Volume 99 ·  Issue 10 ·  2019

The occurrence, development and treatment of tumors are often accompanied by kidney injury, which can be caused by the tumor itself or more often caused by tumor treatment; On the other hand, the risk of tumorigenesis in dialysis patients increases, and the survival rate of dialysis patients with combined tumors is significantly reduced. Therefore, accurate assessment, timely diagnosis and a holistic view of treatment are crucial to the prognosis of patients, which require the joint efforts of multidisciplinary efforts such as oncology and nephrology, and the concept of "oncology nephrology" came into being. This article reviews the concept, its connotation and idea, in order to promote the cross-fusion development of related medical research fields.

With the continuous improvement of long-term survival rate of renal transplant recipients, the number of complicated tumors in renal transplant recipients is increasing in clinical follow-up, and tumors have gradually become one of the important reasons affecting long-term survival of renal transplant recipients. This article will focus on the occurrence, screening, diagnosis and individualized treatment of tumors after renal transplantation.

In the past 20 years, advances in free light chain detection, renal tissue immunoglobulin subtype staining, and mass spectrometry analysis technology have promoted the research progress of monoclonal immunoglobulin-related kidney damage, resulting in many new diagnostic names. Monoclonal immunoglobulin-related kidney damage can be divided into two categories, one is the damage caused by malignant tumors, while the other does not have hematological malignant tumors. Kidney damage caused by monoclonal immunoglobulin alone is called monoclonal immunoglobulinopathy with renal significance. Clinicians need to improve their understanding of this disease, and clarify the cloning of pathogenic cells and targeted chemotherapy can help alleviate kidney disease and improve prognosis. Monoclonal immunoglobulins in patients mainly come from plasma cells and B cells. Bortezomib-based chemotherapy regimen has good efficacy in the treatment of diseases caused by plasma cell cloning.

Malignant tumor is one of the major diseases that endanger human health. Acute kidney injury (AKI) is one of the common and significant complications in the course of tumor and tumor treatment, with high morbidity and mortality. In addition to the tumor itself, the risk of occurrence and death of AKI can also be increased by tumor complications, tumor lysis syndrome, surgical methods, imaging examinations, clinical medication and other factors. AKI also affects the prognosis of tumor. Therefore, it is particularly important to recognize and prevent the risk factors of tumor-associated AKI early. In this paper, the epidemiology, pathogenesis and prevention and treatment strategies of AKI associated with malignant tumors are described.

Hemodialysis is the main alternative treatment for patients with end-stage kidney disease in China at present. Many studies have shown that the incidence of malignant tumors in dialysis patients is significantly higher than that in the general population, ranking third among the causes of death of dialysis patients, second only to cardiovascular diseases and infection, which seriously affects the quality of life and survival time of dialysis patients. This article mainly expounds the epidemiology, pathogenesis, tumor types, screening, treatment and prognosis of malignant tumors in dialysis patients.

To investigate the effect of obstructive sleep apnea (OSA) on the severity of acute pulmonary thromboembolism (PTE).

Clinical data of patients with acute PTE and OSA who were admitted to Anzhen Hospital from January 2015 to December 2017 were retrospectively analyzed in this study.According to the apnea hypopnea index (AHI), patients were divided into AHI≤15/h group and AHI>15/h group. The levels of oxygen desaturation index (ODI), mean pulse oxygen saturation (MSO₂), the lowest pulse oxygen saturation (LSaO₂), oxygen saturation<90% time ratio (Ts90%), hemoglobin, hematocrit (HCT), blood platelet, mean platelet volume (MPV), platelet distribution width (PDW), hypersensitive C-reactive protein (hsCRP), homocysteine (HCY), prothrombin time, activated partial thromboplastin time (APTT), fibrinogen (FIB), D-dimer, fibrin degredation product (FDP), B-type natriuretic peptide, cardiac troponin I (cTnI), arterial partial pressure of oxygen (PaO₂), arterial partial pressure of carbon dioxide (PaCO₂) were compared between AHI≤15/h group and AHI>15/h group. Differences in the severity of PTE between the two groups were compared; binary Logistic regression model was used to analyze the risk factors of acute PTE severity.

A total of 75 patients with acute PTE and OSA were enrolled. Patients in the AHI>15/h group were significantly older [(68.7±9.9) vs (62.8±12.8) years old,P=0.029], and were more likely to have chronic heart failure and/or lung disease (53.1% vs 23.1%, P=0.012) and elevated Pulmonary Embolism Severity Index scores (61.2% vs 30.8%, P=0.012) than those in the AHI≤15/h group. Compared to the AHI>15/h group, the levels of D-dimer and B-type natriuretic peptide were much lower in the AHI ≤15/h group [243.0 (140.0, 471.5) vs 408.0 (258.0, 1 009.5) μg/L,P=0.01; 48.0 (19.8, 87.5) vs 70.0 (34.5, 201.0) ng/L, P=0.039], while arterial oxygen partial pressure was significantly higher [(79.0±10.6) vs (73.4±8.2) mmHg (1 mmHg=0.133 kPa), P=0.015]. In patients with acute PTE and OSA, AHI (P=0.030) and B-type natriuretic peptide level (P=0.023) were independently associated with an increased risk of acute PTE severity.

In patients with PTE and OSA, moderate or severe OSA may aggravate the severity of acute PTE.

To evaluate factors relevant to primary non-response in patients with Crohn′s disease undergoing infliximab (IFX) treatment at week 14.

Patients with Crohn′s disease in the Third Hospital of Peking University who were subject to IFX treatment more than 3 times and followed-up for more than 14 weeks from October 2015 to October 2018 were reviewed. The response was defined by a decrease of ≥100 points from baseline in the Crohn′s Disease Activity Index. The clinical data and laboratory examinations of the two groups were compared, and the treatment outcomes of non-responders were also followed up.

A total of 41 patients were enrolled, among which 27(65.9%) were male. The median age at treatment was 25 years, and 8 patients lost primary response (19.5%). There was no significant difference in the sex, age at diagnosis or treatment, Montreal disease type and laboratory examinations [C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), hemoglobin, albumin] in the response group and non-response group at baseline phase (P>0.05). Baseline CRP decreased from 17.7 (26.2) mg/L to 2.2 (3.6) mg/L in the response group, but increased from 11.7 (9.5) mg/L to 31.6 (28.4) mg/L in the non-response group at week 14 (P=0.024). The trend of ESR change in the response group [from 23.0 (28.5) mm/h to 7.0 (8.5) mm/h] and the non-response group [from 24.5 (22.5) mm/h to 35.0 (26.5) mm/h] was similar with that of CRP (P=0.036). Hemoglobin and albumin were significantly elevated in the response group, but not in the non-response group at week 14 (P=0.593, P=0.255). Among the non-response patients, 5 were converted to responsive after the treatment protocols had been adjusted. The combined immunosuppressant treatment all obtained clinical response.

The elevated CRP and/or ESR may serve as indicators of primary non-response (at week 14) to IFX treatment among Crohn′s disease patients, and the combination of immunosuppressive agents may be one of the effective treatments after excluding infection and other causes.

To evaluate the value of preventive flap placement of terminal ileostomy in laparoscopic radical resection of low rectal cancer.

A retrospective analysis was conducted in the patients (n=63) who received preventive terminal ileostomy in laparoscopic radical resection of low rectal cancer in our institution from April 2016 to March 2018, including 33 patients who underwent ileostomy with flap-placement (flap group), and 30 patients who underwent ileostomy with stent (stent group). Clinical data were collected from both groups and statistically analyzed.

All patients were successfully completed laparoscopic radical resection with preventive ileostomy. All patients of stent group received stoma-closure surgery one month later after rectal resection. There were significantly statistical differences in operating time of ileostomy (28.9±4.3 vs 36.3±2.3, t=11.73, P<0.001) and overall stoma-related complications (1 vs 7, χ ²=4.155,P=0.042), but no difference in anastomosis leakage, operating time of stoma-reversal, parastomal infection, parastomal hernia and parastomal prolapse.

Preventive flap placement of terminal ileostomy represents a secure and feasible approach to laparoscopic low rectal cancer resection. Patients can be released from the discomfort of removing the stent and may suffer fewer stoma-related complications.

To investigate the correlations between the expression of the slingshot-1(SSH1) and the general clinicopathological factors in gastrointestinal stromal tumor (GIST) patients.

Immunohistochemical staining was used to detect the expression of SSH1 protein in 96 gastrointestinal stromal tumors, and the correlations between expression level of SSH1 and general clinicopathological factors were analyzed.

Totally, there were 96 cases of GIST patients (49 males and 47 males), with a mean age of (55.80±12.33) years. The tumors were located in different organs: 62 cases (64.6%) in the stomach, 29 cases (30.2%) in the intestine, and 5 cases (5.2%) in other organs, with a mean tumor size of (5.11±3.73) cm. The low risk group contained 57 cases (59.4%), 18 cases (18.8%) in middle risk group and 21 cases (21.9%) in high risk group. The pathological examination showed that the positive expression rate of CD117, CD34, DOG-1, Ki-67, SMA, S-100 and Desmin was 85.4%, 84.4%, 86.5%, 90.6%, 10.4%, 3.1% and 2.1%, respectively. In 96 cases of GIST, 37 cases (38.5%) had high expression of SSH1, and SSH1 expression level was correlated with the tumor invasion depth, risk classification, tumor mitotic figure count, CD34(+) (P<0.05).

SSH1 plays an important role in the development of GIST. High expression of SSH1 is closely related to the invasion depth, risk classification and tumor mitosis of GIST.

To investigate the risk factors of systemic inflammatory response syndrome (SIRS) in patients undergoing flexible ureteroscopic lithotripsy based on enhanced recovery after surgery (ERAS).

The clinical data of 243 kidney stone cases who underwent flexible ureteroscopic lithotripsy based on ERAS in the First Affiliated Hospital of Wannan Medical College from January 2016 to December 2017 were analyzed retrospectively. The cases were divided into two groups according to whether they had SIRS after surgery: SIRS group (26 cases) and non-SIRS group (217 cases). The age, gender, laterality of kidney stone, history of previous kidney stone surgery, degree of hydronephrosis, multiple kidney stones, length of operation time, white blood cell count of preoperative urine routine, result of preoperative urine culture, use of preoperative antibiotics, diabetes and other chronic diseases in the groups were collected and analyzed.

SIRS occurred in 26 cases in this study, which accounted for 10.7% (26/243). Multivariate analysis found that, moderate and severe hydronephrosis (OR=6.711, P=0.008), stone burden ≥2 cm (OR=10.353, P<0.001), length of operation time ≥ 60 min (OR=5.583, P=0.011), white blood cell count of preoperative urine routine ≥25×10⁶/L (OR=6.195, P=0.005), positive preoperative urine culture (OR=4.216, P=0.011), diabetes and other chronic diseases (OR=4.532, P=0.006) were the independent risk factors for postoperative SIRS (P<0.05).

The occurrence of SIRS after flexible ureteroscopic lithotripsy based on ERAS is closely correlated with hydronephrosis, stone burden, length of operation time, white blood cell count of preoperative urine routine, positive preoperative urine culture, diabetes and other chronic diseases.

To compare the etiology and incidence of pulmonary infection in patients with esophageal carcinoma accompanied by esophagotracheal fistula before and after the airway stent implantation.

The clinical records of patients with esophageal carcinoma accompanied by esophagotracheal fistula in Respiratory Department and Oncology Department of Meitan General Hospital were retrospectively analyzed from March 2008 to January 2018. The demographic data, comorbidities, pathological results and etiology were collected before and after tracheal stents were implanted in all patients. The incidence of pulmonary infection was analyzed, and the classification of etiology was compared before and after tracheal stents implantation.

A total of 100 patients were included in the study. The incidence rate of pulmonary infection before stents implantation was 83.0%. A total of 105 bacterial strains were cultured, including 73 strains of gram-negative bacteria (69.5%) and mainly pseudomonas aeruginosa, 5 strains of gram-positive bacteria [all methicillin-resistant staphylococcus aureus (MRSA)] (4.8%), and 27 strains of fungi (25.7%) and mainly candida albicans. The incidence rate of pulmonary infection was lowered to 53.0% after tracheal stents implantation (χ²=29.102, P<0.001). A total of 79 bacterial strains were cultured, and the main bacteria were still gram-negative bacteria and fungi, in which pseudomonas aeruginosa and candida albicans accounted for the majority. However, 13 strains of MRSA were cultured (16.5%), significantly higher than those before stents implantation (χ²=7.451, P=0.005).

The incidence rate of pulmonary infection in patients with esophageal carcinoma accompanied by esophagotracheal fistula is very high. Gram-negative bacteria and fungi are the main etiologies. Tracheal stents implantation can effectively reduce the incidence of pulmonary infection. However, the incidence rate of MRSA is significantly increased after stents implantation.

To explore the indications and safety of orthopedic liver transplantation for polycystic liver disease (PLD).

Data of 11 patients with PLD who underwent orthotopic liver transplantation between 2004 and 2013 was retrospectively analyzed. Demographic, clinical and follow-up data were collected for statistical analysis. The survival rate was calculated by Kaplan-Meier method.

Over a period of 10 years, the patients received modified piggyback orthopedic liver transplantation (n=9) or combined liver-kidney transplantation (n=2) for PLD. The recipients′ median age was 56 years. Seven patients were classified as Gigot type Ⅱ PLD, and four were classified as Gigot type Ⅲ PLD. Eight patients had severe decreased mobility (Eastern Cooperative Oncology Group, ECOG≥3). Only three cases were Child-Pguh Class C patients and the model for end-stage liver disease (MELD) score was>20. The mean hospitalization duration was (45.4±15.3) days, and the mean length of stay in intensive care unit was (4.1±1.9) days. The perioperative mortality was 18.2% and morbidity of complications was 63.6%. The median follow-up period was 111 months. Two patients died of severe complications after combined liver-kidney transplantation. One patient died of ischemia cholangitis during follow-up. The actuarial 1-, 5-and 10-year survival rate during the follow-up period was 82.2%, 81.8%, and 65.5%, respectively.

Liver transplantation is the only curative and safe procedure for PLD, and it provides a good long-term prognosis and high quality of life for PLD patients. Liver transplantation could be a primary option in treating progressive or advanced PLD.

To investigate the diagnosis and treatment of the mixed epithelial and stromal tumour family of kidney.

Eight cases of the mixed epithelial and stromal tumour family of kidney were retrospectively analyzed. Before operation, radiologic evaluation was performed in all cases, including CT and MRI scan. Three cases were diagnosed as cystic renal cell carcinoma, 5 cases were diagnosed as renal complex cysts. Radical nephrectomy was performed in 4 cases and partial nephrectomy was performed in 4 cases.

The manifestation of the pathological specimens were multilocular cystic or cystic solid tumors grossly. Microscopically, the tumors were composed of two components, epithelial and stromal. Immunohistochemical staining showed that the epithelial components of the tumors were positive for AE1/AE3 (8/8), CK18 (3/3), and CK-7 (1/1). The stromal components were positive for PR (8/8), ER (6/8), Vim (6/6), Desmin (5/5), and SMA (5/5). HB-45 staining were negative (7/7) and Ki-67 staining were negative (7/8). All cases were diagnosed as the mixed epithelial and stromal tumour family of kidney. All patients were followed up for 3-124 months, with a median follow-up of 41 months. No tumour recurrence or metastasis were observed.

The mixed epithelial and stromal tumour family of kidney mostly occurs in women, but have no specific clinical manifestations. They were often misdiagnosed as cystic renal cell carcinoma before operation. These following imaging features may be helpful for diagnosis. The definite diagnosis of the disease depends on the pathological examination, and immunohistochemistry plays an important role in differential diagnosis. Surgical treatment is the first choice, and partial nephrectomy is feasible. Most of the tumors are benign, and the patients can be cured after complete excision.

To analyze the clinical features of infective endocarditis with septic pulmonary embolism, and to improve the diagnosis and treatment of the disease.

Retrospective analysis of clinical manifestations, blood culture, echocardiography, chest CT and diagnosis and treatment of 16 patients with infective endocarditis and septic pulmonary embolism in the First Affiliated Hospital of Zhengzhou University from January 2010 to June 2017 was carried out, and the clinical features of the disease were summarized.

Out of the 16 patients, 4 were males and 12 were females, aged (29.5±9.7) years old, 12 patients were with congenital heart disease. The main clinical manifestations were fever, cough, dyspnea, hemoptysis. There were 7 cases with positive blood culture, and 6 of them were Streptococcus. Echocardiography revealed cardiac vegetations, and all were from right heart. Chest CT was characterized by multiple pulmonary lesions, mainly characterized by multiple nodules and small patch shadows. All 16 patients were initially misdiagnosed as pneumonia. All patients were treated with antibiotics intravenously, 13 patients underwent cardiac surgery, 6 patients were cured, 8 patients improved, and 2 patients were discharged automatically.

Infective endocarditis with septic pulmonary embolism is easily misdiagnosed. In patients with fever and multiple shadows in the lungs, the possibility of right heart infective endocarditis should be considered. The diagnosis can be confirmed once cardiac vegetations are found by echocardiography, and repeated echocardiographic examinations can be performed if necessary. The prognosis of patients treated with surgery as early as possible on the basis of anti-infection is good.

To evaluate the effectiveness and safety of transurethral bipolar plasmakinetic prostatectomy in the treatment of benign prostatic hyperplasia in high-risk and senior patients in China.

The PubMed, Cochrane Library, CBM, CNKI and WanFang databases were searched with computer for collecting relevant interventional case series from establishment dates to September 14, 2018. After quality evaluation and data extraction independently conducted by two authors, the Meta-analysis was performed using the Comprehensive Meta-analysis V2 software.

Eighteen studies involving 1 899 patients are included. Maximum flow rate increased to 12.28 ml/s (95%CI: 8.42-16.14), 12.88 ml/s (95%CI: 9.85-15.92) ,14.32 ml/s (95%CI: 10.47-18.18), 14.93 ml/s (95%CI: 10.19-19.67) and 20.00 ml/s (95%CI: 19.08-20.92) in 1, 3, 6, 12 and 24 months after surgery, respectively. International prostate symptom score decreased to -18.60 (95%CI: -23.20--14.00), -17.62 (95%CI: -20.21--15.03), -19.14 (95%CI: -20.70--17.59), -19.06 (95%CI: -21.53--16.60) and -22.90 (95%CI: -24.26--21.54), respectively. Quality of life decreased to -2.38 (95%CI: -4.26--0.50), -3.39 (95%CI: -4.57--2.21),-3.75 (95%CI: -4.14--3.36), -3.36(95%CI: -4.56--2.16), and -4.58(95%CI: -4.75--4.41). Post void residual decreased to -231.16 ml (95%CI: -288.30--174.01), -76.10 ml (95%CI: -116.71--35.50), -159.90 ml(95%CI: -207.21--112.59) and -87.70 ml (95%CI: -91.91--83.48). The event rate of postoperative adverse reactions all were not high.

Transurethral bipolar plasmakinetic prostatectomy has better clinical efficacy and no obvious side effects in the treatment of benign prostatic hyperplasia in high-risk and senior patients in China.

In order to explore the effective management of severe secondary nasal hemorrhage after endoscopic nasal skull base surgery, a total of 11 cases of severe secondary nasal hemorrhage after endoscopic nasal skull base surgery were retrospectively analyzed in Tianjin Huanhu Hospital from January 2012 to May 2018. Endoscopy was the first choice for severe secondary nasal hemorrhage after endoscopic surgery, and electrocoagulation was feasible to stop hemorrhage after a clear hemorrhage point was found. Angiography should be performed for hemorrhage cases involving skull base and internal carotid artery after endoscopic surgery, and vascular intervention should be performed if necessary.

Riedel's thyroiditis (RT) is also known as chronic aggressive fibrous thyroiditis, lignoid thyroiditis. It is a rare chronic fibroproliferative inflammation of the thyroid gland, which can penetrate the thyroid capsule and invade adjacent tissues and organs, resulting in compression symptoms. A male patient with RT complicated with acute suppurative thyroiditis was reported. The clinical manifestations, auxiliary examination and diagnosis and treatment were analyzed.

Traditional correlation analysis can provide a possible preliminary basis for exploring key scientific problems to a certain extent. However, researchers must confront the dialectical relationship between correlation and causal association, that is, "correlation does not mean causal association" and "lack of correlation does not mean lack of causal association". Therefore, caution should be exercised when presenting and inferring the results of correlation studies. When dealing with complex dynamic systems, it should not be limited to static correlation analysis, and empirical dynamic modeling methods can be reasonably selected to analyze the causal correlation between variables in coupled systems, so as to avoid making misleading conclusions.

Lung cancer is one of the most common malignant tumors, and the incidence and mortality rate of lung cancer rank first among all kinds of malignant tumors in China and even globally. Ferroptosis is a newly discovered iron-dependent non-apoptotic cell death, which is closely related to cancer. In recent years, several studies have shown that ferroptosis is involved in the development of lung cancer and has positive significance for the treatment of lung cancer. In this paper, the mechanism of ferroptosis and its relationship with the occurrence and treatment of lung cancer are reviewed.

Traumatic pancreatitis (TP) mainly refers to a special type of acute pancreatitis induced by trauma, which is complicated and dangerous, with high complication rate and mortality rate. The treatment of TP should adopt an individualized treatment strategy according to the condition, taking into account the dual principles of pancreatic injury management and acute pancreatitis treatment, and focusing on different disease stages, paying attention to the rational application of trauma ascending concept, injury control, minimally invasive treatment and multidisciplinary diagnosis and treatment in the treatment of TP, so as to improve the prognosis of patients.