Validation of the EKFC equation for glomerular filtration rate estimation and comparison with the Asian-modified CKD-EPI equation in Chinese chronic kidney disease patients in an external study.

OBJECTIVES: The aim of this study is to determine whether new European Kidney Function Consortium (EKFC) equation is more applicable than Asian-modified CKD-EPI equation in clinical practice, having a higher accuracy in estimating GFR in our external CKD population. METHODS: We calculated estimated GFREKFC and GFRCKD-EPI independently using the EKFC and Asian-modified CKD-EPI formulas, respectively. The clinical diagnostic performance of the two equations was assessed and compared by median bias, precision, accuracy (P30) and so on, using 99mTc-DTPA dual plasma sample clearance method as a reference method for GFR measurement (mGFR). The equation that met the following targets was superior: (1) median bias within ± 3 mL/min/1.73 m2; (2) P30 > 75%; and (3) better precision and 95% limits of agreement in Bland-Altman analysis. RESULTS: Totally, 160 CKD patients were recruited in our external cohort. GFREKFC was highly related to mGFR, with a regression equation of GFREKFC=mGFR × 0.87 + 5.27. Compared with the Asian-modified CKD-EPI equation, EKFC equation demonstrated a wider median bias (-1.64 vs. 0.84 mL/min/1.73 m2, p < 0.01) that was within 3 mL/min/1.73 m2 and not clinically meaningful. Furthermore, the precision (12.69 vs. 12.72 mL/min/1.73 m2, p = 0.42), 95% limits of agreement in Bland-Altman analysis (42.4 vs. 44.4 mL/min/1.73 m2) and incorrect reclassification index of the two target equations were almost identical. Although, EKFC equation had a slightly better P30 (80.0% vs. 74.4%, p = 0.01). CONCLUSIONS: The overall performance of EKFC equation is acceptable. There is no clinically meaningful difference in the performance of the Asian-modified CKD-EPI and EKFC equations within the limits imposed by the small sample size.

The ensemble learning model is not better than the Asian modified CKD-EPI equation for glomerular filtration rate estimation in Chinese CKD patients in the external validation study.

OBJECTIVE: To assess the clinical practicability of the ensemble learning model established by Liu et al. in estimating glomerular filtration rate (GFR) and validate whether it is a better model than the Asian modified Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation in a cohort of Chinese chronic kidney disease (CKD) patients in an external validation study. METHODS: According to the ensemble learning model and the Asian modified CKD-EPI equation, we calculated estimated GFRensemble and GFRCKD-EPI, separately. Diagnostic performance of the two models was assessed and compared by correlation coefficient, regression equation, Bland-Altman analysis, bias, precision and P30 under the premise of 99mTc-diethylenetriaminepentaacetic acid (99mTc-DTPA) dual plasma sample clearance method as reference method for GFR measurement (mGFR). RESULTS: A total of 158 Chinese CKD patients were included in our external validation study. The GFRensemble was highly related with mGFR, with the correlation coefficient of 0.94. However, regression equation of GFRensemble = 0.66*mGFR + 23.05, the regression coefficient was far away from one, and the intercept was wide. Compared with the Asian modified CKD-EPI equation, the diagnostic performance of the ensemble learning model also demonstrated a wider 95% limit of agreement in Bland-Altman analysis (52.6 vs 42.4 ml/min/1.73 m2), a poorer bias (8.0 vs 1.0 ml/min/1.73 m2, P = 0.02), an inferior precision (18.4 vs 12.7 ml/min/1.73 m2, P < 0.001) and a lower P30 (58.9% vs 74.1%, P < 0.001). CONCLUSIONS: Our study showed that the ensemble learning model cannot replace the Asian modified CKD-EPI equation for the first choice for GFR estimation in overall Chinese CKD patients.

Validation of the full-age spectrum equation in the approximation of glomerular filtration rate in Chinese patients with chronic kidney disease.

Introduction: To investigate the validity of the full age spectrum (FAS) equation in determining the glomerular filtration rate (GFR) in Chinese patients with chronic kidney disease (CKD) and to compare the performance of FAS equation and the technetium-99m-diethylene triamine pentaacetic acid (Tc-99m-DTPA) renal dynamic imaging method. Methods: The GFR was determined by three methods in the same day: (a) Tc-99m-DTPA dual plasma sample clearance method (mGFR); (b) FAS equation (eGFR1); (c) Tc-99m-DTPA renal dynamic imaging method (eGFR2). The mGFR was used as the reference standard. The Bland-Altman method, concordance correlation coefficient and regression equation were applied to evaluate the validity of the estimated glomerular filtration rate (eGFR). The bias, precision and accuracy were analyzed to compare the performances of eGFR1 and eGFR2. Results: A total of 162 subjects were enrolled in this study. The eGFR1 was correlated well with mGFR (concordance correlation coefficient was 0.896, p < 0.0001) and the regression equation was mGFR = -0.374 + 1.029eGFR1 (p < 0001). The Bland-Altman analysis proved good agreement between the eGFR1 and mGFR. In comparison with eGFR2, the eGFR1 showed better performance on bias (-1.22 vs. 8.92, p < 0001), precision (15.69 vs. 18.36, p = 0.047) and 30% accuracy (75.31% vs. 59.26%, p = 0.0009) in all participants. Conclusions: The FAS equation is valid in determining the glomerular filtration rate in Chinese patients with chronic kidney disease. The Tc-99m-DTPA renal dynamic imaging method is less accurate than the FAS equation and cannot be employed as the reference method in assessing the performance of FAS equation.

Clinical value of 99Tcm-MIBI gated myocardial perfusion imaging in evaluating sarcoglycanopathy.

AIM: The purpose of this study was to analyse the diagnostic value of gated myocardial perfusion imaging (G-MPI) in the evaluation of myocardial injury in sarcoglycanopathy. MATERIALS AND METHODS: Twenty-eight patients diagnosed with sarcoglycanopathy were evaluated using 99m- -methoxyisobutylisonitrile(99Tcm-MIBI) G-MPI. The data was processed into tomographic images, and the left ventricular function was analysed using quantitative gated SPECT (QGS) to assess the degree of impairment in myocardial and cardiac function. RESULTS: The images of 23 of the patients (82.1%) were positive. Two hundred and twenty-nine sub-segments with abnormal lesions were detected out of 391 cardiac sub-segments of these 23 positive cases. According to the segmental abnormalities, the cases were divided into two cases (8.7%) with single abnormal wall segment, six cases (26.1%) with two abnormal wall segments, and 15 cases (65.2%) with three or more abnormal wall segments or scattered lesions. CONCLUSIONS: 99Tcm-MIBI G-MPI can objectively show impaired myocardium in patients with sarcoglycanopathy. Therefore, this method is helpful for early diagnosis and follow-up of myocardial damage.

Iodine-131: An Effective Method for Treating Lymph Node Metastases of Differentiated Thyroid Cancer.

BACKGROUND The aim of this study was to assess the efficacy of radioactive iodine-131 (¹³¹I) therapy for lymph node metastasis of differentiated thyroid cancer (DTC) and to identify influential factors using univariate and multivariate analyses to determine if identified factors influence the efficacy of treatment. MATERIAL AND METHODS This study included a retrospective review of 218 patients with histologically proven DTC in the post-operation stage. After thyroid tissue remnants were eliminated with ¹³¹I therapy, patients' lymph node status was confirmed by ultrasound and by ¹³¹I whole body scan regarding lymph node metastasis, and then patients were treated with ¹³¹I as appropriate. The treatment efficacy was assessed and possible influencing factors were identified using univariate and multivariate analyses. RESULTS The total effective rate of ¹³¹I therapy was 88.07% (including a cure rate of 20.64% and an improvement rate of 67.43%). The non-effective rate was 11.93%. Of the total 406 lymph nodes of 218 patients, 319 lymph nodes (78.57%) were judged to be effectively cured, including 133 (32.75%) lymph nodes that were totally eliminated and 186 (45.82%) lymph nodes that shrank. Eighty-seven (21.43%) of the 406 lymph nodes had no obvious change. No lymph nodes were found to be in a continuously enlarging state. Distant metastasis, size of lymph node, human serum thyroglobulin (HTG) level, and condition of thyroid remnants ablation were identified as the independent factors influencing the efficacy of treatment using univariate and multivariate analyses. CONCLUSIONS The use of ¹³¹I is a promising treatment for lymph node metastasis of DCT. Distant metastasis, size of lymph nodes, HTG level, and condition of thyroid remnant ablation were independent factors influencing the treatment efficacy.

[Hydrochemical Characteristics, Controlling Factors and Water Quality Evaluation of Shallow Groundwater in Tan-Lu Fault Zone （Anhui Section）].

To study the hydrochemical characteristics, controlling factors, and groundwater quality of the Tan-Lu fault zone (Anhui section), 86 groundwater samples were taken from the areas surrounding the Tan-Lu fault zone (Anhui section), which included the Jianghuai Wavy Plain, the Yanjiang Hill Plain, and the Dabie Mountains in western Anhui. Descriptive statistics, Piper diagram, Gibbs diagram, ion ratio analysis, saturation index, chloride-alkalinity index, and entropy weight water quality index (EWQI) were used to comprehensively study the hydrochemical characteristics and controlling factors of groundwater and to evaluate its quality. The results showed that the shallow groundwater in the Tan-Lu fault zone (Anhui section) was weakly alkaline, with dominant anions and cations of HCO3-, Ca2+ and Na+, respectively, and the hydrochemical types were mainly HCO3-Ca·Mg and HCO3-Na·Ca. The solute source of groundwater was mainly controlled by water-rock interactions, and the weathering of silicate and carbonate rocks jointly contributed to the formation of the chemical components of groundwater. Strong cation exchange adsorption was an important factor causing Na+ enrichment. The overall quality of groundwater in the study area was good but was polluted to a certain extent by human activities. Most of the groundwater in the Jianghuai Wavy Plain and Yanjiang Hill Plain was not suitable for direct drinking. The results of this research have important implications for the sustainable development and utilization of shallow groundwater resources and environmental protection in the Tan-Lu fault zone (Anhui section).

[Hydrochemical Characteristics and Control Factors of Shallow Groundwater in Anqing Section of the Yangtze River Basin].

Shallow groundwater is the main source of water for living and industrial and agricultural production in Anqing City, which is an important basic guarantee to maintain the sustainable development of the social economy and regional ecological environment. In order to further study the water chemical characteristics and controlling factors of shallow groundwater in Anqing City, 196 groups of shallow groundwater samples were collected. A Piper diagram graph, Gibbs chart, ion ratio, and mathematical statistics were comprehensively used to study the water chemical characteristics and controlling factors of groundwater in Anqing City, and the contribution of different sources to the water chemical components of groundwater was quantitatively evaluated. The results showed that the shallow groundwater in Anqing City was weakly alkaline, with pH values ranging from 5.84 to 8.38, with an average value of 7.21. The TDS ranged from 47 to 1 620 mg·L-1, with an average of 324.21 mg·L-1. HCO3- and Ca2+ were the main anions, and the water chemical type was HCO3-Ca type. The chemical components of groundwater were affected by rock weathering leaching, cation alternating adsorption, mineral dissolution and precipitation, and human activities. Ca2+, Mg2+, and HCO3- were mainly derived from the weathering dissolution of carbonate and silicate; Na+, Cl-, and SO42- were affected by industrial activities and domestic sewage discharge; and K+ and NO3- were affected by agricultural activities. The APCS-MLR receptor model analysis further revealed that the chemical components of groundwater were mainly geological factors, industrial factors, agricultural factors, and unknown sources, and their contribution rates were 45.35%, 14.19%, 25.38%, and 15.08%, respectively. Geological factors were important sources of hydrochemical components of shallow groundwater, and human activities aggravated the evolution of groundwater hydrochemistry.

Crayfish-related Haff disease rhabdomyolysis; diagnosis supported by bone scintigraphy.

A number of people suffered rhabdomyolysis caused by eating crayfish in China and the final diagnosis was a rare disease called Haff disease. In this study, we present a 26 years old man with a history of severe muscular soreness for whole body after eating crayfish and this status lasted for about 3 months. Blood analysis showed significant increase in serum creatine kinase and lactate dehydrogenase. The pathology of left biceps brachii muscle revealed rhabdomyolysis. Technetium-99m-methylene diphosphonate ((99m)Tc-MDP) whole body bone scintigraphy showed increased uptake of nearly all muscles, especially those of proximal extremities. The diagnosis was Haff disease supported by histology and clinical characteristics. In conclusion, this case report shows that using bone imaging supports the diagnosis of Haff disease and locates the sites of rhabdomyolysis.

[Health Risk Assessment and Environmental Benchmark of Heavy Metals in Cultivated Land in Wanjiang Economic Zone].

Focusing on the cultivated land in Wanjiang Economic Zone, 338 sets of soil samples of rice, wheat, and their roots were collected; the concentrations of five heavy metals (As, Cd, Cr, Hg, and Pb) were determined; the soil-crop pollution characteristics were evaluated using the method of geo-accumulation index and comprehensive evaluation; the human health risk of ingesting heavy metals from crops was assessed; and the soil environmental reference value of the regional cultivated land was inverted based on the species sensitive distribution model (SSD). The results showed that in the study area, the soil of rice and wheat was polluted by heavy metals (As, Cd, Cr, Hg, and Pb) in varying degrees, among which Cd was the primary pollution factor of rice, with the over-standard rate of 13.33%, and Cr was the main over-standard factor of wheat, with the over-standard rate of 11.32%. The cumulative index showed that the percentage of Cd pollution in rice was 80.7%, and that in wheat was 35.85%. Contrary to the high pollution level of soil heavy metals, only 17.19% and 7.55% of Cd in rice and wheat exceeded the national food safety limit, and the accumulation capacity of the heavy metal Cd was rice>wheat. The health risk assessment indicated that heavy metals had high non-carcinogenic risk and unacceptable carcinogenic risk to adults and children in this study. The carcinogenic risk of rice intake was higher than that of wheat, and the health risk of children was higher than that of adults. SSD inversion showed that the reference values of As, Cd, Cr, Hg, and Pb in paddy soil in the study area were an HC5 of 6.24, 0.13, 258.27, 0.12, and 53.61 mg·kg-1 and an HC95 of 68.81, 5.71, 1068.92, 0.80, and 174.22 mg·kg-1, respectively. The reference values of As, Cd, Cr, Hg, and Pb in wheat soil HC5 were 32.99, 0.04, 271.14, 0.09, and 47.53 mg·kg-1, and the values of HC95 were 225.28, 0.71, 998.58, 1.43, and 241.99 mg·kg-1, respectively. The reverse analysis showed that the HC5 of heavy metals in rice and wheat were lower than the soil risk screening values in the current standard to varying degrees. The current soil standard had loosened for the evaluation results of this region.

[Heavy Metal Pollution Characteristics and Health Risk Assessment of Soil-crops System in Anhui Section of the Yangtze River Basin].

In order to explore the pollution characteristics and health risks of heavy metals in a soil-crop system in the Anhui section of the Yangtze River basin, a total of 338 groups of soil samples from rice, wheat, and their roots were collected, and the contents of eight types of heavy metals were determined. Additionally, the pollution index method, potential ecological hazard, multivariate statistical analysis, and health risk were used to evaluate the heavy metal content in rice and wheat root soil. The results showed that Cd, Cu, Cr, and Ni in the soil had an obvious accumulation effect, and the pollution of rice root soil was more serious than that of wheat soil. The potential ecological risk was mild to moderate, which mainly came from the elements Cd and Hg. Multivariate statistical analysis showed that Cu, Pb, Zn, and Cd were industrial sources and agricultural sources; Cr and Ni were natural sources; and As and Hg were agricultural sources. The absorption and enrichment intensity of heavy metals by rice was in the order of Cd>Zn>Cu>Hg>Ni>As>Cr=Pb, and those in wheat were ordered as Zn>Cd>Cu>Hg>Ni>As=Pb>Cr. The root soil heavy metal health risk assessment indicated that oral intake was the main exposure route of non-carcinogenic risk, and children were more vulnerable to heavy metal pollution. Non-carcinogenic risk assessment showed that wheat root soil posed non-carcinogenic risk to children but no carcinogenic risk. Intake of rice and wheat had some degree of non-carcinogenic risk and unacceptable carcinogenic risk for both adults and children.

Solitary Scapular Metastasis as the First Presentation of Prostate Adenocarcinoma Identified on 99mTc-MDP SPECT/CT.

ABSTRACT: Metastases of prostate carcinoma in the skeleton are usually multiple. Solitary metastasis in appendicular skeleton is extremely rare. We present bone scan findings of solitary scapular metastasis from prostate adenocarcinoma as the initial presentation of his malignancy in a 62-year-old man. The 99mTc-MDP SPECT/CT demonstrated intense activity in the coracoid process of left scapula, whereas the tracer uptakes in other bones were not typical of metastases. The subsequent pathological results of the punctured left scapula confirmed as metastasis from prostate adenocarcinoma.

Expression of Ceruloplasmin in the Peripheral Blood of Patients With Drug-Resistant Epilepsy.

This study was performed to detect the expression of ceruloplasmin in the peripheral blood of patients with drug-resistant epilepsy and explore the mechanisms of iron metabolism disorder in drug-resistant epilepsy. Peripheral blood was collected from 32 patients with drug-resistant epilepsy, labeled the drug-resistant group; 30 patients who were drug responsive, labeled the drug-responsive group; and 34 healthy people, named the normal group.The expression levels of ceruloplasmin mRNA and ceruloplasmin protein in the peripheral blood of the 3 groups were detected using real-time fluorescence-based quantitative polymerase chain reaction and Western blot. The differences in the expression of ceruloplasmin mRNA of different seizure frequencies and types, electroencephalogram abnormal discharges, and different medication methods were analyzed and compared. The relative expression of ceruloplasmin mRNA and ceruloplasmin protein in the drug-resistant epilepsy group was significantly higher than that in the drug-responsive group (P = .002 and .010, respectively) and higher in the drug-responsive group compared with the normal group (P = .014 and .005, respectively). The relative expression of ceruloplasmin mRNA in patients with epilepsy using different medication methods was statistically significant (P = .001). Patients who received a combination of 2 or 3 drugs exhibited a higher expression than those treated with single-drug treatment, whereas those who received a combination of 3 drugs had a higher expression than those with 2 drugs (P = .013, .001, and .011, respectively). There was no significant difference in the relative expression of Cp mRNA in patients with epilepsy with different seizure frequencies and types and abnormal electroencephalogram discharges (all P > .05). The increased expression of ceruloplasmin in the peripheral blood of patients with drug-resistant epilepsy was closely related to the different medication methods, but no obvious correlation with epileptic seizure frequencies or types and abnormal electroencephalogram discharges was identified. The increased expression of ceruloplasmin enhanced iron oxidative damage and may be the potential mechanism of drug-resistant epilepsy and may be one of the drug resistance indicators for combination drugs when treating drug-resistant epilepsy.

Hyperparathyroidism Caused by Coexisting Parathyroid Hyperplasia and Unilateral Bifocal Parathyroid Carcinoma.

ABSTRACT: The coexistence of parathyroid hyperplasia and carcinoma is uncommon. Here we report findings of 99m Tc-sestamibi SPECT/CT study in a case of unilateral bifocal parathyroid carcinoma coexisting with parathyroid hyperplasia in a 49-year-old man. The images showed 4 foci of elevated activity around the thyroid. Histopathology confirmed the 2 lesions of the left side as parathyroid hyperplasia and the other 2 lesions of the right side as parathyroid carcinoma.

The Xiangya equation could not replace the Asian modified CKD-EPI equation in estimating glomerular filtration rate in Chinese patients with chronic kidney disease.

BACKGROUND: To evaluate the clinical practicability of the Xiangya equation in estimating glomerular filtration rate (GFR) and compare with the Asian modified Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation, assessing whether the Xiangya equation could replace the Asian modified CKD-EPI equation as the preferred method for predicting GFR in the Chinese CKD patients in an external validation study. METHODS: The GFR was determined simultaneously by two methods: (a) the Asian modified CKD-EPI equation (GFRCKD-EPI); (b) the Xiangya equation (GFRXiangya); diagnostic performance of the two models was compared by the regression analysis, the Bland-Altman plot, bias, precision and P30 under the background of 99mTc-diethylenetriaminepentaacetic acid (99mTc-DTPA) dual plasma sample clearance method as reference method for GFR measurement (mGFR). RESULTS: A total of 158 Chinese CKD patients were included in our external study. The GFRXiangya was highly related with mGFR, with the correlation coefficient of 0.92. The regression equation was GFRXiangya = 0.55*mGFR + 28.25, where the regression coefficient was far away from one and the intercept was wide. Compared with the Asian modified CKD-EPI equation, the performance of the Xiangya equation demonstrated a poorer bias (9.5 vs - 3.3 ml/min/1.73 m2, P < 0.001), an inferior precision (23.9 vs 13.0 ml/min/1.73 m2, P < 0.001), a lower P30 (51.3% vs 73.4%, P < 0.001) and a wider 95% limit of agreement in Bland-Altman analysis (65.0 vs 44.9 ml/min/1.73 m2). CONCLUSION: Due to relatively inferior performance, the Xiangya equation could not replace the Asian modified CKD-EPI equation in estimating GFR in Chinese patients with chronic kidney disease in our external cohort.

Same-day single-dose vs large-volume split-dose regimens of polyethylene glycol for bowel preparation: A systematic review and meta-analysis.

BACKGROUND: Split-dose regimens (SpDs) of 4 L of polyethylene glycol (PEG) have been established as the "gold standard" for bowel preparation; however, its use is limited by the large volumes of fluids required and sleep disturbance associated with night doses. Meanwhile, the same-day single-dose regimens (SSDs) of PEG has been recommended as an alternative; however, its superiority compared to other regimens is a matter of debate. AIM: To compare the efficacy and tolerability between SSDs and large-volume SpDs PEG for bowel preparation. METHODS: We searched MEDLINE/PubMed, the Cochrane Library, RCA, EMBASE and Science Citation Index Expanded for randomized trials comparing (2 L/4 L) SSDs to large-volume (4 L/3 L) SpDs PEG-based regimens, regardless of adjuvant laxative use. The pooled analysis of relative risk ratio and mean difference was calculated for bowel cleanliness, sleep disturbance, willingness to repeat the procedure using the same preparation and adverse effects. A random effects model or fixed-effects model was chosen based on heterogeneity analysis among studies. RESULTS: A total of 18 studies were included. There was no statistically significant difference of adequate bowel preparation (relative risk = 0.97; 95%CI: 0.92-1.02) (14 trials), right colon Boston Bowel Preparation Scale (mean difference = 0.00; 95%CI: -0.04, 0.03) (9 trials) and right colon Ottawa Bowel Preparation Scale (mean difference = 0.04; 95%CI: -0.27, 0.34) (5 trials) between (2 L/4 L) SSDs and large-volume (4 L/3 L) SpDs, regardless of adjuvant laxative use. The pooled analysis favored the use of SSDs with less sleep disturbance (relative risk = 0.52; 95%CI: 0.40, 0.68) and lower incidence of abdominal pain (relative risk = 0.75; 95%CI: 0.62, 0.90). During subgroup analysis, patients that received low-volume (2 L) SSDs showed more willingness to repeat the procedure using the same preparation than SpDs (P < 0.05). No significant difference in adverse effects, including nausea, vomiting and bloating, was found between the two arms (P > 0.05). CONCLUSION: Regardless of adjuvant laxative use, the (2 L/4 L) SSD PEG-based arm was considered equal or better than the large-volume (≥ 3 L) SpDs PEG regimen in terms of bowel cleanliness and tolerability. Patients that received low-volume (2 L) SSDs showed more willingness to repeat the procedure using the same preparation due to the low-volume fluid requirement and less sleep disturbance.

Comparative performance of FAS equation and Asian modified CKD-EPI in the determination of GFR in Chinese patients with CKD with the 99mTc-DTPA plasma clearance as the reference method.

BACKGROUND: Glomerular filtration rate (GFR) is a useful index in many clinical conditions. However, very few studies have assessed the performance of full age spectrum (FAS) equation and the Asian modified Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation in the approximation of GFR in Chinese patients with chronic kidney disease. OBJECTIVE: This study aimed to compare the diagnostic performance of the above two creatinine-based equations. METHODS: A well designed single-center cross-sectional study was performed and the GFR was determined by 3 methods separately in the same day: technetium-99m-diethylene triamine pentaacetic acid (99mTc-DTPA) dual plasma sample clearance method (mGFR); FAS equation method; Asian modified CKD-EPI equation method. The gold standard method was the mGFR. Equations performance criteria considered correlation coefficient, bias, precision, accuracy and the ability to detect the mGFR less than 60ml/min/1.73m2. RESULTS: A total of 160 patients were enrolled. The diagnostic performance of FAS showed no significant difference in the correlation coefficient (0.89 vs 0.89), precision (15.9 vs 16.1ml/min/1.73m2), accuracy (75.0% vs 76.3%) and the ability to detect the mGFR less than 60ml/min/1.73m2 (0.94 vs 0.94) compared with the Asian modified CKD-EPI equation in all participants. The FAS showed a negative bias, while the new CKD-EPI equation showed a positive bias (-1.20 vs 1.30ml/min/1.73m2, P<0.001). However, they were all near to zero. In the mGFR<60ml/min/1.73m2 subgroup and mGFR>60ml/min/1.73m2 subgroup were consistent with that in the whole cohort. The precision and accuracy decreased when GFR>60ml/min/1.73m2 in both equations. CONCLUSIONS: The FAS equation and the Asian modified CKD-EPI equation had similar performance in determining the glomerular filtration rate in the Chinese patients with chronic kidney disease. Both the FAS equation and Asian modified CKD-EPI can be a satisfactory method and may be the most suitable creatinine-based equation.

Multiple Primary Osseous B-Lymphoblastic Lymphoma/Leukemia Shown on Bone Scintigraphy.

ABSTRACT: Primary osseous B-lymphoblastic lymphoma/leukemia is very rare, especially multiple bones involved. Herein, we reported the bone scintigraphy findings in a 16-year-old adolescent boy with a 20-day history of right thigh pain caused by B-lymphoblastic lymphoma/leukemia. Multiple abnormal MDP-avid foci were noted on 99mTc-MDP bone scintigraphy. Interestingly, the CT images of corresponding lesions were unrevealing. Finally, the B-lymphoblastic lymphoma/leukemia was confirmed by pathology and immunohistochemistry.

Comparative performance of FAS equation and Asian modified CKD-EPI in the determination of GFR in Chinese patients with CKD with the 99mTc-DTPA plasma clearance as the reference method.

BACKGROUND: Glomerular filtration rate (GFR) is a useful index in many clinical conditions. However, very few studies have assessed the performance of full age spectrum (FAS) equation and the Asian modified Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation in the approximation of GFR in Chinese patients with chronic kidney disease. OBJECTIVE: This study aimed to compare the diagnostic performance of the above two creatinine-based equations. METHODS: A well designed single-center cross-sectional study was performed and the GFR was determined by 3 methods separately in the same day: technetium-99m-diethylene triamine pentaacetic acid (99mTc-DTPA) dual plasma sample clearance method (mGFR); FAS equation method; Asian modified CKD-EPI equation method. The gold standard method was the mGFR. Equations performance criteria considered correlation coefficient, bias, precision, accuracy and the ability to detect the mGFR less than 60ml/min/1.73m2. RESULTS: A total of 160 patients were enrolled. The diagnostic performance of FAS showed no significant difference in the correlation coefficient (0.89 vs 0.89), precision (15.9 vs 16.1ml/min/1.73m2), accuracy (75.0% vs 76.3%) and the ability to detect the mGFR less than 60ml/min/1.73m2 (0.94 vs 0.94) compared with the Asian modified CKD-EPI equation in all participants. The FAS showed a negative bias, while the new CKD-EPI equation showed a positive bias (-1.20 vs 1.30ml/min/1.73m2, P<0.001). However, they were all near to zero. In the mGFR<60ml/min/1.73m2 subgroup and mGFR>60ml/min/1.73m2 subgroup were consistent with that in the whole cohort. The precision and accuracy decreased when GFR>60ml/min/1.73m2 in both equations. CONCLUSIONS: The FAS equation and the Asian modified CKD-EPI equation had similar performance in determining the glomerular filtration rate in the Chinese patients with chronic kidney disease. Both the FAS equation and Asian modified CKD-EPI can be a satisfactory method and may be the most suitable creatinine-based equation.

Determination of Pyruvate Metabolic Fates Modulates Head and Neck Tumorigenesis.

Even with increasing evidence for roles of glycolytic enzymes in controlling cancerous characteristics, the best target of candidate metabolic enzymes for lessening malignancy remains under debate. Pyruvate is a main glycolytic metabolite that could be mainly converted into either lactate by Lactate Dehydrogenase A (LDHA) or acetyl-CoA by Pyruvate Dehydrogenase E1 component α subunit (PDHA1) catalytic complex. In tumor cells, accumulating lactate is produced whereas the conversion of pyruvate into mitochondrial acetyl-CoA is less active compared with their normal counterparts. This reciprocal molecular association makes pyruvate metabolism a potential choice of anti-cancer target. Cellular and molecular changes were herein assayed in Head and Neck Squamous Cell Carcinoma (HNSCC) cells in response to LDHA and PDHA1 loss in vitro, in vivo and in clinic. By using various human cancer databases and clinical samples, LDHA and PDHA1 levels exhibit reversed prognostic roles. In vitro analysis demonstrated that decreased cell growth and motility accompanied by an increased sensitivity to chemotherapeutic agents was found in cells with LDHA loss whereas PDHA1-silencing exhibited opposite phenotypes. At the molecular level, it was found that oncogenic Protein kinase B (PKB/Akt) and Extracellular signal-regulated kinase (ERK) singling pathways contribute to pyruvate metabolism mediated HNSCC cell growth. Furthermore, LDHA/PDHA1 changes in HNSCC cells resulted in a broad metabolic reprogramming while intracellular molecules including polyunsaturated fatty acids and nitrogen metabolism related metabolites underlie the malignant changes. Collectively, our findings reveal the significance of pyruvate metabolic fates in modulating HNSCC tumorigenesis and highlight the impact of metabolic plasticity in HNSCC cells.

The relationship between the extracellular matrix and the angiogenesis and metastasis of laryngeal carcinoma.

AIMS: We studied the relationships between the growth, metastasis and angiogenesis of laryngeal carcinoma and extracellular matrix protein-1 (ECM1) and hyaluronan (HA). METHODS: Thirty-three cases of benign and malignant laryngeal tumors were included. Using immunohistochemical staining, we examined the expression of ECM1 and HA in tumors and metastatic lymph nodes and correlated it with counts of microvessel density. RESULTS: The expression of ECM1 (p = 0.004) and HA (p = 0.036) was significantly different between benign and malignant tumors. The expression of ECM1 was strongly associated with microvessel density (Spearman's rho = 0.513, p = 0.017), with the strongest expression present within caner nests. With respect to HA, expression was significantly associated with more advanced clinical TNM stage (Spearman's rho = 0.521, p = 0.015). The link was stronger in cases where metastasis or recurrence occurred than in those without complication (p = 0.014). No significant relationship was found between ECM1 and HA expression among malignant samples (Spearman's rho = 0.383, p = 0.087). CONCLUSIONS: ECM1 has a high association with the growth, metastasis and angiogenesis of laryngeal carcinoma. An increased level of HA expression was related to the process of laryngeal carcinogenesis. Specifically, carcinoma cells with high levels of HA secretion had a higher potential for metastasis. No significant relative expression of ECM1 and HA was found.