Development of a Practical Screening Tool to Predict Sarcopenia in Patients on Maintenance Hemodialysis.

BACKGROUND Sarcopenia is a common complication in maintenance hemodialysis (MHD) and can increase patient hospitalization and mortality. No simple and reliable tools to identify sarcopenia exist. We aimed to develop a screening tool to predict MHD patients at high risk for sarcopenia. MATERIAL AND METHODS This cross-sectional study included 589 and 216 MHD patients for training and validation sets, respectively. We used diagnostic criteria developed by the Asian Working Group on Sarcopenia to screen for sarcopenia. The risk prediction model was established by univariate and multivariate logistic regression analyses. We used the area under the receiver operating characteristic curve (AUROC), calibration curve, Hosmer-Lemeshow test, and decision curve analysis (DCA) to evaluate the model's discrimination ability, calibration ability, and clinical utility. RESULTS The incidence of sarcopenia was 17.1% in the training set and 18.1% in the validation set. We constructed prediction models applying age, body mass index, calf circumference, and serum creatinine and plotted a nomogram. The training set model had an AUROC of 0.922, sensitivity of 85.1%, specificity of 85.9%, and chi-square value (Hosmer-Lemeshow test) of 5.603 (P>0.05); the DCA diagram showed that when the threshold probability was 0 to 0.95, the model predicted a net benefit for sarcopenia in MHD patients. The validation set model had an AUROC of 0.913, sensitivity of 94.3%, specificity of 82.9%, and chi-square value (Hosmer-Lemeshow test) of 9.822 (P>0.05). CONCLUSIONS The screening tool has good discrimination ability, calibration ability, and clinical utility. It could help to identify MHD patients at a high risk for sarcopenia.

Comparison of the prevalence and associated factors of cognitive frailty between elderly and middle-young patients receiving maintenance hemodialysis.

PURPOSE: This study aimed at comparing the prevalence of cognitive frailty and explore the differences in the influencing factors between elderly and middle-young patients receiving maintenance hemodialysis (MHD). METHODS: In this cross-sectional study, the frailty phenotype, mini-mental state examination, and clinical dementia rating were used to assess the current status of cognitive frailty in 852 patients receiving MHD from four hospitals in Lianyungang City and Xuzhou City, Jiangsu Province, China; the influencing factors were then analyzed for statistical significance. RESULTS: Of the total 852 patients receiving MHD, 340 were classified into an elderly group (≥ 60 years) and 512 into a middle-young group (< 60 years). The prevalence of cognitive frailty was 35.9% and 8.8%, respectively. The results of multivariate logistic regression analysis showed that the independent factors of cognitive frailty were age (P < 0.001), education level (P = 0.010), nutritional status (P = 0.001), serum albumin level (P = 0.010), calf circumference (P = 0.024), and social support level (P < 0.001) in the elderly group and comorbidity status (P = 0.037), education level (P < 0.001), nutritional status (P = 0.008), serum creatinine level (P = 0.001), waist circumference (P < 0.001), and depression (P = 0.006) in the middle-young group. CONCLUSION: The prevalence of cognitive frailty was significantly higher in the elderly group than in the middle-young group, and the influencing factors differed between the two populations.

Clinical significance of TGF- beta1 and beta-glucuronidase synchronous detection in human pancreatic cancer.

OBJECTIVE: To investigate the relation of transfer growth factor (TGF-beta1) and beta-glucuronidase (beta-GCD) on the occurrence and progress of pancreatic cancer. METHODS: The expression of TGF-beta1 and beta-GCD in the pancreatic cancer tissue and normal pancreatic tissue was determined synchronously using ABC method of immunohistochemistry. RESULTS: The percentage of TGF-beta1 positive cells was significantly higher in pancreatic cancer tissue (43.8%+/-5.2%) than in adjacent pancreatic tissue (28.7%+/-3.6%, P<0.01). The worse the cancer cells differentiated and lymph nodes metastasis, the more over-expression of TGF-beta1. The percentage of beta-GCD positive cells was also significantly higher in the pancreatic cancer tissue (62.5%+/-4.1%) than in the adjacent pancreatic tissue (33.5%+/-2.8%, P<0.01). The degree of over-expression of beta-GCD was related to the degree of cancer cells differentiation, but not to the lymph nodes metastasis. The expression of TGF-beta1 was significantly correlated with the expression of beta-GCD in pancreatic cancer tissue. CONCLUSIONS: The genesis of pancreatic cancer results from multi-factor, multi-step and multi-gene variation. The synchronous detection of TGF-beta1 and beta-GCD helps to determine the malignant degree of tumors and the prognosis of patients with such disease.