Clinical application of the full-stack smart pelvic floor ultrasound to acquire and measure the minimal levator hiatus plane / 中华超声影像学杂志

Objective:To evaluate the feasibility of Full-stack Smart Pelvic Floor Ultrasound (FSPFU) software in the acquisition and measurement of the minimal levator hiatus (LH).Methods:Transperineal pelvic floor ultrasonography was performed in 119 women of 6-month postpartum from Nov.2020 to Jan.2021 of Shenzhen Second People′s Hospital. Mid-sagittal plane of pelvic floor was set as the initial plane, and the three-dimensional volume data was acquired. The dataset was stored in the machine. The offline volume data was manually adjusted to obtain the minimal LH images and measured by four physicians (two junior physicians as the D1 group and two senior physicians as the D2 group). For comparison, the results were also obtained using the fully automated method—the FSPFU software by a junior physician (the D3 group). The obtained parameters of minimal LH included area, circumference, anterioposterior diameter, transverse diameter, left and right levator-urethral gap distance. Analysis time was recorded for each group. The contours of minimal LH were outlined by three groups and the overlapping rate was calculated. The quality of the resulted images was evaluated and scored by another two senior physicians(A and B) independently.Results:The D3 group had a significant shorter analysis time compared with the other two groups, and the D1 group took a longer time than the D2 group, regardless of the cystocele severity (D1: 82.97 s, D2: 62.51 s, D3: 2.71 s, all P<0.05). The intergroup agreements and correlations of the minimum LH area were good (all ICC>0.85, rs>0.70, P<0.001) and the outlined contours were largely overlapped (>92%). There was no significant difference in image quality among the three groups(all P>0.05). Conclusions:FSPFU software can automatically obtain and measure the minimum LH in an efficient and accurate way, which can improve the effectiveness of the present pelvic floor examination. FSPFU software can be an useful tool in the diagnosis of pelvic floor dysfunctional diseases.

Single center analysis of evolution characteristics of renal disease spectrum in Ningxia from 2008 to 2019 / 中华肾脏病杂志

Objective:To explore the characteristics and evolution trend of renal disease spectrum in Ningxia.Methods:The demographic, clinical manifestations and renal pathological examination results of patients who underwent renal biopsies in the General Hospital of Ningxia Medical University from August 1, 2008 to December 31, 2019 were collected and analyzed retrospectively. According to the time period of receiving renal biopsy, the patients were divided into 2008—2013 group and 2014—2019 group. The age and sex constituent, clinical manifestation, renal disease type, pathological types of primary and secondary glomerular disease and the main clinical manifestations of patients with diabetic nephropathy were compared between the two groups. The changing trend of renal disease spectrum in Ningxia from 2008 to 2019 was analyzed.Results:A total of 3 867 patients who underwent renal biopsies were enrolled in this study, with more males (53.71%, 2 077/3 867), and age of (39.59±14.05) years old. The most common clinical manifestation of patients receiving renal biopsies was nephrotic syndrome (36.33%, 1 405/3 867). Among them, primary glomerular diseases accounted for 78.79% (3047/3 867), followed by secondary glomerular diseases (18.57%, 718/3 867), renal tubulointerstitial diseases (1.45%, 56/3 867) and hereditary nephropathy (1.19%, 46/3 867). The most common primary glomerular disease was IgA nephropathy (44.60%, 1 359/3 047), followed by membranous nephropathy (30.75%, 937/3 047). The most common secondary glomerular disease was Henoch-Sch?nlein purpura nephritis (27.44%, 197/718), followed by lupus nephritis (25.07%, 180/718). Compared with the 2008—2013 group, the proportion of membranous nephropathy increased, the proportion of mesangial proliferative glomerulonephritis (non-IgA deposition) decreased (both P<0.001), the proportions of diabetic nephropathy and hypertensive renal damage increased, and the proportions of Henoch-Sch?nlein purpura nephritis and hepatitis B virus-associated glomerulonephritis decreased in 2014—2019 group (all P<0.01). Compared with the 2008—2013 group, the proportions of acute kidney injury, chronic renal failure, simple hematuria and urinary protein≤1.0 g/24 h increased in kidney biopsy patients in 2014—2019 group, while the proportion of nephrotic syndrome decreased (all P<0.05). Compared with the 2008—2013 group, the proportion of chronic renal failure in diabetic nephropathy patients increased during renal biopsy, and the proportion of albuminuria with hematuria decreased in 2014—2019 group (all P<0.05). Conclusions:Primary glomerular disease is the most common kidney disease in Ningxia. IgA nephropathy is the most common cause, and the proportion of membranous nephropathy is increasing year by year. Henoch-Sch?nlein purpura nephritis is the most common secondary glomerular disease, and the proportions of diabetic nephropathy and hypertensive renal damage are increasing year by year, suggesting that the screening of renal complications of metabolic diseases in Ningxia should be strengthened and pay more attention to the patients with mild abnormal urine test.

Correlation between aortic arch calcification and arteriovenous fistula failure in maintenance hemodialysis patients / 中华肾脏病杂志

Objective:To explore the relationship between aortic arch calcification (AoAC) and arteriovenous fistula (AVF) failure in maintenance hemodialysis (MHD) patients.Methods:The patients who underwent initial AVF and started MHD in the General Hospital of Ningxia Medical University from September 2016 to September 2017 were retrospectively recruited and prospectively followed up until two years after AVF surgery or withdrawal from MHD or death. Calcification of the aortic arch was estimated with plain chest radiology. The patients were divided into four groups (0-3 grade) according to the aortic arch calcification score (AoACs). Spearman correlation analysis was used to analyze the relationship between AoACs and AVF failure. Multivariate logistic regression was used to analyze the influencing factors of AVF failure.Results:A total of 165 MHD patients were included in this study, with age of (55.52±14.06) years old and 102 males (61.82%). Among 128 AoAC patients (77.6%), 45 patients were categorized as grade 1 (27.3%), 35 patients as grade 2 (21.2%) and 48 patients as grade 3 (29.1%). There was significant difference in the, age, pulse pressure, corrected calcium, phosphorus, diastolic blood pressure, intact parathyroid hormone and AVF failure between AoAC group and no AoAC group (grade 0 calcification) (all P<0.05). The results of Spearman correlation analysis showed that AoACs was positively correlated with AVF failure ( r=0.759, P=0.010), age ( r=0.407, P<0.001), pulse pressure ( r=0.575, P=0.006), and diabetes history ( r=0.848, P=0.049), blood calcium ( r=0.591, P=0.018), and blood phosphorus ( r=0.509, P=0.012), and negatively correlated with diastolic blood pressure ( r=-0.614, P=0.013). Multivariate logistic regression analysis showed that diabetes history ( OR=6.702, 95% CI 1.431-31.396, P=0.016), high corrected calcium ( OR=10.830, 95% CI 3.479-35.300, P=0.008), high phosphorus ( OR=3.792, 95% CI 1.128-12.750, P=0.031) and AoAC ( OR=4.473, 95% CI 1.490-13.428, P=0.008) were the independent influencing factors of AVF failure. Conclusions:AoAC is an independent risk factor for AVF failure in MHD patients. Evaluation of AoAC has predictive value for AVF failure.

The study on brain biometry and cerebral hemodynamics in fetuses with hypoplastic left heart syndrome in the second trimester of gestation / 中华超声影像学杂志

Objective:To explore the changes of biparietal diameter, head circumference and cerebrovascular hemodynamics in fetuses with hypoplastic left heart syndrome (HLHS) during middle pregnancy.Methods:The biparietal diameter, head circumference, middle cerebral artery pulsatility index (MCA-PI), umbilical artery pulsatility index (UA-PI) and MCA-PI/UA-PI (CPR) of 41 fetuses with HLHS(HLHS group) were retrospectively analyzed from January 2015 to December 2019 in Beijing Anzhen Hospital, and were compared with those of 82 normal fetuses matched for gestational age at the same period (control group).Results:The Z-scores of head circumference, MCA-PI and CPR in with HLHS group were lower than in control group(all P<0.05); Head circumference in HLHS group were weakly and positively correlated with the MCA-PI and CPR ( r=0.385, 0.416; all P<0.05). Conclusions:There are some changes in the head circumference and cerebral hemodynamics in fetuses with HLHS during mid-gestational age, and the head circumference is weakly and positively correlated with MCA-PI and CPR, which has clinical significance.

Effect of hemoglobin volatility on cardiovascular prognosis in peritoneal dialysis patients / 中华肾脏病杂志

Objective:To investigate the effect of hemoglobin (Hb) volatility on cardiovascular prognosis in peritoneal dialysis (PD) patients.Methods:Retrospective cohort study was designed. Patients undergoing stable PD for more than 3 months and followed up regularly for at least 1 year were enrolled from May 1, 2013 to October 31, 2014 in the General Hospital of Ningxia Medical University. According to the Hb variation based on the mean changes in Hb standard deviation at 1 month, 3 months, 6 months, 12 months over baseline Hb, all patients were divided into low volatility group (≤10 g/L), moderate volatility group (>10-20 g/L) and high volatility group (>20 g/L), and baseline information were compared among these groups. Kaplan-Meier survival analysis and Cox regression equation were used to analyze the relationship between Hb variation and cardiovascular mortality and all-cause mortality. Besides, the patients were divided into qualified group (Hb≥110 g/L) and substandard group (Hb<110 g/L) by the Hb level at the study endpoint (cardiovascular death and all-cause death) according to KDIGO guidelines and relevant literature. Cox regression analysis was used to analyze the relationship between Hb variation and cardiovascular death in qualified group or substandard group. Multivariate linear regression analysis was used to analyze the related factors of Hb fluctuation in PD patients.Results:A total of 267 patients were enrolled. There were 160 males (59.93%) in this study. The age was (52.66±13.72) years old, and the median dialysis age was 37(21, 61) months. The patients' baseline Hb (before dialysis) was (80.16±14.89) g/L and at the end of the study Hb was (105.34±22.08) g/L. Body mass index and baseline Hb levels in the high volatility group were lower than those in low volatility group and moderate volatility group (all P<0.05). Both moderate and high volatility groups had lower estimated glomerular filtration rate than that in low volatility group, and high volatility group had higher urea nitrogen level than that in low volatility group (all P<0.05). The amount of erythropoietin usage in the high volatility group was higher than that in moderate volatility group ( P<0.05). The Kaplan-Meier survival analysis results showed that there was no significant difference in survival rate for all-cause death (Log-rank χ2=0.735, P=0.693) and cardiovascular death (Log-rank χ2=2.961, P=0.228) in different Hb volatility groups. Cox regression analysis showed that after adjusting for age, sex, serum creatinine, and blood albumin, higher Hb volatility was associated with a lower risk of cardiovascular death ( HR=0.972, 95% CI 0.947-0.999, P=0.040). After adjusting for related confounding factors, higher Hb volatility was still a protective factor for cardiovascular death in the substandard group ( HR=0.946, 95% CI 0.903-0.992, P=0.022), but there was no significant correlation between Hb fluctuation and all-cause death. Multivariate linear regression analysis results showed that the fluctuation level of Hb was positively correlated with Kt/V ( B=4.682, 95% CI 2.480-6.884, P<0.001) and erythropoietin dosages ( B=0.001, 95% CI 0-0.001, P=0.003), and negatively correlated with baseline Hb ( B=-0.554, 95% CI -0.651--0.457, P<0.001). Conclusions:High Hb variability is a protective factor for cardiovascular death in PD patients with lower Hb level (substandard Hb). Adopting a reasonable program to correct anemia timely to reach the standard level has a greater impact on reducing risk of cardiovascular death in PD patients than Hb variation in anemia treatment.

The correlation between serum levels of oxidative stress indicators and renal interstitial fibrosis in patients with IgA nephropathy / 中华肾脏病杂志

Objective To investigate the relationship between serum levels of oxidative stress indicators and the degree of renal interstitial fibrosis in patients with IgA nephropathy (IgAN).Methods Seventy eight patients with confirmed primary IgAN in General Hospital of Ningxia Medical University from January 2013 to December 2014 were enrolled.The patients were divided into T0 group (n=30),T1 group (n=26) and T2 group (n=22) according to the grade of tubular atrophy/interstitial fibrosis of Oxford pathological classification criteria for IgAN in 2009.Meanwhile,thirty cases of health examiner were enrolled as control subjects.The levels of serum malondialdehyde (MDA),superoxide dismutase (SOD),catalase (CAT) and glutathione peroxidase (GSH-Px) were detected by xanthine oxidase method,thiobarbituric acid spectrophotometry method,ultraviolet spectrophotometry method,chemical colorimetric method,respectively.The levels of serum advanced oxidation protein products (AOPPs),transforming growth factor beta 1 (TGF-β1),monocyte chemotactic protein 1 (MCP-1),transforming growth factor alpha (TGF-α),interleukin 6 (IL-6) and hypoxia inducible factor 1 alpha (HIF-1α) were detected by enzyme linked immunosorbent assay (ELISA) in all groups.Spearman correlation analysis was used to analyze the correlation between serum oxidative stress indicators and traditional risk factors of tubular atrophy/renal interstitial fibrosis.Multivariable linear regression analysis was used to analyze the correlation between oxidative stress indicators and degree of renal tubular atrophy/renal interstitial fibrosis.Results There were differences in serum levels of AOPPs,MDA,SOD,CAT and GSH-Px in IgAN patients with different degrees of renal interstitial fibrosis (all P ＜ 0.05).With the increase of renal interstitial fibrosis,the levels of AOPPs and MDA increased gradually,while the levels of SOD,CAT and GSH-Px decreased gradually.Serum AOPPs,MDA,SOD,CAT,GSH-Px concentration in IgAN patients were correlated with the mean arterial pressure (MAP),total blood protein (TP),albumin (Alb),Scr,uric acid (UA),24-hour urinary protein volume and estimated glomerular filtration rate (eGFR).Multivariate regression analysis showed that the AOPPs levels of blood were positively correlated with MAP,Scr,UA and 24-hour urinary protein (all P ＜ 0.01),and negatively correlated with TP,Alb,eGFR (all P ＜ 0.05).The serum levels of AOPPs and MDA in IgAN patients were positively correlated with the levels of TGF-β1,MCP-1,TGF-α,IL-6 and HIF-1α.The levels of SOD,CAT and GSH-Px were negatively correlated with the levels of TGF-β1,MCP-1,TGF-α,IL-6 and HIF-1α.Multivariate stepwise regression analysis showed that the degree of renal interstitial fibrosis in IgAN patients was positively correlated with serum AOPPs level (β=0.285,P=0.001),negatively correlated with CAT (β=-0.346,P ＜ 0.001),GSH-Px (β=-0.303,P ＜0.001).Conclusions The level of serum oxidative stress in IgAN patients is elevated and positively correlated with the degree of renal interstitial fibrosis,suggesting that oxidative stress may be involved in the occurrence and development of renal interstitial fibrosis.

The effect of mild hypothermia on the myocardial and microcirculatory dysfunction induced by epinephrine during early post-resuscitation / 中华急诊医学杂志

Objective To investigate the effect of mild hypothermia on the myocardial and microcirculation dysfunction induced by epinephrine during early post-resuscitation in a rat model of cardiac arrest and cardiopulmonary resuscitation (CPR).Methods Transesophageal cardiac pacing was performed in order to elicit cardiac arrest for 5 min in SD male rats.Totally 40 rats were randomly (random number) divided into 4 groups (n=10):normothermic control group (N),normothermic epinephrine group (N+E),hypothermic control group (H),and hypothermic epinephrine group (H+E).Chest compression was then initiated.Epinephrine (0.02 mg/kg) or saline was administrated at 1 min during CPR.Restoration of spontaneous circulation (ROSC) was recorded,and the rates of ROSC were observed.Myocardial and microcirculatory function were observed at 1,2,3,and 4 h during early post-resuscitation.Serum lactate level was assessed at baseline and ROSC 4 h.Results The ROSC rates were 10/10 in the H+E group,9/10 in the N+E group,4/10 in the H group,and 1/10 in the N group,respectively.Ejection fraction (EF)and cardiac output (CO) in the H+E group were significantly higher than that of other groups (P＜0.05).Total vessel density,perfused vessel density,proportion of perfused vessels,and microvascular flow index in the H+E group were also significantly higher than those of other groups during early post-resuscitation.The serum lactate level in the H+E group was significantly lower than that in the N+E and H groups..Conclusions Both epinephrine and mild hypothermia can improve the success rate of resuscitation.However,mild hypothermia can improve the epinephrine induced myocardial and microcirculatory dysfunction during postresuscitation in the rat cardiac arrest.

Preliminary investigation of paravaginal support structure in women by Hyaline imaging of three-dimensional pelvic floor sonography / 中国医师杂志

Objective We aim to evaluate and discuss the feasibility of Hyaline imaging of three-dimension sonography in observation of paravaginal support structure in normal nonporous women.Methods Total of 45 normal infertile women were chosen.Three-dimensional volume datasets were collected at rest by transperineal ultrasound.The three-dimensional Hyaline images were acquired off-line.We observed the morphologic features of paravaginal support structure on the axial plane in middle vagina and measured the anteroposterior and lateral horizontal distances between bilateral paravaginal support structure and ureter.The consistency between two sonographers were analyzed by intraclass correlation coefficient (ICC).Results In three-dimensional Hyaline imaging sonogram,paravaginal support structure was appeared as typically tenting-like shaped.The anteroposterior distances between paravaginal support structure and center of ureter were listed as followed:left (-0.31 ± 1.29) mm,right (0.47 ± O.99) mm.While the lateral horizontal distances were left (12.67 ± 6.70) mm,right (13.01 ± 5.75) mm.There were no statistical differences between bilateral both anteroposterior and lateral horizontal distances.The consistency between two sonographers for distinguishing paravaginal support structure on the middle-vaginal plane and measuring distances between paravaginal support structure and center of ureter was remarkably high (ICC is 0.87 and 0.82).Conclusions Hyaline imaging technology of three-dimensional pelvic floor sonography could be used to observe paravaginal support structure in women.The normal paravaginal support structure is typically showed as bilateral symmetrical tenting-like structure,which is on the same level as the center of ureter.It provides normal anatomic radiological evidence and helps study defect of paravaginal support structure caused by pregnancy or delivery.

Lycium barbarum polysaccharides alleviate kidney injury and oxidative stress in unilateral ureteral obstruction rats / 中华肾脏病杂志

Objective To investigate the effect of lycium barbarum polysaccharides (LBP) on oxidative stress in renal tissue of rats with renal interstitial fibrosis (RIF).Methods The RIF rat model was established by unilateral ureteral obstruction (UUO).A total of 108 specified pathogen free (SPF) class healthy adult male Sprague-Dawley (SD) rats were randomly divided into sham operation group,UUO model group and treatment group.The treatment group was further divided into low,medium and high dose of LBP groups and benazapril group.From the next day of the operation,the rats were given continuous intragastric administration for 3 weeks.The LBP low,medium and high dose groups were given 400,600,800 mg · kg1 · d-1 LBP,respectively.The benazapril group was administered with 1.05 mg · kg-1 · d-1 benazepril hydrochloride.The sham operation group and UUO model group were daily fed normal saline solution by gavage.Six rats were sacrificed randomly at 7,14 and 21 days after operation.Their blood samples were collected to detect the serum creatinine (Scr) and the kidney organ index was calculated.The pathological changes on the surgical side were observed by both HE staining and Masson staining.Meanwhile,the levels of malondialdehyde (MDA) and superoxide dismutase (SOD) in the renal tissue were detected by colorimetry detection.The expression of transforming growth factor-β1 (TGF-β1) protein was detected by immunohistochemical staining and the expression of TGF-β1 mRNA was detected by real time PCR.Results (1) Compared with the sham group,the Scr and kidney organ index of the UUO model group and treatment groups increased at each time point (all P ＜ 0.05).Compared with the UUO model group,the kidney organ index of LBP low dose group in the 7th days,the LBP medium and high dose group in the 21st days as well as benazapril group in the 7th and 21st days were significantly lower (all P ＜ 0.05).(2) Renal pathological change:compared with the sham operation group,both the renal tubular interstitial injury index and collagen positive area of the else groups were higher at each time point (all P ＜ 0.05).Compared with the UUO group,the tubulointerstitial injury index and collagen staining positive area of LBP dose groups and benazapril group significantly decreased at different time points (all P ＜ 0.05).(3) Compared with the sham group,in renal tissue of the other groups the level of MDA increased,SOD level decreased,while the expressions of TGF-1 mRNA and protein increased (all P ＜ 0.05).Compared with the UUO model group,LBP low,medium and high dose group as well as benazapril group had lower MDA level,higher SOD level as well as lower expressions of TGF-1 mRNA and protein at each time point (all P ＜ 0.05).Conclusions The pathological injury in UUO rats can be improved by the LBP.The LBP can alleviate the oxidative stress status of the kidney tissue by decreasing MDA and increasing SOD.The further study on the LBP delaying the progression of RIF is to be conducted.

Tea polyphenols down-regulate JNK phosphorylation to inhibit neuron apoptosis in rats with cardiac arrest / 中华危重病急救医学

Objective To study the effect of tea polyphenols (TP) on c-Jun N-terminal kinase 1/2 (JNK1/2) phosphorylation and cell apoptosis in brain tissues in rats with cardiac arrest (CA) following cardiopulmonary resuscitation (CPR). Methods Healthy male Sprague-Dawley (SD) rats were randomly divided into sham group (n = 6), CA group (n = 12), and TP group (n = 12). The rats in CA and TP groups were induced ventricular fibrillation (VF) via esophagus stimulation with alternating current. Five minutes after CA, CPR was performed. Once restoration of spontaneous circulation (ROSC) was gained, normal saline (NS) and TP were injected intravenously in CA and TP groups with 10 mg/kg, respectively. Cortex of 6 rats in each group was harvested at 12 hours and 72 hours after ROSC. Cortex of sham group was harvested at 72 hours after operation without VF induction. The expressions of phosphorylated JNK1/2 (p-JNK1/2), JNK1/2, caspase-3, Bax and Bcl-2 were measured by Western Blot. Cell apoptosis was detected by TdT-mediated dUTP nick end labeling (TUNEL), and p-JNK/TUNEL double positive cells were detected by fluorescence double staining. Results Compared with sham group, the expressions of p-JNK, caspase-3 and Bax were increased, the expression of Bcl-2 was declined, and the apoptotic cells were significantly increased at 72 hours after ROSC in CA group. Compared with CA group, the phosphorylation of JNK was significantly declined at 12 hours and 72 hours after ROSC in TP group (the ratio of p-JNK1/2 and JNK1/2: 3.200±0.060 vs. 5.700±0.210, 1.400±0.060 vs. 5.400±0.090, both P < 0.05), the expressions of caspase-3 and Bax were decreased [caspase-3 (gray value): 42.00±5.23 vs. 54.00±7.84, 38.74±4.60 vs. 58.68±7.19; Bax (gray value): 38.04±6.21 vs. 68.76±6.08, 58.84±7.99 vs. 70.03±7.36, all P < 0.05], the expression of Bcl-2 was increased (gray value: 37.36±3.11 vs. 28.47±7.46, 48.78±6.55 vs. 29.54±3.13, both P <0.05); the cell apoptosis rate was reduced at 72 hours [(31.14±4.51)% vs. (45.87±3.95)%, P < 0.01], and p-JNK/TUNEL double positive cells/TUNEL cells ratio was significantly decreased (10.00±0.85 vs. 52.70±3.05, P < 0.01).Conclusion The inhibition of neuron apoptosis caused by TP after CPR in rats with CA is related to the inhibition of JNK1/2 phosphorylation.

Association between obesity and absolute renal risk factors in patients with IgA nephropathy / 中华肾脏病杂志

Objective To investigate the influence of obesity on renal lesion in IgA nephropathy (IgAN) patients by analyzing the association between obesity and absolute renal risk factors (ARR).Method Clinical-pathological data of IgAN patients diagnosed by renal biopsy in General Hospital of Ningxia Medical University were collected retrospectively.According to the body mass index (BMI),patients were divided into non-obese group (BMI ＜ 28,N-OB group) and obese group (BMI≥28,OB group).Their clinical characteristics,pathological index and ARR scores were compared.The relationship of BMI and ARR was analyzed by ordinal logistic regression models.Results (1) A total of 674 IgAN patients with mean age of 35.5+ 11.3 years were enrolled,including 94 in OB group and 580 in N-OB group respectively.Compared with those in the N-OB group,the proportion of male,age,mean arterial pressure,blood uric acid,blood triglyceride,diabetes mellitus and hypertension increased in OB group (all P ＜ 0.01).Patients in OB group had lower estimated glomerular filtration rate (eGFR) and higher ARR score than those in N-OB group (all P ＜ 0.05).(2) More severe thickening renal small artery wall and hyaline degeneration were observed in the OB group than in the N-OB group (all P ＜ 0.01).There was no statistical difference between the two groups in Lee classification,Oxford classification,mesangial cell proliferation,glomerular sclerosis,crescent formation,renal tubular atrophy,interstitial inflammatory cell in filtration and endothelial cell proliferation.(3) After adjusting for age,sex,blood uric acid,serum albumin,eGFR,low density lipoprotein,glomerular sclerosis,interstitial inflammatory cell infiltration,renal tubular atrophy and vascular wall thickening,BMI was still an independent risk factors for ARR in IgAN patients (OR=1.09,95％ CI 1.03-1.14).Conclusions BMI is an independent risk factors for ARR in IgAN patients.Early prevention and control of obesity and its associated risk factors may improve outcomes of IgAN patients.

Effect of potassium chloride on restoration of spontaneous circulation and survival rate in rat with ventricular fibrillation / 中华急诊医学杂志

Objective To study the effect of potassium chloride (KCl) before CPR on successful resuscitation of rats with ventricular fibrillation (VF).Methods Sprague-Dawley (SD) rats with VF induced by alternating electricity current were randomly (ramdam runmber) divided into KCl group and normal saline (NS) group.Rats of two groups were prepared with 0.8 mL/kg of 2.5％ KCl in KCI group and equivalent volume of NS in NS group instead before CPR.The resuscitation was considered to be failure if ROSC was absent for 10 min.The comparisons of time required for ROSC,the average attempt of defibrillation,the average joule used for defibrillation,ROSC rate and 72 h survival rate were carried out between the two groups.Results The length of time required for ROSC in the KCl group (n =10) was shorter than that in NS group (n=10) [(283.89±152.44) svs.(404.38±164.27) s] (t=1.369,P =0.196).The average attempt of defibrillation in KCl group were fewer compared to the NS group [(1.50 ± 0.75) times vs.(2.66 ± 0.57) times,(t =2.701,P =0.022)],the average joule used for defibrillation in KCl group were less compared to NS group [(3.75 ± 2.86) J vs.(8.33 ± 2.88) J,(t =2.78,P =0.019)].The ROSC rate in the KCl group was higher than that in NS group (P =0.011).The 72 h survival rate in KCl group was higher than that in NS group (P =0.001).Conclusions Increasing plasma potassium level before CPR could increase the ROSC rate and survival rate in rats with VF.

Assessment of the influencesof different delivery methods of contractibility of the puborectalis in postpartum women by pelvic ultrasound / 中华医学超声杂志（电子版）

Objective To assess the recovery of contraction function ofpuborectalis (PR) in women at different periods after delivery with different delivery modes,and to discuss the effect of delivery mode on PR contraction.Methods Between September 2016 and December 2016,168 primiparas who underwent ultrasound examination at the First Affiliated Hospital of Shenzhen University were enrolled.All participants were able to accomplish Valsalva maneuver.Participants were divided into two groups according to delivery modes:the vaginal delivery group and the cesarean section group.This two groups were further divided into three groups according to their periods after delivery:42-60 days after delivery (group l),61-90 days after delivery (group 2) and more than 90 days after delivery (group 3).Two dimensional translabial ultrasound examination were performed in all participants both at rest and in maximal contraction status.Thickness of anterior,middle and posterior parts of PR were measured and thickening rate was calculated.Data were evaluated by t-test and comparisons were made between the vaginal delivery groups and cesarean section groups,respectively.Results In the vaginal delivery group 1,the thickening rate of the anterior,middle and posterior parts of right-side PR were (35.57 ± 19.80)％,(31.46 ± 20.96)％ and (24.18 ± 21.51)％,while the thickening rate of left-side PR were (25.23 ± 14.36)％,(21.25 ± 13.79)％ and (20.60± 11.58)％,respectively.In the cesarean section group 1,the thickening rate of the anterior,middle and posterior parts of right-side PR were (30.27± 19.22)％,(29.50± 17.21)％ and (28.25± 14.92)％,while the thickening rate of left-side PR were (33.02± 20.65)％,(30.56± 20.11)％ and (28.64± 14.84)％,respectively.In the vaginal delivery group 2,the thickening rate of the anterior,middle and posterior parts of right-side PR were (29.62t 16.93)％,(24.94± 14.56)％ and (19.26± 11.12)％,while the thickening rate of left-side PR were (20.17±15.70)％,(19.95± 13.07)％ and (22.19± 14.50)％,respectively.In the cesarean section group 2,the thickening rate of the anterior,middle and posterior parts of right-side PR were (30.82± 15.65)％,(17.70± 10.34)％and (19.30± 7.02)％,while the thickening rate of left-side PR were (18.33± 1 1.61)％,(16.46 ± 10.51)％and (16.62± 1 1.69)％,respectively.In the vaginal delivery group 3,the thickening rate of the anterior,middle and posterior parts of right-side PR were (33.56 ±19.79)％,(25.18 ±11.80)％ and (17.44± 11.41)％,while the thickening rate of left-side PR were (28.06± 10.93)％,(22.25 ± 11.82)％ and (22.15 ± 12.69)％,respectively.In the cesarean section group 3,the thickening rate of the anterior,middle and posterior parts of right-side PR were (46.36± 20.65)％,(17.00 ± 10.34)％ and (10.86±3.40)％,while the thickening rate of left-side PR were (22.54± 13.81)％,(13.90± 10.51)％ and (18.24± 11.17)％,respectively.There were no statistically difference of the thickening rate of PR in both side between the vaginal delivery subgroups and the cesarean section subgroups (For group 1,right side:t=0.87,P=0.34;t=0.32,P=0.75;t=0.68,P=0.50;left side:t=1.48,P=0.15;t=1.82,P=0.08;t=1.36,P=0.12.For group 2,right side:t=0.22,P=0.83;t=1.64,P=0.11;t=0.01,P=0.99;left side:t=0.43,P=0.67;t=0.79,P=0.44;t=1.13,P=0.27.For group 3,right side:t=0.73,P=0.48;t=1.22,P=0.23;t=0.868,P=0.40.left side:t=0.89,P=0.41;t=1.79,P=0.89;t=0.79,P=0.44).Conclusion There was no significant differences between the impact of two delivery modes on the contraction function of the PR,and the protective effect of caesarean section on the contraction function of the PR was limited.

Effect of potassium chloride on rat ventricular fibrillation model during cardiopulmonary resuscitation / 中华危重病急救医学

Objective To investigate whether increasing the concentration of serum potassium facilitates the cardioversion to sinus rhythm during cardiopulmonary resuscitation (CPR) in a rat ventricular fibrillation (VF) model. Methods Sprague-Dawley (SD) rats with sustained VF by electrical induction were randomized into two groups by random number table. Five minutes after onset of electrical induction, 2.5% potassium chloride solution at a dose of 0.8 mL/kg (KCl group, n = 9) or equivalent normal saline (NS group, n = 9) was given respectively via femoral vein followed by traditional CPR. The changes of electrocardiogram (ECG) and the effect of defibrillation were compared between the two groups. Results During the CPR, the number of animals with spontaneous cardioversion (2 vs. 1, P = 1.000) and successful defibrillation (7 vs. 3, P = 0.026) were both increasing in KCl group compare with those in the NS group, which required fewer defibrillation (1.60±0.79 vs. 2.70±0.58, P = 0.064), lower calculative defibrillation energy (J: 4.00±3.00 vs. 8.30±2.89, P = 0.068), more animals restore spontaneous circulation (ROSC, 9 vs. 4, P = 0.029) and shorter ROSC time (s: 265.10±134.58 vs. 421.30±162.06, P = 0.096). At the beginning of CPR, animals in two groups all presented the fine amplitude (amplitude < 0.5 mV). At CPR 3 minutes the KCl group presented significantly larger amplitude compared with NS group (mV: 0.92±0.16 vs. 0.67±0.23, P = 0.030); The amplitude decreased in the animals which did not attain cardioversion to sinus rhythm over time. The animal number of fine amplitude at CPR 7 minutes were 0 and 5, respectively, in the KCl group and the NS group. Conclusion Increasing serum potassium concentration facilitates the VF amplitude enlargement, promotes the spontaneous conversion, increases the successful rate of defibrillation and reduces the energy for defibrillation in a rat VF model.

The effect of win55, 212-2 on neuronal apoptosis in post-resuscitation in rats / 中华急诊医学杂志

Objective To investigate the pharmacological hypothermic effect of WIN55, 212-2 on neuronal apoptosis after cardiopulmonary resuscitation. Methods Cardiac Arrest ( CA ) was induced in Sprague-Dawley rats.Five minutes after onset of CA, cardiopulmonary resuscitation ( CPR) was carried out.At 30 minutes post-resuscitation, the animals were randomized into three groups (n=10 in each group): (1) WIN55, 212-2 hypothermia group [W group, WIN55, 212-2, 1 mg/(kg· h)].(2) Normothermia group (NT group, 5%DMSO);(3) WIN55, 212-2 with normothermia group (W+NT group, WIN55, 212-2, 1 mg/(kg· h).Animals in WIN55, 212-2 hypothermia group and WIN55, 212-2 with normothermia group were dealt with continuous intravenous infusion of WIN55, 212-2 [1 mg/(kg· h)] for 4 h, while rats in NT group were infused with equal volume of 5% DMSO instead.The survival time and neurological deficit score ( NDS) were observed.The CA models were established in three groups.After rats were sacrificed, the brains were harvested for detecting histopathological changes and apoptosis of neural cell at 24 h, 48 h and 72 h after ROSC respectively.Five animals of each group were chosen randomly ( random number ) .Results Body temperatures of rats in W group decreased from 37°C to 34°C in 4 hours.Accumulated survival rate in W group was higher than that in the other two groups ( P=0.02) .NDS was significantly improved in W group than that in the other two groups ( P<0.05) .Morphological change in W group was less serious than that in the other two groups.The number of neuron apoptosis in W group was smaller than that in the other two groups.Conclusions WIN55, 212-2 inducing pharmacologically hypothermia during post-resuscitation prolonged survival and improved cerebral function in rat cardiac arrest models.The beneficial effects of WIN55, 212-2 were associated with ameliorating the histopathological damage in brain and alleviating the neuron apoptosis.

Renoprotective action by erythropoietin via BMP/SMAD signaling pathway in renal anemia in rats and its mechanism / 西安交通大学学报(医学版)

Objective To investigate the protective effect of erythropoietin (EPO)on the kidney of renal anemia rats and further explore the renoprotective action and possible mechanisms.Methods A total of 90 SD rats were randomly divided into 5 groups:normal control rats (NC),simple anemia group (SA),iron + EPO group (IR+EPO),erythropoietin group (EPO),and iron group (IR)with 18 in each.The rats were sacrificed after 4 weeks’ treatment with intragastrically-injected adenine.Serum creatinine (Scr),blood urea nitrogen (Bun),hemoglobin (Hb),hematocrit (Hct),and hepcidin were measured with automated hematology analyzer.The expressions of bone morphogenetic protein-6 (BMP-6 ),a serine/threonine kinase receptor-1 (SMAD-1 )and serine/threonine kinase receptor-4 (SMAD-4)in the kidney were detected by immunohistochemistry and Western blot.Results ①The results of general indicators:BUN and Scr in IR + EPO group and EPO group were lower than those in SA group (P <0.01).Hb and Hct in IR + EPO group and EPO group were increased significantly compared with those in SA group (P <0.01).Hepcidin was significantly increased in simple anemia group (P <0.01).② ELISA results showed that Hepcidin was lower in IR + EPO group and EPO group than in SA group (P <0.01).③ The results of pathological observation indicated that EPO could reduce rat renal pathology and function.④ Immunohistochemistry revealed that SMAD-4,SMAD-1 and BMP-6 were expressed in the rat glomerular cells and renal tubular epithelial cells.⑤ Western blot further indicated that the expression of SMAD-4 was significantly decreased in IR + EPO group and EPO group (P < 0.01 ).The expression of SMAD-1 in IR+EPO group and EPO group was decreased (P <0.05)while that of BMP-6 was elevated in IR+EPO group and EPO group (P <0.01 ).Conclusion The expression and secretion of hepcidin were inhibited by EPO via the BMP/SMAD pathway,which further corrects anemia and exerts a renal protective effect.

Clinical features of coronary artery ectasia in the elderly / 老年心脏病学杂志（英文版）

Objective To investigate the incidence, imaging and clinical characteristics in elderly patients with coronary artery ectasia (CAE). Methods A retrospective analysis was conducted on patients with CAE who underwent coronary angiography between January 2006 and December 2012. According to age, the enrolled patients were divided into two groups (elderly group, age≥ 65 years; non-elderly group, age < 65 years). The clinical feature, imaging characteristics and the 5-year survival rate of the two groups were compared.Results The preva-lence of CAE in elderly patients was 0.33%. Patients in elderly group were found to have significantly higher proportion of female (30.1%vs. 10.1%,P< 0.001), three-vessel disease (60.5%vs. 45.2%,P = 0.003) and localized ectasia (55.0%vs. 40.2%,P = 0.003). In addition, body mass index (20.90 ± 2.71 kg/m2vs. 22.31 ± 2.98 kg/m2,P < 0.001) and percentage of current smokers (45.0%vs. 64.6%,P < 0.001) were significantly lower in elderly group. Cumulative survival curves demonstrated reduced 5-year cumulative survival at the follow-up in the elderly group compared with the non-elderly group (88.0%vs. 96.0%,P = 0.002). But the 5-year event free survival rate failed to show a significant difference between the two groups (31.0%vs. 35.0%,P= 0.311).ConclusionThe prevalence of CAE in elderly patients was 0.33%, which was about 1/3 of the entire numbers of CAE patients. There were significant differences between the elderly and the non-elderly patients with CAE in terms of coronary artery disease risk factors and coronary artery ectatic characteristics. CAE might be asso-ciated with increased mortality risk in the elderly.

Correlation of serum hepcidin with residual renal function and micro-inflammation in peritoneal dialysis patients / 中华肾脏病杂志

Objective To study the correlation of serum hepcidin with residual renal function and micro-inflammation state in continuous ambulatory peritoneal dialysis (CAPD) patients.Methods Thirty-four stable CADP patients were involved in this study as observers (CAPD group),who had accepted CAPD treatment more than three months; twenty non-dialysis patients with stage 5 of chronic kidney disease were selected as control group.According to the level of high sensitivity Creactive protein (hs-CRP),CAPD patients were divided into two subgroups.There were 14 patients in the hsCRP elevated group (hs-CRP ＞ 3.00 mg/L) and 20 patients in the hs-CRP normal group.In addition,there had been 14 patients with residual renal function in CAPD group.Serum hepcidin was measured by ELISA.Serum Ferritin (FER),hs-CRP,routine blood and biochemistry were measured by routine methods.Calculated estimated glomerular filtration rate (eGFR).Pearson correlation and linear regression were used to assess the correlation of serum hepcidin with other laboratory parameters in CAPD patients.Results (1) Serum hepcidin was significantly higher in CAPD patients than control group,but eGFR was significantly lower (P ＜ 0.01).(2) Serum hepcidin levels of no residual renal function patients increased more significantly in CAPD group (P ＜ 0.05).(3) Serum hepcidin levels were higher in hs-CRP elevated group than hs-CRP normal group (P ＜ 0.05).(4) Pearson correlation analyses revealed that serum hepcidin was positively correlated with hs-CRP (r=0.501) and FER (r=0.847,all P ＜ 0.01),and was negatively correlated with Hb (r=-0.919),TRF (r=-0.751),TIBC (r=-0.532,all P ＜ 0.05).(5) Multiple linear regression analysis showed that ferritin and hs-CRP were closely associated with serum hepcidin level in CAPD.Conclusions Serum hepcidin level markedly elevate in CAPD patients,especially in the patients with no residual renal function and micro inflammatory state increased more significantly.

Sex differences affecting the effect of CPR in the mouse cardiac arrest model / 中华急诊医学杂志

Objective Objectives To investigate the gender difference affecting the efficacy of cardiopulmonary resuscitation (CPR) in the mouse cardiac arrest (CA) model.Methods CA was induced in 30 Kunming mice (15 male and 15 female) by trans-oesophageal cardiac pacing for 4 minutes.Epinephrine was then administrated intra-artery,and CPR was performed.The time required for restoration of spontaneous circulation (ROSC) was observed,but if ROSC failed to appear at 10 minutes after CPR,resuscitation was discontinued.Blood pressure and electrocardiograms of resuscitated animals were invasively monitored for an additional 60 minutes.Blood pressure,heart rate,the restoration of spontaneous respiration (ROSR) and survival time were observed and recorded.Results All 15 female mice and 14 of 15 male mice had ROSC.There were no significant differences in the time required for ROSC,ROSR,and survival between the two groups [(50±17)svs.(46±12)s; (2.4±1)minvs.(2.5±1)min; 28 (1,72)h vs.16 (3,72)h,P ＞ 0.05)].Moreover,neither blood pressure nor heart rate showed significant differences one hour after ROSC between the two groups.Conclusions Sex differences did not affect the efficacy of CPR,but the precise mechanism is still unclear,and further investigations are required.

Impact of intra-arterial versus intravenous administration of epinephrine on the efficacy of CPR in mice / 实用医学杂志

Objective To compare the impact of intra-arterial versus intravenous administration of epinephr-ine on the efficacy CPR in mice. Methods Transoesophageal cardiac pacing was performed to induce cardiac arrest for 4 minitues in 20 Kunming male mice. The mice were then randomized to two groups (n = 10 in each group), and received epinephrine of 0.02 mg/kg via either carotid artery (IA-gro) or jugular vein (IV-gro) injection. Chest compression and ventilation were performed; and the rate of restoration of spontaneous circulation (ROSC) and survival time were recorded. CPR was stopped if spontaneous circulation was not restored within 10 minutes. Results There was no significant difference in the rates of ROSC between IA-gro and IV-gro (10/10 vs. 8/10, P>0.05), nor in the time of ROSC or survival time [51 ± 13 s vs. 62 ± 24 s; 8.5 (6.0, 17.0) h vs. 6.5 (2.8, 21.3) h, P > 0.05]. Conclusions Neither intra-arterial nor intravenous administration of epinephrine has no obvious impact on the efficacy of CPR in mice.