Ascites is one of the major complications of liver cirrhosis and is associated with a poor prognosis. It is important to distinguish noncirrhotic from cirrhotic causes of ascites to guide therapy in patients with nonc...Ascites is one of the major complications of liver cirrhosis and is associated with a poor prognosis. It is important to distinguish noncirrhotic from cirrhotic causes of ascites to guide therapy in patients with noncirrhotic ascites. Mild to moderate ascites is treated by salt restriction and diuretic therapy. The diuretic of choice is spironolactone. A combination treatment with furosemide might be necessary in patients who do not respond to spironolactone alone. Tense ascites is treated by paracentesis, followed by albumin infusion and diuretic therapy. Treatment options for refractory ascites include repeated paracentesis and transjugular intrahepatic portosystemic shunt placement in patients with a preserved liver function. Potential complications of ascites are spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS). SBP is diagnosed by an ascitic neutrophil count > 250 cells/mm3 and is treated with antibiotics. Patients who survive a first episode of SBP or with a low protein concentration in the ascitic fluid require an antibiotic prophylaxis. The prognosis of untreated HRS type 1 is grave. Treatment consists of a combination of terlipressin and albumin. Hemodialysis might serve in selected patients as a bridging therapy to liver transplantation. Liver transplantation should be considered in all patients with ascites and liver cirrhosis.展开更多
Acute kidney injury(AKI),defined as an abrupt increase in the serum creatinine level by at least 0.3 mg/dL,occurs in about 20% of patients hospitalized for decompensating liver cirrhosis.Patients with cirrhosis are su...Acute kidney injury(AKI),defined as an abrupt increase in the serum creatinine level by at least 0.3 mg/dL,occurs in about 20% of patients hospitalized for decompensating liver cirrhosis.Patients with cirrhosis are susceptible to developing AKI because of the progressive vasodilatory state,reduced effective blood volume and stimulation of vasoconstrictor hormones.The most common causes of AKI in cirrhosis are pre-renal azotemia,hepatorenal syndrome and acute tubular necrosis.Differential diagnosis is based on analysis of circumstances of AKI development,natriuresis,urine osmolality,response to withdrawal of diuretics and volume repletion,and rarely on renal biopsy.Chronic glomerulonephritis and obstructive uropathy are rare causes of azotemia in cirrhotic patients.AKI is one of the last events in the natural history of chronic liver disease,therefore,such patients should have an expedited referral for liver transplantation.Hepatorenal syndrome(HRS) is initiated by progressive portal hypertension,and may be prematurely triggered by bacterial infections,nonbacterial systemic inflammatory reactions,excessive diuresis,gastrointestinal hemorrhage,diarrhea or nephrotoxic agents.Each type of renal disease has a specific treatment approach ranging from repletion of the vascular system to renal replacement therapy.The treatment of choice in type 1 hepatorenal syndrome is a combination of vasoconstrictor with albumin infusion,which is effective in about 50% of patients.The second-line treatment of HRS involves a transjugular intrahepatic portosystemic shunt,renal vasoprotection or systems of artificial liver support.展开更多
AIM： To evaluate the accuracy of spot urinary Na/K and Na/creatinine （Cr） ratios as an alternative to 24-h urinary sodium in monitoring dietary compliance in patients with liver cirrhosis and ascites treated with d...AIM： To evaluate the accuracy of spot urinary Na/K and Na/creatinine （Cr） ratios as an alternative to 24-h urinary sodium in monitoring dietary compliance in patients with liver cirrhosis and ascites treated with diuretics. METHODS： The study was carried on 40 patients with liver cirrhosis and ascites treated with diuretic therapy. Patients were divided into two groups according to 24-h urinary sodium. We measured spot urine Na/K ratio, Na/ Cr ratio and 24-h urinary sodium. Student＇s t test was used to compare the interval variables and x^2 test to compare the nominal variables between the two groups. Receiver operator characteristic curve was used to identify the best cutoff point for Na/K and Na/Cr ratio. RESULTS： The best cutoff point for Na/K ratio was 2.5 （P 〈 0.001） and area under the curve （AUC） was 0.9, and for Na/Cr ratio, the best cutoff point was 35 （P 〈 0.001） and AUC was 0.885. Na/K ratio showed higher sensitivity and accuracy compared to Na/Cr ratio （87.5% and 87% for Na/K ratio; 81% and 85% for Na/Cr ratio, respectively）. CONCLUSION： Spot urine Na/K ratio has adequate accuracy for assessment of dietary sodium restriction compared with 24-h urinary sodium in patients with liver cirrhosis and ascites.展开更多
Background Acute myocardial infarction （AMI） is a common cause of heart failure （HF）, which can develop soon after AMI and may persist or resolve or develop late. HF after an MI is a major source of mortality. The...Background Acute myocardial infarction （AMI） is a common cause of heart failure （HF）, which can develop soon after AMI and may persist or resolve or develop late. HF after an MI is a major source of mortality. The cumulative incidence, prevalence and resolution of HF after MI in different age groups are poorly described. This study describes the natural history of HF after AMI according to age. Methods Patients with AMI during 1998 were identified from hospital records. HF was defined as treatment of symptoms and signs of HF with loop diuretics and was considered to have resolved if loop diuretic therapy could be stopped without recurrence of symptoms. Patients were cate- gorised into those aged 〈 65 years, 65-75 years, and 〉 75 years. Results Of 896 patients, 311,297 and 288 were aged 〈 65, 65-75 and 〉75 years and of whom 24%, 57% and 82% had died respectively by December 2005. Of these deaths, 24 （8%）, 68 （23%） and 107 （37%） oc- curred during the index admission, many associated with acute HF. A further 37 （12%）, 63 （21%） and 82 （29%） developed HF that persisted until discharge, of whom 15, 44 and 62 subsequently died. After discharge, 53 （24%）, 55 （40%） and 37 （47%） patients developed I-IF for the first time, of whom 26%, 62% and 76% subsequently died. Death was preceded by the development of HF in 35 （70%）, 93 （91%） and 107 （85%） in aged 〈 65 years, 65-75 years and 〉75 years, respectively. Conclusions The risk of developing HF and of dying after an MI in- creases progressively with age. Regardless of age, most deaths after a MI are preceded by the development of HF.展开更多
A novel oleanane-type triterpenic acid was isolated from the leaves of Gymnema sylvestre(Asclepiadaceae). The structure was characterized as 3β, 16β, 22β, 28-tetrahydroxy- olean-12-en-30-oic acid on the basis of sp...A novel oleanane-type triterpenic acid was isolated from the leaves of Gymnema sylvestre(Asclepiadaceae). The structure was characterized as 3β, 16β, 22β, 28-tetrahydroxy- olean-12-en-30-oic acid on the basis of spectral evidence, including 1D- and 2D-NMR (HMQC, HMBC, H-1H 1COSY and NOESY).展开更多
To the Editor Monitoring urine output remains essential to the care of adult patients admitted to the hospital. In acute, decompen- sated heart failure, ongoing assessment of urine output is required to adjust diureti...To the Editor Monitoring urine output remains essential to the care of adult patients admitted to the hospital. In acute, decompen- sated heart failure, ongoing assessment of urine output is required to adjust diuretic dosing in keeping with current recommendations for hospitalized patients, In patients with acute kidney injury, assessment of urine output is essential for diagnosis and management. The diagnosis of circulatory shock is supported by renal hypoperfusion as measured by low urine output. Indwelling urinary cathe- ters are routinely used for the ＂strict＂ monitoring of urine output, which is an accepted indication.展开更多
Objective: To detect the inhibition of urogenitalchlamydia trachomatis (CT) by 12 traditional Chinesemedicines in vitro.Methods: The inhibition of CT isolates by these medicineswas detected by micro-culture technique ...Objective: To detect the inhibition of urogenitalchlamydia trachomatis (CT) by 12 traditional Chinesemedicines in vitro.Methods: The inhibition of CT isolates by these medicineswas detected by micro-culture technique with McCoy cellsin vitro. Results: All the diuretic traditional Chinese medicinesinhibited urogenital CT The minimum inhibitoryconcentrations (MICs) ranged from 0.122 mg ml^(-1) to 62.5mg ml^(-1). Diathus superbus L., Poria cocos (Shew.) Woft,Polyporus umbellatus (Pers.) Fries, and Artemisia capillariesThunb showed stronger inhibition than the other eighttraditional Chinese medicines. The numbers and sizes ofinclusions bodies reduced gradually and disappeared finallywith the increase of the concentrations. Conclusion: All the 12 diuretic traditional Chinesemedicines inhibited urogenital CT.展开更多
Objective Nephrolithiasis is a common urological disease. This study aims to evaluate the preventive and therapeutic effects of hydro-alcoholic extract of Aerva lanata(L.) roots(HAEAL) on ethylene glycol-induced nephr...Objective Nephrolithiasis is a common urological disease. This study aims to evaluate the preventive and therapeutic effects of hydro-alcoholic extract of Aerva lanata(L.) roots(HAEAL) on ethylene glycol-induced nephrolithiasis in rats.Methods Fifty grams of shade-dried coarsely powdered Aerva lanata(L.) root was successively extracted with organic solvents in increasing order of polarity [petroleum ether(60-80 ℃), chloroform, and ethanol] using a Soxhlet apparatus, and then concentrated. Physical tests including nature, color, odor, and texture were performed on the herbal suspension. In vitro nephrolithiasis assessment was performed by nucleation assay, aggregation assay, and crystal growth assay. Thirty adult male Wistar albino rats were randomly divided into five groups(six rats in each group). Group 1: negative control group without induction or treatment till day 28. Group 2: positive control group receiving a daily oral solution of 0.75% ethylene glycol till day 14, and mixed with distilled water till day 28. Group 3: standard group receiving a daily oral solution of 0.75% ethylene glycol till day 14 and Cystone(750 mg/kg) from day 15 to day 28. Group 4: low dose HAEAL group receiving a daily oral solution of 0.75%ethylene glycol till day 14, and 400 mg/kg HAEAL from day 15 to day 28(1 mL per day). Group 5: high dose HAEAL group receiving a daily oral solution of 0.75% ethylene glycol till day 14,and 800 mg/kg HAEAL from day 15 to day 28(1 mL per day). Urine(urine volume, pH value,appearance, odor, and turbidity) examination and serum test were performed. On day 29, the kidneys were dissected, and histopathology examination was performed to determine the degree of tubular injury.Results The suspension showed stability and aroma with no turbidity at room temperature.The suspension did not show changes in color and odor until day 3, indicating that the preparation was stable for 72 h. Body weight decreased in the positive control group indicating stone formation and changes in water intake. Both standard and HAEAL treatments restored the body weight to normal levels after treatment, indicating the beneficial effects of the treatment. Histopathological examination revealed no significant findings in the negative control group, whereas the positive control group showed inflammation in the kidney parenchyma.Compared with positive control group, there was increase in urine volume and excretion of urinary constituents such as calcium and oxalate(P < 0.01) as well as improved clearance rate(P < 0.05) in HAEAL treatment groups, in addition, the urine pH value of HAEAL groups was increased.Conclusion HAEAL reduced nephrolithiasis formation and had a diuretic effect, which could be used to promote the expulsion of stones. Further studies are needed to enhance the stability of the suspension for the production of better pharmaceutical formulations.展开更多
文摘Ascites is one of the major complications of liver cirrhosis and is associated with a poor prognosis. It is important to distinguish noncirrhotic from cirrhotic causes of ascites to guide therapy in patients with noncirrhotic ascites. Mild to moderate ascites is treated by salt restriction and diuretic therapy. The diuretic of choice is spironolactone. A combination treatment with furosemide might be necessary in patients who do not respond to spironolactone alone. Tense ascites is treated by paracentesis, followed by albumin infusion and diuretic therapy. Treatment options for refractory ascites include repeated paracentesis and transjugular intrahepatic portosystemic shunt placement in patients with a preserved liver function. Potential complications of ascites are spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS). SBP is diagnosed by an ascitic neutrophil count > 250 cells/mm3 and is treated with antibiotics. Patients who survive a first episode of SBP or with a low protein concentration in the ascitic fluid require an antibiotic prophylaxis. The prognosis of untreated HRS type 1 is grave. Treatment consists of a combination of terlipressin and albumin. Hemodialysis might serve in selected patients as a bridging therapy to liver transplantation. Liver transplantation should be considered in all patients with ascites and liver cirrhosis.
文摘Acute kidney injury(AKI),defined as an abrupt increase in the serum creatinine level by at least 0.3 mg/dL,occurs in about 20% of patients hospitalized for decompensating liver cirrhosis.Patients with cirrhosis are susceptible to developing AKI because of the progressive vasodilatory state,reduced effective blood volume and stimulation of vasoconstrictor hormones.The most common causes of AKI in cirrhosis are pre-renal azotemia,hepatorenal syndrome and acute tubular necrosis.Differential diagnosis is based on analysis of circumstances of AKI development,natriuresis,urine osmolality,response to withdrawal of diuretics and volume repletion,and rarely on renal biopsy.Chronic glomerulonephritis and obstructive uropathy are rare causes of azotemia in cirrhotic patients.AKI is one of the last events in the natural history of chronic liver disease,therefore,such patients should have an expedited referral for liver transplantation.Hepatorenal syndrome(HRS) is initiated by progressive portal hypertension,and may be prematurely triggered by bacterial infections,nonbacterial systemic inflammatory reactions,excessive diuresis,gastrointestinal hemorrhage,diarrhea or nephrotoxic agents.Each type of renal disease has a specific treatment approach ranging from repletion of the vascular system to renal replacement therapy.The treatment of choice in type 1 hepatorenal syndrome is a combination of vasoconstrictor with albumin infusion,which is effective in about 50% of patients.The second-line treatment of HRS involves a transjugular intrahepatic portosystemic shunt,renal vasoprotection or systems of artificial liver support.
文摘AIM： To evaluate the accuracy of spot urinary Na/K and Na/creatinine （Cr） ratios as an alternative to 24-h urinary sodium in monitoring dietary compliance in patients with liver cirrhosis and ascites treated with diuretics. METHODS： The study was carried on 40 patients with liver cirrhosis and ascites treated with diuretic therapy. Patients were divided into two groups according to 24-h urinary sodium. We measured spot urine Na/K ratio, Na/ Cr ratio and 24-h urinary sodium. Student＇s t test was used to compare the interval variables and x^2 test to compare the nominal variables between the two groups. Receiver operator characteristic curve was used to identify the best cutoff point for Na/K and Na/Cr ratio. RESULTS： The best cutoff point for Na/K ratio was 2.5 （P 〈 0.001） and area under the curve （AUC） was 0.9, and for Na/Cr ratio, the best cutoff point was 35 （P 〈 0.001） and AUC was 0.885. Na/K ratio showed higher sensitivity and accuracy compared to Na/Cr ratio （87.5% and 87% for Na/K ratio; 81% and 85% for Na/Cr ratio, respectively）. CONCLUSION： Spot urine Na/K ratio has adequate accuracy for assessment of dietary sodium restriction compared with 24-h urinary sodium in patients with liver cirrhosis and ascites.
文摘Background Acute myocardial infarction （AMI） is a common cause of heart failure （HF）, which can develop soon after AMI and may persist or resolve or develop late. HF after an MI is a major source of mortality. The cumulative incidence, prevalence and resolution of HF after MI in different age groups are poorly described. This study describes the natural history of HF after AMI according to age. Methods Patients with AMI during 1998 were identified from hospital records. HF was defined as treatment of symptoms and signs of HF with loop diuretics and was considered to have resolved if loop diuretic therapy could be stopped without recurrence of symptoms. Patients were cate- gorised into those aged 〈 65 years, 65-75 years, and 〉 75 years. Results Of 896 patients, 311,297 and 288 were aged 〈 65, 65-75 and 〉75 years and of whom 24%, 57% and 82% had died respectively by December 2005. Of these deaths, 24 （8%）, 68 （23%） and 107 （37%） oc- curred during the index admission, many associated with acute HF. A further 37 （12%）, 63 （21%） and 82 （29%） developed HF that persisted until discharge, of whom 15, 44 and 62 subsequently died. After discharge, 53 （24%）, 55 （40%） and 37 （47%） patients developed I-IF for the first time, of whom 26%, 62% and 76% subsequently died. Death was preceded by the development of HF in 35 （70%）, 93 （91%） and 107 （85%） in aged 〈 65 years, 65-75 years and 〉75 years, respectively. Conclusions The risk of developing HF and of dying after an MI in- creases progressively with age. Regardless of age, most deaths after a MI are preceded by the development of HF.
文摘A novel oleanane-type triterpenic acid was isolated from the leaves of Gymnema sylvestre(Asclepiadaceae). The structure was characterized as 3β, 16β, 22β, 28-tetrahydroxy- olean-12-en-30-oic acid on the basis of spectral evidence, including 1D- and 2D-NMR (HMQC, HMBC, H-1H 1COSY and NOESY).
文摘To the Editor Monitoring urine output remains essential to the care of adult patients admitted to the hospital. In acute, decompen- sated heart failure, ongoing assessment of urine output is required to adjust diuretic dosing in keeping with current recommendations for hospitalized patients, In patients with acute kidney injury, assessment of urine output is essential for diagnosis and management. The diagnosis of circulatory shock is supported by renal hypoperfusion as measured by low urine output. Indwelling urinary cathe- ters are routinely used for the ＂strict＂ monitoring of urine output, which is an accepted indication.
文摘Objective: To detect the inhibition of urogenitalchlamydia trachomatis (CT) by 12 traditional Chinesemedicines in vitro.Methods: The inhibition of CT isolates by these medicineswas detected by micro-culture technique with McCoy cellsin vitro. Results: All the diuretic traditional Chinese medicinesinhibited urogenital CT The minimum inhibitoryconcentrations (MICs) ranged from 0.122 mg ml^(-1) to 62.5mg ml^(-1). Diathus superbus L., Poria cocos (Shew.) Woft,Polyporus umbellatus (Pers.) Fries, and Artemisia capillariesThunb showed stronger inhibition than the other eighttraditional Chinese medicines. The numbers and sizes ofinclusions bodies reduced gradually and disappeared finallywith the increase of the concentrations. Conclusion: All the 12 diuretic traditional Chinesemedicines inhibited urogenital CT.
文摘Objective Nephrolithiasis is a common urological disease. This study aims to evaluate the preventive and therapeutic effects of hydro-alcoholic extract of Aerva lanata(L.) roots(HAEAL) on ethylene glycol-induced nephrolithiasis in rats.Methods Fifty grams of shade-dried coarsely powdered Aerva lanata(L.) root was successively extracted with organic solvents in increasing order of polarity [petroleum ether(60-80 ℃), chloroform, and ethanol] using a Soxhlet apparatus, and then concentrated. Physical tests including nature, color, odor, and texture were performed on the herbal suspension. In vitro nephrolithiasis assessment was performed by nucleation assay, aggregation assay, and crystal growth assay. Thirty adult male Wistar albino rats were randomly divided into five groups(six rats in each group). Group 1: negative control group without induction or treatment till day 28. Group 2: positive control group receiving a daily oral solution of 0.75% ethylene glycol till day 14, and mixed with distilled water till day 28. Group 3: standard group receiving a daily oral solution of 0.75% ethylene glycol till day 14 and Cystone(750 mg/kg) from day 15 to day 28. Group 4: low dose HAEAL group receiving a daily oral solution of 0.75%ethylene glycol till day 14, and 400 mg/kg HAEAL from day 15 to day 28(1 mL per day). Group 5: high dose HAEAL group receiving a daily oral solution of 0.75% ethylene glycol till day 14,and 800 mg/kg HAEAL from day 15 to day 28(1 mL per day). Urine(urine volume, pH value,appearance, odor, and turbidity) examination and serum test were performed. On day 29, the kidneys were dissected, and histopathology examination was performed to determine the degree of tubular injury.Results The suspension showed stability and aroma with no turbidity at room temperature.The suspension did not show changes in color and odor until day 3, indicating that the preparation was stable for 72 h. Body weight decreased in the positive control group indicating stone formation and changes in water intake. Both standard and HAEAL treatments restored the body weight to normal levels after treatment, indicating the beneficial effects of the treatment. Histopathological examination revealed no significant findings in the negative control group, whereas the positive control group showed inflammation in the kidney parenchyma.Compared with positive control group, there was increase in urine volume and excretion of urinary constituents such as calcium and oxalate(P < 0.01) as well as improved clearance rate(P < 0.05) in HAEAL treatment groups, in addition, the urine pH value of HAEAL groups was increased.Conclusion HAEAL reduced nephrolithiasis formation and had a diuretic effect, which could be used to promote the expulsion of stones. Further studies are needed to enhance the stability of the suspension for the production of better pharmaceutical formulations.
