Metabolic Syndrome-Related Kidney Injury: A Review and Update.

Metabolic syndrome (MetS) includes visceral obesity, hyperglycemia, dyslipidemia, and hypertension. The prevalence of MetS is 20-25%, which is an important risk factor for chronic kidney disease (CKD). MetS causes effects on renal pathophysiology, including glomerular hyperfiltration, RAAS, microalbuminuria, profibrotic factors and podocyte injury. This review compares several criteria of MetS and analyzes their differences. MetS and the pathogenesis of CKD includes insulin resistance, obesity, dyslipidemia, inflammation, oxidative stress, and endothelial dysfunction. The intervention of MetS-related renal damage is the focus of this article and includes controlling body weight, hypertension, hyperglycemia, and hyperlipidemia, requiring all components to meet the criteria. In addition, interventions such as endoplasmic reticulum stress, oxidative stress, gut microbiota, body metabolism, appetite inhibition, podocyte apoptosis, and mesenchymal stem cells are reviewed.

Long-term statin use before primary percutaneous coronary intervention improves treatment outcomes of acute myocardial infarction.

Numerous studies have reported that high-dose statin loading therapy prior to primary percutaneous coronary intervention (PPCI) improves the clinical outcomes of patients following acute myocardial infarction (AMI). However, little is known about the effects of long-term statin use prior to PPCI on such outcomes. Therefore, the aim of the present analysis was to clarify the effects of long-term statin use before PPCI on the treatment outcomes of patients following AMI. The records of 213 patients who had AMI and met the inclusion criteria were retrospectively reviewed. Patients were divided into two groups: A control group (n=178) who had received no statin pretreatment before AMI onset, and a statin group (n=35) who had received statin treatment for ≥1 month before AMI onset. All patients received a standard treatment regimen for the secondary prevention of coronary artery disease after PPCI. Baseline clinical variables, details of the PPCI procedure and clinical outcomes within 3 months after treatment were reviewed. Patients in the statin group were significantly older than those in the control group (P=0.003). Compared with the control group, there was a greater proportion of patients with hyperlipidemia and previous angina pectoris in the statin group. There were no differences in the use of other drugs (aspirin, ß-blockers and angiotensin-converting enzyme inhibitors) prior to PPCI between the two groups. The corrected TIMI frame count (cTFC) was significantly lower in the statin group than in the control group (24.1±12.8 vs. 29.4±14.3, respectively; P=0.043). Multivariable linear regression analysis showed that long-term statin use before AMI was a significant predictor of cTFC after PPCI (P=0.012). Furthermore, the incidence of major adverse cardiac events within 3 months after PPCI was higher in the control group than in the statin group (16.8 vs. 2.9%, respectively; P=0.032). Logistic regression analysis showed that previous statin use was associated with the incidence of major adverse cardiac events within 3 months after treatment (P=0.012). The results of the present study demonstrate that long-term statin use prior to PPCI improved treatment outcomes after AMI in actual clinical practice.

Single-stage internal fixation for thoracolumbar spinal tuberculosis using 4 different surgical approaches.

STUDY DESIGN: A retrospective study was conducted on 148 spinal tuberculosis (TB) patients (M:F, 92:56; mean age, 39.7±12.3; range, 16-74 y) treated with anterior debridement and bone graft fusion with nail and screw internal fixation (nails+screws group); posterior pedicle screw fixation (pedicle screw group); vertebral arch pedicle internal fixation through a posterior route (posterior arch fixation group); or posterior debridement, bone graft fusion, and vertebral arch pedicle internal fixation (arch fixation group). OBJECTIVE: We investigated 4 variant surgical approaches for internal fixation of spinal TB. SUMMARY OF BACKGROUND DATA: The effectiveness of single-stage surgical fixation for different degrees of spinal TB is a matter of debate. METHODS: Operation time and bleeding volume were recorded. Complications, American Spinal Injury Association (ASIA) score, C-reactive protein, and erythrocyte sedimentation rate were examined preoperatively and 6 months after surgery. RESULTS: Overall, 78, 48, 16, and 6 patients underwent nails+screws, pedicle screws, arch fixation, and posterior arch fixation approaches, respectively. The mean operation times were 175.8±48.8, 308.5±76.7, 143.8±43.0, and 398.3±90.8, respectively (P<0.01). Mean blood transfusion volumes were 1227.1±988.2, 1771.7±794.7, 467.7±123.3, and 2833.3±1083.8 mL, respectively (P<0.01). Primary wound healing was achieved in 127 patients. No patients experienced spinal TB recurrence or failure of bone graft or fixation. All groups achieved significantly improved C-reactive protein and erythrocyte sedimentation rate, but significantly improved ASIA scores were only observed in the nails+screws and pedicle screw groups (P<0.01). CONCLUSIONS: Surgical approach limitations and advantages should be considered based on the position and severity of spinal TB infection to maximize functional outcomes and minimize surgical risks.