Aortitis and periaortitis: The puzzling spectrum of inflammatory aortic diseases

Aortitis and periaortitis are inflammatory diseases of the aorta and its main branches; they differ in the extension of inflammation, which is confined to the aortic wall in aortitis, and spreads to the periaortic space in periaortitis. Aortitis is classified as non-infectious or infectious. Non-infectious aortitis represents a common feature of large-vessel vasculitides but can also be isolated or associated with other rheumatologic conditions. Periaortitis can be idiopathic or secondary to a wide array of etiologies such as drugs, infections, malignancies, and other proliferative diseases. Notably, both aortitis and periaortitis may arise in the context of IgG4-related disease, a recently characterised fibro-inflammatory systemic disease. Prompt recognition, correct diagnosis and appropriate treatment are essential in order to avoid life-threatening complications.     

Predictive monitoring in neonates

Premature infants are physiologically immature and are particularly vulnerable to systemic illnesses. Instability of vital signs related to immaturity of organ systems are common but may also represent early manifestations of serious illness. While vital signs are frequently or continuously monitored in critically unwell neonates, changes in these parameters are subtle in the early phase of illness such as sepsis and difficult to interpret using traditional neonatal monitoring tools. Recent advances in identifying trends and patterns of vital signs in the pre-clinical phase of the illness, particularly in the field of heart rate characteristics monitoring has opened up the potential to improve outcomes through rapid and timely investigations and early intervention. This article reviews the current evidence in predictive monitoring of neonates and discusses potential clinical implications.     

Shrunken pore syndrome - a common kidney disorder with high mortality. Diagnosis,prevalence, pathophysiology and treatment options

Invasive studies show that the glomerular sieving coefficients for 5–30 kDa plasma proteins in the human kidney may be selectively reduced compared to those for small molecules < 0.9 kDa, commonly used to measure glomerular filtration rate (GFR). Identification of this pathophysiological state, called shrunken pore syndrome (SPS), can easily and non-invasively be done by comparing estimations of GFR using cystatin C (13.3 kDa) and creatinine (0.113 kDa). SPS is present if the estimate of GFR using cystatin C is lower than 60 or 70% of the estimate using creatinine in the absence of non-renal influences on cystatin C or creatinine. All studies of SPS show that the 3- or 5-year mortality is strongly increased and high hazard ratios for mortality associated with SPS have been observed for many different patient cohorts, including cohorts with normal measured GFR, no albuminuria and no diagnosis. The prevalence of SPS in the cohorts so far investigated is between 0.2 and 36%. Proteome studies of SPS demonstrate that the high mortality associated with the syndrome might be caused by the accumulation of 10–30 kDa signalling proteins promoting development of atherosclerosis and thus suggesting use of monoclonal antibodies to reduce the levels of the most detrimental signalling proteins as a treatment option. The KDIGO recommendations for classification of chronic kidney disease (CKD) comprise determination, or estimation, of GFR and analysis of albuminuria and therefore cannot identify a large fraction of the patients with SPS. The high prevalence and mortality of SPS and the possible treatment options strongly suggest that the KDIGO recommendations should be expanded to include determination of cystatin C to be able to identify all patients with SPS.     

Glomerular filtration rate in liver transplant for unresectable hepatoblastoma

Most children with hepatoblastoma manifest, at the time of LT, a decrease in renal function due to chemotherapy that could be further deteriorated by the use of calcineurin inhibitors. The purpose of this work was to examine the long‐term follow‐up of renal function in a cohort of children transplanted for unresectable hepatoblastoma. We present a retrospective observational study of 10 pediatric patients who received a LT for unresectable hepatoblastoma between 1996 and 2016. All patients included in this study were followed up on a regular basis and were assessed for GFR before transplantation and at least once a year during follow‐up. All patients received standardized chemotherapy treatment for hepatoblastoma and immunosuppression according to hospital protocols. There was a marked decrease in GFR at the time of the LT in five patients presenting renal complications during the pretransplant cycles of chemotherapy. Three patients, one of them with prior kidney involvement, presented complications after LT, namely acute kidney failure and decrease in GFR. Those patients who presented with the lowest GFR at the time of LT eventually recovered renal function at levels similar to the rest of the group on follow‐up. Chemotherapy‐induced nephrotoxicity is a concern in patients treated for hepatoblastoma. Some individuals will develop low GFR after chemotherapy; therefore, strict follow‐up is recommended, as low GFR may affect the doses of subsequent chemotherapy and immunosuppression. Stabilization of GFR levels and occasional improvement can be observed in the post‐transplant period.     

2014—2019年四川省通江县居民主要慢性病死亡及早死概率分析

摘 要 目的 分析2014—2019年四川省通江县死因监测数据，了解居民主要慢性病死亡及早死概率等数据，为地区卫生健康工作提供依据。方法 利用2014—2019年通江县死因监测数据，按照国际疾病分类标准(ICD-10)对数据进行分类，采用死亡率、早死概率等指标进行分析。结果 2014—2019年通江县居民慢性病死亡占总死亡的比例为89.99%，其中30~69岁死亡的占慢性病死亡总数的32.69%，总人群、男性和女性慢性病粗死亡率呈上升趋势，年度变化百分比分别为5.04%、4.98%和5.12%，男性慢性病粗死亡率高于女性(x2=123.02，P＜0.01)；主要慢性病死亡占总死亡的82.86%，其中恶性肿瘤粗死亡率呈下降趋势(APC=-3.65%，P＜0.05)，心脑血管疾病、慢性呼吸系统疾病和糖尿病的粗死亡率呈上升趋势(APC=6.39%、9.90%和33.73%，P＜0.05)；主要慢性病早死概率在13.32%~20.51%之间波动，心脑血管疾病、恶性肿瘤、慢性呼吸系统疾病和糖尿病的早死概率分别为7.69%、5.71%、2.28%和0.33%，随着时间变化趋势差异无统计学意义(P＞0.05)。结论 主要慢性病已成为通江县居民慢性病死亡的主要原因，应采取健全慢性病防控体系、加强慢性病筛查与早诊早治及践行健康生活方式等综合干预措施，降低主要慢性病的影响。     

Peri-ictal heart rate variability parameters as surrogate markers of seizure severity

This study aims at defining objective parameters reflecting the severity of peri-ictal autonomic changes and their relation to post-ictal generalized electroencephalography (EEG) suppression (PGES), with the view that such changes could be detected by wearable seizure detection systems and prove useful to assess the risk of sudden unexpected death in epilepsy (SUDEP). To this purpose, we assessed peri-ictal changes in heart rate variability (HRV) and correlated them with seizure duration, intensity of electromyography-based ictal muscle activity, and presence and duration of post-ictal generalized EEG suppression (PGES). We evaluated 75 motor seizures from 40 patients, including 61 generalized tonic-clonic seizures (GTCS) and 14 other major motor seizure types. For all major motor seizures, HRV measurements demonstrated a significantly decreased parasympathetic activity and increased sympathetic activity in the post-ictal period. The post-ictal increased sympathetic activity was significantly higher for GTCS as compared with non-GTCS. The degree of peri-ictal decreased parasympathetic activity and increased sympathetic activity was associated with longer PGES (>20 s), longer seizure duration, and greater intensity of ictal muscle activity. Mean post-ictal heart rate (HR) was an independent predictor of PGES duration, seizure duration, and intensity of ictal muscle contraction. Our results indicate that peri-ictal changes in HRV are potential biomarkers of major motor seizure severity.     

利用交叉滞后通径分析研究血压与肾小球滤过率之间的时间因果关系

目的了解血压(blood pressure,BP)与肾小球滤过率(estimated glomerular filtration rate,eGFR)之间的因果关系。方法于2013年1-8月在辽宁省大洼、彰武和辽阳县农村地区采用多阶段随机整群抽样方法建立了心血管疾病研究队列,并于2015年8月-2016年1月对其中6893名35岁及以上农村居民进行随访调查。采用交叉滞后通径分析模型描述BP与eGFR在高血压和非高血压人群中的因果关系。结果 6893名农村居民(女性占52.3%;平均年龄52.39±10.10岁)的平均随访时间为(28.74±3.47)个月。对于高血压患者,eGFR与收缩压(systolic BP,SBP)相互影响,但eGFR先于SBP发生变化[eGFR→SBP的路径系数ρ1=-0.112,P<0.001;SBP→eGFR的路径系数ρ2=-0.070,P<0.001;ρ1 vs ρ2,P=0.044];eGFR单向影响舒张压(diastolic BP,DBP)。对于非高血压人群,eGFR与SBP相互影响,无先后之分;eGFR与DBP不相互影响。结论农村高血压患者eGFR和血压是相互作用的,且仅存在eGFR升高先于SBP升高。农村非高血压人群eGFR和SBP是相互作用的,且没有先后顺序之分,eGFR和DBP之间无因果关系。     

Conventional vs machine learning–based treatment planning in prostate brachytherapy: Results of a Phase I randomized controlled trial

PurposeThe purpose of this study was to evaluate the noninferiority of Day 30 dosimetry between a machine learning–based treatment planning system for prostate low-dose-rate (LDR) brachytherapy and the conventional, manual planning technique. As a secondary objective, the impact of planning technique on clinical workflow efficiency was also evaluated.Materials and Methods41 consecutive patients who underwent I-125 LDR monotherapy for low- and intermediate-risk prostate cancer were accrued into this single-institution study between 2017 and 2018. Patients were 1:1 randomized to receive treatment planning using a machine learning–based prostate implant planning algorithm (PIPA system) or conventional, manual technique. Treatment plan modifications by the radiation oncologist were evaluated by computing the Dice coefficient of the prostate V_150% isodose volume between either the PIPA—or conventional—and final approved plans. Additional evaluations between groups evaluated the total planning time and dosimetric outcomes at preimplant and Day 30.Results21 and 20 patients were treated using the PIPA and conventional techniques, respectively. No significant differences were observed in preimplant or Day 30 prostate D_90%, V_100%, rectum V₁₀₀, or rectum D_1cc between PIPA and conventional techniques. Although the PIPA group had a larger proportion of patients with plans requiring no modifications (Dice = 1.00), there was no significant difference between the magnitude of modifications between each arm. There was a large significant advantage in mean planning time for the PIPA arm (2.38 ± 0.96 min) compared with the conventional (43.13 ± 58.70 min) technique (p >> 0.05).ConclusionsA machine learning–based planning workflow for prostate LDR brachytherapy has the potential to offer significant time savings and operational efficiencies, while producing noninferior postoperative dosimetry to that of expert, conventional treatment planners.