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Objective:To investigate the association between cognitive impairment and all-cause mortality in middle and elderly adult patients undergoing maintenance hemodialysis (HD).Methods:A prospective cohort study was conducted. Patients from 11 HD centers in Beijing between April and June 2017 were enrolled. Baseline data were collected, and a series of neuropsychological batteries covered 5 domains of cognitive function were applied for the assessment of cognitive function. The patients were then classified as normal and cognitive impairment groups according to the fifth version of the Diagnostic and Statistical Manual of Mental Disorders criteria (DSM-V) and followed-up until June 2018. The clinical characteristics of the two groups of patients were compared. Kaplan-Meier survival analysis was used to compare the difference in the cumulative survival rate between the two groups. Multivariate Cox regression model was used to analyze the independent influencing factors of all-cause mortality, to determine the relationship between cognitive impairment and different cognitive domain impairments and all-cause death.Results:A total of 613 patients were enrolled, of which 496(80.91%) patients had cognitive impairment. Compared with the normal cognitive function group, the patients in the cognitive impairment group tended to be older, longer dialysis vintage, a higher proportion of diabetes, hypertension, and stroke, increased serum iPTH level, and lower education level and urea clearance index (Kt/V) (all P<0.05). After (49.53±8.42) weeks of follow-up, Kaplan-Meier survival analysis showed that the cumulative survival rate of cognitive impairment group was significantly lower than that of cognitive normal group (Log-rank χ2=8.610, P=0.003). Multivariate Cox regression analysis showed that history of diabetes ( HR=2.742, 95% CI 1.598-4.723, P<0.001), coronary heart disease ( HR=1.906, 95% CI 1.169-3.108, P=0.010), dialysis vintage (every increase of 1 month, HR=1.007, 95% CI 1.003-1.011, P=0.001), serum level of albumin (every increase of 1 g/L, HR=0.859, 95% CI 0.809-0.912, P<0.001), cognitive impairment ( HR=2.719, 95% CI 1.088-6.194, P=0.032) were independently associated with all-cause mortality. Multivariate Cox regression analysis on different cognitive domains also indicated that memory impairment ( HR=2.571, 95% CI 1.442-4.584, P<0.001), executive function impairment ( HR=3.311, 95% CI 1.843-5.949, P=0.001) and three, four, five domains combined impairment ( HR=5.746, 95% CI 1.880-17.565, P=0.002; HR=12.420, 95% CI 3.690-41.802, P<0.001; HR=13.478, 95% CI 3.381-53.728, P<0.001) were independently related to all-cause mortality. Conclusions:Cognitive impairment is an independent risk factor of all-cause mortality in middle and elderly adult patients undergoing maintenance hemodialysis, and the risk is significantly increased in patients with the impairment of the domains of memory, executive function, or in the combination of three to five cognitive domains.
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Objective:To investigate the clinical features and associated influencing factors of cognitive impairment in middle-aged and elderly Chinese adult patients undergoing maintenance hemodialysis (HD).Methods:A cross-sectional study was conducted among HD patients from 11 centers in Beijing city from April 2017 to June 2017. A neuropsychological battery covering domains of attention/processing speed, executive function, memory, language, and visuospatial function was applied in cognitive function assessment. Patients were classified as normal cognitive function group and cognitive impairment group according to the fifth version of the diagnostic and statistical manual of mental disorders criteria (DSM-V). Multivariate binary logistic regression was used to analyze the independent influencing factors of cognitive impairment. Results:A total of 613 HD patients were included in the study, and the prevalence of cognitive impairment was 80.91% (496/613). Attention impairment (81.05%) and memory impairment (63.51%) were the most common impaired domains, and 79.23% was concomitant impairment across two or more cognitive domains among those with cognitive impairment. Compared with the patients in the normal cognitive function group, the patients in the cognitive impairment group had senior age, longer dialysis vintage, higher proportion of diabetes, hypertension, and stroke, higher level of serum intact parathyroid hormone (iPTH), lower education level, and lower urea clearance index (Kt/V) (all P<0.05). Factors were independently associated with cognitive impairment including increasing age ( OR=1.110, 95% CI 1.072-1.150, P<0.001), education time>12 years (with education time<6 years as reference, OR=0.323, 95% CI 0.115-0.909, P=0.032), history of diabetes ( OR=2.151, 95% CI 1.272-3.636, P=0.004), history of stroke ( OR=2.546, 95% CI 1.244-5.210, P=0.011), increased dialysis vintage ( OR=1.016, 95% CI 1.010-1.022, P<0.001), reduced Kt/V( OR=0.008, 95% CI 0.002-0.035, P<0.001), and increased iPTH level ( OR=1.002, 95% CI 1.002-1.003, P=0.012). Conclusions:The prevalence of cognitive impairment in middle-aged and elderly adult Chinese patients undergoing HD is high. Memory and attention are the most commonly impaired domains. Increasing age, low education level, history of diabetes and stroke, increased dialysis vintage, reduced Kt/V and increased serum iPTH are the independent influencing factors associated with cognitive impairment.
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Objective To investigate the prevalence of mcr-1 gene,a plasmid-mediated polymyxin resistance gene,in Escherichia coli(E.coli) strains isolated in Dongyang of Zhejiang Province and to under-stand the epidemiological characteristics of E.coli strains carrying mcr-1 gene in order to provide local clini-cians with a theoretical basis for prevention and control of the spread of mcr-1-bearing E.coli strains. Meth-ods A total of 315 E.coli strains were collected in the People′s Hospital of Dongyang, Zhejiang Province from January to December 2016. All strains were isolated from specimens of blood,urine,respiratory tract, etc. PCR was performed to detect the genes confering resistance to polymyxin (mcr-1 gene), β-lactamase and carbapenem. Minimal inhibitory concentrations (MIC) of antibiotics against mcr-1-positive strains were determined by micro-broth dilution method. Conjugation test was performed to confirm whether the mcr-1 gene was located on the transferable plasmid. Multilocus sequence typing (MLST) was used for molecular typing of mcr-1-positive strains. Results Five mcr-1-positive strains were identified from 315 E.coli strains with a positive rate of 1.6%. Two out of the five mcr-1-positive E.coli strains contained β-lactamase resist-ance genes,blaTEM-1and blaCTX-M-14. Both of them were resistant to the first, second and third generation of cephalosporins and one was also resistant to cefepime. All of the five mcr-1-positive E.coli strains were sen-sitive to ciprofloxacin and levofloxacin,but resistant to ticarcillin/clavulanic acid. No carbapenem resistance genes were detected. One transconjugant was successfully obtained by transconjugation assay. MLST analysis showed that a total of four sequence types were identified, including ST131 (two strains), ST43 (one strain),ST69 (one strain) and ST349(one strain). Conclusion Only 1.6% of all E.coli strains isolated in Dongyang area of Zhejiang Province carry mcr-1 gene,indicating that there is no epidemic of mcr-1 gene-positive E.coli infection. The coexistence of mcr-1 gene and β-lactamase resistance genes in E.coli strains isolated in Dongyang suggests that local clinicians should avoid antibiotic abuse to prevent the spread of drug-resistant E.coli.
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Objective To explore the reasons and clinical characteristics of gastrointestinal bleeding in maintenance hemodialysis patients.Methods Clinical data of 28 hemodialysis patients combined with gastrointestinal bleeding were retrospectively analyzed.The reasons and clinical characteristics of gastrointestinal bleeding were analyzed.Results The incidence rate of gastrointestinal bleeding in hemodialysis patients was 20.9%,hemorrhage of upper digestive tract in 23 cases (82.1%)and hemorrhage of lower digestive tract in 5 cases (17.9%).The reasons of hemorrhage of upper digestive tract were mucosal erosion bleeding of gastric esophagus duodenum in 15 cases (65.2%)and peptic ulcer in 8 cases (34.8%).The positive rate of helicobacter pylori infection was 66.7%(12 /18).In 10 cases (35.7%),gastrointestinal bleeding happened within three months after hemodialysis.Vascular access for hemodialysis were used by central venous catheterization in 13 cases (46.4%)and arteriovenous fistula in 15 cases (53.6%).The prognosis of gastrointestinal bleeding in hemodialysis patients were continuing hemodialysis in 23 cases (82.1%),turned to peritoneal dialysis in 2 cases (7.2%)and death in 3 cases (10.7%).Conclusion The major reason of gastrointestinal bleeding in hemodialysis patients is hemorrhage of upper digestive tract.Mucosal erosion bleeding of gastric esophagus duodenum is major in hemorrhage of upper digestive tract.The positive rate of helicobacter pylori infection is higher.More than 1 /3 gastrointestinal bleeding happens within three months after hemodialysis.The prognosis of the majority of patients is good by internal medicine combined therapies and no heparin hemodialysis.
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Objective To investigate the relation between serum level of fibroblast growth factor (FGF)-23 and left ventricular hypertrophy in non dialysis patients with chronic kidney disease (CKD). Methods One hundred and twenty-four non dialysis patients with CKD were selected. Among them 34 cases were CKD 1-2 stage (CKD 1-2 stage group), 50 cases were CKD 3-4 stage (CKD 3-4 stage group), and 40 cases were CKD 5 stage (CKD 5 stage group). Thirty-two subjects of healthy people were selected as control group. The serum FGF-23, urea nitrogen, creatinine, calcium, phosphorus, intact parathyroid hormone (iPTH) and hemoglobulin levels were measured. The cardiac structural parameters were assessed by Doppler echocardiography, which included left ventricular end-diastolic diameter (LVDd), interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT) and left ventricular ejection fraction (LVEF). Left ventricular mass index (LVMI) was calculated by Devereux formula. The patients were diagnosed as left ventricular hypertrophy according to LVMI (male ≥ 125 g/m2, female ≥ 110 g/m2). The relation between FGF-23 and left ventricular hypertrophy was analyzed. Results Among the patients with CKD, left ventricular hypertrophy was in 46 cases (hypertrophy group), non left ventricular hypertrophy was in 78 cases (hypertrophy group), and the incidence of left ventricular hypertrophy in patients with CKD was 37.1% (46/124). The lgFGF- 23, lgiPTH and phosphorus levels in hypertrophy group were significantly higher than those in non hypertrophy group:1.69 ± 0.33 vs. 1.50 ± 0.27, 1.98 ± 0.45 vs. 1.74 ± 0.32 and (1.50 ± 0.59) mmol/L vs. (1.27 ± 0.39) mmol/L, the calcium, albumin, hemoglobulin and LVEF levels were significantly lower than those in non hypertrophy group:(2.06 ± 0.24) mmol/L vs. (2.17 ± 0.20) mmol/L, (35.76 ± 4.18) g/L vs. (39.74 ± 5.73) g/L, (96.65 ± 22.66) g/L vs. (117.15 ± 27.67) g/L and (59.62 ± 12.02)%vs. (67.76 ± 6.69)%, and there were statistical differences (P0.05). The incidences of left ventricular hypertrophy and LVMI in CKD 1-2 stage group, CKD 3-4 stage group and CKD 5 stage group were significantly higher than those in control group:11.8%(4/34), 36.0%(18/50) and 60.0% (24/40) vs. 3.1% (1/32), (91.18 ± 16.17), (111.25 ± 27.89) and (124.82 ± 24.80) g/m2 vs. (84.41 ± 13.77) g/m2, those indexes in CKD 3-4 stage group, CKD 5 stage group were significantly higher those in CKD 1-2 stage group, and those indexes in CKD 5 stage group were significantly higher than those in CKD 3-4 stage group, and there were statistical differences (P0.05). Multiple linear regression analysis result showed that LVMI (Y) was negatively correlated with hemoglobulin (X1) and LVEF (X2), and the regression equation was Y = 255.201- 0.424 X1- 1.092 X2. Conclusions The incidence of left ventricular hypertrophy increases gradually with the decline of renal function in non dialysis patients with CKD. The serum level of FGF-23 is related to left ventricular hypertrophy and the degree of heart failure in non dialysis patients with CKD. Anemia and cardiac function state are closely related to left ventricular hypertrophy in non dialysis patients with CKD.
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<p><b>OBJECTIVE</b>To explore efficacy and safety of modified FOLFIRINOX (mFOLFIRINOX) regimen by dose attenuation in locally advanced pancreatic cancer (LAPC) and metastatic pancreatic cancer(MPC).</p><p><b>METHODS</b>Between April 2014 and October 2015, 35 patients with LAPC (n=18) or MPC (n=17) were treated with mFOLFIRINOX regimen (irinotecan 135 mg/m(2), oxaliplatin 68 mg/m(2), 5-FU 2 400 mg/m(2), no bolus of 5-FU, leucovorin 400 mg/m(2)) in the Second Affiliated Hospital of Zhejiang University School of Medicine. The primary end point was progression free survival. The second end points were overall survival, objective response rate, adverse effects, surgical resection rate for LAPC.</p><p><b>RESULTS</b>Among 35 patients, 6 patients (17.1%) who dropped out and received less than 2 cycles were excluded for response analysis. Among the other 29 patients, 9 patients had grade 3 or 4 adverse effects. No patients ceased treatment due to adverse effects. The 29 patients received 5 (2-13) cycles were evaluated by efficacy and found partial remission in 16 cases, stable disease in 10 cases, progression disease in 3 cases. Response rate was 55.2%. Nine patients with LAPC accomplished surgery after neoadjuvant treatment without perioperative complication and death, and 6 patients accepted R0 resection.</p><p><b>CONCLUSIONS</b>The mFOLFIRINOX regimen used in the study is well-tolerated in Chinese population with high treatment efficacy on patients with LAPC and MPC. Further investigation of efficacy and adverse effects on more advanced pancreatic cancer patients is necessary.</p>
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Humans , Antineoplastic Combined Chemotherapy Protocols , Camptothecin , Disease Progression , Disease-Free Survival , Fluorouracil , Leucovorin , Neoadjuvant Therapy , Organoplatinum Compounds , Pancreatic Neoplasms , Drug Therapy , Tertiary Care Centers , Treatment OutcomeABSTRACT
Objective To explore possible associations between osteopontin(OPN) and intact parathyroid hormone(iPTH),to investigate effects of them on the progression of carotid artery calcification in patients receiving long-term hemodialysis.Methods Forty-eight maintenance hemodialysis (MHD) patients and 28 age-and sex-matched healthy volunteers were recruited.The concentration of OPN in peripheral blood was determined by enzyme linked immunosorbent assay (ELISA).Levels of iPTH and presence of plaques in the common carotid arteries were also measured.The demographics were recorded.Results Compared with controls,levels of OPN[(137.4±80.8) ng/L vs (31.6±6.7) ng/L,P ＜ 0.01] and iPTH[(456.4±326.4) ng/L vs (66.9±19.3) ng/L,P ＜ 0.01] were higher in MHD patients before hemodialysis,the numbers of calcific plaques in the common carotid arteries were increased in MHD patients (P ＜ 0.01).There was a positive correlation between pre-dialysis OPN levels and iPTH levels (r =0.620,P ＜ 0.01) in MHD patients.Higher levels of OPN and iPTH correlated with greater numbers of calcific plaques in the common carotid arteries after division into three subgroups of MHD patients based on calcific plaques.In multiple linear regression analysis,the correlation between the pre-dialysis OPN and iPTH levels remained the same even if adjusting for confounding effects[β =0.468,95％C1 (0.036,0.195),t =2.936,P =0.005].Conclusion OPN level is positively correlated with iPTH level in hemodialysis patients,which suggesting that both of them play important roles in the progression of carotid artery calcification.
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Tumor invasion and metastasis are regarded as main reasons for the failure of therpy and the reason of patients death.The mechnism of tumor metastasis is still uncertain.The pre-metastatic niche hypothesis provides us with new ideas to discover the mechnism.Numerous materials are involved in the formation of the pre-metastatic niche according to this hypothesis,including bone marrow-derived cells,microvesicles,exosomes,CD44,and so on.A further research on this hypothesis helps to deeply understand the nature of metastasis and leads clinical doctors to explore novel targets for clinical diagnoses and therapies.
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0.05).While there were significant differences when comparing CINⅠwith CINⅡ-Ⅲ(?2=14.97,P
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OBJECTIVE To analyze the susceptible factors and resistance of Acinetobacter baumannii in ICU,in order to create a novel thought of effective prevention and control of A. baumannii cross-infection. METHODS Specimens were collected from ICU patients with infections from Sep 2006 to Sep 2008. The infection characteristic was analyzed and the drug sensitivity was tested to know the risk factors of infection retrospectively. RESULTS The factors of low immunity,severe wound,invasive operation and using ventilator led to the serious cross-infection of A. baumannii in ICU .In vitro drug susceptibility test,the sensitive rates only to cefoperazone/sulbactam and amikacin were higher. They were 65.09% and 72.64%,respectively. CONCLUSIONS It has great significance in the prevention and control of A. baumannii cross-infection in ICU to strengthen the environment disinfection,were education of nosocomial infection knowledge among medical staff,executeing the hand-washing system strictly,useing the antibiotics rationally,keeping the susceptible crowd and adopting de-escalation strategy of prevention and control.
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OBJECTIVE To investigate the change in antibiotic resistance of Pseudomonas aeruginosa(PAE) in our hospital,for the guidance of rational use of antibacterials. METHODS We reviewed the isolation rates of antimicrobial agents from 2004 to 2007,and its construction ratio among the commonly encountered Gram-negative bacilli,and the resistance rates of P.aeruginosa to 14 kinds. RESULTS We totally isolated 823 strains of PAE and the isolation rates of PAE was 13.3% in 2004 but 18.5% in 2007.In the four years,there was the highest isolation rate of 72.54% in sputum and throat mucus specimens.The lowest resistance rate was to amikacin(from 12.2% to 6.21%,the average was 8.75%),and the next was to cefoperazone/sulbactam(from 6.10% to 12.26%,the average was 8.99%);the total resistance rates to ticarcillin and piperacillin was more than 36.00% and there was a lower resistance rate to ticarcillin/clavulanic acid(32.93%)after adding the enzyme inhibitor,while to piperacillin/tazobactam was 20.16%.Drug-resistance rate to ceftazidime was from 19.51% to 43.17%(the average was 33.05%);to cefepime from 22.34% to 34.16%(the average was 29.40%);to imipenem from 19.51% to 23.29%(the average was 22.60%);to meropenem from 11.17% to 18.18%(the average was 15.43%);to the fluoroquinolones antibiotics ciprofloxacin from 32.61% to 44.59%(the average was 38.52%);and to levofloxacin was 26.40% in average. CONCLUSIONS There is commonly increasing resistance of PAE.Reviewing the resistance situation dynamically and selecting the antibiotics reasonably can produce great significance for clinical therapy and postpon its multidrug-resistance.
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Objective To explore the association between circulating endothelial cells (CECs)and atherosclerosis in maintenance hemodialysis(MHD)patients. Methods A crosssectional study was performed to investigate the association between CECs and carotid atherosclerotic change in 65 MHD patients,25 non-hemodialysis patients with chronic kidney disease(CKD)of stage 4 or 5(CKD-non-HD)and 24 age-and Sex-matched healthy controls. CECs in peripheral blood were determined by multiparametrie flow cytometry(FCM).CECs were labeled with CD3-PerCP and CD146-PE before FCM and identified as CD3dim,CD146bright.Atherosclerosis in both groups Was assessed by the measurement of common carotid arery intimamedia thickness (CCA-IMT)and plaque of the common carotid arteries with ultrasound scanner. Results CECs were significantly higher in pre-dialysis patients[(151.52±98.24) cell/ml]and CKD-non-HD patients[(183.00±81.38)cell/ml ] compared with control group[(106.50± 24.14)cell/ml](P<0.05 and P<0.01,respectively).But the number of CECs was not significantly different between MHD and CKD-non-HD patients.CCA-IMT was also significantly higher in MHD patients[(0.94±0.36)mm]and CKD-non-HD patients [(1.02±0.37)mml compared with control group[(0.75±0.15)mm](P<0.05 and P<0.01,respectively).The number of pre-dialysis CECs was positively correlated with CCA-IMT in MHD patients(r=0.328,P<0.01).Multivariate analysis showed that CEC level was a strong independent risk factor of CCA-IMT. Conclusion InMHD patients, CEC level is associated with carotid atherosclerosis and may be used as a marker to evaluate the endothelial damage.
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Objective To investigate the relationship between the incidence and grade of diabetic nephropathy (DN) and diabetic retinopathy (DR) in patients with type 2 diabetes mellitus. Methods A total of 154 patients with type 2 diabetes mellitus (80 males and 74 females) were investigated, ocular fundus were examined after mydriasis, at the same day, blood urea nitrogen, creatinine, glycosylated hemoglobin, blood fat, serum albumin were determined, the microalbuminuria and the glomerular filtration rate were performed. Results The incidences of DR with each stage were significantly different according to different DN stages. Univariate analyses revealed that the disorder of DR was positively correlated with the duration of diabetes, microalbuminuria, blood cholesterol (P<0.01 or <0.05), and negatively correlated with the glomerular filtration rate (P<0.01). Conclusion The incidence OFDN and DR has the highly concordance, and their lesions have some parallel relationship.
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OBJECTIVE To survey the distribution of the pathogenic microorganisms in biles collected from cholelithiasis patients and their susceptibility to antibiotics,to guide the selection of reasonable antibiotics.METHODS Totally 546 bile samples were cultured and tested for antibiotics susceptibility.RESULTS Bacteria were cultured from 332 samples with a positive rate of 60.81%,the first three were Escherichia coli(32.96%),Enterococcus faecalis(12.74%),and Klebsiella pneumoniae(9.97%).The pathogenic microorganisms were more sensitive to the third and fourth generation cephalosporins,antibiotic/?lactamase inhibitor combination,carbopenems and aminoglycosides antibiotics,while less sensitive to the first and second generation cephalosporins,penicillins,macrolide antibiotics and fluoroquinolones.CONCLUSIONS The pathogenic microorganisms in bile are very various,E.coli,E.faecalis and K.pneumoniae are usually cultured,fungous and anaerobic infections cannot be ignored.Doctors should pay more attention to analyze the bacterial resistance profile and use the antibiotics properly.
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OBJECTIVE: To explore the immunological mechanism of exfoliative tongue fur in children with asthma. METHODS: Thirty-nine children with asthma, twenty-eight children with repetitive respiratory tract infection (non-asthma) and eleven healthy children were divided into five groups, which were asthma with exfoliative fur or with non-exfoliative fur groups, non-asthma with exfoliative fur or with non-exfoliative fur groups and normal control group. The concentrations of keratin 13 and bcl-2 in cells exfoliated from tongue fur were detected by immunohistochemical method. The expression levels of blood cell chemokine receptor-3 (CCR-3) and CD4(+) were examined by flow cytometry, and the levels of serum cortisol and IgE were detected by radioimmunoassay. RESULTS: The levels of blood CD4(+) and CCR-3 of children with asthma and exfoliative fur were higher than those in the asthma with non-exfoliative fur group and the normal control group (P<0.05). The serum level of cortisol in the groups of asthma with exfoliative fur and non-asthma with exfoliative fur were lower than that in the other groups (P<0.05). The serum levels of IgE in asthma with exfoliative fur or with non-exfoliative fur groups were higher than that in the other groups (P<0.05). Concentrations of keratin 13 in the cells exfoliated from tongue fur in the groups of asthma or non-asthma with exfoliative fur were lower than that of the other groups (P<0.05). There was no significant difference of expression level of bcl-2 in the cells exfoliated from tongue fur among these five groups. CONCLUSION: There is a reasonably close relationship between the formation of exfoliative tongue fur and the immune system such as low level of serum cortisol and high levels of blood CD4(+) and CCR-3, which may all promote the formation of exfoliative fur. The disability of keratinization and apoptosis of epithelial cells of tongue may also be one cause for its formation.