Objective:To observe the expression of connective tissue growth factor(CTGF) and its receptor-low density lipoprotein receptor-related protein (LRP), and the relevant signaling pathway for the regulation by long-term high glucose exposure in cultured podocytes. Methods:The effects of high glucose on the expression of CTGF and its receptor LRP were analyzed by western blotting. The activation of mitogen activated protein kinase ( MAPKS )signaling pathway by high glucose was also examined. Results: Basal levels of CTGF were observed in cultured mouse podocytes, the levels of CTGF protein were increased by high glucose medium groups on the 2nd day, reached the peak on the 4th day(P0.05).The levels of CTGF expression in normal glucose and mannitol glucose groups did not change markly. High glucose medium induced phosphorylation of ERK_ 1/2 at as early as minute 30, reached the peak at hour 6; maintained the activity at hours 12 and 24, and declined to the basal level at hour 48. However, phosphorylation of ERK_ 1/2 was not detected in normal glucose and mannitol glucose groups. Blockade of phosphorylation of ERK_ 1/2 with PD98059, a specific ERK_ 1/2 activation inhibitior, did decrease the high glucose-triggered expression of CTGF protein in 4 days. High glucose had no effect on the expression of LRP protein at each time point. Conclusion: Acute high glucose (2-4 days)stimulated the expression of CTGF protein via ERK_ 1/2-dependent signaling pathway in cultured podocytes, while cultured in high glucose for 6-8 days, the podocytes did not increase its CTGF level. Long-term high glucose had no effect on the expression of LRP in podocytes.

Objective To assess the efficacy and safety of ACD-A solution as anticoagulant during continuous renal replacement therapy (CRRT) in high risk of bleeding patients.Methods Forty high risk bleeding patients on continuous veno-venous hemofiltration (CVVH) were randomly divided into two groups:ACD-A group (22 patients,61 cases) and heparin-free group (18 patients,47 cases).Serum creatinine,function of the coagulation system,electrolyte and acid-base were monitored pre-and post-CVVH.The vital signs of the patients during treatment,dialyser clotting and the incidence of bleeding episodes were recorded.Results (1) The serum level of creatinine decreased significantly after treatment in both groups,but the rate of decrease was obviously higher in ACD-A group than that in heparin-free group[(55.4± 10.2)％ vs (42.0±5.2)％,P=0.031].(2) The average duration of CVVH treatment was (17.3±3.8) h in ACD-A group and (9.7±4.5) h in heparin-free group.There was significant difference between them (P =0.019).The frequency of dialyzer clotting was much higher in heparin-free group than that in ACD-A group (88％ vs 4.9％,P ＜ 0.001).(3) There was no significant difference in the function of the coagulation system between pre-and post-CVVH in either group (P ＞ 0.05).(4) Electrolyte,acid-base and glucose tended to be stable during the treatment in ACD -A group.(5) The vital signs were kept stable and no bleeding episodes were found in all patients of two groups.Conclusions Anticoagulation with ACD-A is safe,effective and convenient for CRRT in critically ill patients at high risk of bleeding.The occurrence of complications can be reduced by configurating appropriate replacement fluid and close laboratory monitoring.

According to the requirements of the ‘three guidance’ talent-cultivation model pro-posed by our university, humanistic spirit was permeated from multi angels during the process of phys-iology. Students'occupation quality was cultivated; physiology knowledge and clinical practice was combined for students; early contacting with clinical knowledge was conducted and teacher-student role reversal method was applied to train students' communication skills. Teaching practice showed that the reformed teaching model not only can ensure the quality of teaching but also can improve the comprehensive quality of students.

Objective To review the experience on screening,diagnosis and treatment for neonatal congenital hypothyroidism (CH)in Xuancheng City,Anhui Province.MethodsFrom Jan 2008 to Dec 2014,peripheral blood samples from the heel were collected among 83787 neonates and the blood samples were sent to the screening center to test the level of thyroid stimulating hormone (TSH).Neonates with abnormal level of TSH were admitted to our hospital for further TSH and free tetraiodothyronine (FT4 )tests. Neonates with CH diagnosis were given standard treatments of levothyroxine and their thyroid function, physical and intelligence development were evaluated on a routine basis.Results Among the 106 neonates with abnormal TSH level ,68 were diagnosed CH.The prevalence of CH in Xuancheng City was 0.8 ‰.All 68 patients with CH received levothyroxine treatment and 6 cases were lost during follow-up.44 patients received physical examination and their bone ages were normal. 53 patients received intelligence assessment.Only 1 of them was diagnosed of mental retardation, and 3 with suspicious mental retardation.Conclusion Neonatal screening is necessary for the early diagnosis and treatment of CH. Neonates with CH can have normal physical and mental development if they receive standard treatment as early as possible and followed up regularly.

Objective: To identify the risk of HIV infection among men who have sex with men (MSM) with different sex roles, so as to provide insights into the prevention and control strategies for HIV infection among MSM. Methods: Peer-driven sampling method was employed to recruit MSM in a city in Xinjiang Uygur Autonomous Region in 2022, a questionnaire survey was conducted to collect demographic information and sexual behaviors, and laboratory tests were conducted to detect HIV and syphilis antibodies. The characteristics of sexual behaviors among MSM with different sex roles and prevalence of HIV infection were analyzed, and factors affecting HIV infection among MSM were identified using a multivariable logistic regression model. Results: A total of 666 MSM were investigated, with a mean age of (28.70±8.09) years and 577 local residents (86.64%). There were 166 insertive MSM (24.92%), 179 receptive MSM (26.88%) and 321 both receptive and insertive MSM (48.20%). The HIV infection rate was 8.26%, with 3.61% in insertive MSM, 13.41% in receptive MSM, and 7.79% in both receptive and insertive MSM. Significant differences were seen in age, recruitment route, sexual orientation, age of first homosexual sex, condom use with temporary partners and HIV infection rate among different sex roles (all P<0.05). Multivariable logistic regression analysis showed that insertive MSM had a lower risk of HIV infection than both receptive and insertive MSM (OR=0.513, 95%CI: 0.272-0.969), while there was no significant difference in the risk of HIV infection between receptive MSM and both receptive and insertive MSM (OR=2.088, 95%CI: 0.081-5.380). Conclusions The risk of HIV infection among receptive and both receptive and insertive MSM are higher than that among insertive MSM. Classified measures should be taken to reduce the transmission of HIV in this population.

ObjectiveTo report the methods and clinical efficacy of bridging severed thumbs and fingers with foot joint compound flaps.Methods Ten patients with completely amputated thumbs and fingers with extensive defects in the proximal phalanx had bridged and repaired by using composite-free flap with joints from foot. Three of 4 cases of thumb amputation were repaired by using composite flaps of the second metatarsophalangeal and proximal interphalangeal joints in foot,and the other was used composite flap of the second metatarsophalangeal joints in foot.Donor sites underwent the second metatarsals distal osteotomy associated with free skin graft. And 6 cases with absent fingers by using composite-free flaps of the proximal interphalangeal joint to repair. The donor site in foot underwent metatarsophalangeal and toe joints osteotomy.ResultsAll flaps and replanted thumbs and fingers survived. Hand wounds recovered by primary repair.Donor site in foot all healed by primary repair except for 1 case,which healed after several dressing changes.All 10 cases were followed-up from 6 to 28 months,averaged of 9 months.The metacarpophalangeal joint of 4 replanted thumbs extension between -10° and 0°,and flexion between 20° and 50°.The function of fullfield digital mammography recovered well in 3 replanted thumbs, as well as the function of thumb-middle in the other. Three of them could completely 2-5 fingers tapping,one case could complete middle finger tapping,four cases could complete radial abduction.The proximal interphalangeal joints of 6 replanted fingers extension between -10° and 0°,and flexion between 30° and 90°,averaged of 50°.Sensory recovery of 1 case reached S4,two cases reached S3+,five cases reached S3,and 2 cases of S2.All replanted bones and joints healed after transplantations(bone healing time was 6 to 16 weeks), with no occurrence of re-fracture nor nonunion. Walking function was not significantly affected. According to the evaluation criteria of replanted severed fingers by Chinese Medical Association,one was excellent,eight were good,and 1 was poor.The excellent and good rate was 90％. Conclusion Repairing amputated thumbs and fingers with foot joint compound flaps could not only maximize the recovery of replanted fingers shape,but also get some function,which to meet everyday needs of patients.

Objective To evaluate a method of the finger reconstruction with second toe in primary operation. Methods Six patients with Ⅲ-Ⅳ° defect of fingers received the reconstructive transplantationusing the second toe. A triangular flap plastic surgery was also performed at the "pulp" and "neck" of the second toe for the reconstruction. Results Finger reconstruction and local triangle skin all survived. Five patients were followed from 8 months to 15 months, the shape of the reconstructed finger got a good looking. Pulp sensory recovery was good, 2-PD reached 8-10 mm. The patients were satisfied. Conclusion local triangle skin flap transfer and finger reconstruction in primary operation is a good method to improve the shape of reconstructed finger, which avoid the shape defect in enlargement pulp and narrow hand palm. The clinical outcomes are satisfying.

Objective To investigate clinical effects of evaluating the reoeonstructiun of wounds in the thumb-nail donor site using tibial of the second toe in reducing and preventing complications related to this are. Methods Surface of the thumb-nail flap donor site was pestoperatively recovered using tibial flaps of the second toe for 8 patients; conjunct full-thickness dermotaplasthy was performed for the sites which could not be completely covered by flaps. Full-thickness flaps were used to repair the second-toe doner sites. Results All flaps in the thumb-nail donor sites of the 8 patients survived; partial necrosis of base in the second toe was seen in one case, and the wonds healed with change of dreeings. A follow-up study beyon d4 to 14 months revealed favorable texture, normal shape of flaps and complete healing of the graft area without formation of ulcer. Foot-walking functions were not exposed to significant impact. Conclusion It is a safely and reliably effective method to repair the thumb-nail donor sites using tibiai flaps of the second toe such that complications in the donor sites are minimized.

Objectives To evaluate the lung function in patients of severe secondary hyperparathyroidism caused by uremia and to analyze related factors.Methods The pulmonary function of 70 patients with uremia ( 40 patients with severe secondary hyperparathyroidism, 30 MHD patients without SHPT) and 30 healthy people was determined.Correlative analysis was performed between parameters such as pulmonary function indexes and clinical or laboratory parameters. Results Lung function was significantly different between patients with uremia and healthy subjects(P<0.05, respectively). A number of lung function indicators were negatively correlated with iPTH,C reactive protein( CRP) ,dialysis age but were positively correlated with hemoglobin (Hb) and albumin(Alb) (P <0.05).Conclusion Patients with SHPT show impaired lung function.IPTH, dialysis age, Hb, Alb and CRP can be used as important indicators of lung function.

Objective To evaluate the clinical effects of free dorsalis pedis flap on the repair of two skin and soft tissue defects in hand. Methods From February 2003 to February 2009, free dorsalis pedis flap was used to repair two skin and soft tissue defects in 11 patients. Six cases were males and 5 females.Two was used the hand skin and soft tissue defects in 4 cases; back of the hand skin and soft tissue defect with the middle finger proximal palmar skin and soft tissue defect in 1 case, the hand ripped through injury to the back of the hand of the hand ripped through skin and soft tissue defects in 3 cases, were cut flap:proximal flap 3 cm× 3 cm-8 cm × 7 cm, distal flap 4 cm × 2 cm-6 cm × 5 cm. Foot for the area will adopt the lower abdominal full-thickness skin grafting. Results Uniform flap survival period of the wound healing class, foot skin graft donor sites were successfully survived. Ten patients were followed up from 6 to 19 months, with an average follow-up of 9 months. Follow-up flap fine texture, appearance of natural, nonbloated, feeling to restore S2-S3, hand function recovered satisfactorily, for the district of foot healed well without ulceration and ulcer formation,had no effect on walking function. Conclusion The dorsalis pedis flap for hand two series of skin and soft tissue defects, with design flexibility, excellent texture flaps, etc., is to repair the hand skin and soft tissue defects of the two better way.