Objective To examine the interrelations among vascular calcification, bone denaity,osteoprotegerin (OPG) and soluble receptor activator of NF-kB ligand (sRANKL) in maintenance hemodialysis (MHD) patients. Methods The levels of serum OPG and sRANKL from 39 MHD patients were measured by ELISA. The vascular calcification was detected by plain radiographs. Bone mineral density (BMD) was measured with dual-energy X-ray absorptionmeter.Interrelations among above parameters were examined statistically. Results (1) Among 39 MHD patients, 25 cases were identified as vascular calcification by radiographic film. The proportion of patients with mild vascular calcification was 41.0% (16 cases), moderate and severe vascular calcification was 23.1% (9 cases). Compared to patients with mild vascular calcification,serum OPG level [(342.50±171.53) ng/L vs (206.21±137.88) ng/L,t=-2.253, P=0.0251 and OPG/sRANKL ratio (454.65±455.63 vs 135.31±136.81, t=59, P=0.035)were significantly higher in patients with moderate and severe vascular calcification,while serum sRANKL level [(0.10±0.08) pmol/L vs (0.12±0.08) pmol/L, t=0.534, P>0.05] was not significantly different. Multiple linear regression analysis showed that OPG/sRANKL ratio was independent factor of vascular calcification score. (2)Compared to patients with normal bone volume, the patients with abnormal bone volume had higher serum OPG level [(249.05±137.66) ng/L vs (226.67±170.12) ng/L], lowerserum sRANKL level [(0.11±0.08) pmol/L vs (0.12±0.02) pmol/L], and higher OPG/sRANKL ratio(202.31±219.24 vs 148.08±210.10), but these parameters were not significantly different betweenthese two groups. Multiple linear regression analysis showed that OPG/sRANKL ratio was anindependent factor of T score of lumbar vertebra. (3)Muhiple linear regression analysis revealed that vascular calcification score was an independent factor of T score of lumbar vertebra and hip.Conclusions Vascular calcification score is an independent factor of BMD of lumbar vertebra and hip in MHD patients. Serum OPG/sRANKL ratio may play an important role in the association between vascular calcification and BMD in MHD patients.

Purpose:To investigate the main prognostic factors of patients with renal cell carcinoma.Methods:104 cases of patients with postoperative renal cell carcinoma were analyzed by Cox regression models.Results:Four factors showed significant relation to prognosis: clinical stage, radical nephrectomy for renal cell carcinoma, hematuria, embolization of renal artery. A predicting equation was established, and the predicting values were calculated according to the individual features of patients. The predicting and actual values were compared, and the sensitivity, specificity and overall concordance were 73.3%, 83.3%, and 80.4% respectively.Conclusions:Radical nephrectomy for renal cell carcinoma and embolization of renal artery were protective factors of renal cell carcinoma and the clinical stage and hematuria were risky factors.

BACKGROUND: Studies in animals suggest that pipecuronium dose not induce hemodynamic chan-ges related to histamine release or to an effect on the autonomic nervous system. Therefore the effects of bolus administration of large doses of pipecuronium, up to 0.20 mg/kg, on the intubation condition, onset and duration of neuromuscular blockade, heart rate and blood pressure were studied during fentanyl- nitrous oxide anesthesia. METHOD: Forty adults were randomly assigned to receive a bolus injection of either 0.05, 0.10, 0.15, 0.20 mg/kg of pipecuronium. Neuromuscular blockade was measured using mechanomyographic activity of the adductor pollicis muscle after supramaximal stimulation of the ulnar nerve. Four subgroups of 10 patients received pipecuronium doses of 0.05, 0.10, 0.15 and 0.20 mg/kg, respectively, as an intubating dose. RESULTS: The times of onset and clinical duration (mean sem) after each dose were as follows: 0.05 mg/kg, 2.98 0.42 and 41.5 2.42 min; 0.10 mg/kg, 1.54 0.06 and 82.9 7.48 min; 0.15 mg/kg, 1.41 0.14 and 124.8 13.1 min; 0.20 mg/kg, 1.12 0.05 and 187.1 12.8 min. The intubation condition, time of onset and duration after doses of 0.05 mg/kg were significantly different from values after the higer doses. The duration was increased with dose-increments. No dose-related changes in heart rate or blood pressure were observed. CONCLUSION: The authors conclude that dose of 0.10 mg/kg and over has good intubation condition clinically and large bolus dose of pipecuronium can be safely used with a significantly prolonged duration of action without hemodynamic change.
Adult* ; Anesthesia ; Animals ; Autonomic Nervous System ; Blood Pressure ; Heart Rate ; Hemodynamics ; Histamine Release ; Humans ; Intubation ; Intubation, Intratracheal* ; Neuromuscular Blockade ; Nitrous Oxide ; Pipecuronium* ; Ulnar Nerve

BACKGROUND: Long-term phenytoin therapy induces resistance to the neuromuscular blocking effects of metocurine, atracurium, doxacurium, and pipecuronium. This study examine neuromuscu-lar blocking effect and recovery of mivacurium in isolated rat phrenic-hemidiaphragm with two-weeks phenytoin pretreatment. METHOD: After the administration of 14 days of phenytoin 40 mg/kg, administered intraperitoneally twice daily (n=10), ED90, antagonism of neostigmine and 4-aminopyridine on the electrically evoked twitch response and train-of-four (TOF) stimulation were compared to control groups in isolated rat phrenic-hemidiaphragm preparation. RESULTS: ED90 was significantly greater in the phenytoin group than in the control group (319 +/- 39.5 g vs. 209.5 +/- 52.2 g, respectively). After the administration of neostigmine 0.75 M, the recovery of the single twitch and TOF ratio were significantly lesser in the phenytoin group than in the control group (single twitch; 19.6 +/- 6.6% vs. 69.2 +/- 9.4%, TOF ratio; 0.258 +/- 0.149 vs. 0.543 +/- 0.1, respectively). After the administration of 4-aminopyridine 40uM, the recovery of the single twitch and TOF ratio were no significant differrence between the phenytoin group and the control group (twitch; 118.1 +/- 25.3% vs. 122.6 +/- 24.8%, TOF ratio; 0.937 +/- 0.051 vs. 0.949 +/- 0.067, respectively). CONCLUSION: Long-term phenytoin therapy induces resistance to the neuromuscular blocking effects of mivacurium.
4-Aminopyridine ; Animals ; Atracurium ; Drug Interactions ; Neostigmine ; Neuromuscular Blockade* ; Phenytoin* ; Pipecuronium ; Rats*

Insertion of indwelling arterial catheter has become a valuable procedure for blood pressure monitoring and for measurement of blood gas tension during anesthesia. A 34-year-old man with chronic alcoholism and diabetes mellitus was admitted to the hospital because of hyperosm-olar coma. On the first hospital day, percutaneous left radial artery cannulation was carried out for hemodynamic monitoring and arterial blood gas analysis after a modified Allen's test appear-ed to be positive. On the eleventh hospital day, the catheter was removed because of fever and sign of infection at the insertion site. Treatment with vancomycin by sensitivity test was begun on day 13, after continued for 2 weeks. On day 34 a pulsatile mass was noted at the insertion site. During surgery, a pseudoaneurysm of 1X1.2 cm size was found, and liquified hematoma and necrotic material were noted. The aneurysm was removed and end to end anastomosis was successfully completed. We suggest that risk factors for pseudoaneurysm may include abnormal state of vessel wall, multiple attempts at cannulation, increased duration of catheterization, adva-nced age, prolonged hospitalization, hematoma and infection at cannulation site.
Adult ; Alcoholism ; Anesthesia ; Aneurysm ; Aneurysm, False* ; Blood Gas Analysis ; Blood Pressure Monitors ; Catheterization* ; Catheters ; Coma ; Diabetes Mellitus* ; Fever ; Hematoma ; Hemodynamics ; Hospitalization ; Humans ; Radial Artery* ; Risk Factors ; Vancomycin

BACKGROUND: Magnesium sulfate (MgSO4) is widely utilized in the treatment of preeclamptic hyperreflexia. It is well known that magnesium enhances nondepolarizing neuromuscular blockade. Eclamptic convulsions are almost always prevented by magnesium in plasma concentrations of 4 to 7 mEq/L. METHODS: The effects of various concentration of magnesium on the potency and reversibility of pipecuronium were investigated in vitro rat phrenic nerve-hemidiaphragm. The phrenic nerve-hemidiaphragm was dissected and suspended in organ bath containing modified Krebs' solution. Forty samples were divided into 4 groups (n=10 in each group). Group I was studied at the physiologic magnesium concentration(2.4 mEq/L, control group). Group II, III, IV were studied at the concentration of 4, 5.5, and 7 mEq/L, respectively. In each group, we added pipecuronium until twitch height decreased more than 90% of initial level. To compare the recovery, we added neostigmine and calcium, and then, measured TOF ratio. RESULTS: The amounts of added pipecuronium were 73.8+/-15.2 microgram (mean+/-S.D.) in Group I, 38.1+/-5.0 microgram in Group II, 33.0+/-4.1 microgram in Group III and 16.1+/-1.7 microgram in Group IV. The amounts of pipecuronium in Group II, III, IV were significantly less than Group I. After the addition of neostigmine, the values of TOF ratio were under 0.6 in all groups. But after the addition of calcium, all groups were recovered with TOF ratio over 0.85 except Group I. CONCLUSIONS: This study indicated that the increased magnesium concentration potentiated pipecuronium-induced neuromuscular blockade and at higher level, it was more apparent. Neostigmine was not significantly effective to reverse the pipecuronium-induced neuromuscular blockade potentiated with magnesium. But calcium was significantly effective.
Animals ; Baths ; Calcium ; Magnesium Sulfate ; Magnesium* ; Neostigmine ; Neuromuscular Blockade* ; Pipecuronium ; Plasma ; Rats* ; Reflex, Abnormal ; Seizures

PURPOSE: Helicobacter pylori infection induces phenotype-stabilizing methylation and promotes gastric mucosal atrophy that can inhibit CpG-island methylation. Relationship between the progression of gastric mucosal atrophy and the initiation of CpG-island methylation was analyzed to delineate epigenetic period for neoplastic transformation. MATERIALS AND METHODS: Normal-appearing gastric mucosa was biopsied from 110 H. pylori–positive controls, 95 H. pylori–negative controls, 99 gastric cancer patients, and 118 gastric dysplasia patients. Gastric atrophy was assessed using endoscopic-atrophic-border score. Methylation-variable sites of eight CpG-island genes adjacent to Alu (CDH1, ARRDC4, PPARG, and TRAPPC2L) or LTR (MMP2, CDKN2A, RUNX2, and RUNX3) retroelements and stomach-specific TFF3 gene were analyzed using radioisotope-labeled methylation-specific polymerase chain reaction. RESULTS: Mean ages of H. pylori–positive controls with mild, moderate, and severe atrophy were 51, 54, and 65 years and those of H. pylori–associated TFF3 overmethylation at the three atrophic levels (51, 58, and 63 years) tended to be periodic. Alu-adjacent overmethylation (50 years) was earlier than TFF3 overmethylation (58 years) in H. pylori–positive controls with moderate atrophy. Cancer patients with moderate atrophy showed late Alu-adjacent (58 years) overmethylation and frequent LTR-adjacent overmethylation. LTR-adjacent overmethylation was frequent in cancer (66 years) and dysplasia (68 years) patients with severe atrophy. CONCLUSION: Atrophic progression is associated with gastric cancer at moderate level by impeding the initiation of Alu-adjacent methylation. LTR-adjacent methylation is increased in cancer patients and subsequently in dysplasia patients.
Atrophy* ; DNA Methylation ; Epigenomics ; Gastric Mucosa ; Gastritis, Atrophic ; Genes, Essential* ; Helicobacter pylori ; Housekeeping* ; Humans ; Methylation* ; Polymerase Chain Reaction ; Retroelements ; Stomach Neoplasms*

Objective:To construct an ultra-early limb movement program for elderly hip fracture surgery patients based on evidence-based practice and the Delphi method.Methods:From May to December 2023, the PIPOST Model (population, intervention, professional, outcome, setting, type of evidence) was used to develop evidence-based questions. Relevant databases were searched to obtain, summarize, and evaluate evidence related to ultra-early limb movement after hip fracture surgery in elderly patients. A draft of the movement program was created with the search timeline set until June 1, 2023. A total of 29 experts were invited to participate in two rounds of Delphi expert consultation to finalize the ultra-early limb movement program for elderly hip fracture surgery patients.Results:A total of 20 studies were included, consisting of six guidelines, four expert consensuses, three systematic reviews, and seven original research articles. The response rates for the two rounds of Delphi expert consultation were 100.00% (29/29) and 86.21% (25/29). The expert authority coefficients were 0.931 and 0.920, and the Kendall coordination coefficients were 0.205 and 0.112 (all P<0.01). The final ultra-early limb movement program for elderly hip fracture surgery patients included four modules and 39 operational items. Conclusions:This study develops an evidence-based, expert-validated ultra-early limb movement program for elderly hip fracture surgery patients, demonstrating its necessity, scientific basis, and practicality. The program provides a reference and guidance for clinical staff in facilitating ultra-early movement for hip fracture patients post-surgery.

Purpose: Nocturnal enuresis has been regarded as one of the most prevalent problems of childhood. Nocturnal enuresis may lead to a distressing and perplexing problem for children, resulting in social withdrawal, guilty feelings, and a sense of loneliness. In this study, we investigated changes in self-awareness, anxiety, depression, and behavior estimation before and after treatment in children with primary nocturnal enuresis. MATERIALS AND METHODS: Psychologic inventories were evaluated in 48 primary nocturnal enuretic patients who had been successfully treated for their nocturnal enuresis from April 2001 to March 2002. Before and after treatment, self-administered questionnaires, such as Kovac's Children's Depression Inventory, Piers-Harris Children Self-Concept scale, and State-Trait Anxiety Inventory for Children, were evaluated by the enuretics. Their parents were also evaluated by the Child Behavior Check list. RESULTS: In Kovac's Children's Depression Inventory and Piers-Harris Children Self-Concept scale, there were no signs of psychologic abnormality before and after treatment of nocturnal enuresis in terms of self-awareness and depression. Compared with the pre-treatment scores, there was significant improvement in trait anxiety after treatment of nocturnal enuresis (p<0.05). In the Child Behavior Check list, the parents thought that enuresis did not lead to abnormal behavior in their children. CONCLUSIONS: These results suggest no serious psychopathologic abnormalities before and after treatment of primary nocturnal enuresis. The enuretic patients may suffer from trait anxiety. Consequently, the successful treatment of nocturnal enuresis may alleviate a child's anxiety and prevent secondary psychopathologic abnormalities.
Anxiety* ; Child ; Child Behavior ; Depression* ; Enuresis ; Equipment and Supplies ; Humans ; Loneliness ; Nocturnal Enuresis* ; Parents ; Surveys and Questionnaires ; Self Concept ; Weights and Measures*

OBJECTIVETo investigate the clinical manifestations and endoscopic features of abdominal type Henoch purpura in children and improve the diagnostic level.

METHODSRetrospective review was made on the clinical, endoscopic and histopathological features of 57 cases of children with Henoch purpura abdominal type who had been hospitalized from Jan. 2002 to May 2007. Upper gastrointestinal endoscopy was performed in all cases. All the cases had various digestive system symptoms without cutaneous purpura before endoscopy. Mucosal specimens were taken from sinus ventriculi and duodenum for histopathological analysis. Helicobacter pylori (H.pylori) infection was identified by rapid urease test and histology, and diagnosis of H.pylori infection was made when both were positive.

RESULTSThe common gastrointestinal symptoms of Henoch purpura were abdominal pain (46 cases), vomiting (32 cases), hematochezia (11 cases), diarrhea (4 cases) and abdominal distention (1 case). Three cases had arthralgia and joint swelling. The main laboratory findings were increased peripheral white blood cells (33 cases, 57.9%), 1/5 of cases had elevated C reactive protein (CRP), low serum albumin and seroperitoneum. Endoscopy demonstrated the damages to the mucosa, which varied from congestion, edema, petechia and ecchymosis (37 cases, 64.9%) to erosive and multiple ulcers (14 cases, 24.6%), granulation of mucosa in descendent duodenum (4 cases, 7.0%), and diffuse hemorrhage of mucosa (2 cases, 3.5%). The upper gastrointestinal endoscopy showed that the commonest and most serious position involved was the descendent duodenum (55 cases, 96.5%), followed by duodenal bulb (32 cases, 56.1%) and stomach (18 cases, 36.1%), esophagus was less involved (1 case, 1.8%). Histological manifestations showed swollen vascular endothelial cells of capillary vessels and small blood vessels, fibrotic necrosis of small vessels and bleeding, diffuse perivascular lymphocytic and neutrophilic infiltration and nuclear debris in mucosa and submucosa. Three cases (5.3%) were found infected with H. pylori. In 49 cases (86.0%) cutaneous purpura appeared 1 - 7 days after endoscopy. Eight cases had no cutaneous purpura until they left hospital. Two cases were lost to follow up and 6 cases (10.5%) remained free from cutaneous purpura were followed up until now (1 - 5 years).

CONCLUSIONDescending duodenum is the commonest and most serious position of upper gastrointestinal tract involved in Henoch purpura. Upper gastrointestinal endoscopy with the mucosal biopsy are useful for the early diagnosis of Henoch purpura.

Abdominal Pain ; pathology ; physiopathology ; Child ; Duodenum ; pathology ; physiopathology ; Endoscopy ; instrumentation ; Humans ; Purpura, Schoenlein-Henoch ; pathology ; physiopathology