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ABSTRACT Objectives: Accurate preoperative prediction of adverse pathology is crucial for treatment planning of renal cell carcinoma (RCC). Previous studies have emphasized the potential of prostate-specific membrane antigen positron emission tomography / computed tomography (PSMA PET/CT) in differentiating between benign and malignant localized renal tumors. However, there is a scarcity of case reports elucidating the identification of aggressive pathological features using PET/CT. Our study was designed to prospectively compare the diagnostic value of enhanced CT, 68Ga-PSMA-11 and 18F-fluorodeoxyglucose (18F-FDG) PET/CT in clear-cell renal cell carcinoma (ccRCC) with necrosis or sarcomatoid or rhabdoid differentiation. Materials and Methods: A prospective case series of patients with a newly diagnosed renal mass who underwent enhanced CT, 68Ga-PSMA-11 and 18F-FDG PET/CT within 30 days prior to nephrectomy was included. Complete preoperative and postoperative clinicopathological data were recorded. Patients who received neoadjuvant targeted therapy, declined enhanced CT or PET/CT scanning, refused surgical treatment or had non-ccRCC pathological indications were excluded. Radiological parameters were compared within subgroups of pathological characteristics. Bonferroni corrections were used to adjust for multiple testing and statistical significance was set at a p-value less than 0.017. Results: Seventy-two patients were available for the final analysis. Enhanced CT demonstrated poor performance in identifying necrosis, sarcomatoid or rhabdoid differentiation and adverse pathology (all P > 0.05). The maximum standardized uptake value (SUVmax) of 68Ga-PSMA-11 PET/CT was more effective than 18F-FDG PET/CT in identifying tumor necrosis and adverse pathology, with an area under the curve (AUC) of 0.85 (cutoff value=25.26, p<0.001; Delong test z=2.709, p=0.007) for tumor necrosis and AUC of 0.90 (cutoff value=25.26, p<0.001; Delong test z=3.433, p<0.001) for adverse pathology. However, no significant statistical difference was found between 68Ga-PSMA-11 and 18F-FDG PET/CT in predicting sarcomatoid or rhabdoid feature (AUC of 0.91 vs.0.75, Delong test z=1.998, p=0.046). Subgroup analyses based on age, sex, tumor location, maximal diameter, stage and WHO/ISUP grade demonstrated that 68Ga-PSMA-11 PET/CT SUVmax had a significant predictive value for adverse pathology. Enhanced CT value and SUVmax demonstrated strong reliability [intraclass correlation coefficient (ICC) > 0.80], indicating a robust correlation. Conclusions: 68Ga-PSMA-11 PET/CT demonstrates distinct advantages in identifying aggressive pathological features of primary ccRCC when compared to enhanced CT and 18F-FDG PET/CT. Further research and assessment are warranted to fully establish the clinical utility of 68Ga-PSMA-11 PET/CT in ccRCC.
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Objective:To evaluate the efficacy and safety of oral anisodine hydrobromide tablets in the treatment of nonarteritic anterior ischemic optic neuropathy (NAION).Methods:A multicenter nonrandomized controlled trial was conducted.A total of 282 acute NAION patients (282 eyes) were recruited from 16 hospitals in China from July 2020 to May 2021.Patients were divided into two groups according to treatment methods, which were control group (124 cases, 124 eyes) receiving regular treatment including citicoline sodium plus Ginkgo biloba leaf liquid extract or Ginkgo biloba leaf extract tablets plus mecobalamin, and experimental group (158 cases, 158 eyes) receiving treatment in control group plus oral anisodine hydrobromide tablets 1 mg, twice daily for 2 to 3 months.Best corrected visual acuity (BCVA), visual field index (VFI), peripapillary retinal nerve fiber layer (pRNFL) and radial peripapillary capillary vessel density (RPC) were assessed at 1, 2, 3, and 6 months after enrollment using the standard decimal visual acuity chart, 750i Humphery visual field analyzer, Cirrus HD-OCT 4000/Cirrus HD-OCT 5000, RTVue-XR optical coherence tomography respectively.The primary outcomes were BCVA and VFI, and the secondary outcomes were pRNFL, RPC, and the side effects during the follow-up.The study adhered to the Declaration of Helsinki.All patients were fully informed about the treatment and purpose of this study and voluntarily signed the informed consent form.The study protocol was approved by Chinese PLA General Hospital (No.S2020-021-01). Results:In all, 242 patients (242 eyes) completed the follow-up of BCVA, and 98 patients (98 eyes) completed the VFI follow-up.In terms of visual function, BCVA and VFI improved significantly over time in the two groups, and BCVA and VFI were better in experimental group than in control group at various follow-up time points (all at P<0.05). In terms of structure, pRNFL gradually decreased in both groups with the extension of treatment, and pRNFL was significanthy thinner in experimental group than in control group at various follow-up time points (all at P<0.05). There was no significant difference in RPC between the two groups at the last follow-up ( P>0.05). There were two cases with side effects and one case was discontinued due to side effects 25 days after enrollment. Conclusions:Oral anisodine hydrobromide can improve visual acuity and visual field in NAION and accelerate the regression of optic disc edema, with good safety.
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@#With the rapid development of the field of interventional therapy of cardiac valve, the innovative researches of interventional therapy of cardiac valve products have become the focus of global research. At present, there is a serious shortage of interventional valvular medical devices on the market in China, and large-scale interventional valve products are undergoing early human trials or confirmatory clinical trials. The effective quality control of clinical trials is of great significance to ensure that clinical trial data can be used to support the marketing of device products. By analyzing the problems in clinical trials quality control of interventional valvular medical devices in our hospital, and combining the characteristics of device products and diseases, we explore the key points of quality control and provide reference for the implementation and completion of high-quality clinical trials.
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Objective:To observe any effect of fast walking on walking speed, 6-minute walking test (6MWT) time, and on serum levels of growth differentiation factor-8 (GDF-8) and insulin-like growth factor-1 (IGF-1) in patients with sarcopenia.Methods:A total of 61 sarcopenia patients were randomly divided into an observation group ( n=31) and a control group ( n=30). Both groups were given conventional drug therapy. In addition, the observation group underwent 30-minutes of walking at 100-120 steps/min (about 60% of maximum heart rate) three times a week for 12 weeks. The control group also walked, but at 70-90 steps/min (less than 50% of maximum heart rate). Grip strength, walking speed, 6MWT time, skeletal muscle index (ASMI) and serum GDF-8 and IGF-1 were compared before and after the intervention. Results:There were no significant differences in grip strength or ASMI between observation group and control group (comparing males with males and females with females) before the experiment. Afterward, grip strength and ASMI in the observation group had increased significantly on average. Both were then significantly higher than the control groups′ averages, which had not changed significantly. Average walking speed, 6MWT time and serum IGF-1 levels had improved significantly in both groups, but the observation group′s average improvement was significantly greater. A significant decrease the average serum GDF-8 level was observed in the observation group, but not in the control group.Conclusion:Fast walking can improve the walking of persons with sarcopenia, raise serum IGF-1 levels, and significantly reduce serum GDF-8.
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Objective:To explore the causal relationship between body mass index (BMI) and hypothyroidism using the two-sample Mendelian randomization model.Methods:A large-scale anthropometric genome-wide association study published in the GIANT database was used to select single nucleotide polymorphisms (SNPs) which were statistically significantly associated with BMI as an instrumental variable ( P<5×10 -8, linkage disequilibrium r 2<0.1). The causal relationship between BMI and hypothyroidism was determined by the inverse variance weighted (IVW), weighted median method and the MR-Egger method, respectively. A heterogeneity test, gene pleiotropy test, and sensitivity analysis were performed to evaluate the stability and reliability of the results. Results:A total of 89 SNPs related to BMI were screened out as instrumental variables. IVW analysis suggested that for every standard deviation increase in BMI, the risk of hypothyroidism increased by 0.9% (odd ratio ( OR)=1.009, 95% confidence interval ( CI): 1.006-1.012, P<0.001). Similar results were obtained with the weighted median method ( OR=1.007, 95% CI: 1.002-1.011, P=0.003) and the MR-Egger method ( OR=1.008, 95% CI: 1.001-1.015, P=0.006). The MR-Egger analysis showed that genetic pleiotropy did not bias the results (intercept=0.000 1, P=0.776), the one-by-one exclusion method did not show that a single instrumental variable SNP had a significant impact on the results, and the difference was not statistically significant ( P>0.05). Conclusion:Mendelian randomized analysis showed a positive causal relationship between BMI and hypothyroidism.
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Wnt/β-catenin is an evolutionarily conserved, complex developmental signal pathway that regulates embryogenesis, cell fate, tissue homeostasis, injury repair, and the pathogenesis of human diseases. Mounting evidence demonstrates that Wnt/β-catenin signaling plays a key role in early nephrogenesis. It is relatively silent in normal adult kidneys but reactivated in a wide variety of animal models of nephropathies and in human kidney diseases. Activation of Wnt/β-catenin after acute kidney injury contributes to proper repair and regeneration of damaged renal tubules. However, sustained activation of this signal cascade is closely related to the development and progression of fibrotic chronic kidney disease. In this paper, we systematically review the components and mechanisms of Wnt/β-catenin signaling and its role in kidney repair and fibrosis after injury. A better delineation of the mechanisms of this pathway will provide novel targets and new strategies for designing effective treatment of various kidney diseases.
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Animals , Humans , Fibrosis , Kidney/metabolism , Renal Insufficiency, Chronic , Wnt Signaling Pathway , beta Catenin/metabolismABSTRACT
Objective:To observe the clinical effect of Senling Baizhu san (SLBZS) on patients with sarcopenia.Methods:Eighty patients with spleen-stomach weakness sarcopenia admitted to the department of geriatrics of Hangzhou Third People's Hospital from January 2018 to March 2020 were enrolled. The patients were divided into control group and observation group by random number table method, 40 cases in each group. All patients were treated with conventional Western medicine, and the observation group was treated with SLBZS 100 mL, twice a day, on the basis of conventional Western medicine. The course of the treatments was 12 weeks. Grip strength and walking speed were recorded before and after treatment, and appendicular skeletal mass index (ASMI) was calculated. The serum levels of silence infor-mation regulator 1 (SIRT1), growth differentiation factor-8 (GDF-8) and insulin-like rowth factor-1 (IGF-1) were detected by enzyme linked immunosorbent assay (ELISA). The mRNA expression of AMP-activated protein kinase-α (AMPK-α) in serum was detected by real-time quantitative polymerase chain reaction (RT-qPCR).Results:Compared with before treatment, grip strength, ASMI, IGF-1, SIRT1 and AMPK-α mRNA in both groups were significantly increased after treatment, while GDF-8 was significantly decreased. The changes of above indexes in the observation group were more significant than those in the control group after treatment [grip strength (kg): 20.00 (15.50, 21.00) vs. 18.20 (14.93, 19.50), ASMI (kg/m 2): 5.80 (5.25, 6.00) vs. 5.30 (5.20, 5.50), IGF-1 (μg/L): 246.00 (229.00, 259.50) vs. 207.00 (187.00, 233.00), SIRT1 (ng/L): 649.2±38.3 vs. 624.6±38.6, AMPK-α mRNA (2 -ΔΔCt): 0.30±0.03 vs. 0.27±0.03, GDF-8 (μg/L): 13.50 (12.00, 17.80) vs. 15.60 (14.08, 19.98), all P < 0.05]. There was no significant difference in walking speed between the two groups before and after treatment [0.56 (0.53, 0.62) m/s and 0.58 (0.55, 0.62) m/s in the control group before and after treatment, 0.58 (0.54, 0.64) m/s and 0.60 (0.56, 0.65) m/s in the observation group before and after treatment, both P > 0.05]. Spearman correlation analysis showed that IGF-1 was positively correlated with SIRT1 ( r = 0.341, P = 0.002), IGF-1 was positively correlated with walking speed ( r = 0.250, P = 0.026), and ASMI was positively correlated with grip strength ( r = 0.367, P = 0.001). Conclusion:On the basis of conventional Western medicine, SLBZS has a remarkable effect on patients with sarcopenia of spleen-stomach weakness, which can provide a new idea of combining traditional Chinese and Western medicine for the treatment of sarcopenia.
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Objective:To explore the associations of urinary retinol binding protein (RBP) and β 2-microglobulin (β 2-MG) with urinary albumin to creatinine ratio (UACR) and renal function in hospitalized patients with type 2 diabetes mellitus (T2DM). Methods:A total of 1 030 Chinese patients with T2DM were included in this study. The subjects were divided into the UACR normal group (<30 mg/g), microalbuminuria group (30-300 mg/g) and macroalbuminuria group (>300 mg/g). Patients with normal UACR were further divided into two groups according to the estimated glomerular filtration rate (eGFR): the eGFR low group (<90 ml·min -1·1.73m -2) and the normal eGFR group (≥90 ml·min -1·1.73m -2). Urine RBP and β 2-MG levels among the groups were compared. Multiple linear regression analyses were applied to evaluate risk factors of urine RBP and β 2-MG. Results:In all patients ( n=1 030), urine RBP and β 2-MG increased gradually with the increase of UACR across the three groups, the proportions of abnormal urine RBP (>0.7 mg/L) and β 2-MG (>370 μg/L) in these groups were 3.8%, 8.5%, 39.0% ( P<0.001), and 12.9%, 26.7%, 46.8% ( P<0.001), respectively. In the UACR normal group ( n=788), 12.2% of the patients were with eGFR<90 ml·min -1·1.73m -2. The proportion of abnormal β 2-MG (>370 μg/L) was higher in the eGFR low group than that in the eGFR normal group (29.2% vs. 10.7%, P<0.001). Multivariate linear stepwise regression analyses were performed using natural logarithm of urine RBP or β 2-MG as dependent variable, and showed that urine RBP was independently associated with UACR ( β=0.0005, P<0.001), serum creatinine ( β=0.006, P<0.001) and glycosylated hemoglobin A1c ( β=0.050, P=0.001), and β 2-MG was independently correlated with UACR ( β=0.000 4, P<0.001), serum creatinine ( β=0.011, P<0.001), systolic blood pressure ( β=0.005, P=0.031) and fasting blood-glucose ( β=0.027, P=0.046). Conclusions:Urine RBP and β 2-MG are positively associated with high UACR and impaired renal function in T2DM patients, and these changes could occur before UACR and eGFR turned out to be abnormal. It is recommended that urine RBP and β 2-MG be detected as early as possible to identify diabetic kidney disease in patients with normal UACR and eGFR.
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Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) can speed up the regeneration of future liver remnant (FLR) in short period of time, and offer a chance for surgical resection for patients without sufficient FLR. However, ALPPS still remains controversy due to its high perioperative morbidity and mortality, as well as the uncertain long-term oncological benefits. How to solve these problems is the key to ensure the safety of surgery.This article focus on the indication selection, liver function reserve evaluation and timing to perform the second stage surgery, surgical mode evolution and comparison with portal venous embolization/portal venous ligation+two-stage hepatectomy.
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Humans , Embolization, Therapeutic , Hepatectomy/methods , Ligation , Liver/surgery , Liver Neoplasms/surgery , Liver Regeneration , Portal Vein/surgery , Treatment OutcomeABSTRACT
Objective@#To investigate the effects of micronutrient supplementation for the elderly on plasma homocysteine level and cognitive function in institutional older adults.@*Methods@#A total of 98 older adults with the score≤11 by mini nutritional assessment short-form aged 65-100 years were enrolled and assigned to either intervention group or control group (n=49 each), with either a package of micronutrient pack or placebo daily, for three months. Fasting blood samples were collected both at baseline and the end of study to detect serum vitamin B12, folate and plasma homocysteine (Hcy) concentrations. Global cognitive function was assessed using the mini-mental state examination (MMSE). The paired t test was used to compare the continuous variables between the two groups after intervention. The relationship between changes in MMSE score and changes in plasma Hcy concentrations was examined by least-squares linear regression.@*Results@#Eighty-two patients completed the study, and 17 patients withdrew from the study due to diarrhea and hospital discharge with the drop rate of 17.3%. Compared to the control group, concentrations of serum vitamin B12 (128.8±34.8 vs 13.3±16.0 pmol/L, P=0.003) and folate (21.1±1.6 vs 0.6±0.5 nmol/L, P<0.01) significantly increased in the intervention group over 3-month supplementation, while plasma Hcy levels were remarkably reduced (-5.3±0.7 vs 1.7±0.3 μmol/L, P<0.01). The incidences of deficiency of folate, deficiency of serum vitamin B12and high Hcy all decreased in intervention group. Although individual item scores in MMSE were not changed markedly, change of total MMSE score in intervention group were higher than that in the control group (1.2±3.0 vs -0.2±2.5, P<0.05).@*Conclusions@#The supplementation of the micronutrient pack in long-term care facilities can reduce the incidence of hyperhomocysteinemia, and improve the total MMSE score.
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Geriatric ability to live independently will be severely impaired when mild cognitive impairments(MCI)eventually develop into dementia.Patients with dementia usually suffer from micronutrients deficiencies(MNDs). In turn, MNDs may accelerate cognitive decline based on disruption of one carbon metabolism, DNA damage repair, mitochondrial function and glucose, lipid and phospholipids metabolism which lead to the damage of neurotransmitter synthesis, myelination and synaptogenesis.Clinical evidences show that the oral supplementation of B-group vitamins(vitamin B6 10-25 mg/d, vitamin B120.025-0.500 mg/d and folate 0.4-2.0 mg/d)and specific micronutrients compounds for at least 3 months may improve overall cognitive function and short-term memory ability of the elderly.More double-blind, placebo-controlled, randomized human intervention studies are still needed to evaluate effects of micronutrients supplementation on geriatric cognitive function and to determine the requirements, dosage and time of intervention.
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Geriatric ability to live independently will be severely impaired when mild cognitive impairments(MCI) eventually develop into dementia.Patients with dementia usually suffer from micronutrients deficiencies (MNDs).In turn,MNDs may accelerate cognitive decline based on disruption of one carbon metabolism,DNA damage repair,mitochondrial function and glucose,lipid and phospholipids metabolism which lead to the damage of neurotransmitter synthesis,myelination and synaptogenesis.Clinical evidences show that the oral supplementation of B-group vitamins(vitamin B6 10-25 mg/d,vitamin B12 0.025-0.500 mg/d and folate 0.4-2.0 mg/d) and specific micronutrients compounds for at least 3 months may improve overall cognitive function and short-term memory ability of the elderly.More double-blind,placebo-controlled,randomized human intervention studies are still needed to evaluate effects of micronutrients supplementation on geriatric cognitive function and to determine the requirements,dosage and time of intervention.
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Objective To investigate the effects of micronutrient supplementation for the elderly on plasma homocysteine level and cognitive function in institutional older adults. Methods A total of 98 older adults with the score≤11 by mini nutritional assessment short-form aged 65-100 years were enrolled and assigned to either intervention group or control group (n =49 each), with either a package of micronutrient pack or placebo daily, for three months. Fasting blood samples were collected both at baseline and the end of study to detect serum vitamin B12, folate and plasma homocysteine (Hcy) concentrations. Global cognitive function was assessed using the mini-mental state examination (MMSE). The paired t test was used to compare the continuous variables between the two groups after intervention. The relationship between changes in MMSE score and changes in plasma Hcy concentrations was examined by least-squares linear regression. Results Eighty-two patients completed the study, and 17 patients withdrew from the study due to diarrhea and hospital discharge with the drop rate of 17. 3％. Compared to the control group, concentrations of serum vitamin B12 (128. 8±34. 8 vs 13. 3±16. 0 pmol/ L, P =0. 003) and folate (21. 1±1. 6 vs 0. 6±0. 5 nmol/ L, P<0. 01) significantly increased (-5. 3±0. 7 vs 1. 7±0. 3 μmol/ L, P<0. 01). The incidences of deficiency of folate, deficiency of serum vitamin B12and high Hcy all decreased in intervention group. Although individual item scores in MMSE were not changed markedly, change of total MMSE score in intervention group were higher than that in the control group (1. 2±3. 0 vs -0. 2±2. 5, P<0. 05). Conclusions The supplementation of the micronutrient pack in longterm care facilities can reduce the incidence of hyperhomocysteinemia, and improve the total MMSE score.
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Objective To investigate the distribution of urinary iodine level and its relationship with thyroid function in Tibetan adults in Lhasa. Methods Tibetan residents living in Lhasa and its surrounding countryside were recruited by the method of multistage randomized cluster sampling. Their salt iodine, drinking water iodine, urinary iodine, and thyroid function levels were detected. According to the urinary iodine level, these subjects were divided into the iodine deficiency group ( urinary iodine<100μg/L) , the iodine enough group ( urine iodine 100-199μg/L) , the iodine adequate group ( urine iodine 200-299 μg/L ) and the iodine excessive group ( urine iodine≥300μg/L) . The differences in thyroid function among various groups were compared. Results A total of 2235 subjects were included in the study. The overall level of urinary iodine was in skewed distribution, with a median ( upper and lower quartiles) of 154 (99, 229) μg/L. The proportion of subjects with insufficient iodine intake was 25.7％, while those of the enough, adequate, and excessive groups were 41. 5％, 21. 3％, and 11. 5％, respectively. There was no significant difference in urine iodine level between males and females [152(95,219)μg/L vs 155(100,232)μg/L P>0.05]. The urinary iodine levels in residents of urban were higher than those in rural residents [157(101,232)μg/L vs 140(92,200)μg/L, P<0.05]. The urinary iodine levels in the young, middle-aged, and elderly groups were 175 ( 116,256) , 136 ( 91, 200) , and 116 ( 68, 164)μg/L respectively, showing a gradual decrease in urine iodine level with aging (P<0.05). The average salt iodine content of Tibetan adults in Lhasa was 23.16 mg/kg, and that in drinking water was 4.33μg/L. There were no significant differences in TSH levels among various iodine intake groups ( P>0.05) . The levels of thyroid peroxidase antibody ( TPOAb) and thyroglobulin antibody ( TGAb) were gradually decreased with the increase of urinary iodine level (P<0.05). Conclusion More than 50％ of Tibetans are at the status of low iodine and high iodine intakes in Lhasa. Although the salt iodine content meets national standards, the drinking water iodine content is lower than that standard.
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OBJECTIVE@#To study whether the pulsed electromagnetic fields (PEMF) promoting rat osteoblasts differentiation and maturation is related to the primary cilia and PI3K/AKT pathway, and to explore the mechanism of PEMF in promoting bone differentiation.@*METHODS@#Enzyme solution was used to obtain newborn SD rats calvarial osteoblasts (ROB), which were processed by 50 Hz 0.6 mT PEMF for 0, 0.5, 1, 1.5 and 2 h, detecting PI3K and AKT protein expression and changes in primary cilia length and incidence; with LY294002 blocking PI3K/AKT signaling pathways we observed whether PEMF promoted osteogenic differentiation of ROB was affected; by interfering IFT88 gene expression by RNAi to inhibit primary cilia we observed whether PI3K/AKT signaling pathway and osteogenic differentiation of ROB was affected. Osteogenic differentiation indexes included alkaline phosphatase (ALP) activity, Real-time PCR and Western blot detection of osteogenic related genes of BMP-2, COL-1 and OSX and calcified nodules number, etc..@*RESULTS@#After exposure to PEMF for 0, 0.5, 1, 1.5, and 2 h, the protein expression of PI3K and AKT in ROB were increased significantly (P<0.01) and the primary cilia became longer; and the protein expression of PI3K reached the highest level at 0.5 h, as the treatment time of PEMF increased, the PI3K protein expression decreased. AKT showed higher protein expression at 0.5 h and 1.5 h. After blocking the PI3K/AKT signaling pathway with the PI3K blocker LY294002, PEMF could no longer increase ALP activity and the gene expressions of BMP-2, COL-1, OSX which were osteogenically related. However, PEMF could increase the ALP activity and the osteogenically related gene expression in ROB before blocking. After RNAi interfered the primary cilia, PEMF could no longer increase the protein expression of PI3K, which indicated that PEMF could not activate the PI3K/AKT signaling pathway after primary cilia interfering; secondly, the effect of PEMF on enhancing ALP activity disappeared, it also decrease the gene expressions of BMP-2, COL-1, and OSX, and the ability of increasing the calcification nodule formation also disappeared, indicating that the ability of PEMF to promote osteoblast maturation and mineralization disappeared after primary cilia interference.@*CONCLUSION@#PEMF activated the PI3K/AKT signaling pathway through primary cilia on the surface of osteoblasts, then promoted bone formation activity and differentiation.
Subject(s)
Animals , Rats , Cell Differentiation , Cells, Cultured , Cilia , Electromagnetic Fields , Osteoblasts , Osteogenesis , Phosphatidylinositol 3-Kinases , Proto-Oncogene Proteins c-akt , Rats, Sprague-Dawley , Signal TransductionABSTRACT
Objective To explore the risk factors of intravesical recurrence (IVR) of upper-tract urothelial carcinoma (UTUC) after surgery. Methods The medical records of 445 patients with complete follow-up data and undergoing UTUC surgery in our hospital from Jan. 2008 to Dec. 2017 were collected in this study. The baseline demographics, surgical methods, postoperative pathology, follow-up data and other related information were analyzed. Risk factors of the IVR were analyzed by univariate and multivariate Cox regression models. Results The median follow-up time was 33.5 months, and the IVR rate was 18.0% (80/445), of which 66.2% (53/80) occurred within one year after surgery. Univariate Cox analysis revealed that aged. ≥65 years old (odds ratio [OR]=1.99, 95% confidence interval [CI] 1.22-3.22, P<0.01), with history of bladder cancer (OR)= 2.69, 95% CI 1.71-4.24, P<0.01), receiving nephron-sparing surgery (OR)= 2.15, 95% CI 1.30-3.57, P<0.01), and cancer occurring in the lower segment of ureter (OR)= 1.40, 95% CI 1.11-1.78, P<0.01) were significantly related to IVR of UTUC after surgery. These risk factors were also independent risk factors of IVR of UTUC after surgery in the multivariate Cox regression model. Conclusion≥Aged.65 years old, bladder cancer history, receiving nephron-sparing surgery and cancer occuring in lower segment of ureter are the independent risk factors of IVR of UTUC after surgery. The UTUC patients with these risk factors should be suggested to receive careful surveillance and regular cystoscopy examination.
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Objective To label granulocytes in a state of differentiation in mouse bone marrow (BM) with EdU (5-ethynyl-2′-deoxyuridine) for further understanding the changes in granulocyte produc-tion at different stages of differentiation during inflammation. Methods C57BL/6 mice were intraperitoneal-ly (i.p.) injected with EdU and heat-inactivated Escherichia coli(HI E.coli). BM cells were harvested at different time points after HI E.coli injection and then stained with fluorescent-conjugated antibodies(Abs). Myeloblasts,promyelocytes,myelocytes, metamyelocytes and band and segmented neutrophils were identi-fied by fluorescence-activated cell sorting(FACS). The percentage of EdU-positive cells in each population was recorded. Results The percentage of EdU-positive myeloblasts in mice increased by 10.0% at 24 h af-ter intraperitoneal injection with HI E.coli,but decreased by 75.0% and 23.0% at 48 h and 72 h,respec-tively. The percentage of EdU-positive promyelocytes declined by 23.0%,54.5%,64.3% and 77.8% at 24 h,48 h,72 h and 96 h,respectively. The percentage of EdU-positive myelocytes increased by 60.0% and 10.0% at 24 h and 48 h,but decreased by 80.0% and 90.0% at 72 h and 96 h. The percentage of EdU-positive metamyelocytes increased by 50.0% at 24 h,but decreased by 33.3%,61.5% and 66.7% at 48 h,72 h and 96 h. The percentage of EdU-positive band and segmented cells increased by 14.0% at 24 h,but decreased by 50.0%, 77.8% and 88.0% at 48 h, 72 h and 96 h. Conclusion Emergency granulopoiesis occurred 24 h after the establishment of HI E.coli-induced model of acute peritonitis, which meant that the proliferation of myeloid precursor cells,especially that of myelocytes and metamyelocytes,was accelerated and resulted in increasing number of mature neutrophils immigrating to sites of inflammation.
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Objective To observe the clinical therapeutic effect of Yiqiwenyang Huoxuelishui [a traditional Chinese medicine (TCM) prescription] on patients with cardiorenal syndrome (CRS) and its influence on gut flora. Methods Sixty-nine patients with definite diagnosis of CRS accompanied by heart-kidney yang deficiency admitted to Department of Geriatrics of the Third People's Hospital of Hangzhou from January 2015 to December 2016 were enrolled, and the patients were divided into two groups according to whether they received traditional Chinese medicine (TCM) or not. The control group (33 cases) was treated with only western medicine; the combination group (32 cases) was treated with conventional western medicine in addition of 100 mL of Yiqiwenyang Huoxuelishui decoction oral administration, twice a day, and the therapeutic course of both groups was 8 weeks. Before and after treatment, the level changes of left ventricular ejection fraction (LVEF), plasma N-terminal pro-brain natriuretic peptide (NT-proBNP), carbohydrate antigen-125 (CA-125), growth differentiation factor-15 (GDF-15), growth differentiation factor-11 (GDF-11), blood creatinine (SCr), blood urea nitrogen (BUN), gut flora changes and the incidence of adverse reactions were observed in the two groups; after treatment, the clinical therapeutic effect of the two groups were compared. Results After treatment, the levels of LVEF and bifidobacteria, lactobacilli in intestinal tract of the two groups were significantly higher than those before treatment; while the levels of NT-proBNP, DGF-15, GDF-11, CA-125, SCr, BUN and enterococcus and enterobacter in the two groups were significantly lower than those before treatment, and the changes of the above indicators in combination group were more obvious than those in the control group [LVEF: 0.51±0.10 vs. 0.46±0.08, NT-proBNP (ng/L): 658±45 vs. 814±57, GDF-15 (ng/L): 604±32 vs. 708±36, CA-125 (U/L): 4.50±0.33 vs. 5.10±0.37, GDF-11 (ng/L): 491±19 vs. 594±23, SCr (μmol/L): 105±11 vs. 125±13, BUN (mmol/L): 8.1±3.5 vs. 9.7±4.2, bifidobacteria (cfu/g): 8.23±0.46 vs. 7.54±0.33, lactobacilli (cfu/g): 7.96±0.31 vs. 7.09±0.23, enterococcus (cfu/g): 6.32±0.19 vs. 7.15±0.28, enterobacter (cfu/g): 6.13±0.33 vs. 7.18±0.37, all P < 0.05]. In the combination group, there were 2 cases with mild abdominal distension and nausea at the initial stage, and 1 case with mild diarrhea, and because the manifestations were so mild, it was not necessary to stop the treatment. No hypotension occurred in both groups, and no liver or kidney function damage was observed. The rate of total therapeutic effect in the combination group was higher than that of the control group [87.5% (28/32) vs. 60.6% (20/33), P < 0.05]. Conclusion Yiqiwenyang Huoxuelishui prescription for treatment of patients with CRS accompanied by heart-kidney yang deficiency was safe and effective, it can elevate the clinical therapeutic effect, quality of life and improve the gut flora.
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Due to pathophysiological changes, the risk of micronutrient deficiency in geriatric increased. Currently, dietary intake of vitamin A, vitamin B1, vitamin B2, vitamin B12, vitamin C, vitamin E, folic acid, calcium, magnesium, zinc and selenium was still lower than the recommended dietary reference intake in the elderly. Geriatric micronutrient deficiencies may contribute to the decrease of physiological function, immune function and cognitive function. It may also result in frailty and increase the risk of adverse clinical outcomes. The appropriate supplementation of single or multiple micronutrients can improve physiological function, cogni-tive function, immune function and frailty, meantime, reduce the risk of cardiovascular disease and infection. Given there are still no generally accepted standards on the time and method of intervention, population-based randomized controlled studies are needed to provide the basis for promoting healthy ageing.
ABSTRACT
Objective To explore pathogenic bacteria distribution and drug susceptibility testing results in children with purulent meningitis in Jinan area. Methods A total of 54 children with purulent meningitis were selected from January 2010 to December 2014, the cerebrospinal fluid smear and culture, according to the national standard of clinical inspection technology for bacteria isolation and identification by disc diffusion method for drug sensitive test were retrospectively analyzed. Results A total of 54 strains of pathogenic bacteria including 36 strains of gram-positive coccus, and 17 strains of gram-negative bacillus and one strain of suspected Neisseria meningitides were found. A total of 31 strains gram positive coccus is Streptococcus pneumoniae, and most gram-negative bacilli is E. coli. In the Gram-positive coccus, 61.3% was sensitive to penicillin, and more than 90% was sensitive to ceftriaxone and cefepime, 83.3% was sensitive to meropenem, 94.7% resistant to azithromycin, and 58.1% resistant to oxazocilline. In Gram-negative bacilli, 60% was sensitive to ampicillin sulbactam 71.4% was sensitive to cephalosporin , 57.1% was sensitive to ceftriaxone , 66.6% was sensitive to cefepime. Conclusions From cerebrospinal fluid cultured of purulent meningitis, Streptococcus pneumoniae and E. coli were major pathogenic bacteria in children with purulent meningitis in Jinan area.