Objective: to explore the application effect of high-quality nursing management mode in nursing management of nephrology department. Methods: 80 patients in the department of nephrology of our hospital were randomly d...Objective: to explore the application effect of high-quality nursing management mode in nursing management of nephrology department. Methods: 80 patients in the department of nephrology of our hospital were randomly divided into control group and observation group. The selected time range is from April 2021 to April 2022. The control group adopted conventional nursing mode, while the observation group adopted high-quality nursing management mode on the basis of conventional nursing. The incidence of adverse events, nursing quality score and patients' satisfaction with nursing were compared between the two groups. Results: the incidence of adverse events in the observation group was 5.0%, which was significantly lower than that in the control group (χ2 = 6.3154). In the observation group, the scores of isolation disinfection (95.32 ± 3.31), rescue items (96.33 ± 4.31), nursing document writing (93.62 ± 2.31), graded nursing (93.52 ± 4.31) and safety of nursing quality (94.42 ± 4.31), data patients' satisfaction with nursing in the observation group was 95.0%, significantly higher than that in the control group (χ2 = 6.3161, P < 0.05). Conclusion: the adverse events in the nursing of patients in nephrology department are closely related to the nursing mode. As a new nursing mode, high-quality nursing can reduce the occurrence of adverse events, encourage patients to recognize the clinical nursing work in nephrology department, and play an important role in improving the quality of nursing work in nephrology department.展开更多
Ultrasound has long been an essential tool in nephrology,traditionally used for procedures like vascular access and kidney biopsies.Point-of-care ultrasonography(POCUS),a rapidly evolving bedside technology,is now gai...Ultrasound has long been an essential tool in nephrology,traditionally used for procedures like vascular access and kidney biopsies.Point-of-care ultrasonography(POCUS),a rapidly evolving bedside technology,is now gaining momentum in nephrology by providing real-time imaging to enhance physical examination findings.Unlike comprehensive radiology-performed ultrasound,POCUS focuses on specific clinical questions,providing immediate and actionable insights.This narrative review examines the philosophy behind POCUS,its expanding applications in nephrology,and its impact on patient care,including its role in diagnosing obstructive uropathy,guiding fluid management,and evaluating hemodynamics in cardiorenal syndrome.Additionally,the review addresses barriers to widespread adoption,such as the need for structured training,competency validation,and interdisciplinary cooperation.By integrating POCUS into routine practice,nephrologists can refine diagnostic accuracy,improve patient outcomes,and strengthen the role of bedside medicine.展开更多
<strong>Context:</strong> Due to the late referral of the pads to the nephrologist and the lack of medical follow-up, many patients are admitted with complications from kidney disease requiring the urgent ...<strong>Context:</strong> Due to the late referral of the pads to the nephrologist and the lack of medical follow-up, many patients are admitted with complications from kidney disease requiring the urgent start of hemodialysis sessions. <strong>Purpose:</strong> Study the profile of emergency hemodialysis patients in order to ease their management. <strong>Methods:</strong> This was a retrospective, descriptive and analytical study carried out at the Nephrology Department of the Teaching Hospital of Yopougon from January 1st to December 31st, 2016. This study included all patients who had received a first session of hemodialysis in an emergency context. <strong>Results:</strong> We collected 146 patients with an average age of 39.80 ± 14.55 years and a sex ratio of 0.6 for men. Before admission, patients were known as hypertensives (63.9%), followed by CKD (23.9%) and HIV-infected (8.2%). The main clinical signs were hypertension (64.3%), edema (44.5%) and coma (30.1%). Anemia was observed in 97.2% of cases and it was less than 8 g/dl in 57.5%. Kidney failure was chronic in 75.3% and acute in 24.6%. Chronic nephropathies were glomerular (54.1%), vascular (20.5%). The main indications for hemodialysis were encephalopathy (33.5%), severe uremia (28%), acute pulmonary edema (19.8%), persistent anuria (11.6%) and hyperkalemia (5.4%). The vascular approach was a catheter in 97.2% (femoral site in 53.4% and jugular in 43.8% and arteriovenous fistula in 2.7%). Death was observed in 17.8%. In univariate analysis, age > 65 years (p = 0.04), coma (p = 0.004) and acute kidney failure (p = 0.02) were associated with the risk of death, and in multivariate analysis, only coma (p = 0.024, OR = 5.88) seemed to be associated with mortality risk for our patients. <strong>Conclusion:</strong> Hemodialysis in an emergency situation is a common practice in the Teaching Hospital of Yopougon and mainly concerns patients with CKD.展开更多
BACKGROUND Chronic kidney disease(CKD)contributes significantly to emergency department(ED)presentations in low-and middle-income countries.These patients frequently have multiple comorbidities and face high in-hospit...BACKGROUND Chronic kidney disease(CKD)contributes significantly to emergency department(ED)presentations in low-and middle-income countries.These patients frequently have multiple comorbidities and face high in-hospital mortality.However,limited data exist on early predictors of mortality at ED admission.Identifying key clinical and laboratory features associated with adverse outcomes may support timely risk stratification and targeted interventions for acutely ill CKD patients.AIM To identify baseline predictors of in-hospital mortality in adult Indian patients with CKD admitted to the ED.METHODS This retrospective study was conducted from January 2021 to December 2022 at the Acute Care and Emergency Medicine Unit of the Postgraduate Institute of Medical Education and Research,Chandigarh,India.CKD was diagnosed and staged following the Kidney Disease:Improving Global Outcomes guidelines.Data were extracted from medical records using a structured form.All consecutive patients aged≥18 years were included.Independent mortality predictors were identified using multivariate Cox regression analysis.RESULTS Among 354 patients(mean age 49 years;58%males),60.5%had CKD stage 5,and 41.2%were on maintenance dialysis.Hypertension(74.9%)and diabetes(46.0%)were common comorbidities.Diabetic kidney disease was the primary etiology in 35.6%,while 43.2%had unknown causes.Infection(63.0%)was the most frequent cause for ED admission.In-hospital mortality was 29.1%(n=103).Independent mortality predictors were Glasgow coma scale(GCS)<15[hazard ratio(HR):1.822,P=0.017],hyperglycemia(HR:1.641,P=0.020),and low albumin(HR:1.270,P=0.028).Advanced age,Charlson comorbidity Index,quick Sequential Organ Failure Assessment,and neutrophilia were significant in univariate but not multivariate analysis.CKD stage,dialysis dependency,cardiovascular disease,and neutrophil-lymphocyte ratio were not predictive.CONCLUSION A low GCS,hyperglycemia,and low albumin levels at admission independently predict in-hospital mortality in CKD patients presenting to the ED,warranting early recognition and targeted interventions.展开更多
Introduction: Hypercalcemia is the most common metabolic complication in myeloma. The aim of this study was to evaluate the management strategy of hypercalcemia in myeloma at the nephrology department of Louis Pasteur...Introduction: Hypercalcemia is the most common metabolic complication in myeloma. The aim of this study was to evaluate the management strategy of hypercalcemia in myeloma at the nephrology department of Louis Pasteur hospital of Chartres. Patients and Methods: We carried a retrospective study of patients treated for myeloma-related hypercalcemia between January 1, 2019 to December 31, 2021. The clinical, paraclinical, therapeutic and evolutive characteristics were studied. Results: Eight patients were included in this study with a median age of 67 years [41 - 85] and a sex ratio (M/F) of 1. A quarter of patients were known with chronic kidney disease. Four patients (50%) had symptoms of hypercalcemia. Biologically, the mean hemoglobin was 9.8 ± 2.7 g/dl, all patients had an acute kidney injury with a mean creatinine level of 364.1 ± 173.3 mmol/l, a mean serum calcium of 3.42 ± 0.59 mmol/l and three quarter of patients had bone lesions. Five patients (62.5%) were rehydrated with a mean volume of saline of 2700 ± 836.7 ml/24h. Seven patients (87.5%) received biphosphonates and none received diuretics. The mean normalization time of the serum calcium was 5 days. Conclusion: Hypercalcemia is frequent in malignancy and represents a poor prognosis factor of the disease. A well-conducted therapeutic strategy allows rapid normalization.展开更多
Kidney transplantation(KT)accounts for nearly three-fourths of organ transplants in India,with living donors contributing to 82%of cases.Induction immunosuppression is essential to optimize initial immunosuppression,r...Kidney transplantation(KT)accounts for nearly three-fourths of organ transplants in India,with living donors contributing to 82%of cases.Induction immunosuppression is essential to optimize initial immunosuppression,reduce acute rejections,and enable tailored use of maintenance agents.Rabbit anti-thymocyte globulin(rATG)and interleukin-2 receptor anatagonists(IL-2RA/IL-2RBs)are the most widely used induction therapies.However,data on induction practices across India are limited.To evaluate induction immunosuppression practices across KT centers in India and establish a consensus for different subsets of KT recipients.A nationwide online survey was conducted by the Indian Society of Organ Transplantation(ISOT)among its members(400 KT centers).Responses were analyzed to assess induction practices across diverse donor types,age groups,and immunological risk profiles.Heterogeneity in practices prompted consensus building using a modified Delphi process.Literature review and expert panel discussions(April 2024)were followed by structured voting,and 16 consensus statements were finalized.Of 400 centers approached,254 participated.rATG was the most commonly used induction therapy,followed by IL-2RBs;alemtuzumab was least used.Significant heterogeneity was observed in type,dose,and duration of induction therapy.Consensus recommendations were framed:rATG for high immunological risk recipients and deceased donor KTs;IL-2RB or low-dose rATG for low immunological risk;rituximab in ABOincompatible KTs;and tailoring based on age,diabetes,donor type,infection risk,and affordability.This first ISOT consensus provides 16 India-specific statements on induction therapy in KT.It emphasizes risk-stratified,evidenceinformed,and context-appropriate induction strategies,supporting standardization of care across the country.展开更多
BACKGROUND Post-transplant tertiary hyperparathyroidism(PT-tHPT)is a well-recognized complication following kidney transplantation,characterized by persistent excessive secretion of parathyroid hormone(PTH)despite imp...BACKGROUND Post-transplant tertiary hyperparathyroidism(PT-tHPT)is a well-recognized complication following kidney transplantation,characterized by persistent excessive secretion of parathyroid hormone(PTH)despite improved renal function.It is potentially associated with an increased risk of cardiovascular events,renal osteodystrophy,pathologic fractures,graft loss,and mortality.AIM To evaluate the incidence,risk factors,and outcomes of PT-tHPT amongst kidney transplant recipients.METHODS A total of 887 transplant recipients who underwent transplantation between 2000 and 2020 were evaluated.Univariable and multivariable logistic regression was performed to determine the predictors of tertiary hyperparathyroidism.Graft and recipient outcomes were assessed using multivariable Cox regression.A separate multivariable Cox regression was performed to determine the effect of treatment strategies on outcomes.RESULTS PT-tHPT,defined as elevated PTH(>65 ng/L)and persistent hypercalcemia(>2.60 mmol/L),was diagnosed in 14%of recipients.Risk factors for PT-tHPT included older age[odds ratio(OR)=1.36,P<0.001],Asian ethnicity(OR=0.33,P=0.006),total ischemia time(OR=1.03,P=0.048 per hour),pre-transplant serum calcium(OR=1.38,P<0.001)per decile increase,pre-transplant PTH level(OR=1.31,P<0.001)per decile increase,longer dialysis duration(OR=1.12,P=0.002)per year,history of acute rejection(OR=2.37,P=0.012),and slope of estimated glomerular filtration rate change(OR=0.91,P=0.001).There were a 3.4-fold higher risk of death-censored graft loss and a 1.9-fold greater risk of recipient death with PT-tHPT.The three treatment strategies of conservative management,calcimimetic and parathyroidectomy did not significantly change the graft or patient outcome.CONCLUSION Pretransplant elevated calcium and PTH levels,older age and dialysis duration are associated with PT-tHPT.While PT-tHPT significantly affects graft and recipient survival,the treatment strategies did not affect survival.展开更多
Introduction: Acute kidney injury (AKI) is defined as a sudden and reversible deterioration in renal function. It is a life-threatening condition in hospitalized patients. Our objectives were to determine the prevalen...Introduction: Acute kidney injury (AKI) is defined as a sudden and reversible deterioration in renal function. It is a life-threatening condition in hospitalized patients. Our objectives were to determine the prevalence of AKI in a nephrology department, list the causes, describe the evolutionary profile and identify the factors associated with death. Patients and Methods: We reviewed the records of patients hospitalised between 1 January 2016 and 31 October 2020 in the nephrology department of Brazzaville University Hospital. We included patients aged at least 18 years whose discharge diagnosis included the item AKI. Study variables were socio-demographic data, clinical and paraclinical signs, stage and type of AKI, etiology and evolutionary profile. Results: Of the 1823 patients hospitalised, 244 (13.38%) were hospitalised for AKI. Of these, 60.2% were boys and 39.8% girls, with an average age of 47 19 years. The average consultation time was 10 6.5 days. AKI was stage 3 in 69.57% of cases. It was functional, organic and obstructive in the order of 55.28%, 36.02% and 8.69%. Dialysis was indicated in 62 patients (38.51%) and performed in 24 patients (14.9%). In-hospital mortality was 27.95%, with an average hospital stay of 9.6 5.8 days. Metabolic acidosis and anemia were the main causes of death in 14.28% and 4.35% of patients respectively. Factors associated with death were male sex, socioeconomic level, coma, indication for dialysis and absence of dialysis, with a p Conclusion: AKI is more common in young adult males. Mortality is relatively low. Improving prognosis requires early management and access to dialysis.展开更多
BACKGROUND Early renal artery thrombosis after kidney transplantation is rare but often leads to graft loss.Prompt diagnosis and intervention are essential,particularly in patients with inherited thrombophilias such a...BACKGROUND Early renal artery thrombosis after kidney transplantation is rare but often leads to graft loss.Prompt diagnosis and intervention are essential,particularly in patients with inherited thrombophilias such as factor V Leiden(FVL)mutation.CASE SUMMARY A kidney transplant recipient with FVL mutation developed an acute transplant renal artery thrombosis.The immediate post-operative Doppler ultrasonography revealed thrombosis of the main and inferior polar renal arteries.Emergent thrombectomy and separate arterial re-anastomoses were performed after cold perfusion with heparinized saline and vasodilator solution.Reperfusion was successful with immediate urine output and gradual improvement in renal function.The patient was discharged on direct oral anticoagulation therapy.CONCLUSION Early detection and surgical intervention can preserve graft function in posttransplant renal artery thrombosis even in patients at high risk.展开更多
Objective: Chronic end-stage renal failure is a major public health problem in developing countries and is poorly documented. The objective of this study was to describe the epidemiological, diagnostic, therapeutic, a...Objective: Chronic end-stage renal failure is a major public health problem in developing countries and is poorly documented. The objective of this study was to describe the epidemiological, diagnostic, therapeutic, and evolutionary aspects of patients admitted for end-stage renal failure to the Department of Nephrology at the University Hospital of Brazzaville. Patients and Methods: This was a descriptive cross-sectional study collecting prospective data that took place over 10 months. We included 128 patients who were exhaustively identified. Sociodemographic, clinical, therapeutic and developmental data were collected using a standardized and pretested pre-established survey form. The EPI info software enabled the analysis and processing of the data. Results: We reported a male predominance with a sex ratio of 2.5. The median age was 50 years. The first cause found was diabetes (55%) followed by hypertension (46%). The majority of patients had a dialysis emergency and half could not be dialyzed for financial reasons. Conclusion: Our results highlighted that certain epidemiological parameters of end-stage renal failure are constantly changing, such as frequency, while others remain static, including the main etiologies, gender, and age. However, mortality continues to increase and deserves more attention.展开更多
BACKGROUND The use of induction immunosuppression agents has improved kidney transplant outcomes,but selecting the optimal agent remains a point of debate.AIM To compare the long-term outcomes of kidney transplant rec...BACKGROUND The use of induction immunosuppression agents has improved kidney transplant outcomes,but selecting the optimal agent remains a point of debate.AIM To compare the long-term outcomes of kidney transplant recipients receiving alemtuzumab vs basiliximab induction,focusing on graft function,acute rejection,infection,malignancy,post-transplant glomerulonephritis,and survival,using a propensity score matched cohort design.METHODS Kidney transplant recipients who received alemtuzumab or basiliximab induction from 2014 to 2019 across two nephrology centres in Northwest England were evaluated.Propensity score matching at a 1:1.5 ratio ensured comparability between cohorts.Baseline characteristics,immunosuppression regimens,and outcomes were analyzed.Linear,binary logistic and Cox proportional hazard regression models.RESULTS A total of 436 recipients were included,with a median follow-up of 5.2 years.The matched cohort(n=262)had a mean age of 51.1±13.5 years;39%were female and 92%were white.There was no significant difference in the cumulative incidence of acute rejection[odds ratio(OR)=2.10;95%CI:0.9-4.9;P=0.110].Compared with basiliximab,alemtuzumab was associated with lower estimated glomerular filtration rate at 12 months(-6.6 mL/minute/1.73 m2;95%CI:-10.5 to-2.7;P<0.001)and higher risks of cytomegalovirus viremia(OR=3.2;95%CI:1.6-6.5;P<0.001),BK viremia(OR=2.4;95%CI:1.1-5.5;P=0.02),post-transplant malignancy(OR=6.2;95%CI:1.6-29.9;P=0.013),and death-censored graft loss(hazard ratio=3.6;95%CI:1.2-11.4;P=0.03).No significant differences were observed in post-transplant glomerulonephritis or recipient mortality.CONCLUSION In this propensity score-matched analysis,alemtuzumab induction was associated with lower graft function at 12 months and higher risks of viral infection,post-transplant malignancy,and graft loss compared with basiliximab.These findings highlight the need for further studies to confirm the long-term safety and effectiveness of alemtuzumab in kidney transplantation.展开更多
Alzheimer’s disease is the most common cause of dementia.Although increasing evidence suggests that disruptions in lipid metabolism are closely associated with the disease,the overall profile of lipid and sterol chan...Alzheimer’s disease is the most common cause of dementia.Although increasing evidence suggests that disruptions in lipid metabolism are closely associated with the disease,the overall profile of lipid and sterol changes that occur in the brain during Alzheimer’s disease remains unclear.In this study,we compared brain tissues extracted from 32-week-old male wild-type mice and 5×FAD transgenic Alzheimer’s disease model mice,which carry mutations in the amyloid precursor protein(APP)and presenilin 1(PS1)genes.Using untargeted lipidomics and sterolomics techniques,we investigated the metabolic profiles of lipids,with a focus on sterols specifically,in three brain regions:cerebellum,hippocampus,and olfactory bulb.Our results revealed significant alterations in various lipids,particularly in the hippocampus and olfactory bulb,suggesting changes in energy levels in these regions.Further pathway analysis indicated notable disruptions in key metabolic processes,particularly those related to fatty acids and cell membrane components.Additionally,we observed decreased expression of 15 genes involved in lipid and sterol regulation.Collectively,these findings provide new insights into how imbalances in lipid and sterol metabolism may contribute to the progression of Alzheimer’s disease,highlighting potential metabolic pathways involved in the development of this debilitating disease.展开更多
Background:Artificial intelligence(AI)is transforming healthcare,demanding reevaluation of medical education.China's“New Medical Education”initiative urgently requires a standardized AI literacy framework for me...Background:Artificial intelligence(AI)is transforming healthcare,demanding reevaluation of medical education.China's“New Medical Education”initiative urgently requires a standardized AI literacy framework for medical students to address fragmented standards,rapid technological evolution,and insufficient localized ethical norms.Objective:To establish a Chinese expert consensus defining core AI competencies and a multi-modal assessment framework for medical students.Methods:A multidisciplinary(including medical education,clinical medicine,medical AI,public health,and medical ethics)expert group(n=32)developed an initial competency list based on the“Knowledge-Skills-Attitude”Medical Competency Model.Two Delphi rounds(100%response rate;consensus threshold:mean≥4.0,CV≤0.25)refined the framework.Core competencies were prioritized via Analytic Hierarchy Process(AHP).The final consensus document was established after multiple expert group meetings.Results:The consensus defines AI literacy for medical students as a comprehensive attribute for integrating AI into profes-sional knowledge,clinical practice,research,and health management.It comprises a 21-item Competencies of AI Proficiency(CAIP)list across knowledge(eight indicators),skills(seven indicators),and attitude(six indicators)dimensions.Key com-petencies prioritized include understanding AI's role in multidisciplinary knowledge integration(CAIP3),identifying AI output biases(CAIP4),understanding health data governance(CAIP2),maintaining physician-led AI-assisted diagnosis(CAIP16),and identifying AI diagnostic biases(CAIP12).A multi-modal assessment framework is recommended,including paper-based/computerized tests for knowledge,situational judgment tests(SJTs)for attitudes,and objective structured clinical examinations(OSCEs)with a specific“AI Clinical Decision Conflict Scoring Scale”for skills.A multi-stage dynamic assessment system(“Pre-enrollment-Pre-clinical-Post-clinical”)is proposed for longitudinal tracking.Educational integration pathways emphasize embedding AI literacy modularly from early undergraduate years,constructing an integrated curriculum covering fundamental principles,advanced large model applications(e.g.,prompt engineering,agent development),and ethical considerations,supported by a"digital twin hospital platform."Conclusion:This consensus provides authoritative,China-specific guidance for defining and assessing medical students'AI literacy,adhering to national policies and regulations.It offers a core action framework for optimizing AI integration into medical education,fostering future healthcare professionals proficient in both AI technology and medical humanism,with a commitment to dynamic updating to adapt to evolving AI advancements.展开更多
Context and Object: Late nephrology case management for patients with chronic renal failure is consistently associated with high morbidity rate. The objectives of this study were to determine the factors associated wi...Context and Object: Late nephrology case management for patients with chronic renal failure is consistently associated with high morbidity rate. The objectives of this study were to determine the factors associated with late nephrology case management and to describe the evolution of patients depending on the time of care nephrology. Material and Methods: It was a 5-year prospective study, observational type, going from January 1st, 2010 to December 31th, 2014. We studied all the patients hospitalized with chronic renal failure with dialysis or not and we excluded the patients hospitalized for acute renal failure. Results: The study population includes 307 men (53.4%) and 268 women (46.6%) with a sex ratio of 1.14. Age population ranged between 15 and 85 years old with a mean of 44.4 ± 16.20 years old. Their profession was distributed as follows: 220 housewives (38.3%), 181 workers (31.5%), 104 civil servants (18.1%), 56 students (9.7%) and 14 unemployed (2.4%). Patients came from all regions of the country: Conakry: 389 patients (67.6%);Lower Guinea: 82 (14.3%);Middle-Guinea: 57 (9.9%);Upper Guinea: 31 (5.4%);Guinea Forest Region: 16 (2.8%). In this study population, 48 patients were admitted in emergency (8.3%);105 were scheduled (18.3%) and 422 were referred to the nephrology department (73.4%). Reasons for the emergency admission were acute pulmonary edema in 21 patients (43.7%), decompensated anemia in 13 patients (27.1%), loss of consciousness in 9 patients (18.7%) and malignant hypertension in 5 patients (10.4%). The reference patterns was uremic syndrome in 312 patients (54.3%), followed by high blood pressure in 247 patients (42.9%), an edematous syndrome in 234 patients (40.7%), oligoanuria in 222 patients (38.6%), morphological abnormalities on the renal ultrasound in 4 patients (0.7%). The functional symptoms were vomiting in 379 patients (65.9%), followed by dyspnea in 290 patients (50.4%), headaches in 287 patients (49.9%). Among them, 121 patients could handle alone, 431 were borne by their families and 23 were indigent;181 patients had consulted before 1 month of the beginning of the signs, 238 between 1 and 2 months and 156 after 2 months;48 were admitted in emergency, 105 were programmed by the Nephrology Department and 422 were referred to the other health structures of the country. Conclusion: Several factors contributed to the delay in treatment, among which: the low socioeconomic level, the delay of the reference of the patients, the long distance of the regions, the lack of Nephrology units in the country.展开更多
HIV infection is a major cause of chronic kidney disease, associated with high morbidity and mortality in sub-Saharan Africa. The objective of this study is to assess the prevalence and risk factors of renal disease a...HIV infection is a major cause of chronic kidney disease, associated with high morbidity and mortality in sub-Saharan Africa. The objective of this study is to assess the prevalence and risk factors of renal disease at initiation of antiretroviral therapy. This was a descriptive and analytical retrospective study carried out in the infectious and tropical diseases department at Sylvanus Olympio University Hospital. The data have been extracted from the ESOPE software. Kidney disease was defined by a GFR, estimated by MDRD (Modification of Diet in Renal Disease) formula, less than 60 ml/min/1.73 m2. Risk factors associated with kidney disease were assessed using univariate and multivariate analysis. There were 3118 HIV-infected patients included in our study. The median estimated filtration rate was 94.7 ml/min/1.73 m2: 2.9% had an eGFR 2. 1303 had kidney disease (41.8%). Most patients (30.8%) were in the WHO clinical stage 1. The median CD4 count was 165/μL [IQR = 72 - 274/μL];the median hemoglobin level was 10.4 g/dL [IQR = 8.8 - 11.9 g/dL];all patients had thrombocytopenia less than 100.000/mm3;8.5% had leukocytosis greater than 10.000/mm3. Most of patients had HIV1. In the multivariate analysis, age greater than 40 years (p 3 were significantly associated with renal disease. The prevention of kidney disease must go through the identification of its risk factors in the target populations.展开更多
Introduction: The morbidity and mortality of patients with heart failure are known to increase rapidly in the presence of renal insufficiency, which is usually the cause but may be a consequence. To organize better pr...Introduction: The morbidity and mortality of patients with heart failure are known to increase rapidly in the presence of renal insufficiency, which is usually the cause but may be a consequence. To organize better prevention of renal failure, we undertook this study to identify the determinants of renal failure in the population of patients with heart failure. Methodology: This was a retrospective descriptive and analytical study of heart failure (HF) cases hospitalized from January 1st to December 31st, 2016, over a period for twelve (12) months at CHU Sylvanus Olympio. Patients who performed cardiac Doppler ultrasound were included in our study. Renal failure was defined as eGFR (estimated glomerular filtration rate) less than 60 ml/min/1.73m2. Multivariate logistic regression was performed to investigate associated factors. The dependent variable was DFG status: coded 1 if the GFR is less than 60 ml/min and 0 if not. Results: A total of 216 patients were included. The majority were female (54.17%). The median age of patients was 53 years [IQI = 32 - 61 years] with extremes of 15 and 96 years. 16.49% of patients had a GFR of less than 60 ml/min. In multivariate analysis the average standard of living (OR = 2.40, p = 0.0456), diabetes (OR = 2.67, p = 0.0300), hypertension (OR = 5.66, p = 0.0399), alcoholism (OR = 4.00, p = 0.0063) were the main factors in the development of an RF/HF. Conclusion: The average standard of living, diabetes, hypertension, and chronic alcoholism are the determinants of renal failure in HF.展开更多
Gastric carcinoma(GC)is a malignancy with multifactorial involvement,multicellular regulation,and multistage evolution.The classic Correa's cascade of intestinal GC specifies a trilogy of malignant transformation ...Gastric carcinoma(GC)is a malignancy with multifactorial involvement,multicellular regulation,and multistage evolution.The classic Correa's cascade of intestinal GC specifies a trilogy of malignant transformation of the gastric mucosa,in which normal gastric mucosa gradually progresses from inactive or chronic active gastritis(Phase I)to gastric precancerous lesions(Phase II)and finally to GC(Phase III).Correa's cascade highlights the evolutionary pattern of GC and the importance of early intervention to prevent malignant transformation of the gastric mucosa.Intervening in early gastric mucosal lesions,i.e.,Phases I and II,will be the key strategy to prevent and treat GC.Natural products(NPs)have been an important source for drug development due to abundant sources,tremendous safety,and multiple pharmacodynamic mechanisms.This review is the first to investigate and summarize the multi-step effects and regulatory mechanisms of NPs on the Correa's cascade in gastric carcinogenesis.In Phase I,NPs modulate Helicobacter pylori urease activity,motility,adhesion,virulence factors,and drug resistance,thereby inhibiting H.pylori-induced gastric mucosal inflammation and oxidative stress,and facilitating ulcer healing.In Phase II,NPs modulate multiple pathways and mediators regulating gastric mucosal cell cycle,apoptosis,autophagy,and angiogenesis to reverse gastric precancerous lesions.In Phase III,NPs suppress cell proliferation,migration,invasion,angiogenesis,and cancer stem cells,induce apoptosis and autophagy,and enhance chemotherapeutic drug sensitivity for the treatment of GC.In contrast to existing work,we hope to uncover NPs with sequential therapeutic effects on multiple phases of GC development,providing new ideas for gastric cancer prevention,treatment,and drug development.展开更多
Objective Diabetic kidney disease is a serious complication of diabetes,which is the leading cause of end-stage renal disease worldwide.Approximately 40%of individuals with diabetes develop diabetic kidney disease.At ...Objective Diabetic kidney disease is a serious complication of diabetes,which is the leading cause of end-stage renal disease worldwide.Approximately 40%of individuals with diabetes develop diabetic kidney disease.At present,the most important drugs for diabetic kidney disease include renin-angiotensin-aldosterone system inhibitors,angiotensin receptor blockers,sodium-glucose cotransporter-2 inhibitors,and newly approved aldosterone receptor antagonists.However,to date,there are still no effective drugs to prevent diabetic kidney disease from progressing to end-stage renal disease.Network pharmacology combined with bioinformatics and pharmacology provides a powerful tool for studying the mechanism of drug action.Traditional Chinese medicine has accumulated rich experience in the treatment of diabetic kidney disease,and its multi-target,multi-component,and multi-pathway characteristics provide new ideas for modern medicine.This article reviews the research progress of network pharmacology and drug therapy in diabetic kidney disease.展开更多
Objective:To evaluate the value of rehabilitation nursing based on mind mapping model combined with psychological intervention for patients with nephrotic syndrome(NS).Methods:A total of 60 patients with NS who visite...Objective:To evaluate the value of rehabilitation nursing based on mind mapping model combined with psychological intervention for patients with nephrotic syndrome(NS).Methods:A total of 60 patients with NS who visited our hospital from January 2024 to December 2024 were selected as samples and randomly divided into groups.The observation group received rehabilitation nursing based on the mind mapping model combined with psychological intervention,while the control group received routine intervention.The differences in emotional scores,self-care ability scores,compliance,and complications were compared between the two groups.Results:The anxiety(SAS)and depression(SDS)scores of the observation group were lower than those of the control group,while the self-care ability scale(ESCA)score was higher than that of the control group(P<0.05).The compliance rate of the observation group was higher than that of the control group(P<0.05).The complication rate of NS in the observation group was lower than that in the control group(P<0.05).Conclusion:Rehabilitation nursing based on the mind mapping model combined with psychological intervention can enhance self-care ability,reduce negative emotions,and reduce complications in NS nursing,which is efficient and feasible.展开更多
OBJECTIVE:To establish and evaluate a prognostic model of immunoglobulin A nephropathy(Ig AN)based on integrated Chinese and Western Medicine.METHODS:Retrospective analysis from 1/1/2013 to 12/31/2015 was performed on...OBJECTIVE:To establish and evaluate a prognostic model of immunoglobulin A nephropathy(Ig AN)based on integrated Chinese and Western Medicine.METHODS:Retrospective analysis from 1/1/2013 to 12/31/2015 was performed on 735 patients who were diagnosed with Ig AN.In addition,105 external data sets from 1/1/2016 to 12/31/2018 were used to verify the constructed model.The end point was entry into endstage renal disease or a doubling of serum creatinine(Scr)level from baseline.Kaplan-Meier curve survival analysis and multivariable Cox regression analysis were used to find independent prognostic factors.MATLAB 2018b and artificial neural network(ANN)were used to construct prognostic risk factor prediction models each for Traditional Chinese Medicine(TCM),Western Medicine,and integrated TCM and Western Medicine.The ANN model incorporated WANG Yongjun's new five-type syndrome differentiation for Ig AN.The prediction efficiencies of the three models were compared using the confusion matrix and the area under thecurve(AUC).RESULTS:Patients from 1/1/2013 to 12/31/2015 were followed for a mean of(46±19)months.The 5-year median overall renal survival time was 58.6 months,and a total of 40 patients(5.4%)entered the endpoint.Ratio of males to females was 1.48∶1.Median age of patients undergoing renal puncture was 35 years.Median 24-hour urinary protein was 0.55 g and 37 patients(5.0%)had pronounced proteinuria(24-hour urine protein≥3.5 g).Median serum creatinine was 76μmol/L and mean estimated glomerular filtration rate was(90±33)m L/min per 1.73 m^(2).Oxford classification of renal pathology suggested a high rate of focal segmental glomerulosclerosis(80.3%).Use of immunosuppressants was the most common(71.3%)treatment after renal puncture and improved clinical outcomes of Ig AN.TCM differentiation of kidney deficiency was the most common syndrome(69.5%).Independent risk factors for the endpoint were male,anemia,high urinary protein,and an Oxford classification of segmental sclerosis(S).AUCs of the Western Medicine,TCM,and integrated Chinese and Western Medicine models were 0.89,0.87,and 0.92,respectively.In external data(1/1/2016 to 12/31/2018),the performance of the three models was 0.88,0.80,and 0.94,respectively.CONCLUSIONS:ANN can be used to successfully construct a 5-year prediction model of Ig AN after renal puncture.The efficiency of this model,which combines TCM and Western Medicine factors based on Wang's new five-type syndrome differentiation,exceeds that of Western Medicine factors or TCM factors alone in data from this single-center retrospective study.展开更多
文摘Objective: to explore the application effect of high-quality nursing management mode in nursing management of nephrology department. Methods: 80 patients in the department of nephrology of our hospital were randomly divided into control group and observation group. The selected time range is from April 2021 to April 2022. The control group adopted conventional nursing mode, while the observation group adopted high-quality nursing management mode on the basis of conventional nursing. The incidence of adverse events, nursing quality score and patients' satisfaction with nursing were compared between the two groups. Results: the incidence of adverse events in the observation group was 5.0%, which was significantly lower than that in the control group (χ2 = 6.3154). In the observation group, the scores of isolation disinfection (95.32 ± 3.31), rescue items (96.33 ± 4.31), nursing document writing (93.62 ± 2.31), graded nursing (93.52 ± 4.31) and safety of nursing quality (94.42 ± 4.31), data patients' satisfaction with nursing in the observation group was 95.0%, significantly higher than that in the control group (χ2 = 6.3161, P < 0.05). Conclusion: the adverse events in the nursing of patients in nephrology department are closely related to the nursing mode. As a new nursing mode, high-quality nursing can reduce the occurrence of adverse events, encourage patients to recognize the clinical nursing work in nephrology department, and play an important role in improving the quality of nursing work in nephrology department.
文摘Ultrasound has long been an essential tool in nephrology,traditionally used for procedures like vascular access and kidney biopsies.Point-of-care ultrasonography(POCUS),a rapidly evolving bedside technology,is now gaining momentum in nephrology by providing real-time imaging to enhance physical examination findings.Unlike comprehensive radiology-performed ultrasound,POCUS focuses on specific clinical questions,providing immediate and actionable insights.This narrative review examines the philosophy behind POCUS,its expanding applications in nephrology,and its impact on patient care,including its role in diagnosing obstructive uropathy,guiding fluid management,and evaluating hemodynamics in cardiorenal syndrome.Additionally,the review addresses barriers to widespread adoption,such as the need for structured training,competency validation,and interdisciplinary cooperation.By integrating POCUS into routine practice,nephrologists can refine diagnostic accuracy,improve patient outcomes,and strengthen the role of bedside medicine.
文摘<strong>Context:</strong> Due to the late referral of the pads to the nephrologist and the lack of medical follow-up, many patients are admitted with complications from kidney disease requiring the urgent start of hemodialysis sessions. <strong>Purpose:</strong> Study the profile of emergency hemodialysis patients in order to ease their management. <strong>Methods:</strong> This was a retrospective, descriptive and analytical study carried out at the Nephrology Department of the Teaching Hospital of Yopougon from January 1st to December 31st, 2016. This study included all patients who had received a first session of hemodialysis in an emergency context. <strong>Results:</strong> We collected 146 patients with an average age of 39.80 ± 14.55 years and a sex ratio of 0.6 for men. Before admission, patients were known as hypertensives (63.9%), followed by CKD (23.9%) and HIV-infected (8.2%). The main clinical signs were hypertension (64.3%), edema (44.5%) and coma (30.1%). Anemia was observed in 97.2% of cases and it was less than 8 g/dl in 57.5%. Kidney failure was chronic in 75.3% and acute in 24.6%. Chronic nephropathies were glomerular (54.1%), vascular (20.5%). The main indications for hemodialysis were encephalopathy (33.5%), severe uremia (28%), acute pulmonary edema (19.8%), persistent anuria (11.6%) and hyperkalemia (5.4%). The vascular approach was a catheter in 97.2% (femoral site in 53.4% and jugular in 43.8% and arteriovenous fistula in 2.7%). Death was observed in 17.8%. In univariate analysis, age > 65 years (p = 0.04), coma (p = 0.004) and acute kidney failure (p = 0.02) were associated with the risk of death, and in multivariate analysis, only coma (p = 0.024, OR = 5.88) seemed to be associated with mortality risk for our patients. <strong>Conclusion:</strong> Hemodialysis in an emergency situation is a common practice in the Teaching Hospital of Yopougon and mainly concerns patients with CKD.
文摘BACKGROUND Chronic kidney disease(CKD)contributes significantly to emergency department(ED)presentations in low-and middle-income countries.These patients frequently have multiple comorbidities and face high in-hospital mortality.However,limited data exist on early predictors of mortality at ED admission.Identifying key clinical and laboratory features associated with adverse outcomes may support timely risk stratification and targeted interventions for acutely ill CKD patients.AIM To identify baseline predictors of in-hospital mortality in adult Indian patients with CKD admitted to the ED.METHODS This retrospective study was conducted from January 2021 to December 2022 at the Acute Care and Emergency Medicine Unit of the Postgraduate Institute of Medical Education and Research,Chandigarh,India.CKD was diagnosed and staged following the Kidney Disease:Improving Global Outcomes guidelines.Data were extracted from medical records using a structured form.All consecutive patients aged≥18 years were included.Independent mortality predictors were identified using multivariate Cox regression analysis.RESULTS Among 354 patients(mean age 49 years;58%males),60.5%had CKD stage 5,and 41.2%were on maintenance dialysis.Hypertension(74.9%)and diabetes(46.0%)were common comorbidities.Diabetic kidney disease was the primary etiology in 35.6%,while 43.2%had unknown causes.Infection(63.0%)was the most frequent cause for ED admission.In-hospital mortality was 29.1%(n=103).Independent mortality predictors were Glasgow coma scale(GCS)<15[hazard ratio(HR):1.822,P=0.017],hyperglycemia(HR:1.641,P=0.020),and low albumin(HR:1.270,P=0.028).Advanced age,Charlson comorbidity Index,quick Sequential Organ Failure Assessment,and neutrophilia were significant in univariate but not multivariate analysis.CKD stage,dialysis dependency,cardiovascular disease,and neutrophil-lymphocyte ratio were not predictive.CONCLUSION A low GCS,hyperglycemia,and low albumin levels at admission independently predict in-hospital mortality in CKD patients presenting to the ED,warranting early recognition and targeted interventions.
文摘Introduction: Hypercalcemia is the most common metabolic complication in myeloma. The aim of this study was to evaluate the management strategy of hypercalcemia in myeloma at the nephrology department of Louis Pasteur hospital of Chartres. Patients and Methods: We carried a retrospective study of patients treated for myeloma-related hypercalcemia between January 1, 2019 to December 31, 2021. The clinical, paraclinical, therapeutic and evolutive characteristics were studied. Results: Eight patients were included in this study with a median age of 67 years [41 - 85] and a sex ratio (M/F) of 1. A quarter of patients were known with chronic kidney disease. Four patients (50%) had symptoms of hypercalcemia. Biologically, the mean hemoglobin was 9.8 ± 2.7 g/dl, all patients had an acute kidney injury with a mean creatinine level of 364.1 ± 173.3 mmol/l, a mean serum calcium of 3.42 ± 0.59 mmol/l and three quarter of patients had bone lesions. Five patients (62.5%) were rehydrated with a mean volume of saline of 2700 ± 836.7 ml/24h. Seven patients (87.5%) received biphosphonates and none received diuretics. The mean normalization time of the serum calcium was 5 days. Conclusion: Hypercalcemia is frequent in malignancy and represents a poor prognosis factor of the disease. A well-conducted therapeutic strategy allows rapid normalization.
文摘Kidney transplantation(KT)accounts for nearly three-fourths of organ transplants in India,with living donors contributing to 82%of cases.Induction immunosuppression is essential to optimize initial immunosuppression,reduce acute rejections,and enable tailored use of maintenance agents.Rabbit anti-thymocyte globulin(rATG)and interleukin-2 receptor anatagonists(IL-2RA/IL-2RBs)are the most widely used induction therapies.However,data on induction practices across India are limited.To evaluate induction immunosuppression practices across KT centers in India and establish a consensus for different subsets of KT recipients.A nationwide online survey was conducted by the Indian Society of Organ Transplantation(ISOT)among its members(400 KT centers).Responses were analyzed to assess induction practices across diverse donor types,age groups,and immunological risk profiles.Heterogeneity in practices prompted consensus building using a modified Delphi process.Literature review and expert panel discussions(April 2024)were followed by structured voting,and 16 consensus statements were finalized.Of 400 centers approached,254 participated.rATG was the most commonly used induction therapy,followed by IL-2RBs;alemtuzumab was least used.Significant heterogeneity was observed in type,dose,and duration of induction therapy.Consensus recommendations were framed:rATG for high immunological risk recipients and deceased donor KTs;IL-2RB or low-dose rATG for low immunological risk;rituximab in ABOincompatible KTs;and tailoring based on age,diabetes,donor type,infection risk,and affordability.This first ISOT consensus provides 16 India-specific statements on induction therapy in KT.It emphasizes risk-stratified,evidenceinformed,and context-appropriate induction strategies,supporting standardization of care across the country.
文摘BACKGROUND Post-transplant tertiary hyperparathyroidism(PT-tHPT)is a well-recognized complication following kidney transplantation,characterized by persistent excessive secretion of parathyroid hormone(PTH)despite improved renal function.It is potentially associated with an increased risk of cardiovascular events,renal osteodystrophy,pathologic fractures,graft loss,and mortality.AIM To evaluate the incidence,risk factors,and outcomes of PT-tHPT amongst kidney transplant recipients.METHODS A total of 887 transplant recipients who underwent transplantation between 2000 and 2020 were evaluated.Univariable and multivariable logistic regression was performed to determine the predictors of tertiary hyperparathyroidism.Graft and recipient outcomes were assessed using multivariable Cox regression.A separate multivariable Cox regression was performed to determine the effect of treatment strategies on outcomes.RESULTS PT-tHPT,defined as elevated PTH(>65 ng/L)and persistent hypercalcemia(>2.60 mmol/L),was diagnosed in 14%of recipients.Risk factors for PT-tHPT included older age[odds ratio(OR)=1.36,P<0.001],Asian ethnicity(OR=0.33,P=0.006),total ischemia time(OR=1.03,P=0.048 per hour),pre-transplant serum calcium(OR=1.38,P<0.001)per decile increase,pre-transplant PTH level(OR=1.31,P<0.001)per decile increase,longer dialysis duration(OR=1.12,P=0.002)per year,history of acute rejection(OR=2.37,P=0.012),and slope of estimated glomerular filtration rate change(OR=0.91,P=0.001).There were a 3.4-fold higher risk of death-censored graft loss and a 1.9-fold greater risk of recipient death with PT-tHPT.The three treatment strategies of conservative management,calcimimetic and parathyroidectomy did not significantly change the graft or patient outcome.CONCLUSION Pretransplant elevated calcium and PTH levels,older age and dialysis duration are associated with PT-tHPT.While PT-tHPT significantly affects graft and recipient survival,the treatment strategies did not affect survival.
文摘Introduction: Acute kidney injury (AKI) is defined as a sudden and reversible deterioration in renal function. It is a life-threatening condition in hospitalized patients. Our objectives were to determine the prevalence of AKI in a nephrology department, list the causes, describe the evolutionary profile and identify the factors associated with death. Patients and Methods: We reviewed the records of patients hospitalised between 1 January 2016 and 31 October 2020 in the nephrology department of Brazzaville University Hospital. We included patients aged at least 18 years whose discharge diagnosis included the item AKI. Study variables were socio-demographic data, clinical and paraclinical signs, stage and type of AKI, etiology and evolutionary profile. Results: Of the 1823 patients hospitalised, 244 (13.38%) were hospitalised for AKI. Of these, 60.2% were boys and 39.8% girls, with an average age of 47 19 years. The average consultation time was 10 6.5 days. AKI was stage 3 in 69.57% of cases. It was functional, organic and obstructive in the order of 55.28%, 36.02% and 8.69%. Dialysis was indicated in 62 patients (38.51%) and performed in 24 patients (14.9%). In-hospital mortality was 27.95%, with an average hospital stay of 9.6 5.8 days. Metabolic acidosis and anemia were the main causes of death in 14.28% and 4.35% of patients respectively. Factors associated with death were male sex, socioeconomic level, coma, indication for dialysis and absence of dialysis, with a p Conclusion: AKI is more common in young adult males. Mortality is relatively low. Improving prognosis requires early management and access to dialysis.
文摘BACKGROUND Early renal artery thrombosis after kidney transplantation is rare but often leads to graft loss.Prompt diagnosis and intervention are essential,particularly in patients with inherited thrombophilias such as factor V Leiden(FVL)mutation.CASE SUMMARY A kidney transplant recipient with FVL mutation developed an acute transplant renal artery thrombosis.The immediate post-operative Doppler ultrasonography revealed thrombosis of the main and inferior polar renal arteries.Emergent thrombectomy and separate arterial re-anastomoses were performed after cold perfusion with heparinized saline and vasodilator solution.Reperfusion was successful with immediate urine output and gradual improvement in renal function.The patient was discharged on direct oral anticoagulation therapy.CONCLUSION Early detection and surgical intervention can preserve graft function in posttransplant renal artery thrombosis even in patients at high risk.
文摘Objective: Chronic end-stage renal failure is a major public health problem in developing countries and is poorly documented. The objective of this study was to describe the epidemiological, diagnostic, therapeutic, and evolutionary aspects of patients admitted for end-stage renal failure to the Department of Nephrology at the University Hospital of Brazzaville. Patients and Methods: This was a descriptive cross-sectional study collecting prospective data that took place over 10 months. We included 128 patients who were exhaustively identified. Sociodemographic, clinical, therapeutic and developmental data were collected using a standardized and pretested pre-established survey form. The EPI info software enabled the analysis and processing of the data. Results: We reported a male predominance with a sex ratio of 2.5. The median age was 50 years. The first cause found was diabetes (55%) followed by hypertension (46%). The majority of patients had a dialysis emergency and half could not be dialyzed for financial reasons. Conclusion: Our results highlighted that certain epidemiological parameters of end-stage renal failure are constantly changing, such as frequency, while others remain static, including the main etiologies, gender, and age. However, mortality continues to increase and deserves more attention.
文摘BACKGROUND The use of induction immunosuppression agents has improved kidney transplant outcomes,but selecting the optimal agent remains a point of debate.AIM To compare the long-term outcomes of kidney transplant recipients receiving alemtuzumab vs basiliximab induction,focusing on graft function,acute rejection,infection,malignancy,post-transplant glomerulonephritis,and survival,using a propensity score matched cohort design.METHODS Kidney transplant recipients who received alemtuzumab or basiliximab induction from 2014 to 2019 across two nephrology centres in Northwest England were evaluated.Propensity score matching at a 1:1.5 ratio ensured comparability between cohorts.Baseline characteristics,immunosuppression regimens,and outcomes were analyzed.Linear,binary logistic and Cox proportional hazard regression models.RESULTS A total of 436 recipients were included,with a median follow-up of 5.2 years.The matched cohort(n=262)had a mean age of 51.1±13.5 years;39%were female and 92%were white.There was no significant difference in the cumulative incidence of acute rejection[odds ratio(OR)=2.10;95%CI:0.9-4.9;P=0.110].Compared with basiliximab,alemtuzumab was associated with lower estimated glomerular filtration rate at 12 months(-6.6 mL/minute/1.73 m2;95%CI:-10.5 to-2.7;P<0.001)and higher risks of cytomegalovirus viremia(OR=3.2;95%CI:1.6-6.5;P<0.001),BK viremia(OR=2.4;95%CI:1.1-5.5;P=0.02),post-transplant malignancy(OR=6.2;95%CI:1.6-29.9;P=0.013),and death-censored graft loss(hazard ratio=3.6;95%CI:1.2-11.4;P=0.03).No significant differences were observed in post-transplant glomerulonephritis or recipient mortality.CONCLUSION In this propensity score-matched analysis,alemtuzumab induction was associated with lower graft function at 12 months and higher risks of viral infection,post-transplant malignancy,and graft loss compared with basiliximab.These findings highlight the need for further studies to confirm the long-term safety and effectiveness of alemtuzumab in kidney transplantation.
基金supported by the National Natural Science Foundation of China,Nos.82200784,32271311Qizhen Foundation,No.226‐2023‐00008(all to LH).
文摘Alzheimer’s disease is the most common cause of dementia.Although increasing evidence suggests that disruptions in lipid metabolism are closely associated with the disease,the overall profile of lipid and sterol changes that occur in the brain during Alzheimer’s disease remains unclear.In this study,we compared brain tissues extracted from 32-week-old male wild-type mice and 5×FAD transgenic Alzheimer’s disease model mice,which carry mutations in the amyloid precursor protein(APP)and presenilin 1(PS1)genes.Using untargeted lipidomics and sterolomics techniques,we investigated the metabolic profiles of lipids,with a focus on sterols specifically,in three brain regions:cerebellum,hippocampus,and olfactory bulb.Our results revealed significant alterations in various lipids,particularly in the hippocampus and olfactory bulb,suggesting changes in energy levels in these regions.Further pathway analysis indicated notable disruptions in key metabolic processes,particularly those related to fatty acids and cell membrane components.Additionally,we observed decreased expression of 15 genes involved in lipid and sterol regulation.Collectively,these findings provide new insights into how imbalances in lipid and sterol metabolism may contribute to the progression of Alzheimer’s disease,highlighting potential metabolic pathways involved in the development of this debilitating disease.
基金Science and Technology Innovation 2030 Major Project,Grant/Award Number:2023ZD0508506。
文摘Background:Artificial intelligence(AI)is transforming healthcare,demanding reevaluation of medical education.China's“New Medical Education”initiative urgently requires a standardized AI literacy framework for medical students to address fragmented standards,rapid technological evolution,and insufficient localized ethical norms.Objective:To establish a Chinese expert consensus defining core AI competencies and a multi-modal assessment framework for medical students.Methods:A multidisciplinary(including medical education,clinical medicine,medical AI,public health,and medical ethics)expert group(n=32)developed an initial competency list based on the“Knowledge-Skills-Attitude”Medical Competency Model.Two Delphi rounds(100%response rate;consensus threshold:mean≥4.0,CV≤0.25)refined the framework.Core competencies were prioritized via Analytic Hierarchy Process(AHP).The final consensus document was established after multiple expert group meetings.Results:The consensus defines AI literacy for medical students as a comprehensive attribute for integrating AI into profes-sional knowledge,clinical practice,research,and health management.It comprises a 21-item Competencies of AI Proficiency(CAIP)list across knowledge(eight indicators),skills(seven indicators),and attitude(six indicators)dimensions.Key com-petencies prioritized include understanding AI's role in multidisciplinary knowledge integration(CAIP3),identifying AI output biases(CAIP4),understanding health data governance(CAIP2),maintaining physician-led AI-assisted diagnosis(CAIP16),and identifying AI diagnostic biases(CAIP12).A multi-modal assessment framework is recommended,including paper-based/computerized tests for knowledge,situational judgment tests(SJTs)for attitudes,and objective structured clinical examinations(OSCEs)with a specific“AI Clinical Decision Conflict Scoring Scale”for skills.A multi-stage dynamic assessment system(“Pre-enrollment-Pre-clinical-Post-clinical”)is proposed for longitudinal tracking.Educational integration pathways emphasize embedding AI literacy modularly from early undergraduate years,constructing an integrated curriculum covering fundamental principles,advanced large model applications(e.g.,prompt engineering,agent development),and ethical considerations,supported by a"digital twin hospital platform."Conclusion:This consensus provides authoritative,China-specific guidance for defining and assessing medical students'AI literacy,adhering to national policies and regulations.It offers a core action framework for optimizing AI integration into medical education,fostering future healthcare professionals proficient in both AI technology and medical humanism,with a commitment to dynamic updating to adapt to evolving AI advancements.
文摘Context and Object: Late nephrology case management for patients with chronic renal failure is consistently associated with high morbidity rate. The objectives of this study were to determine the factors associated with late nephrology case management and to describe the evolution of patients depending on the time of care nephrology. Material and Methods: It was a 5-year prospective study, observational type, going from January 1st, 2010 to December 31th, 2014. We studied all the patients hospitalized with chronic renal failure with dialysis or not and we excluded the patients hospitalized for acute renal failure. Results: The study population includes 307 men (53.4%) and 268 women (46.6%) with a sex ratio of 1.14. Age population ranged between 15 and 85 years old with a mean of 44.4 ± 16.20 years old. Their profession was distributed as follows: 220 housewives (38.3%), 181 workers (31.5%), 104 civil servants (18.1%), 56 students (9.7%) and 14 unemployed (2.4%). Patients came from all regions of the country: Conakry: 389 patients (67.6%);Lower Guinea: 82 (14.3%);Middle-Guinea: 57 (9.9%);Upper Guinea: 31 (5.4%);Guinea Forest Region: 16 (2.8%). In this study population, 48 patients were admitted in emergency (8.3%);105 were scheduled (18.3%) and 422 were referred to the nephrology department (73.4%). Reasons for the emergency admission were acute pulmonary edema in 21 patients (43.7%), decompensated anemia in 13 patients (27.1%), loss of consciousness in 9 patients (18.7%) and malignant hypertension in 5 patients (10.4%). The reference patterns was uremic syndrome in 312 patients (54.3%), followed by high blood pressure in 247 patients (42.9%), an edematous syndrome in 234 patients (40.7%), oligoanuria in 222 patients (38.6%), morphological abnormalities on the renal ultrasound in 4 patients (0.7%). The functional symptoms were vomiting in 379 patients (65.9%), followed by dyspnea in 290 patients (50.4%), headaches in 287 patients (49.9%). Among them, 121 patients could handle alone, 431 were borne by their families and 23 were indigent;181 patients had consulted before 1 month of the beginning of the signs, 238 between 1 and 2 months and 156 after 2 months;48 were admitted in emergency, 105 were programmed by the Nephrology Department and 422 were referred to the other health structures of the country. Conclusion: Several factors contributed to the delay in treatment, among which: the low socioeconomic level, the delay of the reference of the patients, the long distance of the regions, the lack of Nephrology units in the country.
文摘HIV infection is a major cause of chronic kidney disease, associated with high morbidity and mortality in sub-Saharan Africa. The objective of this study is to assess the prevalence and risk factors of renal disease at initiation of antiretroviral therapy. This was a descriptive and analytical retrospective study carried out in the infectious and tropical diseases department at Sylvanus Olympio University Hospital. The data have been extracted from the ESOPE software. Kidney disease was defined by a GFR, estimated by MDRD (Modification of Diet in Renal Disease) formula, less than 60 ml/min/1.73 m2. Risk factors associated with kidney disease were assessed using univariate and multivariate analysis. There were 3118 HIV-infected patients included in our study. The median estimated filtration rate was 94.7 ml/min/1.73 m2: 2.9% had an eGFR 2. 1303 had kidney disease (41.8%). Most patients (30.8%) were in the WHO clinical stage 1. The median CD4 count was 165/μL [IQR = 72 - 274/μL];the median hemoglobin level was 10.4 g/dL [IQR = 8.8 - 11.9 g/dL];all patients had thrombocytopenia less than 100.000/mm3;8.5% had leukocytosis greater than 10.000/mm3. Most of patients had HIV1. In the multivariate analysis, age greater than 40 years (p 3 were significantly associated with renal disease. The prevention of kidney disease must go through the identification of its risk factors in the target populations.
文摘Introduction: The morbidity and mortality of patients with heart failure are known to increase rapidly in the presence of renal insufficiency, which is usually the cause but may be a consequence. To organize better prevention of renal failure, we undertook this study to identify the determinants of renal failure in the population of patients with heart failure. Methodology: This was a retrospective descriptive and analytical study of heart failure (HF) cases hospitalized from January 1st to December 31st, 2016, over a period for twelve (12) months at CHU Sylvanus Olympio. Patients who performed cardiac Doppler ultrasound were included in our study. Renal failure was defined as eGFR (estimated glomerular filtration rate) less than 60 ml/min/1.73m2. Multivariate logistic regression was performed to investigate associated factors. The dependent variable was DFG status: coded 1 if the GFR is less than 60 ml/min and 0 if not. Results: A total of 216 patients were included. The majority were female (54.17%). The median age of patients was 53 years [IQI = 32 - 61 years] with extremes of 15 and 96 years. 16.49% of patients had a GFR of less than 60 ml/min. In multivariate analysis the average standard of living (OR = 2.40, p = 0.0456), diabetes (OR = 2.67, p = 0.0300), hypertension (OR = 5.66, p = 0.0399), alcoholism (OR = 4.00, p = 0.0063) were the main factors in the development of an RF/HF. Conclusion: The average standard of living, diabetes, hypertension, and chronic alcoholism are the determinants of renal failure in HF.
基金supported by the Chengdu University of Traditional Chinese Medicine"Xinglin Scholars"Program,China(Grant No.:MPRC2023014).
文摘Gastric carcinoma(GC)is a malignancy with multifactorial involvement,multicellular regulation,and multistage evolution.The classic Correa's cascade of intestinal GC specifies a trilogy of malignant transformation of the gastric mucosa,in which normal gastric mucosa gradually progresses from inactive or chronic active gastritis(Phase I)to gastric precancerous lesions(Phase II)and finally to GC(Phase III).Correa's cascade highlights the evolutionary pattern of GC and the importance of early intervention to prevent malignant transformation of the gastric mucosa.Intervening in early gastric mucosal lesions,i.e.,Phases I and II,will be the key strategy to prevent and treat GC.Natural products(NPs)have been an important source for drug development due to abundant sources,tremendous safety,and multiple pharmacodynamic mechanisms.This review is the first to investigate and summarize the multi-step effects and regulatory mechanisms of NPs on the Correa's cascade in gastric carcinogenesis.In Phase I,NPs modulate Helicobacter pylori urease activity,motility,adhesion,virulence factors,and drug resistance,thereby inhibiting H.pylori-induced gastric mucosal inflammation and oxidative stress,and facilitating ulcer healing.In Phase II,NPs modulate multiple pathways and mediators regulating gastric mucosal cell cycle,apoptosis,autophagy,and angiogenesis to reverse gastric precancerous lesions.In Phase III,NPs suppress cell proliferation,migration,invasion,angiogenesis,and cancer stem cells,induce apoptosis and autophagy,and enhance chemotherapeutic drug sensitivity for the treatment of GC.In contrast to existing work,we hope to uncover NPs with sequential therapeutic effects on multiple phases of GC development,providing new ideas for gastric cancer prevention,treatment,and drug development.
文摘Objective Diabetic kidney disease is a serious complication of diabetes,which is the leading cause of end-stage renal disease worldwide.Approximately 40%of individuals with diabetes develop diabetic kidney disease.At present,the most important drugs for diabetic kidney disease include renin-angiotensin-aldosterone system inhibitors,angiotensin receptor blockers,sodium-glucose cotransporter-2 inhibitors,and newly approved aldosterone receptor antagonists.However,to date,there are still no effective drugs to prevent diabetic kidney disease from progressing to end-stage renal disease.Network pharmacology combined with bioinformatics and pharmacology provides a powerful tool for studying the mechanism of drug action.Traditional Chinese medicine has accumulated rich experience in the treatment of diabetic kidney disease,and its multi-target,multi-component,and multi-pathway characteristics provide new ideas for modern medicine.This article reviews the research progress of network pharmacology and drug therapy in diabetic kidney disease.
文摘Objective:To evaluate the value of rehabilitation nursing based on mind mapping model combined with psychological intervention for patients with nephrotic syndrome(NS).Methods:A total of 60 patients with NS who visited our hospital from January 2024 to December 2024 were selected as samples and randomly divided into groups.The observation group received rehabilitation nursing based on the mind mapping model combined with psychological intervention,while the control group received routine intervention.The differences in emotional scores,self-care ability scores,compliance,and complications were compared between the two groups.Results:The anxiety(SAS)and depression(SDS)scores of the observation group were lower than those of the control group,while the self-care ability scale(ESCA)score was higher than that of the control group(P<0.05).The compliance rate of the observation group was higher than that of the control group(P<0.05).The complication rate of NS in the observation group was lower than that in the control group(P<0.05).Conclusion:Rehabilitation nursing based on the mind mapping model combined with psychological intervention can enhance self-care ability,reduce negative emotions,and reduce complications in NS nursing,which is efficient and feasible.
基金Natural Science Foundation-funded Project:Study on the Mechanism of Compound Centella Asiatica Mediate 24-dehydrocholesterol Reductase/Liver X Receptors(DHCR24/LXR)Signaling Axis to Regulate Macrophage Activation and Alleviate Microinflammation in Diabetic Kidney Disease(No.82205008)Medical Scientific Research Foundation of Zhejiang Province:Study on the Mechanism of Asiaticoside Mediate DHCR24/LXR Signaling Axis to Regulate Macrophage Innate Immune Response in Diabetic Kidney Disease(No.2023RC242)+2 种基金Zhejiang Traditional Medicine and Technology Program:Chen Hongyu's Academic Thought and Clinical Experience in the Diagnosis and Treatment of Diabetic Nephropathy by Knowledge Map(No.2023ZF137)Health Commission of Hangzhou city:Study on Prognosis Model of Ig A Nephropathy Combined with Chinese and Western Medicine based on Artificial Neural Network(No.A20210083)Zhejiang Chinese Medical University Research Foundation:Study on Wang Yongjun's Clinical Decision Model for Diagnosis and Treatment of Diabetic Nephropathy based on Graph Convolutional Neural Network(No.2022FSYYZZ14)。
文摘OBJECTIVE:To establish and evaluate a prognostic model of immunoglobulin A nephropathy(Ig AN)based on integrated Chinese and Western Medicine.METHODS:Retrospective analysis from 1/1/2013 to 12/31/2015 was performed on 735 patients who were diagnosed with Ig AN.In addition,105 external data sets from 1/1/2016 to 12/31/2018 were used to verify the constructed model.The end point was entry into endstage renal disease or a doubling of serum creatinine(Scr)level from baseline.Kaplan-Meier curve survival analysis and multivariable Cox regression analysis were used to find independent prognostic factors.MATLAB 2018b and artificial neural network(ANN)were used to construct prognostic risk factor prediction models each for Traditional Chinese Medicine(TCM),Western Medicine,and integrated TCM and Western Medicine.The ANN model incorporated WANG Yongjun's new five-type syndrome differentiation for Ig AN.The prediction efficiencies of the three models were compared using the confusion matrix and the area under thecurve(AUC).RESULTS:Patients from 1/1/2013 to 12/31/2015 were followed for a mean of(46±19)months.The 5-year median overall renal survival time was 58.6 months,and a total of 40 patients(5.4%)entered the endpoint.Ratio of males to females was 1.48∶1.Median age of patients undergoing renal puncture was 35 years.Median 24-hour urinary protein was 0.55 g and 37 patients(5.0%)had pronounced proteinuria(24-hour urine protein≥3.5 g).Median serum creatinine was 76μmol/L and mean estimated glomerular filtration rate was(90±33)m L/min per 1.73 m^(2).Oxford classification of renal pathology suggested a high rate of focal segmental glomerulosclerosis(80.3%).Use of immunosuppressants was the most common(71.3%)treatment after renal puncture and improved clinical outcomes of Ig AN.TCM differentiation of kidney deficiency was the most common syndrome(69.5%).Independent risk factors for the endpoint were male,anemia,high urinary protein,and an Oxford classification of segmental sclerosis(S).AUCs of the Western Medicine,TCM,and integrated Chinese and Western Medicine models were 0.89,0.87,and 0.92,respectively.In external data(1/1/2016 to 12/31/2018),the performance of the three models was 0.88,0.80,and 0.94,respectively.CONCLUSIONS:ANN can be used to successfully construct a 5-year prediction model of Ig AN after renal puncture.The efficiency of this model,which combines TCM and Western Medicine factors based on Wang's new five-type syndrome differentiation,exceeds that of Western Medicine factors or TCM factors alone in data from this single-center retrospective study.
