Effect of forgetting curve based self-management on cognitive function， daily living ability and treatment efficacy of patients with mild cognitive impairment / 四川精神卫生

ObjectiveTo discuss the effect of forgetting curve based self-management on cognitive function， daily living ability and treatment efficacy of patients with mild cognitive impairment （MCI）. MethodsSimple random sampling method was adopted to enroll 162 MCI patients who met the diagnostic criteria of "Expert Consensus on the Prevention and Treatment of Cognitive Impairment in China" in Nanchong Physical and Mental Hospital and Gaoping Ledele Seniors-Oriented Apartment from April 2020 to June 2021. The selected individuals were classified into study group and control group according to random number table methods， each with 81 cases. Both groups received routine intervention， based on this， study group received the forgetting curve based self-management. The interventions lasted for 3 months in two groups， and patients were assessed using Montreal Cognitive Assessment Scale （MoCA） and Activity of Daily Living Scale （ADL） at the baseline and end of interventions. Then the clinical efficacy was compared between groups. ResultsAfter intervention， an increase was found in MoCA and ADL scores in both groups （tcontrol group=25.004， 12.503， tstudy group=48.211， 24.949， P<0.01）， and post-intervention MoCA and ADL scores in study group were higher than those in control group （t=28.527， 9.433， P<0.01）. The overall efficacy rate was 86.42% in control group， which was lower than 96.30% in study group， with statistical difference （χ²=5.004， P<0.05）. ConclusionForgetting curve based self-management may ameliorate the cognitive function and daily living ability in MCI patients， thus improving the treatment efficacy.

Effect of the interaction between estimated glomerular filtration rate and serum uric acid on all-cause and cardiovascular mortality in patients on peritoneal dialysis / 中华肾脏病杂志

Objective:To explore the effect of the interaction between estimated glomerular filtration rate (eGFR) and serum uric acid (SUA) on all-cause and cardiovascular mortality in patients on peritoneal dialysis (PD).Methods:Patients who performed PD catheterization at the PD center of the First Affiliated Hospital of Sun Yat-sen University and had initiated PD therapy for over 3 months from January 2006 to December 2016 were enrolled and followed up until December 2018. Demographic data, baseline clinical and laboratory examination results of the patients were collected. Kaplan-Meier survival curve and Cox regression analysis were used to explore the correlation between SUA and all-cause mortality, cardiovascular mortality in different eGFR groups of PD patients.Results:A total of 2 124 PD patients were enrolled with age of (47.0±15.2) years, among whom 1 269 patients were male and 536 patients had diabetes. The SUA level was (429±96) μmol/L and the median level of eGFR was 6.69(5.17, 8.61) ml·min -1·(1.73 m 2) -1. After a median follow-up time of 42 months, 554 patients died, among whom 275 patients were cardiovascular death. The Cox regression analysis revealed that there was a significant interaction between eGFR and SUA on all-cause mortality ( P=0.043). The Kaplan-Meier curve showed that the tertile 1 (SUA<384 μmol/L) and tertile 3 (SUA>460 μmol/L) group had significantly higher all-cause mortality ( P=0.009) than the reference group of tertile 2 (SUA 384-460 μmol/L) in the higher eGFR group [eGFR>6.69 ml·min -1·(1.73 m 2) -1]but not in the lower eGFR. After adjusting for relevant demographic data, complications, biochemical results and other variables, in patients with higher eGFR, the risk of all-cause mortality increased by 0.2% ( HR=1.002, 95% CI 1.000-1.003, P=0.019) for every 1 μmol/L increase in SUA. In addition, compared with the tertile 2 reference group, the tertile 3 group was independently correlated with higher risk of all-cause mortality ( HR=1.670, 95% CI 1.242-2.245, P=0.001). Conclusions:The eGFR and SUA level significantly interacts with all-cause mortality, and the higher SUA level in higher eGFR group is an independent risk factor for all-cause mortality in PD patients.

Prevalence and determinants of masked hypertension defined by home blood pressure monitoring in peritoneal dialysis patients / 中华肾脏病杂志

Objective:To evaluate the prevalence of masked hypertension defined by home blood pressure monitoring in patients on peritoneal dialysis (PD) and examine its determinants.Methods:The patients who performed PD in the First Affiliated Hospital of Sun Yat-sen University from January 1, 2006 to December 31, 2013 were recruited. Baseline demographic, clinical and biochemical examination data were collected to analyze the prevalence and clinical characteristics in patients with masked hypertension defined by home blood pressure monitoring. Multivariate logistic regression model was used to analyze the related risk factors of masked hypertension in PD patients with clinic normotension.Results:There were 1 425 patients (866 males) enrolled in this study, with age of (46.9±14.9) years and body mass index of (21.6±3.1) kg/m 2. The prevalence of masked hypertension in PD patients was 31.9%, and the prevalence of masked hypertension in patients with clinic normotension was 57.5%. Multivariate logistic regression analysis showed that higher body mass index ( OR=1.057, 95% CI 1.001-1.116, P=0.047), incorporating diabetes mellitus ( OR=1.996, 95% CI 1.160-3.433, P=0.013), use of multiple antihypertensive drugs ( OR=1.336, 95% CI 1.122-1.590, P=0.001) and elevated office blood pressure ( OR=1.785, 95% CI 1.546-2.060, P<0.001) were independent risk factors of masked hypertension in PD patients with clinic normotension. Conclusions:The prevalence of masked hypertension is high in PD patients. Higher body mass index, incorporating diabetes mellitus, use of multiple antihypertensive drugs and elevated office blood pressure are independent risk factors for masked hypertension in PD patients with clinic normotension.

Impact of continuous quality improvement on reducing the incidence of peritoneal dialysis-related peritonitis in patients within the first year of peritoneal dialysis initiation / 中华肾脏病杂志

Objective:To explore the effect of continuous quality improvement (CQI) on reducing the incidence of peritoneal dialysis (PD)-related peritonitis in patients within the first year of PD initiation.Methods:The patients who received catheter placement from January 2006 to December 2016 in our hospital were enrolled in this study. All patients were divided into four groups: pre-CQI group patients who initiated PD treatment from 2006 to 2007 (before CQI phase, group A), CQI Ⅰphrase patients who initiated PD treatment from 2008 to 2010 (group B), CQI Ⅱ phrase patients who initiated PD treatment from 2011 to 2013 (group C), and CQI Ⅲ phrase patients who initiated PD treatment from 2014 to 2016 (group D). The method of plan, do, check and act (PDCA) was conducted to decrease the incidence of PDRP. All the patients were followed up for 12 months or until they withdrew from PD in this period. Poisson analysis was used to compare the incidence of PDRP among the groups.Results:There were 2 383 PD patients recruited in this study, including 346 cases in group A, 850 cases in group B, 688 cases in group C and 499 cases in group D, with an age of (47.1±15.8) years, among whom 59.1% of the patients were male, and 21.4% with diabetes. The follow-up time was (10.9±2.8) months. Compared with group A, the incidence of PDRP was lower than that in group C (0.156 episodes/patient year vs 0.234 episodes/patient year, P=0.020); the incidence of gram positive PDRP decreased (0.052, 0.049, 0.054 episodes/patient year vs 0.104 episodes/patient year, all P<0.05) in group B, C, D; the incidence of gram negative PDRP increased in group B, then decreased in group C and group D (all P>0.05). Cox regression analysis indicated that CQI was independently associated with the incidence of gram positive PDRP ( HR=0.526, 95% CI 0.349-0.792, P=0.002). Conclusion:CQI can effectively reduce the incidence of gram positive PDRP in patients within the first year of PD initiation.

Correlation between serum 25-hydroxyvitamin D3 level and peritoneal dialysis associated peritonitis / 中华肾脏病杂志

Objective:To explore the correlation between serum 25-hydroxyvitamin D3 [25(OH)D3] level and peritoneal dialysis (PD) associated peritonitis, and provide a new idea for the prevention and treatment of peritonitis.Methods:In this single-center retrospective cohort study, patients who were≥18 years old and were treated with regular PD≥3 months in PD center from January 1, 2014 to September 30, 2018 were recruited, except those who had a history of malignant tumors or systemic infectious diseases, transferred from permanent hemodialysis (HD) or failed kidney transplantation. Baseline data including demographic characteristics as well as clinical and biochemical data were collected. All the patients were followed up until death, transfer to HD, kidney transplantation, transfer to other centers or the end of our study (December 31, 2018), and were divided into low tertile [serum 25(OH)D3 ≤12μg/L], middle tertile[12 μg/L<serum 25(OH)D3≤17 μg/L] and high tertile[serum 25(OH)D3 >17 μg/L] according to the baseline serum 25(OH)D3 level. Multivariate adjusted Poisson model was used to evaluate the association between serum 25(OH)D3 level and PD related peritonitis.Results:A total of 642 patients were enrolled in our study, of whom 341 were male (53.12%) , and the age was (47.58±14.10) years old. The serum 25(OH)D3 level was (13.83±6.41) μg/L. As for the primary disease, 67.19% were chronic glomerulonephritis. During a median 42(19, 59) months follow-up period, 232 peritonitis occurred in 139 patients. After adjusting for confounders, including gender, age, albumin, body mass index(BMI), calcium-phosphorus product, intact parathyroid hormone (iPTH), diabetes, charlson index and drug use, multivariate Poisson regression analysis showed that the risk of peritonitis in the middle tertile and the low tertile was 92% (95% CI 0.62-1.38, P= 0.690) and 1.74 times (95% CI 1.19-2.54, P=0.004) of the high tertile respectively. The difference between the low tertile and the high tertile was statistically significant. Conclusions:The level of serum 25(OH)D3 is closely related to the occurrence of PD associated peritonitis. Low level serum 25(OH)D3 is an independent risk factor for peritonitis in PD patients.

Associations of low serum total bilirubin level with all?cause mortality and cardiovascular mortality in peritoneal dialysis patients / 中华肾脏病杂志

Objective To investigate the association of low serum total bilirubin (TBIL) levelwith all?cause mortality and cardiovascular mortality in peritoneal dialysis patients. Methods As a single ? center, retrospective, cohort study, all the patients who underwent peritoneal dialysis catheterization in the Department of Nephrology, the First Affiliated Hospital of Sun Yat?sen University and started peritoneal dialysis for more than 3 months from January 1, 2006 to December 31, 2010 were included. Demographics, baseline clinical and laboratory test results were collected. All patients were followed up until December 31, 2012. Patients were divided into 4 groups according to their baseline serum TBIL levels (interquartile range). Kaplan?Meier method was used to compare the survival rate of each group. Cox regression model was used to analyze the association of TBIL with all?cause mortality and cardiovascular mortality. Logistic regression was used to analyze the influencing factors of low TBIL level. Results A total of 880 peritoneal dialysis patients with baseline TBIL data were enrolled in this study, with age of (48.0 ± 15.4) years old, among whom 59.0％ were male. Median TBIL was 4.5 μmol/L and interquartile range was 3.4?5.8 μmol/L. The comparison between TBIL quartile groups showed that the difference in proportion of diabetics, Charlson comorbidity index, hemoglobin, serum albumin, serum calcium, intact parathyroid hormone, urea nitrogen, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) was statistically significant (all P<0.05), while the difference in body mass index (BMI), estimated glomerular filtration rate, serum creatinine, urea nitrogen, uric acid and phosphorus was not statistically significant. After a median follow?up of 31 months, 194 patients died, 104 of which were cardiovascular deaths. Kaplan?Meier curves showed higher all?cause mortality in patients with TBIL≤3.4 μmol/L (Q1 group) (P=0.032) and there was no statistical difference in the cardiovascular mortality among different groups. After adjusting for biochemical indicators such as demographics, comorbidities, and liver function, taking baseline TBIL Q2 level (3.4<TBIL≤4.5 μmol/L) as a reference, the hazard ratio for all?cause death in patients with TBIL≤3.4 μmol/L was 1.702 (95％CI 1.093-2.650, P=0.019), and the hazard ratio for cardiovascular death was 1.760 (95％CI 0.960-3.227, P=0.068). Multiple logistic regression analysis results showed that diabetes (OR=1.065, 95％CI 1.010-1.122, P=0.019) and high BMI (OR=1.838, 95％CI 1.056-3.197, P=0.031) were risk factors for baseline serum TBIL≤3.4 μmol/L. However, high hemoglobin (OR=0.990, 95％CI 0.982-0.998, P=0.011), high serum albumin (OR=0.950, 95％CI 0.916-0.985, P=0.006) and high ALT (OR=0.998, 95％CI 0.976-0.999, P=0.036) were the protective factors for patients with baseline serum TBIL≤3.4 μmol/L. Conclusion Baseline serum TBIL≤3.4 μmol/L in peritoneal dialysis patients is independently associated with all?cause mortality, and is not significantly associated with cardiovascular mortality; and baseline serum TBIL≤3.4 μmol/L occurred is associated with diabetes, high body mass index, low levels of hemoglobin, serum albumin and ALT.

Prevalence and risk factors of restless legs syndrome in maintenance peritoneal dialysis patients / 中华肾脏病杂志

Objectives To investigate the prevalence and its risk factors of restless legs syndrome (RLS) in maintenance peritoneal dialysis (PD) patients.Methods Patients who performed PD in the First Affiliated Hospital of Sun Yat-sen University were recruited by convenience sampling.International Restless Legs Syndrome Study Group diagnostic criteria and International Restless Leg Syndrome rating scale were used to diagnose and evaluate the RLS and its severity.Co-morbidities level,baseline demographic,clinical and biochemical data were collected to analyze the clinical characteristics of patients with RLS.Multivariate logistic regression analysis was used to assess the risk factors for RLS.Results A total of 421 PD patients were enrolled in this study.Their age was (46.3±12.8) years old,44.2％ were female and 17.3％ with diabetes.The median vintage of PD was 46.8(28.0,73.5) months.The prevalence of RLS was 14.0％,most of whom were affected with moderate or severe RLS.Logistic regression analysis showed that younger age,long-term dialysis duration,higher serum calcium and phosphorus were the risk factors associated with RLS in PD patients after adjustment for confounders (all P ＜ 0.05).Conclusions Prevalence of RLS in PD patients is 14.0％.Younger age,long-term dialysis duration,higher serum calcium and phosphorus were the risk factors associated with

Risk of deep venous thrombosis among patients undergoing knee arthroscopy based on Caprini risk assessment / 中国组织工程研究

BACKGROUND:After arthroscopic knee surgery, deep vein thrombosis easily occurs. Currently, there were no specific clinical manifestations in deep vein thrombosis, so a fast, convenient and reliable risk assessment tool was needed to evaluate the clinical high-risk groups for prevention and intervention. The effectiveness of Caprini Risk Assessment Scale used in thrombosis risk assessment has been confirmed by a large number of researches, but the current domestic research is less. OBJECTIVE:To verify the validity of Caprini risk assessment scale in evaluations of high deep venous thrombosis risk patients among knee arthroscopy patients, and to explore effective strategies for prevention of deep vein thrombosis in patients undergoing knee arthroscopic surgery. METHODS: A case-control study design was used to colect 49 deep vein thrombosis patients admitted to the Department of Orthopedics, Renhe Hospital of Three Gorges University from January 2008 to June 2015 as case group, and randomly selected 98 patients admitted during the same period of non-deep vein thrombosis patients as control group. Caprini risk assessment scale was used to assess risk assessment and risk grading of deep venous thrombosis, and to explore the correlation between risk classification and risk of deep vein thrombosis. RESULTS AND CONCLUSION: (1) Basic conditions comparison: application time of tourniquet, the proportion of smoking patients, and proportion of deep venous thrombosis and (or) the history of pulmonary thromboembolism were higher in the case group than in the control group (P < 0.05). (2) Caprini score was significantly higher in the case group than in the control group (P < 0.001). In the case group, the proportion of very high risk patients (53%) was highest, folowed by high risk (25%), totaly 78%. In the control group, the proportion of high risk patients (32%) was highest, folowed by low risk (29%). Significant differences in above risk degree analysis were identified between the two groups (P< 0.001). (3) Deep venous thrombosis and (or) the history of pulmonary thromboembolism was positively correlated with Caprini score in the case and control groups (P < 0.05). Caprini score was positively associated with application time of tourniquet in the case group (P< 0.05). (4) Logistic regression analysis of Caprini risk classification and the risk of deep vein thrombosis: with increased caprini risk classification, the risk of deep vein thrombosis increased significantly. The risk of deep venous thrombosis in patients with high risk and very high risk was 2.130 and 11.786 times of patients with low risk, respectively. (5) These results indicate that Caprini risk assessment model can effectively assess the risk of deep vein thrombosis among patients receiving knee arthroscopy.

The introduction of peritoneal dialysis nursing model of Home Dialysis Unit in the affiliated hospital of Colorado University / 中国实用护理杂志

This article introduced the peritoneal dialysis nursing model of Home Dialysis Unit in the affiliated hospital of Colorado University,including:overall status,setting and distribution,responsibilities of staff,work model of PD (pre-dialysis education,catheter insertion,CAPD/CCPD training,clinic visit model,home visit model,etc),and explored the enlightenment of this model on PD nursing in our country.This model provided references for dialysis center distribution,staff arrangement,pre-dialysis education,home visit,increase of social support and so on.

Clinical characters of peritoneal dialysis-related staphylococcus peritonitis / 中华肾脏病杂志

Objective To provide evidence for clinical diagnosis and treatment of staphylococcus peritonitis through retrospective analysis of peritoneal dialysis related clinical characters. Methods Patients who experienced staphylococcus peritonitis were observed as peritonitis group.Patients did not experience peritonitis were observed as one-to-one control group in order to investigate predictors of staphylococcus peritonitis,bacteria spectrum,antimicrobial resistance and clinical outcomes. Results There were 74 patients enrolled in either group.For patients in peritonitis group,Kt/V(1.74±0.03 vs 2.61±0.48,P＜0.01),CrCL[(55.82±2.22) ml/min vs (76.13±17.42) ml/min,P＜0.01],GFR [(1.32±0.55) ml/min vs (3.08±0.75) ml/min,P＜0.01],nutrition index,hemoglobin[(91.70±25.43) g/L vs (111.50±19.59) g/L,P＜0.01],potassium[(3.43±0.70) mmol/L vs (3.78±0.73) mmol/L,P=0.002],sodium [(137.09±5.06) mmol/L vs (140.57±3.55)mmol/L,P＜0.01],chloride [(98.31±6.14) mmol/L vs (101.52±4.58) mmol/L,P=0.001] and calcium [(2.23±0.24) mmol/L vs (2.31±0.22) mmol/L,P=0.04] in serum were significantly lower than those in control group.The morbidity of staphylococcus peritonitis was 0.030 episode per year in recent five yearn.The major strains were Staphylococcus epidermidis,followed by Staphylococcus aureus.Staphylococci were all sensitive to vancomycin,teicoplanin and linezolid.The cure rate was 89.19％,and mortality was 4.05％.Relapse rate of Staphylococcus epidermidis peritonitis was higher (40％) than other strains. Conclusions Poor nutrition,insufficient dialysis,longer followup interval,anemia,electrolytic imbalance are the risk factors of Staphylococcus peritonitis.The morbidity and mortality are lower than before.Staphylococcus epidermidis peritonitis has higher relapse rate and requires more attention to prevention and treatment.

Effect of follow-up frequency on the dialysis quality of peritoneal dialysis patients / 中国实用护理杂志

Objective To investigate the effect of follow-up frequency on the dialysis quality of patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods 298 CAPD pa-tients were selected for retrospective analysis from December 2005 to April 2007. All patients were di-vided into two groups according to different follow-up frequency: group A (shorter than 3 months),group B (longer than 3 months). The dialysis quality of the two groups was compared. Results The levels of hemoglobin, albumin and transferrin of group A were (112.19±20.62)mmol/L, (40.45±4.50) retool/L, (2.43±0.29) mmol/L,which were significantly higher than those of group B, (99.63±20.69) mmol/L, (38.01±5.02)mmol/L,(2.29±0.36) mmol/L (P＜0.05). In addition, edema level, life self-care,work capacity, median duration of dialysis, education level and address in group A were significantly different from those of group B (P ＜ 0.05). Conclusion Shortening follow-up frequency plays an im-portsnt role in improving the dialysis quality of CAPD patients.