Endothelial injury and inflammation in patients with hyperuricemic nephropathy at chronic kidney disease stages 1-2 and 3-4

BACKGROUND Endothelial injury and inflammation are the main pathological changes in hyperuricemic nephropathy(HN);however,they have not been assessed in patients in the early,middle,and late phases of HN.AIM To investigate endothelial injury and inflammatory conditions between patients with HN at chronic kidney disease(CKD)stages 3-4 and CKD 1-2.METHODS This study enrolled 80 patients(49 and 31 with HN at CKD stage 1-2 and 3-4,respectively)from the Department of Nephrology,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine between July 2021 and January 2022.Plasma levels of heparan sulfate,endocan,oxidized low-density lipoprotein(Ox-LDL),E-selectin,soluble intercellular adhesion molecule-1(slCAM1),interleukin(IL)-1β,and IL-6 and urine levels of lipocalin-type prostaglandin D synthase(L-PGDS),IL-1β,and IL-6 were measured using enzyme-linked immunosorbnent assay.RESULTS Comparison between patients with HN at CKD 1-2 and those with HN at CKD 3-4 showed that age and disease course were significant factors(P<0.001 and P<0.010,respectively).There were no statistical differences in sex,heart rate,body mass index,and systolic and diastolic blood pressures.The incidence of hypertension was also significant(P=0.03).Plasma levels of heparin sulfate(P<0.001),endocan(P=0.034),E-selectin(P<0.001),slCAM1(P<0.001),IL-1β(P=0.006),and IL-6(P=0.004)and the urine levels of L-PGDS(P<0.001),IL-1β(P=0.003),and IL-6(P<0.001)were high in patients with HN at CKD 3-4 than in those with HN at CKD 1-2.The difference in plasma Ox-LDL levels was not significant(P=0.078).CONCLUSION Vascular endothelial injury and inflammation were higher in patients with HN at CKD3-4 than at CKD 1-2.Plasma heparin sulfate and slCAM1 levels are synergistic factors for CKD staging in HN.

Effects of yiqi yangyin huoxue therapy on IgA nephropathy: a systematic review and meta-analysis of randomized controlled trials

Objective To assess the efficacy and safety of Yiqi Yangyin Huoxue therapy (YYHT) for the treatment of IgA nephropathy. Methods Databases articles about YYHT in treating IgAN patients were searched through February 2018. Comparisons were YYHT alone or YYHT in combination with western medicine as experimental intervention, and western medicine as the control. Randomized controlled trials (RCTs) were selected. Cochrane collaboration tool was used for assessing risk of bias to evaluate methodologies. RevMan 5.3 software was applied to analyze the data of included trials. Results A total of 21 studies involving 1473 patients were included. Meta-analysis results demonstrated that YYHT alone or YYHT in combination with western medicine were more efficacious than only western medicine in decreasing proteinuria [MD =-0.41, 95% CI (-0.53,-0.29), P < 0.00001] and the urine red blood cells [MD =-7.46, 95% CI (-9.28,-5.64), P < 0.00001]. There also showed improvement in the clinical total effective rate [OR = 2.78, 95% CI (2.14, 3.61), P < 0.00001] between the two groups. Some of the included trials did not report the adverse events. Conclusions Current evidence shows that YYHT can reduce proteinuria and urine red blood cells and improve the total efficacy rate. Since poor quality and publication bias of some included trials, more evidence-based medicine studies needed to define the role of YYHT in the treatment of IgAN.

Minimal change disease caused by polycythemia vera: A case report

BACKGROUND Polycythemia vera(PV),often attributed to the JAK2 V617F mutation,is characterized by enhanced red blood cell counts in the peripheral blood.PV-associated renal disease is clinically rare;to date,there have been reports of other chronic kidney diseases related to PV,but no reports on PV-associated minimal change disease.CASE SUMMARY A 37-year-old man presented with proteinuria and high red blood cell count on January 4,2021.The patient underwent bone marrow and renal biopsies,then was subsequently diagnosed with PV and minimal change in disease.Hydroxyurea was administered and proteinuria remission was achieved.The patient’s last visit was on April 14,2022.CONCLUSION We inferred that there may be a causal relationship between PV and minimal change disease.

The review of clinical application of X-shaped balance acupuncture therapy for joint pain and activity disorder

Musculoskeletal diseases such as neck, shoulder, back and leg pain are ext remely common in clinic. Diseases of the joints of the ext remi ti es, especially sputum, wr ist spr ains, and periarthritis of the shoulders, and even lumbar disc herniation, use X-shaped balance acupuncture therapy to relieve pain and improve motor function. The method of obtaining acupoints is simple and easy to operate. Many of clinical comparison shows that this therapy is simple to conventional acupuncture and moxibustion in the treatment of local pain and joint diseases. This review concluded the advantaged about the X-shaped balance acupuncture therapy and it worth to clinical promotion.

Uremic clearance granule combined with Alprostadil in the treatment of chronic renal failure: A systematic review and meta-analysis

Objective: To evaluate whether the combination of Uremic clearance granule with Alprostadil is superior to Alprostadil alone for CRF. Methods: Relevant RCTs were searched through March 2019. Data were analyzed by Stata 15.0. Results: Nine articles involving 726 patients were enrolled in this study. Meta-analysis showed that the total effective rate [OR = 3.68 (2.44, 5.55), P < 0.001], Scr [SMD =-2.34 (-3.49,-1.19), P < 0.001], BUN [SMD =-1.80 (-2.73,-0.87), P < 0.001], Ccr [SMD = 0.71 (0.44, 0.97), P < 0.001] were better in the experimental group. But there were no significant difference in UA, CysC, 24h-Upro and incidence of adverse reactions (all P > 0.05) between two groups. No serious adverse reactions were found. Conclusions: The effect of the integrated medicine on CRF was better than Alprostadil alone. Uremic clearance granule is safe and has no obvious adverse reactions.

Meta-analysis of Laparoscopic cyst decortication versus traditional open cyst decortication for ADPKD in China: evidence based on 362 cases and 399 controls

Objectives:To assess the safety,feasibility and clinical benefits of LCD and OCD for the treatment of ADPKD.Methods:Databases articles comparing LCD and OCD in treating PKD were collected through March 2019.After screening for inclusion and data extraction,meta-analysis was performed by the RevMan 5.3 software.Results:A total of 9 studies involving 761 patients were finally included,with 362 cases in LCD group and 399 cases in OCD group.LCD was associated with a shorter operative time(MD=-36.24,95%CI:-44.20^-28.28,P<0.00001)and postoperative hospital stay(MD=-4.04,95%CI:-5.13^-2.95,P<0.00001).Besides,LCD had an earlier time to postoperative ambulation(MD=-14.90,95%CI:-16.33^-13.48,P<0.00001)and earlier time to first flatus(MD=-1.52 days,95%CI:-1.65^-1.40,P<0.00001;MD=-10.76 hours,95%CI:-12.71^-8.81,P<0.00001).In addition,LCD had a lower intraoperative blood loss(MD=-159.81,95%CI:-243.32^-76.31,P=0.0002)and lower analgesic dosage(MD=-56.62,95%CI:-84.16^-29.08,P<0.0001).There showed no statistically significant difference between the two groups in Scr,Bun,systolic and diastolic blood pressure(all P>0.05).Conclusions:Current evidence demonstrated a shorter postoperative hospital stay,lower blood loss,less postoperative pain,and other advantages.LCD may therefore be a feasible and safe surgical approach of ADPKD.

Changes in the Bispectral Index in Response to Loss of Consciousness and No Somatic Movement to Nociceptive Stimuli in Elderly Patients

Background： Bispectral index （BIS） is considered very useful to guide anesthesia care in elderly patients, but its use is controversial for the evaluation of the adequacy of analgesia.This study compared the BIS changes in response to loss of consciousness （LOC） and loss of somatic response （LOS） to nociceptive stimuli between elderly and young patients receiving intravenous target-controlled infusion （TCI） of propofol and remifentanil.Methods： This study was performed on 52 elderly patients （aged 65-78 years） and 52 young patients （aged 25-58 years）, American Society of Anesthesiologists physical status Ⅰ or Ⅱ.Anesthesia was induced with propofol administered by TCI.A standardized noxious electrical stimulus （transcutaneous electrical nerve stimulation, [TENS]） was applied （50 Hz, 80 mA, 0.25 ms pulses for 4 s） to the ulnar nerve at increasing remifentanil predicted effective-site concentration （Ce） until patients lost somatic response to TENS.Changes in awake, prestimulus, poststimulus BIS, heart rate, mean arterial pressure, pulse oxygen saturation, predicted plasma concentration, Ce of propofol, and remifentanil at both LOC and LOS clinical points were investigated.Results： BISLOC in elderly group was higher than that in young patient group （65.4 ＆#177; 9.7 vs.57.6 ＆#177; 12.3） （t =21.58, P 〈 0.0001） after TCI propofol, and the propofol Ce at LOC was 1.6 ＆#177; 0.3 μg/ml in elderly patients, which was significantly lower than that in young patients （2.3 ＆#177; 0.5 μg/ml） （t =7.474, P 〈 0.0001）.As nociceptive stimulation induced BIS to increase, the mean of BIS maximum values after TENS was significantly higher than that before TENS in both age groups （t =8.902 and t =8.019, P 〈 0.0001）.With increasing Ce of remifentanil until patients lost somatic response to TENS, BISLOS was the same as the BISLOC in elderly patients （65.6 ＆#177; 10.7 vs.65.4 ＆#177; 9.7）, and there were no marked differences between elderly and young patient groups in BISawake, BISLOS, and Ce of remifentanil required for LOS.Conclusion： In elderly patients, BIS can be used as an indicator for hypnotic-analgesic balance and be helpful to guide the optimal administration of propofol and remifentanil individually.