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With the gradual maturity of renal replacement therapy technology, prolonging life span and improving quality of life of patients with uremia have become the ultimate management goals. In recent years, many studies at home and abroad have suggested that hypomagnesemia has an adverse effect on the prognosis of dialysis patients, which may be related to an increased risk of death. We understand the correlation between blood magnesium and blood pressure, cardiovascular disease, bone metabolism and vascular calcification, point out that blood magnesium may become one of the control indicators to reduce the mortality of dialysis patients, and explore its new clinical application.
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Objective To evaluate the efficacy and safety of X-ray guided endoscopic gastrojejunostomy using stent in treatment of malignant gastric outlet obstruction ( GOO ) . Methods Six hospitalized patients with malignant GOO underwent X-ray guided endoscopic gastrojejunostomy using stent in the department of gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University between March 2017 and June 2017. The technical success rate, clinical success rate, procedure time, adverse events and follow-up were recorded and analyzed in this retrospective study. Results The stent was successfully placed in the 6 patients with 100％ ( 6/6) technical success rate. The mean procedure time was 91. 7±51. 8 min. After the procedure, all patients were fed liquid or semi-liquid diet, and the GOO score system was increased from 0-1 before operation to 2-3 after operation. The clinical success rate was 100％(6/6). Peritonitis was observed in 2 patients during operation, and resolved by abdominal drainage. Gastrointestinal bleeding occurred in 1 patient after operation, which was resolved with conservative treatment. During a mean follow-up period of 78. 6 days (range 32-100 days), there was no recurrence of obstruction symptoms except that 1 patient died because of tumor progress 60 days after procedure. Conclusion The X-ray guided endoscopic gastrojejunostomy using stent is feasible and safe to treat malignant GOO with a reliable short-term efficacy.
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Objective To explore the early predictive value of red cell distribution width (RDW) for contrast-induced nephropathy (CIN) in patients after enhanced computed tomography (CT). Methods A total of 218 patients who underwent enhanced CT between June 2015 and June 2017 at Huizhou Central Municipal Hospital were enrolled in this study. Patients were divided into CIN group and no-CIN group. The diagnostic criteria for CIN is an increase in serum creatinine (Scr) of more than 44.2 μmol/L or 25％ of the baseline value within 3 days of contrast agent use. The general information and clinical characteristics in two groups were compared. The risk factors of CIN were analyzed by logistic regression analysis. The receiver operator characteristic curve (ROC) was used to assess the value of RDW for predicting the occurrence of CIN. Results Among 218 patients, 10(4.59％ ) patients had CIN. In the CIN group age, baseline Scr and baseline RDW were significantly higher, while hemoglobin, baseline estimated glomerular filtration rate (eGFR), red blood cell, white blood cell, albumin, and high - density lipoprotein cholesterol were significantly lower than those in the no - CIN group (all P＜0.05). Binary logistic regression analysis revealed that baseline RDW (OR=2.250, 95％CI 1.031-4.911, P=0.042) and eGFR (OR=0.963, 95％ CI 0.928-0.999, P=0.044) were correlated with the occurrence of CIN. ROC analysis confirmed the area under the curve of RDW as a predictor of CIN was 0.798 (P＜0.001). The cut - off value of RDW was 14.5％ , and the diagnostic sensitivity and specificity in CIN were 70.00％ and 85.58％, respectively. Conclusions Increased baseline RDW and decreased eGFR are the risk factors of the occurrence of CIN after enhanced CT. RDW has a good predictive value, and it may be a good biomarker for the early diagnosis of CIN.
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Objective@#To summarize and analyze the clinical data of hepatic venous pressure gradient (HVPG) and to explore the application value of HVPG in the diagnosis, evaluation and clinical treatment of portal hypertension in cirrhosis.@*Methods@#The patient data of HVPG measurement performed in Shandong Provincial Hospital from April 2010 to November 2017 were collected.@*Results@#A total of 633 patients with 833 times of HVPG measurements were included. There was significant difference in HVPG between patients with different etiologies, different Child-pugh grades and different degrees of decompensated cirrhosis.@*Conclusion@#The HVPG test is suitable for the diagnosis and evaluation of portal hypertension. The HVPG of patients with different severity of liver cirrhosis can guide the choice of the treatment plan, and the HVPG measurement should also be strictly standardized and quality control.
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Objective To explore the relationship of phospholipase A2 receptor (PLA2R) expression in renal tissue with clinical characteristics,prognosis of idiopathic membranous nephropathy (IMN) patients.Methods 134 patients diagnosed as nephropathy proven by biopsy was selected as subjects of this research,including 98 patients with IMN patients,10 patients with secondary membranous nephropathy and 26 patients with other renal glomerular diseases.The expression of PLA2R antigen in renal tissue was detected by immuno-fluorescence chemistry staining.Results The positive rate of renal PLA2R expression in IMN patients was higher than that in SMN patients (91.84％ vs 40.00％,P＜ 0.01),whereas there is no expression in other glomerular diseases.The PLA2R negative group were mainly stage Ⅰ membranous nephropathy,and positive group was mainly in stage Ⅱ.The distribution of pathological stage between the two groups was statistically significant (P ＜0.01).Compared with the positive group,the negative group was manifested with higher eGFR[(115.91± 23.32) ml· min-1 · (1.73 m2)-1 vs (94.06±27.38) ml· min-1 · (1.73 m2)-1,P=0.031],associated with the higher 12-month complete remission rate (87.50％ vs 44.07％,P=0.021).Conclusions The expression of PLA2R antigen in renal tissue plays an important role in the diagnosis,disease evaluation and prognosis of IMN.The negative PLA2R in kidney tissue of IMN may indicate a good clinical prognosis.
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Objective To explore the relationship between obesity and serum testosterone level among community adult males.Methods The stratified cluster sampling method was adopted to extract 1 166 male residents aged 20 years old and over in Zunyi City and conduct the questionnaire survey and physical examination.Fasting venous blood samples were collected for detecting the serum total testosterone(TT),sex hormone binding globulin(SHBG) and luteinizing hormone(LH).Then free testosterone index(cFT),free testosterone index(FTI) and testosterone secreting index(TSI) were calculated.Results The average levels of serum TT,SHBG,cFT,FTI,TSI and LH in 1 166 adult males were(16.83±4.90)nmol/L,(42.15 ± 20.21)nmol/L,(0.31 ±0.10)nmol/L,(0.46 ± 0.19) IU/L,(3.40 ± 2.04) IU/L and(6.77 ± 5.14) IU/L respectively;the Pearson correlation analysis showed that WHtR,BMI and WC were negatively correlated with TT,SHBG,TSI and LH,and were positively correlated with FTI,WHtR was negatively correlated with cFT,BMI and WC were negatively correlated with LH,the differences were statistically significant(P＜0.05).The multivariate linear regression analysis shown that WHtR was negatively correlated with TT,SHBG,TSI and LH;and was positively correlated with FTI,the differences were statistically significant(P＜0.01).Conclusion Adult male central obesity may be associated with the decrease of serum TT,SHBG,TSI and LH levels,and increase of FTI level.
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Objective To investigate the efficacy of percutaneous transhepatic variceal embolization (PTVE) with Cyanoacrylate (TH glue) in treating large gastric fundal variceal bleeding.Methods PTVE was performed on 24 patients with TH glue injected into the main stem of left gastric vein and its fundic branches.The degree of varices in gastric fundus,rebleeding rate and survival rate after the procedure were compared with those before.Results Varices in gastric fundus were all embolized successfully with TH glue.The diameter of varices was reduced to below 5mm or disappeared in 20 patients (83.3％),and reduced to 5-10mm in the other 4 ( 16.7％ ) During the follow-up period of 3-36 months(mean 16.6 months),the rebleeding rate and mortality were 12.5 ％ ( 3/24 ),and 12.5 ％ (3/24),respectively.One patient died of liver cancer,and two others died of chronic liver failure.Conclusion PTVE with TH glue is of ideal therapeutic effect to block the feeding veins of large gastric fundal varices.
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Objective To study the effect of mixed purified autogenic and allogeneic hematopoietic stem cell transplantation for the treatment of systemic lupus erythematosus. Methods Thirty-six MRL/lpr mice were randomly divided into the control group, the study group,the mixed group ( the ratio of autogenic to hematopoietic stem cells, mixed in different proportions were infused intravenously after 60Co irradiation. The study group were treated with daily intraperitoneal infusion of dexamethasone 1 mg·kg-1·d-1, while the control group were treated with intraperitoneal infusion of equivalent volume of saline daily. The changes of serum creatinine level, the urine protein excretion of the mice and blood WBC count were compared. Repeat measures ANOVA was used for data analysis. ELISA was used for anti-nuclear antibody detection Light microscopy, electronic micros-copy, immunofluorescence were applied to detect the pathological changes in renal tissue. Results Serum creatinine and urine protein excretion levels increased with time in the ontrol group, while those of the transplant group and the study group decreased. The reduction in mixed transplantation group and the study group was more evident compared with that of the allogeneic group. The difference was statistically significant (P＜0.05), but there was no significant difference between the mixed transplantation groups and the study group (P＞0.05). The histopathologic damage was most serious in the control group as pathological injury score of most mice were in grade 3 or 4. The majority of the histopathologic damage of the allogeneic group was in grade 2. Most f pathological damage of the study drug group and the mixed transplantation group were grade 1 or 2. Conclusion Mixed hematoopoietic stem cell transplantation for the treatment of murine systemic lupus erythematosus can effectively correct heavy proteinuria in murine systemic lupus erythematosus so improve the renal damage. It is a safe and effectively way to treat murine systemic lupus erythematosus.
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Objective To explore expression of nuclear factor kappa B (NF-κB) and change of peripheral blood dendritic cells(DCs) surface. Methods The expression of NF-κB and DCs in kidney of 40 LN cases were measured,by ALP-anti-ALP mice immune complex law(APAAP) and density gradient separation centrifugal meth-ods. Results kidney tissue of LN patients, NF-κB in the glomeruli and tubules showed a high level of expression ; CD80+ ,CD86+, HLA-DR+ expression decreasedtacrolimus group than the control group Division before and after the shape of the DCs had no effect on tacrolimus after the DCs could inhibit the proliferation of T cells and T cells to Th2 cell transformation. Conclusinn In vitro Tacrolimus inhibits the DCs mature in LN patients, NF-κB in LN kidney LN local expression and the occurrence and development of related.
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Objective To study the clinical characteristics and the influencing factors of hypertension in IgA nephropathy(IgAN)patients with normal renal function.Methods From 2002 to 2006,a total of 507 idiopathic IgAN patients with normal renal function(eGFR≥90 mL/min)confirmed by renal biopsy were treated in the First Affiliated Hospital of Sun Yat-sen University.The patients were divided into a hypertension group(n=93)and a normal group(n=414)according to the BP levels.Univariate and multivariate logistic regression analysis were used to analyze the relationship between the hypertension and the clinical characteristics.Results We found that 18.3%(93/507)of the IgAN patients had hypertension,with hypertension as the main symptom in some cases.Univariate analysis showed that male sex,older age,higher BMI,elevated level of triglyceride and cholesterol were the clinical risk factors for hypertension in IgAN patients(P