ABSTRACT
Objective To investigate clinical and epidemiological features of pneumocystis jirovecii pneumonia (PJP) in kidney transplant recipients. Methods Clinical data of 68 kidney transplant recipients admitted from July, 2021 to December, 2021 were collected. All patients were divided into the PJP group (n=11), common pulmonary infection group (n=24) and non-pneumonia group (n=33) according to the status of pulmonary infection. The incidence and treatment of PJP after kidney transplantation were analyzed. Basic characteristics and laboratory parameters of the recipients were compared among all groups. The genotyping and transmission map of PJP patients were evaluated. Results Among 64 kidney transplant recipients, 11 cases were definitely diagnosed with PJP. The most common clinical manifestations included elevated body temperature, and dry cough complicated with progressive dyspnea. Chest CT scan showed diffuse interstitial inflammation and ground glass-like lesions of bilateral lungs in all patients. After diagnosis, all patients were orally given with compound sulfamethoxazole for 3-4 weeks. Two patients received non-invasive ventilator-assisted ventilation due to severe lung infection and dyspnea, and the remaining patients were given with nasal cannula oxygenation. One patient experienced elevated serum creatinine level upon discharge, and developed renal allograft failure. The remaining 10 recipients with PJP obtained normal renal allograft function, and no recipient died. Compared with the non-pneumonia group, the rejection rate was higher, the length of hospital stay was longer, the lymphocyte count was less, the lymphocyte proportion was lower, the levels of C-reactive protein, serum creatinine and lactate dehydrogenase were higher, and the levels of serum albumin was lower and CD4+T cell count was less in the PJP group (all P < 0.05). Compared with common pulmonary infection group, the lymphocyte count was less, the lymphocyte proportion was lower, the CD4+T cell count was less and 1, 3-β-D- glucan (BDG) level was higher in the PJP group (all P < 0.05). No new genotype was detected in 10 of the 12 testing samples. It was considered that PJP mainly depended on two transmission chains and two independent transmission individuals. Conclusions Kidney transplant recipients are prone to pneumocystis jirovecii (PJ) infection due to impaired cellular immune function. The most common clinical manifestations consist of elevated body temperature and dry cough complicated with progressive dyspnea, accompanied by headache and fatigue in partial patients. Chest CT scan shows diffuse interstitial inflammation and ground glass-like lesion of bilateral lungs. PJ may be transmitted through respiratory tract. Small-scale PJP might occur in the follow-up outpatient of kidney transplant recipients. Preventive measures should be delivered in a timely manner.
ABSTRACT
Objective To analyze the correlation between internal iliac artery calcification and delayed graft function (DGF) and short-term prognosis of kidney transplant recipients. Methods Clinical data of 222 kidney transplant recipients were retrospectively analyzed. According to the recovery of renal function, all recipients were divided into the DGF group (n=50) and immediate graft function (IGF) group (n=172). According to whether the recipients were complicated with severe internal iliac artery calcification, DGF and IGF groups were further divided into the high-risk DGF (n=22), low-risk DGF (n=28), high-risk IGF (n=41) and low-risk IGF(n=131) subgroups, respectively. Clinical data of donors and recipients were statistically compared between two groups. The incidences of postoperative DGF and internal iliac artery calcification were recorded. The risk factors of DGF after kidney transplantation, and the correlation between internal iliac artery calcification and clinical parameters were analyzed. Short-term prognosis of recipients with DGF complicated with severe internal iliac artery calcification was evaluated. Results The incidence of DGF was 22.5% (50/222). Among all recipients, 28.4% (63/222) were complicated with severe internal iliac artery calcification. In the DGF group, 44% (22/50) of the recipients were complicated with severe internal iliac artery calcification, higher than 23.8% (41/172) in the IGF group (P < 0.05). Univariate analysis showed that high serum creatinine (Scr) level of donors, male donor, high triglyceride level and severe internal iliac artery calcification of recipients were the risk factors for DGF after kidney transplantation (all P < 0.05). Multivariate logistic regression analysis revealed that Scr≥143 μmol/L of donors and severe internal iliac artery calcification of recipients were the independent risk factors for DGF after kidney transplantation (both P < 0.05). Correlation analysis indicated that internal iliac artery calcification was weakly correlated with the age of recipients and renal artery anastomosis (both P < 0.05). In the DGF group, the Scr level at postoperative 1 month was significantly higher, whereas the estimated glomerular filtration rate (eGFR) was significantly lower than those in the IGF group (both P < 0.05). The eGFR at postoperative 12 months in the high-risk DGF subgroup was significantly lower than those in the low-risk DGF, high-risk IGF and low-risk IGF subgroups (all P < 0.05). Conclusions Internal iliac artery calcification is not only a risk factor for recovery of renal allograft function, but also negatively affects short-term prognosis of renal allograft function.
ABSTRACT
【Objective】 To explore the effects of early application of erythropoietin (EPO) in patients with anemia after renal transplantation. 【Methods】 Patients who underwent renal transplantation in the First Affiliated Hospital of Soochow University were retrospectively analyzed. According to whether EPO was applied after operation, the patients were divided into EPO group and routine group. Patients with delayed renal function recovery were excluded, and the remaining patients were further analyzed. The general, laboratory and follow-up data of the two groups were compared, and adverse drug reactions were observed. 【Results】 The hemoglobin (P=0.026), red blood cell count (P=0.038) and hematocrit (P=0.011) in EPO group were higher than those in the routine group 2 weeks after operation, while the postoperative serum creatinine level was lower (P=0.001). Since the first week after operation, the reticulocyte count in EPO group was significantly higher than that in routine group (P<0.01). There was a negative correlation between hemoglobin and serum creatinine in EPO group at week 1 (r=-0.375, P=0.010) and week 2 (r=-0.386, P=0.008). During the treatment, 6 patients showed transient elevation of serum potassium, which returned to normal after symptomatic treatment, and no obvious adverse drug reactions were observed. 【Conclusion】 Continuous application of erythropoietin in the early stage after renal transplantation can significantly improve anemia in renal transplant patients and promote the recovery of renal function.
ABSTRACT
【Objective】 To analyze the correlation between CT attenuation value of renal papilla and occurrence and development of renal calculi. 【Methods】 The clinical data of 100 patients with calcium oxalate stones treated during Aug.2020 and Jul.2022 were retrospectively analyzed, including 60 with primary stones, and 40 with recurrent stones. The 30 healthy volunteers were enrolled in the control group. CT attenuation value of renal papilla was measured with plain scan CT, and risk factors were identified with the receiver operating characteristic (ROC) curve. The correlation of CT attenuation value and 24 h urine metabolism was analyzed. 【Results】 The CT attenuation value of renal papilla was significantly higher in the primary group [34.92 (IQR: 3.84)] and recurrent group [43.00 (IQR: 8.74)] than in the control group [32.58 (IQR: 5.21)] (P<0.05). Compared with the primary group, the recurrent group had decreased citric acid level but increased calcium level in 24 h urine (P<0.05). The citrate ion and calcium ion were correlated with the CT attenuation value (P<0.05). 【Conclusion】 Patients with high renal papilla density have a high risk of stone formation and recurrence. Increased renal papilla density is a warning signal for the development of stones. The high calcium and low citric acid in 24 h urine have certain effects on the occurrence and development of urolithiasis. Intake of calcium should be limited and citric acid should be supplemented in patients with calcium oxalate stones.
ABSTRACT
Objective To evaluate the predictive values of serum neutrophil gelatinase-associated lipocalin (NGAL), urine NGAL, serum cystatin C (Cys-C) and serum creatinine (Scr) for early delayed graft function (DGF) in kidney transplant recipients. Methods Clinical data, blood and urine samples of 159 kidney transplant recipients were collected. All recipients were divided into the DGF group (n=42) and immediate graft function (IGF) group (n=117) according to the incidence of DGF. Clinical data of all recipients were analyzed. The changes of serum NGAL, urine NGAL, Cys-C and Scr levels were statistically compared between two groups. The predictive values of different markers for early DGF were assessed. Results Among 159 kidney transplant recipients, DGF occurred in 42 cases with an incidence rate of 26.4%. There were statistically significant differences in donor age, cold ischemia time of donor kidney and complement-dependent cytoxicity (CDC) between the two groups(all P < 0.05). Within postoperative 2 weeks, the serum NGAL levels in the DGF group were higher than those in the IGF group (all P < 0.05). The Cys-C, Scr and urine NGAL levels in the DGF group were higher compared with those in the IGF group within 3 weeks after kidney transplantation(all P < 0.001). Serum NGAL, urine NGAL, Cys-C and Scr levels had certain predictive values for early DGF in kidney transplant recipients. Cys-C yielded the highest predictive value with a cut-off value of 4.73 mg/L, sensitivity of 0.833, specificity of 0.812 and area under the curve (AUC) of 0.895. Conclusions Cys-C has higher predictive value for early DGF in kidney transplant recipients compared with serum NGAL, urine NGAL and Scr.
ABSTRACT
Objective:To explore independent risk factors and risk stratification for diagnosis of clinically significant prostate cancer (CsPCa) in biopsy-naive patients with nonsuspicious multiparametric magnetic resonance imaging (mpMRI).Methods:The data of 549 patients who underwent initial systematic biopsy (SB) in the First Affiliated Hospital of Soochow University, the Second Affiliated Hospital of Soochow University and Traditional Chinese Medicine Hospital of Kunshan between October 2015 and January 2021 were retrospectively reviewed. Nonsuspicious mpMRI was defined as Prostate Imaging-Reporting and Data System (PI-RADS)≤2. All patients received systematic 12 core prostate biopsy, 278 of them by transperineal and 271 by transrectal biopsies. The median age of the patients was 67 (62, 73) years, the median prostate specific antigen (PSA) was 9.01 (6.15, 13.64) ng/ml, the median prostate volume was 48.41 (35.85, 64.28) ml, and 54 patients were positive in digital rectal examination (DRE). Taking CsPCa as the outcome index, receiver operating characteristic (ROC) analysis was performed on age, tPSA, f/tPSA and PSA density (PSAD) to obtain the optimal cut-off value, and logistics regression was used to explore the independent risk factor of CsPCa in mpMRI negative patients. The optimal cut-off value when the negative predictive value (NPV) of mpMRI diagnosis of CsPCa was 100%, was taken as the protective factor, and the risk stratification model was finally proposed.Results:Of all 549 cases, 44 were CsPCa, 35 were clinically insignificant prostate cancer and 470 were non-prostate cancer. There were significant differences in age (71 vs. 67 years old), tPSA (11.95 vs. 8.75 ng/ml), PSAD [0.31 vs. 0.18 ng/(ml·cm 3)], f/tPSA (0.12 vs. 0.16) and DRE positive rate (38.6% vs. 7.3%) between CsPCa group and non-CsPCa group ( P<0.01). Cut-off values were taken in ROC analysis when the Youden index was at its maximum. The optimal cut-off values of each continuous variable were: age=65 years, tPSA=10ng/ml, f/tPSA=0.2 and PSAD=0.15 ng/(ml·cm 3). Multivariate analysis showed that ages over 65 years ( OR=3.43, 95% CI 1.55-7.58, P=0.002), f/t PSA ratio<0.2 ( OR=3.84, 95% CI 1.28-11.56, P=0.016), PSAD>0.15 ng/(ml·cm 3) ( OR=3.60, 95% CI 1.13-11.51, P=0.03) and positive DRE ( OR=5.20, 95% CI 2.39-11.32, P<0.001) were independent risk factors of CsPCa. When NPV was 100%, the cut-off values were taken as the protective factors: age≤55 years, f/tPSA≥0.3, PSAD≤0.1 ng/(ml·cm 3). Combined with independent risk factors, preliminary risk stratification was conducted: those with ≥2 high risk factors were considered as high risk group, those with ≥2 protective factors were considered as low risk group, and the middle region was considered as medium risk group. Conclusions:Patients with age>65 years, f/tPSA<0.2, PSAD > 0.15 ng/(ml·cm 3) and DRE positive are independent risk factors of CsPCa in mpMRI negative patients. Patients in the high-risk group were recommended to undergo prostate biopsy, while patients in the low-risk group could be considered to avoid biopsy.
ABSTRACT
Objective:To evaluate the predictive value of the quick sequential organ failure assessment(qSOFA) score in septic shock after percutaneous nephrolithotomy(PCNL).Methods:309 patients who underwent PCNL at the First Affiliated Hospital of Soochow University between May 2018 and October 2019 were retrospectively reviewed. Among them, there were 192 men and 117 women, whose mean age was (51.4±12.8)years (range from 20 to 79 years). There were 82 cases(26.5%) of hypertension and 23 cases(7.4%) of diabetes. There were 88 patients(28.5%) with positive preoperative urine culture.102 patients(33.0%) were diagnosed with staghorn calculi by abdominal CT and urinary tract abdominal plain film(KUB).78 patients(25.2%) had a history of urinary surgery. The qSOFA and SIRS were evaluated to all patients within 24 h after PCNL and the best diagnostic criteria was considered as qSOFA≥2 and SIRS≥2. Receiver operating characteristic(ROC) curves were constructed and the areas under the curve(AUC) were calculated to compare the discriminatory ability of qSOFA and SIRS with the post-PCNL septic shock. A univariate logistic regression analysis was used to identify the covariates associated with post-PCNL sepsis. Then adjusted multivariate analysis was used to identify the predictive value of positive qSOFA and SIRS for the postoperative clinical outcomes including postoperative hospitalization days, postoperative blood transfusion, postoperative re-intervention, residual stone, planned readmission within 30 days and unplanned readmission within 30 days.Results:Among the 309 patients who underwent PCNL, 23 patients(7.4%) met the positive qSOFA criterion while 84 patients(27.2%) developed to SIRS. 7 patients(2.3%) were admitted to ICU after operation and were eventually diagnosed as septic shock, among which 6 patients met the criteria of qSOFA and SIRS. 8 patients(2.6%) underwent multi-channel operation. The median operative time of 309 patients was 85(56, 115) min. Postoperative calculus composition analysis showed that 64 patients(20.7%) were infectious calculi. Postoperative KUB showed residual calculi in 179 patients (57.9%). The median postoperative hospital stay was 7(6, 9) days. 10 patients(3.2%) received blood transfusion. 9 patients(2.9%) received re-intervention after surgery. There were 41 patients (13.3%) of planned readmissions and 16 cases (5.2%) of unplanned readmissions within 30 days. The AUC of qSOFA and SIRS was 0.900 and 0.799 respectively. The qSOFA had a higher specificity, positive likelihood ratio and positive predictive value(94.4%, 15.23, 26.1%)than that of SIRS(74.2%, 3.32, 7.1%)for septic shock. In univariate logistic regression analysis significant associations were observed between positive urine culture, stone size, staghorn stones, struvite stones, surgery history, operation time and sepsis after PCNL. Multivariate logistic regression analysis revealed that postoperative length of stay( OR=1.237, 95% CI 1.048-1.459, P=0.012) and postoperative transfusion( OR=8.265, 95% CI 1.409-48.481, P=0.019) were closely associated with qSOFA after adjusting for covariates shown to be related to post-PCNL sepsis mentioned above. Conclusions:The qSOFA could be superior to SIRS in predicting septic shock after PCNL.
ABSTRACT
Objective:To explore the effect of previous intestinal resection on anastomotic fistula within 30 days after surgery in Crohn′s disease.Methods:The clinical data from 92 Crohn′s disease patients who underwent intestinal resection and anastomosis at the Department of General Surgery in Shanghai Ninth People′s Hospital, Shanghai Jiaotong University School of Medicine from Jan 2016 to Sep 2019. Patients were divided into no previous intestinal resection group ( n=45) and previous intestinal resection group ( n=47). The relationship between previous intestinal resection and postoperative anastomotic leak in Crohn′s disease patients with intestinal resection and anastomosis was analyzed. Results:A total of 11 cases (12% leak rate) underwent postoperative anastomotic leak. There were 2 leaks in patients with no previous history of intestinal resection, while 9 leaks in patients with previous bowel resection (χ 2 =4.722, P=0.03). The OR of the postoperative anastomotic leak in Crohn′s disease patients with previous intestinal resection compared with no previous intestinal resection group was 5.092 (95% CI: 1.035-25.048). Patients with 1 previous resection (24 cases) had a leak rate of 13%, whereas patients with >1 previous resection episodes (23 cases) had a leak rate of 26%. The number of previous resection episodes correlated with an increasing risk for clinical anastomotic leak (correlation coefficien r=0.995). Conclusions:Previous intestinal resection is an independent risk factor for ensuing postoperative anastomotic leak in Crohn′s disease patients with intestinal resection and anastomosis.
ABSTRACT
Objective To investigate the relationship between uric acid stone formation and visceral fat area based on computed tomography.Methods As many as 247 patients admitted to our hospital were retrospectively reviewed from January 2017 to January 2018.There were 161 males (65.2％) and 86 females (34.8％).The average age was 51 (20-88 years).According to the results of stone analysis after surgery,the patients were divided into uric acid stone group and non-uric acid stone group.According to the abdominal CT scan,Image J software was used to measure the anthropometric measurements like waist circumference,total fat area (TFA),and visceral fat area (VFA),and subcutaneous fat area (SFA).The clinical characteristics of different stone components were compared.An univariate and multivariate logistic regression analysis was used to identify the independent factors associated with uric acid stone formation.Different anthropometric measurements were compared by using the area under receiver operating characteristic curve.Results The uric acid stones in high VFA group (28/110;25.5％) were obviously more frequent than that in the low VFA group (7/137;5.1％) (P ＜ 0.05).The results of the univariate logistic regression analysis showed that age,diabetes,hyperlipidemia,TFA,waist circumference,body mass index (BMI),VFA,uric acid,and urine pH were statistically significant (P ＜ 0.05).Multivariate logistic regression analysis revealed that diabetes (OR =3.408,95％ CI 1.123-10.340,P =0.030),VFA (OR =6.740,95％ CI 1.95 1-23.279,P =0.003),uric acid (OR =3.182,95 ％ CI 1.120-9.040,P =0.030) and urine pH (OR =4.052,95％ CI 1.095-14.989,P =0.036) were independent factors associated with uric acid stone formation.The area under the curve of TFA,waist circumference,BMI,VFA,and SFA were 0.659,0.665,0.632,0.723 and 0.544,respectively.Conclusions Diabetes,VFA,uric acid and urine pH are independent factors influencing the formation of uric acid stones.Compared with other anthropometric measurements such as TFA,waist circumference,BMI,and SFA,VFA can better assess abdominal obesity and predict the formation of uric acid stones.
ABSTRACT
Coronary atherosclerotic heart disease is a serious threat to human life and health. In recent years, the main treatment for it is to implant the intravascular stent into the lesion to support blood vessels and reconstruct blood supply. However, a large number of experimental results showed that mechanical injury and anti-proliferative drugs caused great damage after stent implantation, and increased in-stent restenosis and late thrombosis risk. Thus, maintaining the integrity and normal function of the endothelium can significantly reduce the rate of thrombosis and restenosis. Stem cell mobilization, homing, differentiation and proliferation are the main mechanisms of endothelial repair after vascular stent implantation. Vascular factor and mechanical microenvironmental changes in implanted sites have a certain effect on re-endothelialization. In this paper, the process of injury caused by stent implantation, the repair mechanism after injury and its influencing factors are expounded in detail. And repairing strategies are analyzed and summarized. This review provides a reference for overcoming the in-stent restenosis, endothelialization delay and late thrombosis during the interventional treatment, as well as for designing drug-eluting and biodegradation stents.
ABSTRACT
Objective@#To investigate the clinicopathological features of EBV-positive T/NK cell lymphoproliferative diseases (EBV+ T/NK-LPD).@*Methods@#The clinical characteristics of 156 cases of EBV+ T/NK-LPD were collected from August 2002 to March 2015 at Beijing Friendship Hospital, Capital Medical University. Immunohistochemical staining, EBER in situ hybridization and clonal analysis of TCR gene were performed. All patients were followed up.@*Results@#There were 106 male and 50 female patients; patients′ age ranged from 1 to 75 years (median 20 years). The course of the diseases before diagnosis ranged from 2 to 540 months (median 20 months). Fever was noted in 122 patients (78.2%), 108 patients had lymphadenopathy (69.2%), and 75 patients had hepatosplenomegaly (48.1%). Thirty-three cases were grade 1, 68 cases were grade 2, and 55 cases were grade 3. TCR gene arrangement analysis was performed in 45 cases, and 33 cases (73.3%) showed clonal rearrangement. The follow-up period ranged from 1-134 months, and 44 patients (28.2%) died. There was a trend of increased death rate associated with increasing grade (P>0.05).@*Conclusions@#There are many types of EBV+ T/NK-LPD, and they can be classified as systemic, relatively localized and localized. The prognosis should be based on a comprehensive analysis of pathology and clinical data. There is no significant correlation between morphological grade and mortality. An important goal of therapy is to prevent serious complications.
ABSTRACT
Objective To explore the role of B7-H3 in the Tie2 expressing monocytes (TEMs) mediated angiogenesis of clear cell renal cell carcinoma (ccRCC).Methods Level of B7-H3 expression on TEMs surface was detected by flow cytometry in ccRCC tissues and normal renal tissues,which were obtained from April 2016 to August 2016 from 20 patients.Microvessel density (MVD) labeled by CD34 in high B7-H3 + TEMs group and low B7-H3 + TEMs group was detected by immunohistochemical examination in ccRCC specimens.B7-H3 + TEMs and B7-H3-TEMs were co-cultured with the 786-O cell lines,and B7-H3 + TEMs and B7-H3-TEMs culture supernatants were collected as conditioned medium,then the effect of B7-H3 + TEMs on angiogenesis was tested by tubule formation assay and mouse aortic ring assay.Results Flow cytometry showed that the frequency of B7-H3 expression on TEMs in ccRCC was (45.10 ± 17.78)％,and the frequency of B7-H3 expression in normal kidney tissues was (10.28 ± 4.28) ％.The frequency of B7-H3 expression on TEMs was significantly higher than that in normal renal tissues (P ＜ 0.001).The MVD of high B7-H3 + TEMs group (103.81 ± 29.28) was higher than that of low B7-H3 + TEMs group (76.55 ± 20.80) (P =0.027).The results of tube formation assay showed that the number of tubule formation of HUVEC in B7-H3 +TEMs group(55.25 ± 11.48) was significantly greater than that of B7-H3-TEMs group (31.34 ± 8.45) and blank control group (25.00 ± 6.74) (P ＜ 0.001).The results of mouse aortic ring assay showed that the number of neovascularization in B7-H3 + TEMs group(77.35 ± 18.47) was significantly greater than that of B7-H3-TEMs group (39.42 ± 8.29) and blank control group (28.79 ± 7.63) (P ＜0.001).Conclusions B7-H3 + TEMs can promote angiogenesis in ccRCC,and might act as an effective target in anti-angiogenic therapy for ccRCC.
ABSTRACT
Objective To estimate the value of transrectal ultrasound/magnetic resonance imaging (TRUS/MR) fusion targeted prostate biopsy(targeted biopsy,TB) in the biopsy naive patients.Methods Between September 2015 and September 2016,91 patients with PI-RADS ≥ 3 suspicious regions on the multiparametric magnetic resonance imaging (mpMRI) were retrospectively evaluated.The age of patients was 46-83 years (median 68).Serum PSA level before biopsy was 1.2-85 ng/ml (median 11.2 ng/ ml),in which 36 cases with PSA ＜ 10 ng/ml,30 cases 10-20 ng/ml,and 25 cases ＞ 20 ng/ml.Two-core TB using real-time virtual sonography (RVS) platform for mpMRI-suspicious lesions was followed by 12-core systematic biopsy (SB).The detection rates for any cancer (PCa) and clinically significant prostate cancer (CsPCa) were compared between TB and SB.Results The total detection rate for PCa was 57.1％,with a comparable positive rate between TB (44.0％) and SB (51.7％) groups which did not significantly differ (P =0.14).The proportion of CsPCa in TB group was higher than that in SB group (80.0％ vs.68.1％,P =0.21).In TB group,detection of PCa for grade 5 lesions was significantly higher than that for grade 3 lesions (77.1％ vs.10.3％,P ＜0.001).Detection of PCa was comparable between TB and SB groups in different regions of PSA ＜ 10 ng/ml,10 ～ 20ng/ml and ＞ 20ng/ml (27.8％ vs.36.1％,50％ vs.56.7％,60％ vs.68％,respectively).Conclusions This study revealed a similar rate of prostate cancer detection between 2-core targeted biopsy guided by TRUS/MR fusion and 12-core random biopsy in different PSA regions for no prior biopsy men.TB maybe tend to detect high proportion of CsPCa.PI-RADS is instructive to select appropriate patients for TB.
ABSTRACT
Objective To discuss the distribution laws of TCM syndromes of early threatened abortion; To analyze the related factors of pregnancy outcome of early threatened abortion. Methods The study included 1010 hospital patients who were diagnosed as early threatened abortion. Excel2010 was used to establish database in order to collect general information such as the age, menstrual history, times of abortion and adverse pregnancy, incidence of solar term and pregnancy week, the type of TCM syndromes and the pregnancy outcome (at least 3 months after being out of hospital) of patients. The distribution laws of TCM syndromes, and related factors of pregnancy outcome were analyzed. Results Among the 1010 cases, 762 cases were with kidney deficiency syndrome (75.4%); followed by blood heat syndrome, a total of 178 cases, accounting for 17.6%; qi and blood deficiency syndrome, a total of 40 cases, accounting for 4%; blood stasis syndrome, a total of 15 cases, accounting for 1.5%; liver stagnation syndrome, a total of 15 cases, accounting for 1.5%. The distribution of TCM syndromes was statistical significance in the different age groups and the incidence of pregnancy week (P0.05). Among the 1010 cases, follow-up to 698 cases, 567 cases were successful pregnancies, accounting for 81.2% of the follow-up of patients; 131 cases were failed pregnancies, accounting for 18.8% of the follow-up of patients. In the study, it found that there was statistical significance between different age groups and pregnancy outcomes (P=0.026). The pregnancy outcomes were related to the age groups (P=0.012, OR=1.063), and it was not related to TCM syndromes, times of abortion, times of adverse pregnancy, menstruation, pregnancy week. Conclusion Kidney deficiency syndrome is the main syndrome of early threatened abortion. The distribution of TCM syndromes is related to the age group and the incidence of pregnancy week of patients. Age of patients is the related factor affecting the pregnancy outcome.
ABSTRACT
Objective To analyze clinical differential diagnostics and medication law of CAI Lian-xiang of treating gynecological diseases from theChong-Ren;To provide references for clinical medication. Methods Medical cases of gynecological diseases treated by differential diagnostics from“Chong-Ren”from December 2013 to January 2015 in out-patient department of Xiyuan Hospital of CACMS by CAI Lian-xiang were collected. Excel2007 was used to establish the database, and the frequency and correlation analysis were made on the differentiation, treatment principles, treatment methods, medicine and medical combination by using the large data intelligent analysis system of Chinese medicine diagnosis and treatment. The results were confirmed with CAI Lian-xiang's academic thought and clinical experience. Results Totally 103 medical cases, 277 diagnosis times, 277 prescriptions and 92 kinds of Chinese materiamedica were included. Although different types of gynecological diseases from theChong-Ren treatment of specific treatment were different, all were related to liver, spleen and kidney;prescription contained 22 high-frequency medicines (>50 times), and the first three medicines were Cuscutae Semen 178 times (64.3%), Angelicae Sinensis Radix 167 times (60.3%), Paeonize Radix 158 times (57.0%). The association analysis results showed 9 combination of Tiaochongren medicine combination group, 11 Qiangchongren meidcine combination group, 4 Zichongren medicine combination group, and 4 Guchuanrenmediicne combination group. Conclusion CAI Lian-xiang believes that gynecological diseases are closely related to “Chong-Ren”, and treatment from“Chong-Ren”focuses on the adjustment and nourishment of liver, spleen and kidney. The data miningresults of medication law is accordance with the relevant academic thoughts, which can provide references for clinic.
ABSTRACT
Objective To probe into the distribution characteristics of traditional Chinese medicine syndromes of polycystic ovary syndrome and lay the foundation of the establishment of polycystic ovary syndrome's TCM diagnostic criteria. Methods Relevant modern literature was researched from CNKI and Wanfang and PubMed during 1949-2016, and a total of 257 literature were retrieved and included into the database. The title, author, name of syndromes and symptoms were listed in Excel and Access, and the original syndromes and symptoms were standardized and combined, and the frequency more than 2% items were analyzed. Results The high-frequency TCM syndromes of polycystic ovary syndrome were: phlegm-dampness, kidney asthenia, kidney yang deficiency, kidney asthenia and blood stasis, phlegm-blood stasis, liver depression and kidney asthenia, depression of the liver generated pathogenic fire, blood stasis, kidney yin deficiency,qi stagnation and blood stasis, spleen and kidney's yang deficiency, spleen asthenia and phlegm-dampness, liver depression, liver depression and qi stagnation. The symptoms were summarized. The current situation of the researches on traditional Chinese medicine syndromes of polycystic ovary syndrome was discussed. Conclusions The nature of the disease were mainly excessive and deficiency syndrome. The main disease locations were kidney, liver and spleen. The pathogenic factors mainly were phlegm-dampness and static blood. There were deficiencies in the researches on traditional Chinese medicine syndromes of polycystic ovary syndrome which required improvements and further studies.
ABSTRACT
Objective To investigate the changes and clinical significance ot the expression ot microRNA in plasma and peripheral blood mononuclear cells in patients with schizophrenia.Methods 174 patients with schizophrenia in Danzhou People 's Hospital were selected as the case group and the other 80 healthy persons as control group The relative expression levels of 8 microRNA in two groups of plasma and pcripheral blood mononuclear cells were detected by real-time quantitative fluorescent PCR(MiR-195,MiR-346,MiR-181b,MiR-212,MiR-30e,MiR-432,MiR 7,MiR-34a),and the differences of microRNA in the plasma and peripheral blood mononuclear cells were compared between the two groups.ROC curve was used to analyze the sensitivity and specificity of microRNA as diagnostic criteria for schizophrenia and Logistic regression analysis of the relative risk of microRNA in schizophrenia.Results The expression levels of MiR-195,MiR-181b,MiR-132,MiR-30e,MiR-7 and in the patients of the case group(3.11±1.05,2.18±0.72,1.85±0.74 and 9.61±1.87) were significantly higher than those in the control group(4.48±1.07,2.92±0.86,3.53±1.07 and 11.96±2.73,P＜0.05 or P＜0.01).The expression levels of MiR-181b,MiR-212,MiR-30e and MiR-34a in peripheral blood mononuclear cells of patients in the case group (-4.20±1.16,0.27 ±0.55,-4.83± 1.05 and 2.64± 1.08) were significantly higher than those in control group (-3.56±0.81,0.91±0.68,-3.49±1.22 and 3.95±1.03,P＜0.05 or P＜0.01).Logistic regression analysis showed that plasma MiR-181b and MiR-30e were significantly relative risk (OR=2.357,95 ％ CI:1.361 ～ 4.093;OR=2.064,95 ％ CI:1.147～3.815),and peripheral blood mononuclear cells MiR-30e also had significant relative risk (OR=1.628,95 ％CI:0.914～2.926).ROC curve analysis showed that 95％CI and AUC in plasma and peripheral blood mononuclear cells of MiR-181b were 0.702 (0.784～0.632),0.658 (0.593 to 0.736),and plasma and peripheral blood mononuclear cell of MiR-30e were 0.775 (0.706～0.857),0.758 (0.686～0.839),respectively.Spearman correlation analysis showed that plasma MiR 181b and plasma MiR-30e were significantly correlated (r=0.547,P =0.043).Conclusion Abnormal expression of microRNA in patients with schizophrenia,and plasma and peripheral blood mononuclear cells MiR-181b and MiR-30e had good diagnostic value for schizophrenia patients.
ABSTRACT
Objective Data mining method was used to analyze gynecological clinical medication rule of Cai Lianxiang who is a famous veteran TCM doctor. Methods A total of 165 cases and 337 visits of Cai Lianxiang were selected to establish a database by excel, and were analyzed by TCM diagnosis and treatment data intelligent analyses system. High-frequency herbs and combinations of herbs were analyzed and were used to accord with academic thoughts and clinical experience of Cai Lianxiang. Results Results showed 10 high-frequency herbs and 7 herb combinations, which accorded with academic thoughts of Cai Lianxiang. The pathogenesis of gynecological diseases was defficiency of essence and blood, the inbalance among live, spleen and kidney. Thus, the principles of treatment were enriching essence and nourishing blood, adjusting liver, supplementing kidney and fortifying spleen. Conclusion It is significant that the data mining methods were used to summarize the rules of Cai Lianxiang's gynecological medication.
ABSTRACT
[Abstract ] Objective Pelvic radiation disease(PRD) is multiple injuries in more than one organ resulted by pelvic radio-therapy.Patients have the symptoms of frequent feces and fecal incontinence after the resection of small bowel lesion .Sugeries on PRD patients were mainly distal ileum and ilieocecal valve resections , while the most susceptible part of pelvic radiation injury is rectum . However , little research has been done concerning PRD patients′anorectal functions .This study was mainly to evaluate the anorectal function of cervical cancer patients with PRD in order to provide evidence for the therapy and prognosis of PRD . Methods Cervical cancer patients with PRD in need of small bowel resection who hospitalized in our department from January 2014 to January 2015 were collected as patient group , while people from outpatient physical exam group were selected as control group according to the exclusion criteria of hypertension , diabetes, constipation and unrelaxed pelvic floor syndrome .PDR group and control group were matched according to age.All subjects underwent colonoscopy and anorectal manometry .Rectal radiation injury was estimated on the basis of colonoscopy results.Anorectal manometry results of PRD group and control group were analysised statistically . Results PRD group and control group both included 20 women without stenosis or obstruction in rectum .Significant difference was found between PRD group and con-trol group in anal resting pressure (47.23 ±9.08 mmHg vs 58.25 ±9.24 mmHg, P<0.05), anal maximum squeezing pressure (47.23 ±9.08 mmHg vs 58.25 ±9.24 mmHg, P<0.01), anal distension pressure (23.30 ±12.49 mmHg vs 39.10 ±9.99 mmHg, P<0.01), rectal defecation pressure(22.85 ±16,69 mmHg vs 50.90 ±9.14 mmHg, P<0.01) and maximum tolerated rectal volume (112.85 ±51.34 mL vs 173.50 ±48.15 mL, P<0.01).There was no significant difference between the two groups as to the lenghth of functional sphincters(P=0.313),rectum initial threshold(P=0.416) and rectal defecation threshold(P=0.161). Conclusion Ionization radiation that injures PRD patients′internal anal sphincters and external anal sphincters also reduces maximum tolerated rec -tal volumes preoperatively .It′s necessary to assess the muscles and nerve functions of anorectum before intestinal surgery in order to make a proper operation plan which will improve PRD patients′life quality.
ABSTRACT
Climacteric syndrome is a common clinical disease with high incidence.The understanding of the disease is progressing in recent years.This article collects thirty-seven documents in this field in recent eight years.The pathogenesis of climacteric syndrome is divided into two aspects as the deficiency of the kidney and the imbalance of the liver, the spleen and the heart.It also sums up the therapy of climacteric syndrome from this two aspects.At last, the authors propose that we should pay attention to the importance of the liver, the spleen and the heart in both the pathogenesis and the therapy.