Summary Background The prevalence of chronic kidney disease is high in developing countries. However, no national survey of chronic kidney disease has been done incorporating both estimated ...glomerular filtration rate (eGFR) and albuminuria in a developing country with the economic diversity of China. We aimed to measure the prevalence of chronic kidney disease in China with such a survey. Methods We did a cross-sectional survey of a nationally representative sample of Chinese adults. Chronic kidney disease was defined as eGFR less than 60 mL/min per 1·73 m2 or the presence of albuminuria. Participants completed a lifestyle and medical history questionnaire and had their blood pressure measured, and blood and urine samples taken. Serum creatinine was measured and used to estimate glomerular filtration rate. Urinary albumin and creatinine were tested to assess albuminuria. The crude and adjusted prevalence of indicators of kidney damage were calculated and factors associated with the presence of chronic kidney disease analysed by logistic regression. Findings 50 550 people were invited to participate, of whom 47 204 agreed. The adjusted prevalence of eGFR less than 60 mL/min per 1·73 m2 was 1·7% (95% CI 1·5–1·9) and of albuminuria was 9·4% (8·9–10·0). The overall prevalence of chronic kidney disease was 10·8% (10·2–11·3); therefore the number of patients with chronic kidney disease in China is estimated to be about 119·5 million (112·9–125·0 million). In rural areas, economic development was independently associated with the presence of albuminuria. The prevalence of chronic kidney disease was high in north (16·9% 15·1–18·7) and southwest (18·3% 16·4–20·4) regions compared with other regions. Other factors independently associated with kidney damage were age, sex, hypertension, diabetes, history of cardiovascular disease, hyperuricaemia, area of residence, and economic status. Interpretation Chronic kidney disease has become an important public health problem in China. Special attention should be paid to residents in economically improving rural areas and specific geographical regions in China. Funding The Ministry of Science and Technology (China); the Science and Technology Commission of Shanghai; the National Natural Science Foundation of China; the Department of Health, Jiangsu Province; the Sichuan Science and Technology Department; the Ministry of Education (China); the International Society of Nephrology Research Committee; and the China Health and Medical Development Foundation.
The traditional Chinese medicine, Tripterygium wilfordii Hook F (TwHF) is widely used to treat Crohn's disease (CD) in China.
The authors compared different doses of TwHF with mesalazine in 198 ...patients with CD over a 52-week period. Subjects were randomized to receive mesalazine (3 g/d), low-dose TwHF (1.5 mg·kg·d), or high-dose TwHF (2.0 mg·kg·d).
A total of 137 patients completed the study. At week 52, a significant lower proportion of patients in the high-dose TwHF group (7/71) had clinical recurrence compared with patients in the low-dose TwHF (15/68, P = 0.047) or mesalazine group (17/59, P = 0.006), whereas the difference between the low-dose TwHF group and the mesalazine group was not significant (P = 0.503). Patients receiving mesalazine experienced less adverse events than those receiving high-dose TwHF (P = 0.029) and those receiving low-dose TwHF (P = 0.048), but no significant difference was found about drug adverse events resulted withdrawal in the 3 groups (P > 0.05). In addition, compared with low-dose TwHF and mesalazine, the authors also detected significant superiority of high-dose TwHF arm in the decrease of CDAI and SESCD (P < 0.05).
A 2.0 mg/kg daily TwHF was well tolerated and prolonged remission in patients with CD.
Stroke can cause high morbidity and mortality, and ischemic stroke (IS) and transient ischemic attack (TIA) patients have a high stroke recurrence rate. Antiplatelet agents are the standard therapy ...for these patients, but it is often difficult for clinicians to select the best therapy from among the multiple treatment options. We therefore performed a network meta-analysis to estimate the efficacy of antiplatelet agents for secondary prevention of recurrent stroke. We systematically searched 3 databases (PubMed, Embase, and Cochrane) for relevant studies published through August 2015. The primary end points of this meta-analysis were overall stroke, hemorrhagic stroke, and fatal stroke. A total of 30 trials were included in our network meta-analysis and abstracted data. Among the therapies evaluated in the included trials, the estimates for overall stroke and hemorrhagic stroke for cilostazol (Cilo) were significantly better than those for aspirin (odds ratio OR = .64, 95% credibility interval CrI, .45-.91; OR = .23, 95% CrI, .08-.58). The estimate for fatal stroke was highest for Cilo plus aspirin combination therapy, followed by Cilo therapy. The results of our meta-analysis indicate that Cilo significantly improves overall stroke and hemorrhagic stroke in IS or TIA patients and reduces fatal stroke, but with low statistical significance. Our results also show that Cilo was significantly more efficient than other therapies in Asian patients; therefore, future trials should focus on Cilo treatment for secondary prevention of recurrent stroke in non-Asian patients.
Summary Animal studies indicate that adult renal stem/progenitor cells can undergo rapid proliferation in response to renal injury, but whether the same is true in humans is largely unknown. To ...examine the profile of renal stem/progenitor cells responsible for acute tubular necrosis in human kidney, double and triple immunostaining was performed using proliferative marker and stem/progenitor protein markers on sections from 10 kidneys with acute tubular necrosis and 4 normal adult kidneys. The immunopositive cells were recorded using 2-photon confocal laser scanning microscopy. We found that dividing cells were present in the tubules of the cortex and medulla, as well as the glomerulus in normal human kidney. Proliferative cells in the parietal layer of Bowman capsule expressed CD133, and dividing cells in the tubules expressed immature cell protein markers paired box gene 2, vimentin, and nestin. After acute tubular necrosis, Ki67-positive cells in the cortex tubules significantly increased compared with normal adult kidney. These Ki67-positive cells expressed CD133 and paired box gene 2, but not the cell death marker, activated caspase-3. In addition, the number of dividing cells increased significantly in patients with acute tubular necrosis who subsequently recovered, compared with patients with acute tubular necrosis who consequently developed protracted acute tubular necrosis or died. Our data suggest that renal stem/progenitor cells may reside not only in the parietal layer of Bowman capsule but also in the cortex and medulla in normal human kidney, and the proliferative capacity of renal stem/progenitor cells after acute tubular necrosis may be an important determinant of a patient's outcome.
Abstract Background Long-term outcomes of very late stent thrombosis (VLST) after implantation of drug-eluting stents (DES) are still unclear. The aim was to evaluate the long-term outcomes after ...VLST of DES, and to analyze the related factors of long-term outcomes in these patients. Methods From January 2006 to February 2013, patients with angiographically defined VLST were studied. The clinical characteristics, angiography and interventional data, and anti-platelet therapy protocols were analyzed. The patients were divided into two groups according to the occurrence of major adverse cardiac events (MACE) during follow-up. The clinical and interventional data between the two groups were compared. Results Sixty-two patients were enrolled consisting of 55 males and 7 females with an average age of 58.6 ± 10.2 (41–82) years. The mean time from first implantation of DES to occurrence of VLST was 38.7 ± 18.1 (12.5–84) months. One patient died in hospital. Sixty-one patients survived to discharge, and MACE occurred in 17 patients after a median follow-up of 32.1 ± 19.1 (median: 44, range 5–88) months. The total MACE rate was 29.0% (18/62), and Kaplan–Meier survival analysis showed the estimated MACE-free survival was 45.1%. The rate of implantation of an additional first-generation DES during the first VLST in the group with events was higher (44.4% vs.11.4%, respectively, p = 0.007). The percentage of continuous dual antiplatelet therapy (DAPT) at the longest available follow-up was higher in the event-free group (27.8% vs. 75.0%, respectively, p = 0.001). Multivariable Cox regression analysis revealed that the only independent predictors for freedom of MACE during long-term follow-up was continuous DAPT at the longest available follow-up hazard ratio (HR) = 0.30, 95% CI: 0.09–0.97, p = 0.04. Conclusions Long-term outcomes after VLST were unfavorable. Implantation of an additional first-generation DES might be avoided, and DAPT should be continued.
Abstract Purpose We investigated the effects of therapeutic mild hypothermia on patients with severe traumatic brain injury after craniotomy (TBI). Methods Eighty patients with severe TBI after ...unilateral craniotomy were randomized into a therapeutic hypothermia group with the brain temperature maintained at 33°C to 35°C for 4 days, and a normothermia control group in the intensive care unit. Vital signs, intracranial pressure, serum superoxide dismutase level, Glasgow Outcome Scale scores, and complications were prospectively analyzed. Results The mean intracranial pressure values of the therapeutic hypothermia group at 24, 48, and 72 hours after injury were much lower than those of the control group (23.49 ± 2.38, 24.68 ± 1.71, and 22.51 ± 2.44 vs 25.87 ± 2.18, 25.90 ± 1.86, and 24.57 ± 3.95 mm Hg; P = .000, .000, and .003, respectively). The mean serum superoxide dismutase levels of the therapeutic hypothermia group at days 3 and 7 were much higher than those of the control group at the same time point (533.0 ± 103.4 and 600.5 ± 82.9 vs 458.7 ± 68.1 and 497.0 ± 57.3 μ g/L, respectively; P = .000). The percentage of favorable neurologic outcome 1 year after injury was 70.0% and 47.5%, respectively ( P = .041). Complications, including pulmonary infections (57.5% in the therapeutic hypothermia group vs 32.5% in the control group; P = .025) were managed without severe sequelae. Conclusions Therapeutic mild hypothermia provides a promising way in the intensive care unit for patients with severe TBI after craniotomy.
Exposure to particulate matter (PM) has been a major public health threat, but the potentially differential effects on asthma of PM remain largely unknown in high altitude settings. We evaluated the ...effects of ambient PM on asthma in high altitude settings.
The study recruited a representative sample from high altitude settings using a multistage stratified sampling procedure. Asthma was defined by a self-reported history of diagnosis by a physician or by wheezing symptoms in the preceding 12 months. The annual mean PM2.5 and PM10 concentrations were calculated for each grid cell at 1-km spatial resolution based on the geographical coordinates.
We analyzed data for participants (mean age 39.1 years, 51.4% female) and 183 (3.7%, 95% confidence interval (CI): 3.2–4.2) of the participants had asthma. Prevalence was higher in women (4.3%, 95% CI 3.5–5.1) than in men (3.1%, 2.4–3.8) and increasing with higher concentration of PM exposures. For an interquartile range (IQR) difference (8.77 μg/m3) in PM2.5 exposure, the adjusted odds ratio (OR) was 1.64 (95% CI 1.46–1.83, P < 0.001) for risk of asthma. For PM10, there was evidence for an association with risk of asthma (OR 2.34, 95% CI: 1.75–3.15, P < 0.001 per IQR of 43.26 μg/m3). Further analyses showed that household mold or damp exposure may aggravate PM exposure associated risks of asthma.
This study identified that PM exposure could be a dominate environmental risk factor for asthma but largely unconsidered in the high-altitude areas. The association between PM exposure and asthma should be of interest for planners of national policies and encourage programs for prevention of asthma in residents living at high altitudes.
•Considering the advantages of VT and CNN models, our GasHis-Transformer model integrates the describing capability of global and local information of VT’s and CNN’s.•In GasHis-Transformer, the idea ...of multi-scale image analysis is introduced to describe the details of gastric tissues and cells under a microscope.•GasHis-Transformer not only obtains good classification performance on gastric histopathological images but also shows an excellent generalization ability on other histopathological image datasets.•A Dropconnect based lightweight network is proposed to reduce the model size and training time of GasHis-Transformer for clinical applications with improved confidence.
In this paper, a multi-scale visual transformer model, referred as GasHis-Transformer, is proposed for Gastric Histopathological Image Detection (GHID), which enables the automatic global detection of gastric cancer images. GasHis-Transformer model consists of two key modules designed to extract global and local information using a position-encoded transformer model and a convolutional neural network with local convolution, respectively. A publicly available hematoxylin and eosin (H&E) stained gastric histopathological image dataset is used in the experiment. Furthermore, a Dropconnect based lightweight network is proposed to reduce the model size and training time of GasHis-Transformer for clinical applications with improved confidence. Moreover, a series of contrast and extended experiments verify the robustness, extensibility and stability of GasHis-Transformer. In conclusion, GasHis-Transformer demonstrates high global detection performance and shows its significant potential in GHID task.
Cardiodynamicsgram (CDG) has emerged recently as a noninvasive spatiotemporal electrocardiographic method for subtle cardiac dynamics information analysis within electrocardiogram (ECG). This study ...sought to evaluate the clinical utility of CDG for early coronary artery disease (CAD) detection in suspected patients with CAD presenting with nondiagnostic ECGs. A total of 421 suspected patients with CAD presenting with nondiagnostic ECG were enrolled. Standard 12-lead ECG and CDG were performed simultaneously, 1 day before invasive coronary angiography. Diagnostic accuracy of CDG for early CAD detection was assessed with reference to coronary angiography as the gold standard. Coronary angiography showed ≥1 coronary arteries stenosis of >50% in 347 patients. Of these 347 patients with CAD, 294 patients were positive in CDG. Of 74 non-CAD controls, 63 patients were negative in CDG. Diagnostic accuracy of CDG at presentation for CAD was 84.6%, sensitivity 84.7%, and specificity 83.7%. In patients presenting with nondiagnostic ECGs, an abnormal status can be detected early through noninvasive CDG. CDG is highly sensitive for the early diagnosis of CAD. Underlying causes of false-negative CDG findings included number of diseased coronary arteries and collateral circulation. Subtle myocardial damage that was not detectable on coronary angiography might be the major cause of false-positive findings.
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