Value of handgrip strength in predicting the mortality of hemodialysis patients

Objective To analyze the risk factors of mortality among patients treated by maintenance hemodialysis (MHD), and identify whether handgrip strength (HGS) or other nutrient markers could predict the mortality independently. Methods One hundred and eight patients receiving regular MHD in Peking Union Medical College Hospital from July to September, 2008 were involved. Baseline data including clinical data, nutrient data such as subjective global assessment, anthropometrics and biochemical measurement were collected. After being followed for 72 months, the patients' mortality and morbidity of cardiovascular event were recorded. Cox regression model was used to estimate the risk factors of mortality. Results The average age of 108 MHD patients was (57.6±13.0) years. During the 6-years following up, 35 patients died (32.4%), of whom 62.9% died of cardiovascular events. Among variables, patients’ age, residual urine volume, serum creatinine level, prealbumin level and mean leg circumference were risk factors for all-cause mortality. The patient with lower HGS bore higher risk for all-cause mortality (HR=2.842, 95%CI 1.390-5.811) and cardiovascular death (HR=2.826, 95%CI 1.150-6.947). After adjusting gender, age, history of cardiovascular disease and diabetes, body mass index (BMI), dialysis vintage, Kt/V, nPCR and prealbumin, lower handgrip strength was still an independent risk factor of all-cause mortality (HR=2.505, 95%CI 1.112-5.642). In prediction for all-cause mortality by HGS, the area under the receiver operating characteristic curve(ROC) were 0.705 and 0.682 among men and women respectively. Conclusion Lower handgrip strength can predict mortality of maintenance hemodialysis patients independently.     

Subthalamic deep brain stimulation for refractory Gilles de la Tourette’s syndrome: clinical outcome and functional connectivity

Background

Deep brain stimulation (DBS) is a promising novel approach for managing refractory Gilles de la Tourette’s syndrome (GTS). The subthalamic nucleus (STN) is the most common DBS target for treating movement disorders, and smaller case studies have reported the efficacy of bilateral STN-DBS treatment for relieving tic symptoms. However, management of GTS and treatment mechanism of STN-DBS in GTS remain to be elucidated.

Methods

Ten patients undergoing STN-DBS were included. Tics severity was evaluated using the Yale Global Tic Severity Scale. The severities of comorbid psychiatric symptoms of obsessive–compulsive behavior (OCB), attention-deficit/hyperactivity disorder, anxiety, and depression; social and occupational functioning; and quality of life were assessed. Volumes of tissue activated were used as seed points for functional connectivity analysis performed using a control dataset.

Results

The overall tics severity significantly reduced, with 62.9% ± 26.2% and 58.8% ± 27.2% improvements at the 6- and 12-months follow-up, respectively. All three patients with comorbid OCB showed improvement in their OCB symptoms at both the follow-ups. STN-DBS treatment was reasonably well tolerated by the patients with GTS. The most commonly reported side effect was light dysarthria. The stimulation effect of STN-DBS might regulate these symptoms through functional connectivity with the thalamus, pallidum, substantia nigra pars reticulata, putamen, insula, and anterior cingulate cortices.

Conclusions

STN-DBS was associated with symptomatic improvement in severe and refractory GTS without significant adverse events. The STN is a promising DBS target by stimulating both sensorimotor and limbic subregions, and specific brain area doses affect treatment outcomes.

     

Does radiological conjugate eye deviation sign play a role in acute stroke imaging? A meta-analysis

Journal of Neurology - The diagnostic value of non-contrast CT (NCCT) in acute stroke imaging remains indispensable, especially under emergency conditions with limited resources. The radiological...     

Multi-granular Intuitionistic Fuzzy Three-Way Decision Model Based on the Risk Preference Outranking Relation

As an important extension of decision-theoretic rough sets, three-way decision theory provides a new perspective for people to deal with uncertain problems. However, the traditional multi-granularity decision-theoretic rough sets model has limited ability in describing the risk preferences of decision-makers and the processing of intuitionistic fuzzy information. In addition, as far as we know, most of the risk loss functions in existing studies are based on utility theory. However, the complete compensability between attributes is not always true, and this fact may lead to inconsistencies between the final calculated results and the actual situation. We propose a multi-granular intuitionistic fuzzy three-way decision model based on the risk preference outranking relation. In this scenario, we first define the outranking relation on the intuitionistic fuzzy set and fuse it for the purpose of risk preference calculation. Next, starting from the single granularity, the relations between the membership outranking relation class, the nonmembership outranking relation class, and the rough approximation are analyzed, and the related properties are proven. Then, the single granularity is extended to construct the multi-granular intuitionistic fuzzy decision-theoretic rough sets and their corresponding three-way decision model. Furthermore, by systematically studying the decision loss costs of optimistic and pessimistic states, three-way decision rules are induced. The rationality and effectiveness of our proposed model are verified through a case study analysis and comparisons with existing methods. The results show that our proposed model can quantitatively analyze and calculate the uncertainty of decision-makers’ cognitive risk preferences, achieve global control of the decision-making process, and reduce the loss of decision-making costs.

     

The role of hypertriglyceridemia and treatment patterns in the progression of IgA nephropathy with a high proportion of global glomerulosclerosis

International Urology and Nephrology - Many studies have focused on finding predictors for mild IgAN progression. However, the cases of severe IgAN with a high proportion of global...     

肝胆外科从数字虚拟人、三维可视化到数字智能化发展的现状

数字智能化肝胆外科的发展经历了十几年的演进过程,从数字虚拟人技术到质控化、同质化三维可视化精准诊疗体系的建立;从三维可视化到数字智能化技术临床转化及诊疗模式的转换;实现了疾病的经验性诊断到深度学习智能化诊断与治疗和经验性手术到多模态影像实时手术导航的技术创新;从肿瘤的形态学诊断深入到分子影像学精准诊断的研究。在这个过程中只有不断地进行研究创新、理论创新和技术创新才能给数字智能化外科赋予新的生命力。未来,从关键分子功能可视化实现肝癌分子、细胞层面边界界定和早诊早治,对改变肝癌患者肝切除术后的预后具有重大的临床价值。此外,为了实现智能化肝切除手术导航,突破技术瓶颈,研发具有自动导航技术、机器学习智能规划技术和多模态影像融合技术的智能化机器人实时导航肝切除手术系统具有重要的临床意义,给数字智能化肝胆外科的发展带来了新的机遇和挑战。