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BACKGROUND@#The clinical importance of hypokalemia is likely underrecognized in Chinese dialysis patients, and whether its clinical effect was mediated by serum albumin is not fully elucidated. This study aimed to explore the association between serum potassium and mortality in dialysis patients of a Chinese nationwide multicenter cohort, taking albumin as a consideration.@*METHODS@#This was a prospective nation-wide multicenter cohort study. Restricted cubic splines were used to test the linearity of serum potassium and relationships with all-cause (AC) and cardiovascular (CV) mortality and a subsequent two-line piecewise linear model was fitted to approach the nadir. A mediation analysis was performed to examine relations of albumin to potassium and mortalities.@*RESULTS@#A total of 10,027 patients were included, of whom 6605 were peritoneal dialysis and 3422 were hemodialysis patients. In the overall population, the mean age was 51.7 ± 14.8 years, 55.3%(5546/10,027) were male, and the median dialysis vintage was 13.60 (4.70, 39.70) months. Baseline serum potassium was 4.30 ± 0.88 mmol/L. After a median follow-up period of 26.87 (14.77, 41.50) months, a U-shape was found between potassium and mortality, and a marked increase in risk at lower potassium but a moderate elevation in risk at higher potassium were observed. The nadir for AC mortality risk was estimated from piecewise linear models to be a potassium concentration of 4.0 mmol/L. Interestingly, the significance of the association between potassium and mortality was attenuated when albumin was introduced into the extended adjusted model. A subsequent significant mediation by albumin for potassium and AC and CV mortalities were found ( P < 0.001 for both), indicating that hypokalemia led to higher mortality mediated by low serum albumin, which was a surrogate of poor nutritional status and inflammation.@*CONCLUSIONS@#Associations between potassium and mortalities were U-shaped in the overall population. The nadir for AC mortality risk was at a potassium of 4.0 mmol/L. Serum albumin mediated the association between potassium and AC and CV mortalities.
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Adult , Aged , Female , Humans , Male , Middle Aged , East Asian People , Hypokalemia/etiology , Kidney Failure, Chronic/mortality , Potassium/blood , Prospective Studies , Renal Dialysis , Serum Albumin/analysisABSTRACT
Objective:To assess the bacterial profiles and antimicrobial susceptibility patterns in uropathogens, and help to inform the empiric treatment decisions for urinary tract infection in outpatient settings.Methods:A single institutional retrospective analysis was performed on positive urine cultures from outpatient settings between January 1998 and December 2018. To analyze changes over time, trends analysis were undertaken on bacterial profiles, antimicrobial susceptibility and resistance.Results:A total of 1.172 pathogenic bacteria were isolated after exclusion of duplicate strains originated from the same patient, including 991(84.6%) Gram-negative bacterial strains and 181(15.4%) Gram-positive strains. The most common Gram-negative uropathogens were Escherichia coli (60.8%) and Klebsiella pneumonia (8.1%). Enterococcus faecalis (4.6%) was the predominant Gram-positive strain. The detection rate of Escherichia coli increased significantly, from 50.8% to 63.2% ( χ2=7.978, P=0.046), and no significant difference was observed in the distribution of major uropathogenic bacteria over the 20 years (all P>0.05). The proportion of extended-spectrum β-lactamase (ESBLs) producing strains increased significantly across the 20 years ( P<0.05). The resistance rates of Escherichia coli to amoxicillin and clavulanate potassium, aztreonam, ceftazidime, ciprofloxacin and sulbactam + cefoperazone increased significantly (all P<0.05). All the isolates sustained high susceptibility to tazobactam + piperacillin, amikacin, imipenem and nitrofurantoin (95.0%, 95.7%, 97.9% and 91.1%). Similar to those of Escherichia coli, Klebsiella pneumoniae remained a high and stable sensitivity to tazobactam+piperacillin, amikacin and imipenem during the 20 years (79.1%, 88.0% and 80.3%). However, the proportion of ESBLs producing strains increased significantly ( P<0.05). Among Gram-positive bacteria isolates, the sensitivity rates of Enterococcus faecalis to ampicillin, nitrofurantoin and penicillin G were 100.0%. No vancomycin resistant strain was detected in Gram-positive bacteria. Conclusions:From 1998 to 2018, Escherichia coli and Klebsiella pneumoniae are the most common Gram-negative bacteria uropathogens obtained in outpatient settings. Significant increases of resistance to some antimicrobial agents such as second- and third-generation cephalosporins and fluoroquinolones are observed during the 20 years and high susceptibilities to tazobactam+piperacillin, amikacin, imipenem and nitrofurantoin sustain over time. Local treatment strategies of urinary tract infections on outpatient basis should be made according to epidemiology of drug resistance and individual characteristics to control the spread and curb the prevalence of drug resistant.
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Objective To study how ANGPTL4 modulates phenylephrine(PE)-induced cardiac fibrosis. Methods PE was applied to induce cardiac fibrosis. The knockdown effect of ANGPTL4 under PE stimuli was confirmed by Western blot;the proliferation of cardiac fibroblast was detected by CCK-8;mRNA levels of Collagen 1(Col1)and connective tissue growth factor(CTGF)were detected by QPCR to investigate the regula-tion of cardiac fibrosis by ANGPTL4. Results PE induced the proliferation of cardiac fibroblast and the up-regula-tion of mRNA levels of Col1 and CTGF;ANGPTL4 knockdown deteriorated cardiac fibrosis,manifested by the up-regulation of Col1 and CTGF. Conclusion ANGPTL4 inhibits PE-induced cardiac fibrosis.
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Objective We make a retrospective analysis , to compare to COPD group and discuss the risk factors and the clinical features in acute exacerbation in patients with ACOS to follow-up the exacerbating frequency after regular treatment in both two groups in one year. Methods There were 56 patients with ACOS and 80 patients with COPD from 2013 to 2015 in our hospital in 30%≤FEV1<80% in the stable phase. The common data of the enrolled patients included the age,sex,smoking, and allergic rhinitis or other allergic diseases in family. We analyzed laboratory index including PaO2,PaCO2,CRP,white blood cells,IgE of serums and compared the proportion of antibiotics,system used of glucocorticoid and noninvasive ventilation in hospitalization of acute exacerbation and followed up exacerbating frequency after using ICS united LABA/LAMA. Results The age and smoking index in the ACOS group were lower than the COPD group (P < 0.05). The allergic rhinitis or other familial allergic diseases,lower age of 60,the high IgE in serum were risk factor, in ACOS. In acute exacerbation, the PaCO2,IgE and WBC in serum were higher than that of the COPD group(P <0.05). The midian length of stay in hosipital was 12 days in the ACOS group and 8 days in the COPD group. The proportion of antibiotics,systemic administration of glucocorticoid and noninvasive ventilation in hospitalization of acute exacerbation in the ACOS group were higher than that of the COPD group (P < 0.05). The exacerbating frequency was decreased after using ICS united LABA/LAMA(1.2±0.6 vs 3.8±1.3,P < 0.05)in both ACOS and COPD groups. Conclusions The allergic diseases may participate in ACOS, in which it has familial tendency. In acute exacerbation, ACOS patients had even more inflammation and faster course than COPD patients. Using ICS united LABA/LAMA can reduce exacerbating frequency in ACOS.
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Objective To observe the clinical effect of peroutaneous ethanol injection therapy (PEIT) of parathyroid gland guided by color ultrasound on dialysis patients with secondary hyperparathy-roidism. Methods Percutaneons ethanol injection therapy (PELT) was used for seven patients who suf-fered from secondary hyperparathyroidism, and systemic perioperative nursing care and relative health edu-cation were applied. Results All patients had obtained successful operation without any operative sud-denness or associated complications,Patients" serious scratching and bone ache was obviously relieved.Conclusions Treatment with PEIT and effective nursing to patients suffered from secondary hyper-parathyroidism can reduce the complications, and than improve the quality of live for patients.
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Objective To investigate sexual dysfunction and its rehabilitation,as well as quality of life in patients after spinal cord injury(SCI). Methods Sixty-two male patients with SCl were assessed with a 5-item version of the International Index of Erectile Function(IIEF-5),an especially-designed sexual function scale,and the World Health Organization's quality of life questionnaire(WHO-QOL).Their results were compared with those of 146 other patients with work injuries hospitalized in the same period.Results 77.9% of 62 cases had moderate to severe erectile dysfunction.though more than half of them remained sexually active.52.7% had attempted sexual intercourse,but only 19.5% succeeded,and only 14.5% obtained sexual satisfaction.69.1% of the 62 patients had psychological symptoms,and 27.27% had family problems.Their average score on the WHO-QOL was significantly lower than that of the other disabled workers.There were significant differences between the two groups with regard to quality of life.especially in the physiological and social relationships domains. Conclusion Most male patients with SCI had sexual dysfunction and decreased quality of life.Sexual dysfunction rehabilitation of SCI patients needs urgent strengthening.
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Objective To investigate the main origin of IL-6 during acute rejection of renal transplantation and provide the experimental foundations for expounding the molecular pathogenic mechanism of acute rejective reaction of renal transplantation Methods 3'IL-6 probe with in situ hybridization technique was used to detect the IL-6mRNA expression in renal graft. Results (1) Renal graft expression of IL-6mKNA in acute rejection was higher than that in CsA toxicosis, stable transplantation and normal control. (2) Expression of IL-6mRNA in tubular epithe-lium of acute rejection graft was higher than that in glomerular cells ,vascular endotheli-um and interstitium. (3) The expression of IL-6mRNA in renal graft of CsA toxicosis was similar with that in stable transplantation and normal control. Conclusion Renal graft cells may produce IL-6 directly during acute rejection. The abnormal expression and activation of IL-6 in renal graft may play an important role in the mechanism of renal acute rejection. Graft tubular epithelium may play a more important role in the cause of immunorejection.