Objective:To increase the understanding of neuroleptic malignant syndrome, rhabdomyolysis and acute renal injury in advanced-aged patients with Parkinson's disease after abdominal surgery.Methods:We report a case of malignant syndrome, rhabdomyolysis and acute renal injury in an 85-year-old patient with Parkinson's disease after abdominal surgery in our department.The diagnosis and successful treatment experience were summarized, and a literature review was conducted.Results:The body temperature was as high as 40.5℃ in this patient, accompanied by stiffness, sustained involuntary shaking, increased muscle tone, serum creatine kinase at 104 615 U/L, tachycardia, low blood pressure, accelerated breathing rate, disturbance of consciousness, excessive sweating and other clinical manifestations, which met the diagnostic criteria for neuroleptic malignant syndrome.The patient had complications including concurrent rhabdomyolysis, acute renal injury and shock.The emergency was resolved after an early diagnosis and proactive treatment.Conclusions:If patients with Parkinson's disease have a high fever with rigidity or sudden aggravation within a short period of time after medication, the possibility of neuroleptic malignant syndrome should be considered and the causes should be screened.

Patients with severe liver disease are prone to bacterial and fungal infections, and then develop toxic shock. The onset of the disease may be insidious, but the disease progresses rapidly with a high fatality rate. Current research results show that special conditions such as translocation of intestinal flora and immune paralysis in patients with severe liver disease are susceptible factors for infection and toxic shock. Furthermore, it is currently recognized that the treatment of severe liver disease complicated with toxic shock must be treated with antibiotics and maintenance of hemodynamic stability. Other treatments, such as hydrocortisone and strict glycemic control, are quite controversial and may not necessarily reduce mortality. Herein, we summarize the epidemiology, susceptibility factors; diagnosis and management strategies of severe liver disease complicated with toxic shock, highlighting the characteristics of toxic shock under the background of severe liver disease, so as to detect, prevent and treat septic shock in patients with severe liver disease as early as possible to reduce the fatality rate.

Objective: To explore the efficacy of tenofovir disoproxil and adefovir dipivoxil treatment in patients with hepatitis B virus e antigen (HBeAg) negative was analyzed through the comparison of highly sensitive HBV viral load monitoring with HBV genotyping and drug resistance mutations. Methods: The clinical data of newly diagnosed chronic hepatitis B patients from January 2015 to June 2017 in outpatients and inpatients were randomly divided into tenofovir and adefovir group. Quantitative detection of HBV DNA levels before therapy and at 12, 24, 48, 96, and 120 weeks after therapy were determined for HBV genotypes and drug-resistant mutations in HBeAg-negative patients. Student’s t-test was used to compare the measurement data between groups. The data of comparison between groups were tested by χ ². Results: A total of 106 cases of HBeAg-negative patients were collected. Tenofovir disoproxil had a higher rate of HBV DNA suppression (54%) than adefovir dipivoxil treatment (42%), but the difference was not statistically significant (P = 0.19). After 120 weeks of treatment, a total of 46 patients (93.9%) were enrolled in the tenofovir disoproxil group with HBV DNA quantitation < 2 000 IU / ml. Adefovir dipivoxil group of patients with HBV DNA < 2 000 IU / ml a total of 40 cases, accounting for 75.5%. The difference between the two groups was statistically significant (P < 0.05). For 49 cases of HBeAg-negative patients, HBV B, C, B and C were mixed before tenofovir dipivoxil treatment, and C1653T, A1762T and G1764A mutation sites were detected in patients with D genotype. Patients C, B, C, B, and C were examined for C1673T, G1896, G1858, G1899A. After treatment, the detection rate of the above mutation sites decreased, but C1653T, C1673T and G1899A were not detected. New mutation sites such as G1915A / C, L180M, M204V, V207I / L, T184A and V173L were detected, Low resistance rate (25%). Conclusion Tenofovir disoproxil can be recommended as a treatment for HBeAg-negative patients. For HBeAg-negative patients, the choice of high-sensitivity detection of HBV DNA levels, better monitoring of anti-HBV efficacy.

Objective To investigate the clinical features of elderly patients with stage 3-4 chronic kidney disease ( CKD ) and to analyze the risk factors of the kidney function progression. Methods This was a cross-sectional study. The clinic data of elderly patients (≥60 years) with stable clinical manifestation in Beijing Hospital from January ,2014 to December ,2015 was collected.Based upon the eGFR derived from Cockcroft-Gault (CG) equation ,all patients were divided into groups of CKD 3a group ,CKD 3b group and CKD 4 group ,respectively. Moreover ,patients were separated into the old group (＜ 80 years) and the very old group (≥80 years) based on the age. The demographic features ,primary diseases history ,body mass index (BMI) ,blood routine ,urine routine , blood biochemistry ,Cystatin C and iPTH were recorded.Logistic regression analysis of kidney function progression was also conducted. Results One-hundred and eighty-three cases were enrolled with a mean age of(80 ± 9)years.Along with the descent of kidney function ,the age ,levels of proteinuria and iPTH gradually ascended (F＝ 12.352 ,5.910 ,5.910 ;P＝ 0.000 ,0.003 ,0.003 ,respectively) and the BMI and serum albumin gradually descended (F＝9.758 ,11.088 ;P＝0.000 ,0.000 ,respectively).In addition ,compared to the old group ,very old group was associated with decreased level of eGFR [(37.1 ± 9.9) ml·min－1·1.73 m －2vs. (44.0 ± 12.0) ml·min－1·1.73 m －2,t＝ －4.280 ,P＝0.000] and increasedlevelofCystatinC[(1.71±0.84)mg/L vs. (1.40±0.69)mg/L ,t＝3.484 ,P＝0.001].The Logistic regression analysis indicated that the proteinuria was an independent risk factor for the progression of kidney function ( OR ＝3.856 ,P＝0.004). Conclusions As the gradually descended of the eGFR level in elderly patients with stage 3-4 CKD ,age ,proteinuria and iPTH gradually ascended ,BMI and serum albumin descended ,respectively. The level of eGFR decreased and CystatinC increased significantly with the increasing age. Proteinuria was an independent risk factor for progression of the kidney function.

Objective To evaluate the effect of cyclic pressure cold therapy on fast rehabilitation of patients undergoing total knee arthroplasty.Methods A total of 40 patients undergoing primary total knee arthroplasty were included in control group,receiving the conventional peri-operative nursing and rehabilitation protocol and cold therapy with ice pack.And another 38 patients who received fast-track surgery protocol and cyclic pressure cold therapy were as experimental group.The function evaluation score,pain,average hospitalization days and complications of two groups were compared.Results The postoperative VAS scores of two groups were significantly lower,and postoperative HSS scores were significantly higher compared with that of preoperation (P ＜ 0.05).The VAS scores and HSS scores were significantly lower in experimental group were better than the control group at 24 h and 1 week (P ＜ 0.05).The average hospitalization day of experimental group was significantly less than that of control group(P ＜ 0.05).Conclusion Cyclic pressure cold therapy can improve the VAS score and HSS score,accelerate the rehabilitation process in fast rehabilitation of total knee arthroplasty.

Objective To evaluate the effect of cyclic pressure cold therapy on fast rehabilitation of patients undergoing total knee arthroplasty.Methods A total of 40 patients undergoing primary total knee arthroplasty were included in control group,receiving the conventional peri-operative nursing and rehabilitation protocol and cold therapy with ice pack.And another 38 patients who received fast-track surgery protocol and cyclic pressure cold therapy were as experimental group.The function evaluation score,pain,average hospitalization days and complications of two groups were compared.Results The postoperative VAS scores of two groups were significantly lower,and postoperative HSS scores were significantly higher compared with that of preoperation (P ＜ 0.05).The VAS scores and HSS scores were significantly lower in experimental group were better than the control group at 24 h and 1 week (P ＜ 0.05).The average hospitalization day of experimental group was significantly less than that of control group(P ＜ 0.05).Conclusion Cyclic pressure cold therapy can improve the VAS score and HSS score,accelerate the rehabilitation process in fast rehabilitation of total knee arthroplasty.

Objective To investigate serum vitamin D levels and influencing factors in elderly patients with stage 3 to 4 chronic kidney disease (CKD) and to analyze the relationship between vitamin D deficiency and left ventricular hypertrophy (LVH).Methods This study involved 107 elderly outpatients (≥60 years) with stage 3 to 4 CKD who had visited Beijing Hospital between January 2014 and September 2016.We retrospectively analyzed their clinical and laboratory data including gender,age,height,weight,blood pressure,glycosylated hemoglobin,hemoglobin (Hb),albumin,creatinine,lipid,calcium,phosphorus,intact parathyroid hormone (iPTH),high sensitivity C-reactive protein,B-type natriuretic peptide (BNP),25-OH-D3,and ultrasonic cardiogram.Based on estimated glomerular filtration rate,patients were divided into three groups:the stage 3a CKD group,the stage 3b CKD group,and the stage 4 CKD group.Differences in the parameters between the groups were compared.In addition,25-OH-D3 levels were used to determine whether the patient had vitamin D deficiency and the left ventricular mass index was used to identify left ventricular hypertrophy (LVH),and the relationship between vitamin D deficiency and LVH was examined.Results Body mass index,body surface area and calcium levels declined while age,phosphorus and BNP levels increased with the development of stage 3a,stage 3b and stage 4 CKD.Mean 25 O)H-D3 levels were 22.6 (5.9-58.0) μg/L and 17.5 (10.1 46.3) μg/L for CKD stage 3 and 4 patients,respectively,and the difference between them was statistically significant (Z =-2.121,P 0.033).Compared with patients with no vitamin D deficiency,patients with vitamin D deficiency were more likely to be female (x2 7.460,P=0.006) and were associated with higher P (Z=-2.090,P=0.037),iPTH (Z=-2.855,P=0.004) and BNP (Z=-3.134,P 0.002),and lower Hb (t=-3.305,P=0.001).The rates of LVH in vitamin D deficient patients and non-vitamin D deficient patients were 8 cases(34.8 ％) and 12 cases(14.3 ％),respectively (P=0.035).Conclusions Vitamin D levels show progressive decline as chronic kidney disease advances into later stages.In addition,vitamin D deficiency is more common among female patients and is often accompanied by lower Hb levels,higher BNP levels and higher incidences of calcium-phosphate metabolism disorders and LVH.The results suggest that vitamin D may play an important role in renal anemia,calcium-phosphate metabolism and LVH.

Objective To prospectively investigate the characteristics and correlative influential factors for the changes in pulmonary artery hypertension (PAH)in chronic kidney disease (CKD) patients without end-stage renal disease.Methods Complete clinical and laboratory data of 133 outpatients without ESRD (CKD stage 2,3 and 4)in Beijing Hospital between January 2012 and January 2013 were retrospectively analyzed.Pulmonary artery systolic pressure(PASP)was assessed by echocardiography according to the guideline from the American Society of Echocardiography in 2010,and PASP more than 35 mmHg(1 mmHg=0.133 kPa)was diagnosed as PAH.Results PAH was found in twelve(9.0 ％) patients,including 7 females and 5 males,with mean age(82.9 ± 5.4 years).The prevalence of PAH was 2.3％,10.9％ and 17.6％ in the patients of CKD stage 2,3 and 4(P＜ 0.05) respectively.PASP could be calculated in 67 patients in whom tricuspid regurgitation was present.The mean PASP was (27.1 ± 5.4) mmHg,(31.0 ± 8.3) mmHg and (37.3 ± 13.8) mmHg in patients with CKD stage 2,3 and 4,respectively(P ＜ 0.05).Body mass index(BMI),eGFR and BUN showed significant differences between PAH group and non-PAH group with statistical significance (P＜0.05).Multivariate logistic regression analysis revealed that the lower BMI and the higher stage of CKD were independent risk factors for PAH (P ＜ 0.05).Conclusions PAH is not a rare complication in the CKD patients without end-stage renal disease.The incidence of PAH is significantly associated with lower BMI and the higher stage of CKD.Doppler echocardiography should be performed periodically to detect PAH in CKD patients in order to improve the prognosis of these patients.

Asian Continental Ancestry Group ; genetics ; Carcinoma, Hepatocellular ; genetics ; China ; Gene Frequency ; Genetic Predisposition to Disease ; Humans ; Liver Neoplasms ; genetics ; Mongolia ; Polymorphism, Single Nucleotide