Prediction of disease prognosis by four blood biochemical indicators in patients with perianal necrotizing fasciitis / 医学研究生学报

ObjectiveNecrotizing fasciitis (NF) has a high rate of deterioration and rapid progress, and the mortality rate is still high even after receiving treatment. The study was to explore evaluation value of serum procalcitonin (PCT), C-reactive protein (CRP) and plasma albumin (ALB) and prealbumin (PA) in the prognosis of patients with perianal necrotizing fasciitis (NF).MethodsAll data and detection data of serum PCT, CRP and plasma ALB, PA at admission from 41 perianal NF patients admitted to Hefei first people's Hospital Group from May 2009 to August 2019 were retrospectively collected. The death status was statistically analyzed. The patients in this group were divided into survival group and non-survival group, and the predictive value of various indicators on the prognosis of NF was evaluated. ResultsThe ratio of male to female was 9.25∶1. There were multiple complications, and diabetes mellitus was most common (41.46%). The patients with mixed infection and negative bacterial culture accounted for 12.20% and 17.07%, respectively. There were many kinds of bacteria detected out. Klebsiella pneumoniae (20.45%), Escherichia coli (15.91%) and streptococcus (15.91%) were common. All underwent one or more surgical treatments, with mortality of 17.07%. There was no significant difference between survival group and death group in gender, complications, microbiological test results, operation status within 6h or and nutrition support (P>0.05), while there were significant differences in time from onset to admission, proportion of patients in ICU, serum PCT and CRP, plasma ALB and PA and proportion of patients undergoing vacuum sealing drainage (VSD) (P<0.05). Logistic multivariate regression analysis showed that long duration from onset to admission, staying in ICU, high serum PCT and CRP, low plasma ALB and PA, and no conducting VSD were risk factors of poor prognosis (P<0.05). Serum PCT, CRP and plasma ALB, PA predict the prognosis receiver operating characteristic(ROC) curve, the area under the curve is 0.859, 0.811, 0.802, 0.747; the area under the curve of the four indicators combined prediction is 0.926.ConclusionThere are certain features in terms of gender, complications and microorganisms in perianal NF patients. Death risk is high. In addition, serum PCT and CRP, plasma ALB and PA are also related with prognosis, which can be applied as biochemical indexes for prognosis evaluation.

Muscle mass loss and intermuscular lipid accumulation were associated with insulin resistance in patients receiving hemodialysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>An accelerated muscle wasting was the pivotal factor for protein-energy wasting in end stage renal disease. However, very few researches have examined the skeletal muscle quantity and quality in clinical patients. This study investigated the muscle morphologic changes by magnetic resonance imaging (MRI) and analyzed the related factors in hemodialysis patients.</p><p><b>METHODS</b>Fifty-eight patients receiving maintenance hemodialysis (HD) were investigated and 28 healthy adults with gender and age matched were used as controls (Control). Anthropometry, cytokine factors, and laboratory data were measured. The muscle and intermuscular adipose tissues (IMAT) were analyzed via a Thigh MRI. The bicep samples were observed after HE staining. Homeostatic model assessment of insulin resistance (HOMA-IR) was measured and their association with muscle wasting was analyzed.</p><p><b>RESULTS</b>HD patients tended to have a lower protein diet, anthropometry data, and serum albumin, but the C reactive protein and interleukin-6 increased significantly. The MRI showed that HD patients had less muscle mass and a lower muscle/total ratio, but the fat/muscle and IMAT was higher when compared to the Control group. The muscle fiber showed atrophy and fat accumulation in the biceps samples come from the HD patients. Moreover, we found that the HD patients presented with a high level of plasma fasting insulin and increased HOMA-IR which negatively correlated with the muscle/total ratio, but positively with the fat/muscle ratio.</p><p><b>CONCLUSIONS</b>Muscle wasting presented early before an obvious malnutrition condition emerged in HD patients. The main morphological change was muscle atrophy along with intermuscular lipid accumulation. Insulin resistance was associated with muscle wasting in dialysis patients.</p>

Efficacy and safety of Changfu peritoneal dialysis solution: a multi-center prospective randomized controlled trial / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>A multi-center large scale study is needed to confirm the efficacy and safety of domestic peritoneal dialysis (PD) solutions. Some researchers believe that 6 L/d is enough for adequate dialysis, but there is no multi-center prospective study on Chinese population to confirm this. In this study, we evaluated the efficacy and safety of domestic PD solution (Changfu) and its difference between 6 L and 8 L dosage.</p><p><b>METHODS</b>Adult PD patients who had taken PD therapy for at least one month were selected and divided into four groups according to two dialysis solution brands and two dialysis dosages, i.e., 6 L dose with Changfu dialysis solution, 6 L dose with Baxter dialysis solution, 8 L dose with Changfu dialysis solution, and 8 L dose with Baxter dialysis solution. After 48 weeks, the changes of primary and secondary efficacy indices were compared between different types and different dosages. We also analyzed the changes of safety indices.</p><p><b>RESULTS</b>Changes of Kt/V from baseline to 48 weeks between Changfu and Baxter showed no statistical differences; so did those of creatinine clearance rate (Ccr). Normalized protein catabolic rate (nPCR) from baseline to 48 weeks between Changfu and Baxter showed no statistical differences; so did those of net ultrafiltration volume (nUF) and estimated glomerular filtration rate (eGFR). Changes of nPCR from baseline to 48 weeks between 6 L and 8 L showed no statistical differences; so did those of nUF and eGFR. The decline of Kt/V from baseline to 48 weeks in 6 L group was more than that in 8 L group. Change of Ccr was similar. During the 48-week period, the mean Kt/V was above 1.7/w, and mean Ccr was above 50 L×1.73 m(-2)×w(-1). More adverse events were found in Changfu group before Changfu Corporation commenced technology optimization, and the statistical differences disappeared after that.</p><p><b>CONCLUSIONS</b>The domestic PD solution (Changfu) was proven to be as effective as Baxter dialysis solution. During 48-week period, a dosage of 6 L/d was enough for these patients to reach adequate PD. Clinical study promotes technological optimization, further helps to improve the safety indices of the medical products.</p>

Effects of glycyrrihizic acid and prednisone on pathological and ultrastructural changes of kidney in rats with chronic aristolochic acid nephropathy / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To investigate the effects of glycyrrihizic acid (GA) and prednisone on renal injury in chronic aristolochic acid nephropathy (AAN) rat model.</p><p><b>METHODS</b>Ninety-eight male Wistar rats of SPF grade were randomly divided into 4 groups, the normal control group (n = 20), the GA group, the model group, and the prednisone group, 26 rats in each group. Rats in the latter 3 groups were made into AAN model by administration of aristolochic acid (AA, contained in extract of Caulis Aristolochiae Manshuriensis) 20 mg/(kg x d) by gastric gavage, and equal volume of drinking water was given to rats in the control group. Medication was started 2 h later, the GA group was treated with GA 25 mg/(kg x d), the prednisone group with prednisone 3.15 mg/(kg x d), and to the other two groups equal volume of drinking water was given. Body weight was measured weekly, renal function related indices and morphology of the renal tissue were examined at the 4th, 8th and 12th weekend.</p><p><b>RESULTS</b>Along with the feeding time, body weight in the control group increased steadily, while that in the treated groups increased slowly. The ratio of serum creatinine/body weight increased markedly in the model group, while it significantly lowered in the treated groups. Morphological examination showed that the structural injury in the treated groups was milder than that in the model group, and its degree of fibrosis was milder also (15% - 20% vs 30%). Electronmicroscopy showed that AA induced, injury degeneration and necrosis of renal tubular epithelial cells, and markedly injured the cell organs, such as mitochondria, and induced nuclear variation, while in the treated groups, it was mainly limited in renal tubule, with normal cell organs, few nucleolus variation and less interstitial collagen fibers.</p><p><b>CONCLUSION</b>GA and prednisone could reduce the serum creatinine level, improve renal function, relieve the renal morphological changes, and decrease the inter stitial fibrosis, showing a definite preventing effect on chronic AAN in rats.</p>