Higher D-dimer and activated partial thromboplastin time are poor prognostic factors in patients with peritoneal dialysis-related peritonitis.

INTRODUCTION: Coagulation system dysfunction is associated with adverse outcomes of peritoneal dialysis (PD) and bacterial infection. We investigated the association between coagulation system and treatment failure of peritoneal dialysis-related peritonitis (PDRP). METHODS: We collected records of patients aged ≥18 years with PDRP. PDRP episodes were divided into: shortened activated partial thromboplastin time (APTT) group and prolonged APTT group, low D-dimer (DD) group and high DD group. The baseline characteristics of the groups were collected and compared. The association between APTT, DD and treatment failure of PDRP was analyzed using logistic regression analysis. RESULTS: Thirty episodes of treatment failure were observed in 110 episodes of PDRP in our study. After adjusting for variables, prolonged APTT (OR = 1.166 [1.049-1.296], p = 0.004) or high level of DD (OR = 1.374 [1.057-1.787], p = 0.017) was associated with treatment failure of PDRP. CONCLUSION: Prolonged baseline APTT or high level of DD increased the risk of treatment failure of PDRP.

Hypertriglyceridemia is a risk factor for treatment failure in patients with peritoneal dialysis-related peritonitis.

OBJECTIVE: Disorders of triglycerides (TG) are common in patients with peritoneal dialysis (PD). Hypertriglyceridemia has been demonstrated in various infections. The association between triglycerides and the outcomes of peritoneal dialysis-related peritonitis (PDRP) was investigated in this study. METHODS: We retrospectively investigated patients with PDRP from January 1, 2013 to October 31, 2020. Hypertriglyceridemia was defined as triglycerides ≥ 1.7 mmol/L. PDRP episodes were divided into two groups: hypertriglyceridemia and normal levels of triglycerides. The clinical and laboratory baseline data of the two groups were collected and compared. The association between triglycerides and treatment failure was analyzed by logistic regression analysis. RESULTS: Ninety episodes in 66 patients were recorded in our center. Hypertriglyceridemia occurred in 38% (34/90) of episodes. Twenty-five episodes were not cured in 90 episodes (27.8%, 25/90). The levels of thrombocytes, high-sensitivity C-reactive protein (hs-CRP), low-density lipoprotein cholesterol (LDL-C) and glycated hemoglobin, were higher in hypertriglyceridemia episodes of PDRP at baseline. The bacterial classification was different between elevated triglyceride group and normal triglyceride group. Adjusted for age, duration of dialysis, residual renal function, diabetes, thrombocytes, hs-CRP, serum albumin, cholesterol, HDL-C, LDL-C, intact parathyroid hormone (iPTH), glycated hemoglobin and spectrum of bacteria, hypertriglyceridemia were associated significantly with treatment failure of PDRP in our study (OR 3.416, 95% CI 1.223-9.540 p < 0.05). CONCLUSION: Hypertriglyceridemia at baseline was an independent risk factor for treatment failure of PDRP.

[Heterogeneous Oxidation of Secondary Organic Tracers of Isoprene and Toluene by Ozone].

For this paper, chamber experiments were carried out to investigate the oxidation of secondary organic tracers of toluene and isoprene by ozone under different conditions (relative humidity, mixing state, etc.) using a relative rate constants approach. The uncertainty of the tracer-based method due to the ozone oxidation of secondary organic tracers was also addressed. The results showed that the effective rate constants of analogue of 2-methyl erythritol (AME) and 2,3-dihydroxy-4-oxopentanoic acid (DHOPA) were (4.60±0.66)×10-19 cm3·(molecule·s)-1and (6.57±0.51)×10-19 cm3·(molecule·s)-1, respectively. Given the instability of the secondary organic tracers caused by the oxidation, the contributions of toluene and isoprene to secondary organic aerosols could be underestimated by 16.5%-44.8% and 18.3%-47.3%, respectively.

A novel method of organotypic spinal cord slice culture in rats.

This study was undertaken to establish a method for the culture of organotypic spinal cord slices. A long-term organotypic spinal cord slice culture was conducted from postnatal rats. Lumbar spinal cord was isolated, and meninges were removed from the spinal cord. The spinal cord was embedded in 4% agarose, and was sectioned by vibratome into slices. Then the slices were cultured on the surface of the membrane inserts, which were placed in six-well plates containing 1 ml of growth medium at 37°C in an incubator with 5% humidified carbon dioxide. The cultured organotypic spinal cord slices were examined by light microscopy and immunocytochemistry. The organotypic spinal cord slices were fully attached to the membrane inserts after 10 days in vitro. The general change in color and transparency from whitish to transparent gray appeared at the seventh and eighth day. Under the light microscope, the outgrowth of cells from the edge of the living slices arose from the second day of the culture, and arose to peak at the sixth and seventh day. The organotypic spinal cord slices were characterized as clear, semitransparent structures with bright and good refraction until the 14th day of culture. The viability of the slices was excellent as assessed by the trypan blue exclusion method at the 28th day, and they were positive for NeuN and GFAP. This culture technique, which does not require complex operation skills, might be a simple and efficient method for obtaining organotypic spinal cord slices in sufficient number, high viability, and contamination-free from postnatal rats.

Elevated baseline serum IgA may predict earlier proteinuria remission in IgA nephropathy patients.

The goals of this work were to investigate the correlations of elevated serum IgA with renal pathology and outcome of proteinuria in IgA nephropathy patients. Retrospective cohort analysis enrolled 90 IgA nephropathy patients (proteinuria ≥0.5 g/24 hr, estimated glomerular filtration rate (eGFR) ≥30 ml/min/1.73 m2) who were admitted to The Sixth Affiliated Hospital of Sun Yat-sen University from 2013.01 to 2017.04. The elevated serum IgA level was found in 20 (22.2%) patients. In clinical characteristics, serum IgG, ratio of IgA/C3 and recurrent mucosal infection rate were increased obviously in high serum IgA group compared with normal serum IgA group (serum IgG, 14.90±3.50 g/L vs. 10.27±3.49 g/L, P<0.001, IgA/C3, 4.45±1.21 vs. 2.77±0.75, P<0.001, recurrent mucosae infection rate, 40.0% vs. 14.3%, P=0.027). In kidney biopsy, mesangial proliferation was significantly more common in normal serum IgA group (81% vs. 50% in high serum IgA group, P=0.028). The proportion of crescent less than 25% more often occurred in elevated IgA group (81.3% vs. 63.8% in normal IgA group). The Kaplan-Meier curves showed that proteinuria remission rate for patients with high serum IgA was 80%, 85%, 90%, 95% and 95% after 3, 6, 9, 12 and 15 months compared with patients with normal serum IgA (proteinuria remission rate, 45%, 64%, 75%, 86% and 93%, P=0.020). Cox proportional hazard regression model indicated that elevated serum IgA (RR=1.984, P=0.040) and steroids therapy (RR=2.192, P=0.030) were independent predictors for proteinuria remission in IgA nephropathy patients. In view of our data, more active treatments may improve outcome of IgA nephropathy patients with elevated serum IgA. We conclude that elevated serum IgA may indicate a higher proteinuria remission rate within a shorter period of time in IgA nephropathy patients.

Alarm Value of Somatosensory Evoked Potential in Idiopathic Scoliosis Surgery.

BACKGROUND: Somatosensory evoked potential (SSEP) monitoring is performed to examine postoperative clinical findings when a monitoring event was noted intraoperatively and to ascertain the alarm threshold for intraoperative neural damage. METHODS: The tibial SSEP of both lower limbs was recorded intraoperatively in patients with idiopathic scoliosis. Change of SSEP amplitude as opposed to the baseline was categorized into 4 levels: decrease <40%, decrease of 40%-50%, decrease of 50%-60%, and decrease >60%. Postoperative neurologic function of patients was examined and compared with SSEP data. RESULTS: The baseline amplitude before incision was significantly different from the amplitude after spine exposure. An amplitude reduction of >60% during scoliosis correction procedures was observed in 6 legs, and 4 of them had postoperative deterioration in motor status. As the measure of threshold for alarm, an amplitude reduction of >50% compared with baseline resulted in more false-positive outcomes compared with amplitude attenuation of >60%. CONCLUSIONS: Compared with the traditional SSEP baseline before skin incision, the baseline acquired after spine exposure results in more accurate monitoring. A >60% decrease in SSEP amplitude could be a more suitable alarm threshold.

Association between glycemic control and birthweight with glycated albumin in Chinese women with gestational diabetes mellitus.

AIMS/INTRODUCTION: To assess glycated albumin (GA) as a potential glycemic index in managing gestational diabetes mellitus (GDM). MATERIALS AND METHODS: Eligible pregnant women were divided into the GDM group with abnormal result on a 75-g oral glucose tolerance test (OGTT) and the control (normal) group. GA measurements, Pearson's correlation analysis, multiple logistic regression and receiver operating characteristic curve analysis were obtained at the follow-up examination of participants in the two groups. RESULTS: A total of 2,118 women were assigned to the GDM group (n = 639) and control group (n = 1,479). The mean level of serum GA in GDM group was significantly greater than that in the control group at both 24-28 and 36-38 weeks of gestation (P < 0.05). The area under the receiver operating characteristic curve for GA defining good glycemic control in GDM was 0.874 (95% confidence interval 0.811-0.938). The cut-off point for the GA levels derived from the receiver operating characteristic curve was 11.60%, which had sensitivity and specificity for detecting a poor glycemic status of 75.93% and 86.36%, respectively. The risk of birthweight ≥3,500 g and macrosomia increased significantly with GA levels ≥13.00% at 24-28 weeks and ≥12.00% at 36-38 weeks of gestation. CONCLUSIONS: GA might be an appropriate and conveniently measured index that can detect poor glycemic control and predict birthweights in GDM women.

Pregnancy-related Acute Kidney Injury and a Review of the Literature in China.

OBJECTIVE: To determine the incidence, causes and prognosis of pregnancy-related acute kidney injury (PR-AKI) in Chinese women. METHODS: From July 2004 to February 2013, 18,589 women of Han ethnicity who attended the Obstetrics and Nephrology Department of our tertiary hospital were investigated, and individuals meeting the PR-AKI criteria were included in the analysis. The WanFang, Chinese Science Journal, Chinese Knowledge, MEDLINE, EMBASE and Cochrane library databases were searched, and literature describing PR-AKI diagnoses with Chinese women as study subjects and a sample size of ≥5 were included. RESULTS: The incidence of PR-AKI was 0.1183% (22/18,589). Hemorrhagic shock (31.8%) and pre-eclampsia (severe, 18.2%) were the two most common causes of PR-AKI. Twelve women recovered completely, six women displayed persistent proteinuria and four women had an increased serum creatinine level at discharge. There were no cases of death. Twenty women demonstrated adverse pregnancy outcomes (90.9%), including eight cases of stillbirth (36.4%). In our literature review, 29 of 4,076 articles were included, and the incidence of PR-AKI in China was found to range from 0.02% to 1.84%. Pregnancy hypertension (49.2%) and postpartum hemorrhage (13.8%) were found to be the most common causes of PR-AKI in China. The prognosis improved in 81.9% of the patients, the renal function deteriorated in 4.5% of the patients and 13.6% of the patients died. The rate of stillbirth was 27.0%. CONCLUSION: The maternal condition after active treatment was good, whereas the pregnancy outcomes were generally poor. Although the incidence of PR-AKI was relatively low, this finding is noteworthy. Further studies are thus warranted to improve maternal-fetal outcomes.

A Rare Complication of Spine Surgery: Guillain-Barré Syndrome.

OBJECTIVE: Since little has been reported about Guillain-Barré syndrome (GBS) after spine surgery, we sought to determine some of the clinical features and the management of the condition. METHODS: A total of 4 cases of GBS after spine surgery were included. The medical charts of the patients were reviewed to obtain demographic and clinical details. All the patients underwent neurologic and electrophysiologic examinations and were followed up after surgery. RESULTS: The onset of symptoms about GBS was 2-7 days after the operation. Neurologic evaluation showed weaknesses of upper and lower extremities and repeal of tendon reflexes. The patients exhibited typical clinical symptoms and signs of GBS and electromyographic findings. Lumbar puncture was performed in 2 cases, and cerebrospinal fluid examination showed albuminocytological dissociation. All the 4 patients were diagnosed as GBS on the basis of typical clinical, laboratory, and electrophysiologic findings. Intravenous immunoglobulin was instituted. At follow-up, one patient needed ventilator support; one patient could transfer from bed to chair; one walked with assistive devices; and the remaining patient had residual minor neurologic deficits. CONCLUSIONS: These cases warn surgeons to be alert to the association of GBS and spine surgery. On the basis of our experience, we recommend consideration of this rare diagnosis in patients with paralysis after spine surgery.

Relationship between MCP-1 promoter -2518 A/G gene polymorphism (rs1024611) and systemic lupus erythematosus/lupus nephritis.

Results from the published studies on the association between monocyte chemoattractant protein-1 (MCP-1) promoter -2518 A/G (rs1024611) gene polymorphism and systemic lupus erythematosus (SLE)/lupus nephritis (LN) are still conflicting. This meta-analysis was performed to evaluate the relationship between MCP-1 A/G gene polymorphism and SLE/LN and to explore whether MCP-1 A allele, AA genotype or GG genotype could become a predictive marker for SLE/LN risk. Association studies were identified from the databases of PubMed, Embase, Cochrane Library and CBM-disc (China Biological Medicine Database) as of 1 January 2014, and eligible investigations were synthesized using meta-analysis method. Results were expressed with odds ratios (OR) for dichotomous data, and 95% confidence intervals (CI) were also calculated. Sixteen investigations were identified for the analysis of association between MCP-1 A/G gene polymorphism and SLE, consisting of 2425 patients with SLE and 2567 controls. In the overall populations, Asians, Caucasian population, the association between MCP-1 A/G gene polymorphism and SLE susceptibility was not found. Interestingly, a trend toward an association between A allele/AA genotype and LN risk was observed in overall populations, although there was no statistical difference. However, this meta-analysis indicated that AA genotype was associated with LN risk in Caucasians (OR = 0.71; 95% CI: 0.54-0.93; p = 0.01). In conclusion, our results indicate that AA homozygous might be a significant genetic molecular marker to predict the SLE patients developing into LN in Caucasians. However, more investigations are required to further clarify this association.

A case of a naturally conceived pregnancy associated with multiple ovarian cysts in a patient with severe untreated primary hypothyroidism.

There are few reports of multiple ovarian cysts secondary to hypothyroidism, and multiple ovarian cysts associated with pregnancy most commonly occur in association with assisted reproductive technologies. Herein, we report a case of a naturally conceived pregnancy occurring 2 years after stopping treatment for primary hypothyroidism. The patient developed multiple ovarian cysts in the first trimester, and laboratory studies and ultrasonography were consistent with hypothyroidism. Herein, we present the case and discuss the importance of prenatal screening for hypothyroidism.

Frequency of established cardiovascular disease and its risk factors in Chinese patients with systemic lupus erythematosus.

Cardiovascular disease (CVD) is one of the most serious complications of systemic lupus erythematosus (SLE). This study investigated the frequency of established CVD and its associated risk factors in Chinese patients with SLE. A retrospective, cross-sectional analysis was conducted of 1,072 consecutive patients with SLE from a single center. Patients with CVD were identified on the basis of medical record documentation. Stepwise multivariate logistic regression was used to assess the risk factors of CVD. Of the 1,072 patients with SLE, 71 (6.6%) had CVD. Patients with CVD were older than patients without CVD (39.0 ± 15.6 vs. 31.9 ± 13.3 years; P < 0.001), the frequency of CVD in patients aged ≤19 years, between 20 and 39 years, between 40 and 69 years, and greater than 60 years was increased by 3.4%, 5.5%, 9.2%, 20.4%, respectively. The frequency of CVD was higher in SLE patients with nephritis than without nephritis (7.6% vs. 3.8%; P = 0.026). Multivariate regression analyses confirmed that age ≥60 years (OR = 5.098; 95% CI 1.333, 19.488), higher diastolic blood pressure (OR = 1.050; 95% CI 1.022, 1.078), higher serum creatinine levels (OR = 1.002; 95% CI 1.000, 1.003), and long-term use of glucocorticoids (OR = 1.005; 95% CI 1.000, 1.010) were risk factors for CVD. HDL-C levels (OR = 0.121; 95% CI 0.041, 0.358) were negatively associated with CVD in patients with SLE. Our data suggest that the frequency of CVD was high in Chinese patients with SLE, and independent risk factors for CVD were increased age, higher diastolic blood pressure, higher serum creatinine levels, long-term use of glucocorticoids, and lower HDL-C levels.

Acute pancreatitis in pregnancy: a 6-year single center clinical experience.

BACKGROUND: The acute abdomen remains a challenge for all obstetricians and physicians who take part in the care of women in pregnancy. To add substantially to our understanding of acute pancreatitis (AP) in pregnancy, in particular affirming the increased risks for mother and fetus associated with AP, we explored features of clinical manifestation and the strategy of management of this disease during pregnancy, and its effects on maternal and fetal outcomes. METHODS: A retrospective review of medical records of all pregnant patients diagnosed with AP admitted to the Department of Obstetrics and Gynecology, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University between 2005 and 2010 was performed. Information was collected from presentation, management, and outcome from medical records. RESULTS: There were 11 cases in 2010, accounting for 44% of 25 cases. Among these cases, mild AP (MAP) occurred in 15 cases (60%), while the rest cases were severe AP (SAP) (40%). The major etiology of AP in pregnancy was due to gallstone and cholecystitis. Clinical features together with elevation of the plasma concentrations of pancreatic enzymes were the cornerstones of diagnosis. Positive conservative treatment was taken in most of the cases (21 cases, 84%) with a favorable outcome. Seven cases of critically ill patients were monitored in intensive care unit, and 4 patients underwent surgical interventions. As a result, all of 25 patients had better prognosis, no maternal death was observed. There were 8 preterm labors and 2 fetal losses, accounting for the perinatal mortality of 8%. Fetal malformation was not observed. CONCLUSIONS: While a pregnant woman suffers acute abdominal pain, early diagnosis and severity assessment of AP are very important. Conservative comprehensive treatment with intensive care is recommended. Surgical intervention should be performed as late as possible.

[Study on apoptosis of placental syncytiotrophoblast in patients with severe preeclampsia].

OBJECTIVE: to investigate apoptosis of placental syncytiotrophoblast in patients with early-onset and late-onset severe preeclampsia. METHODS: from November 2008 to May 2009, 15 cases with early-onset severe preeclampsia and 15 cases with late-onset severe preeclampsia matched with 10 women with normal pregnancies as control at Sixth Affiliated Hospital of Shanghai Jiaotong University were enrolled in this study. Enzyme-linked immunosorbent assay was used to measure syncytiotrophoblast microparticles (STBM) levels in peripheral venous plasma. Caspase-3 were measured by western blotting. RESULTS: (1) STBM: the level of STBM of (71 ± 21) microg/L in early-onset group were significantly higher than (42 ± 30) microg/L in late-onset group and (26 ± 11) microg/L in control group (P < 0.05). The level of STBM in late-onset group and control group did not reach statistical difference (P > 0.05). (2) Caspase-3: the level of caspase-3 protein were 0.85 ± 0.61 in early-onset group and 0.77 ± 0.46 in late-onset group, which were all significantly higher than 0.32 ± 0.15 in control group (P < 0.05). However, the level of caspase-3 protein in early-onset group did not show remarkable difference compared with that in late-onset group (P > 0.05). CONCLUSION: STBM are shed into the maternal circulation in higher amounts in early-onset preeclampsia, which indicated that early-onset and late-onset severe preeclampsia may have different etiology and pathogenesis.

[Effects of nuclear factor-kappaB decoy oligodeoxynucleotide on the function of human umbilical artery smooth muscle cells induced by umbilical sera in preeclampsia].

OBJECTIVE: To study the effects of nuclear factor-kappaB (NF-kappaB) decoy oligodeoxynucleotide (ODN) on the preeclamptic umbilical serum induced expression of precollagen I, III mRNA and tumor necrosis factor-alpha (TNF-alpha) in cultured human umbilical artery smooth muscle cells (HUASMC). METHODS: Primary cultured HUASMC of normal pregnancy were divided into four groups: group A (HUASMC were incubated with umbilical serum of normal pregnancy); group B (HUASMC were incubated with umbilical serum of preeclampsia); group C (HUASMC were transfected with NF-kappaB cis decoy ODN 48 h before incubation with umbilical serum of preeclampsia); group D (HUASMC were transfected with NF-kappaB scramble ODN 24 h before incubation with umbilical serum of preeclampsia). NF-kappaB cis decoy ODN and NF-kappaB scramble ODN were transfected with cationic lipofectamine to the latter two groups, respectively. The proliferation of human umbilical artery smooth muscle cells was evaluated by methyl thiazolyl tetrazolium and the apoptosis was analyzed by flow cytometry. The expression levels of precollagen I, III mRNA were detected by RT-PCR, the expression levels of TNF-alpha were detected by western blot. RESULTS: (1) The proliferation of group B (0.19 +/- 0.02) and group D (0.18 +/- 0.03) was significantly increased as compared with those of group A (0.11 +/- 0.02) and group C (0.14 +/- 0.02) (P < 0.05). (2) The apoptosis rates of group B [(7.8 +/- 1.3)%], group C [(10.1 +/- 1.2)%] and group D [(8.1 +/- 1.3)%] were significantly reduced as compared with that of group A [(14.3 +/- 1.2)%] (P < 0.05), and there was a significant difference between groups B and C (P < 0.05). (3) The expression levels of precollagen I mRNA of group B (0.31 +/- 0.04), group C (0.23 +/- 0.04) and group D (0.30 +/- 0.03) were significantly increased as compared with that of group A (0.16 +/- 0.02) (P < 0.05), and there was a significant difference between groups B and C (P < 0.05). (4) There were no significant differences among the four groups in the expression level of precollagen III mRNA (P > 0.05). (5) The expression of TNF-alpha of group B (0.74 +/- 0.11), group C (0.36 +/- 0.09) and group D (0.79 +/- 0.12) were significantly higher than that of group A (0.15 +/- 0.03) (P < 0.05), and the expression of TNF-alpha of groups B and D were significantly higher than that of group C (P < 0.05), while there was no significant difference between groups B and D (P > 0.05). CONCLUSIONS: NF-kappaB cis decoy ODN could down-regulate the proliferation, as well as the expression levels of precollagen and TNF-alpha of HUASMC induced by umbilical serum of preeclampsia. NF-kappaB may play an important role in the pathogenesis of placental artery abnormalities in preeclampsia.