Clinical Focus

Advances in the treatment of idiopathic membranous nephropathy

Fu Shuxia1, Fu Shuli2

2019, 34(12): 1061-1065. doi:10.3969/j.issn.1004-583X.2019.12.001

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The immunosuppressive therapy for idiopathic membranous nephropathy(IMN) with nephrotic syndrome is mainly a routine therapeutic modality to relieve proteinuria and stabilize renal function.This article summarizes the progress of calcineurin inhibitors and rituximab to IMN with nephrotic syndrome.

Esophageal diverticulosis in North China: trend analysis of five years in 124 349 patients undergoing gastroscopy

Dai Xin1, Zhang Rui2, Zhao Wei1, Wang Bangmao1

2019, 34(12): 1066-1071. doi:10.3969/j.issn.1004-583X.2019.12.002

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Objective To investigate the incidence ofesophageal diverticulosis, diverticulum size, its clinical manifestation, treatment and prognosis in the increasingly aging North China. Methods A total of 124 349 patients undergoing gastroscopy from 2014 to 2018 were selected. As the diverticulum of esophagus was found,its occurrence sites, clinical manifestation, treatment and prognosis were recorded. Results Totally 124 349 patients underwent gastroscopy, of which 574 patients were diagnosed as esophageal diverticulosis with an overall detection rate of 0.46%. And the midesophageal diverticula accounted for the highest proportion.The group of patients over 60 years old took up higher proportion than any other group(P<0.001). There was a significant difference in the size of esophageal diverticula between the group of patients under 39 years oldand the group of elderly patients (P<0.05). The clinical manifestation of esophageal diverticula of different sizes was statistically significant(P<0.05). Among 138 patients who were diagnosed as esophageal diverticulosis, a total of 74 patients did not receivetreatment and were followed up regularly.Conclusion Esophageal diverticulum occurs rarely in China. And there was significantly difference in thesize of esophageal diverticulumof different age groups.

Multivariate analysis of postoperative anastomotic leakage in patients with gastric carcinoma

Ma Jiangtao1，2, Zeng Fanrong2, Zhang Yunxiao1, Li Shuo1, Yu Ling1, Tan Hongyu1

2019, 34(12): 1072-1075. doi:10.3969/j.issn.1004-583X.2019.12.003

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Objective To explore the influencing factors of postoperative anastomotic leakage in patients with gastric carcinoma.Methods The clinical data of 499 patients that underwent elective radical gastrectomy at Peking University Cancer Hospital from September 2016 to June 2018 were retrospectively reviewed. Logistic regression was used to analyze the related factors of postoperative anastomotic leakage. Results Among 499 patients with gastric carcinoma, a total of 23 cases (4.6%) had postoperative anastomotic leakage. And the factors related to the postoperative anastomotic leakage included large resection range (OR=2.633, P=0.045), intraoperative hypotension (OR=4.617, P=0.007), postoperative pain (OR=2.838, P=0.022) and drinking history (OR=2.809, P=0.022).Conclusion Large resection range, intraoperative hypotension, postoperative pain and drinking history were risk factors for postoperative anastomotic leakage.

Relationship analysis between chimerism and relapse of leukemia after allogeneic hematopoietic stem cell transplantation

Liu Fang, Zhang Xuejun, Niu Zhiyun, Wen Shupeng, Wang Ying, Wang Fuxu

2019, 34(12): 1076-1080. doi:10.3969/j.issn.1004-583X.2019.12.004

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Objective To investigate the relationship between chimerism and leukemia relapse after allogeneic hematopoietic stem cell transplantation(allo HSCT). Methods Totally 73 adults with leukemia undergoing myeloablative allo HSCT from January 2014 to June 2018 were retrospectively analyzed. Polymerase chain reaction amplification of short tandem repeat sequence（STRPCR） was used to detect donor cell chimerism rates of recipient bone morrow after +30 d, +60 d,+90 d of transplantation. Then the relationship between chimerism and the relapse was analyzed.Results Thechimerism rate of the relapse group was lower than that of non-relapsegroup after +90 d of transplantation. Patients with low chimerism had higher relapse rate after +60 d and +90 d of transplantation（P=0.021, 0.027, respectively）. Multivariate analysis showed that leukemia status before transplantation, donor cell chimerismrate after +60 days of transplantation, donor cell chimerismrate after +90 days of transplantation were the risk factors of relapse after patients undergoing allo HSCT. Conclusion The study indicated that chimerismrate has predictive value for leukemia recurrence afterallo HSCT. And the recurrence rate of patients with low chimerism after +60 d and +90 d of transplantation is high.

Analysis of clinical features and risk factors in rheumatoid arthritisrelated interstitial lung disease

Qin Qian1, 2, Yang Xiaohong1, 2, Zhou Wenjun3a, Zheng Jianxiong3a, Xiong Qin3b, Zhang Quanbo3b, Qing Yufeng3a

2019, 34(12): 1081-1084. doi:10.3969/j.issn.1004-583X.2019.12.005

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Objective To investigate the clinical features and risk factors of rheumatoid arthritis（RA）related interstitial lung disease(ILD) . Methods A total of 373 RA patients treated from January 1st 2017 to June 30th 2018 were collected. According to the clinical manifestations and highresolution CT (HRCT) of the lungs, the patients were divided into RA with ILD group and RA with non ILD(NILD) group. Then the clinical features of these two groups were analyzed.Results ①Of 373 RA patients, 229 cases had ILD and 76 cases had respiratory symptoms. ② The age, age of onset and the ratio of male and female were higher in ILD group than those in NILD group; ③The number of swollen joints, tenderness joints, and incident of morning stiffness, cough and postexercise shortness in ILD group were higher than those of NILD group; ④The levels of erythrocyte sedimentation rate, white blood cell count, neutrophil count, low density lipoprotein, hypersensitive Creactive protein, urea, creatinine, uric acid, cystatin C, rheumatoid factor, anticyclic citrullinated peptide antibody in ILD were higher than those of NILD group. The levels of albumin and apolipoprotein A1 were lower than those of NILD group; ⑤ Age, number of joint involvement and antiCCP antibody were independent risk factors for RArelated ILD, and albumin was the protective factor. Conclusion RA is easy to combine with ILD, but it is concealed. The risk factors are advanced age, heavy joint involvement and high titer antiCCP antibody.

Effect of external counterpulsation treatment on sleep disturbance in patients with coronary heart diseasebased on a mixed research perspective

Jin Shengnan1, Li Xian2a, Liu Meixia2b, Zhou Ce2b, Li Wei2c, Wang Shan2b

2019, 34(12): 1085-1088. doi:10.3969/j.issn.1004-583X.2019.12.006

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Objective To observe the improvement effect of external counterpulsation treatment on sleep disturbance in patients with coronary heart disease through mixed research methods.Methods In quantitative study, totally 80 patients diagnosed with coronary heart disease(CHD) with sleep disorder were randomly divided into control group and experimental group.The control group was given cardiology routine nursing and healthy sleep method, and the intervention group was given external counterpulsation treatment on this basis.Pittsburgh Sleep Scale was used to evaluate the sleep disorder of the patients before and after the treatment.The qualitative study randomly selected 17 patients from two groups for semistructured interview. The score of Pittsburgh Sleep Scale and patients' feelings before and after the treatment were compared between the two groups.Results After treatment, there was statistically significant difference between control group and experimental group in the scores and total scores of other factors except the score of sleep disorder(P<0.05).The external counterpulsation treatment could help patients shorten the time to fall asleep, improve the sleep efficiency, reduce the waking situation at night, improve daytime sleepiness, reduce the frequency of hypnotic drugs, and improve the sleep disorder of patients with CHD.Conclusion The external counterpulsation can improve sleep disturbance in patients with CHD, and it also can be used in cardiac rehabilitation of clinical in the future.

Peripheral blood lymphocyte and monocyte ratio predicts relapse in patients with diffuse large B cell lymphoma

Yang Tingting1, Wang Yanyan1, Wang Baohong2

2019, 34(12): 1089-1093. doi:10.3969/j.issn.1004-583X.2019.12.007

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Objective To investigate the relationship between peripheral blood lymphocyte and monocyte ratio (LMR) and clinical features of patients with diffuse large Bcell lymphoma (DLBCL), and to judge the prognosis and predict the relapse.Methods The clinical data of 126 DLBCL patients was retrospectively analyzed. Statistical methods were used to analyze the relationship between clinical features, prognosis and relapse, and to explore the value of predicting relapse.Results Patients in the low LMR (<2.25) group were often accompanied by B symptoms, high IPI score, late clinical stage, and elevated β2microglobulin levels (P<0.05). Totally 43 cases of 126 patients (37.7%) suffered relapse, with a median relapse time of 12 (270) months. Multivariate analysis (OR=2.586, P=0.028) showed that low LMR was significantly associated with relapse at followup, low LMR was more risky than high LMR, and low LMR was related to shorter overall survival (OS) and diseasefree survival (DFS) (OS: P=0.015; PFS: P=0.006). Conclusion This study suggests that when LMR is less than 2.25, it indicates poor prognosis. And during the followup, a lower LMR can be used as a marker to predict relapse in patients with DLBCL.

Comparison of neutrophil to lymphocyte ratio and traditional inflammatory markers in predicting for contrastinduced nephropathy in patients with type 2 diabetes mellitus

Gu Xiaolan1, Zhang Delong2, Li Xinyu1, Liu Yingshu1, Li Ning1, Gao Zhengnan1

2019, 34(12): 1094-1097. doi:10.3969/j.issn.1004-583X.2019.12.008

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Objective To compare the neutrophil to lymphocyte ratio(NLR) and NGAL for contrastinduced nephropathy(CIN) predictive value in patients with type 2 diabetes mellitus. Methods A total of 88 patients with enhanced CT of type 2 diabetes mellitus were selected. The blood routine examination, SCr，CysC, hsCRP and NGAL were measured before enhanced CT, after 6 hours, 24 hours and 48 hours of enhanced CT. According to the results of tourine MA/Cr, the patients were divided into two groups, diabetic nephropathy(DN) and non DN group. Based on the diagnosis of CIN, the 88 patients were divided into CIN group(n=82) and normal group(n=6) to analyze the association of NLR and NGAL, and to compare the predictive value of NLR and other indexes.Results Totally six patients (6.8%) with DN suffered from CIN after enhanced CT. NLR and NGAL were higher in patients with DN than patients without DN（P＜0.05）. Pearson correlation analysis showed that NLR was positively associated with SCr（r=0.785，P=0.012） and NGAL （r=0.764，P=0.018）. After adjustment for some factors, according to the logistics regression, NLR was still a risk factor of CIN（P＜0.05）.Conclusion DN patients are more likely to have CIN. NLR and urine NGAL were higher in patients with DN.

Analysis of risk factors of thromboembolism in patients with ANCAassociated vasculitis

Li Tinga, Xu Qiangb, Xing Guangqunc

2019, 34(12): 1098-1101. doi:10.3969/j.issn.1004-583X.2019.12.009

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Objective To analyze the clinical features and related risk factors of antineutrophil cytoplasmic antibody associated vasculitis (AAV) complicated with thromboembolism events.Methods A total of 177 patients diagnosed as AAV from January 2013 to December 2018 were collected, of which 28 patientswith ATE and VTE and 149 patients. Logistic regression analysis was used to explore the risk factors of AAV patients complicated with thromboembolism.Results In the embolization group，23 patients(82.1%) were in AAV active stage, five patients(17.9%) were in remission stage, and 50.0% of the patients suffered from the disease two months after the diagnosis. Compared with nonembolization group, the acute infection rate, BVAS score, serum creatinin and ESR level in embolization group were higher. However, the blood platelet count and C3 level were lower (P<0.05). Multivariate logistic regression analysis showed that complicated acute infection, the level of ESR and C3 were independent risk factors for AAV complicated with thromboembolism.Conclusion Patients with AAV have a higher risk of thromboembolism during the active period, especially two months after the diagnosis of the disease. AAV patients with acute infection, increased ESR and decreased C3 may be more susceptible to thromboembolism.

Systematic evaluation of the effects of glucagonlike peptide 1 receptor agonists on islet cell function in overweight and obese patients with type 2 diabetes

Zheng Xin， Zhu Yugang， Wang Defeng

2019, 34(12): 1102-1107. doi:10.3969/j.issn.1004-583X.2019.12.010

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Objective To systematically evaluate the effect of glucagonlike peptide 1（GLP1） receptor agonist（RA) on islet cell function in overweight and obese patients with type 2 diabetes. Methods A computerbased search of relevant databases at home and abroad to find a randomized controlled trial (RCT) of GLP1 RA in overweight and obese patients with type 2 diabetes. Results Finally 13 RCT were selected, indicating GLP1 RA significantly improved the fasting blood glucose (FPG) and glycosylated hemoglobin (HbA1c) in obese patients with type 2 diabetes, and showed significant advantages in improving body weight, and GLP1 RA could greatly improve. Islet cell function in obese patients (MD=5.80, 95%CI=3.168.45,P<0.01). Conclusion In overweight and obese patients, GLP1 RA can significantly improve blood glucose and lose weight, and it has proved the advantage of protecting islet cell function from different aspects. Such drugs provide a new choice for obese and overweight patients to reduce blood glucose.

Metaanalysis of the effect of highfat and lowsugar diet on respiratory function in patients with mechanical ventilation of COPD

Zhou Yanxiang1, Mei Bo2, Liu Zhongyang2

2019, 34(12): 1108-1114. doi:10.3969/j.issn.1004-583X.2019.12.011

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Objective To systematically evaluate the effects of highfat and lowsugar diet on respiratory function in patients with mechanical ventilation of chronic obstructive pulmonary disease(COPD). Methods Chinese and English databases, such as China national knowledge infrastructure (CNKI), VIP database (VIP), Wanfang database, PubMed, EMbase were searched. Randomized controlled trials(RCTs) in Chinese and English on highfat and lowsugar diet and COPD mechanical ventilation published in 2019 were collected from January to October. Two researchers independently screened the literature that met the inclusion and exclusion criteria, summarized the opinions and extracted the data. The Cochrane bias risk assessment tool was used to evaluate the quality of the literature. Results A total of 15 RCTs were collected, including 1 146 patients. Metaanalysis showed the data of highfat and lowsugar group were higher than those of control group in many aspects, such as VE(MD=-1.4, Z=8.23, P＜0.01, 95%CI -1.74, -1.07), VCO2 (MD=-42.61, Z=8.65, P＜0.01, 95%CI -52.26, -32.96), VO2(MD=-30.16, Z=7.37, P＜0.01, 95%CI -38.18,-22.14), RQ(MD=-0.08, Z=19.3, P＜0.01, 95%CI -0.08,-0.07), PaCO2(MD=-1.13, Z=5.93, P＜0.01, 95%CI -1.5, -0.76), PaO2(MD=1.24, Z=8.02, P＜0.01, 95%CI 0.94, 1.54). Conclusion Highfat and lowsugar diets can improve respiratory function in patients with COPD mechanical ventilation, reduce the production of CO, lower PaCO2, raise PaO2, and correct respiratory failure.

Three cases of patients with cardiac arrest under ECMO and literature review

Niu Shaoqian1, Zhang Xiaoqing1, Tian Yingping2a, Fu Xianghua2b

2019, 34(12): 1115-1118. doi:10.3969/j.issn.1004-583X.2019.12.012

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Acute myocardial infarction (AMI) and acute fulminant myocarditis can be manifested as pulseless electrical activity. Patients of cardiac arrest (CA) with nonpulsating electrical activity have a very high mortality rate before the cause is corrected. Extracorporeal membrane oxygenation (ECMO), an artificial cardiopulmonary support organ, provides a bridge treat patients with CA. A total of three patients who had undergone cardiopulmonary resuscitation were treated with ECMO. By introducing the treatment process of those cases, we aimed to improve the understanding of ECMO assisted treatment.

Primary myelofibrosis with paroxysmal nocturnal hemoglobinuria: a case report and literature review

Feng Sanli1,2, Zhang Jingnan2, Qiao Shukai2, Wang Wenfei1, Li Yang2, Xing Lina2, Guo Xiaonan2

2019, 34(12): 1119-1122. doi:10.3969/j.issn.1004-583X.2019.12.013

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The clinical characteristics of the pathogenesis of primary myelofibrosis (PMF) with paroxysmal nocturnal hemoglobinuria (PNH) were analyzed. Bone marrow imaging and bone marrow pathology were carried out by means of cytochemical staining and silver staining. Flow cytometry(FCM) was used to detect CD55 and CD59 on the surface of erythrocytes and granulocytes. And the granulocytes and monocytes were detected by FLAER.For further diagnosis, highthroughput sequencing technology(also known as the second generation sequencing)was used for genetic testing.The patient was clinically characterized by severe splenomegaly and anemia, which might be diagnosed with PMF by bone marrow examination.However, bone marrow pathology showed myelofibrosis (MF) grade 3. Genetic testing showed that BCR/ABL fusion gene was negative and JAK2 V617F positive. Therefore, the patient was diagnosed with PMF.Then, the patient was treated with danazol, testosterone undecanoate, erythropoietin(EPO), thalidomide, and blood product support.While the blood product infusion was ineffective during treatment and brown urine appeared, but the relevant examination was improved.The blood routine test showed that high reticulocyte, direct bilirubin, indirect bilirubin were high, the Coombs test was negative for twice, FCM showed the reduction of CD55 and CD59, and FLAER presented the expression defect of granulocytes and monocytes. And PIGA gene mutation was found positive.Therefore, the patient was diagnosed as PMF with PNH.

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