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Objectives:To investigate the risk factors of sarcopenia in patients receiving maintenance peritoneal dialysis (MPD).Methods:One hundred and thirteen patients receiving maintenance MPD for ≥3 months during January and December 2017 were enrolled in this study. According to the Asian Working Group for Sarcopenia(AWGS)algorithm, there were 26 patients with sarcopenia accounting for 23.0% of all MPD patients. Demographic and anthropometric data were collected; laboratory tests were conducted, Kt/V urea and normalized protein equivalent of total nitrogen appearance were calculated; the bioelectrical impedance analysis (BIA) was performed and grip strength was tested. The nutritional status was evaluated with Subjective Global Assessment (SGA). Logistic regression was used to analyze the risk factors of sarcopenia in MPD patients. Results:BMI and dialysis dose of patients with sarcopenia were significantly lower than those without sarcopenia [(20.35±2.35) kg/m 2vs. (23.81±3.14) kg/m 2, t=-5.181, P<0.01; (5.57±1.83) L/d vs. (6.66±1.71) L/d, t=-2.795, P<0.01]. The bioelectrical impedance analysis showed that the total water content of patients with sarcopenia was higher than that of patients without sarcopenia [(35.44±6.40) kg vs. (28.52±4.89) kg, t=5.077, P<0.01]; while the protein content[(7.46±1.31) kg vs. (9.24±1.63) kg, t=-5.080, P<0.01] and skeletal muscle content [(20.54±4.18) kg vs. (25.88±4.95) kg, t=-4.980, P<0.01] of patients with sarcopenia were lower than those without sarcopenia. Multivariate analysis showed that decreased BMI( OR=0.934, 95 %CI: 0.723-0.998, P<0.01) and body protein ( OR=0.927, 95 %CI: 0.698-0.996, P<0.01), increased total body water( OR=1.382, 95 %CI: 1.053-1.813, P=0.02) were independent risk factors for sarcopenia in MPD patients. Conclusion:The incidence of sarcopenia in MPD patients is high, which is associated with the excessive volume load and malnutrition of patients.
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Chronic heart failure,especially the end-stage heart failure,is often accompanied by the loss of muscle mass,strength and functions of muscle.A large amount of trust evidences supported that sarcopenia was linked to poor prognosis of heart failure.This paper has reviewed the epidensiological features,medchanisms,prognosis,and treatment of heart failure-related sarcopenia.
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AIM:To explore the effects of different intensity of warfarin on patients with coronary atherosclerotic heart disease complicated with atrial fibrillation.METHODS:One hundred and seven cases of coronary heart disease complicated with atrial fibrillation patients in our hospital were selected and were randomly divided into experimental group (n =54) and control group (n =53) by random number table.The experimental group (low intensity) received initial amount of warfarin for 1.25 mg/d,and NR monitoring 24 h after treatment,if INR＜ 1.4,3-5 mg/d increased by 0.5-1.0 mg/d,monitoring one time per week,INR maintained within 1.4-2.0.INR of the control group (medium intensity) maintained within 2.0-2.6.One month monitoring after INR stabilized.All patients were treated for about 4 weeks,and warfarin was maintained at a dose of 1.25-7.5 mg/d.The primary and secondary end points and bleeding events were observed and compared after 2 years of treatment.RESULTS:The INR of the experimental group and the control group were 1.71 ± 0.38,2.36 ± 0.35,respectively.The ratio of total bleeding event of the experimental group and the control group was 22.2％ and 41.5％,respectively.Those of the experimental group were lower than those of the control group,and the difference was all statistically significant (P＜ 0.05).CONCLUSION:The efficacy of low-intensity warfarin in the treatment of coronary atherosclerotic heart disease complicated with atrial fibrillation is comparable to that of moderate-intensity warfarin therapy,but low-intensity warfarin shows better saftey.
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AIM:To investigate the effects of atorvastatin reloading in pre-percutaneous coronary intervention ( PCI) period on endothelial progenitor cell ( EPC) count and inflammatory cytokine expression in the stable angina pectoris patients who had previously received long-term statin treatment.METHODS:The patients with stable angina pectoris that had received long-term statin therapy and planned to accept PCI were randomized into 3 groups:80 mg atorvastatin 12 h and 40 mg 2 h before coronary angioplasty (80 mg reloading), pre-operatively with 40 mg/d atorvastatin for 7 d (40 mg re-loading) , and without atorvastatin reloading ( no reloading ) .CD45 -/CD133+/CD34 +, CD45 -/CD34 +/KDR+ and CD45 -/CD144 +/KDR+EPCs in 100 μL peripheral blood were determined by flow cytometry 1 h prior to PCI and 1 h, 6 h and 24 h after PCI.The serum concentrations of soluble intercellular adhesion molecule 1 ( sICAM-1) , C-reactive protein ( CRP) and troponin I ( TnI) were analyzed immediately prior to and 24 h after PCI.RESULTS:(1) In 80 mg reloading group, the numbers of circulating CD45 -/CD133 +/CD34 +and CD45 -/CD34 +/KDR+early differentiation stage EPCs 1 h and 6 h after coronary angioplasty was significantly elevated compared with those before PCI (P<0.05).(2) In control group, the serum concentrations of sICAM-1 and CRP 24 h after PCI were significantly elevated ( P<0.05) compared with preoperative values.(3) The rise in serum TnI concentration from pre-to post-operation in 80 mg reloading group was lowerthan that in control group.CONCLUSION: The method of atorvastatin reload before PCI affects the number of EPCs inperi-operative period.High dose of atorvastatin application before PCI triggers early EPC circulation.The serum levels ofpost-operative inflammatory cytokine sICAM-1 as well as CRP are reduced by atorvastatin reloading before PCI.