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0bjective To investigate the occurrence of frequent intradialytic hypotension in hemodialysis patients and Analyzed influencing factors. Methods The 1 933 hemodialysis sections of 156 maintenance hemodialysis patients in the Huashan hospital affiliated to Fudan University in Shanghai were selected, and divided into frequent intradialytic hypotension and non- frequent intradialytic hypotension depending on whether the incidence of intradialytic hypotension is greater than 20%, and the patients' dialysis data and biochemical examination data are collected for the analysis of influencing factors. Results The incidence of frequent IDH in maintenance hemodialysis patients was 62.18%(97/156), and the pre-dialysis blood pressure of frequent IDH patients were higher than non-frequent IDH patients, frequent IDH patients: (134.02±21.01)/(73.85±10.73) mmHg(1 mmHg=0.133 kPa), non-frequent IDH patients: (124.66 ± 17.89)/(69.32 ± 10.65) mmHg, (t=-2.851,-2.558, P＜0.05), but lower in post-dialysis, frequent IDH patients:(114.91±19.21)/(68.38±11.41) mmHg, non-frequent IDH patients: (127.90± 20.58)/(74.46±11.79) mmHg, (t=3.989, 3.189, P＜0.01). Binary Logistic regression analysis showed that hemoglobin ( OR=0.354, P=0.015) and high-density lipoprotein ( OR=0.155, P=0.003) were protective factors for the occurrence of frequent IDH, and ultrafiltration volume/weight ( OR=6.021, P=0.002) and N-terminal pro-brain natriuretic peptide ( OR=2.687, P=0.020) were risk factors. Conclusions The incidence of frequent IDH in hemodialysis patients is high, and patients with high filtration rate, high N-terminal pro-brain natriuretic peptide, low hemoglobin and high density lipoprotein should be paid close attention to. It is recommended to regularly monitor patients' biochemical indicators, strengthen blood pressure monitoring for high-risk groups, and timely deal with the symptoms of low blood pressure.
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Objective The aim of the study was to investigate the early failure of newly created arteriovenous fistula(AVF) in patients on maintenance hemodialysis and the factors responsible for the failure. Methods The clinical data were retrospectively reviewed, preoperative examination and laboratory biochemical indicators of 88 patients with newly created AVF for maintenance hemodialysis in our hospital through Hospital Management Information System and telephone follow-ups. Binary Logistic regression was used to analyze the protective factors for early failure. Results In 88 patients, early failure of the AVF was found in 15 patients. Twenty-three factors, including gender, were involved in statistical analysis. There were statistical differences between the two groups in hypertension (χ2=7.689, P=0.006) and whether they had early referral to nephrologists (χ2=5.334, P=0.021). Further regression analysis showed hypertension ( OR=0.192, 95% CI=0.0538-0.692, P=0.012) was protective factor and without early referral ( OR=3.651, 95% CI=1.068-18.302, P=0.039) was the risk factor of early failure. Conclusion This study shows that no early referral and combined hypertension is an important factor affecting the early failure, emphasizing the clinical work, for the diagnosis of patients with chronic kidney disease, early nephrological referral should be established, and blood pressure monitoring should be done to help reduce the incidence of complications.
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Objective To evaluate volume doubling time (VDT) and net mass doubling time of tumor (nMDT) of pulmonary pure ground glass nodules (PGGN) of different pathological types and to investigate whether VDT and nMDT can help to differentiate invasive pulmonary adenocarcinomas from minimally invasive adenocarcinomas and preinvasive lesions.Methods Fifty-one pathologically confirmed pGGNs in 46 patients were retrospectively evaluated,in whom at least two HRCT scans were obtained preoperatively (median scan times,3 times;range,2-6 times) with 1-month or longer follow-up interval (median follow-up interval,251 days;range,30-1 552 days).According to the rechecked results of the postoperative pathological section,51 pGGNs were divided into two groups:group A,invasive adenocarcinoma (IAC),30 pGGNs (58.8％);group B,21 pGGNs (41.2％),including 8 minimally invasive adenocarcinoma (MIA),7 adenocarcinomas in situ (AIS) and 6 atypical adenomatous hyperplasia (AAH).The volume,cumulative percentage of volume growth and VDTs of pGGNs were automatically acquired by Lung VCAR (advantage windows 4.6,GE HealthCare).Subsequently,the mass,cumulative percentage of mass growth and nMDTs of pGGNs were calculated.The count data and measurement data between two groups were compared using Fisher exact probability and Mann-Whitney U test,respectively.A pairwise comparision were performed by using Wilcoxon signed-rank test.Subsequently,the receiver operating characteristic (ROC) curve was used to determine the optimal cut-off values of VDT and nMDT for the differential diagnosis of IAC and MIA/AIS/AAH,and calculated the area under the curve (AUC).Results The median VDT and nMDT of 51 pGGNs were 1 854.11 days (range,165.22—+∞ days) and 1 138.45 days (range,95.92—+ ∞ days),respectively.The median nMDT was shorter than the median VDT,and the difference was significant (Z=-2.444,P=-0.O15).The median VDTs of IAC and MIA/AIS/AAH were 847.07 days (165.22—+∞ days) and 4 460.09 days (691.14—+∞ days),respectively.The median nMDTs of IAC,MIA/AIS/AAH were 769.93 days (95.92—+∞ days) and 3814.77 days (611.56—+∞ days),respectively.The median VDT and nMDT of IAC were significantly shorter than those of MIA/AIS/AAH (Z=-3.443,-3.860,P＜ 0.01,respectively).Differentiating IAC from MIA/AIS/AAH,the optimal cutoff value of VDT was 2095.86 days (sensitivity,71.4％;specificity,80.0％),the optimal cutoff value of nMDT was 1 169.77 days (sensitivity,81.0％;specificity,76.7％).Conclusions In pulmonary pGGNs,IAC showed significantly shorter VDT and nMDT than MIA/AIS/AAH.When VDT is shorter than 2 095.86 days or nMDT is shorter than 1 169.77 days,IAC is suggested.
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Objective To analyze the imaging characteristics of lung cancer detected by LDCT ( low-dose CT )lung cancer screening. Methods Between July 1st, 2007 and June 30th, 2013, 7 141 asymptomatic enrolled participants aged 40-88 years old (male 4 710, female 2 431, median age 47), and 1 071 volunteer participants aged ≤39 underwent chest LDCT. The imaging characteristics were analyzed retrospectively in lung cancer pathologically proved. Three types were classified according to the imaging findings: solid lesion, part-solid lesion and non-solid lesion. Results A total of 31 participants (32 lesions) were diagnosed as lung cancer, including 30 adenocarcinomas, 1 carcinoid and 1 small cell lung cancer. The detecting rate of the lung cancer was 0.4%(31/8 212). The solid lesion was further classified as classical solid nodule, irregular solid lesion and atypical solid nodule, and the part-solid lesion was further classified as part-solid nodule, irregular part-solid lesion and cystic part-solid nodule. Lung cancer or probably lung cancer was diagnosed in 24 cases (77.4%), and uncertainty diagnosis was made in 3 cases (9.7%). Benign or probably benign was diagnosed in 3 cases, and another 1 cases were missed at baseline screening. The false positive rate and the false negative rate was 9.7%and 3.1%, respectively. Conclusion The imaging characteristics of lung cancer detected by LDCT are varied, which provide preliminary experience in lung cancer screening.
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To explore the clinical significance of serum cardiac troponin I (cTnI) for the detection of myocardial injury in children with Kawasaki disease (KD) in acute stage, the levels of serum cTn I, creatine kinase (CK), creatine kinase isoenzyme (CK-MB), lactic dehydrogenase (LDH) and glutamic oxalacetic transaminase (GOT) were determined in 40 children with KD and 23 controlled children without heart disease, respectively. The results showed that the levels of serum cTn I and CK-MB in the KD group were significantly higher than those in the controlled group (P＜0.001),while no obviously differences of CK, LDH and GOT were noticed between two groups (P＞0.05). cTn I was more sensitive comparing to CK-MB for the detection of myocardial injury (P＜0.05). It is concluded that the determination of cTn I and CK-MB will be available for the diagnosis of myocardial injury in children with KD in acute stage, and the determination of cTn I is more sensitivity and specificity comparing to CK-MB.