Survival analysis of hemodialysis patients aged 80 years and over / 中华老年医学杂志

Objective:To investigate the long-term survival rate and the influencing factors for prognosis in patients aged 80 years and over who underwent hemodialysis.Methods:Clinical data of 82 patients with end stage renal disease (ESRD) who started dialysis in≥80 years of age and underwent hemodialysis for more than three months in our hospital from May 2008 to May 2017 were retrospectively analyzed.Kaplan-Meier method was used to analyze the survival rate of patients.Log-rank test was used to compare survival rate of hemodialysis patients aged≥80 years versus aged<80 years.Cox regression model was performed to analyze the influencing factors for prognosis in elderly patients undergoing hemodialysis.Results:The median survival time of 82 hemodialysis patients aged≥80 years was 34 months, and their 6-month, 12-month, 24-month and 36-month survival rates were 90.0%, 73.6%, 60.8% and 49.4%, respectively.The top three death causes were cardiovascular events, septic shock, and malignant tumors.The median survival time of the hemodialysis patients aged<80 years was 52 months, and their 6-month, 12-month, 24-month and 36-month survival rates were 94.7%, 85.5%, 72.4% and 65.8%, respectively.Log-rank test demonstrated that the survival rate was lower in patients aged≥80 years than in patients aged<80 years( χ2=5.284, P=0.022). Multivariate Cox regression analysis indicated that diabetes mellitus was an independent risk factor for the survival in hemodialysis patients aged≥80 years( HR=3.470, 95% CI: 1.364~8.827, P=0.009), while targeted levels of body mass index(BMI)( HR=0.806, 95% CI: 0.706~0.921, P=0.001)and serum albumin level( HR=0.861, 95% CI: 0.789~0.938, P=0.001)were the independent protective factors for the survival in hemodialysis patients aged≥80 years. Conclusions:The survival rate is lower in hemodialysis patients aged≥80 years than in those aged<80 years.The top death causes is cardiovascular events, septic shock, and malignant tumors.Diabetes mellitus, low levels of BMI and serum albumin are the main risk factors for the survival in advanced elderly patients undergoing hemodialysis.

RIP3-mediated necroptosis induced by radiation injury in neuronal cells / 中华放射肿瘤学杂志

Objective:To observe the presence or absence of necroptosis in PC12 cells after radiation injury, and to detect the expression of receptor-interacting protein 3(RIP3) and evaluate its regulatory effect on necroptosis.Methods:PC12 cells were treated with different doses of irradiation and their necroptosis was detected by lactate dehydrogenase (LDH) release at different time points. After pretreatment with necroptosis inhibitor Necrostatin-1(Nec-1), the changes of cell necroptosis were detected by LDH. The expression level of RIP3 after irradiation intervention was detected by Western blot (WB). After pretreatment with the RIP3-specific inhibitor GSK′872, the changes of cell necroptosis were detected by LDH. The best transfection sequence of RIP3 knockout was screened by WB. The cells were divided into the control group, irradiation group, solvent control group, no-load control group and pretreatment group. WB, immunofluorescence staining, MTT, LDH and Annex V-fluorescein Isothiocyanate/Propidium Iodide (AnnexV-FITC/PI) flow cytometry were used for detection and analysis.Results:After 4 Gy irradiation, the degree of cell necrosis was the highest after 3 hours of culture, and the expression level of RIP3 protein was up-regulated. The cell necrosis was decreased after Nec-1, GSK′872 and RIP3 gene knockdown pretreatment.Conclusions:The radiation injury of 4 Gy can induce the necroptosis of PC12 cells, and the most significant effect can be observed when cultured for 3 hours after irradiation. RIP3 is involved in the process of necroptosis of PC12 cells induced by radiation injury, and plays a pivotal positive regulatory role.

Observation on the influence of ademetionine for the proteometabolism and fibrosis indexes of patients with chronic hepatitis B / 中国生化药物杂志

Objective To observe the influence of ademetionine for the proteometabolism and fibrosis indexes of patients with chronic hepatitis B.Methods110 patients with chronic hepatitis B in our hospital from January to December 2016 were randomly divided into control group(conventional treatment of hepatitis B group)55 cases and observation group(conventional treatment and ademetionine group)55 cases.The serum expression levels of proteometabolism and fibrosis indexes of two groups before the treatment and after the treatment were detected and compared.ResultsThe serum expression levels of proteometabolism and fibrosis indexes of two groups before the treatment were compared,there were no significant differences,while the serum expression levels of proteometabolism indexes of observation group after the treatment were all higher than those of control group,the serum expression levels of fibrosis indexes were all lower than those of control group,there were all significant differences(all P<0.05).ConclusionThe ademetionine can significantly improve the expression state of proteometabolism and fibrosis indexes of patients with chronic hepatitis B,so the application value for the patients with chronic hepatitis B is relatively higher.

Protective effect of astragaloside Ⅳ on high glucose-induced podocyte adhesion and its mechanism / 中华肾脏病杂志

ObjectiveTo study the effect of astragaloside Ⅳ(AS-Ⅳ) on glucose-induced podocyte adhesion and its possible mechanism. MethodsConditionally immortalized mouse podoeytes were treated with 10, 50, 100 mg/L AS-Ⅳ and with 100 mg/L AS-Ⅳ for 3, 6, 12, 24 h. Cell attachment was measured by fluorescence and centrifugation cell adhesion assays, respectively. Expression of α3β1 integrin mRNA and protein was examined by real-time PCR and Western blot. ResultsHigh glucose induced a significant reduction in adherent podocytes compared to normal glucose group (P<0.05). AS-Ⅳ improved high glucose-induced podocyte adhesion in a time- and dose-dependent manner. Real-time PCR and Western blot analysis revealed that high glucose-induced down-regulation of α3β1 integrin in podocytes were significantly meliorated by AS-Ⅳ (P<0.05). ConclusionAstragaloside Ⅳ improved high glucose-induced podocyte adhesion which may be mediated through α3β1 integrin up-regulation.

Contrast-induced nephropathy in the elderly and the correlated clinical risk factors / 中华老年医学杂志

Objective To investigate the incidence of contrast-induced nephropathy (CIN) in the elderly undergoing coronary angiography and the correlated clinical risk factors.Methods 0.90% sodium chloride (1 ml · kg~-1 · h~-1 ) was administered 6 hours before and 12 hours after contrast media administration for 195 elderly patients,and the dose of sodium chloride was half when the patients were suffering from severe congestive heart failure.The levels of serum creatinine (Scr) and cystatin C were measured 3 days before and on the 2nd,5th day after the administration of contrast,respectively .Results(1) The incidence of CIN was 8.7% (17/195).The renal function of 11 cases recovered to baseline level 3 months after the use of contrast,2 cases had transformation to chronic renal failure but without undergoing maintenance hemodialysis,and 3 cases were dependent on maintenance hemodialysis,while 1 case developed multiple organ dysfunction until death.(2) There was no significant difference between pre-and post-contrast administration in the level of cystatin C (t=O.137,P= 0.891). But the concentration of Scr was reduced significantly on the 2nd day compared with the baseline (t=4.776,P = 0.000).Both the cystatin C and Scr recovered to the baseline on the 5th day.(3) There were no significant differences between the CIN and non-CIN group in gender,the dose of contrast,the baseline Scr,and the proportion of coronary heart disease.But there were significant differences in age,the baseline serum cystatin C,the proportions of diabetes mellitus,hypertension and congestive heart failure.(4) The clinical risk factors of CIN were the baseline Scr (OR = 1.039),the baseline serum cystatin C (OR=6.654),diabetes mellitus (OR=8.104) and congestive heart failure (OR=9.597) according to the analysis of logistic regression.ConclusionsWith the hydration and the use of low-osmolar nonionic contrast,it is safe to receive contrast examination for the elderly patients.The baseline serum levels of Scrand cystatin C,diabetes mellitus and congestive heart failure are the clinical risk factors of CIN.Compared with Scr,serum cystatin C is the more powerful predictor for the development of CIN.

A randomized, controlled clinical trial on meropenem versus imipenem/cilastatin for the treatment of bacterial infections / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of meropenem in Chinese patients, we conducted a study for the treatment of patients with lower respiratory tract infections, urinary tract infections and other infections.</p><p><b>METHODS</b>A total of 182 hospitalized patients were enrolled in the study. 90 patients received 500 mg meropenem every 12 hours (or 1 g every 12 hours if necessary) and 92 patients received imipenem/cilastatin 500 mg/500 mg every 12 hours (or 1 g every 12 hours if necessary) by intravenous infusion. The duration of treatment was 7 - 14 days for both groups.</p><p><b>RESULTS</b>Seventy of 90 cases receiving meropenem and 70 of 92 cases receiving imipenem/cilastatin were assessable for clinical efficacy. The overall efficacy rates were 90% for the meropenem group and 87% for the imipenem/cilastatin group, and the bacterial eradication rates were 86% in both groups. 93 (76%) of 123 strains isolated from patients produced beta-lactamases. Adverse drug reactions were evaluated in 72 cases in the meropenem group and 70 cases in the imipenem/cilastatin group. The adverse drug reaction rates were 9.7% and 8.6%, respectively. The results showed that there were no statistical differences between these two groups (P > 0.05).</p><p><b>CONCLUSION</b>Meropenem is effective and safe for the treatment of bacterial infections caused mainly by beta-lactamase-producing strains.</p>

The association between anti-basement membrane zone antibodies and clinical manifestations in patients with systemic lupus erythematosus / 中华风湿病学杂志

Objectives To detect anti-basement membrane zone(BMZ)antibodies in systemic lupus ery-thematosus(SLE)patients and to explore its association with clinical manifestations.Methods Anti-BMZ anti-bodies were examined by indirect immunofluorescence in the sera of70patients with SLE.The correlation between anti-BMZ antibodies and clinical data of SLE was analyzed.Results Anti-BMZ antibodies could be found in the sera of about70%SLE patients,including IgG,IgM,IgA.They predominantly bound to the epidermis,but also bound to the dermis or both.The positive rate of anti-BMZ antibodies was significantly higher in patients with skin lesions than that of patients without skin lesions.There is no significant difference between the two groups in ac-tive and remission,kidney involvement,arthritis,alopecia,photoallergy,positive anti-dsDNA antibodies and the posi-tive rate of anti-BMZ antibodies.Conclusion Anti-BMZ antibodies presents in the sera of SLE patients with high positive rate.It is correlated with the development of skin lesions of SLE patients,but not with the activity of SLE,other clinical manifestations and anti-dsDNA antibodies.Anti-BMZ antibodies may be involved in the pathogenlic mechanism of the development of skin lesions in SLE patients.