SciCombinator

Discover the most talked about and latest scientific content & concepts.

Journal: Zhonghua nei ke za zhi

0

A total of 109 in patients with crayfish-related rhabdomyolysis were enrolled in our hospital from July to August 2016,including 31.2%(34/109)males and 68.8% (75/109)females.The number of home-cooked crayfish accounted for 60.6% (66/109). Main symptom was back pain 96.3% (105/109). The misdiagnosis rate was 15.6% (17/109). On day 1, 2, 3 after admission and the day before discharge,serum creatine kinase were 1 175(446, 2 258)IU/L,3 710(2 137, 8 875)IU/L,1 899(1 063, 4 595)IU/L and 317(152, 532)IU/L,respectively(P<0.001).Serum myoglobin were (603±484)μg/L,(313±284)μg/L,(104±74)μg/L and (55±20)μg/L,respectively(F=39.1, P<0.001).Females were more susceptible to crayfish-related rhabdomyolysis. Home-cooked crayfish is prone to induce rhabdomyolysis and easily to be misdiagnosed. Creatine kinase and myoglobin showed characteristic dynamic changes.

0

We represented a 22-year-old male patient who developed rhabdomyolysis, acute kidney failure and acute hepatic failure and was finally diagnosed as multiple acyl-CoA dehydrogenase deficiency. The patient appeared temporary stable status after high dose vitamine-B(2) supplement whereas deterioration was still fatal with pulmonary infection, acute respiratory failure and acute heart failure.

0

Objective: The incidence of gastrointestinal symptoms in diabetes is higher than that of non-diabetes. Thus, the aim of the present study was to observe the efficacy and safety of bifidobacterium tetragenous viable bacteria tablets in the treatment of constipation in patients with type 2 diabetes mellitus.Methods:This is a multicenter, randomized, double-blind, placebo-controlled, parallel group-comparison clinical research. The subjects were randomly divided into study group and control group according to 1∶1 ratio by computer generated random number method. The subjects were either treated with bifidobacterium tetragenous viable bacteria tablets (study group) or placebo (control group) for eight weeks, and they were followed up for four weeks without changing foundation therapy for diabetes. The primary outcome was the change of complete spontaneous bowel movements (CSBMs).Results:A total of 234 subjects (the study group:116 cases; the control group: 118 cases) from 7 centers were included in the present study. The baseline characteristics were comparable between the two groups. In the study group, the CSBMs at 0, 2, 4, 8 and 12 weeks were 0.0 (0.0, 1.0) , 1.0 (0.5, 2.0) , 2.0 (1.0, 3.0) , 3.0 (2.0, 3.5) , 2.0 (1.0, 3.0) times per week, respectively, while the CSBMs of the control group at each corresponding weeks were 0.0 (0.0, 1.0) , 1.0 (0.0, 1.5) , 1.0 (0.0, 1.5) , 1.0 (0.0, 2.0) , 1.0 (0.0, 1.5) times per week, respectively. There is significant difference in CSBMs between the two groups (P<0.05). Moreover, after 12 weeks treatment, the CSBMs over spontaneous bowel movements (SBMs) ratio in the study group was higher than that in the control group [0.53 (0.40, 0.67) vs 0.33 (0.00,0.50),P=0.048], indicating a more complete evacuation sensation in the study group. More subjects in the study group (66.38%) reached Bristol stool classification of normal criteria than those in the control group (48.31%,P=0.005). There were significantly improvement of bowel function index in the study group [study group 42.7 (33.3, 56.7), control group 60.6 (51.7, 75.7),P<0.000 1]. Furthermore, the symptoms of constipation was improved, and the satisfaction for the treatment was high in the study group. There were no significant differences of the safety indicators between the two groups.Conclusions:Bifidobacterium tetragenous viable bacteria tablets can be used in patients with type 2 diabetes mellitus and constipation. Compared with placebo, it improves constipation and has no obvious adverse effects.

Concepts: Diabetes mellitus type 2, Diabetes mellitus, Constipation, Randomness

0

Objective: To determine whether thyroid hormone (TH) level could also be an independent and incremental predictor of adverse events in patients with hypertrophic cardiomyopathy (HCM).Methods:A total of 982 consecutive patients with HCM at the National Center for Cardiovascular Diseases (China) from October 2009 to December 2013 were included in the present study, and followed up till the end of December 2016. The patients were divided into three groups according to the levels of free triiodothyronine (FT3): the group 1 (FT3≤4.28 pmol/L,n=335), the group 2 (FT3>4.28-<4.79 pmol/L,n=310), and the group 3 (FT34.79-6.30 pmol/L,n=337).Results:After a follow-up period of (53.8±14.1) months, 39 patients (4.0%) either suffered death with all causes or received a cardiac transplantation (7.8%, 2.9% and 1.2% of the patients in the group 1, group 2 and group 3, respectively). A multivariable Cox regression analysis revealed that FT3≤4.28 pmol/L was associated with a significantly higher risk of all-cause mortality or cardiac transplantation (HR8.83, 95%CI1.115- 69.905,P=0.039) in HCM patients.Conclusions:Low levels of FT3is a risk factor of adverse events for patients with HCM, indicting a role of FT3as a marker for assessing the risk of long-term adverse events in these patients.

Concepts: Regression analysis, Cardiomyopathy, Touring car racing, Thyroid, Thyroid hormone, Hypertrophic cardiomyopathy, Iodine, Triiodothyronine

0

Objective: To analyze the clinical features of secondary gout in glycogen storage disease type Ⅰa (GSD Ⅰa), so as to improve the awareness of this disease.Methods:The clinical features, laboratory findings, treatments and prognosis of 5 GSD Ⅰa patients with secondary gout who had been admitted to the Peking Union Medical College Hospital during 2006 to 2016 were collected and analyzed. GSD Ⅰa was confirmed by liver biopsy and genotyping.Results:Among the 5 patients (median age: 27 years), 3 were males and 2 were females. The mean age of gout onset was 17 ranging from 10 to 22 years old. The common manifestations of GSD included hepatomegaly since childhood, hypoglycemia, growth retardation, anemia, hyperlactacidemia and hyperlipidemia. All the 5 patients were complicated with gouty tophi and kidney stone. Gouty tophi and kidney stone were identified 3.8 years and 10.2 years after the first occurrence of articular symptoms, respectively. Renal damage occurred in 3 cases. All the patients underwent several therapeutic modalities including lifestyle intervention, allopurinol, and raw corn starch treatment.Conclusions:Determination of the presence of primary disease should be performed actively for young-onset gout with early occurrence of gouty tophi. GSD should be suspected if there exist clinical manifestations like hepatomegaly, recurrent hypoglycemia, growth retardation. Early management of hyperuricemia and gout in GSD patients is important to prevent complications and improve prognosis.

Concepts: Hypoglycemia, Glycogen, Starch, Gout, Allopurinol, Glycogen storage disease, Hyperuricemia, Kidney stone

0

Objective: To evaluate the impact of cardiovascular risk factors on index of microvascular resistance (IMR) and coronary flow reserve (CFR) and to explore the characteristics of IMR and CFR and the relationship between IMR and angiographic features in patients with intermediate coronary stenosis and chest pain.Methods:Fractional flow reserve (FFR), CFR, and IMR were measured in patients who underwent invasive coronary angiography with 40%-70% stenosis by visual assessment. All patients with FFR>0.75 were enrolled and grouped with the cut-off points of IMR≥25 and CFR≤2.0. Patients with IMR≥25 were group H, including two sub-groups (high IMR-low CFR, group H1and high IMR-high CFR, group H2), while those with IMR<25 were group N. The thrombolysis in myocardial infarction (TIMI) frame were counted.Results:A total of 34 patients with FFR>0.75 were enrolled with 61.8%(21 cases) of males and 38.2% (13 cases) of females. The mean age was (57.3±8.1) years old. High IMR accounted for 47.1% of all cases. There was significant difference between group H and N in TIMI frame (33.0 vs. 20.8,P=0.031). There were significant differences between group H1and H2in homocysteine (17.8 µmol/L vs. 12.0 µmol/L,P=0.005) and IMRcorr(58.0 vs. 36.1,P=0.002). IMRcorrwas correlated to TIMI frame (r=0.40,P=0.012) for all cases. The sensitivity and specificity of inferring IMR≥35.3 by TIMI frame were 0.75 and 0.65 (P=0.049) with TIMI frame over 40.5.Conclusions:High IMR may be one of the reasons for chest pain in patients with intermediate coronary stenosis. There is no correlation between vascular risk factors and IMR or CFR, while there is positive correlation between TIMI frame and IMR. The specificity is 65% for inferring IMR rise with TIMI frame over 40.5.

Concepts: Myocardial infarction, Atherosclerosis, Angina pectoris, Positive predictive value, Cardiology, Atheroma, Type I and type II errors, Sensitivity and specificity

0

Objective: To reinforce the awareness of colorectal endometriosis (EM) in colonoscopy examination.Methods:Patients diagnosed as colorectal EM at Peking Union Medical College Hospital between February 2002 and February 2017 were enrolled in this study. The clinical characteristics and endoscopic features of EM lesions were summarized and compared between pathologically positive group and negative group.Results:A total of 34 cases were included with average age of (38.3±8.9) years old. All EM lesions located within rectum and sigmoid colon. The endoscopic lesions manifested as protrusion in 21 cases (61.8%) and protrusion-depression in 13 cases (38.2%), local stenosis in 8 cases (23.5%); erosive surface in 33 cases (97.1%) with local spontaneous hemorrhage in 4 cases (11.8%); nodal surface in 23 cases (67.6%), and lymphangiectasis base in 9 cases (26.4%). Endoscopic biopsy specimens were obtained in all cases with average 3 (2, 4) pieces. Positive results were found only in 4 patients (11.8%) with 3 endometriosis and one (endometrial) adenosarcoma. Compared with negative group, spontaneous hemorrhage was more frequent in positive group (2/4 vs. 2/30,P=0.013). Mean biopsy sample number was significantly larger in positive group (5 vs. 3,P=0.004).Conclusions:Colorectal endometriosis is mostly located within rectosigmoid region. Endoscopic features mainly include protrusion or protrusion-depression lesions with erosive and nodular surface, or local stenosis. Spontaneous hemorrhage under colonoscopy yields higher positive rate for biopsy, thus increasing biopsy sample numbers may improve pathology results.

Concepts: Pathology, Ulcerative colitis, Crohn's disease, Colon, Colonoscopy, Rectum, Endoscopy, Sigmoidoscopy

0

Objective: To evaluate the changes of macrophages and expression of Rac1 in the inflammatory site of Crohn’s disease, and to investigate the effects of 6-thioguanine (6-TG) and peptidoglycan on apoptosis of human peripheral blood monocyte-macrophage by regulating Rac1 signaling pathway.Methods:Ten patients with Crohn’s disease and eight healthy controls diagnosed were enrolled at Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital from January 2013 to January 2014. The number of macrophages, apoptosis and expression of Rac1 in the inflammation sites and non-inflammation sites of intestinal mucosa were detected in both patients and controls. Peripheral blood mononuclear cells (PBMCs) were sorted by CD14immunomagnetic beads. The apoptosis of monocytes, expression of Rac1 and related apoptosis signaling molecules were detected in patients treated with peptidoglycan, 6-TG and Rac1 inhibitor NSC23766 and another 15 healthy donors.Results:The number of macrophages and apoptotic cells significantly increased in the inflammatory group of Crohn’s disease patients compared with the non-inflammatory group. The expression of PAK1, downstream molecular of Rac1 signaling pathway of macrophages was also significantly higher in the inflammatory group of Crohn’s disease patients than that in healthy controls and non-inflammatory group. Compared with control group, anti-apoptotic signals (NF-κB, Bcl-xL and STAT-3) in PBMCs increased in the peptidoglycan group, while slightly decreased in 6-TG group. 6-TG and NSC23766 significantly promoted peptidoglycan-related anti-apoptosis [peptidoglycan group (8.6±3.7)%, peptidoglycan+ 6-TG group (42.0±2.7)%, peptidoglycan+ NSC23766 group (58.5±6.9)%,P<0.05].Conclusions:Peptidoglycan plays a role in the pathogenesis of Crohn's disease by recruiting macrophages. However, 6-TG inhibits peptidoglycan-induced activation of Rac1 signaling pathway leading to macrophage apoptosis.

Concepts: Immune system, White blood cell, Monocyte, Macrophage, Apoptosis, Gastroenterology, Spleen, PBMC

0

Objective: To evaluate the effect of continuous veno venous hemofiltration (CVVH) on neutrophil gelatinase associated lipocalin (NGAL) in critically ill patients with acute kidney injury (AKI).Methods:Critically ill patients with AKI who needed CVVH and admitted to Department of Critical Care Medicine of Peking Union Medical College Hospital were enrolled prospectively from January 2015 to June 2015. AN69 membrane filters were used for CVVH. Prefilter, postfilter,and plasma NGAL measurements were taken at 10 mins, 4 hours and 8 hours (T 10 min, T 4 h, T 8 h) after CVVH. The influence of membrane filter and volume management on NGAL level was analyzed.Results:Forty patients were recruited.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was 22.9±7.0. The sequential organ failure score (SOFA) was 12.1±2.9, and ICU mortality was 27.5%. During CVVH, there were no significant differences in NGAL levels between prefilter [T 10 min:39.3 (24.8, 62.4) μg/min; T 4 h: (45.1±23.2)μg/min; and T 8 h: (45.5±22.4)μg/min] and postfilter [T 10 min: 33.5 (25.1, 60.7) μg/min; T 4 h: (44.2±24.3)μg/min, and T 8 h: (45.9±22.4)μg/min] (P> 0.05 for all). Compared with the survival group[310.0(162.0, 588.0) μg/L], plasma NGAL level in T 10 min [684.0(270.0, 944.0) μg/L] was significantly higher in death group (P= 0.033). After fluid balance correction, T 4 h [603.4(484.8, 620.2) μg/L] and T 8 h [590.2 (475.9, 749.4) μg/L] plasma NGAL levels in death group were significantly higher than those in the survival group [T4 h: 419.5 (227.5, 552.4) μg/L;T 8 h: 400.7(196.1, 517.4) μg/L] with statistical significance (P<0.01 for both).Conclusions:During CVVH, AN69 membrane filter does not have significant effect on plasma NGAL level in critically ill patients with AKI. After volume balance correction, plasma NGAL level could be used as an effective indicator in these patients.

Concepts: Nephrology, Statistical significance, Effect size

0

A 60-year-old man presented with severe watery diarrhea for 2 months complicated with weight loss and acute kidney injury. He did not respond well to antidiarrheal medicines, empirical antibiotics and dietary exclusion of gluten or even complete bowel rest. The final diagnosis of autoimmune enteropathy (AIE) was made based on histopathologic findings of endoscopic biopsy from duodenal mucosa after excluding neoplastic disease, inflammatory bowel disease, and infectious diarrhea, etc. Chronic diarrhea and oliguria alleviated after the administration of corticosteroids.

Concepts: Medicine, Cancer, Bacteria, Ulcerative colitis, Crohn's disease, Gastroenterology, Inflammatory bowel disease, Diarrhea