[Vesselplasty for the treatment of spinal metastases complicated by posterior wall destruction of vertebral body].

OBJECTIVE: To evaluate the early clinical efficacy and safety of vesselplasty for the treatment of spinal metastases complicated by posterior wall destruction of vertebral body. METHODS: The clinical data of 19 patients(21 segments) with spinal metastases complicated by posterior wall destruction of vertebral body treated from January 2016 to January 2017 were retrospectively analyzed. There were 15 males and 4 females, aged 40 to 85 years old with a mean of (66.00±10.25) years . All patients had severe low back pain before the operation, which were diagnosed by CT as damage-type metastatic tumor of the vertebral posterior wall. All patients were treated by vesselplasty technique. Nineteen vertebrae received percutaneous unilateral pedicle puncture and two vertebrae received percutaneous bilateral pedicle puncture. VAS, ODI were recorded before operation, 1 d and 3 d after operation respectively. X-ray and CT scan were used to observe bone cement leakage and complications. RESULTS: All the operations were successful and postoperative pain was significantly relieved. Postoperative VAS score and ODI of the two groups were significantly improved (P<0.05). A small amount of bone cement leakage occurred in one vertebral body, which was a vertebral venous plexus leakage, but no clinical symptoms after operation. CONCLUSION: Vesselplasty for the treatment of spinal metastases complicated by posterior wall destruction of vertebral body can significantly reduce the symptoms of thoracolumbar back pain, improve the quality of life, reduce the incidence of bone cement leakage, and has high clinical efficacy and safety.

Variability of glomerular filtration rate estimation equations in elderly Chinese patients with chronic kidney disease.

BACKGROUND: Chronic kidney disease (CKD) is recognized worldwide as a public health problem, and its prevalence increases as the population ages. However, the applicability of formulas for estimating the glomerular filtration rate (GFR) based on serum creatinine (SC) levels in elderly Chinese patients with CKD is limited. MATERIALS AND METHODS: Based on values obtained with the technetium-99m diethylenetriaminepentaacetic acid ((99m)Tc-DTPA) renal dynamic imaging method, 319 elderly Chinese patients with CKD were enrolled in this study. Serum creatinine was determined by the enzymatic method. The GFR was estimated using the Cockroft-Gault (CG) equation, the Modification of Diet in Renal Disease (MDRD) equations, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, the Jelliffe-1973 equation, and the Hull equation. RESULTS: The median of difference ranged from -0.3-4.3 mL/min/1.73 m(2). The interquartile range (IQR) of differences ranged from 13.9-17.6 mL/min/1.73 m(2). Accuracy with a deviation less than 15% ranged from 27.6%-32.9%. Accuracy with a deviation less than 30% ranged from 53.6%-57.7%. Accuracy with a deviation less than 50% ranged from 74.9%-81.5%. None of the equations had accuracy up to the 70% level with a deviation less than 30% from the standard glomerular filtration rate (sGFR). Bland-Altman analysis demonstrated that the mean difference ranged from -3.0-2.4 mL/min/1.73 m(2). However, the agreement limits of all the equations, except the CG equation, exceeded the prior acceptable tolerances defined as 60 mL/min/1.73 m(2). When the overall performance and accuracy were compared in different stages of CKD, GFR estimated using the CG equation showed promising results. CONCLUSIONS: Our study indicated that none of these equations were suitable for estimating GFR in the elderly Chinese population investigated. At present, based on overall performance, as well as performance in different CKD stages, the CG equation may be the most accurate for estimating GFR in elderly Chinese patients with CKD.

How increased VEGF induces glomerular hyperpermeability: a potential signaling pathway of Rac1 activation.

Despite growing evidence for a pathogenic role of vascular endothelial growth factor (VEGF) in microvascular complications of diabetes, the underlying mechanism responsible for its detrimental effect remains unknown. In the current study, we hypothesized that some of the detrimental effects of VEGF on microvascular endothelial cells in the diabetic milieu stem from its aberrant signaling, which leads to perturbed tight junction assembly and increased endothelial permeability. Using an integrated in vitro approach, we investigated whether the effect of VEGF on endothelial cell permeability involves Rac1 GTPase activation and tight junction disassembly. Rac1 activity was detected by Western blotting in cell membrane protein as well as pull-down assay. The permeability of glomerular endothelial cells monolayer was detected as transendothelial electronic resistance. Then tyrosine phosphorylated occludin protein was detected by Western blotting after immunoprecipitation. N17Rac1 cells are obtained by transfection of glomerular endothelial cells with a dominant negative mutant of Rac1. The data obtained in this study indicate that activation of Rac1 GTPase contributes to VEGF-induced endothelial cell hyperpermeability. We also observed that Rac1 activation leads to increased endothelial permeability through tyrosine phosphorylation of occludin. Indeed, N17Rac1 cells dramatically attenuated the effect of VEGF on phospho-occludin and endothelial cell permeability. These results, when taken together, provide a framework for understanding the role of VEGF-induced Rac1/phospho-occludin pathway in the integrity of endothelial barrier function in the glomerulus.

[Clinical control study of dialysates with different concentrations of calcium on blood pressure in patients under hemodialysis for prolonged period].

OBJECTIVE: To investigate the changes in blood pressure in hemodialysis patients treated with low calcium dialysate or high calcium dialysate for long time. METHODS: Fifteen patients undergoing hemodialysis were enrolled in this study. High calcium dialysate (1.75 mmol/L, Dca1.75) was first used for 6 months, then low calcium dialysate (1.25 mmol/L, Dca1.25) was used for 6 months. Serum calcium, phosphate, blood urea nitrogen, and creatinine were measured, blood pressure was recorded before and after hemodialysis at the beginning, and also at 1, 2, 3 and 4 hours after hemodialysis. RESULTS: Compared with that before the treatment, systolic and diastolic blood pressure lowered significantly after single low calcium hemodialysis for 4 hours (both P<0.05), while systolic and diastolic blood pressure rose significantly after single high calcium hemodialysis (both P<0.05). Systolic blood pressure changed more obviously after two hemodialyses (both P<0.05). Changes in systolic, diastolic and mean blood pressure were positively related to changes in serum total calcium (r(1)=0.326, P(1)=0.054; r(2)=0.383, P(2)=0.037; r(3)=0.391, P(3)=0.032). During 6 months of hemodialysis with low calcium dialysate, blood pressure lowered slightly with no significant difference in it (P>0.05), while systolic blood pressure rose during 6 months of hemodialysis with high calcium dialysate (P<0.05). Changes in systolic blood pressure were significantly different between two groups using dialysates with different calcium concentrations (P<0.05). CONCLUSION: Systolic blood pressure and incidence of hypertension decrease after single low calcium hemodialysis.

[Clearance effect of different blood purification techniques on parathyroid hormone in renal function failure patients on maintenance hemodialysis].

OBJECTIVE: To evaluate the effect of different blood purification techniques on serum parathyroid hormone (PTH) level in chronic hemodialysis (HD) patients with renal failure. METHODS: Ninety patients were randomly divided into three groups: absorption (AP) group, hemodiafiltration (HDF) group, and HD group. Patients in AP group received therapy with resin absorptive devices associated with HD, patients in HDF group received HDF, while patients in HD group received HD. Blood routine examination, serum albumin, globulin, blood urea nitrogen, creatinine and PTH were measured before and after these treatments, and vital signs and side effects were recorded during HD. Glomerular filtration rate (GFR) and the length of HD were compared among three group. RESULTS: (1)Serum PTH in AP group was decrease from (291.7+/-237.5)ng/L to (122.2+/-114.5)ng/L, the difference was statistically significant. The mean single clearance rate was 48.6%+/-55.2%, the rate of relief from skin discomfort was 83.3%e10/12 cases). (2)Serum PTH in HDF group was decreased from(325.9+/-423.1)ng/L to (90.9+/-93.7)ng/L, the difference was statistically significant. The mean single clearance rate was 59.5%+/-22.7%, and the rate of relief from skin discomfort was 50.0%(4/8 cases).(3)Serum PTH in HD group was decreased from (297.7+/-211.3)ng/L to (248.1+/-105.5)ng/L, which showed no statistically significant difference. The mean single clearance rate was 13.1%+/-30.2%, the rate of relief from skin discomfort was 14.3%(1/7 cases). CONCLUSION: Resin absorptive devices and HDF can safely and effectively clear PTH, relieve skin discomfort; while hemodialysis alone can not.

[Comparison of serum leptin clearance with different blood purification].

OBJECTIVE: To compare the serum Leptin clearance efficiency with different blood purification treatment. METHODS: Thirty-one chronic end-stage renal failure hemodialysis (HD) patients (16 men, 15 women, mean age (54.0+/-11.0) years) were enrolled into the study. All the patients were treated with routine hemodialysis, the serum Leptin levels were examined before and after HD. Then they were divided into two groups, one was to be treated with hemodiafiltration (12 patients), and the other was to be treated with blood adsorption (8 patients). The same serum Leptin levels were examined before and after treatment. Serum Leptin concentration was detected by radioimmunoassay (RIA). RESULTS: The concentration of serum Leptin was not significantly decreased after routine hemodialysis in HD patients ((11.820+/-5.507) microg/L vs. (12.255+/-5.172) microg/L, P>0.05). Leptin concentrations after hemodiafiltration and blood adsorption therapy were decreased to the levels of (29.07+/-8.56) percent and (40.29+/-8.33) percent respectively, and their curative effect was significantly different (P=0.001). CONCLUSION: Routine hemodialysis can influence serum Leptin levels in HD patients. Hemodiafiltration and blood adsorption therapy can lower serum Leptin levels. Blood adsorption therapy is better than hemodiafiltration in the clearance of serum Leptin.