Objective To investigate the preventive effect of continuous quality improvement(CQI) on malnutrition,inflammation,peritoneal dialysis adequacy and cardiovascular events in elderly patients undergoing peritoneal dialysis.Methods A single-center prospective self-controlled study was performed.32 stable elderly patients to undergo continuous ambulatory peritoneal dialysis (CAPD) were included.The continuous quality improvement program was conducted by using the 4-step problem-solving framework called the PDCA cycle (plan,do,check and act).The dialysis adequacy,nutritional status,inflammation and cardiovascular events were analyzed before and after PDCA.Results Compared with before PDCA,the proportion of patients with Kt/V≥1.7 and urea kinetics (Kt/V) level were increased after PDCA [71.8％ vs.93.75％,(1.97±0.36) vs.(2.08±0.33),both P＜ 0.05].Serum levels of albumin (ALB),prealbumin (PAB) and serum carbon dioxide combining power (CO2 CP) were increased after PDCA (all P＜0.05).The proportion of patients with ALB≥40 g/L was increased after PDCA as compared with before PDCA (9.4％ vs.31.3％,P＜0.05).The nutritional variables including mid-arm circumference (MAC),triceps skinfold thickness (TSF),mid arm muscle circumference (MAMC),and lean body mass (LBM),lean body mass percentage (LBM％),normalized protein equivalent of total nitrogen appearance (nPNA),handgrip strength were improved after PDCA (P＜ 0.05).High sensitivity C-reactive protein (hs-CRP) level and the proportion of patients with hs-CRP＞3 mg/L were decreased after PDCA as compared with before PDCA [(8.65±6.22) mg/L vs.(5.37±4.33) mg/L,53.1％ vs.25％,both P＜0.05].The incidence of peritoneal dialysis related peritonitis was reduced obviously from 1 case every 25.4 months to 1 case every 78.1 months after PDCA (P ＜ 0.05).The hospitalization rate due to cardiovascular events was decreased after PDCA as compared with before PDCA (25％ vs.3.13％,P＜0.05).Conclusions CQI may significantly improve the malnutrition,inflammation and dialysis adequacy,and reduce the hospitalization rate due to cardiovascular events in elderly patients undergoing peritoneal dialysis.

[Objective] To summarize image manifestations in intestinal tuberculosis (ITB) examined by multi-slice computed tomography enteroclysis (MSCT) and evaluate the diagnostic value of MSCTE in ITB,[Methods] The imaging findings were retrospectively analyzed in 15 cases of ITB that were confirmed by endoscopy or postoperative pathologic examination,including the location,number,shape,edge,surrounding tissue alterations of ITB and other associated changes in the peritoneum,mesentery and solid abdominal organs,and compared with endoscopy and pathology.[Results] In 15 patients,ileocecum was involved in 13 cases (87％),4 cases (27％) showed multi-segmental symmetric intestinal mural thickening,9 patients (60％) showed solid masses,1 case (7％) showed multi-segmental symmetric intestinal mural thickening and solid masses,1 case (7％) showed homogenous enhanced masses and perforation,12 cases (86％) showed enlarged lymph nodes (LNs) with rim enhancement,and 2 cases (13％) showed the comb sign of enhanced mesenteric vessels.Based on enhancement pattern of MSCTE,ITB was divided into three types:homogenous enhancement type (n=5);target sign type (n=2);caseous necrosis type (n=2).[Conclusion] The imaging features of ITB are diverse.MSCTE can clearly display the shape of intestinal mucosa,the alterations of intestinal wall and the relationship between lesion and adjacent tissues,which provides valuable information for the clinic diagnosis of ITB.

[Objective] To measure the diameter of the superior rectal vein (SRV) & theinferior mesenteric vein (IMV) by CT and analyze their relationship with lymphatic metastasis of rectal carcinoma.And to discuss the feasibility of utilizing SRV to prcdict lymph node metastasis of rectal cancer.[Methods] The CT imaging and pathological data of 105 rectal carcinoma patients were analyzed retrospectively.We measured and compared the diameter of every patient's SRV & IMV by CT in the presence and absence of microvascular tumor thrombus,signet ring cell,lymph node metastasis and distant metastasis.The accuracy of predicting lymph node metastasis for rectal carcinoma by the diameter of SRV were evaluated by ROC curve.[Results] There were statistical differences in the diameters of SRV and IMV between rectal cancer group with lymph node metastasis (D =4.34 mm,D =5.00 mm) and without (D =3.56 mm,D =4.81 mm;P ＜ 0.001,P =0.023).The differences were significant in the diameter of SRV between rectal cancer group with microvascular tumor thrombus or signet ring cell and without (P =0.019,P =0.044).However,the diameter of IMV showed no statistical difference between rectal cancer group with microvascular tumor thrombus or signet ring cell and without (P =0.605,P =0.663).And there was no statistical difference in the diameter of SRV or IMV between rectal cancer patients with distant metastasis and without (P ＞ 0.05).Regarding 3.75 mm as the cut-off value for the diameter of SRV to predict lymph node metastasis for rectal cancer patients,the sensitivity was 90.9％ and the specificity was 82.0％.Regarding 4.65 mm as the cut-off value for the diameter of IMV to predict lymph node metastasis for rectal cancer patients,the sensitivity was 87.3％ and the specificity was 38％.[Conclusions] It is completely feasible to utilize the diameter of SRV measured by CT to predict lymph node metastasis of rectal carcinoma with high sensitivity,accuracy,and relatively high specificity.

Objective To explore the diagnosis and treatment efficacy of bronchobiliary fistula due to hepatic cystic echinococcosis.Methods A retrospective evaluation of 39 patients with BBF was performed during 1992 to 2012.We divided the 39 patients into group A treated before 2001 and group B after 2002.A retrospective analysis was made.Results There were three deaths among the 39 BBF patients due to hepatic hydatid disease.The cause of death was septic shock due to severe infection.There were no statistical differences in the basic factors,age (t =0.84,P =0.554),gender (P =1.0),and sputum volume (t =0.98,P =0.703),hydatid diameter (t =1.11,P =0.406),operation time,chest infection (P =1.0),mortality (P =0.235) between the two groups (P ＞ 0.05).While postoperative length of stay(t =7.64,P =0.000),postoperative complications of residual cavity (P =0.001),length of tube drainage(t =6.747,P =0.01),recurrence of bronchial fistula (P =0.022),pleural dissemination (P =0.018),reoperation rate (P =0.049) were all in favour of group B (P ＜ 0.05).Conclusions Surgery is the choice of therapy for BBF due to hepatic hydatid disease,and one-stage procedure is expected to achieve the best outcomes.

OBJECTIVETo explore the effects of a novel human chemokine-like factor 1 (CKLF1) on stem cell/progenitor cells.

METHODSHuman bone marrow mononuclear cells were separated by Ficoll (1.077 g/ml), and cultured in suspension and semisolid colony culture. The effects of CKLF1 on CFU-GM and CFU-Mix were observed.

RESULTSThe number of CFU-GM was significantly increased in 10 groups by addition of CKLF1 plasmid supernatant. The mean value was 234.81 +/- 98.71/1 x 10(5) cells, 2.42 fold of control group (P < 0.05). The mean value of CFU-Mix in groups of negative control, CKLF1, PHA, GM-CSF and G-CSF were 82.00 +/- 20.25, 105.76 +/- 36.70, 146.63 +/- 27.09, 143.33 +/- 60.23 per 1 x 10(5) cells, respectively, no statistical differences were seen between control and CKLF1 groups. The CD(34)(+) cells were detected by FACS. The average percentage in the groups of normal control, CKLF1, PHA and GM-CSF were (0.75 +/- 0.62)%, (1.32 +/- 0.87)%, (0.15 +/- 0.02)%, and (0.29 +/- 0.23)%, respectively. Compared with control, no significant differences were seen between each group (P > 0.05).

CONCLUSIONNovel chemokine-like factor 1 can increase the proliferation of CFU-GM, which indicated that CKLF1 could increase the proliferation of human bone marrow hematopoietic progenitor cells and colony formation.

Objective To explore the influence of lack of parental accompaniment, physical abuse and neglect in childhood on the psychological distress of college entrant students. Methods In a comprehensive university in Sichuan Province, 8367 freshmen were surveyed using the 6-item Kessler psychological distress (K6) scale and a questionnaire for lack of parental accompany, physical abuse and neglect in childhood. The students were divided into rural group and urban group for data analysis. Results The months of lack of maternal and/or paternal accompaniment were more in rural group than that in urban group (P<0.05). In rural group, female (standardizedβ’=0.139, P<0.001), neglect (standardizedβ’=0.237, P<0.001) and physical abuse (standardized β’=0.076, P<0.001) were associated with K6 scale. In urban group, female (standardizedβ’=0.091, P<0.001), lack of paternal accompaniment (standardizedβ’=0.050, P<0.001), ne? glect (standardized β’=0.169, P<0.001) and physical abuse (standardized β’=0.095, P<0.001) related with K6 scale. Conclusions Neglect and physical abuse are independent risk factors to freshmen both from rural and urban areas. Lack of paternal accompaniment in childhood is a risk factor only in urban freshmen. Further research should select more rep?resentative samples and also include more factors which may interact with the loss of parental accompaniment such as pa?rental divorce and conditions regarding so calledleft-behindchildren in rural area.

Objective To examine the clinical characteristics and red cell distribution width (RDW) changes and to investigate the prognostic value of RDW in elderly patients undergoing peritoneal dialysis(PD). Methods We retrospectively analyzed the data of 59 elderly patients aged 60 or over who had undergone regular PD for over three months at Beijing Hospital from July 1 ,2005 to June 30 ,2017.All patients were followed up until the occurrence of a composite event or until December 31 ,2017. General characteristics ,baseline laboratory data ,RDW at baseline ,and time-average RDW during the follow-up were compared between the non-survival group and the survival group.Cox regression analysis was performed to determine whether RDW was an independent risk factor of all-cause mortality. Results Fifty-nine elderly PD patients with a mean age of (70.5 ± 6.6) years were included.The median follow-up duration was 40(25 ,56)months and the median survival duration was 57(36.6 ,74.4)months. The 1-,3-,and 5-year survival rates of all patients were 98.3%(n＝58) ,72.9%(n＝ 43) ,and 52.5%(n＝ 31) ,respectively.Twenty-eight patients died during the follow-up ,of whom 15 died of infection ,8 of cardio-cerebrovascular disease and 5 of other causes.Non-survivors had higher Charlson Comorbidity Index (CCI)scores ,higher levels of RDW at baseline ,higher time-average RDW ,lower initial total KT/V ,and lower initial total CCr (all P＜0.01).In univariate analysis ,high CCI ,high basic RDW ,high time-average RDW ,low serum albumin ,low serum ferrum , and low serum cholesterol were associated with all-cause mortality (all P＜ 0.05).In multivariate- adjusted Cox analysis ,high CCI(HR＝1.679 ,95% CI :1.238-2.236 ,P＝0.001)and high time-average RDW(HR ＝ 1.889 ,95% CI :1.195-2.987 ,P ＝ 0.007)were independent predictors for all-cause mortality in elderly PD patients. Conclusions Time-average RDW may independently predict the mortality of elderly PD patients. The prognostic value of dynamic RDW may be similar to that of CCI.

Objective To investigate the feasibility of utilizing visceral abdominal adiposity tissue (VAT) volume quantification using MRI to predict type 2 diabetes mellitus (T2DM).Methods Forty-eight subjects including 15 T2DM (T2DM group),17 impaired glucose tolerance (IGT,IGT group) and 16 normal glucose tolerance (NGT,NGT group) were enrolled in this study.All subjects underwent upper abdominal iterative decomposition of water and fat with echo asymmetry and least square estimation-image quantification (IDEAL-IQ) MRI scanning.VAT volume of the second and third lumber vertebral body ranges (VATV L2,VATV L3),sum of VATV L2 and L3 (total VATV),hepatic and pancreatic fat were measured in fat fraction mapping of T1WI IDAEL-IQ sequence on post-processing workstation.The accuracy of predicting T2DM using VAT was evaluated by Logistic regression equation via ROC curve.Results The mean of VATV L2,VATV L3 and total VATV in T2DM group were significantly higher than those of IGT group and NGT group (P＜0.05),while there were no significant difference of these metrics between IGT group and NGT group (P＞0.05).Taking 460.34 ml as the cut-off value for VATV L2 to predict T2DM,sensitivity was 73.33％,specificity was 75.76％ and accuracy was 75.00％,respectively.Taking 429.46 ml as the cut-off value for VATV L3 to predict T2DM,sensitivity was 86.67％,specificity was 72.73％ and accuracy was 77.08％,respectively.Taking 887.83 ml as the cut-off value for total VATV to predict T2DM,the sensitivity,specificity and accuracy were 86.67％,72.73％ and 77.08％,respectively.Only VATV L3 was enrolled by Logistic regression equation (P=0.01,OR=1.01),and the sensitivity,specificity and total accuracy of prediction for T2DM were 80.00 ％,88.20 ％,and 84.40 ％,respectively.Conelnsion It is feasible to utilize VAT volume quantification with MRI to predict T2DM.VATV L3 is a better predictor.

OBJECTIVE: To explore whether MRI fusion technology (combined T2-weighted imaging [T2WI] and fat-suppressed T2WI [T2WI-(FS)]) improves signal differences between anal fistulas and surrounding structures. MATERIALS AND METHODS: A total of 32 patients with confirmed diagnoses of anal fistula were retrospectively studied. All available T2WI and T2WI-(FS) images for each patient were used to generate fusion image (T2WI-(Fusion)) based on the addition of gray values obtained from each pixel via an MR post-processing work station. The discriminability of fistula, perianal sphincter, and perianal fat in T2WI, T2WI-(FS), and T2WI-(Fusion) images was quantified with Fisher's scoring algorithm. For subjective visual image assessment by researchers, five-point scale scores were determined using a modified double-stimulus continuous quality-scale test to evaluate T2WI-(FS), T2WI, enhanced axial three-dimensional-volumetric interpolated breath-hold examination (3D-VIBE), and T2WI-(Fusion) sequence images. The differences were subsequently compared. RESULTS: Mean Fisher scores for fistulas vs. sphincters obtained from T2WI-(Fusion) (F(Fusion-fistula) = 6.56) were significantly higher than those from T2WI (F(T2WI-fistula) = 3.35) (p = 0.001). Mean Fisher scores for sphincters vs. fat from T2WI-(Fusion) (F(Fusion-sphincter) = 10.84) were significantly higher than those from T2WI-(FS) (FS(FS-sphincter) = 2.57) (p = 0.001). In human assessment, T2WI-(Fusion) showed the same fistula discriminability as T2WI-(FS), and better sphincter discriminability than T2WI. Overall, T2WI-(Fusion) showed better discriminability than T2WI, T2WI-(FS), and enhanced 3D-VIBE images. CONCLUSION: T2WI and T2WI-(FS) fusion technology improves signal differences between anal fistulas and surrounding structures, and may facilitate better evaluation of anal fistulas and sphincters.
Anal Canal ; Diagnosis ; Fistula ; Humans ; Magnetic Resonance Imaging ; Rectal Fistula ; Retrospective Studies

Objective To evaluate the clinical efficacy of plasma exchange(PE)and double plasma molecular absorption system(DPMAS)in the treatment of primary biliary cholangitis(PBC)and the effect of this therapy on prognosis.Methods The clinical data on 526 PBC patients in our hospital from December 2013 to January 2022 were retrospectively analyzed.The patients were divided into different groups according to different therapies and then matched with propensity.The changes in symptoms,laboratory indexes and MELD scores were compared between two groups before and after treatment,and the clinical efficacy of artificial liver treatment for PBC patients was assessed.The effect of this treatment on the survival outcomes in these patients via comparing the cumulative survival rates at 3,6 and 12 months between the two groups.Results The efficiency was better in the group with artificial liver treatment in addition medical therapy than the group with medical treatment alone,the difference was statistically significant(76.7%vs.55.8%,χ2 = 4.214,and P = 0.040).Cox proportional risk regression showed that TBIL was an independent risk factor affecting the 3-,6-,or 12-month survival in PBC patients.Conclusions Artificial liver support system can effectively relieve symptoms,reduce levels of ALT,AST and TBIL,improve blood coagula-tion function,and lower MELD scores in PBC patients.This therapy revealed a trend of improvement in 3-,6-,or 12-month survival outcomes.