Objective To assess the effect of hemoperfusion (HP) and hemodiafiltration (HDF) on elimination of para?thyroid hormone (PTH) from plasma in long-term hemodialysis patients.Methods MEDLINE (1966—2013.8), Embase (1974—2013.8), Chinese Wanfang database (1996—2013.8),CNKI(1979—2013.8)and the clinical control test database of Cochrane Library were searched. Published reports, unpublished studies and abstract from conference were retrieved manu?ally, all of which include studies of effect of PTH elimination through hemoperfusion and hemodiafiltration. Quality assess?ment and data mining were conducted by two independent investigators who performed meta-analysis using RevMan 5.2. Re?sults A total of 12 reports (400 patients) met the inclusion criteria and were included in this study. The meta-analysis showed that the elimination rate of PTH in long term hemodialysis patients was similar between using hemoperfusion and us?ing hemodiafiltration(WMD=-0.34,95%CI:-12.66-11.98,P=0.96). What’s more the elimination rate ofβ2-MG were also similar(WMD=-2.92,95%CI:-16.64-10.8,P=0.68)between those two treatments. However,The remission rate of pruritus was higher in patients using HP group than in HDF group(RR=1.33,95%CI:1.08-1.62,P=0.006). Conclusion HP and HDF can effectively clear PTH in chronic hemodialysis patients, but there was no statistically different between the two treat?ment methods.

Objective To evaluate the efficacy and safety of cinacalcet on secondary hyperparathyroidism (SHPT) in patients with end-stage renal disease (ESRD). Methods Patients with ESRD and SHPT for the treatment with calcimimetic agents were included in this study. MEDLINE (1996.1-2014.9), OVID (1963.1-2014.9), Chinese Wanfang database (1996.1-2014.9), CNKI (1996.1-2014.9) and the clinical control test database of Cochrane Library were searched . Related literature, including published or unpublished papers, and meeting procedding were hand-searched. Quality assessment and data extraction were conducted by two independent investigators. Meta-analysis was conducted by RevMan 5.2. Results Nineteen randomized controlled trials involving 7 702 patients were included. The meta-analysis showed that compared with conventional therapy,cinacalcet can significantly decrease serum parathyroid hormone in dialysis patients [WMD=-301.54 μg/L, 95%CI:(-344.38)-(-258.7)μg/L, P<0.05], decrease serum level of calcium [WMD=-8.3 mg/L, 95%CI:(-9.1)-(-7.4)mg/L, P<0.05], and decrease serum level of phosphorus [WMD=-3.4 mg/L, 95%CI:(-4.6)-(-2.3) mg/L, P<0.05]. The total incidence of adverse events was similar (RR=1.03, 95%CI:0.98-1.09, P>0.05). Cinacalcet increased nausea (RR =2.05, 95%CI :1.53-2.75, P<0.05), vomiting (RR =2.00, 95%CI:1.78-2.23, P<0.05), diarrhea (RR=1.15, 95%CI:1.03-1.30, P<0.05), and asymptomatic hypocalcaemia (RR=7.60, 95%CI:5.61-10.30, P<0.05), but they were usually transient, and mild to moderate in severity. The mortality was similar (RR=0.97, 95%CI:0.89-1.05, P>0.05). Conclusion Results confirm that cinacalcet suppresses parathyroid hormone and decreases calcium and phosphorus in secondary hyperparathyroidism patients receiving dialysis. Cinacalcet increases risks of nausea, vomiting, diarrhea and hypocalcaemia,without increasing mortality.

ObjectiveTo investigate the clinical phenotypes of familial hypercholesterolemia (FH) caused by exon 13 A606T mutation in low deusity lipoprotein receptor.MethodsClinical data of the suffered family were collected and analyzed,as well as measurement of perivascular intima-medial thickness and follow-mediated-dilation function by ultrasonography.ResultsThere were totally 11 sufferers including 4 males and 9 females,aged 8-90 years,with 2 homozygotes and 9 heterozygotes.Among them, one homozygote showed angina pectoris and hematuria,both homozygotes had skin xanthomata.TC,TG,LDL-C and HDL-C were(7.39 ± 1.30) mmol/L,(0.93 ± 0.36) mmol/L,( 11.76 ± 1.10) mmol/L and ( 1.22 ±0.17) mmol/L,respectively.The left/right sided intima-medial thickness of the common,internal,external and bulb carotid artery were ( 1.15 ±0.45) mm/( 1.30 ±0.60) mm,(0.82 ±0.30) mm/( 1.00 -0.66)mm,(0.77 ±0.28) mm/(0.78 ±0.30) mm and ( 1.40 ±0.59) mm/( 1.46 ±0.71 ) mm respectively.The brachial artery flow mediated dilation rate was (4.85 ±4.80)％.Echocardiography revealed 2 patients with cardiac valvular disease and 3 with atrium septum aneurysm. ConclusionFH patients show a variety of phenotypes incuding extraordinary hypercholesterolemia,subcutaneous xanthomata and premature coronary heart disease.

Objective To investigate the relationship between polymorphism of codon54of the man-nose-binding lectin(MBL)gene and serum concentration in patients with systemic lupus erythematosus(SLE).Methods The MBL gene54(GGC/GAC)polymorphism was analyzed by polymerase chain reaction and restrict fragment length polymorphism(PCR-RFLP)in44patients with SLE and45healthy controls.Serum levels of MBL were also determined by ELISA.Results The frequencies of the wild homozygons(GGC/GGC)and het-erozygotse(GGC/GAC)of MBL codon54did not differ significantly between patients(GGC/GGC71%,GGC/GAC27%,GAC/GAC2%)and healthy controls(GGC/GGC78%,GGC/GAC22%,GAC/GAC2%).The serum MBL level of the three genotypes was(1.8?0.6)mg/L(n=31),(1.5?0.6)mg/L(n=12),1.17mg/L(n=1)respective-ly in SLE group;(3.0?1.0)mg/L(n=35),(2.2?1.0)mg/L(n=10)in control group.The(GGC/GGC and GGC/GAC)genotypes in SLE group were significantly lower than the control group.Conclusion The condon54mutation of the MBL gene may be not associated with low serum level of MBL in patients with SLE.

Objective:To systematically evaluate the predictive value of neutrophil-lymphocyte ratio (NLR) in acute kidney injury (AKI).Methods:All studies about the predictive effect of NLR on AKI were searched in the National Medical Library of the United States PubMed Database, the Embase database in the Netherlands, the Chinese Biology Medicine disc (CBMdisc) and the Chinese Evidence Based Medicine Cochrane Centre Database (CEBM/CCD). The data updated by October 2020, and regardless of language, region or whether blind method was used. Two authors independently extracted data and evaluated the quality of the studies. Data extracted from the studies were analyzed with RevMan 5.3 to assess the predictive value of NLR on AKI. A subgroup Meta-analysis was conducted to assess the predictive value of NLR on AKI according to different countries, different disease types (cardiovascular surgery, infectious diseases, other diseases including burns, cirrhosis, and emergency), and different sample sizes (≤ 300 cases and > 300 cases). The publication bias of included studies about the predictive effect of NLR on AKI were assessed by funnel plots.Results:A total of 11 studies were included in this Meta-analysis, including 4 997 patients, 1 308 patients in AKI group, and 3 689 patients in non-AKI group. The Meta-analysis results showed that: increased NLR had predictive value for the occurrence of AKI [mean difference ( MD) = 2.73, 95% confidence interval (95% CI) was 1.78-3.68, P < 0.000 01]. Subgroup analysis showed that increased NLR had predictive value for the occurrence of AKI in patients from Southeast Asia ( MD = 4.04, 95% CI was 1.09-6.99, P = 0.007) and Eurasia ( MD = 2.51, 95% CI was 1.12-3.90, P = 0.000 4). Increased NLR had predictive value for the occurrence of AKI in patients undergoing cardiovascular surgery ( MD = 0.77, 95% CI was 0.34-1.20, P = 0.000 4), infectious diseases ( MD = 4.74, 95% CI was 1.51-7.96, P = 0.004) and other diseases ( MD = 8.53, 95% CI was 6.26-10.80, P<0.000 01). Increased NLR had predictive value for the occurrence of AKI in studies with a sample size of ≤ 300 cases ( MD = 6.02, 95% CI was 4.90-7.14, P <0.000 01) and > 300 cases ( MD = 1.32, 95% CI was 0.61-2.03, P = 0.000 3). There was no significant publication bias in the included studies assessed by funnel plots. Conclusion:NLR is an important predictive tool for AKI.

Objective To assess the treatment efficacy and safety of lanthanum carbonate (LC) in patients on maintenance hemodialysis. Methods MEDLINE (1996—2014), Embase (1974—2014.12), Pubmed (1996—2014.12), Cochrane library, Chinese Wanfang database (1996—2014.12) and CNKI (1979—2014.12) were searched. Lanthanum carbonate and hemodialysis were used as Chinese and English search terms respectively, and the articles met the inclusion and exclusion criteria were used as supplements. Quality assessment and data mining were conducted by two independent investigators who performed Meta-analysis using RevMan5.2. Results Nine trials with 2 674 participants were included in this study. The Meta-analysis showed that there were similar blood levels of calcium [WMD=-0.24,95%CI:(-0.61)-0.14, P=0.21], phosphorus [WMD=0.14,95%CI:(-0.02)-0.30,P=0.08] and phosphate control rates (RR=0.91,95%CI:0.70-1.17, P=0.44) between control group and lanthanum carbonate group. There were lower incidence rates of hypercalcemia (RR=0.17, 95%CI:0.06-0.47, P=0.000 7) and blood levels of calcium-phosphorus product [WMD=-2.17,95%CI:(-3.99)-(-0.35), P=0.02], and higher levels of parathyroid hormone (iPTH, WMD=105.69, 95%CI:70.38-141.00, P<0.000 01) and bone-specific alkaline phosphatase (BAP, WMD=6.47, 95%CI:0.43-12.50, P=0.04) in these two groups. There were no significant differences in incidence rates of gastrointestinal adverse events between two groups. Conclusion Lanthanum carbonate should be used as preferred choice of phosphate binders to control serum phosphorus in patients on maintenance hemodialysis.

Objective To investigate the clinical value of multi-slice CT angiography (MSCTA) of lower limbs in patients with peripheral arterial occlusive disease (PAOD) using the test-bolus technique.Methods Forty-four patients with PAOD were enrolled consecutively in the study.In group I, 18 subjects underwent CTA by bolus triggering method and in group 2, 26 subjects underwent CTA by test-bolus technique.During scanning procedure in group 2 subjects, the bolus transit time to aorta ( TAO ), popliteal arteries (Tpop ) and aorto-popliteal bolus transit time (T,) were calculated through dynamic acquisition at their respective level and the delay time were immediately set as TAO and scan time as double Tt.Two independent senior attending physicians with training experience in interpreting CTA determined the quality of each arterial segment visualization based on 5 parameters (1.visible farthest branch, 2.clarity of vessels border, 3.presence of venous contamination, 4.grading of stenosis, 5.CT value at 4 arterial segments).Inter-observer agreement on imaging quality between readers was evaluated using Cohen's k statistic by calculating K values.X2 test and t test were used to compare the quality of images in both groups.Results In group 2 patients,a larger individual variation in transit time of the contrast to reach aorta was obserued [ TAO = ( 17.1 ± 2.6) s with a range of 12.0—22.0 s ] and aorto-popliteal transit time [ Tt = ( 14.8 ± 5.5 ) s with a range of 8.0—24.0 s ].CTA of group 2 patients demonstrated bettor quality over group I patients' CTA, especifieally in the infra-pop|iteal and foot area arteries. There was an excellent inter-observer agreement for group 2 patients ( K ＞ 0.80 ) whereas in group 1 agreement in infra-popliteal segments for venous contamination ( K value 0.60 ) and stenosis degree ( K value 0.50 ) were not satisfactory enough.Group 1 patients were reported to have more severe stonosis in infra-popliteal and foot arteries( X2 = 30.55 and22.41,P＜0.01).Conclusion There was a wide interindividual variation in transit time for contrast medium to reach aorta and pollteal artery. Adaptive method by using two low-dose test bolus injection determined interindividual variation in delay time and scan time and thus above parameters was able to produce better quality images than using bolus triggering technique in below knee and foot region arteries.

Objective To evaluate the effect of continuous renal replacement therapy (CRRT) on the remove of inflammatory mediators and the function of endothelial cells in patients with multiple organ dysfunction syndrome (MODS). Methods Thirty patients with MODS were enrolled in this study. All of the patients underwent CRRT for at least 24 hours. Peripheral blood levels of IL-1β, IL-4, IL-6, IL-10, TNF-α, E-selectin, sVCAM-1, slCAM-1 and PAF-AH were measured at the beginning and 3, 6, 12, 24 h after initiation of CRRT. Results Nineteen patients survived after 14 days and 17 patients survived after 28 days during therapy. The clinical oxygenation and bemodynamics were improved after 6 h of CRRT. Among inflammatory mediators, the levels of TNF-α, IL-6, IL-10 rose gradually from the beginning [(462.24±331.03) ng/L, (106.39±90.82) ng/L, (124.51±118.39) ng/L), and reached the peak at 12 h [(887.88±975.46) ng/L, (132.01±118.14) ng/L, (167.01±161.66) ng/L], and the levels of IL-1β, IL-4 decreased from initiation of CRRT. But there were no significant differences in the levels of above cytokines between at the beginning and at the end of CRRT. There were significant differences in the levels of cytokines between survival and death group. The level of IL-6 in death group [(145.45±14.28) ng/L] was significantly higher than that in survival group [(106.03±10.86) ng/L]. The level of IL-10 in death group [(94.93±16.09) ng/L] was significantly lower than that in survival group [(143.06± 12.24) ng/L]. Levels of E-select, sVCAM-1 and sICAM-1 elevated from the beginning and reached the peak at 12 h, but no significant differences were found between intiation and the end of CRRT. The level of PAF-AH increased after initiation, and there was a significant difference between beginning and the end of CRRT. Levels of cytokines for endothelial cell function were significantly different, such as E-selectin [(287.13±42.70) μg/L vs (266.26±65.26) μg/L], sVCAM-I [( 1697.25± 475.24) μg/L vs (1488.10±691.67) μg/L], sICAM-1 [(975.33±142.50) μg/L vs (835.40±332.41) μg/L], and PAF-AH [(9.07±6.38 ) μg/L vs (16.32±8.95)μg/L]. Conclusions Clinical oxygenation and hemodynamics can be improved, and endothelial cell function can be improved partly by CRRT. There were no significant differences of inflammatory mediator levels between initiation and the end of CRRT. IL-6 and IL-10 can be used as predicators for prognosis of MODS patients.

Objective: To observe the prognosis of continuous renal replacement therapy (CRRT) in patients with multiple organ dysfunction syndrome(MODS). Methods: Thirty patients with MODS were enrolled in this study and were divided into two groups (survival group and death group) by their outcomes. All of these patients underwent CRRT for at least 24 h. The levels of interleukin (IL)-1β, IL-4, IL-6, IL-10 and tumor necrosis factor(TNF)-α were measured at the beginning and 3, 6,12 and 24 h after initiation of CRRT. Results: Among these thirty patients, the level of TNF-α came to peak at 12 h, and there was no significant difference between beginning and the end of CRRT. The level of IL-6 in death group was higher than that in survival group. There were correlations among numbers of complications, abnormalities of co-agulation and acute pathologic and chronic health evaluation Ⅱ(APACHEⅡ) separately. Conclusion: Clinical oxygenation and hemodynamics situation can be improved by CRRT, but there were no significant differences in levels of inflammatory mediators between initiation and the end of CRRT.

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.