Table of Content

    30 June 2023, Volume 18 Issue 03 Previous Issue   
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    Original article
    Investigation of serum uric acid level in adult patients and analysis of related influencing factors
    LUO Yadan, YUAN Liying, LU Yide, WANG Ziqiu, WANG Zhaohui
    2023, 18 (03):  141-145.  DOI: 10.16138/j.1673-6087.2023.03.002
    Abstract ( 47 )   HTML ( 7 )   PDF (567KB) ( 30 )  

    Objective To investigate the distribution characteristics of hyperuricemia(HUA) and related influencing factors among the adult patients in Ruijin Hospital, and provide the clinical reference for prevention and treatment of HUA. Methods A retrospective study of serum uric acid was carried out on 47 100 people in Ruijin Hospital in June 2018, who were over 18 years old. Among them, 27 091 were males and 20 009 were females. The value of serum uric acid and distribution in different gender, age groups and clinical departments were studied. Results The total detection rate of HUA was 20.26%; it was 22.82% in male, and it was 16.88% in females. The serum uric acid level was negatively correlated with age in males, and females (≤50 years) (P<0.05), while it was positively correlated with female over 50 years (P<0.05). The high incidence age groups were 18-30 years in male, and in women over 71 years(P<0.05). Three departments with the highest HUA detection rate were the departments of nephrology, cardiac surgery outpatient and hypertension outpatient. Conclusions The detection rate of HUA in the study was high. The overall blood uric acid level in men was higher than that in women. The blood uric acid level in men gradually decreased with age, and the blood uric acid level in women showed a trend of decreasing and then increasing. Learning the distribution characteristics of uric acid in population could give help in strengthening education and prevention work in the susceptible population.

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    Clinical features, diagnosis and genetic analysis of a family with cystinuria
    WANG Ziqiu, NI Liyan, QIAO Panpan, TAN Taoran, XIE Jingyuan, CHEN Xiaonong, TANG Yonghua, WANG Zhaohui
    2023, 18 (03):  146-151.  DOI: 10.16138/j.1673-6087.2023.03.003
    Abstract ( 28 )   HTML ( 1 )   PDF (1113KB) ( 8 )  

    Objective To explore the clinical features, diagnosis and treatment points and genetic factors of cystinuria by analyzing a family with cystinuria. Methods The proband was a 28-year-old male, and the data of the family with cystinuria was retrospectively analyzed. The stone composition of the proband was determined by urine sediment microscopy, energy spectrum CT and infrared spectroscopy. The peripheral blood DNA samples of the proband and family members were extracted and captured by the target sequence. High-throughput sequencing technology was used to screen mutant genes, and the progress of diagnosis and treatment of cystinuria was discussed referring to literatures. Results The proband in this family was firstly diagnosed at 15 years old. His main clinical manifestation was recurrent left urinary tract calculi combined with proteinuria. The mother’s main manifestation was proteinuria, and the father had no symptoms related to kidney. The sequencing results showed that the proband had a compound heterozygous mutation in the solute carrier family 3, member 1(SLC3A1) gene, including the frameshift mutation NM_000341:exon3:c.703delG ( mother was the carrier of the heterozygous mutation) and missense mutation NM_000341:exon8:c.1366C>T (father is a carrier of the heterozygous mutation). According to American College of Medical Genetics and Genomics(ACMG) guidelines, both mutations were classified as suspected pathogenic variants. The proband had a history of multiple ureteroscopic lithotripsy, and specific hexagonal crystals could be found in urine sedimentary mirror examination and the stone composition was determined to be L-cystine by spectrum CT. After being diagnoses as cystinuria, the proband was treated with alkalization of urine and proteinuria, and his current condition was stable. Conclusions A specific diagnostic method for cystinuria is to find hexagonal crystals in urine sediment microscopy. Spectrum CT can be applied to diagnose cystine stones non-invasively. Genetic disease should be strongly considered in the patients with recurrent stones at young age, and genetic testing can be used as etiological diagnosis method for cystinuria.

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    Contrast study on efficacy of ultrasound-guided transversus abdominis plane block combined with rectus sheath block in peritoneal dialysis catheterization
    WANG Chaojun, YU Ling, WANG Hengjie, REN Hong, SHI Manman, ZHENG Hong, MA Yuhua, XU Tian
    2023, 18 (03):  152-156.  DOI: 10.16138/j.1673-6087.2023.03.004
    Abstract ( 37 )   HTML ( 2 )   PDF (654KB) ( 9 )  

    Objective To compare the effects of ultrasound-guided transversus abdominis plane block(TAPB) combined with rectus sheath block(RSB), TAPB and local infiltration anesthesia in peritoneal dialysis catheterization,and to explore and promote the ideal anesthesia method for peritoneal dialysis catheterization. Methods A total of 46 patients who underwent peritoneal dialysis catheterization in our hospital from May 2016 to June 2021 were enrolled and randomly divided into three groups according to the random number method: ultrasound-guided TAPB combined with RSB (group A),ultrasound-guided TAPB (group B) and local infiltration anesthesia group (group C). The mean arterial pressure (MAP), heart rate, visual analogue scale (VAS) score at different time points during the operation [anesthesia (T0), skin incision (T1), separation of rectus abdominis (T2), establishment of subcutaneous tunnel (T3), and skin suture (T4)], overall operation duration, number of additional anesthetics, number of intraoperative and postoperative adverse reactions and postoperative complications were compared and analyzed among three groups. Results There was no statistically significant difference in MAP and heart rate (all P>0.05) in group A and group B, while both MAP and heart rate in group C showed significant difference (P<0.05) during the operation time (T0, T1, T2, T3 and T4). Compared with group A, additional anesthetics during operation in group B and group C was more frequently used (P<0.05). Compared with group A, the VAS scores of group B at T2, and the VAS scores of group C at T1, T2, T3 and T4 were significantly higher (P<0.05). The operation time of group A was significantly shorter than that of group B and group C (P<0.05). The postoperative complications in group A were significantly less than those in group B and group C (P<0.05). Conclusions Compared with ultrasound-guided TAPB and local infiltration anesthesia, the ultrasound-guided TAPB combined with RSB is a relatively ideal anesthesia method for peritoneal dialysis catheterization, which shows the advantages of safe anesthesia, stable hemodynamics, better comfort and fewer postoperative complications.

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    Value of serum N-terminal pro-brain natriuretic peptide levels in primary screening peritoneal dialysis patients with volume overload
    LI Hua, HUANG Xiaomin, ZHANG Chunyan, DU Lu, REN Hong, XU Tian
    2023, 18 (03):  157-164.  DOI: 10.16138/j.1673-6087.2023.03.005
    Abstract ( 30 )   HTML ( 1 )   PDF (845KB) ( 14 )  

    Objective To explore the relationship between serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level and hydration status and cardiac function indexes in the patients receiving peritoneal dialysis(PD) treatment,and to further analyze the factors affecting the level of NT-proBNP. Methods A total of 111 patients with PD who were followed up in the PD Center of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from May 2019 to January 2022 were enrolled and the data was analyzed retrospectively. According to the results of multi-frequency bioelectrical impedance body composition monitor (BCM), relative hydration status (DHS), the ratio obtained through dividing extracellular water (ECW) by overhydration (OH), the patients were divided into normal volume group (OH/ECW≤15%) and overhydration group (OH/ECW>15%). The relationship between serum NT-proBNP level and hydration status in two groups was compared, and the related factors affecting the level of NT-proBNP were further analyzed and discussed. Using BCM result as the“gold standard”, the receiver operator characteristic curve(ROC curve) determined the optimal threshold of NT-proBNP as the capacity was overloaded. The patients were divided into two groups according to NT-proBNP and their clinical data were compared. Results The indexes including systolic blood pressure, urine volume, urea clearance index (Kt/V), creatinine clearance rate(CCr), dialysate to plasma ratio for urea at 4 hours(4hD/PCr), types of antihypertensive drugs, type of diuretic, hemoglobin, serum albumin, log2(NT-proBNP), interventricular septal thickness (IVST), left ventricular posterior wall thickness(LVPWT), left atrial diameter(LAD), OH, TBW, ECW, OH/TBW, ECW/TBW and ECW/ICW were detected in volume overload group and normal volume group, and showed statistically significant (all P<0.05). log2(NT-proBNP) level was correlated with systolic blood pressure, dialysis duration, ultrafiltration volume, dialysis dose, antihypertensive drug group, IVST, LVPWT, LAD, left ventricular end-systolic dimension (LVESD), left ventricular end-diastolic dimension (LVEDD), OH, OH/ECW were positively correlated (all P<0.05). It was negatively correlated with urine volume, Kt/V, CCr, normalized protein catabolic rate (nPCR), hemoglobin, serum albumin and LVEF (all P<0.05). NT-proBNP 4 896 ng/L could be used as the critical value of initial screening capacity overload and was applied to divide the patients into two groups, and the systolic blood pressure, urine volume, ultrafiltration volume, Kt/V, CCr, IVST, LVPWT, OH/ECW indicators showed significant differences (all P<0.05) in two groups. Conclusions The level of NT-proBNP in PD patients is generally increased, and it indicates volume overload as its value is greater than 4 896 ng/L, which can be used as a simple monitoring index for the preliminary judgment of volume overload in PD patients.

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    Dose-adjusted daratumumab combined with DCEP in treatment of multiple myeloma dual-refractory to bortezomib and lenalidomide
    WANG Yan, TAO Yi, JIN Shiwei, MI Jianqing, LIU Yuanfang
    2023, 18 (03):  165-170.  DOI: 10.16138/j.1673-6087.2023.03.006
    Abstract ( 26 )   HTML ( 1 )   PDF (659KB) ( 15 )  

    Objective To explore the efficacy and safety of dose adjustment daratumumab with dexamethasone, cyclophosphamide, etoposide, cisplatin (DA-DDCEP) regimen in the patients with multiple myeloma (MM) dual-refractory to bortezomib and lenalidomide. Methods From March in 2020 to September in 2022, a total of 17 patients from the department of hematology of our hospital were included in this retrospective study. The overall response rate(ORR), optimal response rate, progression-free survival (PFS), and overall survival (OS) time were statistically analyzed, and the effect of different treatment responses, Eastern Cooperative Oncology Group (ECOG) physical status, and whether accompanied by extramedullary diseases (EMD) on survival were eveluated. Hematologic and nonhematologic toxicity associated with treatment were observed. Results In 17 patients with a mean age of(63.2±10.0) years, eight(47%) were males and a median treatment line number was 5(3-8). After a median cycle of 4(2-14), the ORR and complete response (CR) rates were 65% and 18%. After median follow-up months of 26 (11-40), the median PFS and OS time were 8 and 12 months, respectively. The response to the treatment had a significant impact on survival. Comparing response[≥(partial response, PR)] with non-response patients, PFS was 14 months vs. 2 months (P=0.000) and OS was 19 months vs. 7 months(P=0.05). The ECOG physical state has no impact on survival, comparing ECOG score ≤2 with >2 patients, PFS was 8 months vs. 7 months (P=0.863) and OS was 19 months vs. 10 months (P=0.615). Contrasting relapse with EMD or without EMD, PFS was 6 months vs. 14 months (P=0.009) and OS was 9 months vs. 19 months (P=0.187), respectively. Grade 3-4 adverse events included 8 case (47%) neutropenia, 8 case (47%) anemia, 9 case (53%) lymphocytopenia and 9 case (53%) thrombocytopenia. There were 5 cases (29%) of pulmonary infection, all of which were grade 2. In addition, hepatitis B reactivation occurred in two patients. Conclusions DA-DDCEP regimen is effective in myeloma patients dual-refractory to bortezomib and lenalidomide, and the patients with poor ECOG physical status can tolerate the treatment and benefit from it. The survival of patients with EMD still need to be improved. Overall safety is good, but hepatitis B virus should be monitored carefully.

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    All-trans retinoic acid promotes apoptosis effect of tumor necrosis factor related apoptosis induced ligand on a variety of pancreatic cancer cells
    ZHU Ying, TANG Yuming, HUANG Jia, ZHANG Yongping, YAO Weiyan
    2023, 18 (03):  171-176.  DOI: 10.16138/j.1673-6087.2023.03.007
    Abstract ( 19 )   HTML ( 1 )   PDF (714KB) ( 11 )  

    Objective To observe whether all trans retinoic acid (ATRA) can promote the apoptosis effect of tumor necrosis factor related apoptosis induced ligand (TRAIL) on various pancreatic cancer cells. Methods The pCA13 plasmid carrying TRAIL gene was transfected into three types of pancreatic cancer cell SW1990, Patu8988 and Bx-PC3 respectively. ATRA or equivalent solvent was added after 24 h of transfection. The cell viability was measured by the methyl thiazolyl tetrazolium(MTT) method, apoptosis rates and the expression of TRAIL receptor R1 and R2 were detected by flow cytometry, and the apoptosis was observed by terminal deoxynucleotidyl transferase(TdT) mediated dUTP nick end labeling (TUNEL) and Hoechst double staining and transmission electron microscopy. Results The cell viability of the TRAIL+ATRA group was significantly inhibited compared to the group without ATRA (P<0.05). The result of the flow cytometry showed that ATRA significantly promoted cell apoptosis compared with the group without ATRA(P<0.05). Apoptosis was observed by transmission electron microscopy after TUNEL and Hoechst double staining. However, there was no significant difference in expression of TRAIL-R1 and R2 between the TRAIL+ATRA group and the non-ATRA group(P>0.05). Conclusions ATRA can promote the apoptosis of TRAIL on various pancreatic cancer cells, and its mechanism is not related to the up-regulation of TRAIL-R1 and R2.

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    A simple prediction model for risk of functional impairment in elderly
    BAI Tingting, LI Feika, XU Gang, JIANG Qianwen, WU Fang
    2023, 18 (03):  177-182.  DOI: 10.16138/j.1673-6087.2023.03.008
    Abstract ( 26 )   HTML ( 2 )   PDF (793KB) ( 11 )  

    Objective The main objective was to construct a risk prediction model of functional impairment in the elderly. Methods A total of 481 elderly patients who were admitted to four tertiary hospitals, including Shanghai Ruijin Hospital, from December in 2019 to December in 2020 were enrolled. The basic information, comorbidities, geriatric syndrome, and test results were collected. The functional impairment in 231 patients were assessed. LASSO and Logistic regression were adopted to screen predictors and construct a Nomogram. The calibration curve, decision analysis curve and concordance index(C index) were used for evaluation. Results Nine predictors including age group, gender, social activity, stroke, diabetes, anxiety, cognitive impairment, frailty and albumin were screened to construct a nomogram of impaired function in the elderly, and the calibration curve and decision analysis curve were used to validate the model, which indicated good predictive performance and clinical benefit. C index=0.938 [95% confidence interval (CI)=0.917-0.959] showed good discrimination. Conclusions The Nomogram established in the study has shown good predictive ability, clinical benefit and differentiation, which can be used easily and quickly to assess the risk of functional impairment in the elderly and provide an intuitive and effective guidance tool for clinical prediction of functional impairment in the elderly.

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    Medical education
    Application of computer-aided teaching mode in clinical learning dyslipidemia for general practice residents
    Mukadas Rahman, YE Chenjing, ZHOU Shuying, ZHANG Chenli, TONG Jianjing, ZHANG Xian
    2023, 18 (03):  183-187.  DOI: 10.16138/j.1673-6087.2023.03.009
    Abstract ( 13 )   HTML ( 1 )   PDF (2968KB) ( 6 )  

    Objective To explore the teaching method based on computer-aided teaching mode in the clinical learning dyslipidemia for general practice residents. Methods A total of 42 residents who participated in standardized training for general practice residents at our hospital from July in 2019 to August in 2022 were selected as the research subjects. They were randomly divided into a reference group and a research group. The reference group learned dyslipidemia through traditional teaching methods while the research group learned it through a computer-aided teaching mode. Before and after the course, the basic theoretical knowledge assessment and clinical case application analysis assessment in two groups were performed and the scores were compared. In addition, a questionnaire survey was conducted to evaluate how well the residents learned the key points of dyslipidemia, their subjective learning attitude, and their acceptance of application of computer-aided teaching mode in general practice. Results In research group, the basic theoretical knowledge(40.52±2.93 vs 37.86±5.20), clinical practical case analysis scores(39.95±2.84 vs 36.24±3.94), and score increase of basic theoretical knowledge and clinical practical case analysis after learning (11.67±4.37 vs 7.86±5.57; 13.00±3.69 vs 8.14±4.95) were higher than those in reference group and showed statistical differences(P<0.05). Compared to reference group, the scores in research group were significantly higher in terms of learning key point of dyslipidemia (35.48±1.33 vs 29.29±1.85), the subjective learning attitude(25.81±1.25 vs 21.05±0.97), and acceptance of computer-aided teaching mode (27.95±0.80 vs 18.33±1.15) in general practice (P<0.05). Conclusions The teaching method based on computer-aided teaching mode is superior to traditional teaching methods in clinical learning of dyslipidemia for general practitioners. Besides,it can also improve basic theoretical knowledge learning and clinical comprehensive ability in practical application, and it’s easy to be acceptable by general practitioners.

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    Case report
    A case report of Gitelman syndrome with false gout as the first manifestation
    XU Wenjun, DING Heyuan, WU Guowei, et al
    2023, 18 (03):  188-189.  DOI: 10.16138/j.1673-6087.2023.03.010
    Abstract ( 20 )   HTML ( 1 )   PDF (340KB) ( 17 )  
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    Exchange of clinical experience
    Discussion on management models in patients with chronic respiratory diseases
    YANG Linglin, CHEN Yujie, WANG Yi, et al
    2023, 18 (03):  192-196.  DOI: 10.16138/j.1673-6087.2023.03.012
    Abstract ( 22 )   HTML ( 1 )   PDF (725KB) ( 31 )  
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    Review article
    An update on complement targeted treatment of IgA nephropathy
    ZHANG Huijian, LI Guisen
    2023, 18 (03):  197-200.  DOI: 10.16138/j.1673-6087.2023.03.013
    Abstract ( 32 )   HTML ( 1 )   PDF (481KB) ( 51 )  
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    Research progress on pathogenesis of diabetic nephropathy
    BI Liming, WANG Zhaohui
    2023, 18 (03):  201-205.  DOI: 10.16138/j.1673-6087.2023.03.014
    Abstract ( 27 )   HTML ( 1 )   PDF (501KB) ( 27 )  
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    Research progress of mineralocorticoid receptor antagonists in treatment of diabetic nephropathy
    ZHANG Xiaoyue, WANG Weiming
    2023, 18 (03):  206-210.  DOI: 10.16138/j.1673-6087.2023.03.015
    Abstract ( 15 )   HTML ( 1 )   PDF (500KB) ( 23 )  
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    Research progress of chronic kidney injury in primary aldosteronism
    LAI Liqin, GONG Yanchun
    2023, 18 (03):  211-214.  DOI: 10.16138/j.1673-6087.2023.03.016
    Abstract ( 24 )   HTML ( 1 )   PDF (423KB) ( 25 )  
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    Application of lipid-modulating drugs in treatment of non-alcoholic fatty liver disease
    ZHANG Ruixiang, SUN Shuoshuo, WEI Xiao, et al
    2023, 18 (03):  215-220.  DOI: 10.16138/j.1673-6087.2023.03.017
    Abstract ( 25 )   HTML ( 2 )   PDF (710KB) ( 27 )  
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    Research progress of interleukin⁃37 effect on cardiovascular diseases
    SU Zhengjia, XIANG Xiaogang, LIANG Qiuli, et al
    2023, 18 (03):  221-224.  DOI: 10.16138/j.1673-6087.2023.03.018
    Abstract ( 28 )   HTML ( 1 )   PDF (430KB) ( 22 )  
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