Objective To study the effectiveness of niacinamide in treating maintenance hemodialysis patients with hyperphosphatemia.Methods It was a prospective and randomized controlled trial.Patients with hyperphosphatemia (serum phosphate ＞ 1.45 mmol/L) were randomly assigned into two groups:control group (continue their original phosphate binder and rocaltrol treatment) and niacinamide therapy group (additionally received niacinamide,titrated from 600 mg/d to 1200 mg/d).The treatment lasted for 8 weeks.Serum phosphate and calcium were tested every 2 weeks and normalized protein catabolic rate and other relevant indexes were tested monthly.Results 100 patients were recruited and 93 of them completed the trial,including 44 from the therapy group and 49 from the control group.By the repeated measures analysis of variance,changes of serum phosphate in two groups displayed a statistical significant difference,but the levels of serum calcium in both remained steady.At the end of trial,compared to control group,therapy group appeared decreased serum phosphate levels [(1.59±0.36) mmol/L vs (1.94±0.25) mmol/L,P ＜ 0.001] and increased serum HDL levels [(1.32±0.54) mmol/L vs (1.09±0.41) mmol/L,P=0.02].Meanwhile,two groups showed no significant difference in intact parathyoid hormone and alkaline phosphatase.Adverse reactions including thrombocytopenia and gastrointestinal dysfunction were observed in niacinamide therapy group.Conclusions Niacinamide is effective on controlling hyperphosphatemia along with phosphate binder in maintenance hemodialysis patients.It also increases the serum HDL levels.Nonetheless,it is important to monitor the number of platelet.

Objective To investigate the role of Rho/ROCK signaling pathway in mediating restraint stress-induced blood-brain barrier(BBB)injury in the amygdala of rats.Methods Sixty male SD rats were randomized equally into control group(with food and water deprivation for 6 h per day),restraint stress group(with restraint for 6 h per day),stress + fasudil treatment(administered by intraperitoneal injection at 1 mg/100 g 30 min before the 6-h restraint)group,and fasudil treatment alone group.The elevated plus-maze test was used to detect behavioral changes of the rats,serum corticosterone and S100B levels were determined with ELISA,and Evans Blue leakage in the brain tissue was examined to evaluate the changes in BBB permeability.The changes in expression levels of tight junction proteins in the amygdala were detected using immunofluorescence assay and Western blotting,and Rho/ROCK pathway activation was detected by Pull-down test and Western blotting.Ultrastructural changes of the cerebral microvascular endothelial cells were observed using transmission electron microscopy.Results Compared with those in the control group,the rats in restrain stress group and stress+fasudil group showed obvious anxiety-like behavior with significantly increased serum corticosterone level(P<0.001).Compared with those in the control group and stress+fasudil group,the rat models of restrain stress showed more obvious Evans Blue leakage and higher S100B expression(P<0.01)but lower expressions of tight junction proteins in the amygdala.Pull-down test and Western blotting confirmed that the expression levels of RhoA-GTP,ROCK2 and P-MLC 2 were significantly higher in stress group than in the control group and stress + fasudil group(P<0.05).Transmission electron microscopy revealed obvious ultrastructural changes in the cerebral microvascular endothelial cells in the rat models of restrain stress.Conclusion Restraint stress induces BBB injury in the amygdala of rats by activating the Rho/ROCK signaling pathway.

Objective To investigate the role of Rho/ROCK signaling pathway in mediating restraint stress-induced blood-brain barrier(BBB)injury in the amygdala of rats.Methods Sixty male SD rats were randomized equally into control group(with food and water deprivation for 6 h per day),restraint stress group(with restraint for 6 h per day),stress + fasudil treatment(administered by intraperitoneal injection at 1 mg/100 g 30 min before the 6-h restraint)group,and fasudil treatment alone group.The elevated plus-maze test was used to detect behavioral changes of the rats,serum corticosterone and S100B levels were determined with ELISA,and Evans Blue leakage in the brain tissue was examined to evaluate the changes in BBB permeability.The changes in expression levels of tight junction proteins in the amygdala were detected using immunofluorescence assay and Western blotting,and Rho/ROCK pathway activation was detected by Pull-down test and Western blotting.Ultrastructural changes of the cerebral microvascular endothelial cells were observed using transmission electron microscopy.Results Compared with those in the control group,the rats in restrain stress group and stress+fasudil group showed obvious anxiety-like behavior with significantly increased serum corticosterone level(P<0.001).Compared with those in the control group and stress+fasudil group,the rat models of restrain stress showed more obvious Evans Blue leakage and higher S100B expression(P<0.01)but lower expressions of tight junction proteins in the amygdala.Pull-down test and Western blotting confirmed that the expression levels of RhoA-GTP,ROCK2 and P-MLC 2 were significantly higher in stress group than in the control group and stress + fasudil group(P<0.05).Transmission electron microscopy revealed obvious ultrastructural changes in the cerebral microvascular endothelial cells in the rat models of restrain stress.Conclusion Restraint stress induces BBB injury in the amygdala of rats by activating the Rho/ROCK signaling pathway.

The standardized workflow of computer-aided static guided implant surgery includes preoperative exami-nation,data acquisition,guide design,guide fabrication and surgery.Errors may occur at each step,leading to irrevers-ible cumulative effects and thus impacting the accuracy of implant placement.However,clinicians tend to focus on fac-tors causing errors in surgical operations,ignoring the possibility of irreversible errors in nonstandard guided surgery.Based on the clinical practice of domestic experts and research progress at home and abroad,this paper summarizes the sources of errors in guided implant surgery from the perspectives of preoperative inspection,data collection,guide de-signing and manufacturing and describes strategies to resolve errors so as to gain expert consensus.Consensus recom-mendation:1.Preoperative considerations:the appropriate implant guide type should be selected according to the pa-tient's oral condition before surgery,and a retaining screw-assisted support guide should be selected if necessary.2.Da-ta acquisition should be standardized as much as possible,including beam CT and extraoral scanning.CBCT performed with the patient's head fixed and with a small field of view is recommended.For patients with metal prostheses inside the mouth,a registration marker guide should be used,and the ambient temperature and light of the external oral scan-ner should be reasonably controlled.3.Optimization of computer-aided design:it is recommended to select a handle-guided planting system and a closed metal sleeve and to register images by overlapping markers.Properly designing the retaining screws,extending the support structure of the guide plate and increasing the length of the guide section are methods to feasibly reduce the incidence of surgical errors.4.Improving computer-aided production:it is also crucial to set the best printing parameters according to different printing technologies and to choose the most appropriate postpro-cessing procedures.

Hereditary hemochromatosis is a rare autosomal genetic disorder that can cause multi-organ dysfunction in the liver,pancreas,spleen,heart and pituitary gland,with diverse clinical manifestations,make the diagnosis difficult.In recent years,with the deepening of clinical understanding and the development of genetic diagnosis tools,the diagnostic rate of this disease has increased significantly.In this paper,we report a case of hereditary hemochromatosis type 3 involving multiple organs and complicated by severe heart failure,aiming to improve the clinicians'understanding of this disease and reduce the leakage and misdiagnosis.