Analysis of hemorrhage upon ultrasound-guided percutaneous renal biopsy in China: a retrospective study.

PURPOSE: Ultrasound-guided percutaneous renal biopsy (PRB) has been considered as a golden standard for CKD diagnosis and is employed to identify potential therapeutic targets since 1950s. Post-biopsy hemorrhage is the most common complication, while severe bleeding complication might cause nephrectomy or death. Therefore, how to reduce the occurrence of complications while ensuring the success of PRB is always a clinical research topic. METHODS: This study retrospectively collected and established a renal biopsy database of each patient who underwent ultrasound-guided PRB at a tertiary teaching hospital from September 2017 to December 2020 through the Health Information System. All the data were statistically processed by SPSS software. RESULTS: A total of 1146 patients underwent PRB for various reasons. The overall rate of post-biopsy hemorrhage was 37.70% (432/1146). Of those bleedings, minor bleeding after PRB was found in 337 (29.41%), middle bleeding 84 (7.33%), major bleeding 11 (0.96%). Besides that, there were 96 patients (8.38%) reported their discomfort symptoms. There was no death. Females were at significantly increased risk of hemorrhagic complication than males (OR = 2.017, CI = 1.531-2.658). While the risk for hemorrhagic complication significantly decreased as BMI and platelet before renal biopsy increased (OR = 0.956, CI = 0.924-0.989; OR = 0.998, CI = 0.996-1.000). As the APTT time prolonged, the risk for hemorrhagic complication significantly increased (OR = 1.072, CI = 1.023-1.123). Those patients whose albumin were higher, also had higher risk for hemorrhagic complication than other patients (OR = 1.020, CI = 1.000-1.041). Specifically, postoperative urination within 4 h increased the risk for hemorrhagic complication (OR = 1.741, CI = 1.176-2.576). CONCLUSION: Our analysis finds that the incidence of post-biopsy bleeding complication is 37.70%, and its risk is associated with female, lower BMI, lower platelet before renal biopsy, prolonged APTT, higher albumin, and postoperative urination within 4 h. The findings highlighted the importance of perioperative management for renal biopsy, including adequate risk assessment, tailored careful observation after PRB. And medical staff should pay more attention to fluid management after ultrasound-guided PRB.

Combining Serum Procalcitonin Level, Thromboelastography, and Platelet Count to Predict Short-term Development of Septic Shock in Intensive Care Unit.

OBJECTIVE: Despite the recent advances in diagnosis and treatment, sepsis continues to lead to high morbidity and mortality. Early diagnosis and prompt treatment are essential to save lives. However, most biomarkers can only help to diagnose sepsis, but cannot predict the development of septic shock in high-risk patients. The present study determined whether the combined measurement of procalcitonin (PCT), thromboelastography (TEG) and platelet (PLT) count can predict the development of septic shock. METHODS: A retrospective study was conducted on 175 septic patients who were admitted to the intensive care unit between January 2017 and February 2021. These patients were divided into two groups: 73 patients who developed septic shock were assigned to the septic shock group, while the remaining 102 patients were assigned to the sepsis group. Then, the demographic, clinical and laboratory data were recorded, and the predictive values of PCT, TEG and PLT count for the development of septic shock were analyzed. RESULTS: Compared to the sepsis group, the septic shock group had statistically lower PLT count and TEG measurements in the R value, K value, α angle, maximum amplitude, and coagulation index, but had longer prothrombin time (DT), longer activated partial thromboplastin time (APTT), and higher PCT levels. Furthermore, the Sequential Organ Failure Assessment (SOFA) score was higher in the septic shock group. The multivariate logistic regression analysis revealed that PCT, TEG and PLT count were associated with the development of septic shock. The area under the curve analysis revealed that the combined measurement of PCT, TEG and PLT count can be used to predict the development of septic shock with higher accuracy, when compared to individual measurements. CONCLUSION: The combined measurement of PCT, TEG and PLT count is a novel approach to predict the development of septic shock in high-risk patients.

Pseudoileus caused by primary visceral myopathy in a Han Chinese patient with a rare MYH11 mutation: A case report.

BACKGROUND: Chronic intestinal pseudo-obstruction (CIPO) is a syndrome of intestinal motor dysfunction caused by intestinal nerve, muscle, and/or Cajal stromal cell lesions. CIPO is a serious category of gastrointestinal dynamic dysfunction, which can eventually lead to the death of patients with intestinal failure. Due to considerable phenotypic heterogeneity, the estimated incidence of CIPO is 1/476190 and 1/416666 in men and women, respectively. According to the etiology, CIPO can be divided into idiopathic and secondary, of which the latter is the most common, often secondary to tumor, virus infection, connective tissue disease, neurological diseases, and endocrine diseases. Idiopathic CIPO in the intestinal tract is divided into visceral myopathy, neuropathy, and stromal cell lesions according to the location. Surgery is usually not recommended for CIPO, because it often does not benefit patients with CIPO, and postoperative intestinal obstruction is likely to occur, which may even worsen the condition. CASE SUMMARY: Here, we describe the case of a 43-year-old male Han Chinese patient with a 15-year history of recurrent abdominal distention with no clear cause. The results of physical, biochemical, and other relevant examinations showed no clear abnormalities. Contrast-enhanced computed tomography (CT) indicated a large duodenum, clear expansion of the intestinal lumen, and CIPO. Whole exome sequencing (WES) of the patient and his mother confirmed the diagnosis of primary familial visceral myopathy type 2 chronic pseudoileus with a rare heterozygous gene mutation in MYH11. This is the second reported case of CIPO with a heterozygous MYH11 [NM_001040113.1: c.5819delC (p.Pro1940Hisfs*91)] mutation. CONCLUSION: This case report indicates that physicians can perform routine clinical examinations, CT, and WES to achieve a diagnosis and treatment of CIPO in early disease stages.

Non-motor symptoms in multiple system atrophy: A comparative study with Parkinson's disease and progressive supranuclear palsy.

Background: Non-motor symptoms (NMS) are compulsory clinical features for the clinical diagnosis of multiple system atrophy (MSA), some of which precede motor symptoms onset. To date, few studies have systematically investigated NMS in MSA and the timing of presenting NMS as the disease progresses. Clinically, MSA is difficult to be differentiated from Parkinson's disease (PD) and progressive supranuclear palsy (PSP), and the differences in NMS between MSA and PD/PSP remain unclear. The aim of this study was to compare the burden of NMS between MSA and PD/PSP and to delineate the timing of NMS presentation relative to the onset of motor symptoms in MSA. Methods: A total of 61, 87, and 30 patients with MSA, PD, and PSP, respectively, were enrolled in this study. NMS was systematically assessed in all patients using the NMS scale (NMSS), and the onset of NMS relative to the onset of motor symptoms in MSA was investigated. Results: MSA group had higher total NMSS scores (82.15 ± 46.10) than the PD (36.14 ± 30.78) and PSP (50.30 ± 55.05) groups (p < 0.001 overall). The number distribution pattern of the NMS was significantly different among the three parkinsonian disorders (p < 0.001 overall). In total, 85.2% of patients with MSA had more than 10 NMS, which was significantly higher than PD (28.7%) and PSP (33.3%). The frequency and scores of many NMSS subdomains and symptoms were higher in MSA than in PD and PSP (all p < 0.05). Multivariate logistic regression analysis revealed that patients with fainting, lack of motivation, swallowing, and loss of sexual interest could be attributed to MSA rather than PD or PSP, while patients with loss of concentration and forgetfulness were characteristic features of PD or PSP rather than MSA. REM-sleep behavior disorder (RBD), constipation, problems having sex, and loss of sexual interest preceded the motor symptoms onset of MSA by 2.81 ± 4.51, 1.54 ± 6.32, 1.35 ± 4.70, and 0.45 ± 3.61 years, respectively. Conclusion: The NMS spectrum in MSA differs from that of PD and PSP. Patients with MSA have a higher NMS burden than patients with PD or PSP. RBD, constipation, problems having sex, and loss of sexual interest may become early diagnostic clinical markers of MSA.

Magnetic resonance imaging and Crohn's disease endoscopic index of severity: Correlations and concordance.

AIM: To examine the correlation between magnetic resonance imaging (MRI) and endoscopic index of severity (CDEIS) in patients with Crohn's disease (CD). METHODS: This was a retrospective study of 104 patients with CD that were treated at the Ruijin Hospital between March 2015 and May 2016. Among them, 61 patients with active CD were evaluated before/after treatment. MRI and endoscopy were performed within 7 d. CDEIS was evaluated. MRI parameters included MaRIA scores, total relative contrast enhancement (tRCE), arterial RCE (aRCE), portal RCE (pRCE), delay phase RCE (dRCE), and apparent diffusion coefficient. The correlation and concordance between multiple MRI findings and CDEIS changes before and after CD treatment were examined. RESULTS: Among the 104 patients, 61 patients were classified as active CD and 43 patients as inactive CD. Gender, age, disease duration, and disease location were not significantly different between the two groups (all P > 0.05). CRP levels were higher in the active group than in the inactive group (25.12 ± 4.12 vs 5.14 ± 0.98 mg/L, P < 0.001). Before treatment, the correlations between CDEIS and MaRIAs in all patients were r = 0.772 for tRCE, r = 0.754 for aRCE, r = 0.738 for pRCE, and r = 0.712 for dRCE (all MaRIAs, P < 0.001), followed by MRI single indexes. Among the active CD patients, 44 cases were remitted to inactive CD after treatment. The correlations between CDEIS and MaRIAs were r = 0.712 for aRCE, r = 0.705 for tRCE, r = 0.685 for pRCE, and r = 0.634 for dRCE (all MaRIAs, P < 0.001). CONCLUSION: Arterial MaRIA should be an indicator for CD follow-up and dynamic assessment. CD treatment assessment was not completely concordant between CDEIS and MRI.

Metastases to the Pancreas: Computed Tomography Imaging Spectrum and Clinical Features: A Retrospective Study of 18 Patients With 36 Metastases.

The aim of this study is to identify the key computed tomography (CT) imaging findings and clinical characteristics of pancreatic metastases for its differential diagnosis. CT images and clinical features of 18 patients with 36 histopathologically proven pancreatic metastases were retrospectively reviewed. The primary malignancy included non-small cell lung cancer (NSCLC) (n = 7), gastrointestinal carcinoma (n = 5), renal cell carcinoma (RCC) (n = 3), osteosarcoma (n = 1), cardiac sarcomas (n = 1), and neuroendocrine ethmoid sinus carcinoma (n = 1). Pancreatic metastases were metachronous in 12 patients (ranging from 4 to 72 months). Tumor markers were elevated for 8 patients, of which 7 patients had NSCLC and gastrointestinal carcinoma, and 1 patient had osteosarcoma. Metastases from NSCLC and gastrointestinal carcinoma frequently presented as small well-circumscribed lesions, with homogeneous or rim enhancement, and or local pancreatic infiltration instead of focal mass, mimicking local pancreatitis. Neuroendocrine ethmoid sinus carcinoma affecting the pancreas also exhibited local pancreatic infiltration. Metastases from RCC and cardiac sarcomas had typical characteristics of hypervascular lesions. Osteosarcoma metastasizing to pancreas had special manifestation, that is, cystic lesion with thick wall and calcification. Although pancreatic metastases have a broad spectrum of CT appearances, lesions from some types of primary tumors exhibited characteristic imaging features, which, in combination with oncological history, will contribute to correct diagnosis.

Differentiation of Crohn's disease from intestinal tuberculosis by clinical and CT enterographic models.

BACKGROUND: Crohn's disease (CD) and intestinal tuberculosis (ITB) have similar clinical, radiological, and endoscopic features. The objective of our study was to investigate the values of clinical features and computed tomographic (CT) enterographic manifestations in the differential diagnosis between CD and ITB. METHODS: Clinical features and CT enterographic manifestations in a cohort of 141 patients with CD and 47 patients with ITB were reviewed retrospectively. Parameters were screened by logistic regression analysis. Furthermore, the diagnostic efficacy of screened parameters was analyzed by regression equation (mathematical model) and receiver operating characteristic curve. RESULTS: The clinical features indicative of CD were hematochezia and perianal disease; features indicative of ITB include positive purified protein derivative skin test, occurrence of ascites, pulmonary tuberculosis, and night sweats. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of regression mathematical model established by clinical features were 94.3, 80.4, 91.0, 93.7, and 82.6%, respectively. CT enterographic manifestations indicative of CD were the involvement of the left colon, asymmetric pattern of involvement and abscess, comb sign; manifestations indicative ITB were the distribution of the lymph nodes along the right colic artery, contracture of ileocecal valve, fixed patulous ileocecal valve and lymph nodes with central necrosis The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of regression mathematical model established by CT enterographic parameters were 96.5, 93.6, 95.7, 97.8, and 89.8%, respectively. CONCLUSIONS: The accuracy of CT enterographic model suggests the possibility of using CT enterography as an alternative to endoscopy in the differentiation between CD and ITB.

{9-Hexyl-2-[2-phenyl-6-(pyridin-2-yl)pyridin-4-yl]-9H-carbazole}di-iodido-zinc.

In the title compound, [ZnI2(C34H31N3)], the Zn(II) atom is four-coordinated by two I atoms and the pyridine N atoms from the bidentate 6'-phenyl-2,2'-bi-pyridine ligand in a distorted tetra-hedral geometry.

[A new retrieval method for ozone concentration at the troposphere based on differential absorption lidar].

Aerosols interfere with differential absorption lidar ozone concentration measurement and can introduce significant errors. A new retrieval method was introduced, and ozone concentration and aerosol extinction coefficient were gained simultaneously based on the retrieval method. The variables were analyzed by experiment including aerosol lidar ratio, aerosol wavelength exponent, and aerosol-molecular ratio at the reference point. The results show that these parameters introduce error less than 8% below 1 km. The measurement error derives chiefly from signal noise and the parameters introduce error less than 3% above 1 km. Finally the vertical profile of tropospheric ozone concentration and aerosol extinction coefficient were derived by using this algorithm. The retrieval results of the algorithm and traditional dual-wavelength difference algorithm are compared and analyzed. Experimental results indicate that the algorithm is feasible, and the algorithm can reduce differential absorption lidar measurement error introduced by aerosol.

Special diaphragm-like strictures of small bowel unrelated to non-steroidal anti-inflammatory drugs.

AIM: To summarize clinical, endoscopic, radiologic and pathologic features of special diaphragm-like strictures found in small bowel, with no patient use of non-steroidal anti-inflammatory drugs (NSAIDs). METHODS: From January 2000 to December 2009, 5 cases (2 men and 3 women, with a mean age of 41.6 years) were diagnosed as having diaphragm-like strictures of small bowel on imaging, operation and pathology. All the patients denied the use of NSAIDs. The clinical, endoscopic, radiologic and pathologic findings in these 5 patients were retrospectively reviewed from the hospital database. Images of capsule endoscopy (CE) and small bowel follow-through (SBFT) obtained in 3 and 3 patients, respectively, and images of double-balloon enteroscopy and computed tomography enterography (CTE) obtained in all 5 patients were available for review. RESULTS: All patients presented with long-term (2-16 years) symptoms of gastrointestinal bleeding and varying degrees of anemia. There was only one stricture in four cases and three lesions in one case, and all the lesions were located in the middle or distal segment of ileum. Circumferential stricture was shown in the small bowel in three cases in the CE image, but the capsule was retained in the small bowel of 2 patients. Routine abdomen computed tomography scan showed no other abnormal results except gallstones in one patient. The lesions were shown as circumferential strictures accompanied by dilated small bowel loops in the small bowel on the images of CTE (in all 5 cases), SBFT (in 2 cases) and double-balloon enteroscopy (in all cases). On microscopy, a chronic inflammatory infiltrate and circumferential diaphragm were found in all lesions. CONCLUSION: Diaphragm-like strictures of small bowel might be a special consequence of unclear damaging insults to the intestine, having similar clinical, endoscopic, radiologic and pathologic features.

Spatial and seasonal variation of polychlorinated biphenyls in Songhua River, China.

The spatial and seasonal variation of polychlorinated biphenyls (PCBs) were investigated in water and sediment samples collected from Songhua River, China, from 2007 to 2008. The total concentration of PCB congeners ranged from 1.1 to 14 ng/l in water and 0.26-9.7 ng/g dry weight (dw) in sediment. The results of seasonal variation may suggest an impact to PCB concentration in water from its atmospheric input, the dilution to PCBs concentrations of high stream in summer, and a general trend towards increased volatilization in warmer conditions. From PCBs concentrations comparison between upstream and downstream of industrial urban cities, it was obvious that industrial urban cities reflect an important pollutant source for PCBs in our study, also with the evidences of high concentrations of PCBs occurring in high development industry and residential areas. Meanwhile, the homologue profile of PCBs in Songhua was analyzed, whose comparison with published data indicates that the sources of PCBs accumulated in the sediment may also came from the residue of PCBs production in China. Total five dioxin-like PCBs (CB-77, 81, 105, 114, and 126) and nine (CB-77, 81, 105, 114, 118, 123, 126, 156, and 167) were found in Songhua water and sediment.

[Study on the measurement of the atmospheric extinction of fog and rain by forward-scattering near infrared spectroscopy].

In the visible and near IR, absorption is negligible so that the atmospheric extinction can be derived by atmospheric scattering which is mainly contributed by fog droplet, rain droplet, another types of droplet and small articles. The forward-scattering visibility meter (FVM) works by illuminating with near IR light a small sample volume of about 100 mL of air and measuring the intensity scattered in the angular range of 30 to 36 degrees. The scattered intensity is proportional to the extinction coefficient regardless of the article size distribution and after wavelength calibration. The ratio of scattered signal to extinction coefficient of fog and haze can be achieved by comparative test of FVM outputs and manual observations. Nevertheless, as a result of the application of the measurement during rain with the ratio of fog and haze, an unacceptable error is raised. To obtain an accuracy extinction measurement during rain, an appropriated ratio of scattered signal to extinction coefficient of rain would be found. The calculation for different size distributions of fog and rain with Mie theory has been made in this paper. And a comparison of extinction measurements made with two FVMs and manual observations during fog and rain has been made. The result shows that during rain the FVM extinction coefficient is from 20% to 60% greater than that of manual observations. This result can be used to define correction factors so that the FVM using forward-scattering near IR spectroscopy not only can be used to estimate extinction during fog and haze as well as during rain.

[Application of FTIR spectra fitting method in retrieving gas concentrations].

The method of retrieving gas concentrations by FTIR spectra measurement system is studied. NLLS fitting algorithm is used to complete the quantitative analysis of CO gas under WINDOWS operating system. The spectra of HITRAN database is employed as calibrating and training sets during the procedure of fitting FTIR spectrum. The measured IR transmittance spectra of CO are best fitted with the calculated spectra in HITRAN. The CO concentrations are acquired after the best fitting. The absolute accuracy of the results of retrieve achieves 1%-5%.

[Immune responses against cancers in cervical lymph nodes of laryngeal carcinoma].

OBJECTIVE: Densities of dendritic cells (DC) and hyperplastic follicular response in cervical lymph nodes were performed to prove their roles in immune responses against cancers. METHODS: Paraffin blocks were prepared for staining with monoclonal antibodies against CD45RO, CD20 and S-100 proteins,in 157 lymph nodes obtained from elective cervical lymphadenectomy in 47 cases of laryngeal squamous cell carcinomas. RESULTS: Quantitative analysis showed that the patients who survived longer than 5 years had significant higher number of follicles and higher extent of infiltration by DCs in the lymph nodes than those who less than 5 years (P < 0.001). According to negative or positive lymph node metastasis, there were statistically significant differences between two groups (P < 0.001). The patients who possessed T cell increase type follicular reaction had significant higher five-year survival rate ( P < 0.01) and lower lymph node metastasis rate (P < 0.05) than those who possessed T cell decrease type reaction. CONCLUSION: DCs and hyperplastic follicular response may be more directly involved in the host immune reaction against tumor. The classification of follicular reaction, the densities of DCs and follicular reaction, can serve as important indicators in assessing prognosis of laryngeal carcinomas.