ON101 Cream Increases the Wound Healing Rate in Diabetic Patients with Uremia—Cases Report

Diabetic patients who underwent long-term dialysis may increase the prevalence of foot ulceration. In addition, diabetic foot ulcer (DFUs) patients with end-stage renal disease (ESRD) do not heal well, and the amputation rate is 6.5 - 10 times higher compared to the non-nephropathic diabetic population. Thus, a suitable therapeutic agent was needed. ON101 is a topical cream that promotes diabetic wound healing through a unique macrophage-regulating ability. In this case series, we included 5 diabetes patients (mean age 54.6 ± 8.7 years, 4 mal) with ESRD (mean eGFR 7.4 ± 3.35 mL/min/1.73m2) and had experienced dialysis for at least 4.5 years. These patients also have UT (University of Texas) grade 2A DFUs that have existed for at least 1.5 months (mean ulcer duration 8.3 ± 8.97 months). These subjects were applied ON101 twice daily for up to 20 weeks, and wound size was recorded during treatment. Among these subjects, three ulcers (patient No. 1, 2, and 3) completely healed within 10 weeks upon ON101 application, and one ulcer was 99% reduced at 20th weeks (patient No. 4). Only one ulcer didn’t show an obvious response that may due to poor compliance in wound care and glucose control. In summary, the overall healing rate was 60%, suggesting ON101 performed equivalence healing efficacy in dialysis patients compared with those who did not have dialysis.

Evaluation of the Application Effect of Psychological Nursing Intervention on Maintenance Hemodialysis Patients with Uremia

Objective:To evaluate the application effect of psychological nursing intervention on maintenance hemodialysis(MHD)patients with uremia.Methods:Sixty cases of uremic patients admitted to the hospital between May 2023 and May 2024 were selected for MHD treatment and divided using the random number table method into 30 cases in each group.The observation group implemented psychological nursing intervention,while the reference group received conventional nursing intervention,after which the nursing effects were compared.Results:After nursing,the psychological state score of the observation group was lower than that of the reference group;the treatment compliance of the observation group was higher than that of the reference group;the self-care ability score of the observation group was higher than that of the reference group,and the quality-of-life score of the observation group was higher than that of the reference group(P<0.05).Conclusion:Psychological nursing intervention for uremic MHD patients can improve their negative psychology,enhance treatment compliance,and comprehensively improve patients’self-care ability and quality of life.

Diagnosis of uremia patients based on color space

Since traditional nail diagnosis is susceptible to objective factors such as illumination,medical experience,etc.,a nail diagnosis system of traditional Chinese medicine which combines objective nail image acquisition with information analysis is proposed and applied to the clinical research of nail diagnosis of uremia patients.Fifteen nail pictures of uremic patients were collected and segmented.The color information of nails was extracted.The relationship between the hemoglobin values of uremic patients and the values of color space before and after maintenance hemodialysis was analyzed by correlation analysis and multiple regression analysis.The experimental results show that the hemoglobin value of uremic patients have certain correlations with multiple color channels;before and after dialysis,there are significant changes in multiple channels;and the related multiple regression equation is established.

Aging and uremia:Is there cellular and molecular crossover?

Many observers have noted that the morphological changes that occur in chronic kidney disease(CKD) patients resemble those seen in the geriatric population, with strikingly similar morbidity and mortality profiles and rates of frailty in the two groups, and shared characteristics at a pathophysiological level especially in respect to the changes seen in their vascular andimmune systems. However, whilst much has been documented about the shared physical characteristics of aging and uremia, the molecular and cellular similarities between the two have received less attention. In order to bridge this perceived gap we have reviewed published research concerning the common molecular processes seen in aging subjects and CKD patients, with specific attention to altered proteostasis, mitochondrial dysfunction, post-translational protein modification, and senescence and telomere attrition. We have also sought to illustrate how the cell death and survival pathways apoptosis, necroptosis and autophagy are closely interrelated, and how an understanding of these overlapping pathways is helpful in order to appreciate the shared molecular basis behind the pathophysiology of aging and uremia. This analysis revealed many common molecular characteristics and showed similar patterns of cellular dysfunction. We conclude that the accelerated aging seen in patients with CKD is underpinned at the molecular level, and that a greater understanding of these molecular processes might eventually lead to new much needed therapeutic strategies of benefit to patients with renal disease.

Effect of hemodialysis combined with hemoperfusion on dialysis efficiency, lipid metabolism and atherosclerosis in patients with uremia

Objective:To study the effect of hemodialysis (HD) combined with hemoperfusion (HP) on dialysis efficiency, lipid metabolism and atherosclerosis in patients with uremia.Methods:A total of 70 patients with uremia who were treated in our hospital between March 2013 and October 2015 were collected and divided into observation group and control group (n=35) according to double-blind randomized control method. Observation group of patients received hemodialysis combined with hemoperfusion, control group of patients received hemodialysis alone, and the treatment lasted for 6 months. After 6 months of intervention, automatic biochemical analyzer was used to detect renal function indexes and lipid metabolism indexes, and the two-dimensional ultrasound was used to quantitatively determine the carotid atherosclerosis parameters.Results:Before intervention, differences in renal function, lipid metabolism and atherosclerosis levels were not statistically significant between two groups of patients;after 6 months of intervention, renal function indexes blood urea nitrogen (BUN), serum creatinine (Scr),β2-microglobulin (β2-MG) and blood uric acid (BUA) levels of observation group were lower than those of control group, lipid metabolism indexes total cholesterol (TC), triglyceride (TG), apolipoprotein A1 (ApoA1) and apolipoprotein B (ApoB) levels were lower than those of control group, and differences between groups were statistically significant;quantitative carotid ultrasound parameters gray-scale median (GSM) of observation group was higher than that of control group, enhanced intensity (EI) and enhanced density (ED) were lower than those of control group, and differences between groups were statistically significant.Conclusion:Hemodialysis combined with hemoperfusion can improve the dialysis efficiency, also reduce lipid metabolism disturbance and delay the formation of atherosclerosis in patients with uremia.

Analysis of Proteomic Components of Sera from Patients with Uremia by Two Dimensional Electrophoresis and Matrix Assisted Laser Desorption/Ionization Time of Flight Mass Spectrometry

Summary： The different sera proteomic components between uremia patients and normal subjects were studied through two-dimensional gel electrophoresis technique. Immobilized pH gradient two- dimensional polyacrylamide gel electrophoresis （2DE）, silver staining, ImageMaster 2D 5.0 analysis software, matrix assisted laser desorption ionization-time of flight mass spectrometry （MALDI-TOF-TOF-MS） and IPI human database searching were used to separate and identify the proteome of the sera from the patients with uremia. The results showed that satisfactory 2DE patterns of the serum proteins were obtained. Twenty-six protein spots showed significant difference in quantity in uremia patients, and 20 protein spots were identified by MALDI-TOF-TOF-MS. It was concluded that good reproducibility could be obtained by applying immobilized pH gradient 2DE to separate and identify the proteome in serum, which provided the foundation for the further study on uremia toxins oertaining to orotein.

Clinical significance of TnI, hs-CRP and NT-proBNP in the diagnosis of myocardial damage in uremia patients

Objective:To study the clinical significance of troponinI(TnI),high sensitivity C reactive protein(hs-CRP)and N-terminal pro-brain natriuretic peptide(NT-proBNP)in the diagnosis of myocardial damage in uremia patients.Methods:114 uremia patients treated in our hospital from January 2017 to February 2019 were selected.According to whether myocardial damage occurred,patients were divided into two groups including uremia group(63 cases)anduremia myocardial damage group(51 cases).50 hospitalized patients with non-chronic kidney disease and non-cardiovascular disease in our hospital were selected as control group.The levels of TnI,hs-CRP and NT-proBNP in 1,3 and 7 days after admission were detected and compared.Meanwhile,the ecg indexes of left?ventricular?ejection?fraction(LVEF)and Thickness of the posterior wall of the left ventricle(LVPWd)were recorded and compared.Person correlation was used to analyze the correlation between the levels of TnI,hs-CRP,NT-proBNP and ecg indexes including LVEF and LVPWd.COX regression analysis was used to analyze the independent riskfactors affecting the clinical prognosis of uremia patients.Results:The levels of TnI,hs-CRP,NT-proBNP in the three groups were significantly different on 1,3,7 days after admission.The levels of the three indexes(TnI,hs-CRP,NT-proBNP)in uremia combined with myocardial damage group and uremia group were decreased with treatment.However,the levels of the three indexes(TnI,hs-CRP,NT-proBNP)in uremia combined with myocardial damage group were the highest(P<0.05).Compared with the other two groups,the LVEF of uremia combined with myocardial damage group was the lowest,while the LVPWd was the thickest,showing a significant difference(P<0.05).There was negativecorrelation between LVEF and TnI,hs-CRP,NT-proBNP levels.However,LVPWd was positively correlated with TnI,hs-CRP and NT-proBNP levels(P<0.05).COX regression analysis showed that TnI,hs-CRP,NT-proBNP levels,LVEF and LVPWd were the independent factors affecting the clinical prognosis of uremia patients Conclusion:The level of TnI,hs-CRP,NT-proBNP was dynamic change in the onset and treatment process in uremia combined with myocardial damage patients,which could be used for early diagnosis of uremia combined with myocardial damage.

Effect of high-flux and low-flux hemodialysis on the side metabolites and cytokines in patients with uremia

Objective:To study the effect of high-flux and low-flux hemodialysis on the side metabolites and cytokines in patients with uremia.Methods: A total of 50 patients with uremia who accepted high-flux hemodialysis and 140 patients with uremia who accepted low-flux hemodialysis in our hospital between March 2015 and March 2016 were selected and included in high-flux group and low-flux group respectively. Before and after dialysis, serum was collected respectively to determine the levels of side metabolites, calcium-phosphorus metabolism indexes and cytokines.Results: 3 months after dialysis, serum Ca levels of two groups of patients were not significantly different from those before dialysis while BUN, Scr,β2-MG, sTfR, P, PTH and AKP levels were significantly lower than those before dialysis;3 months after dialysis, serum BUN, Scr and Ca levels of high-flux group were not significantly different from those of low-flux group whileβ2-MG, sTfR, P, PTH, AKP, TNF-α, IL-1β, IL-6, IL-8 and IL-10 levels were significantly lower than those of low-flux group.Conclusion:Compared with low-flux hemodialysis, high-flux hemodialysis treatment of uremia can more effectively remove middle molecular and macromolecular toxins, correct calcium-phosphorus metabolism disorder and relieve micro-inflammatory state.

Effect of hemodialysis in combined with hemoperfusion on the toxin clearance rate and carotid intima in patients with uremia

Objective:To explore the effect of hemodialysis (HD) in combined with hemoperfusion (HP) on the toxin clearance rate and carotid intima in patients with uremia.Methods: A total of 40 patients with uremia who were admitted in our hospital from May, 2015 to February, 2017 were included in the study and randomized into the control group (n=20) and the study group (n=20). The patients in the two groups were given routine HD treatment. On the above basis, the patients in the study group were given HP treatment, continuously for 3 months. The toxin content, clearance rate, and serum inflammatory cytokines before and after treatment in the two groups were detected and compared. The ultrasound diagnostic apparatus was used to detect the carotid IMT before and after treatment in the two groups. Results: Scr and BUN after treatment in the two groups, and PTH andβ2-MG contents in the study group were significantly reduced when compared with before treatment. PTH andβ2-MG contents after treatment in the study group were significantly lower than those in the control group, while PTH andβ2-MG clearance rate was significantly higher than that in the control group. The serum MDA, hs-CRP, IL-6, and TNF-α levels after treatment in the two groups were significantly reduced when compared with before treatment. The serum hs-CRP, IL-6, and TNF-α levels after treatment in the study group were significantly lower than those in the control group. IMT and plaque area after treatment in the control group were significantly increased when compared with before treatment, while IMT and plaque area in the study group were not significantly changed. The plaque area after treatment in the study group was significantly less than that in the control group.Conclusions: HD in combined with HP can significantly enhance the toxin clearance rate of large molecules in patients with uremia, alleviate the inflammatory reaction, and meanwhile effectively delay the occurrence of atherosclerosis and other cardiovascular complications.

One Case of Diabetes Nephropathy Stage V, Combined Valvular Disease, Total Heart Failure with Diabetes Foot Gangrene

The patient was found to have 4+urine sugar by physical examination 14 years ago and was treated with oral hypoglycemic drugs. Insulin was injected intramuscularly nine years ago. Two and a half years ago, it was found that the color of the thumb, index and middle toe of the left foot became black. He went to a third-class hospital in Beijing and was diagnosed as “diabetes foot”. He was treated with “balloon dilation of lower limb blood vessels of diabetes foot”. Half a year ago, the third toe on the right side was broken and treated in the hospital again. “Popliteal artery stent implantation” was given for the diagnosis of “double kidney insufficiency, diabetes foot, left heart failure, combined heart valve disease”, “Hemofiltration therapy” and anti-inflammatory, amino acid supplementation, kidney function protection, anticoagulation, anemia correction and other treatments. Later, he went to our hospital and was diagnosed by the TCM diagnosis: category of consumptive disease, toe or finger gangrene (syndrome/pattern of qi and yin deficiency). Western medicine diagnosed: stage V of diabetes nephropathy, type II diabetes foot gangrene, combined with heart valve disease, hypoalbuminemia, double kidney cyst, moderate anemia, pleural effusion, hyperkalemia, pulmonary infection, and total heart failure. The patient was treated by the Qi-acupuncture therapy of TCM in combination with Chinese and Western medicine Medical treatment made the patient significantly better and discharged.

联机血液透析滤过对尿毒症皮肤瘙痒的疗效观察

【目的】观察联机血液透析滤过(HDF)对尿毒症皮肤瘙痒的临床疗效。【方法】将20例患者随机分成两组,治疗组10例,每周HDF 1次,血液透析(HD)2次;对照组10例,每周HD 3次,疗程为3个月。观察两组治疗前后患者皮肤瘙痒缓解情况以及血尿素氮(BUN)、肌酐(Cr)、β2-微球蛋白(β2-MG)、甲状旁腺激素(PTH)的数值变化。【结果】治疗组患者皮肤瘙痒的缓解率为80%,明显高于对照组(20%),且差异有显著性(P<0.01)。治疗组血β2-MG、PTH较对照组下降明显(P<0.01);但BUN、Cr的下降程度两组间差异无显著性。【结论】HDF能有效清除β2-MG、PTH大中分子物质,是治疗尿毒症患者皮肤瘙痒的一种有效方法。

尿毒症肺损害

本文报告我院1983年1月至1987年12月收治的36例尿毒症病人。11例(30.6％)有咳嗽、8例(22.2％)有气喘和(或)呼吸困难、9例(25.0％)有胸腔积液、17例(47.2％)呼吸音异常。26例(72.2％)胸片异常,表现为肺纹理增多紊乱、肺门阴影增浓、以肺门为中心向外扩散的蝶形阴影、肺部片状模糊阴影、肋膈角模糊或消失。尿毒症肺损害和病程长短、贫血程度、BUN浓度、高血压存在与否无固定关系。病人有咳嗽、气喘、呼吸困难者,多有胸片异常(P<0.05)。

甲状旁腺全切除术加前臂移植治疗尿毒症难治性继发性甲状旁腺功能亢进

【目的】研究甲状旁腺全切除术加自体前臂移植对于尿毒症引起的难治性继发性甲状旁腺功能亢进的效果。【方法】总结分析本院12例因慢性肾脏疾病长期接受规律性血液透析的患者发生继发性甲状旁腺功能亢进（SHPT），因持续性高血钙及高甲状旁腺素（parathyroid hormone，PTH），药物治疗无效，予行甲状旁腺全切除术加前臂移植术的疗效。比较手术前及手术后血PTH值，血钙值以及相关临床症状的变化情况。【结果】手术后12例病患无一例死亡，其中8例血PTH降至正常水平，血钙值一度低于正常水平，经补充钙剂之后恢复正常水平并维持，4例患者术后血PTH及血清钙数值明显降低，但仍高于正常值，故术后再次切除部分移植于前臂的甲状旁腺组织，术后血PTH及血清钙数值均降至正常。全组术后低血钙症发生率达66．7％（8／12）。血清钙术后三周内下降明显，至术后6个月逐渐恢复至正常水平。病患全身骨痛，皮肤瘙痒，乏力，纳差等症状改善明显。骨密度测定，骨量上升明显。【结论】甲状旁腺全切除术加前臂自体移植对于治疗尿毒症难治性继发性甲状旁腺功能亢进症疗效明确，是一种安全可靠的治疗手段。

Morphological characteristics of spermatozoa before and after renal transplantation

Aim: To investigate the changes of the spermatozoa ultrastructures before and after renal transplantation in uremic patients. Methods: The sperm of five uremic patients before and after transplantation and four healthy volunteers were collected and examined by scanning electron microscopy. Results: Abnormal spermatozoa were found in patients pre-transplantation; abnormalities included deletion of the acrosome, absence of the postacrosomal and postnuclear ring, dumbbell-like changes of the head, tail curling, and absence of the mitochondrial sheath in the mid-segment. After renal transplantation, most of the spermatozoa became normal. Conclusion: There are many abnormalities with regard to the appearance and structure of the head, acrosome, mitochondria and tail of the spermatozoa in uremic patients. The majority of the spermatozoa returned to normal after renal transplantation, but a few still presented some abnormalities possibly relating to the administration of immunosuppressants.

Role of β2-microglobulin in uremic patients may be greater than originally suspected

The role of beta2-microglobulin(β2M) in dialysisrelated amyloidosis as a specific amyloid precursor was defined in the 1980 s. Studies in those years were largely related to β2M amyloidosis. In 2005, for what was probably the first time in the available literature, we provided data about the association betweenβ2M and early-onset atherosclerosis in hemodialysis patients without co-morbidities. In recent years, the role of uremic toxins in uremic atherosclerosis and the interest in β2M as a marker of cardiovascular(CV) and/or mortality risk have grown. In the current literature,clinical studies suggest that β2M is an independent, significant predictor of mortality, not only in dialysis patients, but also in predialysis patients and in the highrisk portion of the general population, and it seems to be a factor strongly linked to the presence and severity of CV disease. It is still unknown whether β2M is only a uremic toxin marker or if it also has an active role in vascular damage, but data support that it may reflect an increased burden of systemic atherosclerosis in a setting of underlying chronic kidney disease. Thus, although there have been some inconsistencies among the various analyses relating to β2M, it promises to be a novel risk marker of kidney function in the awareness and detection of high-risk patients. However, more research is required to establish the pathophysiological relationships between retained uremic toxins and further biochemical modifications in the uremic milieu to get answers to the questions of why and how. In this review, the recent literature about the changing role of β2M in uremic patients will be examined.

Vascular calcification:When should we interfere in chronic kidney disease patients and how?

Chronic kidney disease （CKD） patients are endangered with the highest mortality rate compared to other chronic diseases. Cardiovascular events account for up to 60% of the fatalities. Cardiovascular calcifcations affect most of the CKD patients. Most of this calcification is related to disturbed renal phosphate handling. Fibroblast growth factor 23 and klotho defciency were incriminated in the pathogenesis of vascular calcification through different mechanisms including their effects on endothelium and arterial wall smooth muscle cells. In addition, deficient klotho gene expression, a constant feature of CKD, pro-motes vascular pathology and shares in progression of the CKD. The role of gut in the etio-pathogenesis of systemic infammation and vascular calcifcation is a newly discovered mechanism. This review will cover the medical history, prevalence, pathogenesis, clinical relevance, different tools used to diagnose, the ideal timing to prevent or to withhold the progression of vascular cal-cification and the different medications and medical procedures that can help to prolong the survival of CKD patients.

Acupuncture Treatment for 34 Cases of Uremic Cutaneous Pruritus

Chronic renal insufficiency is the result of renal injuries and progressive deterioration caused by various reasons. At the late stage, i.e. the period of uremia, it may be complicated with abnormalities of various systems. Along with the development and popularization of hemodialysis, the survival time of uremic patients can be prolonged, but uremic pruritus affects greatly the quality of life of the patients. For this purpose, we have treated 68 cases of the patients with acupuncture and western medicine respectively, and made clinical observations on the therapeutic results. A report follows.……

尿毒症合并急性左心衰患者的病因分析及血液透析后的临床疗效

【目的】探讨尿毒症合并左心衰患者的病因及对患者行急诊血液透析后的疗效，同时对其并发症发生情况进行总结，为临床救治提供指导。【方法】收集本院急诊科自2008年1月至2014年1月收治的尿毒症合并急性左心衰的患者共67例，分析其发生急性左心衰的病因，评估血液透析后的疗效，调查其发生不良反应的情况。【结果】急性左心衰的诱因中，血容量过多所占比例为35．8％，排在第一位；高血压15例，占22．4％；肺部等感染13例，占19．4％；贫血9例，占13．4％；电解质紊乱6例，占9．0％。治疗后患者的血清肌酐、尿素氮、二氧化碳结合力、血压、心率、呼吸、平均动脉压和血氧饱和度较治疗前均均有改善，且治疗前后相比较差异有显著性（P＜0．01）。治疗后的不良反应主要是低血压，其次是睡眠障碍、皮肤瘙痒、食欲不振、呕吐等。【结论】尿毒症合并急性左心衰的患者的病因复杂，行血液透析治疗的疗效确切，能明显改善患者症状，但是会出现多样复杂的不良反应，严重影响患者的就医体验，故需准确处理，积极沟通。

Pelvic lipomatosis and renal transplantation:A case report

BACKGROUND Pelvic lipomatosis is a rare disease of unknown etiology,characterized by the overgrowth of pelvic adipose tissue that causes compression of the urinary tract including the bladder and ureters,rectum and blood vessels.The patient may progressively develop obstructive uropathy which could subsequently lead to renal failure.At present,there are no reports of renal transplantation due to uremia caused by pelvic lipomatosis.The ideal management of patients with pelvic lipomatosis after renal transplantation is not yet well-established due to the lack of literature and follow-up data.CASE SUMMARY We report a 37-year-old male patient with pelvic lipomatosis who received a successful living donor renal transplantation on July 22,2015.The operation was complicated as the iliac vessels and bladder were wrapped entirely in excessive abnormal fat.The external iliac artery and vein were located using ultrasonographic guidance.The adipose tissue around the right bladder was removed as far as possible,and the graft ureter was reimplanted into the bladder,using the Lich-Gregoir technique.At 22 mo after transplantation,graft percutaneous nephrostomy was performed under ultrasonographic guidance for urinary diversion due to hydronephrosis of the graft kidney.Follow-up at four years showed that the renal allograft function was stable.CONCLUSION When patients with pelvic lipomatosis develop renal failure,renal transplantation could be a feasible treatment strategy.