Objective To investigate the survival of older patients with iliac vein tunneled cuffed catheters on maintenance hemodialysis. Methods A total of 70 older patients with external iliac vein tunneled cuffed catheters on maintenace hemodialysis were included in this study, there were 94 patients with internal jugular vein tunneled cuffed catheters as control group. The baseline anthropometric and 1aboratory parameters were measured. The catheter dysfunction and catheter related complications were documented. Results There were lower survival rate and catheter survival in the external iliac vein group compared with internal jugular vein group(χ2=13.714, P<0.01; χ2=13.093, P<0.01). Compared with internal jugular vein group, there was lower rate of catheter infection in external iliac vein group(χ2=9.416, P<0.01); In addition, there were higher rate of cardiovascular disease(CVD) events and catheter dysfunction among patients in external iliac vein group (χ2=7.492, P<0.01; χ2=5.912, P<0.05). Furthermore, the incidence of catheter dysfunction and cardiovascular disease events were the independent risk factors of mortality for older patients with iliac vein tunneled cuffed catheters on maintenance hemodialysis by Cox regression model. Conclusions Patients with iliac vein tunneled cuffed catheters have a shorter survival time. Those with catheter dysfunction or cardiovascular disease events are in higher risk of mortality.

Objective To investigate the survival rate in elderly patients with long-term catheters hemodialysis.Methods A total of 127 elderly patients receiving maintained hemodialysis were included in this study.Patients were divided into two groups according to catheter location:long term indwelling internal jugular vein catheter group and long term indwelling vena iliac external catheter group.The baseline anthropometric and laboratory parameters were measured.The catheter dysfunction and catheter related complications were observed.Results The incidence of catheter dysfunction was higher in iliac vein catheter group than in internal jugular vein catheter group (51.5 ％ vs.24.5％,x2 =8.459,P=0.015),and there were no significant differences in the catheter related infection rate and cardiovascular (CVD) event rate between the two groups.Kaplan-Meier survival curves showed that mean survival time was lower in vena iliac external catheter group than in internal jugular vein catheter group (1.9 years vs.2.5 years,x2 =10.847,P=0.001),and still was lower after controlling the catheter dysfunction and cardiovascular events (x2 =9.915,P=0.002;x2=4.368,P =0.037).Multivariate logistic regression analysis showed that levels of hemoglobin,creatinine,systolic blood pressure,parathormone and age were the independent risk factors for mortality in elderly patients with long term catheter hemodialysis.Conclusions There is a high incidence of CVD events in elderly patients with long-term catheter hemodialysis.The incidence of catheter dysfunction is higher and the survival rate is lower in elderly patients with long-term indwelling vena iliac external catheter hemodialysis.

Objective: To study the efficacy of 1 mg·kg^-1·d^-1 and 2.0 mg·kg^-1·d^-1 of propranolol in the treatment of infantile hemangiomas, so as to provide an ideal dosage for clinical treatment. Methods: From September 2015 to October 2016, there were 89 patients in accordance with the inclusion criteria of infantile hemangiomas. According to randomized and controlled principle, the patients were assigned to receive two propranolol regimens, Group A(n=45): propranolol at a dose of 1 mg·kg^-1·d^-1; Group B(n=44): propranolol at a dose of 2 mg·kg^-1·d^-1. 1 or 2 mg of propranolol base per kilogram per day, divided into two doses.The first dose was taken at 9, next at 15.The effective rate, cure rate and adverse effect rate were compared at the six months after treatment. The duration of the treatment was compared after 12 months′ treatment, and the recurrence rate was compared at the three months after being cured.The data were statistically processed with SPSS 22.0. The sample rate was compared with χ² test, and the data were compared with t test. P<0.05 was statistically significant difference. Results: Group A: Treatment for 6 months, 45 children were evaluated as follows: the effective rate was 91.1%(41/45), the cure rate was 60%(27/45). The incidence of adverse reactions was 13.3%(6/45). The cure rate of group A at 12 months was 86.7%(39/45). The duration of treatment was 7.6±2.7 months.The recurrence rate was 9.5%(4/42). Group B: Treatment for 6 months, 44 children were evaluated as follows: the effective rate was 90.9%(40/44), the cure rate was 72.7%(32/44). The incidence of adverse reactions was 15.9%(7/44). The cure rate of group B at 12 months was 88.6%(39/44). The duration of treatment was 6.2±1.9 months. The recurrence rate was 11.9%(5/42). The effective rate of the two groups at 6 months was not statistically significant(χ²=2.583, P=0.461). The cure rate of the two groups at 6 months was statistically significant(χ²=8.339, P=0.004). The incidence of adverse effects was not statistically significant(χ²=0.118, P=0.731). The cure rate of the two groups at 12 month was not statistically significant(χ²=0.080, P=0.778). The duration of treatment between the groups was statistically significant (t=0.290, P=0.009). The recurrence rate of the two groups after 3 months withdrawal was no statistical difference(χ²=0.124, P=0.724). Conclusions The propranolol doses at 1 mg·kg^-1·d^-1 and 2 mg·kg^-1·d^-1 in the treatment of infantile hemangiomas are safe and effective. The propranolol dose at 1 mg·kg^-1·d^-1 doesn′t decrease the effective and cure rate, not increase the recurrence rate in infantile hemangiomas. Low dose at 1 mg·kg^-1·d^-1 can be used as a common dose of propranolol in infantile hemangiomas.

Objective To evaluate the relationship between low vitamin D level and metabolic syndrome (MS) in maintenance hemodialysis (MHD) patients.Methods A total of 143 patients who had received MHD from Jan 2016 to Jan 2017 in the dialysis center of our hospital were enrolled.Their clinical and laboratory data were collected.The serum 25(OH)D3 levels were measured by chemiluminescence instrument.According to the levels of 25(OH)D3,patients were divided into three groups:sufficient group (＞ 30 μg/L),insufficient group (15-30 μg/L) and deficient group (＜ 15 μg/L) to explore how the 25(OH)D3 were associated with MS and abnormal metabolic parameters,including central obesity,raised triglycerides (TG),reduced high-density lipoprotein cholesterol (HDL-C),raised systolic blood pressure (SBP),raised diastolic blood pressure (DBP) and increased fasting blood glucose (FBG).The risk factors of MS and abnormal metabolic factors were analyzed by multivariate logistic regression model.Results Among the 143 MHD patients,the median of serum 25(OH)D3 was 24.30(12.90,29.50) μg/L and the prevalence of MS was 45.45％(65 cases).Among 3 groups the prevalence of MS,the abdominal circumference and the serum TG showed statistical differences,and they increased with the severity of 25(OH)D3 deficiency (all P ＜ 0.05).The body mass indexes of patients in the insufficient and deficient groups were elevated compared with that in the sufficient group (all P ＜ 0.05).SBP,TG and FBG in deficient group were significantly higher but HDL-C was lower than those in the other two groups (all P ＜ 0.05).The more abnormal metabolism existed,the lower 25(OH)D3 levels patients had (H=61.316,P＜0.001).Multivariate logistic regression analysis showed that in MHD patients low 25(OH)D3 negatively correlated with MS (OR=0.889,95％CI 0.846-0.934,P ＜ 0.001) and abnormal metabolic factors central obesity (OR=0.913,95％CI 0.874-0.953,P ＜ 0.001),raised TG (OR=0.932,95％ CI 0.894-0.971,P=0.001),reduced HDL-C (OR=0.901,95％ CI 0.845-0.959,P=0.001),raised SBP (OR=0.898,95％CI 0.847-0.953,P＜ 0.001) and raised FBG (OR=0.956,95％CI 0.920-0.994,P=0.024).Conclusions The prevalence of MS is high in MHD patients and low levels of 25(OH)D3 may be an independent risk factor for MS and abnormal metabolic factors.

Objective To investigate the possible risk factors for the progression of abdominal aortic calcification (AAC) in MHD patients.Methods Total of 170 patients on MHD between June 2014 and October 2014 in the dialysis center of the Second Hospital of Tianjin Medical University were included prospectively.Lateral lumbar radiography were applied to evaluate patients' AAC score (AACs) at baseline and after two-years of follow-up respectively.According to the change of AACs,the patients were divided into rapid AAC progression group and non-rapid AAC progression group.Multivariable Logistic regression models were used to determine the risk factors for the progression of AAC in MHD patients.Results At baseline,the presence of AAC (AACs≥1) was 43.5％(74/170).The mean follow-up duration was 27.6(24.7,28.0) months.AACs were available in 111 patients,and the presence of AAC was 78.4％(87/111).During the follow up,36 patients developed new AAC;rapid AAC progression was seen in 54 patients,and non-rapid AAC progression was seen in 57 patients.Multivariate Logistic regression analysis demonstrated that hyperphosphatemia (OR=4.373,95％ CI 1.562-7.246,P=0.005) and high density lipoprotein (HDL) (OR=0.031,95％CI 0.003-0.338,P=0.004) were independent risk factors for AAC progression in MHD patients.Conclusions Hyperphosphatemia and low HDL may promote the progression of AAC.Well-controlled serum phosphate and lipid metabolism may slow the progression of vascular calcification,reducing cardiovascular morbidity and mortality.

Objective:To analyze the risk factors of acute kidney injury (AKI) in hip fracture patients with serious underlying diseases and establish a prediction nomogram.Methods:Clinical information of hip fracture patients admitted to the intensive care unit (ICU) of Beth Israel Deaconess Medical Center (BIDMC) was analyzed using the Medical Information Mart for Intensive Care (MIMIC)-IV. Patient comorbidities, disease scores, vital signs and laboratory tests, surgical modalities, invasive procedures, and drug use were recorded. According to the diagnostic criteria of AKI in the Kidney Disease Improving Global Outcome (KDIGO) guideline, the enrolled patients were randomly divided into training set and validation set. Based on logistic regression analysis, least absolute shrinkage and selection operator (LASSO) logistic regression algorithm was used to analyze the risk factors of AKI after admission, and the corresponding prediction model was calculated.Results:A total of 474 patients were enrolled, including 331 in the training set and 143 in the validation set. According to the diagnostic criteria of AKI of KDIGO guidelines, the patients were divided into AKI group (159 cases) and non-AKI group (172 cases). Univariate analysis showed that age ( t=2.61, P=0.009), coronary heart disease (χ 2=2.08, P=0.038), heart failure (χ 2=2.60, P=0.009), hemoglobin ( t=1.89, P=0.059), platelets ( t=1.81, P=0.070), urea nitrogen ( t=2.83, P=0.005), blood creatinine ( t=3.65, P<0.001), blood sodium ( t=2.55, P=0.011), blood glucose ( t=2.52, P=0.012), anion gap ( t=3.44, P=0.001), diastolic blood pressure ( t=2.72, P=0.007), mean arterial pressure ( t=2.16, P=0.031), SOFA score ( t=3.69, P<0.001), simplified acute physiological function score II (SAPSII) score ( t=2.95, P=0.003), as well as furosemide (χ 2=2.03, P=0.042), vancomycin (χ 2=1.70, P=0.089), vasoactive medications (χ 2=3.74, P<0.001) and use of invasive mechanical ventilation (χ 2=4.81, P<0.001) were risk factors associated with the development of AKI in hip fracture patients. Multivariate logistic regression analysis showed that age ( OR=1.03, P<0.001), coronary heart disease ( OR=2.05, P=0.069), hemoglobin ( OR=0.88, P=0.050), blood creatinine ( OR=1.37, P=0.009), blood sodium ( OR=1.07, P=0.026), anion gap ( OR=1.09, P=0.028) and vasoactive medications ( OR=3.83, P=0.018) and the use of invasive mechanical ventilation ( OR=6.56, P<0.001) were independent predictors of the development of AKI in hip fracture patients with serious underlying diseases. The area under the curve of the nomogram prediction model constructed by the above 8 predictors was 0.789, and the calibration curve of the nomogram was close to the ideal diagonal. Decision curve analysis showed that the net benefit of the model was significant. Conclusion:The incidence of AKI is high in hip fracture patients with serious underlying diseases. Age, coronary heart disease, hemoglobin, serum creatinine, serum sodium, anion gap, vasoactive drugs, and invasive mechanical ventilation can predict the occurrence of AKI to a certain extent. Combined with the risk factors, the construction of the corresponding prediction model can predict and manage the diagnosis and treatment of AKI in patients with hip fracture complicated with severe underlying diseases.

Objective To evaluate the clinical efficacy and safety of recipient-site pre-expansion via tumescent anesthesia in facial fat grafting .Methods Facial fat grafting was operated through the technology of recipient-site pre-expansion via tumescent anesthesia .The high-frequency ultrasonography was used to record the changes of soft tissue thickness , blood flow signal and transplant area in certain-points.Theresult were analyzed by SPSS 11.5.The survival rates of fat grafting were compared by Kruskal-Wallis H test.The area of soft tissue blood flow signals were analyzed by variance analysis .The patients' postoperative satisfaction rates and pain were evaluated by mean value .Results 14 cases were treated , with obvious improvement .Results of high frequency ultrasonography showed the median and quartile spacing of the soft tissue thickness was 70.1％(53.85％), 56.4％(51.95％), and 16.7％in the first month, third month and the sixth month after operation , separately.The difference between the three groups was statistically significant (H=1.4 ×108, P<0.05).The area of soft tissue blood flow signals was(3.97 ±0.84)‰,(2.21 ±0.55)‰,(6.89 ±2.39)‰,(14.61 ±4.66)‰,(9.39 ±3.94)‰, (15.87 ±3.02)‰before the operation, 24 hours, the first month, third month and the sixth month after operation,separately.The difference between the six groups were statistically significant (F=3.471, P <0.05).No complication occurred in the following-up period.Patients were satisfied with the pain relief. Conclusions It is safe and effective to apply recipient-site pre-expansion via tumescent anesthesia in fat grafting.

Objective To evaluate the clinical efficacy and safety of recipient-site pre-expansion via tumescent anesthesia in facial fat grafting .Methods Facial fat grafting was operated through the technology of recipient-site pre-expansion via tumescent anesthesia .The high-frequency ultrasonography was used to record the changes of soft tissue thickness , blood flow signal and transplant area in certain-points.Theresult were analyzed by SPSS 11.5.The survival rates of fat grafting were compared by Kruskal-Wallis H test.The area of soft tissue blood flow signals were analyzed by variance analysis .The patients' postoperative satisfaction rates and pain were evaluated by mean value .Results 14 cases were treated , with obvious improvement .Results of high frequency ultrasonography showed the median and quartile spacing of the soft tissue thickness was 70.1％(53.85％), 56.4％(51.95％), and 16.7％in the first month, third month and the sixth month after operation , separately.The difference between the three groups was statistically significant (H=1.4 ×108, P<0.05).The area of soft tissue blood flow signals was(3.97 ±0.84)‰,(2.21 ±0.55)‰,(6.89 ±2.39)‰,(14.61 ±4.66)‰,(9.39 ±3.94)‰, (15.87 ±3.02)‰before the operation, 24 hours, the first month, third month and the sixth month after operation,separately.The difference between the six groups were statistically significant (F=3.471, P <0.05).No complication occurred in the following-up period.Patients were satisfied with the pain relief. Conclusions It is safe and effective to apply recipient-site pre-expansion via tumescent anesthesia in fat grafting.

Objective:To explore the risk factors of severe acute kidney injury (AKI) in septic patients, and to establish an hour-specific prediction model.Methods:Based on the information of septic patients in the Medical Information Mart for Intensive Care-Ⅳ (MIMIC-Ⅳ) database, general information, comorbidities, vital signs, severity scoring system, laboratory indicators, invasive operations and medication use were recorded. The enrolled patients were randomized into a training set and a validation set according to a ratio of 7∶3. AKI was diagnosed according to the guidelines of Kidney Disease: Improving Global Outcome (KDIGO). Based on Lasso regression and Cox regression, the risk factors of severe AKI (AKI stage 2 and stage 3) in septic patients were analyzed and hour-specific prediction model were established. Consistency index (C-index), area under the receiver operator characteristic curve (AUC) and calibration curve were used to assess the predictive efficacy of the model.Results:A total of 20 551 septic patients were enrolled, including 14 385 patients in the training set and 6 166 patients in the validation set. Multivariate Cox regression analysis showed that atrial fibrillation [hazard ratio ( HR) = 1.266, 95% confidence interval (95% CI) was 1.150-1.393], heart failure ( HR = 1.348, 95% CI was 1.217-1.493), respiratory failure ( HR = 1.565, 95% CI was 1.428-1.715), heart rate ( HR = 1.004, 95% CI was 1.002-1.007), mean arterial pressure ( HR = 1.245, 95% CI was 1.126-1.377), lactic acid ( HR = 1.051, 95% CI was 1.025-1.077), simplified acute physiology score Ⅱ (SAPSⅡ, HR = 1.019, 95% CI was 1.016-1.023), serum creatinine ( HR = 1.171, 95% CI was 1.127-1.216), anion gap ( HR = 1.024, 95% CI was 1.010-1.038), serum potassium ( HR = 1.155, 95% CI was 1.079-1.236), white blood cell count ( HR = 1.006, 95% CI was 1.003-1.009) and furosemide use ( HR = 0.414, 95% CI was 0.368-0.467) were independently associated with severe AKI in septic patients (all P < 0.01). The above predictors were applied to construct an hour-specific prediction model for the occurrence of severe AKI in septic patients. The C-index of the prediction model was 0.723 and 0.735 in the training and validation sets, respectively. The AUC for the occurrence of severe AKI at 12, 24, and 48 hours were 0.795 (95% CI was 0.782-0.808), 0.792 (95% CI was 0.780-0.805), and 0.775 (95% CI was 0.762-0.788) in the training set, and the AUC were 0.803 (95% CI was 0.784-0.823), 0.791 (95% CI was 0.772-0.810), and 0.773 (95% CI was 0.752-0.793) in the validation set, respectively. The calibration curves of the two cohorts were in good agreement. Conclusion:The hour-specific prediction model effectively identifies high-risk septic patients for developing severe AKI within 48 hours, aiding clinicians in stratifying patients for early therapeutic interventions to improve outcomes.