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Objective: To investigate the short-term efficacy of anti-IgE monoclonal antibody (Omalizumab) in the treatment of recurrent chronic rhinosinusitis with nasal polyps (CRSwNP) complicated with asthma. Methods: Patients with recurrent CRSwNP and comorbid asthma in Beijing TongRen Hospital from May to December of 2020 were continuously recruited and received a 4-month therapy of stable background treatment plus Omalizumab. Results of visual analog scales (VAS) of nasal symptoms, sino-nasal outcome test-22 (SNOT 22) and nasal polyp scores were collected at baseline and post-treatment (1, 2, 3 and 4 months after treatment). Blood routine tests, total nasal resistances (TNR), minimum cross-sectional areas (MCA), total nasal cavity volumes (NCV), forced expiratory volumes in one second (FEV1)/forced vital capacity (FVC) and adverse events were collected at baseline and 4 months after treatment. All results were evaluated for short-term efficacy of Omalizumab. GraphPad Prism 8.2.1 was used for statistic analysis. Results: Ten patients were collected, including 3 males and 7 females, aged (41.13±12.64) years old (x¯±s). Compared to results at baseline, the VAS scores of nasal obstruction, rhinorrhea, hyposmia and headache after 4 months treatment were significantly decreased (1.80±1.48 vs 6.70±2.83, 2.40±1.27 vs 6.40±3.44, 2.70±2.91 vs 8.20±2.25, 0.60±1.08 vs 3.60±2.72, t value was 5.045, 4.243, 5.312, 3.402, respectively, all P<0.01). The scores of SNOT-22 (25.6±20 vs 61.3±33.32, t=4.127, P=0.002 6), nasal polyp scores (2.20±0.92 vs 4.60±0.84, t=9.000, P<0.01) and the count and percentage of eosinophils in peripheral blood were significantly decreased ((94.10±97.78)×109/L vs (360.00±210.80)×109/L, (32.90±27.06)% vs (64.40±20.73)%, t value was 3.678, 2.957, respectively, all P<0.05). NCV (0-5 cm and 0-7 cm) of patients were improved from baseline ((12.62±2.84) cm3 vs (10.40±2.09) cm3, (27.50±14.15) cm3 vs (16.81±6.40) cm3, t value was 2.371, 2.445, respectively, all P<0.05). Conclusions: The 4-month treatment of Omalizumab can significantly improve the nasal symptoms and quality of life of patients with recurrent CRSwNP complicated with asthma, shrink nasal polyps size and reduce the number of peripheral blood eosinophils. Omalizumab can be used as an alternative therapy for refractory CRSwNP patients in the future.
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Adult , Female , Humans , Male , Middle Aged , Antibodies, Anti-Idiotypic , Asthma/drug therapy , Chronic Disease , Nasal Polyps/drug therapy , Omalizumab/therapeutic use , Quality of Life , Rhinitis/drug therapyABSTRACT
@# Objective ToinvestigatetherelationshipbetweenplasmalipoproteinassociatedphospholipaseA2(LpPLA2)levelandin-stentrestenosis(ISR)afterpercutaneouscoronaryintervention(PCI).Methods Atotalof208patients treatedwithPCIandexaminedwithafollow-upcoronaryangiograph(CAG)wereincludedinthisstudy.Thepatientswere dividedinto2groupsbasedontheresultsofISRcondition:ISRgroup(n=29)andNISRgroup(n=179).Theplasmalevelsof Lp-PLA2weredetectedbeforefirst-PCIoperationandfollow-upCAGintwogroups.Thegeneralclinicaldata,biochemical parameters,coronarycoronariography,interventionalfeaturesandplasmalevelsofLp-PLA2werecomparedbetweenthetwo groups.LogisticregressionanalysiswasusedtoanalyzetheindependentriskfactorforISR.Receiveroperatingcharacteristic curvewasusedtoevaluatethepredictiveabilityoftheplasmalevelofLp-PLA2totheoccurrenceofISR.Results (1)In ISRgroup,patientswiththehistoryoftype2diabetes,levelsoflowdensitylipoproteincholesterol(LDL-C)andlevelsof glycosylatedhemoglobin(HbA1c)weresignificantlyhigherthanthoseinNISRgroup,whileserumlevelsoftotalbilirubin(TBIL)decreased,thelengthofthestentwaslonger,andstentdiameterwassmaller(P＜0.05).(2)InISRgroup,theLp-PLA2 level and ΔLp-PLA2 level were higher before first-PCI operation than those in NISR group (P＜0.05). (3) Logistic regressionanalysisshowedthatT-BIL,stentdiameterandΔLp-PLA2weretheindependentriskfactorsforISR(P＜0.05). (4)Thereceiveroperatingcharacteristiccurve(ROC)areaofΔLp-PLA2forpredictingpost-PCIISRoccurrencewas0.862, theoptimalcutoffvalueofΔLp-PLA2was20.68μg/L,thesensitivitywas79%,andthespecificitywas83%.Conclusion TheincreasedlevelofLp-PLA2afterPCIiscorrelatedwithISR,andtheregularmonitoringthelevelofLp-PLA2hassome significanceinforecastingISR.
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Objective To investigate the primary application of 3D printing technique in vascularized fibula resection and grafting for mandible ameloblastoma. Methods The data of 3 cases of unilateral mandibular ameloblastoma were retrospectively collected.The thin slice CT scan of mandible was performed before operation.The scanned original data were imported into mimics 17.0 software for 3D reconstruction.Mirror image of the healthy side mandible was generated by the mirror image tool of the software.Preoperative planning,designing transplantation of vascularized fibula bone,pre-bending and pre-shaping titanium plate,surgical simulation were done by the mirror model.Results All operations were performed successfully,and were in agreement with the preoperative planning.The facial appearance and mandible function were both satisfactory.Conclusion 3D printing technology assisting mandibular ameloblastoma resection and bone graft reconstruction is able to optimize preoperative planning,provide individualized treatment and achieve postoperative satisfaction.
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BACKGROUND: Posterior pedicle screw fixation of lower cervical spine has many advantages. However, because of the special anatomy of pedicle, the technical requirements of nailing placement are high and it is also a challenge to surgeons. The application of three-dimensional (3D) printing technology can help to complete screw placement, and has certain advantages. OBJECTIVE: To introduce the method of 3D printing personalized navigation template assisted posterior lower cervical pedicle screw fixation and evaluate its clinical application value. METHODS: Totally 20 patients with lower cervical spine pedicle screw internal fixation who were treated from June 2015 to December 2016 in Affiliated Hospital of Yan'an University were retrospectively analyzed. Before the surgery, the patient's lower cervical spine CT data was introduced into the relevant software and the 3D printing personalized navigation template assisted nailing pedicle screw was designed. The number of screws inserted was recorded. After the operation, CT scan was used to calculate the accuracy rate of screw placement. Preoperative and postoperative cervical spine Visual Analogue Scale score and spinal function score of Japanese Orthopedic Association were used to evaluate the clinical effect of cervical nerve. RESULTS AND CONCLUSION: (1) All patients were followed up for 3 months postoperatively. (2) 3D printing personalized navigation template assisted 132 pedicle screws. The precise insertion rate was 94.7%. Among them, 125 screws were at grade 0 (94.7%, 125/132), 3 screws grade 1 (2.3%, 3/132), 4 screws grade 2 (3.0%, 4/132), no screw grade 3. (3) At postoperative 1 and 3 months, the neck shoulder Visual Analogue Scale score and spinal function score of Japanese Orthopedic Association of the patients were significantly improved (P < 0.05), but there was no significant difference (P > 0.05), compared with those at preoperative. (4) In summary, 3D printing personalized navigation template assisted cervical pedicle screw placement had the high insertion rate and satisfactory clinical efficacy.
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ABC efflux proteins are a kind of transporters mediating diversified endogenous and exogenous efflux protein substrates across the plasma membrane by depending on the chemical energy released by ATP hydrolysis. As a vitally important functional membrane, it is widely found in various tissues and organs. The drug changes the expressions and/or functions of the transport proteins, which will affect the disposal process of substrate drugs corresponding to transporters , and finally lead to the pharmacokinetic interactions. The efflux proteins take part in the absorption, distribution, metabolism and excretion of drugs, and mainly consist of P-glycoprotein(P-gp), multidrug resistance associated protein(MRP) and breast cancer resistance protein(BCRP). The induction effect or inhibition effect of drugs on efflux protein plays a greatly significant role in the drug interaction produced by the compatibility of traditional Chinese medicine, which may be one of the important mechanisms of the theory of seven features of compatibility. In this article, the effects of seven features of compatibility on the ABC efflux transporters were reviewed, in order to reveal the roles of efflux protein in the herb-pairs compatibility, and provide new ideas for the mechanism and rationality of herb compatibility.
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Humans , ATP-Binding Cassette Transporters , Metabolism , Drug Interactions , Medicine, Chinese Traditional , Multidrug Resistance-Associated Proteins , Metabolism , Plant Preparations , PharmacologyABSTRACT
BACKGROUND: Thoracolumbar fracture is commonly seen in spinal injuries, which causes loss of stability of the spine, as well as spinal cord and nerve compression, even deformity and paralysis. The diagnosis and treatment of thoracolumbar fracture remain controversial.OBJECTIVE: To summarize the mechanism of thoracolumbar fracture based on finite element method, its classification and transpedicular screw fixation.METHODS: The first author retrieved CNKI and PubMed databases for the relevant literature published between January 2000 and December 2016. The keywords were "finite element method, thoracolumbar spine fracture,transpedicular screw fixation" in Chinese and English, respectively.RESULTS AND CONCLUSION: (1) The finite element analysis method can simulate the mechanism of thoracolumbar fracture and provides a reference for the studies on the occurrence, development and treatment of thoracolumbar fracture. (2) The classification of thoracolumbar fracture is beneficial for planning a rational treatment strategy and evaluating prognosis. (3) Compared with the traditional screw fixation, the transpedicular screw fixation holds advantages in biomechanical stability and postoperative correction effect. (4) There are various classifications for thoracolumbar fracture; differences in severity and cartilage injury are difficult to simulate completely. (5) The finite element analysis method shows certain application limitations due to long learning curve and modeling time as well as complicated calculations.
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BACKGROUND: The lower cervical pedicle screw fixation is the most stable internal fixation of the cervical spine in biomechanics, which can penetrate the anterior, middle and posterior columns of the spine, effectively restore the sagittal sequence of the cervical spine, provide strong internal fixation and high fusion rate. OBJECTIVE: To review the relevant information of the anatomical structure of lower cervical pedicle, the biomechanical property of screw fixation, and three-dimensional printing technology-assisted screw placement at home and abroad. METHODS: PubMed and CNKI databases were searched for the articles concerning lower cervical pedicle screw fixation from January 1990 to January 2017. The key words were "lower cervical, pedicle screw, 3D printing technology" in Chinese and English, respectively. Totally 193 articles were researched, and the repetitive research, case report and meta-analysis were excluded. RESULTS AND CONCLUSION: (1) Finally 52 eligible articles were enrolled for result analysis. (2) Although it has a very high risk to fix lower cervical pedicle screw, the risk could be minimized or avoided through fully individualized evaluation preoperatively and precise fixation intraoperatively. So the lower cervical pedicle screw fixation has high clinical value.
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As the essential characteristics of malignant cancer,invasion and metastasis are the main reason for failure treatment and high death rate of cancer patients.It is necessary to find out safe and effective anti-invasion and anti-metastasis drugs for the improvement of clinical efficacy.With the definite therapeutic effect and mild side-effects,Chinese materia medica(CMM) including curcumin,peiminine,β-elemi and so on,have become hotspots in anti-invasion and anti-metastasis drugs research.The mechanisms for the effective ingredients of CMM anti-tumor invasion and metastasis were reviewed in this paper.
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AIM:To investigate the effects of luteolin on invasion,migration and adhesion of human hepatocelluar carcinoma HepG2 cells.METHODS:HepG2 cells were cultured and treated with luteolin at 10,20 and 40 μmol/L respectively.The invasion capability was examined by cell invasion assay.The migration ability was examined by wound healing assay.The adhesion capability was measured by adhesion assay.The protein levels of E-cadherin,N-cadherin,vimentin and Snai1 were determined by Western blot analysis.RESULTS:Luteolin inhibited the invasion,migration and adhesion ability of HepG2 cells in vitro in a dose-dependent manner.After treatment with luteolin,the expression of E-cadherin was increased significantly and the expression of N-cadherin,vimentin and Snai1 were decreased significantly.CONCLUSION:Luteolin inhibits the invasion,migration and adhesion ability of human hepatocelluar carcinoma HepG2 cells.The mechanism may be related to the regulatory effects of luteolin on epithelial-mesenchymal transition.
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As the essential characteristics of malignant cancer,invasion and metastasis are the main reason for failure treatment and high death rate of cancer patients.It is necessary to find out safe and effective anti-invasion and anti-metastasis drugs for the improvement of clinical efficacy.With the definite therapeutic effect and mild side-effects,Chinese materia medica(CMM) including curcumin,peiminine,β-elemi and so on,have become hotspots in anti-invasion and anti-metastasis drugs research.The mechanisms for the effective ingredients of CMM anti-tumor invasion and metastasis were reviewed in this paper.
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AIM:To investigate the effects of luteolin on invasion,migration and adhesion of human hepatocelluar carcinoma HepG2 cells.METHODS:HepG2 cells were cultured and treated with luteolin at 10,20 and 40 μmol/L respectively.The invasion capability was examined by cell invasion assay.The migration ability was examined by wound healing assay.The adhesion capability was measured by adhesion assay.The protein levels of E-cadherin,N-cadherin,vimentin and Snai1 were determined by Western blot analysis.RESULTS:Luteolin inhibited the invasion,migration and adhesion ability of HepG2 cells in vitro in a dose-dependent manner.After treatment with luteolin,the expression of E-cadherin was increased significantly and the expression of N-cadherin,vimentin and Snai1 were decreased significantly.CONCLUSION:Luteolin inhibits the invasion,migration and adhesion ability of human hepatocelluar carcinoma HepG2 cells.The mechanism may be related to the regulatory effects of luteolin on epithelial-mesenchymal transition.
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AIM: To investigate the effects of oridonin on the invasion and migration of hepatocelluar carcinoma cells.METHODS: Human hepatocelluar carcinoma MHCC-97H cells were cultured and treated with 5, 10 or 20 μmol/L oridonin.The migration ability was measured by wound healing assay.The invasion ability was examined by Transwell invasion assay.The adhesion capabilities were evaluated by adhesion assay.The protein levels of LIM kinase-1 (LIMK-1), cofilin and phosphorylated cofilin (p-cofilin) were determined by Western blot.RESULTS: Oridonin inhibited the migration, invasion and adhesion abilities of MHCC-97H cells in a dose-dependent manner (P<0.05).After oridonin treatment, the expression of cofilin had no obvious change, but the protein levels of LIMK-1 and p-cofilin decreased significantly.CONCLUSION: Oridonin inhibits the invasion and migration of MHCC-97H cells.The mechanism may be related with the regulatory effect of oridonin on LIMK-1/cofilin signal transduction pathway.
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Chinese materia medica (CMM) in combination with chemical drug is an effective treatment for diseases. CMM sustain moderate effect, including multiple components, multiple targets, multiple pathways and integrated regulation characteristics; While the effect of chemical drug is rapid and shows definite target and single way, the combination of the two can be complementary advantages, synergistic effects and reduce toxicity. P-glycoprotein (P-gp) is a kind of energy dependent transmembrane transport protein; Its mediated efflux effect is one of important targets for drug delivery. The induction or inhibition of P-gp plays a significant factor in the interaction generated when CMM and chemical drug combined application. In this paper, interaction of CMM combined with chemical drug in P-gp level was briefly reviewed, in order to reveal the role of P-gp in joint use Chinese and Western medicine, and to provide reference for the rational use of drugs to integration of Chinese and Western medicine in clinic.
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Objective To observe the early clinical effect of single kidney transplantation from cardiac death pediatric donors to adult recipients. Methods Clinical data of 6 single kidney transplantations from cardiac death pediatric donors in adult recipients in Department of Organ Transplantation ,Guangdong Province No.2 People′s hospital were retrospectively analyzed. the transplant operations were carried out between January 2010 to may 2016.The median age of 6 pediatric donors was 9 years (5 years to 15 years). All recipients had the same blood type. The median age of 12 recipients was 38 years (21 years to 65 years),with 4 man and 8 women. All recipients received kidney transplantation for the first time,and overall reactive antibodies(PRA) were negative,with HLA mismatch between 1to 4. All recipients received single kidney transplantation in right fossa iliaca. Results 12 kidney transplantations were successful. The renal allografts recovered successfully without acute renal rejection , delayed graft function or primary nonfunction. Renal function of 5 of recipients immediately recovered in 5 days,5 recovered in 10 days,and 2 recovered slowly. 1 recipient manifested urine leak and recovered after drainage. 1 case developed delayed incision healing and recovered after dressing at stage II. All patients and renal grafts functions were wellnormal during follow?up period between 1 month to 36 months. Conclusion The early clinical effect of single kidney transplantation from cardiac death pediatric donors to adult recipients is good and could be a promising pathway to expand the organ donor sources.
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<p><b>OBJECTIVE</b>To assess the antinociceptive and anti-inflammatory properties of the aqueous extract of Armadillidium vulgare (AV).</p><p><b>METHODS</b>The antinociceptive effect of AV (400, 600 and 800 mg/kg) was investigated in mice using the acetic acid-induced writhing, formalin-induced nociceptive, and hot plate tests. Phlogogen-induced paw edema using carrageenan, dextran, or compound 48/80 as phlogogen was used as inflammatory models to evaluate AV's anti-inflammatory effect. Additionally, the bioactive substances glucosamine (GLcN) and taurine in AV were determined using high-performance liquid chromatography.</p><p><b>RESULTS</b>Oral treatment of the mice with AV (600 and 800 mg/kg) significantly reduced the number of writhes in the acetic acid-induced writhing test (P<0.01) but not the hot plate test (P>0.05). All doses tested significantly inhibited paw-withdrawal during the second phase of the formalin-induced nociceptive model (P<0.01). AV demonstrated a strong anti-inflammatory effect in all those inflammatory models (P<0.05).</p><p><b>CONCLUSIONS</b>AV has antinociceptive and anti-inflammatory effects, providing scientific evidence of the efficacy of its traditional use in pain treatment. Furthermore, GLcN and taurine contribute, at least in part, to the anti-inflammatory activity of AV.</p>
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Animals , Female , Male , Mice , Analgesics , Pharmacology , Anti-Inflammatory Agents , Pharmacology , Edema , Drug Therapy , Inflammation , Drug Therapy , Isopoda , Chemistry , Pain , Drug Therapy , Pain Measurement , Phytotherapy , Plant Extracts , Chemistry , Pharmacology , Water , ChemistryABSTRACT
Objective To investigate the dynamic changes of regulatory T cells (Treg ) and the surface expression of programmed death (PD)‐1 and the level of transforming growth factor (TGF )‐βduring antiviral treatment in patients with chronic hepatitis C (CHC) .Methods Eighty‐six CHC patients referred to the First Affiliated Hospital of Zhengzhou University from October 2012 to October 2013 were included ,and all of them were administered with pegylated interferon α‐2a and ribavirin .Thirty healthy controls were enrolled .The percentage of Treg cells ,PD‐1 expression and TGF‐β level were analyzed by flow cytometry at baseline and at time of achieving rapid virological response (RVR ) , early viral virological (EVR ) , end‐of‐treatment virological response (ETVR ) and sustained virological response (SVR) ,or not achieving SVR .Comparison between two groups was analyzed by t test .Results Among 86 CHC patients ,the proportions of RVR ,EVR ,ETVR ,and SVR at week 24 of follow‐up were 29 cases ,67 cases ,79 cases and 67 cases ,respectively .Percentage of Treg cells in CHC patients was much higher than that in healthy controls (10 .31 ± 5 .61 vs 2 .18 ± 0 .65 ,t = 2 .28 , P< 0 .05) .During antiviral therapy ,percentages of Treg cells declined ,not only in CHC patients with HCV genotype 1b (at baseline , RVR ,EVR ,and ETVR :14 .44 ± 3 .78 ,11 .01 ± 1 .79 ,8 .24 ± 2 .98 ,and 5 .36 ± 1 .47 ,respectively ) ,but also in those infected with HCV genotype 2a (at baseline ,RVR ,EVR ,and ETVR :12 .34 ± 2 .82 ,8 .99 ± 1 .68 ,7 .53 ± 2 .96 ,and 4 .79 ± 1 .23 ,respectively ) .Expressions of PD‐1 and TGF‐β also decreased .At baseline ,the expressions of PD‐1 in patients with SVR and without SVR were 29 .11 ± 14 .65 and 37 .73 ± 11 .65 ,respectively (t = 2 .15 , P = 0 .04) ,and the levels of TGF‐β were 41 .20 ± 18 .96 and 56 .75 ± 14 .42 ,respectively (t= 2 .66 ,P< 0 .01) .At week 24 ,the expressions of PD‐1 in patients with SVR and without SVR were 10 .36 ± 4 .81 and 36 .46 ± 10 .52 ,respectively (t= 13 .95 ,P< 0 .01) ,and the levels of TGF‐β were 10 .06 ± 4 .64 and 45 .23 ± 17 .85 , respectively ( t = 11 .85 , P < 0 .01 ) . Conclusions Percentages of Treg cells and expressions of PD‐1 and TGF‐β decrease during antiviral treatment in CHC patients .Thus ,it could be of assist to predict the treatment response by monitoring these parameters .
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Objective To investigate the prevalence of depression in maintenance hemodialysis (MHD) patients. Additionally,to explore the relationship between depression and microinflammation,serum zinc levels and malnutrition in MHI) patients.Methods One hundred fifty-seven MHD patients were enrolled in this study.The patients were divided into two groups:depressed patients and non-depressed patients,according to the Beck Depression Inventory.The following data were collected:social factors,biochemical index,serum zinc levels,malnutrition-inflammation (MIS) score and IPI score.Binary logistic regression analysis was performed.Results Symptoms of depression were exhibited by 45.2％ of MHD patients (71/157 ).Symptoms of moderate or severe depression were exhibited by 24.2 ％ of the patients ( 38/157 ).However,signicant differences were shown in age [( 62 ± 11 ) vs.( 50 ± 13 ) years old],MIS score [( 7.2 ± 2.2 ) vs.( 3.3 ± 1.6 ) scores],white blood cell count [( 6.4 ± 1.8 ) × 109/L vs.( 5.8 ±1.5) × 109/L],high sensitivity C-reactive protein (hsCRP) [(9 ±6) vs.(4 ±4) mg/L],hemoglobin [(10.7±1.5) vs.(11.3±1.5) g/L],albumin[(33±4) vs.(37 ±3) g/L],fasting glucose [(6.7±3.5) vs.(5.6±2.1) mmol/L],serum zinc [(8.5±2.6) vs.(10.1 ±2.9) μmol/L] between depressed patients and non-depressed patients ( All P ＜ 0.05 ). Binary logistic regressive analysis revealed that the independent risk factors of depression in MHD patients were their MIS score ( OR =2.908,95％ CI =2.037 -4.151 ),as well as their hsCRP( OR =1.217,95％ CI=1.075 - 1.370),serum zinc and fasting glucose levels(OR=1.315,95％CI=1.039 - 1.664).Conclusions There was a high prevalence of depression in MHD patients.Depression is also highly correlated with microinflammation,serum zinc levels,and malnutrition.MIS scores,hsCRP,serum zinc levels and fasting glucose levels.
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Objective To investigate prevalence of metabolic syndrome (MS) and its related factors in patients with maintaining hemodialysis (MHD). Methods A total of 162 cases on MHD in Beijing Chaoyang Hospital during June to December 2010, were enrolled in this study and divided into MS group and non-MS group according to the diagnostic criteria for MS set by the International Diabetes Federation. Anthropometric and blood biochemical characteristics of the two groups were compared with t-test and x2 test Risk factors for MS were explored with binary logistic regression analysis. Results Prevalence of MS was 40. 7% (66/162) . There was significant difference found in body mass index [(24. 2 ±3. 1) vs. (21. 6 ±2. 7) kg/m2], waistline circumference[(93 ±8) vs. (79 ±7)cm] , white blood cell count [(6. 8 ± 1. 5) × 109/L vs. (5. 6 ± 1. 4) × 109/L] , hypersensitive serum C-reactive protein [(7 ± 5)vs. (4 ±3) mg/L], high-density lipoprotein-cholesterol [(0. 99 ±0. 26)vs. (1.39 ±0.39) mmol/L], low-density lipoprotein-cholesterol [(2. 5 ± 0. 8) vs. ( 2. 1 ± 0. 7) mmol/L], triglyceride ( TG) [( 2. 1 ±1.1 )vs. (1.3±0.8) mmol/L], fasting blood glucose [(5.9±2. 7)vs. (4.8±1.3) mmol/L], serum level of iron [(16±7)vs. (13 ±5) μmol/L], uric acid [(429±114) vs. (388±88) (μmol/L], and carbon dioxide combining power (CO2CP) [(22 ±4)vs. (23 ±4) mmol/L]between MS group and non-MS group (All P 0.05). Binary logistic regressive analysis revealed that serum level of iron (OR = 1.058,95% CI = 1.001 -1. 119), white blood cell count ( OR = 1. 786,95% CI = 1. 346 - 2.371) and hypersensitive serum C-reactive protein (OR = 1. 101,95% CI = 1.010 - 1.201 ) were independent risk factors for MS in MHD patients. Conclusions Morbidity of MS is high in patients with MHD, involved with inflammation process. Serum level of iron, white blood cell count and hypersensitive serum C-reactive protein are independent risk factors for MS in patients with MHD and no inevitable connection between MS and nutritional status in them is found.
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ObjectiveTo explore the prevalence and influencing factors of restless legs syndrome (RLS) in elderly maintenance hemodialysis (MHD) patients, to analyze the relationship between RLS and sleep quality, and to observe the efficacy and safety of hemoperfusion in improving RLS and sleep quality in elderly MHD patients with RLS. MethodsA total of 118 cases with maintenance bemodialysis were involved in this study. The RLS was diagnosed according to the criteria of the International Restless Legs Syndrome Study Group (IRLSSG). The subjects' quality of sleep was assessed by the Pittsburgh Sleep Quality Index (PSQI). The elderly MHD patients with RLS received hemoperfusion once a week for 3 months. The clinical and biochemical indexes were collected including age, gender, duration of hemodialysis, pre-dialysis blood concentrations of creatinine, hemoglobin, parathyroid hormone, β2-microglobulin, etc. T test, X2 test and binary logistic regression analysis were performed. ResultsRLS prevalence was found in 26.27% (11 men, 20 women, the ratio was 0. 55 : 1) of 118 elderly MHD patients. The duration of hemodialysis,sex ratio (female/male), the level of serum phosphorus, β2-microglobulin and parathyroid hormone in elderly MHD patients with RLS were significantly higher than those in elderly MHD patients withoutRLS (t=2. 332,X2=15. 343,t=4. 784,13. 124,10. 900;all P<0. 05). And there were no significant differences in age, dry weight, material of dialyzer membrane, and levels of serum creatinine, urea nitrogen, hemoglobin, hematocrit, calcium, ferritin and transferrin saturation between patients with RLS and without RLS(t=0. 341,0. 008, 1. 055,0. 051,0. 899,0. 912,0. 601,0. 192,0. 200,1. 094;all P>0.05). Logistic regression analysis revealed that serum parathyroid hormone and β2-microglobulinwere the important risk factors for RLS in elderly MHD patients. PSQI was higher in RLS group than in non-RLS group[(10. 7±2.7) vs. (4.9±2.5), t=10. 948,P=0. 000] . The manifestations of poor sleep were poor indexes of subjective sleep quality, sleep duration, habitual sleep efficiency and daytime dysfunction in MHD patients with RLS. And the RLS severity was correlated with PSQI (r=0. 839,P<0. 05). After the treatment with hemoperfusion, the level of serum phosphorus, serum parathyroid hormone, serum β2-microglobulin, RLS severity score and PSQI were significantly decreased in RLS patients compared with pre-hemoperfusion. The vital sign of RLS patients were stable during hemoperfusion, and there were no adverse events after the treatment with hemoperfusion. ConclusionsThe prevalence of RLS is high, and poor sleep quality is found in elderly MHD patients with RLS. Serum parathyroid hormone and β2-microglobulin are the important risk factors for RLS in elderly MHD patients. Hemoperfusion can effectively improve the RLS and sleep quality and is well tolerated.
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<p><b>BACKGROUND</b>Central venous thrombosis is a serious and life-threatening complication in hemodialysis (HD) patients with an indwelling catheter. The present study aimed to investigate the prevalence and characteristics of thrombosis of the superior vena cava and auxiliary branches in Chinese HD patients with an indwelling internal jugular venous catheter and to explore its risk factors.</p><p><b>METHODS</b>Fifty-four patients on maintenance hemodialysis (MHD) with an indwelling catheter were enrolled in this cross-sectional study. The thrombosis of the internal jugular vein, subclavical vein, brachiocephalic vein and superior vena cava was assessed by vascular ultrasound. Collected were data on age, gender, ultrafiltration volume, Kt/V, blood pressure, levels of hemoglobin, serum albumin, lipid, calcium, and phosphorus, and parathyroid hormone.</p><p><b>RESULTS</b>The patients were given short- or long-term double lumen central venous catheters. Among them, 42 patients had the catheter placed into the right internal jugular vein, and 12 patients into the left internal jugular vein. Different degrees of central venous thrombosis were found in 33 patients (61.1%). The prevalence of thrombosis in the jugular vein, brachiocephalic vein, subclavical vein and superior vena cava was 61.1% (33/54), 44.4% (24/54), 16.7% (9/54) and 5.6% (3/54), respectively. Among the 33 HD patients with central venous thrombosis, the percentages for one, two, three and four affected veins were 27.3% (9/33), 45.4% (15/33), 18.2% (6/33) and 9.1% (3/33), respectively. Twelve (12/33, 36.4%) of the 33 HD patients with central venous thrombosis had clinical symptoms. Nine patients (27.3%) had edema of the upper extremity and 3 (9.1%) had new-onset symptoms of pulmonary embolism such as cough, chest distress and short breath. The incidences of diabetes mellitus and malignant tumor and levels of lipoprotein a and homocysteic acid were significantly higher in the HD patients with central venous thrombosis than in those without central venous thrombosis. Logistic regressive analysis revealed that high level of homocysteic acid was the important risk factor for central venous thrombosis in HD patients with indwelling catheterization of the internal jugular vein.</p><p><b>CONCLUSIONS</b>The prevalence of central venous thrombosis in Chinese HD patients with indwelling catheterization of the internal jugular vein is quite high, especially in those patients with diabetes mellitus, malignant tumor, high levels of serum lipoprotein and homocysteic acid. Its clinical symptoms are insidious but dangerous. High level of homocysteic acid may be the important risk factor for central venous thrombosis in Chinese HD patients with indwelling catheterization of the internal jugular vein.</p>