Volume 101 ·  Issue 04 ·  2021

Chronic kidney disease (CKD) and hypertension are two closely interlinked public health problems. Kidney is an important organ for regulating blood pressure. Renal lesions may lead to increased blood pressure, and hypertension further accelerates the progression of renal disease, thereby forming a vicious circle which affects the prognosis of patients. Volume overload is an important mechanism in the development of hypertension in patients with CKD. Therefore, more emphasis should be put on volume management of CKD patients with hypertension.

To establish the luciferase immunoprecipitation system assay (LIPS) to test tetraspanin 7 autoantibody (TSPAN7A) and evaluate its value in Chinese type 1 diabetes (T1D) patients.

Renilla luciferase-tagged TSPAN7 plasmids were transfected into 293T cells to obtain Renilla luciferase-tagged TSPAN7 fusion protein. The cell lysate was incubated with sera overnight, followed by addition of protein A-agarose and extensive wash. Finally, the substrate of Renilla luciferase was added and luminescence was detected. Sera from 100 T1D patients [64 males and 36 females,with a mean age of (28±16) years], 119 type 2 diabetes (T2D) patients [78 males and 41 females,with a mean age of (47±12) years] and 98 healthy volunteers [55 males and 43 females,with a mean age of (28±12) years] from the Department of Metabolism and Endocrinology of the Second Xiangya Hospital, Central South University from 2014 to 2017, were tested by LIPS to evaluate the frequency of TSPAN7A. Radioligand binding assay (RLA) was used to test glutamic acid decarboxylase autoantibodies (GADA), protein tyrosine phosphatase-2 autoantibodies (IA-2A) and zinc transporter 8 autoantibodies (ZnT8A).

The frequencies of GADA, IA-2A, ZnT8A and TSPAN7A in T1D patients were 72.0%, 40.0%, 29.0% and 25.0%, respectively. After Bonferroni correction, the positivity of TSPAN7A was lower than GADA (P<0.001), but similar with IA-2A (P=0.035) and ZnT8A (P=0.630). The positivity of TSPAN7A in T1D patients was significantly higher than that in T2D (0.84%, P<0.001) and in healthy controls (1.02%, P<0.001). In combination with TSPAN7A, the positivity of islet autoantibodies in T1D patients increased from 82% to 85%. There was no significant difference in clinical characteristics between TSPAN7A-positive T1D and the other three islet autoantibodies-positive patients.

This study succeeded in establishing LIPS method to assay TSPAN7A. Moreover, TSPAN7A are valid islet autoantibodies for T1D patients in China.

To investigate the correlations of diurnal brain functional variations with serum biomarkers and objective sleep quality in patients with chronic insomnia disorder (CID).

A total of 60 CID patients and 30 healthy sleep volunteers who visited Department of Sleep Disorders of Chaohu Hospital affiliated to Anhui Medical University from March 2018 to June 2019 were collected. Diurnal brain function state was evaluated by Quantitative Measurement System of Brain Functional Status, and serum concentrations of corticotropin-releasing hormone (CRH) and glial fibrous acidic protein (GFAP) were detected using enzyme-linked immunosorbent assay (ELISA). The sleep quality in the CID group was evaluated using ploysomnography (PSG) at the same time. The brain function status indicators with significant changes in CID group were acquired, and the consistency of these indicators with serum biological markers and objective sleep quality was analyzed.

There were 23 males and 37 females in chronic in somnia patients; 15 males and 15 females in the healthy control group. Compared with the healthy controls, four brain function indicators of CID patients increased (brain inertia (196.0(163.0, 258.0)vs 168.5(148.8,182.5)), brain chaos (5.0(1.0, 10.0)vs 0(0,2.0)), internal concentration (31.0(13.0, 45.0)vs 2.0(0,27.5)) and endogenous anxiety (12.0(4.0, 18.0)vs 0(0,6.5)), but one indicator decreased (brain inhibitory value (47.0(32.0, 58.0)vs 59.0(46.3,66.3))) (all P<0.05).The brain chaos value positively correlated with the serum GFAP level (r=0.374,P=0.006), and the brain inertia value positively correlated with the serum CRH level (r=0.299,P=0.031). The value of brain inhibition positively correlated with the sleep latency (r=0.284,P=0.042). However, the values of internal concentration negatively correlated with the sleep efficiency (r=-0.276,P=0.048) and the time in non-rapid eye movement sleep stage 1 (r=-0.341, P=0.024).

The brain waves of CID patients show significant changes in their brain function indicators, which are related to serum biological markers and objective sleep quality.

To explore the value of neuroendoscopy combined with fluorescence angiography in anterior circulation aneurysm clipping.

A total of 15 patients with anterior circulation aneurysm from Department of Neurosurgery, Zhongnan Hospital of Wuhan University between October 2018 and January 2019 were enrolled. Neuroendoscopy combined with indocyanine green fluorescence angiography (ICGA) was used to determine the shape of the aneurysm, the specific location of the aneurysm neck and its relationship with the aneurysm-bearing artery during anterior circulation aneurysm clipping. Meanwhile, Neuroendoscopy combined with ICGA can be employed to observe whether there was stenosis and incomplete clamping of the aneurysm-bearing artery after clipping the aneurysm, and whether there was misclamping of the perforating branches hidden under the posterior wall of the aneurysm.

The success rate of aneurysm clipping in 15 cases was 15/15. After aneurysm clipping, ICGA and neuroendoscopy were performed. The residual aneurysm neck was detected in 3 cases, and the position of aneurysm clip was adjusted or aneurysm clips were added. In one case, the anterior choroidal aneurysm was found to be mistakenly clipped. After adjusting the aneurysm clip, ICGA and neuroendoscopy showed that the anterior choroidal artery was normal. In another case, the A1 segment aneurysm was clipped. ICGA and neuroendoscopy found that the perforating branch blood vessels were mistakenly clipped. After the adjustment of the aneurysm clip, the blood vessels recovered their patency. There were no surgical-related deaths, disability and coma cases in the study.

During aneurysm clipping, neuroendoscopy combined with ICGA can reduce cerebral vasospasm, decrease the misclipping rate of perforation of blood vessels, and avoid residual neck of aneurysm, stenosis or occlusion of aneurysm-bearing artery by using neuroendoscopy to observe whether misclipping of the perforating branch vessels exist and whether the aneurysm is clipped. Therefore, it can reduce postoperative complications.

To investigate the effect of neoadjuvant chemotherapy (NCT) on the lymph node ratio (LNR) of patients with stage ⅢA-N2 non-small cell lung cancer (NSCLC), and analyze the relationship between LNR and prognosis.

The data of 128 patients with stage ⅢA-N2 NSCLC admitted to the Department of Cardiothoracic Surgery of the First Affiliated Hospital of Hebei North University from January 2013 to December 2018 were retrospectively collected. The patients were divided into two groups according to the treatment method. The patients in the observation group (64 cases) were treated with NCT and surgery, and the patients in the control group (64 cases) were treated with surgery. Lymph node metastasis and survival were observed in the two groups. Subgroups were divided according to LNR and N2 lymph node status, and survival analysis was performed for each subgroup. Univariate and multivariate analysis were conducted for the observation group.

The number of metastatic lymph nodes, the proportion of patients with positive lymph nodes, and the rate of lymph node metastasis in the observation group were lower than those in the control group,3.8±2.1 vs 4.9±2.4,92.2% vs 100%,19.1% vs 22.4% respectively (all P<0.05). Progression-free survival (PFS) and overall survival (OS) in the observation group were better than those in the control group (bothP<0.05). Both the observation and control subgroups with low LNR had better PFS and OS than the subgroups with high LNR (bothP<0.05). Patients in the observation group with non-multi-site N2 lymph node metastasis had better PFS and OS (bothP<0.05). Univariate analysis of observation group showed that patients with low LNR had better 2-year PFS and OS(bothP<0.05). Multivariate analysis showed that the higher the LNR, the greater the risk of death (HR=2.178,95%CI: 1.025-4.626,P=0.043) and progression (HR=2.130,95%CI: 1.123-4.038,P=0.021).

NTC could improve the prognosis and reduce LNR of patients with stage ⅢA-N2 NSCLC, and LNR was expected to be a prognostic indicator.

To investigate the changes of spontaneous brain activity in patients with end-stage renal disease (ESRD) by combining three different resting state functional magnetic resonance low frequency amplitude algorithms, including amplitude of low-frequency fluctuations (ALFF), fractional amplitude of low-frequency fluctuations (fALFF), and percent amplitude of fluctuation (PerAF), and to analyze the associations between spontaneous brain activity changes and clinical variables.

The data of 31 ESRD patients treated with maintenance hemodialysis and 37 healthy volunteers in the Department of Nephrology and Renal Transplantation of the Affiliated Hospital of Qingdao University from August 2018 to December 2019 were retrospectively collected. The resting state functional magnetic resonance imaging (rs-fMRI) scan was performed to calculate the ALFF, fALFF, and PerAF values of the whole brain of the subjects in each group. Independent sample t test was used for comparison between groups, and Pearson correlation analysis was used to investigate the correlation between spontaneous brain activity changes in brain regions with significant differences and clinical variables.

Compared to healthy volunteers, patients with ESRD had decreased mean ALFF(mALFF) values of the right lingual gyrus, bilateral anterior precuneus, left inferior frontal gyrus, and right middle cingulate gyrus (FDR (false discovery rate) correction, all P<0.01); and decreased mean PerAF (mPerAF) values of the bilateral anterior precuneus, bilateral posterior cingulate cortex, right calcarine fissure and surrounding cortex, bilateral inferior parietal lobule/temporoparietal junction (including bilateral angular gyrus, middle temporal gyrus, left supramarginal gyrus), and bilateral inferior frontal gyrus (FDR (false discovery rate) correction, all P<0.01); but there was no significant difference in mean fALFF (mfALFF) value between the two groups. Correlation analysis showed that the mPerAF values of the right angular gyrus (r=-0.509, P=0.003) and the left supramarginal gyrus (r=-0.405, P=0.024) were negatively correlated with serum potassium concentration in ESRD patients, while mALFF values of the bilateral anterior precuneus (r=0.058, P=0.004) and mPerAF values of the left gyrus (r=0.415, P=0.020) were positively correlated with hemoglobin level.

In ESRD patients, spontaneous brain activity was reduced in multiple brain regions, mainly located in default mode network(DMN), which might be the underlying pathophysiological mechanisms of their brain damage. Controlling serum potassium and hemoglobin levels was essential to prevent the progression of brain damage in ESRD patients.

To analyze the reasons of residual partial anomalous pulmonary venous connection (PAPVC) after previous cardiac surgery, and summarize the strategies and experience for diagnosis and treatment of secondary correction operation.

The clinical data of 18 patients who were admitted to Fuwai Hospital of Chinese Academy of Medical Sciences and Fuwai Yunnan Cardiovascular Hospital from June 2009 to May 2019 were retrospectively analyzed. All the patients underwent secondary cardiac surgery to treat PAPVC. The preoperative and intraoperative characteristics and postoperative complications of the patients were summarized and analyzed.

Totally, there were 7 male and 11 female cases, aged 1-49 years (median age: 4.5 years). In the first cardiac surgery, 3 patients were diagnosed with PAPVC, which existed after surgery. One patient was diagnosed with total anomalous pulmonary venous connection (TAPVC), but left PAPVC after surgery. The remaining 14 patients were all missed preoperative and intraoperative diagnosis. After the initial surgery, most patients had no significant symptoms (11/18), but PAPVC was found in 11 cases due to postoperative cardiac murmur or transthoracic echocardiography (TTE). In the secondary surgery, there were 4 cases of type A, 10 cases of type B, 2 cases of type C, no type D, and 2 cases of mixed type, respectively, according to Bordy classification. The diagnostic accuracy of TTE and CT angiography (CTA) was 50.0% and 92.9%, respectively. There was no death after the second surgery, but pulmonary vein occlusion, pericardial effusion, anastomotic stenosis and other complications occurred in 4 patients.

The main causes of missed diagnosis of PAPVC are the undefined cardiac structural deformities before operation and the lack of careful exploration during the operation. TTE is simple and feasible to diagnose PAPVC, and it can improve the diagnostic accuracy when combined with CTA.

To explore whether the use of pancreatic stent combined with somatostatin can produce the synergistic effect of preventing acute pancreatitis (AP) and hyperamylasemia (HP) after endoscopic retrograde cholangiopancreatography (ERCP).

From January 2019 to December 2019, the clinical data of 325 patients with ERCP were analyzed retrospectively in cholelithic center of Shanghai East Hospital Affiliated to Tongji University. According to the different methods of AP prevention, the patients were divided into the observation group (pancreatic stent and somatostatin) and the control group (pancreatic stent) and the incidence of AP and HP were compared.

In the observation group, there were 5 cases of AP (3.65%) and 10 cases of HP (7.30%). In the control group, there were 7 cases of AP (3.72%) and 19 cases of HP (10.11%). The incidence of AP and HP in the observation group was lower than that in the control group, but the differences were not statistically significant (χ²=0.001, P=0.972; χ²=0.768, P=0.381).

The use of pancreatic stent combined with somatostatin will not produce the synergistic effect of preventing AP and HP after ERCP.

To investigate the effect of histone deacetylase (HDAC) activity on connective tissue diseases (CTD) associated pulmonary fibrosis (PF) in mice.

A single tracheal administration of bleomycin induced PF in C57BL/6J male mice was performed to establish a PF model. The experimental mice were divided into three groups: bleomycin group (group B, n = 16) which was given bleomycin A2 physiological saline solution 2.5 μl/g body weight, saline group (Group C, n = 16) which was given physiological saline solution 2.5 μl/g body weight and no operation group (group N, n = 16). At 7, 14 and 21 days after administration, the animals were randomly killed and their specimens were collected. The activity of HDAC2 and HDAC4 was detected by colorimetry. Hematoxylin-eosin staining was used to evaluate pulmonary alveolitis and Masson staining for pulmonary fibrosis. The variance, correlation and binary variable correlation were analyzed.

The HDAC2 activity in lung tissue of mice in the bleomycin group was significantly higher than that in the no operation group (2.00±0.40 vs 1.00±0.23, P<0.05) and the saline group (2.00±0.40 vs 1.48±0.33,P<0.05). The HDAC2 activity in the bleomycin group was significantly higher than that in the no operation group (2.40±0.28 vs 1.00±0.23,P<0.01, 2.23±0.41 vs 1.00±0.23,P<0.01) and the saline group (2.40±0.28 vs 1.39±0.23,P<0.05, 2.23±0.41 vs 1.35±0.42,P<0.05). The change trend of HDAC2 activity between the bleomycin group and the saline group was different. There was no significant difference in HDAC4 activity in lung tissue of mice between the bleomycin group, the no operation group and the saline group. 14 days after tracheal administration, HDAC4 activity in the bleomycin group and the saline group were significantly higher than that in the no operation group (1.18±0.36 vs 1.00±0.12,P<0.01, 1.09±0.33 vs 1.00±0.12,P<0.01). HDAC2 activity in lung tissue of mice was positively correlated with pathological scores of alveolitis (r=0.428, P<0.01) and pulmonary fibrosis (r=0.508, P<0.01). HDAC4 activity in lung tissue of mice was positively correlated with the pathological scores of alveolitis (r=0.355, P<0.05) and pulmonary fibrosis (r=0.457, P<0.01). Binary linear regression analysis showed that HDAC2 activity had a stronger effect on the process of PF lesions than HDAC4 activity in lung tissue of mice.

When pulmonary fibrosis occurred in mice, the activities of HDAC2 and 4 in pulmonary fibrosis were significantly increased. The activity of HDAC2 increased rapidly and lastingly, and the activity of HDAC4 fluctuated significantly and increased briefly. Changes in HDAC2 activity have stronger effects on alveolitis and fibrosis than HDAC4.

To evaluate the safety and effectiveness of combined hepatic artery resection for the treatment of hilar cholangiocarcinoma.

We searched Pubmed, The Cochrane Library, Embase, Web of Science, China Knowledge Network, Wanfang Data Resource System, Vip-Chinese Sci-tech Journal System Database, and China Biomedical Literature Database, and collected the randomized controlled studies or retrospective studies on the safety and efficacy of combined hepatic artery resection and non-hepatic artery resection in the treatment of hilar cholangiocarcinoma. The search period is from January 1, 2006 to December 31, 2019. Review Manager 5.3 software was used to analyze the extracted data indicators.

A total of 14 articles were collected, and a total of 2 374 patients with hilar cholangiocarcinoma were included in the study. Meta-analysis results showed that the perioperative mortality in the hepatic artery resection (HAR) group was higher than that of the control group (OR=1.70, 95%CI=0.02-2.90, P=0.05), and the total postoperative morbidity rate was higher than that of the control group (OR=1.28, 95%CI= 0.93-1.76, P=0.13), both of which were not statistically significant compared with the control group. Subgroup analysis showed that the incidence of liver failure (OR=1.15, 95%CI= 0.73-1.82, P=0.54), biliary fistula (OR=1.20, 95%CI= 0.78-1.84, P=0.40), and abdominal infection in the two groups (OR=0.98, 95%CI= 0.53-1.83, P=0.95) was without significant difference. The R0 resection rate of the HAR group was higher than that of the control group, and the difference was not statistically significant (OR=1.08, 95%CI=0.66-1.75, P=0.77). The rates of lymph node metastasis in the HAR group were higher than that in the control group (OR= 2.48, 95%CI= 1.05-5.84, P=0.04). One-year(OR=0.48, 95%CI= 0.32-0.72, P=0.000 5), 3-year (OR= 0.51, 95%CI=0.36-0.72, P=0.000 1), and 5-year (OR=0.50, 95%CI=0.35-0.70, P<0.000 1) survival rates of HAR group were lower than those of the control group. The survival rates of patients in HAR group treated with combined chemotherapy drugs after operation were significantly improved (OR= 7.33, P=0.02).

The safety of combined HAR treatment for hilar cholangiocarcinoma is acceptable, but poor postoperative survival may be related to the high lymph node metastasis rate. Therefore, it is still necessary to be cautious in carrying out this operation. Combined with adjuvant chemotherapy after surgery may improve survival.

This article reports a case of a young woman with sudden syncope onset, electrocardiogram suggested third degree atrioventricular block, and clinical diagnosis of fulminant myocarditis. After admission, multiple skin ulcers were found on physical examination. Skin pathological biopsy was diagnosed as extranodal natural killer (NK) /T cell lymphoma. Sudden abdominal pain occurred during hospitalization. Surgical laparotomy revealed multiple intestinal perforations, and the pathology was extranodal NK/T cell lymphoma. The patient started with fulminant myocarditis, and extranodal NK/T cell lymphoma involved the skin and intestine successively. It is very rare, with complicated clinical manifestations and easy misdiagnosis.

This article reports a case of renal tubular injury caused by zoledronate sodium. A 64-year-old female was admitted to hospital due to "fatigue for more than 1 month and severe hypophosphatemia was found". Chronic kidney disease complicated with renal loss of phosphorus, potassium, uric acid, metabolic acidosis in normal anion space and small molecule proteinuria showed renal tubular function impairment. A retrospective review of the medical history showed that during the treatment of lung adenocarcinoma, the patient was infused with zoledronate sodium for a long time, and the dose of zoledronate sodium was adjusted, and the renal injury was partially improved.

Antrum vasodilatation (GAVE) is a rare disease, mainly manifested by repeated occult bleeding in the digestive tract, with a course of several years to decades, and repeated blood transfusions are required to improve symptoms such as anemia. In this case, the patient had recurrent melena and moderate to severe anemia for nearly 20 years. Gastroscopy revealed GAVE with severe esophageal varices. After treatment with argon ion coagulation (APC) and intrahepatic stent portosystemic shunt (TIPS) through jugular vein, the patient's gastrointestinal bleeding was effectively controlled.

Islet transplantation is currently the only clinical treatment that can achieve radical cure of advanced diabetes through minimally invasive treatment. It can enable patients to achieve physiological regulation of blood sugar, get rid of exogenous insulin, and control or reverse the occurrence and development of diabetes-related complications. The early development of islet transplantation is slow. In recent years, many advances have been made in islet isolation and transplantation technology. This article reviews the progress of islet origin, preparation technology and transplantation immune protection in clinical treatment and basic research.

After exogenous ingestion, nitrate can be converted into nitrite in vivo, and finally nitric oxide (NO), a classic signaling molecule in cell biology, can be formed through various pathways. In recent years, NO has been found to participate in and mediate many complex physiological and pathophysiological reactions in vivo. At the same time, it can play different roles such as protection and damage in different sources, different contents, different action objects and pathways. Cerebrovascular disease has the characteristics of high incidence, high recurrence rate and high disability rate. At present, it is known that nitrate metabolism and NO participate in various regulations and regulations in the pathway of cerebrovascular disease. Through the elaboration of the complex regulation of nitrate metabolism in cerebrovascular diseases, the related contents of nitrate metabolism and pathogenesis, complications and prognosis of cerebrovascular diseases are discussed, so as to provide basis for future clinical diagnosis and treatment.