Brain magnetic resonance and cognitive function changes in maintenance hemodialysis patients

Objective To investigate cerebrovascular lesions on maintenance hemodialysis (MHD) patients, including types of cerebrovascular disease, and cognitive function changes. Methods A cross-sectional study was applied. A total of 270 MHD patients at hemodialysis center of Peking Union Medical College Hospital were screened, and finally 117 cases were enrolled. Demographic information, aboratory data, MRI and MRA data were collected and assessed. Cognitive function was evaluated with C - MMSE (Chinese mini mental test examination) and C - MoCA (Chinese montreal cognitive assessment). The related factors were selected by Spearman correlation analysis, multiple linear regression and logistic regression analysis. Results The patients’average age was (56.0± 12.5) years, average hemodialysis age was (73.5±60.8) months. Only 5.1% patients had clinical history of cerebral infarction or hemorrhage. Pre - hemodialysis blood pressure was (142.7/80.3±18.2/12.9) mmHg, Post-hemodialysis blood pressure was (130.2/79.1±23.4/14.9) mmHg. A total of 18.8% patients had intra-hemodialysis hypotension, spKt/V was (1.45±0.25). MR results showed that 12.0% patients had cerebral artery stenosis, 5.1% patients had cortical infarcts, 39.3% patients had lacunar infarcts, 47.0% patients had microbleeds, 7.7% patients had chronic hematoma, 52.1% patients had abnormal brain whiter matter lesions (WMLs). In cognitive function evaluation, 20.9% patients had abnormal C-MMSE scores, but 65.2% patients had abnormal C-MoCA results. Multiple linear regression showed age (b=0.059, P＜0.01), dialysis age (b=0.005, P＜0.05) were associated with WMLs in MHD patients. Intra-hemodialysis hypotension was an independent risk factor of lacunar infarcts (b=2.123, P＜0.01) and microbleeds (b=3.531, P＜0.01). Low serum albumin level was an independent risk factor of cognitive decline (b=0.314, P＜0.05). Logistic regression analysis showed pre - hemodialysis systolic blood pressure was an independent risk factor of cortical infarcts [OR=1.088, 95%CI (1.018-1.152), P＜ 0.05]. Gender, dialysis age and pre - dialysis serum TCO2 level were related with chronic hematoma. Conclusions WMLs is related with dialysis voltage. Lacunar infarcts and mirobleeds are related with intra - hemodialysis hypotension. Lacunar infarcts, WMLs and nutritional status are contributed to decline of cognition in MHD patients.     

Identification of a human B-cell/myeloid common progenitor by the absence of CXCR4

CXCR4 is a chemokine receptor required for hematopoietic stem cell engraftment and B-cell development. This study found that a small fraction of primitive CD34(+)/CD19(+) B-cell progenitors do not express CXCR4. These CD34(+)/CD19(+)/CXCR4(-) cells were also remarkable for the relative lack of primitive myeloid or lymphoid surface markers. When placed in B-lymphocyte culture conditions these cells matured to express CXCR4 and other surface antigens characteristic of B cells. Surprisingly, when placed in a myeloid culture environment, the CXCR4(-) B-cell progenitors could differentiate into granulocyte, macrophage, and erythroid cells at a high frequency. These data define a novel B-cell/myeloid common progenitor (termed the BMP) and imply a less restrictive pathway of myeloid versus lymphoid development than previously postulated.     

Clinical factors predictive of outcome with bortezomib in patients with relapsed, refractory multiple myeloma

Bortezomib, a potent and reversible proteasome inhibitor, affects the myeloma cell and its microenvironment, resulting in down-regulation of growth and survival signaling pathways and durable responses in patients with relapsed and refractory myeloma. Potential associations between baseline parameters and outcomes with bortezomib were explored in 202 patients who received bortezomib 1.3 mg/m2 twice weekly for 2 weeks every 3 weeks for up to 8 cycles in a phase 2 trial. Using European Group for Blood and Marrow Transplantation criteria, the response rate (complete or partial response) to bortezomib alone was 27% and was not associated with sex, race, performance status, isotype, chromosome 13 deletion, number or type of previous therapies, or concentration of hemoglobin or beta2-microglobulin. By multivariate analysis, factors associated with lower response were being age 65 or older versus younger than 65 (19% vs 32%; P < .05) and plasma-cell infiltration in bone marrow greater than 50% versus 50% or less (20% vs 35%; P < .05). Factors that may be indicative of tumor burden (bone marrow plasma-cell infiltration greater than 50%, hypoalbuminemia, thrombocytopenia) were predictive of overall survival. Chromosome 13 deletion and elevated beta2-microglobulin, generally considered poor prognostic factors, were not predictive of poor outcome with bortezomib in this study.     

Cardiovascular Events in Alcoholic Syndrome With Alcohol Withdrawal History: Results From the National Inpatient Sample

Background

Epidemiologic studies suggest reduced cardiovascular disease (CVD) events with moderate alcohol consumption. However, heavy and binge drinking may be associated with higher CVD risk. Utilizing the Nationwide Inpatient Sample, we studied the association between a troublesome alcohol history (TAH), defined as those with diagnoses of both chronic alcohol syndrome and acute withdrawal history and CVD events.

Hodgkin's Disease in Childhood

Thirty-eight children with Hodgkin’s disease have been treated over the past 8yr with either intensive radiotherapy orcombination chemotherapy (MOPP), depending on their initial stage. The mediansurvival of the entire group of childrenhas not yet been reached, as 63% are stillalive, but it will be in excess of 58 mo.Median survivals by stage are as follows:stage I, greater than 46 mo; stage II,greater than 46 mo; stage III, 35 mo; andstage IV, 26.7 mo. Although the numbersof children are small, these results appearsignificantly superior to published reportsutilizing less intensive radiotherapy andsingle-agent chemotherapy and suggestthat intensive radiotherapy for localizeddisease and combination chemotherapy foradvanced disease may, at present, be thepreferred forms of therapy for Hodgkin’sdisease in childhood.

Submitted on October 16, 1972 Revised on December 26, 1972 Accepted on December 28, 1972     

二尖瓣替换术后房颤转复为窦性心律的临床分析

在风湿性心脏病二尖瓣病变中，慢性心房纤颤（简称房颤）是一种常见的并发症。房颤会给病人带来许多问题，如左房血栓形成、体循环栓塞、心房扩大和心输出量减少等并发症，从而增加了死亡率，影响了生活质量的提高。因此，人们一直采用各种方法使之转复为窦性心律。风湿性心脏病二尖瓣替换术同时给予电除颤，可使部分病人恢复窦性心律。本组对89例患风湿性心脏病二尖瓣替换术后房颤转复情况进行了回顾性研究，根据手术后病人出院时的心律情况将病人分为两组，A组为出院时仍为房颤者，B组为出院时为窦性心律者。分析结果表明，风湿性心脏病二尖瓣替换术后，解除了机械梗阻，部分术前伴有房颤的病人术后可以转复为窦性心律，但能维持至1个月以上者较少，仅占手术病人的15．7％。病人手术时的年龄、房颤病史长短及左房径对房颤转复情况有显著影响，且可以预见其短期效果，根据本组病例分析的结果表明，年龄小于40岁、房颤病史不超过一年、左房径小于55mm的病人，窦性心律可维持在1个月以上。