Objective: To evaluate the preliminary effect for serum albumin (ALB) level in patients with chronic heart failure (CHF) treated by cardiac resynchronization (CRT).
Methods: A total of 54 CHF patients treated in our hospital from 2009-01 to 2013-12 were studied. The patients were divided into 2 groups: CRT group and Control group, in which the patients were treated by medication. n=27 in each group. The blood test of biochemistry, 24 hour dynamic ECG monitoring with QRS duration, echocardiography, ALB level, heart rate (HR), left ventricular end-diastolic dimension (LVEDD) and left ventricular ejection fraction (LVEF) were recorded at admission as baseline information, and the above examinations were repeated 2 to 3 times during 6-15 months of follow-up period.
Results: The age, gender and baseline information were similar between 2 groups. Compared with admission, during followed-up period, CRT group had increased ALB, LVEF, P<0.05, decreased HR, P<0.001, shorter QRS duration, P<0.001 and LVED remained similar;while Control group had decreased ALB, P<0.05 and LVEF, LVED, QRS duration, HR remained similar. Logistic regression analysis indicated that in CRT group, with adjusted LVEF, QRS duration and ALB, serum ALB level was the most relevant indicator for CRT efifcacy, P<0.01.
Conclusion: CRT could improve the cardiac function and increase ALB in CHF patients, therefore serum ALB level might be related to CRT efifcacy at certain degree.

Objective:To explore the determination conditions for reducing end of hydroxyethyl starch by DNS spectrophotometry. Methods:The reducing end of hydroxyethyl starch was determined using the standard curve of glucose solutions. The effects of DNS reagent with different volume, heating temperature, heating time and standing time after reaction on the determination were investiga-ted. Results:The optimal determination conditions were as follows:the DNS volume was 0. 8 ml, the reaction temperature was 85℃, the reaction time was 5 minutes, and the colored solution was determined at the wavelength of 540 nm. Conclusion: The method is simple and accurate with good reproducibility, which can be used to determine reducing end of hydroxyethyl starch.

Objective To analyse the radiological features and the diagnostic method of pulmonary alveolar proteinosis(PAP).Methods X-ray and CT manifestations of PAP in 37 cases confirmed with fiberoptic bronchoscopy and bronchoalveolar lavage were studied retrospectively.Results The radiologic features of PAP could be characterized as geographic,the “crazy-paving” pattern,lobar or segmental consolidation(air-brochogram sign)and like intersititial fibrosis.The radiologic manifestations were stable and more serious than the symptoms.Conclusion PAP is of typical radiologic feature,it is not difficult for diagnosis in combination with clinical characteristics.

Objective · To improve the surgical procedure of correcting upper eyelid retraction.Methods · Patients suffering upper eyelid retraction of 2-5 mm caused by thyroid-associated ophthalmopathy were treated with modified levator lengthening technique in Shanghai Ninth People's Hospital (Shanghai Jiao Tong University School of Medicine,China) from July 2013 to December 2014.Results· Of the 34 patients underwent the modified levator lengthening surgery for upper eyelid retraction correction,there were 7 males and 27 females.After 6 months,upper eyelid retraction got fully resolved in 25 cases and partly improved in 9 cases.The palpebral fissure height demonstrated an average decrease of 3.7 mm (P=0.000).Patient's ocular discomfort such as photophobia and tearing were either cured or improved.Conclusion · Modified levator lengthening surgery can effectively correct upper eyelid retraction,improve the patient's appearance and cure their ocular discomfort.

Objective To investigate the effect of Valsartan on Disintegrin metalloproteinases (ADAMs10,17) expressions in the process of heart failure (HF) after myocardial infarction (MI).MethodsAdult male Wistar rats weighing (200 ± 30) g were given humane care in compliance with the rules of the Animal Experimentation Committee of the first hospital of Harbin Medical University.And then the left anterior descending coronary artery was ligated.Based on UCG (LVEF ＜ 45％) Results The successfully MI-operated Wistar rats were divided randomly (random number) into three groups:HF group (HF group),placebo group (Pla group) and valsartan group (Val group).The rats in the Pla group and Val group were given the same volume of normal saline and valsartan 50 mg/ (kg · d),provided by Novartis company) by gavage.After 16 weeks,heart function was assessed by hemodynamic evaluation and serum TNF-α from LV cavity was measured by ELISA (R&D,USA).Muscle samples were extracted from the ischemic zone,and then the ADAMs 10,17 expressions were measured by immunoblotting.All the data were expressed by mean ± standard and evaluated by Student' s t test.Results After 16 weeks,the data of LV function including LVdp/dt LVdp/dtmin and LVSP were significantly improved in Val group than the others (P =0.006,P =0.015,P =0.003),and the LVEDP level was decreased (P =0.002).At the same time,the TNF-o level in the Val group was lower than that in the HF group (P =0.023).The ADAM17 and TNF-R1 expressions in the Val group was reduced compared with those in the HF group (P =0.01 1,P =0.022).However,ADAM10 expression is unchangeable in the four groups.Conclusions Valsartan may reduce the ADAM17 and TNF-R1 expressions in the ischemic zone,decrease the TNF-αconcentration and function in LV cavity so as to inhibit cardiac remodeling and improve heart function after MI.

Objective: To investigate whether metabolic syndrome (MS) independently influences the renal outcomes of chronic kidney disease (CKD) 1-4 stage patients. Methods: Since July 2006 to September 2008, a total of 766 clinically stable CKD patients in the hospital were enrolled in this prospective study and followed up until December 31th, 2016. The CKD patients were divided into MS group and non-MS group according to the Chinese Diabetes Society (CDS) criterion of MS. The renal outcomes that needs to initiate renal replacement therapy were observed and recorded during the follow-up. Kaplan-Meier analysis was used to evaluate the influence of MS on CKD patients′ renal outcomes. Cox regression analysis was used to assess the independent risk factors of renal outcome of CKD patients. Results: Among 766 patients with CKD 1-4 stage, 97 patients initiated renal replacement therapy, and the prevalence of MS was 31.5%(241/766) in CKD patients. In the CKD 1-4 stage patients, the occurring rate of initiating renal replacement therapy was significantly higher in MS group than that of non-MS group (χ²=56.367, P<0.001). Cox regression analysis showed that 24-hour urine protein ≥1.0 g, MS and initial serum phosphate ≥1.3 mmol/L were the independent risk factors of initiating renal replacement therapy in CKD 1-4 stages. Conclusions More than 1/3 CKD patients are accompanied with MS. It has been demonstrated that MS, as well as 24-hour urine protein ≥1.0 g and initial serum phosphate ≥1.3 mmol/L, are the independent influencing factors of the renal outcomes in CKD 1-4 stage patients.

Objective:To explore the incidence, influencing factors and prognostic value of cardiac valve calcification (CVC) in chronic kidney disease (CKD) non-dialysis patients.Methods:The non-dialysis patients with CKD stage 1-5 who were hospitalized and underwent echocardiography in the Department of Nephrology, Xuanwu Hospital, Capital Medical University from January 1, 2018 to December 31, 2019 were retrospectively admitted. The patients were divided into CVC group and non-CVC group, and the clinical data were compared between the two groups. The deadline for follow-up was November 1, 2021, and the follow-up end point event was all-cause mortality. Logistic regression model was used to analyze the risk factors of CVC in patients with CKD, and Cox proportional hazards regression model was used to analyze the risk factors of all-cause mortality in patients with CKD.Results:A total of 563 patients with CKD were enrolled in the study, with age of (59.49±13.97) years old, and 352 males (62.52%). There were 325 patients (57.73%) with CKD stage 1-3 and 238 patients (42.27%) with CKD stage 4-5. The incidence of CVC in CKD stage 1-5 patients was 32.32%(182/563). Aortic valve calcification occurred in 30.73%(173/563), mitral valve calcification occurred in 9.77% (55/563), double valve (mitral and aortic valve) calcification occurred in 8.35% (47/563), and tricuspid valve calcification occurred in 0.18%(1/563). Age (t=12.223, P<0.001) and the proportions of CKD stage 4-5 ( χ 2=10.854, P=0.001), hypertension ( χ 2=7.811, P=0.005), diabetes ( χ 2=8.424, P=0.004), hyperlipidemia ( χ 2=9.331, P=0.002), and taking statins ( χ 2=4.868, P=0.027) in CVC group were significantly higher than those in non-CVC group. Total cholesterol (t=2.243, P=0.025), low density lipoprotein cholesterol (t=2.025, P=0.043), platelet count (t=2.230, P=0.026) and estimated glomerular filtration rate (t=8.630, P<0.001) in CVC group were lower than those in the non-CVC group. Logistic regression analysis results showed that age≥60 years old (≥60 years old/<60 years old, OR=7.412, 95% CI 4.514-12.170, P<0.001), CKD stage 4-5 (stage 4-5/stage 1-3, OR=2.791, 95% CI 1.730-4.505, P<0.001) and hyperlipidemia ( OR=5.241, 95% CI 3.283-8.367, P<0.001) were the independent influencing factors of CVC in patients with CKD. Five hundred and sixty-three patients were followed up for an average of 26 months, including 68 cases (12.08%) of death, 436 cases (77.44%) of survival and 59 cases (10.48%) of loss to follow-up. Multivariate Cox regression analysis results showed that age≥60 years old (≥60 years old/<60 years old, HR=2.157, 95% CI 1.127-4.127, P=0.020), serum albumin<30 g/L (<30 g/L/≥30 g/L, HR=1.923, 95% CI 1.037-3.568, P=0.038) and double valve calcification (double valve calcification/no valve calcification, HR=2.516, 95% CI 1.279-4.950, P=0.008) were the independent influencing factors of all-cause death in patients with CKD. Conclusions:CVC accounts for 32.32% in non-dialysis patients with CKD stage 1-5. Older age, worse renal function and hyperlipidemia are the independent risk factors of CVC in CKD patients. Older age, hypoproteinemia and double valve calcification are the independent risk factors of all-cause death in patients with CKD.

IgA nephropathy (IgAN) is one of the common primary glomerulonephritis, which is also an important risk factor for end-stage renal disease. Kidney transplantation is the optimal treatment for end-stage renal disease induced by IgAN, whereas there is still a risk of recurrence of IgAN after kidney transplantation. At present, research progress upon IgAN recurrence after kidney transplantation is relatively lacking. The pathogenesis of IgAN recurrence remains elusive, and its pathological manifestations are not specific. The diagnosis of IgAN recurrence still depends on renal biopsy. Besides, no effective prevention and treatment are available for recurrent IgAN. In this article, research progress on IgAN recurrence after kidney transplantation was illustrated from the perspectives of pathogenesis, diagnosis, risk factors and treatment, aiming to provide reference for clinical prevention and treatment of IgAN recurrence after kidney transplantation and improve clinical prognosis of kidney transplant recipients.

Objective:To observe the risk of acute kidney disease and disorders (AKD) in patients with coronary heart disease or non-valvular atrial fibrillation who were taking rivaroxaban for the first time in our hospital.Methods:A retrospective case-control analysis was performed using the hospital database to screen for patients with coronary heart disease or non-valvular atrial fibrillation who were taking rivaroxaban for the first time for more than 3 months during January 1, 2018 to June 30, 2019. A total of 279 patients with serum creatinine reviewed within 3 months were as the rivaroxaban group, and 317 patients with coronary heart disease or non-valvular atrial fibrillation who did not take rivaroxaban during the same period in our hospital were selected as the control group. The general condition and the incidence of AKD were compared between the two groups, and the influencing factors of AKD were analyzed by logistic regression analysis.Results:The prothrombin time and international normalized ratio were higher in the rivaroxaban group than those in the control group (both P<0.01). There was no significant difference in age, gender, serum creatinine and urea level between the two groups. The incidence of AKD in the rivaroxaban group was 4.30%(12/279), and the incidence of AKD in the control group was 1.26%(4/317). The relative risk ( RR) of the two groups of patients was 3.409. Logistic regression analysis showed that older age (≥75 years old, OR=1.166, 95% CI 1.012-1.343, P=0.033) and diabetes ( OR=34.261, 95% CI 1.639-716.326, P=0.023) were risk factors for AKD in patients taking rivaroxaban. Rivaroxaban was a risk factor for AKD in patients with coronary heart disease or non-valvular atrial fibrillation ( OR=3.500, 95% CI 1.115-10.988, P=0.032). Conclusions:The incidence of AKD in patients taking rivaroxaban for the first time due to coronary heart disease or non-valvular atrial fibrillation was 4.30%. Taking rivaroxaban is a risk factor for AKD in patients with coronary heart disease or non-valvular atrial fibrillation. Older age and diabetes are the risk factors for AKD in the rivaroxaban group.

Objective:To evaluate the correlation between age and renal outcomes in patients with stage 2-4 chronic kidney disease (CKD) and the impact of age on CKD outcomes in kidney diseases of different etiologies.Methods:A prospective cohort study included 470 patients with stage 2-4 CKD. The Kaplan Meier method was used to analyze the differences in CKD outcomes among different age groups. The independent risk factors for CKD progression were analyzed using a multivariate Cox regression model. We adjusted for baseline differences in risk factors for CKD outcomes between two age groups using propensity score matching (PSM).Results:Among 470 patients, 39 cases of end-stage renal disease (ESRD) events (all starting dialysis) and 51 deaths were observed. The Kaplan Meier survival curve ( P=0.039) and Cox regression univariate survival analysis ( P=0.043) both showed that <60 years old is a risk factor for CKD patients to progress to ESRD. In multivariate Cox regression, age remained an independent risk factor for the progression of CKD patients (hazard ratio 0.386, 95% CI: 0.163-0.916; P=0.031). For kidney diseases with different causes, in patients with hypertensive kidney damage ( P=0.024) and primary glomerulonephritis ( P=0.047), the cumulative incidence rate of ESRD in patients <60 years old was higher than that in patients ≥60 years old. There was no statistically significant difference in all-cause mortality rates between patients aged <60 and ≥60 years old ( P=0.646). Conclusions:Elderly patients with stage 2-4 CKD have a lower ESRD risk than younger patients. This discovery helps nephrologists and decision-makers optimize the management of elderly CKD patients.