Electron-Dense Deposition Patterns and the Outcomes of Nephrotic Idiopathic Membranous Nephropathy Treated with Tacrolimus in Chinese Adults.

BACKGROUND Tacrolimus may be effective in the short-term treatment of idiopathic membranous nephropathy (IMN). However, it is not clear whether an electron microscopic classification of the homogeneous and heterogeneous types of nephrotic IMN is related to the efficacy of tacrolimus in patients with IMN. This study aimed to explore this question and to provide evidence for individualized patient treatment. MATERIAL AND METHODS This 6-month retrospective study included 61 Chinese patients previously diagnosed with IMN. Patients received treatment was tacrolimus plus glucocorticoid. The patients were divided into a homogeneous group and a heterogeneous group based on the evaluation of electron-dense deposits. The initial clinicopathologic factors in the 2 groups were analyzed, and the difference in efficacy of tacrolimus in the 2 groups was assessed. The factors predicting remission were also studied. RESULTS No significant alteration in the initial clinicopathologic status was found between the 2 groups, except for proteinuria, serum albumin levels, systolic blood pressure, and renal biopsy results (stages I/II/III/IV). After 3 months of treatment, the difference in remission was not significant between the 2 groups. However, after 6 months of treatment, a significant difference in remission rates was observed between the 2 groups. The binary logistic model showed that the homogeneous nephrotic IMN was independently associated with total remission (partial plus complete remission), and was also related to complete remission. CONCLUSIONS The results of our study revealed that the homogeneous type of nephrotic IMN had a higher short-term remission rate and a predictive value for partial or complete remission, and it might be a meaningful marker of the short-term response to tacrolimus.

Correlation between lumbar multifidus fat infiltration and lumbar postoperative infection: a retrospective case-control study.

BACKGROUND: The aim of this study was to investigate the correlation between lumbar multifidus fat infiltration and lumbar postoperative surgical site infection (SSI). Several clinical studies have found that spine postoperative SSI is associated with age, diabetes, obesity, and multilevel surgery. However, few studies have focused on the correlation between lumbar multifidus fat infiltration and SSI. METHOD: A retrospective review was performed on patients who underwent posterior lumbar interbody fusion (PLIF) between 2011 and 2016 at our hospital. The patients were divided into SSI and non-SSI groups. Data of risk factors [age, diabetes, obesity, body mass index (BMI), number of levels, and surgery duration] and indicators of body mass distribution (subcutaneous fat thickness and multifidus fat infiltration) were collected. The degree of multifidus fat infiltration was analyzed on magnetic resonance images using Image J. RESULTS: Univariate analysis indicated that lumbar spine postoperative SSI was associated with urinary tract infection, subcutaneous fat thickness, lumbar multifidus muscle (LMM) fat infiltration, multilevel surgery (≥2 levels), surgery duration, drainage duration, and number of drainage tubes. In addition, multiple logistic regression analysis revealed that spine SSI development was associated with sex (male), age (> 60 years), subcutaneous fat thickness, LMM fat infiltration, and drainage duration. Receiver operating characteristic curve analysis indicated that the risk of SSI development was higher when the percentage of LMM fat infiltration exceeded 29.29%. Furthermore, Pearson's correlation analysis demonstrated that LMM fat infiltration was correlated with age but not with BMI. CONCLUSION: Indicators of body mass distribution may better predict SSI risk than BMI following PLIF. Lumbar Multifidus fat infiltration is a novel spine-specific risk factor for SSI development.

[Risk factors for surgical site infection following posterior lumbar intervertebral fusion].

OBJECTIVE: To analyze the risk factors of surgical site infection (SSI) following posterior lumbar intervertebral fusion. METHODS: This retrospective case-control study was conducted in 2904 patients undergoing posterior lumbar intervertebral fusion from 2011 to 2016. Forty-three patients with SSI within 30 days after the operation served as the case group, and 334 randomly selected patients without infection served as the control group. Age, gender, diabetes, body mass index (BMI), albumin level, multilevel procedures, subcutaneous fat thickness, surgery duration and the percentage of lumbar multifidus muscle fat infiltration were analyzed, and univariate and multivariate logistic regression analyses were performed to identify the risk factors of SSI. RESULTS: Multivariate logical regression analysis identified a female gender, subcutaneous fat thickness, multilevel surgery, and lumbar multifidus muscle fat infiltration as significant risk factors for SSI (P < 0.05). BMI was not correlated with fat infiltration in the lumbar multifidus muscle (P > 0.05). CONCLUSIONS: A female gender, multilevel surgery, subcutaneous fat thickness and fat infiltration in the multifidus muscle are related to SSI following posterior lumbar intervertebral fusion. Fat infiltration in the multifidus muscle was a spine-specific risk factor for SSI independent of BMI.