Association of adequate dietary phosphate restriction education and phosphorus management in maintenance hemodialysis patients / 中华肾脏病杂志

Objective:To explore the effects of dietary phosphate restriction education on serum phosphorus level, dietary phosphate intake and the knowledge of hyperphosphatemia in maintenance hemodialysis (MHD) patients.Methods:This study was a retrospective cohort study. A total of 116 hemodialysis patients in Huashan Hospital, Huadong Hospital and Tongji Hospital from October 2019 to December 2020 were enrolled in this study. They were divided into short-term group (84 cases) and long-term group (32 cases). The short-term group did not receive education or received education≤60 minutes. Meanwhile, the long-term group received education>60 minutes. Serum phosphorus level, dietary phosphate intake and knowledge of hyperphosphatemia were compared between the two groups after 4 weeks.Results:At baseline, age [64(56, 69) years old vs 65(60, 73) years old, Z=-1.493, P=0.136], the proportion of males [58.3%(49/84) vs 56.3%(18/32), χ2=0.041, P=0.839], dialysis age [55(26, 130) months vs 53(20, 132) months, Z=-0.062, P=0.951], body mass index, diabetes history, single-pool Kt/V, proportion of calctriol used, blood calcium, blood phosphorus, intact parathyroid hormone and dietary protein, dietary phosphorus and dietary phosphorus protein ratio had no statistical significance between short-term group and long-term group (all P>0.05). Adequate dietary phosphate restriction education reduced dietary phosphate intake [777.98(653.81, 943.16) mg/d vs 896.56(801.51, 1 015.51) mg/d, Z=-2.903, P=0.004], phosphate/protein ratio [13.16(11.52, 14.21) mg/g vs 15.27(13.31, 17.48) mg/g, Z=-3.929, P<0.001] and serum phosphorus level [(1.42±0.37) mmol/L vs (1.85±0.44) mmol/L, t=4.984, P<0.001]. Meanwhile, such education significantly improved achievement rate of serum phosphorus (62.5% vs 41.7%, χ2=4.034, P=0.045). In addition, patients in long-term group answered more questions correctly (completely correct plus partially correct) about the causes (93.8% vs 72.6%, χ2=6.120, P=0.013), poor prognosis (78.1% vs 52.4%, χ2=6.372, P=0.012) of hyperphosphatemia as well as the types of food with high phosphate (65.6% vs 52.4%, χ2=1.650, P=0.199). Conclusion:Adequate dietary phosphate restriction education reduces serum phosphorus level and dietary phosphate intake, and improves the knowledge of hyperphosphatemia in MHD patients.

Practice of a hemodialysis alliance in the context of closed-loop hospital management / 中华医院管理杂志

Closed-loop hospital management can effectivly cope with the COVID-19 pandemic. In order to ensure the continuity of treatments for hemodialysis patients under closed-loop management and minimize possible medical and infection risks, Huashan Hospital affiliated to Fudan University and 9 hospitals in Shanghai established a hemodialysis alliance in January 2021.The alliance optimized hemodialysis resources within the region through overall planning by preparing sites, materials and personnel shifts in advance, and establishing management systems and work processes to ensure that patients could be quickly and orderly diverted to other blood dialysis centers for uninterrupted high-quality hemodialysis services, in case that some hemodialysis centers in the alliance under closed-loop management.From November 2021 to April 2022, 317 of 1 459 hemodialysis patients in the alliance were diverted to other centers for treatment, accumulating 1 215 times/cases of treatments without obvious adverse reactions. The practice could provide a reference for medical institutions to quickly establish mutual support mode under major public health events.

Impaired Na⁺−K⁺-ATPase signaling in renal proximal tubule contributes to hyperuricemia-induced renal tubular injury

Hyperuricemia contributes to renal inflammation. We aimed to investigate the role of Na⁺–K⁺–ATPase (NKA) in hyperuricemia-induced renal tubular injury. Human primary proximal tubular epithelial cells (PTECs) were incubated with uric acid (UA) at increasing doses or for increasing lengths of time. PTECs were then stimulated by pre-incubation with an NKA α1 expression vector or small interfering RNA before UA (100 μg ml⁻¹, 48 h) stimulation. Hyperuricemic rats were induced by gastric oxonic acid and treated with febuxostat (Feb). ATP levels, the activity of NKA and expression of its α1 subunit, Src, NOD-like receptor pyrin domain-containing protein 3 (NLRP3) and interleukin 1β (IL-1β) were measured both in vitro and in vivo. Beginning at concentrations of 100 μg ml−1, UA started to dose-dependently reduce NKA activity. UA at a concentration of 100 μg ml⁻¹ time-dependently affected the NKA activity, with the maximal increased NKA activity at 24 h, but the activity started to decrease after 48 h. This inhibitory effect of UA on NKA activity at 48 h was in addition to a decrease in NKA α1 expression in the cell membrane, but an increase in lysosomes. This process also involved the subsequent activation of Src kinase and NLRP3, promoting IL-1β processing. In hyperuricemic rats, renal cortex NKA activity and its α1 expression were upregulated at the 7th week and both decreased at the 10th week, accompanied with increased renal cortex expression of Src, NLRP3 and IL-1β. The UA levels were reduced and renal tubular injuries in hyperuricemic rats were alleviated in the Feb group. Our data suggested that the impairment of NKA and its consequent regulation of Src, NLRP3 and IL-1β in the renal proximal tubule contributed to hyperuricemia-induced renal tubular injury.

Role and significance of sentinel lymph node biopsy for the treatment of melanoma of the extremities / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the role of sentinel lymph node biopsy (SLNB) for the treatment of melanoma of the extremities.</p><p><b>METHODS</b>From April 2007 to August 2013, forty-eight (25 men and 23 women) cases of melanoma of the extremities underwent sentinel lymph node biopsy. All the cases had sentinel lymph node biopsy and surgery. Among them 37 cases underwent limb salvage surgery, while 11 cases underwent amputation. Of the cases with limb salvage, 28 cases underwent free skin grafting or local flap grafting reconstruction after wide resection. Of the surgical margin, wide resection was performed in 37 patients, and radical resection was performed in 11 cases. There were 39 cases in stage I or II, and 9 cases in stage III. After the surgery, adjuvant chemotherapy was performed in 9 cases, and adjuvant biotherapy of interferon and interleukin was performed in 26 cases. Except for 2 cases, 46 cases were followed up with a mean follow-up period of 20.1 months (range from 2 to 60 months).</p><p><b>RESULTS</b>39 (81.3%) cases had negative SLNB, while 9 (18.8%) cases had positive SLNB. Recurrence or metastasis was more common in those with positive SLNB (3 of 9 cases, 33.3%) compared with those with negative SLNB (4 of 39 cases, 10.3%). The median disease-free survival of patients with negative results was 19.5 months, significantly longer than that of the positive cases (9.5 months, P = 0.03). Otherwise, sex and age showed no significant difference in the disease free survivals.</p><p><b>CONCLUSIONS</b>Sentinel lymph node biopsy enables us to have a better understanding of regional lymph node status through lymphoscintigraphy. It improves the accuracy of staging and provides valuable prognostic information to guide subsequent treatment decisions.</p>

Effect of remote limb ischemic postconditioning on level of adiponectin during myocardial ischemia-reperfusion in rats / 中华麻醉学杂志

Objective To evaluate the effect of remote limb ischemic postconditioning on the level of adiponectin during myocardial ischemia-reperfusion (I/R) in rats.Methods Fifty-seven male Sprague-Dawley rats,aged 8 weeks,weighing 250-350 g,were randomly divided into 3 groups (n =19 each):sham operation group (group S); group I/R; remote limb ischemic postconditioning group (group RLIP).Myocardial ischemia was induced by occlusion of anterior descending branch of left coronary artery for 30 min followed by 180 min reperfusion in urethane-anesthetized rats.In group S,the anterior descending branch was only exposed but not ligated.The animals underwent 10 min ischemia of bilateral hind limbs starting from 20 min of occlusion of the anterior descending branch,followed by reperfusion in RLIP group.The changes in S-T segment were recorded at 30,60,120 and 180 min of reperfusion.At 180 min of reperfusion,the blood samples were taken from the jugular vein for determination of serum levels of creatine kinase MB (CK-MB) and cardiac troponin Ⅰ (cTnⅠ).The animals were then sacrificed and hearts were removed for measurement of myocardial infarct size (IS) and adiponectin contents in myocardial tissues (by ELISA).Results Compared with group S,S-T segment was significantly elevated at each time point,myocardial IS,and serum cTnⅠ and CK-MB levels were increased,and adiponectin contents were decreased in I/R and RLIP groups.Compared with group I/R,elevation of S-T segment was significantly decreased at each time point,myocardial IS,and serum cTnⅠ and CK-MB levels were decreased,and adiponectin contents were increased in RLIP group.Conclusion The mechanism by which remote limb ischemic postconditioning reduces myocardial I/R injury is related to increased level of adiponectin in the myocardium of rats.

Soft tissue leiomyosarcoma of the trunk and extremities:a retrospective analysis of 18 cases / 中国综合临床

Objective To explore the clinical feature,suitable treatment and prognosis of soft tissue leiomyosarcoma of the trunk and extremities.Methods Clinical data of 18 cases of pathologically confirmed soft tissue leiomyosarcoma of the trunk and extremities from January 1999 to December 2012 were analyzed retrospectively.Primary tumors in 7 cases were marginally excised before admitted to our hospital,2 had open biopsy before admission to our hospital,and 8 cases had local relapse at admission; Only one patient took our institute as the first visit.Seventeen cases were performed extended excision of tumors and 1 case underwent marginal resection.All the patients were followed up and the follow-up period was from 16 to 158 months.Results During follow-up period,9 patients developed lung metastasis,and local recurrence occurred in 5 patients.Ten patients died and 8 survived.Of the ten dead cases,seven died of tumor progression and 3 died from non-tumor factors.In the 8 patients survived,2 survived with tumor.The 5-year overall survival rate was 59.2％.Conclusion Soft tissue leiomyosarcoma of the trunk and extremities are rare malignant tumors,mostly occurred in elder patients and presenting soft tissue mass.Local recurrence and distant metastasis are common and associated with a poor prognosis.Surgical excision combined with adjuvant radiation is the common treatment strategy.

Serum concentrations of tumor markers in patients with chronic kidney diseases and the analysis of related factors / 中国实用内科杂志

Objective Our study intended to check whether there are any changes of serum concentrations of tumor markers in patients with chronic kidney disease,and to determine the related factors.Methods Atotal of 232 hospitalized patients in Nephrology Department in Zhongshan Hospital of Fudan University from March to June in 2005 were divided into groups respectively according to their levels of Ccr,Upro and Salb.Then Kruskal-Wallis test was applied to confirm the relationships among Ccr,Upro,Salb and serum tumor markers.Furthermore,multielement logistic regression was used to analyze the independent effect of age,Ccr,effusion in serous cavity,the levels of proteinuria and serum albumin on the levels of these markers in CKD patients.Results The serum levels of CEA,CA 199,NSE and SCC in different Ccr groups,the levels of CA 199,CA125,NSE and SCC in different Salb groups,the levels of CA 125,NSE and SCC in different Upro groups,had significant statistical differences.Age was the risk factor of the increased levels of CEA and PSA;effusion in serous cavity was the risk factor of increased levels of CA 125.The decreased level of Ccr was the risk factor of CA 125 and SCC.The elevated Upro was the risk factor of SCC.The decreased Salb was the risk factor of CA 199,CA 125 and NSE.Conclusion When we diagnose some tumors according to their serum levels of tumor markers such as CEA,CA 199,CA 125,NSE,SCC and PSA,we must note that whether the patients are aged or have complications such as large proteinuria,hypoalbuminemia,effusion in serous cavity or decreased kidney function.

Lipid profiles of patients on continuous ambulatory peritoneal dialysis / 中国实用内科杂志

Objectives To investigate the serum lipid profiles in patients with continuous ambulatory peritoneal dialysis(CAPD).Methods Serum lipid levels were cross-sectional and prospective investigated in patients with CAPD.Results Compared with those in normal controls,serum TG and apoB increased while HDL,HDL 2,apo A1/apoB and LCAT activity decreased significantly in CAPD patients.TC,LDL-ch and Lp(a) also increased in CAPD patients.Serum Lp(a),LDL-ch,apoB and apoE increased significantly following the CAPD therapy.Conclusions Hyperlipidemia is quite common in CAPD patients and serum lipid levels may change with the time on CAPD.

Expression of IL-1ra mRNA and dysfunction of phagocytosis and intracellular killing of peripheral blood neutrophils in HD patients / 第二军医大学学报

Objective: To investigate the function and IL 1ra gene expression of neutrophils in hemodialysis (HD) patients. Methods: Gene expression was studied by reverse transcribe polymerase chain reaction (RT PCR) from untreated neutrophils in healthy controls and HD patients. Phagocytosis and bactericidal assays decreased in the number of viable extracellular and intracellular bacteria by colony counts. Results: Freshly isolated neutrophils spontaneously expressed icIL 1ra, sIL 1ra mRNA in HD patients. Phagocytosis and intracellular killing of neutrophils in HD patients impaired obviously when exposed to staphylococcus aureus in comparison with healthy controls. Conclusion: Untreated neutrophils in HD patients spontaneously express icIL 1ra and sIL 1ra mRNA, which is consistent with the suppressed phagocytosis and intracellular killing capacity. [

Protective effect of peritoneal dialysis on patients with acute hemorrhagic necrotic pancreatitis / 中华肾脏病杂志

Objective To explore the protective effects of peritoneal dialysis on tissue and organ damage induced by acute hemorrhagic necrotic pancreatitis (AHNP) . Methods Thirty-four AHNP patients were randomly divided into PD group ( n = 21) and control group (n=13). Control group was treated with conventional therapy, while PD group was treated with conventional therapy companied by intermittent peritonea] dialysis (IPD). Urinary and serum amylase, the plasma levels of TNF and IL-1, faecal occult blood test and serum leucocyte were examined. Functions of brain, kidney , liver and heart were observed. Results The protective effect was better in PD group than that in normal group (P

Abnormal prostaglandin production in pathogenesis of chronic renal failure induced by cane of Aristolochia manshuriensis / 中草药

Object To understand if abnormal prostaglandin production is involved in the pathogenesis of chronic renal failure induced by the cane of Aristolochia manshuriensis Kom. Methods Rats in experimental group were given 10 g/kg of the cane of A. manshuriensis everyday for eight weeks. The control group was given the same amount of tap water. At the 8th week, kidney pathology, renal function, serum creatinine (SCr), blood urea nitrogen (BUN) and urinary protein excretion were recorded. The content of 6 keto PGF 1? and TXB 2 in the urine, plasma and renal cortex tissues were determined. Results The urinary protein excretion, SCr and BUN had been significantly increased in rat experimental group. Microscopic examination of the kidney revealed focal degeneration and necrosis of tubular epithelial cells and slight intersititial fibrosis. The ratio of 6 keto PGF 1? /TXB 2 was markedly decreased in the urine, plasma as well as renal cortex tissues. Conclusion Abnormal prostaglandin production is an important pathogenic factor in the pathogenesis of chronic renal failure induced by the cane of A. manshuriensis

Experimental study of the nephrotoxicity of Guangfangji / 中国药理学通报

AIM To study the nephrotoxicity of various doses of Guangfangji . METHODS Normal Wistar rats were given 1, 5 and 10 g?kg -1 of Guangfangji respectively. Renal pathology and function were observed. RESULTS Rats given 1 g?kg -1 of Guangfangji for 8 weeks showed normal renal function and histology Rats given 5 g?kg -1 of Guangfangji significantly increased 24 hour urinary protein excretion Tubular degeneration and interstitial edema was observed Blood urea nitrogen (BUN) and serum creactinine (Scr) remained in the normal range BUN and Scr increased significantly in the group given 10 g?kg -1 of Guangfangji for 4 weeks The tubulointerstitial abnormalities were more severe in the group given 5 g?kg -1 of Guangfangji CONCLUSION Longterm use of pharmacopoeial dose of Guangfangji shows no harm to the kidney.Renal injury may occur if relatively large dose of Guangfangji is given and the period of treatment using this drug is relatively longer

Progress in the study of chinese herbs nephropathy / 中国药理学通报

Kidney damage caused by inappropriate use of some chinese herb drugs are quite common in our country. This review give a brief introduction of those reports concened, which include the most frequently used herb drugs of Aristolochia and their main components, the pharmacokinetic of Aristolochic acid, the different clinical manifestation of chinese herb nephropathy and the possible mechanism of the nephrotoxicity of Aristolochic acid.