Changes in renal function and morphological variations of kidney diseases in rheumatoid arthritis patients

Objective:Rheumatoid nephropathy is one of the most severe extra-articular manifestations of rheumatoid arthritis(RA)associated with a very unfavorable prognosis.This study aimed to identify changes in renal function and morphological variations of kidney diseases in RA patients.Methods:The study enrolled patients(126 patients)between 18 and 55 years of age with a confirmed active RA of more than 12 months.Each patient underwent the following range of laboratory and instrumental research methods:general clinical analysis of blood and urine,performing urinalysis according to Nechiporenko method;determining daily proteinuria;determining the blood content of glucose,urea,creatinine,uric acid,total bilirubin,liver transaminase level,ionogram,lipidogram,and coagulogram;determining the blood content of rheumatoid factor,anti-streptolysin O,and C-reactive protein;and X-ray of the joints of hands and feet.Renal function was examined by estimating glomerular filtration rate,tubular reabsorption index,and renal functional reserve.For studying the morphological changes in the kidneys under ultrasound examination,renal biopsy was performed in 31 patients with RA with urinary syndrome(proteinuria more than 0.3 g per day and hematuria).Results:Nephropathy in RA is characterized by impaired renal function and manifested by an increased blood creatinine and a decrease in glomerular filtration rate and renal functional reserve.Among morphological variations of nephropathy at RA,mesangial proliferative glomerulonephritis prevails,accounting for 48.4%of patients.Other disorders include the secondary amyloidosis(29.0%of patients),tubulointerstitial nephritis(16.1%),membranous glomerulonephritis(3.2%),and focal-segmental glomerulosclerosis(3.2%).Conclusion:Kidney damage is a common systemic manifestation of RA with a long and active course,a major nephropathy trigger.

Analysis of Winter Physical Training and Functional Reserve in College Physical Education Teaching

Physical training and functional reserve in winter physical education teaching can optimize the energy consumption of the body,regulate cardiopulmonary function,and stabilize emotions.It is essential to clarify the strategies of winter physical training and functional reserve as well as the existing issues in college physical education teaching,which subsequently improves students’physical functions and achieves comprehensive development goals.

A new scoring system for assessment of liver function after successful hepatectomy in patients with hepatocellular carcinoma

BACKGROUND:Whether a major liver resection is safe has been judged mainly from the patient’s hepatic reserve.However,a safe limit for liver resection does not exist yet.This study aimed to construct a new scoring system as a guide to determine a safe limit for liver resection and avoid liver dysfunction after hepatectomy.METHODS:Eighty-six patients with hepatocellular carcinoma who had undergone hepatectomy in West China Hospital from March 2007 to June 2010 were reviewed.The patients were classified according to the levels of total bilirubin after hepatectomy and the parameters in the perioperative period were compared.Receiver operating characteristic (ROC) analysis was made to assess the liver function compensatory (LFC) value to predict liver dysfunction of the patients after hepatectomy.LFC value is defined as the preoperative KICG value×22.487+standard remnant liver volume (SRLV)×0.020.RESULTS:Patients were classified into group Ⅰ (normal group,n=69) and group Ⅱ (with total bilirubin >85.5 μmol/L for 7 days after hepatectomy,n=17) based on the levels of total bilirubin after hepatectomy.Group II was further divided into two subgroups:recovered subgroup (n=14) and fatal subgroup (n=3).There were no significant differences in preoperative data or intraoperative findings except the indocyanine green test parameters (KICG and ICG R15) and SRLV.ROC analysis showed that the sensitivity and specificity of an LFC value ≤13.01 were 94.1% and 82.6% respectively for predicting liver dysfunction of the patients after hepatectomy.CONCLUSIONS:The LFC value appears to be a good predictor of postoperative liver dysfunction in patients who undergo hepatectomy for HCC.An expected LFC value of 13.01 seems to be a safe limit for liver resection.

Indocyanine green clearance in evaluating the recovery of liver reserve function after superselective transarterial chemoembolization

Transarterial chemoembolization(TACE)may ravage normal liver tissues apart from the neoplastic nodules which offset the anti-tumor effect.This study aimed to evaluate the recovery of liver reserve function(LRF)after TACE by indocyanine green(ICG)clearance test and other routine liver function tests.Forty-six newly diagnosed HCC patients who had undergone TACE as the initial treatment from January 2011 to January 2012 were enrolled in this study.The effects of age,basic ICG clearance rate and interval time between two assessments on the recovery of LRF were analyzed.We found that ICG retention rate at the 15 minutes(ICGR15)was significantly increased after TACE(12.3±8.1%vs 16.8±12.1%,P【0.01)in all the 46 patients.In particular,the ICGR15 value was increased in older patients(age】55 years,20.3±12.5%vs 13.7±7.2%,P【0.01).The interval of ICG test also affected the ICGR15 value(≤47days,17.8±11.4%after vs 12.1±7.1%before TACE,P【0.01).Our data suggested that TACE decreased LRF,especially in older patients.ICG test was more sensitive to evaluate the recovery of LRF after TACE than the Child-Pugh grade and routine liver function tests.

Effects of transjugular intrahepatic portosystemic shunt using the Viatorr stent on hepatic reserve function in patients with cirrhosis

BACKGROUND As transjugular intrahepatic portosystemic shunt(TIPS)creation alters the hemodynamic status of the portal system,whether reduced portal blood supply affects the synthetic reserve function of the liver has been the focus of clinical attention.Since the Viatorr stent entered the Chinese market in 2015,it has not yet been widely used in clinical practice.Further,unlike other countries,the main cause of liver cirrhosis in China is viral hepatitis.Therefore,use of the Viatorr stent to establish a TIPS channel in patients with liver cirrhosis with differing etiologies is of great clinical interest.AIM To investigate factors affecting changes in liver reserve function after TIPS Viatorr stent implantation.METHODS Clinical data from 200 patients with cirrhotic portal hypertension who received TIPS treatment from March 2016 to March 2020 were analyzed retrospectively.The patients were divided into three groups(A-C),according to their disease etiology,with post-hepatitis,autoimmune,and alcoholic cirrhosis,respectively.Preoperative and postoperative liver and renal function and coagulation data,Child-Pugh grade,and model for end-stage liver disease(MELD)scores were collected.Statistical analyses were performed using the t-test or chi-square test.The incidence and of hepatic encephalopathy and patient survival were calculated using Kaplan-Meier method.RESULTS The surgical success rate was 100%,with mean portal pressure gradient(mmHg)decreasing from 25.5±5.22 to 10.04±2.76(t=45.80;P<0.001).After 24 mo,the cumulative incidence of hepatic encephalopathy in group A was significantly lower than that in group B/C,while the cumulative survival rate was significantly higher in group A than in group B/C(P<0.05 for both).The Child-Pugh score for group A was 6.96±1.21,which was significantly better than those of groups B(7.42±0.99;t=-2.44;P=0.016)and C(7.52±1.12;t=-2.67;P=0.009).Further,the MELD score for group A(9.62±2.19)was significantly better than those for groups B(10.64±1.90;t=-2.92;P=0.004)and C(10.82±2.01;t=-3.29;P=0.001).CONCLUSION Insertion of 8 mm internal diameter Viatorr stent has no significant effects on liver reserve function.Changes of liver reserve function in the medium and long term may be related to the etiology and treatment of portal hypertension.

Clinical value of predictive models based on liver stiffness measurement in predicting liver reserve function of compensated chronic liver disease

BACKGROUND Assessment of liver reserve function(LRF)is essential for predicting the prognosis of patients with chronic liver disease(CLD)and determines the extent of liver resection in patients with hepatocellular carcinoma.AIM To establish noninvasive models for LRF assessment based on liver stiffness measurement(LSM)and to evaluate their clinical performance.METHODS A total of 360 patients with compensated CLD were retrospectively analyzed as the training cohort.The new predictive models were established through logistic regression analysis and were validated internally in a prospective cohort(132 patients).RESULTS Our study defined indocyanine green retention rate at 15 min(ICGR15)≥10%as mildly impaired LRF and ICGR15≥20%as severely impaired LRF.We constructed predictive models of LRF,named the mLPaM and sLPaM,which involved only LSM,prothrombin time international normalized ratio to albumin ratio(PTAR),age and model for end-stage liver disease(MELD).The area under the curve of the mLPaM model(0.855,0.872,respectively)and sLPaM model(0.869,0.876,respectively)were higher than that of the methods for MELD,albumin bilirubin grade and PTAR in the two cohorts,and their sensitivity and negative predictive value were the highest among these methods in the training cohort.In addition,the new models showed good sensitivity and accuracy for the diagnosis of LRF impairment in the validation cohort.CONCLUSION The new models had a good predictive performance for LRF and could replace the indocyanine green(ICG)clearance test,especially in patients who are unable to undergo ICG testing.

Clinical observation of Kuntai capsule combined with Fenmotong in treatment of decline of ovarian reserve function

BACKGROUND Decreased ovarian reserve function is an ovarian hypofunction disease that occurs in women before 40 years of age,leading to a decline in fertility and perimeno-pausal symptoms,such as irregular menstruation,amenorrhea,infertility,de-creased libido,and autonomic nervous dysfunction.Fenmatong(FMT)is a com-pound mixture of estradiol tablets and estradiol didroxyprogesterone tablets,which can improve ovarian reserve function by supplementation of exogenous estrogen.However,this treatment has also been shown to cause breast pain,gastrointestinal discomfort,irregular vaginal bleeding,and changes in sexual desire.In severe cases,FMT can promote the development of breast cancer,endometrial cancer,and venous embolic disease.AIM To observe the effects of Kuntai capsules and FMT on endocrine indexes and uterine artery blood circulation in patients with decreased ovarian reserve func-tion.METHODS Patients(130)with decreased ovarian reserve function,who were treated in our hospital from May 2018 to May 2020,were divided into two groups:The FMT group,in which patients were treated with FMT,and the observation group,in which patients were treated with Kuntai capsules.Chinese medicine symptom scores,uterine artery blood flow parameters,ovarian ultrasound test indexes,pictorial blood loss assessment chart(PBAC)scores,and hormone levels were recorded,and total effective rates were calculated for both groups.RESULTS The total effective rate in the observation group was higher than that in the FMT group(P<0.05).After treatment,primary symptoms,including low menstrual volume,delayed menstruation,red color and thick consistency of menses,di-zziness,palpitation,weakness at the waist and knee,insomnia and excessive dreaming,irritability,and dryness and astringency of the pudendal canal in the observation group decreased,and scores for primary and secondary symptoms in the observation group were significantly lower than those in the FMT group(P<0.05).The systolic peak flow rate(PSV),end-diastolic flow rate(EDV),ovarian diameter,sinus follicle count,and resistance index(RI)of the uterine arteries in the observation group and FMT group increased after treatment.Notably,the PSV,EDV,ovarian diameter,and antral follicle count in the observation group were higher than those in the FMT group,whereas the RI in the observation group was lower than that in the FMT group(P<0.05).The PBAC scores in the observation and FMT groups increased after treatment,with that in the ob-servation group becoming significantly higher than that in the FMT group(P<0.05).After treatment,estradiol(E2)and anti-Mullerian hormone(AMH)levels increased,whereas follicle-stimulating hormone(FSH)levels decreased in the observation group and FMT group;E2 and AMH levels became significantly higher and FSH levels became significantly lower in the observation group than in the FMT group(P<0.05).CONCLUSION Compared with FMT,Kuntai capsules promoted uterine artery blood circulation,improved menstruation,relieved symptoms,regulated endocrine function,and improved curative effects.

Clinical efficacy of antiviral therapy in patients with hepatitis Brelated cirrhosis after transjugular intrahepatic portosystemic shunt

BACKGROUND As a country with a high burden of hepatitis B,China has about 86 million cases of hepatitis B virus infection,ranking the first in the world.Currently,there are about 390000 deaths due to hepatitis B-related complications such as liver cirrhosis and liver cancer every year.Consequently,how to control portal hypertension,improve liver functional reserve,and reduce the incidence of hepatic failure and liver cancer in such patients is the focus of current clinical attention.Previous clinical study in our center suggested that at 24 mo after transjugular intrahepatic portosystemic shunt(TIPS),the liver functional reserve of patients with hepatitis B cirrhosis was better than that of patients with alcoholinduced and immune cirrhosis,which may be related to the effective etiological treatment.AIM To investigate the clinical efficacy of three first-line antiviral drugs recommended by the guidelines of prevention and treatment for chronic hepatitis B in China(2019)in the treatment of patients with hepatitis B-related cirrhosis who had received a TIPS.METHODS The clinical data of 137 patients with hepatitis B-related cirrhosis with portal hypertension after receiving TIPS at our centre between March 2016 and December 2020 were analysed retrospectively.According to different anti-viral drugs,the patients were divided into entecavir(ETV)(n=70),tenofovir alafenamide fumarate(TAF)(n=32),and tenofovir disoproxil fumarate(TDF)(n=35)groups.The cumulative incidence of hepatic encephalopathy and hepatocellular carcinoma,survival,and changes in hepatic reserve function and glomerular filtration rate in patients treated with different antiviral drugs within 24 mo after surgery were investigated.RESULTS At 24 mo after surgery,the Child-Pugh score in the TAF group(6.97±0.86)was lower than that in the TDF(7.49±0.82;t=-2.52,P=0.014)and ETV groups(7.64±1.17;t=-2.92,P=0.004).The model for end-stage liver disease score in the TAF group at 24 mo after surgery was 9.72±1.5,which was lower than that in the TDF(10.74±2.33;t=-2.09,P=0.040)and ETV groups(10.97±2.17;t=-2.93,P=0.004).At 24 mo after surgery,the estimated glomerular filtration rate(eGFR)in the TAF group(104.41±12.54)was higher than that in the TDF(93.54±8.97)and ETV groups(89.96±9.86)(F=21.57,P<0.001).CONCLUSION At 24 mo after surgery,compared with TDF and ETV,TAF has significant advantages in the improvement of liver functional reserve and eGFR.

Hepatic trisegmentectomy for 29 patients with huge liver neoplasms

Objective: To evaluate retrospectively the feasibility and effect of hepatic trisegmentectomy in therapy of huge neoplasms of the liver. Methods: From July 1993 to October 1999, 29 pa- tients with huge hepatic neoplasms underwent hepatic trisegmentectomy. Of these, 23 patients suffered from primary liver cancer, 1 hepatic infiltration of gallbladder cancer, 1 metastasis of colon cancer, 1 hepatic angiosarcoma, 1 hepatic neurofibroma, and 2 huge liver cysts. Twenty-six patients were subjected to right trisegmentectomy and the rest 3 left triseg- mentectomy. All trisegmentectomies were performed under normothermic interruption of the porta hepatis at single time and these interruptions lasted 15 to 40 minutes. Results: The relatively good effect was seen in our se- ries. The 1-, 3-, 5-year survival rates for primary liver cancer patients were 63.6%, 36.4% and 27.3 %, respectively. The survival period for the pa- tients with hepatic infiltration of gallbladder cancer and liver metastasis of colon cancer was 6 months. Those with hepatic angiosarcoma, hepatic neurofi- broma and huge liver cysts have been surviving 35, 26, 25 and 40 months, respectively. Major complica- tions were noted in 5 patients, and one (3.4%, 1/29) died. Conclusion: Hepatic trisegmentectomy is safe and ef- fective in treatment of huge hepatic neoplasms if its indications and operative techniques are properly mastered.

Association between IDEAL-IQ MRI fat fraction quantification and pelvic bone marrow reserve function in concurrent chemoradiotherapy for cervical cancer

Objective:To analyze the association between iterative decomposition of water and fat with echo asymmetry and least-squares estimation quantification sequence(IDEAL-IQ)magnetic resonance imaging(MRI)of bone marrow fat fraction and bone marrow reserve function during concurrent chemoradiotherapy for cervical cancer.Methods:The study retrospectively analyzed twenty-six patients with stage IB1 to IVA cervical cancer treated between February 2020 and November 2020.All patients received concurrent chemoradiotherapy that included platinum alone or combined paclitaxel and platinum.Pelvic IDEAL-IQ MRI(plain and enhanced)was performed before and after treatment.Regions of interest,including the fifth lumbar vertebra,sacrum,ilium,ischium,and femoral neck,were manually delineated,and the bone marrow fat fraction was measured.Peripheral blood cell counts were recorded during treatment,and the relationship between the fat fraction values and changes in the blood cell counts was explored.Results:IDEAL-IQ MRI bone marrow fat fraction was associated with platelet nadir and platelet decline during treatment.The average pelvic bone marrow fat fraction before chemoradiotherapy was moderately negatively correlated with platelet count nadir during concurrent chemoradiotherapy(r=-0.450,P?0.021).The change in average pelvic bone marrow fat fraction through chemoradiotherapy was moderately positively correlated with the degree of thrombocytopenia(r=0.399,P=0.044).Conclusion:Bone marrow fat content quantified by IDEAL-IQ was associated with platelet count nadir and the degree of thrombocytopenia in patients with cervical cancer undergoing concurrent chemoradiotherapy.

Hydrogen-rich Water Exerting a Protective Effect on Ovarian Reserve Function in a Mouse Model of Immune Premature Ovarian Failure Induced by Zona Pellucida 3

Background：Premature ovarian failure （POF） is a disease that affects female fertility but has few effective treatments.Ovarian reserve function plays an important role in female fertility.Recent studies have reported that hydrogen can protect male fertility.Therefore,we explored the potential protective effect of hydrogen-rich water on ovarian reserve function through a mouse immune POF model.Methods：To set up immune POF model,fifty female BALB/c mice were randomly divided into four groups：Control （mice consumed normal water,n =10）,hydrogen （mice consumed hydrogen-rich water,n =10）,model （mice were immunized with zona pellucida glycoprotein 3 [ZP3] and consumed normal water,n =15）,and model-hydrogen （mice were immunized with ZP3 and consumed hydrogen-rich water,n =15） groups.After 5 weeks,mice were sacrificed.Serum anti-M＆#252;llerian hormone （AMH） levels,granulosa cell （GC） apoptotic index （AI）,B-cell leukemia/lymphoma 2 （Bcl-2）,and BCL2-associated X protein （Bax） expression were examined.Analyses were performed using SPSS 17.0 （SPSS Inc.,Chicago,IL,USA） software.Results：Immune POF model,model group exhibited markedly reduced serum AMH levels compared with those of the control group （5.41 ± 0.91 ng/ml vs.16.23 ± 1.97 ng/ml,P =0.033） and the hydrogen group （19.65 ± 7.82 ng/ml,P =0.006）.The model-hydrogen group displayed significantly higher AMH concentrations compared with that of the model group （15.03 ± 2.75 ng/ml vs.5.41 ± 0.91 ng/ml,P =0.021）.The GC AI was significantly higher in the model group （21.30 ± 1.74%） than those in the control （7.06 ± 0.27%）,hydrogen （5.17 ± 0.41%）,and model-hydrogen groups （11.24 ± 0.58%） （all P 〈 0.001）.The GC AI was significantly higher in the model-hydrogen group compared with that of the hydrogen group （1 1.24 ± 0.58% vs.5.1 7 ± 0.41%,P =0.021）.Compared with those of the model group,ovarian tissue Bcl-2 levels increased （2.18 ± 0.30 vs.3.01 ± 0.33,P =0.045） and the Bax/Bcl-2 ratio decreased in the model-hydrogen group.Conclusions：Hydrogen-rich water may improve serum AMH levels and reduce ovarian GC apoptosis in a mouse immune POF model induced by ZP3.

Expectations for partial splenic arterial embolization simultaneous transcatheter arterial chemoembolization for hepatocellular carcinoma

Hepatocellular carcinoma(HCC)is frequently complicated by cirrhosis,and it is not unusual for treatment options to be limited as a result of pancytopenia due to hypersplenism.Partial splenic embolization(PSE)has been performed for thrombocytopenia resulting from hypersplenism.However,the safety and effi cacy of concurrent transcatheter arterial chemoembolization(TACE)with PSE for HCC remain unclear.Thrombocytopenia has been improved,and treatment continued using concurrent PSE.In addition,the hepatic functional reserve could be maintained even after treatment for HCC.Concurrent TACE and PSE for HCC with thrombocytopenia can be expected to help maintain a hepatic reserve,and it may contribute to improving the prognosis of HCC.Hence,PSE could lead to an asplenic state.The appearance of Howell-Jolly bodies on a peripheral blood smear is reported useful for assessing splenic function.The appearance of Howell-Jolly bodies is associated with an increased risk for post-splenectomy sepsis/overwhelming post-splenectomy infection in patients with reduced splenic function.These bodies are frequently observed in peripheral erythrocytes after PSE,and when they are present,it is appropriate to administer the pneumococcal vaccine to prevent severe infection.The expectations for PSE combined with TACE for the treatment of HCC associated with cirrhosis are reviewed.