Kidney transplantation from donors with Marfan syndrome: report of 2 cases and literature review / 器官移植

Objective To investigate the feasibility and clinical experience of kidney transplantation from donors with Marfan syndrome (MFS). Methods Clinical data of 2 recipients undergoing kidney transplantation from the same MFS patient were retrospectively analyzed and literature review of 2 cases was conducted. Characteristics and clinical diagnosis and treatment of kidney transplantation from MFS patients were summarized. Results The Remuzzi scores of the left and right donor kidneys of the MFS patient during time-zero biopsy were 1 and 2. No significant difference was observed in the renal arteriole wall compared with other donors of brain death and cardiac death. Two recipients who received kidney transplantation from the MFS patient suffered from postoperative delayed graft function. After short-term hemodialysis, the graft function of the recipients received the left and right kidney began to gradually recover at postoperative 10 d and 20 d. After discharge, serum creatinine level of the recipient received the left kidney was ranged from 80 to 90 μmol/L, whereas that of the recipient received the right kidney kept declining, and the lowest serum creatinine level was 232 μmol/L before the submission date (at postoperative 43 d). Through literature review, two cases successfully undergoing kidney transplantation from the same MFS donor were reported. Both two recipients experienced delayed graft function, and then renal function was restored to normal. Until the publication date, 1 recipient has survived for 6 years, and the other recipient died of de novo cerebrovascular disease at postoperative 2 years. Conclusions MFS patients may serve as an acceptable source of kidney donors. However, the willingness and general conditions of the recipients should be carefully evaluated before kidney transplantation. Intraoperatively, potential risk of tear of renal arterial media should be properly treated. Extensive attention should be paid to the incidence of postoperative complications.

Treatment of thoraco-abdominal aortic disease with fenestrated stent-graft or branch stent-graft technique guided by 3D printing / 中华普通外科杂志

Objective To summarize the experience and effect of applying 3D printing to repair thoraco-abdominal aortic disease with fenestrated stent-graft or branch stent-graft technique.Methods From Oct 2017 to Sep 2018,22 patients with thoracic and abdominal aortic diseases,including aortic arterial dissection (9 patients) and aortic aneurysm (13 patients) were admitted.There were 19 males and 3 females,with mean age of (60 ± 13) years.Before the surgery 3D printing model guide plate was made according to CT,and then the pre-fenestrated stent-graft technique,branch stent-graft technique and other techniques were adopted in the surgery to perform endovascular repair.Resuits All of the operations were completed in one stage without open surgery.The average operation time was (5.67 ± l.23) hours without renal insufficiency and paraplegia,1 branch artery was lost during operation (1.4％) and 1 patient died (4.5％).Conclusion The application of 3D printing in the treatment of thoraco-abdominal aortic disease involving branches is more accurate than traditional measurement and localization.It had a safe and reliable short-term result.

Study on the diagnosis and transfusion treatment of thrombelastography for trauma-induced coagulopathy / 中华急诊医学杂志

Objective To assess the diagnosis of thrombelastography (TEG) for trauma-induced coagulopathy (TIC) and explore whether TEG could guide transfusion for TIC patients.Methods We retrospectively analyzed all trauma patients who underwent the TEG and conventional coagulation tests (CCTs) admission in the emergency intensive care unit from February to December 2018.The definition of TIC is prothrombin time (PT) 18 s,international normalized ratio (INR) 1.5,activated partial thromboplastin time (APTT) 60 s or platelet count (PLT) 100 x 109/L.The diagnostic value of TEG for TIC was evaluated by receiver operating characteristic curve,area under the curve (AUC),sensitivity,specificity,positive predictive value (PPV) and negative predictive value (NPV),and the transfusion guidance of TEG for TIC patients was assessed by multivariate regression analyses.Results A total of 242 patients were included,including 62 patients in the TIC group and 180 patients in the non-TIC group.The differences in TEG between the two groups were statistically significant.The AUCs of TIC assessed by maximum amplitude (MA) and coagulation index (CI) were the largest,0.779 and 0.786 respectively,and the sensitivity were greater than 80％ and NPV were greater than 90％.The sensitivity,PPV and NPV of reaction time (R) were minimal.After confounders were controlled,all TEG values were correlated with blood volumes within the first 24 h and massive transfusion,of which R had the highest odds ratio and regression coefficient.Conclusions MA and CI have the highest diagnostic value,while R has little diagnostic value but a relatively large blood therapeutic significance of TIC.MA ＜ 52.9 mm or CI ＜-1.0 can be used as a threshold for identifying TIC.The diagnosis of TIC and the guidance transfusion for TIC patients by TEG is beneficial.

Study on the diagnosis and transfusion treatment of thrombelastography for trauma-induced coagulopathy / 中华急诊医学杂志

Objective@#To assess the diagnosis of thrombelastography (TEG) for trauma-induced coagulopathy (TIC) and explore whether TEG could guide transfusion for TIC patients.@*Methods@#We retrospectively analyzed all trauma patients who underwent the TEG and conventional coagulation tests (CCTs) admission in the emergency intensive care unit from February to December 2018. The definition of TIC is prothrombin time (PT) 18 s, international normalized ratio (INR) 1.5, activated partial thromboplastin time (APTT) 60 s or platelet count (PLT) 100×109/L. The diagnostic value of TEG for TIC was evaluated by receiver operating characteristic curve, area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), and the transfusion guidance of TEG for TIC patients was assessed by multivariate regression analyses.@*Results@#A total of 242 patients were included, including 62 patients in the TIC group and 180 patients in the non-TIC group. The differences in TEG between the two groups were statistically significant. The AUCs of TIC assessed by maximum amplitude (MA) and coagulation index (CI) were the largest, 0.779 and 0.786 respectively, and the sensitivity were greater than 80% and NPV were greater than 90%. The sensitivity, PPV and NPV of reaction time (R) were minimal. After confounders were controlled, all TEG values were correlated with blood volumes within the first 24 h and massive transfusion, of which R had the highest odds ratio and regression coefficient.@*Conclusions@#MA and CI have the highest diagnostic value, while R has little diagnostic value but a relatively large blood therapeutic significance of TIC. MA < 52.9 mm or CI < -1.0 can be used as a threshold for identifying TIC. The diagnosis of TIC and the guidance transfusion for TIC patients by TEG is beneficial.

Investigation and analysis of the trend of emergency patients in a 3rd grade class a hospital in 2016 / 中华急诊医学杂志

Objective To investigate the influence of meteorological factors on the number of patients and the time patients visiting the emergency department for medical care.Methods The data of meteorological variation and air pollution associated with the characteristics of distribution of time when the patients visited the emergency department in a tertiary grade A class hospital in Shanghai were collected in 2016.Quasi Poisson generalized additive model (GAM) applied for time series analysis was used to find the correlation between daily temperature and number of patients visiting emergency department,and with the distributed lag nonlinear model (DLNM) the relationship between the temperature and humidity was established and the confounding factors related with time visiting the emergency department was controlled in this model.Results In 2016,the average number of emergency visits in a tertiary grade A class hospital in Shanghai was 1027.The peak flow of patients occurred between 18:00 to-22:00 and trough emerged between 2:00 to-8:00.The number of visits in winter was greater than that in spring and autumn,and the number of patients on weekends and holidays was more than that on weekdays.The response of temperature exposure to the change of emergency volume in the hospital showed a J shape distribution.The low temperature and high temperature caused increase in visits,and the low temperature effect could last more than 2 weeks.The lowest number of visits occurred when the temperature (that is the lowest suitable temperature for medical treatment) was about 7 degrees Celsius,and the daily number of patients in emergency internal medicine was increased to 1.09 times (95％CI:1.03～1.16) compared with the optimum temperature.Compared with the optimum temperature,the daily visits increased to 1.27 times (95％CI:1.08～1.50) in the highest temperature.When the suitable temperature decreased by 1 degree,the visiting quantity increased by 2.43％ (95％CI:0.83％～4.18％),and the number of visits increased by 0.96％ (95％CI:0.31％～1.64％) every 1 degree rise.Conclusions There was a difference in the number of emergency visits between different times,and low temperature and high temperature had an obvious influence on the amount of emergency visits,and the effect of low temperature on the volume of visits was more lasting.

The association of blood IL-1β to injury and its complications in patients with multiple trauma / 中华急诊医学杂志

Objective To investigate the relationship between the dynamic changes of interleukin-1β (IL-1β) levels and severity and complications of patients with multiple trauma at the early stage.Methods Among 97 patients with multiple trauma in Emergency Department of Shanghai Jiao Tong University Affiliated Sixth People's Hospital between August 2015 and May 2016,12 patients were excluded as follows,(1) with burns or chemical injuries;(2) pregnancy or menopausal women;(3) had bacterial infection a week ago;(4) with chronic diseases.The other 85 patients with multiple traumas were classified into three categories according to the injury severity score (ISS).That is,the slight group (22 cases,9≤ ISS ＜ 15),moderate group (35 cases,15 ≤ ISS ＜ 25) and severe group (28 cases,ISS ≥ 25).Their venous blood samples were collected at 6,12,24,48 and 72 hours after trauma respectively,and the serum IL-1 β levels were measured using a specific immunoluminometric assays.The basal conditions including age,the hospitalization days and so on among these three groups were compared via ANOVA.The mean IL-1 β levels at above time intervals among three groups were compared.Finally,the relationship between the peak concentration of IL-1β and injury severity and complications was analyzed by multiple Logistic regression.Results (1) As the increasing severity of trauma,the patients with longer days of hospitalization and higher rate of multiple organ dysfunction syndrome (MODS) (P ＜ 0.05).(2) The levels of IL-1 β in the moderate and severe groups were remarkably higher than those in the slight group (P ＜ 0.02).(3) The IL-1β levels in each group peaked at 6 hours after trauma and began to decline.(4) Multivariate logistic analysis showed that peak concentration of IL-1 β was still an independent predictor for injury severity (moderate group:odds ratio,1.21;95％ confidence interval:1.05-1.39,P =0.007;severe group:odds ratio,1.20;95％ confidence interval:1.03-1.40,P =0.019) and sepsis (odds ratio,1.28;95％ confidence interval:1.10-1.50,P =0.001),but had no significant association with MODS and trauma mortality even after controlling other risk factors.Conclusions The serum IL-1β at 6 hours after injury could be used as an early effective indicator to evaluate the injury severity and infectionrelated complications in patients with multiple trauma.

Clinical Observation of Electroacupuncture at Baihuanshu (BL30) and Huiyang (BL55) for Chronic Prostatitis / 上海针灸杂志

Objective To observe the therapeutic efficacy of electroacupuncture at Baihuanshu (BL30) and Huiyang (BL55) for chronic prostatitis. Method Ninety patients were divided into an acupuncture-medication group and a Chinese medication group, 45 in each group, to respectively receive electroacupuncture at Baihuanshu and Huiyang plus oral administration of Chinese medication, and single Chinese medication treatment, 4 weeks as a treatment course. The therapeutic efficacy was evaluated by adopting the Chronic Prostatitis Symptom Index by National Institutes of Health (NIH-CPSI). Result The general score of NIH-CPSI dropped in both groups after intervention (P＜0.05), while the decrease in the acupuncture-medication group was more significant (P＜0.05), and it had a significantly higher therapeutic efficacy than the Chinese medication group (P＜0.05). Conclusion Electroacupuncture at Baihuanshu and Huiyang can significantly improve the symptoms of chronic prostatitis, and it’s superior to oral administration of Chinese medication in comparing the clinical efficacy.

Clinical Observation of Electroacupuncture at Baihuanshu (BL30) and Huiyang (BL35) for Chronic Abacterial Prostatitis / 上海针灸杂志

ObjectiveTo observe the clinical efficacy of electroacupuncture at Baihuanshu (BL30) and Huiyang (BL35) in treating chronic abacterial prostatitis.MethodSixty patients with chronic abacterial prostatitis were divided into a treatment group(n=30) and a control group (n=30), respectively to receive electroacupuncture plus Chinese herbal medicine and Chinese herbal medicine alone.ResultAfter intervention, the scores of National Institutes of Health-Chronic Prostatitis symptom index (NIH-CPS) dropped in both treatment and control groups, while the decrease was more significant in the treatment group (P<0.05); the pain or discomfort score from the NIH-CPS dropped in both groups, while the decrease was more marked in the treatment group (P<0.05).ConclusionElectroacupuncture and Chinese herbal medicine both are effective in treating chronic abacterial prostatitis, and electroacupuncture plus Chinese herbal medicine can produce a more significant efficacy than Chinese herbal medicine alone.

Therapeutic window of mycophenolate mofetil for preventing acute graft rejection following renal transplantation / 南方医科大学学报

<p><b>OBJECTIVE</b>To determine the optimal dose range (therapeutic window) of mycophenolate mofetil (MMF) for preventing acute graft rejection following renal transplantation.</p><p><b>METHODS</b>The trough concentration of MMF (MPA-C0) at 12 h after oral administration of the drug (two doses daily given at an interval of 12 h) was monitored in 110 renal transplant recipients within a month, in 2-3 months, and over 4 months after the transplantation using EMIT method. The occurrence of acute graft rejection and drug toxicity were observed in all the patients during the one-year follow-up.</p><p><b>RESULTS</b>s The incidence of acute graft rejection after transplantation was 13.64% (15/110) in these patients. Drug toxicity and complications occurred in 32.73% (36/110) of the patients, including 12 cases with reduced white blood cell counts, 10 with MMF cid-associated diarrhea, 10 with infection, 4 with liver function damage. Acute rejection was successfully reversed after methylprednisolone treatment and drug toxicity was managed by corresponding treatment and adjustment of MMF dose. No deaths or graft removal occurred in these patients. The ROC curve showed that a MPA-C0 of 1.40-2.80 mg/L was optimal in preventing acute rejection after the transplantation and reducing adverse drug effects.</p><p><b>CONCLUSION</b>Monitoring MPA-C0 and individualized MMF dosing help to prevent acute graft rejection, reducing drug toxicity and complications, and improving graft survival rate after renal transplantation.</p>

Correlation of platelet parameters with delayed graft function after kidney transplantation / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the relationship between platelet parameters and delayed graft function (DGF) early after kidney transplantation.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of 232 recipients within 2 months following kidney transplantation performed between January, 2009 and September, 2013, among whom 29 experienced DGF. The laboratory data of the preoperative and postoperative platelets were collected from all the recipients.</p><p><b>RESULTS</b>Compared with the preoperative levels, the platelet number (PLT) and platelet hematocrit (PCT) were decreased on day 1 after kidney transplantation and was the lowest on day 5 (P<0.05), followed by gradual increase till reaching the highest levels on day 15 (P<0.05) and recovery of the preoperative level in days 30-60. The average platelet volume (MPV), platelet volume distribution width (PDW) and large platelet ratio (P-LCR) were increased on day 1, highest on day 7 (P<0.05), and reduced to the preoperative level on day 15, but then rose again slowly. MPV and P-LCR in days 30 to 60 and PDW in days 45 to 60 were significantly higher than the preoperative levels (P<0.05). The patients with DGF showed lowered PLT than those without DGF since day 2, and this difference was statistically significant in days 7 to 10, while PCT remained comparable between the two groups; MPV, PDW, and P-LCR were higher in DGF group than in DGF-free group with statistically significant difference on days 7, 10, and 15 (P<0.05).</p><p><b>CONCLUSION</b>Platelet function is associated with postoperative renal graft function recovery, and platelet parameters can provide new markers for monitoring the occurrence and reversion of DGF.</p>

Analysis of actual mismatch risk for KIR genes and KIR ligand related genes in kidney transplant recipients / 中华器官移植杂志

Objective To evaluate the actual mismatch risk for KIR genes,KIR ligand HLA-C gene and KIR ligand HLA-Bw4I80 related genes in kidney transplant recipients and their donors.Method KIR genes,KIR ligand HLA-C gene and KIR ligand HLA-Bw4I80 related genes were analyzed in 322 recipients and their donors who received kidney transplantation.The effect of mismatches on acute rejection after transplantation was studied as well.Result In 322 cases of recipients and their donors,average mismatch risk for KIR-L gene was 4.73％,9.10％ for KIR-S gene and 1.95％ for KIR ligand HLA-C gene respectively.There were 245 cases (76.09％) of KIR ligand HLA-Bw4I80 related genes mismatch and 77 cases (23.91 ％) of match resepctively.There was no statistically significant difference in AR rate between KIR ligand HLA-Bw4I80 related genes mismatch group and match group (8.16％ in 245 vs.7.79％ in 77) (P＞0.05).AR reversal rate in mismatch group and match group was 95.0％ and 66.7％ (P＞0.05).Conclusion The mismatch risk for KIR ligand HLA-Bw4I80 related genes was even common between kidney transplant recipients and their donors,and this specific mismatch may be of benefit to patients who undergo actuate rejection.Further study is still required.

Sexual function in premenopausal women before and after renal transplantation / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the changes in sexual function in premenopausal women after renal transplantation.</p><p><b>METHODS</b>Forty-two married premenopausal women receiving dialysis therapy for at least 6 months with normal renal function for 6 months after renal transplantation were examined for hormonal profiles and menstrual cycles. The sexual functions of the patients were evaluated using Female Sexual Function Index (FSFI) before and 6 months after the transplantation.</p><p><b>RESULTS</b>Before renal transplantation, amenorrhea, oligomenorrhea, polymenorrhea, and eumenorrhea were found in 18 cases (42.9%), 10 cases (23.8%), 5 cases (11.9%) and 9 cases (21.4%), as compared to 7 cases (16.7%), 5 cases (11.9%), 6 cases (14.3%) and 24 cases (57.1%) after the transplantation, respectively. Prolactin (PRL), follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels significantly decreased and estradiol (E2) and progesterone (P) significantly increased after renal transplantation (P<0.001). Nineteen patients (45.2%) before and 36 patients (85.7%) after the surgery reported to have an active sexual life (P<0.001). The total incidences of female sexual dysfunction before and after kidney transplantation were 90.5% and 40.5% (P<0.001), respectively. The scores for sexual desire, arousal, lubrication, satisfaction, orgasm, and pain in FSFI were significantly increased after kidney transplantation (P<0.001).</p><p><b>CONCLUSIONS</b>A successful renal transplantation can significantly improve sexual functions in premenopausal women.</p>

Investigation of sexual function and health of offspring in male kidney transplant recipients / 中华器官移植杂志

Objective To investigate sexual function in male kidney transplant recipients and their offsprings health condition.Methods We studied 60 male kidney transplant recipients who had a normal sex life before kidney failure and had good renal graft function after transplant.The questionnaire was used to investigate the time of first spermatorrhea,viability of sex activities,frequency and sexual intercourse satisfaction of sex activities,procreation status,growth and intelligence status of the offspring.Semen routine tests before and after the transplantation were done.Results Hyposexuality or declined sexual function was found in all over 60 cases of recipients.And after surgery,sexual function of the recipients was improved obviously following the graft function gradually regained.Fifty-four patients had spermatorrhea in the first 1-3 months post-transplantation,and rest 6 cases had no spermatorrhea because of sexual life.After operation 56 male patients began to have sex life in 2-4 months with satisfaction rate of 86.7％ (52/60),except the other 4 cases who refused sex life due to worrying about graft damage by sex life.Sixty-eight children were born by 56 recipients after operation,and the growth and intelligence status had no significant difference from the children of the same age.No transplant graft failure or rejection was found after the recipients had children.Conclusion After kidney transplantation,the sexual function of male recipients could return to the normal status and the growth and intelligence status of the offspring is normal.

Effects of cyclosporin A and tacrolimus on biological behaviors of lung cancer A549 cells in nude mice / 中华器官移植杂志

Objective To explore the effects of cyclosporin A (CsA) and tacrolimus (Tac) on biological behaviors of lung cancer A549 cells in nude mice.Methods Thirty-six models of transplanted tumor in Balb/c mice were established by using lung cancer A549 cells and divided into three groups:control group,without given any immunosuppressant; CsA group,intraperitoneally given CsA; Tac group,intraperitoneally given Tac.The transplanted tumor growth curve was drawn according to the transplanted tumor volume,and the influencing ratio was calculated according to the final tumor weight.The changes in cell migration ability were observed by using Transwell system.Terminal deoxynucleotidyl transferase mediated UTP nick end labeling (TUNEL) assay was used to examine the apoptosis index of the transplanted tumor.Quantitative RT-PCR was used to detect the expression levels of Bcl-2 mRNA and Bax mRNA.Results The growth of transplanted tumor in CsA and Tac groups was faster than in control group.Final tumor volume and final tumor weight in CsA and Tac groups were greater than those in control group.The influencing ratio in CsA and Tac groups was 19％ (P＜0.05) and 25％ (P＜0.05),respectively.The migration ability was greater in CsA and Tac groups than in control group (P＜0.01).The apoptosis index of the transplanted tumor in CsA and Tac groups was lower than in control group (P＜0.05).The expression level of Bcl-2 mRNA was higher in CsA and Tac groups than in control group (P＜0.05),and that of Bax mRNA was lower in CsA and Tac groups than in control group (P＜0.05).Conclusion Both CsA and Tac can promote the growth of transplanted tumor in nuce mice bearing 549 cells and enhance the invasion forces,which is probably related with the apoptosis induction of tumor cells.

Risk factors for standard Tac-related nephrotoxicity in renal transplant recipients / 中华器官移植杂志

ObjectiveTo investigate the factors for standard TAC-related nephrotoxicity in renal transplant recipients. MethodsClinical data of 132 patients in TAC-based regiment with a dose of 0. 15-0.3 mg· kg-1 · day-1 and a trough level of 8-11 μg/L during first 2 years post renal transplantation, were retrospectively analyzed. TAC-related nephrotoxicity was diagnosed by renal biopsy and/or clinical criteria. All recipients were divided into 2 groups: TAC nephrotoxicity group (n = 25) and control group (n = 107). Logistic regression analysis was used to rank the relative risk of potential variables including age, gender, delayed graft function (DGF), drug exposure, duration of therapy,liver function, albumin level, hematocrit and gene polymorphism for CYP3A5 and MDR1.ResultsTAC-related nephrotoxicity was found in 25 (18. 9 ％ ) recipients. Univariate and Logistic regression analysis revealed that the influencing factors for TAC-related nephrotoxicity with a standard immunosuppressive regimen and a normal trough level range were identified as: abnormal liver function (RR = 3. 05,95 ％ CI 0. 879-11. 533, P = 0. 024), albumin level (RR = 0. 966,95 ％ CI 0. 994-1. 006, P = 0. 018 ), hematocrit ( RR = 0. 999, 95 ％ CI 0. 998-1. 000, P = 0. 032), CYP3A5 gene polymorphism (RR= 0. 777,95 ％ CI 0. 023-6. 798,P= 0. 032) ,and MDR1 gene polymorphism (RR=0. 654,95 ％ CI 0. 053-7. 109, P = 0. 017). ConclusionLiver function, albumin level, hematocrit, and gene polymorphism for CYP3A5and MDR1as well are influencing factors for TAC-related nephrotoxicity in renal transplant recipients with a standard immunosuppressive regimen and a normal trough level range,in which abnormal liver function is the most important adverse risk factor. These factors should be considered for better individual therapy in renal transplant recipients.

Clinical features and electrophysiology analysis of 13 cases of infantile spinal muscular atrophy / 上海交通大学学报（医学版）

Objective To investigate the clinical and electrophysiology features of infantile spinal muscular atrophy,and explore the clinical significance of genetic diagnosis. Methods The clinical data of 13 infants suffering from infantile spinal muscular atrophy were analysed.The serum creatine phosphokinase was examined,and nerve conduction velocity was tested in median nerve,ulnar nerve,tibial nerve and peroneal nerve.The parameters such as distal motor latency,motor nerve conduction velocity and amplitude of compound motor active potential were analysed.Electromyography was performed in no less than four muscles,and the insertion potential,spontaneous potential and motor unit action potential were observed.Deletion of exon 7 in SMN1 gene was detected by polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP). Results All these infants were characterized by progressive flaccid paralysis in limbs.In all cases,amplitude of muscle response was significantly decreased,with prolonged distal latency and slowed conduction velocity.Electromyography demonstrated motoneuron degeneration.Deletion of exon 7 in SMN1 gene was detected in all 13 infants. Conclusion There are unique clinical and electrophysiology features for infantile spinal muscular atrophy,and electromyography may play an important role in the diagnosis.Prenatal genetic diagnosis may help to avoid the birth of this kind of infants.

Stroke and its related factors in chronic kidney disease patients / 中华肾脏病杂志

Objective To investigate the stroke occurrence of chronic kidney disease (CKD) and its related factors, especially the carotid atherosclerosis. Methods The data of stroke occurrence in 700 CKD patients hospitalized in Renji Hospital during 2007 were analyzed retrospectively. The incidences of stroke were compared among CKD [Ⅰ-Ⅱ, CKD Ⅲ-Ⅴ non-dialysis patients and dialysis patients. Carotid atherosclerosis of 409 CKD patients was examined by color Doppler ultrasound. The related factors were selected by Spearmnan correlation analysis and Logistic regression analysis. Results Of 700 CKD patients, 67 cases (9.57%) experienced at least one episode of stroke, which was much higher than that of general population. The related factors of stroke in CKD included GFR, age, SBP, CRP, Lpa, serum glucose, pre-albumin, HDL and carotid atherosclerosis. Logistic regression revealed that SBP (β=1.021, P=0.042), CRP (β=1.008, P=0.024) and carotid atherosclerosis (β =3.456, P=0.025) were risk factors of stroke in CKD. Incidence of carotid atherosclerosis was high (50.37%) in CKD patients, besides it was significantly higher in CKD patients with stroke history as compared to those without stroke history (80.0% vs 47.4%, P<0.01). Conclusions The incidence of stroke is quite high in CKD patients, which is closely associated with hypertension, inflammation and glyeolipid metabolism disorder. Carotid atherosclerosis is common in CKD patients with stroke, which may be helpful in screening cerebrovascular diseases in CKD patients.

Pay close attention to drug-induced lupus / 中西医结合学报

Drug-induced lupus (DIL) is a lupus-like illness that has been recognized as a side effect of over 80 drugs since its first description in association with sulfadiazine in 1945. The epidemiology and clinical course of idiopathic systemic lupus erythematosus and DIL differ markedly, and prognosis is generally favorable in the latter although occasional life-threatening cases have been reported in the literature. Constant pharmacovigilance is crucial for prompt diagnosis and cessation of offending therapy, hence achieving the best outcome. This review discusses the clinical presentation, diagnosis and treatment of DIL so as to call for vigilance of medical workers.

Changes in the nerve conducting velocity and biological indices of workers exposed to low-concentration lead / 中国组织工程研究

BACKGROUND:Whether long time exposure to the lead concentration which is withinthe state allowed range will cause any bad effects on people's health?OBJECTIVE: To investigate the nerve conducting velocity (NCV) and other biological indices of workers who are exposed to low concentration lead.DESIGN: It was an investigation and the subjects were workers exposed to low concentration lead.SETTING: Occupational Disease Department and Electrophysiological Department of Xinhua Affiliated Hospital of the Shanghai Second Medical University.PARTICIPANTS: In lead contact group were 66 heat treatment workers who were exposed to lead and received physical examination from September 2000 to October 2002. In control group were 40 office workers that worked at the same factory but were not exposed to lead.METHODS: Questionnaire and laboratory examination were adopted for measurement of NCV and other biological indices like blood lead, blood zinc protoaetioporphyrin (ZPP), blood free protoporphyrin (FPP) and hemoglobin content in the two groups. And the relative risk analysis was conducted.biological indices in both groups.RESULTS: All the 106 subjects entered analysis stage. In lead contact group there were 34 workers of more than 10 working years and the other ulnar nerve in those of over 10 working years were faster than those in control group [(50.11 ±4.76) m/s, (63.11±2.58) m/s vs (47.59±4.86)m/s,those of over 10 working years was higher than those of less than 10years [(0.568±0.28), (0.425±0.31) μmol/ L, P ＜ 0.05]. So was the FPP level [(2.24±0.32), (2.09±0.27) μmol/L, P ＜ 0.05] and urine lead level [(0.087±0.008), (0.083±0.007) μmg/L, P ＜ 0.05]. The ZPP level of those of over 10 working years was also higher than those less than 10 years [(1.42±0.33) μmol/L vs (1.25±0.35) μmol/L, P ＜ 0.05] and control [(1.42±0.33) μmol/L vs (1.22±0.44) μmol/L, P＜ 0.05]. The hemoglobin of those of over 10 working years was lower than those of less than 10 years [(12.26±4.5) g/L vs (14.55±4.81) μmol/L, P ＜ 0.05] and control [(12.26±4.5) g/L years presented abnormality in conducting sensory signals and the abnormality rate was 3% (1/32). Whereas four cases in those with more than 10working years did so and the abnormality rate was 12% (4/34). As for biological indices, one case in those less than 10 working years was beyond normal values (abnormality rate 3%) and five did so in those of over 10working years (abnormality rate 15%). It could be seen that changes in both NCV and biological indices of those of over 10 working years were more serious than those les than 10 years exposure with the relative risks of 4.1 and 5.3 respectively.CONCLUSION: Persistent exposure to lead not only alters biological indices but also damages nervous system in different degrees. Sensory verve of lower extremities and motor nerves of upper extremities are usually damaged first. Peripheral nerve injury is common in workers of over 10 working years. Because the regeneration of nervous system is poor, so the nerve injury is usually irreversible. Therefore the neuroelectrophysiological changes always predict early nerve injury and so neuroelectrophysiological monitoring can be adopted for prevention of nerve injury.