Arthrogryposis, renal dysfunction and cholestasis (ARC) syndrome is a rare genetic disorder and has not been described in China. We present a female infant with neonatal intrahepatic cholestasis from a Chinese family ...Arthrogryposis, renal dysfunction and cholestasis (ARC) syndrome is a rare genetic disorder and has not been described in China. We present a female infant with neonatal intrahepatic cholestasis from a Chinese family with ARC syndrome. All 23 coding exons and flanking introns of the VPS33B gene were amplified and sequenced using peripheral lymphocyte genomic DNA of the patient and her parents. Genetic testing revealed two novel mutations (c.1033delA and c.1567C>T) in the VPS33B gene. The patient is a compound heterozygote and her parents were heterozygous for each of the mutations.展开更多
OBJECTIVE To assess the role of beta-blockers(BB)in patients with chronic kidney disease(CKD)aged≥75 years.METHODS AND RESULTS From January 2008 to July 2014,we included 390 consecutive patients≥75 years of age with...OBJECTIVE To assess the role of beta-blockers(BB)in patients with chronic kidney disease(CKD)aged≥75 years.METHODS AND RESULTS From January 2008 to July 2014,we included 390 consecutive patients≥75 years of age with ejection fraction≤35%and glomerular filtration rate(GFR)≤60 m L/min per 1.73 m^2.We analyzed the relationship between treatment with BB and mortality or cardiovascular events.The mean age of our population was 82.6±4.1 years.Mean ejection fraction was 27.9%±6.5%.GFR was 60-45 m L/min per 1.73 m^2 in 50.3%of patients,45-30 m L/min per 1.73 m^2 in 37.4%,and<30 m L/min per 1.73 m^2 in 12.3%.At the conclusion of follow-up,67.4%of patients were receiving BB.The median follow-up was28.04(IR:19.41-36.67)months.During the study period,211 patients(54.1%)died and 257(65.9%)had a major cardiovascular event(death or hospitalization for heart failure).BB use was significantly associated with a reduced risk of death(HR=0.51,95%CI:0.35-0.74;P<0.001).Patients receiving BB consistently showed a reduced risk of death across the different stages of CKD:stage IIIa(GFR=30-45 m L/min per 1.73 m^2;HR=0.47,95%CI:0.26-0.86,P<0.0001),stage IIIb(GFR 30-45 m L/min per 1.73 m^2;HR=0.55,95%CI:0.26-1.06,P=0.007),and stages IV and V(GFR<30 m L/min per 1.73 m~2;HR=0.29,95%CI:0.11-0.76;P=0.047).CONCLUSIONS The use of BB in elderly patients with HFr EF and renal impairment was associated with a better prognosis.Use of BB should be encouraged when possible.展开更多
BACKGROUND The VPS33B(OMIM:608552)gene is located on chromosome 15q26.1.We found a female infant with autosomal recessive arthrogryposis,renal dysfunction and cholestasis syndrome 1(ARCS1)caused by mutation in VPS33B....BACKGROUND The VPS33B(OMIM:608552)gene is located on chromosome 15q26.1.We found a female infant with autosomal recessive arthrogryposis,renal dysfunction and cholestasis syndrome 1(ARCS1)caused by mutation in VPS33B.The child was diagnosed with ARCS1(OMIM:208085)after the whole exome sequencing revealed two heterozygous mutations(c.96+1G>C,c.242delT)in the VPS33B gene.CASE SUMMARY We report a Chinese female infant with neonatal cholestasis disorder,who was eventually diagnosed with ARCS1 by genetic analysis.Genetic testing revealed two new mutations(c.96+1G>C and c.242delT)in VPS33B,which is the causal gene.The patient was compound heterozygous,and her parents were both heterozygous.CONCLUSION This study extends the mutational spectrum of the VPS33B gene to provide a molecular basis for the etiological diagnosis of ARCS1 and for genetic counseling of the family.展开更多
Objective:The aim of this study was to investigate renal insufficiency in patients with chemotherapy.Methods:Prescribing chemotherapy in a regular hemodialysis patient with renal failure,and monitoring of serum drug c...Objective:The aim of this study was to investigate renal insufficiency in patients with chemotherapy.Methods:Prescribing chemotherapy in a regular hemodialysis patient with renal failure,and monitoring of serum drug concentrations to determine its safety and effectiveness.Results:Chemotherapy assessment efficiency:SD(better),hemodialysis did not affect THP treatment,their safety was guaranteed.Conclusion:The chemotherapy of renal dysfunction is not an absolute contraindication to fully assess the patient's adverse effects and tolerability,the reasonable arrangements for hemodialysis and the timing of administration can be safe and effective chemotherapy.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is one of the most common malignancies worldwide.However,the number of patients with chronic kidney disease(CKD)is on the rise because of the increase in lifestyle-related disea...BACKGROUND Hepatocellular carcinoma(HCC)is one of the most common malignancies worldwide.However,the number of patients with chronic kidney disease(CKD)is on the rise because of the increase in lifestyle-related diseases.AIM To establish a tailored management strategy for HCC patients,we evaluated the impact of comorbid renal dysfunction(RD),as stratified by using the estimated glomerular filtration rate(EGFR),and assessed the oncologic validity of hepatectomy for HCC patients with RD.METHODS We enrolled 800 HCC patients who underwent hepatectomy between 1997 and 2015 at our university hospital.We categorized patients into two(RD,EGFR<60 mL/min/1.73 m^(2);non-RD,EGFR≥60 mL/min/1.73 m^(2))and three groups(severe CKD,EGFR<30 mL/min/1.73 m^(2);mild CKD,30≤EGFR<60 mL/min/1.73 m2;control,EGFR≥60 mL/min/1.73 m^(2))according to renal function as defined by the EGFR.Overall survival(OS)and recurrence-free survival(RFS)were compared among these groups with the log-rank test,and we also analyzed survival by using a propensity score matching(PSM)model to exclude the influence of patient characteristics.The mean postoperative observation period was 64.7±53.0 mo.RESULTS The RD patients were significantly older and had lower serum total bilirubin,aspartate aminotransferase,and aspartate aminotransferase levels than the non-RD patients(P<0.0001,P<0.001,P<0.05,and P<0.01,respectively).No patient received maintenance hemodialysis after surgery.Although the overall postoperative complication rates were similar between the RD and non-RD patients,the proportions of postoperative bleeding and surgical site infection were significantly higher in the RD patients(5.5%vs 1.8%;P<0.05,3.9%vs 1.8%;P<0.05,respectively),and postoperative bleeding was the highest in the severe CKD group(P<0.05).Regardless of the degree of comorbid RD,OS and RFS were comparable,even after PSM between the RD and non-RD groups to exclude the influence of patient characteristics,liver function,and other causes of death.CONCLUSION Comorbid mild RD had a negligible impact on the prognosis of HCC patients who underwent curative hepatectomy with appropriate perioperative management,and close attention to severe CKD is necessary to prevent postoperative bleeding and surgical site infection.展开更多
Background:Renal cystic disease arising from various etiologies results in fluid-filled cavities within the kidneys.Moreover,preexisting renal dysfunction has been shown to exacerbate multiple pathologies.While swine ...Background:Renal cystic disease arising from various etiologies results in fluid-filled cavities within the kidneys.Moreover,preexisting renal dysfunction has been shown to exacerbate multiple pathologies.While swine bred for biomedical research are often clinically inspected for illness/parasites,more advanced diagnostics may aid in uncovering underlying renal abnormalities.Methods:Computed tomography was performed in 54 female prepubertal Yorkshire swine to characterize renal cysts;urine and blood chemistry,and histology of cysts were also performed.Results:Digital reconstruction of right and left kidneys demonstrated that roughly one-third of the animals(17/54;31%)had one or more renal cyst.Circulating biomarkers of renal function were not different between animals that had cysts and those that did not.Alternatively,urinary glucose(P=.03)was higher and sodium(P=.07)tended to be lower in animals with cysts compared to animals without,with no differences in protein(P=.14)or potassium(P=.20).Aspiration of cystic fluid was feasible in two animals,which revealed that the cystic fluid urea nitrogen(97.6±28.7 vs 911.3±468.2 mg/dL),potassium(29.8±14.4 vs 148.2±24.85 mmol/L),uric acid(2.55±1.35 vs 11.4±5.65 mg/dL),and creatinine(60.34±17.26 vs 268.99±95.79 mg/dL)were much lower than in the urine.Histology demonstrated a cyst that markedly compresses the adjacent cortex and is lined by a single layer of flattened epithelium,bounded by fibrous connective tissue which extends into the parenchyma.There is tubular atrophy and loss in these areas.Conclusion:This study provides valuable insight for future studies focusing on kidney function in swine bred for biomedical research.展开更多
Objectives To evaluate the relationship of renal dysfunction,coronary heart disease and percutaneous coronary intervention(PCI).Methods(l)The subjects:There were 376 patients who come from department of cardiology of ...Objectives To evaluate the relationship of renal dysfunction,coronary heart disease and percutaneous coronary intervention(PCI).Methods(l)The subjects:There were 376 patients who come from department of cardiology of our hospital in this study undergoing coronary angiography.The patients were divided into two groups? according to coronary angiography:coronary artery disease(group A,n =263),in which 141 patients with renal dysfunction(group A1) and 122 patients with normal renal function(group A2):patients with other kinds of cardiovascular disease but normal coronary angiography(group B.n=113).Before the coronary angiography, all patients were measured the serum creatinine, microalbuminuria,fasting blood-glucose,triglycerides,total cholesterol,high density lipoprotein,low density lipoprotein, blood pressure in fasting 12 hours.(2)The diagnostic criteria for renal dysfunction:male serum creatinine】115 umol/L and/or microalbuminuria】30 mg,female】107 umol/L and/ or】30 mg.Results(1)The differences of renal function indexes in the group A and B:The mean level of microalbuminuria and serum creatinine was higher significantly in group A than that of the group B(43.48±38.93 vs.11.23±7.07 and 101.52±37.22 vs.80.62±17.4 respectively.Conclusions The coronary heart disease patients with renal dysfunction had more severe coronary artery stenosis,The renal dysfunction is a strong and independent risk factors for the coronary heart disease and beeds more revascularization therapy.展开更多
Background： Chronic kidney disease （CKD） with moderate-to-severe renal dysfunction usually exhibits an irreversible course, and available treatments for delaying the progression to end-stage renal disease are limit...Background： Chronic kidney disease （CKD） with moderate-to-severe renal dysfunction usually exhibits an irreversible course, and available treatments for delaying the progression to end-stage renal disease are limited. This study aimed to assess the efficacy and safety of the traditional Chinese medicine, Niaoduqing particles, for delaying renal dysfunction in patients with stage 3b-4 CKD.Methods： The present study was a prospective, randomized, double-blind, placebo-controlled, naulticentcr clinical trial. Frorn May 2013 to December 2013,300 CKD patients with an estimated glomerular filtration rate （eGFR） between 20 and 45 ml ＂rain ~＂ 1.73 m 2, aged 18-70 years were recruited from 22 hospitals in 11 Chinese provinces. Patients were randomized in a 1：1 ratio to either a test group, which was administered Niaoduqing particles 5 g thrice daily and 10 g before bedtime for 24 weeks, or a control group, which was administered a placebo using the same methods. The primary endpoints were changes in baseline serum creatinine （Scr） and eGFR after completion of treatment. The primary endpoints were analyzed using Student＇s t-test or Wilcoxon＇s rank-sum test. The present study reported results based on an intention-to-treat （ITT） analysis. Results： A total of 292 participants underwent the ITT analysis. At 24 weeks, the median （interquartile range） change in Scr was 1.1 （-13.0-24.1） and 11.7 （-2.6-42.9） p, mol/L for the test and control groups, respectively （Z = 2.642, P = 0.008）, and the median change in eGFR was -0.2 （-4.3-2.7） and -2.2 （-5.7-0.8） ml.min-1·1.73 m-2, respectively （Z = -2.408, P = 0.016）. There were no significant differences in adverse events between the groups. Conclusions： Niaoduqing particles safely and effectively delayed CKD progression in patients with stage 3b-4 CKD. This traditional Chinese medicine may be a promising alternative medication for patients with moderate-to-severe renal dysfunction.展开更多
Background： Renal function is associated with mortality and functional disabilities in stroke patients, and impaired autonomic function is common in stroke, but little is known regarding its effects on stroke patient...Background： Renal function is associated with mortality and functional disabilities in stroke patients, and impaired autonomic function is common in stroke, but little is known regarding its effects on stroke patients with renal dysfunction. This study sought to evaluate the association between autonomic function and stroke in patients with renal dysfunction. Methods： This study comprised 232 patients with acute ischemic stroke consecutively enrolled from February 2013 to November 2014 at Guangdong Provincial Hospital of Chinese Medicine in China. All patients recruited underwent laboratory evaluation and 24 h Holter electrocardiography （ECG）. Autonomic function was measured based on the heart rate variability （HRV） using 24 h Holter ECG. Renal damage was assessed through the estimated glomerular filtration rate （eGFR）, and stroke severity was rated according to the National Institutes of Health Stroke Scale （NIHSS）. The Barthel index and modifed Rankin score were also determined following admission. All the clinical covariates that could potentially affect autonomic outcome variables were adjusted with linear regression. Results： In the patients with a mild or moderate decreased eGFR, the values for the standard deviation of the averaged normal-to-normal RR interval （SDANN） index （P = 0.022L very low frequency （VLF） （P = 0.043）, low frequency （LF） （P= 0.023）, and ratio of low-to-high frequency power （LF/HF） （P = 0.001 ） were significantly lower than those in the patients with a normal eGFR. A lnultinomial linear regression indicated that eGFR （t - 2.47, P - 0.014）, gender （t - -3.60, P 〈0.001）, and a history of hypertension （t = -2.65, P = 0.008） were the risk factors of LF/HF; the NIHSS score （SDANN index： t = -3.83, P 〈 0.001 ; VLF： t = -3.07, P = 0.002： LF： t = -2.79, P = 0.006） and a history of diabetes （SDANN index： t = -3.58, P 〈 0.001; VLF： t = -2.54, P = 0.012; LF： t = -2.87, P = 0.004） were independent factors Ibr the SDANN index, VLF, and LF; the Oxfordshire Community Stroke Project （t = -2.38, P = 0.018） was related to the SDANN index. Conclusions： Autonomic dysfunction is aggravated with the progression ofeGFR stage in patients with acute ischemic stroke; the eGFR is an independent factor of LF/HF in the adjusted models. Stroke severity and a history of diabetes are more significantly associated with HRV in patients with acute ischemic stroke at different stages of renal dysfnnction.展开更多
Objective： To investigate the effect of Huanshuai Recipe Oral Liquid （缓衰口服液, HSR） on retarding the progression of renal dysfunction in patients with atherosclerotic renal artery stenosis （ARAS）. Methods： A ...Objective： To investigate the effect of Huanshuai Recipe Oral Liquid （缓衰口服液, HSR） on retarding the progression of renal dysfunction in patients with atherosclerotic renal artery stenosis （ARAS）. Methods： A total of 52 ARAS patients with the Chinese medicine （CM） syndrome of qi deficiency and blood stasis, phlegm and dampness retention were recruited and randomly assigned into the treatment group （36 cases） and the control group （16 cases）. Both groups received a basic treatment （high-quality low-protein diet, blood pressure control, lipid-lowering, correcting the acidosis, etc.）. In addition, the treatment group received 20 mL HSR and the control group received placebo, 3 times a day for 6 months. Renal function （serum creatinine, blood urea nitrogen and uric acid） and blood lipids （cholesterol, triglycerides and low density lipoprotein） were examined monthly. The estimated glomerular filtration rate （eGFR） and CM syndrome score were compared between groups. Results： After treatment, compared with the control group, the serum creatinine level, uric acid level and CM syndrome score of the treatment group were significantly decreased （P〈0.05 or P〈0.01）, and the eGFR in the treatment group were significantly increased （P〈0.05）. Conclusion： HSR can effectively improve the renal function and clinical symptoms of ARAS patients.展开更多
In the present study, we aimed to investigate the optimal dosage regimens of piperacillin/tazobactam in patients with chronic kidney disease according to their different classes of renal function based on bacterial re...In the present study, we aimed to investigate the optimal dosage regimens of piperacillin/tazobactam in patients with chronic kidney disease according to their different classes of renal function based on bacterial resistance. A total of 2700 simulationswere applied based on a published population pharmacokinetic and pharmacodynamic model using nonlinear mixed effects modeling (NONMEM) software. Permissible optimal dosage regimens were defined as those associated with a less than 10% of patients whose probabilities of target attainment (PTA) were not attain target. For patients with mild to moderate renal injury, 4/0.5 g of piperacillin/tazobactam every 12 h in 30 min intermittent infusion could attain the target. If the MIC (minimum inhibitory concentration) for the pathogen was 8 mg/L or 16 mg/L, either an 8-h or 6-h dosing interval or extended 2–6 h infusion regimen had to be used to achieve the outcome of the therapy. Regarding MIC was up to above 32 mg/L, a high dose of piperacillin (12–24 g/d) in continuous infusion was the only approach that could achieve the effective target in patients with renal dysfunction. A low dose with extended 4–6 h infusion regimen was recommended for patients with severe renal injury. Our study identified permissible optimal piperacillin/tazobactam dosage regimens for patients with renal dysfunction with an MIC up to 64 mg/L. The findings of this study would be helpful for precise administration of piperacillin/tazobactam in clinical practice.展开更多
Objective The aim of the present study mas to compare the gender difference for cadmium-induced renal tubular dysfunction between the male and female inhabitants. Methods Urinary β2-microglobulin was measured in 299 ...Objective The aim of the present study mas to compare the gender difference for cadmium-induced renal tubular dysfunction between the male and female inhabitants. Methods Urinary β2-microglobulin was measured in 299 male (94%) and 342 female (92%) inhabitants aged 54-72 years,and the development of renal tubular dysfunction for 11 years was studied in the 62 married couples from them. Results A significantly higher cumulative incidence was found in both men and women in cadmium-polluted area,showing 68. 4% in men and 64. 8% in women compared to 15. 3% in men and 5. 9% in women in the reference areas. Relative risk of renal tubular dysfunction in females (11. 0) was higher than males (4. 5). The ratios of urinary β2-microglobulin and glucose were higher in women than those in men in both the cadmium-polluted areas and the reference areas. Conclusion Although almost identical incidences were detected between men and women, the changes in excretion of β2-microglobulin and glucose was greater in women than those in men. These findings suggest that renal tubular dysfunction might be more progressive in women than that in men.展开更多
AIMTo determine the accuracy of fractional excretion of sodium (FeNa) in the diagnosis of hepatorenal syndrome (HRS). METHODSEighty-eight liver transplantation candidates with renal dysfunction and/or proteinuria were...AIMTo determine the accuracy of fractional excretion of sodium (FeNa) in the diagnosis of hepatorenal syndrome (HRS). METHODSEighty-eight liver transplantation candidates with renal dysfunction and/or proteinuria were included in the study sample. The baseline characteristics of the patients were obtained. All the 88 patients underwent iothalamate glomerular filtration rate testing, 24-h urine collection for urinary sodium and protein excretions, random urine for sodium and creatinine testing, and percutaneous kidney biopsy. FeNa was calculated using the equation [(urine sodium × serum creatinine)/(serum sodium × urine creatinine)] × 100%. Diuretic use was recorded among the participants. Patients on renal replacement therapy were not included in the original sample. RESULTSSeventy-seven (87%) of the 88 patients had FeNa P = 0.4). FeNa P = 0.47). Calculated positive predictive value and negative predictive value for FeNa P = 0.41). CONCLUSIONFeNa 1%.展开更多
Kidney dysfunction is one of the most serious complications resulting from the use of traditional medicine which is common in Africa accounting for about 35% of renal damage in HIV-infected patients. In this cross sec...Kidney dysfunction is one of the most serious complications resulting from the use of traditional medicine which is common in Africa accounting for about 35% of renal damage in HIV-infected patients. In this cross sectional study, 250 HIV-infected patients were groups as follows: ART GrpA (100), ART + traditional medicine use GrpB (100) and ART treatment naïve + traditional medicine GrpC (50). Tubular dysfunctions were defined when at least two or more of the following abnormalities were repeatedly present: Uricosuria ≥ 0.05 mg/dl, Phosphaturia ≥ 20.0 mg/dl, Glucosuria ≥ 0.1 mg/dl, Proteinuria = positive protein on dipstick urine. Renal dysfunctions were found to be significantly high (P = 0.001) in the group of patients treated with ART + traditional medicine. 27 (64.29%) patients followed by ART treatment naïve patients + traditional medicine;12 (28.57%) patients and only 4 (7.14%) patients developed renal toxicity in the ART treatment Grp. But strikingly CD4 counts were also significantly higher in Grp B (683 cell/ul) compared to group A (446 cell/ul) and C (206 cell/ul). Our results show that HIV-infected patients on ART combined with traditional medicine might develop renal abnormalities in the presence of high CD4 counts, in the course of incessant use of traditional medicine. Thus it is important that more research be conducted on its usage among the Black population with HIV infection.展开更多
Liver transplant(LT)outcomes have markedly improved in the recent decades,even if long-term morbidity and mortality are still considerable.Most of late deaths are independent from graft function and different comorbid...Liver transplant(LT)outcomes have markedly improved in the recent decades,even if long-term morbidity and mortality are still considerable.Most of late deaths are independent from graft function and different comorbidities,including complications of metabolic syndrome and de novo neoplasms,seem to play a key role in determining long-term outcomes in LT recipients.This review discusses the main factors associated with late mortality and suggests possible strategies to improve long-term management and follow-up after liver transplantation.In particular,the reduction of drug toxicity,the use of tools to identify high-risk patients,and setting up a multidisciplinary team also for long-term management of LT recipients may further improve survival after liver transplantation.展开更多
Arthrogryposis, renal dysfunction and cholestasis (ARC) syndrome (OMIM 208085) is an autosomal recessive disorder that is caused by mutations in 2 interacting genes VPS33B and VIPAS39. Mutations in VPS33B gene account...Arthrogryposis, renal dysfunction and cholestasis (ARC) syndrome (OMIM 208085) is an autosomal recessive disorder that is caused by mutations in 2 interacting genes VPS33B and VIPAS39. Mutations in VPS33B gene account for most cases of ARC. As low or normal gamma-glutamyl transpeptidase (GGT) activity has been described in all patients with ARC syndrome identified so far, ARC syndrome is a possible diagnosis for low GGT cholestasis. Here we describe a Chinese patient with neonatal cholestasis and a high GGT level in three consecutive tests. She had other typical manifestations of ARC syndrome, including arthrogryposis multiplex congenita, renal involvement and ichthyosis. Genetic study of the VPS33B gene further confirmed the diagnosis by identification of compound heterozygosity of two known disease-causing mutations, c.403+2T > A and c.1509-1510insG. The mechanism of high GGT in this patient is unclear. Nevertheless, this case indicates that ARC syndrome cannot be excluded from the differential diagnosis of neonatal cholestasis even if high GGT activity is found.展开更多
AIM:To determine whether hypermagnesemia recently reported in adult patients possibly develops in children with functional constipation taking daily magnesium oxide.METHODS:We enrolled 120 patients (57 male and 63 fem...AIM:To determine whether hypermagnesemia recently reported in adult patients possibly develops in children with functional constipation taking daily magnesium oxide.METHODS:We enrolled 120 patients (57 male and 63 female) aged 1-14 years old (median:4.7 years) with functional constipation from 13 hospitals and two private clinics.All patients fulfilled the Rome Ⅲ criteria for functional constipation and were treated with daily oral magnesium oxide for at least 1 mo.The median treatment dose was 600 (500-800) mg/d.Patients were assessed by an interview and laboratory examination to determine possible hypermagnesemia.Serum magnesium concentration was also measured in sex-and agematched control subjects (n=38).RESULTS:In the constipation group,serum magnesium concentration [2.4 (2.3-2.5) mg/dL,median and interquartile range] was significantly greater than that of the control group [2.2 (2.0-2.2) mg/dL] (P < 0.001).The highest value was 3.2 mg/dL.Renal magnesium clearance was significantly increased in the constipation group.Serum magnesium concentration in the constipation group decreased significantly with age (P < 0.01).There was no significant correlation between the serum level of magnesium and the duration of treatment with magnesium oxide or the daily dose.None of the patients had side effects associated with hypermagnesemia.CONCLUSION:Serum magnesium concentration increased significantly,but not critically,after daily treatment with magnesium oxide in constipated children with normal renal function.展开更多
Since the discovery of the coronavirus disease 2019 outbreak,a vast majority of studies have been carried out that confirmed the worst outcome of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection in...Since the discovery of the coronavirus disease 2019 outbreak,a vast majority of studies have been carried out that confirmed the worst outcome of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection in people with preexisting health conditions,including diabetes,obesity,hypertension,cancer,and cardiovascular diseases.Likewise,diabetes itself is one of the leading causes of global public health concerns that impose a heavy global burden on public health as well as socio-economic development.Both diabetes and SARS-CoV-2 infection have their independent ability to induce the pathogenesis and severity of multi-system organ failure,while the co-existence of these two culprits can accelerate the rate of disease progression and magnify the severity of the disease.However,the exact pathophysiology of multi-system organ failure in diabetic patients after SARS-CoV-2 infection is still obscure.This review summarized the organ-specific possible molecular mechanisms of SARS-CoV-2 and diabetesinduced pathophysiology of several diseases of multiple organs,including the lungs,heart,kidneys,brain,eyes,gastrointestinal system,and bones,and subsequent manifestation of multi-system organ failure.展开更多
The dosing of anti-Parkinson drugs is considered as the optimal control of the symptoms of PD,and increasing the dose of drugs is a common method to treat the aggravate state of PD.However,this is a case of PD elderly...The dosing of anti-Parkinson drugs is considered as the optimal control of the symptoms of PD,and increasing the dose of drugs is a common method to treat the aggravate state of PD.However,this is a case of PD elderly patient who had nephritic syndrome,with an increase in the dose,the symptoms did not get improved,but a series of other adverse effects appeared.展开更多
Background Prognosis of patients with acute ST-elevation myocardial infarction （STEMI） and renal dysfunction （RD） who received primary percutaneous coronary intervention （PCI） has not been fully investigated in ...Background Prognosis of patients with acute ST-elevation myocardial infarction （STEMI） and renal dysfunction （RD） who received primary percutaneous coronary intervention （PCI） has not been fully investigated in the drug-eluting stent （DES） era. This study aimed to evaluate the impact of admission serum creatinine level on short-term outcomes in patients with acute STEMI undergoing DES-based primary PCI. Methods Primary PCI with DES implantation was attempted in 619 consecutive STEMI patients within 12 hours of symptom onset. Among them, 86 patients had a serum creatinine level ≥115 μmol/L on admission （RD group）, and the remaining 533 patients had normal renal function （non-RD group）. The primary endpoint was 30-day major adverse cardiac events （MACE, including death, non-fatal reinfarction, and target vessel revascularization）, and the secondary endpoint was subacute stent thrombosis. Results Patients in the RD group were older than those in the non-RD group. There are more female patients in the RD group and they had a history of hypertension, myocardial infarction and revascularization. The occurrence rates of Killip class ≥2 （29.1% vs 18.6%, P=0.02） and multi-vessel （62.8% vs 44.5%, P=0.001） and triple vessel disease （32.6% vs 18.2%, P=0.002）, in-hospital mortality （9.3% vs 3.8%, P=0.03）, and MACE rate during hospitalization （17.4% vs 7.7%, P=-0.006） were higher in the RD group than those in the non-RD group. At a 30-day clinical follow-up, the MACE-free survival rate was significantly reduced in the RD group （76.7% vs 89.9%, P=-0.0003）. Angiographic stent thrombosis occurred in 3 （3.5%） and 7 （1.3%） of patients in the RD group and non-RD group, respectively （P=0.15）. Multivariate analysis revealed that the serum creatinine level 〉115 μmol/L on admission was an independent predictor for MACE rate at a 30-day follow-up （Hazard ratio （HR） 3.31,95% CI 1.19-9.18, P 〈0.001）. Conclusion Despite similar prevalence of stent thrombosis at a 30-day clinical follow-up, the short-term prognosis of STEMI patients with elevated serum creatinine on admission undergoing DES-based primary PCI remains unfavorable.展开更多
基金Supported by National Natural Science Foundation of China,No.81070281
文摘Arthrogryposis, renal dysfunction and cholestasis (ARC) syndrome is a rare genetic disorder and has not been described in China. We present a female infant with neonatal intrahepatic cholestasis from a Chinese family with ARC syndrome. All 23 coding exons and flanking introns of the VPS33B gene were amplified and sequenced using peripheral lymphocyte genomic DNA of the patient and her parents. Genetic testing revealed two novel mutations (c.1033delA and c.1567C>T) in the VPS33B gene. The patient is a compound heterozygote and her parents were heterozygous for each of the mutations.
文摘OBJECTIVE To assess the role of beta-blockers(BB)in patients with chronic kidney disease(CKD)aged≥75 years.METHODS AND RESULTS From January 2008 to July 2014,we included 390 consecutive patients≥75 years of age with ejection fraction≤35%and glomerular filtration rate(GFR)≤60 m L/min per 1.73 m^2.We analyzed the relationship between treatment with BB and mortality or cardiovascular events.The mean age of our population was 82.6±4.1 years.Mean ejection fraction was 27.9%±6.5%.GFR was 60-45 m L/min per 1.73 m^2 in 50.3%of patients,45-30 m L/min per 1.73 m^2 in 37.4%,and<30 m L/min per 1.73 m^2 in 12.3%.At the conclusion of follow-up,67.4%of patients were receiving BB.The median follow-up was28.04(IR:19.41-36.67)months.During the study period,211 patients(54.1%)died and 257(65.9%)had a major cardiovascular event(death or hospitalization for heart failure).BB use was significantly associated with a reduced risk of death(HR=0.51,95%CI:0.35-0.74;P<0.001).Patients receiving BB consistently showed a reduced risk of death across the different stages of CKD:stage IIIa(GFR=30-45 m L/min per 1.73 m^2;HR=0.47,95%CI:0.26-0.86,P<0.0001),stage IIIb(GFR 30-45 m L/min per 1.73 m^2;HR=0.55,95%CI:0.26-1.06,P=0.007),and stages IV and V(GFR<30 m L/min per 1.73 m~2;HR=0.29,95%CI:0.11-0.76;P=0.047).CONCLUSIONS The use of BB in elderly patients with HFr EF and renal impairment was associated with a better prognosis.Use of BB should be encouraged when possible.
基金Supported by the Hainan Province Clinical Medical Center,No.(2021)75 and(2021)276。
文摘BACKGROUND The VPS33B(OMIM:608552)gene is located on chromosome 15q26.1.We found a female infant with autosomal recessive arthrogryposis,renal dysfunction and cholestasis syndrome 1(ARCS1)caused by mutation in VPS33B.The child was diagnosed with ARCS1(OMIM:208085)after the whole exome sequencing revealed two heterozygous mutations(c.96+1G>C,c.242delT)in the VPS33B gene.CASE SUMMARY We report a Chinese female infant with neonatal cholestasis disorder,who was eventually diagnosed with ARCS1 by genetic analysis.Genetic testing revealed two new mutations(c.96+1G>C and c.242delT)in VPS33B,which is the causal gene.The patient was compound heterozygous,and her parents were both heterozygous.CONCLUSION This study extends the mutational spectrum of the VPS33B gene to provide a molecular basis for the etiological diagnosis of ARCS1 and for genetic counseling of the family.
文摘Objective:The aim of this study was to investigate renal insufficiency in patients with chemotherapy.Methods:Prescribing chemotherapy in a regular hemodialysis patient with renal failure,and monitoring of serum drug concentrations to determine its safety and effectiveness.Results:Chemotherapy assessment efficiency:SD(better),hemodialysis did not affect THP treatment,their safety was guaranteed.Conclusion:The chemotherapy of renal dysfunction is not an absolute contraindication to fully assess the patient's adverse effects and tolerability,the reasonable arrangements for hemodialysis and the timing of administration can be safe and effective chemotherapy.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is one of the most common malignancies worldwide.However,the number of patients with chronic kidney disease(CKD)is on the rise because of the increase in lifestyle-related diseases.AIM To establish a tailored management strategy for HCC patients,we evaluated the impact of comorbid renal dysfunction(RD),as stratified by using the estimated glomerular filtration rate(EGFR),and assessed the oncologic validity of hepatectomy for HCC patients with RD.METHODS We enrolled 800 HCC patients who underwent hepatectomy between 1997 and 2015 at our university hospital.We categorized patients into two(RD,EGFR<60 mL/min/1.73 m^(2);non-RD,EGFR≥60 mL/min/1.73 m^(2))and three groups(severe CKD,EGFR<30 mL/min/1.73 m^(2);mild CKD,30≤EGFR<60 mL/min/1.73 m2;control,EGFR≥60 mL/min/1.73 m^(2))according to renal function as defined by the EGFR.Overall survival(OS)and recurrence-free survival(RFS)were compared among these groups with the log-rank test,and we also analyzed survival by using a propensity score matching(PSM)model to exclude the influence of patient characteristics.The mean postoperative observation period was 64.7±53.0 mo.RESULTS The RD patients were significantly older and had lower serum total bilirubin,aspartate aminotransferase,and aspartate aminotransferase levels than the non-RD patients(P<0.0001,P<0.001,P<0.05,and P<0.01,respectively).No patient received maintenance hemodialysis after surgery.Although the overall postoperative complication rates were similar between the RD and non-RD patients,the proportions of postoperative bleeding and surgical site infection were significantly higher in the RD patients(5.5%vs 1.8%;P<0.05,3.9%vs 1.8%;P<0.05,respectively),and postoperative bleeding was the highest in the severe CKD group(P<0.05).Regardless of the degree of comorbid RD,OS and RFS were comparable,even after PSM between the RD and non-RD groups to exclude the influence of patient characteristics,liver function,and other causes of death.CONCLUSION Comorbid mild RD had a negligible impact on the prognosis of HCC patients who underwent curative hepatectomy with appropriate perioperative management,and close attention to severe CKD is necessary to prevent postoperative bleeding and surgical site infection.
文摘Background:Renal cystic disease arising from various etiologies results in fluid-filled cavities within the kidneys.Moreover,preexisting renal dysfunction has been shown to exacerbate multiple pathologies.While swine bred for biomedical research are often clinically inspected for illness/parasites,more advanced diagnostics may aid in uncovering underlying renal abnormalities.Methods:Computed tomography was performed in 54 female prepubertal Yorkshire swine to characterize renal cysts;urine and blood chemistry,and histology of cysts were also performed.Results:Digital reconstruction of right and left kidneys demonstrated that roughly one-third of the animals(17/54;31%)had one or more renal cyst.Circulating biomarkers of renal function were not different between animals that had cysts and those that did not.Alternatively,urinary glucose(P=.03)was higher and sodium(P=.07)tended to be lower in animals with cysts compared to animals without,with no differences in protein(P=.14)or potassium(P=.20).Aspiration of cystic fluid was feasible in two animals,which revealed that the cystic fluid urea nitrogen(97.6±28.7 vs 911.3±468.2 mg/dL),potassium(29.8±14.4 vs 148.2±24.85 mmol/L),uric acid(2.55±1.35 vs 11.4±5.65 mg/dL),and creatinine(60.34±17.26 vs 268.99±95.79 mg/dL)were much lower than in the urine.Histology demonstrated a cyst that markedly compresses the adjacent cortex and is lined by a single layer of flattened epithelium,bounded by fibrous connective tissue which extends into the parenchyma.There is tubular atrophy and loss in these areas.Conclusion:This study provides valuable insight for future studies focusing on kidney function in swine bred for biomedical research.
文摘Objectives To evaluate the relationship of renal dysfunction,coronary heart disease and percutaneous coronary intervention(PCI).Methods(l)The subjects:There were 376 patients who come from department of cardiology of our hospital in this study undergoing coronary angiography.The patients were divided into two groups? according to coronary angiography:coronary artery disease(group A,n =263),in which 141 patients with renal dysfunction(group A1) and 122 patients with normal renal function(group A2):patients with other kinds of cardiovascular disease but normal coronary angiography(group B.n=113).Before the coronary angiography, all patients were measured the serum creatinine, microalbuminuria,fasting blood-glucose,triglycerides,total cholesterol,high density lipoprotein,low density lipoprotein, blood pressure in fasting 12 hours.(2)The diagnostic criteria for renal dysfunction:male serum creatinine】115 umol/L and/or microalbuminuria】30 mg,female】107 umol/L and/ or】30 mg.Results(1)The differences of renal function indexes in the group A and B:The mean level of microalbuminuria and serum creatinine was higher significantly in group A than that of the group B(43.48±38.93 vs.11.23±7.07 and 101.52±37.22 vs.80.62±17.4 respectively.Conclusions The coronary heart disease patients with renal dysfunction had more severe coronary artery stenosis,The renal dysfunction is a strong and independent risk factors for the coronary heart disease and beeds more revascularization therapy.
基金This study was supported by grants from the National Key Technology R＆D Program （Nos. 2013BAI09B05 and 2015BAI12B06）, Key Program of the National Natural Science Foundation of China （No. 81330019）, General Program of the National Natural Science Foundation of China （No. 81270794）, and the Beijing Science and Technology Project （No. D 131100004713003 and No. D171100002817002）.
文摘Background： Chronic kidney disease （CKD） with moderate-to-severe renal dysfunction usually exhibits an irreversible course, and available treatments for delaying the progression to end-stage renal disease are limited. This study aimed to assess the efficacy and safety of the traditional Chinese medicine, Niaoduqing particles, for delaying renal dysfunction in patients with stage 3b-4 CKD.Methods： The present study was a prospective, randomized, double-blind, placebo-controlled, naulticentcr clinical trial. Frorn May 2013 to December 2013,300 CKD patients with an estimated glomerular filtration rate （eGFR） between 20 and 45 ml ＂rain ~＂ 1.73 m 2, aged 18-70 years were recruited from 22 hospitals in 11 Chinese provinces. Patients were randomized in a 1：1 ratio to either a test group, which was administered Niaoduqing particles 5 g thrice daily and 10 g before bedtime for 24 weeks, or a control group, which was administered a placebo using the same methods. The primary endpoints were changes in baseline serum creatinine （Scr） and eGFR after completion of treatment. The primary endpoints were analyzed using Student＇s t-test or Wilcoxon＇s rank-sum test. The present study reported results based on an intention-to-treat （ITT） analysis. Results： A total of 292 participants underwent the ITT analysis. At 24 weeks, the median （interquartile range） change in Scr was 1.1 （-13.0-24.1） and 11.7 （-2.6-42.9） p, mol/L for the test and control groups, respectively （Z = 2.642, P = 0.008）, and the median change in eGFR was -0.2 （-4.3-2.7） and -2.2 （-5.7-0.8） ml.min-1·1.73 m-2, respectively （Z = -2.408, P = 0.016）. There were no significant differences in adverse events between the groups. Conclusions： Niaoduqing particles safely and effectively delayed CKD progression in patients with stage 3b-4 CKD. This traditional Chinese medicine may be a promising alternative medication for patients with moderate-to-severe renal dysfunction.
文摘Background： Renal function is associated with mortality and functional disabilities in stroke patients, and impaired autonomic function is common in stroke, but little is known regarding its effects on stroke patients with renal dysfunction. This study sought to evaluate the association between autonomic function and stroke in patients with renal dysfunction. Methods： This study comprised 232 patients with acute ischemic stroke consecutively enrolled from February 2013 to November 2014 at Guangdong Provincial Hospital of Chinese Medicine in China. All patients recruited underwent laboratory evaluation and 24 h Holter electrocardiography （ECG）. Autonomic function was measured based on the heart rate variability （HRV） using 24 h Holter ECG. Renal damage was assessed through the estimated glomerular filtration rate （eGFR）, and stroke severity was rated according to the National Institutes of Health Stroke Scale （NIHSS）. The Barthel index and modifed Rankin score were also determined following admission. All the clinical covariates that could potentially affect autonomic outcome variables were adjusted with linear regression. Results： In the patients with a mild or moderate decreased eGFR, the values for the standard deviation of the averaged normal-to-normal RR interval （SDANN） index （P = 0.022L very low frequency （VLF） （P = 0.043）, low frequency （LF） （P= 0.023）, and ratio of low-to-high frequency power （LF/HF） （P = 0.001 ） were significantly lower than those in the patients with a normal eGFR. A lnultinomial linear regression indicated that eGFR （t - 2.47, P - 0.014）, gender （t - -3.60, P 〈0.001）, and a history of hypertension （t = -2.65, P = 0.008） were the risk factors of LF/HF; the NIHSS score （SDANN index： t = -3.83, P 〈 0.001 ; VLF： t = -3.07, P = 0.002： LF： t = -2.79, P = 0.006） and a history of diabetes （SDANN index： t = -3.58, P 〈 0.001; VLF： t = -2.54, P = 0.012; LF： t = -2.87, P = 0.004） were independent factors Ibr the SDANN index, VLF, and LF; the Oxfordshire Community Stroke Project （t = -2.38, P = 0.018） was related to the SDANN index. Conclusions： Autonomic dysfunction is aggravated with the progression ofeGFR stage in patients with acute ischemic stroke; the eGFR is an independent factor of LF/HF in the adjusted models. Stroke severity and a history of diabetes are more significantly associated with HRV in patients with acute ischemic stroke at different stages of renal dysfnnction.
基金Supported by the Project of State Administration of Traditional Chinese Medicine,China(No.06-07LB22)Capital Characteristic Clinical Application Research,China(No.Z121107001012013)
文摘Objective： To investigate the effect of Huanshuai Recipe Oral Liquid （缓衰口服液, HSR） on retarding the progression of renal dysfunction in patients with atherosclerotic renal artery stenosis （ARAS）. Methods： A total of 52 ARAS patients with the Chinese medicine （CM） syndrome of qi deficiency and blood stasis, phlegm and dampness retention were recruited and randomly assigned into the treatment group （36 cases） and the control group （16 cases）. Both groups received a basic treatment （high-quality low-protein diet, blood pressure control, lipid-lowering, correcting the acidosis, etc.）. In addition, the treatment group received 20 mL HSR and the control group received placebo, 3 times a day for 6 months. Renal function （serum creatinine, blood urea nitrogen and uric acid） and blood lipids （cholesterol, triglycerides and low density lipoprotein） were examined monthly. The estimated glomerular filtration rate （eGFR） and CM syndrome score were compared between groups. Results： After treatment, compared with the control group, the serum creatinine level, uric acid level and CM syndrome score of the treatment group were significantly decreased （P〈0.05 or P〈0.01）, and the eGFR in the treatment group were significantly increased （P〈0.05）. Conclusion： HSR can effectively improve the renal function and clinical symptoms of ARAS patients.
基金Peking University Third Hospital research funding(Grant No.7476-01)
文摘In the present study, we aimed to investigate the optimal dosage regimens of piperacillin/tazobactam in patients with chronic kidney disease according to their different classes of renal function based on bacterial resistance. A total of 2700 simulationswere applied based on a published population pharmacokinetic and pharmacodynamic model using nonlinear mixed effects modeling (NONMEM) software. Permissible optimal dosage regimens were defined as those associated with a less than 10% of patients whose probabilities of target attainment (PTA) were not attain target. For patients with mild to moderate renal injury, 4/0.5 g of piperacillin/tazobactam every 12 h in 30 min intermittent infusion could attain the target. If the MIC (minimum inhibitory concentration) for the pathogen was 8 mg/L or 16 mg/L, either an 8-h or 6-h dosing interval or extended 2–6 h infusion regimen had to be used to achieve the outcome of the therapy. Regarding MIC was up to above 32 mg/L, a high dose of piperacillin (12–24 g/d) in continuous infusion was the only approach that could achieve the effective target in patients with renal dysfunction. A low dose with extended 4–6 h infusion regimen was recommended for patients with severe renal injury. Our study identified permissible optimal piperacillin/tazobactam dosage regimens for patients with renal dysfunction with an MIC up to 64 mg/L. The findings of this study would be helpful for precise administration of piperacillin/tazobactam in clinical practice.
基金Supported by Grant-in-Aid for Scientific Research from the Ministry of Education,Japan(B.09480121)
文摘Objective The aim of the present study mas to compare the gender difference for cadmium-induced renal tubular dysfunction between the male and female inhabitants. Methods Urinary β2-microglobulin was measured in 299 male (94%) and 342 female (92%) inhabitants aged 54-72 years,and the development of renal tubular dysfunction for 11 years was studied in the 62 married couples from them. Results A significantly higher cumulative incidence was found in both men and women in cadmium-polluted area,showing 68. 4% in men and 64. 8% in women compared to 15. 3% in men and 5. 9% in women in the reference areas. Relative risk of renal tubular dysfunction in females (11. 0) was higher than males (4. 5). The ratios of urinary β2-microglobulin and glucose were higher in women than those in men in both the cadmium-polluted areas and the reference areas. Conclusion Although almost identical incidences were detected between men and women, the changes in excretion of β2-microglobulin and glucose was greater in women than those in men. These findings suggest that renal tubular dysfunction might be more progressive in women than that in men.
文摘AIMTo determine the accuracy of fractional excretion of sodium (FeNa) in the diagnosis of hepatorenal syndrome (HRS). METHODSEighty-eight liver transplantation candidates with renal dysfunction and/or proteinuria were included in the study sample. The baseline characteristics of the patients were obtained. All the 88 patients underwent iothalamate glomerular filtration rate testing, 24-h urine collection for urinary sodium and protein excretions, random urine for sodium and creatinine testing, and percutaneous kidney biopsy. FeNa was calculated using the equation [(urine sodium × serum creatinine)/(serum sodium × urine creatinine)] × 100%. Diuretic use was recorded among the participants. Patients on renal replacement therapy were not included in the original sample. RESULTSSeventy-seven (87%) of the 88 patients had FeNa P = 0.4). FeNa P = 0.47). Calculated positive predictive value and negative predictive value for FeNa P = 0.41). CONCLUSIONFeNa 1%.
文摘Kidney dysfunction is one of the most serious complications resulting from the use of traditional medicine which is common in Africa accounting for about 35% of renal damage in HIV-infected patients. In this cross sectional study, 250 HIV-infected patients were groups as follows: ART GrpA (100), ART + traditional medicine use GrpB (100) and ART treatment naïve + traditional medicine GrpC (50). Tubular dysfunctions were defined when at least two or more of the following abnormalities were repeatedly present: Uricosuria ≥ 0.05 mg/dl, Phosphaturia ≥ 20.0 mg/dl, Glucosuria ≥ 0.1 mg/dl, Proteinuria = positive protein on dipstick urine. Renal dysfunctions were found to be significantly high (P = 0.001) in the group of patients treated with ART + traditional medicine. 27 (64.29%) patients followed by ART treatment naïve patients + traditional medicine;12 (28.57%) patients and only 4 (7.14%) patients developed renal toxicity in the ART treatment Grp. But strikingly CD4 counts were also significantly higher in Grp B (683 cell/ul) compared to group A (446 cell/ul) and C (206 cell/ul). Our results show that HIV-infected patients on ART combined with traditional medicine might develop renal abnormalities in the presence of high CD4 counts, in the course of incessant use of traditional medicine. Thus it is important that more research be conducted on its usage among the Black population with HIV infection.
文摘Liver transplant(LT)outcomes have markedly improved in the recent decades,even if long-term morbidity and mortality are still considerable.Most of late deaths are independent from graft function and different comorbidities,including complications of metabolic syndrome and de novo neoplasms,seem to play a key role in determining long-term outcomes in LT recipients.This review discusses the main factors associated with late mortality and suggests possible strategies to improve long-term management and follow-up after liver transplantation.In particular,the reduction of drug toxicity,the use of tools to identify high-risk patients,and setting up a multidisciplinary team also for long-term management of LT recipients may further improve survival after liver transplantation.
基金Supported by National Natural Science Foundation of China,No.81070281
文摘Arthrogryposis, renal dysfunction and cholestasis (ARC) syndrome (OMIM 208085) is an autosomal recessive disorder that is caused by mutations in 2 interacting genes VPS33B and VIPAS39. Mutations in VPS33B gene account for most cases of ARC. As low or normal gamma-glutamyl transpeptidase (GGT) activity has been described in all patients with ARC syndrome identified so far, ARC syndrome is a possible diagnosis for low GGT cholestasis. Here we describe a Chinese patient with neonatal cholestasis and a high GGT level in three consecutive tests. She had other typical manifestations of ARC syndrome, including arthrogryposis multiplex congenita, renal involvement and ichthyosis. Genetic study of the VPS33B gene further confirmed the diagnosis by identification of compound heterozygosity of two known disease-causing mutations, c.403+2T > A and c.1509-1510insG. The mechanism of high GGT in this patient is unclear. Nevertheless, this case indicates that ARC syndrome cannot be excluded from the differential diagnosis of neonatal cholestasis even if high GGT activity is found.
文摘AIM:To determine whether hypermagnesemia recently reported in adult patients possibly develops in children with functional constipation taking daily magnesium oxide.METHODS:We enrolled 120 patients (57 male and 63 female) aged 1-14 years old (median:4.7 years) with functional constipation from 13 hospitals and two private clinics.All patients fulfilled the Rome Ⅲ criteria for functional constipation and were treated with daily oral magnesium oxide for at least 1 mo.The median treatment dose was 600 (500-800) mg/d.Patients were assessed by an interview and laboratory examination to determine possible hypermagnesemia.Serum magnesium concentration was also measured in sex-and agematched control subjects (n=38).RESULTS:In the constipation group,serum magnesium concentration [2.4 (2.3-2.5) mg/dL,median and interquartile range] was significantly greater than that of the control group [2.2 (2.0-2.2) mg/dL] (P < 0.001).The highest value was 3.2 mg/dL.Renal magnesium clearance was significantly increased in the constipation group.Serum magnesium concentration in the constipation group decreased significantly with age (P < 0.01).There was no significant correlation between the serum level of magnesium and the duration of treatment with magnesium oxide or the daily dose.None of the patients had side effects associated with hypermagnesemia.CONCLUSION:Serum magnesium concentration increased significantly,but not critically,after daily treatment with magnesium oxide in constipated children with normal renal function.
基金Supported by a Predoctoral Fellowship Grant from the American Heart Association,No.835262(to Roy B).
文摘Since the discovery of the coronavirus disease 2019 outbreak,a vast majority of studies have been carried out that confirmed the worst outcome of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection in people with preexisting health conditions,including diabetes,obesity,hypertension,cancer,and cardiovascular diseases.Likewise,diabetes itself is one of the leading causes of global public health concerns that impose a heavy global burden on public health as well as socio-economic development.Both diabetes and SARS-CoV-2 infection have their independent ability to induce the pathogenesis and severity of multi-system organ failure,while the co-existence of these two culprits can accelerate the rate of disease progression and magnify the severity of the disease.However,the exact pathophysiology of multi-system organ failure in diabetic patients after SARS-CoV-2 infection is still obscure.This review summarized the organ-specific possible molecular mechanisms of SARS-CoV-2 and diabetesinduced pathophysiology of several diseases of multiple organs,including the lungs,heart,kidneys,brain,eyes,gastrointestinal system,and bones,and subsequent manifestation of multi-system organ failure.
文摘The dosing of anti-Parkinson drugs is considered as the optimal control of the symptoms of PD,and increasing the dose of drugs is a common method to treat the aggravate state of PD.However,this is a case of PD elderly patient who had nephritic syndrome,with an increase in the dose,the symptoms did not get improved,but a series of other adverse effects appeared.
文摘Background Prognosis of patients with acute ST-elevation myocardial infarction （STEMI） and renal dysfunction （RD） who received primary percutaneous coronary intervention （PCI） has not been fully investigated in the drug-eluting stent （DES） era. This study aimed to evaluate the impact of admission serum creatinine level on short-term outcomes in patients with acute STEMI undergoing DES-based primary PCI. Methods Primary PCI with DES implantation was attempted in 619 consecutive STEMI patients within 12 hours of symptom onset. Among them, 86 patients had a serum creatinine level ≥115 μmol/L on admission （RD group）, and the remaining 533 patients had normal renal function （non-RD group）. The primary endpoint was 30-day major adverse cardiac events （MACE, including death, non-fatal reinfarction, and target vessel revascularization）, and the secondary endpoint was subacute stent thrombosis. Results Patients in the RD group were older than those in the non-RD group. There are more female patients in the RD group and they had a history of hypertension, myocardial infarction and revascularization. The occurrence rates of Killip class ≥2 （29.1% vs 18.6%, P=0.02） and multi-vessel （62.8% vs 44.5%, P=0.001） and triple vessel disease （32.6% vs 18.2%, P=0.002）, in-hospital mortality （9.3% vs 3.8%, P=0.03）, and MACE rate during hospitalization （17.4% vs 7.7%, P=-0.006） were higher in the RD group than those in the non-RD group. At a 30-day clinical follow-up, the MACE-free survival rate was significantly reduced in the RD group （76.7% vs 89.9%, P=-0.0003）. Angiographic stent thrombosis occurred in 3 （3.5%） and 7 （1.3%） of patients in the RD group and non-RD group, respectively （P=0.15）. Multivariate analysis revealed that the serum creatinine level 〉115 μmol/L on admission was an independent predictor for MACE rate at a 30-day follow-up （Hazard ratio （HR） 3.31,95% CI 1.19-9.18, P 〈0.001）. Conclusion Despite similar prevalence of stent thrombosis at a 30-day clinical follow-up, the short-term prognosis of STEMI patients with elevated serum creatinine on admission undergoing DES-based primary PCI remains unfavorable.
