Objective: To study the application of glucose infusion test (GIT) in assaying the vascular access recirculation rate in hemodialysis patients. Methods: Access recirculation was assayed by both urea test (UT) and GIT in 82 hemodialysis patients, and 17 patients were also examined by Doppler ultrosonics method. The results of the Doppler ultrosonics were compared with those of UT and GIT. Results: Thirty-seven (45.12%) patients showed positive results with GIT and 29 patients (35.36%) with UT.All 17 patients had recirculation confirmed by Doppler ultrosonics and all had positive results by GIT (100%), but only 9 (52.94%) of the 17 patients had positive results by UT. Conclusion: Comapared with UT, GIT is more sensitive, more ecnomical,and simpler in determining vascular access recirculation, and can be used as a new method for screening vascular access recirculation.

Objective To study the quantitative method of determination of Fas ligand (FasL) and T-cell intracellular antigen-1 (TIA-1) in renal allografts and to evaluate its clinical significance. Methods The magnitude of intragraft FasL and TIA-1 mRNA was quantified by competitive PCR in 42 samples obtained to diagnose the etiology of graft dysfunction, and the results were expressed as the ratio of picograms of target gene to picograms of ?-actin, and were compared with the histopathogical diagnosis based on Banff criteria. Results Of all 42 samples, the transcripts were detectable in 11 for FasL and 27 for TIA-1. Intragraft expression of FasL and TIA-1 was significantly up-regulated in acute rejection group compared with chronic rejection group (P

Objective To observe the inhibitory effect of IL-4 on the IL-1?-induced rat mesangial cell proliferation, the release of PGE 2, and on the COX-2 mRNA and protein expression, so as to explore the related mechanism of anti-glomerulosclerosis. Methods Rat mesangial cell (MC) was cultured in vitro and the IL-1? -induced proliferation of MC was detected by MTT method. ELISA method was employed to measure the contents of PGE 2 in blank control group, IL-1? group, IL-4+IL-1? group, NS-398 group, NS-398+IL-1? group, indomethacin group, indomethacin+IL-1? group. The expression of mRNA and protein of COX-1 and COX-2 gene were detected by RT-PCR and Western blot, respectively. Results IL-1? could induce the proliferation of MC when the concentration was 0.1-100ng/ml in 12h, 24h and 48h. When its concentration was 2ng/ml, it had the strongest effect in 24h. All the IL-4, NS-398, indomethacin could inhibit IL-1? to induce MC producing PGE 2. The inhibitory rates are in proper order as: IL-4 (84.9%), NS-398(56.5%), and indomethacin(41.2%). Both IL-4 and NS-398 could obviously inhibit the expression of COX-2 mRNA and protein proved by RT-PCR and Western blot. Indomethacin could strongly inhibit the expression of COX-1 mRNA and protein, while only shew a weak inhibition on the expression of COX-2 mRNA and protein. Conclusion IL-4 could markedly inhibit the IL-1? -induced MC proliferation, down-regulate COX-2 gene, decrease the production of PGE 2, and thus take effect on anti-glomerulosclerosis.

Objective Peripheral arterial diseases(PAD)are most common conditions in patients with end stage renal disease(ESRD). However, PAD hasn′t been extensively studied like other cardiovascular or cerebrovascular diseases such as coronary heart disease and cerebral infarction among ESRD patients. The present study aims to investigate the ultrasonic characteristics of PAD and risk factors related to peripheral arterial intima thickening and plaques formation. Methods Seventy-three ESRD patients and 21 healthy individuals (as control) were involved in the investigation, and their carotid and lower-extremity arteries including tunica intima, lumen diameter, plaques and Doppler spectrums were examined with color Doppler ultrasonic technique. Then, the risk factors related to intima thickening and plaques formation among ESRD patients were studied combining with their clinical data and biochemical makers. Results The lesions of varying degrees in peripheral arteries occured in 52.1%(38/73) ESRD patients, including intima thickening, coarse and chaotic tunica intima, strong echo masses or atheromatous plaques with different shapes and sizes, widened and deformed Doppler spectrums, accelerated peak systolic velocity and lowered or disappeared diastolic reverse peak at narrow sites, low resistant blood flow at apo-stenosis sites (prolonged systolic accelerative time and decreased acceleration). The incidence of PAD was significantly higher in ESRD patients than that in control group (14.3%, P

10 years) groups.The form and function of ventricle were measured.And the blood pressure,hemoglobin,plasma albumin,pre-albumin,lipid,C responsive protein,calcium,phosphate and parathyroid hormone before dialysis were determined.Results The cardiac output(CO) of 1～2 years group was the highest.The left ventricular end-systolic and end-diastolic dimension(LVEDd/s)and left ventricular mass index(LVMI)of ≤1 year group were the lowest.With the increase of the dialysis ages,the blood pressure and the proportion of diabetes patients and those with LVH decreased,but the hemoglobin,plasma albumin,pre-albumin,calcium,phosphate and parathyroid hormone increased,while the CRP decreased.Conclusion With the increase of the dialysis ages,the left ventricular function of the uremic hemodialysis patients improves,which is probably associated with the improvement of anemia,malnutrition and inflammation.

[Objective] : To predict the autophagy-related pathogenesis and key diagnostic genes of diabetic kidney disease (DKD) through bioinformatics analysis, and to identify related Chinese medicines. [Methods] : Data from sequencing microarrays GSE30528, GSE30529, and GSE1009 in the Gene Expression Omnibus (GEO) were employed. Differentially expressed genes (DEGs) with adjusted P < 0.05 from GSE30528 and GSE30529 were identified. Combining these DEGs with the human autophagy gene database, Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses, and protein-protein interaction (PPI) network analysis were conducted on the obtained DKD autophagy-related genes. Subsequently, the least absolute shrinkage and selection operator (LASSO) regression and support vector machine-recursive feature elimination (SVM-RFE) algorithms were adopted to select autophagy-related genes. The diagnostic capability of these genes was assessed through analysis with the external validation set from microarray GSE1009, and relevant Chinese medicines were inversely predicted using the SymMap database. [Results] : A total of 2 014 DEGs were selected from GSE30528 and GSE30529, leading to the identification of 37 DKD autophagy-related genes. GO analysis indicated 681 biological mechanisms, including autophagy regulation and plasma membrane microdomain activity. KEGG enrichment analysis identified 112 related signaling pathways. PPI network analysis showed a marked enrichment of autophagy-related genes in DKD. Through LASSO regression and SVM-RFE, four core diagnostic genes for autophagy in DKD were identified: protein phosphatase 1 regulatory subunit 15A (PPP1R15A), hypoxia inducible factor 1 alpha subunit (HIF1α), deleted in liver cancer 1 (DLC1), and ceroid lipofuscinosis neuronal 3 (CLN3). The external validation set demonstrated high diagnostic efficiency for these genes. Finally, 146 kinds of potential Chinese medicines were predicted using the SymMap database, with heatclearing and detoxifying medicine and blood-activating and stasis-eliminating medicine accounting for the largest proportion (25/146 and 13/146, respectively). [Conclusion] This study analyzed and validated bioinformatics sequencing databases to elucidate the potential molecular mechanisms of DKD autophagy and predicted key diagnostic genes, potential therapeutic targets, and related Chinese medicines, laying a solid foundation for clinical research and application.

Objective: To study the prevalence and pathogenesis of TT virus (TTV) in hemodialysis patients. Methods: Serum TTV DNA was tested in 69 hemodialysis patients from our hospital by nested-PCR using primers from a conservative region of TTV genenome, genetic analysis and detection of hepatitis C virus antibody (anti-HCV) and the levels of alanine aminotransferase (ALT) were also carried out simultaneously. Results: The overall prevalence of TTV viremia was 27.5%. The PCR-amplified gene fragment from one patient was sequenced, and its gene sequence homologies with GH1,TA278, TTVCHN1 and TTVCHN2 ranged from 89% to 100%, its deduced amino acid sequence ranged from 87% to 100%. There was no significant difference of TTV prevalence between anti-HCV positive and negative patients. No significant elevation of ALT was found in all patients. Conclusion: High prevalence of TTV infection is found among hemodialysis patients, and TTV infection has no significant association with HCV infection or elevation of ALT.

Objective To assess the safety and efficacy of gabapentin in treatment of refractory uremic pruritus in maintenance hemodialysis (MHD)patients. Methods A randomized controlled trial was performed.Forty-nine MHD patients with severe pruritus were randomly divided into treatment group(gabapentin 100-300 mg at dialysis day before sleep)and the control group(loratadine 10 mg daily).The efficacy was assessed by visual analogue score,pruritus score and improved Duo's VAG Score after 12-week treatment,and the side effect was also observed to assess the safety. Results After treatment,the frequency,degree and area of pruritus in 25 patients of treatment group were significantly reduced,and VAS score(1.46±1.38vs 8.71±1.17,P＜0.01),VAG score(2.92±1.63 vs 8.29±0.68,P＜0.01)and the improved Duo's pruritus score(11.33±3.99 vs 30.75±4.87,P＜0.01)decreased significantly compared with that of prior treatment.The symptoms of 24 patients in control group were improved partly,which were not as good as those in treatment group(P＜0.01).The side effects of gabapentin were drowsiness and dizziness,but most symptoms were relieved or disappeared within 1 week and no patient interrupted therapy.No serious adverse events were observed. Conclusion Gabapentin is safe and effective for refractory uremic pruritus,but long-term efficacy and safety requires larger sample and long-term observation.

Abstract Objective To compare the quality of life in long-term hemodialysis patients using tunnel cuffed catheter with arterio-venous fistula. Methods Thirty patients using tunnel cuffed catheter (catheter group) and another 30 patients using arterio-venous fistula (fistula group) were observed. The rate of infection,thrombus and blood flow were recorded. The lab examinations such as blood urea nitrogen,creatinine,serum electrolyte,hemoglobin, C reactive protein, parathyrine, β2 microglobulin were measured,subjective global assessment (SGA) was made, KT/V and urea reduction ratio (URR) were calculated.Quality of life was surveyed with KDQOL-SFTM questionnaire and to conduct comparative analysis. Results KT/V was 1.49 ± 0.25 in catheter group, and 1.45 ± 0.28 in fistula group, there was no significant difference between the two groups. The lab examinations and SGA were similar in two groups. There were no significant difference of quality of life between the two groups except for pain (the score in catheter group was significantly higher than that in fistula group). The rate of infection was significantly higher in catheter group than that in fistula group. The rate of thrombus was similar in two groups. Conclusions As alternative of fistula in patients whose fistula could not be established, the tunnel cuffed catheter could give adequate dialysis and satisfactory quality of life,and is predominating in pain-reducing. The rates of infection and thrombus are decreased, but maintain the important problems to be solved.

Objective To identify the therapeutic effect and safety of mini -percutaneous nephrolithotomy combined with antegrade modular flexible ureteroscope for the treatment of staghorn stone.Methods The clinical data of 116 patients with staghorn calculi who underwent mini -percutaneous nephrolithotomy combined with antegrade modular flexible ureteroscope were retrospectively analyzed.Of the 116 patients,63 cases were men,53 cases were women .Age ranged from 2 5 to 6 7 years .The diameter ofcalculi ranged from 4 6 to 9 8 (mean =4 6 )mm .There were 63 large complete staghorn renal calculi in these patients.Results All procedures were performed successfully using a single lithotripsy tract.The mean surgical time was (125.4 ±30.0)minutes.The initial stone -free rate was 81.03%(94 /116).Twenty -two cases had several residual calculi from 12 to 25mm.Post -procedure complications included hemorrhage in 9 patients,fever(>38.5 ℃)in four patients,and reactive pleural effusion in one patient. Blood loss requiring transfusion,sepsis,adjacent organ injury and kidney loss were not observed.Conclusion Mini -percutaneous nephrolithotomy combined with antegrade modular flexible ureteroscope has good therapeutic effect in treating renal staghorn calculi,since the technique in treating the renal staghorn calculi makes the operation period shorter,the rate of stone -free higher,the operation wounds smaller,the rate of complication lower,the rate of surrounding organ injury less.