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Books: 232	Journals: 18	Articles: 21389

Abstract

Meiyi Shi and Zhefeng Quan

Department of Anesthesiology, Beijing Geriatric Hospital, Beijing, China
Background: Palonosetron, a second-generation 5-HT3 receptor antagonist, is widely used for postoperative nausea and vomiting (PONV) prophylaxis. Anaphylaxis induced by palonosetron during general anesthesia is extremely rare, and the risk of severe anaphylaxis upon re-exposure in polysensitized atopic patients is inadequately recognized. Case report: A 50-year-old female underwent an uneventful hepatectomy, receiving palonosetron without adverse reaction. Ten weeks later, during pre-induction for laparoscopic rectal cancer surgery, she received oxycodone, palonosetron, and penehyclidine hydrochloride. One minute after completion, she developed generalized rash (> 60% body surface area), hypotension (81/50 mmHg), and tachycardia (125 bpm), requiring vasopressor support; surgery was cancelled. Subsequent skin testing was positive for ondansetron (++), cisatracurium (+), and propofol (+), while negative for chlorhexidine, rocuronium, and etomidate. Conclusion: Prior uneventful exposure to palonosetron does not guarantee future safety. Atopic patients with polysensitization are at significantly increased risk of severe anaphylaxis upon re-exposure. Positive ondansetron skin testing provides indirect evidence identifying palonosetron as the culprit. All 5-HT3 receptor antagonists should permanently be avoided in such patients, and alternative antiemetics (e.g., dexamethasone, droperidol, NK1 antagonists) should be selected. Correspondence to:
Zhefeng Quan, MD, No. 118, Wenquan Road, Haidian District, Beijing 100095, China
Email: [email protected]

Abstract

Zhou Meiyang, Huang Haole, and Zhou Canxin

Department of Nephrology, The Affiliated People’s Hospital, Ningbo University, Ningbo, Zhejiang, China
Background: Fibroblast growth factor 23 (FGF23) is a phosphaturic hormone increasingly recognized as a potential contributor to cardiovascular complications in chronic kidney disease (CKD). This study investigated the association between circulating intact FGF23 levels and the severity of vascular calcification and cardiovascular event risk in peritoneal dialysis (PD) patients. Materials and methods: In this retrospective cohort study, we enrolled 150 PD patients treated at our center between January 2020 and January 2025. All biomarker measurements and vascular imaging data were extracted from clinically indicated chronic kidney disease–mineral and bone disorder (CKD-MBD) and cardiovascular risk assessments documented in the medical record; no additional blood sampling or CT radiation exposure was performed solely for research. FGF23 testing was clinician-initiated rather than routine, so analyses incorporated prespecified approaches to evaluate potential selection bias. Vascular calcification was assessed using complementary modalities: simple vascular calcification score (SVCS) on plain radiographs, coronary artery calcification (CAC) by computed tomography, and abdominal aortic calcification (AAC) by computed tomography. Cardiovascular events were recorded during a median follow-up of 36 months. Associations between log-transformed FGF23 and outcomes were evaluated using multivariable regression with events-per-variable monitoring, and incremental predictive value was assessed with bootstrap-validated discrimination and reclassification metrics. Results: FGF23 levels were significantly and positively correlated with all three vascular calcification scores. Patients in higher FGF23 tertiles demonstrated greater vascular calcification burden and a higher cumulative incidence of cardiovascular events. In fully adjusted Cox models, each unit increase in log-transformed FGF23 was associated with a higher hazard of cardiovascular events (HR 1.74, 95% CI: 1.18 – 2.56, p = 0.005). Addition of FGF23 to a base model improved bootstrap-corrected discrimination (optimism-corrected area under the curve increment 0.024) and reclassification (category-free net reclassification improvement 0.16, p = 0.002). Attenuation of the FGF23–event association after adjustment for vascular calcification scores was consistent with partial mediation through the calcification pathway, although formal causal mediation was not performed. Conclusion: Elevated FGF23 levels are independently associated with greater vascular calcification burden and higher cardiovascular event risk in PD patients. FGF23 may contribute to refined cardiovascular risk stratification in this population, though prospective validation and formal mediation analyses are needed to clarify the underlying pathways. Correspondence to:
Zhou Meiyang, MD, Department of Nephrology, The Affiliated People’s Hospital, Ningbo University, 251 Baizhang East Road, Ningbo, Zhejiang, 315040, China
Email: [email protected]

Abstract

Hamza El Falah¹, Vanesa Bijol², Gashu Ayehu³, Yonah C. Ziemba⁴, Kenar D. Jhaveri³, and Jordan L. Rosenstock¹

¹Division of Nephrology, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, ²Arkana Laboratories, Little Rock, AR, ³Division of Kidney Disease and Hypertension, Glomerular Center at Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, and ⁴Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY, USA
Aims: IgA nephropathy (IgAN) is traditionally considered a polytypic disorder, although λ light chain predominance on immunofluorescence (IF) is common. In some cases, monotypic IgA (mIgA) staining is identified. Whether mIgA represents a variant of IgAN or should be classified as proliferative glomerulonephritis with monoclonal immune deposits (PGNMID) remains controversial, particularly in cases with isolated κ deposits or membranoproliferative (MP) or membranous patterns. We performed this study to characterize all mIgA cases in our institutional biopsy database, with emphasis on hematologic evaluation and clinical outcomes. Materials and methods: The Northwell Health kidney biopsy database was reviewed, identifying 8 mIgA cases (1.3% of IgA biopsies). Electronic medical records were reviewed for clinical, laboratory, histological, and follow-up data. Results: Five cases demonstrated κ restriction, and 3 showed λ. Median age was 42 years, and 75% were male. No patient had a known hematologic disorder at presentation. Median serum creatinine was 1.75 mg/dL. Histological patterns included mesangioproliferative +/– sclerosing (62.5%), sclerosing alone (25%), and MP (12.5%). Only 1 patient had a monoclonal gammopathy, but it was non-IgA. Bone marrow biopsies and flow cytometry revealed no hematologic neoplasms. One patient underwent blood mass spectrometry, which was negative. Treatments varied, and most patients achieved stable or improved renal function. One patient with a prior transplant and diabetic nephropathy developed thrombotic microangiopathy and entered hospice. Among 6 patients with follow-up (mean 39.5 months), none developed hematologic malignancy. Conclusion: These findings support the non-monoclonal nature of most mIgA cases, with no detectable clones at baseline or follow-up. Larger studies using advanced detection techniques are needed to clarify clonal risk and guide optimal therapy. Correspondence to:
Jordan L. Rosenstock, Division of Nephrology, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
Email: [email protected]

Abstract

Clinical Nephrology, Vol. 106 – No. 4/2026 (299-314)

Beyond erythropoiesis-stimulating agents: The evolving role of hypoxia-inducible factor stabilizers in anemia of chronic kidney disease 

Joel Shah¹, William Wells-Gatnik¹, Kunal Sharma¹, Sidhartha Senapati¹, Lakshmi Kattamuri¹, Aimee Hechanova², Fernanda Payan-Schober², and Biff F. Palmer³

¹Department of Internal Medicine, ²Department of Nephrology, and ³Departments of Education and Internal Medicine, Texas Tech University Health Sciences Center El Paso, TX, USA
Anemia is one of the most common complications affecting individuals with chronic kidney disease (CKD). It is driven primarily by relative erythropoietin (EPO) deficiency, chronic inflammation, and altered iron metabolism. Emerging therapies, known as hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs), offer a novel oral treatment approach by stabilizing intracellular HIF levels to mimic tissue hypoxia and stimulate endogenous EPO production. This comprehensive narrative review synthesizes literature indexed in PubMed, MEDLINE, Scopus, and Web of Science to evaluate the efficacy of HIF stabilizers in the anemia of CKD compared to current guideline-directed therapies worldwide. Phase 3 clinical trials consistently demonstrate that HIF-PHIs are non-inferior to conventional erythropoiesis-stimulating agents (ESAs) and superior to placebo in increasing and maintaining hemoglobin levels in both dialysis-dependent and non-dialysis-dependent CKD patients. Additionally, HIF-PHIs improve iron mobilization and utilization by decreasing hepcidin levels. However, trials have raised safety concerns regarding cardiovascular outcomes, including major adverse cardiovascular events, and an increased incidence of thromboembolic events, particularly in non-dialysis-dependent populations. These safety signals have led to divergent global regulatory pathways, with the United States Food and Drug Administration largely restricting approvals to dialysis-dependent patients, while agencies in Europe and Japan have granted broader authorizations. As a growing body of literature accumulates, HIF-PHIs offer a promising oral alternative to ESAs that addresses both relative EPO deficiency and iron sequestration. While they have the potential to become a new standard of care, therapy initiation requires individualized risk-benefit assessments, and continued post-marketing surveillance is necessary to fully elucidate long-term cardiovascular and thromboembolic risks.Correspondence to:
Prof. Biff F. Palmer, MD
Departments of Education and Internal Medicine
Texas Tech University Health Sciences Center
5001 El Paso, TX 79905, USA
Email: [email protected]

Abstract

Nehaa Sohail¹, Sabrina Zheng¹, Zuhair Zaidi², Ayaan Sohail³, Wesam Abdel-Jaber¹, Inaaya Lodhi⁴, Sino Mehrmal⁵, Misha V. Koshelev⁶, and Biff F. Palmer¹

¹Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, ²UT Southwestern Medical School, Dallas, ³John P. and Kathrine G. McGovern Medical School, University of Texas Health Science Center at Houston, Houston, ⁴University of North Texas, Denton, TX, ⁵Epiphany Dermatology, St. Louis, MO, and ⁶Department of Dermatology, University of Texas Health Science Center at Houston, Houston, TX, USA
Patients undergoing Mohs micrographic surgery (MMS) on perioperative diuretics represent a medically complex population, yet the impact of diuretic use on postoperative outcomes remains underexplored. Despite use in patients with cardiometabolic comorbidities, limited research has evaluated how perioperative diuretic exposure influences postoperative outcomes following MMS. This study investigates the association between perioperative diuretic use and postoperative outcomes following MMS. Utilizing the TriNetX database, MMS patients were matched on a 1 : 1 basis according to perioperative diuretic use. Outcome variables were evaluated over a 30- and 90-day follow-up period. Among 37,781 matched patients, diuretic use was associated with higher odds of surgical site infection at both 30 days (OR 1.29, 95% CI 1.03 – 1.62, p = 0.03) and 90 days (OR 1.36, 95% CI 1.12 – 1.65, p < 0.001), as well as substantially increased odds of rash or cellulitis at 30 days (OR 1.95, 95% CI 1.68 – 2.26, p < 0.001) and 90 days (OR 1.92, 95% CI 1.74 – 2.13, p < 0.001). Perioperative diuretic use was linked to increased odds of infection, rash or cellulitis, postoperative pain, opioid use, emergency department visits, sepsis, and short-term mortality, with time-to-event analysis identifying loop and osmotic diuretics as the primary drivers of risk. Correspondence to:
Nehaa Sohail, MBA, 5001 El Paso Drive, El Paso, TX 79905, USA
Email: [email protected]

Abstract

Yu Wang⁴, Li Zhang¹#², Chang-jiu Liang³, and Chang Wang¹#²

¹Department of Nephrology, Institute of Nephrology, Second Affiliated Hospital of Hainan Medical University, ²Hainan Clinical Research Center for Urinary System Disease, ³Department of Hematology, Second Affiliated Hospital of Hainan Medical University, Haikou, and ⁴Department of Endocrinology and Metabolism, Shenzhen University General Hospital, Shenzhen University, Shenzhen, China
We report the case of a 53-year-old man who presented with Fanconi syndrome as the initial clinical manifestation. Laboratory findings included hypokalemia, hypophosphatemia, mild metabolic acidosis, and renal glucosuria. Kidney biopsy revealed crystalline light-chain proximal tubulopathy (LCPT) with κ-restricted light-chain deposition in proximal tubular epithelial cells. Bone marrow examination demonstrated multiple myeloma with plasma cells containing Auer rod-like intracytoplasmic inclusions, an extremely rare morphological finding. The coexistence of crystalline κ-restricted LCPT and Auer rod-like inclusions in plasma cells is exceedingly rare and remains poorly characterized. This case underscores the diagnostic value of kidney biopsy in unexplained Fanconi syndrome and suggests that abnormal physicochemical properties of monoclonal κ light chains may contribute to intracellular crystal formation in both renal tubular epithelial cells and plasma cells. Correspondence to:
Dr. Chang Wang, Department of Nephrology, Institute of Nephrology, 2nd Affiliated Hospital of Hainan Medical University, 368 Yehai Ave, Longhua District, Haikou 570311, People’s Republic of China
Email: [email protected]

Abstract

Clinical Neuropathology 4-2026

Christian Mawrin

Abstract

Allergologie select, Vol. 10/2026 (197-208)

In vitro diagnostics in hymenoptera venom allergy: Current concepts and perspectives

Thilo Jakob¹, Timo Buhl², and Jörg Fischer³

¹Department of Dermatology and Allergy, University Medical Center Gießen, Justus Liebig Universität Gießen, Gießen, ²Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, and ³Department of Dermatology and Allergology, Augsburg University Hospital, Augsburg, Germany
Background: Hymenoptera venom allergy (HVA) is a leading cause of anaphylaxis in adults and requires precise diagnostic work-up to guide venom immunotherapy (VIT). However, the high prevalence of asymptomatic sensitization and frequent double sensitization complicate the identification of clinically relevant allergens. Materials and methods: This narrative review summarizes current concepts and recent advances in in vitro diagnostics of HVA, including conventional IgE testing, component-resolved diagnostics (CRD), IgE ratio analysis, and cellular assays and biomarkers for risk stratification. Emphasis is placed on their diagnostic performance, limitations, and clinical applicability. Results: Measurement of venom-specific IgE remains the cornerstone of HVA diagnosis, offering high sensitivity for clinically relevant HVA. CRD using recombinant, CCD-free allergens improves discrimination between primary sensitization and cross-reactivity, particularly in patients with double sensitization to honeybee and yellow jacket venoms. However, incomplete allergen panels, especially in honeybee venom allergy, limit sensitivity. IgE ratio analysis has emerged as a complementary tool to identify the most likely culprit venom, although it may be influenced by recent sting exposure. Cellular assays such as the basophil activation test provide functional information and may support diagnosis in complex cases but are restricted to specialized centers. In addition, biomarkers such as basal serum tryptase and KIT p.D816V mutation are important for risk stratification. Conclusion: Modern in vitro diagnostics substantially enhance the precision of HVA diagnosis but cannot replace clinical history. An integrated approach combining serology, molecular diagnostics, ratio analysis and, where appropriate, functional assays, is essential for accurate identification of the relevant venom and optimal patient management.Correspondence to:
Thilo Jakob, MD, Department of Dermatology and Allergy, University Medical Center Gießen, Justus Liebig Universität Gießen, Gaffkystrasse 14, 35392 Gießen, Germany
Email: [email protected]

Abstract

Yasuhiro Horiuchi

Division of Dermatology, Tsuruse Orthopedic Clinic, Saitama, Japan
One challenge in atopic dermatitis is facial eczema, which requires delicate management because of the sensitive nature of facial skin. This report presents a 30-year-old male patient with facial eczema associated with atopic dermatitis, which could not be cured by conventional treatment, even with the continuation of oral betamethasone. The facial lesions were treated with pediatric 0.03% tacrolimus ointment. The patient was administered 200 mg/day tranilast and 300 mg/day roxithromycin. Within 3 weeks, his eczematous lesions on the face, as well as the severe itching, were completely cured. Addition of this combination therapy may be a promising therapeutic strategy for treating uncontrollable atopic dermatitis, particularly for facial eczema and itching. Correspondence to:
Yasuhiro Horiuchi, MD, Division of Dermatology, Tsuruse Orthopedic Clinic 201-11 Fujikubo, Miyoshi, 354-0041 Saitama, Japan
Email: [email protected]

Abstract

International Journal of Clinical Pharmacology and Therapeutics, Vol. 64 – No. 10/2026 (548-554)

Blinatumomab-induced catastrophic immune effector cell-associated neurotoxicity with diffuse cerebral edema in a patient with ALL: Case report 

Xuemei Guo, Yuting Wei, Yongjun Fang, and Rufeng Lin

Department of Hematology, Children’s Hospital of Nanjing Medical University, Nanjing, China; Key Laboratory of Hematology, Nanjing Medical University Nanjing, China
Background: Blinatumomab, a bispecific T-cell engager that targets CD19, has emerged as a significant therapeutic option for relapsed or refractory B-cell acute lymphoblastic leukemia (B-ALL). While immune effector cell–associated neurotoxicity syndrome (ICANS) is a recognized complication, most neurological adverse events are mild to moderate and generally reversible. Catastrophic and fatal neurotoxicity, however, remains exceedingly rare, particularly among pediatric patients.
Case Presentation: We present a case involving a 13-year-old boy diagnosed with MLL-AF4–positive precursor B-ALL who experienced catastrophic neurotoxicity during blinatumomab therapy. Following the achievement of molecular remission and successful tolerance of the first treatment cycle without neurological complications, the patient developed an abrupt-onset fever on day 13 of the second cycle. Despite the immediate discontinuation of blinatumomab and the administration of dexamethasone, his condition rapidly deteriorated, leading to confusion, refractory seizures, and coma within hours. Cranial computed tomography revealed diffuse cerebral edema with suspected subarachnoid hemorrhage and impending brain herniation. Intensive supportive management, which included osmotic therapy, antiepileptic treatment, mechanical ventilation, and vasopressor support, failed to reverse the neurological decline. Ultimately, the patient developed irreversible loss of brainstem reflexes and deep coma.
Conclusion: This case underscores a previously unrecognized and severe pattern of delayed-onset, fatal neurotoxicity associated with blinatumomab, which can occur beyond the conventional early treatment window and despite prior tolerance to the drug. Clinicians must remain vigilant for neurological symptoms linked to fever throughout all treatment phases. Further research is urgently required to elucidate risk factors, identify predictive biomarkers, and refine monitoring strategies to avert catastrophic central nervous system injury in pediatric patients undergoing T-cell–engaging immunotherapy.Correspondence to:
Dr. Rufeng Lin
Department of Hematology
Children‘s Hospital of Nanjing Medical University
Code 72, Guangzhou Road
Nanjing city, Jiangsu province, China
Email: [email protected]

Abstract

Wanbing Lin¹, Jun Ying², Xianbao Liu³, and Lijun Mou¹

¹Department of Nephrology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou City, ²Department of Nephrology, Jinhua Municipal Central Hospital, Jinhua City, and ³Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
Background: Hypokalemia is a common clinical electrolyte disorder. In normotensive patients with renal potassium (K⁺) wasting, distinguishing vomiting-related upper gastrointestinal (UGI) disorders from renal tubular diseases (RTDs), including Gitelman syndrome (GS) and distal renal tubular acidosis (dRTA), is challenging due to overlapping manifestations. Assessment based on isolated urinary potassium excretion has limited diagnostic value. Materials and methods: We retrospectively analyzed 86 normotensive hypokalemic patients with inappropriate renal K⁺ loss admitted to our department (2016 – 2025), divided into the UGI group (n = 25, vomiting-related) and RTD group (n = 61: 34GS, 27dRTA). Clinical characteristics and blood/urine biochemical parameters were systematically collected. The spot urine K⁺/creatinine (Cr) ratio, fractional excretion of electrolytes (FEK, FENa, FECl), and blood/urine Na⁺/Cl^– ratios were calculated. Between-group comparisons and ROC curve analysis were performed. Results: Compared with the RTD group, the UGI group had a significantly higher female proportion, lower BMI, shorter duration of hypokalemia-related symptoms, marked hypochloremia, hyponatremia, severe metabolic alkalosis, and elevated serum Cr and uric acid (UA) (all p < 0.05). Spot urine analysis showed higher Na⁺, lower Cl^–, and elevated Na⁺/Cl^– and FENa/FECl ratios, whereas spot urine K⁺/Cr ratio and FEK did not differ significantly between groups. ROC analysis demonstrated that spot urine Cl^– had the highest diagnostic accuracy for vomiting-induced hypokalemia (AUC 0.978; cutoff < 33.3 mmol/L, sensitivity 92%, specificity 95.1%). Urine Na⁺/Cl^– and FENa/FECl ratios also achieved excellent performance (both AUC 0.965). Notably, serum Cl^– also showed favorable diagnostic performance (AUC 0.939) with a cutoff of < 94.9 mmol/L. Conclusion: Vomiting-related UGI disorders and RTDs both cause normotensive hypokalemia with renal K⁺ wasting. Notably, vomiting-related UGI disorders predominantly affect females with lower BMI and may be complicated by prerenal acute kidney injury (AKI). Serum Cl^– measurement serves as a valuable initial screening tool for suspected UGI disorders. Urinary K⁺ excretion markers have limited diagnostic value, and comprehensive urinary electrolyte analysis is required. Among all evaluated parameters, spot urine Cl^– concentration demonstrates the highest diagnostic performance. Correspondence to:
Lijun Mou, PhD, Department of Nephrology, The Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangcheng District, Hangzhou City 310009, Zhejiang Province, China, Xianbao Liu, PhD, Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangcheng District, Hangzhou City 310009, Zhejiang Province, China
Email: [email protected]

Abstract

International Journal of Clinical Pharmacology and Therapeutics, Vol. 64 – No. 10/2026 (505-506)

Methotrexate in rheumatoid arthritis: Old habits die hard

Barrington (Barry) G. Woodcock-Kloberdanz

Abstract

Trace Elements and Electrolytes, Vol. 43 – No. 3/2026 (89-96)

Magnesium and postoperative pain following tonsillectomy: A systematic review 

Jens Büntzel¹#⁵, Sören Klaus Büntzel², Klaus Kisters³#⁵, and Oliver Micke⁴#⁵

¹Department of Otolaryngology, Südharz Klinikum Nordhausen, Nordhausen, ²Department of Radiotherapy, Special Oncology, Medical School Hannover, Hanover, ³operasan dialysis center Herne, Herne, ⁴Department of Radiotherapy, Franziskus Hospital Bielefeld, Bielefeld, and ⁵German Society for Magnesium Research, Germany
Background: Postoperative pain following tonsillectomy remains a major clinical challenge, particularly in pediatric patients. Magnesium, an essential electrolyte with neuromodulatory properties, has been suggested to exert analgesic effects through inhibition of N-methyl-D-aspartate (NMDA) receptors and modulation of central sensitization. However, its clinical effectiveness in tonsillectomy-related pain has not been systematically evaluated.
Objective: To systematically review clinical studies investigating the effect of magnesium administration on postoperative pain and analgesic consumption following tonsillectomy or adenotonsillectomy.
Materials and methods: A systematic literature search was conducted in PubMed/MEDLINE, Embase, and Cochrane CENTRAL from database inception to the date of last search. Controlled clinical studies evaluating perioperative or postoperative magnesium administration in tonsillectomy patients were included. Outcomes of interest were postoperative pain intensity and analgesic consumption. Study selection followed PRISMA 2020 guidelines. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool.
Results: Eleven studies were included in the qualitative synthesis, most of which were randomized controlled trials conducted in pediatric populations. Magnesium was administered via different routes, including intravenous, topical, and local peritonsillar application. Several studies reported reduced postoperative pain scores and/or decreased analgesic requirements in patients receiving magnesium, including a recent double-blind randomized trial demonstrating significant analgesic benefits following local peritonsillar magnesium administration. Overall risk of bias was judged as low to moderate, with common limitations including small sample sizes and incomplete reporting of randomization procedures.
Conclusion: Current evidence suggests that magnesium may provide a modest, additive analgesic benefit following tonsillectomy, particularly as part of a multimodal analgesic regimen. Local application of magnesium may represent a promising approach; however, due to clinical and methodological heterogeneity, further well-designed randomized controlled trials are required to define optimal dosing, timing, and routes of administration.Correspondence to:
Prof. Dr. med. Jens Büntzel
Klinik für HNO-Erkrankungen, Kopf-Hals-Chirurgie
Südharz Klinikum Nordhausen gGmbH
Dr.-Robert-Koch-Str. 39
99734 Nordhausen, Germany
Email: [email protected]

Abstract

Chunyan Hu¹, Yuanyuan Liao², and Tao Zhang³

¹Department of Urology, ²Department of Nursing, and ³Department of Neurosurgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
Objective: This study aimed to examine whether a multidimensional intensive nursing strategy could improve bone metabolism and quality of life in hemodialysis patients with renal osteodystrophy (ROD). Materials and methods: 90 ROD patients on maintenance hemodialysis were randomized into an intervention group (routine + multidimensional intensive nursing, n = 45) or a control group (routine nursing alone, n = 45). Primary outcomes were bone metabolism markers and WHOQOL-BREF scores; secondary outcomes included calcium-phosphorus levels, VAS, SAS, SDS, ESCA scores, and adverse events. Results: The intervention group showed lower β2-microglobulin and parathyroid hormone, higher WHOQOL-BREF scores, better calcium-phosphorus balance (higher calcium, lower phosphorus), lower VAS/SAS/SDS, and higher ESCA scores vs. controls (all p < 0.05). Adverse events and complications were also reduced (both p < 0.05). Conclusion: Multidimensional intensive nursing may improve bone metabolism, calcium-phosphorus balance, self-care, and quality of life, while reducing pain, anxiety, depression, and complications in hemodialysis patients with ROD. Correspondence to:
Tao Zhang, Department of Neurosurgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan, China
Email: [email protected]

Abstract

Risa Someya¹,², Kosuke Takata¹,², Takeshi Uchikura², Yusuke Oshita³, and Kenji Momo⁴

¹Department of Pharmacy, Showa Medical University Northern Yokohama Hospital, Yokohama, ²Division of Hospital Pharmaceutics, Department of Hospital Pharmaceutics, School of Pharmacy, Showa Medical University, Tokyo, ³Department of Orthopedic Surgery, Showa Medical University Northern Yokohama Hospital, Yokohama, and ⁴Division of Clinical Research, Department of Hospital Pharmaceutics, School of Pharmacy, Showa Medical University, Tokyo, Japan
Objective: To describe the treatment patterns and reoperation rates after claims-defined postoperative periprosthetic joint infection (PJI) identified 1 – 6 months after total knee or hip arthroplasty using a Japanese nationwide claims database. Materials and methods: Patients who underwent total knee or hip arthroplasty between 2005 and 2017 were identified. Claims-defined postoperative PJI was operationally defined as infection-related claims accompanied by systemic antibacterial treatment in 1 – 6 months after arthroplasty. The agents targeting methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) included vancomycin, daptomycin, linezolid, and teicoplanin. The primary outcome was reoperation after claims-defined postoperative PJI. Results: Among the 2,805 patients, 59 (2.1%) developed postoperative PJI 1 – 6 months after arthroplasty. Of these, 8 underwent immediate surgical intervention, and the remaining 51 patients were initially managed with antibiotic treatment without surgical intervention. Of these, 12 received anti-MRSA agents and 39 received non-MRSA agents. Reoperation was performed in 3 of 12 (25.0%) patients who received anti-MRSA agents and 6 of 39 (15.4%) patients who did not receive anti-MRSA agents. Among the patients treated with anti-MRSA agents, 11 of 12 (91.7%) required second- or third-line therapy. Diabetes mellitus was present in 66.7% and 83.3% of the reoperated patients who received and did not receive anti-MRSA agents, respectively; liver disease was observed in 66.7% and 16.7% of the patients, respectively. Conclusion: This claims-based descriptive analysis indicated that treatment escalation and reoperation were observed after claims-defined postoperative PJI identified 1 – 6 months after arthroplasty. Because pathogen data were unavailable and receipt of anti-MRSA agents was used as a treatment-based classification, these findings should be interpreted as descriptive treatment-pattern data rather than microbiologically confirmed comparisons. Correspondence to:
Associate Prof. Kenji Momo, PhD, Division of Clinical Research, Department of Hospital Pharmaceutics, School of Pharmacy, Showa Medical University, Hatanodai 1-5-8, Shinagawa-ku, Tokyo 142-8555, Japan
Email: [email protected]

Abstract

Yi Qian Zhang, Jun Xia Wu, Hai Yan Tu, Zhao Ting Ren, Pei Pei Chen, Jia Xiu Zhang, and Kun Ling Ma

Department of Nephrology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
Background: Sodium-glucose cotransporter 2 (SGLT2) inhibitors are now recommended as first-line therapies for chronic kidney disease. However, real-world evidence on henagliflozin, China’s first-developed SGLT2 inhibitor, for treating IgA nephropathy (IgAN) is lacking. This study explored the real-world efficacy and safety of henagliflozin in Chinese IgAN patients. Materials and methods: This study retrospectively reviewed 48 IgAN patients on henagliflozin for 12 weeks. The primary outcome was the urinary albumin-to-creatinine ratio (UACR). Secondary outcomes included estimated glomerular filtration rate (eGFR), serum creatinine (Scr), uric acid (UA), and albumin (Alb). Adverse events (AEs) were also recorded. Results: Henagliflozin induced a significant reduction in UACR between baseline and week 12 (227.26; IQR, 90.13 – 677.85 vs. 153.06; IQR, 24.68 – 401.76 mg/g; p < 0.001), with a median decrease of 47.9%. Clinical response, defined as a ≥ 30% decrease in UACR, was achieved in 64.6% of patients by week 12. The UA levels also decreased markedly (p < 0.001). The eGFR declined until week 8 (p ≤ 0.015) but returned to near-baseline level by week 12 (p = 0.055). Scr increased over time (p = 0.005), and Alb improved until week 8 (p ≤ 0.007) and then plateaued at week 12 (p = 0.45). AEs included urinary tract infections in 5 patients, Scr increase of ≥ 50% in 1, and hyperkalemia in 1. Conclusion: Henagliflozin demonstrated significant albuminuria- and UA-lowering effects over 12 weeks in Chinese IgAN patients. With renal-metabolic benefits and favorable safety, henagliflozin is emerging as an encouraging therapeutic option for IgAN. Correspondence to:
Kun Ling Ma, PhD, Department of Nephrology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
Email: [email protected]

Abstract

Jiaxin Dong, Qian Zhang, Min Huang, Jing Zhou, Suming Zhou, and Dongmei Zhu

Department of Geriatrics ICU, Critical Care Center, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
Objective: This study aimed to investigate the potential of the platelet-to-lymphocyte ratio (PLR) as a predictive biomarker for augmented renal clearance (ARC) in patients undergoing intracerebral hemorrhage (ICH) surgery. Materials and methods: A single-center retrospective cohort study was conducted on 174 patients who underwent ICH surgery. Pearson or Spearman correlation analyses were used to examine the relationship between PLR and baseline characteristics. Restricted cubic spline curves were employed to assess the association between PLR and ARC occurrence. Logistic regression models were applied to identify risk factors for ARC, while the predictive performance of PLR was evaluated using receiver operating characteristic curves. All statistical analyses were performed using IBM SPSS Statistics v.24.0 and R v.4.0.2. Results: Among the 174 patients, 99 (56.9%) developed ARC. The optimal cutoff value for PLR was determined to be 201.31. The AUC of PLR for predicting ARC was 0.69 (95% CI: 0.61 – 0.77), with a sensitivity of 65.3% and specificity of 73.7%. Subgroup analyses revealed that this association was particularly pronounced in patients aged over 55 years, those with a body mass index ≤ 25 kg/m², an APACHE II score of 10 – 20, and a hemorrhage volume ≤ 30 mL. Integrating PLR into a composite model (APACHE II, SOFA, and GCS) increased the AUC from 0.70 (95% CI: 0.62 – 0.78) to 0.73 (95% CI: 0.65 – 0.81). The addition of PLR to the composite scoring system yielded a category net reclassification improvement of 0.12 (95% CI: 0.00 – 0.25). Conclusion: Preoperative low PLR is significantly associated with the early occurrence of ARC and serves as an independent predictor for ARC. Correspondence to:
Dongmei Zhu, Department of Geriatrics ICU, Critical Care Center, The First Affiliated Hospital with Nanjing Medical University, 210029 Nanjing, People’s Republic of China
Email: [email protected]

Abstract

Yunhui Zhang, Hong Wang, Keming Geng, Guifen Chai, and Jun Luo

Department of Nephrology, Huangshan People’s Hospital, Huangshan, Anhui Province, China
Background: Residual kidney function influences outcomes and quality of life in peritoneal dialysis (PD), but the optimal initiation strategy remains uncertain. Materials and methods: We retrospectively studied 120 incident PD patients treated at a tertiary nephrology center in China from February to December 2023. Patients were categorized by initial prescription as low-dose continuous ambulatory PD (CAPD-L), full-dose CAPD (CAPD-F), daytime ambulatory PD (DAPD), or automated full-dose PD (APD-F). Twelve-month outcomes included 24-hour residual urine volume, weekly total Kt/V, nutritional and mineral markers, and documented uremia-related symptoms. Baseline imbalance was assessed using standardized mean differences, and longitudinal changes were analyzed using repeated-measures models with group-by-time interactions. Urine volume was considered a surrogate measure of residual kidney function. Results: Baseline imbalance was notable, particularly for age and urine volume. At 12 months, mean 24-hour urine volumes were 962.7 ± 198.6, 790.5 ± 210.4, 960.1 ± 180.3, and 945.7 ± 190.2 mL/day in the CAPD-L, CAPD-F, DAPD, and APD-F groups, respectively. The between-group difference was significant (p = 0.006), as was the unadjusted group-by-time interaction (p = 0.003). Weekly total Kt/V remained above 1.7 in all groups. No significant between-group differences were observed in serum albumin or documented uremia-related symptoms at 12 months. Conclusion: Initial low-dose CAPD and daytime PD were associated with different residual urine-volume trajectories while dialysis adequacy was maintained. No symptom-burden benefit was demonstrated. Given the non-randomized design, baseline imbalance, limited adjustment for treatment selection, and use of urine volume as a surrogate, these findings are exploratory and require prospective confirmation. Correspondence to:
Yunhui Zhang, Department of Nephrology, Huangshan People’s Hospital, No. 4, Liyuan Road, Tunxi District, Huangshan 245000, Anhui Province, China
Email: [email protected]

Abstract

Chao Chen, Wen Wen, and Lu Wang

Department of Nephrology, Urological Metabolism and Immunoecology Laboratory, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
Objective: To assess the associations of life’s crucial 9 (LC9) and its components with all-cause and cardiovascular disease (CVD)-related mortality in patients with diabetic kidney disease (DKD). Materials and methods: Records of DKD patients were extracted from the National Health and Nutrition Examination Survey database. The relationships of LC9 scores with all-cause and CVD-related mortality were investigated by weighted univariate and multivariable COX proportional hazard models, with hazard ratios (HRs) and 95% confidence intervals (CIs). The associations were further explored based on different characteristics of DKD patients, including age, sex, CVD, cancer, diabetic retinopathy, and anemia. Random forest models were used to evaluate the importance of LC9 components for all-cause and CVD-related mortality. Results: Among 1,877 DKD patients, 586 died from any cause, and 193 were CVD-related. DKD patients with elevated LC9 scores (≥ 47.778) had lower odds of all-cause and CVD-related mortality, compared to those with LC9 score < 47.778. For per 10-point increase in LC9 score, the risk of all-cause and CVD-related mortality decreased by 0.26 and 0.37 times in DKD patients, respectively. Similar results were found in different characteristics of DKD patients. Physical activity, sleep duration, and BMI were the most important factors for all-cause mortality in DKD patients, followed by depression. For CVD-related mortality risk, sleep duration and depression were of significant importance, followed by dietary quality. Conclusion: High LC9 scores were associated with lower odds of all-cause and CVD-related mortality, suggesting that incremental improvements in modifiable factors may be beneficial to the prognosis of DKD patients. Correspondence to:
Lu Wang, BS, Department of Nephrology, Urological Metabolism and Immunoecology Laboratory, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing 400016, China
Email: [email protected]

Abstract

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