Preliminary application of CT on accessing aortic arch calcification during parathyroid SPECT/CT in patients with renal secondary hyperparathyroidism / 中华核医学与分子影像杂志

Objective:To access the clinical value and related risk factors of aortic arch calcification (AoAC) in patients with renal secondary hyperparathyroidism (SHPT) on CT during parathyroid SPECT/CT imaging.Methods:From January 2014 to May 2021, 136 renal SHPT patients (70 males, 66 females, age (50.1±11.4) years) who underwent parathyroid 99Tc m-methoxyisobutylisonitrile (MIBI) SPECT/CT in Affiliated Jiangyin Hospital of Nantong University were retrospectively enrolled. AoAC score was estimated with CT(1-5), and patients were divided into none-light AoAC group (AoAC score<3) and moderate-severe AoAC group (AoAC score≥3). Independent-sample t test or Mann-Whitney U test was used to compare differences of various indicators between two groups. Univariate binary logistic regression was used to analyze the influencing factors of AoAC. Results:Of 136 renal SHPT patients, 111(81.62%) were AoAC detected by CT. There were 84 patients in none-light AoAC group and 52 patients in moderate-severe AoAC group. The age ((46.7±9.8) vs (55.7±11.6) years; t=-4.84, P<0.001), pulse pressure (52(41, 64) vs 60(51, 70) mmHg (1 mmHg=0.133 kPa); z=-3.27, P=0.001), serum corrected calcium (2.41(2.28, 2.53) vs (2.49±0.22) mmol/L; z=-2.50, P=0.013), serum phosphorus ((1.95±0.39) vs (2.14±0.48) mmol/L; t=-2.54, P=0.012), calcium phosphorus product ((4.68±1.07) vs (5.29±1.10) mmol 2/L 2;t=-3.21, P=0.013) and parathyroid hormone (PTH) level (106.30(90.15, 127.45) vs 109.90(87.93, 157.63) pmol/L; z=-2.09, P=0.036) between non-light AoAC group and moderate-severe AoAC group were significantly different. Logistic regression analysis showed that serum phosphorus (odds ratio ( OR)=7.261, 95% CI: 2.416-21.819, P<0.001), calcium and phosphorus product ( OR=1.598, 95% CI: 1.073-2.380, P=0.021) and PTH level ( OR=1.018, 95% CI: 1.007-1.029, P=0.001) were independent risk factors of AoAC. Conclusions:Hybrid SPECT/CT can be used for an effective method of evaluating AoAC in patients with renal SHPT. High serum phosphorus, high calcium phosphorus product and high PTH level may be independent risk factors of AoAC.

Analysis of illness and consultation within two weeks in a community in Chengdu / 中华全科医师杂志

Objective:To survey the status of illness and consultation within two weeks among residents in a community in Chengdu.Methods:A multi-stage stratified random sampling was used to carry out a questionnaire survey among the residents in a community in Chengdu during March to April 2019. The disease status, disease severity and consultation within two weeks were surveyed, and influencing factors of two-week illness were analyzed with logistic regression.Results:Among 2 714 participants, 715 had illness (900 times) within two weeks, with a two-week prevalence rate of 26.3%. The main symptoms were dizziness (6.4%, 58/900), cough (6.2%, 56/900), lumbago and leg pain (4.9%, 44/900), palpitations (3.3%, 30/900) and headache (3.1%, 28/900). The three most common diseases were hypertension (38.3%, 345/900), diabetes (19.3%, 174/900) and common cold (6.4%, 58/900). In this survey, the rate of two-week in bed was 20.6‰(56/2 714), and the rate of two-week off work was 4.8‰(13/2 714). Age, gender, education level and work status were the influencing factors of the illness in two weeks ( P<0.05). The choice of medical institution was also different among residents. Conclusion:The survey suggest that primary care should focus on the key groups of residents in the community such as elderly, women, low education level, retirement and unemployed; and it is necessary to strengthen the primary care institutions and two-way referral system of health care.

Analysis of knowledge and clinical skill competition results in general practitioners attending grass-roots health post training / 中华全科医师杂志

The knowledge and clinical skill competition scores of 331 general practitioners (GPs),who attended the grassroots health posts training in Sichuan Province and Chengdu Municipality in 2016 and 2017,were documented.The factors influencing the competition results were analyzed.The mean knowledge test score of 331 participants were higher than the clinical skill score [(76.89±6.56) vs.(54.13±10.91),P＜0.01].The mean operational score in the clinical skill competition was higher than that of medical history collection,physical examination and clinical interview abilities [(32.31 ±3.28) vs.(21.82±5.09),P＜0.01].There were significant differences in knowledge and clinical skill scores among doctors from different regions or with different professional ranks (P＞0.05).The levels of clinical skills of general practitioners at the grass-roots level need to be further improved,according to relevant influencing factors.

Clinical characteristic and correlative factors of maintenance hemodialysis patients with restless legs syndrome / 中华肾脏病杂志

Objective To explore the prevalence and the correlative factors of restless legs syndrome (RLS) in maintenance hemodialysis (MHD) patients.Methods The basic information and clinical laboratory results of 307 MHD patients were collected.The international RLS study group (IRLSSG) diagnostic criteria were applied to assess the presence and the severity of RLS.Binary logistic analysis was used for exploring correlative factors of RLS.Results The prevalence of RLS was 12.1％ in the MHD patients,with 73.0％ patients having mild-to-moderate symptoms and 83.8％ having chronic RLS.There was no significant difference between MHD patients with and without RLS in age,gender,dialysis age,daily urine,Kt/V,history of smoking,drinking,hemoglobin,serum creatinine,urea nitrogen,uric acid,calcium,phosphorus,magnesium,potassium,intact parathyroid hormone (iPTH),prealbumin,albumin and alkaline phosphatase.But the frequency of daily exercise in RLS group is significantly lower than that in non-RLS group (Z=-4.114,P ＜ 0.001).Logistic regression analysis showed that daily exercise was a correlative factor of RLS (B=-2.203,OR=0.111,95％CI 0.033-0.371,P ＜ 0.001).Conclusions RLS is a common complication in MHD patients,with chronic state and mild-to-moderate symptoms.RLS is correlated with daily exercise,which may be a scientific approach to treat or prevent this disease.

Correlation between the ratio of intima to tunica media thickness and the expression of bone matrix proteins in small renal artery of diabetic nephropathy rats / 中华肾脏病杂志

Objective To observe the expression of bone matrix proteins and the change of intima-tunica media thickness ratio in diabetic rat small renal artery and to explore their correlation and effects on diabetic nephropathy. Methods Seventy healthy SD rats were randomly divided into diabetic group(DN,n=40)and normal control group(N,n=30).DN rat model was induced by streptozotocin(STZ)intraperitoneal injection and the N group rats were given the same dose of citrate buffer.Thirty-five rats were successfully induced in DN group.The rats were sacrificed at week 4,12 and 24,respectively.The protein and mRNA expression of core-bind factor alpha 1(Cbfcd).bone morphogenetic protein 2(BMP-2)and matrix Gla protein(MGP)in smallrenal artery were detected by immunohistochemistry,in-situ hybridization and real-time PCR at each time point. Results Cbfctl and BMP-2 were expressed obviously in small renal artery of DN group by immunohistochemistry stain and in-situ hybridization from 4 to 24 weeks compared with N group at each time point,reaching the peak at week 24.Real-time PCR showed that the MGP mRNA was evidently increased at week 4,slightly decreased at week 12,lowest at week 24in DN group.The BMP-2 mRNA began to increase from week 4 onward,being peak at week 24in DN group.The ratio of intima to tunica media thickness had no significant difference in DN group compared with N group at week 4,but at week 12 and 24 there were significant difference between them.There was a positive correlation between Cbfα1 and BMP-2 expression,but they were negatively correlated with the expression of MGP.The ratio of intima to tunica media thickness was significantly-correlated with the expression of Cbfα1 and BMP-2. Conclusions The ratio of intima to tunica media thickness is positively correlated with Cbfα1 and BMP-2 in small renal artery of early DN.Cbfα1,BMP-2 and MGP may be involved in the progression of vascular lesions in DN.

Interventional effect of irbesartan on vascular endothelial growth factor and its FIk-1 receptor expressions in the kidney of diabetic rats / 中国组织工程研究

BACKGROUND: Some studies have presented that vascular endothelial growth factor and its receptor system may take part in onset and development of diabetic nephropathy (DN).OBJECTIVE: To further verify the interventional effects of irbesartan on vascular endothelial growth factor (VEGF) and its Flk-1 receptor expressions in kidney of diabetes mellitus (DM) rat, and the possible mechanism of irbesartan.DESIGN: Randomized control animal study.SETTING: West China Hospital of Sichuan University.MATERIALS: Eighteen male closed colony SD rats weighing 150-200 g were cared in standardization.METHODS: This study was performed at Laboratory of West China Hospital of Sichuan University from August 2006 to April 2007. All rats were randomly divided into a DN group, an irbesartan group and a normal control group, with 6 rats in each group. 10 g/L streptozotocin (55 mg/kg) was intraperitoneally injected to establish models; rats in the control group were administrated with the same dosage of citric acid buffer solution; rats in the irbesartan group were administrated with 3 mg/(kg·d) irbesartan after model establishment. VEGF and FIk-1 expressions were detected using reverse transcription polymerase chain reaction (RT-PCR) and immunohistochemistry technique; while, urine protein level, area and volume of renal glomerulus were detected, and correlations of data were analyzed.MAIN OUTCOME MEASURES: ①Renal pathological indicators, urine protein level, area and volume of renal glomerulus; ②VEGF and Flk-1 expressions;③renal immunohistochemical examination;④ correlation analysis.RESULTS:① Renal pathological examination by HE staining indicated that renal glomerulus was remarkably enlarged in the DN group; mesangial matrix was increased; mesangial cells were also increased; renal tubule was expanded. The lesions in the irbesartan group were milder compared to the DN group. Urine protein level in the DN group was significantly higher compared to the control group (P ＜ 0.01); renal weight/body mass, area and volume of renal glomerulus were significantly higher compared to the control group (P ＜ 0.01); urine protein level, renal weight/body mass, area and volume of renal glomerulus in the irbesartan group were significantly lower compared to the DN group (P ＜ 0.01). ② By the 16th week,VEGF and Flk-1 expressions in the DN group were significantly up-regulated compared to control group (P ＜ 0.05); while,VEGF and Flk-1 expressions in the irbesartan group were also up-regulated compared to the control group by the 16th week (P ＜ 0.05) but down-regulated compared to the DN group (P ＜ 0.05). ③ VEGF staining in the DN group was darker compared to control group (P ＜ 0.01), while the staining in the irbesartan group was also darker compared to the control group (P ＜0.01), but the staining in the irbesartan group was lighter compared to the DN group (P ＜ 0.01). Flk-1 staining was similar to the VEGF. ④ VEGF and Flk-1 were positively correlated, with urine protein level, area and volume of renal glomerulus (P ＜0.05).CONCLUSION: VEGF and its Flk-1 receptor play important roles in DN pathogenesis. Over expressions may cause renal injury, but irbesartan (angiotensin Ⅱ receptor antagonist) has the protective effects on kidney through inhibiting abnormal expression of VEGF and Flk-1.

Clinical manifestations,prognosis and risk preventing strategy of acute aortic dissection / 重庆医科大学学报

Objectives:To analyze the clinical manifestations of acute AD so as to improve diagnosis and treatment.Method:50 cases of AD were studied retrospectively.Results:24 out of 50 cases were acute AD.Among them,21patients(87.5%) suffered pain,16 cases(66.7%) with hypertension.The misdiagnosis rate was 50% and mortality rate was 33.3%(8/24).Conclusions:(1)There was a high rate of hypertension among AD patients and it occurs more among male than female.(2)Pain is the main clinical manifestation and the affect place was closely related to the AD location.When there is asymmetrical blood pressure,shock and wider mediastinum,the prognosis is severely negative.(3)Ultrasound,CT and MRI are good examination techniques for AD(4)Attetion on AD,multidisciplinary cooperation,and doctor-patient communication can reduce the risk of this disease.

The experimental study on the relationship between proangiogenic factors and the peritubular angiogenesis of diabetic renal / 中国实用内科杂志

Objective To explore the role and significance of vascular endothelial growth factor(VEGF)and angiopoietin-2(Ang-2)in peritubular angiogenesis of diabetic kidney.Methods diabetic rats were induced by Streptozotocin.The expressions of VEGF and Ang-2 in renal tissue of rats were detected by immunohisochemistry.VEGF and Ang-2 mRNA in kidney was also detected by RT-PCR,and quantified by computerimage analysis.Results From 2-week to 24-week,VEGF mRNA level in diabetic renal upregulated continuously compared with control group,with peak level at 16 and 20 weeks.VEGF immunostaining in diabetic renal tubuli increased apparently compared with control group.Ang-2 mRNA in diabetic renal was only detected at 16 and 20 weeks.Ang-2-expressing peritubular microvessel in diabetic renal cortex was found by immunohistochemistry from 12 -week to 24-week with peak level at 16 week.No detecable Ang-2 mRNA and immunostaining were found in control renal.The changes correlated VEGF with Ang-2 in diabetic renal after 12 weeks.Conclusion There are the formation of Ang-2-staining peritubular microvessels in diabetic renal cortex in middle and later stages.VEGF and Ang-2 take part in angiogenesis in diabetic renal.