Objective To investigate the clinical characteristics of peptic ulcer in young and middle-aged patients and old-aged patients,and to improve the awareness of clinicians.Methods A retrospective analysis was performed in 351 cases (old-aged group) and 351 cases (young and middle-aged group) of peptic ulcer in our hospital from Jan,2012 to Jan,2013.The clinical data were compared between the two groups,including clinical symptoms,complications,ulcer site,size,concomitant diseases,treatment and outcome.Results (1) Clinical symptoms:the symptoms were not typical in old-aged group compared to young and middle-aged group (80.3％ vs 73％),complications as the initial symptom was more common (46.7％ vs 29.6％,P＜0.001),typical upper abdominal pain were lower than those in the young and middle-aged group (19.7％ vs 37％,P＜0.001);(2) Common complications:old-aged patients with complications was significantly higher than in the young and middle-aged group (46.7％ vs 29.6％,P＜0.05),in which bleeding,perforation and obstruction were common;(3) Ulcer site:gastric ulcer,elevation ulcer werw more common in old-aged patients than young and middle-aged patients (P＜0.05);(4) Ulcer size:giant ulcer (more than 2.0 cm) was more common in old-aged patients than young and middle-aged patients (15.1％ vs 4.3％,P＜0.05);but there was no difference in the infection rate of Helicobacter pylori (HP) between them (90.3％ vs 90.9％,P＞0.05);(5) Concomitant diseases:the incidence of concomitant diseases was higher in old-aged patients,including diabetes,cardiovascular disease,gallstones,cholecystitis,gout (47％ vs 15.7％,P＜0.05);(6) Treatment and outcome:the mortality of old-aged patients with complications was significantly higher than those in the young and middle-aged group (14％ vs 3.8％,P＜0.05).Conclusion The clinical manifestations of peptic ulcer in old-aged patients are atypical,with characteristics of high morbidity,high incidence of complications,high mortality.Early diagnosis and treatment is essential to improve the prognosis and reduce mortality.

Objective To investigate the clinical effects of communicating tumors on anterior skull base with neuroendoscope-assisted surgery. Methods Nineteen eases of crani-nosel and crani-orbital nosel communicating tumors underwent the combined craniofacial approach. The defect of anterior skull base was repaired with the compound flap with pedicel frontal galea muscle and temporalis myofascial flap.Results All 19 patients were successfully treated without CSF leak and cranial infection. The tumor total re-section rate was 78.9%, subtotal resection rate was 15.8% ,partial resection rate was 5.3%. Four patients of benign tumor were survival,15 patients of malignant tumor 2- year survival was 11, 3-year survival was 8,above 5- year survival was 6. Conclusion The neuroendoscope-assisted combined craniofacial approach can provide a relatively safe and effective resection for communicating tumors on anterior skull base,and has better clinicall value.

Objective To explore the maternal and fetal outcomes and treatment strategies of pregnant women with Eisenmenger syndrome. Methods Datas of pregnant women with Eisenmenger syndrome from September 2009 to March 2017 were analyzed retrospectively. Results Three patients did not accept regular prenatal care. Two patients suffered from eclampsism. Two patients suffered from arrhythmia. One patient suffered from pulmonary infection. Four patients suffered from congestive heart failure. One patient had no complications. One patient died from pulmonary hypertension crisis within 72 h of postpartum. Four of the seven perinatal infants died from premature complications. Conclusions Patients with Eisenmenger syndrome have tendency to become heart failure and so are unsuitable for pregnancy. Once paitents have pregnancy, high mortality exists. So progestation counseling and management should be strengthened. Early pregnancy should be terminated. In mid or late trimester of pregnancy, regular prenatal care should be needed to help mothers and fetuses get better outcomes.

Objective To analyze the incidence and risk factors of de novo malignant tumors in renal transplant recipients. Methods Clinical data of 1 549 renal transplant recipients were retrospectively analyzed, including the basic status, pathological type and incidence rate of patients with de novo malignant tumors after renal transplantation. The survival situation of these patiensts was assessed. And the risk factors of de novo malignant tumors after renal transplantation were identified. Results The incidence rate of de novo malignant tumors in renal transplant recipients was 3.03%(47/1 549). The 47 recipients were (48±12) years old when undergoing renal transplantation, and they were (55±12) years old when diagnosed malignant tumors. The time interval between transplantation and diagnosis was 66 (36, 100) months. Among the de novo malignant tumors, colorectal cancer was the most common, with a cumulative incidence rate (CIR) of 0.58%. The survival time of 47 recipients with de novo malignant tumors after renal transplantation was 59 (2, 135) months, and the 5-year survival rate was 50%. The recipients with the age > 45 years old when undergoing renal transplantation was a risk factor for de novo malignant tumors after renal transplantation (P < 0.05). Conclusions The incidence rate of de novo malignant tumors is relatively high in renal transplant recipients. The recipients with the age > 45 years old when undergoing renal transplantation is a risk factor for de novo malignant tumors.

Objective:To Explore the value of prolonging compression hemostasis time in reducing bleeding related complications after ultrasound guided percutaneous renal biopsy.Methods:A retrospective analysis was conducted on the clinical data of 405 patients who underwent ultrasound guided percutaneous renal biopsy at the Guangzhou First People′s Hospital. Three groups were divided based on whether to immediately compress and stop bleeding after renal biopsy and the compression time. The group A was treated with no compression and stop bleeding, the group B was treated with compression and stop bleeding for 2 minutes, and the group C was treated with compression and stop bleeding for 5 minutes. The patient′s gender, age, preoperative blood pressure, coagulation, hemoglobin, platelets, and other indicators were recorded. The number of punctures and the immediate postoperative perirenal hematoma and bleeding at the puncture site were recorded. The perirenal hematoma and gross hematuria were re-examined 24 hours after surgery.Results:Compared with the group A and the group B, the incidence of postoperative bleeding related complications in the group C was lower. The incidence of perirenal hematoma 24 hours after surgery in the group A was 62.09%, the group B was 62.50%, and the group C was 44.09%, with a statistically significant difference ( P=0.003); The incidence of gross hematuria 24 hours after surgery in the group A was 8.79%, the group B was 7.29%, and the group C was 1.57%, with a statistically significant difference ( P=0.030). The incidence of immediate postoperative perirenal hematoma in the group A was 52.20%, 53.12% in the group B, and 38.58% in the group C, with a statistically significant difference ( P=0.033). Conclusions:Immediate compression hemostasis for 5 minutes after ultrasound guided percutaneous renal biopsy can effectively reduce postoperative perirenal hematoma and gross hematuria, alleviate postoperative pain, shorten bed rest time, and improve surgical safety.

Objective To explore the prognostic value of MCF in elderly patients with cardiac amy-loidosis using CMR.Methods A retrospective analysis was conducted on 54 elderly patients with cardiac amyloidosis diagnosed in our hospital.All patients underwent CMR imaging.They were di-vided into a survival group of 25 cases and a mortality group of 29 cases based on clinical out-comes.Correlations of MCF with CMR parameters and biochemical indicators were evaluated.Cox regression analysis was performed to identify independent predictors of patient survival.Survival analysis was used to assess the value of MCF in predicting patient prognosis.Results The surviv-al group had significantly higher MCF than the mortality group[(70.63±24.72)％vs(43.59± 13.36)％,P=0.001].As MCF increasing,LVEF level was in an increasing trend,while LVMI,LVGPWT,ECV,and troponin T and NT-proBNP levels showed a decreasing trend.Multivariate Cox regression analysis revealed that MCF was an independent predictor of patient survival(HR=0.922,95％CI:0.866-0.981,P=0.011).Kaplan-Meier survival curve showed that the patients with MCF＞57％had significantly higher survival rates than those with MCF ≤57％(P＜0.01).Conclusion MCF is an effective imaging indicator for evaluating the prognosis of elderly patients with cardiac amyloidosis,which can help identify high-risk patients and guide clinical treatment.

OBJECTIVE: Obesity is recognized as a significant risk factor for diabetes and hypertension. The present study aimed to examine the associations between adults'obesity risk and childhood and parental obesity. METHODS: A total of 204 children aged 6-17 years were recruited in 2002 with an average follow-up period of 13.2 years. Height and body weight were measured by trained staffs. Overweight and obesity were defined based on the Chinese standard for children and adults. T-test, analysis of variance, and Chi-square analysis were used for single factor analysis. Multiple linear and logistic regression analyses were used to perform multifactor analysis. RESULTS: The percentage of non-obese children who grew up to be non-obese adults was 62.6%, and that of obese children who grew up to be obese adults was 80.0%. There was a significant association between childhood body mass index (BMI) and adulthood BMI with a β regression coefficient of 3.76 [95% confidence interval (CI): 1.36-6.16], and between childhood obesity and adulthood obesity with an odds ratio of 5.76 (95% CI: 1.37-24.34). There was no statistical difference between parental obesity at baseline and children's adulthood obesity, after adjustment of confounders. Male participants and those aged 10.0-13.0 years had a higher risk of adulthood obesity with odds ratios of 2.50 (95% CI: 1.12-5.26) and 3.62 (95% CI: 1.17-11.24), respectively. CONCLUSION Childhood obesity is an important predictor of adulthood obesity.
Adolescent ; Adult ; Body Mass Index ; Child ; China ; epidemiology ; Female ; Follow-Up Studies ; Humans ; Male ; Obesity ; epidemiology ; etiology ; Odds Ratio ; Parents ; Pediatric Obesity ; epidemiology ; etiology ; Prevalence ; Prospective Studies ; Young Adult

OBJECTIVE: To investigate the optimal dose range of immunosuppressants in patients with autosomal dominant polycystic kidney disease (ADPKD) after renal transplantation. METHODS: A cohort of 68 patients with ADPKD who received their first renal transplantation between March, 2000 and January, 2018 in our institute were retrospectively analyzed, with 68 non-ADPKD renal transplant recipients matched for gender, age and date of transplant as the control group. We analyzed the differences in patient and renal survival rates, postoperative complications and concentrations of immunosuppressive agents between the two groups at different time points within 1 year after kidney transplantation. The concentrations of the immunosuppressants were also compared between the ADPKD patients with urinary tract infections (UTI) and those without UTI after the transplantation. RESULTS: The recipients with ADPKD and the control recipients showed no significantly difference in the overall 1-, 5-, and 10- year patient survival rates (96.6% 96.0%, 94.1% 93.9%, and 90.6% 93.9%, respectively; > 0.05), 1-, 5-, and 10-year graft survival rates (95.2% 96.0%, 90.8% 87.2%, and 79.0% 82.3%, respectively; > 0.05), or the incidences of other post- transplant complications including acute rejection, gastrointestinal symptoms, cardiovascular events, pneumonia, and neoplasms ( > 0.05). The plasma concentrations of both tacrolimus and mycophenolate mofetil (MPA) in ADPKD group were significantly lower than those in the control group at 9 months after operation ( < 0.05). The incidence of UTI was significantly higher in ADPKD patients than in the control group ( < 0.05). In patients with ADPKD, those with UTI after transplantation had a significantly higher MPA plasma concentration ( < 0.05). CONCLUSIONS In patients with ADPKD after renal transplant, a higher dose of MPA is associated with a increased risk of UTI, and their plasma concentrations of immunosuppressants for long-term maintenance of immunosuppression regimen can be lower than those in other kidney transplantation recipients.
Graft Survival ; Humans ; Immunosuppressive Agents ; Kidney Transplantation ; Polycystic Kidney, Autosomal Dominant ; Retrospective Studies