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【Objective】 To explore the mechanism of macrophage-inducible C-type lectin (Mincle) and microinflammatory state in uremia. 【Methods】 SD rats were randomly divided into uremia group and sham operation group. The morphology and permeability of intestinal tissue, the morphology of intestinal tissue and macrophages were observed by transmission electron microscope, the expression of Mincle was detected in intestinal tissue sections, and the expressions of Toll-like receptor 4 (TLR-4) and NF-kappa B (NF-κB) protein on the surface of macrophages were detected by Western blotting. After the plasma was separated, the levels of endotoxin, C-reactive protein (CRP), interleulin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were detected by Limulus lysate dynamic turbidimetric assay, and enzyme-linked immunosorbent assay (ELISA). The data were analyzed with IBM SPSS19.0 software. 【Results】 The expression of Mincle in the jejunum, ileum, and colon in uremia group was higher than that in sham-operation group (P<0.05). The expressions of TLR4 and NF-κB protein significantly differed in the ileum, jejunum and colon in uremia group (P<0.001). The levels of endotoxin, CRP, IL-6, and TNF-α were significantly increased in uremia group compared with sham-operation group (P<0.05). 【Conclusion】 In uremia, Mincle on the surface of intestinal macrophages increases and further through TLR4/NF-κB pathway mediates the transformation of intestinal macrophages to M1 type, releasing inflammatory products and causing systemic microinflammation.
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Objective:To evaluate the risk factors of acute kidney injury (AKI) in patients with multiple wasp stings.Methods:Patients with multiple wasp stings were retrospectively enrolled in Hanzhong Central Hospital from September 2010 to November 2020. Based on whether the patients developed AKI, the patients were divided into AKI group and non-AKI group. The general characteristics and laboratory examinations between the two groups were compared. The logistic regression model was used to analyze the risk factors of AKI.Results:A total of 356 patients with multiple wasp stings were recruited in this study, with 196 males (55.1%). The age was 56.0(45.0, 64.0) years old. There were 59 patients (16.6%) with hypertension and 13 patients (3.6%) with diabetes. There were 51 patients (14.3%) in the AKI group and 305 patients (85.7%) in the non-AKI group. Baseline data and biochemical examinations indicated that the two groups showed significant differences in gender, age, sting sites (systemic or local), sting needles, proportions of gross hematuria, leukocyte count, hemoglobin, creatine kinase, alanine transaminase, aspartate aminotransferase, total bilirubin, proportions of urinary protein, and proportions of urine occult blood (all P<0.05). The multivariate logistic regression analysis results showed that the increasing number of sting needles (every 10 needles increase, OR=1.866, 95% CI 1.289-2.071, P=0.001), gross hematuria ( OR=9.770, 95% CI 2.586-36.910, P=0.001), decreasing hemoglobin (every 1 g/L increase, OR=0.016, 95% CI 0.001-0.355, P=0.009), increasing aspartate aminotransferase (every 100 U/L increase, OR=1.311, 95% CI 1.144-1.502, P<0.001), and increasing total bilirubin (every 10 μmol/L increase, OR=1.200, 95% CI 1.008-1.430, P=0.041) were independent influencing factors of AKI. Conclusions:The increasing number of sting needles, gross hematuria, decreasing hemoglobin, increasing aspartate aminotransferase, and increasing total bilirubin are independent risk factors of AKI in patients with multiple wasp stings.
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Objective:To explore the relative genes that may influence kidney aging and verify the expression of clock gene Arntl in aging kidney. Methods:The differentially expressed genes between C57BL/6 male aging mice (24 months old) group and young mice (3 months old) group were identified by whole transcriptome sequencing, and the enriched biological pathways and key proteins were analyzed by bioinformatics methods. RT-qPCR and Western blotting were used to verify the mRNA and protein expression of Arntl.Results:(1) A total of 119 differentially expressed genes were screened between aging mice group and young mice group by whole transcriptome sequencing. Differentially expressed genes were mainly enriched in biological processes such as rhythmic process, circadian rhythm and circadian regulation of gene expression (all P<0.001). Protein-protein interaction analysis results showed that Nfil3, Hspa8, Arntl, Hlf, Rorc, Per3 and Npas2 and so on, were the key proteins in these differentially expressed genes. The results of RT-qPCR confirmed that the expression differences of clock genes Arntl, Nfil3, Npas2 and Per3 between aging mice group and young mice group were consistent with sequencing results (all P<0.05). (2) Compared with C57BL/6 young mice group and SAMR1 rapidly aging mice, the protein expression of Arntl in aging mice group and SAMP8 rapidly aging mice had downward trends. Conclusions:Clock genes and their circadian biological pathways may play an important role in the process of renal aging. The expression of Arntl in aging kidney has a downward trend.
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Objective:To analyze the differentally expressed long non-coding RNA (lncRNA) among mice of different ages and explore the mechanism of kidney aging.Methods:Male C57BL/6 mice aged 3-month-old ( n=5), 12-month-old ( n=5) and 24-month-old ( n=5) (each weighting about 25 g) were randomly selected. PAS staining, Masson staining and senescence associated β-galactosidase (SA-β-gal) staining were used to detect the pathology and cell senescence of mice kidney. High throughput sequencing was performed to detect the differentially expressed lncRNA and their fragments per kilobase million. Real-time quantitative PCR was used to verify the differentially expressed lncRNA. Competitive endogenous RNA (ceRNA) network, which consisted of lncRNA, miRNA and mRNA was built. GO and KEGG enrichment analysis method were used to predict the biological function of differentially expressed lncRNA. Results:PAS staining and Masson staining showed the development of kidney fibrosis, and SA-β-gal staining positive region was increased significantly as age increased. There were 938 known lncRNA and 542 novel lncRNA differentially expressed among different ages' mouse kidney. Compared with 3-month-old mice, 33 lncRNA were up-regulated and 43 lncRNA were down-regulated in 12-month-old mice. Compared with 3-month-old mice, 130 lncRNA were up-regulated and 91 lncRNA were down-regulated in 24-month-old mice. Compared with 12-month-old mice, 36 lncRNA were up-regulated and 22 lncRNA were down-regulated in 24-month-old mice. The results of qRT-PCR about verified 10 lncRNAs with larger differential expression multiples and higer expression levels were consistent with the sequencing data. GO enrichment analysis showed that the target genes of lncRNA differentially expressed in the three groups were mostly located in the nucleus and cytoplasm, and might play a role by binding to proteins or participate in various protein phosphorylation, cell cycle, transcription, transcription regulation and other processes. KEGG enrichment analysis showed that the target genes of lncRNA differentially expressed in the three group were significantly enriched in Rap1 signaling pathway, FOXO signaling pathway and MAPK signaling pathway, which were closely related to kidney aging.Conclusion:There are significant differences in expression of lncRNA among the kidney of different ages mice, which are involved in the occurrence of renal senescence.
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Objective:To investigate the clinical effect on ultrasound-guided vascular access-interventional therapy of hemodialysis in day surgery mode.Methods:Hemodialysis patients with vascular access dysfunction who underwent ultrasound-guided interventional therapy in the First Affiliated Hospital of Xi'an Jiaotong University from September 1, 2018 to October 31, 2020 were retrospectively analyzed. Demographic and clinical data were collected by electronic medical record system and telephone follow-up. Kaplan-Meier method was used to analyze the patency rate of vascular access.Results:A total of 421 cases of ultrasound-guided vascular access intervention were performed in 269 patients. The technical success rates of stenosis, chronic occlusion and acute occlusion lesion were 98.8%, 90.6% and 86.4%, respectively, and 406 cases (96.4%) of 246 patients were clinically successful. The postoperative brachial artery blood flow was 821(627, 1 029) ml/min, which was significantly higher than 309(202, 453) ml/min before the operation ( Z=-13.547, P<0.001). No serious complications occurred during and after the operation. At 6, 12, 18 and 24 months after operation, the primary patency rate was 74%, 59%, 48% and 45%, respectively, the assisted primary patency rate was 94%, 91%, 88% and 82%, and the secondary patency rate was 96%, 93%, 91% and 86%. Compared with the conventional inpatient surgery mode, the total cost of the day surgery mode was significantly reduced [12 067(10 051, 13 198) yuan vs 14 986(12 411, 20 643) yuan, Z=-13.185, P<0.001], and the hospital stay was significantly shortened [5.1(3.5, 6.9) h vs 73.4(31.6, 146.6) h, Z=-13.348, P<0.001]. Conclusion:It is safe and effective to perform interventional therapy for vascular access malfunction under ultrasound in day surgery mode, which can save cost and time of hospitalization, and can be carried out in hospitals with relevant conditions.
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Objective To evaluate the clinical effect and safety of regional citrate anticoagulation (RCA) in continuous renal replacement therapy (CRRT) for acute kidney injury (AKI) after hepatectomy.Methods A retrospective analysis of the clinical data of all patients with AKI after hepatectomy for CRRT admitted to surgical intensive care unit (ICU) of the First Affiliated Hospital of Xi'an Jiaotong University from January 19th, 2013 to January 19th, 2018 was performed. According to the different anticoagulants, the patients were divided into no anticoagulant group (NA group), low molecular heparin anticoagulation (LMHA) group and RCA group. The general data of patients during the perioperative period; renal function, the internal environment, electrolyte and blood coagulation function before and after CRRT; the filter time, the number of filters and adverse events (bleeding, frequent filter blood coagulation, metabolic alkalosis, metabolic acidosis, hypocalcemia, citrate accumulation, etc.) during CRRT were collected. Kaplan-Meier survival curve was used to analyze the life span of the first filter during different anticoagulation. Results A total of 67 cases were included in this study, including 11 in the NA group, 25 in the LMHA group and 31 in the RCA group. There was no significant difference in gender, age, underlying disease, etiology (tumor), Child-Pugh stage (A or B), CT angiography (CTA), basic renal function [serum creatinine (SCr), cystatin C (Cys C)], the American Society of Anesthesiologists (ASA) stage; surgical approach; intraoperative bleeding volume, blood transfusion, blood pressure, time of duration of low blood pressure; and postoperative circulatory failure, hepatic insufficiency and sepsis among three groups. However, the length of ICU stay in RCA group was significantly less than the LMHA group and NA group (days: 8.16±2.24 vs. 10.48±5.11, 13.29±6.64, bothP< 0.05). Compared with before CRRT, the levels of SCr, Cys C and Lac were significantly decreased in RCA group and LMHA group after CRRT [SCr (μmol/L): 89.02±21.90 vs. 248.30±55.32, 105.10±49.00 vs. 270.10±156.00; Cys C (mg/L): 2.18±0.95 vs. 2.94±1.26, 2.26±0.76 vs. 3.07± 0.90; Lac (mmol/L): 2.21±1.46 vs. 3.62±1.73, 2.37±1.24 vs. 4.03±1.69, allP < 0.05]; in addition, LMHA group and NA group had significant effects on hemoglobin (Hb), platelet count (PLT) and activated partial thromboplastin time (APTT) after CRRT [Hb (g/L): 85.4±5.1 vs. 99.6±23.6, 80.0±7.6 vs. 101.4±7.8; PLT (×109/L): 27.60±8.22 vs. 62.04±16.49, 21.36±3.91 vs. 61.45±17.69; APTT (s): 63.07±10.25 vs. 41.52±3.65, 49.56±5.77 vs. 41.09± 3.45, allP < 0.05]; at the same time, Cys C level and prothrombin time (PT) in the NA group after CRRT treatment were significantly increased compared with the others [Cys C (mg/L): 3.59±0.64 vs. 2.29±0.51, PT (s): 26.41±2.43 vs. 23.64±1.92 , bothP < 0.05]. Finally, the time of filters (hours: 60.52±8.82, 31.04±7.03, 13.73±6.26,F = 183.412, P < 0.001) and the number of filter during treatment (number: 2.03±0.60, 3.12±0.73, 4.64±1.29,F = 45.933,P <0.001) in the RCA group, LMHA group and NA group had statistically significant difference. Meanwhile, the incidence of adverse events such as bleeding (0 vs. 4, 7,χ2 = 23.961,P < 0.001) and frequent filter coagulation (1 vs. 10, 11,χ2 =35.413,P < 0.001) in RCA group was significantly lower than that in LMHA group and NA group. Kaplan-Meier survival analysis showed that the life time of the first filter in RCA group was significantly longer than that in LMHA group and NA group (χ2 = 139.45,P < 0.05).Conclusion The application of RCA in patients with AKI after hepatectomy during CRRT is safe and effective, which can significantly prolong the life of the filter and reduce the risk of bleeding.
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Nosocomial infection is one of the most common diseases in the intensive care unit (ICU), which has received much concern due to its multi-type infection, more severe infection, difficulty in treatment and high mortality. However, the drug resistance of bacteria is increasingly serious with the wide use of the antibiotics which is no longer an ideal strategy. Instead, the control and prevention of infection from their sources is the key to reduce ICU infection. Especially for some particular nosocomial infections, such as hospital acquired pneumonia (HAP) and ventilator associated pneumonia(VAP), comprehensive measures are needed to take to break the spell of ICU infection.
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Objective:To construct an integrated medical care service mode in hemodialysis and explore the application effect of the concept of integrated medical service in hemodialysis patients.Methods:In 2016,100 patients who had regular hemodialysis(lasting for more than 3 months) were selected from July to Septembe ras the control group,while another100 patients who had the regular hemo dialysis (lasting for more than 3 months) and received the concept of integrated medical care service were selected from October to December as the observation group.The treatment compliance,the incidence of hemodialysis complications,and patient satisfaction of twogroups were compared.Results:Both the treatment compliance and patient satisfaction of the participants in the observation group were significantly higher than those in the control group (P ＜ 0.05),while the incidence of hemodialysis complications in the observation group was significantly lower than that in the control group (P ＜ 0.05).Conclusion:The implementation of integrated medical careservice concept can fully deepen the service concept of people-oriented and patient-centered,carry out humanized services,improve the treatment compliance of hemodialysis patients,reduce the complications,promote the cooperation of doctors and nurses,enhance the effect of health education,and improve the patient satisfaction.
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Objective To investigate whether gut microbiome dysbiosis and translocation occurred in experimental uremia,and whether they consequently contribute to microinflammation.Methods Health male SD rats were randomly divided into uremic group and sham group.Uremic group were operated for 5/6 nephrectomy to establish uremic models,while sham group were only operated for nephrocapsulotomy.Postoperative blood,livers,spleens,and mesenteric lymph nodes (MLNs) were subjected to bacterial 16S ribosomal DNA amplification to determine if bacteria were present.Bacterial genomic DNA samples from the MLNs and colon were amplified with specific primers designed by the 16SrRNA sequence of the species obtained from blood,livers and spleens.Pyrosequencing was used to analyze the ileum and colonic microbio.me of each subject.Intestinal permeability to 99mTc-DTPA,plasma hs-CRP,and IL-6 were measured.Results Bacterial DNA in extraiutestinal sites and altered colonic microbiomes at the phylum,family,and genus levels were detected in some rats in the uremic group.Bacterial genomic DNA in MLNs and colon were obtained by primers specific for bacterial species observed from blood,livers,and spleens of identical individuals.Intestinal permeability,plasma hs-CRP,and IL-6 levels were statistically higher in the uremic group compared with that in sham group(all P ＜ 0.05).Conclusion Gut microbiome dysbiosis occurs and presumably bacteria translocate to the systemic and lymph circulation,thereby contributing to microinflammation in experimental uremia.
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To evaluate the efficacy and safety of Tanreqing Injection, a compound traditional Chinese herbal medicine, for community-acquired pneumonia.
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To evaluate the efficacy and safety of new drugs of traditional Chinese medicine (TCM) for acute upper respiratory tract infection (common cold).
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There are many medical students who make artificial data in their scientific research and scientific paper.Therefore,it's very urgent to carry on the ethical education of scientific research to medical students.This article tries to make some ethical discussion on the responsibility of the scientific research monality of medical students.
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Objective To study the dynamic changes and clinical significance of D-D, t-PA and PAI in patients with acute renal failure during the process of different methods of blood purification. Methods Thirty-seven ARF patients were divided into three groups: HD group, HDF group and HF group. Plasma D-D level, t-PA and PAI activity were determined 1 hour, 4 hours before and after treatment. Normal control group consisted of fourteen healthy people. Results ① Plasma D-D level and PAI activity in ARF patients were obviously higher than those in control group, while t-PA activity was lower(P0.05). ③ After 4 hours of the treatment, compared with HD group, HDF and HF groups had significant difference in plasma D-D level, t-PA and PAI activity(P
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Objective To observe the removal of tumor necrosis factor-? (TNF-? ), interleukin-6 (IL-6) and endothelin-1 (ET-1) in continuous renal replacement therapy (CRRT) on hemorrhagic fever with renal syndrome (HFRS) patients, and investigate the effect of inflammatory mediators on HFRS. Methods A total of 40 patients with moderate or more severe HFRS were divided into two groups randomly. Continuous venous-venous hemofiltration (CVVH) was applied to the 20 cases in CVVH group, and hemodialysis (HD) was applied to the 20 cases in HD group. The levels of TNF-? and IL-6 were measured by enzyme-linked immunosorbent assay (ELISA), and ET-1 level was measured by radioimmunoassays (RIA). Results ① In comparing CVVH and HD groups, the days of oliguria (3.0?2.1, 6.0?3.4), incidence of complications (25%, 40%), and mortality (15%, 25%) had significant differences (P0.05). ④ In CVVH group, IL-6 and ET-1 could be detected constantly in filtrate, but TNF-? was not detectable. TNF-?, IL-6 and ET-1 were not detectable in dialysate. Conclusion Continuous blood purification can remove plasma inflammatory mediators. Therefore, it is helpful in recovering renal function, improving the prognosis of HFRS, and decreasing complications and mortality. CVVH is one of the best methods to treat HFRS.