Analysis of etiological composition and changing trend of chronic kidney disease / 中华健康管理学杂志

Objective:To analyze the etiological composition and changing trends in chronic kidney disease.Methods:CKD patients from our hospital were in cluded in the study from three separate periods, 173 patients from 1990-1991, 956 patients from 2009-2010, and 1440 patients from 2018-2019. The etiology of CKD in patients between the younger and middle-aged group and the elderly group were compared using the χ2 test, and the Bonferroni method was used to correct the pairwise comparisons.Results:The leading cause of CKD in 1990-1991, 2009-2010, and 2018-2019 was chronic glomerulonephritis (52%), chronic glomerulonephritis (35%), and diabetes (36%), respectively. The distribution of the etiologies was different signficantly among the three cohorts (χ2=74.375, P<0.001). Compared with 1990-1991, the percentage of CKD related to diabetes (χ2=14.847, P=0.001) and hypertension (χ2=12.279, P=0.002) significantly increased, while chronic glomerulonephritis showed a downward trend (χ2=19.976, P<0.001). Among the elderly CKD patients, the leading cause of CKD in the three cohorts was chronic glomerulonephritis (34%), diabetes (40%), and diabetes (43%), respectively. Conversely, diabetes and hypertension have become the predominant causes in 2009-2010 and 2018-2019. Although chronic glomerulonephritis remained the leading cause of CKD in the past 30 years, the percentage declined gradually among the younger and middle-aged patients with CKD. The percentage of CKD related to diabetes (χ2=31.345, P<0.001) and hypertension (χ2=15.485, P<0.001) significantly increased. In addition, in the 2018-2019 cohort, there were 494 patients with end-stage renal disease (ESRD), and the percentage of ESRD related to diabetes and hypertension were 48% and 37%, respectively. Conclusion:Diabetes and hypertension have become the predominant causes of CKD in Chinese elderly patients. Although chronic glomerulonephritis was the leading cause among the younger and middle-aged patients with CKD, the percentage declined gradually. Additionally, diabetes and hypertension were also the predominant causes of ESRD.

Clinical value of arterial first approach in laparoscopic pancreaticoduodenectomy for periampullary tumor / 中国医师进修杂志

Objective To investigate the clinical value of arterial first approach in laparoscopic pancreaticoduodenectomy (LPD) for periampullary tumor. Methods The data of 134 patients with periampullary tumor who had underwent LPD between February 2014 and August 2017 were collected. The patients were divided into 2 groups by random digital table method, with 67 cases in each group. The experimental group received arterial first approach LPD, and the control group received traditional approach LPD. The intraoperative, postoperative and survival situations were compared between 2 groups. Follow- up using outpatient examination and telephone interview was performed to detect the tumor- free survival up to February 2018. Results All the patients underwent successful LPD. The time of tumor resection with superior mesenteric venous invasion, volume of intraoperative blood loss and volume of blood transfusion in experimental group were significantly lower than those in control group: (215.6 ± 12.3) min vs. (263.4 ± 21.2) min, (98.9 ± 15.6) ml vs. (130.1 ± 26.7) ml and (1.4 ± 0.9) U vs. (2.9 ± 1.3) U, and there were statistical differences (P<0.05). The rate of R0 resection in experimental group was significantly higher than that in control group: 97.0％ (65/67) vs. 88.1％ (59/67), and there was statistical difference (P<0.05). There was no statistical difference in postoperative 6- month tumor- free survival rate between 2 groups (P>0.05). Conclusions Arterial first approach in LPD can significantly reduce the volumes of intraoperative blood loss and blood transfusion, shorten the time of tumor resection with superior mesenteric venous invasion, and increase the rate of R0 resection.

Standardization and application on ribotyping library of Clostridioides difficile in China / 中华流行病学杂志

Objective@#To establish a standard operation procedure (SOP) for ribosome genotyping (ribotyping) on Clostridioides (C.) difficile, supplement and verify ribotyping typing library, so as to improve the comparability of data between different laboratories and to develop surveillance network of C. difficil in China.@*Methods@#Molecular typing of 54 reference strains from the United States and Europe of C. difficile were performed by using the SOP referencing correspondence from abroad and from our laboratory with a BioNumerics 7.6 software to estimate the reference library of types of C. difficile. Identification of 374 clinical and animal isolates of C. difficile from 13 cities in China between 2010 and 2018, to supplement the library information. Kappa test was used to evaluate the consistency.@*Results@#Results of capillary electrophoresis of reference strains appeared clear and stable, which guaranteed the clustering results being fast and accurate. Results from the supplementary typing showed that there were 84 types of isolates, of which 25 RT types were consistent with reference strains from abroad, while 58 RT types were different from referenced types. In the 40 referenced types, 15 RT types were not found in this study. In the consistency evaluation, the Kappa value was 0.891 and (P<0.01), showing the two Molecular typing as consistent and with close resemblance.@*Conclusions@#The result of capillary electrophoresis by applying SOP for ribotyping on C. difficile base on QIAxcel capillary electrophoresis system, appeared clear and stable. The standardized library seemed more easily used for comparability and data sharing between the laboratories.

Nutritional treatment for elderly chronic kidney disease patients with diabetes / 中国实用内科杂志

Nutritional treatment is of great importance for chronic kidney disease(CKD), with its particularity for elderly patients with diabetes. Low-protein diet, as the core of the nutritional treatment, is expected to improve the prognosis of elderly CKD patients with diabetes. However, considering its higher risk of malnutrition, blood glucose elevation and depression in these patients, appropriate protein limitation and in-time nutritional status assessment should be emphasized.Meanwhile, the weak compliance of low-protein diet in elderly patients should be improved. Since elderly CKD patients with diabetes are likely to suffer from many other complications, individual ized nutritional therapy should be prescribed according to the nutritional status of the patient.

Correlation of Serum Uric Acid and Microalbuminuria with Chronic Vascular Disease in Type 2 Diabetes Mellitus / 中国医科大学学报

Objective To assess the correlation of serum uric acid (SUA) and microalbuminuria (MAU) with chronic vascular disease in type 2 diabetes mellitus (T2DM). Methods The study enrolled 892 T2DM patients. The association of different SUA and MAU levels with the incidence of chronic vascular disease was evaluated. Chronic vascular disease included coronary artery disease (CAD),cerebrovascular disease (CVD),diabetic nephropathy (DN),diabetic retinopathy (DR),and diabetic peripheral neuropathy (DPN). Results With increasing levels of SUA and MAU,the incidence of chronic vascular disease increased. In addition,the level of SUA was positively correlated with the incidence of CAD,CVD,DN,DR,DPN,and total chronic vascular disease,while the MAU level was positively associated with the incidence of CAD,CVD,DR,DPN,and total chronic vascular disease. Multivariate logistic regression analysis revealed that SUA level was an independent predictive risk factor for patients with concurrent CAD,CVD,DN,DR,DPN,and total chronic vascular disease,and MAU level independently predicted the risk of CAD and CVD. Conclusion The levels of SUA and MAU may be reliable biomarkers for prediction of the risk of chronic vascular disease in T2DM patients.

Clinicopathology characteristics of idiopathic membranous nephropathy in elderly patients / 中华全科医师杂志

Objective To investigate the clinicopathological characteristics of idiopathic membranous nephropathy (IMN) in elderly patients.Methods Clinicopatholigical data of 400 patients with IMN identified by renal biopsy from January 2006 to December 2016 were analyzed retrospectively.The patients were divided into three groups:the young (≤44 years old),the middle-aged (45-59 years old) and the elderly (≥60 years old),and the clinicopathological characteristics were compared among three groups.Results The average age of the elderly group was (64.9 ± 4.3) years,the elderly group had worse renal function than the young group (F =784.60,P =0.000) and the middle-aged group [estimated glomerular filtration rate (eGFR) were (91.1 ± 25.9) 、(119.8 ± 37.0) and (102.5 ± 33.2) ml · min-1 · 1.73 m-2,F =21.74,P =0.000].The incidence of hypertension was higher in the elderly group than the other two groups [40.0％ (32/80) vs.19.6％ (30/153) and 22.2％ (37/167),x2 =12.76,P =0.003].The incidence of MN with ischemic nephropathy and tubulointerstitial lesion in the elderly group was higher than in the young group[15.0％ (12/80) vs.5.8％ (9/153),x2 =5.31,P =0.021].Conclusion The elderly patients with IMN are likely to be complicated with hypertension,ischemic nephropathy and tubulointerstitial lesions indicating poorer prognosis,so more attention should be paid to the early diagnosis and treatment of these comorbidities.

Effect of Irbesartan on Delaying Progression of Nephropathy in Patients with Concurrent Diabetic Nephropathy and Hypertension / 中国医科大学学报

Objective To evaluate the effect of irbesartan treatment on progression of nephropathy in patients with concurrent diabet-ic nephropathy (DN) and high blood pressure (HBP).Methods This study enrolled 180 patients with DN and HBP in a single-center,randomized,parallel group clinical trial.All patients were randomized in a 1 ∶ 1 ratio to irbesartan and amlodipine groups,using a software-generated block randomization method.Results After 12 months of treatment,the estimated glomerular filtration rate (eGFR) in the irbesartan group was markedly lower than in the amlodipine group (P =0.026).When grouped according to the Chronic Kidney Disease (CKD) Epidemiology Collaboration equation,results showed that in stage 1-2 CKD and stage 3 CKD patients,reductions in eGFR in the irbesartan group were notably less than in the amlodipine group (P =0.009 and P =0.028,respectively).At 12 months,the decrease in urinary protein excretion (g/24 h) in the irbesartan group was obviously greater than in the amlodipine group (P ＜ 0.001);however,no difference in reduction of systolic and diastolic BP was found between groups (P =0.534 and P =0.386,respectively).Conclusion Irbesartan can ameliorate the progression of nephropathy in patients with concurrent DN and HBP to some extent.

Study on virulence factors of Candida tropicalis isolated from clinical samples / 中华流行病学杂志

Objective To determine the in vitro production of virulence factors for Candida (C.) tropicalis,including aspartyl proteinases,phospholipases and hemolytic activities,describe the regulation of virulence factors varying with time in C.tropicalis,and analyze the differences in aspartyl proteinases and hemolytic activities of C.tropicalis isolated from anatomically distinct sites.Methods A total of 64 C.tropicalis strains were spot-inoculated onto bovine albumin agar,egg yolk agar and sheep blood agar plates,respectively.Then the plates were incubated for 24,48 and 72 hour at 37 ℃,respectively.The aspartyl proteinases,phospholipase and hemolytic activities were determined at each time point,respectively.Results All the C.tropiclais isolates showed positive aspartyl proteinases and hemolytic activities at each time point,but no phospholipases activity was detected in C.tropicalis.On comparison of aspartyl proteinases and hemolytic activities at different time points,aspartyl proteinases activity at 48 and 72 hour was higher than that at 24 hour.During 72 hour,hemolytic activity of C.tropicalis increased.No statistical significant differences in aspartyl proteinases and hemolytic activities of C.tropicalis were observed among different infection sites (P=0.368 and 0.985).Conclusion The C.tropicalis clinical isolates in China have aspartyl proteinases activity,hemolytic activity,but have no phospholipase activity.

Study on genotype and virulence of Cryptococcus neoformans and Cryptococcus gattii clinical isolates in Guigang, Guangxi Zhuang Autonomous Region / 中华流行病学杂志

<p><b>OBJECTIVE</b>To understand the species, genotypes and mating types of Cryptococcus neoformans and Cryptococcus gattii isolated from clinical samples in Guigang, Guangxi Zhuang Autonomous Region.</p><p><b>METHODS</b>A total of 20 Cryptococcus strains were isolated from clinical samples in Guigang from 2009 to 2012. The biological identification was conducted by polymerase chain reaction (PCR) to amplify internal transcribed spacer (ITS) sequences. The serotypes and mating types of C. neoformans and C. gattii were identified by PCR with serotype-specific and mating type-specific primers. The genotype was characterized by PCR fingerprinting and URA5 gene restriction fragment length polymorphism (URA5-RFLP). Phenotype study included growth test at 37 °C, melanin production test and urease test.</p><p><b>RESULTS</b>Among the 20 strains, 19 (95%) were identified as C. neoformans varieties (var.) grubii (serotype A, mating type α, genotype VN I), and only 1 was identified as C. gattii (mating type α, genotype VG I). The results of virulence test showed that all the strains grew well at 37 °C and positive in both urease test and melanin production test.</p><p><b>CONCLUSION</b>C. neoformans var. grubii (serotype A, genotype VN I and mating type α) was the predominant pathogen causing cryptococcosis in Guigang, and C. gattii strain was also detected.</p>

The clinical value of plasma M type phospholipase A2 receptor antibody and IgG subtypes deposition in diagnosis of hepatitis B virus-associated membranous nephropathy / 国际检验医学杂志

Objective To investigate the different expressions of plasma M type phospholipase A2 receptor antibody and IgG subtypes deposition of kidney tissues in idiopathic membranous nephropathy and hepatitis B virus-associated membranous nephropa-thy,and to evaluate the significance of plasma M type phospholipase A2 receptor antibody and IgG subtypes in diagnosis of hepatitis B virus-associated membranous nephropathy.Methods Plasma samples were obtained from patients with idiopathic membranous nephropathy,hepatitis B virus-associated membranous nephropathy and minimal change disease,respectively,before immunosup-pressive therapy.Concentration of plasma M type phospholipase A2 receptor antibody was detected by sandwich ELISA and concen-tration of IgG subtypes were measured by immunofluorescence.Results Concentration of plasma M type phospholipase A2 receptor antibody was (15.4±7.2)μg/mL in idiopathic membranous nephropathy group,higher than that in the hepatitis B virus-associated membranous nephropathy group (10.3±5.7)μg/mL (P <0.01),between idiopathic membranous nephropathy group and hepatitis B virus-associated membranous nephropathy group.There was no distinct difference of IgG subtypes deposition in glomerlar capil-lary wall.Conclusion There is obvious clinical significance of concentration of plasma M type phospholipase A2 receptor antibody in differential diagnosis of idiopathic membranous nephropathy and hepatitis B virus-associated membranous nephropathy,while no distinct significance of IgG subtypes deposition.

Baseline proteinuria, urinary osmotic pressure, and renal function as positive predictors of corticosteroids plus cyclophosphamide treatment efficacy in IgA nephropathy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Very limited data are available on factors predictive of corticosteroids plus cyclophosphamide treatment efficacy on IgA nephropathy (IgAN). The aim of the study was to research the clinical factors predictive of treatment efficacy in IgAN.</p><p><b>METHODS</b>One hundred and fifty-nine patients with IgAN (proteinuria ≥2 g/d and estimated glomerular filtration rate 30-89 ml×min(-1)×1.73 m(-2)) were treated with corticosteroids/cyclophosphamide followed by a 12-month follow-up. According to their response, these patients were divided into remission group (proteinuria <0.5 g/d) and non-remission group (proteinuria ≥0.5 g/d), and their clinical data collected.</p><p><b>RESULTS</b>In the present study, 72.96% of the individuals underwent a complete remission, and their response was related to baseline proteinuria, urinary osmotic pressure, and renal function (P < 0.05). Patients with baseline proteinuria more than 3 g/d, urinary osmotic pressure greater than 600 mOsm/L, and eGFR 60-89 ml×min(-1)×1.73 m(-2) responded well to the combination of corticosteroids and cyclophosphamide (86.90% vs. 57.33%, P = 0.000; 81.48% vs. 64.10%, P = 0.014; 83.17% vs. 55.17%, P = 0.000).</p><p><b>CONCLUSION</b>The response to the combination of corticosteroids and cyclophosphamide might be well associated with baseline proteinuria, urinary osmotic pressure, and renal function in patients with IgAN.</p>

Clinicopathology of 202 diabetes mellitus patients complicated with non-diabetic renal diseases / 中华肾脏病杂志

ObjectiveTo investigate the clinicopathological characteristics of non-diabetic renal diseases (NDRD) in the patients with diabetes mellitus.MethodsClinicopatholigical data of 202 patients with diabetes mellitus and NDRD identified by renal biopsy from January 1st,2003 to December 31st,2010 were analyzed retrospectively.All the patients were divided into three groups:the young (≤35 years old),the middle-aged (36-59 years old) and the elder (≥60 years old).Clinicopathological characteristics were compared among 3 groups.ResultsIn the young group (n=33),42.4％ of patients presented as chronic glomerulonephritic syndrome,while 36.4％ as IgA nephropathy for pathology.In the middle-aged group(n=136),35.3％ of patients presented as chronic glomerulonephritic syndrome,27.2％ as nephritic syndrome,17.6％ as chronic renal failure,14.7％ as latent glomerulonephritis,and 5.1％ as acute renal failure,while42.6％ as IgA nephropathy for pathology.In the elder group(n=33),30.3％ of patients presented as nephritic syndrome,30.3％ as chronic renal failure,while 27.3％ as membranous nephropathy for pathology.ConclusionsIn clinical manifestation,young patients are mainly chronic glomerulonephritic syndrome,middle-aged patients are diversified,and elder patients are mainly nephritic syndrome andchronicrenalfailure. Inpathology, youngandmiddle-agedpatientsaremainlyIgA nephropathy,and elder patients are mainly membranous nephropathy.

The clinical and pathologic features of vascular amyloid deposits of amyloid nephropathy in 6 patients / 中华内科杂志

Objective To analyze clinical and pathologic features of a rare vascular amyloid deposits of amyloid nephropathy ( VADAN) in 6 patients, so as to improve its diagnosis and treatment. Methods All patients received immunopathology, microscopy and electron microscopy examination, and amyloid types were analyzed. Results There were 3 males and 3 females with ages ranging from 52 to 73 years. Two patients suffered from multiple myeloma. Majority patients had slight albuminuria and hematuria. One patient combined with minimal change glomerular disease presented nephrotic syndrome. One patient combined with IgA nephropathy had albuminuria and hematuria. And one patient had myeloma cast nephropathy with acute renal failure. Kidney biopsy proved amyloid deposits along interlobular arterial wall only in all 6 patients. Two cases secondary from multiple myeloma were κ amyloid, and the rests were λ amyloid. Conclusions VADAN is a rare type of amyloid nephropathy. Its clinical manifestation is different from common amyloid nephropathy. Kidney biopsy will benefit its differential diagnosis.

Total parathyroidectomy in treatment of Sagliker syndrome in 10 cases of hemodialysing patients with secondary hyperparathyroidism / 中华内科杂志

Objective To evaluate the efficacy of the parathyroidectomy (PTX) in the treatment of severe secondary hyperparathyroidism (SHPT) with Sagliker syndrome (SS). Methods A retrospective review was undertaken among 212 SS patients underwent PTX in our hospital and with more than 3 years' follow up. The definitions of the efficacy were based on the postoperative intact parathyroid hormone level (iPTH). Cure showed that the iPTH was ＜ 150 ng/L; marked effectiveness was 150-300 ng/L; effectiveness was 301-500 ng/L;ineffectiveness was ＞500 ng/L. The status was defined as persistent SHPT if iPTH was ＞ 150 ng/L after surgery. The status was considered as SHPT recurrence if iPTH was ＜ 100 ng/L in the first week after surgery, and gradually increased and ＞ 150 ng/L with the follow-up. Results ( 1) Ten patients were involved and the average dialysis time was 142 months [male/female: 4/6; age 30-54 (39. 3 ± 10. 4) years]. All patients had severe bone and joint pain, accompanied with progressive facial increases, chicken breast, kyphosis, hip bone deformities, and body height shortening. (2) Preoperative tests: the median of iPTH 2000(1800-2863) ng/L; serum calcium (2. 45 ±0. 21) mmol/L, phosphorus (2. 19 ±0. 51) mmol/L, alkaline phosphatase ( ALP) (1189. 8 ± 780. 0) IU/L. Two to four enlarged parathyroid glands were confirmed by ultrasound and 99Tcm-MIBI parathyroid scintigraphy. ( 3 ) Surgical procedures: local or general anesthesia for PTX. Supplement with calcium and calcitriol implemented low serum calcium after PTX. (4) Follow-up: symptoms, including bone pain, muscle weakness, skin itching, and insomnia, were significantly improved after surgery. Transient hoarseness occurred in 2 cases. The iPTHs of all patients were decreased significantly after surgery. The median of iPTH was 55.5 ( 10-967) ng/L at 1 month post PTX, and was significantly less than prior to PTX (P＜0. 001). Eight patients were cure , 1 marked effectiveness ,and 1 ineffectiveness. Two patients were persistent SHPT, and 1 died of heart failure in the 4th year after PTX. The development of bone deformities was stopped and malnutrition was improved in long-time follow up. The level of iPTH 135(28-390)ng/L(P＜0. 001 ) , serum calcium, phosphorus, and ALP showed normal in the third year. The SHPT recurrence was appeared in the 2nd and 3rd year in 2 out of 8 patients, respectively. Conclusions Total PTX can effectively treat SS by SHPT. It can improve prognosis for patients, such as bone pain disappearing, bone deformities stopping and malnutrition improving, etc. The level of iPTH may rise again in some patients in the future. Therefore, more attentions should be paid to monitoring.

A case report of varicella-zoster virus infection associated glomerulonephritis and encephalitis / 北京大学学报(医学版)

SUMMARY A 15-year-old boy was admitted with nephritic and nephrotic syndrome,renal dysfunction and decreased serum C3,who suffered from varicella for two months.His renal histopathology revealed endocapillary proliferative glomerulonephritis with podocytes proliferation and severe tubular injury by light microscopy.Direct immunofluorescence showed global granular deposition of IgG,IgA,IgM,C3,Clq and fibrinogen in mesangium and along glomerular capillary wall.Electron microscopic examination showed electron-dense deposits in multiple sites of glomeruli.Furthermore,specific serum IgM antibodies against varicella-zoster virus (VZV) were detected.VZV antigen and mRNA were demonstrated in glomerular and tubular epithelial cells by immunohistochemical staining and in-situ hybridization.Virus particles and virus inclusions were identified by electron microscopy and special staining ( Methylene Blue and Eosion staining or Mann staining).The patient also experienced epileptic episodes and his brain MRI and electroenephalogram indicated herpes encephalitis with secondary epilepsy.Therefore,the diagnosis of VZV-associated glomerulonephritis and encephalitis was established.This is the first case of VZV-associated glomerulonephritis with renal histooathological evidence using in situ hybridization technique.

Epidemiology investigation of adult chronic kidney disease in the Hulunbeir Prefecture,Inner Mongolia autonomous region / 中华肾脏病杂志

Objective To investigate the prevalence and risk factors of chronic kidney disease (CKD) in the general adult population in the Hulunbeir Prefecture, Inner Mongolia Autonomous Region where many minorities of north China live. Methods Sampling surveywas performed in the residents aged 20 years and older in the Hulunbeir Prefecture. All the investigated subjects were tested for urinary albumin to creatinine ratio (ACR); hematuria by microscopy of urinary sediment; and GFR estimated by modified MDRD equation for Chinese adults (eGFR). The related risk factors of CKD were also investigated. Results A total of 4522 subjects were enrolled in the study. The prevalence of albuminuria was 7.11％, hematuria was 2.64％ and reduced eGFR [60 ml-min-1·(1.73 m2)-1] was 2.75％. The prevalence of hypertension was 38.90％; hyperglycemia 6.61％; hyperlipidemia 2.72％; increased waist 24.79％ and metabolic syndrome 15.02％. After the subjects with combined microalbuminuria, hematuria and reduced eGFR were excluded, the prevalence of CKD was 12.95％. Logistic regression analysis and stratified analysis showed increased age, increased waist, elevated systolic pressure, hyperglycemia,hypertriglyceridemia and metabolic syndrome were independently associated with albuminuria;increased age, elevated systolic pressure and hyperglycemia were independently associated with reduced eGFR; increased age was independently associated with hematuria. Conclusions The prevalence of adult CKD is 12.95％ in the Hulunbeir Prefecture, Inner Mongolia Autonomous Region. Independent risk factors of CKD include increased age, increased waist, hypertension,abnormal blood glucose or lipid, and metabolic syndrome.

Primary study on the gene typing, molecular characteristics of virulence and resistance associated gene of 12 Clostridium difficile clinical isolates in China / 中国人兽共患病学报

To investigate the gene typing, molecular characteristics of virulence and resistance associated gene of Clostridium difficile from clinical isolates in China, the genes tcdA,tcdB of toxin A and B, cdtA,cdt B of binary-toxin, and erm B of clindamycin resistance were detected by conventional PCR. Genotyping of toxic C. difficile were conducted by means of analysis of 16s-23s internal spacer region polymorphism with PCR assay. Then the antibiotic resistance of toxic C. difficile to ampiciline, clindamycin, metronidazole and vancomycin was conducted with E-test. It was found that 8 toxic C. difficile strains were demonstrated out of 12 clinical isolates, in which 5 strains were tcdA+ and tcdB+, and 3 strains tcdA- and tcdB+, accounting for 62.5% and 37.5% respectively. Binary-toxin genes detection were negative in all the strains. Clindamycin resistance associated gene ermB was positive in 4 out of 8 toxic C. difficile strains, accounting for 50%. 8 toxic isolates were typed into 4 gene types, the dominant type was ZR I,accounting for 62.5%. Resistance rate of 8 toxic C. difficile strains against ampiciline(AC), clindamycin(CM), metronidazole(MZ) and vancomycin(VA) was 37.5%,87.5%,12.5%, and 0 respectively. No isolates belonged to ribotype 027 or 078. Isolation rate of toxic C. difficile is high to 66.7%. There is obvious gene polymorphism in clinical isolates of Chinese toxic C.difficite, and ZR I is preponderant genotype in 4 genotypes. C. difficile shows some resistance to ampiciline, clindamycin, metronidazole, but susceptive to vancomycin.

Survey on Control Status and Knowledge Level about Disease in Asthmatic Patients in Region Level Cities of Shaanxi Province / 中国呼吸与危重监护杂志

Objective To evaluate the control status and knowledge level about disease in asthmatic patients in region level cities of Shaanxi province for effect appraisal of patient education.Methods Eight hospitals were selected from six region level cities, where questionnaire survey was completed in out-patients with asthma (≥ 14 years old).Results A total of 523 patients completed the questionnaire with a ratio of male to female of 1: 1.14,and an average age of (44.3±15.5) years old.The percentage of controlled, partly controlled and uncontrolled by self-evaluation was respectively 26.4%, 52.4% and 11.1%.48% insisted on using inhaled corticosteroids (ICS).The average score was 17.88±4.43 by asthma control test (ACT).The first three medicines used daily were ICS (26.6%), sustained-release theophyline (25.2%) and combination ICS/long-acting β2-agonists (21.8%).12.6% had no medicine and 5.2% used non-orthodox medicines.68.6% patients had omen before exacerbation, and those were sneezing, chest distress and cough.73.6% knew asthma is a disease of airway inilammatian,and 33.3% selected ICS as the leader medicine.Only 32.1% attended the lecture about asthma in hospitals and 85.0% longed for such education.Conclusions The control status and knowledge level about disease in asthmatic patients in cities still need to be improved in Shaanxi province, and too much work need to be done in order to realize the total control in all patients.

Comparative study of clinlcopathological features between two kinds of obesity-related glomerulopathy / 中华肾脏病杂志

Objective To compare the clinicopathological features between two kinds of obesity-related glomerulopathy (ORG). Methods Twenty-three patients with obesity-associated glomerulomegaly (OB-GM) and 22 patients with obesity-associated focal and segmental glomerulosclerosis (OB-FSGS) diagnosed by renal biopsy during 1998 to 2008 in our center were enrolled in this study. A retrospective analysis of clinical and pathological data was carried out. Results (1) All the patients in these two groups were with abdominal obesity. Most of them were middle-aged male. There were no significant differences in gender, age, body mass index and waist circumference between these two groups (P>0.05). The mean course of disease in OB-FSGS group was significantly longer than that in OB-GM group[(21.7±29.7) vs (6.8±9.3) months,P<0.05]. (2) Metabolic syndrome was found in the most patients of these two groups, but there were no significant differences in the levels of serum glucose, triglycerides, HDL-cholesterul, uric acid and blood pressure between them(P>0.05). (3) The 24-hour urinary protein and Ser level in OB-FSGSgroup were significantly higher than those in OB-GM group[(2.49±1.58) vs (0.83±0.87) g/d, P<0.05; (102.09±25.07) vs (87.84±20.63) μmol/L, P<0.05]. The serum albumin level, creatinine clearance and urinary osmotic pressure in the former were significantly lower than those in the latter [(38.67±7.00) vs (44.05±3.55) g/L, P<0.01; (95.78±37.83) vs (128.72±31.20) ml/min, P<0.01; (678.72±91.76) vs (840.69±133.88) mmol/L, P<0.01]. (4) The mean glomerular diameters of both OB-FSGS group and OB-GM group were increased, whose difference was not significant [(204.3±23.1) vs (205.3±14.3) μm, P>0.05]. Conclusion There are significant differences in the mean course of disease, 24-h urinary protein excretion, serum albumin level and renal function between these two different kinds of ORG.

Epidemiological investigation of adult chronic kidney disease in the Xishuangbanna district of Yunnan province / 中华肾脏病杂志

Objective To investigate the prevalence and risk factors of adult chronic kidney disease (CKD) in the Xishuangbanna district of Yunnan province with a big population of minorities. Methods Residents aged 20 years and older in the area of Xishuangbannan were randomly selected by using a stratified, multi-stage sampling method. All the residents were tested for morning spot urine of albumin tO creatinine ratio (ACR) (abnormal≥ 30 mg/g); morning spot urine dipstick of hematufia (abnormal 1+ or greater) was confirmed by urine microscopy (abnormal ＞ 3 red blood cells/HP); and modified simplified MDRD equation for Chinese adult was applied to characteristics, health characteristics (e.g. hyperglycemia, hyperlipidemia and hypertension) and indicators of kidney damage were also examined. Results Eligible data of 5566 subjects were included in the study. The prevalence of albuminuria was 8.06%, hematuria was 4.01% and reduced eGFR was 2.89%. Apart from the repetition among microalbuminuria, hematuria and reduced eGFR, approximately 12.53% subjects had at least one indicator of kidney damage. The prevalence of CKD in stratified subgroups with age, gender, nations and CKD risk factors was coincidence with the Logistic regression results. Age increase, hypertension, byperlipidemia and fasting plasma glucose increase were independently associated with albuminuria; age increase, hypertension were independently associated with reduced renal function; age increase was independently associated with hematouria. Conclusions The prevalence of adult chronic kidney disease is 12.53% in the Xishuangbanna district of Yunnan province. Independent risk factors associated with kidney damage are age, hyperglycemia, hyperlipidemia and hypertension.