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Objective:To explore the clinicopathologic features and risk factors of IgA nephropathy (IgAN) after kidney transplantation.Methods:A retrospective analysis was conducted for biopsy-confirmed IgAN patients after transplantation from January 2016 to September 2019. The clinicopathological characteristics and risk factors of IgAN after expanded criteria donor (ECD) donor for kidney transplantation were examined by statistical analysis of general clinical data and Oxford classification during and after transplantation.Results:The diagnostic rate of IgAN after transplantation was around 12.77%. The clinical symptoms occurred at an average of 22.5 months after transplantation. 66.67%(12/18) patients were in stage 3-4 chronic kidney disease (CKD). There were microscopic hematuria (76.92%) and varying degrees of proteinuria (88.89%). The scores of pathological parameters were as follows: 78% patients with mesangial cell proliferation (M1), 17% with endothelial cell proliferation (E1), 65% with segmental sclerosis (S1), 39% with moderate-to-severe tubules atrophy/interstitial fibrosis (T1/T2) and 17% with crescent formation (C1) respectively. Tubuloatrophy/interstitial fibrosis was associated with estimated glomerular filtration rate (eGFR) at biopsy ( P<0.05). Group of urine protein quantification >1g/d and group of <1g/d group had statistically significant differences in segmental sclerosis and adhesion lesion ( P<0.05). Conclusions:Oxford classification is valuable in the clinical evaluations of allograft IgAN: Tubular atrophy/interstitial fibrosis is associated with a decline of glomerular filtration. And segmental sclerosis and adhesion lesion are correlated with the severity of proteinuria.
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Objective To evaluate the morbidity and the influence factors of the geriatric syndrome in the elderly inpatients. Methods The characteristics of comprehensive geriatric assessment of180 elderly inpatients (83 male and 97 female) with age older than 65 in geriatric department from November 2014 to November 2015 were analyzed. Results Of 180 elderly patients, the incidences of visual loss, multiple co-morbidity, polypharmacy, impairment in activities of daily living, urinary incontinence, chronic constipation and chronic pain were 86.11%(155/180), 85.56%(154/180), 82.78%(149/180), 56.11%(101/180), 49.44%(89/180), 46.67%(75/180) and 42.22%(76/180). Female patients had more incidences compared with male in urinary incontinence [56.70%(55/97) vs. 40.96%(34/83)], chronic pain [56.70% (55/97) vs. 25.30%(21/83)] , impairment in activities of daily living [64.95%(63/97) vs. 45.78%(38/83)] and high risk of falling [43.30%(42/97) vs. 21.69%(18/83)], and there were significant differences (P<0.05). In addition, it was found that with the increasing of age, the incidences of hearing loss and chronic constipation, as well as medications were accordingly higher. When the patients′education level was higher, the incidences of urinary incontinence and impairment in activities of daily living were generally declined. Compared with non-diabetes mellitus group, diabetes mellitus group had higher incidences of comorbidities, multiple co-morbidity, medications, polypharmacy and impairment in activities of daily living:(10.59 ± 3.72) kinds vs. (8.29 ± 4.03) kinds, 94.59%(105/111) vs. 71.01%(49/69), (10.07 ± 3.77) kinds vs. (6.87 ± 3.07) kinds, 89.19%(99/111) vs. 72.46%(50/69), 62.16%(69/111) vs. 46.38% (32/69). With the increasing of the numbers of diabetes- related chronic complications, the incidences of visual loss, chronic constipation and multiple co- morbidity, comorbidities and medications were higher (P<0.05). Conclusions Geriatric syndrome such as visual loss, multiple co- morbidity, polypharmacy, impairment in activities of daily living and urinary incontinence are very common in the elderly inpatients. Elderly patients with diabetes mellitus are much easier to suffer from geriatric syndrome such as multiple co-morbidity, polypharmacy and impairment in activities of daily living.
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Objective To investigate the expression and clinicalsignificance of neutrophils heparin binding protein (HBP) and CD64 in the chronic obstructive pulmonary disease to explore the clinical value. Methods From March 2015 to December 2015 , 197 patients with chronic obstructive pulmonary disease (COPD), 223 patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and 265 healthy persons were recruited in this study. 223 patients with AECOPD were divided into two groups based on bacteria concentration in lower respiratory. Infection group was defined as patients with bacteria concentration exceeded 107 cfu/mL group. The rest of patients were in the non-bacterial infection group. Flow cytometry was used to analyzeexpression of CD64 and convert to index of CD64. Enzyme-linked immunosorbent assay (ELISA) was used to analyze expression of HBP. PCT, hs-CRP and WBC were measured at the same time. Results CD64 , HBP , CRP , WBC and PCT were highly expressed inthe acute exacerbation of chronic obstructive pulmonary patients than those in the chronic obstructive pulmonary patients and healthy group (P<0.01). CD64, HBP , CRP , WBC and PCT were highly expressed inthe acute exacerbation of chronic obstructive pulmonary bacterial infection group patients before treatment than thenon-bacterial infection group (P<0.01). HBP, CD64, CRP , WBC and PCT decline dramatically inthe AECOPDbacterial infection group patients after treatment , which were close to the levels in non-bacterial infection group.When the intercept value of CD64 index was defined as 4.0, the sensitivity to diagnose AECOPD bacterial infection was 92.2% with specificity of 86.2%. When the intercept value of HBP index was defined as 49 ng/mL , the sensitivity to diagnose AECOPD bacterial infection was 87.3% with specificity of 92.3%. Therefore, 4.0 of CD64 index and 49ng/ml of HBP index could be used as sensitive indicator of AECOPD detectedby bacterial infections. Conclusion HBP,CD64 were highly expressed in the acute exacerbation of chronic obstructive pulmonary patients than the those of chronic obstructive pulmonary patients and healthygroup, and decline dramatically after treatment. HBP and CD64 has high sensitivity and specificity to diagnose AECOPD bacterial infection. HBP and CD64 could be used as the indicators of auxiliary diagnosis of acute exacerbation of chronic obstructive pulmonary disease and to guide the clinical medication.
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Objective To study the clinical significance of plasma N-teminal pro brain natriuretic peptide (NT-pro-BNP) level in diagnosis and evaluation prognosis of patients with different heart failure.Methods Plasma NT-pro-BNP level was detected and compared in all patients at the first day and a week after the patients' condition turn better.Results The level of plasma NT-pro-BNP for the high blood pressure's heart disease and the chronic heart failure of coronary heart disease and the chronic heart failure of cor pulmonale were significantly higher than normal (t =2.98,t =2.98,t =2.98,P ＜ 0.01).The level of plasma NT-pro-BNP was reduced after treatment (t =2.56,t =2.75,t =2.88,P ＜ 0.05,P ＜ 0.01,P ＜ 0.01).The level of plasma NT-pro-BNP was gradually increased by the increased degree of the heart failure(t =2.78,P ＜ 0.05).Conclusion The levels of plasma NT-pro-BNP at acute stage for the high blood pressure's heart disease and the chronic heart failure of coronary heart disease and the chronic heart failure of cor pulmonale were increased obviously and descend by the patients' condition return.The level of plasma NT-pro-BNP can monitor patients' condition and estimate the heart failure patients' prognosis.
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Objective To investigate the curative effect of noninvasive positive pressure ventilation combined with aerosol inhalation of budesonide on patients with severe asthma.Methods One hundred and twenty-one patients with severe asthma were randomly assigned to two groups.Both groups were treated with noninvasive positive pressure ventilation based on routine treatment.In addition,patients in the treatment group were given aerosol inhalation of 2 ml budesonide and 2 ml NS,two times each day,14 days for a course.Clinical symptoms improvement and arterial blood pressure changes of two groups before and after treatment were studied to compare the curative effect of the treatments in the two groups.Results There were no significant differences in pH,PaO2 and PaCO2 between the treatment and the control groups(P ＞ 0.05).After one course of treatment,the treatment group had significantly higher levels of pH(7.43 ± 0.04 vs.7.34 ± 0.02,t =3.423,P ＜ 0.05) and PaO2 ( [77.4 ± 16.7 ] mm Hg vs.[ 62.4 ± 16.5 ] mm Hg,t =3.414,P ＜ 0.05 ) and lower levels of PaCO2 ( [43.4 ±8.9] mm Hg vs.[50.9 ± 9.1 ] mm Hg,t =5.317,P ＜ 0.05 ) than the control group.There were significant differences in the total effective rate between the Budesonide group and the control group (96.7％ vs.88.3％,x2 =4.218,P ＜ 0.05 ).Conclusion Noninvasive positive pressure ventilation combined with aerosol inhalation of budesonide is a simple and effective strategy for patients with severe asthma.Thus it may be worthy to be widely used clinically.
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Objective To explore influence of noninvasive positive pressure ventilation treatment on the brain natriuretic peptide(BNP) level of patients with pulmonary heart disease.Methods 104 patients with pulmonary heart disease were randomly divided into two groups,control group ( conventional therapy) and study groups ( noninvasive ventilation),each group 52 cases.The BNP level of the two groups before and after treatment were detected and compared.Results After treatment,the BNP level in the two groups were all decreased,and the BNP level of the study group was( 197.8 ± 39.6) ng/L,which was significantly lower than that of the control group[ (320.9 ± 43.0 ) ng/L ]( t =3.22,P ＜ 0.05).Conclusion Noninvasive positive pressure ventilation treatment could effectively reduce BNP level in patients with pulmonary heart disease.
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Objective To observe the clinical curative effect of chronic heart failure (CHF) treated by noninvasive positive pressure ventilation ( NPPV). Methods 48 cases of CHF were randomly assigned to conventional drug treatment under oxygen (control group, n = 24) and non-invasive positive pressure ventilation ( NPPV) under the conventional therapy group (observation group, n =24). The plasma N-brain natriuretic peptide( proN-BNP) and cardiac function changes in two groups before and after treatment were observed. Results The total effective rate 92% in observation group was significantly higher than 66% in control group ( x2 =3. 7851, P ＜ 0. 05 ) ; The plasma proNBNP、respiratory rate and heart rate after treatment in two groups were lower than before treatment(t = 2.787,2.815, 2. 856,2.789,2.804,2.840,all P＜0.01) ;The plasma proN-BNPand heart rate in observation group after treatment were lower than the control group(t =2.123,2.221,all P ＜0.05). Conclusion Noninvasive positive pressure ventilation could significantly improve heart function,reduce plasma proN-BNP and enharce curative effect.
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Objective To study the influence of BiPAP on lipid level in patients with chronic heart failure of coronary heart disease.Methods 20 patients with chronic heart failure of coronary heart disease were taken BiPAP:Blood samples were taken from forearm vein before and 4 weeks and 12 weeks after treatment,the lipid level was measured and compared.Results The observation group of The coronary heart disease with chronic heart failure in pre-treatment serum level of total cholesterol(TC)(7.47±0.12)mmol/L,triglycerides(TG)(3.52±0.13)mmol/L,low-density lipoprotein cholesterol(LDLc)(3.73 ±0.11)nmmol/L,apolipoprotein-B(Apo-B)(1.37±0.02)g/Lwere significantly lower than 14 weeks after treatment TC(4.5±0.03)mmol/L,TG(2.6±0.02)mmol/L,LDLc(2.8±0.06)mmol/L,Apo-B(1.02±0.02)g/L)(t=2.154,t=2.278,t=2.311,t=2.347,P all<0.05) in coronary heart disease with chronic heart failure;The observation group after treatment 14 weeks of HDL-CH(1.45±0.02)mmol/Land Apo-A(1.21±0.03)g/L lower than before treatment HDLc(1.05±0.01)mmol/L,Apo-A(0.87±0.01)g/L(t=2.234,t=2.318,P all<0.05) in coronary heart disease with chronic heart failure.Conclusion BiPAP therapy could effectively to ameliorate lipid metabolism in patients with chronic heart failure of coronary heartdisease in the long term.
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Objective To evaluate the diagnostic value of Doppler sonography in occult carcinoma of the thyroid(OCT) and its ultrasound features.Methods Uhrasonography and clinical data of 80 cases with OCT confinned by operative pathology were analyzed retrospectively.Results In 80 cases with OCT,a single cancer nodules in 45 cases(56.3%),more than 35 cases of cancer nodules(43.8%);In 135 focus imaging,among border not clear 64 focus(47.7%),the border clear no envelope of 66 focus (48.9%),the border clearance of a halo 5 focus (3.7%);The nodules were slightly lower echo of 100 focus(74.1%),mixed 28 focus(20.7%),slightly stronger echo of 7 focus(5.2%);35 cases of a cancer;the 50 focus showed nodules with blood flow,in which rich 35 focus (70.0%),strip-signal blood flow 14 focus(30.0%);In 35 cases with OCT,among nodular micro-calcification appeared in the 31 cases(88.6%),coarse calcification in 3 cases(9.7%),1 case of arc-shaped calcification(2.9%).Conclusion The diagnosis value of high-frequency sonography was significance in patients with OCT.