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Purpose: Patients with Type 2 diabetes (T2D) have increased risk of depression and anxiety. Evidence suggests that a heightened inflammatory state may contribute to this association. Females experience more depression and higher inflammation levels than males. This study compared associations of serum high-sensitivity C-reactive protein (hs-CRP) levels with symptoms of depression and anxiety between men and women with Type 2 diabetes mellitus (T2DM). Method: Cross-sectional data including demographic and disease characteristics, symptoms of depression and anxiety, clinical data, and laboratory values were collected from 392 patients with T2DM recruited from a general hospital in Shandong Province, China. We evaluated associations between serum hs-CRP level and symptoms of depression and anxiety in males and females separately using multiple linear regressions and χ2 tests for trend. Results: Sex moderated the association between serum hs-CRP level and symptoms of depression ( B = .112 [ SE = 0.049]; p = .022) and anxiety ( B = .137 [ SE = 0.053]; p = .011). Among females, hs-CRP level was positively associated with depression ( B = .034, 95% confidence interval [CI] = [.006, .061]; p = .016, false discovery rate [FDR]-adjusted p = .020) and anxiety ( B = .041, 95% CI [.011, .071], p = .007, FDR-adjusted p = .007). Positive trends indicated a higher prevalence of clinically significant symptoms of depression and anxiety in higher serum hs-CRP categories in females. No associations were found in males. Conclusion: Findings demonstrate that associations between serum hs-CRP level and symptoms of depression and anxiety in patients with T2D are sex-specific, with only females demonstrating a significant positive association.

Objective: Mental disorders of the elderly population in China deserve attention. Social health is significantly associated with depression. This study aimed to evaluate the rate of depressive symptoms and to test the relationships between social health and depressive symptoms among a large sample of community-dwelling elderly adults. Methods: We conducted a cross-sectional study among community-dwelling adults aged 60 years or above in Zhejiang Province, China. Face-to-face interviews were used to complete a structured questionnaire for all participants. We used the Social Health Scale for the Elderly (SHSE) to evaluate social health status and used the short form of the Geriatric Depression Scale to evaluate depressive symptoms. Multivariate logistic regression was used to evaluate the association between social health status and depressive symptoms. Results: Of the total of 3757 participants included, 1887 (50.23%) were female, and the mean±standard deviation (SD) age was (70.0±8.3) years. The rate of depressive symptoms was 25.92%. The social health score was higher in non-depressed participants than in depressed participants (raw score 50.7 vs. 48.3, P

BACKGROUND The aim of this study is to investigate origin, gross features, microscopic features, immunohistochemical properties, and differential diagnosis of adrenal cortical adenoma (ACA) in patients ≥20 years old. METHODS The clinicopathological features of 116 cases of ACA and the immunohistochemical features of 50 cases of ACA were evaluated, and the relevant literature was reviewed. RESULTS In our cohort, 76.72% (89/116) of the cases were functional, and 27 cases had non-functional, benign adrenal adenomas. ACA presented as an island tumor with an envelope, and the mean tumor size was 3.6 cm (range 1-5 cm), with a mean tumor weight of 9.28 g (range 5-113 g). The shape of the tumor cells was consistent, and mitosis was rarely observed. Forty of the 46 patients with cortisol-secreting ACA had tumors containing granule cells. Primary aldosteronism was observed in 43 cases. Thirty-eight cases had endoscopically visible tumors, with clear cells and lipid-rich cytoplasm arranged in irregular patches or strips. Cortisol-producing ACAs were associated with atrophy of the non-tumorous cortex. Adrenocortical adenomas displayed positive immunohistochemical staining for MELAN-A, Syn (46 of 50 cases of ACA), NSE (44 of 50 cases of ACA), Vim (42 of 50 cases of ACA) and Ki-67

Background: To evaluate the effect of individualized education for patients with type 2 diabetes mellitus (T2DM). Methods: A total of 280 patients (158 males, mean age 63 ± 10 years) with T2DM were randomly divided into study and control group. Eysenck Personality questionnaire was used to assess the personality of the patients in the study group, which was provided us one-on-one counseling and individualized management plan. Group education was provided to the control group. Results: At the end of the study, the body mass index (21.5±2.5 vs 23.6±1.6 kg/m 2 , P =0.002), waist circumference (83.7±6.4 vs 85.7±7.7 cm, P =0.03), fasting blood glucose (6.0±0.8 vs 6.9±2.1 mmol/L, P =0.004), HbA1c (6.2±0.6% vs 6.9±3.1%, P =0.03), systolic blood pressure (130.1±8.8 vs 135.1±8.4 mmHg, P =0.003),triglyceride (1.21±0.66 vs 1.46±0.58 mmol/L) and low-density lipoprotein (2.36±0.44 vs 2.84±0.64 mmol/L, P =0.03) in the study group was lower than in the control group. Conclusion: Individualized diabetes education is more effective than group education in facilitating the control of type 2 diabetes. Keywords: Individualization; type 2 diabetes; health education; blood glucose; blood pressure

Human urotensin II (hUII) is a newly discovered substance that can dilate small blood vessels to decrease the blood pressure (BP). Our previous studies showed that some volume-overloaded patients on peritoneal dialysis can maintain normal BP (congestive heart failure excluded), suggesting that these patients have volume resistance capacity. This study is to investigate whether hUII plays an important role in this subgroup of patients on peritoneal dialysis. In this study, 105 patients on continuous ambulatory peritoneal dialysis were enrolled. Volume load was evaluated by the overhydration (OH) value obtained by bioimpedance analysis. OH2.0 kg was defined as normal volume (NV), and OH ≥ 2.0 kg as high volume (HV). Systolic blood pressure (SBP)130 mmHg was defined as normotension (NT) and ≥130 mmHg as hypertension (HT). The patients were thus divided into four subgroups: (1) normotension with normal volume (NT-NV), (2) normotension with high volume (NT-HV), (3) normal volume with hypertension (HT-NV), and (4) high volume with hypertension (HT-HV). hUII was measured using radioimmunoassay method. hUII was significantly higher in normal SBP group than that in high SBP group (p0.05). hUII was higher in the NT-HV group compared with that in the HT-HV group (p0.05). Our study suggests that hUII may be involved in the pathogenesis of the volume resistance HT in peritoneal dialysis patients.

SummaryBackgroundMetabolic syndrome increases the risk of cardiovascular disease (CVD) and all-cause mortality in the general population.AimsTo investigate whether metabolic syndrome affects CVD and all-cause mortality in chronic haemodialysis patients.MethodsThis prospective, observational cohort study was carried out at Peking university third hospital from June 2006 to June 2010. Baseline anthropometric and laboratory parameters were evaluated, and causes and times of mortality were documented. Nutritional status of the patients was assessed using subject global assessment (SGA) and serum albumin levels.ResultsOf 162 haemodialysis patients recruited, five were lost to follow-up, leaving 157 in the final cohort, who were followed for 36−42 months. Mean age was 62 ± 11 years and 55.4% were men. Forty-six patients (30%) had metabolic syndrome. In the metabolic syndrome versus the non-metabolic syndrome group, there were fewer patients with malnutrition (by SGA) (15.2% vs. 55.0%; P < 0.001), but there were no significant differences in CVD mortality (8.7% vs. 10.8%; P = 0.9) or all-cause mortality (15.2% vs. 22.5%; P = 0.39), nor in mean observed survival time (30.8 ± 7.3 vs. 29.8 ± 8.5 months; P = 0.49) or total survival time (67 ± 43 vs. 78 ± 48 months; P = 0.20). Cox regression analysis showed that independent mortality risk factors were pre-existing CVD, age more than or equal to 66 years and serum albumin less than 37g/L (indicating malnutrition).ConclusionMetabolic syndrome was associated with a better nutritional status, but not with CVD or all-cause mortality in the haemodialysis patients in this prospective cohort study.

Objectives: To investigate the epidemiology, diagnosis and prognosis of acute renal failure (ARF) in hospitalized Chinese during the last decade. Methods: The diagnosis of patients with ARF in Peking University Third Hospital from January 1994 to December 2003 was reconfirmed and the data of epidemiology, etiology and prognosis were analyzed. Results: Only 209 discharged cases were diagnosed with ARF and all were reconfirmed. Two peak occurrences were found at ages of 35–45 and 60–80 with a male predominance of approximately 59.7%. Patients diagnosed with ARF accounted for 1.19‰ of the admissions in the same period and increased significantly in the last 5 years (p = 0.038). The creatinine level at diagnosis was 345.8 ± 122.6 µmol/l and had no significant change (p > 0.05). The percent of hospital-acquired ARF (HA-ARF) demonstrated a significant increase in 1999–2003 compared to 1994–1998 (p = 0.008). Intrarenal ARF accounted for 73.69% and was multifactorial, with drugs, infections and operations as leading causes. Renal biopsy was performed in 37.32% (78/209) with 53.84% (42/78) having acute interstitial nephritis. Maintenance dialysis was discontinued in 46.41% because their renal function completely or partially recovered. The overall mortality was 37.91% without improvement over time. The mortality was 6.25% for patients in nephrology department, but 65.51% in ICU (p < 0.001), and was 21.6% for patients in community-acquired ARF (CA-ARF), but 63.1% in HA-ARF (p < 0.001). Conclusions: During the past 10 years, the number of patients diagnosed with ARF has been rising in hospitalized Chinese. HA-ARF was the major source, and infections, drugs and operations were the leading causes. The diagnosis and prognosis of acute renal failure did not improve much in this population over the decade studied.

This study aims to quantify and compare the risks of death and end stage renal disease (ESRD) in a prospective cohort of patients with chronic kidney disease (CKD) stages 1-5 under renal management clinic at Peking University Third Hospital and to evaluate the risk factors associated with these two outcomes.This was a prospective cohort study. Finally, 1076 patients at CKD stage 1-5 short of dialysis were recruited from renal management clinic. Patients were monitored for up to Dec, 2011 or until ESRD and death. Glomerular filtration rate was estimated (eGFR) according to the using the CKD Epidemiology Collaboration (CKD-EPI) formula.At the end of follow-up, 111 patients (10.1%) developed ESRD (initiated dialysis or kidney transplantation (ESRD)) and 24 patients (2.2%) had died. There were more ESRD occurrence rate in patients with baseline diabetic nephropathy, lower eGFR, hemoglobin100 g/L and 24 h urinary protein excretion ≥ 3.0 g. By multivariate Cox regression model, having heavy proteinuria and CKD stage were the risk factors of ESRD. For all-cause mortality, the most common cause was cardiovascular disease, followed by infectious disease and cancer. But we failed to conclude any significant variable as risk factors for mortality in multivariate analysis.Our study indicated that baseline diabetic nephropathy, lower hemoglobin level, lower baseline GFR and heavy proteinuria were the risk factors of ESRD. In this CKD cohort, patients were more likely to develop ESRD than mortality, and cardiovascular mortality was the leading cause of death, and then followed by infectious diseases and cancer in this population.

RNAs of GB virus C (GBV-C) and hepatitis C virus (HCV) were sought by reverse-transcription polymerase chain reaction with nested primers deduced from the 5' untranslated region: 79 patients on maintenance hemodialysis, 205 commercial blood donors, and 205 voluntary donors in Beijing were studied. GBV-C RNA was detected in 43 (54%) patients and 17 (8%) commercial donors, and HCV RNA in 43 (54%) patients and 13 (6%) commercial donors, respectively. By contrast, GBV-C RNA was detected only in 2 (1%) and HCV RNA in none among 205 volunteer blood donors serving as controls. Thus both patients and commercial blood donors were at higher risk for infection with GBV-C (P < 0.001) than controls. HCV RNA was detected more often in patients with GBV-C RNA than without (29/43 or 67%, vs. 14/36 or 39%, P < 0.05) as well as in commercial donors with GBV-C RNA than without (5/17 or 29% vs. 8/188 or 4%, P < 0.01). A phylogenetic tree constructed on a sequence of 100 base pairs in the helicase region indicated that GBV-C isolates from Beijing are more similar to Japanese isolates than to isolates from the United States and Africa. Sequences from certain hemodialysis patients and those from some commercial donors were similar, suggesting nosocomial infection and spread among restricted groups.

To evaluate whether urinary phospholipids could be regarded as biomarkers of chronic kidney disease.Thirteen healthy volunteers and 26 consecutive chronic kidney disease patients were included. Urinary phospholipids were quantified by high-performance liquid chromatography coupled with electrospray ionization tandem mass spectrometry.Urinary phosphatidylcholines concentrations (PC 16:0/16:0, 16:0/22:3, 16:0/18:1 and 16:0/18:2) were significantly higher both in glomerulonephritis group (all p 0.001) and in tubulointerstitial injury group (all p 0.05) than in healthy control group. Meanwhile, sphingomyelin concentrations (SM 18:1/16:0 and 18:1/18:0) in glomerulonephritis group were significantly higher than those in healthy control group (all p 0.001). Urinary PCs and SMs were positively correlated with proteinuria but negatively correlated with serum albumin. Meanwhile, PCs were positively correlated with serum creatinine.Our work first demonstrated that urinary phospholipids might be biomarkers for the chronic kidney disease patients. Increased urinary phospholipids in chronic kidney disease patients might result from proteinuria, damaged kidney function or proteinuria induced hypoalbuminemia or lipotoxicity.

Qiong Bai, Xuan Lai, Ai-Hua Zhang, Xin-Hong Lu, Shun-Li Tian, Min-Hua Fan, Yue Wang, Tao WangDivision of Nephrology, Peking University Third Hospital, Beijing, People's Republic of ChinaBackground: Cardiovascular disease is more common in patients with chronic kidney disease (CKD) than in the general population. Endothelial dysfunction is an early predictor of cardiovascular events.Objective: We conducted a cross-sectional study in CKD patients to explore the association of metabolic syndrome (MetS) components with endothelial cell function.Methods: We evaluated clinical and laboratory data in 161 CKD patients from stage 1 to stage 5. Endothelial function was estimated by flow-mediated dilatation (FMD) of the brachial artery and expressed as percentage change relative to baseline diameter. MetS was defined according to the National Cholesterol Education Program-Adult Treatment Panel III criteria.Results: Patients were grouped into two groups according to whether or not they had MetS. FMD was significantly lower in the MetS group than in the group without MetS (P = 0.012). In a Pearson's correlation analysis, FMD was significantly negatively correlated with waist circumference in women (r = –0.223, P = 0.03) and fasting blood glucose (r = –0.186, P = 0.001). Multiple linear regression analysis showed that fasting blood glucose was an independently associated factor for FMD.Conclusion: MetS and some components of MetS (waist circumference in women and fasting blood glucose) are closely associated with a decreased FMD in CKD patients.Keywords: metabolic syndrome, endothelial dysfunction, flow-mediated dilatation, chronic kidney disease

In this study we explored the possible role of arachidonoylethanolamine (AEA) in regulating blood pressure in patients on continuous ambulatory peritoneal dialysis (CAPD). One hundred and five patients on CAPD were enrolled. Volume status was evaluated by the overhydration (OH) value obtained by bioimpedance analysis. OH < 2.0 kg was defined as normal volume (NV) and OH ≥ 2.0 kg as high volume (HV). Home mean systolic blood pressure

To investigate the difference between hospital-acquired acute renal failure (HA-ARF) and community-acquired acute renal failure (CA-ARF) in hospitalized Chinese.The diagnosis of ARF in Peking University Third Hospital from January 1994 to December 2003 was reconfirmed and subdivided into AC-ARF and HA-ARF. Data of epidemiology, etiology, prognosis, and associated factors were analyzed. Single-variable analysis and multivariate logistic regression analyses were performed to investigate the correlation between clinical features and prognosis respectively. Results among 205 reconfirmed CA-ARF had a predominance of 59.5%, but HA-ARF demonstrated an increase by 1.06 during the last five years (p = 0.003). In all, 70.5% CA-ARF was diagnosed in internal medicine with 45.9% in department of nephrology, whereas 59.1% HA-ARF was diagnosed in surgical department with 51.8% in ICU. Distribution difference among departments was significant (p0.01). Further, 90.2% CA-ARF was associated with a single factor, while 36.1% of HA-ARF had two or more causes (p0.01). Also, 26.5% HA-ARF and 18.9% CA-ARF was drug-associated (p0.05) while 24.1% HA-ARF and 12.3% CA-ARF was infection-associated (p0.01). HA-ARF vs. CA-ARF was 62.7% vs. 23.0% in mortality (p0.01), 0.54 +/- 0.24 vs. 0.27 +/- 0.18 in ATI-ISS index (p0.01) and 19.6 +/- 4.9 vs. 15.7 +/- 5.6 in APACHE II scores (p0.01). MODS and SIRS were common independent predictors with oliguria for HA-ARF and advanced age for CA-ARF, respectively.In hospitalized Chinese during the last ten years, CA-ARF was still predominant with simpler cause and lower mortality, whereas HA-ARF was increasing with more complicated cause and higher mortality.

To investigate the differences between hospital-acquired acute renal failure (HA-ARF) and community-acquired acute renal failure (CA-ARF) in epidemiology, etiology and prognosis.The diagnosis of ARF of patients diagnosed with ARF from ICD-9 codes, who were discharged from Peking University Third Hospital from January 1994 to December 2003, was reconfirmed and categorized by two nephrologists independently. The indexes of epidemiology, etiology and prognosis were studied. Single-variable analysis and multivariate logistic regression analysis were performed to investigate the correlation between clinical features and prognosis respectively.Two hundred and five cases were collected and all were reconfirmed. CA-ARF had a predominance of 59.5%. HA-ARF, however, increased by 1.06 times in last 5 years (P0.05); 59.0% of HA-ARF was diagnosed in department of surgery while 70.5% of CA-ARF was in medical department (both P0.05); 36.1% HA-ARF patients had two or more pathogenic causes, while 91.2% CA-ARF only had one cause (P0.05); 49.4% HA-ARF developed after operation; 26.5% HA-ARF and 18.8% CA-ARF were drug-related (P0.05); 24.1% HA-ARF and 12.3% CA-ARF were infection-related (P=0.028). Mortality and recovery rates were 62.7% and 20.6%, respectively, in HA-ARF while 23.0% and 67.2% in CA-ARF respectively (both P0.01). The percentage of oliguria, multiple organ failure (MOF), systemic inflammatory response syndrome (SIRS), and use of mechanical ventilation were significantly higher in HA-ARF than in CA-ARF (all P0.01). Acute tubule necrosis-injury severity score (ATN-ISS), acute pathological and chronic health evaluation (APACHE II) score were 0.54+/-0.24 and 19.6+/-4.9 in HA-ARF, while they were 0.27+/-0.18 and 15.7+/-5.6 in CA-ARF (both P0.01). Multiple regression analysis identified that both MOF and SIRS were common independent risk factors for HA-ARF and CA-ARF, and oliguria and advanced age were respective independent risk factor for HA-ARF and CA-ARF.CA-ARF prevails in hospitalized Chinese patients during the last 10 years, but HA-ARF is increasing in incidence significantly during the last 5 years. The etiology is mostly simple and the prognosis is relatively good in CA-ARF, while the pathogenic cause is mostly complicated and the outcome is much poorer in HA-ARF.

To investigate the change in epidemiology and etiology of hospitalized patients with acute renal failure (ARF) during the last years.The data of hospitalized patients with ARF in the Third Hospital of Peking University during the last 10 years were retrospectively analyzed. The changes in epidemiology and etiology and the relative factors were studied.Two hundred and eleven cases from January 1994 to March 2004 were diagnosed to have ARF during the last 10 years accounting for 0.12% hospitalized patients, with an increasing trend yearly. ARF occurred in patients of all ages with two peak in the 35-45 year and 60-80 years old. The ratio of male over female was about 3 : 2. Among 211 patients, only 33 (15.6%) had renal diseases previously while 178 (84.4%) had never. Eighty-four cases (39.8%)were hospital-acquired ARF which demonstrated a significant increase after 2000 (P0.05). One hundred and twenty-four (58.8%) were diagnosed in internal medicine with a declining trend while 87 (41.2%) were diagnosed in surgical department with a rising trend. Fifty-eight cases (27.5%) were found in intensive care unit (ICU) which demonstrated a increase by 1 89-fold after 2000.Infections, drugs and operations were the major causes for development of ARF with 61 cases (28.9%), 46 cases (21.8%) and 41 cases (19.4%) respectively. Forty-one cases (19.4%) were pre-renal, 156 cases(73.9%) were intrinsic with 72 cases (46.2%) confirmed to be ARF developed from pre-renal factors, and 14 cases (6.6%) were developed from post-renal factors. One hundred and thirty-four cases (85.9%) were acute tubulointerstitial lesions.During the last 10 years, there is an increasing trend in the incidence of ARF in hospitalized patients which might be attributed to hospital-acquired ARF due to drug, infection and operation.