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Objective:To study the evolution of Traditional Chinese Medicine (TCM) syndromes of 171 cases of Kawasaki disease (KD) under the intervention of gamma globulin therapy based on factor analysis.Methods:A cross-sectional study. 171 cases of KD children hospitalized in the Department of Cardiology of Guangzhou Women's and Children's Medical Center from July 2019 to December 2020 were collected. All patients were treated with intravenous gamma globulin (2 g/kg) for 1 week. According to the results of the treatment with C-ball, 171 children with C-ball sensitive KD were selected to collect the four diagnostic data, and the representative syndromes of defensive level, qi level, yin level, and nutritive level were observed. Factor analysis was used to analyze the evolution of syndrome in 171 children with KD c-ball sensitivity.Results:The result of factor analysis showed that the KMO statistics of 171 children with c-ball sensitivity before treatment was 0.792, and Bartley test was significant ( P<0.01). 16 common factors were extracted, and 23 syndromes were screened, mainly including defensive level disorder, qi level disorder,nutritive level disorder,yin level disorder, heat stagnation and blood stasis syndrome. One week after treatment, the statistic of KMO test was 0.787, and Bartley test was significant ( P<0.01). 9 common factors were extracted, and 10 syndromes were screened, mainly including qi deficiency syndrome, yin deficiency syndrome and blood stasis syndrome. Conclusion:Before treatment, the TCM syndromes in KD C-cell sensitive children are mainly nutritive level disorder, defensive level disorder, qi level disorder yin level disorder, and heat stagnation and blood stasis syndrome; after treatment, the main TCM syndromes are mainly qi deficiency syndrome, yin deficiency syndrome and blood stasis syndrome.
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Objective:To analyze the genetic etiology of 487 fetuses with increased nuchal translucency (NT) using copy number variant sequencing (CNV-seq) and explore the relationship between increased NT and chromosomal abnormality.Methods:A retrospective study was performed on 487 fetuses with increased NT who received CNV-seq in the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2020. These fetuses either had NT of ≥3.0-<3.5 mm (Group A, n=129) or ≥3.5 mm (Group B, n=358), the distribution and incidence of chromosomal abnormalities in the two sets of fetuses were analyzed using Chi square test or Fisher's exact test. Results:Fetuses with abnormal chromosomes accounted for 25.9%(126/487) of cases, including 107 with chromosome aneuploidy (22.0%) and 19 with pathogenic or likely pathogenic copy number variation (CNV, 3.9%). The detection rate of fetal aneuploidy in Group B was higher than that in Group A [14.0% (18/129) vs 24.9% (89/358), χ2=6.58, P=0.010]. However, no significant difference was observed regarding the detection rate of pathogenic or likely pathogenic CNV between the two groups ( χ2=0.30, P=0.584). Conclusions:The risk of fetal chromosome aneuploidy increased with NT thickness, but not with pathogenic or likely pathogenic CNV, which needed further verification due to the small sample size. CNV-seq is an option to detect the conventional detection methods for the genetic etiology of NT thickening fetuses.
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Objective:To investigate the clinical manifestations, diagnosis, treatment and prognosis of Kawasaki disease (KD) complicated with acute abdomen in children.Methods:Clinical manifestations, laboratory examinations, abdominal B-ultrasound scans, abdominal plain films, abdominal CT findings, coronary artery lesions and prognosis of 16 children with KD and acute abdomen admitted to Guangzhou Women and Children′s Medical Center, Guangzhou Medical University from August 1, 2015 to July 31, 2019 were retrospectively analyzed.The measurement data of age, leukocyte, hemoglobin, platelet and biochemical indexes are expressed by M (range). Results:A total of 16 cases were included, involving 7 males and 9 females aged 4 years and 8 months (7 months to 8 years). Among them, 9 cases of KD complicated with cholecystitis, 5 cases with intestinal obstruction, 2 cases with acute appendicitis, 2 cases with necrotizing enterocolitis, 2 cases with acute peritonitis and 1 case with acute pancreatitis.There were 3 cases complica-ted with 2 or more kinds of acute abdomen diseases.All 16 patients had symptoms of abdominal pain, 7 cases had vomiting, 4 cases had obvious abdominal distension and 1 case had bloody stool.Abdominal B-ultrasound was performed in all cases, and 8 cases showed enlargement of gallbladder and edema and thickening of gallbladder wall, 2 cases of appendicitis, 2 cases of intestinal obstruction and 1 case of pancreatic enlargement.Abdominal plain film examination was performed in 8 cases, suggesting necrotizing enterocolitis in 2 cases and intestinal obstruction in 2 cases.Abdominal CT examination was performed in 3 cases, including edema of gallbladder wall in 1 case, peritonitis in 1 case, intestinal obstruction in 2 cases and enlargement of pancreas in 1 case.All the 16 cases were treated with pulsed intravenous immunoglobulin (IVIG) at 2 g/kg and antiplatelet agents.Eight IVIG-resistant cases were treated with the second dose of IVIG at 2 g/kg, among whom, 4 children still had fever and intravenous Methylprednisone was given.Two cases underwent enterostomy and abdominal puncture drainage.All the 16 children were followed up until 6 months after discharge, and 4 cases (25%) were complicated with coronary artery aneurysm (CAA) during the acute stage or follow-up period.Conclusions:KD complicated with acute abdomen is more commonly manifested as cholecystitis and intestinal obstruction.Besides the classic symptoms of KD, abdominal pain and vomiting are the most common in KD with acute abdomen.Abdominal ultrasound, plain film and CT examinations are conductive to the early diagnosis of KD complicated with acute abdomen.In addition, the incidence of IVIG-resistance and CAA is relatively high in children with KD complicated with acute abdomen.
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Objective: To review the clinical characteristics of patients with hypersensitivity to oxaliplatin, symptom management, and treatment outcomes to guide further treatment. Methods: From January 2015 to December 2017, 62 cases of hypersensitivity reactions to oxaliplatin were reported to the National Center for Adverse Drug Reaction(ADR) Monitoring in the Daycare Center of Peking University Cancer Hospital & Institute. The hypersensitivity reactions were classified into standard infusion-related reactions and anaphylaxis in accordance with international standards. The clinical data, treatment information, and outcomes of these patients were retrospectively collected and analyzed. Results: The mean age of the 62 patients was (52.9±11.3) years, the male-to-female radio was 1.07:1, and 59.7% (37/62) of patients received premedication with glucocorticoids before oxaliplatin. The median onset time was 6 (interquartile range 4-7.25) cycles with a median cumulative dose of 456.9 (263.5-651.0) mg/m2. Of the 62 patients, 19 (30.6%) patients had an oxaliplatin-free interval, 41 (66.1%) patients were diagnosed with a standard infusion-related reaction, and 21 (33.9%) patients were diagnosed with anaphylaxis based on clinical criteria. The medication was suspended for all patients and the infusion set was replaced. No patient received epinephrine for symptom management. All patients recovered completely; no deaths were reported. In addition, 58.6% (17/29) of patients with grade 2 standard infusion-related reactions who need further treatment were subsequently rechallenged with oxaliplatin, 70.6% (12/17) showed no symptoms of hypersensitivity. Conclusions: Premedication before oxaliplatin was not sufficient and the management of hypersensitivity was not standardized; therefore, the first-line usage of epinephrine should be performed with caution. Most cases of moderate hypersensitivity for soxaliplatin can be rechallenged successfully.
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Objective:To investigate the prevalence of frailty in elderly patients with stage 3-5 non-dialysis chronic kidney disease(ND-CKD)and to analyze its related factors.Methods:A cross-sectional study was conducted.Patients ≥65 years old with stage 3-5 CKD who had never undergone dialysis in the nephrology department and the internal medicine department of our hospital between October 2017 to September 2018 were enrolled.Patients were divided into the non-frail group and the frail group according to the Fried frailty phenotype.Clinical data and laboratory results were collected and comprehensive geriatric assessment was carried out to evaluate participants' medication, comorbidities, daily living ability, nutritional status, depression, cognitive and physical performance.The relevant factors for frailty were analyzed.Results:A total of 193 elderly patients with stage 3-5 ND-CKD were enrolled, 106 male and 87 female, including 68 outpatients and 125 inpatients, with a median age of 79.00(73.00, 85.00)years.There were 143 frailty patients(74.1%), including 41 outpatients and 102 inpatients, accounting for 60.3% and 81.6% of the eligible outpatients and inpatients respectively.Multivariable Logistic regression analysis showed that CKD stage( OR=9.74, 95% CI: 1.12-84.54)and polypharmacy( OR=3.69, 95% CI: 1.09-12.42)were associated with frailty in outpatients, and CKD stage( OR=11.75, 95% CI: 1.38-99.99)and malnourishment or risk of malnutrition( OR=4.22, 95% CI: 1.40-12.74)were correlated with frailty in inpatients. Conclusions:The prevalence of frailty is high in elderly patients with stage 3-5 ND-CKD.CKD stage, polypharmacy and malnourishment or the risk of malnutrition are closely correlated with frailty.
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Anti-N-methyl-D-aspartate receptor encephalitis is severe diffuse encephalitis caused by cerebrospinal fluid(CSF)antibodies against the GluN1 subunit of the NMDAR.Pediatric NMDAR encephalitis is mainly characterized by neurological symptoms such as dyskinesia, ataxia and epilepsy.Auxiliary examinations of the patients show positive CSF IgG antibodies, EEG slow waves and metabolic changes in FDG-PET/CT.But there is lacking of clinical biomarkers for early diagnosis of children with atypical symptoms and negative antibody.Immunotherapy is effective for most children and early treatment can improve prognosis remarkably.At the same time, antipsychotic drugs and antiepileptic drugs can treat children with psycho behavioral symptoms and seizures.However, some patients are refractory to conventional therapies and have neurological sequela even after the application of multiple immunosuppressants.Therefore, more further studies are needed to clarify the pathogenesis and find biomarkers for early diagnosis of pediatric patients.This article reviews the pathogenesis, clinical characteristics, diagnosis and treatments of the disease.
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ObjectiveTo investigate the value of peripheral blood long non-coding RNA-LET (lncRNA-LET) in the diagnosis of chronic hepatitis B (CHB) cirrhosis, and to provide a basis for early clinical diagnosis and treatment of liver cirrhosis. MethodsA total of 175 CHB patients who attended The Affiliated Hospital of Chengde Medical University from March 2017 to May 2019 were enrolled, among whom 52 patients with hepatitis B cirrhosis were enrolled as cirrhosis group and 123 patients without the pathological changes of liver cirrhosis were enrolled as non-cirrhosis group. A total of 40 healthy individuals who underwent physical examination in our hospital during the same period of time were enrolled as normal control group. Liver function parameters and the level of lncRNA-LET in peripheral blood were measured for all subjects. The t-test was used for comparison of continuous data between two groups; an analysis of variance was used for comparison between multiple groups, and the least significant difference t-test was used for further comparison between two groups. The chi-square test was used for comparison of categorical data between groups, and the Kruskal-Wallis H test was used for comparison of ranked data. A Pearson correlation analysis was performed to investigate correlation. The receiver operating characteristic (ROC) curve was used to investigate the value of peripheral blood lncRNA-LET in predicting liver cirrhosis. Results Compared with the normal control group, the cirrhosis group and the non-cirrhosis group had significantly higher serum levels of the liver function parameters total bilirubin (TBil), total bile acid (TBA), albumin (Alb), and alanine aminotransferase (ALT) (all P＜0.05) and a significantly lower serum level of cholinesterase (ChE) (P＜0.05); compared with the non-cirrhosis group, the cirrhosis group had significantly higher serum levels of TBil, TBA, Alb, and ALT (all P＜0.05) and a significantly lower serum level of ChE (P＜0.05). Compared with the normal control group, the cirrhosis group and the non-cirrhosis group had significantly lower relative expression of lncRNA-LET in peripheral blood (P＜0.05), and the cirrhosis group had significantly lower relative expression of lncRNA-LET in peripheral blood than the non-cirrhosis group (P＜0.05). The relative expression of lncRNA-LET decreased significantly with the increase in liver fibrosis stage (P＜0.05). In the patients with CHB, the relative expression of lncRNA-LET in peripheral blood was negatively correlated with liver fibrosis stage, TBil, TBA, Alb, and ALT (r=-0.352,-0.372,-0.364, and -0.410, all P＜0.001) and was positively correlated with ChE (r=0.340, P＜0.001). The ROC curve was used to analyze the value of peripheral blood lncRNA-LET in predicting liver cirrhosis, and the area under the ROC curve was 0934, with an optimal cut-off value of 0.833, a sensitivity of 84.57%, and a specificity of 80.57%. ConclusionThe expression level of lncRNA-LET in peripheral blood decreases with the progression of liver fibrosis and has a good value in the diagnosis of CHB cirrhosis, and therefore, it can be used as a potential biological indicator for the diagnosis of liver cirrhosis.
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BACKGROUND@#Malignant plural effusion (MPE) is one of the most common specimen for liquid biopsy gene detection. This study aims to explore a method for isolating tumor cells from large volume of MPE and evaluate its efficacy and application prospect in gene detection.@*METHODS@#Pleural effusions (>500 mL) from 20 advanced lung cancer patients were obtained by effusion drainage and used to isolate tumor cells with cell separation media Percoll and Ficoll. Cell number and purity were calculated. DNA was extracted from the supernatant (etDNA), total cells and isolated tumor cells of pleural effusion (ETC-DNA) to detect the mutation of tumor-related genes by next-generation sequencing.@*RESULTS@#The median number of cells isolated from malignant pleural effusion was 8.50×10⁴ (interquel range: 9.25×10³-3.75×10⁵), 85.50%±5.80% of the cells were identified as tumor cells. The detection rates of epidermal growth factor receptor (EGFR) gene mutation of etDNA, total cell DNA and ETC-DNA were 70.00%, 50.00% and 70.00%, reseparately, while the median EGFR mutation abundance in 3 components was 16.05% (4.78%-43.06%), 1.09% (0.00%-2.39%), and 33.02% (18.50%-76.70%), respectively. ETC-DNA had good consistency with tissue DNA (P>0.999, kappa=1.000) and etDNA (P>0.999, kappa=1.000). ETC-DNA inclined to have higher EGFR mutation than etDNA, but the result was not statistically significant.@*CONCLUSIONS@#Our method can isolate large amount of tumor cells from a large volume of malignant pleural effusion with high purity. Using ETC-DNA as specimen improves the efficacy of gene detection, thus is worth further study.
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With the population aging, the prevalence of chronic kidney disease(CKD)is increasing.Frailty is a complex syndrome in the elderly.Elderly CKD patients have higher risks of frailty and cognitive impairment than the general elderly population.In recent years, the relationship between frailty and cognition has gradually attracted the attention of researchers at home and abroad.Cognitive frailty is regarded as a subtype of frailty and has become one of the research hotspots in the field of gerontology.However, there are few studies on the relationship between CKD and cognitive frailty in the elderly.This article reviews research progress on the topic, including the epidemiology, evaluation methods and possible pathogenesis of cognitive frailty in elderly CKD patients.
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Objective@#Using data of health information system (HIS) of medical institutions to study the incidence and hospitalization of herpes zoster in three districts of Beijing.@*Methods@#According to the different level of economic development and geographical features in Beijing, 3 districts of Xicheng, Changping and Miyun were chosen and all 110 medical institutions of the first level and above in the 3 districts are included in the survey. All the outpatient and inpatient herpes zoster cases in 2015 were retrospectively reviewed by HIS system. After distinguishing the reduplicated cases, Using the first outpatient case as a molecule and the resident population as denominator to estimate the annual incidence rate, as well as the annual hospitalization rate was estimated based on primary diagnostic hospitalized cases as molecule and the resident population as denominator.@*Results@#A total of 32 313 primary visit outpatient cases were investigated, of which 18 360 cases (56.8%) were women and 20 923 cases (64.8%) were ≥50 years old. The overall estimated incidence of the 3 districts was 8.8‰ with an increase trends with age and reached to the highest in ≥80 years old (30.5/1 000). The incidence of Xicheng, Changping and Miyun districts are respectively 16.2‰, 4.0‰ and 5.7‰. A total of 701 primary visit inpatient cases were identified, of which 366 cases (52.2%) were women and 651 cases (92.9%) were ≥50 years old. The estimated annual hospitalization rate was 19.4/100 000, with the primary and secondary diagnostic hospitalization rate are respectively 5.9/100 000 (212 cases) and 13.5/100 000 (489 cases). The disease types of secondary diagnostic inpatient herpes zoster cases were as follows: cardiovascular disease (19.0%, 93 cases), stroke (14.5%, 71 cases), pneumonia/chronic obstructive pulmonary disease (14.1%, 69 cases), tumor (12.5%, 61 cases) and diabetes (5.7%, 28 cases).@*Conclusion@#Most of the herpes zoster cases in Beijing are over 50 years old, and the incidence of female is slightly higher than male. This disease should become a public health issue of great concern.
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Objective@#To explore the value of diffusion-weighted magnetic resonance imaging (MR-DWI) technique in predicting the efficacy of radiotherapy in patients with esophageal cancer, using experimental animal models.@*Methods@#BALB/c nude mice were subcutaneously injected with Eca-109 cell lines and then tumor formed. The experimental group (16 cases) received a single dose of 15 Gy (6 MV X-rays) delivered by a medical linear accelerator, while the control group (24 cases) did not receive any treatment. The two groups were scanned every other day, started one day before the radiotherapy. The scanning sequences included T1-weight imaging, T2-weight imaging, and DWI. The observation time was 1 month. According to the changes of the tumor volume and apparent diffusion coefficient (ADC) value of the two groups, 7 key time points were selected to observe the difference of cell density and tissue necrosis ratio between the two groups (6 cases in each group).@*Results@#From day 7 after radiotherapy, the experimental group had statistically smaller volume of transplanted tumors than the control group, namely (1.729±0.906) cm3 vs (2.671±0.915) cm3(P<0.05). From day 3 after radiotherapy, the experimental group had statistically higher ADC values [(1.017±0.255)×10-6 vs (0.833±0.142)×10-6 mm2/s, P<0.05], lower cell density of transplanted tumor (25.56±1.40 vs 33.48±4.18%, P<0.05), and less proportion of tissue necrosis [(32.19±1.21) % vs (29.16±2.16)%, P<0.05], respectively. The ADC value was negatively correlated with cell density (r=-0.703, P<0.001) and positively correlated with tissue necrosis ratio (r=0.658, P=0.003).@*Conclusions@#Single dose of large fraction radiotherapy could inhibit the growth of xenograft. ADC values may change at the early stage prior to morphological changes of tumor. The change of cell density and necrosis ratio of transplanted tumor are in line with the change of ADC value. MR-DWI has the value of early prediction of esophageal cancer radiotherapy efficacy.
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Objective@#To investigate the characteristics of long-term changes in giant coronary artery aneurysm (GCAA) caused by Kawasaki disease (KD) and the technical approach of using selective coronary angiography (SCAG) in children.@*Methods@#A retrospective analysis was made in 52 patients with KD and GCAA in acute phase, including 38 males and 14 females with an average age of (4.1±2.5) years old ranging from 1 to 14 years old, from January 2008 to December 2018 at the Department of Cardiology, Guangzhou Women and Children′s Medical Center.The selective coronary angiography (SCAG) was performed in the patients who were followed up for (10.6±3.6) years (1-19 years). The changes in coronary artery lesions were analyzed and the technical approach of SCAG was discussed in children.@*Results@#Among 52 patients investigated by SCAG, the location of coronary artery lesion was found the left-anterior descending branch in 21 cases(40.4%), 20 cases(38.5%) in the right coronary artery, 8 cases(15.4%) in the left main trunk and 3 cases(5.7%) in circumflex.The left coronary artery in 2 cases and the right coronary artery in 4 cases were completely occluded, and collateral vessel formation was found in 12 cases.There were 21 cases of right coronary artery stenosis, including 7 cases of the right coronary artery occlusion and bridge-like neovascularization, and 4 cases of the right coronary artery woven lesions (thrombotic occlusion and clustered neovascularization). There were 27 cases of the left coronary artery stenosis with different degrees, including 5 cases of the left coronary artery occlusion and bridge-like neovascularization, and 2 cases of the left coronary artery woven lesions (thrombotic occlusion and clustered neovascularization). All of 52 patients with GCAA were followed up for 1 to 19 years.GCAA still existed in 40 cases.Regression to small coronary artery aneurysm was found in 8 cases, and mild-dilation regression was observed only in 4 patients.The resting electrocardiogram showed pathological Q wave and the left ventricular enlargement in 6 cases, and normal in the remaining 46 patients.The children had no subjective symptoms and their activities were not restricted.Compared with SCAG, echocardiography detected 52 cases with proximal morphological changes in the coronary artery, but distal changes were found only in 3 cases.And 12 cases with coronary artery occlusion and neovascularization failed to be prompted by echocardiography.@*Conclusions@#GCAA induced by KD can persist for a long time, and has characteristics of coronary occlusion, stenosis, and collateral vessel formation.The conventional electrocardiogram and echocardiography are insensitive to the coronary artery morphology and dysfunction in KD sequelae.The SCAG is of great value in tracking this disease.For using SCAG in children, as long as the approp-riate equipment and projection angle are selected, and the operation skills are mastered, satisfactory images and high success rate can be obtained.
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Objective@#To investigate the safety and efficacy of Warfarin combined with Aspirin in the treatment of multiple medium and giant coronary artery aneurysms in Kawasaki disease(KD).@*Methods@#Clinical and follow-up data of 45 children diagnosed with KD complicated with multiple medium-sized and giant coronary artery aneurysms from April 2014 to December 2018 at Guangzhou Women and Children′s Medical Center were collected.These children were divided into 2 groups.A total of 31 cases received regular oral Warfarin combined with Aspirin called experimental group.There were 14 patients treated with oral Aspirin and Clopidogrel called control group.General information, laboratory examination, electrocardiogram, echocardiography, outcome and bleeding complications of the 2 groups were analyzed retrospectively.@*Results@#(1) In experimental group, there were 22 patients found thrombosis under echocardiography.The 10 patients′ thrombosis disappeared, 5 patients′ thrombosis reduced, and 2 patients′ increased after treatment.In control group, there were 5 cases found thrombosis.The 2 cases′ thrombosis reduced and 3 cases′ throm-bosis increased.The number of thrombosis in experimental group was significantly reduced, and the number of new thrombosis was less than that in control group (χ2=6.454, P<0.05). (2) The number of coronary artery aneurysms in experimental group increased slowly than that in control group [12.90%(4/31 cases)vs.14.28%(2/14 cases)]. (3) The number of coronary artery aneurysms in experimental group decreased rapidly than that in control group [23.91%(11/46 cases)vs.10.00%(1/10 cases)]. (4) The number of cases of tumor retraction in experimental group was more than that in control group [74.19%(23/31 cases)vs.42.85%(6/14 cases)]. (5) During the followed-up, there was no abnormality in the blood phosphokinase isozyme and troponin, no abnormality in the electrocardiogram and echocardiogram, no ventricular enlargement and abnormal ventricular wall movement, and the ejection fraction value was within the normal range.No active bleeding and no death occurred in the two groups.@*Conclusions@#Warfarin combined with Aspirin is very safe and effective in the treatment of KD coronary tumor, it can reduce thrombosis effectively.Compared with oral Aspirin and Clopidogrel, Warfarin combined with Aspirin can reduce the number of multiple medium-sized and large coronary artery aneurysms and reduce the diameter of coronary artery aneurysms.
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Objective@#To summarize the clinical characteristics of pediatric hypertrophic cardiomyopathy and analyze its etiology for providing guidance for early identification, diagnosis and prognosis.@*Methods@#Fifty-two cases of pediatric hypertrophic cardiomyopathy admitted to Guangzhou Women and Children′s Medical Center from January 2012 to June 2018 were retrospectively analyzed and summarized from the aspects of age, gender, family history, clinical features, auxiliary examination, etiology, drug efficacy and disease outcome.@*Results@#(1) There were 52 cases in this group including 36 males and 16 females.The ages of patients ranged from 15 days to 14 years (with mean age of 27.7 months, median 6.5 months). A total of 34 patients (65.4%) were followed up for 1-78 months (mean 30.6 months). Echocardiography showed 52 cases of left ventricular wall thickening (100%), 21 cases of double ventricular hypertrophy (40.4%), 18 cases of left ventricular outflow tract obstruction (34.6%), and 18 cases of hepatic enzyme elevation (34.6%). The etiology of 11 cases was clear (21.2%), including 7 cases of type Ⅱ glycogen accumulation, 3 cases of Noonan syndrome and 1 case of primary carnation deficiency.No routine heart transplantation was performed at the end of follow-up, and 12 patients (35.3%) died, 7 cases of whom died in infancy.@*Conclusions@#Children with hypertrophic cardiomyopathy have a relatively young age, so it is necessary to search for the etiology actively, carry out disease risk assessment, and conduct personalized management and treatment.
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Objective@#To estimate the effect of urate-lowering therapy with febuxostat on oxidative stress in chronic kidney disease (CKD) stages 3-5 patients with hyperuricemia (HUA).@*Methods@#The study was a prospective cohort study. The patients of CKD stages 3-5 with HUA between June 2015 and June 2018 in the Affiliated Hospital of Qingdao University were prospectively analyzed. The patients were assigned to febuxostat (A) group, allopurinol (B) group and non-hyperuricemia (C) group according to the level of serum uric acid and the choice of urate-lowering drugs. Serum uric acid, hypersensitive C-reactive protein (hs-CRP), plasma malondialdehyde (MDA), superoxide dismutase (SOD) and endothelin-1 (ET-1) were measured at baseline, 1 month and 3 months after treatment and the changes of the values of inflammation and oxidative stress before or after treatment were compared. According to the level of serum uric acid, patients were divided into attainment group and nonattainment group, and the correlation between uric acid and oxidative stress was analyzed at baseline and 3 months after treatment respectively.@*Results@#There was no significant difference in baseline levels of serum uric acid, inflammation and oxidative stress between group A and group B (P>0.05). The levels of serum uric acid, hs-CRP, MDA and ET-1 of group A and group B were significantly higher than those of group C, but the level of SOD of group A and group B was significantly lower than that of group C at baseline (P<0.001). After treatment for 1 month and 3 months, the values of serum uric acid, hs-CRP, MDA and ET-1 in group A were significantly lower than those in group B, while the level of SOD in group A was significantly higher than that in group B (P<0.001). Compared with pre-treatment period, both the serum uric acid, hs-CRP, MDA and ET-1 levels of group A and group B were declined significantly while SOD had a significant rise after 3 months treatment (P<0.001). The changes of group A were significantly higher than those of group B (P<0.001). At baseline and 3 months after treatment, serum uric acid was positively related to hs-CRP, MDA and ET-1, but negatively related to SOD in nonattainment group (| r|>0.50, P<0.001); serum uric acid was positively related to hs-CRP, MDA and SOD (| r|>0.70, P<0.001), and there was no correlation between serum uric acid and ET-1 in attainment group (P>0.05).@*Conclusions@#Febuxostat performed better than allopurinol in lowering urate and inhibiting oxidative stress in CKD stages 3-5 patients with HUA, thus reducing vascular endothelial injury. Elevated serum uric acid may be one of the important factors that promote oxidative stress and increase endothelial damage in CKD patients.
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Objective To explore the risk factors of post-hepatectomy acute kidney injury (AKI),a Nomogram predictive model of secondary AKI after hepatectomy was established which can provide guidance for the selection of clinically relevant treatment plans and improve the prognosis of surgical patients.Methods A total of 2769 patients who underwent hepatectomy in the Affiliated Hospital of Qingdao University from October 2012 to July 2018 were included in the study.The post-hepatectomy AKI was diagnosed according to the KDIGO AKI criteria in 2012.The selected patients were divided into AKI group (n=133) and non-AKI group (n=2636);they were divided into training group (n=2050) and test group (n=719) according to Enrollment time.The differences of preoperative clinical data,length of hospital stay,and in-hospital mortality between patients with AKI and non-AKI group were compared.The risk factors of post-hepatectomy AKI were evaluated by the Cox regression.A Nomogram predictive model of AKI after hepatectomy was established,and receiver operating curve (ROC) and consistency curve were used to verify the accuracy of the predictive model.Results The incidence of AKI after hepatectomy was 4.80％(133/2769).Compared with non-AKI group,preoperative serum albumin,hemoglobin,and hematocrit levels were lower in AKI group;the level of blood transaminase,total bilirubin,alkaline phosphatase,triglyceride,lactate dehydrogenase,and fibrinogen were higher (P ＜ 0.050);the proportion of preoperative aspirin application was higher (P ＜ 0.001);the duration of operation was longer (P=0.002);the proportion of open surgery was higher (P ＜ 0.001);the mortality rate was higher (P ＜ 0.050);the length of hospital stay was longer (P ＜ 0.050).Cox regression results showed hypertriglyceridemia,hypoalbuminemia,alkaline phosphatase,aspartate aminotransferase,open surgery,lower preoperative glomerular filtration rate,aspirin and duration of surgery were independent risk factors for AKI.We incorporated these indicators into the Nomogram to establish a predictive model for AKI after hepatectomy,the area under ROC curve was 0.764.The area under ROC curve of the test group was 0.781.Conclusion The Nomogram predicting model of AKI after hepatectomy has high accuracy,which is helpful for prognosis of patients who underwent hepatectomy.
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To explore the relationship between paediatric early warning score (PEWS) and the occurrence of mechanical ventilation complications in children with acute respiratory distress syndrome (ARDS). Methods: A total of 110 children with ARDS diagnosed in First Affiliated Hospital of Hebei North University, who underwent mechanical ventilation, were selected. The baseline data, blood gas analysis index, laboratory test index, ventilator parameters, pediatric critical illness score (PCIS) and PEWS in the children were recorded. With reference to ventilatory treatment results, the children with ventilator-associated complications were included in the trial group (n=20), while the patients with good cohort status were included in the control group (n=40) according to the nested case-control study. Independent sample t-test and multivariate logistic regression analysis were used to analyze the factors affecting the occurrence of complications after ventilatory treatment. Results: There were statistically significant differences in multiple organ dysfunction syndrome (MODS), partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2), partial pressure of carbon dioxide (PaCO2), serum creatinine (SCr), albumin (ALB), blood urea nitrogen (BUN), mechanical ventilation time, mean article pressure (MAP), tidal volume (VT), positive end-expiratory pressure (PEEP), PCIS, PEWS between the control group and the experimental group (all P<0.05). Multivariate logistic regression analysis showed that MODS, PaO2/FiO2, PaCO2, VT, PEEP and PEWS had influence on complications after mechanical ventilation in children with ARDS (all P<0.05). Conclusion: The MODS, PaO2/FiO2, PaCO2, VT, PEEP, and PEWS exert effects on complications after mechanical ventilation in children with ARDS. PEWS combined with other indicators can assess the risk of complications in children with ARDS after mechanical ventilation.
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Child , Humans , Case-Control Studies , Positive-Pressure Respiration , Respiration, Artificial , Respiratory Distress Syndrome , Tidal VolumeABSTRACT
Objective To estimate the effect of urate-lowering therapy with febuxostat on oxidative stress in chronic kidney disease (CKD) stages 3-5 patients with hyperuricemia (HUA). Methods The study was a prospective cohort study. The patients of CKD stages 3-5 with HUA between June 2015 and June 2018 in the Affiliated Hospital of Qingdao University were prospectively analyzed. The patients were assigned to febuxostat (A) group, allopurinol (B) group and non -hyperuricemia (C) group according to the level of serum uric acid and the choice of urate-loweringdrugs. Serum uric acid, hypersensitive C-reactive protein (hs-CRP), plasma malondialdehyde (MDA), superoxide dismutase (SOD) and endothelin-1 (ET-1) were measured at baseline, 1 month and 3 months after treatment and the changes of the values of inflammation and oxidative stress before or after treatment were compared. According to the level of serum uric acid, patients were divided into attainment group and nonattainment group, and the correlation between uric acid and oxidative stress was analyzed at baseline and 3 months after treatment respectively. Results There was no significant difference in baseline levels of serum uric acid, inflammation and oxidative stress between group A and group B (P>0.05). The levels of serum uric acid, hs-CRP, MDA and ET-1 of group A and group B were significantly higher than those of group C, but the level of SOD of group A and group B was significantly lower than that of group C at baseline (P<0.001). After treatment for 1 month and 3 months, the values of serum uric acid, hs-CRP, MDA and ET-1 in group A were significantly lower than those in group B, while the level of SOD in group A was significantly higher than that in group B (P<0.001). Compared with pre-treatment period, both the serum uric acid, hs-CRP, MDA and ET-1 levels of group A and group B were declined significantly while SOD had a significant rise after 3 months treatment (P<0.001). The changes of group A were significantly higher than those of group B (P<0.001). At baseline and 3 months after treatment, serum uric acid was positively related to hs-CRP, MDA and ET-1, but negatively related to SOD in nonattainment group (|r|>0.50, P<0.001);serum uric acid was positively related to hs-CRP, MDA and SOD (|r|>0.70, P<0.001), and there was no correlation between serum uric acid and ET-1 in attainment group (P>0.05). Conclusions Febuxostat performed better than allopurinol in lowering urate and inhibiting oxidative stress in CKD stages 3-5 patients with HUA, thus reducing vascular endothelial injury. Elevated serum uric acid may be one of the important factors that promote oxidative stress and increase endothelial damage in CKD patients.
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Objective To investigate the characteristics of long-term changes in giant coronary artery aneurysm (GCAA) caused by Kawasaki disease (KD) and the technical approach of using selective coronary angiography (SCAG) in children.Methods A retrospective analysis was made in 52 patients with KD and GCAA in acute phase,including 38 males and 14 females with an average age of (4.1 ±2.5) years old ranging from 1 to 14 years old,from January 2008 to December 2018 at the Department of Cardiology,Guangzhou Women and Children's Medical Center.The selective coronary angiography (SCAG) was performed in the patients who were followed up for (10.6 ± 3.6) years (1-19 years).The changes in coronary artery lesions were analyzed and the technical approach of SCAG was discussed in children.Results Among 52 patients investigated by SCAG,the location of coronary artery lesion was found the left-anterior descending branch in 21 cases(40.4％),20 cases(38.5％) in the right coronary artery,8 cases (15.4％) in the left main trunk and 3 cases(5.7％) in cimumflex.The left coronary artery in 2 cases and the right coronary artery in 4 cases were completely occluded,and collateral vessel formation was found in 12 cases.There were 21 cases of right coronary artery stenosis,including 7 cases of the right coronary artery occlusion and bridge-like neovascularization,and 4 cases of the right coronary artery woven lesions (thrombotic occlusion and clustered neovascularization).There were 27 cases of the left coronary artery stenosis with different degrees,including 5 cases of the left coronary artery occlusion and bridge-like neovascularization,and 2 cases of the left coronary artery woven lesions (thrombotic occlusion and clustered neovascularization).All of 52 patients with GCAA were followed up for 1 to 19 years.GCAA still existed in 40 cases.Regression to small coronary artery aneurysm was found in 8 cases,and mild-dilation regression was observed only in 4 patients.The resting electrocardiogram showed pathological Q wave and the left ventricular enlargement in 6 cases,and normal in the remaining 46 patients.The children had no subjective symptoms and their activities were not restricted.Compared with SCAG,echocardiography detected 52 cases with proximal morphological changes in the coronary artery,but distal changes were found only in 3 cases.And 12 cases with coronary artery occlusion and neovascularization failed to be prompted by echocardiography.Conclusions GCAA induced by KD can persist for a long time,and has characteristics of coronary occlusion,stenosis,and collateral vessel formation.The conventional electrocardiogram and echocardiography are insensitive to the coronary artery morphology and dysfunction in KD sequelae.The SCAG is of great value in tracking this disease.For using SCAG in children,as long as the appropriate equipment and projection angle are selected,and the operation skills are mastered,satisfactory images and high success rate can be obtained.
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Objective To investigate the safety and efficacy of Warfarin combined with Aspirin in the treatment of multiple medium and giant coronary artery aneurysms in Kawasaki disease(KD).Methods Clinical and followup data of 45 children diagnosed with KD complicated with multiple medium-sized and giant coronary artery aneurysms from April 2014 to December 2018 at Guangzhou Women and Children's Medical Center were collected.These children were divided into 2 groups.A total of 31 cases received regular oral Warfarin combined with Aspirin called experimental group.There were 14 patients treated with oral Aspirin and Clopidogrel called control group.General information,laboratory examination,electrocardiogram,echocardiography,outcome and bleeding complications of the 2 groups were analyzed retrospectively.Results (1) In experimental group,there were 22 patients found thrombosis under echocardiography.The 10 patients' thrombosis disappeared,5 patients' thrombosis reduced,and 2 patients' increased after treatment.In control group,there were 5 cases found thrombosis.The 2 cases' thrombosis reduced and 3 cases' thrombosis increased.The number of thrombosis in experimental group was significantly reduced,and the number of new thrombosis was less than that in control group (x2 =6.454,P ＜ 0.05).(2) The number of coronary artery aneurysms in experimental group increased slowly than that in control group [12.90％ (4/31 cases) vs.14.28％ (2/14 cases)].(3) The number of coronary artery aneurysms in experimental group decreased rapidly than that in control group [23.91％ (11/46 cases)vs.10.00％ (1/10 cases)].(4) The number of cases of tumor retraction in experimental group was more than that in control group [74.19％ (23/31 cases)vs.42.85％ (6/14 cases)].(5) During the followed-up,there was no abnormality in the blood phosphokinase isozyme and troponin,no abnormality in the electrocardiogram and echocardiogram,no ventricular enlargement and abnormal ventricular wall movement,and the ejection fraction value was within the normal range.No active bleeding and no death occurred in the two groups.Conclusions Warfarin combined with Aspirin is very safe and effective in the treatment of KD coronary tumor,it can reduce thrombosis effectively.Compared with oral Aspirin and Clopidogrel,Warfarin combined with Aspirin can reduce the number of multiple medium sized and large coronary artery aneurysms and reduce the diameter of coronary artery aneurysms.