Controlling serum phosphorus levels is critical in patients with renal failure. Currently phosphate-binding agents are widely used to reduce phosphate absorption in patients with endstage renal disease. If possible,serum phosphorus level should be reduced without disturbing calcium homeostasis or increasing accumulation of potentially toxic elements. Aluminum hydroxide and traditional calcium -based phosphate binders are commonly used to control serum phosphorus level. Aluminum hydroxide can effectively lower serum phosphorus level,but aluminum can accumulates in the body and results in toxic effect. Traditional calcium-based phosphate binders tend to promote hypercalcemia and calcium overloading,and accelerate cardiovascular calcification. Therefore aluminum -free and calcium-free phosphate-binding agents have become the focus of study; however,agents like sevelamer hydrochloride and lanthanum carbonate are not widely used due to high price,although they are effective in controlling serum phosphorus level. New generation of phosphate binders,such as colestilan,nicotinic acid and magnesium salt,are cheaper than their previous counterparts,but their long -term effect still needs to be observed. This article summarizes the progress of non-calcium phosphate binders in treatment of end-stage renal diseases,hoping to help clinical drug usage.

BACKGROUND:Ligamentum flavum hypertrophy is one of the most important factors of lumbar spinal stenosis, but the molecular mechanism is stil not very clear. OBJECTIVE:To explore the role of basic fibroblast growth factor, connective tissue growth factor and transforming growth factor β1 in hypertrophy of the lumbar ligamentum flavum. METHODS: The ligamentum flavum samples were divided into three groups according to different diseases: control group (acquired from the patients with lumbar spinal canal tumor,n=6), lumbar disc herniation (LDH) group (acquired from the patients with LDH,n=6) and lumbar spinal stenosis (LSS) group (acquired from the patients with LSS,n=6). Then the mRNA expressions of basic fibroblast growth factor, connective tissue growth factor, transforming growth factor β1 and colagen I, III, V of the ligamentum flavum were detected using real-time quantitative RT-PCR method. The roles of basic fibroblast growth factor, connective tissue growth factor and transforming growth factor β1 were explored. RESULTS AND CONCLUSION:The expression of basic fibroblast growth factor mRNA in the LSS group was significantly higher than that in the LDH and control groups (bothP < 0.05); the expression of connective tissue growth factor mRNA was not found statisticaly different among the three groups, although it was slightly higher in the LSS group (P> 0.05); the expression of transforming growth factor β1 mRNA was significantly higher in the LSS group than in the LDH and control groups (bothP < 0.01). The colagen I mRNA expressed significantly higher in the LSS group than the LDH and control groups (bothP < 0.05), but both the colagen III and V mRNA showed no significant difference among the three groups (P> 0.05). This study indicate that both basic fibroblast growth factor and transforming growth factor β1 play important roles in the formation process of the lumbar ligamentum flavum hypertrophy, and the main type of the colagen in the hypertrophied ligamentum flavum is colagen I.

Objective:To investigate and analyze the hospital staff and patients, awareness about anesthesiologists′ work.Methods:A questionnaire survey was conducted among the hospital staff in the non-anesthesiology departments and non-operating room and the patients undergoing elective surgery at the same time in tertiary hospitals.Logistic regression was used to analyze the factors affecting the level of awareness of the respondents.Results:Sixty point three percent of the respondents had a low level of awareness about the anesthesiologists′ work.Compared with the patients, the physicians ( OR=2.866, 95%CI: 1.405-5.848) had higher level of awareness.There was no significant difference in the levels of awareness among the nurses ( OR=1.633, 95%CI: 0.815-3.273), medical technicians ( OR=1.359, 95%CI: 0.630-2.935), administrative staff ( OR=1.470, 95%CI: 0.651-3.317) and the patients.The respondents, aged 36-50 yr ( OR=1.848, 95%CI: 1.224-2.792), with master′s degree ( OR=2.068, 95%CI: 1.090-3.925) and bachelor′ s degree ( OR=3.624, 95%CI: 1.701-7.723), had higher level of awareness, and the respondents without history of anesthesia and surgery ( OR=0.574, 95%CI: 0.380-0.867) and without medicine-related education background ( OR=0.354, 95%CI: 0.145-0.865) had lower level of awareness. Conclusion:There is insufficient awareness about anesthesiologists′ work among hospital staff and patients.Hospital staff are generally better than patients in terms of the level of awareness, but there are differences among different job categories.There is no significant difference in the level of awareness among nurses, medical technicians, administrative staff and patients.The respondents who are middle-aged, with higher education level, with history of anesthesia and surgery and with medicine-related education background, have higher level of awareness.

Objective:To assess the effect of low-dose esketamine on postoperative cognitive function in elderly patients undergoing non-cardiac surgery.Methods:One hundred and twenty-four patients, aged 65-80 yr, regardless of gender, with a body mass index of 18-35 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, were assigned to either esketamine group (group E, n=64) or control group (group C, n=60) using a random number table method. Group E received intravenous esketamine at a dose of 0.5 mg/kg, while group C received an equal volume of normal saline intravenously. Anesthesia was induced with intravenous fentanyl, propofol and rocuronium and maintained using combined intravenous-inhalational anesthesia in both groups. Patient-controlled analgesia was carried out postoperatively. Cognitive function tests including a simple mental state examination, auditory word learning test, tracking connection test A and B, number symbol replacement test, Boston naming test and complex graph test were performed at 1 day before surgery and 30 days after surgery, and postoperative cognitive dysfunction was determined using Z-score method. Delirium was assessed using Confusion Assessment Method from 1 to 7 days after operation. The operative hypotension, postoperative delayed emergence, nausea and vomiting, and hallucinations were recorded. The recovery time of spontaneous breathing, eye opening to verbal command and extubation time were recorded. Results:Compared with group C, the incidence of cognitive dysfunction at 30 days after surgery and intraoperative hypotension was significantly decreased ( P<0.05), and no significant change was found in the recovery time of spontaneous breathing, eye opening to verbal command, extubation time, incidence of postoperative delayed emergence, delirium, nausea and vomiting, and hallucinations in group E ( P>0.05). Conclusions:Low-dose esketamine can improve postoperative cognitive function in elderly patients undergoing non-cardiac surgery.