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25 August 2017, Volume 16 Issue 04 Previous Issue    Next Issue

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Soluble Klotho attenuates high glucose-induced renal fibrosis through inhibiting STAT3 pathway LI Huilin, WU Ping, LIU Shuang, JIANG Gengru 2017, 16 (04):  371-376.  DOI: 10.16150/j.1671-2870.2017.04.006 Abstract ( 326 )   PDF (636KB) ( 63 )   Objective: To observe the effect of Klotho on high glucose-activated phosphorylation of signal transducer and activator of transcription 3 (STAT3) and expression of fibrosis related gene in renal tubular epithelial cells under high glucose. Methods: Human proximal tubular epithelial cells (HK2) were cultured and incubated with high glucose (HG, D-glucose 30 mmol/L), normal glucose (NG, D-glucose 5 mmol/L), high mannitol (HM, D-glucose 5 mmol/L and mannitol 25 mmol/L), and Klotho or HO3867 in the presence of high glucose. STAT3 activation and expression of target genes were assayed by Western blot or real time fluorescence quantitative PCR(rt-fqPCR). Results: Compared with NG or HM, a significant decrease of endogenous Klotho gene level was detected after HG treatment(P<0.01). Western blot analysis revealed that the level of STAT3 phosphorylation was significantly increased after HG treatment compared with NG or HM(P<0.01). The activation of STAT3 induced by high glucose was markedly reduced by Klotho or HO3867 treatment(P<0.01). The level of mRNA expression of fibrosis related gene(α-SMA, Col4A1, FN) was significantly increased after high glucose treatment in HK-2 cells (P<0.01), while was markedly inhibited by Klotho treatment(P<0.01). HO3867, the inhibitor of STAT3, partially decreased the mRNA levels of above mentioned genes (P<0.01). Conclusions: Soluble Klotho could attenuate high glucose-induced renal fibrosis, which might be achieved partially through inhibition of STAT3 pathway. References | Related Articles | Metrics

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Klotho expression in hyperphosphate-induced calcified vascular smooth muscle cells JIANG Zuanhong, CHEN Zijin, WANG Zhiyu, CHEN Qiujing, LU Lin, MA Xiaobo, YU Haijin, CHEN Xiaonong 2017, 16 (04):  377-383.  DOI: 10.16150/j.1671-2870.2017.04.007 Abstract ( 257 )   PDF (947KB) ( 46 )   Objective: To investigate the changes of Klotho expression in rat vascular smooth muscle cells (VSMCs) calcification induced by high phosphate. Methods: Rat VSMCs was cultured in vitro, the proliferation of VSMCs induced by different concentrations of phosphate was detected by cell counting kit-8 (CCK-8). VSMCs were treated with high phosphate (3 mmol/L) for 3 days or 6 days, and the calcification of VSMCs was evaluated by alizarin red staining. The activity of alkaline phosphatase (ALP) and calcium content in VSMCs were detected by ALP assay kit and calcium colorimetric assay kit, respectively. The expression of mRNA and protein of bone morphogenetic protein 2 (BMP-2), Runt related transcription factor 2 (Runx2) and Klotho were detected by quantitative real-time polymerase chain reaction (qrt-PCR) and Western blotting (WB). Results: Higher-phosphate media inhibited the proliferation of VSMCs. After being incubated in high-phosphate media for 6 days, calcified nodules were observed with alizarin red staining and calcium content was significantly increased; qrt-PCR demonstrated that levels of BMP-2 and Runx2 mRNA and protein were increased and the expressions of Klotho mRNA and protein levels were decreased. Conclusions: Klotho might be involved in the hyperphosphate-induced calcification and phenotype changes in VSMCs. References | Related Articles | Metrics

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Outcome and risk factors of patients with renal failure due to ANCA-associated vasculitis after emergency hemodialysis XING Peng, LIU Simeng, CHEN Zijin, REN Hong, CHEN Xiaonong, LI Xiao 2017, 16 (04):  384-389.  DOI: 10.16150/j.1671-2870.2017.04.008 Abstract ( 312 )   PDF (613KB) ( 85 )   Objective: To analyze the outcome and risk factors of patients with renal failure due to ANCA-associated vasculitis(AAV) after emergency hemodialysis. Methods: The clinical data of patients diagnosed as renal failure due to AAV and treated with emergency hemodialysis from Jan. 2006 to Jan.2016 were recruited, and the outcome (renal reco-very, death within 3 months, maintenance dialysis) and risk factors were analyzed. The survival patients who came into maintaining dialysis were divided into two groups: the peritoneal dialysis group and hemodialysis group. Results: A total of 58 patients were enrolled. Renal function of 9 patients recovered after emergency hemodialysis; 24 patients died within 3 months, and the main causes of death were pneumonia and disease activity. The patients died had older age (P=0.001), higher BVAS scores (P=0.048), lower level of platelets (P=0.004) than that of survival patients. Logistic regression analysis showed that old age (OR=1.087, 95% CI: 1.014-1.165), high BVAS scores (OR=1.160, 95% CI: 1.005-1.339), low level of platelets (OR=1.011, 95% CI: 1.002-1.021 ) were risk factors for early death. Twenty-five patients came into maintaining dialysis, including 10 cases with peritoneal dialysis (PD) and 15 cases with hemodialysis (HD). At 6 months after dialysis, BVAS scores of PD group reduced from baseline 15 (13,18) to 2 (2,4) (P=0.001); BVAS scores of HD group decreased from baseline 16 (14,21) to 4 (2,6) (P=0.001). There were no significant differences in hemoglobin, serum albumin between the two groups at 6 months, 1 year and 2 years (P>0.05). Two HD patients and four PD patients died during follow-up, and pneumonia was the main cause of death. The difference in long-term survival rate between the two groups was not significant (P=0.235). Conclusions: Old age, high BVAS scores, low level of platelets are risk factors for death of patients with renal failure due to AAV in early period. On maintaining dialysis, the control of vasculitis activity and long-term survival rate are similar between HD and PD groups. Pneumonia is the main cause of death both in early period and on maintai-ning dialysis. References | Related Articles | Metrics

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Analysis of depression and related factors in maintenance hemodialysis patients LU Jiayue, ZHAN Yaping, ZHANG Weiming, LI Ping, LIU Shang, ZHU Minxia, CAI Hong, NI Zhaohui 2017, 16 (04):  390-393.  DOI: 10.16150/j.1671-2870.2017.04.009 Abstract ( 282 )   PDF (446KB) ( 72 )   Objective: To analyze the prevalence of depression in maintenance hemodialysis patients in our dialysis center and its related factors by cross-sectional study. Methods: Beck Depression Inventory(BDI) was used to assess the depression occurred in patients of our dialysis center. According to the BDI score, patients were divided into normal group (BDIs≤10) and emotional disorders group(BDIs>10). The prevalence of depression and related factors were analyzed in these two groups. Results: Of the 109 maintenance hemodialysis patients, 100 completed the questionnaires, with a completion rate of 91.7%. There were 60 males and 40 females, with an average age of (58±14) years (27-86 years), and an average dialysis age of (43±39) months (3-165 months). There were 69 cases in normal group and 31 cases in emotional disorder group (16 cases with 10<BDIs≤15, 9 cases with 15<BDIs≤25 and 6 cases with BDIs>25); 15 cases had depression(15.0%). There were no statistical differences in age, dialysis age, education, family support, arrangement of dialysis, dialysis related complications, hemoglobin, serum albumin, iPTH and spKt/V between the two groups, the only difference was the proportion of females (P<0.05). The linear regression equation showed that the BDI score was negatively correlated with spKt/V (r=-0.27, P<0.05). Conclusions: The prevalence of depression in maintenance hemodialysis patients in our dialysis center is high, especially in female patients. Inadequate dialysis might increase the severity of depression in the patients.Regular screening of depression at dialysis center is helpful for early detection of emotional disorders in dialysis patients, and early psychological intervention and drug treatment could be taken to improve the quality of life in dialysis patients. References | Related Articles | Metrics

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Correlation of expression of MCP-1 on wall of radial artery with stenosis of cannulation site in arteriovenous fistula with buttonhole in hemodialysis patients LIU Ling, ZHANG Chen, LI Mingxin, QIN Ximiao, HUANG Bihong, XUE Jun 2017, 16 (04):  394-398.  DOI: 10.16150/j.1671-2870.2017.04.010 Abstract ( 183 )   PDF (664KB) ( 60 )   Objective: To investigate whether the existed local inflammation and general micro-inflammation during arteriovenous fistula operation would predict the stenosis of arteriovenous fistula(AVF) in site of cannulation with buttonhole technique thereafter. Methods: Twenty-three patients with chronic kidney disease(CKD) stage 5 were allocated into 2 groups according to the expression of MCP-1 on the wall of radial artery during the operation of constructing AVF: low MCP-1 expression group and high MCP-1 expression group. All of the AVF were cannulated with buttonhole technique and followed up for 48 months. Results: The stenosis rate of cannulation site was 5 per 560 patient-month in low MCP-1 expression group, 8 per 209 patient-month in high MCP-1 expression group (u=-2.080, P<0.05). Compared with low MCP-1 expression group, the Hazzar ratio for high MCP-1 expression group to develop cannulation site stenosis was 0.08 (95% CI: 0.02-0.32, P<0.01). COX analysis revealed that high MCP-1 expression on radial artery and high level of hsCRP were the risk factors for cannulation site stenosis and the HR were 1.008 and 17.84, respectively(P<0.05). Conclusions: The expression of MCP-1 on radial artery and the level of hsCRP could predict the stenosis of the cannulation site of AVF with buttonhole. References | Related Articles | Metrics

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Impact of "Report and Interpretation of Rare Pathogenic Microorganism Isolated" on medical practice LIU Jingxian, CHEN Feng, YU Jing, LIU Ying 2017, 16 (04):  399-403.  DOI: 10.16150/j.1671-2870.2017.04.011 Abstract ( 345 )   PDF (1222KB) ( 43 )   Objective: To evaluate the impact of implementation of "report and interpretation of rare pathogenic microorganism isolated" on clinical practice and communication between microbiology laboratory and clinicians. Methods: From Feb 2015, the microbiology laboratory of our hospital added a "report and interpretation of rare pathogenic microorganism isolated" form for the identification report when rare microorganism was isolated from clinical samples,which was considered to be of potential clinical significance. All the "report and interpretation of rare pathogenic microorganism isolated" issued during Feb 2015 to Nov 2016 were analyzed and the information of clinical data of patients and clinician's feedback were collected. SPSS Statistics 19.0 software was used to analyze the data. Results: From Feb 2015 to Nov 2016, 75 "report and interpretation of rare pathogenic microorganism isolated" were sent to 24 clinical departments, which involved 45 kinds of rare microorganism. Susceptibility test could not be performed routinely in Shanghai area on 93.3%(42/45) of the rare pathogens isolated. The average time from sample reception to delivery of the "report and interpretation of rare pathogenic microorganism isolated" was (3.5±1.5) days. After receiving the" report and interpretation of rare pathogenic microorganism isolated", 56.0%(42/75) of clinicians took related actions, with a higher ratio in 2016(62.7%, 37/59) than that in 2015(31.3%, 5/16) (P=0.024). Fifty-nine out of 75 patients from whom rare pathogen was isolated were clinically diagnosed as infectious disease.Patients who accepted therapy according to the recommendation offered with "report and interpretation of rare pathogenic microorganism isolated" had a higher successful rate than those who didn't(P<0.01). Conclusions: The "report and Interpretation of rare pathogenic microorganism isolated" has a positive role in clinical practice, and the clinician's acceptance for the "report and interpretation of rare pathogenic microorganism isolated" is increasing gradually. References | Related Articles | Metrics

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A preliminary study on diagnostic value of TSPOT.TB in HIV infection/acquired immuodeficiency syndrome patients with positive Mycobacteria culture ZHANG Guihong, XIA Qianlin, SHAN Menglin, ZHENG Jianghua 2017, 16 (04):  404-408.  DOI: 10.16150/j.1671-2870.2017.04.012 Abstract ( 364 )   PDF (481KB) ( 50 )   Objective: To investigate the diagnostic value of T cells spot test of Tuberculosis infection （TSPOT.TB） in human immunodeficiency virus infection/acquired immuodeficiency syndrome patients with positive Mycobacteria culture. Methods: A retrospective study was conducted on 251 HIV infection/AIDS patients with Mycobacteria infection receiving TSPOT.TB test from July 2012 to Dec 2016 in Shanghai Public Health Center affiliated to Fudan University. MPB64 colloidal gold method was taken as the golden standard. The value of TSPOT.TB for diagnosing tuberculosis infection in HIV infection/AIDS patients with positive Mycobacteria culture was analyzed. Patients was divided into groups according the infection site and CD4+ T cell count, and the diagnostic value of TSPOT.TB in patients with extra-pulmonary and pulmonary infection and in patients with CD4+ T≤200/μL and CD4+ T>200/μL was analyzed. Results: Among the 251 HIV infection /AIDS patients with Mycobacteria infection, the diagnostic sensitivity and specificity of TSPOT.TB for Tuberculosis were 83.70% and 80.17%. The diagnostic sensitivity of TSPOT.TB in patients with extra-pulmonary and pulmonary Tuberculosis infection were 85.00% and 82.67%, respectively, and there was no statistical difference( χ2=0.133, P=0.715). The specificity of TSPOT.TB in these two groups were 93.10% and 75.86%, respectively, and there was a statistically significant difference between the two groups ( χ2=4.067, P=0.044). In HIV infection/ AIDS patients with CD4+ T≤200/μL and CD4+ T>200/μL, the diagnostic sensitivity of TSPOT.TB for Tuberculosis was 81.58% and 80.95%, respectively, and there was no statistical difference ( χ2=0.000, P=1.000) between the two groups, yet the specificity of TSPOT.TB were 85.86% and 47.06%, respectively, and the difference was statistically significant ( χ2=11.408, P=0.001). Conclusions: The diagnostic sensitivity of TSPOT.TB for HIV infection/AIDS patients with active Tuberculosis is high, and the infection site and CD4+ T cells counts might not be the impact factors of sensitivity of TSPOT.TB, but they can influence the specificity of TSPOT.TB. References | Related Articles | Metrics

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An investigation on pathogenicity and drug sensitivity of 1 097 isolates from patients with fungal vaginitis in Jiading District of Shanghai XU Weixin, CAI Xushan, HUANG Zhongfa, HUANG Qiulan, HE Yanhong, XIANG Mingjie 2017, 16 (04):  409-413.  DOI: 10.16150/j.1671-2870.2017.04.013 Abstract ( 290 )   PDF (580KB) ( 41 )   Objective: To investigate the distribution and drug sensitivity of pathogens of fungal vaginitis in Jiading District of Shanghai for providing a guidance for clinical diagnosis and treatment of the disease. Methods: Altogether 1 097 leucorrhea specimens were collected from patients with fungal vaginitis in obstetrics and gynecology department from 5 hospitals(Jiading District Central Hospital, Maternal and Child Health Hospital, Jiading District Hospital of Traditional Chinese Medicine, Nanxiang Hospital and Anting Hospital), from July 2015 to June 2016. The specimens were cultured and drug sensitivity test was performed. The results were analyzed by SPSS 13.0. Results: There was no significant difference in distribution of pathogens among these hospitals, and Candida albicans was the most common (81.5%). The highest proportion (14.6 percent) of non-Candidaalbicans was found in Candidaglabrata. The proportion of Candida albicans in recurrent patients was 67.0%. Overall sensitive rates of all strains to fluconazole, voriconazole and itraconazole were 98.9%, 92.0% and 70.0%, respectively. The sensitivity of Candida albicans and non-Candida albicans to 3 azoles were 99.6%, 92.6%, 72.4% and 84.8%, 89.2% and 59.1%, respectively. For hospital, the five hospitals showed significant differences in sensitivity of drugs in the case of voriconazole and itraconazole. Conclusions: Candida albicans is the main pathogen of fungal vaginitis in Jiading District of Shanghai. The distribution of pathogens in patients with recurrent fungal vaginitis shows a trend of diversity. Some pathogens appeare with more obvious itraconazole resistance. There are also differences in drug sensitivity among the strains and different hospitals. To emphasize the pathogen examination and drug sensitivity test of fungal vaginitis is helpful for clinicians to prescribe better clinical treatment. References | Related Articles | Metrics

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Application of Wells score, revised Geneva score, simplified Wells and revised Geneva score for assessing clinical probability of pulmonary embolism CHAO Huijuan, CHENG Changqiang, CHEN Ling, CHENGQijian 2017, 16 (04):  414-418.  DOI: 10.16150/j.1671-2870.2017.04.014 Abstract ( 538 )   PDF (530KB) ( 62 )   Objective: To analyze the clinical data of pulmonary embolism(PE) patients retrospectively for evaluating the performance of clinical scores(Wellsscore, revised Geneva scoreand their simplified versions) in assessing the probabi-lity of PE. Methods: A total of 78 patients diagnosed as PE and received treatment were recruited at Ruijin Hospital from June 2011 to June 2016 and at Ruijin Hospital North Branch from December 2012 to June 2016. All the patients were assessed by Wells score, revised Geneva score and simplified Wells score and simplified revised Geneva score, respectively. The performance of these scores were analyzed and compared. Results: For Wells score,15.38% patients had low clinical probability, 70.51% patients had moderate clinical probability and 14.10% patients had high clinical probability. By revised Geneva score, the percentages of low, moderate and high clinical probability were 20.52%, 70.51% and 8.98%, respectively. Bysimplified Wells score, the percentages of PE unlikely and PE likely were 33.33% and 66.67%, respectively. By simplifiedrevised Geneva score, the percentages of PE unlikely and PE likely were 55.13% and 44.87%, respectively; and the percentages of low, moderate and high probability were 19.23%, 74.36% and 1.28%, respectively, when the three levels scoring was used. Most patients had moderate or high clinical probability of PE when assessed by Wells score and revised Geneva score, with a percentage of moderate or high clinical probability of 84.61% and 79.49%, respectively; there was no significant difference in performance between Wells score and revised Geneva score (P=0.482). Among these 78 patients, the sensitivity of Wells score and simplified Wells score for PE were 84.61% and 66.67%, respectively(P<; 0.01). The percentages of PE patients diagnosed by simplified Wells score, simplified revised Geneva score-two levels scoring and simplified revised Geneva score-three levels scoring were 66.67%, 44.87% and 75.64%, respectively. The difference between the simplified revised Geneva score-two levels scoring and simplified revised Geneva score-three levels scoring was statistically significant(P<; 0.01). Significant difference was also found between simplified Wells score and simplified revised Geneva score-two levels scoring. Conclusions: For assessing the clinical probability of PE, the higher the clinical score, the higher the sensitivity of Wells score, revised Geneva score and simplified Wells score for diagnosing PE is. The Wells score has similar performance with revised Geneva score in diagnosing PE. Compared with simplified Geneva score-two level and simplied Wells score, Simplified revised Geneva score-three levels scoring could improve the vigilance of PE and decrease the rate of missed diagnosis. References | Related Articles | Metrics

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Association of metabolically healthy obesity, insulin resistance with risk of diabetes: a prospective study NI Hengru, LIN Lin, PENG Kui, HAO Mingli, WANG Tiange, GAO Jinli 2017, 16 (04):  419-424.  DOI: 10.16150/j.1671-2870.2017.04.015 Abstract ( 227 )   PDF (623KB) ( 49 )   Objective: To investigate the association between metabolically healthy obesity (MHO) and risk of diabetes in population in Shanghai and to assess the role of insulin resistance in their relationship. Methods: A prospective study was performed among 1 967 participants aged 40 years or older in Baoshan community, Shanghai. The participants were categorized into four groups according to obesity and metabolic status: metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese(MUNO), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO). Questionnaire interview, anthropometric measurements, and biochemical measurements were obtained in the participants. Metabolic profiles and rate of incident diabetes were compared between the groups. Results: After a median follow-up period of 4 years, the rate of incident diabetes in group MHNO, group MUNO, group MHO, and group MUO were 3.4%, 16.4%, 7.7%, and 17.5%, respectively. Multivariate logistic analysis revealed that patients in group MHO had an increased risk of incident diabetes [odds ratio (OR)=2.25, 95% confidence interval (CI) 1.31-3.85] when compared with subjects in MHNO. Compared with patients in group MHNO, patients resistant to insulin [homeostasis model assessment of insulin resistance(HOMA-IR≥2.5)] in group MHO had an increased OR for incident diabetes (OR=5.20, 95% CI 2.56-10.56). Conclusions: The 4-year follow-up revealed that patients of MHO have a high incidence of diabetes in which insulin resistance might play a role. References | Related Articles | Metrics

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Correlation analysis on nutritional status of elderly malignant tumor patients and one-year mortality SHENG Hong, CAO Weixin 2017, 16 (04):  425-429.  DOI: 10.16150/j.1671-2870.2017.04.016 Abstract ( 259 )   PDF (502KB) ( 77 )   Objectives: To investigate the nutritional status of elderly malignant tumor patients and to analyze the relation between malnutrition and one-year mortality. Methods: The nutritional status of elderly patients diagnosed as malignant tumor admitted in the department of gerontology, Ruijin Hospital were assessed by mininutritional assessment-short form (MNA-SF), and body mass index (BMI), hemoglobin, prealbumin, albumin, triglyceride and total cholesterol were measured and the patients were followed up for calculating the one-year survival. Results: One hundred and twenty four patients were included in the study. The incidence of nutrition, risky malnutrition and malnutrition was 69.4%, 26.6% and 4.0%, respectively, according to the MNA-SF. The one-year mortality was 17.7% in overall patients; and among the three groups, the one-year mortality was the highest(60%) in malnutrition group. After adjustment for confounding variables, COX regression model suggested that malnutrition can increase the risk of one-year mortality. Conclusions: Malnutrition can predict independently the risk of death of the elderly malignant tumor patients within one year. References | Related Articles | Metrics