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ObjectiveTo explore the preparation method of a rat model of adenine-induced chronic renal failure complicated with cardiovascular disease by investigating the effect of different time points of adenine gastric lavage on general vital signs， biochemical indicators， and cardiac and renal tissue structure and function of model rats. MethodRats in the model group were administered adenine at 150 mg·kg-1·d-1 by gavage for 16 weeks， while those in the normal group were given an equal volume of 0.5% carboxymethyl cellulose sodium solution by gavage. At weeks 5， 13， 17， 24-hour urinary protein quantification （24 h-UTP）， biochemical indicators， cardiac ultrasound， and changes in cardiac and renal tissue structure and function were measured in both the model and normal groups. Blood pressure was measured at weeks 5 and 13 in both groups. Weekly changes in body weight were recorded， and general conditions of the rats were observed daily. Result① Compared with the normal group， the model group showed a significant decrease in body weight （P<0.05）. ② Rats in the model group exhibited a significant increase in urine volume， and proteinuria appeared at week 13. ③ Compared with the normal group， the model group showed significant differences in triglyceride （TG）， total cholesterol （TC）， creatinine （Cr）， blood urea nitrogen （BUN）， blood potassium， and blood phosphorus at week 5 （P<0.05）， which increased gradually over time. At week 17， uric acid levels were significantly elevated （P<0.05）， and blood calcium levels were reduced at the end of week 17 （P<0.01）. ④ Compared with the normal group， the model group showed a significant increase in blood pressure at week 5 （P<0.05）， which progressively worsened. ⑤ There was no statistically significant difference in left ventricular wall thickness between the model and normal groups at week 5， but a significant difference was observed at week 13 （P<0.05）. ⑥ Fibrosis appeared in the kidneys of rats in the model group at week 5 and gradually worsened， while obvious fibrosis occurred around the cardiovascular system at week 13 as compared with the results in the normal group. ⑦ In the proximal tubular epithelial cells of the model group， there was an increasing presence of high-density rhomboid needle-shaped crystals， damaged cell membrane integrity， increased cell spacing， increased lysosomes， increased mitochondrial proliferation， denser mitochondrial cristae， and outer mitochondrial membrane. ⑧ Compared with the rats in the normal group， rats in the model group exhibited depressed spirits， significantly reduced activity， hunched posture， dry fur， pale ears and toes， swollen cheeks， increased nocturnal urination， and dark and viscous blood. ConclusionAdenine by gavage at 150 mg·kg-1·d-1 for 12 weeks can be used to establish a rat model of chronic renal failure complicated with cardiovascular disease， which can be used for the prevention and treatment research on chronic renal failure and its associated cardiovascular complications. The syndrome of adenine-induced rat model of chronic renal failure belongs to the deficiency of spleen and kidney， turbidity and stasis obstruction， and can be used to study the mechanisms of warming and tonifying the spleen and kidney， resolving stasis， and eliminating turbidity in the treatment of chronic renal failure.
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Objective:To analyze the levels of serum calcium,phosphate,fibroblast growth factor 23 (FGF23),and Klotho proteins in patients with chronic kidney disease (CKD),and to investigate the correlations of FGF23 and Klotho proteins with cardiac complicates in patients with chronic kidney disease-mineral and bone disorder (CKD-MBD).Methods:A total of 180 CKD-MBD patients were enrolled for this study.Among them,60 patients underwent regular hemodialysis,60 patients did not undergo renal replacement therapy and 60 patients were diagnosed as second hyperparathyroidism (SHPT).Thirty age and gendermatched health volunteers served as controls.Serum samples were collected and tested,and the demographical,clinical and biochemical data were all recorded.FGF23 and Klotho levels in serum samples were analyzed by enzyme-linked immunosorbent assay.Data of echocardiography and plain abdominal X rays were collected as well.The influential factors for cardiovascular injury,the relationship between biochemical indexes and ectopic calcification,and the correlations of FGF23 and Klotho with cardiac complicates were analyzedResults:Patients,who kept hemodialysis,especially those with SHPT,exhibited an increase in serum FGF23 level while a decrease in serum Klotho protein levels (P＜0.01).Patients with higher levels of serum FGF23 were more likely to have ectopic calcification (OR=4.667),while patients with lower levels of serum Klotho had high risks to get myocardial hypertrophy (OR=3.496).Receiver operator characteristic (ROC) curve analysis showed that the area under the curve (AUC) for FGF23 was 0.778 (P＜0.01) while for Klotho was 0.715 (P＜0.01).Conclusion:Patients,who kept hemodialysis,especially those with SHPT,have a significant increase in serum FGF23 protein levels and a significant decrease in serum Klotho protein levels.Serum FGF23 and Klotho protein levels are closely correlated with left ventricular enlargement and hypertrophy.Serum FGF23 and Klotho protein are risk factors for heart.
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Objective To summarize the clinical experience of thoracic injury.Methods Analyze 778 cases of thoracic injury,including soft tissue injury,rib fracture,hemothorax and pneumothorax,pulmonary contusion,cardiovascular injury,et al.The causes of the injury including traffic accident,injury suffered from the job and dispute,et al.Results 774 cases were cured among all the 778 cases with the recovery rate of 99.35％.There were 5 cases died with the death rate of 0.65％,including 1 case of heart rupture,1 case of large vessle rupture,2 cases of brain combining injury,1 case of spleen combining injury.Conclusion Thoracic injury arise new characteristic in recent years.The main causes of the injury are traffic accident,injury suffered form the job and dispute.Most cases may be cured by rapid treatment.The main causes of death are haemorrage shock due to cardiovascular or spleen rupture and combination of severe brain injury.
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We describe a novel method for repeat median sternotomy. We have successfully used ‘finger’ lifting resternotomy technique and achieved zero major cardiovascular injury/catastrophic hemorrhage events at reoperation. After general anesthesia, all patients were placed in the supine position and two external defibrillator pads were placed on the chest wall. We perform a median skin and subcutaneous incision along the previous sternotomy incision extending 3 cm distal to the sternum. The sternal wires that had been used for the previous closure were left in place but untied. Using a long electric cautery, right thoracotomy was performed under the right costal arch approach. Then, the operator could approximate the sternal wires in the retro-sternal space. At the same time, the operator could confirm the retro-sternal adhesion status which by touching with a finger. Resternotomy was performed using an oscillating saw pointed toward the operator's finger, which allowed safe re-median sternotomy from the lower to the upper part of the sternum. This technique of finger-lifting resternotomy has been employed in 50 cardiovascular reoperations and resulted in 0 incident of major cardiac injury or catastrophic hemorrhage. The finger-lifting resternotomy technique is safe and simple in reoperation procedures and yield excellent early outcomes.