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Objective:To determine the impact of early serum sodium concentrations on the survival prognosis in maintenance hemodialysis (MHD) patients.Methods:It was a retrospective cohort study. The newly admitted hemodialysis patients who were included in the registration system of Zhejiang Province Dialysis Quality Control Center from January 1, 2010 to December 31, 2019 were identified. Follow-up was conducted until December 31, 2020. Baseline data were collected for the first three months of dialysis, in which the mean level of serum sodium was defined as early serum sodium. Patients were divided into five groups based on early serum sodium level. Restricted cubic spline (RCS) was used to fit the relationship between long-term serum sodium level and risk of death. Kaplan-Meier model and Log-rank test were used to compare the survival rates of different groups. Multivariable Cox regression was used to analyze the correlation between early serum sodium level and death.Results:A total of 26 309 MHD patients were included in this study, and their ages were (59.07±15.41) years (ranging from 18 to 100 years). Among them, 13 643 (51.9%) were over 60 years old and 15 843 (60.2%) were males. Among the primary diseases of chronic renal failure, chronic glomerulonephritis was the first [13 703 cases (52.1%)], followed by diabetic nephropathy [6 460 cases (24.6%)], hypertensive nephropathy [1 293 cases (4.9%)], polycystic kidney disease [1 164 cases (4.4%)], etc. According to early serum sodium level, 12 883 patients (49.0%) had hyponatremia (serum sodium <135 mmol/L), of which 4 001 patients (15.2%) had serum sodium ≤130 mmol/L; 1 529 patients (5.8%) had hypernatremia (serum sodium >145 mmol/L). Patients were divided into the following 5 groups: 4 001 cases (15.2%) in group 1 (serum sodium ≤130 mmol/L), 8 882 cases (33.8%) in group 2 (130 <serum sodium <135 mmol/L), 8 231 cases (31.3%) in group 3 (135≤serum sodium ≤140 mmol/L), 3 666 cases (13.9%) in group 4 (140 < serum sodium≤145 mmol/L) and 1 529 cases (5.8%) in group 5 (>145 mmol/L). Among them, patients in the Na≤130 mmol/L group had a slightly older age, a higher proportion of diabetes and cardiovascular disease, a lower level of blood uric acid, albumin, hemoglobin, and a higher level of alkaline phosphatase and leukocytes, while patients in the Na >145 mmol/L group had an older age and a higher proportion of cardiovascular disease. After follow-up of (55.67±33.58) months, a total of 4 954 patients (18.8%) died, 1 537 patients (5.8%) underwent kidney transplantation, 128 patients (0.5%) were converted to peritoneal dialysis. Of the deaths, 990 (20.0%) were due to cardiovascular diseases, 498 (10.1%) to cerebrovascular diseases and 400 (8.1%) to infections, and cardiovascular disease was the main cause of death. RCS curve fitting of the relationship between serum sodium level and risk of death found that the all-cause mortality hazard ratio ( HR) increased with decreasing or increasing serum sodium, and the optimal serum sodium was between 135 mmol/L and 140 mmol/L. Kaplan-Meier survival curve showed that the risk of all-cause death (Log-rank test, χ2=66.5, P<0.001), the risk of cardiovascular death (Log-rank test, χ2=31.5, P<0.001) and the risk of infection death (Log-rank test, χ 2=28.6, P<0.001) were significantly different among five groups. The 10-year cumulative survival rate was 63.0%, 71.5%, 72.5%, 67.8% and 61.4% in groups with different serum sodium levels from low to high, and the 10-year cumulative cardiovascular mortality rate was 9.6%, 6.2%, 5.5%, 7.3% and 11.7%, and the 10-year cumulative infection mortality rate was 4.9%, 3.2%, 1.7%, 2.8% and 3.9%. Multivariable Cox regression showed early serum sodium level >145 mmol/L was an independent relevant factor for all-cause death in MHD patients ( HR=1.237, 95% CI 1.045-1.465, P=0.013). Conclusions:MDH patients are more likely to develop hyponatremia in the early stage of dialysis. The cumulative survival rate of all-cause death, cardiovascular death and infection death in patients with predialysis serum sodium ≤130 mmol/L and >145 mmol/L within three months after initiation of dialysis is significantly lower than those in other levels. Early serum sodium >145 mmol/L is associated with higher mortality in MHD patients.
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OBJECTIVE To compare anti-ischemic stroke （IS） effect of different extraction parts from Gastrodia elata， and to provide reference for screening the anti-IS effective parts of G. elata. METHODS G. elata was extracted and separated by ethanol reflux extraction and ethyl acetate extraction. The rat model of diffuse cerebral thrombosis was induced by internal carotid artery injection of arachidonic acid （AA）； the anti-IS effect of G. elata powder， ethanol extract of G. elata， residue of ethanol extract of G. elata， ethyl acetate extract of G. elata， residue of ethyl acetate extract of G. elata， gastrodin and aspirin （positive control drug） were investigated with the content of Evans blue （EB） in the ischemic brain tissue as index. RESULTS Compared with model group， aspirin， ethanol extract of G. elata and ethyl acetate extract of G. elata could significantly decrease the content of EB in the ischemic brain tissue of model rats （P＜0.05）. G. elata powder had the tendency to reduce the content of EB in the ischemic brain tissue of model rats， without statistical significance （P＞0.05）. The residue of ethanol extract of G. elata， residue of ethyl acetate extract of G. elata and gastrodin had little effect on the content of EB in the ischemic brain tissue of model rats. CONCLUSIONS Both ethanol extract of G. elata and ethyl acetate extract of G. elata have anti-IS effects， which are stronger than that of G. elata powder.
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Objective:To retrospectively analyze the early mortality and related risk factors in adult patients with maintenance hemodialysis (MHD).Methods:Adult MHD patients from 2008 to 2018 were enrolled and divided into training data group and validation data group. In training data group, multivariate logistic regression was used to analyze the risk factors of early death within 120 days after hemodialysis and establish a prediction model. The receiver operating characteristic (ROC) curve was applied to evaluate the prediction ability of the model.Results:A total of 4 885 patients were included. The cumulative mortality within 120 days was 20.97/100 person years, and that within 365 days was 12.25/100 person years. A total of 3 603 patients in the training data group were analyzed. The following risk factors were correlated with early mortality (all P<0.05), including age at start of dialysis over 60 years old ( OR=1.792), non-chronic glomerulonephritis ( OR=2.214), cardio-cerebrovascular disease ( OR=2.695), plasma albumin less than 35 g/L ( OR=1.358), platelet count less than 120×10 9/L ( OR=2.194), serum creatinine less than 600 μmol/L ( OR=1.652), blood urea nitrogen over 30 mmol/L ( OR=1.887), blood phosphorus less than 1.13 mmol/L ( OR=1.783), pulse pressure over 55 mmHg(1 mmHg=0.133 kPa) ( OR=1.656), low density lipoprotein less than 1.5 mmol/L ( OR=1.873), and blood calcium over 2.5 mmol/L ( OR=1.876). Risk prediction model was established. The other 1 282 cases in the validation data group were verified. The area under ROC curve was 0.810, with sensitivity 85.7%, and specificity 62.5%. Conclusion:The mortality rate of adult MHD patients within 120 days after dialysis is high. The established prediction model can effectively predict the risk of early death.
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Objective:To explore the relationship between end-dialysis over-weight (edOW) in initial stage of hemodialysis and long-term prognosis in maintenance hemodialysis patients.Methods:The data of initial uremia patients receiving hemodialysis in the First Affiliated Hospital, College of Medicine, Zhejiang University from January 1, 2008 to April 30, 2017 were retrospectively analyzed. The end point of follow-up was death or until April 30, 2018. The general data including age, gender, body mass index, primary disease, complications and laboratory indicators of the patients and the related parameters of dialysis from four to twelve months were collected. Kaplan-Meier method was used to analyze survival rate. Cox multivariate regression was used to analyze the relationship between edOW and all-cause mortality and cardiovascular disease (CVD) mortality.Results:A total of 469 patients (300 males, 64.0%) were enrolled, with age of (56.9±17.1)years old. During the follow-up period of (4.1±2.4) years (1.0-10.3 years), 102 patients died. The main cause of death was cardiovascular and cerebrovascular events, accounting for 44.1% (45/102). The value of edOW was (0.28±0.02) kg. The patients were divided into edOW<0.28 kg group ( n=292) and edOW≥0.28 kg group ( n=177) according to the mean value of edOW. Kaplan-Meier survival analysis showed that the long-term survival rate in edOW<0.28 kg group was higher than that in edOW≥0.28 kg group (Log-rank χ2=4.134, P=0.043), and the CVD mortality in edOW≥0.28 kg group was significantly higher than that in edOW<0.28 kg group (Log-rank χ2=11.136, P=0.001). Cox multivariate regression analysis showed that high edOW was an independent influencing factor for all-cause death and CVD death in hemodialysis patients ( HR=1.541, 95% CI 1.057-2.249, P=0.025; HR=1.930, 95% CI 1.198-3.107, P=0.007). Conclusion:High edOW in early phase is an independent influencing factor of all-cause and CVD death in hemodialysis patients.
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Objective@#To explore the epidemiological characteristics and influencing factors of abdominal obesity among primary and middle school students in Hangzhou, and to provide evidence for abdominal obesity prevention.@*Methods@#A total of 27 967 students from 711 classes 23 primary and middle schools in 4 districts and 5 counties in Hangzhou were investigated. The 90th percentile (P90) of waist circumference of the same ethnicity, age and gender was used as the diagnostic value for abdominal obesity. Chi-square test was used to identify the deference among groups. Multilevel analysis was applied on the influencing factors of abdominal obesity.@*Results@#The rate of abdominal obesity among primary and middle school students in Hangzhou was 17.69%, with urban (20.98%) higher than rural (15.61%), boys’ (20.40%) higher than girls’ (14.92%), highest in primary school students (20.83%) and lowest in high school students (15.30%). The effects of school and class on abdominal obesity among primary and middle school students were significant (P<0.01).@*@#The rate of abdominal obesity among primary and middle school students in Hangzhou was higher than national average level. In addition to the individual factors, management on healthy food and nutrition should be a high priority on every class and every school.
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Objective To explore the effect of total parathyroidectomy (PTX) with forearm autograft on the anemia and cardiac function in uremic patients with secondary hyperparathyroidism (SHPT).Methods The clinical data of 130 uremic patients who received PTX with forearm autograft in the First Affiliated Hospital of Zhejiang University from October 2010 to December 2015 were retrospectively analyzed.The changes of anemia and echocardiogram before and after operation were compared.According to the presence of left ventricular hypertrophy (LVH) before operation,the patients were divided into LVH group and non-LVH group.Echocardiographic indexes before and one year after operation of the two groups were compared.Results (1) Three months and one year after operation,hemoglobin and hematocrit increased while erythropoietin average usage decreased significantly (P＜0.01).(2) Compared with preoperative period,the dry weight was significantly increased one year after operation,and the cardiac function indexes including left ventricular end diastolic diameter (LVDd),interventricular septum end diastolic thickness (IVSd),left ventricular posterior wall end diastolic thickness (LVPWd),interventricular septum systolic thickness (IVSs),left ventricular systolic diameter (LVDs),left ventricular myocardial mass (LVM),and left ventricular myocardial mass index (LVMI) decreased significantly (P ＜ 0.05).(3) In the non-LVH group,only IVSs decreased one year after operation (P ＜ 0.05).In the LVH group,LVDs,LVDd,LVPWd,LVM,LVMI and IVSs were decreased significantly one year after operation than those in preoperative period (P ＜ 0.05).Conclusions PTX with forearm autograft is an effective treatment for uremic patients with SHPT significantly improving anemia and left ventricular structure and function,especially for patients with ventricular hypertrophy in preoperative.
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To analyze the test results of five serum markers of hepatitis B virus (HBV) among university freshmen from 2007 to 2012.Among a total of 10 827 freshmen,there were 5 021 freshmen from 2007 to 2009 with all five serum markers.The overall ratio of HBsAg positive was 4.5％,4.8％,4.8％ and 4.0％ for each year.And it had no statistically significant difference.The overall ratio of single-HBsAb positive was 34.8％,37.4％,29.0％ and 37.9％ for each year and the figure of 2008 was lower than those of 2007 and 2009 (P ＜ 0.01).The overall ratio of five markers all negative were 58.3％,55.4％,63.9％ and 55.8％ for each year and the figure of 2008 was higher than those of 2007 and 2009 (P ＜ 0.01).And 34.5％ of HBsAg positive freshmen were HBsAg(+),HBeAg (+),HBcAb (+) and 44.2％ HBsAg(+),HBeAb(+),HBcAb(+).The prevalence ratio of HBsAg for males was higher than that for females (5.1％ vs.3.2％,P ＜0.01).Among 5 806 freshmen tested during 2010-2012,522(9.0％) had a serum level of alanine transaminase (ALT) ＞ 40 U/L,including HBsAg positive (n =12),single anti-HBs positive (n =213) and five negatives (n =288).Approximate 50％ university freshmen have no anti-HBs indicating a low level of immunity.And the students should acquire the knowledge of hepatitis B,improve the ratio of vaccination,strengthen the monitoring and prevent its spread through concerted measures.
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In this study, the hypolipidemic effect of exopolysaccharides (EPS) from Pleurotus geesteranus 5# fermenting liquor by the optimal culture conditions in a 5-L stirred-tank reactor was investigated. The hypolipidemic effect of the polysaccharide, investigated in streptozotocin induced diabetic mice, decreased plasma glucose, total cholesterol and triacylglycerol concentrations by 17.1 %, 18.8 % and 12.0 %, respectively. The results of the present investigation strongly demonstrate the potential of this polysaccharide to prevent hyperglycemia in the experimental animals. Under optimal culture conditions, the maximum concentrations of mycelial and EPS were 22.63 g/L after 7 d cultivation and 11.09 g/L after 10 d, respectively. Furthermore, the morphological parameters (i.e. mean diameter, circularity, roughness and compactness) of the pellets and the broth viscosity were characterized. It was proved that compactness of the pellet morphology (R²=0.963, p<0.01) was significantly and positively determined with mycelial biomass. Moreover, mean diameter (R²=93.3, p<0.01) and broth viscosity (R²=0.950, p<0.01) were significantly and positively determined with EPS content.