Objective To evaluate the cardiovascular risk for non-cardiac thoracic surgery （NCTS） in elderly patients with dobutamine stress echocardiography and to decrease surgical risk for NCTS in the geriatrics. Methods Dobutamine stress echocardiography was used for cardiovascular evaluation in 32 NCTS candidates aged over 65 years. Patients with positive echocardiography underwent coronary angiography. Postoperative course and all complications were carefully recorded for the study. Results No serious cardiovascular events occurred during the test except for atrial or ventricular premature contracts in 5 cases. In 2 patients （6.7%,2/30） dobutamine test was positive and coronary artery occlusion was proved by further angiography. Thoracotomy was performed in 28 cases, including 2 cases with dubious result at dobutamine test. Cardiopulmonary complications occurred in 13 patients （46.4%,13/28） after surgery. Supraventricular tachyarrhythmia was the most common complication, occurred in 8 patients （28.6%,8/28）. One of the 2 patients with dubious result at dobutamine test developed definitive angina in the 5th postoperative day. The negative predictive value of dobutamine test was 100%. Conclusion Dobutamine stress echocardiography is a safe and effective method to evaluate major cardiovascular risk of NCTS in the geriatrics. But it is not predictive of tachyarrhythmia after surgery.
Objective To evaluate the efficacy and safety of tripterygium for diabetic nephropathy. Methods All randomized or quasi-randomized controlled trials (RCTs or quasi-RCTs) of tripterygium for biabetic nephropathy were collected from The Cochrane Library (Issue 1, 2010), MEDLINE (1996 to March 2010), CNKI (1994 to March 2010), and CBM (1978 to March 2010). Two reviewers evaluated the quality of the trials and extracted the data independently. RevMan 5.0 software was used for meta-analyses. Results A total of 12 RCTs involving 862 patients were identified. The methodology of the included trials was poor and potential publication bias existed. The meta-analyses results showed: (1) Compared with the conventional treatment, the tripterygium showed more effects in reducing the 24-hour urinary protein (Clinical phase: WMD= –0.49, 95%CI –0.63 to –0.34, No phase: WMD= –0.60, 95%CI –0.96 to –0.24), and the urinary albumin excretion rate (UAER) (WMD= –148.75, 95%CI –238.01 to –59.48) was higher than that of the conventional treatment. (2) There were no significant differences between the two groups in the effect on the serum creatinine (Clinical phase: WMD= –8.43, 95%CI –18.15 to 1.29, No phase: WMD= –0.66, 95%CI –2.12 to 0.79) and creatinine clearance rate (WMD= 1.74, 95%CI –6.34 to 9.83). (3) Without enough data, it was uncertain to define the effect of tripterygium on lipids, blood pressure of the DN patients. (4) No severe adverse events or allergic reactions were reported. Conclusion Tripterygium may be a kind of medicine relatively safe and effective for diabetic nephropathy. However, the evidence is not b enough because of some low-quality trials and publication bias. Rigorously-designed, randomized, double-blind, and placebo-controlled trials of tripterygium for diabetic nephropathy are needed to further assess the effect.
ObjectiveTo study and analyze the clinical characteristics, treatment and prognosis of chronic kidney disease (CKD) patients with tuberculosis.MethodsThe cases of CKD with tuberculosis treated in respiratory department, nephrology department and infection department of the Affiliated Hospital of Southwest Medical University during January 2014 to December 2018 and followed up for at least half a year were collected as the study subjects. The clinical characteristics of CKD patients with tuberculosis and to observe the treatment, prognosis and adverse reactions were analyzed.ResultsA total of 74 patients were enrolled in the analysis, including 51 males (68.91%) and 23 females (31.08%), and with a mean age of (52.1±15.5) years. The use rate of immunosuppress drug in CKD G1\G2\G3 stage was very high (100%, 100%, 70%, respectively), and patients in G5 stage had the highest TB infection by 49 cases. There were 58 cases of pulmonary tuberculosis, which was the main form of tuberculosis. Extrapulmonary tuberculosis was very common too, and there were 40 cases including 29 cases of lymph node tuberculosis. Among 53 cases of acid fast bacilli smear, 8 cases were positive; lung biopsy positive in 1; lymph node biopsy was positive in 5 cases; 53 cases were initially treated and 21 cases were retreated. The main symptoms of 74 patients were emaciation (33 cases), fever (30 cases), and fatigue (25 cases); the common symptoms of 58 patients with pulmonary tuberculosis were cough and expectoration (41 cases). Pulmonary tuberculosis mainly infected the upper field of lung (39 cases). The most common imaging features was patchy shadow in 17 cases, followed by single or multiple nodules in 15 cases. The number of cases with lymph node enlargement in drainage area, pleural effusion, and pleural thickening were 36, 34 and 24, respectively. The sensitivity of tuberculosis interferon-gamma release assays (TB-IGRA), tuberculosis polymerase chain reaction (TB-PCR) and Mycobacterium tuberculosis protein chip was 79.6%, 18.8% and 61.7%, respectively. After tuberculosis treatments, 51 cases were successful, 14 cases failed, 5 cases died, and 4 cases could not be evaluated. Sixteen cases had serious and typical adverse reactions, including 12 cases of drug-induced liver injury, and 11 cases of treatment failure due to these serious adverse reactions.ConclusionsThe incidence rate of tuberculosis is high in CKD patients and the clinical manifestations are atypical. Pulmonary tuberculosis is the main form of tuberculosis, extrapulmonary tuberculosis is very common and mainly lymph node tuberculosis. The sensitivity of TB-IGRA, TB-PCR and Mycobacterium tuberculosis protein chip detection are lower than that of common patients. The success rate of tuberculosis treatment in CKD patients is low, the adverse reaction rate is high, and the adverse reactions are the main causes of treatment failure.
Objective To investigate the clinical characteristics and prognosis of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis with acute kidney injury (AKI) as the first manifestation, and provide new ideas for the prevention and treatment of this disease. Methods A retrospective analysis was performed on 144 patients diagnosed with ANCA-associated vasculitis in Affiliated Hospital of Southwest Medical University between August 2013 and March 2020. The patients were divided into AKI group and non-AKI group according to whether they were complicated with AKI at admission, and the differences in clinical characteristics were analyzed. The risk factors were screened by multiple logistic regression analysis. Results Among the 144 patients with ANCA-associated vasculitis, 30 cases (20.8%) were complicated with AKI at admission, and 70 cases (48.6%) died by the end of follow-up. There were 16 death cases (53.3%) in the AKI group, and 54 death cases (47.4%) in the non-AKI group, but the difference was not statistically significant (P>0.05). Single-factor analyses showed that in the AKI group, the pre-admission incidence of hematuria, neutrophil count, serum creatinine, systolic blood pressure, and Birmingham Vasculitis Activity Score were higher than those in the non-AKI group, while the red blood cell count and estimated glomerular filtration rate (eGFR) were lower than those in the non-AKI group, and the differences were statistically significant (P<0.05). Multiple logistic regression analysis showed that the neutrophil count [odds ratio (OR)=1.172, 95% confidence interval (CI) (1.003, 1.371), P=0.046] and eGFR [OR=0.942, 95%CI (0.907, 0.979), P=0.002] were independent influencing factors for AKI. Conclusions Elevated neutrophil count is an independent risk factor for ANCA-associated vasculitis complicated with AKI. It has certain guiding significance for clinical work. Early identification and intervention of these patients may contribute to reduce the case fatality rate and improve prognosis.
Objective To explore the expression and changes of serum irisin in adenine-induced chronic kidney disease (CKD) model, and the role of irisin and related pathway in CKD renal fibrosis. Methods Twenty male SD rats were randomly divided into a control group and a model group (CKD group) using a simple randomization method, with 10 rats in each group. At the end of the 2nd and 4th week, biochemical indicators, serum irisin and serum bone morphogenetic protein 7 (BMP7) levels, renal pathologic changes and interstitial fibrosis of renal tubules were measured in two groups of rats. The protein expression levels and messenger RNA (mRNA) expression levels of alpha-smooth muscle actin (α-SMA), collagen type I (Col-Ⅰ), BMP7, and Smad1 in rat kidney tissue were detected and compared. Results Compared with the control group at the end of the 2nd and 4th week, the CKD group showed that the serum creatinine (Scr), serum urea nitrogen (BUN), and 24-hour urinary protein level were increased (P<0.05), the protein expression levels and mRNA expression levels of α-SMA and Col-Ⅰ were increased (P<0.05), while the serum irisin and serum BMP7 were decreased (P<0.05), the protein expression levels and mRNA expression levels of BMP7 and Smad1 were reduced (P<0.05). Compared with the end of the 2nd week, the CKD group at the end of the 4th week showed that the serum Scr, serum BUN, and 24-hour urinary protein level were increased (P<0.05), the protein expression levels and mRNA expression levels of α-SMA and Col-Ⅰ were increased (P<0.05), while the serum irisin and serum BMP7 were decreased (P<0.05), the protein expression levels and mRNA expression levels of BMP7 and Smad1 were reduced (P<0.05). Compared to the control group, the renal tissue structure of the CKD group showed significant structural disorders and interstitial fibrosis of the renal tissue, which worsened over time. Serum irisin was negatively correlated with α- SMA and Col - Ⅰ (r=−0.917, −0.902, P<0.001) respectively, while serum irisin was positively correlated with serum BMP7 (r=0.842, P<0.001); Kidney tissue BMP7 was positively correlated with Smad1 (r=0.884, P<0.001). The cluster heat map showed that compared with the control group, BMP7 and recombinant fibronectin type Ⅲ domain containing were significantly decreased, α-SMA and Col-Ⅰ were significantly increased in CKD group; recombinant fibronectin type Ⅲ domain containing were positively correlated with BMP7, and negatively correlated with α-SMA and Col-Ⅰ. Conclusions irisin may be involved in the process of renal fibrosis in adenine-induced CKD via the BMP7/Smad1 axis. This will provide new ideas for the prevention and treatment of renal fibrosis.
ObjectiveTo evaluate the data of preoperative aortic root CT angiography (CTA), compare it with two-dimensional transthoracic echocardiography and investigate the correlation of the two measurements with the actual intraoperative measurement data.MethodsClinical data of 53 patients with aortic valve diseases who underwent aortic valve repair in our hospital from January 2018 to August 2020 were retrospectively analyzed, including 38 males and 15 females with an average age of 42.9±18.3 years ranging from 10 to 77 years. Preoperative two-dimensional transthoracic echocardiography (TTE) and aortic root CTA measurements were collected, including aortic valve annulus (AVA), aortic sinus (Sinus) and sino-tubular junction (STJ). In comparison with the intraoperative measurements during the aortic valve repair surgery, the consistency analysis was performed.ResultsBoth the preoperative echocardiography AVA measurements and the CT AVA measurements were positively correlated with the intraoperative AVA measurements (P<0.001). Compared with the echocardiography AVA data [correlation coefficient (ρ)=0.74, mean squarederror (MSE)=12.78], the CT AVA data were more accurate and consistent with the intraoperative AVA measurements (ρ=0.95, MSE=2.72). CT AVA data had a higher correlation coefficient with the intraoperative measurements, compared to that of the echocardiography AVA data (P<0.001).ConclusionIn comparison with two-dimensional transthoracic echocardiography, preoperative morphological evaluation of aortic root CTA is more consistent with the actual intraoperative measurements during aortic valve repair surgery.