非诺贝特对糖尿病大鼠肾功能改善作用及抗氧化应激机制

目的研究非诺贝特对糖尿病大鼠肾功能的改善作用及其机制。方法大鼠一次性腹腔注射链脲佐菌素65mg·kg-1制备糖尿病模型,随机分为对照组、模型组,非诺贝特低、中、高剂量(20,40,80mg·kg-1)组,每组10只,每天灌胃给予相应剂量的非诺贝特,于第8周末测尿白蛋白(Alb)、视黄醇结合蛋白(RBP)和肌酐;腹主动脉取血,测定血糖和糖化血红蛋白(Hb A1c)。取出肾脏,一部分肾组织用4℃生理盐水冲洗后,称重研磨制成匀浆,再离心,取上清液测定MDA、SOD活性、GSH活性、NO含量、NOS活性和Na-K-ATP酶活性。另一部分肾组织光镜下检测组织病理学变化。结果与对照组相比,模型组Alb和RBP明显升高(P<0.05),肾组织中NO含量、NOS、GSH和SOD活性明显降低(P<0.05)、MDA含量明显升高,Na-K-ATP酶活性降低(P<0.05),肾组织病理损伤严重。与模型组相比,非诺贝特80mg·kg-1组Alb和RBP明显降低(P<0.05),肾组织中NO含量、NOS、GSH-Px和SOD活性明显上升、MDA含量明显下降,Na-K-ATP酶活性升高(P<0.05),肾组织病理损伤减轻。结论非诺贝特能降低糖尿病大鼠肾脏损伤起保护作用,这可能与提高肾脏抗氧化应激损伤有关。     

肝素联合低分子肝素预防动静脉内瘘术后早期血栓形成

摘 要 目的： 研究肝素联合低分子肝素对预防动静脉内瘘（AVF）术后早期血栓形成的影响。方法: 采用前瞻性研究方法,将299例行AVF术的患者随机分为两组,对照组患者术后给予低分子肝素5 000 IU皮下注射qd×7 d;观察组术中在游离动脉端与静脉端分别推注1 500 u肝素钠,术后给予低分子肝素5 000 IU皮下注射qd×7 d。观察两组患者术后1周和4周AVF血栓形成率及药品不良反应（ADR）发生情况。结果: 术后1周,对照组和观察组的AVF血栓形成率分别为3.4%和0;术后4周分别为4.8%和0.67%,观察组均明显低于对照组（P<0.05）。两组ADR发生率差异无统计学意义（P>0.05）,未发生严重不良反应。结论: 肝素联合低分子肝素可降低AVF术后早期血栓形成率,提高手术成功率,安全性较好。     

TURP联合EMS经尿道同期治疗前列腺增生并发尿路结石（附37例报道）

目的：评估经尿道前列腺电切术（TURP）联合第三代瑞士气压弹道碎石联合超声碎石吸附设备（EMS）经尿道同期治疗良性前列腺增生（BPH）合并尿路结石患者的临床疗效。方法回顾性分析该科2011年4月—2014年7月37例良性前列腺合并尿路结石的患者资料,先采用输尿管镜配合气压弹道碎石术治疗输尿管结石,肾镜下气压弹道及超声碎石清石术治疗膀胱结石,而后采用经尿道前列腺电切术（TURP）治疗BPH。结果效果良好,37例患者均一次手术成功,所有结石一次性被清除,无大出血,膀胱穿孔,水中毒,严重感染及尿失禁等并发症,但有1例尿道外口狭窄经行尿道扩张治愈。术后复查KU B显示尿路内无结石残留,随访3～12个月,所有患者无结石复发。结论 TURP联合EMS手术具有创伤小,操作方式简单,手术时间短,术后恢复快,安全,并发症少等优点,是治疗BPH并尿路结石简单而有效方法。     

Evaluating Factors Contributing to Dropout in a Large Peritoneal Dialysis Program

BackgroundThe low prevalence of peritoneal dialysis (PD) (9%) vs. hemodialysis (HD) (88.2%) is partly due to patient dropout from therapy.MethodsThis retrospective study identified patients who withdrew from PD between 2016 and 2018 in our program. We evaluated all other factors as controllable losses. Analysis included time on therapy at dropout (very early, early or late) and method of initiation (HD to PD conversion, unplanned PD, or planned start).ResultsEighty-three patients enrolled into our PD program. 27 dropped out; 24 were due to controllable factors, 3 due to death, with a median age at dropout of 52 years old. We determined psychosocial factors (PF) to be the largest controllable factor influencing dropout; contributing a 63% rate among all controllable factors. When considering time until dropout, 100% of very early dropout patients and 50% of late dropout patients did so due to PF. Among early dropout patients 67% dropped out due to other medical reasons. The mean time to dropout for PF, other, and infection (INF) were 13, 26, and 33 months, respectively. When considering type of initiation, we found PF to be the largest attributable factor with 50% of unplanned, 100% of planned, and 50% of conversions stopping therapy.ConclusionsOur study indicates that the primary reason for controllable loss from therapy was secondary to PF regardless of the time on therapy or the method of initiation to therapy.     

Low-dose oral hydroxychloroquine led to impaired vision in a child with renal failure: Case report and literature review

Introduction:Hydroxychloroquine (HCQ) has received much attention in the treatment of coronavirus disease 2019 recently. However, it can cause irreversible vision loss. Few cases have been reported in pediatric patient with HCQ-related adverse reactions. Appropriate administration and early disease recognition are important for reducing the adverse drug reactions of HCQ.Patient concerns:We report a case of a 14-year-old Chinese girl who sought treatment for rapidly decreasing vision in the left eye over 3 days. The simulation results of the population pharmacokinetic model of HCQ revealed that the plasma concentration of HCQ abnormally increased before the visual acuity of the eye decreased.Diagnosis:She was diagnosed as HCQ related drug adverse reaction.Interventions:The daily dose of HCQ for this patient was adjusted from 100 mg/d to 50 mg/d.Outcomes:Follow-up for 6 months showed no more vision loss recurrence. However, the existing decreased visual acuity of the eye did not recover either.Conclusion:Although decreased visual acuity is an infrequent symptom, ophthalmologists should be aware of the possibility of HCQ concentration enrichment and consider minimizing HCQ use when a child with renal hypofunction seeks treatment for shortsightedness.     

Comparison of the antidiabetic effects of linagliptin among groups with a normal renal function and a mild or severe renal impairment – retrospective observation study of Japanese patients with type 2 diabetes mellitus

Objective: The clinical course > 6 months after the initiation of linagliptin in patients with type 2 diabetes was compared among the groups divided by their renal function.

Methods: Two hundred and sixteen Japanese patients with type 2 diabetes treated with 5 mg once daily linagliptin were studied as the treated set. One hundred and forty-five subjects whose medications were not changed during the observation period were investigated as the full analysis set to assess the effectiveness. The subjects were divided into three groups based on an eGFR: eGFR ≥ 60, 59 – 45 and < 45 ml/min/1.73 m². The parameters were analyzed separately in the patients receiving monotherapy and additional therapy of linagliptin.

Results: The HbA1c (NGSP) levels significantly improved in both the patients receiving monotherapy and additional therapy. The changes in the HbA1c levels at 6 months were not significantly different between the groups with an eGFR ≥ 60, 59 – 45 and < 45 ml/min/1.73 m² receiving monotherapy (?1.0, ?0.8 and ?0.8%, respectively). Similarly, those were not significantly different between the different groups receiving additional therapy (?0.6, ?0.5 and ?0.7%, respectively).

Conclusions: Linagliptin is considered to be effective for patients with type 2 diabetes and renal impairment in the present analysis performed at our institution.     

Tumor microenvironment immune subtypes for classification of novel clear cell renal cell carcinoma profiles with prognostic and therapeutic implications

Currently, no effective prognostic model of clear cell renal cell carcinoma (ccRCC) based on immune cell infiltration has been developed. Recent studies have identified 6 immune groups (IS) in 33 solid tumors. We aimed to characterize the expression pattern of IS in ccRCC and evaluate the potential in predicting patient prognosis. The clinical information, immune subgroup, somatic mutation, copy number variation, and methylation score of patients with TCGA ccRCC cohort were downloaded from UCSC Xena for further analysis. The most dominant IS in ccRCC was the inflammatory subgroup (immune C3) (86.5%), regardless of different pathological stages, pathological grades, and genders. In the C3 subgroup, stage IV (69.1%) and grade 4 (69.9%) were the least presented. Survival analysis showed that the IS could effectively predict the overall survival (OS) (P < .0001) and disease-specific survival (DSS) (P < .0001) of ccRCC alone, of which group C3 (OS, HR = 2.3, P < .001; DSS, HR = 2.84, P < .001) exhibited the best prognosis. Among the most frequently mutated ccRCC genes, only VHL and PBRM1 were found to be common in the C3 group. The homologous recombination deficiency score was also lower. High heterogeneity was observed in immune cells and immunoregulatory genes of IS. Notably, CD4+ memory resting T cells were highly infiltrating, regulatory T cells (Treg) showed low infiltration, and most immunoregulatory genes (such as CX3CL1, IFNA2, TLR4, SELP, HMGB1, and TNFRSF14) were highly expressed in the C3 subgroup than in other subgroups. Enrichment analysis showed that adipogenesis, apical junction, hypoxia, IL2 STAT5 signaling, TGF-beta signaling, and UV response DN were activated, whereas E2F targets, G2M checkpoint, and MYC targets V2 were downregulated in the C3 group. Immune classification can more accurately classify ccRCC patients and predict OS and DSS. Thus, IS-based classification may be a valuable tool that enables individualized treatment of patients with ccRCC.