不同阶段慢性肾脏病患者血清成纤维细胞生长因子23与血管钙化的相关性

目的探讨不同阶段慢性肾脏病(CKD)患者血清成纤维细胞生长因子23(FGF-23)与血管钙化的关系。方法选取2017年1月—2018年6月天津医科大学总医院肾内科收治的CKD患者128例。分为CKD1~2期组、CKD3~4期组、CKD5期组、钙化组及无钙化组,另选取同期健康群众50例作为对照组。比较各组的FGF-23、尿素氮(BUN)、血清肌酐(Scr)、胱抑素C(CysC)、肾小球滤过率(GFR)、钙及磷水平,比较不同阶段的CKD患者的钙化率。分析CKD患者血清FGF-23与临床相关指标的相关性,分析FGF-23的独立影响因素。结果CKD5期组的血清FGF-23、BUN、Scr、CysC及磷均高于其他3组(P<0.05),GFR、钙均低于其他3组(P<0.05);CKD3~4期组的血清FGF-23、BUN、Scr、CysC均高于CKD1~2期组和对照组(P<0.05),GFR低于CKD1~2期组和对照组(P<0.05);CKD1~2期组的血清Scr、CysC高于对照组(P<0.05),GFR低于对照组(P<0.05)。钙化组的血清FGF-23、BUN、Scr、CysC、磷均高于无钙化组和对照组(P<0.05),GFR低于无钙化组和对照组(P<0.05)。CKD患者血清FGF-23与BUN、Scr、CysC及磷呈正相关(P<0.05),与GFR呈负相关(P<0.05)。经Logistic回归分析得知,GFR[Ol^R=0.312(95%CI:0.200,0.487)]和磷[OR=3.714(95%CI:1.889,7.302)]是血清FGF-23的影响因素(P<0.05)。结论CKD患者血清FGF-23水平随临床分期增加而升高,且存在血管钙化的患者血清中FGF-23异常升高,其水平可反映患者的血管钙化情况。

Highly Ordered Supramolecular Assembled Networks Tailored by Bioinspired H-Bonding Confinement for Recyclable Ion-Transport Materials

Controlling dynamic molecular self-assembly to finely tune macroscopic properties offers chemical solutions to rational material design.Here we report that combining disulfide-mediated ring-opening polymerization withβ-sheet-like H-bonding self-assembly can drive a direct small-molecular assembly into a layered ionic network with precise architectural tunability and controllable functions as ion-transport membranes.This strategy enables a one-step evaporationinduced self-assembly from discrete small molecules to layered ionic networks with high crystallinity.The interlayer distances can be readily engineered with nanometer accuracy by varying the length of the oligopeptide side chain.The synergy of the layered structure and hydrophilic terminal groups facilitates the formation and ordering of interlayer water channels,endowing the resulting membranes with high efficiency in transporting ions.Moreover,the inherent dynamic nature of poly(disulfide)s allows chemical recycling to monomers under mild conditions.We foresee that the robust strategy of combining dynamic disulfide chemistry and noncovalent assembly can afford many opportunities in designing smart materials with unique functions and applications.

Knee joint pain treated with scraping combined with collateral bloodletting therapy

Objective： To observe the clinical efficacy of knee joint pain treated with scraping combined with collateral bloodletting therapy in comparison with the routine acupuncture techniques.Methods： From March 2017 through to September 2017, 60 outpatients of knee joint pain were collected from the Acupuncture-Moxibustion Department. They were randomly divided into the group A（treated with scraping combined with collateral bloodletting therapy） and the group B（treated with the simple needling therapy of acupuncture）, 30 cases in each one. Once treatment was given every day and10 times consist of one course, two courses of treatment were required. At the end of treatment, the visual analogue scale（VAS） was adopted to evaluate the pain index, tenderness index and the overall effect of the patients in the two groups. Based on the Lysholm knee scale, the scores were compared in the patients of the two groups before and after treatment.Results： The total effective rate was 96.7% in the group A and was 86.7% in the group B, indicating the significant difference（P〈0.05）. VAS value was 3.03 ± 0.62 in the group A and was 3.67 ± 0.74 in the group B after treatment, indicating that difference is statistically significant（P〈0.05）. The Lysholm knee score was 89.2 ± 4.8 in the group A and was 82.4 ± 2.6 in the group B after treatment, indicating that difference is statistically significant（P〈0.05）.Conclusion： The scraping combined with collateral bloodletting therapy is significant in the efficacy on knee joint pain and feasible in the clinical guidance.

Cutaneous region bleeding drainage for 35 swollen boil patients

Objective:To observe the clinical efficacy of swollen boil treated by cutaneous region drainage.Methods:35 swollen boil patients were selected and treated with cutaneous region bleeding drainage by applying bloodletting first and then cupping on the head of boil part. A course of treatment included 3 times, and the efficacy was assessed after 2 courses.Results:After treatment, 30 clinical cases were cured, 4 improved, and 1 unhealed. The total effective rate was 97.1%.Conclusions:Significant therapeutic effect of the cutaneous region drainage was found in curing swollen boil.

HBsAg Loss Due to Tenofovir Treatment for HBV Reactivation Following DAAs Therapy in One Patient with HBV-HCV Coinfection

Hepatitis B virus(HBV)reactivation induced by administration of direct-acting antiviral agents(DAAs)to treat hepatitis C virus(HCV)infection has been reported in previous studies,the subsequent clinical outcomes varied from no symptom to liver failure or death,however,the timing of anti-HBV treatment is controversial.We report the clinical HBV reactivation in a 51 years old female fibrotic patient with chronic HBV-HCV infection during the paritaprevir/ritonavir/ombitasvir and dasabuvir(PrOD)therapy.Her baseline HCV RNA,HBV DNA,alanine aminotransferase(ALT),and liver stiffness measurement levels were 5,560,000IU/mL,<15IU/mL,48U/L,and 11.8 kPa,respectively.At 8weeks of PrOD treatment,her HCV RNA,HBV DNA,and ALT levels were<15IU/mL,2,880,000 IU/mL,and 837U/L,respectively,and clinical reactivation was diagnosed.Meanwhile,tenofovir was immediately used for anti-HBV treatment.Fortunately,HBV DNA and ALT were undetectable and normalized after 16weeks of anti-HBV therapy,and unexpectedly,hepatitis B surface antigen loss occurred at 80weeks of anti-HBV treatment.This study may extend our understanding of the timing of anti-HBV therapy to prevent potential HBV reactivation during DAAs treatment in HBVHCV coinfected patients,and proper initiation timing may lead to functional cure of chronic HBV infection.