OBJECTIVES: To explore the value of serum cystatin C (CysC) levels in evaluating renal prognosis in IgA nephropathy (IgAN) patients. METHODS: We retrospectively collected the clinical data of IgAN patients diagnosed by renal biopsy at Guangdong Provincial People's Hospital from January, 2014 to December, 2018. Based on baseline serum CysC levels, the patients were divided into high serum CysC (>1.03 mg/L) group and normal serum CysC (≤1.03 mg/L) group. The composite endpoint for poor renal prognosis was defined as ≥50% decline in estimated glomerular filtration rate (eGFR) and/or progression to end-stage renal disease (ESRD). Lasso regression, multivariate Cox regression and Kaplan-Meier survival analysis were used to identify the risk factors and compare renal survival rates between the two groups. Smooth curves fitting and threshold effect analysis were used to explore the relationship between serum CysC levels and the outcomes. A nomogram model was constructed and its predictive performance was evaluated using concordance index, calibration curve, receiver operating characteristic (ROC) curve and the area under curve (AUC). RESULTS: A total of 356 IgAN patients were enrolled, who were followed up for 4.65±0.93 years. The composite endpoint occurred in 74 patients. High serum CysC was identified as an independent risk factor for poor renal prognosis in IgAN (HR=2.142, 95% CI 1.222 to 3.755), and the patients with high serum CysC levels had a lower renal survival rate (Log-rank χ²=47.970, P<0.001). In patients with serum CysC below 2.12 mg/L, a higher CysC level was associated with an increased risk of poor renal prognosis (β=3.487, 95% CI: 2.561-4.413, P<0.001), while above this level, the increase of the risk was not significant (β=0.676, 95% CI: -0.642-1.995, P=0.315). The nomogram model based on serum CysC and 3 other independent risk factors demonstrated good internal validity with a concordance index of 0.873 (95% CI: 0.839-0.907) and an AUC of 0.909 (95% CI: 0.873-0.945). CONCLUSIONS Serum CysC levels are associated with renal prognosis in IgAN patients, and high serum CysC an independent risk factor for poor renal prognosis.
Humans ; Glomerulonephritis, IGA/diagnosis* ; Cystatin C/blood* ; Prognosis ; Risk Factors ; Retrospective Studies ; Glomerular Filtration Rate ; Kidney Failure, Chronic ; Male ; Female ; Adult ; Nomograms ; Middle Aged

Objective To explore the economic toxicity perceptions and experiences of caregivers of colorectal cancer patients from the perspective of social ecological systems theory.Methods Using purposive sampling,18 caregivers of colorectal cancer patients hospitalized in the gastrointestinal sur-gery and oncology departments of a tertiary grade A hospital in Yangzhou were selected for semi-struc-tured interviews.The Colaizzi 7-step analysis method was employed to organize and analyze the data.Results Three main themes and nine sub-themes were extracted regarding the economic toxicity expe-riences and needs of caregivers of colorectal cancer patients.Microsystem included multiple negative experiences,impacted individual health,and difficulties in surrogate decision-making;mesosystem in-cluded heavy family financial burden,altered family lifestyle,and tense family atmosphere;macrosys-tem included needs for the scope and intensity of medical insurance reimbursement,needs for medical resources and services,and a desire for social support.Conclusion The ecological system of caregiv-ers of colorectal cancer patients is not optimistic,and is generally affected by economic toxicity.Inter-vention strategies can be sought from multiple aspects,including alleviating the negative experiences of caregivers,strengthening social support,and paying attention to the needs of caregivers,aiming to re-duce the level of economic toxicity among caregivers of colorectal cancer patients.

Objective: To investigate the risk factors of postoperative acute kidney injury (AKI) in patients aged between 40 and 50 years old undergoing cardiac valvular surgery and the impact on outcome. Methods: The clinical data of 286 patients aged between 40 and 50 years old undergoing cardiac valve surgery in Guangdong Provincial People′s Hospital from January 2012 to December 2016 were analyzed retrospectively. Preoperative coronary angiography was performed in all patients. All patients enrolled were divided into AKI group and non-AKI group according to the existence or not of postoperative AKI. Patients with AKI were further divided into AKI stage 1, stage 2, and stage 3 groups according to KDIGO guideline. Demographic characteristics, preoperative clinical data including serum creatinine, estimated glomerular filtration rate, hemoglobin, uric acid, urinary protein, presence or absence of chronic kidney disease, left ventricular ejection fraction, pulmonary artery pressure, New York Heart Association (NYHA) functional classification, preoperative co-morbidity (hypertension, diabetes, anemia, cerebrovascular disease, peripheral artery disease), preoperative medication(vasoactive drugs, diuretic, renin-angiotensin system inhibitor (RASI), surgical data (contrast dosage in coronary angiography, type of cardiac valve surgery) were recorded and analyzed in this retrospective study. The risk factors for postoperative AKI and its impact on clinical outcomes (mortality, hospitalization expenses and Intensive Care Unit stay duration) were evaluated. Logistic regression analysis was used to determine the risk factors for postoperative AKI and the adjusted variables with P<0.2 were selected for the multivariate logistic regression analysis to define the independent determinants for AKI. Results: AKI was defined in 106 out of 286 enrolled patients, including 96 patients with AKI stage 1, 10 patients with AKI stage 2 and no patients with AKI stage 3. The proportion of coexisting cerebrovascular diseases was higher in AKI group than in non-AKI group (9(8.49%) and 5(2.78%), χ²=4.677, P=0.031), while there was no difference among other baseline data between the two groups. Multivariate logistic regression analysis showed that preoperative complications of cerebral vascular disease was an independent risk factor of postoperative AKI (OR=3.578, 95%CI 1.139-11.242, P=0.029). Five out of 106 AKI patients died during hospitalization while there was only 1 patient died among 180 patients without AKI. Patients with AKI after cardiac valve operation experienced higher mortality than patients without AKI (χ²=5.625, P=0.028). Further analysis showed that there was no difference in hospitalization mortality between patients with AKI stage 2 and stage (χ²=0.686, P=0.408) while the hospitalization mortality in patients with AKI stage 2 was higher than those without AKI (χ²=8.113, P=0.004). The hospitalization expenses in patients with AKI were 10.38(8.59,12.54) ×10⁴ RMB, significantly higher than that in patients without AKI (9.72(8.03,11.93) ×10⁴ RMB)(P=0.043). There was no difference in hospitalization expenses between patients with AKI stage 1 and without AKI (P=0.635). The hospitalization expenses in patients with AKI stage 2 was higher than those without AKI (P=0.023). Intensive Care Unit stay duration in patients with AKI was 3(1,4) days, significantly higher than those without AKI (P=0.044). There was no difference in Intensive Care Unit stay duration in patients with AKI stage 1 and without AKI (P=0.978), while Intensive Care Unit stay duration in patients with AKI stage 2 was significantly longer than those without AKI (P=0.006). Conclusions Preoperative complications of cerebral vascular disease is an independent risk factor of postoperative AKI. Non-senile patients with AKI after cardiac valvular surgery is associated with a higher proportion of mortality, hospitalization expenses and Intensive Care Unit stay duration as compared patients without postoperative AKI.

Space reduction after the premature loss of the second primary molars is one of the important factors affecting the occurrence of malocclusion, often increasing the demand for orthodontic treatment. It has great significance to select and apply appropriate appliances to maintainthe space soon after the premature loss of the second primary molars. The space should be maintained until the adjacent teeth and the successors erupt successfully. This review summarizes the selection and clinical application of the space maintainer for the premature loss of the second primary molars in different periods, to improve dentists′ awareness of the importance of space maintainers and to provide advises for clinical choices.

OBJECTIVE: To explore the contents of secoiridoid substances (gentiopicroside, swertiamarin, sweroside) in the leaves of Gentiana rigescens from different populations in Dali Bai Autonomous Prefecture (Shorted for Dali prefecture), and to provide reference for the selection of fine varieties, the development and utilization of G.rigescens. METHODS: The contents of secoiridoid substances in the leaves of G. rigescens from different populations in Dali prefecture were determined by HPLC, and the HPLC fingerprint was established. The contents of secoiridoid substances in the leaves of G. rigescens from different populations was studied by using single factor variance analysis, clustering analysis and principal component analysis. RESULTS: There were statistical significance in the contents of gentiamarin, swertiamarin and sweroside and the total contents in the leaves of G. rigescens from different populations in Dali prefecture (P<0. 05 or P<0. 01). Twelve common peaks were found in HPLC fingerprint, and HPLC fingerprint similarities of common peaks except Gantong population were all over 0. 972. Three peaks of them were identified as the characteristic peaks of gentiamarin, swertiamarin and sweroside which were correlated to the activities. The total contents of gentiamarin, swertiamarin and sweroside from different populations obtained by clustering analysis were consistent with that by HPLC fingerprint principal component analysis. CONCLUSIONS: There are great differences in the content of gentiamarin, swertiamarin and sweroside in the leaves of G. rigescens from different populations in Dali prefecture. The similarity of secoiridoid substances in the leaves of G. rigescens from different populations except Gantong population is higher.

Objective We aimed to investigate the clinical values of combination of blood creatinine and cystatin C for acute kidney injury(AKI)diagnosi. Methods Total 7 627 patients were studied retrospectively. The AKI was classified by creatinine or cystatin C according to the Kidney Disease:Improving Global Outcomes criteria. Results The maximum levels of cystatin C and creatinine were correlated(Spearman′s rank coefficient 0.699,P < 0.001). The area under a receiver operating characteristic curve of maximum cystatin C value for pre-dicting in-hospital death was 0.761(95% confidence interval 0.693 ~ 0.828). Total 1 004 and 173 patients were classified into AKI by blood creatinine or by cystatin C(13.2% vs.2.3%,P<0.001),respectively.The total inci-dence of AKI was 14.7% diagnosed by the combination of the two markers.In multivariable logistic model,the cre-atinine negative plus cystatin C positive group was associated with a higher in-hospital death compared with the cre-atinine and cystatin C double negative group(OR 15.524,95% confidence interval 5.110 ~ 47.166,P < 0.001). Conclusion Combination of cystatin C increased sensitivity of creatinine for AKI diagnosis and facilitated to iden-tify in-hospital patients with high risk.

ObjectiveAnalyze the mechanism of traditional Chinese medicine Salvia miltiorrhiza in treating coronary heart disease (CHD).MethodsThe animal experiment using actual research, namely the selection of rat isolated heart perfusion model, rat model of myocardial ischemia and ventricular tachycardia in rabbits model, then the effects of different animal groups in hemodynamics, coronary flow, serum superoxide dismutase (SOD) content, malondialdehyde (MDA) the results of the content.ResultsAfter treatment, the content of SOD was significantly increased and the content of MDA was significantly decreased in the treatment group, and the difference between the two groups was statistically significant (P<0.05).ConclusionTraditional chinese medicine Salvia miltiorrhiza has significant effect on the treatment of coronary heart disease, which is beneficial to the recovery of patients' condition, and is worthy of clinical application.

Objective To investigate the effects of global registry of acute coronary events (GRACE) and Can Rapid risk stratification of unstable angina patients suppress adverse outcomes with early implementation of the ACC/AHA guidelines(CRUSADE) score in the nursing care for patients with acute coronary syndrome (ACS).Methods A total of 128 patients with ACS undergoing percutaneous coronary intervention (PCI) who were admitted from March 2015 to May 2016 were enrolled in this study and divided into usual care group (63 cases) and optimized care group (65 cases). Patients in the usual care group received usual care according to the guidelines, while patients in the optimized care group received optimized care according to GRACE and CRUSADE score. The major adverse cardiac events, the incidence of bleeding complications, average hospitalization and hospitalization costs were recorded and compared between the two groups. Results The characteristics of angiography (multiple vessel rate and target vessel distribution) and procedures of PCI (position, number, length and diameter of stents, coronary blood flow classification after the implantation of stents) were similar (all P>0.05). There were tendencies of reduction in the incidence of MACE, bleeding complications and average hospitalization time in patients of optimized care group compared to the usual care group, with no statistically significant differences between the two groups (P>0.05). The hospitalization costs in the optimized care group (33491±1982)RMB were significantly less than those in the usual care group (36562±2395)RMB. The difference was statistically significant (t=-7.914,P<0.001).Conclusions Optimized care according to GRACE and CRUSADE can improve the treatment effects of ACS patients undergoing PCI and decrease the cost.

Objective To evaluate the clinical efficacy of cutaneous scraping and cupping therapy for the treatment of hyperplasia of mammary glands. Methods Eighty patients with hyperplasia of mammary glands were randomized into test group(42 cases) and control group(38 cases). Both groups were given conventional basic treatment including psychological counseling and oral use of Chinese patent medicine, and the test group additionally received cutaneous scraping and cupping therapy on acupoints of Xuanji(CV21), Danzho ng (CV17), Jianjing(GB21), Kufang(ST14) , Tianzhong(SI11), Dazhui(GV14), and Ashi(focus of mammary mass and pain). The scores of pain visual analog scale(VAS) and World Health Organization Quality of Life Scale Brief Version(WHOQOL-BREF) were observed, and the clinical efficacy of the two groups was evaluated. Results (1) The total effective rate of the test group was 88.10%, and that of the control group was 65.79%, the inter-group difference being statistically significant (P<0.01). (2) After treatment, VAS scores of the test group were decreased obviously(P<0.01), and the control group showed a decreasing trend(P>0.05). Test group had better effect on improving VAS scores than the control group(P<0.05).(3) After treatment , the scores in physiological dimension of WHOQOL-BREF were much increased(P<0.05), and the changes in the scores of other dimensions were not obvious(P>0.05). The control group showed no obvious changes in the scores of each dimension of WHOQOL-BREF before and after treatment(P>0.05). The inter-group comparison showed that the test group had better effect on improving the scores in physiological dimension of WHOQOL-BREF (P<0 . 05). Conclusion Cutaneous scraping and cupping therapy is effective on relieving pain and improving QOL of patients with hyperplasia of mammary glands.

OBJECTIVE: To investigate the CT virtual endoscopy (CTVE) shows the display method of the normal structure of the middle ear, and evaluation of middle ear disease, particularly in the value and significance of the connection status of the ossicular chain, established display ossicular chain and middle ear structure methods. METHOD: Volume scanning with a spiral CT unit was performed in forty normal cases and thirty patients with suspected lesions of middle ear. Respectively, with Germany's Siemens (Siemens SOMATOM Sensation 16) spiral CT the Inner Ear scanner patients with axial scanning, reconstruction of the original image, the software selected Fly-through A, B, C the point approach CTVE imaging studies. Focus ossicular chain connection status, and chronic otitis media shown the results of surgery in exploratory image control. RESULT: Normal group CTVE in the hammer bone, incus promontory, facial nerve, the lateral semicircular canal display rate was 100%; stapes, the two arch of the display rate in three display levels, respectively, to 57.5%, 70.0%, 97.5%; round window, oval window was 90.0%, 93.0%, 97.5%. Ossicular injury, displacement, interruption, deletion, deformity in cases of otitis media, trauma, temporal bone malformations. CONCLUSION CTVE link relations between the three ossicles (such as interrupt, etc.) have a certain advantage. By choosing the appropriate approach, CTVE has a considerable advantage in the ossicles and their connections, relations as well as pathological state. By comparing CTVE in three different display levels,the technique of CTVE is considered to be an advantageous supplement of tomography.
Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Ear Ossicles ; diagnostic imaging ; Female ; Humans ; Imaging, Three-Dimensional ; Male ; Middle Aged ; Temporal Bone ; diagnostic imaging ; Tomography, X-Ray Computed ; Young Adult