Military training-related acute kidney injury / 解放军医学杂志

Military training-related acute kidney injury (MTRAKI) is a common and frequently occurring disease during training in war and peacetime, and severe MTRAKI may cause death and seriously affect the combat effectiveness of the army. The present paper focuses on the clinical features of MTRAKI, including clinical manifestations, classification and diagnosis, and also summarizes the predisposing factors, including the increase in training intensity, the decline in physical fitness of training personnel, environmental factors, nutritional status, energy intake level and genetic susceptibility. And the pathogenesis of MTRAKI was also discussed. It is believed that the redistribution of blood caused by military training can cause kidney ischemia, oxidative stress, inflammation and apoptosis, thus to cause or aggravate MTRAKI. For critically ill patients, continuous renal replacement therapy (CRRT) can better stabilize the internal environment, remove toxins and inflammatory mediators, and greatly reduce mortality. The purpose of present paper is to improve the understanding of MTRAKI, reduce the incidence, and achieve early detection and timely treatment.

Bacterial culture of bile from patients with obstructive jaundice and antibiotic sensitivity / 中国内镜杂志

Objective To investigate the characteristics of microbial isolates and the positive rate from bile cultures taken from obstructive jaundice patients, then compare the antimicrobial sensitivities to guide the rational choice and use of antibiotics. Methods Bile cultures from 322 patients from January 2012 to April 2016 were reviewed. Specimens were obtained from patients that were diagnosed obstructive jaundice. The bile specimens were examined for pathogenic respectively. At the same time, the empirical antibiotics of the 322 cases prior to operation were also analyzed. Results Bile culture was positive in 246 among322 cases, the positive culture rate was 76.40%. A total of 267 pathogens were isolated in bile culture: 208 Gram-negative bacteria, 48 Gram-positive bacteria and 11 fungus. The most common pathogens in all were Escherichia coli (208 strains, 53.18%), Enterococcus faecium (28 strains, 10.49%), Klebsiella pneumoniae (27 strains, 10.11%). The most sensitive antibiotics against Gram-negative bacteria were imipenem and meropenem (with susceptibility rate for 98.08%, respectively). The more sensitive antibiotics against Gram-negative bacteria were efoperazone/sulbactam, amikacin, piperacillin/tazobactam (susceptibility 92.31%, 88.46% and 85.58%). The lowest susceptibility rate of Gram-negative to twelve kings of antimicrobial agents were levofloxacin, andaztreonam (susceptibility 29.81%, 28.37%). The most sensitive antibiotics against Gram-positive bacteria were linezolid, teicoplanin and vancomycin(with susceptibility rate for 100.00%, respectively). The more sensitive antibiotics against Gram-positive bacteria was chloromycrtin (susceptibility 88.89%). The lower susceptibility rate of Gram-positive were levofloxacin (susceptibility 25.00%). 281 cases of patients before surgery empirical use of antimicrobial drugs. Monotherapy was used in 219 cases. The main drug was levofloxacin (86/219), the second was cefoperazone/sulbactam (70/219). The dual therapy was used in 62 cases, the mainly was cefoperazone/sulbactam plus ornidazole or metrornidazole(27/62), the second was levofloxacin plus ornidazole or metrornidazole (12/62). Conclusions Gram negative bacteria were the predominant bile pathogens found in patients with obstructive jaundice. And the most prominent Gram-negative pathogens were Escherichia coli. The sensitive rates of cefoperazone/sulbactam, amikacin and piperacillin/tazobactam were higher, which could be used as the preferred antimicrobial agents. Imipenem and meropenem should remain the last alternative when all other therapies fail or serious infection; The empirical antibiotics's pertinence was not very suitable, levofloxacin's resistance rates in obstructive jaundice was higher. It should be avoided to choose during empirical antimicrobial therapy.

Prevalence, awareness, treatment, and control of hypertension in the non-dialysis chronic kidney disease patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Data on the epidemiology of hypertension in Chinese non-dialysis chronic kidney disease (CKD) patients are limited. The aim of the present study was to investigate the prevalence, awareness, treatment, and control of hypertension in the non-dialysis CKD patients through a nationwide, multicenter study in China.</p><p><b>METHODS</b>The survey was performed in 61 tertiary hospitals in 31 provinces, municipalities, and autonomous regions in China (except Hong Kong, Macao, and Taiwan). Trained physicians collected demographic and clinical data and measured blood pressure (BP) using a standardized protocol. Hypertension was defined as systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg, and/or use of antihypertensive medications. BP < 140/90 mmHg and < 130/80 mmHg were used as the 2 thresholds of hypertension control. In multivariate logistic regression with adjustment for sex and age, we analyzed the association between CKD stages and uncontrolled hypertension in non-dialysis CKD patients.</p><p><b>RESULTS</b>The analysis included 8927 non-dialysis CKD patients. The prevalence, awareness, and treatment of hypertension in non-dialysis CKD patients were 67.3%, 85.8%, and 81.0%, respectively. Of hypertensive CKD patients, 33.1% and 14.1% had controlled BP to < 140/90 mmHg and < 130/80 mmHg, respectively. With successive CKD stages, the prevalence of hypertension in non-dialysis CKD patients increased, but the control of hypertension decreased (P < 0.001). When the threshold of BP < 130/80 mmHg was considered, the risk of uncontrolled hypertension in CKD 2, 3a, 3b, 4, and 5 stages increased 1.3, 1.4, 1.4, 2.5, and 4.0 times compared with CKD 1 stage, respectively (P < 0.05). Using the threshold of < 140/90 mmHg, the risk of uncontrolled hypertension increased in advanced stages (P < 0.05).</p><p><b>CONCLUSIONS</b>The prevalence of hypertension Chinese non-dialysis CKD patients was high, and the hypertension control was suboptimal. With successive CKD stages, the risk of uncontrolled hypertension increased.</p>

Effects of fluvastatin on the activation of p38 mitogen-activated protein kinase in glomerular mesangial cells under high concentration of glucose / 药学学报

This study is to investigate the effects of fluvastatin on the activation of p38 mitogen-activated protein kinase (p38 MAPK) and cAMP response element-binding protein (CREB1) in glomerular mesangial cells under high concentration of glucose. High concentration glucose and fluvastatin were used to stimulate the cultured rat glomerular mesangial cells (GMCs) in vitro. The protein expressions of p38 MAPK, CREB1, p-p38 MAPK and p-CREB1 were observed with Western blotting. TGF-beta1 and fibronectin (FN) mRNA were measured with reverse transcription and polymerase chain reaction (RT-PCR). The protein synthesis of laminine (LN) and type IV collagen in the supernatants of the GMCs were detected with radioimmunoassay. Compared with low glucose control group, the expressions of p-p38 MAPK, p-CREB1 were increased obviously in high glucose group, TGF-beta1 mRNA and FN mRNA, LN and type IV collagen in the supernatants were increased significantly in GMCs under high concentration glucose medium. The expression levels of p-p38 MAPK, p-CREB1, TGF-beta1 mRNA, and FN mRNA, LN and type IV collagen in the supernatants were significantly lower in the fluvastatin group than those in the high concentration glucose group. It is concluded that fluvastatin can inhibit over production of TGF-beta1 and ECM proteins in GMCs under high concentration of glucose, partly by regulating the phosphorylation of p38 MAPK and CREB1.