Effects of paricalcitol combined with hemodiafiltration on bonemetabolism-related indexes in patients with diabetic nephropathy and chronic renal failure

BACKGROUND Diabetic nephropathy(DN)is frequently seen in the development of diabetes mellitus,and its pathogenic factors are complicated.Its current treatment is controversial,and there is a lack of a relevant efficacy prediction model.AIM To determine the effects of paricalcitol combined with hemodiafiltration on bonemetabolism-related indexes in patients with DN and chronic renal failure(CRF),and to construct an efficacy prediction model.METHODS We retrospectively analyzed 422 patients with DN and CRF treated in Cangzhou Central Hospital between May 2020 and May 2022.We selected 94 patients who met the inclusion and exclusion criteria.Patients were assigned to a dialysis group(n=45)and a joint group(n=49)in relation to therapeutic regimen.The clinical efficacy of the two groups was compared after treatment.The changes in laboratory indexes after treatment were evaluated,and the two groups were compared for the incidence of adverse reactions.The predictive value of laboratory indexes on the clinical efficacy on patients was analyzed.RESULTS The dialysis group showed a notably worse improvement in clinical efficacy than the joint group(P=0.017).After treatment,the joint group showed notably lower serum levels of serum creatinine,uric acid(UA)and blood urea nitrogen(BUN)than the dialysis group(P<0.05).After treatment,the joint group had lower serum levels of phosphorus,procollagen type I amino-terminal propeptide(PINP)and intact parathyroid hormone than the dialysis group,but a higher calcium level(P<0.001).Both groups had a similar incidence of adverse reactions(P>0.05).According to least absolute shrinkage and selection operator regression analysis,UA,BUN,phosphorus and PINP were related to treatment efficacy.According to further comparison,the non-improvement group had higher risk scores than the improvement group(P<0.0001),and the area under the curve of the risk score in efficacy prediction was 0.945.CONCLUSION For treatment of CRF and DN,combined paricalcitol and hemodiafiltration can deliver higher clinical efficacy and improve the bone metabolism of patients,with good safety.

Hypophosphatemia as a prognostic tool for post-hepatectomy liver failure:A systematic review

BACKGROUND Post-hepatectomy liver failure(PHLF)is one of the main causes of postoperative mortality and is challenging to predict early in patients after liver resection.Some studies suggest that the postoperative serum phosphorus might predict outcomes in these patients.AIM To perform a systematic literature review on hypophosphatemia and evaluate it as a prognostic factor for PHLF and overall morbidity.METHODS This systematic review was performed according to preferred reporting items for systematic reviews and meta-analyses statement.A study protocol for the review was registered in the International Prospective Register of Systematic Reviews database.PubMed,Cochrane and Lippincott Williams&Wilkins databases were systematically searched up to March 31,2022 for studies analyzing postoperative hypophosphatemia as a prognostic factor for PHLF,overall postoperative morbidity and liver regeneration.The quality assessment of the included cohort studies was performed according to the Newcastle-Ottawa Scale.RESULTS After final assessment,nine studies(eight retrospective and one prospective cohort study)with 1677 patients were included in the systematic review.All selected studies scored≥6 points according to the Newcastle-Ottawa Scale.Cutoff values of hypophosphatemia varied from<1 mg/dL to≤2.5 mg/dL in selected studies with≤2.5 mg/dL being the most used defining value.Five studies analyzed PHLF,while the remaining four analyzed overall complications as a main outcome associated with hypophosphatemia.Only two of the selected studies analyzed postoperative liver regeneration,with reported better postoperative liver regeneration in cases of postoperative hypophosphatemia.In three studies hypophosphatemia was associated with better postoperative outcomes,while six studies revealed hypophosphatemia as a predictive factor for worse patient outcomes.CONCLUSION Changes of the postoperative serum phosphorus level might be useful for predicting outcomes after liver resection.However,routine measurement of perioperative serum phosphorus levels remains questionable and should be evaluated individually.

Effects of Lanthanum Carbonate on Vascular Calcification in Elderly Maintenance Hemodialysis Patients

Summary： The effect of lanthanum carbonate on abdominal aortic calcification （AAC） in the elderly maintenance hemodialysis （MHD） patients was investigated. Fifty-four cases subjected to routine MHD complicated with skin pruritus admitted to our hospital were selected and randomly divided into case group （n=28） and control group （n=26）. The control group was given routine MHD alone. The case group was given lanthanum carbonate additionally on the basis of routine MHD. The changes of itching degrees at first and third month, and serum calcium, phosphorus, calcium-phosphorus products, intact parathyroid hormone （iPTH） levels and AAC scores at third month after treatments were compared be- tween the two groups. The correlation between calcium-phosphorus products and AAC scores was also analyzed. There was no significant difference in the baseline of blood urea nitrogen （BUN）, serum creatinine （Scr）, uric acid, albumin, hemoglobin, C reactive protein （CRP）, low density lipoprotein （LDL）, high density lipoprotein （HDL）, triglyceride, total cholesterol between case group and control group （P〉0.05 for all）. There was also no significant difference in the baseline itching scores between the case group and the control group （P〉0.05）. At 1st and 3rd month after treatment, the itching scores in the case group were 14.2±3.2 and 10.5±2.3, respectively, which were significantly lower than the baseline and those in the control group （P〈0.05 for all）. At 1 st and 3rd month after treatment, the itching scores in the control group were 23.6v5.9 and 24.8±6.3, respectively, which were significantly higher than the baseline （P〈0.05）. There was no significant difference in the baseline of serum calcium, phos- phorus, calcium-phosphorus products, iPTH levels between the case group and control group （P〉0.05）. At 3rd month after treatment, serum phosphorus, calcium-phosphorus products and iPTH levels in the case group were decreased significantly as compared with the baseline （P〈0.05）, and the serum calcium, phosphorus, calcium-phosphorus products, and iPTH levels were statistically decreased as compared with those in the control group （P〈0.05）. The AAC scores showed statistically significant difference between the case group and the control group （P〈0.05）. The serum phosphorus and AAC scores showed a positive correlation in both two groups. It was suggested that the administration of lanthanum carbon- ate in the elderly MHD patients can effectively relieve itching, and simultaneously reduce serum phos- phorus and iPTH levels, resulting in the attenuation of vascular calcification.

Early Diagnosis and Prevention of Osteodystrophy in Perinatal Cow

Hydroxyproline is the main component of collagen,accounting for 20% or so of collagen,and metabolic changes in bone collagen directly affect the level of hydroxyproline in the blood.So inspecting the content of hydroxyproline is very important for pathogenesis and prophylactico-therapeutic measures on osteodystrophy of dairy cows.This experiment monitored and studied the change regularity of serum calcium,serum phosphorus and serum free hydroxyproline of perinatal cow in Hebei Province,and discussed a new and early diagnosis way for osteodystrophy.Thus,effective control measures could be implemented before the bone became deformed without any clinical symptom.The paper provided a theoretical foundation for early diagnosis of perinatal cow.