Effect of surgical treatment for anorectal melanoma: a propensity score-matched analysis of the Surveillance, Epidemiology, and End Results programme data.

OBJECTIVE: Anorectal melanoma (AM) is a rare but aggressive tumour with limited information in the existing literature. This study aimed to assess the effect of surgical treatment for AM and predict the prognosis of affected patients. DESIGN: A retrospective cohort study. SETTING: Data of patients diagnosed with AM between 1975 and 2016 in the USA were collected from the Surveillance, Epidemiology, and End Results (SEER) database. PARTICIPANTS: This study enrolled a total of 795 patients with AM from the SEER database and the validation cohort comprised 40 patients with AM enrolled from Chinese institutes. PRIMARY AND SECONDARY OUTCOME MEASURES: Overall survival (OS) and AM-specific survival (AM-SS). RESULTS: A total of 795 patients with AM diagnosed between 1975 and 2016 were enrolled in this study. Data over the past four decades showed a trend of increase in incidence rate. A nomogram based on a multivariate Cox regression model was generated to predict AM-SS. The C-index of the nomogram was 0.74 (95% CI 0.71 to 0.77) on internal verification. In the validation cohort, the C-index of the nomogram was 0.72 (95% CI 0.68 to 0.76). The results of propensity score matching (PSM) analysis showed that patients who underwent surgical treatment achieved significant survival (OS: log-rank=17.41, p<0.001; AM-SS: log-rank=14.55, p<0.001). Patients who underwent surgery were stratified into local and extended surgery subgroups. AM-SS and OS were also compared after PSM, but the results were not significantly different between the two surgery subgroups (all p>0.05). CONCLUSIONS: The nomogram based on the analysis of SEER data showed good performance in predicting OS and AM-SS. Patients with AM can benefit from surgery; however, extensive surgery and appendectomy may not improve AM-SS or OS.

Diagnosis and treatment of posterior Monteggia fracture with atypical radiographic features / 中华创伤骨科杂志

Objective:To discuss the atypical radiological features of posterior Monteggia fracture and appropriate treatment of the fracture.Methods:A retrospective study was conducted of the 12 patients who had been treated for posterior Monteggia fracture with atypical radiological features at Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital from July 2019 to December 2020. They were 7 males and 5 females, aged from 18 to 65 years (mean, 46.5 years). Their elbow X-ray and CT scan features included unidentified upper ulnoradial dislocation, presence of triangular or quadrilateral butterfly fracture pieces in front of the fracture end at the level of ulnar coronal process, normal humeroradial joint or forward dislocated radial head, comminuted fracture or anterior edge fracture of the radial head, or backward angulated fracture of the radial neck. The proximal ulnar fractures were fixated with olecranon anatomical locking compression plate or with assistant kirschner wire and tension band fixation; the ulnar coronoid process fractures were fixated with kirschner wire or lag screws or a mini-plate; the radial head fractures were fixated with headless compressing screws or a mini-plate or treated with radial head replacement; the severe injury to the radial collateral ligament was repaired with a suture anchor. Fracture union time, complications and range of elbow motion at the final follow-up were recorded. Elbow function was assessed by Mayo elbow performance score (MEPS).Results:All patients were followed up for 6 to 28 months (mean, 16.4 months). All fractures achieved bony union after 12 to 19 weeks (14.6 weeks). The final follow-ups revealed the following: the range of elbow flexion and extension ranged from 75° to 145°, averaging 100.5°; the range of forearm rotation ranged from 80° to 155°, averaging 132.0°; the MEPS ranged from 50 to 100 points, averaging 86.2 points and yielding 5 excellent, 4 good, 2 fair and 1 poor cases. Elbow stiffness developed in 3 cases.Conclusion:Understanding the atypical radiological features of posterior Monteggia fracture can promote better diagnosis and treatment of the posterior Monteggia fracture in clinic.

Changes in clinical practice of chronic kidney disease mineral and bone disorder in Shanghai / 中华肾脏病杂志

Objective:To investigate the clinical practice of chronic kidney disease-mineral and bone disorder (CKD-MBD) in maintenance hemodialysis patients in Shanghai, and to better understand the changes of clinical practice for CKD-MBD.Methods:Sixty-four hospitals with qualified dialysis center in Shanghai were selected for questionnaire survey as of March 2019. The survey questionnaire included the number of hemodialysis and peritoneal dialysis patients, the implementation of CKD-MBD guidelines, the learning of CKD-MBD guidelines, the detection and distribution of CKD-MBD biochemical indicators, the treatment of hyperphosphatemia, the treatment of secondary heperparathyroidism (SHPT) and renal bone disease, and the concentration of calcium ion in dialysate. The results were compared with previous survey data in 2011.Results:There were sixty-three hospitals included in this study, with 10 168 maintenance hemodialysis patients and 4 610 maintenance peritoneal dialysis patients in Shanghai. 84.1%(53/63) hospitals implemented the guidelines smoothly, which increased by 28.5% compared with the rate (55.6%) of 2011. The successful implementation rates for guidelines in secondary and tertiary hospitals were 83.3%(25/30) and 84.8%(28/33) , which increased by 44.0% and 11.7% respectively (39.3% of secondary hospitals and 73.1% of tertiary hospitals in 2011). All hospitals carried out the detection for serum calcium and phosphorus. The rate for parathyroid hormone (PTH), total alkaline phosphatase (AKP), bone specific alkaline phosphatase (BAP), 25-hydroxy vitamin D[25(OH)D], and other bone metabolism-related biomarkers were 98.4%(62/63), 90.5%(57/63), 19.0%(12/63), 90.5%(57/63) and 42.9%(27/63), respectively; coronary artery CT, lumbar lateral X-ray plain, echocardiography, bone mineral density, and vascular ultrasound were carried out in 68.3%(43/63), 74.6%(47/63), 100.0%(63/63), 68.3%(43/63)and 69.8%(44/63), respectively. Compared with 2011, the proportion of detection for PTH, AKP, BAP, 25(OH)D, coronary artery CT, lumbar lateral film and echocardiography increased by 2.1%, 1.6%, 0.5%, 47.9%, 14.6%, 20.9% and 1.9%, respectively. The proportion of patients with serum phosphorus ranging in 0.80-1.45 mmol/L(KDIGO guideline), serum phosphorus ranging in 0.80-1.78 mmol/L(KDOQI guideline), calcium ranging in 2.10-2.54 mmol/L, and PTH ranging in 150-600 ng/L were 37.0%(3 323/8 969), 50.7%(4 571/9 018), 60.2%(5 568/9 244) and 33.2%(3 018/9 087). Compared with 2011(39.6%, 53.5% and 34.1%), the proportion of patients with ideal serum phosphorus (0.80-1.78 mmol/L) and calcium (2.10-2.54 mmol/L) levels increased by 11.1% and 6.7% respectively, and the proportion with PTH 150-300 ng/L decreased by 0.9%. The proportion of hospitals for using non-calcium phosphate binders (lanthanum carbonate from 1.9% to 87.3% and sevelamer carbonate from 14.8% to 63.5%) and surgical treatment (from 38.9% to 68.3%) for SHPT dramatically increased.Conclusions:Through the availability of medicine increases, and nephrologists gain deeper understanding in management and treatment of CKD-MBD, the detection rate for CKD-MBD indicators and the eligible rate have significantly improved compared with those in 2011. However, the comprehensive management of CKD-MBD in Shanghai still faces great challenges. It is still necessary to further improve eligible rate for serum phosphorus and iPTH, so as to provide more evidences and management strategies for integrated management of end-stage renal disease and prevention of abnormal calcium and phosphorus metabolism in patients.

Preliminary study on improved "pull technique" for peritoneal dialysis extubation / 中国综合临床

Objective:To introduce the improved "pull technique" and its preliminary application in Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine.Methods:Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine has started to implement the "pull technique" since March 2018.After one patient suffered from postoperative tunnel infection, we′ve improved the operation method: after successful extubation, small incision was made at the tunnel entrance, and the skin was properly trimmed and sutured to close the tunnel entrance.Results:Until May 2020, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine has implemented the modified tube removal for 15 patients.During the follow-up period (0-25 months), there was no secondary infection or peritoneal effusion.Conclusion:For patients who meet the indications of "pull technique" , the improved "pull technique" is a trial method, which can reduce the risk of secondary infection and peritoneal effusion.

Application of UpToDate ? clinical consultant system in evidence-based teaching of standardized training for specialists / 中华医学教育探索杂志

This paper describes how to apply UpToDate ? system can be applied into the evidence-based teaching of difficult and critical clinical problems of nephrology, combined with the practical case of standardized training for specialists. The treatment difficulties can be put forward by teachers or students, and appropriate terms are selected to search in UpToDate ?. The students are required to learn the content of the searched items, and then give their treatment choices and clarify reasons according to the condition of patients. After that, the instructing doctor will comment on the statements of each training specialist, and give treatment plans. Promotion the application of UpToDate ? system is helpful to improve the teaching quality of the standardized training for specialists.

Mitsugumin 53 promotes mitochondrial autophagy through regulating Ambra1 expression in C2C12 myoblast cells.

In this study, we investigated the function of Mitsugumin 53 (MG53) in regulation of mitochondrial autophagy in skeletal muscle cells and explored its potential application in the prevention and treatment of skeletal muscle atrophy in rats with chronic kidney disease (CKD). The expression of autophagy beclin 1 regulator 1 (Ambra1) and MG53 in skeletal muscles of 5/6 nephrectomized rats was measured, and the effect of MG53 on mitochondrial autophagy of C2C12 myoblasts was investigated by in vitro experiments. Our results show the expression of Ambra1 and MG53 in the skeletal muscle of CKD rats was significantly decreased. In vitro experiments showed that MG53 overexpression could promote the expression of Ambra1 and mitochondrial autophagy in C2C12 cells, suggesting that recovery of autophagy by MG53 intervention may help remove abnormal mitochondria and alleviate muscle atrophy. In conclusion, the damaged or functionally incomplete mitochondria in CKD rats could not be effectively removed, which may be related to the low activity of Ambra1. In vitro experiments showed that MG53 overexpression could promote the expression of Ambra1 in C2C12 cells and restore mitochondrial autophagy. Whether MG53 can help remove abnormal mitochondria and relieve CKD-induced muscle atrophy requires further study.

Correlation analysis between thromboelastography and early neurological deterioration in patients with acute cerebral infarction / 中国脑血管病杂志

Objective To investigate the predictive significance of thromboelastography ( TEG) for early neurological deterioration ( END) in patients with acute cerebral infarction. Methods This was a case-control study. From March 2016 to August 2017,a total of 195 consecutive patients with acute mild to moderate cerebral infarction (National Institute of Health stroke scale [NIHSS] score <16) within 24 h after onset were registered prospectively. The demography, clinical data, and laboratory test results were collected. The TEG examinations were completed after admission. According to whether having END or not within 3 d after admission,they were divided into either a END group (n=60) or a non-END group (n=135). A logistic regression model was established to analyze the relationship between TEG parameters and END. Results Of the 195 eligible patients,60 (30. 8%) experienced END. TEG reaction time (RT) and kinetic time ( RT) in patients of the END group were significantly less than those of the non-END group (4. 1 ± 1. 1 min vs. 4. 4 ± 1. 2 min;1. 3 ± 0. 3 min vs. 1. 5 ± 0. 4 min,t=3. 395 and 3. 093,respectively;all P<0. 01). The proportions of the shortened RT and KT in patients of the END group were significantly higher than those of the non-END group (80. 0％ [48/60] vs. 63. 0％ [85/135],18. 3％ [11/60] vs. 8. 1％ [11/135]). There were significant differences (χ2 =5. 560 and 4. 305,all P <0. 05). After adjusting for the factors of age,sex,diabetes mellitus,smoking,baseline NIHSS score,and serum hypersensitive C-reactive protein, logistic regression analysis showed that the shortened RT was independently correlated with END (OR,1. 612,95％ CI 1. 094-2. 376,P=0. 016). Conclusion The shortened TEG coagulation time RT on admission has a certain predictive value for END within 3 d after onset of acute mild to moderate cerebral infarction.

Autoimmune research on nerve root injury induced by non-compressive nucleus pulposus protrusion / 中国免疫学杂志

Objective:To discuss the autoimmune response on the mechanism and clinical significance of nerve root injury induced by the non-compressive nucleus pulposus protrusion.Methods:Forty-eight female SD rats were randomly divided.Twenty-four female SD rats were recruited as model group,and the others as control.After ten days,twenty days and forty days,the pain threshold of left hind leg and the levels of TNF-α, CD4+, CD8+T cells were measured, the nerve root changes in morphology were observed by HE.Results:Compared with the control group,model group in ten days,twenty days,which left hind leg pain threshold,the proportion of CD4,CD8+T cell and the expression of TNF-αare significantly different.After forty days,these two groups have no statistical differ-ence.After ten days,lumbar nerve root cross-sectional myelin of model group was partial disintegrated.The worst damage happened in twenty days,and almost recovered to normal in forty days.Conclusion:T cell-mediated autoimmunity and TNF-αplay an important role to the nerve root injury in the early time of the non-compressive nucleus pulposus protrusion.

DC-SIGN expression on podocytes and its role in immune and inflammatory responses of lupus nephritis / 中华肾脏病杂志

Objective To explore the expression of DC?SIGN, the phenotype of dendritic cells (DCs), on podocytes, and its role in immune and inflammatory responses of lupus nephritis (LN). Methods DC?SIGN and IgG1 expression in renal tissues of lupus nephritis patients were observed by immunohistochemistry and immunofluorescence. The 4?week old LN mice were randomly divided into the experimental group and the intervention group. C57BL/6J mice were used as normal control group. Mice of the intervention group were injected anti?DC?SIGN antibody at 6?week old. Mice were sacrificed at 16, 20, 24, 28?week old respectively, to observe the mice renal function and pathological changes. And DC?SIGN and IgG1 expression in renal tissue were observed by immunohistochemistry and immunofluorescence. In addition, mice podocytes were treated with serum of LN mice. Flow cytometry was used to investigate the expression of MHC II, CD80 and DC?SIGN expression on podocytes. Mixed lymphocyte reaction was used to detect the ability of stimulating T cells proliferation. IFN?gamma and IL?4 in supernatant were determined by ELISA. Results (1) Expression of DC?SIGN and IgG1 was found in glomeruli of lupus nephritis patients. (2) Accompanied by increased proteinuria of LN mice from 20?week old (P<0.01), DC?SIGN and IgG1 expression was found in glomeruli, and the renal function deteriorated up to 24 week?old (P<0.01). Mice with anti?DC?SIGN antibody intervention appeared reduced proteinuria and remission of renal function (P<0.01). (3) After stimulated by serum of LN mice, the expression of DC?SIGN, MHC II and CD80 was up?regulated, stimulation of T cell proliferation was enhanced (P<0.01), and IFN?gamma/IL?4 ratio increased (P<0.01). Anti?DC?SIGN antibody treatment down?regulated the expressions of DC?SIGN, MHC II and CD80 on podocytes, decreased the ability of stimulating T cell proliferation and lowered the ratio of IFN?gamma/IL?4 (P<0.01). Conclusions Podocytes in lupus nephritis can play DC?like function through the expression of DC?SIGN, which may be involved in immune and inflammatory responses of renal tissue. However, inhibiton of DC?SIGN can depress immune function of podocytes and have prevention and treatment effect.

The role of Foxo1 and ubiquitin-proteasome system markers in muscle atrophy caused by chronic kidney disease / 中华内科杂志

Objective To identity whether there is muscle atrophy phenomenon in end-stage kidney disease patients and to detect the level of transcription factor Foxo1 and the activity of ubiquitin-proteasome system.Methods Twenty-two patients in chronic kidney disease (CKD) stage 5 were selected and their mean muscle cross sectional area was measured.mRNA and protein levels of Foxo1,Atrogin-1,MuRF1 in rectus abdominis biopsies obtained from consecutive patients were detected.Control biopsies were obtained from 8 healthy subjects during elective surgery for abdominal wall hernias and 6 subjects during elective surgery for adenomyosis.Results Compared with the control group,cross sectional area of muscle fibers decreased and the transcription and protein levels of Foxo1,Atrogin-1,MuRF1 were upregulated in CKD group(P＜0.05).Protein level of p-Foxo1 decreased in CKD group(P＜0.05).Conclusion There exist muscle atrophy phenomenon in CKD patients,which may associate with the upregulation of Foxo1 and activation of ubiquitin-proteasome system.

Skeletal muscle wasting in diabetic kidney disease rats and the effect of low-protein diet combined with a-keto acids / 中华肾脏病杂志

Objective To observe the muscle wasting in diabetic kidney disease (DKD) model of type 2 and non-obese diabetes mellitus in Goto-Kakizaki (GK) rats,and to evaluate the effect of lowprotein diet supplemented with α-keto acids on muscle wasting.Methods Forty-five male 24-weekage GK rats were randomly divided into three groups:normal protein diet group (22％ casein diet,NPD),low protein diet group (6％ casein diet,LPD) and LPD + α-keto group (5％ casein + 1％ α-keto,Keto).Fifteen gender-and age-matched Wistar rats were served as the control group (CTL).The living condition of GK rats was observed and body weight was measured once a week.Urine albumin,serum glucose,lipids,albumin,creatinine and urea nitrogen were measured at the age of 24,32,40,48 weeks.Soleus muscle at the age of 48-week was observed to calculate the muscle size with software.Expressions of atrogin-1,MuRF-1 and MyoD,myogenin were examined by Q-PCR and Western blotting.Results Compared with the CTL group,NPD,LPD,Keto groups had lower body weight [(317.90± 13.81),(330.38±11.96),(390.44±12.25) g vs (429.43± 16.85) g,all P ＜ 0.05],higher urine albumin [(14.36±5.52),(8.12±4.61),(5.58±3.50) mg/24 h vs (0.61±0.16) mg/24 h,all P ＜ 0.05],higher serum creatinine [(81.50±7.88),(66.32±8.36),(63.44±8.21) μmol/L vs (24.43±6.15) μmol/L,all P ＜0.05] and urea nitrogen [(7.53±1.05),(5.63±1.40),(5.54±0.97) mmol/L vs (2.98±0.62) mmol/L,all P ＜0.05].The cross-sectional area of soleus muscle fibers was larger in CTL group.Compared with CTL group,the expression levels of atrogin-1 and MuRF-1 increased significantly (all P ＜ 0.05),and of MyoD and myogenin decreased significantly in NPD,LPD,Keto groups (all P ＜ 0.05).In Keto group after 40 weeks,muscle wasting was improved compared with NPD and LPD group [body weight (381.62± 15.82) g vs (331.50±17.58),(326.60± 13.43) g,all P ＜ 0.05],cross-sectional area of soleus muscle increased,levels of urine albumin,serum creatinine and urea nitrogen decreased (all P ＜ 0.05),the protein expressions of atrogin-1 and MuRF-1 decreased,and myogenin and MyoD were higher as compared to CTL group (all P ＜ 0.05).There were no significant differences between NPD and LPD group.Conclusions In DKD condition,protein degradation in the skeletal muscle is accelerated,the genes which control muscle atrophy are activated,and proliferation and differentiation of the muscle satellite cells are impaired.Low-protein diet supplemented with α-keto acids can improve muscle wasting induced by DKD.

Effect of hepatitis B virus X gene on apoptosis and immune molecules of renal tubular epithelial cells / 中华肾脏病杂志

Objective To investigate the effect of hepatitis B virus X (HBX) gene on apoptosis and immune molecules of human proximal renal tubular epithelial cell line (HK-2).Methods The eukaryotic vector pcDNA3.1-myc-HBX containing HBX gene was transiently transfected into HK-2 cells by lipofectamine mediation.Untransfected HK-2 cells and those transfected with empty vector were used as controls.The TLR4 expression was detected by real-time PCR and Western blotting.The apoptosis of cells and expression of MHC-Ⅱ and CD40 were detected by flow cytometry,and the contents of IL-4 and IFN-γ in the supernatant were detected by EIISA.Results Compared with control groups,the number of apoptotic cells was significantly increased in the HBX transfection group (P ＜ 0.05),and the expressions of TLR4,MHC-Ⅱ and CD40 were also significantly increased in the HBX transfection group (all P＜0.05).IFN-γ level in the supernatant of HBX transfection group was higher (P ＜ 0.05),but IL-4 level was lower as compared to control groups (all P ＜ 0.05).Conclusions Over-expression of HBX gene may induce apoptosis of HK-2 cells and upregulate the expression of immune molecules of renal tubular epithelial cells leading to injury of cells and dysfunction of immunomicroenviroment.

Mitochondrial damage in proetin-energy wasting of skeletal muscle in rats with diabetic kidney disease and the effect of low-protein diet combined with α-keto acids / 中华肾脏病杂志

Objective To observe the mitochondrial damage associated with protein-energy wasting of skeletal muscle in diabetic kidney disease (DKD) model of Goto-Kakizaki(GK) rats and evaluate the effects of low-protein diet supplemented with α-keto acids on muscle wasting.Methods Forty-five male 24-week-age GK rats were randomly divided into three groups,normal protein diet group (NPD),low-protein diet group (LPD) and LPD +or-keto group (Keto).Fifteen gender and age matched Wistar rats were served as control group (CTL).The living condition of GK rats was observed and the weight was measured once a week.Urine albumin,serum glucose,creatinine and urea nitrogen were measured at 24,32,40,48 week age.Soleus muscle was observed to calculate the muscle size and the percentage of Ⅰ and Ⅱ type muscle fiber with software after SDH and NADH staining at 48-week-age.Tissue ultrastructure was observed under the transmission electron microscopy.The activity of citrate synthase was detected by spectrophotometer.Expression of mitochondrial DNA was examined by Q-PCR.Results Compared with the CTL group,NPD,LPD and Keto groups had lower body weight,higher urine albumin,higher serum creatinine and urea nitrogen (P ＜ 0.05).The crosssectional area of muscle fibers was larger in CTL group.Compared with CTL group,the muscle fiber was partly broken,the mitochondrial morphology was obviously changed,the percentage of type Ⅱmuscle fiber was increased significantly (P ＜ 0.05),and the activity of citrate synthase and the number of mitochondrial DNA were decreased significantly in NPD,LPD and Keto groups (P ＜ 0.05).In Keto group,muscle wasting was improved compared with NPD and LPD group (P ＜ 0.05),the crosssectional area of soleus muscle increased and the percentage of type Ⅱ muscle fiber decreased,levels of urine albumin,semm creatinine and urea nitrogen decreased (P ＜ 0.05).Under transmission electron microscopy,the muscle fiber of keto group was intact and mitochondiral morphology was close to that of CTL group.The activity of citrate synthase and number of mitochondiral DNA were higher as compared to CTL group (P ＜ 0.05).There were no significant differences between NPD and LPD group.Conclusions In DKD condition,protein degradation in the skeletal muscle is accelerated,mitochondrion is swelling,the number of mitochondrial DNA is decreased and mitochondrial function is impaired.Low-protein diet supplemented with α-keto acids can improve mitochondrial damage and muscle wasting induced by DKD.

Uric acid up-regulates the expression of prostanoid 2 in the glomerular mesangial cells through the p38MAPK pathway / 中华肾脏病杂志

Objectives To investigate the role and mechanism of p38 mitogerra activated protein kinase (p38MAPK) in up-regulation of prostanoid 2 induced by uric acid in rat glomerular mesangial cells (GMCs).Methods Rat glomerular mesangial cells were cultured in vitro,then stimulated with different concentrations of uric acid (50,100,300 μmol/L),or stimulated with different concentrations of uric acid (50,100,300 μmol/L) after pretreatment with p38MAPK specific inhibitor SC68376 (10 μmol/L) for 30 min.Activated p38MAPK was detected by Western blotting.The expression of prostanoid 2 was measured by ELISA.Cyclooxygenase-2 mRNA expression was determined by RT-PCR.Results Uric acid could activate p38MAPK and up-regulate the mRNA expressions of prostanoid 2 and cyclooxygenase-2 in rat glomerular mesangial cells (all P ＜ 0.05).SC68376 inhibited those effects of the above-described induced by uric acid.Conclusion Uric acid can promote the expression of prostanoid 2 in rat glomerular mesangial cells,whose mechanism may be related to the activation of p38MAPK and the promotion of cyclooxygenase-2 synthesis,and further up-regulation of prostanoid 2 expression.

A study on the change of autophagy in skeletal muscle of patients with chronic kidney disease / 中华肾脏病杂志

Objective To study skeletal muscle atrophy and the change of autophagy in skeletal muscle of patients with chronic kidney disease.Methods Mean muscle cross sectional area,mRNA and protein expression of autophagy markers Bcl-2-adenovirus E1B interacting protein 3 (LC3B),Bcl-2-adenovirus E1B interacting protein 3 (Bnip3),Beclin-1 were measured in rectus abdominis biopsies obtained from 22 consecutive patients with stage 5 CKD scheduled for peritoneal dialysis from 4 hospitals in Shanghai.Control biopsies were obtained from another 8 healthy subjects during elective surgery for adenomyosis and 6 subjects during elective surgery for abdominal wall hernias.Rectus abdominis muscles were obtained at the beginning of surgery.HE staining was performed and mean cross sectional area (CSA) was calculated.Electron microscopy was used to confirm the changes of autophagy.mRNA levels of LC3B,Beclin-1,Bnip3 were evaluated by RT-PCR and protein levels of those parameters were evaluated by Western blotting.Results Compared with control group,mean CSA of muscle fibers was decreased and the transcript levels of LC3B,Beclin-1,Bnip3 were up-regulated in CKD group.Similarly,protein levels of LC3BⅠ,LC3B Ⅱ,Beclin-1 and Bnip3 were increased in CKD group.Additionally,activation of autophagy was confirmed by the appearance of autophagosomes by electron microscopy.Conclusion Chronic kidney disease may cause skeletal muscle atrophy and lead to activation of autophagy,which may contribute to muscle atrophy.

Relationship between body mass index and mortality in hemodialysis patients: a meta-analysis.

BACKGROUND: Previous studies have reported that reduced mortality rates in hemodialysis (HD) patients were negatively related to body mass index (BMI). The potentially protective effect of increased BMI in HD patients has been referred to as 'reverse epidemiology'. Our meta-analysis was conducted to examine the relationship between different BMI ranges and mortality in HD patients. METHODS: Eligible studies assessing the effects of BMI ranges on all-cause mortality (published from 1966 to February 2012) were searched, using 'hemodialysis' or 'haemodialysis' and 'obese' or 'body mass index' or 'overweight' as key words, in combination with 'mortality', 'survival', 'reverse epidemiology' and 'obesity paradox'. Inclusion criteria were that trials reported mortality in HD patients according to the traditional World Health Organization/National Institutes of Health BMI classification, and BMI levels are acceptable within 2 index points. The quality of the trials was evaluated using the risk of bias assessment in studies included in Cochrane reviews. The mortality rates in HD patients were the primary end point of the study. With no significant heterogeneity, a fixed-effects model was used for analyses. RESULTS: Four studies with a total of 81,423 patients met final inclusion criteria. Compared to individuals with non-elevated BMI, those with elevated BMI (BMI ≥25, OR 0.67, 95% CI 0.65-0.68) had a lower all-cause mortality. In a risk-adjusted sensitivity analysis, elevated BMI levels (adjusted hazard ratio 0.94, 95% CI 0.92-0.96) remained protective against mortality. CONCLUSION: High BMI levels were associated with lower all-cause mortality rates in HD patients. It is possible that more stable hemodynamic status, cytokine and neurohormonal alternations contribute to the protective effects of BMI on mortality in HD patients. There is a need for prospective studies to elucidate mechanisms behind this relationship.

Effect of hepatitis B virus X gene on transdifferentiation of human proximal tubular epithelial cells / 中华肾脏病杂志

Objective To investigate the effects of hepatitis B virus X (HBX) gene on cell morphology and transdifferentiation of human proximal tubular epithelial cells.Methods The eukaryotic vector pcDNA3.1-myc-HBX containing HBX gene was transiently transfected into HK-2 cells by lipofectamine mediation.The expression of HBX was confirmed by Q-PCR and Western blotting.Untransfected HK-2 cells and those transfected with empty vector were used as control.The morphology of HK-2 cells was observed by microscopy,the expressions of differentiation marker proteins α-SMA and E-cadherin were detected by Western blotting and Q-PCR,and the contents of IL-1,IL-6 and TNF-α in the supernatant were detected by ELISA assay.Results HBX was successfully expressed in HK-2 cells after transfection.After transfection of HBX gene,the shape of HK-2 cells became irregular,HK-2 cells significantly expressed E-cadherin and α-SMA,and had high levels of IL-1,IL-6 and TNF-α in the cell supernatant (P＜0.01).Conclusion Overexpression of HBX gene in renal tubular epithelial cells may damage cell morphology and promote the occurrence of epithelial-mesenchymal transdifferentiation,which may be related to the inflammatory microenvironment.

Expression of parathyroid hormone in renal tissues of patients with early stage chronic kidney disease and its role in renal lesions / 中华肾脏病杂志

Objective To investigate the expression and distribution of parathyroid hormone (PTH) in renal tissues of early stage chronic kidney disease (CKD),and to elucidate its potential role in renal lesion.Methods Eighty-two patients of early stage CKD (stage 1 and 2) diagnosed as glomerulonephritis (GN) with different pathologic types by renal biopsy in our department between 2009 and 2012 were enrolled in the study.Renal tissues of eight patients with mismatched HLA haplotype or the normal part of renal cancer were chosen as controls.Scr,BUN,serum calcium,phosphorus,PTH and 25(OH)VitD3 were measured.Creatinine clearance (Ccr) was calculated by Cockcroft-Gault (CG)formula.99mTc-DTPA clearance rate was used to detect GFR.Patients were divided into mild,moderate and severe groups according to the renal interstitial extent of inflammatory cells infiltration.Immunohistochemistry was used to observe the expression and distribution of PTH in renal tissues.Image-Pro Plus software was used to calculate A value of PTH in renal tissues and compare the extent of PTH expression.Results The levels of calcium,phosphorus,25(OH)VitD3 and PTH in peripheral blood from GN patients of CKD stage Ⅰ and 2 were normal.PTH had no correlation with the above indexes.PTH expression could be seen in renal tissues of all the GN patients with different pathologic types,and it mainly located in renal tubular,only a few in glomeruli and interstitium.The expression of PTH in renal tissues of GN increased compared with the controls (P ＜ 0.01).Furthermore,PTH expression elevated with the increase of inflammatory cells infiltration in interstitium.However the expression of PTH was not significantly different among different pathologic types of GN.Conclusions In the early stage CKD,PTH expression in patients of GN increases,which occurs earlier as compared to PTH elevation in peripheral blood and the imbalance of minerals and bone metabolism.The intensity of PTH expression is associated with the local inflammation.

A meta-analysis of hemoglobin target for anemia of patients with chronic kidney disease / 中华肾脏病杂志

Objective To explore the role of hemoglobin (Hb) level in mortality and morbidity of chronic kidney disease (CKD)patients,aiming to give some evidence for therapy of anemia.Methods Randomized,clinical trials (RCTs) were identified by searching Medline,Embase and the Cochrane library.All the analyses were performed using the Revman software available free from the Cochrane collaboration.Results Twenty-three trials involving 10 204 patients were identified.Overall,the high Hb target was associated with increased risk of all-cause mortality (RR=1.10,95％ CI 1.00 to 1.21),hypertension (RR=1.40,95％ CI 1.12 to 1.75),stroke and hospitalization (RR=1.07,95％ CI 1.00 to 1.14) compared with low Hb target (P＜0.05).No significant difference was found in the risks of non-fatal mycardial infarction (RR=1.13,95％ CI 0.79 to 1.62) and renal replacement therapy (RR =1.00,95％ CI 0.85 to 1.18).Conclusions Targeting low Hb target is beneficial to CKD patients based on reduced risk of hypertension,hospitalization,stroke and all-cause mortality.However,no significant difference is found in non-fatal mycardial infarction and renal replacement therapy.

Relationship between body mass index and all-cause mortality in hemodialysis patients: a meta-analysis / 中华内科杂志

ObjectiveTo explore the relationship between the different body mass index (BMI) ranges and all cause mortality in hemodialysis (HD) patients. MethodsEligible studies assessing the effects of BMI ranges on all-cause mortality(published from 1966 to 2012 )were searched, using hemodialysis/haemodialysis and obese/body mass index/overweight andmortality/surwival/reverse epidemiology/obesity paradox in PubMed,Embase,ScienceDirect,Wilcy,Scopus and Ovid. Inclusion criteria were that trials reported mortality in HD patients according to the traditional WHO/NIH BMI classification,and BMI levels were acceptable within 2 kg/m2.The quality of the trials was evaluated using the assessing risk of bias in studies included in Cochrane reviews.The mortality rate in HD patients was the primary endpoint of the study.ResultsWith no significant heterogeneity ( I2 =0％,P =0.45 ),a fixed-effects model was used for analysis.Four studies with a total of 81 423 patients met final inclusion criteria.Compared to individuals with non-elevated BMI levels,the elevated group (BMI ≥25 kg/m2) was associated with lower all-cause mortality ( OR 0.67,95％ CI 0.65-0.68 ). In a risk-adjusted sensitivity analysis,elevated BMI levels remained protective against mortality( adjusted HR 0.94,95％ CI 0.92-0.96 ).ConclusionsHigh BMI levels are associated with lower all-cause mortality rate in HD patients.More stable hemodynamic status,cytokine and neurohormonal alternations,and nutritional status maybe contribute to the protective effects of BMI on the mortality of HD patients.There is a need for more prospective studies to elucidate underlying mechanisms.