Objective To analyze the risk factors associated with acute renal failure (ARF) in critically ill obstetric patients in intensive care unit (ICU).Methods A retrospective analysis of 192 critically ill obstetric patients admitted to the ICU for postpartum complications was conducted. There were 10 patients excluded because 3 died of amniotic embolism with massive hemorrhage in ICU and 7 had incomplete records, therefore, only 182 critically ill obstetric patients were enrolled in this study. According to the occurrence of ARF or not, the patients were divided into ARF group (68 cases) and non-ARF group (114 cases). The indicators of preeclampsia, HELLP syndrome (hemolysis, elevated liver enzymes, thrombocytopenia), acute fatty pregnancy liver, postpartum hemorrhage, sepsis were collected in the two groups. The main drugs used in the 4 days after delivery were as follows: ① plasma volume expanders: fluids (crystalloids, artificial colloids, hypertonic albumin and 4% serum albumin) and blood products (packed red cells, concentrated platelets, fibrinogen, fresh frozen plasma and activated factor Ⅶ); ② antifibrinolytic drug: tranexamic acid; ③ anti-hypertensive drugs: angiotensin-converting enzyme inhibitors (ACEI), diuretics; ④ nephrotoxic drugs: aminoglycosides, contrast agent. The above indexes were firstly analyzed by the univariate method, and the risk factors with statistical significance were further analyzed by multivariate logistic regression method to screen out the independent risk factors of developing ARF in critically ill obstetric patients in ICU.Results Univariate analysis showed that HELLP syndrome, tranexamic acid and hypertonic albumin infusion used in 4 days after delivery were the risk factors of ARF (χ2 value was 4.92, 4.29, 5.53, respectively, allP < 0.05). The multivariate logistic regression analysis showed: HELLP syndrome [odds ratio (OR) = 10.478, 95% confidence interval (95%CI) was 1.248 - 17.953,P = 0.030] and hypertonic albumin infusion used in 4 days after delivery [OR = 6.632, 95%CI was 1.211 - 16.328,P = 0.029] were the independent risk factors to develop ARF.Conclusions The occurrence of ARF in a critically ill obstetric patient in ICU is a process involving multiple factors, therefore, it is necessary to fully recognize the risk factors influencing the development of this disease; the presence of HELLP syndrome and hypertonic albumin infusion used in 4 days after delivery are the independent risk factors of developing ARF. Thus, particular attention should be paid to those patients with such high risk factors to decrease the incidence of ARF.

Objective To study the technique and clinical effect of endoscopic surgery using high frequency electrotome with suction device for nasopharyngeal angiofibroma. Methods In this study, we retrospective analyzed the clinical data of 10 patients treated between January 2009 and December 2015. All these patients were treated by endoscopic surgery using high frequency electrotome with suction device. The average blood loss during surgery, tumor residual, recurrent tumor and duration of recovery were evaluated. Results The tumor was completely removed in all 10 patients. The average blood loss was 465 ml, there was no postoperative complication, all patients had no residual tumor, and there was no recurrent tumor over a follow-up of 6~18 months. Conclusion Though it was not preoperative transcatheter arterial embolization, the endoscopic surgery using high frequency electrotome with suction device can be used to treated nasopharyngeal angiofibroma which either limited to nasopharyngeal cavities and paranasal sinus with intraoperative blood pressure control.

Objective To analysis the MRI features of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), to improve the understanding of MRI manifestations of this disease. Meth?ods The clinical manifestations, neuroimaging analysis and genetic analysis were performed in the CADASIL pedigree proband and his families. Results Five of six cases were confirmed with C2182T mutation on exon 14 of the NOTCH3, of which three cases were diagnosed by MRI. Brain MRI findings included bilateral symmetric distributed confluent lesions in the subcortical and periventricular white matter in the frontal lobe, hypointensity on T1WI and hyperintensity on both T2WI and T2 FLAIR imaging in four cases. The external capsule was involved in three cases, with hyperintensity on T2WI. Subcortical lacunar lesions (SLLs) were shown in three cases. Lacunar infarction in the basal ganglia and thalamus were presented in four cases. T2WI hyperintensity at the brain stem was found in two cases. Cerebral microbleeds were re?vealed in three cases. There was no O’Sullivan sign in all the six cases. Conclusions There is characteristic change of MRI in CADASIL patients, which may play a very important role in screening these cases.

Objective To investigate the effects of heme oxygenase-1 (HO-1) protein transduction mediated by cell penetrating peptide PEP-1 on intestinal injury in a rat model of sepsis induced by cecal ligation and puncture (CLP).Methods Twenty-four healthy male Sprague-Dawley rats,aged 7-9 weeks,weighing 210-260 g,were randomly divided into 4 groups (n =6 each) using a random number table:sham operation group (group S),group CLP,low-dose fusion protein PEP-1-HO-1 + CLP group (group P1) and high-dose fusion protein PEP-1-HO-1 + CLP group (group P2).Fusion protein PEP-1-HO-1 0.3 mg was administrated via the left iliac vein at 1 h before CLP and 5 h after CLP in group P1.Fusion protein PEP-1-HO-1 0.6 mg was administrated via the left iliac vein at 1 h before CLP and 5 h after CLP in group P2.The equal volume of normal saline was given instead of PEP-1-HO-1 in the other groups.The animals underwent laparotomy,but the caecum was not ligated or punctured in group S.Blood samples were collected at 12 h after CLP from the right common carotid artery for measurement of serum TNF-α and IL-6 levels.The rats were then sacrificed and intestines were removed for microscopic examination and for determination of malondialdehyde (MDA) content and superoxide dismutase (SOD) activity in intestinal tissues.Results Compared with group S,the serum TNF-α and IL-6 levels,and MDA content in intestinal tissues were significantly increased,while SOD activity in intestinal tissues was decreased in CLP,P1 and P2 groups.Compared with group CLP,the serum TNF-α and IL-6 levels,and MDA content in intestinal were significantly decreased,while SOD activity in intestinal tissues was increased in P1 and P2 groups.Compared with group P1,the serum TNF-α and IL-6 levels,and MDA content in intestinal tissues were significantly decreased,while SOD activity in intestinal tissues was increased in group P2.The pathological changes of intestines were significantly mitigated in P1 and P2 groups as compared with group CLP.Conclusion HO-1 protein transduction attenuates intestinal injury induced by sepsis in rats,and the mechanism is related to inhibition of systemic inflammatory responses and lipid peroxidation in intestinal tissues.

Objective:To detect the factors related to hemocytopenia and interstitial lung disease (ILD) secondary to primary Sj?gren's syndrome (pSS) in in-patients.Methods:Clinical characteristics of patients with pSS hospitalized in China-Japan Friendship Hospital from March 2014 to October 2020 were retrospectively analyzed. Patients were divided into different groups according to hemocytopenia and ILD. Chi-square test and Mann-Whitney U test were used to compare data in subgroups, and logistic regression were used to detect factors related to hemocytopenia and ILD secondary to pSS. Results:Five hundred and seventy-one inpatients with pSS were included in this study and the female: male ratio was 8∶1. Two hundred and seventy five of included patients had hemocytopenia (48.2%) and 180 patients had ILD (31.5%). Compared with patients without hemocytopenia, patients with hemocytopenia had higher ratio in low C3 [ OR=2.326, 95% CI(1.483, 3.650), P<0.01] and elevation of erythrocyte sedimentation rate (ESR) [ OR=1.912, 95% CI(1.233, 2.964), PP<0.01) . Compared with patients without ILD, patients with ILD showed higher ratio in male[ OR=2.509, 95% CI(1.269, 4.959), P<0.01) and fatigue [ OR=5.190, 95% CI(5.190, 13.931), P<0.01) , lower positive rate of anti-SSA antibody [ OR=0.392, 95% CI(0.230, 0.668), P<0.01) and anti-CENPB [ OR=0.337, 95% CI(0.145, 0.782), P<0.01] antibodies, and lower ratio in low C3[ OR=0.332, 95% CI(0.189, 0.582), P<0.01]. Conclusion:Low C3 and high ESR may be risk factors for developing hemocytopenia in patients with pSS. Men with pSS may be susceptible to ILD, while pSS patients with ILD may have lower ratio in positive anti-SSA antibody, positive anti-CENPB antibody and low C3. All of these findings are yet to be validated by future prospective cohort studies.

Objective To evaluate the efficacy of cyclosporin A (CSA) in the treatment of idiopathic membranous nephropathy (IMN), a prospective controlled clinical study was performed. Methods This study included a group of 30 IMN patients, among them 15 were treated with CSA and 15 with captopril (CAP). The diagnosis of IMN was made with exclusion of secondary forms of membranous nephropathy by extensive clinical and pathological studies. No patients received steroids or cytotoxic agents for six months prior to enrollment. In the CSA group, CSA was given at an initial dosage of 5mg*kg-1*d-1, gradually tailed off over the first three months and maintained at 2mg*kg-1*d-1 for 12 months. In the CAP group, CAP was given at a dosage of 37.5mg/day. Results In the first three months, 6 (6/15)complete remissions (CR) and 2 (2/15) partial remissions (PR) were observed in the CSA group while only 2 (2/15) PRs were observed in the CAP group. Before the end of the 15-months, 8 patients in the CSA group experienced CR and 4 patients experienced PR. One CR patient relapsed as the dosage of CSA was reduced, so 7 patients remained in CR at the end of the first 15-months. No additional CR or PR was observed in the CAP group during late follow-up. At the last visit (an average follow-up time of 44 months) in the CSA-group, another 2 CR patients had relapsed and 1 CR patient shifted to PR after stopping the CSA treatment, so 4 CR and 5 PR remained in the CSA group. In the CAP group, 3 spontaneous CRs occurred beyond 1.5 year's follow-up, with 3 CR and 2 PR at the last visit. No difference was found between the averages of the initial and the last serum creatinine levels in either group. No serious adverse effects were found during CSA treatment. Re-biopsy data of three patients responsive to CSA treatment showed that no pathological improvement of glomerular basement membrane was observed, even in cases at remission. Tubulointerstitial fibrosis was found in 1 relapsed CR patient, whoseserum creatinine increased above the normal range, but not in the other 2 patients whose serum creatinine remained in the normal range. Conclusions CSA therapy at a dosage of 5mg*kg-1*d-1 is effective in inducing remission of nephrotic syndrome in adult IMN patients within three months, with a response rate of 80%. A relatively high rate of relapse (50%) was observed within 2 years after the withdrawal of CSA treatment.

OBJECTIVETo analyze the clinical features and genetic cause for a family affected with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL).

METHODSClinical manifestations, neuroimaging, and genetic analysis were performed.

RESULTSThe main clinical features have included stroke, emotional disturbance and history of migraine without progressive memory impairment. A positive family history was confirmed. Cranial MRI has revealed multi-infarct lesions and white matter hyperintensity involving bilateral basal ganglia, subcortex and brain stem. All such features were in keeping with the diagnosis of CADASIL. A rare 2182C>T mutation in exon 14 of the NOTCH3 gene was identified in all available cases.

CONCLUSIONBoth clinical and molecular features suggested that the family has been affected with CADASIL.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Migraine Disorders ; genetics ; Receptor, Notch3 ; Receptors, Notch ; genetics

OBJECTIVETo investigate retrospectively the incidence, distribution of primary disease and clinicopathologic characteristics of diffuse crescentic glomerulonephritis (DCGN) in Chinese patients.

METHODSOne hundred and seventy-two consecutive patients diagnosed as having DCGN out of 9828 cases of non-transplanting renal biopsies over sixteen years, were studied. DCGN is categorized into three types according to immunopathologic characteristics. The incidence of this disease, its primary diseases, clinical characteristics and serum antineutrophil cytoplasmic antibodies (ANCAs) were analyzed.

RESULTSThe distribution of patients among the three classifications was 8.7% type I, 68.6% type II and 22.7% type III. Clinically, the majority of patients (69.8%) presented rapidly progressive glomerulonephritis (RPGN), but 30.2% manifested a chronic nephritic syndrome or chronic renal failure. In terms of related conditions, 93% were anemic, 61.6% had hypertension, 50.6% oliguria, 45.3% nephrotic syndrome, 43% uremic syndrome and 39.5% displayed gross hematuria. Those patients who were positive in serum for ANCAs had predominantly type III DCGN. Two cases with anti-GBM-antibody crescentic glomerulonephritis and three with lupus nephritis were also positive for ANCAs in serum.

CONCLUSIONDCGN is not rare in Chinese patients. A majority of patients in our study presented with RPGN, but 30.2% manifested a chronic renal failure. Lupus patients with DCGN that were positive for ANCAs had more severe vasculitic lesions.

Adolescent ; Adult ; Aged ; Child ; China ; epidemiology ; Female ; Glomerulonephritis ; classification ; epidemiology ; Humans ; Male ; Middle Aged

OBJECTIVETo analysis the pathological demography in Chinese patients undergoing renal biopsy from our nephrology center.

METHODSBetween January 1979 and October 2000 in Jinling Hospital, Nanjing, China, 10,002 attempts of percutaneous renal were performed in patients with renal disease from 33 provinces of China. The pathological classifications were made according to the WHO criteria of 1982 for renal pathology or the modified WHO criteria of 1995 by a panel of pathologists and nephrologists during routine clinical-pathological rounds. The pathological demography between those specimens collected from 1979 - 1989 and those from 1990 - 1999 was compared.

RESULTSThe mean age of the 10,002 subjects undergoing renal biopsy was 31.4 +/- 13.0 years (ranging from 1 to 78 years), with a male to female ratio of 1.3:1; for the 592 renal transplant recipients, the mean age was 37.5 +/- 9.1 years (ranging from 16 to 66 years), with a male to female ratio of 2.36:1. Primary glomerular diseases (PGD) accounted for 71% of the total patients undergoing renal biopsies, secondary glomerular nephritis (SGN) 23%, tubular-interstitial diseases 3.2%, unclassified renal diseases 1.3%, hereditary and congenital renal diseases 1.0%, end stage renal diseases 0.96%, and recently realized or rare renal diseases 0.15%. IgA nephropathy (IgAN) was the most frequent pathological pattern (40%) of PGD, followed by mesangial proliferative lesion (MsPL) (30%), membranous nephropathy (MN) (10%), and focal segmental glomerulosclerosis (FSGS) (6%). Lupus nephritis (LN) was the most pathology common seen (74%) in SGN. During the 22 years of the study period, there was a steady increase in patients with SGN discovered during pathological evaluation of renal disorders. A rise in prevalence was found in IgA nephropathy, MN (both P < 0.001), crescentic glomerulonephritis (P < 0.0001), anti-GBM disease, and hemolytic-uremic syndrome/thrombotic thrombocytopenic purpura related renal damages (both P < 0.001). There was a decrease in endocapillary proliferative glomerulonephritis (P < 0.001) and IgM nephropathy (IgMN) (P < 0.01) from 1990 - 1999 as compared to 1979 - 1989. Infrequent renal pathological entities were also diagnosed in this group, including Niemann Pick disease, Fabry's disease, POEMS syndrome, and lipoprotein glomerulonephropathy.

CONCLUSIONSThis is the largest series of renal biopsy data in China, and therefore may reflect the demographic picture of renal diseases in this country. Changes in prevalence of renal pathological entities were reflected in this group of patients over the last 22 years. In primary glomerular diseases, IgA nephropathy is still the most frequently observed pathological pattern. In SGN, LN appeared the most often. Increased prevalence was found in anti-GBM nephritis and HUS/TTP.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Japan ; epidemiology ; Kidney Diseases ; epidemiology ; pathology ; Male ; Middle Aged ; Prevalence

Objective:To compare the clinical characteristics of patients with primary Sj?gren's syndrome (pSS) by gender and age of disease onset.Methods:Clinical data of hospitalized patients with pSS in China-Japan Friendship Hospital from March 2014 to August 2020 were retrospectively analyzed. Patients were divided into different groups according to their genders and ages of disease onset (young grong <30 years, middle-age group 30-59 years, elderly group ≥60 years). Chi-square test and Mann-Whitney U test were used to compare data in subgroups, and logistic regression was performed to analyze data after control covariates. Results:Five hundred and forty one patients with pSS were included in this study and 481 of them were women (88.9%) Women had higher ratio than men in dry mouth [ OR (95% CI) =2.172(1.091, 4.323), P=0.027], dry eyes [ OR(95% CI)=2.179(1.062, 4.469), P=0.034], leukocytopenia [ OR(95% CI)=3.789(1.150, 12.482), P=0.029], ANA titer≥1∶160 [ OR(95% CI)=2.233(1.279, 3.898), P<0.01], positive anti-SSA [ OR(95% CI)=2.919(1.644, 5.183), P<0.01], positive anti-Ro52 [ OR(95% CI)=3.018(1.685, 5.405), P<0.01], while men had higher ratio than women in parotid enlargement [ OR(95% CI)=2.345(1.281, 4.325), P<0.01], and interstitial lung disease (ILD) [ OR(95% CI)=2.593(1.460, 4.606), P<0.01]. Compared with patients in young group, patients in middles age group had higher ratio in dental caries [ OR(95% CI)=5.940(2.230, 15.819), P<0.01], xero-phthalmia [ OR(95% CI)=2.904(1.313, 6.425), P<0.01], arthralgia [ OR(95% CI)=1.959(1.039, 3.694), P=0.038] and ILD [ OR(95% CI)=2.247(1.018, 4.959), P=0.045], but lower ratio in renal involvement [ OR(95% CI)=0.402(0.211, 0.766), P<0.01]; patients in elderly group had higher ratio in dental caries [ OR(95% CI)=7.437(2.441, 22.656), P<0.01], xerophthalmia [ OR(95% CI)=6.084(1.901, 19.468), P<0.01], and ILD [ OR(95% CI)=4.857(2.029,11.627), P<0.01]. Compared with patients in elderly group, patients in young group had higher positive rate in anti-SSA [ OR(95% CI)=2.836(1.245, 6.459), P=0.013], anti-SSB [ OR(95% CI)=3.075(1.413, 6.690), P<0.01], rheumatoid factors (RF) [ OR(95% CI)=3.323(1.620, 6.817), P<0.01] and elevated immunoglobulin G (IgG)[ OR(95% CI)=3.567(1.747, 7.284), P<0.01]; patients in middle age group had higher positive rate in anti-SSB[ OR(95% CI)=2.330(1.315, 4.130), P<0.01], RF [ OR(95% CI)=2.026(1.279, 3.208), P<0.01], and elevated IgG [ OR(95% CI)=2.077(1.297, 3.327), P<0.01]. Conclusion:Women with pSS present a higher ratio in dry mouth, dry eyes, leukocytopenia and positive autoantibodies than men, while parotid enlargement and ILD are more common in men than women. Young patients are prone to renal involvement, middle-aged patients are prone to arthralgia, while elderly patients are prone to dental caries and xerophthalmia. With the growth of age, the positive rates of autoantibodies and elevated IgG are decreased gradually in patients with pSS, but the ratios of dental caries, xerophthalmia and ILD is increased gradually.