Objective To explore the effect of gender,training duration and type of sports on electro-cardiographic changes in Chinese elite athletes by performing electrocardiography(ECG).Methods A to-tal of 891 Chinese elite athletes who underwent ECG examinations between 2016 and 2019 were in-cluded in the study.The ECGs were divided into three groups according to the guidelines of the Euro-pean Society of Cardiology(ESC)in 2010:group 0(normal ECG),group 1(common and training-relat-ed ECG)and Group 2(uncommon and training-unrelated ECG).The effect of gender,training dura-tion(4 to 6 years,7 to 10 years and more than 11 years)and sports types(skill,strength,endur-ance and mixed categories)on the ECG changes was assessed.Results No significant differences were found in Group 2 in sex,training duration or sports types.However,the prevalence of common train-ing-related ECG changes was significantly higher in male athletes than in female athletes(58.9%vs.47.4%).Moreover,the highest prevalence was found in athletes with more than 11 years of training,significantly higher than those with 4-6 years of training(P<0.05).A highly significant difference was also observed among athletes of different sports(P<0.01),with the highest in those of the mixed cate-gory at 64.6%.Moreover,sinus bradycardia occurred with significantly higher incidence in athletes un-dertaking mixed and endurance training than others(P<0.05).Conclusion The training-related ECG changes of Chinese elite athletes is closely correlated to their gender,training duration and sports types.

Background:Following the short-term outbreak of coronavirus disease 2019(COVID-19)in December 2022 in China,clinical data on kidney transplant recipients(KTRs)with COVID-19 are lacking.Methods:We conducted a single-center retrospective study to describe the clinical features,complications,and mortality rates of hospitalized KTRs infected with COVID-19 between Dec.16,2022 and Jan.31,2023.The patients were followed up until Mar.31,2023.Results:A total of 324 KTRs with COVID-19 were included.The median age was 49 years.The median time between the onset of symptoms and admission was 13 d.Molnupiravir,azvudine,and nirmatrelvir/ritonavir were administered to 67(20.7%),11(3.4%),and 148(45.7%)patients,respectively.Twenty-nine(9.0%)patients were treated with more than one antiviral agent.Forty-eight(14.8%)patients were treated with tocilizumab and 53(16.4%)patients received baricitinib therapy.The acute kidney injury(AKI)occurred in 81(25.0%)patients and 39(12.0%)patients were admitted to intensive care units.Fungal infections were observed in 55(17.0%)patients.Fifty(15.4%)patients lost their graft.The 28-d mortality rate of patients was 9.0%and 42(13.0%)patients died by the end of follow-up.Multivariate Cox regression analysis identified that cerebrovascular disease,AKI incidence,interleukin(IL)-6 level of>6.8 pg/mL,daily dose of corticosteroids of>50 mg,and fungal infection were all associated with an increased risk of death for hospitalized patients.Conclusions:Our findings demonstrate that hospitalized KTRs with COVID-19 are at high risk of mortality.The administration of immunomodulators or the late application of antiviral drugs does not improve patient survival,while higher doses of corticosteroids may increase the death risk.

Objective:To analyze the impact of post-dialysis blood pressure (Post-BP) on the long-term survival prognosis of maintenance hemodialysis (MHD) patients and the related risk factors.Methods:It was a retrospective cohort study. The data of patients who underwent their first hemodialysis (HD) from January 1, 2007, to June 30, 2021, as recorded in the dialysis registration system of the Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine was retrospectively analyzed. The mean Post-BP was calculated for each HD session 4-6 months after hemodialysis. According to the mean value of post-dialysis diastolic pressure (Post-DBP) at 4-6 months after dialysis, patients were divided into 3 groups (Post-DBP<80 mmHg, 80 mmHg≤Post-DBP<90 mmHg, Post-DBP≥90 mmHg). According to whether the mean value of post-dialysis systolic pressure (Post-SBP) was ≥140 mmHg and whether the mean value of Post-DBP was ≥80 mmHg, patients were divided into 4 groups (Post-SBP<140 mmHg, Post-DBP≥80 mmHg; Post-SBP≥140 mmHg, Post-DBP≥80 mmHg; Post-SBP<140 mmHg, Post-DBP<80 mmHg; Post-SBP≥140 mmHg, Post-DBP<80 mmHg). Patients' first dialysis time was used as the starting point of follow-up, and the end point of follow-up was death or conversion to peritoneal dialysis or kidney transplantation or up to December 31, 2021. Kaplan-Meier survival analysis, Log-rank test, and multivariate Cox regression model were used to analyze the relationship between Post-BP and survival rate and the related factors of prognosis in MHD patients.Results:According to inclusion criteria, a total of 1 213 patients were included. Kaplan-Meier survival curve showed that the long-term survival rate had statistically significant differences among Post-DBP<80 mmHg, 80 mmHg≤Post-DBP<90 mmHg and Post-DBP≥90 mmHg groups (Log-rank test, χ2=58.838, P<0.001), and Post-DBP<80 mmHg group was the lowest. Further comparing the cardiovascular diseases (CVD) mortality among the three groups, the curve showed a statistically significant difference (Log-rank test, χ2=27.926, P< 0.001), and the highest CVD mortality was found in the Post-DBP<80 mmHg group. Multivariate Cox regression model analysis showed that Post-DBP<80 mmHg was an independent associated factor for death in MHD patients (with Post-DBP mmHg≥90 group as reference, HR=4.197, 95% CI 1.452-12.197, P=0.008). When patients were divided into 4 groups according to whether the mean value of Post-SBP was ≥140 mmHg and whether the mean value of Post-DBP was ≥80 mmHg, Kaplan-Meier survival analysis showed a statistically significant difference in long-term survival rate among the four groups (Log-rank test, χ2=65.636, P<0.001), among which Post-SBP≥140 mmHg, Post-DBP<80 mmHg group had the lowest long-term survival rate. Further comparing the CVD mortality rate among the four groups, the curve showed a statistically significant difference (Log-rank test, χ2=29.784, P<0.001), and the highest CVD mortality rate was found in the Post-SBP≥140 mmHg, Post-DBP<80 mmHg group. Multivariate Cox regression analysis revealed that regardless of whether the average Post-SBP was ≥140 mmHg, Post-DBP<80 mmHg was an independent associated factor for death in MHD patients(with Post-SBP<140 mmHg, Post-DBP≥80 mmHg group as reference, Post-SBP≥140 mmHg, Post-DBP<80 mmHg group: HR=3.416, 95% CI 1.294-9.019, P=0.013; Post-SBP<140 mmHg, Post-DBP<80 mmHg group: HR=3.574, 95% CI 1.451-8.802, P=0.006). Conclusions:The long-term survival rate of the group with Post-SBP≥140 mmHg and Post-DBP<80 mmHg is significantly lower. Post-DBP<80 mmHg is an independent risk factor for death in MHD patients regardless of whether the average Post-SBP is ≥140 mmHg.

Triple-negative breast cancer (TNBC) represents a distinct subtype of breast cancer, characterized by unique clinical traits including early lung metastasis, elevated recurrence rates, and diminished survival prospects. Owing to the lack of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 expression, concrete therapeutic targets remain elusive, thereby confining available clinical treatment methods. In the context of advanced TNBC, chemotherapy remains the predominant therapeutic approach. In recent years, with the in-depth study of tumor microenvironment, new immunotherapy targets have been discovered one after another. Thus, immunotherapy-based combined therapy strategies have brought new hope in patients with advanced TNBC.

Objective:To explore the application value of heparin-binding protein (HBP) in the early diagnosis and assessment of severe adenovirus pneumonia.Methods:A total of 90 children diagnosed with adenovirus pneumonia admitted in the Department 1 of Emergency and Pediatric Intensive Care Unit 1 in Hunan Children′s Hospital from January 2019 to March 2020 were recruited.HBP levels in children with adenovirus pneumonia were detected.The correlation between HBP with white blood cell count (WBC), neutrophil ratio (N), C-reactive protein (CRP), interleukin-6(IL-6) and erythrocyte sedimentation rate (ESR) were examined.Receiver operating characteristic(ROC) curve analysis was conducted to explore the value of HBP in the early diagnosis and assessment of severe adenovirus pneumonia.Children with adenovirus pneumonia were divided into severe adenovirus pneumonia group (severe group) and non-severe adenovirus pneumonia group (non-severe group) according to their severity.Those in the severe group were further divided into bronchiolitis obliterans(BO) group and non-BO group according to the occurrence of BO.Results:(1) The HBP level in children with adenovirus pneumonia was (49.47±34.19) μg/L, which was significantly higher in the severe group than that of non-severe group[(82.88±44.02) μg/L vs.(35.15±13.08) μg/L, t=15.349, P<0.05]. Children in the severe group were significantly younger, and they had a significantly longer length of stay, lower Pediatric Critical Illness Scores (PCIS), and higher inflammatory markers like HBP, WBC, N, CRP, IL-6, and ESR compared with those of the non-severe group (all P<0.05). No significant difference in the procalcitonin (PCT) level was detected between groups.(2) The HBP was positively correlated with inflammatory markers like WBC ( r=0.38, P<0.05), N ( r=0.26, P<0.05), CRP ( r=0.47, P<0.05), IL-6 ( r=0.76, P<0.05), and ESR ( r=0.35, P<0.05). However, HBP did not have a significant correlation with PCT ( r=0.097, P>0.05). (3) In the severe group, the HBP level of the children with invasive mechanical ventilation, oxygenation index(P/F index)≤ 200 mmHg (1 mmHg=0.133 kPa) and BO was significantly higher than that of the non-invasive mechanical ventilation, P/F index> 200 mmHg and non-BO (all P<0.05). (4) The area under the ROC curve of HBP, WBC, N, CRP, ESR and IL-6 in predicting the severity of adenovirus pneumonia were 0.915, 0.748, 0.770, 0.740, 0.820 and 0.798, respectively.When the cut-off value of HBP was 45 μg/L, the sensitivity and specificity of HBP were 81.48% and 85.71%, respectively. Conclusions:As an inflammatory mediator, HBP is involved in the inflammatory response of the body.It may be a useful new marker for the early diagnosis of severe adenovirus infection, which also has a certain value in the evaluation of the severity and prognosis of the disease.The findings provide a basis for early clinical intervention and treatment of adenovirus infection in children.

Objective:To investigate the emergency treatment and clinical effect when the guidewire stuck in the right atrium during central vein catheter placement for hemodialysis.Methods:Five cases with guidewire stuck in the right atrium during central vein catheter placement for hemodialysis from January 2011 to July 2018 admitted into the First Affiliated Hospital of Zhejiang University were retrospectively analyzed. In two cases, the guidewires were found completely stuck when the insert depth was about 20 cm. The guidewires were not able to move forward nor backward. In the other three cases, the guidewires could be moved forward but not backward with the insert depth at about 18 cm. All patients received emergent computed tomography angiography (CTA) or digital subtraction angiography (DSA) imaging. Images showed that the guidewires were stuck in the right atrium near the ventricular valve. The guidewire core drawing method, the multipurpose angiography(MPA) catheter capturing method and the manual guidewire adjusting method were used for emergent treatment.Results:One patient with completely stuck guidewire was successfully treated with guidewire core drawing method and the temporary central vein catheter catheterization through the internal jugular vein was performed under DSA. In a completely stuck case and a retrogradely stuck case, the J-shaped ends of the warped guidewires were captured into the MPA catheter, and the guidewires were then withdrawn from right atriums along with the contrast catheter. In the other 2 retrogradely stuck cases, under DSA, the guidewires were repeatedly pushed, the direction of J-shaped ends was manually adjusted, and then the guidewires were repeatedly pushed and pulled until catheters can be pulled out of the right atriums. The later 4 cases had permanent central vein catheter placement with the same guidewire after the stuck guidewires were withdrawn from the right atrium and readjusted.Conclusions:All three methods can successfully solve the emergent situation of the stuck guidewire in the right atrium. For patients with completely stuck guidewires, the MPA catheter capturing method can be simpler, safer, and more effective.

Objective:To observe the clinical characteristics and prognosis of patients with rapidly progressive glomerulonephritis (RPGN) caused by lupus nephritis, antineutrophil cytoplasmic antibodies (ANCA) - associated vasculitis, or primary glomerulonephritis who were treated with peritoneal dialysis (PD) and then withdrew PD because of renal recovery.Methods:Data of the above patients were retrospectively analyzed. The patients were diagnosed as RPGN and received PD therapy in Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University from February 2009 to August 2018. The patients were divided into early withdrawal group (PD time≤183 days, n=24) and late withdrawal group (PD time>183 day, n=24). The differences of clinical characteristics between the two groups were compared. The cumulative incidence of adverse events in both groups was analyzed using Kaplan-Meier curves. Cox proportional hazards model was used to analyze the risk factors influencing the prognosis of patients. Results:Forty-eight RPGN patients were included. The median time of maintaining PD was 178(76, 378) days. Compared with the late withdrawal group, the patients in early withdrawal group had lower levels of urine volume, serum albumin and parathyroid hormone, and lower rates of gross hematuria and hypertension at the beginning of PD, and received higher rates of methylprednisolone impulse, combined immunosuppressive agents, and hemodialysis or continuous renal replacement therapy (all P<0.05). At the time of PD withdrawal, the levels of serum creatinine, serum calcium, serum albumin and parathyroid hormone in the early withdrawal group were significantly lower than those in the late withdrawal group (all P<0.05). The Kaplan-Meier curves showed that there was no significant difference in the cumulative survival of patients in both groups (log-rank test χ2=3.485, P=0.062). Cox regression analysis revealed serum creatinine≥209 μmol/L at the time of PD withdrawal was an independent risk factor for poor prognosis ( HR=5.253, 95% CI 1.757-15.702, P=0.003). Conclusions:PD can be used for RPGN patients caused by lupus nephritis, ANCA-associated vasculitis and primary nephritis. Serum creatinine≥209 μmol/L at the time of PD withdrawal is an independent risk factor for poor prognosis.

OBJECTIVE: To investigate the associations between mean arterial pressure (MAP) and mortality in patients with peritoneal dialysis (PD). METHODS: A total of 1737 patients with terminal renal diseases under PD in the First Affiliated Hospital of Zhejiang University from 2008 to 2016 were enrolled. Patients were followed up for 33.0(19.3, 52.4) months. The mean arterial pressure over the first 3 months of PD therapy were calculated. All-cause death and cardiovascular death were assessed using Cox regression models adjusted for demographics, laboratory measurements, comorbid conditions and antihypertensive medications. RESULTS: During the follow-up, 208 patients died, among which 95(45.7%) patients died of cardiovascular causes. Compared with patients with MAP >95-<120 mmHg, patients with MAP ≤ 95 mmHg were associated with significantly higher risk of all-cause death (=1.40,95%:1.01-1.93,<0.05); patients with MAP ≥ 120 mmHg were associated with significantly higher risk of all-cause (=2.12,95%:1.32-3.40, <0.01) and cardiovascular morality (=2.55, 95%:1.38-4.70, <0.01). MAP presents a U-shaped association with all-cause mortality and a J-shaped association with cardiovascular mortality. CONCLUSIONS Both high MAP and low MAP are associated with higher risk of mortality in PD patients.
Arterial Pressure ; Humans ; Kidney Failure, Chronic ; mortality ; pathology ; Peritoneal Dialysis ; Renal Dialysis ; Risk Factors

Objective: To investigate the association between the home blood pressure (BP) and morality in peritoneal dialysis (PD). Methods: PD patients from the First Affiliated Hospital of Zhejiang University from January 1, 2008 to June 30, 2016 were studied. Over the first 6 months PD therapy, systolic SB (SBP) and diastolic BP (DBP) averaged as 5 (<120 to≥150 mmHg in 10 mmHg increments) and 4 (<70 to≥90 mmHg in 10 mmHg increments) categories, respectively, as well as continuous measures. All-cause and cardiovascular mortality were assessed by using Cox regression models adjusted for demographics, laboratory measurements, comorbid conditions and antihypertensive medications. The relationships between home BP and all-cause and cardiovascular mortality were assessed by restricted cubic spline regression model. Results: A total of 1663 PD patients were included with a median follow-up of 29.9 months, in which 737 patients (44.3%) were female. The SBP and DBP were (135.2±15.8) mmHg and (83.1±10.5) mmHg, respectively. Two hundred and twenty-one PD patients died during the study period, of which 102 patients (46.2%) died of cardiac-cerebral vascular events. With 130≤SBP<140 mmHg as a refernece, SBP≥150 mmHg (HR=1.83, 95%CI 1.19-2.82, P=0.005) and SBP<120 mmHg (HR=2.05, 95%CI 1.29-3.27, P<0.001) were associated with significantly higher risks of all-cause morality, but not cardiovascular morality. With 80≤DBP<90 mmHg as a refernece, patients with DBP≥90 mmHg exhibited significantly higher risks of all-cause mortality (HR=1.80, 95%CI 1.21-2.68, P=0.009). SBP presented a U-shaped association with all-cause mortality. DBP presented a J-shaped association with all-cause mortality. Conclusions Higher SBP, lower SBP and higher DBP are associated with higher risks of all-cause mortality in PD patients. However, neither SBP nor DBP is observed statistically significant relationship with the risk of cardiovascular mortality. Further prospective and randomized clinical trials are needed to determine the optimal BP targets and improve the management of hypertension in PD patients.