Objective To evaluate the fluid balance and dry weight with whole body bioelectrical impedance analysis (BIA) in patients with maintenance hemodialysis ( MHD). Methods Twenty patients in stable condition with MHD for more than one year were selected ( MHD group). Extra-cellular water ( ECW) and intra-cellular water (ICW) were measured by BIA before hemodialysis, after hemodialysis and at intervals of hemodialysis (24 h and 48 h after hemodialysis), and related parameters were calculated. Whether patients with MHD achieved dry weight at 0 h was analysed, and the effects of average daily urine volume on ECW and ICW were explored. Another 20 healthy volunteers were served as controls. Results Compared with control group, ECW retrieved by ideal body weight was significantly higher before hemodialysis in MHD group (P<0.05). In MHD group, ECW was significantly lower after hemodialysis than that before hemodialysis (P < 0.05). ECW/total body water (TBW) was significantly lower and ICW/TBW was significantly higher after hemodialysis than those before hemodialysis and at intervals of hemodialysis ( P < 0.05). ICW and ECW at each time point were significantly related to body weight. ICW and ECW retrieved by ideal body weight at 0 h and 24 h of those who achieved dry weight were significantly higher than those who did not achieve dry weight ( P < 0.05). ECW and ICW before hemodialysis and 24 h after hemodialysis were significantly lower in those with urine volume <400 mL/d than those with urine volume ≥400 mL/d (P <0.05). Conclusion BIA analysis indicates that changes of fluid balance before hemodialysis, after hemodialysis and at intervals of hemodialysis in patients with MHD are characterized by ECW, and ECW/TBW is a more sensitive parameter. ICW and ECW retrieved by ideal body weight may be sensitive parameters to determine the dry weight in patients with MHD.

Objectives By Oxford pathological classification and analysis of circulating complement complement 3 (C3),renal C3 deposition,and clinical laboratory tests,we discussed the correlation between complement C3 and immunoglobin A nephropathy (IgAN) in pathogenesis.Methods A retrospective study of 558 IgAN cases at Xinhua Hospital from January of 2000 through December of 2013 was performed.All 558 IgAN diagnoses were made and confirmed by renal needle biopsy.Results Compared to patients who had circulating C3 ＜ 0.9,patients with circulating C3 level ＞ 0.9 showed statistically significant decreases in serum creatinine [(100.92 ± 105.31) μmol/L vs (157.58 ± 208.39) μmol/L,t =-2.283,P =0.025],blood urea nitrogen [(5.69 ± 2.88) mmol/L vs (7.69 ± 5.90) mmoL/L,t =-2.81,P =0.006];besides,other parameters like IgA,body weight,body mass index (BMI),cholesterol,triglyceride,serum IgA/C3 ratio,albumin,and estimated glomeruli filtrate rate (eGFR) also presented statistically significant differences between two patient groups;no statistically significant differences were observed between two groups in glomerular mesangial cell proliferation,capillary endothelial proliferation,segmental glomerular sclerosis or adhesions,renal tubule atrophy,tubulointerstitial fibrosis,and formation of glomerular crescent;meanwhile,no statistically significant differences were observed between two groups in mesangial depositions of IgA,IgG,IgM,and complement C3;meanwhile the blood level of C3 between C3 deposition negative group,deposition 2 + and 3 + subgroup showed statistically significant differences (2.493 and 2.782;0.013 and 0.006),nevertheless,prognostic indices in Oxford classification,such as mesangial cell proliferation,capillary endothelial proliferation,segmental glomerular sclerosis or adhesions,renal tubule atrophy and tubulointerstitial fibrosis,were also statistically different between two patient groups (Pearson Square test result was 50.782,35.141,21.105,30.182,respectively;P ＜0.01).Conclusions Renal deposition of complement C3 or decrease in circulating C3 level may be associated with a poor prognosis of IgA nephropathy,and alteration in C3 dynamics may be implicated in the pathogenesis of IgAN through its involvement in humoral immunity.

Objective: To examine the correlation between anxiety and perceived stress among medical personnel in a tertiary specialized cancer hospital, so as to provide the evidence for improving psychological health among medical personnel. Methods: In-service doctors, nurses and technicians were sampled from a tertiary specialized cancer hospital, and their demographics, perceived stress and sources of stress were collected using self-designed questionnaires. Anxiety was evaluated using the Self-rating Anxiety Scale (SAS), and the associations of anxiety with perceived stress and source of stress were examined using a multivariable logistic regression model. Results: A total 800 questionnaires were allocated and 655 valid questionnaires were recovered, with an effective recovery rate of 81.88%. The respondents included 160 men (24.43%) and 495 women (75.57%), and 297 respondents (45.34%) were at ages of 30 to 39 years. There were 14 respondents with no or low level of stress (2.14%), 245 with general level of stress (37.40%), 289 with high level of stress (44.12%), and 107 with extremely high level of stress (16.34%). The prevalence of anxiety was 36.64% among respondents. Multivariable logistic regression analysis identified perceived stress at work (OR=2.205, 95%CI: 1.657-2.675), doctor-patient relationship (OR=2.259, 95%CI: 1.561-3.282) and interpersonal relationship (OR=2.272, 95%CI: 1.387-3.693) as a factor affecting anxiety among medical personnel. Conclusion The anxiety correlates with stress at work, doctor-patient relationship and interpersonal relationship among medical personnel in a tertiary specialized cancer hospital.

Objective To investigate whether the combination of maintenance hemodialysis (MHD) with hemoperfusion(HP) can improve the clearance rate of middle- and largemolecule uremic toxins so as to improve the quality of life and reduce the mortality in MHD patients. Methods A prospective, randomized and controlled clinical trial was carried out. One hundred MHD patients were selected and then randomly divided into two groups after four weeks of run-in period. HD+HP group received MHD alone 2 times a week and the combined treatment of HD with HP (HD+HP) once a week, whereas HD group received MHD alone 3 times a week. The follow up lasted for mean 2 years. The primary outcome was the death of patients. Secondary end points included clinical data, leptin, high sensitive C-reactive protein (hsCRP), interleukin 6 (IL-6),β2 microglobulin (β2-MG), parathyroid hormone (PTH), tumor necrosis factor α (TNF-α) and the indexes of dimensions of Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36Chinese Edition ). Results At the end of the two-year observation, the serum concentration of leptin, hsCRP, PTH, IL-6, β2-MG and TNF-α, systolic blood pressure (SBP), diastolic blood pressure(DBP), heart rate(HR), cardiothoracie ratio, left ventricular mass index (LVMI), EPO dose and the types of antihypertensive drugs used were lower in HD +HP group as compared to HD group (all P＜0.05). HD+HP group had higher hemoglobin (Hb), ejection fraction (EF) and body mass index (BMI) (all P＜0.05). No significant differences between two groups were found in terms of serum albumin (Alb), serum iron (SI), total iron binding capacity (TIBC), cardiac output (CO),Kt/V, early/atrial mitral inflow velocities (E/A) (all P＞0.05). Besides, the SF-36 indicated that the total score of overall dimensions in HD+HP group was higher (P＜0.05) and the quality of life of HD+HP group was evidently better as compared to HD group. The Kaplan-Meier survival curves for the 2-year observation period showed that patients in HD +HP group had obvious survival advantage, while Log-rank test results showed P＜0.05. No serious adverse incidents occurred during the HD+HP treatment. Conclusion HD+HP is superior to HD in eliminating regularly middleand large-molecules uremic toxins and has a potential role in improving the quality of life and survival rate of MHD patients.