Table of Content

05 June 2016, Volume 31 Issue 6

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Detection of minimal residual disease using flow cytometry in patients with acute myeloid leukemia: challenges  and  tactics

Chang Yingjun1，2， Zhao Xiaosu2

2016, 31(6):  581-584.  doi:10.3969/j.issn.1004-583X.2016.06.001

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Flow cytometry (FCM) has been one of the important methods for detection of minimal residual disease (MRD) in patients with acute leukemia. However， there are a number of questions on MRD evaluation by FCM in patients with acute myeloid leukemia. Here， the challenges and tactics are discussed on  FCM assessment of AML MRD.

State and advance of familial colorectal cancer without identifiable gene mutations

Han Ying

2016, 31(6):  585-589.  doi:10.3969/j.issn.1004-583X.2016.06.002

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Although 30% of individuals diagnozed with colorectal cancer(CRC) are reported a family history of the disease， only 5% to 6% carry germline mutations in genes associated with known hereditary cancer syndromes. The evaluation and management of families affected with CRC can be complicated by variability in disease phenotypes and the sensitivity of genetic tests is limited. In this review， we examine what is currently known about familial CRC and what we have yet to learn， and explore how novel genomic approaches might be used to identify additional genetic and epigenetic factors implicated in heritable risk for cancer.

Treatment of hyperphosphatemia in chronic kidney disease patients

Li Ying

2016, 31(6):  590-593.  doi:10.3969/j.issn.1004-583X.2016.06.003

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Hyperphosphatemia is an independent risk factor for mortality in patients with chronic kidney disease (CKD). The prognosis of patients with CKD can be improved by effectively controlling the hyperphosphatemia. At present， the main measure of controlling the level of phosphorus includes limitting  dietary phosphorus intake， oral administration of phosphorus and dialysis. Among them， oral intestinal phosphate binding agent is the most convenient and effective method to reduce phosphorus in CKD patients.

Treatment of heart failure in patients with chronic kidney disease

Gu Guoqiang，Cui Wei

2016, 31(6):  594-599.  doi:10.3969/j.issn.1004-583X.2016.06.004

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Heart failure (HF) is highly prevalent in patients with chronic kidney disease (CKD) and endstage renal disease (ESRD) and is strongly associated with mortality in these patients. However， the treatment of HF in patients with CKD is unclear， as there is very little strong evidence to support any recommendations. Guidelines for the management of HF in the general population may not apply entirely to those with CKD， since such patients，particularly those with severe renal impairment， were quite often excluded from most of RCTs that served as a rationale for these guidelines.

Progress in treatment strategies of patients with acute coronary

Liu Jinming， Li Fang， Xie Yanan

2016, 31(6):  600-605.  doi:10.3969/j.issn.1004-583X.2016.06.005

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Chronic kidney disease (CKD) is an independent risk factor of cardiovascular disease (CVD)， and CVD is the main cause of death in CKD. Because of the  increased risk of bleeding in patients with CKD and acute coronary syndrome(ACS)， the basic treatment of drugs and other therapeutic measures are reduced， especially percutaneous coronary intervention treatment， which is associated with increased morbidity and mortality. This review systematically focuses on the pathogenesis， clinical characteristics and treatment strategies in patients with ACS and CKD.

The treatment of chronic kindey disease complicated surgery

Zhang Guojian

2016, 31(6):  606-609.  doi:10.3969/j.issn.1004-583X.2016.06.006

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The characteristics of chronic kidney disease(CKD) are high morbidity and mortality，longer duration and difficult to cure， which eventually develop into kindey failure. Serious complications of CKD includes hypoproteinemia， hypertension， anemia， bleeding and thrombosis. Surgical disease complicated CKD that needs surgery is a clinically intractable and difficult problem. The author described the problems that clinicians should pay attention to and solve， including diet control and monitoring of patients and drug selection application， which would avoid  serious adverse events.

Multidisciplinary collaboration in chronic kidney disease combined with management of  pregnancy

Xing Ying， Chang Ruijing， Chen Duo

2016, 31(6):  610-614.  doi:10.3969/j.issn.1004-583X.2016.06.007

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Pregnancy complicated by chronic kidney disease (CKD) is one factor of the highrisk pregnancy (HRP) in obstetrics. With the development of modern medicine and the prevalence of kidney dialysis， the standard measurement of HRP and the medical treatment for premature infant have been improved， which makes it possible for successful pregnancy for women with CKD. For surviving through pregnant period， multidisciplinary partnerships are needed. This  review focuses at  the multidisciplinary partnerships for pregnancy complicated by CKD.

The therapy of infection in patients with chronic kidney disease

Pan Wensen，Yuan Yadong

2016, 31(6):  615-620.  doi:10.3969/j.issn.1004-583X.2016.06.008

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Chronic kidney diseases (CKD) are very common in clinical work，including glomerulonephritis，pyelonephritis，nephrotic syndrome，renal tubular interstitial disease，diabetes kidney disease， hypertension， and renal vascular disease and others. Patients with CKD are susceptible to infectious disease. And infection will always prompt chronic renal failure due to deteriorated kidney function. Infection is  usually  a direct cause of death for patients with CKD. Therefore， more knowledge about the risk factors and characteristics of CKD is helpful to treat the infection and improve the prognosis of patients with CKD.

Treatment of chronic kidney disease with rheumatic diseases

Peng Chenxing

2016, 31(6):  621-625.  doi:10.3969/j.issn.1004-583X.2016.06.009

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Rheumatic diseases involve multiple organs and systems， and kidney is one of the most commonly involved organs. Common rheumatic diseases such as systemic lupus erythematosus， rheumatoid arthritis， systemic sclerosis， antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis， primary sjgren syndrome and gout may combine with chronic kidney disease. The author reviews the progress in the treatment of chronic kidney disease  with rheumatic diseases.

Treatment in hypertensive patients with chronic kidney disease

Yang Xiuchun1， Zong Yijun2， Xiao Bing1

2016, 31(6):  626-630.  doi:10.3969/j.issn.1004-583X.2016.06.010

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The interaction between chronic kidney disease and hypertension has been well known. It has been a big challenge in the treatment of hypertensive patients with chronic kidney disease in clinic. Both nerve and humoral regulation play an important role in the pathogenesis of hypertensive patients with chronic kidney disease， and lowering blood pressure can keep renal function intact. Different kinds of antihypertensive drugs have their own feature in hypertensive patients with chronic kidney disease.      

Treatment of chronic kidney disease with diabetes mellitus

Zhang Songyun

2016, 31(6):  631-635.  doi:10.3969/j.issn.1004-583X.2016.06.011

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Treatment strategy in diabetic patients with chronic kidney disease(CKD) includes lifestyle  intervention， glycemic control， blood pressurelowering therapy， lipidlowering therapy， antiplatelet therapy and renal replacement therapy. All treatments follow the principle of safety， effectiveness and individualization. Lifestyle intervention focuses at the restriction of salt and protein intake. Drug selection and dose adaptation should be based on the pharmacokinetic characteristics and the renal function.  Linagliptin， glipizide and pioglitazone can be used through the CKD process without dose adjustment.  RAAS inhibitors should be considered as an initial therapy for hypertension. Statin is recommended in diabetic patients with CKD of stage 1 to  4. Aspirin is recommended as the first choice for antiplatelet therapy and clopidogrel is an alternative for aspirin in patients with clear intolerance or contraindications for aspirin. Dialysis is initiated in patients with diabetes on the same criteria as in those without diabetes.

Standardized treatment of chronic renal anemia

Wen Shupeng，Yang Lin

2016, 31(6):  636-640.  doi:10.3969/j.issn.1004-583X.2016.06.012

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Anemia is one of the common complications of chronic kidney disease(CKD) and is mostly due to deficiency of erythropoietin (EPO)  and iron. It is a ramification of decline in fuctional renal mass.  Erythropoiesisstimulating agents (ESA) and iron have been available since decades to treat anemia of CKD. The article reviews the recent evaluation in chronic renal anemia and therapeutic target in hemoglobin，indications，use，efficacy and considerations in EPO and iron therapy， and research progress of new ESA to raise the understanding in standard treatment of chronic renal anemia.

Analysis of risk factors in readmission patients with coronary heart disease

Fan Chong， Li Guangping

2016, 31(6):  641-643.  doi:10.3969/j.issn.1004-583X.2016.06.013

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ObjectiveTo analyze the risk factors in readmitted patients with coronary heart disease， intending to strength the preventive and therapeutic strategy to reduce the readmission ratio of highrisk population. MethodsA total of 115 readmitted patients with CHD were selected as the experiment group， on the contrary， 78 initial patients with CHD were statistically analyzed as the control group. The relationship between readmission and clinical indicators were explored. ResultsThe valnes in age，high blood pressure，T2DM， AMI， cardiac function NYHA ⅢⅣ， LAD， LVEDD， IVS and LVPW were significantly higher in experiment group than in control group， however， LVEF was significantly lower in experiment group than in control group (P<0.05).  Multivariable logistic regression analysis showed that age， hypertension， LAD， and  LVEF were associated with readmission (P<0.05). ConclusionStrengthening the intervention and devoting special attention on patients with high blood pressure and diabetes， elderly ages and the related complications， taking measures to improve heart function will have substantial benefits on preventing the readmission in patients with CHD.

Correlation of homocysteine，Nterminal Btype natriuretic peptide， structure and #br# function of  left ventricular   in elderly patients with chronic heart failure

Wang Zichen， Wei Zhanyun， He Jingyu， Tan Jing， Hua Qi

2016, 31(6):  644-648.  doi:10.3969/j.issn.1004-583X.2016.06.014

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ObjectiveTo investigate the relation between homocysteine (Hcy)， Nterminal Btype natriuretic peptide，structure and function of the left ventricular in elderly patients with chronic heart failure (CHF) . MethodsCHF group included 84 elderly patients with CHF， who were hospitalized in Cardiology at Xuanwu Hospital. According to the criterion of New York Heart Association (NYHA) class，CHF group was divided into three groups， cardiac function grade Ⅱ included 34 cases， grade Ⅲ 38 cases， grade Ⅳ  12 cases. At the same time， control group enrolled 78 cases of healthy people， who had health check in the hospital. Hcy  and NTproBNP were detected，the left ventricular enddiastolic diameter (LVEDD)， left ventricular ejection fraction (LVEF ) were measured in two groups using color Doppler ultrasound. CHF group was treated with routine therapies，and recombinant human brain natriuretic peptide(rhBNP)，first given 1.5 μg/kg loading dose， and then intravenous pump   0.01  μg·k-1·min-1 for 72 h.After treatment  for 7 days， the clinical data and laboratory results were collected. The data of two groups were compared and correlations were analyzed. Results①Hcy and NTproBNP in CHF group were significantly higher than those of control group(P<0.05); ② Hcy  and NTproBNP were the highest in  group of cardiac function Ⅳas compared with the groups of heart function Ⅱand Ⅲ(P<0.05); and Hcy and NTproBNP in group of cardiac function Ⅲ were higher than those of cardiac function Ⅱ group(P<0.05); ③Hcy and NTproBNP  sharply decreased after the heart failure symptoms improved(P<0.05). However， there were no significant differences in LVEDD， and LVEF before and after the treatment (P>0.05). ④There were positive correlation between the level of Hcy and NTproBNP（r=0.586，P<0.05）， LVEDD（r=0.284，P＜0.05），and the level of Hcy was negatively correlated with LVEF（r=-0.492，P＜0.05）.ConclusionThe level of Hcy  is increasing with the aggravating of heart failure and it has great relativity with NTproBNP， LVEDD and LVEF， so it can reflect the severity of heart failure.

Significance of adiponectin and visfatin joint monitoring in predicting heart failure after PCI #br# in acute myocardial infarction

Zhang Qin1， Zhu Lei1， Jia Dalin2

2016, 31(6):  649-653.  doi:10.3969/j.issn.1004-583X.2016.06.015

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ObjectiveTo investigate the significance of adiponectin and visfatin joint monitoring in predicting heart failure after PCI in acute myocardial infarction. MethodsA total of 157 cases of AMI patients undergoing PCI were selected. According to whether heart failure happened after PCI， the patients were divided into occurrence group (n=62) and nonoccurrence group (n=95). Forty cases of healthy were selected as control group. The echocardiography and blood biochemical examination data of all subjects were collected. In all AMI patients after PCI the next day and the control group in medical examination day， the serum levels of visfatin and APN were detected by using automated enzymelinked fluorescence analyzer. ResultsThe LVDs in occurrence group was greater than that in nonoccurrence group and control group， while LVEF was less than that of nonoccurrence group and control group(P<0.05). LDLC， CKMB， cTnI， NTproBNP， CRP， WBC and NE in occurrence group and nonoccurrence group were higher than those in control group， and  CKMB， cTnI and NTproBNP in occurrence group were higher than those in nonoccurrence group(P<0.05). The levels of APN in occurrence group and nonoccurrence group were lower than that of control group， while the levels of visfatin were higher than that of control group(P<0.05)， the level of APN in occurrence group was lower than that of nonoccurrence group， while the level of visfatin was higher than that of nonoccurrence group(P<0.05). Pearson correlation analysis showed that serum APN level in occurrence group was negatively correlated with TC， LDLC， CKMB， cTnI， CRP and NE (P<0.05)， and serum visfatin level was positively correlated with  TC， LDLC， CKMB， cTnI， NTproBNP， NE and LVDs (P<0.05). ROC curve showed that  the serum APN level in AMI patients after PCI can predict the occurrence of heart failure APN<13.67  g/L，the sensitivity was 64.2%， specificity  87.1%. Visfatin>6.29  mg/L， serum visfatin level showed the  sensitivity  90.3%， specificity  77.9%. ConclusionThe serum level of APN in AMI patients after PCI was reduced， while visfatin was elevated. They could be as indicators to predict heart failure occurring after PCI.

Safety analysis of  rivaroxaban in  perioperative period of pacemaker implantation

Qin Lijun1， Wu Xue1， Wang Jintao1， XU Yuansheng1，Yang Baoping2， Sun Xiaoqiang3， Xu Yixian1

2016, 31(6):  654-657.  doi:10.3969/j.issn.1004-583X.2016.06.016

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ObjectiveTo observe the incidence of perioperative pocket hemorrhage of pacemaker in patients with oral anticoagulant rivaroxaban， and to provide evidence for optimizing perioperative anticoagulation therapy. MethodsThe clinical data of patients with pacemaker implantation were retrospectively analyzed， and the patients were divided into two groups according to different anticoagulation therapies.  Group A patients (n=80) received longterm anticoagulant treatment with warfarin， INR adjusted to 1.52.0 before implantation， warfarin was not suspended  in preoperative period. In  group B(n=72)，patients received anticoagulant treatment with rivaroxaban  constantly. The incidence of pocket hemorrhage was compared after pacemaker implantation in two groups. ResultsA total of 152 patients with anticoagulation therapies  were operated pacemaker implantation. Group A showed mild pocket bleeding in 4 cases， moderate pocket bleeding in 2 cases，severe pocket bleeding in 1 case.Group B had mild pocket bleeding in 4 cases， moderate pocket bleeding in 1 case，but no severe pocket bleeding. There was no significant difference  in pocket bleeding  between two groups （P>0.05）. ConclusionIn  perioperative period of pacemaker implantation， the constant application of rivaroxaban did not increase the risk of bleeding compared with warfarin.

Effect and significance of plasma homocysteine in patients with chronic heart failure

Liu Shasha1，Tian Xiang2，Li Fang2， Di Shuhua2， Qi Qiang2，Wang Wei2，Geng Wei2

2016, 31(6):  658-662.  doi:10.3969/j.issn.1004-583X.2016.06.017

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ObjectiveTo investigate the role of plasma homocysteine and its clinical significance in chronic heart failure  patients by observing the relationship of plasma homocysteine (Hcy) and B type natriuretic peptide (BNP).MethodsA total of 151 chronic heart failure patients including 93 males and 58 females， average age （66.7±11.6） years were investigated，and  249 patients with normal cardiac function at the same time of hospitalization served as control group.Plasma  Hcy， BNP，lipids， blood glucose were studied.Results①The plasma Hcy concentration in heart failure  patients was significantly higher than control group (19.90±5.07)  μmol/L vs  (14.84±4.87) μmol/L(P<0.01);The serum BNP concentration in heart failure patients was significantly higher than control group (1 851.67±742.59) ng/L vs  (197.5±84.5)  ng/L(P<0.01). ② The plasma Hcy and BNP were different from New York Heart Association (NYHA) classes  (P<0.01). ③ The plasma Hcy and BNP were linear positive correlation (r=0.629，P<0.01). ④The results of logistic regression showed that hypertension (OR=1.826，95%CI=1.0213.266，P<0.05），diabetes (OR=1.716，95%CI=1.0202.887，P<0.05)，hyperlipidemia (OR=1.856，95%CI=1.0153.396，P<0.05)，smoking (OR=1.952，95%CI=1.2333.089，P<0.05)，Hcy(OR=3.743，95%CI=2.2716.169，P<0.01)  were risk factors for patients with chronic heart failure.⑤Receiver operating characteristic curve analysis indicated the cut  off of Hcy for chronic  heart failure was 17.75  μmo/L (ROC area under curve: 0.754，95%CI=0.7060.802，P<0.01) with 73.90% specificity and 66.20%  sensitivity.ConclusionHcy  is an independent risk factor for chronic heart failure， and the cut of value can be used as a new diagnostic index for chronic heart failure.

Clinical analysis of pulmonary sequestration on 36 cases

Li Min1，Wei Shibin2

2016, 31(6):  663-665.  doi:10.3969/j.issn.1004-583X.2016.06.018

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ObjectiveSummarizing the clinical manifestations of pulmonary sequestration， imaging features， pathological features and  treatment. MethodsRetrospective analysis was made in the clinical data of 36 cases of pulmonary sequestration on their clinical manifestations，imaging features， pathological features and their treatment，the effects of the three methods were analyzed and compared. ResultsPulmonary sequestration can be cured by surgical treatment.  The surgical treatment is more thorough，while interventional treatment effect is not ideal.ConclusionThe incidence of pulmonary sequestration was low， the clinical manifestations lack  specificity.The  enhanced CT and the vascular reconstruction can diagnose the disease. The main cure of pulmonary sequestration  is surgeryoriented treatment.

Effect of recombinant interferonin α1b by atomization inhalation in children with moderate to severe capillary bronchiolitis

Huang Guangli， Shi Qingsheng，Li Junqin，Chen Suping，Wang Mingfei

2016, 31(6):  666-668.  doi:10.3969/j.issn.1004-583X.2016.06.019

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ObjectiveTo evaluate the clinical effect and value of recombinant interferonin α1b by atomization inhalation in children with moderate to severe capillary bronchiolitis. MethodsSeventyfour children with moderate to severe capillary bronchiolitis were divided into treatment group  (36 cases) and control group (38 cases) according to whether the use of recombinant interferonin α1b atomization inhalation. The same comprehensive treatment was given to both groups， but the treatment group children added recombinant interferonin α1b atomization inhalation therapy. The conditions and treatment effect of respiratory rate（RR），gasp，three depressions sign，amount of food and pulmonary signs of  two group were analyzed. ResultsThe total effective rate of treatment group was 97.4% (37/38)， higher than 86.1% (31/36) of  control group (P<0.05).ConclusionThe effect of recombinant interferonin α1b atomization inhalation in  children with moderate to severe capillary bronchiolitis is good，it shortens the period of treatment and  is  worthy of application.

Levothyroxine replacement dose in patients with hypothyroidism during pregnancy

Chen Lin1，2， Liu Jun2， Zhuang Chanjuan1， Li Guimei1， Deng Dongmei1

2016, 31(6):  669-672.  doi:10.3969/j.issn.1004-583X.2016.06.020

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ObjectiveTo explore the levothyroxine dose in patients with hypothyroidism during pregnancy. MethodsA total of 274 pregnant subjects with hypothyroidism including 207 patients with subclinical hypothyroidism (SHT) and 67 patients with clinical hypothyroidism (HT) were enrolled in this study from March 2014 to March 2015. According to thyrotrophic (TSH) levels， the levothyroxine dose was adjusted to reach the targets with the first trimester TSH ranging 0.12.5 mU/L， the second trimester(T2) TSH ranging 0.23.0 mU/L and the third trimester(T3) TSH ranging 0.33.0 mU/L. The subjects were divided into different groups on the basis of TSH levels， including TSH1 group: TSH 35 mU/L， TSH2 group: TSH 58 mU/L， TSH3 group: TSH 810 mU/L， TSH4 group: TSH 1015 mU/L， TSH5 group: TSH 1520 mU/L and TSH6 group: TSH>20 mU/L. ResultsThe levothyroxine doses were respectively (52.26±19.43) μg in T1 period，( 56.69±20.58) μg in T2 period and  (56.76±19.99) μg in T3 period in subclinical hypothyroidism， and respectively   (64.58±50.26) μg in T1 period，(66.67±47.64) μg in T2 period and （65.91±34.06） μg in T3 period in clinical hypothyroidism. The doses of levothyroxine were （45.65±16.08） μg，（72.32±14.85） μg， （75.00±13.06) μg， (112.5±53.03) μg，(137.5±23.18) μg and  (150.00±23.13) μg from TSH1 group to TSH6 group， respectively. The doses of levothyroxine in TSH2， TSH3， TSH4 and TSH5 groups were significantly higher than that of TSH1 group during T1 to T3 trimester (P<0.05). The doses of levothyroxine in TSH4， TSH5 and TSH6 groups were significantly higher than that of TSH2 group (P<0.05). The doses of levothyroxine in TSH4， TSH5 and TSH6 groups higher than TSH3 group (P<0.05); The doses of levothyroxine in TSH5 and TSH6 groups were significantly higher than that of TSH4 group (P<0.05). The dose of levothyroxine in TSH6 group were significantly higher than that of TSH5 group (P<0.05). ConclusionThe levothyroxine (LT4) dose in clinical hypothyroidism in T1， T2 and T3 trimester were significantly higher than those in subclinical hypothyroidism (P<0.05). The dose of levothyroxine sodium increased significantly accompanied by the increased TSH level during pregnancy (P<0.05).

Introduction of the expert consensus statement for  definition， diagnosis and treatment of #br# acute exacerbations of idiopathic pulmonary fibrosis using Delphi Technology

Guo Xianli，Yuan Shengfang，Song Ning

2016, 31(6):  673-675.  doi:10.3969/j.issn.1004-583X.2016.06.021

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The evidence based medicine for clinical diagnosis and treatment of acute exacerbation of idiopathic pulmonary fibrosis (AEIPF) is insufficient. So far， there is still lack of specialized and systematic expert consensus for AEIPF clinical diagnosis and treatment. Recently， British scholars developed a consensus statement for the definition， diagnosis， and treatment of AEIPF using Delphi technique， especially put forth some advice on the support treatment， use of antimicrobial agents， immunosuppressive agents， anticoagulant，and anti fibrosis drugs， also rose step treatment， discharge planning， longterm management suggestions，et al. This paper will introduce related expert consensus， in order to provide practical reference for chinese clinicians to manage AEIPF.