Circadian Rhythmicity as a Predictor of Quality of Life in Allogeneic Hematopoietic Cell Transplant Patients

Context

Quality of life (QoL) is increasingly recognized as an important outcome of cancer treatment. Previous studies have examined clinical predictors of QoL, but with the increasing prevalence of wearable sensors that monitor sleep and activity patterns, further investigation into whether these behaviors are predictive of post-treatment QoL is now feasible. Among patients receiving aggressive cancer treatment such as hematopoietic cell transplantation (HCT), analysis of circadian rhythms (24-hour patterns of sleep and activity) via wearable sensors is limited.

Assessment of fluid and nutritional status using bioelectrical impedance methods in acute kidney injury patients requiring continuous renal replacement therapy

Objective To investigate the predictive value of nutritional and fluid status measured by bioelectrical impedance methods for the prognosis of acute kidney injury (AKI) patients undergoing continuous renal replacement therapy (CRRT). Methods Patients with severe AKI received CRRT in the First Affiliated Hospital of Nanjing Medical University from September 2016 to September 2018 were enrolled, and divided into death group and survival group according to 28-day survival. Cox regression was used to analyze the association between 28-day survival and lean tissue index (LTI), fat tissue index (FTI), the ratio of extracellular water (ECW) and body cell mass (BCM) (ECW/BCM), and overhydration (OH), respectively. Results A total of 156 patients were included, including 101 males and 55 females. The age was (62.7±15.4) years, with sequential organ failure assessment (SOFA) score of 9.9±3.9. The 28-day mortality rate was 46.2%. The pre-CRRT OH values in the 28-day survival group and death group were 2.95(1.80, 5.50) L and 4.20(2.95, 5.70) L(P=0.016), and ECW/BCM values were 1.00(0.76, 1.18) and 1.07(0.88, 1.25) (P=0.033), respectively. Univariate Cox regression analysis showed that pre-CRRT high OH values (HR=1.08, 95%CI 1.00-1.17, P=0.040) and high ECW/BCM values (HR=3.02, 95%CI 1.46-6.22, P=0.003) were associated with 28-day death. The changes of OH values (HR=0.83, 95%CI 0.72-0.95, P=0.008) and ECW/BCM values (HR=6.79, 95%CI 1.72-26.82, P=0.006) between pre-CRRT and the 7th day after CRRT initiation were significantly associated with 28-day mortality in patients who survived 7 days after CRRT initiation. After adjusting for age, gender, and SOFA scores, multivariate Cox regression analysis showed that the high OH value (HR=1.16, 95%CI 1.06-1.27, P=0.002) and the high ECW/BCM value (HR=2.80, 95%CI 1.30-6.06, P=0.003) before CRRT, the change of OH value (HR=0.82, 95%CI 0.72-0.95, P=0.008) and ECW/BCM value (HR=2.79, 95%CI 1.30-5.98, P=0.009) between the 7th day after CRRT initiation and pre-CRRT, were independently associated with 28-day death, while LTI (HR=0.93, 95%CI 0.86-1.02, P=0.113) and FTI (HR=0.98, 95%CI 0.92-1.04, P=0.475) before CRRT were uncorrelated with 28-day death. Conclusions In bioelectrical impedance analysis, the high OH value and high ECW/BCM value before CRRT are associated with 28-day mortality in patients with AKI, while the nutritional indicators LTI and FTI before CRRT are not significantly related. The correction of fluid overload by CRRT within 7 days may reduce the risk of 28-day mortality.     

Instrument-based Tests for Measuring Anterior Chamber Cells in Uveitis: A Systematic Review

ABSTRACT

Purpose

New instrument-based techniques for anterior chamber (AC) cell counting can offer automation and objectivity above clinician assessment. This review aims to identify such instruments and its correlation with clinician estimates.     

妊娠期高血压患者血清微小RNA-210、-204-5p、-376c与其血液流变学指标的相关性及其诊断价值研究

目的探讨妊娠期高血压患者血清微小RNA(miRNA)-210、-204-5p、-376c与其血液流变学指标的相关性，以及其诊断价值。 方法采用简单随机抽样方法，随机抽取2016年10月至2018年10月，于河北省黄骅市人民医院收治的妊娠期高血压患者80例为研究对象，并纳入研究组(n＝80)。采用相同抽样方法，随机抽取同期于本院接受定期产前检查的80例中孕期正常妊娠妇女为对照，纳入对照组(n＝80)。采用实时荧光定量PCR，检测2组受试者血清miRNA-210、-204-5p及-376c的相对表达量。采用全自动血细胞分析仪，检测2组受试者的血液流变学指标。2组受试者血清miRNA-210、-204-5p、-376c相对表达量及血液流变学指标比较，采用成组t检验。采用受试者工作曲线下面积(ROC-AUC)，分析血清miRNA-210、-204-5p及-376c的相对表达量，对妊娠期高血压的诊断价值。采用Pearson相关系数分析妊娠期高血压患者血清miRNA-210、-204-5p及-376c的相对表达量与其血液流变学指标的相关性。本研究获得河北省黄骅市人民医院伦理委员会批准(批准文号：18101523)，并且受试者均签署临床研究知情同意书。2组受试者的年龄、入组时孕龄、孕前人体质量指数、孕次、产次等一般临床资料分别比较，差异均无统计学意义(P>0.05)。 结果①研究组患者血清miRNA-210、-204-5p的相对表达量分别为(1.56±0.35)与(1.78±0.40)，均显著高于对照组的(0.59±0.11)与(0.72±0.15)，研究组患者血清miRNA-376c的相对表达量为(0.33±0.09)，却显著低于对照组的(1.24±0.32)，2组上述指标分别比较，差异均有统计学意义(t＝23.648、22.193、24.485，均为P<0.001)。②血清miRNA-210、-204-5p及-376c的相对表达量诊断妊娠期高血压的ROC-AUC分别为0.824(95%CI：0.738～0.902，P<0.001)，0.871(95%CI：0.810～0.943，P<0.001)，0.833(95%CI：0.746～0.908，P<0.001)。根据约登指数最大原则，血清miRNA-210、-204-5p及-376c的相对表达量，对于诊断妊娠期高血压的最佳临界值分别为0.696、1.512及0.712，此时其诊断妊娠期高血压的敏感度分别为83.3%、93.1%及85.0%，特异度分别为85.0%、75.0%及85.0%。③研究组患者的全血低切黏度(WRV)、低切还原黏度(LSRV)、血浆黏度(PV)分别为(7.9±1.5) mPa·s、(17.6±3.6) mPa·s、(1.6±0.3) mPa·s，分别显著高于对照组的(7.2±1.3) mPa·s、(15.6±3.4) mPa·s、(1.2±0.2) mPa·s，2组上述指标比较，差异均有统计学意义(t＝3.154、P＝0.002，t＝3.613、P<0.001，t＝9.923、P<0.001)。④妊娠期高血压患者血清miRNA-210相对表达量与其WRV、LSRV、PV，均呈正相关关系(r＝0.343、P＝0.002，r＝0.415、P<0.001，r＝0.287，P＝0.001)；血清miRNA-204-5p相对表达量与PV亦呈正相关关系(r＝0.326、P＝0.003)；miRNA-376c相对表达量与WRV、LSRV，均呈正相关关系(r＝0.317、P＝0.004，r＝0.351、P＝0.001)。 结论妊娠期高血压患者血清miRNA-210、-204-5p、-376c相对表达量与其血液流变学指标存在相关性，并且有望成为诊断妊娠期高血压的潜在生物标志物。     

儿童复发性腹股沟斜疝的腹腔镜内环结扎术治疗

目的探讨腹腔镜内环结扎术治疗儿童复发性腹股沟斜疝的优势及手术经验。 方法选择2013年1月至2018年1月，广州市妇女儿童医疗中心收治的34例复发性腹股沟斜疝患儿为研究对象。回顾性分析其临床病例资料。根据本次入院采取的手术治疗方式，将其分为腹腔镜组(n＝19，采用腹腔镜内环结扎术)和开放手术组(n＝15，采用疝囊高位结扎术)。采用独立样本t检验及χ²检验，对2组患儿一般临床资料、术中及术后情况等，进行统计学分析。本研究符合2013年修订的《世界医学协会赫尔辛基宣言》要求，所有患儿监护人均于术前签署手术治疗知情同意书。 结果①开放手术组患儿术后，3例出现阴囊血肿，1例出现医源性隐睾。2组患儿术后均未发生伤口感染、睾丸萎缩、阴囊积液及再次复发等其他并发症。②2组患儿中，男性患儿所占比例、月龄及初次手术为腹腔镜手术所占比例比较，差异均无统计学意义(P>0.05)。腹腔镜组患儿的手术时间、术中出血量、住院时间及术后并发症发生率分别为(30.0±10.7) min、(1.0±0.3) mL、(1.2±0.4) d、0，均显著短于或少于开放手术组的(44.7±24.5) min、(2.3±1.3) mL、(3.3±1.0) d、26.7%；其住院费用为(7 547±820)元，则显著高于开放手术组的(5 488±1 218)元，并且差异均有统计学意义(t＝－2.347、P＝0.044，t＝－3.859、P＝0.002，t＝－8.171、P<0.001，P＝0.029，t＝5.580、P<0.001)。 结论腹腔镜内环结扎术治疗儿童复发性腹股沟斜疝，具有安全有效、术中情况良好、术后并发症少等优势，但住院费用相对偏高。     

临床药师对垂体瘤卒中合并哮喘患者的术后药学监护

摘 要本文介绍1例有哮喘病史的患者行经蝶垂体瘤切除术后哮喘加重的案例。临床药师根据垂体瘤卒中急症特征及氢化可的松药动学特点，为患者制定了个体化的糖皮质激素替代治疗方案。在患者出现明显哮喘症状时及时调整糖皮质激素和支气管扩张剂。使用低剂量的右美托咪定适当镇静改善患者烦躁，避免患者自主呼吸与呼吸机对抗导致哮喘治疗不佳。治疗过程中，临床药师协助医师根据患者情况及时调整治疗方案，充分体现了临床药师在外科围手术期患者药物治疗管理中的价值。     

Genome-Wide Meta-Analysis Identifies Three Novel Susceptibility Loci and Reveals Ethnic Heterogeneity of Genetic Susceptibility for IgA Nephropathy

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Effects of Ginkgo biloba extract EGb761 on neural differentiation of stem cells offer new hope for neurological disease treatment

Stem cell transplantation has brought new hope for the treatment of neurological diseases.The key to stem cell therapy lies in inducing the specific differentiation of stem cells into nerve cells.Because the differentiation of stem cells in vitro and in vivo is affected by multiple factors,the final differentiation outcome is strongly associated with the microenvironment in which the stem cells are located.Accordingly,the optimal microenvironment for inducing stem cell differentiation is a hot topic.EGb761 is extracted from the leaves of the Ginkgo biloba tree.It is used worldwide and is becoming one of the focuses of stem cell research.Studies have shown that EGb761 can antagonize oxygen free radicals,stabilize cell membranes,promote neurogenesis and synaptogenesis,increase the level of brain-derived neurotrophic factors,and replicate the environment required during the differentiation of stem cells into nerve cells.This offers the possibility of using EGb761 to induce the differentiation of stem cells,facilitating stem cell transplantation.To provide a comprehensive reference for the future application of EGb761 in stem cell therapy,we reviewed studies investigating the influence of EGb761 on stem cells.These started with the composition and neuropharmacology of EGb761,and eventually led to the finding that EGb761 and some of its important components play important roles in the differentiation of stem cells and the protection of a beneficial microenvironment for stem cell transplantation.