益肾保真方对慢性肾衰竭大鼠肾纤维化干预作用的实验研究

目的探讨益肾保真方对慢性肾衰竭(CRF)大鼠肾纤维化的干预作用及其机制。方法采用两步分肾切除法复制5/6肾切除大鼠慢性肾衰竭模型,随机分为假手术组、模型组、益肾保真方高剂量组、益肾保真方低剂量组及尿毒清组。各组均干预6周,观察大鼠的血肌酐、尿素氮、尿蛋白定量及肾组织病理变化情况,检测肾小球硬化指数、肾组织Ⅳ型胶原含量及结缔组织生长因子(CTGF)、α-平滑肌肌动蛋白(α-SMA)的表达。结果与模型组比较,益肾保真方组尿蛋白、血肌酐、尿素氮、肾组织IV型胶原含量均显著降低,与尿毒清组比较差异无统计学意义(P>0.05);与模型组比较,益肾保真方组大鼠肾小球硬化指数降低,肾组织CTGF、α-SMA表达下调,与尿毒清组比较差异有统计学意义(P<0.05)。结论益肾保真方能延缓肾衰竭进展,干预肾纤维化进程,其机制可能与下调肾组织CTGF、α-SMA的表达,抑制肾脏固有细胞的转分化,从而减少细胞外基质成分的合成和积聚有关。

在线血液透析滤过在慢性肾衰竭综合救治中的临床实用研究

【摘要】目的探讨在线血液透析滤过（online-HDF）在慢性肾衰竭综合救治中的临床效果及安全性。方法随机选取在我院进行血液透析的82例慢性肾衰竭患者，分为血液透析（HD）组（38例）和HDF／HD组（44例），HD组进行常规血液透析，HDF／HD组两次血液透析后进行一次血液滤过，对比两组治疗后血肌酐（Scr）、血尿素氮（BUN）、血清磷的变化及并发症情况。结果HDF／HD组治疗后Scr,BUN与对照组相比差异无统计学意义，血清磷与对照组相比差异有统计学意义（P〈0．05），HDF／HD组发生低血压反应等并发症明显少于HD组。结论在线血液透析滤过在慢性肾衰竭综合救治中安全方便，效果显著。

舒适护理对血液透析治疗慢性肾衰竭患者生活质量及舒适度的影响

目的探讨舒适护理对血液透析治疗慢性肾衰竭(CRF)患者生活质量及舒适满意度的影响。方法选取2014年1月至2016年6月在驻马店市中医院接受血液透析的98例CRF患者,根据入院顺序分组,各49例。对照组给予常规护理措施,观察组在对照组基础上实施舒适护理干预。对比两组干预前后生活质量评分,并统计舒适满意度。结果干预前,两组生活质量评分比较,差异无统计学意义(P>0.05);干预后,观察组生活质量评分高于对照组,且观察组舒适满意度(97.96%)高于对照组(75.51%),差异有统计学意义(P<0.05)。结论舒适护理有利于提高血液透析治疗CRF患者舒适满意度,且可有效改善其生活质量。

从《金匮要略·虚劳篇》探讨慢性肾衰竭的治疗法则

总结仲景治疗虚劳之法,探讨慢性肾衰竭的病因病机及治则治法。病因以五劳七伤损及脏腑为要,治则包括:(1)甘温健脾,斡旋中州;(2)补肾填精,扶正固本;(3)慢病缓图,兼顾标本。后世在其基础上不断补充丰富,认为"风湿、虚、瘀、浊毒"常相互交织,促进慢性肾衰竭的发展,故临床诊治时须"有是证,用是药",不可拘泥。

慢性肾衰竭合并感染患者血清因子的变化规律研究

目的探讨慢性肾衰竭合并感染患者血清因子变化规律并分析其对策,为临床治疗提供有益参考。方法按照有无合并感染将慢性肾衰竭患者48例分为感染组和未感染组,每组24例,检测其血清生化指标和相关因子含量,从而分析其变化规律。结果感染组血清生化指标与未感染组近似,差异无统计学意义;感染组丙二醛(MDA)、白介素-6(IL-6)、白介素-8(IL-8)和Lp含量分别为(12.35±3.45)μmol/L、(130.33±13.65)pg/L、(190.62±17.25)pg/L和(34.15±2.45)ng/ml,均明显高于未感染组;感染组一氧化氮(NO)、超氧化物歧化酶(SOD)含量分别为(1.78±0.94)μmol/L和(0.73±0.22)mg/L均明显低于非感染组,差异均有统计学意义(P<0.05);感染组内随病情加重,MDA、IL-6、IL-8和Lp含量均呈增高趋势,而NO和SOD含量均呈下降趋势,差异均有统计学意义(P<0.05)。结论慢性肾衰竭合并感染患者其血清因子呈现规律性变化,这对治疗方案制定有指导意义,且应加强护理以使患者病情趋于平稳。

Management of chronic heart failure in the older population

Chronic heart failure （CHF） is the leading cause of hospitalization for those over the age of 65 and represents a significant clinical and economic burden. About half of hospital re-admissions are related to co-morbidities, polypharmacy and disabilities associated with CHF. Moreover, CHF also has an enormous cost in terms of poor prognosis with an average one year mortality of 33%–35%. While more than half of patients with CHF are over 75 years, most clinical trials have included younger patients with a mean age of 61 years. Inadequate data makes treatment decisions challenging for the providers. Older CHF patients are more often female, have less cardiovascular diseases and associated risk factors, but higher rates of non-cardiovascular conditions and diastolic dysfunction. The prevalence of CHF with reduced ejection fraction, ischemic heart disease, and its risk factors declines with age, whereas the prevalence of non-cardiac co-morbidities, such as chronic renal failure, dementia, anemia and malignancy increases with age. Diabetes and hypertension are among the strongest risk factors as predictors of CHF particularly among women with coronary heart disease. This review paper will focus on the specific consideration for CHF assessment in the older population. Management strategies will be reviewed, including non-pharmacologic, pharmacologic, quality care indicators, quality improvement in care transition and lastly, end-of-life issues. Palliative care should be an integral part of an interdiscipli-nary team approach for a comprehensive care plan over the whole disease trajectory. In addition, frailty contributes valuable prognostic in-sight incremental to existing risk models and assists clinicians in defining optimal care pathways for their patients.

TREATMENT OF COMPLICATIONS DUE TO PERITONEAL DIALYSIS FOR CHRONIC RENAL FAILURE WITH TRADITIONAL CHINESE MEDICINE

In this paper,the experience in the treatment of complications due to continuousambulatory peritoneal dialysis for chronic renal failure with traditional Chinese medicine(TCM)is reported.Modified Renshen Yangrong Tang(Ginseng Nutrition Decoction)wasused for anorexia and hypoproteinemia;modified Xiangsha Liujunzi Tang(Decoction ofCyperus and Amomum with Six Noble Ingredients)for abdominal pain and distension;modified Da Chaihu Tang(Major Bupleurum Decoction)for peritonitis;modifiedShenling Baizhu San(Powder of Ginseng,Poria and Atractylodes)for diarrhea due toinsufficiency of the spleen with abundance of dampness;Lizhong Tang(Decoction forRegulating the Function of Middle-jiao)and modified Sishen Wan(Pills of FourMiraculous Drugs)for insufficiency of both the spleen and the kidney;Siwu Tang(Decoction of Four Ingredients)added with other drugs for cutaneous pruritus,andGuishao Sijunzi Tang(Decoction of Four Noble Drugs added with Chinese Angelica Rootand white Peony Root)for renal anemia.The therapeutic principles of invigorating theliver and kidney,strengthening the bones and muscles,and promoting blood circulation toeliminate blood stasis were adopted in the treatment of renal osteopathy,and thetherapeutic principles of invigorating the liver and kidney,expelling phlegm and resolvingdampness,and promoting blood circulation to eliminate blood stasis in the treatment ofhyperlipemia.Shen Tekang capsules(capsules for improving the renal function)wasadministered to patients for strengthening the viability and improving the nutrition state,and the recipe for treating renal function failure(both formulated by the authors)forimproving the renal function so as to decrease the frequency and duration of dialysis.

Effects of mindfulness meditation on trait mindfulness,perceived stress,emotion regulation,and quality of life in hemodialysis patients:A randomized controlled trial

Objective:This study aimed to examine the effects of mindfulness meditation on trait mindfulness,perceived stress,emotion regulation,and quality of life in end-stage renal disease patients undergoing hemodialysis.Methods:An experimental study with repeated measures design was conducted among a sample of 74 end-stage renal disease patients undergoing hemodialysis between January and May 2021 in the dialysis center at Jahra hospital,Kuwait.The patients were randomly assigned to the experimental(n?37)and control groups(n?37).The experimental group participated in 30-min mindfulness meditation sessions(three sessions a week for five weeks)held during their hemodialysis sessions;the participants in the control group were instructed to sit with their eyes closed and relaxed for 30 min three times a week for five weeks during hemodialysis sessions.The dependent variables of both groups were measured at baseline(T0),middle of intervention(T1),and end of intervention(T2)using the Mindful Attention Awareness Scale(MAAS),Perceived Stress Scale(PSS),Emotion Regulation Questionnaire(ERQ),and Kidney Disease Quality of Life(KDQOL-36)questionnaire.The study was registered in the ClinicalTrial.gov(Identifier:NCT05176730).Results:The repeated measures ANOVA(within-subject)results for the experimental group showed that mindfulness meditation had significantly decreased perceived stress by the end of the intervention.Also,mindfulness meditation improved mindfulness,emotion regulation,and kidney disease-related quality of life in the experimental group,and this improvement occurred significantly at both T1 and T2.The repeated measures ANOVA(within and between-subject)results showed that the experimental group,as compared to the control group,had lower perceived stress,higher trait mindfulness,higher emotional regulation,and higher kidney disease-related quality of life over time.Conclusions:The positive findings of this study offer health policy-makers and hospital administrators a promising tool to use with patients undergoing hemodialysis as a way to manage stress and improve quality of life.However,this study should be replicated in multiple settings with follow-up assessments.

Pseudomelanosis duodeni associated with chronic renal failure

Pseudomelanosis duodeni (PD) is a rare dark speckled appearance of the duodenum associated with gastrointestinal bleeding,hypertension,chronic heart failure,chronic renal failure and consumption of different drugs.We report four cases of PD associated with chronic renal failure admitted to the gastroenterology outpatient unit due to epigastric pain,nausea,melena and progressive reduction of hemoglobin index.Gastroduodenal endoscopy revealed erosions in the esophagus and stomach,with no active bleeding at the moment.In addition,the duodenal mucosa presented marked signs of melanosis;later confirmed by histopathological study.Even though PD is usually regarded as a benign condition,its pathogenesis and clinical significance is yet to be defined.

Erectile dysfunction in hemodialysis: A systematic review

Men with chronic renal failure （CRF） on hemodialysis have been frequently associated with erectile dysfunc-tion （ED）, with an of between 20% to 87.7%. As a result of the multi-system disease processes present in many uremic men, it is apparent that the pathogenesis of ED is most probably multifactorial. Factors to be con-sidered include peripheral vascular disease, neurogenic abnormalities, hormonal disturbances and medications used for treatment of conditions associated with CRF. These physiological abnormalities may be supplement-ed by signifcant psychological stresses and abnormali-ties resulting from chronic illness. Treatment must start with the determination and treatment of the underlying causes. In addition to psychological treatment, furtherlines of treatment of ED in CRF can be classifed as 1stline （medical treatment which includes oral phosphodi-esterase-5 inhibitors and hormone regulation）, 2nd line（intracavernosal injection, vacuum constriction devicesand alprostadil urethral suppositories） or 3rd line （sur-gical treatment）. Renal transplantation improves thequality of life for some patients with CRF and subse-quently it may improve erectile function in a signifcantnumber of them, however still there is high incidenceof ED after transplantation.

Effects of Low-Molecular-Weight-Chitosan on the AdenineInduced Chronic Renal Failure Rats in vitro and in vivo

The effects of low-molecular-weight-chitosan （LMWC） on chronic renal failure （CRF） rats induced by adenine were investigated in vivo and in vitro. Chitosan were hydrolyzed using chitosanase at pH 6-7 and 37℃ for 24h to obtain LMWC. In vitro, the effect of LMWC on the proliferation of renal tubular epithelial cells （RTEC） showed that it had no cytotoxic effect and could promote cell growtfi. For the in vivo experiment, chronic renal failure rats induced by adenine were randomly divided into control group, Niaoduqing group, and high-, medium- and low-dose LMWC groups. For each group, we detected serum creatinine （SCR）, blood urea nitrogen （BUN）, and total superoxide dismutase （T-SOD）, glutathione oxidase （GSH-Px） activities of renal tissue, and obtained the ratio of kidney weight/body weight, pathological changes of kidney. The levels of serum SCR, BUN were higher in the adenine-induced rats than those in the control group, indicating that the rat chronic renal failure model worked successfully. The re- suits after treatment showed that LMWC could reduce the SCR and BUN levels and enhance the activities/levels of T-SOD and GSH-PX in kidney compared to control group. Histopathological examination revealed that adenine-induced renal alterations were restored by LMWC at three tested dosages, especially at the low dosage of 100mgkg-1 d-1.

Use of agents stimulating erythropoiesis in digestive diseases

Anemia is the most common complication of inflammatory bowel disease (IBD). Control and inadequate treatment leads to a worse quality of life and increased morbidity and hospitalization. Blood loss, and to a lesser extent, malabsorption of iron are the main causes of iron def iciency in IBD. There is also a variable component of anemia related to chronic inflammation. The anemia of chronic renal failure has been treated for many years with recombinant human erythropoietin (rHuEPO), which significantly improves quality of life and survival. Subsequently, rHuEPO has been used progressively in other conditions that occur with anemia of chronic processes such as cancer, rheumatoid arthritis or IBD, and anemia associated with the treatment of hepatitis C virus. Erythropoietic agents complete the range of available therapeutic options for treatment of anemia associated with IBD, which begins by treating the basis of the inflammatory disease, along with intravenous iron therapy as f irst choice. In cases of resistance to treatment with iron, combined therapy with erythropoietic agents aims to achieve near-normal levels of hemoglobin/hematocrit (11-12 g/dL). New formulations of intravenous iron (iron carboxymaltose) and the new generation of erythropoietic agents (darbepoetin and continuous erythropoietin receptor activator) will allow better dosing with the same eff icacy and safety.

Exploiting PLSA model and conditional random field for refining image annotation

This paper presents a new method for refining image annotation by integrating probabilistic la- tent semantic analysis （PLSA） with conditional random field （CRF）. First a PLSA model with asymmetric modalities is constructed to predict a candidate set of annotations with confidence scores, and then model semantic relationship among the candidate annotations by leveraging conditional ran- dom field. In CRF, the confidence scores generated lay the PLSA model and the Fliekr distance be- tween pairwise candidate annotations are considered as local evidences and contextual potentials re- spectively. The novelty of our method mainly lies in two aspects ： exploiting PLSA to predict a candi- date set of annotations with confidence scores as well as CRF to further explore the semantic context among candidate annotations for precise image annotation. To demonstrate the effectiveness of the method proposed in this paper, an experiment is conducted on the standard Corel dataset and its re- sults are ＇compared favorably with several state-of-the-art approaches.

Preparation and characterization of controlled-release fertilizers coated with marine polysaccharide derivatives

Encapsulation of water-soluble nitrogen fertilizers by membranes can be used to control the release of nutrients to maximize the fertilization ef fect and reduce environmental pollution.In this research,we formulated a new double-coated controlled-release fertilizer(CRF)by using food-grade microcrystalline wax(MW)and marine polysaccharide derivatives(calcium alginate and chitosan-glutaraldehyde copolymer).The pellets of water-soluble nitrogen fertilizer were coated with the marine polysaccharide derivatives and MW.A convenient and eco-friendly method was used to prepare the CRF.Scanning electron microscopy(SEM)and Fourier transform infrared spectroscopy(FTIR)were used to characterize the morphology and composition of the products.The nitrogen-release properties were determined in water using UV-Vis spectrophotometry.The controlled-release properties of the fertilizer were improved dramatically after coating with MW and the marine polysaccharide derivatives.The results show that the double-coated CRFs can release nitrogen in a controlled manner,have excellent controlled-release features,and meet the European Standard for CRFs.

Regime Behavior in the Sea Surface Temperature-Cloud Radiative Forcing Relationships over the Pacific Cold Tongue Region

Previous analyses on the estimates of water vapor and cloud-related feedbacks in the tropics usually use observations over the Earth Radiation Budget Experiment （ERBE） period （1985-89）. To examine the sample dependence of previous estimates, the authors extend the analysis to two additional periods： 1990-94 and 1995-99. The results confirm our hypothesis, i.e., the values of the feedbacks depend on the period of data coverage. The differences in the feedbacks from cloud radiative forcings （CRFs） estimated from the three periods are particularly significant. Two possible causes for these differences are proposed. First, a regime behavior in the CRFs-Sea Surface Temperature Anomaly （SSTA） rela- tionship over the cold tongue region is revealed： when SSTA is below -0.5℃, the CRF anomalies are insensitive to the SSTA; when the SSTA is between -0.5℃ and 2.0℃, the CRF anomalies are positively correlated with the SSTA; however, when the SSTA exceeds 2.0℃, the CRF anomalies decrease with the SSTA. This regime behavior is due to the regime behavior of cirrostratus and deep convective clouds. Second, the CRFs-SSTA relationship is regulated by remote forcings. Warming of the far eastern equatorial Pacific would reduce the water vapor convergence over the central Pacific by weakening the trade wind over the southeastern Pacific, thereby reducing the feeding of moisture to the convective flow. The results suggest that CRFs-SSTA relationships during ENSO events are nonlinear and strongly depend on the magnitude and the spatial distribution of the SSTA.

Corticotropin-releasing factor secretion from dendritic cells stimulated by commensal bacteria

AIM:To study the production and secretion of corticotropin-releasing factor (CRF) by dendritic cells and the influence of commensal bacteria.METHODS:JAWSⅡ cells (ATCC CRL-11904),a mouse dendritic cell line,were seeded into 24-well culture plates and grown for 3 d.Commensal bacterial strains of Clostridium clostrodiiforme (JCM1291),Bacteroides vulgatus (B.vulgatus) (JCM5856),Escherichia coli (JCM1649),or Fusobacterium varium (F.varium) (ATCC8501) were added to the cells except for the control well,and incubated for 2 h.After incubation,we performed enzyme-linked immunosorbent assay for the cultured medium and reverse transcription polymerase chain reaction for the dendritic cells,and compared these values with controls.RESULTS:The level of CRF secretion by control dendritic cells was 40.4±6.2 pg/mL.The CRF levels for cells incubated with F.varium and B.vulgatus were significantly higher than that of the control (P<0.0001).CRF mRNA was present in the control sample without bacteria,and CRF mRNA levels in all samples treated with bacteria were above that of the control sample.F.varium caused the greatest increase in CRF mRNA expression.CONCLUSION:Our results suggest that dendritic cells produce CRF,a process augmented by commensal bacteria.

Biochemical Changes in Chronic Renal Failure Pre and Post Hemodialysis

The aim of the study was to evaluate Paraoxonase-I （PON-1）, resistin and bone mineral markers （Parathyroid Hormone （PTH）, Ca＋＋ and P） levels as biochemical marker for patients with Chronicrenal Failure （CRF）. The sample of this study consists of 100 patients and 100 apparently healthy individuals. All patients were those who were receiving Hemodialysis （HD） therapy in the dialysis unit in Kirkuk general. The levels of PON-1, Ca＋＋ were significantly lower in CRF patients pre HD when compared with healthy controls, and significantly increased in post HD as compared to pre HD, but still lower than normal controls. Serum P, resistin and PTH levels were significantly higher in CRF patients pre HD process when compared with healthy controls, and their levels were significantly decreased after HD as compared to pre HD, but remained higher than controls. PON-1 was negatively correlated with the resistin, Blood Urea （BU）, Creatinine （Cr）, PTH, but positively correlated with Ca＋＋. PON-I activity was significantly decreased in CRF patients before HD and increased after HD, but remained lower than controls. PON-1 was negatively correlated with the Body Max Index （MBI）, resistin, BU, Cr, PTH, but significantly and positively correlated with Ca＋＋.

Contrast induced nephropathy after percutaneous coronary intervention： risk factors and preventive strategy

Objective To analyze the risk factors and clinical outcome of contrast induced nephropathy （CIN） in patients with coronary artery disease （CAD） after percutaneous coronary intervention （PCI） and discuss its prevention. Methods Fifty-four patients with C1N among 729 patients who received PCI were retrospectively studied and the related risk factors, cardiovascular events and preventive strategy were analyzed. Results C1N was strongly associated with pre-procedure chronic renal failure, diabetes mellitus and large-dose contrast. The incidence of cardiac mortality and major adverse cardiac events 1 year after PCI in CIN group was higher than that in group without CIN. Conclusion Chronic renal failure, diabetes mellitus and dosage of contrast agent were three independent risk factors of CIN. CIN could affect the patients＇ prognosis. A well overall perioperative management of CAD patients following PCI, especially hydration therapy, is the most important strategy for prevention of CIN.

Secondary hyperparathyroidism associated with multiple brown tumor:a case report

Brown tumour represents a serious complication of hyperparathyroidism.Definitive diagnosis is based on histological examination,clinical,radiological and laboratory data.Here we report a case of multiple brown tumours localised in collarbone,rib and in the distal ulna due to secondary hyperparathyroidism in a 37-year-old women with chronic renal failure.The clinical management of brown tumour aimed primarily to reduce the elevated parathyroid hormone levels by pharmacological treatment.In our experience,clinicians usually consider brown tumor of hyperparathyroidism is caused by giant cell lesions in maintenance hemodialysis recipients,and multiple brown tumours are rarely seen in these patients.

Serum granulocyte colony-stimulating factor in patients with chronic renal failure

Objective To gain a better understanding of the regulatory mechanism and kinetic behaviour of granulocyte colony-stimulating factor (G-CSF).Methods An enzyme-linked immunosorbent assay (ELISA) method was used to detect serum G-CSF in 61 patients with chronic renal failure±long-term hemodialysis and 30 normal controls. Results Serum G-CSF levels in CRF patients were significantly higher than in normal controls. Eighty percent of patients had detectable G-CSF and serum G-CSF levels were 566.40±207.98?ng/L in non-hemodialyzed (non-HD) patients. The detectable percentage in hemodialyzed patients was 93.33%, serum G-CSF levels in pre-HD and post-HD patients were 1255.36±611.25?ng/L and 1151.61±599.47?ng/L respectively. Serum G-CSF levels in HD patients were slightly higher than in non-HD patients, but no significant difference was found between the two groups. No difference was found between the G-CSF values obtained in pre-HD and post-HD patients. There was no relationship between G-CSF levels and WBC, BUN or Scr (P>0.05).Conclusion The high value of G-CSF in patients with CRF may be caused by a decrease in G-CSF clearance and/or an increase in G-CSF release.