Effect of health management of progressive resistance training on the self-efficacy and bone mineral density improvement in patients with osteoporosis / 中华健康管理学杂志

Objective:To explore the effect of health management of progressive resistance training on self-efficacy and bone mineral density (BMD) improvement in osteoporosis patients.Methods:It was a cross-sectional study. Clinical data of 156 patients with primary osteoporosis treated in Jiangnan Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine from September 2019 to March 2022 were analyzed retrospectively. A simple random sampling method was implied, and 78 patients were set as control group, they were treated with conventional osteoporosis drugs and routine health education and peer education. And the other 78 patients were set as observation group, and progressive resistance training was added to the health management program in these patients on the basis of the intervention of the control group. Combined with the 6-month follow-up records of the two groups, the changes of self-efficacy level and the improvement of BMDin the two groups before and after the intervention were analyzed and compared. The above indexes were statistically analyzed with χ2 test or t test. Results:The compliance of diet, psychology, exercise and medication in the observation group was 97.4%, 97.4%, 98.7% and 97.4%, respectively, which were all higher than those in the control group (89.7%, 87.2%, 88.5% and 87.2%). The self-efficacy score before and after intervention in the observation group was 110.09±11.73 and 217.05±8.12, the anxiety score was 46.44±3.17 and 31.92±3.28, the depression score was 51.60±3.42 and 33.32±2.98, the osteoporosis knowledge score was 14.99±2.14 and 24.40±1.28, respectively; and those were 110.81±12.53 and 185.36±12.29, 46.92±2.18 and 36.53±3.54, 51.56±3.93 and 39.02±2.65, 14.76±2.93 and 20.11±1.84 respectively in the control group; and there was no statistically significant difference in above-mentioned indexes between the two groups before the intervention (all P>0.05); but after 6 months of intervention, the above-mentioned scores of the observation group were all significantly superior than those in the control group (all P<0.05). The BMD of lumbar spine L 1-4, femoral trochanter and hip in the observation group before intervention was 0.869±0.127, 0.608±0.110 and 0.740±0.138, respectively, and after the intervention, it was 0.915±0.107, 0.654±0.108 and 0.785±0.134, respectively; the BMD of lumbar spine L 1-4, femoral trochanter and hip in the control group was 0.833±0.126, 0.607±0.114 and 0.738±0.135, respectively before intervention, and it was 0.869±0.114, 0.643±0.114 and 0.748±0.124, respectively after intervention. After intervention, the lumbar L 1-4 bone density in the observation group was higher than that in the control group, the difference was statistically significant ( P<0.05). There was no significant difference in all the BMD before intervention and the BMD of the femoral trochanter and the hip after intervention between the two groups (all P>0.05). Conclusion:The health management of progressive resistance training combined with drug therapy can effectively improve the BMD in patients with osteoporosis.

J-shaped association between dietary zinc intake and new-onset hypertension: a nationwide cohort study in China / 医学前沿

We aimed to investigate the relationship of dietary zinc intake with new-onset hypertension among Chinese adults. A total of 12,177 participants who were free of hypertension at baseline from the China Health and Nutrition Survey were included. Dietary intake was assessed by three consecutive 24-h dietary recalls combined with a household food inventory. Participants with systolic blood pressure ≽ 140 mmHg or diastolic blood pressure ≽ 90 mmHg or diagnosed by a physician or under antihypertensive treatment during the follow-up were defined as having new-onset hypertension. During a median follow-up duration of 6.1 years, 4269 participants developed new-onset hypertension. Overall, the association between dietary zinc intake and new-onset hypertension followed a J-shape (P for non-linearity < 0.001). The risk of new-onset hypertension significantly decreased with the increment of dietary zinc intake (per mg/day: hazard ratio (HR) 0.93; 95% confidence interval (CI) 0.88-0.98) in participants with zinc intake < 10.9 mg/day, and increased with the increment of zinc intake (per mg/day: HR 1.14; 95% CI 1.11-1.16) in participants with zinc intake ≽ 10.9 mg/day. In conclusion, there was a J-shaped association between dietary zinc intake and new-onset hypertension in general Chinese adults, with an inflection point at about 10.9 mg/day.

Characteristics and risk factors of acute kidney injury progressed to chronic kidney disease: a prospective, observational cohort study / 中华肾脏病杂志

Objective:To prospectively investigate the characteristics of acute kidney injury (AKI) that progressed to chronic kidney disease (CKD) (AKI to CKD) in patients hospitalized for AKI, determine the risk factors of AKI to CKD, and preliminarily evaluate the performance of clinical risk factor model for predicting AKI to CKD.Methods:This was a prospective, observational cohort study. Patients hospitalized for AKI and without a prior CKD [estimated glomerular filtration rate (eGFR)<60 ml·min -1·(1.73 m 2) -1] were enrolled in Nanfang Hospital of Southern Medical University from April 2015 to December 2019. Survived patients were followed 90 days after AKI and the renal function 90 days post AKI was determined. The primary endpoint was AKI to CKD, defined as new-onset CKD [eGFR<60 ml·min -1·(1.73 m 2) -1 90 days post AKI]. According to AKI progressed to CKD or not, AKI patients were divided into two groups (with or without AKI to CKD). The baseline clinical data of demographics, comorbidities, baseline renal function, AKI severity, receiving hemodialysis or not, and other lab parameters were compared between two groups. The logistic regression model was used to analyze the risk factors of AKI to CKD. Finally, receiver operator characteristic (ROC) curve was drawn to evaluate the performance of clinical risk factor model for predicting AKI to CKD. Results:A total of 168 patients with AKI was enrolled in this study[male, n=91; female, n=77; age (44.0±18.4) years], in which 64 patients (38.1%) developed new-onset CKD 90 days post AKI and 104 patients (61.9%) did not. Compared to those without AKI to CKD, patients with AKI to CKD were older, and had a higher proportion of hypertension, lower levels of eGFR and hemoglobin, higher proportion of receiving hemodialysis, and higher level of discharged serum creatinine (all P<0.05). There was no significant difference in the proportion of diabetes and use of RAS inhibitors, urine protein level, and other lab parameters between two groups. Multivariate logistic regression analysis shows that receiving hemodialysis ( OR=2.516, 95% CI 1.251-5.060, P=0.010), hypertension ( OR=2.446, 95% CI 1.124-5.324, P=0.024), and lower baseline eGFR ( OR=0.975, 95% CI 0.950-0.999, P=0.043) were the independent risk factors for AKI to CKD. The clinical risk factor model including age, receiving hemodialysis, hypertension, and baseline eGFR produced moderate performance for predicting AKI to CKD, with the area under ROC curve of 0.712, 95% CI 0.634-0.790. Conclusions:AKI survivors are at high risk for developing CKD. Receiving hemodialysis, hypertension, and lower baseline eGFR are independent risk factors for predicting AKI to CKD. More studies are needed to improve the performance of clinical risk factor model for early detecting high risk patients who will develop AKI to CKD.

Hemodialysis before percutaneous renal biopsy on postoperative bleeding complications in patients with acute kidney injury / 中华肾脏病杂志

Objective To evaluate whether hemodialysis before percutaneous renal biopsy (PRB) reduces the risk of bleeding complications in patients with acute kidney injury (AKI).Methods This study was a cohort observational study.Patients who were diagnosed as AKI and received PRB in Nanfang Hospital of Southern Medical University from January 2015 to December 2018 were included in the study.Patients were divided into preoperative dialysis group and preoperative non-dialysis group according to whether PRB patients received hemodialysis treatment.According to whether perirenal hematoma occurred after the operation,the patients were divided into the groups with and without the perirenal hematoma.The baseline clinical data of AKI stage,hemoglobin,coagulation function and renal pathological changes before PRB,and perirenal hemorrhage complications after operation,including the size of perirenal hematoma within 24 hours,gross hematuria,low back pain,decreased hemoglobin value and interventional treatment (such as interventional surgery,blood transfusion,etc) in the two groups were compared.The logistic regression model was used to analyze the risk factors of perirenal hematoma after PRB.Results Ninety patients with AKI were enrolled in this study,including 41 in the preoperative dialysis group and 49 in the preoperative non-dialysis group.The proportion of patients AKI with stage 2-3 in the preoperative dialysis group was significantly higher than that in preoperative non-dialysis group (100.0％ vs 75.5％,P＜0.001).There were no significant differences in coagulation function indexes and platelet counts between the two groups.Renal ultrasound within 24 hours after PRB showed that there were no significant differences in the incidence of postoperative perirenal hematoma (56.1％ vs 63.3％,P=0.489),the incidence of postoperative perirenal large size hematoma (≥5 cm,26.1％ vs 22.6％,P=0.766),and the magnitude of the decrease in hemoglobin (3.7％ vs 1.2％,P=0.505) between the preoperative dialysis group and the preoperative nondialysis group.No blood transfusion,arteriovenous fistula,renal vascular intervention or surgery,and no hospital death occurred in the two groups.The renal pathological manifestations of the patients with and without perirenal hematoma were mainly acute tubular necrosis (ATN) and there were no significant differences between the patients with and without perirenal hematoma in indicators such as age,gender,body mass index,diabetes percentage,hypertension percentage,AKI staging,preoperative dialysis or not,serum creatinine,blood urea nitrogen,hemoglobin,platelet count and renal pathological types.After adjusting for indicators such as preoperative AKI stage and renal pathological changes,logistic regression analysis results showed that perirenal after PRB was not independently correlated with preoperative dialysis (β=0.568,P=0.241);Multivariate logistic regression analysis resluts showed that hematoma (≥5 cm) after PRB was also not independently correlated with preoperative dialysis (β=0.967,P=0.958).Conclusions Preoperative hemodialysis does not reduce the risk of bleeding complications after PRB in patients with AKI.The role of preoperative hemodialysis in reducing the risk of bleeding complications after PRB needs further study and verification.

Hemodialysis before percutaneous renal biopsy on postoperative bleeding complications in patients with acute kidney injury / 中华肾脏病杂志

Objective@#To evaluate whether hemodialysis before percutaneous renal biopsy (PRB) reduces the risk of bleeding complications in patients with acute kidney injury (AKI).@*Methods@#This study was a cohort observational study. Patients who were diagnosed as AKI and received PRB in Nanfang Hospital of Southern Medical University from January 2015 to December 2018 were included in the study. Patients were divided into preoperative dialysis group and preoperative non-dialysis group according to whether PRB patients received hemodialysis treatment. According to whether perirenal hematoma occurred after the operation, the patients were divided into the groups with and without the perirenal hematoma. The baseline clinical data of AKI stage, hemoglobin, coagulation function and renal pathological changes before PRB, and perirenal hemorrhage complications after operation, including the size of perirenal hematoma within 24 hours, gross hematuria, low back pain, decreased hemoglobin value and interventional treatment (such as interventional surgery, blood transfusion, etc) in the two groups were compared. The logistic regression model was used to analyze the risk factors of perirenal hematoma after PRB.@*Results@#Ninety patients with AKI were enrolled in this study, including 41 in the preoperative dialysis group and 49 in the preoperative non-dialysis group. The proportion of patients AKI with stage 2-3 in the preoperative dialysis group was significantly higher than that in preoperative non-dialysis group (100.0% vs 75.5%, P<0.001). There were no significant differences in coagulation function indexes and platelet counts between the two groups. Renal ultrasound within 24 hours after PRB showed that there were no significant differences in the incidence of postoperative perirenal hematoma (56.1% vs 63.3%, P=0.489), the incidence of postoperative perirenal large size hematoma (≥5 cm, 26.1% vs 22.6%, P=0.766), and the magnitude of the decrease in hemoglobin (3.7% vs 1.2%, P=0.505) between the preoperative dialysis group and the preoperative non-dialysis group. No blood transfusion, arteriovenous fistula, renal vascular intervention or surgery, and no hospital death occurred in the two groups. The renal pathological manifestations of the patients with and without perirenal hematoma were mainly acute tubular necrosis (ATN) and there were no significant differences between the patients with and without perirenal hematoma in indicators such as age, gender, body mass index, diabetes percentage, hypertension percentage, AKI staging, preoperative dialysis or not, serum creatinine, blood urea nitrogen, hemoglobin, platelet count and renal pathological types. After adjusting for indicators such as preoperative AKI stage and renal pathological changes, logistic regression analysis results showed that perirenal after PRB was not independently correlated with preoperative dialysis (β=0.568, P=0.241); Multivariate logistic regression analysis resluts showed that hematoma (≥5 cm) after PRB was also not independently correlated with preoperative dialysis (β=0.967, P=0.958).@*Conclusions@#Preoperative hemodialysis does not reduce the risk of bleeding complications after PRB in patients with AKI. The role of preoperative hemodialysis in reducing the risk of bleeding complications after PRB needs further study and verification.

Effect of dietary sodium intake on residual renal function in patients undergoing peritoneal dialysis: a prospective study of 33 cases / 南方医科大学学报

OBJECTIVE@#To explore the impact of dietary sodium-intake on residual renal function in patients undergoing peritoneal dialysis (PD).@*METHODS@#Thirty-three patients on PD with stable dialysis were regularly followed up for 12 months. The daily sodium intake of the patients was calculated based on the 3-day dietary record. Based on the mean daily sodium intake, the patients enrolled were divided into low-salt group (sodium intake≤3.0 g/day, 19 patients) and high-salt group (sodium intake>3.0 g/day, 14 patients). The baseline data of the patients were recorded, and the indicators of residual renal function and peritoneal function were regularly tested. The patients were followed-up at 3-month intervals, and their urine volume, peritoneal ultrafiltration volume and other clinical indicators were recorded and the biochemical indexes were detected to evaluate the changes in the residual renal function and peritoneal function.@*RESULTS@#There was a positive correlation between the total sodium excretion and dietary sodium intake in these patients (=0.536, =0.0013), and sodium excretion by dialysis was positively correlated with their sodium intake (=0.901, =0.000). Regression analysis suggested that the total sodium excretion was correlated with dietary sodium intake (β=0.416, 95% : 0.170-0.666; < 0.0018); sodium excretion by dialysis was associated with dietary sodium intake (β=0.489, 95% : 0.395-0.582; < 0.001). The residual renal function was reduced by 17.48±11.22 L /(w·1.73 m) in the low-salt group, as compared to 30.20±18.30 L /(w·1.73 m) in the high-salt group (=0.032). The reduction in the residual renal function was correlated with sodium intake in the PD patients (=0.409, =0.018). Multivariate regression analysis showed that sodium intake was an independent factor contributing to the reduction of residual renal function (β=14.646, 95% CI 7.426-21.866, < 0.001).@*CONCLUSIONS@#Sodium excretion by PD in patients with continuous ambulatory PD is positively correlated with their dietary sodium intake, which contribute to the decrease of residual renal function. A high dietary sodium intake may accelerate the reduction of residual renal function in these patients.

Role of fibroblast growth factor 8 in process of dental epithelium-induced directional differentiation of human postnatal dental pulp stem cells into odontoblasts and pulp cells / 中国病理生理杂志

AIM: To study the effects of fibroblast growth factor 8 (FGF8) on directional differentiation of human dental pulp stem cells (hDPSCs) into odontoblasts and pulp tissue.METHODS: hDPSCs were isolated and cultured, and identified with flow cytometry by detecting cell surface markers of hDPSCs.FGF8 at concentration of 50 μg/L was added into the mineralization fluid to induce the differentiation of the hDPSCs.The mRNA expression of dentin sialophosphoprotein (DSPP), alkaline phosphatase (ALP), bone sialoprotein (BSP) and core-binding factor alpha 1 (Cbfa-1) in differentiated cells was detected by real-time PCR.FGF8 and mouse E11.5 dental epithelium formed restructuring cell group with hDPSCs, and then the restructuring cell group was transplanted under renal capsule membrane in nude mice for tissue culture.DNA in situ hybridization was used to identify the sources of odontoblasts and pulp cells.RESULTS: The surface markers of CD29 and CD90 showed positive in isolated hDPSCs.FGF8 induced hDPSCs to form a distinct mineralization nodule, and the expression of dentin-specific proteins, DSPP, BSP and Cbfa-1, was increased.hDPSCs were induced to differentiate into odontoblasts and pulp cells by E11.5 dental epithelium and FGF8.CONCLUSION: FGF8 can assist dental epithelium to induce directional differetiation of hDPSCs into odontoblasts and pulp cells, and formation of dentin and dental pulp cavity structure.

Study of central venous oxygen saturation monitoring applicated in fluid resuscitation of patients with severe sepsis and septic shock / 中国基层医药

Objective To guide the fluid resuscitation in patients with severe sepsis and septic shock by monitoring the central venous oxygen saturation(ScvO2),and to improve the rescue success rate and prognosis of patients with sepsis.Methods Based on the standard of ScvO2 of 6h,45 patients with severe sepsis and septic shock were divided into two groups:observation group(n=28) and control group(n=17).The ScvO2,mean arterial pressure(MAP) and central venous pressure(CVP) levels were measured in the two groups after fluid resuscitation,and then the mortality,MAP compliance rate and CVP compliance rate were compared between the two groups.Results Compared with mortality in the control group(52.94%),the mortality in the observation group(14.29%) was significantly lower,the difference was significant (x2=5.927,P=0.015),but after 6h's fluid resuscitation,the MAP and CVP standard number in the two groups did not exist significant difference(x2=1.182,P>0.05).Conclusion ScvO2 with or without reaching the standard level(more than 65%) was positively correlated with the severity of the disease after fluid resuscitation in patients with severe sepsis and septic shock.Therefore,the monitoring of ScvO2 plays an important role in guiding the treatment of fluid resuscitation and judging the prognosis.

Effect of Tetramethylpyrazine on IL-8,IL-12 and IL-33 Levels in Serum and MMP-10 and NF-κB Protein Expression in Joint Synovial Tissues in Rats with Collagen-induced Arthritis / 医药导报

Objective To observe the effect of tetramethylpyrazine (TMP) on serum interleukin 8 (IL-8),interleukin 12 ( IL-12) and interleukin 33 ( IL-33) levels and MMP-10 and NF-κB protein expression in joint synovial tissues in rats with collagen-induced arthritis ( CIA) ,and further to investigate the mechanism for treating rheumatoid arthritis. Methods Rats were randomly divided into normal control group( n=10) ,model control group,dexamethasone group,low-dose of TMP and high-dose of TMP groups ( n=9 each) . The CIA model was established in all the groups except for the normal control group. Rats of dexamethasone group were give 2 mg.kg-1 of dexamethasone;Rats of low-dose and high-dose of TMP group were given 50,100 mg.kg-1 of TMP, respectively.The toe volume and arthritis index (AI) were used to evaluate joint inflammation. The levels of IL-8,IL-12 and IL-33 in the serum of rats were detected by ELISA. The expression levels of MMP-10 and NF-κB in joint synovial were detected by Western blotting. Results Compared with CIA group,the toe volume and AI were significantly reduced in high-dose of TMP groups and dexamethasone groups,and levels of IL-8,IL-12 and IL-33 and the expression levels of MMP-10 and NF-κB were decreased significantly (P0.05). Conclusion TMP at 100 mg.kg-1 showed obvious inhibition on CIA rats. The mechanism may be correlated to balancing the effect of proinflammatory factor and anti-inflammatory cytokines,improving immune function in rats,reducing joint synovial inflammation,and alleviating the destruction of the articular cartilage.

The application effect of bedside blinding method of active indwelling of nasojejunal tube combined with the nasogastric tube gastrointestinal decompression for patients with severe stroke / 中国基层医药

Objective To investigate the effects of bedside blinding method of active indwelling of nasojejunal tube combined with the nasogastric tube gastrointestinal decompression for patients with severe stroke.Methods 50 patients with severe stroke were selected and divided into two groups by using random number tables,which are the observation group and the control group,with 25 cases in each group.The patients in the observation group were treated with bedside blinding method of active indwelling of nasojejunal tube combined with the nasogastric tube gastrointestinal decompression,while the patients in the control group simply received bedside indwelling of nasogastric tube.The enteral nutritional goal -rate of target feeding volume on the 7th day and the 14th day after admission and trace the incidence of gastric stasis,the reflux and aspiration,the aspiration pneumonia in the patients of the two groups within 14 days and the situation of the days of mechanical ventilation,the days in ICU and the 30 -day mortality of patients were compared in the two groups.Results The enteral nutritional goal -rate of target feeding volume on the 7th day and the 14th day in the observation group were superior to those of the control group[The goal -rate of target feeding volume on the 7th day:88% vs.64%,χ2 =3.947,P =0.047;the goal -rate of target feeding volume on the 14th day:80% vs.52%,χ2 =4.367,P =0.037].Meanwhile the incidence of gastric stasis,the reflux and aspiration,the aspiration pneumonia in the patients of the observation group within 14 days were significantly lower than those in the patients of the control group within 14 days[The gastric retention rate:8% vs.56%(14 /25 ),χ2 =10.784,P =0.001;the reflux rate:0% vs.24%(6 /25),χ2 =4.735,P =0.03;the aspiration rate:8% vs.32%,χ2 =4.500,P =0.034;the incidence of aspiration pneumonia:24% vs.68%,χ2 =9.742,P =0.002].The days of mechanical ventilation and the days in ICU of the patients in the observation group are far less than those of the patients in the control group[The days of mechanical ventilation:(11.16 ±4.86)d vs.(13.72 ±3.67)d,t =-2.101,P =0.041;the days in ICU:(15.36 ±5.66)d vs.(18.72 ±2.99)d,t =-2.625,P =0.012].While there was no significant difference between the two groups on the 30 -day mortality(24% vs.32%,χ2 =0.397,P =0.529).Conclusion The bedside blinding method of active indwelling of nasojejunal tube combined with the nasogastric tube gastrointestinal decompression can significantly improve the enteral nutritional goal -rate of target feeding volume for patients with severe stroke and greatly reduce the incidence of gastric stasis,the reflux and aspiration,the aspiration pneumonia,and limit the days of mechanical ventilation and the days in ICU.Accordingly,it has the value of popularization in the clinical application.

The level of advanced oxidation protein products in serum is associated with dialysate glucose exposure dose in patients undergoing non-diabetic maintenance peritoneal dialysis / 实用医学杂志

Objective To investigate the association between the level of advanced oxidation protein products (AOPP) in serum and the dialysate glucose exposure dose in patients undergoing non-diabetic maintenance peritoneal dialysis (PD). Methods In this cross-sectional study, the levels of serum AOPP were measured in 192 non-diabetic PD patients. Based on the exposure dose of dialysate glucose , PD patients were assigned into the high-dose exposure and low-dose exposure groups. Serum C-reactive protein levels were also measured and the rates of cardio-vascular disease (CVD) were recorded in both groups. Results The levels of serum AOPP were higher in the high-dose exposure group, as compared with the low-dose exposure group [(78.7 ± 15.6) mmol/L vs. (71.7 ± 14.8) mmol/L, P = 0.003]. The serum C-reactive protein levels [4.6 (3.0-11.4) mg/L vs. 3.0 (2.2-5.3) mg/L, P < 0.001] and the rates of CVD (53.6% vs. 35.8%, P = 0.014) were also higher in the high-dose exposure group. After multivariate adjustment ,the level of serum AOPP was independently associated with dialysate glucose exposure dose (β = 0.157, P = 0.031) and duration of PD (β = 0.164, P =0.043). Conclusion The serum AOPP levels are associated with the dialysate glucose exposure doses in non-diabetic PD patients. Minimizing the glucose load might reduce the risk of developing CVD.

High central pulse pressure level is associated with cardiovascular disease in patients receiving maintenance peritoneal dialysis / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the association between central pulse pressure level and cardiovascular diseases (CVD) in patients receiving maintenance peritoneal dialysis.</p><p><b>METHODS</b>This cross-sectional study was conducted in 234 patients on maintenance peritoneal dialysis. Central pulse pressure levels were measured using a SphygmoCor analyzer, and cardiovascular diseases were defined as diagnosed ischemic heart disease, heart failure, stroke or peripheral vascular disease.</p><p><b>RESULTS</b>The central pulse pressure levels of patients with CVD were significantly higher than those without CVD (51.7 ± 22.5 vs 43.7 ± 17.8 mmHg, P=0.004), while the brachial pulse pressure levels were comparable between the two patient groups. After adjusting for brachial pulse pressure and other relevant risk factors, central pulse pressure level was found to independently associate with CVD (adjusted OR=1.33, 95% CI 1.01-1.73, P=0.04 ).</p><p><b>CONCLUSION</b>High central pulse pressure level may serve as a risk factor for CVD in patients on maintenance peritoneal dialysis.</p>

Incidence and influencing factors of aldosterone breakthrough during therapy with angiotensin Ⅱ receptor blockers alone,or combined with angiotensin-converting enzyme inhibitors in patients with non-diabetic nephropathy / 中华肾脏病杂志

Objective To investigate the incidence and influencing factors of aldosterone breakthrough during therapy with angiotensin Ⅱ receptor blockers (ARB) alone,or combined with angiotensin-converting enzyme inhibitors (ACEI) in Chinese patients with non-diabetic nephropathy.Methods A total of 144 patients with non-diabetic nephropathy were treated with ARB or combination therapy of ACEI and ARB for a mean follow-up period of 12 months.Aldosterone breakthrough was determined according to the change of plasma aldosterone concentration before and after treatment during 6-month and 12-month ACEI/ARB treatment.Results In 6 months,aldosterone breakthrough occurred in 21 patients,corresponding to 14.58％,while in 12 months,occurred in 39 patients,corresponding to 27.08％.Although the overall urinary protein excretion (UPE) decreased after treatment in both groups (P＜0.05),non-breakthrough group had a more remarkable reduction in UPE (P＜0.05).Univariate Logistic regression demonstrated that risk factors of aldosterone breakthrough included pre-treatment values of UPE (OR=3.643,P=0.073) and eGFR (OR=0.980,P=0.025).Multivariate Logistic model revealed pre-treatment values of eGFR was positively associated with aldosterone breakthrough (OR=0.980,P=0.025).Conclusions The incidence of the aldosterone breakthrough increases with duration of treatment.The patients with aldosterone breathrough have higher level of UPE,and enhanced decline in eGFR.Pretreatment value of eGFR is independent risk factor of aldosterone breakthrough.

The prognostic value for cardiovascular events of elevated NT-proBNP in coronary heart disease patients with metabolic syndrome / 中国基层医药

Objective To explore the prognostic value for cardiovascular events of elevated NT-proBNP in coronary heart disease(CHD) patients with metabolic syndrome(MS).Methods The level of NT-proBNP was measured in 165 CHD patients with MS diagnosed by coronary angiography.After 2 years follow-up,we recorded the corresponding cardiovascular events in those patients.Results The NT-proBNP level was much higher in ACS group than that in SCHD group( P ＜ 0.01 ).There were totally 45 events after 2 years.After adjustment of traditional risk factors including hypertension,diabetes,smoking history and high sensitivity C reactive protein( hs-CRP),Cox proportional hazard analysis indicated that high NT-proBNP level( ＞ 111.58ng/L)was an independent risk factor for future events (relative risk 2.67,P ＜0.01 ).Conclusion Elevated NT-proBNP level might be one of the independent risk factor for cardiovascular events in CHD patiens with MS.

Current situation of the clinical competence training for clinical medicine postgraduates with professional degree and its countermeasures / 中华医学教育探索杂志

Extensive attention was paid on how to ensure the cultivation quality for postgraduates with professional degree under the background of the enrollment expansion.The problems in the cultivation of postgraduates with professional degree including declined quality among enrolled students,inefficient training program,unsound management system and little clinical operation chance were analyzed combined with the practice and explore in the clinical competence training for postgraduates with professional degree in Guangxi university of Traditional Chinese Medicine.Some countermeasures were put forward in improving clinical competence for postgraduates with professional degree,for instance the improvement of the management system,tutor team,quality supervision system,clinical skill training and the construction of training bases.

Comparison of effects of anesthesia induction with different anesthetics on intraocular pressure / 中华麻醉学杂志

Objective To compare the effects of propofol,nidazolarm versus etomidate combined with sufentanil for anesthesia induction on intraocular pressure.Methods Forty-five ASA Ⅰ or Ⅱ patients,aged 20-40 yr,scheduled for surgery under general surgery,were randomly divided into 3 groups(n =15 each):propofol group(group P); midazolam group(group M)and etomidate group(group E).Anesthesia was induced with iv injection of propofol 2 mg/kg,midazolam 0.2 mg/kg,and etomidate 0.3 mg/kg in P,M and E groups respectively,and then with iv injection of sufentanil 0.2 μg/kg and cisatracurium 0.2 mg/kg in all the groups.The patients were then tracheal intubated.Intraocular pressure(IOP)and MAP were recorded at 1 m in before induction of anesthesia (T0),before intubation(T1),and at 0,1 and 2 min after intubation(T2-4).Results Compared with group P,the incidence of intraocujar hypotension was significantly decreased in group M(P ＜ 0.01).Compared with group E,the incidence of intraocular hypertension was significantly decreased in P and M groups(P ＜ 0.05),The correlation coefficient between MAP and IOP was 0.831,0.889 or 0.806 in group P,M or E respectively(P ＜0.05),and there was no significant difference in the correlation coefficient among the three groups(P ＞ 0.05).Conclusion Midazolam combined with sufentanil for anesthesia induction exerts less influence on lOP and the degree of MAP fluctuations is a major factor contributing to the change in IOP.

Effect of pressure phase plane derived τ and K on evaluation of left ventricular diastolic function in isolated rat heart during ischemia/reperfusion / 中国病理生理杂志

AIM: To analyze and compare the changes of pressure phase plane(PPP) derived τ and K on isolated rat heart during ischemia/reperfusion, and to explore the value of PPP derived τ and K for evaluation of left ventricular diastolic dysfunction. METHODS: LVEDP, -d(p/dt)_(max), τ and K were measured and calculated during ischemia/reperfusion in Sprague-Dawley rat hearts. Meanwhile, the level of lactate dehydrogenase (LDH) in the coronary effluent was measured, and the ultrastructure changes in myocardium were observed under electron microscope. RESULTS: Compared with control group, τ increased and K reduced significantly in each ischemic group in a time dependent manner (P<0.05). With prolonged ischemia, τ was even higher and K was even lower (P<0.05). Compared with control group, except ischemia 15 min, LDH in other groups increased significantly at 10 min and 20 min after reperfusion (P<0.05). Compared with ischemia 30 min, LDH of ischemia 45 min and ischemia 60 min were even higher at 10 min and 20 min after reperfusion (P<0.05). With prolonged ischemia, the abnormal changes of the myocardial ultrastructure were observed. CONCLUSION: PPP derived τ and K may be promising indexes for quantitative assessment of left ventricular diastolic function on isolated) rat heart during ischemia/reperfusion, and indication of the severity of ischemia/reperfusion injury.

Effect of early correction of anemia with erythropoietin on left ventricular mass in predialysis patients:a multi-center trial / 老年心脏病学杂志（英文版）

Objective To assess the effects of early correction of anemia with recombinant human erythropoietin (rHuEPO) on the development and progression of left ventricular hypertrophy (LVH) in patients with mild-to-moderate chronic renal insufficiency (CRI) who are not on hemodialysis. Methods A total of 158 patients with serum creatinine from 147μmol/L to 400μmol/L were nrolled in this prospective, multicenter study. Eighty-six patients with hemoglobin (Hb)＜110g/L received rHuEPO treatment with a target Hb of ≥110g/L (Group A). Forty patients with comparable Hb concentration (＜110g/L) but did not receive rHuEPO (Group B) and 32 patients with Hb≥110g/L and without rHuEPO treatment (Group C) were served as controls. Left ventricular mass index (LVMI) was evaluated by echocardiography at baseline and every 3 months for 2 years. Results There was no difference in age, gender, etiology of renal failure, blood pressure and cardiovascular risk factors among the 3 groups. At baseline, the prevalence of LVH was 72.1% in group A,72.5% in group B and 59.4% in group C. LVMI was inversely correlated with Hb levels (r=0.70, P＜0.01). During the 2-year period, the mean LVMI decreased from 142.6±25.7g/m2 to 132.4±18.5 g/m2 in group A, while increased significantly in both group B and group C. The mean Hb concentration increased from 93.8±14.6g/L to 111.2±10.3g/L (P＜0.05) in group A, but tended to decrease in group B and group C. There was no significant change of the mean blood pressure, number of anti-hypertensive drugs and serum creatinine concentrations in all 3 groups. However, patients' serum creatinine doubled more often in group B and group C than in group A.Conclusions LVH was common in predialysis CRI patients and was associated with the severity of anemia. Early intervention with rHuEPO may reverse LVH in these patients.

Exploration and Reform of Surgical Experiment Teaching / 中华医学教育探索杂志

In order to solve some problems which we are confronted with in new period during the course of practical teaching in surgery,we carried out some teaching reforms and explorations,such as stimulating study interests,reforming teaching process,strengthening practical ability,persisting after-school training and so on,which have got good results and laid a firm foundation for cultivating medical talents with practical competence.

Pro-inflammatory cytokines up-regulate expression of adhesion molecules on hum an type-B synovial cells / 中国免疫学杂志

Objective: Enhanced expression of adhesion molecules on synovial tissu e has been demonstrated in patients with dialysis-related amyloidosis (DRA). T he study was conducted to elucidate the mechanisms by which the expression of adh esion molecules on synovial cells was up-regulated.Methods: Human type-B synov ial cells were cultured in vitro with β2-microglobulin modified with adva nced glycation end products (AGE-β2m) , native β2-microglobulin (β2 m) , tumor necrosis factor-α（TNF-α）and interleukin -1β（ IL-1β）. The expression of intercellular adhesion molecule-1(ICAM-1), vasc ular cell adhesion molecule-1(VCAM-1), and E-selectin was examined by immunofluor esc enct staining and flow cytometer analysis. Results:ICAM-1 and VCAM-1, but not E -selectin, were constitutively expressed on human type-B synovial cells. TNF -α a nd IL-1β enhanced the expression of ICAM-1 and VCAM-1 in a dose- and time - depen dent manner. Neither of these cytokines appeared to induce the expression of E - selectin. Both β2m and AGE-β2m had no direct effect on the expression of the a dhesion molecules.Conclusion: Elevated level of IL-1β and TNF-α in the synov ial tissue may up-regulate the expression of adhesion molecules on synovial cel ls and therefore promote local monocytes infiltration.