RESUMEN
Japanese encephalitis is a mosquito-borne disease caused by the Japanese encephalitis virus (JEV) that is prevalent in Asia and the Western Pacific. Currently, there is no effective treatment for Japanese encephalitis. Curcumin (Cur) is a compound extracted from the roots of Curcuma longa, and many studies have reported its antiviral and anti-inflammatory activities. However, the high cytotoxicity and very low solubility of Cur limit its biomedical applications. In this study, Cur carbon quantum dots (Cur-CQDs) were synthesized by mild pyrolysis-induced polymerization and carbonization, leading to higher water solubility and lower cytotoxicity, as well as superior antiviral activity against JEV infection. We found that Cur-CQDs effectively bound to the E protein of JEV, preventing viral entry into the host cells. In addition, after continued treatment of JEV with Cur-CQDs, a mutant strain of JEV was evolved that did not support binding of Cur-CQDs to the JEV envelope. Using transmission electron microscopy, biolayer interferometry, and molecular docking analysis, we revealed that the S123R and K312R mutations in the E protein play a key role in binding Cur-CQDs. The S123 and K312 residues are located in structural domains II and III of the E protein, respectively, and are responsible for binding to receptors on and fusing with the cell membrane. Taken together, our results suggest that the E protein of flaviviruses represents a potential target for the development of CQD-based inhibitors to prevent or treat viral infections.
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Virus de la Encefalitis Japonesa (Especie) , Encefalitis Japonesa , Puntos Cuánticos , Animales , Antivirales/farmacología , Antivirales/uso terapéutico , Carbono , Virus de la Encefalitis Japonesa (Especie)/química , Virus de la Encefalitis Japonesa (Especie)/genética , Encefalitis Japonesa/tratamiento farmacológico , Simulación del Acoplamiento Molecular , Proteínas del Envoltorio Viral/metabolismoRESUMEN
Upon EV-A71 infection of a host cell, EV-A71 RNA is translated into a viral polyprotein. Although EV-A71 can use the cellular translation machinery to produce viral proteins, unlike cellular translation, which is cap-dependent, the viral RNA genome of EV-A71 does not contain a 5' cap and the translation of EV-A71 protein is cap-independent, which is mediated by the internal ribosomal entry site (IRES) located in the 5' UTR of EV-A71 mRNA. Like many other eukaryotic viruses, EV-A71 manipulates the host cell translation devices, using an elegant RNA-centric strategy in infected cells. During viral translation, viral RNA plays an important role in controlling the stage of protein synthesis. In addition, due to the cellular defense mechanism, viral replication is limited by down-regulating translation. EV-A71 also utilizes protein factors in the host to overcome antiviral responses or even use them to promote viral translation rather than host cell translation. In this review, we provide an introduction to the known strategies for EV-A71 to exploit cellular translation mechanisms.
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Enterovirus Humano A/fisiología , Infecciones por Enterovirus/metabolismo , Regulación Viral de la Expresión Génica/fisiología , Sitios Internos de Entrada al Ribosoma , Biosíntesis de Proteínas/fisiología , ARN Viral/metabolismo , HumanosRESUMEN
BACKGROUND: Systemic inflammation has been implicated in complications and heightened mortality of patients with secondary hyperparathyroidism. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are widely available surrogate markers of inflammation. This study sought to delineate the changes in NLR and PLR after parathyroidectomy. METHODS: A total of 213 patients undergoing initial parathyroidectomy from 2010 to 2015 for secondary hyperparathyroidism were identified from a prospectively maintained clinical database. Among 183 patients free of persistent or recurrent disease, follow-up NLR and PLR were available for analysis in 85 patients. RESULTS: In the whole study population, the baseline NLR was positively correlated with male sex, total white blood cell count, height, serum phosphorus, and calcium-phosphorus product levels. The baseline PLR was positively correlated with platelet count, serum phosphorus, and calcium-phosphorus product levels and negatively associated with patient age. Postoperative parathyroid hormone levels were positively correlated with NLR and PLR at follow-up. For patients who had successful parathyroidectomy, there was a decrease in NLR (P = 0.0006), PLR (P = 0.0003), and platelet count (P = 0.033), whereas hemoglobin significantly increased (P = 0.0002) after surgery. Those with persistent or recurrent hyperparathyroidism had no change in NLR, PLR, hemoglobin, total white blood cell, or platelet count. CONCLUSIONS: Successful parathyroidectomy is associated with a decrease in NLR and PLR. The modulatory effects of parathyroidectomy on systemic inflammation may partially explain the benefits of surgery in secondary hyperparathyroidism.
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Plaquetas , Hiperparatiroidismo Secundario/cirugía , Linfocitos , Neutrófilos , Paratiroidectomía , Femenino , Humanos , Hiperparatiroidismo Secundario/sangre , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , RecurrenciaRESUMEN
BACKGROUND/AIMS: Fabry disease (FD), a rare x-lined genetic disorder is a cause of renal deterioration. The phenotype of FD is highly variable and nonspecific, and correct diagnosis has always been delayed. We aimed to explore the prevalence and clinical presentation of FD in this high-risk male population in a Northern Taiwan medical center. METHODS: This is the first study to survey the incidence of FD in this high-risk population through the platform of a chronic kidney disease (CKD) education program in Asia. A total of 1,012 male patients with unknown CKD causes were screened using an assay of alpha-galactosidase A activity (α-Gal A) by dried blood spots (DBS). A final GLA gene analysis was also done for those with low enzyme activity. RESULTS: We identified two new patients with classic FD and four patients with late-onset FD. One novel GLA mutation with c.413 G>A was found in one classic FD patient (index 5). The prevalence of FD is about 0.59 % (6 in 1,012) in the high-risk population group with CKD. The clinical symptoms of FD patients are nonspecific except in those with various degrees of renal failure. Those patients' correct diagnosis was delayed, taking years and even decades. Three patients received enzyme replacement therapy and one started regular hemodialysis due to persistent renal function deterioration. Another two patients were found from family screening through a new index. In addition, a false negative result occurred in one patient who was proved to have FD by his kidney pathology as determined by this screening. CONCLUSION: FD is not such as rare a disease and its prevalence is greater in this high-risk male population. Clinicians need to be aware that FD should be included in the differential diagnosis in CKD with unknown etiology.
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Enfermedad de Fabry/diagnóstico , Fallo Renal Crónico/etiología , Adulto , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Enfermedad de Fabry/epidemiología , Humanos , Isoenzimas/sangre , Isoenzimas/genética , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Prevalencia , Proteínas Recombinantes/sangre , Proteínas Recombinantes/genética , Insuficiencia Renal Crónica , Taiwán , Adulto Joven , alfa-Galactosidasa/sangre , alfa-Galactosidasa/genéticaRESUMEN
BACKGROUND/AIMS: Indoxyl sulfate (IS) is a protein-bound uremic toxin that accumulates in patients with chronic kidney disease (CKD). We explored the effect of IS on human early endothelial progenitor cells (EPCs) and analyzed the correlation between serum IS levels and parameters of vascular function, including endothelial function in a CKD-based cohort. METHODS: A cross-sectional study with 128 stable CKD patients was conducted. Flow-mediated dilation (FMD), pulse wave velocity (PWV), ankle brachial index, serum IS and other biochemical parameters were measured and analyzed. In parallel, the activity of early EPCs was also evaluated after exposure to IS. RESULTS: In human EPCs, a concentration-dependent inhibitory effect of IS on chemotactic motility and colony formation was observed. Additionally, serum IS levels were significantly correlated with CKD stages. The total IS (T-IS) and free IS (F-IS) were strongly associated with age, hypertension, cardiovascular disease, blood pressure, PWV, blood urea nitrogen, creatine and phosphate but negatively correlated with FMD, the estimated glomerular filtration rate (eGFR), hemoglobin, hematocrit, and calcium. A multivariate linear regression analysis also showed that FMD was significantly associated with IS after adjusting for other confounding factors. CONCLUSIONS: In humans, IS impairs early EPCs and was strongly correlated with vascular dysfunction. Thus, we speculate that this adverse effect of IS may partly result from the inhibition of early EPCs.
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Células Progenitoras Endoteliales/efectos de los fármacos , Endotelio Vascular/fisiopatología , Indicán/efectos adversos , Insuficiencia Renal Crónica/patología , Anciano , Células Cultivadas , Estudios Transversales , Técnicas de Diagnóstico Cardiovascular , Células Progenitoras Endoteliales/citología , Endotelio Vascular/efectos de los fármacos , Femenino , Humanos , Indicán/sangre , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND/AIMS: Advanced glycation end products (AGEs) are pro-inflammatory and pro-oxidative compounds that play a critical role in endothelial dysfunction and atherosclerosis. Protein-bound uremic toxins, indoxyl sulfate (IS) and p-cresyl sulfate (PCS), inhibit endothelial function. We explored the association of IS and PCS with AGEs in a hemodialysis (HD) cohort. METHODS: This study was a cross-sectional study that recruited 129 stable patients on maintenance HD in a single medical center from July 1 to July 15, 2011. Serum levels of total and free IS, PCS and AGEs were measured concurrently. General laboratory results and patient background were also investigated. RESULTS: Serum levels of AGEs were associated with total IS (r = 2.7, p < 0.01) but not total PCS (r = 0.01, NS), free IS (r = 0.11, NS) or free PCS (r = 0.04, NS) using Pearson's analysis. Multiple linear regression analysis showed that total IS was significantly related to AGEs (ß = 0.296, p < 0.01), free IS (ß = 0.502, p < 0.01) and creatinine (ß = 0.294, p < 0.01). Serum AGEs levels were also independently correlated with diabetes status (ß = 0.250, p = 0.01) and total IS (ß = 0.341, p < 0.01) concentrations after adjusting for other confounding variables. Moreover, patients with diabetes had higher serum AGEs levels than patients without diabetes (p < 0.01). CONCLUSIONS: These findings suggest that serum levels of total IS were associated with AGEs levels, which may participate in the process of atherosclerosis.
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Cresoles/sangre , Productos Finales de Glicación Avanzada/metabolismo , Indicán/sangre , Diálisis Renal , Ésteres del Ácido Sulfúrico/sangre , Anciano , Biomarcadores , Creatinina/sangre , Estudios Transversales , Nefropatías Diabéticas/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis de Regresión , Insuficiencia Renal Crónica/etiología , Insuficiencia Renal Crónica/terapia , Insuficiencia Renal Crónica/orina , Resultado del TratamientoRESUMEN
OBJECTIVES: The severity of acute kidney injury (AKI) has been a well-known predictor for in-hospital mortality. Whether AKI duration could predict in-hospital mortality is not clear. This study determines the association between the in-hospital mortality and AKI duration in patients after non-cardiac surgery. MATERIALS AND METHODS: Surgical patients who were admitted to the ICU were enrolled. AKI cases were defined using KDIGO guidelines and categorized according to the tertiles of AKI duration (1st tertile: 2 days, 2nd tertile: 3-6 days and 3rd tertile: 7 days). The adjusted hazard ratios (HRs) for in-hospital mortality are compared to those without AKI. The predictability of mortality is accessed by calculating the area under the curve (AUC) for the receiver operating characteristic (ROC) curve. RESULTS: From a total of 318 postoperative patients, 98 developed AKI (1st tertile: 34 cases, 2nd tertile: 30 cases and 3rd tertile: 34 cases) and 220 had no AKI. The in-hospital mortality rates are 6.8% (non-AKI), 50% (1st tertile), 46.7% (2nd tertile) and 47% (3rd tertile). The HR's for in-hospital mortality are 7.92, 6.68 and 1.68, compared to the non-AKI group (p = 0.006, 0.021 and 0.476). Cumulative in-hospital survival rates are significantly different for the non-AKI group and the AKI groups (p < 0.001). The AUC for AKI duration and stage together (0.804) is higher than that for AKI stage and AKI duration alone (0.803 and 0.777) (both ps < 0.001). CONCLUSION: In addition to severity, the duration of AKI may be a predictor of in-hospital mortality in patients, after non-cardiac surgery.
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Lesión Renal Aguda/etiología , Lesión Renal Aguda/mortalidad , Causas de Muerte , Mortalidad Hospitalaria/tendencias , Procedimientos Quirúrgicos Operativos/mortalidad , Lesión Renal Aguda/fisiopatología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Estudios de Cohortes , Enfermedad Crítica/mortalidad , Enfermedad Crítica/terapia , Femenino , Humanos , Unidades de Cuidados Intensivos , Estimación de Kaplan-Meier , Tiempo de Internación , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/fisiopatología , Modelos de Riesgos Proporcionales , Curva ROC , Estudios Retrospectivos , Medición de Riesgo , Estadísticas no Paramétricas , Procedimientos Quirúrgicos Operativos/efectos adversos , Factores de Tiempo , Adulto JovenRESUMEN
BACKGROUND: Aluminum overload and accumulation in tissues may lead to skeletal, hematological, and neurological toxicity. The aim of this study was to assess the effects of serum aluminum levels on presentations, postoperative recovery, and symptom improvement in patients undergoing parathyroidectomy for secondary hyperparathyroidism. METHODS: From 2008 to 2013, all patients with end-stage renal disease undergoing initial parathyroidectomy were included in the study. Serum aluminum level was measured preoperatively and/or within 1 week after surgery. Preoperative and postoperative biochemical profile and symptoms were compared between the low and high aluminum groups. RESULTS: A total of 176 patients were included in the study. Of these, 38 (22 %) patients had serum aluminum levels higher than 20 µg/L. A higher percentage of patients in the high aluminum group were on peritoneal dialysis than in the low aluminum group (24 vs. 4 %, p = 0.001). Both groups had similar bone mineral density and changes in biochemical profiles. The preoperative parathyroidectomy assessment of symptoms (PAS) score was not associated with serum aluminum levels (p = 0.349), whereas the postoperative PAS score showed positive association (p = 0.005). There was a negative association between serum aluminum levels and the improvement of total PAS scores (p = 0.001). The high aluminum group had more residual symptoms in three aspects: bone pain (p = 0.038), difficulty getting out of a chair or car (p = 0.045), and pruritus (p = 0.041). CONCLUSIONS: A high serum aluminum level was associated with reduced symptom improvement in patients undergoing parathyroidectomy for secondary hyperparathyroidism.
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Aluminio/sangre , Hiperparatiroidismo Secundario/sangre , Hiperparatiroidismo Secundario/cirugía , Adulto , Anciano , Densidad Ósea , Femenino , Humanos , Hiperparatiroidismo Secundario/etiología , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Dolor Musculoesquelético/sangre , Dolor Musculoesquelético/etiología , Paratiroidectomía , Diálisis Peritoneal , Periodo Posoperatorio , Prurito/sangre , Prurito/etiología , Índice de Severidad de la EnfermedadRESUMEN
The prognosis of critically ill patients with cirrhosis is poor. Our aim was to identify an objective variable that can improve the prognostic value of the Model of End-Stage Liver Disease (MELD) score in patients who have cirrhosis and are admitted to the intensive care unit (ICU). This retrospective cohort study included 177 patients who had liver cirrhosis and were admitted to the ICU. Data pertaining to arterial blood gas-related parameters and other variables were obtained on the day of ICU admission. The overall ICU mortality rate was 36.2%. The bicarbonate (HCO3) level was found to be an independent predictor of ICU mortality (odds ratio, 2.3; 95% confidence interval [CI], 1.0-4.8; p = 0.038). A new equation was constructed (MELD-Bicarbonate) by replacing total bilirubin by HCO3 in the original MELD score. The area under the receiver operating characteristic curve for predicting ICU mortality was 0.76 (95% CI, 0.69-0.84) for the MELD-Bicarbonate equation, 0.73 (95% CI, 0.65-0.81) for the MELD score, and 0.71 (95% CI, 0.63-0.80) for the Acute Physiology and Chronic Health Evaluation II score. Bicarbonate level assessment, as an objective and reproducible laboratory test, has significant predictive value in critically ill patients with cirrhosis. In contrast, the predictive value of total bilirubin is not as prominent in this setting. The MELD-Bicarbonate equation, which included three variables (international normalized ratio, creatinine level, and HCO3 level), showed better prognostic value than the original MELD score in critically ill patients with cirrhosis.
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Bicarbonatos/sangre , Indicadores de Salud , Unidades de Cuidados Intensivos/estadística & datos numéricos , Cirrosis Hepática/mortalidad , Índice de Severidad de la Enfermedad , Biomarcadores/sangre , Femenino , Humanos , Cirrosis Hepática/sangre , Cirrosis Hepática/diagnóstico , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Pronóstico , Análisis de Regresión , Estudios Retrospectivos , Taiwán/epidemiologíaRESUMEN
Enterovirus A71 (EV-A71) is transmitted through the respiratory tract, gastrointestinal system, and fecal-oral routes. The main symptoms caused by EV-A71 are hand, foot, and mouth disease (HFMD) or vesicular sore throat. Upf1 (Up-frameshift protein 1) was reported to degrade mRNA containing early stop codons, known as nonsense-mediated decay (NMD). Upf1 is also involved in the NMD mechanism as a host factor detrimental to viral replication. In this study, we dissected the potential roles of Upf1 in the EV-A71-infected cells. Upf1 was virulently down-regulated in three different EV-A71-infected cells, RD, Hela, and 293T, implying that Upf1 is a host protein unfavorable for EV-A71 replication. Knockdown of Upf1 protein resulted in increased viral RNA expression and production of progeny virus, and conversely, overexpression of Upf1 protein resulted in decreased viral RNA expression and production of progeny virus. Importantly, we observed increased RNA levels of asparagine synthetase (ASNS), one of the indicator substrates for the NMD mechanism, which indirectly suggests that EV-A71 infection of cells suppresses NMD activity in the host. The results shown in this study are useful for subsequent analysis of the relationship between the NMD/Upf1 mechanism and other picornaviruses, which may lead to the development of anti-picornavirus drugs.
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Enterovirus Humano A , Infecciones por Enterovirus , Enterovirus , Enfermedad de Boca, Mano y Pie , Humanos , Enterovirus/genética , Enterovirus/metabolismo , Enterovirus Humano A/genética , Enterovirus Humano A/metabolismo , Proteínas , Replicación Viral , Antígenos Virales , ARN Viral/genéticaRESUMEN
AIM: Few published reports have mentioned the difference between absolute interdialytic weight gain (IDWG) and IDWG/DW (IDWG%), and subsequent effects on daily dialysis. The aim of present study was to evaluate the difference between absolute IDWG and IDWG% in new haemodialysis patients. METHOD: We retrospectively reviewed the records of 255 patients who recently received conventional haemodialysis for at least 1 year at the same centre from 1997 to 2008. The first 4 weeks after starting haemodialysis was defined as the pre-study period. Data were collected for 5-56 weeks. RESULTS: IDWG% value remained relatively constant in the first year of haemodialysis despite most patients having certain residual renal function. For haemodialysis outcomes, both absolute IDWG and IDWG% were significantly correlated with intradialytic hypotension (IDH) in men and heavy women. After dividing patients into four strata, which according to the gender and the median dry weight, stepwise multivariate linear regression analysis showed that absolute IDWG, rather than IDWG%, was an independent risk factor for IDH in heavy men (Beta = 0.585, P < 0.001) and heavy women (Beta= 0.458, P < 0.001). CONCLUSIONS: Absolute IDWG, rather than IDWG%, is an independent risk factor for IDH in heavy haemodialysis patients. Therefore, higher absolute IDWG needs to be strictly controlled despite the corresponding IDWG% possibly being relatively small in heavy haemodialysis patients.
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Hipotensión/etiología , Diálisis Renal , Aumento de Peso , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de RiesgoRESUMEN
OBJECTIVE: The aim of the present study was to assess the relationship between interdialytic weight gain (IDWG) and nutrition markers in hemodialysis (HD) patients, by means of repeated measures analysis. METHODS: The records of 255 patients, who had recently received conventional HD for a minimum of 1 year, were retrospectively reviewed. Nutrition markers, including serum albumin, serum phosphate, blood urea nitrogen, and creatinine, were recorded at monthly intervals and subjected to repeated measures analysis. RESULTS: Patients with higher IDWG/dry weight (IDWG%) (>5%) had significantly lower body mass index throughout the study. Repeated measures analysis of variance indicated no significant difference in these nutrition markers for patients with different IDWG%. At the end of the study, neither IDWG nor IDWG% were found to be associated with albumin or phosphate, on linear regression analysis. CONCLUSIONS: There was no evidence of better nutrition in new HD patients with higher IDWG%. Although increased intake is promoted as critical for improving nutritional status in HD patients, it may be inappropriate to focus solely on the benefits of higher IDWG%, which can also lead to the development of hypertension, left ventricular hypertrophy, and intradialytic hypotension.
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Estado Nutricional/fisiología , Diálisis Renal , Aumento de Peso , Índice de Masa Corporal , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Fosfatos/sangre , Estudios Retrospectivos , Albúmina Sérica/análisisRESUMEN
BACKGROUND: Despite preoperative localization or intraoperative parathyroid hormone, monitoring increased the operative successful rate, recurrent, and persistent secondary hyperparathyroidism are still unavoidable after parathyroidectomy or reoperation. We present our experience of using percutaneous ethanol injection therapy (PEIT) in treating these patients. PURPOSE: To conduct a prospective study of 49 patients with recurrent and persistent hyperparathyroidism using PEIT after subtotal parathyroidectomy or reoperative failure. PATIENTS AND METHODS: From January 2001 to August 2009, 49 patients with recurrent or persistent 2HPT after subtotal parathyroidectomy received PEIT. All dialysis patients were divided into 2 groups: recurrent group (n = 28) and persistent group (n = 21). Before PEIT, every patient received sestamibi-(99m)Tc scintigraphy (MIBI scanning), neck ultrasonography (US), bone scanning (T-score and Z-score), and parathyroid function testing. We compared the responses to PEIT treatment in the recurrent and persistent groups with the following parameters: treatment success rate, improvement in bone density, concurrence in diagnosis between US and MIBI scanning and complications. RESULTS: Treatment success was defined as intact PTH < 300 pg/mL; recurrent group is 25 of 28 (89.3%) and persistent group is 20 of 21 (95.2%) (P = 0.694). There was no difference in success rate statistically. T-score in recurrent group before PEIT was -1.2 ± 0.9 and after treatment was -0.6 ± 0.6 (P = 0.004), which is statistically significant. In the persistent group, T-score before PEIT was -1.2 ± 1.0 and after treatment was -0.8 ± 0.6 (P = 0.101). There was no significant difference. For consistence between neck US and MIBI scanning were concordant in the recurrent group in 20 of 28 (71.4%); in persistent group, it was 14 of 21 (66.6%) (P = 0.245); there was no significant difference. Regarding the complications, only hypocalcemia was significantly more common in the recurrent group. Hypocalcemia occurred in 14 of 28 patients in the recurrent group and 6 of 21 in the persistent group (P = 0.022). CONCLUSIONS: Regardless of which group patient was in, PEIT can achieve satisfying result when parathyroid masses were detected by US. Subtotal parathyroidectomy plus PEIT was probably the best combination for treatment of secondary hyperparathyroidism.
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Técnicas de Ablación/métodos , Etanol/uso terapéutico , Hiperparatiroidismo Secundario/tratamiento farmacológico , Glándulas Paratiroides/efectos de los fármacos , Administración Cutánea , Anciano , Distribución de Chi-Cuadrado , Enfermedad Crónica , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Hiperparatiroidismo Secundario/etiología , Hiperparatiroidismo Secundario/cirugía , Masculino , Persona de Mediana Edad , Paratiroidectomía/métodos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/tratamiento farmacológico , Recurrencia , Diálisis Renal/efectos adversos , Diálisis Renal/métodos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: Female gender is associated with an increased risk of parathyroid nodular hyperplasia and parathyroidectomy rate in dialysis patients. The purpose of this study was to assess differences between women and men undergoing parathyroidectomy for secondary hyperparathyroidism. METHODS: We reviewed 121 consecutive patients with end-stage renal disease and advanced secondary hyperparathyroidism who underwent parathyroidectomy between 2004 and 2007. Preoperative characteristics and short-term outcome of these patients were evaluated. RESULTS: Compared with men (n = 43), women (n = 78) had lower preoperative bone mineral density (both T-scores and Z-scores) as well as lower preoperative hemoglobin levels. The cause of renal failure was also different between the two groups. No differences in preoperative calcium-phosphorus product, alkaline phosphatase, or parathyroid hormone levels were observed. Follow-up analysis showed that biochemical improvement and 1-y recurrence rate was similar between genders. CONCLUSION: Women with secondary hyperparathyroidism had worse bone mineral metabolism before parathyroidectomy. Additional research regarding target organ susceptibility to hyperparathyroidism in different genders is warranted.
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Hiperparatiroidismo Secundario/cirugía , Paratiroidectomía , Caracteres Sexuales , Adolescente , Adulto , Anciano , Densidad Ósea , Femenino , Hemoglobinas/metabolismo , Humanos , Hiperparatiroidismo Secundario/metabolismo , Masculino , Persona de Mediana Edad , Hormona Paratiroidea/metabolismo , Estudios Prospectivos , Recurrencia , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
AIMS: To evaluate the role of the quantitative vascularization index (VI) as a measure of the completeness of percutaneous ethanol injection therapy (PEIT). METHODS: A total of 37 dialysis patients with secondary hyperparathyroidism refractory to medical therapy received PEIT. We analyzed the role of a quantitative marker of parathyroid adenoma activity, i.e. VI, flow index and vascular flow index as measured by 3-dimensional Doppler ultrasound with a 3-dimensional histogram software, for all patients before treatment and at 1 month and 6 months after PEIT. RESULTS: Serum intact parathyroid hormone (i-PTH) level showed a strong positive correlation with the VI both before (p < 0.001) and after (p < 0.001) PEIT. There was no correlation between i-PTH level and the volume of the gland either before (p = 0.697) or after (p = 0.564) PEIT. One month after PEIT, 20 patients (group 1) reached the target of i-PTH ≤ 300 pg/ml and 17 patients (group 2) did not. Group 2 patients had significantly greater VI and i-PTH prior to PEIT than group 1 patients (42.23 ± 8.38 vs. 14.95 ± 8.07, p <0.001 and 1,447 ± 243 vs. 859 ± 231, p < 0.001 respectively). CONCLUSION: A higher VI indicates a higher i-PTH, and the VI may be a reliable predictor of the completeness of PEIT.
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Diálisis/efectos adversos , Etanol/administración & dosificación , Hiperparatiroidismo Secundario/diagnóstico por imagen , Hiperparatiroidismo Secundario/tratamiento farmacológico , Interpretación de Imagen Asistida por Computador/métodos , Uremia/diagnóstico por imagen , Uremia/tratamiento farmacológico , Enfermedad Crónica , Femenino , Indicadores de Salud , Humanos , Hiperparatiroidismo Secundario/etiología , Inyecciones Subcutáneas , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Resultado del Tratamiento , Ultrasonografía , Uremia/etiologíaRESUMEN
BACKGROUND: Despite the poor prognosis of patients with both cirrhosis and renal failure, most reports on renal function and outcomes of cirrhosis have come from liver transplant registries. The present study aimed to investigate the association between renal function and cirrhosis in a broader population. METHODS: 3,857 patients were enrolled after the exclusion of patients with incomplete data. The most recent demographic data after the latest laboratory measurements obtained at outpatient or inpatient department were collected. RESULTS: In predicting renal function, estimated glomerular filtration rate (eGFR) was found to be dissociated from Child-Pugh points (ß = -0.01, p = 0.691), different causes of cirrhosis, and presence of diabetes (ß = -0.03, p = 0.112). In terms of predicting in-hospital mortality, the sensitivity (60-82%) and specificity (70-90%) of the model for end-stage liver disease (MELD) score increased with the decrease in eGFR. However, the blood urea nitrogen (BUN)/creatinine ratio was better than the MELD score in patients with normal eGFR. CONCLUSION: In contrast to prerenal causes of kidney injury, the underlying causes of cirrhosis or diabetes had relatively minor effects on renal function in cirrhotic patients. The BUN/creatinine ratio was a better index than the MELD score in predicting in-hospital mortality in cirrhotic patients with normal renal function.
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Lesión Renal Aguda/mortalidad , Lesión Renal Aguda/fisiopatología , Mortalidad Hospitalaria , Cirrosis Hepática/mortalidad , Cirrosis Hepática/fisiopatología , Lesión Renal Aguda/complicaciones , Anciano , Estudios Transversales , Femenino , Mortalidad Hospitalaria/tendencias , Humanos , Pruebas de Función Renal/métodos , Cirrosis Hepática/complicaciones , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
We assessed the characteristics of the new semi-quantitative test paper (Clinitek ATLAS Pro(12)) using random urine samples. Three hundred urine samples were analyzed using either the new test paper, conventional dipsticks, quantitative (P/C ratio), or immunological quantitative methods (A/C ratio). Our study showed that the new test paper is highly sensitive and specific for the detection of urinary protein. The new test paper also detected the urine protein more accurately than the conventional test and has a lower false-positive rate. In addition, the new test paper detected 14 of the 300 patients (4.7%) as dilute urine samples needing reassessment. Seventeen of the 300 samples tested were negative with conventional dipsticks but positive with the new test paper. The new semi-quantitative test paper not only has higher sensitivity than the conventional dipstick method, but also has potential to detect dilute samples.
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Proteinuria/diagnóstico , Urinálisis/métodos , Adulto , Anciano , Creatinina/orina , Reacciones Falso Negativas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proteinuria/orina , Tiras Reactivas , Sensibilidad y EspecificidadRESUMEN
Indoxyl sulfate and p-cresylsulfate was associated with poor clinical outcome of uremia. We explored the relationship between the two toxins and renal function in chronic kidney disease (CKD) patients. This study enrolled 103 stable CKD patients (stage 3-5 and hemodialysis (HD) patients). Serum levels of indoxyl sulfate and p-cresylsulfate were measured using ultra performance liquid chromatography. General laboratory results and patient background were also checked. Patients with advanced CKD had higher serum indoxyl sulfate, p-cresylsulfate based on ANOVA test. There were significant correlation between indoxyl sulfate and p-cresylsulfate and serum creatinine after multivariate regression analysis (B=3.59, P<0.01; B=0.93, P=0.04, respectively). In addition, there was a positive correlation between indoxyl sulfate and p-cresylsulfate level (r=0.61, P<0.01). Indoxyl sulfate and p-cresylsulfate level increased gradually while renal function declined and reached the peak at the stage of HD. Serum indoxyl sulfate level was closely associated with p-cresylsulfate level in CKD patients.
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Cresoles/sangre , Indicán/sangre , Fallo Renal Crónico/sangre , Estudios de Cohortes , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Análisis Multivariante , Ésteres del Ácido SulfúricoRESUMEN
We present two cases of peritoneal dialysis (PD) catheter-related Pseudomonas peritonitis that were poorly responsive to treatment guidelines of antibiotics and early catheter removal, and uncommonly complicated with ongoing intractable infections. An emergency exploratory laparotomy with extensive intraoperative peritoneal lavage and drainage was performed. The patients recovered dramatically and were transferred to hemodialysis permanently. These unusual cases show the possibility of persistent intra-abdominal infection that may extend extra-abdominally. Early diagnosis of persistent infection, timely surgical intervention, and concept of source control are of utmost importance.
Asunto(s)
Infecciones Relacionadas con Catéteres/etiología , Diálisis Peritoneal/efectos adversos , Peritonitis/etiología , Infecciones por Pseudomonas/etiología , Adulto , Infecciones Relacionadas con Catéteres/microbiología , Infecciones Relacionadas con Catéteres/cirugía , Humanos , Laparotomía , Masculino , Lavado Peritoneal , Peritonitis/microbiología , Peritonitis/cirugía , Infecciones por Pseudomonas/microbiología , Infecciones por Pseudomonas/cirugía , Resultado del Tratamiento , Adulto JovenRESUMEN
Wasp bites usually bring temporary discomfort and pain, but on occasion, they can cause serious infections and fatal allergic reactions. We report on a patient who experienced massive wasp stings and developed multiple organ failure, including acute kidney, hepatic failure, and circulatory collapse 4 days later. He was treated with aggressive fluid resuscitation, inotropic agent, intravenous injection of steroids, broad-spectrum antibiotics, and hemodialysis. After intensive treatment, his liver function recovered one month later. Recovery of renal function was delayed, and the patient needed temporary regular hemodialysis. The pathology of kidney biopsy showed acute tubulointerstitial nephritis. This case shows that toxic reactions following massive wasp attacks may happen several days after the fact and result in severe, multiorgan system dysfunction.