Objective To explore the impact of total parathyroidectomy(tPTX)on carotid-femoral pulse wave velocity(cfPWV)in hemodialysis patients. Methods A total of 35 patients undergoing hemodialysis with refractory secondary hyperparathyroidism and treated with tPTX were studied. Before tPTX and 1 year after the oper-ation,cfPWVwas measured and hepatic and renal function,serum calcium,serum phosphorus,intact parathyroid hormone and hemoglobin were measured. The impact of tPTX on cfPWV in hemodialysis patients was analyzed. Results Serum calcium,serum phosphorus and intact parathyroid hormone decreased(P < 0.01),while hemo-globin and serum albumin increased(P < 0.01)and cfPWV decreased 1 year after the operation,which showed statistical significance(P<0.01). The cfPWV of the patients with tPTX was still higher than that of healthy indi-viduals(P<0.01). Conclusion tPTX can effectively reduce cfPWV in hemodialysis patients with refractory sec-ondary hyperparathyroidism.

Aim To assess the effects of Banqiao Codonopisis Pilosula(BCP)decoction on learning and memory dysfunction in AD model rats induced by high activity GSK-3β and its possible mechanism.Methods The SD rats(4 months old,♂)were divided into five groups,namely,sham-operated group(blank group),AD model group,BCP high-dose(2.16 g·kg-1·d-1)group,BCP medium-dose(1.08 g·kg-1·d-1)group,and BCP lower-dose(0.54 g·kg-1·d-1)group.Treatment group received BCP decoction by gavage once a day for 14 days,while other groups were offered drinking water by gavage once a day for 14 days.The autonomous behavior activities of all rats were observed and recorded after gavage.In the last seven days by gavage,Morris water maze test was used to test the spatial learning and memory ability of the five groups.After five days training,treatment groups and AD model group were injected wortmannin(WT,PI3K specific inhibitor)and GF-109203X(GFX,PKC specific inhibitor)(100 μmol·L-1 of each,total volume of 10 μL)into the right lateral ventricle of the rats.The blank group was only injected 2％DMSO.The spatial memory retention was detected by water maze 24 hours after lateral ventricle injection.Then,changes in the spatial learning memory of rats were observed.The level of Tau phosphorylation in SD rat hippocampus and the expression and activity changes of related protein kinase GSK-3β were detected by Western blot and immunohistochemistry.The changes of Nissl bodies in SD rat hippocampus were observed by Nissl′s staining.Results After intragastric administration of BCP,the rat autonomous behavior activities in each group all showed a declining trend,and the differences in low-dose and middle-dose groups had statistical significance compared with blank group.The Morris water maze tests showed that the latency navigation of model group was significantly longer than that of blank group(P<0.01),while that of the BCP three doses groups was shorter than that of model group(P<0.05).Compared with the same group,the latency navigation of the three groups after gavage BCP low,middle and high dose was significant shorter than that without gavage(P<0.05).Western blot results showed that the activity of GSK-3β in AD model group was up-regulated compared with the blank group.However,BCP inhibited activity of GSK-3β.Western blot and immunohistochemistry results showed the level of Tau phosphorylation in AD model group was increased compared with the blank group in the area of CA3(P<0.05).Compared with AD model group,the level of Tau phosphorylation was decreased in treatment group.Nissl′s staining results showed that dendritic spines in AD model group was significantly attenuated compared with the blank group(P<0.05).Far more dendritic spines were observed in treatment group than in AD model group.The number of Nissl′s bodies in neuron cells of hippocampus in hippocampal CA3 was obviously larger in treatment groups than in AD model group.These effect of BCP was dose-dependent.Conclusions BCP can prevent the learning and memory dysfunction in AD model rats induced by high activity of GSK-3β.The mechanism may be related to inhibiting GSK-3β activity and then reducing the level of phosphorylation of Tau and improving neural development.

Objective:To study the effect of different crystalloid resuscitation on renal function in septic shock rabbits, and to provide a theoretical basis for the choice of crystalloid for clinical fluid resuscitation.Methods:Thirty-six healthy male New Zealand white rabbits were divided into six groups by random number table: control group, model group, and four crystalloid groups including normal saline (NS) group, lactate Ringer solution (LR) group, acetate Ringer solution (AR) group, and sodium potassium magnesium calcium glucose injection (SPMCG) group, with 6 rabbits in each group. Rabbits were infused with Escherichia coli lipopolysaccharide (LPS) 500 μg/kg via the marginal ear vein (infused at a constant speed within 20 minutes), and then continued to infuse in an increase of 300 μg/kg every 10 minutes, the maximum dose was 2 mg/kg, until the mean arterial pressure (MAP) dropped to 60% of the basal value, the septic shock model was considered to be successfully reproduced. The rabbits in the control group were not injected with LPS, and other operations were the same as in the model group. Different crystalloid groups were given crystal solution immediately after modeling for resuscitation (predetermined fluid volume 60 mL/kg, transfusion within 3 hours). The volume stress test was performed every hour to guide the fluid volume, and the stroke volume index increase rate (ΔSVI) < 15% was the end point of resuscitation. The control group and the model group were given NS 4 mL·kg -1·h -1 to maintain the physiological requirement. All groups were given tracheotomy and mechanical ventilation, and the hemodynamic changes were monitored by pulse-indicated continuous cardiac output (PiCCO). The dynamic changes of hemodynamic indexes, arterial blood gas analysis, electrolytes, blood glucose and renal function biomarkers were monitored before modeling, immediately after modeling and 3, 6, and 12 hours after resuscitation. Results:① Hemodynamic indicators: after modeling, the MAP in the model group and the four fluid resuscitation groups decreased significantly, the cardiac index (CI) increased, and the systemic vascular resistance index (SVRI), global end-diastolic volumn index (GEDVI) decreased. After different crystalloid resuscitation at different time points, MAP, SVRI, and GEDVI increased in the four crystalloid groups. ②Arterial blood gas analysis, electrolytes, blood glucose: blood lactic acid (Lac) in the model group and the four fluid resuscitation groups increased after model success. After fluid resuscitation, the Lac of each crystalloid group began to decrease and reached to the lowest at 12 hours. Compared with the LR, AR and SPMCG groups, the pH value decreased in the NS group at 6 hours and 12 hours of fluid resuscitation (6 hours: 7.29±0.00 vs. 7.40±0.02, 7.35±0.02, 7.37±0.02; 12 hours: 7.27±0.02 vs. 7.38±0.02, 7.39±0.02, 7.35±0.01; all P < 0.05). After fluid resuscitation, blood Cl - levels at 3, 6, and 12 hours in the NS group were significantly higher than those in the LR, AR and SPMCG groups (mmol/L: 113.4±0.6 vs. 101.4±3.6, 108.0±1.1, 106.0±0.8 at 3 hours; 115.1±2.0 vs. 101.1±2.7, 109.0±2.2, 105.3±0.6 at 6 hours; 116.9±0.1 vs. 104.2±4.4, 107.6±1.7, 108.7±0.6 at 12 hours; all P < 0.05). There was no significant difference in blood glucose at each time point among the four crystalloid groups. ③ Biomarkers of renal function: blood and urine neutrophil gelatinase associated lipocalin (NGAL) and cystatin C (Cys C) were significantly increased in the model group and four fluid resuscitation groups. After fluid resuscitation, blood, urine NGAL and Cys C decreased. There was no significant difference in blood, urine NGAL and Cys C at all the time points among the different fluid resuscitation groups. Conclusions:In the rabbit model of septic shock induced by Escherichia coli LPS, hyperchloremia and acidosis occurred after NS resucitation, but did not occur during the recovery of LR, AR and SPMCG. There was no difference in the effects of different crystalloid resuscitation on renal function in septic shock rabbits.

Objective To investigate the clinical significance of complement activation in patients with HBV related glomerulonephritis (HBV-GN).Methods Biopsy-proven HBV-GN patients admitted in our hospital were retrospectively recruited.Decreased serum C3 level was defined as C3 ＜ 85 mg/dL.According to the serum C3 level,the patients were divided into the decreased serum C3 group and normal serum C3 group,and the pathological and clinical differences were compared between the two groups.According to the intensity of C3 deposition in the kidney,patients were divided into negative and positive group,and the pathological and clinical differences were compared.Results In this study,29 HBV-GN patients were recruited.There were 18 (62.07％) patients in the normal serum C3 group and 11 (37.93％) patients in the decreased serum C3 group.Compared with the patients with normal serum C3 level,patients with decreased serum C3 level had higher serum creatinine level,lower eGFR level,severer mesangial proliferation and renal interstitial fibrosis (P ＜ 0.05).There were 9 (31.03 ％) patients with negative C3 deposition in the kidney,and 20 (68.97％) patients with positive C3 deposition.Higher cholesterol,higher IgG levels,lower serum albumin,serum C 3 levels,lower eGFR level,severer glomerular sclerosis,inflammatory cell infiltration in renal interstitial,renal tubular atrophy,and renal interstitial fibrosis were associated with a higher grade of C3 deposition in the kidney (P ＜ 0.05).Conclusion There are different levels of complement activation in patients with HBV-GN.Local and systemic complement activation is associated with decreased renal function.Complement activation may be involved in the development of HBV-GN.

Objective To investigate the clinical significance of complement activation in patients with HBV related glomerulonephritis (HBV-GN).Methods Biopsy-proven HBV-GN patients admitted in our hospital were retrospectively recruited.Decreased serum C3 level was defined as C3 ＜ 85 mg/dL.According to the serum C3 level,the patients were divided into the decreased serum C3 group and normal serum C3 group,and the pathological and clinical differences were compared between the two groups.According to the intensity of C3 deposition in the kidney,patients were divided into negative and positive group,and the pathological and clinical differences were compared.Results In this study,29 HBV-GN patients were recruited.There were 18 (62.07％) patients in the normal serum C3 group and 11 (37.93％) patients in the decreased serum C3 group.Compared with the patients with normal serum C3 level,patients with decreased serum C3 level had higher serum creatinine level,lower eGFR level,severer mesangial proliferation and renal interstitial fibrosis (P ＜ 0.05).There were 9 (31.03 ％) patients with negative C3 deposition in the kidney,and 20 (68.97％) patients with positive C3 deposition.Higher cholesterol,higher IgG levels,lower serum albumin,serum C 3 levels,lower eGFR level,severer glomerular sclerosis,inflammatory cell infiltration in renal interstitial,renal tubular atrophy,and renal interstitial fibrosis were associated with a higher grade of C3 deposition in the kidney (P ＜ 0.05).Conclusion There are different levels of complement activation in patients with HBV-GN.Local and systemic complement activation is associated with decreased renal function.Complement activation may be involved in the development of HBV-GN.

Objective:To establish a risk predictive model nomogram of acute kidney injury (AKI) in critically ill patients by combining urinary tissue inhibitor of metalloproteinase 2 (TIMP2) and insulin-like growth factor-binding protein 7 (IGFBP7), and to verify the predictive value of the model.Methods:A prospective observational study was conducted. The patients with acute respiratory failure or circulatory disorder admitted to the intensive care unit (ICU) of Northern Jiangsu People's Hospital from November 2017 to April 2020 were enrolled. The patients were enrolled within 24 hours of ICU admission, and their general conditions and relevant laboratory test indicators were collected. At the same time, urine was collected to determine the levels of biomarkers TIMP2 and IGFBP7, and TIMP2·IGFBP7 was calculated. Patients were divided into non-AKI and AKI groups according to whether grade 2 or 3 AKI occurred within 12 hours after enrollment. The general clinical data and urinary TIMP2·IGFBP7 levels of patients between the two groups were compared. The indicators with P < 0.1 in univariate analysis were included in the multivariate Logistic regression analysis to obtain the independent risk factors for grade 2 or 3 AKI within 12 hours in critical patients. An AKI risk predictive model nomogram was established, and the application value of the model was evaluated. Results:A total of 206 patients were finally enrolled, of whom 54 (26.2%) developed grade 2 or 3 AKI within 12 hours of enrollment, and 152 (73.8%) did not. Compared with the non-AKI group, the patients in the AKI group had higher body mass index (BMI), pre-enrollment serum creatinine (SCr), urinary TIMP2·IGFBP7 and proportion of using vasoactive drugs, and additional exposure to AKI (use of nephrotoxic drugs before enrollment) was more common. Multivariate Logistic regression analysis showed that BMI [odds ratio ( OR) = 1.23, 95% confidence interval (95% CI) was 1.10-1.37, P = 0.000], pre-enrollment SCr ( OR = 1.01, 95% CI was 1.00-1.02, P = 0.042), use of nephrotoxic drugs ( OR = 2.84, 95% CI was 1.34-6.03, P = 0.007) and urinary TIMP2·IGFBP7 ( OR = 2.19, 95% CI was 1.56-3.08, P = 0.000) was an independent risk factor for the occurrence of grade 2 or 3 AKI in critical patients. An AKI risk predictive model nomogram was constructed based on the independent risk factors of AKI. Bootstrap validation results showed that the model had good discrimination and calibration in internal validation. Receiver operator characteristic curve (ROC curve) analysis showed that the area under the ROC curve (AUC) of urinary TIMP2·IGFBP7 alone in predicting grade 2 or 3 AKI within 12 hours in critical patients was 0.74 (95% CI was 0.66-0.83), the optimal cut-off value was 1.40 (μg/L) 2/1?000 (sensitivity was 66.7%, specificity was 85.0%), and the predictive performance of the model incorporating urinary TIMP2·IGFBP7 was significantly better than that of the model without urinary TIMP2·IGFBP7 [AUC (95% CI): 0.85 (0.79-0.91) vs. 0.77 (0.70-0.84), P = 0.005], net reclassification index (NRI) was 0.29 (95% CI was 0.08-0.50, P = 0.008), integrated discrimination improvement (IDI) was 0.13 (95% CI was 0.07-0.19, P < 0.001). Conclusion:The AKI risk predictive model based on urinary TIMP2·IGFBP7 has high clinical value and is expected to be used to early predict the occurrence of AKI in critically ill patients.