Association of Pre- and Post-Donation Renal Function with Midterm Estimated Glomerular Filtration Rate in Living Kidney Donors: A Retrospective Study

PurposeThe estimated glomerular filtration rate (eGFR) at 6 months after donation (eGFR_6m) is strongly associated with the risk of end-stage renal disease in living kidney donors. This study aimed to investigate the incidence of eGFR_6m <60 mL/min/1.73 m² (eGFR_6m <60) and identify the risk factors that can predict the occurrence of eGFR_6m <60 in living kidney donors.Materials and MethodsLiving kidney donors who underwent nephrectomy at Severance Hospital between January 2009 and December 2019 were identified. We excluded 94 of 1233 donors whose creatinine values at 6 months after donation were missing. The risk factors for eGFR_6m <60 were assessed using multivariate regression analysis. The optimal cutoff points for candidate risk factors for predicting eGFR_6m <60 occurrence were determined using the Youden index.ResultsThe eGFR_6m <60 occurred in 17.3% of the participants. Older age (≥44 years), history of hypertension, lower preoperative eGFR (<101 mL/min/1.73 m²), and degree of increase in creatinine levels on postoperative day 2 compared to those before surgery (ΔCr2_pre) (≥0.39 mg/dL) increased the risk of eGFR_6m <60. The addition of ΔCr2_pre to preoperative eGFR yielded a higher predictive accuracy for predicting eGFR_6m <60 than that with preoperative eGFR alone {area under the receiver operating characteristic curve=0.886 [95% confidence interval (CI), 0.863–0.908] vs. 0.862 (95% CI, 0.838–0.887), p<0.001}.ConclusionThe incidence of eGFR_6m <60 was 17.3%. Older age, lower preoperative eGFR, history of hypertension, and greater ΔCr2_pre were associated with the occurrence of eGFR_6m <60 after living donor nephrectomy. The combination of preoperative eGFR and ΔCr2_pre showed the highest predictive power for eGFR_6m <60.     

Safety and Efficacy of Everolimus-Eluting Bioresorbable Vascular Scaffold Versus Second-Generation Drug-Eluting Stents in Real-World Practice

BackgroundThe risk of device thrombosis and device-oriented clinical outcomes with bioresorbable vascular scaffold (BVS) was reported to be significantly higher than with contemporary drug-eluting stents (DESs). However, optimal device implantation may improve clinical outcomes in patients receiving BVS. The current study evaluated mid-term safety and efficacy of Absorb BVS with meticulous device optimization under intravascular imaging guidance.MethodsThe SMART-REWARD and PERSPECTIVE-PCI registries in Korea prospectively enrolled 390 patients with BVS and 675 patients with DES, respectively. The primary endpoint was target vessel failure (TVF) at 2 years and the secondary major endpoint was patient-oriented composite outcome (POCO) at 2 years.ResultsPatient-level pooled analysis evaluated 1,003 patients (377 patients with BVS and 626 patients with DES). Mean scaffold diameter per lesion was 3.24 ± 0.30 mm in BVS group. Most BVSs were implanted with pre-dilatation (90.9%), intravascular imaging guidance (74.9%), and post-dilatation (73.1%) at proximal to mid segment (81.9%) in target vessel. Patients treated with BVS showed comparable risks of 2-year TVF (2.9% vs. 3.7%, adjusted hazard ratio [HR], 1.283, 95% confidence interval [CI], 0.487–3.378, P = 0.615) and 2-year POCO (4.5% vs. 5.9%, adjusted HR, 1.413, 95% CI, 0.663–3.012, P = 0.370) than those with DES. The rate of 2-year definite or probable device thrombosis (0.3% vs. 0.5%, P = 0.424) was also similar. The sensitivity analyses consistently showed comparable risk of TVF and POCO between the 2 groups.ConclusionWith meticulous device optimization under imaging guidance and avoidance of implantation in small vessels, BVS showed comparable risks of 2-year TVF and device thrombosis with DES.Trial RegistrationClinicalTrials.gov Identifier: {"type":"clinical-trial","attrs":{"text":"NCT02601404","term_id":"NCT02601404"}}NCT02601404, {"type":"clinical-trial","attrs":{"text":"NCT04265443","term_id":"NCT04265443"}}NCT04265443     

Associations between breastfeeding intention,breastfeeding practices and post‐natal depression during the COVID‐19 pandemic: A multi‐country cross‐sectional study

Associations between breastfeeding intention, duration and post‐natal depression (PND) have been shown in pre‐COVID‐19 studies. However, studies during COVID‐19 have not examined the associations between breastfeeding intention, breastfeeding practices, and PND in an international sample of post‐natal women, taking into consideration COVID‐19 related factors. This is the first study to address this gap as both PND and breastfeeding may be affected by COVID‐19, and have important long‐term effects on women''s and infant''s health. A cross‐sectional internet‐based survey was conducted with 3253 post‐natal women from five countries: Brazil, South Korea, Taiwan, Thailand, and the United Kingdom from July to November 2021. The results showed that women who intended to breastfeed during pregnancy had lower odds of having PND than women who did not intend to. Women who had no breastfeeding intention but actually breastfed had greater odds (AOR 1.75) of having PND than women who intended to breastfeed and actually breastfed. While there was no statistical significance in expressed breast milk feeding in multivariable logistic regression models, women who had shorter duration of breastfeeding directly on breast than they planned had greater odds (AOR 1.58) of having PND than those who breastfed longer than they planned even after adjusting for covariates including COVID‐19‐related variables. These findings suggested the importance of working with women on their breastfeeding intention. Tailored support is required to ensure women''s breastfeeding needs are met and at the same time care for maternal mental health during and beyond the pandemic.     

炮制引起中药药性及功用的变化

饮片为传统中药的主要应用形式,是中医临床的处方药的组成原料。中药材凡是经过炮制,无论是否加热都称为制饮片,制饮片又有生、熟饮片的区别。基于生制饮片在临床应用的差异性,本文从中药炮制生熟理论、辅料作用论、制药论等传统中药炮制传统理论着手,重点解析炮制如何影响中药的药性,包括中药的四气五味、升降浮沉、归经,补泻、毒性等,依据炮制前后药效物质基础及药理作用的变化实例,诠释炮制使中药药性改变的作用机制。     

诱导型一氧化氮合酶在人皮肤自然衰老过程中的表达和意义

目的:探讨诱型一氧化氮合酶(iNOS)与人皮肤自然衰老的关系.方法:收集整形外科植皮手术中非曝光部位的皮肤标本60例,采用反转录(RT)-PCR和免疫组化的方法检测皮肤组织中iNOS的表达水平,根据年龄分为青少年组、中年组和老年组3组,分析不同年龄组之间iNOS表达水平的差异.结果:青少年组、中年组和老年组iNOS mRNA表达的相对量分别为0.372 7±0.037 1、0.601 4±0.052 5和0.711 0±0.050 7,3组之间的差异具有统计学意义(P＜0.05);免疫组化示iNOS蛋白在青少年组主要为低度阳性,中年组主要为中度阳性.老年组主要为中高度阳性,3组之间的差异亦具有统计学意义(P＜0.05).结论:iNOS在皮肤组织中的表达量随年龄增长而增多,其可能与人皮肤的自然衰老有密切关系.     

UMP与ESWL治疗肾结石合并糖尿病患者的效果及对NGAL、Hb水平的影响研究

目的 探究超微经皮肾镜碎石术(UMP)与体外冲击波碎石术(ESWL)治疗肾结石合并糖尿病患者的效果及对血清中性粒细胞明胶酶相关载脂蛋白(NGAL)和血红蛋白(Hb)水平的影响.方法 选取2017年1月至2019年1月经本院收治的108例肾结石合并糖尿病患者作为研究对象,采用简单随机化原则将其分为两组,每组各54例.对照...     

Effectiveness of Anchoring with Balloon Guide Catheter and Stent Retriever in Difficult Mechanical Thrombectomy for Large Vessel Occlusion

ObjectiveA distal navigation of a large bore aspiration catheter during mechanical thrombectomy (MT) is important. However, delivering a large bore aspiration catheter is difficult to a tortuous or atherosclerotic artery. We report the experience of anchoring with balloon guide catheter (BGC) and stent retriever to facilitate the passage of an aspiration catheter in MT. MethodsWhen navigating an aspiration catheter failed with a conventional co-axial microcatheter delivery, an anchoring technique was used. Two types of anchoring technique were applied to facilitate distal navigation of a large bore aspiration catheter during MT. First, a passage of aspiration catheter was attempted with a proximal BGC anchoring technique. If this technique also failed, another anchoring technique with distal stent retriever was tried. Consecutive patients who underwent MT with an anchoring technique were identified. Details of procedure, radiologic outcomes, and safety variables were evaluated. ResultsA total of 67 patients underwent MT with an anchoring technique. Initial trial of aspiration catheter passage with proximal BGC anchoring technique was successful for 35 patients (52.2%) and the second trial with distal stent retriever anchoring was successful for 32 patients (47.8%). Overall, navigation of a large bore aspiration catheter was successful for all patients (100%) without any procedure related complications. ConclusionOur study showed the usefulness of anchoring technique with proximal BGC and distal stent retriever during MT, especially in those with an unfavorable anatomical structure. This technique could be an alternative option for delivering an of aspiration catheter to a distal location.