5mmol/L), high PAC (≥15-30ng/dL), low PRC (≤2.5-10μIU/mL) and presence of unilateral nodule on adrenal CT (>8-15mm in diameter) showedspecificity of 1. 00 and sensitivity of 0.16-0.52. The model of serum potassium≤3.5mmol/l, PAC≥20 ng/dL, PRC≤5μIU/mL plus a unilateral nodule≥10mmhad the highest sensitivity of 0.52(0.45-0.58) and specificity of 1. 00(0.96-1. 00). In the validation cohort (84 UPA and 117 bilateral PA), the sensitivity and specificity of the model were 0.13(0. 07-0.22) and 1. 00(0.97-1. 00), respectively. Ten previous models were tested, and only one had a specificity of 1. 00 in our cohorts, but with a very low sensitivity [0. 07(0. 04-0.10) and 0. 01(0. 00-0. 06) in our development and validation cohorts, respectively]. Conclusions A combination of high PAC, low PRC, low serum potassium and unilateral adrenal nodule could accurately determine PA subtype in 13-52% of patients with UPA and obviate the need for AVS before surgery. Presentation: No date and time listed

The three-dimensional electrode biological aerated filter (3DE-BAF) has the potential to overcome inherent limitations of conventional electrochemical and biofilm methods. Electrochemical means could enhance the performance and sustainability of biofilm technologies and stimulate the spread of new applications in (waste) water treatment. This paper describes the construction and performance of 3DE-BAF in the treatment of simulated wastewater represented by tetracycline (TC). This is followed by a discussion of electrode performance, the electron transport mechanism and the electrode's effect on the biological community of 3D-EBAF. Given the gap between experimental studies and practical applications, the enlarged anode 3DE-BAF named 3DEAE-BAF reactor was applied with good results to duck farm wastewater. This study could provide guidance as to developing new methods to construct a highly stable 3DE-BAF. The paper concludes that improved 3DE-BAF technology is promising for advanced treatment of livestock wastewater containing antibiotics.

SummaryOverlapping coding regions balance selective forces between multiple genes. One possible division of nucleotide sequence is that the predominant selective force on a particular nucleotide can be attributed to just one gene. While this arrangement has been observed in regions in which one gene is structured and the other is disordered, we sought to explore how overlapping genes balance constraints when both protein products are structured over the same sequence. We use a combination of sequence analysis, functional assays and selection experiments to examine an overlapped region in HIV-1 that encodes helical regions in both Env and Rev. We find that functional segregation occurs even in this overlap, with each protein spacing its functional residues in a manner that allows a mutable non-binding face of one helix to encode important functional residues on a charged face in the other helix. Additionally, our experiments reveal novel and critical functional residues in Env and have implications for the therapeutic targeting of HIV-1.

We report a metasurface device based on nano metal-dielectric-metal plasmon cavity arrays. Investigation of the proposed device indicates the sharp absorption peak of double Fano resonance and multiple periods of time-domain oscillations caused by the three-dimensional double resonance. By adjusting the structure parameters, different absorption patterns can be regulated independently with high degree of freedom. The metasurface exhibits sensitive behavior to the environmental refractive index and possesses the sensitivity of 667 nm RIU-1 as a refractive index sensor in the mid-near infrared band, which can be further considered for glucose or temperature sensing.

Electro-biological particle electrode (EBPE) prepared by lithium slag was used to remove salicylic acid in a three-dimensional electrocatalytic biological coupling reactor (3D-EBCR). The physical and chemical properties of the EBPE, the removal performance of salicylic acid and the degradation mechanism were studied. Results revealed as follows: (1) the EBPE prepared by lithium slag contained effective catalytic components including Fe2O3, SnO2, ZnO, MnO, Rb2O and TiO2, with stable structure and good adsorption performance; (2) the 3D-EBCR with EBPE had strong adaptability to the current intensity in the range of 0.25-0.40 A, and the removal rates of COD and salicylic acid were maintained above 87.1% and 85.2% respectively; (3) salicylic acid was removed through the synergistic action of adsorption, electrochemical oxidation and biological action.

The combination of surface densification and superheated steam treatment is an effective method to improve the mechanical properties and dimensional stability of low-density wood. The objective of the current work is to evaluate the effects of superheated steam treatment on the micromechanical behavior of surface densified wood. The microstructure, chemical composition, cellulose crystalline structure, and micromechanical behavior of surface densified wood under different superheated steam pressures were investigated. Results indicated that both 0.1 MPa and 0.3 MPa superheated steam treatments increased the elastic modulus and hardness of fiber cell walls in surface densified wood. However, the average creep ratio and maximum creep compliance J(50) of surface densified wood under 0.3 MPa decreased by 41.59% and 6.76%, respectively, compared with untreated wood. The improvement of elastic modulus, hardness and creep resistance of surface densified wood treated with superheated steam was associated with the increase of relative crystallinity (CrI) and crystalline size. In addition, 0.3 MPa superheated steam treatment displayed a better effect on the enhancement of the elastic modulus, hardness, and creep resistance of the fiber cell wall than 0.1 MPa superheated steam treatment.

In the past ten years, big data technology Internet technology has become more and more available in the education market. At the same time, the public and the government are paying more and more attention to ideological and political education, which has led to the explosive growth and massive agglomeration of data such as global education literature. In order to integrate ideological and political education literature data, we used a literature retrieval platform for retrieval and applied data mining and other big data technologies. Data from Clarivate Analytics Web of Science (WOS) and the database called China National Knowledge Infrastructure from the journal, Chinese Social Sciences Citation Index (CNKI CSSCI), which do not index preprints, were assessed. Our estimates indicate that 981 documents from WOS and 1247 documents from CNKI CSSCI. Publications include research articles, early access, abstracts, reviews and editorials. For example, among the 1,247 documents in WOS, research articles accounted for 93.782%, early access accounted for 4.077%, and the rest were abstracts, editorials, comments, etc. This article provides a snapshot that briefly introduces the development of ideological and political education literature in the past 10 years to understand the development of ideological and political education.

Lignin is the major components limiting enzymatic hydrolysis and normally removed by acidified sodium chlorite in laboratory. However, the information on delignification kinetics and selectivity at cellular level as the reaction proceeds is limited. In this work, the dynamic removal of lignin and its monolignol in different cell types of poplar were visualized in real time by confocal Raman microscopy. At the initial stage, substantial reduction in lignin concentration was observed especially in cell corner and compound middle lamella of fiber, but the removal rate slowed down in the following process. Delignification was highly cell-selective that the vessel was the most resistant to delignification followed by ray and then by fiber. Besides, the removal behavior of lignin monomers in ray varied significantly with vessel and fiber. In the whole process, the syringyl units was more prone to being removed than guaiacyl units. This information could lead to a better understanding of the delignification process of lignocellulosic biomass by chlorite treatment.

To assess the diagnostic performance of the H-score of 11β-hydroxylase (CYP11B1) and aldosterone synthase (CYP11B2) in the histopathological diagnosis of adrenocortical tumors (ACT). We retrospectively evaluated 199 cases of ACT, of which 85 were diagnosed as aldosterone-producing adenoma (APA), 66 as cortisol-producing adenoma (CPA), 9 as aldosterone–cortisol co-secreting adenoma, 30 as nonhyperfunctioning adenoma, and 9 as adrenocortical carcinoma (ACC). Immunohistochemical staining was performed using anti-CYP11B1 and anti-CYP11B2 monoclonal antibodies. The staining was quantified by the McCarty’s H-score system. The diagnostic performance was assessed by the receiver operating characteristic curve (ROC). The H-score of CYP11B1 is highest in the CPA group and lowest in the ACC group. The H-score of CYP11B2 in the APA group is significantly higher than other ACT groups. The area under ROC (AUC) of an increased H-score of CYP11B2 (>65) for the diagnosis of APA was 0.971 (95%CI 0.937–0.990). The AUC of an increased H-score of CYP11B1 (>204) for the diagnosis of CPA was 0.725 (95%CI 0.658–0.786). The AUC of a decreased H-score of CYP11B1 (

Bisphenol-A (BPA) is a common environmental pollutant, and exposure to it is associated with proteinuria and may predict the progression of chronic kidney disease; however, the mechanism is not clear. Neutrophil extracellular traps (NETs) are a DNA skeleton coated with various proteases, and it is associated with various types of autoimmune nephritis. In this study, we examine whether NETs is involved in BPA-induced chronic kidney injury. In vivo, BPA exposure resulted in impaired renal function and altered renal morphology, including glomerular mesangial matrix expansion and increased renal interstitial fibroblast markers. Meanwhile, more dsDNA can be detected in the serum, and the NETs-associated proteins, MPO and citH3 were deposited in the renal system. In vitro, BPA and NETs treatment caused podocyte injury, a loss of marker proteins and disorder in the actin skeleton. After NETs inhibition via DNase administration, BPA-induced injuries were significantly relieved. In conclusion, the increase of NETosis in circulation and the renal system during BPA exposure suggests that NETs may be involved in BPA-induced chronic kidney injury.

X-ray free-electron lasers (XFELs) play an increasingly important role in addressing the new scientific challenges relating to their high brightness, high coherence and femtosecond time structure. As a result of pulse-by-pulse fluctuations, the pulses of an XFEL beam may demonstrate subtle differences in intensity, energy spectrum, coherence, wavefront, etc., and thus on-line monitoring and diagnosis of a single pulse are required for many XFEL experiments. Here a new method is presented, based on a grating splitter and bending-crystal analyser, for single-pulse on-line monitoring of the spatial characteristics including the intensity profile, coherence and wavefront, which was suggested and applied experimentally to the temporal diagnosis of an XFEL single pulse. This simulation testifies that the intensity distribution, coherence and wavefront of the first-order diffracted beam of a grating preserve the properties of the incident beam, by using the coherent mode decomposition of the Gaussian–Schell model and Fourier optics. Indicatively, the first-order diffraction of appropriate gratings can be used as an alternative for on-line monitoring of the spatial properties of a single pulse without any characteristic deformation of the principal diffracted beam. However, an interesting simulation result suggests that the surface roughness of gratings will degrade the spatial characteristics in the case of a partially coherent incident beam. So, there exists a suitable roughness value for non-destructive monitoring of the spatial properties of the downstream beam, which depends on the specific optical path. Here, experiments based on synchrotron radiation X-rays are carried out in order to verify this method in principle. The experimental results are consistent with the theoretical calculations.

Objective Saline infusion test (SIT), captopril challenge test (CCT), fludrocortisone suppression test (FST) and oral sodium loading test (SLT) are recommended by the Endocrine Society's Clinical Practice Guidelines to diagnose primary aldosteronism, but which one is the best remains controversial. We aimed to summarize the available comparative data and evaluate the diagnostic accuracy of these four tests. Design We searched PubMed, Embase and the Cochrane Library for relevant studies published between January 1980 and January 2018. Patients Eligible studies reported on the accuracy of one or more of the four confirmatory tests in patients suspected of PA. Measurements Two reviewers independently conducted the data extraction of all selected studies, which consisted of study characteristics and data to estimate the summary receiver operating characteristic (SROC) curve and the corresponding summary area under the curve (SAUC), pooled sensitivity and specificity, diagnostic odds ratios (DOR) with 95% confidence interval (CI). Results We identified 26 articles including 3686 patients. Fifteen articles evaluated the diagnostic accuracy of CCT, 10 of SIT, 1 of FST and none of SLT. For CCT, the SAUC was 0.9207, and the pooled sensitivity and specificity were 0.87 (95% CI: 0.84-0.89) and 0.84 (95% CI: 0.81-0.86), respectively. For SIT, the SAUC was 0.9232, and the pooled sensitivity and specificity were 0.85 (95% CI: 0.82-0.87) and 0.87 (95% CI: 0.85-0.89), respectively. For FST, the pooled sensitivity and specificity were 0.87 (95% CI: 0.66-0.97) and 0.95 (95% CI: 0.82-0.99), respectively. Overall, we found no significant differences in the diagnostic accuracy of CCT and SIT. Conclusions CCT and SIT exhibit high and comparable accuracy for diagnosing PA. CCT may be a more feasible alternative as it is safe and much easier to perform.

A series of molecular glass compounds (SP-BOC, SP-AD, and SP-BU) based on 9,9′-spirobifluorene backbone with different kinds of pendant groups (t-butyloxycarbonyl, adamantyl ester, and t-butyl este...

The goal of this research was to develop a new process for simultaneously removing organics and heavy metals of electroplating wastewater by in-situ ion exchange electrocatalysis biological coupling (i-IEEBC). The study evaluated the removal efficiency of coexisting refractory organics and heavy metal ions, and investigated the effects of current density (CD) on the removal performance of the i-IEEBC method. The results indicated the i-IEEBC reactor exhibited higher average removal rates of COD, TOC, Cr and Cu ions, i.e. 87.23%, 80.42%, 91.25%, and 95.97% in that order, which represented an increase by 32.59%, 40.10%, 31.86%, and 33.82%, respectively, compared with BAF. The optimum CD for simultaneously removing organics and heavy metals of electroplating wastewater in i-IEEBC was 0.40 mA/(cm)2. The change of biodegradability and the presence of short chain organic compounds also indirectly confirmed the excellent removal organic pollutants performance of i-IEEBC at the optimum CD. In addition, the composition and construction of CER before and after the application, under the optimum CD, SEM, EDS and FT-IR spectroscopy also showed that the cation exchange properties of CER improved the catalytic lifetime of the particle electrodes. This research provides a highly efficient new alternative to electroplating wastewater treatment technology.

A new spatially coherent beamline has been designed and constructed at the Shanghai Synchrotron Radiation Facility. Here, the design of the beamline is introduced and the spatial coherence is analyzed throughout the whole process by wave optics. The simulation results show good spatial coherence at the endstation and have been proven by experiment results.

Summary Objective The euglycemic‐hyperinsulinemic clamp is the gold standard to evaluate insulin resistance (IR), but there are only a few studies on the prevalence of IR in Chinese Han women with polycystic ovary syndrome (PCOS). This study investigated: (a) the prevalence of IR in Chinese Han women with PCOS by clamp, (b) the degree of reduction in insulin sensitivity (IS) and the contribution of body mass index (BMI). Design Retrospective cross‐sectional analysis. Patients Chinese Han women with PCOS (n = 448) visiting the Department of Endocrinology or the Department of Obstetrics and Gynaecology of the First Affiliated Hospital of Chongqing Medical University. Chinese Han women without PCOS (controls) from the same area (n = 40). Measurements Clamp‐measured IS, age, BMI, and total testosterone. Results The prevalence of IR and reduction in IS were 56.3% and 30.3%, respectively, in Chinese Han women with PCOS (both P 0.05). Conclusions 56.3% of Chinese Han women with PCOS had IR and their reduction in IS was 30.3%. Obesity exacerbated the reduction in IS. When being evaluated by HOMA, the prevalence and the risk factors of IR in Chinese women with PCOS were underestimated.

A novel hybrid method that combines the laser-focused atomic deposition (LFAD) and extreme ultraviolet (EUV) interference lithography has been introduced. The Cr grating manufactured by LFAD has advantages of excellent uniformity, low line edge roughness and its pitch value determined directly by nature constants (i.e. self-traceable). To further enhance the density of the Cr grating, the EUV interference lithography with 13.4 nm wavelength was employed, which replicated the master Cr grating onto a Si wafer with its pitch reduced to half. In order to verify the performance of the gratings manufactured by this novel method, both mask grating (Cr grating) and replicated grating (silicon grating) were calibrated by the metrological large range scanning probe microscope (Met.LR-SPM) at Physikalisch-Technische Bundesanstalt (PTB). The calibrated results show that both gratings have excellent short-term and long-term uniformity: (i) the calibrated position deviation (i.e. nonlinearity) of the grating is below ±1 nm; (ii) the deviation of mean pitch values of 6 randomly selected measurement locations is below 0.003 nm. In addition, the mean pitch value of the Cr grating is calibrated as 212.781 ± 0.008 nm (k = 2). It well agrees with its theoretical value of 212.7787 ± 0.0049 nm, confirming the self-traceability of the manufactured grating by the LFAD. The mean pitch value of the Si grating is calibrated as 106.460 ± 0.012 nm (k = 2). It corresponds to the shrinking factor of 0.500 33 of the applied EUV interference lithographic technique. This factor is very close to its theoretical value of 0.5. The uniform, self-traceable gratings fabricated using this novel approach can be well applied as reference materials in calibrating, e.g. the magnification and uniformity of almost all kinds of high resolution microscopes for nanotechnology.

Supplemental material, sj-pdf-1-jra-10.1177_14703203211003781 for Cardiovascular events and all-cause mortality in surgically or medically treated primary aldosteronism: A Meta-analysis by Ying Jing, Kangla Liao, Ruolin Li, Shumin Yang, Ying Song, Wenwen He, Kanran Wang, Jun Yang, Qifu Li and Jinbo Hu in Journal of the Renin-Angiotensin-Aldosterone System

Wavelength-sized microdisk resonators were fabricated on a single crystalline 4H-silicon-carbide-oninsulator platform (4H-SiCOI). By carrying out microphotoluminescence measurements at room temperature, we show that the microdisk resonators support whispering-gallery modes (WGMs) with quality factors up to $5.25 \times 10^3$ and mode volumes down to $2.69 \times(\lambda /n)^3$ at the visible and near-infrared wavelengths. Moreover, the demonstrated wavelength-sized microdisk resonators exhibit WGMs whose resonant wavelengths compatible with the zero-phonon lines of spin defects in 4H-SiCOI, making them a promising candidate for applications in cavity quantum electrodynamics and integrated quantum photonic circuits., Comment: 5 pages, 4 figures

Objective. It has been increasingly appreciated that G protein-coupled estrogen receptor 1 (GPER1) mediates both proinflammatory and anti-inflammatory response of estrogen. It is also involved in some rapid vascular effects of aldosterone in a mineralocorticoid receptor (MR) independent manner. However, whether GPER1 mediates aldosterone-induced inflammation response in endothelial cells and its relationship with MR are yet undetermined and therefore require further explanation. Method. Based on the hypothesis that GPER1 plays a role in the aldosterone-related vascular inflammation, the present study utilized a model of human umbilical vein endothelial cells transfected with MR siRNA and induced for inflammatory response with increasing concentration of aldosterone. Results. It was discovered that induction of aldosterone had no effect on the expression of GPER1 but promoted the expression of MR. Suppression of MR did not influence GPER1 expression, and GPER1 was capable of mediating part of aldosterone-induced endothelial inflammatory response. This effect may involve phosphoinositide 3-kinases (PI3K) pathway signaling. Conclusion. These findings not only demonstrated the role of GPER1 in aldosterone-induced vascular inflammation but also suggested an alternative for pharmaceutical treatment of hyperaldosteronism considering the unsatisfying effect on cardiovascular risks with MR antagonists.

Metasurface silicon-based optical devices are highly integrated and high-performance, meeting the requirements of photonics integrated circuits. We present a design method for metasurface silicon-based gradient index (GRIN) optical lens. With easy calculation, this method supports large-area GRIN elements design. The Luneburg lens and integrated coupler are shown as examples. Such devices show good performances in simulations. The simulations show that the Luneburg lens can focus light from all directions equally well. The optical 1-dB bandwidth of the integrated coupler is about 100 nm. Our method provides a convenient and feasible approach for designing silicon-based GRIN lenses.

Perirenal fat is adjacent to kidneys and active in metabolism and adipokine secretion. We aimed to investigate whether perirenal fat is an independent predictor for chronic kidney disease (CKD) and compared it with total, subcutaneous, or visceral fat in patients with diabetes. Perirenal fat thickness (PRFT) was measured by computed tomography, and total body fat (TBF), subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT) were assessed by DEXA. In cross-sectional analysis, patients with higher PRFT had a lower estimated glomerular filtration rate (eGFR). Multiple linear regression analysis showed a negative correlation between PRFT and eGFR after confounders adjustment. No association between eGFR and TBF, SAT, or VAT was observed. Longitudinally, 190 patients with type 2 diabetes mellitus (T2DM) without CKD at baseline were followed for 2 years. A total of 29 participants developed CKD. After VAT-based multivariate adjustment, each SD (per-SD) increment in baseline PRFT was associated with a higher incidence of CKD (hazard ratio 1.67, 95% CI 1.04–2.68), while TBF, SAT, and VAT were not. Furthermore, PRFT predicted CKD, with a C-statistic (95% CI) of 0.668 (0.562, 0.774), which was higher than that of TPF [0.535 (0.433, 0.637)], SAT [0.526 (0.434, 0.618)], and VAT [0.602 (0.506, 0.698)]. In conclusion, with perirenal fat there was a higher predictive value for CKD than with total, subcutaneous, or visceral fat in T2DM.

Previous studies revealed that aldosterone-producing adenoma(APA) had a potential for excess co-secretion of cortisol. APA was considered to be composed of heterozygous cell types, including cortisol producing cells(expression of CYP11B1) and aldosterone-producing cells(expression of CYP11B2). The proportion of two cell types and the expression of two steroid synthases showed great heterogeneity in APAs, which may lead to differences in cortisol secretion. However, the hypothesis has not been tested. Therefore, we examined the correlation between tumor size and the ability to autonomously secrete cortisol of APA from the perspective of steroid hormones and immunohistochemistry. 165 patients with surgically proven APA were retrospectively studied. Patients with apparent excess cortisol co-secretion were excluded, which was confirmed by an overnight 1 mg dexamethasone suppression test(1mg-DST). Immunohistochemical staining was performed in 88 tumor specimens and CYP11B2-negative APAs were excluded. The expression of the steroidogenic enzymes was immunohistochemically analyzed, and semi-quantified according to the McCarty H-score system. All APA cases were classified into 2 groups according to the median(15mm) of maximum diameter detected by histological examination: the smaller(n=102) and larger group(n=63). 24am cortisol[78.7(47.7–121.5) VS. 54.6(33.6–81.4) nmol/l, p =0.002] and cortisol after 1mg-DST[28.8(19.1–40.9) VS. 24.1(16.8–30.7) nmol/l, p =0.024] were significantly higher in the larger APA group. The larger APA group had a higher H score of CYP11B1 (p=0.028) and a lower H score of CYP11B2 (p=0.036). Both 24pm cortisol (r =0.2424, p =0.0058)and cortisol after 1mg-DST(r =0.2476, p =0.042)were positively correlated with tumor diameter. The tumor diameter was positively correlated with the H score of CYP11B1 (p=0.0328) and inversely with the H score of CYP11B2(p=0.0285). We tentatively used a new ratio B1 index, calculated by H score of CYP11B1 divided by the sum of H score of CYP11B2 and CYP11B1, to represent the relative expression intensity of CYP11B1 in tumor specimens. B1 index had a stronger correlation with tumor diameter (r =0.3134,p=0.0041). Cortisol after 1mg-DST increased linearly with the tertiles of tumor diameter(p for trend

Aldosterone-producing adenoma (APA) is a main cause of primary aldosteronism (PA). Given that a large benign-appearing unilateral masse (>1 cm in diameter) may represent an aldosterone and cortisol-co-secreting adenoma, dexamethasone suppression testing is required in such patients to exclude or confirm the diagnosis of hypercortisolism. Tuberculosis is highly prevalent in China, and rifamycins are often used in these patients. Rifapentine belongs to the rifamycin family, and we herein for the first time report a case of misdiagnosis of hypercortisolism due to rifapentine use in a patient with APA. Thus, in patients treated with rifapentine, diagnosis of hypercortisolism based on dexamethasone suppression tests can be very misleading.

Introduction Compared with the typical onset of type 2 diabetes in middle age or older, type 2 diabetes with early age of onset has a higher risk of diabetes-related complications. It is unclear whether the early age of diabetes diagnosis would affect the development of end-stage renal disease (ESRD) in patients with diabetic kidney disease (DKD) who are at higher risk of ESRD. Methods We enrolled 1,111 type 2 diabetes patients with DKD in this study. We used the age at diabetes diagnosis of younger than 40 years to define early-onset diabetes and 40 years or older to define late-onset diabetes. Medical history, anthropometry, and laboratory indicators were documented. ESRD was defined by estimated glomerular filtration rate (eGFR) of less than 15 mL/min/1.73 m2 or dialysis. Logistic regression analysis was used to explore the association between early-onset diabetes and ESRD. Results Early-onset diabetes patients had a longer diabetes duration, higher body mass index, and worse blood lipid metabolism profile. Compared with late-onset diabetes patients, patients with early-onset diabetes had a prevalence of ESRD that was twofold higher (9.2% vs 4.3%; P = .009). Univariate analysis showed that early-onset diabetes was a risk factor for ESRD in patients with DKD (P < .05). In multivariate logistic regression analysis, even after adjusting for sex, traditional metabolic factors, drug factors, and diabetes duration, the risk of ESRD in patients with early-onset diabetes was still 3.58-fold higher than in subjects with late-onset (95% CI, 1.47–8.74; P = .005). Conclusions In patients with DKD, early-onset type 2 diabetes is an independent risk factor of ESRD.

Objective: This study aimed to investigate the effect of anti-osteoporosis therapy on plasma aldosterone concentration (PAC), plasma renin concentration (PRC) and the aldosterone/renin ratio (ARR) in patients with postmenopausal osteoporosis. Methods: In 60 patients with postmenopausal osteoporosis, bone mineral density (BMD), PAC and PRC were measured before and after treatment with alendronate (70 mg/week, n=22) or recombinant human parathyroid hormone (20 μg/day, n=35) for 48 weeks. Results: PAC was negatively correlated with the T-score of lumbar spine BMD and femoral neck BMD (lumbar r=−0.386, p37 pg/μIU, and the proportion decreased to 8% (5/57) after treatment. Conclusion: Treatment with alendronate or parathyroid hormone causes decreased PAC and increased PRC, resulting in a decreased ARR in postmenopausal women with osteoporosis.

Abstract: Objective: Saline suppression testing (SST) and captopril challenge test (CCT) are commonly used confirmatory tests for primary aldosteronism (PA). Seated SST (SSST) is reported to be superior to recumbent SST (RSST). Whether SSST is better than CCT remains unclear. Therefore we conducted a prospective study to compare the diagnostic accuracy of SSST and CCT. Methods: Hypertensive patients with high risk of PA were consecutively included. Patients with aldosterone-renin ratio≥1.0 ng•dl-1/μIU•ml-1 were asked to complete SSST, CCT and fludrocortisone suppression test (FST). Using FST as the reference standard (plasma aldosterone concentration [PAC] post-FST ≥6.0 ng•dl-1), area under the receiver-operator characteristic curves (AUC), sensitivity and specificity of SSST and CCT were calculated, and multiple regression analyses were conducted to identify potential factors for false diagnosis. Results: A total of 183 patients diagnosed as PA and 48 as essential hypertension completed the study. Using PAC post-SSST and PAC post-CCT to confirm PA, SSST and CCT had comparable AUCs (AUCSSST 0.83 [0.78,0.88] vs. AUCCCT 0.86 [0.81,0.90], P=0.308). Setting PAC post-SSST and post-CCT at 8.5 ng•dl-1 and 11 ng•dl-1, respectively, the sensitivity and specificity of SSST [0.71 (95%CI 0.64 to 0.77) and 0.82(0.68,0.90)] and CCT [0.73(0.66,0.79) and 0.80(0.66,0.89)] were not significantly different. In the multiple regression analyses, 1SD increment of sodium intake resulted in 40% lower risk of false diagnosis in SSST. Conclusions: SSST and CCT have comparable diagnostic accuracy. Insufficient sodium intake decreases the diagnostic efficiency of SSST but not CCT. Since the CCT is simpler and cheaper, it is preferable to the SSST.

IntroductionAldosterone is a mediator of progressive renal disease, but the mechanisms for aldosterone-mediated renal impairment in mice with diabetes are not fully defined.MethodsAldosterone and/or mineralocorticoid receptor antagonist eplerenone were used to treat the db/db mice with diabetes. Proximal tubule epithelial cells (PTECs) and fibroblasts were cultured. Blood and kidney samples from patients with diabetes with or without diabetic kidney disease (DKD) were used to verify the findings from animals and cultured cells.ResultsWe found that aldosterone promoted proteinuria and tubulointerstitial extracellular matrix (ECM) accumulation in db/db mice with diabetes while eplerenone mitigated the adverse effect of aldosterone. However, coculture of PTECs and fibroblasts found that when PTECs-derived extracellular vesicles (EVs) were taken up by fibroblasts, ECM production increased remarkably. Moreover, C57BL/6 mice injected with EVs from renal cortex of aldosterone-treated db/db mice showed increased ECM accumulation. Function of the ingredients of PTECs-derived EVs were analyzed, and RNAs were identified to be responsible for the EVs-induced fibroblast dysfunction. Furthermore, microRNA (miRNA) array analysis revealed that miR-196b-5p was the most remarkably increased miRNA in PTECs-derived EVs with aldosterone stimulation. Overexpression of miR-196b-5p in fibroblasts increased ECM production, accompanied by inhibition of the SOCS2 expression and enhanced STAT3 phosphorylation. In addition, plasma levels of miR-196b-5p was higher in patients with DKD as compared with patients without DKD and miR-196b-5p levels positively correlated with the albuminuria concentration. In kidney specimens from patients with diabetes, expression of miR-196b-5p, located mainly in PTECs, increased in patients with DKD as compared with the non-DKD.ConclusionThis study demonstrates the involvement of miR-196b-5p-EVs pathway as a novel mechanism in aldosterone-induced renal fibrosis in diabetes. EVs rich in miR-196b-5p mediate the crosstalk between PTECs and fibroblast during the development of renal fibrosis, which might be associated with STAT3/SOCO2 signaling pathway.

Abstract Background: Confirmatory tests of primary aldosteronism (PA), including saline infusion test (SIT), captopril challenge test (CCT) and fludrocortisone suppression test (FST), are recommended by the Endocrine Society Clinical Practice Guideline. In order to simplifying diagnostic process, a criterion for skipping confirmatory tests was established by the guideline, while the evidence is lacking. Objective: To validate and optimize the guideline criterion for skipping confirmatory tests. Design: Prospective diagnostic study. Setting: Chongqing, China. Measurements: A total of 501 patients with high risk of PA were retrospectively enrolled. All of them completed at least two confirmatory tests (CCT, SIT, and FST). The guideline criterion is: history of spontaneous hypokalemia, plasma renin concentration (PRC) below detection levels and plasma aldosterone (PAC)>20ng/dl (550pmol/L). An optimized criterion (history of spontaneous hypokalemia, PRC 20 ng/dl) was established based on the guideline criterion. Parameters such as sensitivity, specificity and area under the receiver-operator characteristic curves (AUC) were calculated to compare the diagnostic value of these two criteria. Results: Using SIT, CCT and FST (cutoffs: PAC post-SIT 10 ng·dl-1; PAC post-CCT 11 ng·dl-1; PAC post-FST 6 ng·dl-1) for PA diagnosis, the specificity of the guideline criterion was 1.00 (0.98–1.00), 1.00(0.98–1.00) and 1.00(0.97–1.00) respectively, while the sensitivity was 0.12 (0.09–0.17), 0.12(0.08–0.16) and 0.09(0.06–0.12) respectively. Compared to the guideline criterion, the sensitivity of the optimized criterion was significantly improved [SIT: 0.42 (0.36–0.49); CCT: 0.41 (0.35–0.48); FST: 0.30 (0.25–0.34), all the P values < 0.001 when compared to the guideline criterion]. However, the specificity of the optimized criterion was similar to the guideline criterion (all the P values>0.05). Limitation: This study was carried out in a single center. Conclusions: The guideline criterion shows high specificity but low sensitivity for direct diagnosis of PA. The optimized criterion has greatly improved the sensitivity and may be more suitable for skipping confirmatory tests of PA.