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Objective:To evaluate left ventricular structural and functional abnormalities and vascular calcification in kidney transplant (KT) recipients, explore their influencing factors and examine the effects of mineral and bone disorders.Methods:From January 2017 to December 2019, retrospective analysis was performed for 292 KT recipients. Biochemical markers of bone metabolism, bone mineral density (BMD), left ventricular hypertrophy (LVH), left ventricular ejection fraction (LVEF), left ventricular diastolic function, coronary artery calcification (CAC) score and thoracic aortic calcification (TAC) score were assessed. Linear regression and binary Logistic regression analyses were employed for evaluating the influencing factors of cardiovascular parameters and the influence of abnormal mineral and bone metabolism.Results:Postoperative abnormalities in mineral and bone disorders were manifested mostly as hypercalcemia (8.9%, 26/292), hypophosphatemia (27.1%, 79/292), low 25-hydroxyvitamin D (25(OH)vitD) (67.0%, 196/292), hyperparathyroidismhigh parathyroid hormone (PTH) (50.6%, 148/292), elevated bone turnover markers and bone loss rate of 25%-30%. The prevalence of LVH, LVEF<50%, left ventricular diastolic dysfunction, high CAC score and high TAC score were 39.9%(116/292), 0%, 13.1%(38/292), 17.3%(50/292) and 39.9%(116/292) respectively. The results of multivariate analysis indicated that LVH was correlated positively with hypertension and serum calcium (Ca) (95% CI: 1.242-28.080, P=0.026; 95% CI: 1.714-277.584, P=0.018); LVEF was correlated positively with lumbar vertebrae BMD (95% CI: 0.000 1-0.005 5, P=0.041); Left ventricular diastolic dysfunction was correlated positively with age, diabetes and parathyroid hyperplasia/nodules (95% CI: 1.050-1.176, P<0.001; 95% CI: 2.118-43.813, P=0.003 and 95% CI: 1.419-9.103, P=0.007); High CAC score was correlated positively with recipient age and dialysis time (95% CI: 1.036-1.160, P=0.001; 95% CI: 1.009-1.041, P=0.002); High TAC score was correlated positively with age (95% CI: 1.095-1.215, P<0.001). Correlation analysis indicated that TAC was correlated positively with serum Ca ( r=0.233, P=0.003), bone-specific alkaline phosphatase (BALP)( r=0.325, P<0.001) and type Ⅰ collagen cross-linked N-terminal peptide (NTX)( r=0.204, P=0.011) and negatively with femoral neck BMD ( r=0.194, P=0.017). Conclusions:There is a high prevalence of left ventricular structural and functional abnormalities and vascular calcification. It is closely correlated with mineral and bone disorders.
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Objective:To observe the efficacy and safety of quadruple low-dose immunosuppressant maintenance therapy of sirolimus(SRL), calcineurin inhibitors(CNIs), mycophenolate mofetil(MMF)and glucocorticoid in recipients switched within three months after renal transplantation.Methods:This retrospective study recruited 61 recipients on quadruple immunosuppressive therapy within three months after renal transplantation from 2013 to 2018. The changes of serum creatinine(SCr), blood urea nitrogen(BUN), hemoglobin(HGB), white blood cell(WBC), platelet(PLT), liver function, fasting blood-glucose(FBG), serum lipid, electrolyte and urine protein before and after using this protocol were recorded.Results:No significant difference existed between before and after protocol switching in WBC or serum sodium. But after protocol switching, significant differences could be observed in SCr, BUN, serum calcium, serum potassium, aspartate transaminase(AST), PLT, alanine transaminase(ALT), HGB, FBG, triglycerides(TG)and cholesterol(TC, P<0.05). Urine protein negative rate was 44.26 % before switching. However, it was 81.97 % after protocol switching. After switching during a 1-year follow-up period, the incidence of pulmonary infection rate was 24.59 %, the incidence of BKV infection rate 4.92 %, the incidence of transplant renal artery stenosis 3.28 % and the incidence of acute rejection 6.56 %. Conclusions:Quadruple low-dose immunosuppression maintenance therapy of SRL, CNIs, MMF and glucocorticoid switched within 3 months after renal transplantation may be an effective and safe protocol of improving renal allograft function and enhancing recipient prognosis.
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Objective:To evaluate the values of bone mineral density(BMD)of renal transplant recipients and analyze the influencing factors so as to provide rationales for preventing and treating osteoporosis after renal transplantation.Methods:A retrospective study was conducted for clinical data of 254 renal transplant recipients hospitalized from January 2017 to May 2019. The values of BMD of right femoral neck and lumbar vertebrae were detected by dual-energy X-ray absorptiometry(DEXA)and their relationships with other clinical parameters analyzed.Results:The average age was(40.5±9.8)years. Males accounted for 66.1 %, and menopausal women 5.9 %. The prevalence of osteopenia/osteoporosis of right femoral neck bone mass and lumbar vertebrae was 20.1 %, 2.8 % and 26.1 %, 3.6 % respectively. Chi-square test showed that recipients with lower BMD of femoral neck and lumbar spine were elders, menopausal women and those with longer postoperative time( P<0.05). Multivariate linear regression analysis indicated that BMD of right femoral neck was positively correlated with BMI and negatively correlated with acute rejection( P<0.05). The BMD of lumbar vertebrae was positively correlated with BMI and negatively correlated with PTH level ( P<0.05). Conclusions:There is a high prevalence of bone loss in kidney transplant recipients. Regular monitoring of BMD, active control of hyperparathyroidism, maintaining an excellent nutritional status, tapering of glucocorticoid dose and using immunosuppressants with less effect on bone metabolism may prevent osteoporosis.
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Objective:To observe the efficacy and safety of Iguratimod in reducing the level of panel reactive antibodies in renal transplant recipients.Methods:The clinical data of 35 patients with PRA-positive renal transplant recipients were retrospectively analyzed. All recipients were treated with Iguratimod for PRA-positive. The changes in PRA levels before and after treatment and the adverse events were observed.Results:Of the 35 recipients, 4 of them were discontinued due to pulmonary infection, and 2 patients were discontinued during the observation period. 3 patients were lost to follow-up. A total of 26 recipients were included. When Iguratimod was taken to 9 months, the PRA was reviewed. 71.5 % of the 207 sites showed a downward trend, 69.9 % of the 107 class I sites and 75.9 % of the 41 class II site showed a downward trend, and there was no difference in renal function before and after treatment. There were no significant changes in blood routine, liver function, blood lipids, and blood glucose. There were no other adverse events.Conclusions:Iguratimod can effectively reduce the level of PRA in renal transplant recipients with less adverse events.
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Objective To provide a basis to satisfy the need for family planning of women of reproductive age,according to the analysis and estimation of family planning status of married or in union women of reproductive age among China,Japan,India,South Africa and the United States of America.Methods U test and Chi-square test were applied to analyze the current situation (1970-2016) and tendency (2017-2030) of family planning indicators of the five countries from 1970 to 2030,which were selected from open database of World Contraceptive Use 2016.Results Compared with the family planning status in 1970,there was a significant change in total demand for family planning,contraceptive prevalence and unmet need for family planning (P＜0.001).To be specific,in 2016,contraceptive prevalence of married or in-union women of reproductive age in China,Japan,India,South Africa and the United States of America was 83.35％,59.9％,56.4％,64.9％ and 73.7％,respectively;unmet need for family planning was 3.8％,13.1％,15.5％,12.2％ and 7.2％,respectively.Besides,contraceptive methods composition in the five countries were changed in 2016 (P＜0.001) and the prevalence of modern methods was higher than traditional methods.Meanwhile,the percentage of demand for family planning satisfied with modern methods were increasing from 1970 to 2016.On the other hand,the projections of total demand for family planning,contraceptive prevalence,unmet need for family planning,composition of contraceptive methods and unmet need for modern methods would change from 2017 to 2030 (P＜0.001).It was estimated that,in 2030,China would have the largest number of people using contraceptive methods and India would have the largest number of people with unmet need for family planning.Moreover,China and India might be the countries with most users of modern methods,and India might be associated with the most users of traditional methods.Conclusions Considering current and projected status of huge total demand for family planning,high contraceptive prevalence,low unmet need for family planning,it is essential to supply approximate contraceptive methods.
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Objective To discuss the risk factors on short-term prognosis after kidney transplantation from donors after cardiac death (DCD). Methods We retrospectively analyzed the information of donors and recipients who performed DCD donor kidney transplantation in our center between January 2011 and August 2015, including 64 donors and 95 recipients. Also, we analyzed the potential relationship among donors' clinical characteristics and the early recovery of graft function, including the incidence of delayed graft function(DGF)and the serum creatinine (SCr) on the 90th day, and infection rate after kidney transplantation.Results We found that when donors had the factors of WIT>10 min, urine volume<100 ml/h, SBP≤100 mmHg or a history of CPR, the incidence of recipients' DGF were 55.6%,73.3%,62.5%,77.8% respectively with a significant difference. Recipients would have more chance to be infected if donors have the following characteristics: male, older than 50 years, died of cerebral hemorrhage which was caused by cardiovascular diseases, WIT>30 min, treated in ICU for more than 10 days or infection. Conclusions Nowadays, DCD has become the main graft source in Chinese kidney transplantation. This research indicates that the donors' factors may affect the recovery of graft function and the incidence of infection after kidney transplantation to some extent.By evaluating rigorously and preserving quality of renal grafts carefully, DCD would become more safe and valid.
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Objective To investigate the mercury exposure level in cord blood of neonatal in Zhoushan Islands and to analyze the related factors,in order to provide scientific basis for relevant prevention and control measures.Methods From June 201 2 to July 201 3,peripheral blood and umbilical cord blood samples were collected in local women who delivered their babies in Zhoushan Islands.Questionnaire survey and mercury exposure test were performed.Results 3 052 maternal blood and neonatal umbilical cord blood samples were tested,and the mean,median,P25 and P75 of the maternal blood mercury were 5.33 ±3.69,4.63,2.8 and 8.2 μg/kg respectively.And the mean,median,P25 and P75 of the cord blood mercury were 7.72 ±4.87,7.31 ,4.7 and 1 1 .2 μg/kg.Single factor analysis showed that the neonatal umbilical cord blood mercury levels were associated the intake of pan -fried mackerel during pregnancy (OR =1 .79,P <0.01 ).No association was found with the sex of newborn,the intake of iron,calcium,and vitamin during pregnancy,the number of mending tooth,the use of whitening cosmetics,the intake of fish and seafood,father's smoking,the average family income and residence time.Multivariate Logistic regression analysis showed that the neonatal umbilical cord blood mercury levels were associated the intake of pan -fried mackerel during pregnancy (OR =1 .96,P <0.01 ).Conclusion Mercury levels in cord blood in Zhoushan area are detected at a high level;the intake of pan -fried mackerel could be one of the major sources of mercury accumulation in neonates.There is an association between the mercury levels of maternal blood and neonatal umbilical cord blood.
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<p><b>OBJECTIVE</b>To compare multiple organ dysfunction score (MODS), the sequential organ failure assessment (SOFA) and the logistic organ dysfunction score (LODS) in predicting hospital mortality in severe sepsis.</p><p><b>METHODS</b>Four hundred and three patients admitted to the ICU from December 2004 to November 2007 with a diagnosis of severe sepsis were enrolled in this study. Their MODS, SOFA, LODS and Acute Physiology and Chronic Health Evaluation (APACHE) II at admission and the highest score during hospitalization were respectively recorded and collected in regard to mortality. The discrimination of three multiple organ dysfunction score systems were assessed by the areas under the receiver operating characteristic curves (AUC).</p><p><b>RESULTS</b>The AUC of admission scores was 0.811 for LODS, 0.787 for SOFA, 0.725 for MODS, and 0.770 for APACHE II in predicting hospital mortality. All maximum scores had better power of discrimination than the admission scores (P < 0.01). The power of discrimination of LODS and SOFA were better than the MODS, either the admission or the highest, respectively (P < 0.01). However, no significant difference was observed between the LODS and the SOFA regarding mortality prediction (P > 0.05). The AUC value for the APACHE II score was much lower compared to LODS (P < 0.01). However, there was no difference in AUC value among APACHE II, SOFA and MODS (P > 0.05).</p><p><b>CONCLUSION</b>LODS, SOFA and MODS show a good discrimination power, while maximum LODS is of the highest discrimination power to predict the outcome of patient with severe sepsis.</p>
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Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , APACHE , Mortalidad Hospitalaria , Unidades de Cuidados Intensivos , Insuficiencia Multiorgánica , Patología , Pronóstico , Sepsis , Mortalidad , Índice de Severidad de la EnfermedadRESUMEN
<p><b>OBJECTIVE</b>To study the contents of organochlorine pesticides in human bodies and residues in serum of populations with non-occupational exposure as well as to study the relationship between organochlorine pesticides in foodstuff and residues levels in serum.</p><p><b>METHODS</b>A cross-section study was conducted. 107 men and 142 women who were all healthy and living in the communities were investigated from Mar. 2004 to Jul. 2004. Level of daily food exposure was estimated through questionnaires while DDTs and HCHs serum levels were detected by EC-ECD. The relationship between organochlorine pesticides contents in foods and residues in serum were analyzed by ridge regression.</p><p><b>RESULTS</b>Fresh fish was positively correlated to men's serum level of beta-HCH and p,p'-DDT (beta = 0.1266 and beta = 0.0595) while vegetables and fruits were negatively correlated to women's serum level of beta-HCH (beta = -0.1066). Soybean was negatively correlated to women's serum level of p,p'-DDE and p,p'-DDT (beta = -0.0965 and 3 = -0.0581). Alcohol consumption was negatively correlated to men's serum level of beta-HCH and p,p'-DDE and women's serum level of p,p'-DDE (beta = -0.1315, beta = -0.1599 and P = -0.1128).Salted meat was negatively correlated to men's serum level of beta-HCH and p, p'-DDT (P = -0. 066 and P = - 0.0569).</p><p><b>CONCLUSION</b>In this study, fresh fish might increase the body burden of organochlorine pesticides and residues while alcohol might promote the excretion of organochlorine pesticides. Pickled meat and vegetal foodstuff might contain low-level of organochlorine pesticides and residues.</p>