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A 31-year-old man sought medical evaluation for a 2-year history of edema and proteinuria, with prior pathology suggesting atypical membranous nephropathy (MN). Despite treatment with a combination of steroids, calcineurin inhibitors, and four courses of rituximab (1 g, intravenous injection), the patient's nephrotic syndrome showed no relief (24 h urine protein peaked at 31.18 g/d), indicating refractory nephrotic syndrome. Later in the disease course, a sudden surge of creatinine level (322.5 μmol/L) prompted a renal biopsy, which revealed concurrent acute interstitial nephritis. Further treatment involving steroids, cyclophosphamide, and a fifth rituximab infusion (1 g, intravenous injection) resulted in improvement in renal function (serum creatinine: 322.5➝147 μmol/L), but the MN failed to achieve partial relief. Subsequent treatment with the novel humanized CD20 monoclonal antibody obinutuzumab (1 g, intravenous injection) was initiated. In the latest follow-up, anti-phospholipase-A2-receptor antibody (PLA2R) antibody were negative, B cells were eliminated, serum albumin was 36 g/L, urine protein-to-creatinine ratio was 4 810 mg/g, and serum creatinine was 162 μmol/L. This case underscores the potential efficacy of obinutuzumab in refractory MN. For advanced MN cases, prompt identification of the cause of acute kidney injury is crucial, emphasizing the need for targeted interventions to potentially stall renal function decline.

Objective: To investigate the clinical characteristics of inpatients with the indication of cardiac implantable electronic devices (CIED) therapy and combined acute pulmonary thromboembolism (APTE). Methods: We retrospectively screened 8 641 inpatients who admitted with the indication of CIED implantation in Fuwai Hospital from January 2014 to May 2019. The clinical characteristics, management strategies and clinical outcome were analyzed for patients diagnosed as APTE. Results: APTE were identified in 45 (5‰) patients in this cohort, there were 18(40%) male patients, the average age was (73±8) years old and body mass index was (27±10) kg/m 2 .Thirty-two (70%) patients were at intermediate-risk and 13 (30%) at low-risk. Anti-coagulation therapy was initiated in 38(84%) patients, and 30 patients underwent CIED implantation (27 pacemaker, 2 CRT and 1 ICD). No postoperative bleeding or pocket hematoma were detected in the 23 patients taking anticoagulation medication before implantation. During an average of (30±7) months' follow up, thrombus was dissolved in 20 patients, hemorrhage complications were observed in 2 patients (1 cerebral hemorrhage and 1 hematuria), anticoagulation therapy was discontinued in these 2 patients. Among 15 patients without immediate CIED implantation and treated with anticoagulation therapy during hospitalization, 2 patients developed complete paroxysmal Ⅲ° atrioventricular block, and recovered after therapy during hospitalization. Seven patients were re-hospitalized for CIED implantation due to bradycardia. Five patients died during follow-up (3 sudden cardiac death, 1 APTE combined with cerebral infarction, and 1 pulmonary infection). Conclusion: APTE is not rare in patients with the indication of CIED implantation, CIED implantation and anti-coagulation therapy are safe for these patients, and transient atrioventricular block could be detected in APTE patients.

Objective: To analyze the clinical characteristics of patients with idiopathic right ventricular outflow tract (RVOT) ventricular arrhythmias (VA) and factors related to the immediate success rate of radiofrequency ablation. Methods: Patients diagnosed as idiopathic RVOT arrhythmia in Fuwai Hospital from February 2009 to January 2013 were retrospectively screened. Patients with structural heart disease or inherited arrhythmia were excluded. All patients underwent endocardial electrophysiological study and radiofrequency catheter ablation. Baseline clinical and operation records were collected and analyzed. Immediate success rate was defined as no inducible ventricular arrhythmia by isoprinosine and electrophysiological induction at the end of ablation. The origins of idiopathic RVOT were classified as septal, anterior, posterior, free wall site, epicardial and RVOT-aorta root site. Results: A total of 468 patients were finally included, and the age was (40.4±13.3) years old and 60.5%(283/468) patients were female. Immediate radiofrequency success rate was 89.3%(418/468). Patients were divided into ablation success group ( n= 418) and ablation failure group ( n= 50). Percent of female patients and patients with interventricular septal origin was significantly higher in the ablation success group than in ablation failure group (261(62.4%) vs. 22 (44.0%) , P= 0.01, and 233(55.7%) vs. 18(36.0%), P= 0.005), while percent of patients with epicardial origin was significantly lower in the ablation success group than in ablation failure group (17(4.1%) vs. 11(22.0%), P< 0.001). Immediate success rate was the highest for patients with the septal origin and the lowest for patients with epicardial origin (92.8%(233/251) vs. 60.7%(17/28), P< 0.05). Multivariate analysis showed that the origin site of VAs was the most important independent factor related to the success rate of ablation. Compared with the septal origin patients, patients with RVOT-aorta root and epicardial origin VAs faced with 1.82-fold and 8.26-fold increased risk of failed ablation, respectively ( OR= 2.82, 95% CI 1.05-7.57, and OR= 9.26, 95% CI 3.60-23.86). Sex category was not the independent risk factor for failed ablation( OR =1.76, 95% CI 0.93-3.33, P =0.08) . Conclusions: The immediate success rate of radiofrequency catheter ablation for idiopathic RVOT ventricular arrhythmia is relative high, however, immediate success rate of radiofrequency catheter ablation is relatively low for patients with epicardial and RVOT-aorta root origin arrhythmia and VAs origin is an independent risk factor of immediate ablation success rate.

Objective: To observe the clinical characteristics and outcomes of patients with acute aortic dissection (AAD) and explore the impact of hypertension., Methods: The present study enrolled 1 087 consecutive patients with AAD who were confirmed by computed tomographic scanning in Fuwai Hospital from January 2008 to December 2010. The major endpoints were in-hospital death and long-term mortality during follow up., Results: A total of 595 (54.7%) patients were Stanford type A and 492 (45.3%) patients were Stanford type B. The median length of follow-up was 24.2 months (interquartile range 10.9, 40.8 months). The prevalence of hypertension was 67.4%(733 cases), and was significantly higher in type B patients than in type A patients (71.3%(351/492) vs. 64.2%(382/595), P=0.01). Regardless of Stanford classification, patients complicating with hypertension were older, had higher comorbidities (coronary heart diseases or diabetes), and less likely to receive surgical treatment compared with those without hypertension (all P<0.05). In Stanford type A AAD group, patients with hypertension had higher levels of admission blood pressure, serum creatinine and inflammatory markers (including WBC count, D-dimer and CRP) than those without hypertension (all P<0.05). In-hospital death (9.9% (38/382)vs. 5.6%(12/213), P=0.07) and long-term mortality (9.0% (31/344) vs. 8.9% (18/201), P=0.98) were similar in hypertensive and normotensive AAD type A patients. In type B AAD group, the in-hospital death rate was significantly higher in patients with hypertension than those without hypertension (5.4%(19/351) vs. 0.7%(1/141), P=0.02), while the long-term mortality was similar (6.9%(23/332) vs. 7.9%(11/140), P=0.71) between patients with and without hypertension. Multiple logistic regression analysis showed that hypertension did not predict the increased risk of in-hospital death of type A or type B AAD patients. The main protective factor of in-hospital mortality was operation in patients with type A AAD. The independent predictors of in-hospital death were age and surgical treatment in patients with type B AAD., Conclusions: Hypertension is a common co-morbidity in patients with AAD. AAD patients with hypertension are usually elder, have higher comorbidities of cardiovascular diseases, and less likely to receive surgical treatment compared with those without hypertension, but hypertension is not associated with increased risk of in-hospital and long-term mortality in both AAD type A and type B patients.

Objective: To investigate the relationship between the urinary albumin excretion (UAE) and serum uric acid in general population., Methods: The study participants were derived from the epidemiological study on the association of metabolic syndrome and chronic kidney disease (CKD) in Pinggu district, Beijing. A total of 992 participants (463 men and 529 women) aged from 30 to 75 years were enrolled in this study. For each participant, UAE, serum uric acid, serum creatinine, and serum lipids were detected and other potential risk factors for CKD were surveyed., Results: (1) The frequencies of microalbuminuria, macroalbuminuria and hyperuricemia were 12.9%, 1.8% and 4.3% respectively. The persons with hyperuricemia had significantly higher frequency of albuminuria than those without hyperuricemia (37.2% vs 13.7%, P < 0.01). (2) The participants were divided according to the quartiles (25%, 50%, 75%) of serum uric acid level, and the frequencies of albuminuria in males were 13.2%, 13.9%, 17.2% and 25.4%, while those in females were 8.4%, 6.2%, 9.6% and 24.8%. (3) Multivariate logistic regression analysis showed, hyperuricemia was significantly associated with albuminuria in females (OR = 2.31, 95%CI 1.15-4.68; P = 0.02), but not in males. If the persons with reduced renal function were excluded, similar result still could be gained., Conclusions: The prevalence of albuminuria increases gradually with uric acid elevation. Serum uric acid is an independent risk factor of elevated UAE, especially in females.

Objective: To investigate the association of orthostatic hypertension and hypotension with hypertensive target organ damage in middle and old-aged hypertensive patients., Methods: This cross-section study was conducted in 4711 hypertensive patients aged 40-75 years old in 7 communities of Xinyang County, Henan Province by a multistage cluster sampling method. All patients received a standardized questionnaire, physical and biochemical examinations, echocardiography, ankle-brachial blood pressure index and orthostatic blood pressure measurement. Orthostatic hypertension was defined as an elevation of systolic blood pressure by 20 mm Hg or more while orthostatic hypotension as a drop of blood pressure by 20/10 mm Hg or more. When an upright posture was assumed. Others not belonging to these two conditions were classified into orthostatic normotension., Results: The prevalence of orthostatic hypertension and hypotension was 16.3% and 23.8% in hypertensive patients. Peripheral artery disease was significantly more frequent in hypertensives with orthostatic hypertension (10.1%) or hypotension (10.7%) than those with orthostatic normotensives (7.4%) (both P<0.05). Patients with orthostatic hypotension had more common left ventricular hypertrophy (53.0% vs 43.2%, P<0.001) and a decreased estimated glomerular filtration rate (38.6% vs 34.4%, P<0.05) than did those with orthostatic normotension. After controlling for age, gender, body mass index and other confounders, orthostatic hypertension was positively associated with peripheral arterial disease (OR 1.39, 95%CI 1.05-1.84) while orthostatic hypotension was significantly associated with peripheral arterial disease (OR 1.45, 95%CI 1.13-1.86) and left ventricular hypertrophy (OR 1.46, 95%CI 1.11-1.84). But no independent association was found between orthostatic hypertension or hypotension and a decreased estimated glomerular filtration rate in hypertensive patients. The adjusted odds ratios (OR) for left ventricular hypertrophy, as predicted by the quintiles of orthostatic systolic blood pressure changes, showed a J-shaped relationship in hypertensive women, and so did peripheral artery disease in untreated hypertensive patients., Conclusion: Hypertensive patients with orthostatic hypertension or hypotension may have an elevated risk of developing target organ damage.

Objective: To investigate the prevalence of hyperuricemia and its associated risk factors in treated and untreated hypertensive patients in Chinese rural area., Methods: This cross-section study was performed in 5235 hypertensive patients aged 40 - 75 years old at Xinyang, Henan by using a multistage cluster sampling method. All patients underwent an investigation composed of a standardized questionnaire, physical and biochemical examination. Hyperuricemia was defined as serum uric acid levels > or = 420 micromol/L in men or > or = 360 micromol/L in women., Results: The overall prevalence of hyperuricemia was 14.1%, and it was higher in men than in women (21.5% vs 10.2%, P < 0.01). With an increase of body mass index (BMI), the prevalence of hyperuricemia and serum uric acid level increased significantly in both sexes [BMI < 25, > or = 30: 14.4%, 30.4%, (328 +/- 83) micromol/L, (383 +/- 86) micromol/L in males; and 7.2%, 17.0%, (251 +/- 70) micromol/L, (293 +/- 75) micromol/L in females, respectively, all P < 0.01]. So did that with increase of age only in female patients (40 - 49 years vs > or = 70 years: 5.8% - 18.0%, respectively, P < 0.01). Antihypertensive treatment, lipid disorder, smoking and alcohol consumption also significantly increased the incidence of hyperuricemia and the serum uric acid level (all P < 0.01). However, no significant differences were found among patients with I, II, and III blood pressure levels (all P > 0.05). After adjustment for age and other conventional risk factors by using multiple logistic regression analysis, hyperuricemia was significantly associated with BMI, alcohol consumption and diuretics in males as well as BMI, lipid disorder, age, smoking, and antihypertensive treatment in females., Conclusions: Hyperuricemia is relatively less common in rural hypertensive patients. The associated risk factors of hyperuricemia and elevated serum uric acids include sex, age, BMI, antihypertensive medicines, lipid disorder, smoking and alcohol consumption. The effect of these factors is different between sexes.

Objective: To evaluate the adhesion of acute myeloid leukemia (AML) blasts to human umbilical vein endothelial cells (HUVECs) and the roles of intercellular adhesion molecule-1 (ICAM-1) and its ligand lymphocyte function associated antigen-1 (LFA-1) in binding of leukemic blasts to HUVECs., Methods: AML blasts attachment to unactivated or tumor necrosis factor alpha (TNF alpha) activated-endothelial cell monolayers was investigate in vitro; The adhesion of leukemic blasts co cultured with unactivated endothelial cells under static conditions at 37 degrees C for 24 hours was observed;The binding of neutrophils and unactivated endothelial cell monolayers exposed to supernatant of blasts were tested. ICAM-1 on endothelial cell surface and sICAM-1 of endothelial cell supernatant were determined by flow cytometry and ELISA detection. We also observed the adhesion of leukemic blasts in the presence of the adhesion blocking mAbs anti-ICAM-1 and anti-LFA-1., Results: This study has shown that the blast cells attached to unactivated endothelium was little (24.33 +/- 2.87)% and increased after exposure of endothelium to TNF alpha (81.87 +/- 4.08)% (n = 21, P < 0.001); The binding of blasts to endothelium also increased significantly after 24 hours co cultured with unactivated HUVEC (82.06 +/- 7.05)%, (n = 21, P < 0.001); The adhesion of neutrophils and unactivated endothelial cell monolayers exposed to supernatant of blasts was increased significantly (83.99 +/- 3.86)%, (n = 21, P < 0.001). Lower levels of ICAM-1 and sICAM-1 expression was detected on unactivated HUVECs (55.81 +/- 4.11)%, (0.839 +/- 0.236) microg/L respectively. Treatment of HUVECs with AML blasts supernatant for 24 hours increased the expression of ICAM-1 (65.36 +/- 5.97)%, (1.424 +/- 0.469) microg/L respectively (n = 21, P < 0.05) and anti-ICAM-1 and anti-LFA-1 significantly inhibited the adhesion of AML blasts attachment to TNF alpha activated-endothelial cell monolayers (20.12 +/- 1.73)%, (n = 10, P < 0.001)., Conclusion: Our results indicate that leukemic blasts have the ability to generate some factors that stimulate endothelial cell to secrete ICAM-1 ane to promote their own adhesion to vascular endothelium, interaction of ICAM-1 and its ligand LFA-1 has a key role in adhesion of leukemic blasts and HUVECs.