Deep learning-based prediction of coronary artery calcium scoring in hemodialysis patients using radial artery calcification.

OBJECTIVE: This study used random forest model to explore the feasibility of radial artery calcification in prediction of coronary artery calcification in hemodialysis patients. MATERIAL AND METHODS: We enrolled hemodialysis patients and performed ultrasound examinations on their radial arteries to evaluate the calcification status using a calcification index. All involved patients received coronary artery computed tomography scans to generate coronary artery calcification scores (CACS). Clinical variables were collected from all patients. We constructed both a random forest model and a logistic regression model to predict CACS. Logistic regression model was used to identify the risk factors of radial artery calcification. RESULTS: One hundred eighteen patients were included in our analysis. In random forest model, the radial artery calcification index, age, serum C-reactive protein, body mass index (BMI), diabetes, and hypertension history were related to CACS based on the average decrease of the Gini coefficient. The random forest model achieved a sensitivity of 76.9%, specificity of 75.0%, and area under receiver operating characteristic of 0.869, while the logistic regression model achieved a sensitivity of 75.2%, specificity of 68.7%, and area under receiver operating characteristic of 0.742 in prediction of CACS. Sex, BMI index, smoking history, hypertension history, diabetes history, and serum total calcium were all the risk factors related to radial artery calcification. CONCLUSIONS: A random forest model based on radial artery calcification could be used to predict CACS in hemodialysis patients, providing a potential method for rapid screening and prediction of coronary artery calcification.

Calcification detection on upper extremity arteries: a comparison of ultrasonic and X-ray methods.

Background: Vascular calcification (VC) has been observed in patients with hemodialysis, whereas few studies have investigated calcification in the upper extremity vasculature. Both ultrasound and X-ray are used to investigate the calcification of arteries in patients. However, there is a lack of data on the consistency between these two methods. The aim of this study was to investigate the occurrence of VC in the radial and ulnar arteries of hemodialysis patients and investigate the detection consistency in VC between ultrasound and X-ray. Methods: Ultrasound and X-ray examinations were performed in the radial and ulnar arteries of both the left and right upper extremities of 40 patients on hemodialysis. The calcification status of arteries was evaluated by the calcification index from ultrasound and X-ray respectively. Clinical variables of patients were collected from all the involved patients. Results: Of the 40 patients, VC was detected in 31 patients by ultrasound, while X-ray detected VC in 22 patients. Compared to ultrasound assessment, X-ray assessment was 73.21% sensitive but only 66.35% specific with a positive predictive value of 53.95% for detecting calcifications in the radial or ulnar artery. The level of agreement between ultrasound and X-ray results was fair. In addition, our data showed that more ulnar arteries had VCs than the corresponding radial arteries. Conclusion: Ultrasound is more sensitive in detecting the presence of calcified atherosclerotic lesions. Ultrasound and X-ray exhibited fair consistency. Ultrasound screening for upper extremity radial and ulnar arteries in hemodialysis patients may deserve attention to explore its clinical significance.

Backtracking cryptic recurrence of esophageal cancer from membranous nephropathy: the detection of glomerular NELL-1 and IgG4.

We reported the detection of neural epidermal growth factor-like 1 (NELL-1) and immunoglobulin G4 (IgG4) on glomerular capillary wall in membrane nephropathy (MN), which led to the discovery of early post-operative recurrence of esophageal squamous cell cancer (ESCC) in a 68-year-old man. Further, NELL-1 was also identified in the cancerous tissue sampled by esophagoscope. Moreover, serum IgG4 percentage seemed to be higher when comparing with both previous reports and another age-matched male with NELL-1-negative MN upon fully recovered ESCC. Therefore, the finding of NELL-1 in a renal biopsy should trigger a detailed workup in search of malignancy, especially with concomitant IgG4 dominance.

Diagnosis and Treatment Rules of Chronic Kidney Disease and Nursing Intervention Models of Related Mental Diseases Using Electronic Medical Records and Data Mining.

Objective: On the basis of electronic medical records, the data mining technology was adopted to explore the law of chronic kidney disease (CKD) and the intervention mode of mental health of patients. Methods: Based on the electronic medical records, the corresponding data extraction, database establishment, and data cleaning of CKD were performed. After that, the related data analysis, frequency analysis, cluster analysis, and nonparametric analysis were used to explore the laws of CKD diagnosis and treatment and nursing intervention mode of mental illness. The most common causes of CKD were chronic glomerulonephritis (43.76%), aristolochic acid nephritis (16.34%), diabetic nephritis (12.87%), and hypertensive nephritis (11.58%). The major treatment method for end-stage patients was alternative therapies, accounting for 46%. Compared with the depression score before intervention, that of the patients after the mindfulness therapy (50.99 ± 9.77 vs. 47.01 ± 9.33, P=0.024 < 0.5) and target behaviour nursing intervention (52.21 ± 8.12 vs. 48.01 ± 9.33, P=0.032 < 0.05) was obviously decreased. Conclusion: The data mining technology based on electronic records showed a good application prospect in the analysis of the diagnosis and treatment of CKD; and target behaviour nursing and mindfulness intervention were effective psychological intervention models.

Protective effect of rhubarb combined with ulinastatin for patients with sepsis.

BACKGROUND: Sepsis is the leading cause of death in critically ill patients. Ulinastatin (UTI), a protease inhibitor, and rhubarb, used as a traditional Chinese medication, are proved to be effective in treating sepsis, but the effect of the combination therapy of these two drugs on sepsis remains unclear. This study aimed to investigate the effect of the combination treatment of UTI and rhubarb on sepsis patients. METHODS: A total of 75 septic patients were randomly divided into control group, UTI group, Rhubarb group, and UTI plus Rhubarb group. Clinical data and score of Acute Physiology and Chronic Health Evaluation II (APACHE II) were collected; lymphocyte subtypes in the peripheral blood were analyzed before and after the 5-day treatment in the Intensive Care Unit. RESULTS: All the therapeutic interventions (UTI alone, rhubarb alone, or UTI plus rhubarb) significantly reduced the levels of C-Reactive protein, white blood cell density, lactic acid, and APACH II scores, and elevated the levels of CD4/CD8, but only UTI plus rhubarb treatment obviously decreased the level of procalcitonin. CONCLUSION: This study suggested that the combination of UTI and rhubarb may be a promising therapeutic scheme to ameliorate sepsis.

The carbon footprints of home and in-center peritoneal dialysis in China.

OBJECTIVE: The provision of healthcare itself is associated with abundant greenhouse gas (GHG) emissions. This study aims to determine the carbon footprints of peritoneal dialysis (PD) with the different modalities and treatment regimes. METHODS: A total of 68 subjects performed with PD treatment were enrolled in this study. Emissions factors were applied to data that were collected for energy consumption, travel, and procurement. RESULTS: The carbon footprints generated by the provision of PD treatment for the individual patient were calculated and normalized to a 2-l PD dialysate volume. The fixed emissions were higher in patients who received PD therapy in center than at home, mostly attributing to the consumption of electricity. Conversely, PD treatment performed in center yielded less variable emissions than that of at home, which resulted from reduced constituent percentage of waste disposal and transportation. Collectively, packaging consumption mostly contributed to the total carbon footprints of PD. CONCLUSION: This study for the first time demonstrates the delivery of PD is associated with considerable GHG emissions, which is mainly attributed to packaging materials, transportation, electricity, and waste disposal. These results suggest that carbon reduction strategies focusing on packaging consumption in PD treatment are likely to yield the greatest benefits.

Effects of Rhubarb combined with ulinastatin on T-cell subsets in sepsis rats.

OBJECTIVE: The pathogenesis of sepsis, a systemic inflammatory response syndrome, is very complicated and not well understood. However, the importance of lymphocyte percentage and ratio is implicated. Rhubarb is a traditional Chinese medication and plays a role in protecting gastrointestinal mucous and controlling the SIRS damage. Ulinastatin is a protease inhibitor that prevents overproduction of inflammatory cytokines. Currently, despite numerous sepsis clinical researches, the study on the effects of combined drug therapy on sepsis is lacking. In this study, we studied Rhubarb and Ulinastatin combination treatment on T lymphocyte subsets in sepsis induced by the cecal ligation and perforation (CLP). Immunosuppression happened at the early stage of severe sepsis in the CLP rat models, as CD3(+), CD4(+), CD4(+)/CD8(+) began to decline, dropped rapidly after 24 h and continuously decreased at 36 h. CD8(+) T lymphocyte showed no significant change in all groups after CLP. The morality of CLP rats was increased with Rhubarb treatment in test dose (1.2 g/100 g). The immunosuppression state of CLP rats ameliorated with UTI treatment at early stage. The immunomodulatory properties were improved along with drug treatment, and immunities were obviously increased after 24 h, moreover, continuously increased at 36 h. The relief effect of immunosuppression after CLP showed much better in Rhubarb combined with UTI treatment than UTI monotherapy. In conclusion, the combination drug treatment facilitates the improvement of sepsis by modifying the lymphocyte percentage.