Exploring symptom clusters in Chinese patients with peritoneal dialysis: a network analysis.

BACKGROUND: In recent years, the research on symptom management in peritoneal dialysis (PD) patients has shifted from a single symptom to symptom clusters and network analysis. This study collected and evaluated unpleasant symptoms in PD patients and explored groups of symptoms that may affect PD patients with a view to higher symptom management. METHODS: The symptoms of PD patients were measured using the modified Dialysis Symptom Index. The symptom network and node characteristics were assessed by network analysis, and symptom clusters were explored by factor analysis. RESULTS: In this study of 602 PD patients (mean age 47.8 ± 16.8 years, 47.34% male), most had less than 2 years of dialysis experience. Five symptom clusters were obtained from factor analysis, which were body symptom cluster, gastrointestinal symptom cluster, mood symptom cluster, sexual disorder symptom cluster, and skin-sleep symptom cluster. Itching and decreased interest in sex may be sentinel symptoms, and being tired or lack of energy and feeling anxious are core symptoms in PD patients. CONCLUSIONS: This study emphasizes the importance of recognizing symptom clusters in PD patients for better symptom management. Five clusters were identified, with key symptoms including itching, decreased interest in sex, fatigue, and anxiety. Early intervention focused on these symptom clusters in PD patients holds promise for alleviating the burden of symptoms.

[Methylselenocysteine Promotes Etoposide Cytotoxicity by Enhancing Homotypic Gap Junctions Composed of Connexin 26].

Objective: To investigate the effect of methylselenocysteine (MSC) on the function of homotypic gap junction (GJ) composed of connexin (Cx) 26 and its regulation of chemotherapeutic drug cytotoxicity. Methods: The Tet-on HeLa cells transfected with and stably expressing Cx26 were used as the tool cells. Effects of MSC on cell growth, GJ function, and Cx26 protein expression were examined by MTT method, parachute assay, and Western blot analysis, respectively. The cytotoxicity of chemotherapeutic drugs was determined by standard colony-forming assay, and the relationship between MSC's effect on cytotoxicity of these chemotherapeutic drugs and its regulation of GJ was further analyzed. Results: In Tet-on HeLa cells, doxycycline (Dox) can induce the expression of Cx26, which could then form functional GJs. Within a concentration range of 50 µmol/L, MSC had no significant effect on HeLa cell growth. Non-toxic concentrations of MSC can enhance GJs in a concentration-dependent manner and exert its effect at the nanomolar level. This effect was associated with an induction of Cx26 protein expression by MSC. Among the three common chemotherapeutic agents with different mechanisms of action, etoposide (Eto) presented cytotoxicity differences between HeLa cells cultured at low density (nonconfluent, no GJ formed) and high density (confluent, GJ formed). What's more, the inhibitory effect of Eto combined with MSC on HeLa cell colony formation was stronger than that of Eto alone, and this effect occurred only in HeLa cells with GJ formation. Conclusion: MSC can potentiate the cytotoxicity of Eto by enhancing the GJs composed of Cx26, indicating that combined strategy of selenide and chemotherapy shows potential value in the treatment of malignant tumors.

[Current status and our consideration on clinical transformation of acupuncture research].

It has become one of the major strategic directions to develop translational medicine and realize the stride leap from basic research to clinical application in the national biomedical field. In recent years, both basic and clinical researches of acupuncture and moxibustion have made landmark progress. However, the transformation of acupuncture and moxibustion techniques still faced with many difficulties, such as low conversion rate and high difficulty of transformation. In this article, we mainly made a preliminary discussion on the current situations of acupuncture and moxibustion transformation from the aspects of basic research content, evidence-based medicine and clinical trials, evaluation criteria for the conclusion of scientific research projects and transformation mode, put forward some existing problems in the transformation process, and proposed some corresponding countermeasures to the problems.

[Clinical and Laboratory Characteristics of Primary Autoimmune Hemolytic Anemia Patients with Negative Results of DAT by Tube Test But Positive Results by Microcolumn Gel Assay].

OBJECTIVE: To investigate the clinical features and laboratory characteristics of primary autoimmune hemolytic anemia (AIHA) patients with negative results of direct antiglobulin test (DAT) by tube test but positive results by microcolumn gel assay, in order to provide references for the diagnosis of these patients. METHODS: 59 patients diagnosed with primary AIHA in our hospital from January 2015 to December 2020 were retrospectively analyzed. According to the results of tube test and microcolumn gel assay, the cases were divided into 3 groups, and the clinical and laboratory characteristics of each group were compared. RESULTS: The cases were grouped as follows: Group I, cases with negative results by both methods of DAT (n=5); Group II, cases with negative results by tube test but positive results by microcolumn gel assay (n=26); Group III, cases with positive results by both methods of DAT (n=28). There was no significant difference in age and sex between Group II and other groups, whereas the positive rate of anti-IgG + anti-C3d of Group II was lower than that in Group III (P=0.015). The main clinical manifestations of Group II were chest tightness, shortness of breath, fatigue, as well as yellow skin and sclera or dark urine, but the incidence rate of these symptoms was not significantly different from other groups. Anemia related indexes in Group II such as red blood cell (RBC) count and hemoglobin (Hb) were lower than the reference intervals, but there was no significant difference compared with other groups. Hemolysis related indexes in Group II such as reticulocyte (Ret) ratio, indirect bilirubin (IBIL), lactate dehydrogenase (LDH) and free-hemoglobin (F-Hb) were higher than the reference intervals, and the latter two items were signficantly higher than those in Group I (P=0.031 and P=0.036). Serum complement C3 and C4 in Group II were higher than those in Group III (P=0.010 and P=0.037). CONCLUSION: Anemia severity of primary AIHA patients who were negative of DAT by tube test but positive by microcolumn gel assay was similar to those with negative or positive results by both DAT methods, but the mechanism and degree of complement system involved in hemolysis might be different. Results above may be helpful for laboratory diagnosis of this kind of patients.

[ITS sequences variation and phylogenetic analysis on 31 geographical populations of Notopterygium incisum].

In this study, 31 Notopterygium incisum populations were analyzed using ITS sequences to investigate the genetic structure. The results showed that: the ITS region ranged in size from 634 to 635 bp and base composition was with high G + C content of 57.8%. Thirty-one polymorphic sites were detected from 402 sequences of 31 populations of N. incisum, and the proportion of polymorphic sites was 4.88%, in which parsimony informative sites were up to 12. And 31 haplotypes were identified based on these polymorphic sites. Molecular variance analysis (AMOVA) indicated that high genetic differentiation (57%) existed among population, and gene flow was low (N(m) = 0.38) among populations. Phylogenetic relationships of 31 haplotypes were analyzed using NJ method with N. forbesiias an out-group. Phylogenetic analysis showed that 31 haplotypes from different populations mixed together and did not form distinct geographically separated clades.

Comparative phylogenetic relationships and genetic structure of the caterpillar fungus Ophiocordyceps sinensis and its host insects inferred from multiple gene sequences.

Ophiocordyceps sinensis (Ascomycota: Ophiocordycipitaceae) is a native fungal parasite of Hepialidae caterpillars and one of the most economically important medicinal caterpillar fungi in China. However, little is known about the phylogenetic and evolutionary relationships between O. sinensis and its host insects. In this study, nuclear ITS and ß-tubulin sequences from O. sinensis and mitochondrial COI, COII, and Cytb sequences from its hosts were analyzed across 33 populations sampled from five regions in China. Phylogenetically, both O. sinensis and its hosts were divided into three geographically correlated clades, and their phylogenies were congruent. Analysis of molecular variance and calculated coefficients of genetic differentiation revealed significant genetic divergence among the clades within both O. sinensis (F(ST)= 0.878, N(ST)=0.842) and its hosts (F(ST)=0.861, N(ST)=0.816). Estimated gene flow was very low for O. sinensis (Nm=0.04) and the host insects (Nm=0.04) among these three clades. Mantel tests demonstrated a significant correlation (P<0.01) between the genetic distances for O. sinensis and its hosts, as well as a significant association (P<0.05) between geographic and genetic distances in both. The similar phylogenetic relationships, geographic distributions, and genetic structure and differentiation between O. sinensis and its hosts imply that they have coevolved.

[Relationship between the expression of autoantibodies against platelet membrane glycoprotein and therapeutic effect in primary immune thrombocytopenia].

OBJECTIVE: To study the expression of specific anti- platelet glycoprotein autoantibodies GP II b/III a, GP I b/IX and GP I a/II a in primary immune thrombocytopenia (ITP), and to evaluate the relationship between the therapeutic effect and the expression of specific anti- platelet glycoprotein antibodies GPIIb/IIIa, GPIb/IX and GPIa/IIa. METHODS: Anti-GPIIb/IIIa, GPIb/ IX and GP I a/II a antibodies were assayed by ELISA for patients with ITP. Total 442 patients in our hospital, who were retrospectively investigated from December 2010 to November 2012, were divided into newly diagnosed ITP, persistent and chronic ITP. The expression of specific anti- platelet glycoprotein antibody in each group was measured separately. The newly diagnosed ITP patients were treated with intravenous IgG (IVIG) and corticosteroids. The relationship between the expression of specific anti- platelet glycoprotein antibodies GPIIb/IIIa, GPIb/IX and GPIa/IIa and the complete response (CR) was studied. RESULTS: Positive rates of anti- platelet glycoprotein antibodies were 59.09%, 26.97% and 37.35% respectively in newly diagnosed ITP, persistent and chronic ITP, the difference was statistical significant (P<0.05). In newly diagnosed ITP, positive rate of antibody against GPIIb/IIIa was 38.64%, double positive rate of antibodies against both GP II b/III a and GP I a/II a was 15.91%, there was statistical significance (P<0.05) compared with that of persistent and chronic ITP. The complete response (CR) rate in newly diagnosed ITP patients with positive antibody against GP II b/III a was 80.39% after treatment with IVIG and corticosteroids. There was statistical significance compared with that in patients having no antibodies (P<0.05). CONCLUSION: The expression of antibodies against GP II b/III a and double positive for both GP II b/III a and GP I a/II a autoantibodies increased in newly diagnosed ITP patients. Patients with anti-GP II b/III a autoantibody had good response to medication with IVIG and corticosteroids.

[Blood pressure variation of hypertensive diabetic nephropathy patients undergoing peritoneal dialysis].

OBJECTIVE: To investigate the variance of blood pressure of hypertensive diabetic patients undergoing continuous ambulatory peritoneal dialysis (CAPD). METHODS: Twenty hypertensive CAPD patients older than 40 years with diabetic nephropathy (DN-PD group) and twenty patients with chronic glomerular nephritis (CGN-PD group) were recruited. Peritoneal status and dialysis adequacy of the patients in the two groups were calculated using PD Adequest. All patients were given 24-hour ambulatory blood pressure monitoring (ABPM). Parameters of blood pressure variation were calculated and compared between the two groups, which included 24 h systolic and diastolic blood pressure variability (24 h SBPV/DBPV) and coefficient of variation (24 h SBPCV/24 h DBPCV), daytime systolic anid diastolic blood pressure variability (dSBPV/ DBPV) and coefficient of variation (dSBPCV/dDBPCV), and night time systolic and diastolic blood pressure variability (nSBPV/ DBPV) and coefficient of variation (nSBPCV/nDBPCV). RESULTS: No significant differences in clinical characteristics were found between the two groups of patients except for fast glucose. No significant differences in average systolic and diastolic blood pressures, average piulse pressure and mean 24 h, daytime, and nighttime arterial pressures were found between the two groups. However, the DN-PD group had significantly higher 24 h SBPV, 24 h SBPCV, dSBPV and dSBPCV than the CGN-PD group (P < 0.05). CONCLUSION: Hypertensive diabetic nephropathy patients undergoing peritoneal dialysis have greater blood pressure variance than those with hypertensive chronic glomerular nephritis, despite a similar result of blood pressure control.

[A comparison of clinical characteristics and survival between diabetic nephropathy patients and non-diabetic nephropathy patients undergoing peritoneal dialysis].

OBJECTIVE: To investigate clinical characteristics and survival of diabetic patients with end-stage renal disease on peritoneal dialysis (PD). METHODS: The clinical data were collected from the patients who initiated PD in our PD Center from Jan, 2009 through Aug, 2011. The patients were divided into diabetic group and non-diabetic group, the survival of patients and risk factors of death were analyzed and compared between the two groups by using Kaplan-Meier and Cox regression analysis. RESULTS: There were 460 PD patients included in this study, 64 (13.9%) of them were diabetic and 396 (86.1%) were non-diabetic. Compared with non-diabetic PD patients, the PD patients with diabetes were older [(63 +/- 13) yr. versus (45 +/- 16) yr. , P < 0.001], while had higher level of high sensitive C reaction protein (hsCRP), lower levels of serum albumin and prealbumin, as well as lower levels of triglyceride and nPCR. There was no statistical difference in serum concentrations of hemoglobin, parathyroid hormone, cholesterol, and Kt/V and residual renal function between the two groups. The survival rates of PD patients with diabetics versus non-diabetics were 73.3% versus 90.7% at 1 year, and 61.8% versus 82.5% (P < 0.05) at 2 years. Mean survival time of diabetic PD patients (24.6 months) was significantly inferior to non-diabetic PD patients (30.1 months) (P < 0.05). The relative risk of mortality in diabetic PD patients was 2. 449 times of that in non-diabetic patients. Multivariate Cox regression analysis, indicated that serum albumin level and patient age were significant risk factors for mortality. CONCLUSION: Diabetic patients tended to be elderly, malnutrition and microinflammation at the beginning of PD. The survival of diabetic PD patients is inferior to non-diabetic PD patients on CAPD. Age and albumin level were risk factors for mortality in PD patients.

[A novel diagnostic measure of platelet-specific antibody in immune thrombocytopenia].

OBJECTIVE: To detect the platelet glycoprotein-specific antibodies in serum of thrombocytopenia patients and evaluate its diagnostic value for immune thrombocytopenia. METHOD: Anti-GPIIb/IIIa, GPIb/IX and GPIa/IIa antibodies were assayed by ELISA kit (PAKUTO) in patients with thrombocytopenia. RESULTS: The sensitivity and specificity of PAKAUTO in immune thrombocytopenia were 44.0% and 95.7%, respectively. The values of positive and negative predictions were 98.0% and 26.2%, respectively. Among those PAKAUTO positive patients, positive rates of GPIIb/IIIa, GPIa/IIa and GPIb/IX were 87%, 35% and 10%, respectively. The positive rate of patients not received immune suppressive agents (58.5%) was significantly higher than those received immune suppressive agents (26.9%) (P < 0.01). The positive rate of patients with platelet count ≤ 20 × 10(9)/L (51.6%) was significantly higher than those with platelet count > 20 × 10(9)/L (27.8%) (P < 0.01). The positive rate of patients with secondary immune thrombocytopenia (66.7%) was significantly higher than those with primary immune thrombocytopenia (41.7%) (P < 0.05). CONCLUSION: The highly specific method (PAKAUTO) could effectively differentiate immune or non-immune thrombocytopenia and be applied to diagnosis of immune thrombocytopenia.

[Application of micro-column gel cards assay for direct Coombs test in diagnosis of autoimmune hemolytic anemia].

OBJECTIVE: To evaluate the clinic value of micro-column gel cards direct Coombs test (gel test) in diagnosis of autoimmune hemolytic anemia (AIHA). METHODS: Specimens of 128 suspected AIHA patients were performed direct Coombs test by conventional tube or gel cards. The results of the two tests were compared. The hemoglobin concentrations, proportions of reticulocyte, serum levels of bilirubin and free hemoglobin were detected simultaneously and compared in subgroups. RESULTS: The positive detection rate of direct Coombs test performed by gel test or tube were 88.4% and 37.7%, respectively. CONCLUSION: Compared with the tube tests, gel test assay is more sensitive, easy to perform and standardized in diagnosis of AIHA, and the gel card can be stored for a long time. The gel test is valuable for the diagnosis of AIHA.