99Tcm-DTPA肾动态显像评估单侧根治性肾切除术后早期患者肾功能

目的 观察⁹⁹Tc^m-二亚乙基三胺五乙酸（DTPA）肾动态显像评估单侧根治性肾切除术后早期患者肾功能的价值。方法 回顾性分析158例接受根治性肾切除术的单侧肾实质肿瘤患者资料及术前经肾动态显像所获肾小球滤过率（GFR）结果,计算估算GFR （eGFR）,并以eGFR 60、90 ml/（min·1.73 m²）为临界值将患者分为3组;评价各组临床资料、肾功能指标与术后3个月eGFR的关系,并以线性回归分析影响术后早期肾功能的独立因素。结果 术前eGFR<60 ml/（min·1.73 m²）患者术后早期肾功能与术前eGFR及对侧GFR均相关（P均<0.05）;对侧GFR为术后早期肾功能的独立影响因素（调整R²=0.910,P<0.001）。术前60 ml/（min·1.73 m²）≤ eGFR<90 ml/（min·1.73 m²）时,术后早期肾功能与患者年龄、高血压病史及术前对侧GFR均相关（P均<0.05）,其中术前对侧GFR为独立影响因素（调整R²=0.463,P<0.001）;术前eGFR ≥ 90 ml/（min·1.73 m²）时,术后早期肾功能与患者年龄、肿瘤性质、术前eGFR、对侧GFR及患侧GFR均相关（P均<0.05）,其中患者年龄、术前eGFR及对侧GFR为独立影响因素（调整R²=0.486,P<0.001）。结论 术前⁹⁹Tc^m-DTPA肾动态显像可用于评估单侧根治性肾切除术后早期患者肾功能。     

声辐射力脉冲弹性成像及超微血流成像技术评估IgA肾病严重程度

目的 分析声辐射力脉冲（ARFI）弹性成像及超微血流成像（SMI）评估IgA肾病（IgAN）严重程度的价值。方法 将124例经穿刺右肾中下极活检病理证实的IgAN患者根据估测肾小球滤过率（eGFR）分为A、B、C组。A组32例,eGFR>90 ml/（min·1.73 m²）;B组54例,eGFR 60~90 ml/（min·1.73 m²）;C组38例,eGFR<60 ml/（min·1.73 m²）,于肾活检前3天内行ARFI及SMI。将取样框置于右肾中下极、两肾柱间邻近肾被膜皮质区域,分别检测剪切波速度（SWV）及血流阻力指数（RI）。对比3组SWV、RI,以Pearson相关分析法观察SWV与RI的相关性。结果 A、B、C组SWV逐渐降低,RI逐渐增加,组间两两比较差异均有统计学意义（P均<0.05）。相关性分析结果显示,A、B、C组SWV均与RI呈负相关（r=-0.709、P<0.001,r=-0.792、P<0.001,r=-0.473、P=0.003）。结论 利用ARFI及SMI能无创评估IgAN严重程度。     

MRI影像组学及临床特征联合模型预测高强度聚焦超声治疗子宫肌瘤效果

目的 观察基于MRI影像组学及临床特征建立的联合模型预测高强度聚焦超声(HIFU)治疗子宫肌瘤效果的效能。方法 回顾性分析257例接受HIFU治疗的单发子宫肌瘤患者,基于治疗前盆腔轴位T2WI、T1WI、T1对比增强(T1C)及表观弥散系数(ADC)图提取病灶影像组学特征。分别以XGBoost特征选择算法及XGBoost分类器建立预测HIFU即刻消融率和随访肌瘤体积缩小率的影像组学联合临床特征模型A和B。按8∶2比例将数据集分为训练集(n=202)和测试集(n=52),采用受试者工作特征(ROC)曲线和混淆矩阵评估模型的预测效能。结果 经XGBoost算法选择后纳入10个影像组学特征,包括4个T1WI、2个T2WI、1个T1C及3个ADC图影像组学特征,结合肌瘤背侧距骶骨距离和T2WI信号强度构建模型A;纳入10个影像组学特征,含4个T1WI、3个TIC及3个ADC图影像组学特征,结合肌瘤T2WI信号强度构建模型B。ROC曲线结果显示,模型A预测训练集和测试集HIFU治疗肌瘤即刻消融率的曲线下面积(AUC)分别为0.94[95%CI(0.90,0.96)]和0.90[95%CI(0.81,0.97)],模型B预测训练集和测试集肌瘤体积缩小率的AUC分别为0.98[95%CI(0.97,0.99)]、0.91[95%CI(0.81,0.98)]。结论 MRI影像组学联合临床特征模型可有效预测HIFU治疗子宫肌瘤近期及远期效果。     

临床和MRI影像组学及深度学习联合模型预测初发前列腺癌骨转移

目的 基于临床、MRI影像组学及深度学习（DL）构建联合模型，评估其预测初发前列腺癌（PCa）骨转移（BM）的价值。方法 回顾性分析286例经病理证实的初发PCa，根据患者来源将其分为训练集（53例BM、121例无BM）和测试集（29例BM、83例无BM）。采用单因素分析及多因素logistic回归分析筛选初发PCa BM的临床独立风险因素，构建临床模型；基于MR T2WI和弥散加权成像（DWI）提取并筛选最佳影像组学特征，构建影像组学标签评分（Rad-score），以最佳DL特征建立DL标签评分（DL-score），进而构建影像组学-DL模型；最后基于临床独立风险因素、Rad-score及DL-score构建联合模型。绘制受试者工作特征（ROC）曲线，计算曲线下面积（AUC），评估各模型预测初发PCa BM的效能，以决策曲线分析（DCA）对比其临床获益。结果 血清前列腺特异抗原（PSA）（OR=1.003，P<0.01）及国际泌尿病理学会（ISUP）评分（OR=3.023，P=0.01）为初发PCa BM的临床独立风险因素；以之构建的临床模型预测训练集及测试集初发PCa BM的AUC分别为0.79及0.81。以影像组学-DL模型及联合模型预测训练集和测试集初发PCa BM的AUC分别为0.90、0.93及0.92、0.95，联合模型在训练集（Z=3.12、P<0.01，Z=1.76、P=0.04）和测试集的AUC （Z=2.89、P<0.01，Z=2.23、P=0.03）均高于临床模型及影像组学-DL模型。DCA显示，阈值取0.10~0.78时，联合模型的临床获益高于临床模型及影像组学-DL模型。结论 临床和MRI影像组学及DL联合模型可有效预测初发PCa BM。     

弥散加权成像瘤内及瘤周影像组学预测乳腺癌组织学分级

目的 观察弥散加权成像（DWI）瘤内及瘤周影像组学预测乳腺癌组织学分级的价值。方法 回顾性分析700例经病理诊断单发乳腺癌患者术前DWI,按8∶2比例分为训练集（n=560,含381例Ⅰ+Ⅱ级和179例Ⅲ级）和测试集（n=140,含95例Ⅰ+Ⅱ级和45例Ⅲ级）。手动勾画瘤内ROI（ROI_瘤内）,将其自动外扩3、5 mm,获得瘤周ROI（ROI_{+3 mm}和ROI_{+5 mm}）,以及瘤内-瘤周ROI（ROI_{瘤内+3 mm}、ROI_{瘤内+5 mm}）。提取并筛选最佳影像组学特征,构建影像组学模型（RM）用于预测乳腺癌组织学分级_;绘制受试者工作特征曲线,计算曲线下面积（AUC）,评估各模型预测效能。以校准曲线评估模型校准度,以决策曲线分析（DCA）评估其临床实用性。结果RM_瘤内、RM_{+3 mm}、RM_{+5 mm}、RM_{瘤内+3 mm}及RM_{瘤内+5 mm}在训练集的AUC分别为0.750、0.724、0.749、0.833及0.807,在测试集分别为0.723、0.718、0.736、0.759及0.782。各模型AUC差异在训练集中均有（P均＜0.01）而在测试集均无统计学意义（P均＞0.05）,且校准度均较高。DCA显示阈值为0.02～0.88时RM_{瘤内+瘤周}在训练集、阈值为0.40～0.72时其在测试集的临床净收益更大。结论 DWI瘤内及瘤周影像组学均可有效预测乳腺癌组织学分级,瘤内-瘤周影像组学诊断效能更高。     

CT影像组学联合CT特征预测肺亚实性结节侵袭性

目的 观察CT影像组学联合CT特征预测肺亚实性结节侵袭性的价值。方法 回顾性分析170例肺亚实性结节患者资料,包括6例非典型腺瘤样增生(AAH)、12例原位腺癌(AIS)、58例微浸润性腺癌(MIA)及94例浸润性腺癌(IAC),将AAH、AIS和MIA归为非侵袭组、IAC归为侵袭组。按7∶3比例将患者分为训练集(n=119,含5例AAH、9例AIS、36例MIA及69例IAC)和验证集(n=51,含1例AAH、3例AIS、22例MIA及25例IAC)。采用单因素及logistic回归分析训练集患者一般资料及病灶CT表现,筛选预测肺亚实性结节侵袭性的独立危险因素并建立CT模型;基于训练集提取及筛选病灶最佳影像组学特征,以之构建影像组学模型。基于CT模型及影像组学模型构建联合模型,并以列线图将其可视化。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),基于验证集评估各模型诊断效能;以校准曲线评价联合模型的校准程度。结果 CT所示结节长径和最大CT值为预测肺亚实性结节为IAC的CT相关独立危险因素,以之构建CT模型。基于训练集筛选出6个最佳影像组学特征并构建影像组学模型。CT模型、影像组学模型及联合模型预测验证集肺亚实性结节侵袭性的AUC分别为0.772、0.785及0.869;联合模型的AUC高于CT模型(Z=2.336,P=0.019)而与影像组学模型差异无统计学意义(Z=1.925,P=0.054),其预测结果与实际结果的一致性较高。结论 CT影像组学联合CT特征可有效预测肺亚实性结节侵袭性。     

CT影像组学联合临床及CT特征预测胸腺上皮肿瘤TNM分期

目的 观察CT影像组学联合临床及CT特征预测胸腺上皮肿瘤（TET）TNM分期的价值。方法 回顾性分析216例经手术病理证实的单发TET患者,以其中151例TNM Ⅰ期为早期组,将27例TNM Ⅲ期及38例Ⅳ期归为晚期组（n=65）。采用单因素分析组间临床资料及胸部CT表现。分别基于平扫（NECT）及增强CT（CECT）提取并筛选最佳影像组学特征,建立预测TET TNM分期的影像组学模型RM_NECT、RM_CECT,联合组间差异有统计学意义的临床及CT特征构建RM_NECT-临床、RM_CECT-临床及RM_{NECT-临床-CT、}RM_{CECT-临床-CT}。按7∶3比例将患者分为训练集（n=151）及 验证集（n=65）,采用重复5折交叉验证法于训练集训练模型,并于验证集验证其效能。结果 组间临床症状及CT所示病灶周围脂肪浸润、纵隔淋巴结肿大、胸腔积液差异均有统计学意义（P均＜0.05）。分别基于NECT及CECT筛选出2个及9个最佳影像组学特征,以之构建相应模型。验证集中,RM_{NECT-临床-CT}预测TET TNM分期的AUC（0.864）高于RM_NECT及RM_NECT-临床（AUC=0.634、0.721,Z=3.081、2.937,P=0.002、0.003）,RM_{CECT-临床-CT}的AUC（0.920）高于RM_CECT及RM_CECT-临床（AUC=0.689、0.751,Z=2.698、2.390,P=0.007、0.017）。结论 CT影像组学联合临床及CT特征能有效预测TET TNM分期。     

基于增强CT影像组学鉴别胸腺瘤组织学分型

目的 观察基于增强CT影像组学鉴别胸腺瘤组织学分型的价值。方法 回顾性分析226例经病理证实的胸腺瘤患者,按7∶3比例将其分为训练集(n=159)及测试集(n=67);利用最大相关最小冗余(mRMR)及最小绝对收缩和选择算子(LASSO)算法筛选最佳影像组学特征,构建鉴别胸腺瘤组织学分型的影像组学模型;以单因素及多因素logistic回归分析筛选鉴别胸腺瘤组织学分型相关的临床及CT表现,构建临床模型和联合影像组学特征及临床、CT特征的影像组学列线图。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评价3种模型鉴别胸腺瘤组织学分型的效能并比较其差异,评价影像组学列线图的临床价值。结果 最终基于增强动脉期及静脉期CT筛选出19个最佳影像组学特征,以建立影像组学模型。临床模型由患者年龄、重症肌无力、病灶CT表现形态、侵犯邻近组织及动脉期CT值构成。训练集中,影像组学列线图及影像组学模型区分低危组胸腺瘤与高危组胸腺瘤的AUC (0.91、0.89)均高于临床模型(0.79,Z=3.62、2.49,P均＜0.05),而影像组学列线图与影像组学模型AUC差异无统计学意义(Z=1.54,P=0.12);3种模型在测试集中的AUC差异均无统计学意义(P均＞0.05)。阈值概率为0.1~1.0时,影像组学列线图的临床获益均大于临床模型及影像组学模型。结论 基于增强CT影像组学模型和基于临床、CT表现及影像组学特征的影像组学列线图均有利于鉴别胸腺瘤组织学分型,后者临床获益更高。     

YOLOX目标检测模型用于自动识别数字减影血管造影图中的血管腔内介入器械

目的 观察YOLOX目标检测模型用于自动识别数字减影血管造影（DSA）图中的血管腔内介入器械的价值。方法 收集37例接受腹部血管腔内介入治疗患者的DSA资料,截取4 435幅图像作为数据集,并按照9∶1比例将其分为训练集（n=3 991）与验证集（n=444）。对数据集中的6种介入器械进行标记后,以YOLOX算法对训练集数据进行深度学习训练,构建YOLOX目标检测模型;基于验证集评估该模型自动识别DSA图中的介入器械的效能。结果 共对4 435幅DSA图像设置6 668个标签,分别针对Terumo 0.035in泥鳅导丝（n=587）、Cook Lunderquist超硬导丝（n=990）、Optimed 5F带刻度猪尾导管（n=1 680）、Cordis MPA多功能导管（n=667）、Boston Scientific V-18可控导丝（n=1 330）及Terumo 6F长鞘（n=1 414）;训练集分别含上述标签527、875、1 466、598、1 185及1 282个,验证集分别含60、115、214、69、145及132个。YOLOX目标检测模型自动识别验证集中上述器械的像素准确率分别为95.23%、97.32%、99.18%、98.97%、97.60%及98.19%,平均像素准确率达97.75%。结论 YOLOX目标检测模型能够自动识别DSA图中的多种血管腔内介入器械。     

抗血栓治疗对大结肠息肉患者内镜下黏膜切除术后迟发性出血的影响

背景与目的 抗血栓治疗被认为是结肠息肉切除术后出血的危险因素。然而,抗血栓治疗对大结肠息肉患者术后迟发性出血的影响尚未完全明确。因此,本研究探讨抗血栓治疗及其相关因素对大结肠息肉患者行内镜下黏膜切除术（EMR）后迟发性出血的影响,以期提高医生对该类患者围手术期管理的认识。方法 回顾性收集2019年1月—2022年12月因大结肠息肉（>10~20 mm）行EMR的157例患者资料,根据EMR期间是否接受抗血栓治疗、使用抗血栓药物类型、术前是否停用抗血栓药物,分别将患者分为抗血栓组（n=51）与非抗血栓组（n=106）、抗凝组（n=33）与抗血小板组（n=36）、停药组（n=35）与未停药组（n=41）。比较各组间术后迟发性（24 h至30 d内）出血发生率及出血时间点的差异,并通过Kaplan-Meier曲线分析各组间术后30 d累积出血发生率。结果 抗血栓组与非抗血栓组迟发性出血发生率差异有统计学意义（19.61% vs. 5.66%,χ²=7.32,P=0.01）;抗血栓组的出血时间点明显早于非抗血栓组（t=2.17,P=0.047）;抗血栓组术后30 d累积出血发生率明显高于非抗血栓组（χ²=6.18,P=0.01）。抗凝组与抗血小板组迟发性出血发生率差异无统计学意义（24.24% vs. 27.78%,χ²=0.11,P=0.74）,两组在出血时间点、术后30 d累积出血发生率方面差异均无统计学意义（t=0.25,P=0.80;χ²=0.13,P=0.72）。停药组与未停药组迟发性出血发生率差异有统计学意义（14.29% vs. 29.27%,χ²=3.97,P=0.046）,未停药组在出血时间点方面明显早于停药组（t=3.03,P=0.01）;停药组术后30 d累积出血发生率明显低于未停药组（χ²=4.36,P=0.04）。结论 抗血栓治疗可能导致大结肠息肉EMR后迟发性出血发生率升高,但术后迟发性出血发生率与抗血栓药物类型无明显关系。术前适当停药可能是降低患者术后出血的有效策略。     

Does body mass index influence the decline of glomerular filtration rate in diabetic type 2 patients with diabetic nephropathy in a developing country?

Background: Diabetic nephropathy (DN) is associated with a high risk of progression to End Stage Renal Disease (ESRD). While obesity has been identified as a factor in the decline of the glomerular filtration rate (GFR) in chronic kidney disease, its role in the progression of DN remains controversial. The objective of this work is to determine GFR decline in relation to BMI in type 2 diabetic (T2D) patients presenting a DN. Methods: A prospective 5-year study conducted in the Eastern region of Morocco. Three BMI groups were distinguished: normal weight, overweight and obese and within each group progressors (eGFR?>?5?ml/min/1.73?m²/year) and non progressors (eGFR? 5?ml/min/1.73?m²/year). Results: Data on 292 patients were compiled. The progressors represented 25.8%, 23.1% and 32.3% of the normal weight, overweight and obese patient groups respectively (p?=?0.29). ESRD was observed in 9.1%, 6.9% and 8.3% (p?=?0.21) in normal weight, overweight and obese patients respectively. In multivariate analysis, low-baseline eGFR was identified as important predictor of progression of DN in each BMI group and in the entire cohort independently of BMI. Vascular co-morbidity events occurred in 9.1%, 16.9% and 19.8% (p?=?0.04) in normal weight, overweight and obese patients respectively. Conclusion: Our results show that the decline of eGFR in the DN of T2D is not directly influenced by BMI and that the major risk factors contributing to this decline remain low-baseline eGFR and increased baseline albuminuria.     

Effect of estimated glomerular filtration rate on periprocedural myocardial infarction in patients undergoing elective percutaneous coronary intervention

Abstract

Backgrounds: Little is known about the effect of the estimated glomerular filtration rate (eGFR) on the periprocedural myocardial infarction (PMI). The aim of this study was to determine an eGFR value that is related with PMI development in patients with stable angina undergoing elective percutaneous coronary intervention (PCI). Method: A retrospective analysis was conducted of 257 consecutive PCI patients with stable angina pectoris. The patients were divided into three groups according to eGFR: Group 1: eGFR?>?90?mL/min/1.73?m², Group 2: eGFR?=?60–89?mL/min/1.73?m², and Group 3: eGFR?=?30–59?mL/min/1.73?m². Cardiac biomarkers were measured before, at 8, and at 24?h after the procedure. Results: Periprocedural myocardial infarction occurred in 19% of the study patients. The frequency of PMI was 13.8% in group 1, 15.2% in group 2, and 35% in group 3 (p?=?0.002). There was an inverse relationship with increasing cardiac biomarkers and decreasing eGFR values. Multiple regression analysis showed that an eGFR value between 30 and 59?mL/min/1.73?m² was an independent variable that significantly affected PMI development after PCI. Conclusions: An estimated glomerular filtration rate between 30 and 59?mL/min/1.73?m² is a predictor of developing PMI after elective PCI in patients with stable angina pectoris.     

Underestimated incidence of kidney disease in nonrenal outpatient

Background and aims: Chronic kidney disease (CKD) has been regarded as a severe threaten to public health, a large percentage of CKD are secondary to other diseases. Serum creatinine is the most common marker of renal function, but it did not always reflect glomerular filtration rate (GFR) accurately. In order to investigate the prevalence of kidney disease in non-renal departments and to provide a basis for the prevention of kidney injury, the present study was conducted in several medical centers.

Methods: A total of 17,462 outpatients were selected randomly from the departments of cardiology, endocrinology, and neurology in 16 hospitals and the incidence of kidney disease was screened. Estimated GFR (eGFR) was calculated by using MDRD-formula.

Results: There are 5293 (30.1%) patients’ eGFR above 90?mL/min/1.73m² among all the subjects in non-renal departments, and 4055(23%) patients’ eGFR lower than 60?mL/min/1.73?m² including 80 patients whose eGFR were below 15?mL/min/1.73?m². Furthermore, among 16616 subjects who have a normal SCr level, there are 3209 respondents’ eGFR lower than 60?mL/min/1.73?m². Moreover, individuals with hypertension or diabetes had a high prevalence of decreased renal function.

Conclusions: This survey indicated kidney injury wildly existed in non-renal outpatients, and the incidence of CKD is underestimated.     

Kidney outcomes and prognostic factors of myeloma associated acute kidney injury in the contemporary era

Myeloma cast nephropathy (MCN) has historically been associated with poor kidney outcomes. We aimed to evaluate the kidney outcomes and identify prognostic factors of myeloma-associated acute kidney injury (M-AKI) in the contemporary era of anti-plasma cell therapy. Patients who received anti-myeloma therapy with M-AKI (January 2012 to June 2020) from a single centre were identified from electronic medical records. Diagnosis of MCN was either biopsy confirmed (BC) or clinically suspected (CS), the latter defined as acute kidney injury with reduced estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m² and involved serum free light chains (iSFLC) >500 mg/L at diagnosis. Twenty-six patients with M-AKI were identified (BC: n = 13, CS: n = 13). Median eGFR at diagnosis was 12 (interquartile range 6–20) mL/min/1.73 m². All six dialysis-requiring patients achieved dialysis independence after 71 (43–208) days. The best-achieved eGFR was 47 (32–67) mL/min/1.73 m² after 120 (63–167) days post-treatment, which was maintained at 47 (33–66) mL/min/1.73 m² 12 months post-treatment. Patients with best-achieved eGFR above the median were more likely to have achieved an iSFLC of <20 mg/L (above median group 62% versus below median group 0%; p < .001) and lower best post-treatment iSFLC (20 (12–90) versus 67 (29–146) mg/L; p < .05). Best-achieved iSFLC was a prognostic factor for superior eGFR following treatment for M-AKI. Despite low eGFR at diagnosis, contemporary anti-myeloma therapy can achieve significant recovery of kidney function.     

Kidney function predicts the risk of asymptomatic peripheral arterial disease in a Chinese community-based population

Purpose

Lower-extremity peripheral arterial disease (PAD) can predict the risk of subsequent cardiovascular disease (CVD) and all-cause mortality. Chronic kidney disease (CKD) as a precursor of CVD has been proven to be independently associated with PAD. However, few data exist regarding the prediction value of kidney function for incident asymptomatic PAD in community-based populations. We aimed to investigate the predicting value of estimated glomerular filtration rate (eGFR) for incident asymptomatic PAD in a Chinese community-based population. A total of 3549 subjects without PAD and eGFR?>?30 ml/min/1.73 m² were included.

Methods

PAD was defined by an ankle-brachial index (ABI)?≤?0.9. Multivariate regression models were used to evaluate the associations.

Results

Subjects were 56.69?±?8.56 years old and 35.9% were males. After 2.36 years of follow-up, the incidence of asymptomatic PAD was 3.1%. The risk of incident PAD was graded related to the categories of eGFR. Compared to participants with normal kidney function, the multivariate adjusted OR [95% CI] for new PAD was 1.31 (0.81–2.12) for those with mildly decreased kidney function, 4.13 (1.73–9.89) for those with grades 3 CKD (P for trend: 0.014). Baseline eGFR was significantly and linearly associated with incident PAD (OR [95% CI] for each 5 mL/min/1.73 m² decrease of eGFR: 1.23 [1.09–1.38]) in participants with baseline eGFR?<?90 mL/min/1.73 m² but not in those with baseline eGFR?≥?90 mL/min/1.73 m² after adjustment for covariates.

Conclusion

Kidney function was an independent risk factor for development of incident PAD in community-based population with baseline eGFR?≤?90 mL/min/1.73 m².

     

Kidney Function and Histological Damage in Autopsy Subjects with Myocardial Infarction

Abstract

Objectives: Chronic kidney disease (CKD) is a major risk factor for cardiovascular disease (CVD). We previously reported renal parenchymal damage in autopsy subjects with stroke or abdominal aortic aneurysm. The aim of this study is to evaluate the relationship between renal histology and clinical characteristics of patients with myocardial infarction (MI). Methods: A total of 699 subjects were autopsied at the National Cerebral and Cardiovascular Center Hospital. We retrospectively evaluated all autopsy cases with MI (n = 123). Estimated glomerular filtration rate (eGFR) was calculated using the Japanese formula. Subjects were classified into four groups: 25 subjects with eGFR ≥ 60 mL/min/1.73 m² and no proteinuria (no CKD), 10 subjects with eGFR ≥ 60 and proteinuria (CKD1/2), 65 subjects with 60 > eGFR ≥ 30 (CKD3), and 23 subjects with eGFR < 30 (CKD4/5). Renal parenchymal damage was evaluated using a semi-quantitative histological score (score 0–3) for glomerulosclerosis, interstitial fibrosis, tubular atrophy, arteriolar hyalinosis, and arteriosclerosis of medium-sized artery (maximum score = 15). Results: The mean histological score was significantly higher in patients with CKD3 and CKD4/5 and was associated with age, hypertension, diabetes, kidney function, proteinuria, and other CVD. Conclusions: In patients with MI, renal parenchymal damage and deteriorating kidney function are closely associated.     

Higher hemoglobin levels using darbepoetin alfa and kidney outcomes in advanced chronic kidney disease without diabetes: a prespecified secondary analysis of the PREDICT trial

Background

In the primary analysis of the PREDICT trial, a higher hemoglobin target (11–13 g/dl) with darbepoetin alfa did not improve renal outcomes compared with a lower hemoglobin target (9–11 g/dl) in advanced chronic kidney disease (CKD) without diabetes. Prespecified secondary analyses were performed to further study the effects of targeting higher hemoglobin levels on renal outcomes.

Methods

Patients with an estimated glomerular filtration rate (eGFR) 8–20 ml/min/1.73 m² without diabetes were randomly assigned 1:1 to the high- and low-hemoglobin groups. The differences between the groups were evaluated for the following endpoints and cohort sets: eGFR and proteinuria slopes, assessed using a mixed-effects model in the full analysis set and the per-protocol set that excluded patients with off-target hemoglobin levels; the primary endpoint of composite renal outcome, evaluated in the per-protocol set using the Cox model.

Results

In the full analysis set (high hemoglobin, n = 239; low hemoglobin, n = 240), eGFR and proteinuria slopes were not significantly different between the groups. In the per-protocol set (high hemoglobin, n = 136; low hemoglobin, n = 171), the high-hemoglobin group was associated with reduced composite renal outcome (adjusted hazard ratio: 0.64; 95% confidence interval: 0.43–0.96) and an improved eGFR slope (coefficient: + 1.00 ml/min/1.73 m²/year; 95% confidence interval: 0.38–1.63), while the proteinuria slope did not differ between the groups.

Conclusions

In the per-protocol set, the high-hemoglobin group demonstrated better kidney outcomes than the low-hemoglobin group, suggesting a potential benefit of maintaining higher hemoglobin levels in patients with advanced CKD without diabetes.

Clinical trial registration

Clinicaltrials.gov (identifier: NCT01581073).

     

扩散峰度成像诊断直肠腺癌:与DWI对比分析

目的对比分析扩散峰度成像(DKI)与DWI在直肠腺癌诊断中的应用价值。方法对38例经病理活检证实的直肠腺癌患者(直肠腺癌组)和38名年龄、性别相匹配的健康志愿者(正常对照组)行MR检查(包括常规T1WI、T2WI、DWI、DKI),经图像后处理获得ADC值、平均扩散系数(MD)和平均扩散峰度(MK)。采用Mann-Whitney U秩和检验比较2组各参数的差异,以ROC曲线评价各参数诊断直肠腺癌的效能,采用Spearman秩相关分析ADC值与MD值、MK值的相关性。结果直肠腺癌组MK值高于正常对照组(P0.001),MD值和ADC值低于正常对照组(P均0.001)。MK值、MD值、ADC值的ROC曲线AUC分别为0.911、0.888、0.827(P均0.05);以MK值0.59、MD值2.15×10~(-3 )mm/s~2、ADC值1.35×10~(-3 )mm/s~2为阈值,诊断直肠腺癌的敏感度分别为89.50%、78.90%、76.30%,特异度分别为84.20%、73.70%、73.70%。ADC值与MK值呈负相关(r=-0.460,P0.05),与MD值呈正相关(r=0.994,P0.05)。结论 DKI模型和DWI单指数模型均有助于诊断直肠腺癌;DKI可提供关于肿瘤微环境扩散特性的信息,相比DWI单指数模型具有更高诊断效能。