Objective To explore the incidence and possible risk factors of restless legs syndrome (RLS) in the maintenance hemodialysis patients.Methods A total of 375 maintenance hemodialysis patients were enrolled in this study from September 1 to 30 in 2012.The diagnosis and assessment of severity were based on the International Restless Leg Syndrome Study Group (IRLSSG) standard.The relevant laboratory parameters and dialysis indicators were collected,such as hemoglobin,serum ferritin,parathyroid hormone,blood flow and dialysis mode.The clinical data were analyzed by multivariate logistic regression method.Results The incidence of RLS was 13.3％ with the severity score of 18.69 ± 0.95.The logistic regression analysis showed that anuria (OR 0.292,95％ CI 0.114-0.750) and β2 microglobulin(OR 1.023,95％C1 1.003-1.044) were the risk factors for RLS in the maintenance hemodialysis patients,while hemoglobin,serum iron and parathyroid hormone were not correlated with RLS.Conclusions The incidence of RLS is high in the maintenance hemodialysis patients.The risk factors of RLS are anuria and β2 microglobulin.Therefore,the preservation of residual renal function and the improvement of dialysis adequacy,especially the removal of the middle molecular weight toxins,may reduce the occurrence of RLS and improve the quality of life in the hemodialysis patients.

Objective Acute kidney injury (AKI) is a common complication after cardiac surgery,especially in elderly patients,and related with poor prognosis.Although much advances in therapies of AKI have been obtained,the prognosis of patients did not improved.In the absence of proven interventions,a reasonable strategy would be to identify modifiable risk factors for AKI.The objective of the present study was to explore modifiable risk factors of acute kidney injury after cardiac surgery with cardiopulmonary bypass in elderly patients.Methods Data from 457 consecutive elderly patients (age ≥60 years old)who underwent cardiac surgery with cardiopulmonary bypass in the Guangdong General Hospital between January 2007 and December 31,2009 were analyzed in this retrospective research.The primary outcome was AKI according to the serum creatinine criteria of the RIFLE (renal Risk,Injury,Failure,Loss of renal function and End-stage renal disease) classification as an increase in serum creatinine ＞ 50％ from baseline to peak value within the first seven postoperative days.The baseline serum creatinine was defined as the latest serum creatinine before cardiac surgery.Univariate anadysis was carried out for patients'demographics data and multivariate analysis by logistic regression was used to obtain the independent risk factors for AKI.Results Among 457 elderly patients,patients mean age was (65.22 ± 4.17) years and they comprised 253 (55.4％) men and 204 (44.6％) women.AKI occurred in 313 (68.5 ％) participants.Compared with patients without postoperative AKI,the media length of intensive care unit was longer in patients with postoperative AKI,4.0 (2.0-7.5) days versus 2.0 (1.0-3.0) days,respectively.In logistic regression model,malc (odds ratio[OR] 1.894,95％ confidence interval[CI] 1.136-3.157),age above 65 years (OR 2.391,95％ CI 1.381-4.142),hypertension (OR 2.286,95％ CI 1.249-4.184),estimated glomerular filtration rate less than 60 ml/min (OR 1.933,95％ CI 1.111-3.362),preoperative uric acid ＞ 450 μ mol/L (OR 2.938,95％ CI 1.633-5.285),use of angiotensin converting enzyme inhibitors/angiotensin receptor inhibitors (ACE1/ARB) before cardiac surgery (OR 2.196,95％ CI 1.283-3.759),use of ACEL/ARB after surgery (OR 0.329,95％ CI 0.156-0.691),use of diuretics (OR 0.149,95％ CI 0.068-0.326),time of cardiopulmonary bypass above 120 min (OR 5.228,95％ CI 3.023-9.041) and prolonged mechanical ventilation (OR 2.921,95％ CI 1.527-5.586) were independent factors of AKI after cardiac surgery with cardiopulmonary bypass.Conclusion Preoperative uric acid above 450μmol/L was a modifiable risk factor of AKI after cardiac surgery with cardiopulmonary bypass in elderly patients.Therapies aimed at mitigating high preoperative uric acid may offer protection against this complication.

Objective To evaluate the efficacy of intraopèrative ultrasonography (IOUS) on primary and repeated hepatectomies for hepatocellular carcinoma (HCC).Methods 430 patients underwent 555 operations for HCC.New tumors detected by IOUS at the primary and repeated hepatectomies were retrospectively analyzed.The long-term outcomes were also studied.Results IOUS had the highest sensitivity in the routinely used imaging examinations.The detection rate by each imaging modality decreased slightly but uniformly at the second hepatectomy.IOUS detected 56 new tumors in 30 patients (7.1％) at the primary hepatectomy and 13 new tumors in 8 (7.3％) at the second.The average size of tumor detected was 8.7±3.8 and 9.0±5.2 mm at the primary and second resections,respectively.The preoperative surgical plan was changed due to the IOUS findings alone in 24 patients (5.6％) at the primary hepatectomy,and in 7 (6.4％) at the second.Although recurrence was frequent in patients with new tumors detected at the primary hepatectomy,long-term survival after appropriate treatment for recurrence was similar to those patients without new tumors detected.Conlusions Despite recent progress in imaging modalities,IOUS is still the most sensitive examination.The same degree of precaution is necessary to detect new tumors using IOUS in repeated hepatectomy.Patients with new tumors detected by IOUS are at high risk for recurrence so that regular check-up is important to improve patient survival.

Recently, there have been many developments and improvements in portal hypertension surgery, but there are still many controversies regarding the surgical indications, the timing of surgery, and the choice of surgical procedures. Minimally invasive laparoscopy and robotics are the leading direction for the development of surgical techniques for portal hypertension. Surgical selection procedures should be based on evidence-based, but guidelines should not be blindly followed. Surgical development needs to strengthen multidisciplinary cooperation, and surgical reform is the driving force for surgical development.

Objective Pulmonary hypertension (PH) was an independent predictor of mortality and new onset cardiovascular events in maintenance hemodialysis (MHD) patients. Recent studies revealed PH complicated by pericardial effusion (PE) increased mortality in non-CKD (chronic kidney disease) population. No such evidence existed in MHD patients. Methods We enrolled 108 MHD patients with diagnosed PH by echocardiography (61 with PE) between 2009 and 2011. All patients had been followed-up for 2 years. The endpoints were all-cause mor-tality, cardiovascular (CV) mortality and new onset CV events. Results The mean age was (60.2 ± 14.1) years, 55.6% were males and SPAP was (53.0 ± 15.4) mmHg. 12.0% were severe PH and 1.9% were moderate-to-severe PE. The overall mortality, cardiovascular mortality and new on-set cardiovascular events in PE and non-PE group were 34.4% vs. 21.3%、 23.0% vs. 12.8% and 54.1% vs. 42.6%, respectively (P > 0.05). Kaplan-Meier curve showed there was no difference on all-cause mortality , CV mortality nor new-onset CV events between PE and non-PE group (Log Rank P > 0.05). Conclusions Compared with patients without PE, the presence of PE in patients with PH did not increase the mortality and worsen the cardiovascular outcome in MHD patients.

[ ABSTRACT] AIM: To investigate the influence of advanced glycosylation end products-modified bovine serum albumin (AGE-BSA) on mammalian target of rapamycin complex 1 (mTORC1), urokinase-type plasminogen activator re-ceptor ( uPAR) , and cell mobility in the podocytes, and to further explore the probable relationship.METHODS: The conditionally immortalized mouse podocyte cell line was cultured in vitro.MTT assay and immunofluorescence were used to analyze the cell viability and cytoskeleton of the podocytes treated with the stimuli and intervention agents.The activity of mTORC1 and the expression level of uPAR in normal podocytes and podocytes treated with control BSA or AGE-BSA were detected by Western blotting.The migration ability of the podocytes was determined by would-healing assay.Rapamycin was added to inhibit the activity of mTORC1 along with the addition of AGE-BSA to observe the changes of uPAR and the motility of podocytes.RESULTS:No significant difference of the cell viability or cytoskeleton in the podocytes treated with the stimuli and intervention agents was observed.AGE-BSA up-regulated the activity of mTORC1 and the expression of uPAR, and induced the high mobility of the podocytes.Rapamycin obviously reduced the high expression level of uPAR and the increase in the migration ability of podocytes caused by AGE-BSA treatment.CONCLUSION: AGE-BSA might cause the high migration of podocytes through the mTORC1/uPAR signaling pathway.

Objective To investigate the related risk factors of contrast-induced acute kidney injury (CI-AKI)after cerebrovascular intervention. Methods The clinical data of 5423 patients performed cerebrovascular angiography and intervention at the Departments of Neurology and Neurosurgery,Guangdong People′s Hospital from January 2005 to December 2013 were analyzed retrospectively. The patients who underwent cerebrovascular angiography and intervention were evaluated and screened. A clinical history database was established. All the selected patients used iodixanol,an isotonic contrast agent. The occurrence of CI-AKI was used as an endpoint. The patients were divided into either a CI-AKI group or a non CI-AKI group. A multivariate Logistic regression model was used to analyze the risk factors associated with the occurrence of CI-AKI. Results A total of 4164 patients were finally enrolled,including 137 had CI-AKI. The incidence of CI-AKI was 3. 3%. The results of multivariate Logistic regression showed that age >60 years (OR,1. 965,95%CI 1. 244-3. 136),baseline estimated glomerular filtration rate (eGFR)<60mL/(min·1. 73 m2)(OR,4. 163,95%CI 2. 422-5. 873),diabetes (OR,3. 140,95%CI 1. 983-3. 902),and anemia (OR,1. 524,95%CI 1. 226 -3. 253)were the influencing factors for occurring CI-AKI after cerebrovascular angiography and intervention. Conclusion Chronic kidney disease (eGFR<60 mL/[min·1. 73 m2 ]),diabetes,anemia,and old age (age >60 years)are the independent risk factors for occurring CI-AKI after cerebrovascular angiography and intervention.

Objective To study whether portal vein thrombosis can be prevented by partial splenectomy combined with portoazygos devascularization,by preserving the integrity of the blood flow of the inferior splenic vessels.Methods 156 patients with portal hypertension and megalosplenia were divided into two groups.62 patients in group A who underwent partial splenectomy and 94 patients in group B who underwent total splenectomy.The postoperative complications,levels of WBC and PLT,volumes of residual spleen,hepatic vein pressure gradient (HVPG),and prevalence of portal vein thrombosis between the two groups were compared.Results The surgery time of group A was slightly higher than group B [(189.0± 38.5) vs.(128.0±36.3) min,P＜0.05].The blood loss of group A was slightly higher than that of group B [(328.0±68.9) vs.(294.0±49.1) ml,P＜0.05].The postoperative infection rate,change in HVPG and rehemorrhage rate between the two groups showed no significant differences (P＞0.05).The elevation in Leucocyte after operation of the two groups were the same,peaking on day 3.The platelet count of group A increased more gently than group B (2 weeks vs 1 week),and its peak was closer to the normal threshold (P＜0.05).The thrombosis rate of the portal vein system in group A was significantly lower than group B within 1 year (P＜0.01).The residual spleen did not enlarge after operation (P＞0.05).Conclusion Subtotal splenectomy combined with pericardial devascularization in patients with portal hypertension and megalosplenia preserved the blood flow of the subsplenic polar vessels and reduced the incidence of portal vein thrombosis.

OBJECTIVETo observe the effect of 11R-VIVIT on lipopolysaccharide (LPS)-induced expression of urokinase-type plasminogen activator receptor (uPAR) in podocytes.

METHODSA LPS-induced proteinuria mouse model and in vitro cultured podocytes treated with LPS were both divided into control group, LPS group and LPS+11 R-VIVIT group. The mRNA and protein expressions of uPAR in mouse kidney tissues and the podocytes were measured by real-time qPCR, laser scanning confocal microscopy and Western blotting.

RESULTSCompared with LPS group, LPS+11 R-VIVIT group showed a significantly lowered urine albumin/creatinine ratio (P<0.001) and markedly reduced mRNA and protein expressions of uPAR (PuPAR mRNA<0.001; PuPAR=0.001).

CONCLUSION11R-VIVIT can ameliorate proteinuria probably by decreasing the expression of uPAR in podocytes.

Animals ; Disease Models, Animal ; Lipopolysaccharides ; adverse effects ; Male ; Mice ; Mice, Inbred C57BL ; Oligopeptides ; pharmacology ; Podocytes ; drug effects ; metabolism ; Proteinuria ; drug therapy ; metabolism ; Receptors, Urokinase Plasminogen Activator ; metabolism

Objective To study the impact of splenectomy and pericardial devascularization on the occurrence and development of portal vein thrombosis and the liver function in patients with cirrhosis complicated by portal hypertension.Methods 29 patients with cirrhosis and portal hypertension who underwent splenectomy and pericardial devascularization in the 302 Hospital of PLA from December 2012 to June 2013 were retrospectively studied.The incidences of PVT before and after operation were monitored.The liver function was assessed using the Child-Pugh classification.Results 29 patients with cirrhosis and portal hypertension underwent splenectomy and pericardial devascularization.The incidences of PVT in the preoperative period,12 days,3 months,6 months after operation were 10.3％,89.7％,51.7％,24.1％,respectively.The Child-Pugh scores in the preoperative period,12 days,3 months,6 months after operation were (5.2 ± 0.4),(5.6 ± 0.7),(5.2 ± 0.7),(5.3 ± 0.7),respectively.Conclusions The incidences of postoperative PVT increased after operation,but it decreased on long-term follow-up after operation.The liver function did not change.