Advances in the classification and treatment of isolated superior mesenteric artery dissection / 中华外科杂志

Isolated superior mesenteric artery dissection (ISMAD) has attracted more and more clinicians' attention in recent years. Patients onset of ISMAD often present with abdominal pain. The misdiagnosis or miss diagnosis is common because of the non-specific symptoms and signs, which even can endanger lives in serious cases. Imaging classification is of great significance for diagnosis and treatment of ISMAD. The Sakamoto classification and the Yun classification are two classical classified methods. However, with the further study of ISMAD, various new classifications emerge. Conservative treatment was once considered as the preferred. As the rapid development of endovascular therapy and the great progress of new devices, stenting therapy can significantly improve symptoms and achieve satisfactory long-term effects, and be even expected to become the preferred method for clinical therapy of ISMAD. However, the long-term effects of endovascular therapy still need a large number of follow-up data, and complications after stent implantation can't be ignored.

Correlation of the renal function changes to prognosis in critical patients with COVID-19 / 解放军医学杂志

Objective: To get the message of kidney injury and its causes in patients with COVID-19, and analyze the correlation of kidney injury to COVID-19 typing and prognosis, so provide a reference for the treatment and prognosis evaluation of COVID-19. Methods: According to the retrospective cohort study protocol, the clinical data and prognosis of 319 confirmed patients with COVID-19, admitted in the General Hospital of Central Theater Command (Wuhan) from Jan. 1st to Mar. 14th, 2020, were collected. The correlation of COVID-19 patients' renal function changes to the classification and prognosis of diseases were analyzed using univariate and multivariate logistic regression analysis. Results: The mean age of the 319 confirmed patients with COVID-19 was (55.2±17.0) years. The proportion of non-critical group (mild+moderate type) and critical group (severe+critical type) were 62.1% (198/319) and 37.9% (121/319), respectively. The fatality rate of present study cohort was 5.6% (18/319). About 3.8% cases (12/319) were with elevated blood urea nitrogen (BUN) and serum creatinine (SCr) at admission, and about 5.6% cases (18/319) were with elevated BUN only at admission. Univariate logistic regression analysis revealed that the age, the levels of SCr and BUN at admission and one week after admission, the combination of diabetes mellitus, and chronic kidney disease were the risk factors associated with the death in critical group patients (P<0.05). Multivariate logistic regression analysis revealed that the elevated levels of BUN at admission and one week after admission were the independent risk factors of death in the critical group patients. Conclusions: The elevated levels of BUN at admission and one week after admission were the important clinical features and independent risk factors associated with the death of critical COVID-19 patients. More attention should be paid to all kinds of clinical factors that may lead to increase the level of BUN.