[Progress in research of risk prediction model for chronic kidney disease]

Chronic kidney disease (CKD) is an important global public health problem that greatly threatens population health. Application of risk prediction model is a crucial way for the primary prevention of CKD, which can stratify the risk for developing CKD and identify high-risk individuals for more intensive interventions. By now, more than twenty risk prediction models for CKD have been developed worldwide. There are also four domestic risk prediction models developed for Chinese population. However, none of these models have been recommended in clinical guidelines yet. The existing risk prediction models have some limitations in terms of outcome definition, predictors, strategies for handling missing data, and model derivation. In the future, the applications of emerging biomarkers and polygenic risk scores as well as advances in machine learning methods will provide more possibilities for the further improvement of the model.

[Retrospective analysis of infliximab in the treatment of Kawasaki disease]

Objective: To investigate the efficacy and safety of infliximab (IFX) therapy for children with Kawasaki disease. Methods: Sixty-eight children with Kawasaki disease who received IFX therapy in Children's Hospital of Fudan University from January 2014 to April 2021 were enrolled. The indications for IFX administration, changes in laboratory parameters before and after IFX administration, response rate, drug adverse events and complications and outcomes of coronary artery aneurysms (CAA) were retrospectively analyzed. Comparisons between groups were performed with unpaired Student t test or Mann-Whitney U test or chi-square test. Results: Among 68 children with Kawasaki disease, 52 (76%) were males and 16 (24%) were females. The age of onset was 2.1 (0.5, 3.8) years. IFX was administered to: (1) 35 children (51%) with persistent fever who did not respond to intravenous immunoglobulin (IVIG) or steroids, 28 of the 35 children (80%) developed CAA before IFX therapy; (2) 32 children (47%) with continuous progression of CAA; (3) 1 child with persistent arthritis. In all cases, IFX was administered as an additional treatment (the time from the onset of illness to IFX therapy was 21 (15, 30) days) which consisted of second line therapy in 20 (29%), third line therapy in 20 (29%), and fourth (or more) line therapy in 28 (41%). C-reactive protein (8 (4, 15) vs. 16 (8, 43) mg/L, Z=-3.38, P=0.001), serum amyloid protein A (17 (10, 42) vs. 88 (11, 327) mg/L, Z=-2.36, P=0.018) and the percentage of neutrophils (0.39±0.20 vs. 0.49±0.21, t=2.63, P=0.010) decreased significantly after IFX administration. Fourteen children (21%) did not respond to IFX and received additional therapies mainly including steroids and cyclophosphamide. There was no significant difference in gender, age at IFX administration, time from the onset of illness to IFX administration, the maximum coronary Z value before IFX administration, and the incidence of systemic aneurysms between IFX-sensitive group and IFX-resistant group (all P>0.05). Infections occurred in 11 cases (16%) after IFX administration, including respiratory tract, digestive tract, urinary tract, skin and oral infections. One case had Calmette-Guérin bacillus-related adverse reactions 2 months after IFX administration. All of these adverse events were cured successfully. One child died of CAA rupture, 6 children were lost to follow up, the remaining 61 children were followed up for 6 (4, 15) months. No CAA occurred in 7 children before and after IFX treatment, while CAA occurred in 54 children before IFX treatment. CAA regressed in 23 (43%) children at the last follow-up, and the diameter of coronary artery recovered to normal in 10 children. Conclusion: IFX is an effective and safe therapeutic choice for children with Kawasaki disease who are refractory to IVIG or steroids therapy or with continuous progression of CAA.

[Prediction model for survival in patients with biliary tract cancer: a development and validation study]

Objective: The aim of the present study was to investigate the survival rate and its prognostic factors for patients with biliary tract cancer, and then a prognostic risk prediction model was constructed to predict the survival probability of patients. Methods: A total of 14 005 patients with biliary tract cancer (including gallbladder cancer, extrahepatic bile duct cancer, and ampulla of Vater cancer), who were diagnosed between 2010 and 2015 in the US National Cancer Institute Surveillance, Epidemiology, and End Results Program (SEER) were included in the development cohort. The prognostic risk factors of biliary tract cancer were investigated using multivariate Cox regression models. The predictive nomograms were then constructed to predict the overall survival probability of 1, 3, and 5 years, and the predictive discrimination and calibration ability of the nomograms were further evaluated. Meanwhile, 11 953 patients who were diagnosed during 2004 to 2009 from SEER Program were then selected to validate the external predictive accuracy of the prediction models. Results: The 1, 3 and 5-year cumulative survival rates of patients with biliary tract cancer were 41.9%, 20.4% and 15.3%, respectively, in the development cohort. Age greater than 50 years, African Americans and Native Americans and Alaska Natives, higher T, N and M stage and poor histological differentiation grade were risk factors for death, while married status, Asia-Pacific Islanders, insured status and surgery on primary site were protective factors. Gender was not significantly associated with the overall survival. The C statistic of the prediction model was 0.73 (95%CI: 0.72-0.74), and the calibration curve showed that the interaction curves of predictive and actual survival rates of 1, 3 and 5 years were close to the 45 degree diagonal. Results in the validation cohort were similar with those in the construction cohort, with a C statistic of 0.70 (95%CI: 0.69-0.72), indicating high external applicability of the prediction model. Findings from gallbladder cancer, extrahepatic bile duct cancer, and ampulla of Vater cancer are in consistent with the overall biliary tract cancer. Conclusions: The survival rate of patients with biliary tract cancer is relatively poor, and the survival prediction model based on prognostic factors has high prediction accuracy. In the future, this prognostic prediction model could be applied to clinical practice to guide individualized treatment for patients with biliary tract cancer.

Sleep and hypertension

PURPOSE

Hypertension is a global public issue, and sleep status was regarded as its risk factor; however, the results were inconsistent. This study aims to deeply investigate the correlation between sleep status and hypertension.

METHODS

The electronic databases Cochrane Library, Pubmed, and Embase updated to May 31, 2019, were retrieved. Studies were selected according to the predefined screening criteria, and their qualities were assessed by using quality check scales. Based on Stata 15.1 software, the associations between sleep status and hypertension were analyzed by meta-analyses, using odds ratio and 95% confidence interval as effect indexes. Furthermore, publication bias and small study bias were evaluated using Begg and Egger's test. In addition, sensitivity analysis was conducted through ignoring one study per time and then observing its influences on the pooled results.

RESULTS

A total of 54 studies (involving 1,074,207 subjects) were eligible for this meta-analysis. Six factors were included in this study. Raised blood pressure was associated with obstructive sleep apnea (OSA), oxygen desaturation index (ODI), short sleep duration, and long sleep duration. The differences in ≤ 5 h, 6 h, ≥ 9 h, and 10 h groups had statistical significances, while there was no significant difference in ≥ 8 h group. Snoring is a risk factor of hypertension (OR = 1.94, 95%CI 1.41-2.67). Subgroup analysis was conducted and results were varied.

CONCLUSIONS

The hypertension risk might be reduced by treated OSA, ODI, and snoring, as well as appropriate sleep duration. More studies with large sample sizes and high qualities should be included to support the findings further.

Discovery of a second species of Hyalocylindrophora and the phylogenetic position of the genus in Bionectriaceae

A new holomorphic species, Hyalocylindrophora bispora, is described and illustrated based on a collection on rotten branches from Guangdong Province, China. The fungus is characterized by fleshy perithecia that become deeply cupulate when dry, covered with long and stiff hairs on the surface, and not change color in KOH or lactic acid. Asci are two-spored and evanescent at maturity. Ascospores are ellipsoidal to elongate-ellipsoidal, unicellular, and warted. Conidiogenous cells are phialidic and cylindrical. Conidia are thick-walled, unicellular, ellipsoidal to somewhat lemon-shaped. This is the first report of sexual state for Hyalocylindrophora. The phylogenetic position of the genus in Bionectriaceae is confirmed by sequence analyses of the combined nuc rDNA 28S, α-actin, and DNA-directed RNA polymerase II subunit 1 regions. Distinctions between the new taxon and the only known species of the genus are compared.

Revision of the genus Thyronectria (Hypocreales) from China

Recent collections and herbarium specimens of Thyronectria from different regions in China were examined. Using combined analyses of morphology and molecular data, we recognized eight species. Among them, Thyronectria atrobrunnea, T. orientalis, and T. sinensis are described and illustrated as new species. Thyronectria atrobrunnea is characterized by blackish brown perithecia that become cupulate when dry, and 8-spored asci containing ellipsoidal to broadly fusiform or subcylindrical ascospores that bud to form bacillar to subellipsoidal ascoconidia within the asci. Thyronectria orientalis can be easily recognized by stromata that are erumpent through the epidermis of the host, immersed or semi-immersed perithecia covered with yellowish green scurf, and ellipsoidal to subfusiform, muriform ascospores. Thyronectria sinensis on Pinus features solitary ascomata that are rarely aggregated, and 8-spored asci giving rise to subcylindrical to vermiform, multiseptate ascospores that form bacillar to allantoid ascoconidia that fill the asci. The new species and their close relatives are compared and differences between them are discussed. Thyronectria strobi is reported for the first time in China. Name changes for the previously recorded species are noted. Phylogenetic analyses inferred from 28S, ITS, RPB1, TEF1, and TUB2 hint that phenotypic characters, viz. stromata, ascospores, appendage of perithecial wall, and host specificity may carry phylogenetic information as previous papers discussed.

One-year follow-up study of post-traumatic stress disorder among adolescents following the Wen-Chuan earthquake in China

Post-traumatic stress disorder (PTSD) is the most common psychological disorder among victims of natural disasters. PTSD prevalence and risk factors among adolescents remain unidentified among victims of the Wen-Chuan earthquake. This study screened survivors to determine the prevalence of PTSD and examined risk factors for PTSD among adolescents at three Wen-Chuan secondary schools. PTSD screening was done using the PTSD Checklist-Civilian version (PCL-C). A generalized estimating equation approach was used to control for repeated measurements in the same individuals and to predict risk factors for PTSD. The study included 1,474 students in grades 7, 8, 10 and 11 from three Wen-Chuan secondary schools at 4, 6, 9, and 12 months after the earthquake. The average age of students was 15.0 (13.0, 16.0) both at the first and the second time point, and 16.0 (14.0, 17.0) at the third and the fourth time point. The screened prevalence of PTSD was 11.2%, 8.8%, 6.8% and 5.7% at 4, 6, 9, and 12 months after the earthquake, respectively. Risk factors for PTSD were: time duration, school location (the proximity of epicenter), grade, nationality, parent injury, and severe property damage. In conclusion, PTSD risk factors are in accordance with previous studies; however, the role of nationality and time duration in post-traumatic stress disorder merits further research.

[Hemolytic reaction resulting from propafenone administration]

Although adverse reactions of many kinds caused by propafenone have been observed, yet there has been no documented report of hemolytic reaction. Four episodes of hemolytic reaction in three patients receiving intravenous propafenone were reported. These reactions took place a few hours after the administration and one of the episodes was complicated with acute left ventricular heart failure and shock. Cessation of propafenone administration together with relevant therapeutic measures tide the patients over and hemolysis disappeared in several hours. Toxicological examination revealed no physical or chemical deterioration and biological contamination of the remaining medication and no such reaction was noted when the drug of the same batch was given to other patients. It is considered that the hemolytic episodes were related to allergic constitution of the patients. Judging from the clinical manifestations, these episodes were hemolytic reactions of immune complex type.