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Objective:To investigate the long-term outcome and prognostic indicators of diffuse pro-liferative lupus nephritis (DPLN).Methods:The primary endpoint of long-term follow-up and factors pos- sibly influencing the outcome were analyzed retrospectively in DPLN patients admitted to the First Affiliated Hospital of Wenzhou Medical University between Jan 1, 2000 and Dec 31, 2014. Patients were classified into three groups according to the evaluated glomerular filtration rate(eGFR) on the first day of admission: eGFR≥60 ml·min -1·1.73 m -2 (regular illness group); 15 ml·min -1·1.73 m -2≤eGFR<60 ml·min -1·1.73 m -2 (serious illness group); eGFR<15 ml·min -1·1.73 m -2 or dialysis (critical illness group). Clinical, histological, and outcome differences among the three groups were evaluated and compared using one-way analysis of variance (ANOVA) , χ2 test, Kaplan-Meier survival curve and Cox reggression analysis. Results:167 DPLN patients were studied [155 women; mean age (30±10) years; mean follow-up of (61±45) months]. Renal and patient survival of all patients was 86% at 5 years and 79% at 10 years. Kaplan-Meier analysis showed the renal and patient survival rate at 10 years in the regular illness group, serious illness group and critical illness group was 91%, 70% and 8%, respectively ( χ2=121.93, P<0.01, overall); regular illness group vs serious illness group ( χ2=4.05, P<0.05); regular illness group vs critical illness group ( χ2=97.05, P<0.01); serious illness group vs critical illness group ( χ2=52.28, P<0.01). Multivariable Cox regression analysis found that haematoglobin (Hb)<80 g/L [ HR=2.7, 95% CI(1.2, 6.3), P=0.019], eGFR<60 ml·min -1·1.73 m -2 [ HR=4.1, 95% CI(2.0, 8.2), P<0.01] and large crescents ≥30%[ HR=1.8, 95% CI (1.1, 2.9), P=0.021], were risk factors for the long-term outcome. Conclusion:DPLN patients with normal or slightly decreased renal function have a better long-term prognosis. Moderate to severe impairment of renal function, anemia and large crescents are associated with poor outcome.
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Objective To investigate the gender differences and psychological influencing factors for anal rectal function in senile patients with functional constipation (FC) .Methods The gender differences and correlation of anal rectal function and psychological factors were compared in elderly patients and control group by anorectal manometry and psychological testing methods .Results The anal pressure drops of analog defecation of elderly female and male patients were attenuated and the rectal sensation thresholds increased compared with that of control group ,and the maximal squeezing pressure ,the rectal defecation pressure and anorectal pressure difference of elderly female patients were attenuated compared with that of elderly male patients .The SAS and SDS stand‐ard score of elderly female and male patients were significantly higher than that of control group .The SAS standard score of elderly female patients were higher than elderly male patients .SAS and SDS were negatively correlated with anorectal pressure difference and positively correlated with rectal first sensation volume (FSV) .Conclusion Anorectal dysfunction and psychological factors were involved in the elderly FC pathogenesy ,and they were related .Elderly female patients suffered more severe anxiety and anorectal motility disorders than male patients .
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Objective To investigate the gender differences of anal rectal function and depression and/or anxiety in elderly patients with functional constipation (FC).Methods Twenty-seven elder female FC patients (elder female patients group),20 elder male FC patients (elder male FC patients group),28 elder healthy female (elder healthy female group) and 24 elder healthy male (elder healthy male group) were selected.The gender differences and correlation of anal rectal function and psychological factors were compared in elderly patients and control group,by using anorectal manometry and psychological testing methods.Results Compared with elder healthy female group,maximum squeeze pressure (MSP),anorectal pressure decreased in elder healthy male group(P ＜ 0.05 or ＜ 0.01),anal canal overpressure,first sensation volume(FSV),defecating sensation volume(DSV),maximum tolerable volume(MTV) increased in elder female patients group (P＜ 0.01).Compared with elder male healthy group,anal canal excess pressure increased,anorectal pressure decreased (P＜ 0.05),and FSV,DSV,MTV increased in elder male patients group (P ＜ 0.01 or ＜ 0.05).MSP,rectum systolic pressure,anorectal pressure in elder female patients group was lower than that in elder male patients group (P ＜ 0.05 or ＜ 0.01),rectal tube excess pressure and rectal sensation threshold was higher than that in elder male patients group,but there was no significant difference (P ＞ 0.05).RRP,rectum systolic pressure,anorectal pressure in elder female healthy group was lower than that in elder male healthy group (P ＜ 0.01).FSV was higher than that in elder male healthy group (P ＜ 0.01).SAS score and SDS score was higher in elder female patients group was higher than that in elder female healthy group (P＜ 0.01),SAS score and SDS score was higher in elder male patients group was higher than that in elder male healthy group(P＜ 0.05 or ＜ 0.01).SAS score was negatively correlated with MSP,rectum systolic pressure,anorectal pressure(P ＜ 0.01),was positively correlated with FSV(P ＜ 0.05).SDS score was negatively correlated with anorectal pressure (P ＜ 0.01),was positively correlated with FSV,DSV,MTV (P ＜0.01).Conclusions Anorectal dys function and psychological factors are involved in the elderly FC pathogenesy,and the two are related.Elderly female patients exist more severe anxiety and anorectal motility disorders than male patients.
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Objective To investigate the infection rates of mycoplasma penetrans (Mpe),mycoplasma pneumoniae (Mp) and mycoplasma ferments (Mf) in patients with IgA nephropathy (IgAN),chronic kideny disease (CKD),and heathy people,to compare the difference of infection rate,and to analyze the association of mycoplasma infection and clinicopathological features in IgAN.Methods Blood samples were collected from 118 patients in IgAN group,90 patients in CKD group,and 89 cases in health control group.DNA of Mpe,Mp and Mf was detected in plasma by PCR.Positive cases were confirmed by Southern blot.According to mycoplasma infection,IgAN patients were divided into two groups,then analyzed the clinicopatholgical features.Results (1)Genus,Mpe,Mp,and Mf positive rates were 33.05％,16.1％,25.45 ％,and 8.47％ in IgAN group,respectively; 5.56％,2.22％,5.56％,and 2.22％ in CKD group,respectively; and 3.33 ％,1.11％,2.22％,and 0 in health group,respectively.Compared with CKD and health group,patients in IgAN group had a higher infection rate in Genus,Mpe,and Mp (P ＜ 0.05).In IgAN group,10 patients had three kinds of mycoplasmas infection at the same time,and positive rate was 8.47％ much higher than CKD group (positive rate was 2.22％) (P ＜ 0.05).(2) Based on mycoplasm detection results,IgAN patients were divided into two groups,overlapping infection group and mycoplasma negative group.In overlapping infection group,the mean age of onset was much younger than negative group.Compared with negative group,overlapping infection group had higher tonsillitis and urinary tract infection rate,more severe microscopic hematuria and tubulointerstitium lesion (P ＜ 0.05).Conclusions Patients with IgAN had higher infection rate of Genus,Mpe and Mp,compared with CKD patients and health people.Compared with mycoplasma negative group in IgAN patients,more severe microscopic hematuria and tubulointerstitium lesion in overlapping infection group,which suggested that infection of Mpe might have some possible connection with IgAN.
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Objective To investigate the features of malignancy in end-stage aristolochic acid nephropathy (AAN) patients undergoing renal replacement therapy in the First Affiliated Hospital of Wenhou Medical University.Methods One hundred and two patients diagnosed as end-stage AAN during 2004 to 2013 were enrolled in the study,and separately udergoing hemodialysis,peritoneal dialysis and renal transplantation,to study the features of the malignancy and its risk factors.Results (1) There were totally 42 AAN patients suffering from malignancy,and 39 of them had urinary cancer.Eight cases of urinary cancer had metastasis,and 11 cases of bladder cancer had repeated recurrences.Patients suffering from malignancy had an increased mortality compared to patients without malignancy (13/42 vs 7/60,P =0.022).(2) Thirteen malignacy cases were diagnosed before the end-stage of AAN,the rest cases appeared in 1-13 years[(4.62±3.31) years] after renal replacement.(3) A further logistic regression analysis of the 29 maligancy patients after renal replacement showed that,the dose of aristolochic acid (counted by Mutong) was the only risk factor of malignancy (P =0.091),compared with the dose of Mutong less than 60 g,the patients with an accumulated dose of Mutong more than 200 g had a 4.26 folds (95％CI 1.02,17.83)higher risk of malignancy.There was no statistic difference of the malignancy risk among different renal replacement therapies,which however might influence the pathogenic sites of the urinary cancer.The simple bladder cancer was the most common malignancy among the hemodialysis patients (72.72％),and the upper urinary tract cancer among the peritoneal dialysis patients (66.67％),while the complex of both were dominant among the renal transplantation patients(40.00％).Conclusions Among the end-stage of AAN patients undergoing renal replacement therapy in Wenzhou area,the incidence of urinary cancer is high,with a character of complex,multiple and repeated recurrences.The occurence of malignancy seems to be separated from the renal function,but turns out obviously dose-dependent.There was no statistical difference of cancer risk among hemodialysis,peritoneal dialysis,and renal transplantation,which may induce different pathogenic sites of the urinary cancer.
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Objective To study the association between Mycoplasma penetrans (Mpe) infection and clinicopathology of IgA nephropathy (IgAN). Methods Blood samples of 118 IgAN patients, 90 patients with chronic kidney disease (CKD) and 89 healthy people were collected. Mpe DNA in serum was detected by PCR and positive samples were confirmed by Southern blotting. According to Mpe infection, IgAN patients were divided into positive and negative groups. Association between clinicopatholgical features of IgAN and Mpe infection was examined.Results Significantly higher Mpe positive rate was found in IgAN group as compared to CKD and healthy groups (16.0% vs 2.2% and 1.1%, P＜0.01). In Mpe positive group, 42.1% patients presented macroscopic hematuria, which was significantly higher than that in Mpe negative group (P＜0.01). While Mpe negative group had greater proteinuria, higher serum creatinine level, higher Lee grading of pathology compared to Mpe positive group. There were no differences of tubulointerstitial lesions and arteriole hypertrophy between two groups. Conclusions IgAN patients have higher Mpe infection rate than CKD patients and healthy people. Mpe positive IgAN patients have more macroscopic hematuria. Mpe infection may be associated with the pathogenesis of IgAN.
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Objective To assess the diagnostic value of confoeal laser endomicroscopy(CLE) in histological gastritis.Methods A total of 149 patients underwent CLE.Standard locations and focal lesions were examined by confocal imaging, and specimens were taken by targeted biopsy.The relationship between confocal images and histological findings were studied systemically.Results The sensitivity,specificity and accuracy of CLE in diagnosis of atrophy were 83.6%,99.6%and 97.5%,respectively;and those in moderate to severe neutrophil infiltration were 81.9%,99.3%,and 95.8%,respectively.The mean kappa values for inter-and intra-observer agreement on the classification of confocal images in groups were 0.749 and 0.811 respectively.Conclusion The validity and reproducibility of CLE in diagnosis of histologic gastritis are promising,which might warrant its further application in clinical practice.
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Objective To evaluate the efficacy of confocal laser endomicroscopy(CLE)for the assessment of the grading of gastric intestinal metaplasia(GIM)in vivo.Methods Patients with known GIM underwent CLE(Pentax EC-3870K).The presence of GIM was indentified immediately by the endoscopist during the procedure.The updated Sydney Classifycation System as reference,GIM was subdivided as mild,moderate and severe according to the area of intestinal metaplasia glands and the number of goblet cells.The histological evaluation remained the gold standard for the final diagnosis of GIM.The presence of the dysplasia and the expression of the Ki67 were examined.Results A total of 151 GIM positive areas were found in 58 patients with mild in 92,moderate in 34.and severe in 25 by CLE. One hundred and forty-six GIM areas were examined histopathologically with positive rate of 96.7%(mild in 82,moderate in 36 and severe in 28).The sensitivity and specificity of CLE were 90.2%and 73.9%in diagnosis of mild GIM,69.4 oA and 92.2%in moderate GIM,71.4% and 95.9%in severe GIM.The kappa coefficient of CLE criteria and the histopathological grading for mild,moderate and severe GIM were 0.65,0.63 and 0.70,respectively.The more severe the GIM,the higher the ratio of incomplete GIM,the ratio of dysplasia and the stronger expression of Ki67.Conclusions CLE may offer an instant and reliable diagnosis for GIM with high accuracy.It is helpful in grading of GIM.
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<p><b>OBJECTIVE</b>To understand the prevalence and spatial distribution of vitamin A deficiency (VAD) in China among children at ages under six years.</p><p><b>METHODS</b>About 8,600 children under 6 years of age in 14 cities and 28 counties of 14 provinces were selected with stratified cluster sampling for survey, including interview with questionnaire for their family information and nutritional status. Blood specimens were collected for measuring serum level of VA with fluorescent spectrophotometry in laboratory.</p><p><b>RESULTS</b>Totally, 8,669 children under 6 (2,877 in urban area and 5,792 in rural area) were surveyed in 14 provinces, with 4,629 males and 4,040 females. Eight cases of night blindness and seven cases of xerophthalmia were found among the children at ages of two to five years. Sixty-one mothers of the children in this group were also found suffering from night blindness. All the cases of night blindness and xerophthalmia both in children and mothers were living in rural areas. Based on their serum levels of VA, 11.7% of the all 1 018 children were diagnosed as VAD, with serum VA concentrations below or equal to 0.70 micro mol/L. Prevalence of VAD was 15.0% and 5.8% in rural (23.3% in the poverty-stricken counties) and urban areas, respectively, and 5.8%, 11.5% and 16.8% in the coastal, inland and remote areas, respectively. The average serum level of VA was 1.20 micro mol/L and 0.99 micro mol/L for urban and rural areas, respectively, with a national average of 1.06 micro mol/L. And, babies under six months of age with an average serum levels of VA < or = 0.70 micro mol/L accounted for 33.4%, and those at ages of four to five years with the same level of VA accounted for 8%. There was significant difference in serum levels of VA between ages, but no significant difference between genders.</p><p><b>CONCLUSION</b>VAD did exist in children of China, especially in the remote and poverty-stricken rural areas and VA supplementation is urgently needed for the children in these regions.</p>