Objective:To investigate the risk factors and prognosis of mitral regurgitation (MR) in patients with chronic kidney disease (CKD).Methods:Clinical data were collected from CKD patients who were hospitalized at the Department of Nephrology, Xuanwu Hospital, Capital Medical University, from January 1, 2018, to December 31, 2019, and underwent echocardiography. Patients were followed up until November 1, 2021, with the endpoint being all-cause mortality.Logistic regression was used to analyze the risk factors of MR in CKD patients. Kaplan-Meier survival analysis was performed to plot the survival curve, with the Log-rank test comparing the survival rate. Multivariate Cox regression analysis was used to identify the risk factors of death in CKD patients.Results:It was a retrospective single-center study. A total of 555 CKD patients were included, with 262 patients developing MR. Of whom, 212 patients had mild MR (80.9%), 44 patients had modreate MR (16.8%), 6 patients had severe MR (2.3%). The prevalence of MR among patients with CKD stages 1 to 5 was 21.9%, 33.0%, 45.9%, 51.9%, and 64.6%, and the prevalence of moderate to severe MR was 0, 5.6%, 7.4%, 10.1%, and 15.9%. Multivariate logistic regression analysis revealed that male sex ( OR=1.579, 95% CI 1.008-2.476, P=0.046), presence of chronic heart disease ( OR=2.263, 95% CI 1.398-3.662, P=0.001), CKD stage 4-5 (with CKD stage 1-3 as reference, OR=1.744, 95% CI 1.007-3.019, P=0.047), and decreasing hemoglobin levels ( OR=0.985, 95% CI 0.975-0.996, P=0.006) were the associated factors for MR in CKD patients. Kaplan-Meier survival analysis indicated higher all-cause mortality (Log-rank, χ2=8.094, P=0.004) in the MR group compared to the non-MR group. Multivariate Cox regression analysis showed that increasing age ( HR=1.072, 95% CI 1.042-1.104, P<0.001), elevating blood phosphorus ( HR=2.782, 95% CI 1.122-6.895, P=0.027), MR ( HR=1.962, 95% CI 1.002-3.839, P=0.049) and decreasing albumin ( HR=0.927, 95% CI 0.886-0.970, P=0.001) were independent associated factors for all-cause death in CKD patients. Conclusions:The overall prevalence of MR and the prevalence of moderate to severe MR are increasing with the progression of CKD. Male sex, presence of chronic heart disease, CKD stage 4-5 and decreasing hemoglobin levels are risk factors for MR in CKD patients. MR is an independent risk factor for all-cause mortality in CKD patients.

Objective:To investigate the risk factors and prognosis of mitral regurgitation (MR) in patients with chronic kidney disease (CKD).Methods:Clinical data were collected from CKD patients who were hospitalized at the Department of Nephrology, Xuanwu Hospital, Capital Medical University, from January 1, 2018, to December 31, 2019, and underwent echocardiography. Patients were followed up until November 1, 2021, with the endpoint being all-cause mortality.Logistic regression was used to analyze the risk factors of MR in CKD patients. Kaplan-Meier survival analysis was performed to plot the survival curve, with the Log-rank test comparing the survival rate. Multivariate Cox regression analysis was used to identify the risk factors of death in CKD patients.Results:It was a retrospective single-center study. A total of 555 CKD patients were included, with 262 patients developing MR. Of whom, 212 patients had mild MR (80.9%), 44 patients had modreate MR (16.8%), 6 patients had severe MR (2.3%). The prevalence of MR among patients with CKD stages 1 to 5 was 21.9%, 33.0%, 45.9%, 51.9%, and 64.6%, and the prevalence of moderate to severe MR was 0, 5.6%, 7.4%, 10.1%, and 15.9%. Multivariate logistic regression analysis revealed that male sex ( OR=1.579, 95% CI 1.008-2.476, P=0.046), presence of chronic heart disease ( OR=2.263, 95% CI 1.398-3.662, P=0.001), CKD stage 4-5 (with CKD stage 1-3 as reference, OR=1.744, 95% CI 1.007-3.019, P=0.047), and decreasing hemoglobin levels ( OR=0.985, 95% CI 0.975-0.996, P=0.006) were the associated factors for MR in CKD patients. Kaplan-Meier survival analysis indicated higher all-cause mortality (Log-rank, χ2=8.094, P=0.004) in the MR group compared to the non-MR group. Multivariate Cox regression analysis showed that increasing age ( HR=1.072, 95% CI 1.042-1.104, P<0.001), elevating blood phosphorus ( HR=2.782, 95% CI 1.122-6.895, P=0.027), MR ( HR=1.962, 95% CI 1.002-3.839, P=0.049) and decreasing albumin ( HR=0.927, 95% CI 0.886-0.970, P=0.001) were independent associated factors for all-cause death in CKD patients. Conclusions:The overall prevalence of MR and the prevalence of moderate to severe MR are increasing with the progression of CKD. Male sex, presence of chronic heart disease, CKD stage 4-5 and decreasing hemoglobin levels are risk factors for MR in CKD patients. MR is an independent risk factor for all-cause mortality in CKD patients.

Objective:To evaluate the correlation between age and renal outcomes in patients with stage 2-4 chronic kidney disease (CKD) and the impact of age on CKD outcomes in kidney diseases of different etiologies.Methods:A prospective cohort study included 470 patients with stage 2-4 CKD. The Kaplan Meier method was used to analyze the differences in CKD outcomes among different age groups. The independent risk factors for CKD progression were analyzed using a multivariate Cox regression model. We adjusted for baseline differences in risk factors for CKD outcomes between two age groups using propensity score matching (PSM).Results:Among 470 patients, 39 cases of end-stage renal disease (ESRD) events (all starting dialysis) and 51 deaths were observed. The Kaplan Meier survival curve ( P=0.039) and Cox regression univariate survival analysis ( P=0.043) both showed that <60 years old is a risk factor for CKD patients to progress to ESRD. In multivariate Cox regression, age remained an independent risk factor for the progression of CKD patients (hazard ratio 0.386, 95% CI: 0.163-0.916; P=0.031). For kidney diseases with different causes, in patients with hypertensive kidney damage ( P=0.024) and primary glomerulonephritis ( P=0.047), the cumulative incidence rate of ESRD in patients <60 years old was higher than that in patients ≥60 years old. There was no statistically significant difference in all-cause mortality rates between patients aged <60 and ≥60 years old ( P=0.646). Conclusions:Elderly patients with stage 2-4 CKD have a lower ESRD risk than younger patients. This discovery helps nephrologists and decision-makers optimize the management of elderly CKD patients.

Humans ; Receptors, Chimeric Antigen ; Immune Checkpoint Inhibitors ; Immunotherapy, Adoptive ; Skin Diseases ; Necrosis ; Cell- and Tissue-Based Therapy

Objective:To explore the incidence, influencing factors and prognostic value of cardiac valve calcification (CVC) in chronic kidney disease (CKD) non-dialysis patients.Methods:The non-dialysis patients with CKD stage 1-5 who were hospitalized and underwent echocardiography in the Department of Nephrology, Xuanwu Hospital, Capital Medical University from January 1, 2018 to December 31, 2019 were retrospectively admitted. The patients were divided into CVC group and non-CVC group, and the clinical data were compared between the two groups. The deadline for follow-up was November 1, 2021, and the follow-up end point event was all-cause mortality. Logistic regression model was used to analyze the risk factors of CVC in patients with CKD, and Cox proportional hazards regression model was used to analyze the risk factors of all-cause mortality in patients with CKD.Results:A total of 563 patients with CKD were enrolled in the study, with age of (59.49±13.97) years old, and 352 males (62.52%). There were 325 patients (57.73%) with CKD stage 1-3 and 238 patients (42.27%) with CKD stage 4-5. The incidence of CVC in CKD stage 1-5 patients was 32.32%(182/563). Aortic valve calcification occurred in 30.73%(173/563), mitral valve calcification occurred in 9.77% (55/563), double valve (mitral and aortic valve) calcification occurred in 8.35% (47/563), and tricuspid valve calcification occurred in 0.18%(1/563). Age (t=12.223, P<0.001) and the proportions of CKD stage 4-5 ( χ 2=10.854, P=0.001), hypertension ( χ 2=7.811, P=0.005), diabetes ( χ 2=8.424, P=0.004), hyperlipidemia ( χ 2=9.331, P=0.002), and taking statins ( χ 2=4.868, P=0.027) in CVC group were significantly higher than those in non-CVC group. Total cholesterol (t=2.243, P=0.025), low density lipoprotein cholesterol (t=2.025, P=0.043), platelet count (t=2.230, P=0.026) and estimated glomerular filtration rate (t=8.630, P<0.001) in CVC group were lower than those in the non-CVC group. Logistic regression analysis results showed that age≥60 years old (≥60 years old/<60 years old, OR=7.412, 95% CI 4.514-12.170, P<0.001), CKD stage 4-5 (stage 4-5/stage 1-3, OR=2.791, 95% CI 1.730-4.505, P<0.001) and hyperlipidemia ( OR=5.241, 95% CI 3.283-8.367, P<0.001) were the independent influencing factors of CVC in patients with CKD. Five hundred and sixty-three patients were followed up for an average of 26 months, including 68 cases (12.08%) of death, 436 cases (77.44%) of survival and 59 cases (10.48%) of loss to follow-up. Multivariate Cox regression analysis results showed that age≥60 years old (≥60 years old/<60 years old, HR=2.157, 95% CI 1.127-4.127, P=0.020), serum albumin<30 g/L (<30 g/L/≥30 g/L, HR=1.923, 95% CI 1.037-3.568, P=0.038) and double valve calcification (double valve calcification/no valve calcification, HR=2.516, 95% CI 1.279-4.950, P=0.008) were the independent influencing factors of all-cause death in patients with CKD. Conclusions:CVC accounts for 32.32% in non-dialysis patients with CKD stage 1-5. Older age, worse renal function and hyperlipidemia are the independent risk factors of CVC in CKD patients. Older age, hypoproteinemia and double valve calcification are the independent risk factors of all-cause death in patients with CKD.

Objective:To analyze the incidence and risk factors of acute kidney injury (AKI) in patients undergoing neurosurgery.Methods:This study was a single center and retrospective research. The patients hospitalized in the general neurosurgery ward of Xuanwu Hospital, Capital Medical University, due to intracranial tumors and intracranial vascular diseases from January 1, 2017 to December 31, 2020 were enrolled. Demographic, clinical data and laboratory examination results of the selected patients were collected. The patients were divided into AKI group and non-AKI group according to AKI diagnosis criteria, and the differences of clinical parameters and medication between the two groups were compared. Logistic regression analysis method was used to analyze the risk factors of AKI in neurosurgical patients.Results:Among 4 509 patients undergoing neurosurgery with age of (51.93±16.03) years old, 2 361 males and 2 148 females, 152 patients (3.37%) had AKI. The incidence of AKI in patients undergoing intracranial tumor surgery was 3.69% (84/2 278), and the incidence of AKI in patients undergoing intracranial cerebrovascular surgery was 3.05%(68/2 231). The length of hospital stay ( t=4.897, P<0.001) and operation time ( t=5.496, P<0.001) in AKI group were significantly longer than those in non-AKI group. The proportions of diabetes mellitus, preoperative serum creatinine, blood urea nitrogen, glycosylated hemoglobin, lactic acid, fibrinogen, and systolic pressure levels in AKI group were significantly higher than those in non-AKI group (all P<0.05); the hemoglobin level in AKI group was significantly lower than that in non-AKI group ( P<0.05). The proportions of patients using angiotensin converting enzyme inhibitors/angiotensin Ⅱ receptor antagonists, cephalosporins, proton pump inhibitors, mannitol, and nonsteroidal anti-inflammatory drugs in AKI group were also significantly higher than those in non-AKI group (all P<0.05). Multivariate logistic regression analysis results showed that hemoglobin<110 g/L ( OR=4.252, 95% CI 1.569-11.527, P=0.004), elevated blood urea nitrogen ( OR=1.304, 95% CI 1.139-1.492, P<0.001) and application of nonsteroidal anti-inflammatory drugs ( OR=2.342, 95% CI 1.044-5.253, P=0.039) were independent risk factors of AKI in neurosurgical patients. Conclusions:The incidence of AKI in patients in neurosurgery general ward is 3.37%. Anemia, elevated blood urea nitrogen and application of nonsteroidal anti-inflammatory drugs are independent risk factors of AKI in patients undergoing neurosurgery.

Background The key enzymes of serine synthesis pathway (SSP) play an important role in tumor growth, proliferation, and invasion, but their roles in arsenic carcinogenesis are unclear. Objective To observe the effects of NaAsO₂ treatment on the expressions of key enzymes [such as phosphoglycerate dehydrogenase (PHGDH), phosphoserine aminotransferase 1 (PSAT1), and phosphoserine phosphatase (PSPH)] of SSP and on the ability to proliferate and migrate in human immortalized skin keratinocytes (HaCaT) and NaAsO₂-induced malignantly transformed HaCaT (T-HaCaT), and to explore the roles of SSP key enzymes in arsenic carcinogenesis. Methods (1) The T-HaCaT cells constructed earlier by our research team were divided into a passage control (0 μmol·L⁻¹ NaAsO₂) group, a T-HaCaT (0.5 μmol·L⁻¹ NaAsO₂) group, a NCT503 (PHGDH inhibitor, 25 μmol·L⁻¹) group, and a NCT503 (25 μmol·L⁻¹) + T-HaCaT (0.5 μmol·L⁻¹ NaAsO₂) group. Western blotting was used to detect the protein expression levels of SSP key enzymes in the passage control group and the T-HaCaT group. CCK8 assay and cell scratch test were used to detect the proliferation and migration rates of cells in each group respectively. (2) Well-grown logarithmic-phase HaCaT cells were treated with 0, 0.625, 1.25, and 2.5 μmol·L⁻¹ NaAsO₂ for 0, 24, 48, and 72 h to detect cell proliferation rate and protein expression levels of SSP key enzymes. In the subsequent experiment, HaCaT cells were pretreated with 25 μmol·L⁻¹ NCT503 for 6 h, and then treated with 2.5 μmol·L⁻¹ NaAsO₂ for 72 h continuously. The experimental groups included a control (0 μmol·L⁻¹ NaAsO₂) group, an exposure (2.5 μmol·L⁻¹ NaAsO₂) group, a pretreatment (25 μmol·L⁻¹ NCT503) group, and a pretreatment (25 μmol·L⁻¹ NCT503) + exposure (2.5 μmol·L⁻¹ NaAsO₂) group, to detect the proliferation rate of cells in each group. Results The protein expression level of PHGDH in the T-HaCaT group were 1.60 times higher than that in the passage control group (P<0.05), and its proliferation rate (177.51%±14.69%) and migration rate (53.85%±0.94%) were also higher than the passage control group’s (100.00%±0.00% and 24.30%±2.26%) (both Ps<0.05), respectively. After the NCT503 intervention, the proliferation rate (144.97%±8.08%) and migration rate (35.80%±0.99%) of cells in the NCT503 + T-HaCaT group were lower than those in the T-HaCaT group (both P<0.05). The proliferation rate of HaCaT cells after NaAsO₂ exposure for 72 h increased with the increase of exposure concentration (r=0.862, P<0.05), and consistently, the protein levels of SSP key enzymes in HaCaT cells in each exposure group were higher than those in the control group (all P<0.05). The proliferation rate of HaCaT cells treated with 2.5 μmol·L⁻¹ NaAsO₂ increased with the extension of exposure time (r=0.775, P<0.05), which was consistent with the changes of PHGDH levels in cells. After the NCT503 intervention, the proliferation rate of the pretreatment + exposure group was significantly lower than that of the exposure group (P<0.05). Conclusion The key enzymes of SSP may play an important role in the proliferation of T-HaCaT cells induced by NaAsO₂.

Objective:To analyze the prevalence and associated factors of malnutrition among children under 6 years of age in Hunan province.Methods:This study was a cross-sectional study. A combination of multistage stratified cluster sampling and systematic sampling approach was used to recruit 10 442 children aged 0-71 months from 144 communities (villages) across 48 streets(towns) in 24 districts(counties) from Hunan province between August and November 2019. Data concerning the children and their mothers, caregivers, and family conditions was collected using unified questionnaire, with the lengths/heights and weights of the children being measured using unified instruments. The length/height for age, weight for age, weight for length/height, and body mass index for age Z scores were calculated and used to evaluate the prevalence of children′s stunting, underweight, and wasting. The chi-square test was used to compare the prevalence of malnutrition among children with different characteristics. The multivariate Logistic regression model was used to conduct multivariate analysis for childrens′ malnutrition.Results:The prevalence of protein-energy malnutrition (PEM) among children under 6 years of age was 6.8% (710/10 442), and the prevalence of stunting, underweight, and wasting were 3.1% (328/10 442), 2.7% (280/10 442), and 3.3% (343/10 442), respectively. Rural areas ( OR=1.60), older age of children (compared with children of 0-11 months, the OR for 12-23, 24-35, 36-47, 48-59, and 60-71 months were 1.42, 1.75, 1.55, 1.70, and 1.88, respectively), low birth weight ( OR=2.72), caregivers of minority ethnicity ( OR=1.95), and large family size ( OR=1.25) were risk factors for children′s PEM. Rural areas and low birth weight were risk factors for stunting in children ( OR=2.13 and 3.28). Rural areas, low birth weight, caregivers of minority ethnicity, and large family size were risk factors for underweight in children ( OR=2.57, 3.34, 1.86, and 1.32). Rural areas ( OR=1.43), older age of children (compared with children of 0-11 months, the OR for 24-35, 36-47, 48-59, and 60-71 months were 1.63, 1.80, 1.84 and 2.17, respectively), low birth weight ( OR=2.36), caregivers of minority ethnicity ( OR=2.88), and large family size ( OR=1.42) were risk factors for children′s wasting. Higher education level of caregivers was a common protective factor for PEM, stunting, and underweight ( OR=0.85, 0.76, and 0.82). Conclusions:The prevalence of stunting, underweight, and wasting among children under 6 years of age in Hunan province were all at a low level. Nevertheless, the urban-rural differences still existed, with these prevalence being affected by children age, birth weight, ethnicity of caregivers, education level, and family size.

Objective:To investigate the relationship between posttraumatic growth and fear of cancer recurrence in patients with breast cancer during chemotherapy.Methods:The Posttraumatic Growth Inventory-C (PTGI-C) and the Fear of Cancer Recurrence Inventory-Chinese Version (FCRI-CV) were used in the Tai'an Central Hospital of Shandong Province and the Second Affiliated Medicine of Shandong First Medical University. A cross-sectional survey was conducted in 208 patients with breast cancer during chemotherapy.Results:The total score of posttraumatic growth of breast cancer patients during chemotherapy period was 65.80±12.36, which was at the middle level. The total score of fear of cancer recurrence was 79.52 ±18.15, which was at the low-medium level. The total score of posttraumatic growth of breast cancer patients during chemotherapy was negatively correlated with the total score of fear of cancer recurrence ( r=-0.449, P<0.01). Conclusion:Posttraumatic growth of breast cancer patients during chemotherapy is closely related to fear of cancer recurrence. The higher the level of posttraumatic growth, the lower the fear of cancer recurrence. This suggests that the fear of cancer recurrence can be reduced by improving the growth level of patients after trauma.

Objective:To observe the risk of acute kidney disease and disorders (AKD) in patients with coronary heart disease or non-valvular atrial fibrillation who were taking rivaroxaban for the first time in our hospital.Methods:A retrospective case-control analysis was performed using the hospital database to screen for patients with coronary heart disease or non-valvular atrial fibrillation who were taking rivaroxaban for the first time for more than 3 months during January 1, 2018 to June 30, 2019. A total of 279 patients with serum creatinine reviewed within 3 months were as the rivaroxaban group, and 317 patients with coronary heart disease or non-valvular atrial fibrillation who did not take rivaroxaban during the same period in our hospital were selected as the control group. The general condition and the incidence of AKD were compared between the two groups, and the influencing factors of AKD were analyzed by logistic regression analysis.Results:The prothrombin time and international normalized ratio were higher in the rivaroxaban group than those in the control group (both P<0.01). There was no significant difference in age, gender, serum creatinine and urea level between the two groups. The incidence of AKD in the rivaroxaban group was 4.30%(12/279), and the incidence of AKD in the control group was 1.26%(4/317). The relative risk ( RR) of the two groups of patients was 3.409. Logistic regression analysis showed that older age (≥75 years old, OR=1.166, 95% CI 1.012-1.343, P=0.033) and diabetes ( OR=34.261, 95% CI 1.639-716.326, P=0.023) were risk factors for AKD in patients taking rivaroxaban. Rivaroxaban was a risk factor for AKD in patients with coronary heart disease or non-valvular atrial fibrillation ( OR=3.500, 95% CI 1.115-10.988, P=0.032). Conclusions:The incidence of AKD in patients taking rivaroxaban for the first time due to coronary heart disease or non-valvular atrial fibrillation was 4.30%. Taking rivaroxaban is a risk factor for AKD in patients with coronary heart disease or non-valvular atrial fibrillation. Older age and diabetes are the risk factors for AKD in the rivaroxaban group.