Objective:To compare the performance of 11 glomerular filtration rate(GFR)equations in Chinese elderly hospitalized patients using dynamic renal imaging as the reference standard.Methods:The retrospective study involved patients aged 60 years and older who were admitted to Beijing Hospital between January, 2017, and January 2020.Glomerular filtration rate(GFR)was assessed through dynamic renal imaging for all participants.Estimated GFR(eGFR)was calculated using various equations based on serum creatinine and/or cystatin C levels, including All Age Spectrum(FAS), Berlin Initiative Study(BIS), Chronic Kidney Disease Epidemiology Collaboration(CKD-EPI), Modification of Diet in Renal Disease Study(MDRD), MDRD in China(MDRDc), and Xiangya..Results:A total of 691 patients, of which 383 were males, with an age range of 60 to 90 years(mean age 71.9±7.7 years), were included in the study.Among the different equations used to estimate glomerular filtration rate(GFR)in ml·min -1·1.73m -2, the smallest deviations were observed with FAScys(2.48), FAScr-cys(3.07), CKD-EPIcys(4.20), and BIScr-cys(7.42).Conversely, the most accurate estimations were found with BIScr-cys(10.38), FAScr-cys(11.94), FAScys(12.08), CKD-EPIcr-cys(13.21), and CKD-EPIcys(13.51).The highest P30 values, indicating the proportion of estimates within 30% of the true GFR, were achieved by FAScr-cys(68.97%), FAScys(68.96%), CKD-EPIcys(63.22%), and BIScr-cys(61.67%).The equations with the lowest root mean square errors were BIScr-cys(9.73), CKD-EPIcr-cys(10.98), FAScr-cys(11.27), CKD-EPIcys(11.52), and FAScys(11.53).Specifically, the FAS equation showed higher accuracy in men, while BIScr-cys and CKD-EPIcys were more accurate in women.Among patients with chronic kidney disease(CKD), the P30 values for BIScr-cys, FAScys, and FAScr-cys were 86.96%, 83.33%, and 80.95% respectively.Notably, for patients with mGFR ≥ 30 ml/min, MDRDc overestimated GFR the most, whereas for patients with mGFR<30 ml/min, Xiangya exhibited the most significant overestimation of GFR. Conclusions:Among the equations tested, BIScr-cys, FAScys, and FAScr-cys demonstrated the highest accuracy and are therefore recommended for use in Chinese elderly hospitalized patients.

Oxidative stress plays a key role in acute kidney injury (AKI). 8-Oxo-7,8-dihydroguanosine (8-oxo-Gsn) can reflect the overall level of oxidative stress in the body. The levels of urinary 8-oxo-Gsn and renal function-related indicators in 62 patients who underwent video-assisted thoracic surgery (VATS) or open-chest surgery were measured during the perioperative period. The results showed that urinary 8-oxo-Gsn increased 24 hours after surgery and decreased 48 hours after surgery as the condition improved. In 10 patients with severe complications, urinary 8-oxo-Gsn continued to rise. The level of urinary 8-oxo-Gsn in the VATS group recovered faster than that in the open-chest surgery group ( P<0.05). There was a certain correlation between the level of urinary 8-oxo-Gsn and postoperative renal injury in thoracic surgery, suggesting that RNA oxidative stress may play an important role in the pathogenesis of surgery-related AKI.

Objective:To collect the Internet news about "sudden death", analyze its characteristics and resuscitation effects, so as to provide reference for formulating intervention strategies.Methods:The Internet was used to search for "sudden death" and "cardiac arrest" on "Baidu" and "360" websites. Reports of sudden death events were collected from January 2013 to December 2022. The age, gender, characteristics of sudden death, implementation characteristics of cardiopulmonary resuscitation (CPR), and pre-hospital and final clinical outcomes of sudden death patients were recorded and analyzed. Subgroup analyses were performed for pre-hospital and final clinical outcomes. Unconditional multivariate Logistic regression analysis was used to screen the related factors affecting the pre-hospital and final clinical outcomes in patients with sudden death.Results:177 news reports were finally confirmed, involving 177 sudden death patients, including 152 males (85.9%) and 25 females (14.1%), aged (37.27±16.82) years old, and 53.1% in the 16-45 years old group. Triggering factors included strenuous exercise (29.9%), heart disease history (7.9%), overwork (6.2%), staying up late and insomnia (4.0%), activation of emotion (2.8%), and no obvious inducement (48.0%). After on-site first aid, 104 cases (58.8%) achieved restoration of spontaneous circulation (ROSC) before hospital admission, and 18 cases (10.2%) recovered consciousness. After clinical treatment, 109 cases (61.6%) achieved ROSC, 86 cases (48.6%) recovered consciousness, and 22 cases (12.4%) did not report the final outcome. Subgroup analysis showed that compared with patients who achieved pre-hospital ROSC ( n = 104), sudden death in non-ROSC patients ( n = 73) mainly occurred during sleep, in residence and without immediate CPR, full CPR, or automated external defibrillator (AED); and patients who ultimately did not recover consciousness clinically ( n = 91) showed similar characteristics compared with patients who recovered consciousness ( n = 86). Multifactorial Logistic regression analysis showed that immediate CPR [pre-hospital ROSC: odds ratio ( OR) = 8.06, 95% confidence interval (95% CI) was 2.36-27.46; final recovery of consciousness: OR = 9.10, 95% CI was 2.46-33.68] and AED defibrillation (pre-hospital ROSC: OR = 36.31, 95% CI was 4.53-291.19; final recovery of consciousness: OR = 3.53, 95% CI was 1.45-8.61) facilitated pre-hospital achievement of sudden death patients ROSC and final recovery of consciousness. Conclusions:Out-of-hospital sudden death mainly occurs in young people, and vigorous exercise is one of the potential factors for out-of-hospital sudden death, with nearly half having no obvious cause. Immediate and rapid CPR and defibrillation are the simplest and most effective on-site first aid methods. Strengthening public CPR and defibrillation education and training, and advocating healthy lifestyle are effective ways to improve the survival rate of sudden death and reduce the occurrence of sudden death. Based on practical clinical rescue experience, the implementation of bystander CPR by medical personnel is also a factor that cannot be ignored in affecting the clinical outcomes of sudden death patients.

Objective:To compare the application of three different glomerular filtration rate(eGFR)-estimating equations in the elderly aged 60 years and over.Methods:The patients aged ≥ 60 years in our hospital from January 2012 to October 2017 were included as research subjects who underwent three GFR detection(as measured GFR i. e.mGFR)of serum creatinine(Scr), serum cystatin C(sCysC)and GFR by 99mTc-DTPA renal dynamic imaging.The advantages and disadvantages of each GFR-estimating(eGFR)equation in the elderly patients were compared.Results:A total of 122 patients were enrolled, including 90 males(73.8%), with a median age of 77 years.The median Scr and sCysC were 109 μmol/L and 1.39 mg/L, respectively, with their average of mGFR being(45.70±18.91)ml·min -1·1.73m -2.Overall, each eGFR-Scr equation over-estimated the GFR in varying degrees.In eGFR-Scr, full age spectrum equation(FAS)-Scr had the smallest bias(2.34)and the best accuracy(P30 75.4%), followed by Berlin Initiative Study(BIS)-Scr(P30 71.3%). In eGFR-CysC, the P30 of FAS-CysC and chronic kidney disease(CKD)-Epidemiology Collaboration(EPI)-CysC were 75.4% and 71.3%, respectively, and the accuracy of eGFR-CysC was comparable to that of BIS-Scr and FAS-Scr.In eGFR-combi, the bias of FAS-combi was the smallest(1.10), and the accuracy of FAS-combi, BIS-combi and CKD-EPI-combi was comparable, the P30 was 81.1%, 79.5% and 74.6%, respectively, and the P30 of FAS-combi and BIS-combi was higher than that of eGFR-Scr and eGFR-CysC.In the 60-80 age group, the accuracy of FAS-combi and BIS-combi was the best, P30 was 77.8% and 76.4% respectively, while, the accuracy of other equations were poor.In patients ≥ 80 years old, except for the modification of diet in renal disease(MDRD)equations and CKD-EPI-scr equation, the accuracy of other equations was acceptable, among which the accuracy of eGFR-combi equation was the best, and the P30 of FAS-combi, BIS-combi and CKD-EPI-combi were 86.0%, 84.0% and 80.0%, respectively. Conclusions:In elderly patients aged 60 years and over, the application of eGFR-combi equation is better than that of the respective eGFR-Scr and eGFR-CysC equations.The FAS equation has the best bias and accuracy, followed by the BIS equation.

Objective:To compare the advantages and disadvantages of several formulas for estimated glomerular filtration rate (eGFR) based on serum creatinine in elderly patients with chronic kidney disease (CKD) over 60 years old.Methods:CKD patients aged≥60 years old in Beijing Hospital from January 2012 to October 2017 were selected as subjects. Measured glomerular filtration rate (mGFR) was detected by 99mTc-DTPA renal dynamic imaging and used as a reference standard. According to the mGFR value, the patients were divided into 4 groups: mGFR<30 ml·min -1·(1.73 m 2) -1 group, 30≤mGFR<45 ml·min -1·(1.73 m 2) -1 group, 45≤mGFR<60 ml·min -1·(1.73 m 2) -1 group and mGFR≥60 ml·min -1·(1.73 m 2) -1 group. The deviation of each formula was compared by Bland-Altman scatter chart, and the accuracy of each formula was evaluated by the proportion of eGFR within mGFR (1±30%) ( P30) and root mean square error ( RMSE). Wilcoxon paired rank sum test was used to compare the deviation of each formula, and McNemar test was used to compare the difference of P30 among these formulas. Results:A total of 628 patients with CKD were enrolled in this study. The median age was 76.0(71.0, 81.0) years old. The median serum creatinine and mGFR were 110.0(86.0, 152.0) μmol/L and 42.90(29.88, 55.68) ml·min -1·(1.73 m 2) -1, respectively. Each eGFR formula based on serum creatinine overestimated glomerular filtration rate in varying degrees. Among them, the accuracy of Berlin Initiative Study (BIS) formula and full age spectrum (FAS) formula was the best ( P30 were 68.3% and 68.0% respectively), followed by the Chinese race coefficient of Chronic Kidney Disease Epidemiology Collaboration (C-CKD-EPI) formula ( P30 was 65.4%). The accuracy of the other formulas was poor. In terms of deviation, C-CKD-EPI formula was the best (0.27). In the group of mGFR<30 ml·min -1·(1.73 m 2) -1, the accuracy of all formulas was poor, and the accuracy of FAS formula was slightly better than that of other formulas ( P30 was 51.0%). In the group of 30≤mGFR<45 ml·min -1·(1.73 m 2) -1, the deviation of C-CKD-EPI formula was the smallest (3.11). In terms of accuracy, BIS and FAS formulas were better than others, and the P30 were 64.6% and 63.0% respectively. In the group of 45≤mGFR<60 ml·min -1·(1.73 m 2) -1, the deviation of C-CKD-EPI formula was also the smallest (0.72), and the accuracy of BIS formula was the best ( P30 was 82.5%), followed by FAS formula ( P30 was 79.7%). In the group of mGFR≥60 ml·min -1·(1.73 m 2) -1, the deviation and accuracy of Xiangya formula were the best (the deviation and P30 were -0.53 and 96.5% respectively), and the P30 of BIS and C-CKD-EPI formulas were 87.6% and 87.6%, respectively. Conclusions:In the elderly patients with CKD over 60 years old, the accuracy of eGFR based on serum creatinine increases with the increase of mGFR. BIS and FAS formulas are recommended first. The accuracy of each formula is poor in patients with severe renal insufficiency.

Objective:To compare death causes and the survival time in elderly patients undergoing hemodialysis versus peritoneal dialysis in the nephrology department of Beijing Hospital in the last 10 years.Methods:This was a retrospective study.Patients aged more than 60 years who had undergone dialysis and died in the dialysis center of Beijing Hospital between January 2010 and January 2019 were enrolled.A detailed medical history including gender, age, primary diseases, diabetes mellitus, time of dialysis initiation, time of death and direct cause of death were recorded.Results:A total of 153 elderly dialysis patients were enrolled, with a mean age of 76.6±7.7 years, a median dialysis vintage of 54.1(26.9, 86.4)months, including 83(54.2%)cases with diabetes.Patients were divided into the hemodialysis group(HD, n=114)and the peritoneal dialysis group(PD, n=39)according to the dialysis method.The mean ages of patients in the HD and PD groups were 77.1±7.9 and 75.0±7.0 years, and the median dialysis vintages were 56.5(27.4, 104.2)and 48.3(26.3, 66.6)months, respectively.The primary diseases of patients undergoing HD and PD were diabetic nephropathy(DN, 32.5% vs.48.7%), chronic glomerulonephritis(29.8% vs.17.9%)and hypertensive renal damage(21.1% vs.10.3%). The top three causes of mortality in patients undergoing HD and PD were cardiovascular diseases(32.4% vs.43.6%), infections(29.8% vs.28.2%)and cerebrovascular diseases(11.4% vs.15.4%). The compositions of primary diseases and death causes were similar between the two groups, with no significant difference.Kaplan-Meier curves indicated that the survival time of dialysis patients with diabetes mellitus was shorter than that of patients without diabetes mellitus(chi-square value was 12.829, P<0.001), and the survival time of HD patients was longer than that of PD patients(chi-square value was 8.161, P=0.004). In patients without diabetes mellitus, the survival time of HD patients was longer than that of PD patients( Z=-2.716, P=0.007). In patients with diabetes mellitus, HD and PD had similar survival outcomes( Z=-0.581, P=0.561). Conclusions:The proportion of patients with diabetic nephropathy is high in elderly dialysis patients.Cardiovascular and cerebrovascular diseases and infections are the main causes of death in elderly dialysis patients.The survival time is longer in HD patients than in PD patients.

Objective To assess the predictive value of serum fibroblast growth factor(FGF)23 level and carotid intima-media thickness (CIMT)for the long-term outcome in maintenance hemodialysis(MHD)patients.Methods A total of 88 MHD patients were enrolled,with a median follow-up of 73.2 months(a range from 11.5 to 75.7 months).CIMT and atherosclerotic plaques were measured by Bmode Doppler ultrasound at baseline by an experienced sonographer.Blood samples were collected and stored in the-80℃ refrigerator for measuring serum FGF23 levels.Results The 88 patients were aged(64.2±11.5)years,with 52 males and 36 females,and the mean CIMT was (1.34±0.38)mm.Carotid artery atherosclerotic plaque was detected in 72(81.8％)subjects.Carotid artery atherosclerotic plaques (CASP)were found in 58 (65.9％)patients aged 60 years and over.Compared with non-elderly patients,elderly patients had the characteristics of high incidence of cardiovascular disease and poor nutritional status.During the follow up period,34 patients died and 23 (67.6％) patients died of cardiovascular disease.Kaplan-Meier curves showed that cardiovascular disease-free survival rate was higher in the normal CIMT group than in thickening CIMT group(Log Rank P=0.003).And subjects with low level of FGF23 had a better survival rate than those with moderate to high level of FGF23(Log Rank P =0.043).Multivariate COX regression analysis showed that FGF23(HR=1.056,95％CI:1.007-1.108,P=0.026)and CIMT(HR=1.165,95％CI:1.032 1.315,P =0.013)were independent predictors for cardiovascular mortality.Multivariate COX regression analysis showed that serum calcium (HR =0.022,95％ CI:0.001-0.489,P =0.016),hemoglobin(HR =0.966,95％CI:0.937-0.997,P =0.033),FGF23 (HR =1.071,95％ CI:1.017-1.128,P =0.010) and CIMT (HR =1.202,95％ CI:1.049-1.377,P =0.008) were independent predictors for cardiovascular mortality in elderly MHD patients.Conclusions Serum level of FGF23 and CIMT are the important predictors for cardiovascular mortality in MHD patients.The proportion of elderly patients with cardiovascular disease is higher,in which the factors affecting prognosis are more complex.

Objective To investigate the effect of iso-osmolar contrast media (IOCM) on renal function in elderly patients. Methods The clinical data of 77 patients aged over 65 years undergoing vascular angiography and interventional therapy using IOCM with a dose>100 ml from September 2016 to May 2017 were retrospectively analyzed. Serum creatinine (CRE), urea and uric acid were measured before angiography, within 48 h and 3-7 d after angiography. The incidence of contrast-induced nephropathy (CIN)and the renal function before and after angiography were compared. Results Among the 77 patients, 58 were males and 19 were females, with an average age of (73.8 ± 7.2) years. The mean serum CRE values before and 3-7 days after angiography were (84.55±39.92)μmol/L and (83.87±38.45)μmol/L respectively (t=0.140, P=0.889);the mean serum urea levels were (5.64±2.36) mmol/L and (6.44±3.15) mmol/L (t=3.041,P=0.003);the mean serum uric acid levels were (281.39±85.30)μmol/L and (333.29±89.89)μmol/L (t=7.297, P<0.001), respectively. CIN occurred in 7 patients with an incidence of 9.1％. In 7 patients with CIN, the mean CRE values increased from (135.71±102.41)μmol/L before angiography, to (180.00±100.45)μmol/L within 48 h and (142.86 ± 92.97) μmol/L 3-7 d after angiography (F=9.876,P=0.011); and the uric acid levels progressively decreased from (353.43 ± 86.73)μmol/L before angiography, to (339.14 ± 85.69)μmol/L within 48 h after angiography and (299.57 ± 95.71) μmol/L 3-7 d after angiography (F=5.713,P=0.029). Conclusion In elderly patients, IOCM has relatively mild effect on renal function during vascular angiography or interventional therapy.

Objective To evaluate the clinical efficacy of triangle flap from the nasal vestibule on correcting the minor form unilateral incomplete cleft lip.Methods 72 patients with the minor-form unilateral incomplete cleft lip were invloved in this study.Based on different surgical procedures,all the patients were divided into two groups:36 patients were treated with harvesting a triangle flap from the nasal vestibule,rotating,increasing lip height;other 36 patients were treated with Millard method as control group.The positive photographs of two groups of patients were taken one year after surgery.Lip height,lip width,nostril width,nostril circumference and visible scar area were measured and compared statistically.Results Good rate of the group of the triangle flap from nasal vestibule was 91.6％ (33/36),but that of the group of Millard method was 72.2％ (29/36) (P＜0.05).The ratios of unaffected to affected sides of lip height,nostril circumference and nasal width in the triangle flap from nasal vestibule were 1.077±0.015,1.083±0.005,and 1.083±0.005;those of other group of Millard method were 1.078±0.013,1.095±0.005 and 1.096±0.015,respectively,with no significant difference (P＞0.05).But there was significant difference in laberal scar between the group of the triangle flap from nasal vestibule (0.510±0.004) mm2 and the control group of Millard method (0.830±0.009) mm2 (P＜0.05).Conclusions The nasal vestibule triangle flap method can significantly decrease the visible scar on lip and achieve the same good result compared to traditional Millard method.

Background In previous study,peripheral retinal nerve fiber layer (RNFL) thickness is considered to be the earliest structural changes which can be detected.3D-OCT can measure the thickness of macular ganglion cell complex (mGCC),which makes the detection of primary glaucoma possible in the early stage.Objective This study was to measure the thickness of mGCC and disc-peripheral RNFL in early stage of primary glaucomous eyes by 3D-OCT and assess the anatomic basis of glaucoma-induced optical nerve damage.Methods 3D-OCT images from 10 patients with advanced stage primary glaucoma in one lateral eye and early stage glaucoma in fellow eye from December 2010 to December 2012 were prospectively analyzed in China-Japan Friendship Hospital.The patients were diagnosed based on the recommended standard of National glaucoma group (1987 version) and received routine eye examination.3D-OCT scanning was performed using 3D-macular mode,3D-macular Wide mode and 3D-disc mode with TOPCON 3D-OCT 2000 system,and the images at macular 6 mm×6 mm area were analyzed.The posterior pole area was divided into 5 concentric rings from fovea toward periphery and equally subdivided into 100 small checks,with the area of 0.6 mm×0.6 mm for each.The probable values in each check were calculated as the ratio of each figure and corresponding normal value.The probable values were expressed as red color (P＜ 1％),yellow color (P＜5％) and gray color (P≥ 5％).Then the disc-periphery RNFL thickness and disc cup were evaluated.Results No evident abnormality was found in the thicknesses of photoreceptors layer and bipolar cell layer in both advanced glaucomous eyes and the early stage of glaucomous eyes in the 10 patients.Serious damage of visual field was seen in the advanced glaucomous eyes and presented with red color in the parapapillary RNFL area,mGCC area and macular RNFL area,showing an evidently attenuation of the thicknesses of parapapillary RNFL,mGCC and RNFL.However,the visual field was close normal in the early stage glaucomous eyes,and mGCC and macular RNFL showed yellow color,while green or yellow color was exhibited in the parapapillary RNFL area,indicating mGCC and macular RNFL thickness was reduced,but parapapillar RNFL thickness was near normal.Conclusions The change of mGCC thickness is earlier than that of peripheral RNFL at optic disc in primary glaucomaous eyes,which may imply that the disappear of macular ganglion cell body is earlier than that of the axon.